Autism Spectrum Disorders: Article Review

Autism is a neurodevelopmental disorder that has for a long time been a challenge to the whole medical fraternity and families. The major challenge has been to find or identify interventions that are most effective and appropriate for the management and treatment of the disorder (Simpson, 2005). The professionals and families have not only focused on the interventions that will help in treating the disorder, but also those that will make better the lives and health of people with this disorder. However, finding the most appropriate and effective interventions has been a problem for both the professionals and the families. This is due to the constraints in the financial resources, geographical locations and lack of support from the relevant organizations (Lindgren & Doobay, 2011). As such, the field has come up with many interventions that cannot be supported by scientific research. Despite the few evidence-based intervention mechanisms, identifying or knowing which intervention is the most effective among the many non-evidenced interventions has been a problem for the whole medical field. For this reason, this paper seeks to review four types of interventions that are in line and have been assessed in accordance with scientific quality accepted standards. For the purposes of explaining and analyzing the efficacy of these interventions, the paper shall review certain research articles that have focused on proving the efficacy of the four interventions and discuss the results and findings of each of these articles to ascertain the effectiveness of the four interventions and if the available scientific evidence that supports their effectiveness is valid and comprehensive.

Introduction
Autism Spectrum Disorders (ASD) are sets of neurodevelopment disorders characterized by major impairments in social relations, restricted interests and the existence of rigid behaviors as well as limitations in communication (Lord, Et.al, 2000). The learning and thinking abilities of individuals with ASD show variance from highly gifted to extremely limited. Essentially, ASD begins at an early age, normally at 3, and can result in problems throughout an individual’s life. It does not discriminate and occurs in all ethnic, racial and socioeconomic groups of individuals and is more likely to affect the males as opposed to females. ASD manifest in three main forms namely Autistic Disorder commonly known as Autism, Pervasive Developmental Disorder (PDD) and Asperger’s Disorder (Simpson, 2005). These conditions manifest similar behaviors, but they are different with regards to when the behavior begins to manifest, the rigorousness of these disorders and the exact pattern of the symptoms. Perhaps to have a better understanding of the ASD, we have to look in depth what the three forms of ASD entails and the difference that is evident among them.
First, Autism is characterized by qualitative mutilation in three places of functionality namely: communication; social interaction and limited repetitive and notable behavior patterns, activities and interests (Lindgren & Doobay, 2011). The most general symptoms include poor “interpretation” of social cues, reduced eye contact, inability to expand peer relationships, delayed development of speech, lack of emotional or social reciprocity, trouble sustaining chat, lack of made-up plays, among others. Symptoms start to manifest before the age of 3. Also, about 60- 75% of Autistic Disordered children are disabled intellectually, but some can develop normal or even higher intellectual abilities. Even in children disabled intellectually, there may exist isolated abilities that are very much developed. Secondly, Asperger’s Disorder is characterized by mutilations in limited or repetitive behavioral patterns, activities and interests combined with social interaction. The most obvious symptoms include failure to develop characteristic peer relationships, poor “interpretation” of social cues, lack of expressive reciprocity, strong preoccupations or interests, and inflexible observance to routines. However, individuals with Asperger Syndrome do not demonstrate general impairments in overall cognitive development or language. Even so, impairments in pragmatic language and visual-motor skills are common (Lord, Et.al, 2000). Lastly, the identification of PDD-NOS is suitable when there is rigorous and persistent impairment in the advancement of common social interaction connected to impairment in both nonverbal and verbal communication abilities or with the existence of common interests, behaviors, and activities; even so, the standards are not attained for a more detailed disorder (Lindgren & Doobay, 2011). This diagnosis is frequently used when patients show more than a few symptoms of an ASD, but does not attain the standards required for both Autistic Disorder and Asperger’s Disorder.
In essence, ASD is among the many disorders that have proved to be challenging to the whole medical practice. In fact, it has been the focus of numerous researches. The researches have mainly aimed at finding the most appropriate and effective interventions that enable the medical practitioners to treat, control, prevent or manage the disorder (Odom, Et.al, 2010). Conversely, no one understands for sure the causes of autism and studies have come up with a number of scientific explanations and theories to determine the real cause of the disorder (Dawson, 2008). In this regard, scientists believe that environmental factors and genes play a part in the cause of autism. These two assertions are based on the fact that this disorder is prevalent in families and thus might be as a result of the passage of the gene from the parents to the children. Aside from the scientific evidence supporting genes and environmental factors as the cause of autism, other people, especially parents, believe that vaccines are the major cause of ASD. However, it is essential to note that ASD is a disorder of the brain and environmental factors play a major role in its causation.
With the prevalence of ASD in our society today, there is a need to recognize and establish the most effective interventions to counter the alarming rate at which this disorder increases. Being that the whole medical practice is currently based on evidence and scientific proof, the most effective interventions for the disorder must be proved scientifically to ascertain their effectiveness in dealing with and managing the disorder (Dawson, 2008). In essence, identifying the most effective behavioral and medical treatments or interventions for neurodevelopmental disorders ought to be based on the basis of scientific evidence. As such, for the purposes of this paper, the focus shall be on four major evidence-based interventions that have been identified and proved through scientific evidence to be effective in treating or managing ASD. These interventions shall be; Applied Behavioral Analysis (ABA); Early Intensive Interventions; Social Skills Training; and Cognitive-Behavior Therapy. These four interventions are supported by significant scientific evidence. Further, the paper shall review four articles that address and discuss each of these interventions, analyze the data of the articles and findings with regards to the effectiveness and efficiency of the interventions.
Research on ASD Interventions
The analysis of these ASD interventions centers on identifying the most effective and appropriate evidence-based interventions for ASD. Applied Behavioral Analysis (ABA), Cognitive-Behavioral Therapy, Early Intensive Interventions and Social Skills Training are all reviewed (Odom, Et.al, 2010). The analysