Below is the paper I wrote for my human development class. References are in APA style so (Person’s last name, date of publication) are included with a list of references at the end. It’s a bit long. If anyone reads it, please feel free to add comments
A brief review of autism: prevalence, symptoms and methods of diagnosing. The paper reviews standard treatments and how those are being impacted by current technology. Finally the paper discusses new avenues of technology research that could impact autism treatment and managing care for those with autism.
Table of contents
- Overview of autism
- Definition of autism
- Theories about the causes of autism
- Detection methods and tests for autism
- Autism Treatments
- Most common drugs
- Technology and Autism Treatment
- Current Computer Usage
- Research into Autism Treatments
Brief overview of Autism
Autism has been in the news a lot lately. Ten years ago the American Psychiatry Association (APA) indicated that 5 in 10,000 people had autism. That number has climbed dramatically. The center for disease control website estimates that 1 in 110 children in the US have Autism.(APA, 2000) A more recent article in Time magazine estimated that the rates of Autism in South Korea are 1 in 38. (Walsh, 2011) These numbers are alarming. Something must be done. This paper attempts to address some of the ways people are using technology and psychiatry to diagnose and treat this condition.
Definition of Autism
First let’s look at what Autism is. The APA classifies Autism as a pervasive developmental disorder.(APA, 2000) This does not mean that Autism affects every development area. It means that Autism cannot be described by a single set of symptoms that can be addressed in a simple way such as an overly loud voice. Autism Disorders have both impaired development in social interactions and communication with a restricted number of activities and interests. (APA, 2000) In each child, this is demonstrated in different ways requiring that treatment be tuned to fit that particular child’s needs.
Typical impairments include lack of eye contact, lack of facial expressions, and limited gestures. Children often fail to develop peer relationships and don’t seem to understand social interactions. They often do not seek to share experiences in normal ways like pointing to something they find interesting or playing games. Many do not seem to be aware of others. (APA, 2000)
While the impairments listed above often show up first, often people are more likely to understand there is a problem when it affects speech. Often autistic children are slow in developing spoken language. Sometimes they learn works but use them in inappropriate ways such as repeating the same word over and over. While many young children might repeat words, autism is usually characterized by a lack of engagement. A child might say “hi” fifteen times in a row to get a response whereas an autistic child will say a word for their own enjoyment without caring if others respond. Unlike the normal child who understands “hi” is a greeting, the autistic child doesn’t seem to indicate they understand the meaning of the word. (APA, 2000)
A diagnosis of autism is not achieved by any one of these traits alone. It requires demonstration of at least six traits out of a list of over thirteen. (APA, 2000) It makes one wonder what one root cause can cause such a wide variety of symptoms in individuals. Early psychoanalytical models talked about the “refrigerator mom” who withheld attention causing the child to withdraw. This was shown to be a myth.( Cipani, 2008) A member of the medical community talked about a link to vaccines stating that children had an adverse reaction to something in the shots, but that was also shown to be false. (Dawson, 2001)
Theories about the Causes of Autism
Recent theories focus more on the genetic and environmental factors. Scientists looking for genetic markers point to copy errors as the source. Each time a cell divides, it creates a copy of the genetic material it contains. This copy helps guide the new cell to function correctly. Sometimes a mistake is made and genes are replaced by junk. When this happens to children, this error can multiply and dramatically affect development. If this happens in a non-critical part of the genetic code, we may never know about it. In autistic children, they find problems with genes associated with speech, communication and brain development.( Pinto et al. 2010)
The genetic component gives us one clue, but there are others. The book Neurology of Autism notes that children with autism go through a faster than normal growth spurt in head size. They suggest that this causes a high volume of neurons that are misconnected.( Coleman, 2005) In normal brain development, unused or faulty neural connections are removed (Berger, 2008), but for some reason this doesn’t happen in autistic children. This leads to a chaotic interpretation of the world where one small aspect of life overshadows everything else.
Scientists have noted that the worst damage appears to be in the mirror neurons. If you were to map a player’s brain when he makes the winning goal, it would show a pattern. If we map a fan’s brain while watching the winning goal, their brain would show a similar pattern. When watching the player, the fan’s mirror neurons kick in. They stimulate the brain of that sports fan to give him or her the same kind of pleasure that the player gets when he or she scores the goal. It’s the same thing when someone watches a movie. If you watch a movie where the main characters live happily ever after, you feel good if you connected with those characters. The mirror neurons help you connect with characters so you can feel a bit of what they feel. However, in autistic people this mirror network doesn’t work. When they watch the game or the movie, they don’t really feel anything. (Oberman, 2006)
One potential reason for this is epilepsy. Epilepsy is like an electrical storm in the brain. If a child has epileptic fits as an infant, a parent may not even know. It could disrupt the neural connections and interrupt the mirror neurons. (Oberman, 2006) Unfortunately, none of these theories gives an effective way to prevent autism. It means parents have kids and hope for the best. If they have a child with autism, they are left with the difficult path of detection and treatment.
Detection of Autism
The standard test for autism is an observation test or a parent teacher questionnaire. In the observation test, a child sits in a room behind mirrored glass and is observed for a set period of time. Ideally this should be done as early as possible because the best outcomes start with early treatment. (Cipani, 2008) Unfortunately, a number of the characteristic signs of autism are difficult to detect until after a child is over 2 years old, like delayed speech. While the average child begins learning words around their first birthday, there are many who wait a few months beyond that. This symptom alone can also be caused by other sources such as deafness. When learning to speak words, many children repeat certain phrases or words and it may be difficult to determine if they really understand the meaning behind the words.
There are a number of early predictors of autism. Normal babies make eye contact often staring into their parent’s eyes for long periods of time while feeding. This is part of the bonding process. Infants also begin displaying shared attention at an early age. This means they point out things that they want an adult to look at and will look when an adult points out something. Both of these traits are often missing in autistic children. (Toth et al. 2006) Another early predictor is facial expression. From an early age, infants will imitate facial expressions of their parents or other caretakers. Autistic children do not imitate. (Toth et al. 2006) This also manifests in the ways children play. Normal children will engage in symbolic play. For example, they will pretend to drink from an empty cup then give a teddy bear a drink from the cup. (Toth et al. 2006) When they do this, they are imitating the behavior of the adults they see around them.
These behaviors correlate will with later language development but do not help much. Detection at an early age relies on parental screening and many parents do not know these early predictors. Even if they did recognize them, detection is highly labor intensive, which may not be feasible for working families. This is where robots may help. Researchers are working on a program called LENA or Language Environment Analysis. This system analyzes audio recordings made in a child’s home environment and analyzes them for language traits of autism. (Xu et al. 2009) So far the initial findings look good.
Most of the research has been done in treatment instead of detection. Standard autism treatments fall into two major categories: one on one therapy and drugs. The two most common and effect therapies are Applied Behavioral Analysis (ABA) and Training and Education of Autistic and other Communication Handicapped Children (TEACCH). ABA starts with an analysis of a child’s behavior. A set of goals are laid out such as making eye contact. In highly structured one on one sessions with a therapist, the child is rewarded every time they do the desired behavior, like getting a sticker every time they make eye contact. The rewards are chosen to match a specific child’s preference so if a child is intensely interested in a specific doll instead of a sticker. They might use a doll or another object as the “reward.” Once this skill is mastered, the child is weaned off of rewards for that behavior. Another skill is chosen. Now instead of getting stickers for eye contact, the child might get rewards for looking when an adult points something out or some other target skill. This process is used to slowly expand a child’s set of social behaviors and skills until they match more closely normal behavior. At the same time, they also engage in similar sessions to encourage language use. (Cipani, 2008)
TEACCH is similar in that it starts with an individual assessment, but interactions are more likely to be in a group setting within a classroom of other autistic children. Children may still get individual instruction, but also get more interactions in a group. The environment is modified to provide different kinds if stimulus to the children such as lights, sounds and patterns. Items in the classroom are color coded and schedules are visually oriented to help children keep them straight.( Callahan et al. 2010)
Both require support and interaction from the family. Both create individualized programs centered around a child’s special needs. ABA tends to have more one on one structured interactions whereas TEACCH may involve more group interactions depending on what the child needs. Both constantly monitor the child’s progress and adjust the program to ensure the child makes progress towards his or her goals.
Which method is better? Unfortunately there is no robust research indicating one is better than the other. Researchers at the University of North Texas analyzed both with the help of autism specialists. They came to the conclusion that both are equally valid. The traits they have in common were the treatment therapies that were the most important. The researchers actually suggested combining the two approaches might be more effective than either one alone. Mostly they concluded that more objective research needs to be done. (Malone et al. 2005) The problem is that any therapy solutions are highly intensive and involve a lot of personal interaction.
Drug treatment seems like an easier route, but care must be taken to understand the desired outcome and the possible dangers. The drugs used fall into a number of categories. The three most common are antipsychotics, stimulants, and antidepressants. Antipsychotics tend to be proscribed to address some of the ways autistic children act. They tend to result in a reduction of tantrums, aggression, and less injurious behavior. The mildest of these drugs can have more minor side effects: weight gain, fatigue, drowsiness, dizziness and drooling. Some of the more extreme have side effects that can lead to death. (Malone et al. 2005)
Antidepressants seem to help with compulsive repetitive behavior, like saying the same word over and over again or insisting on specific rituals. Side effects can include rapid or irregular heart rate, constipation, agitation, increased risk of suicide, and seizures. Not all autism patients will experience side effects.
Stimulants tend to help with hyperactivity and attention span. Side effects can include weight loss, increased social withdrawal. (SZE, 2008) None of these drugs offers a cure for autism. At best they help alleviate some of the most disruptive symptoms. They can help a family deal with an autistic child, but require the child to remain on drugs for an extended period of time. In contrast, some cases treated with ABA or TEACCH have gone on to lead normal productive lives with little indication that they were once diagnosed as autistic.(Cipani 2008)
Technology and Autism Treatment
Current Computer Usage
As a result, a lot of attention is being turned towards computers and technology. Computers and robot intervention could have results similar to the intense therapy options without requiring the additional funding year after year to support progress. The initial investment might be large, but computer aided interventions could mean that more children get the support they need instead of the lucky few who happen to live near an autism center.
Current computer technology focuses on equalizing opportunity and helping children with disabilities communicate with others. Electronic reading machines, portable reading pens, and instructional software help with reading. For help with learning communication skills, there is speech synthesis software, and word queuing and prediction program. One could also use speech recognition software to aid in language skills. (SZE, 2008) Some autistic individuals communicate using a computer because it is less intimidating than talking to a person. They can either communicate through chat rooms and IM or use IPADs to speak for them using speech software. These applications are available now, but like drugs, sometimes appear to treat the symptoms instead of helping the child achieve the best outcome, integration into society.
Research into Autism Treatments
Research is focused on this outcome. How do we best use computers and technology to provide the one on one educational support that can help transition autistic children into adults that reach their full potential. One example is being tested in Italy. There they are testing an android with a human face to help teach the facial expressions that communicate emotional states. People with autism are known for having difficulty inferring and analyzing emotional states both in themselves and others. They call this robot FACE for Facial Automation for Conveying Emotions. (Mazzei, 2010) According to the book, The Relationship Theory of Love, people learn by mapping information over a group of neurons in the brain. Many of these pathways are created in our childhood and get stronger as we learn more. Unfortunately, if we do not learn to distinguish between two things like how to pronounce an r versus an l, it becomes more and more difficult to notice the difference as we get older. (Amini and Lannon 2000)
Autistic children do not learn some of the subtle facial expressions that communicate feeling. As they grow older, it can become remain difficult for them to pick up on the queues that indicate someone is angry or sad. Foreign language speakers can learn the difference between r and l by listening repeatedly to tapes that highlight the difference between these two sounds. (Wu, Li, F. and Lu, N. 2010) The FACE system does the same with facial expressions. Autistic individuals can interact with the android, which expresses one of six emotional states. In addition, cameras in the eyes can be used to track the autistic person’s face like a real person would. Researchers are working to enhance their 3D modeling to improve both the number of emotional states that the android can mimic and improve the quality of the facial expressions. (Amini and Lannon 2000) Techniques like this promise to help even adults with autism begin to unlock some of the keys to social interactions.
Another promising direction of research is into virtual communities. In South Korea, they are using virtual communities with therapists to allow autistic children to experiment with social interactions and learn appropriate behavior. It’s like using half-life to learn to live in the real world instead of using it to escape. (Wu, Li, F. and Lu, N. 2010)
Other research works to predict autistic behavior patterns like biting, or screaming by looking for an increase in minor movements. The autistic individual has wearable sensors that detect movement. The intensity that person’s movement is recorded and analyzed using a complex computer algorithm. An increase in certain types of movement happens right before an individual is about to have an episode. (Min and Tewfik, 2010) For children, this data could be used to help teach self-soothing. For example, if a teacher knows that a child is about to have an episode, that teacher could recommend an activity that specifically helps that child. It might be some time alone in a quiet place or some other reward the child finds soothing. For adults, it might help reduce the amount of medication used to help them live a fuller life. No matter what the age of the person involved, prediction of autistic behavior patterns can help a therapist in target therapy for that individual.
Along this line, there are several researchers that are using computers to help children monitor their own behavior. When autistic individuals monitor their own behavior, it increases the number of tasks that get done and increases verbal communication. It has also been shown to reduce tantrums, screaming and self destructive behavior. (Soares, Vannest, and Harrison 2009) Self monitoring in this case involves keeping track of tasks completed without undesired behavior. For example, a child gets to put a sticker on a board whenever a task is completed without undesired behavior or a child gets one sticker for completing a task and two for completing it without undesired behavior. (Soares, Vannest, and Harrison 2009)
Computer technology is not required for this kind of self monitoring, but can help. In one study, they used a computer generated checklist. Once the child filled it out, the child obtained a sticker to put on his monitor board. He received a sticker every time the task was complete and the sticker itself served to remind him of the desired behavior. His reward for good behavior was to play with a giant Mickey Mouse and the stickers were Mickey Mouse stickers. Because the self monitoring was prompted by the computer, the individual modified his behavior with minimal interaction from the teacher. (Soares, Vannest, and Harrison 2009)
Autism is a complicated problem. Each individual shows different symptoms and needs some kind of specialized treatment. Rates of autism seem to be increasing making this problem more difficult with time. We do not know what causes autism. We only know that it affects the brain function and learning. Intense therapeutic interventions have been used to allow a few children to lead normal lives, but most remain mentally challenged for life. Drugs affect symptoms allowing families to deal with an autistic person more easily, but require a person to continue taking them to maintain the results. Computer technology has been used to detect autism and act as aids helping an autistic people communicate and learn language skills. More recent research seeks to augment therapy in new and different ways: teaching self monitoring, helping autistic people understand facial expressions, predicting when autistic people will have an episode and training them how to deal with social interactions. More research needs to be done both into the causes of autism and more effective ways to treat it.
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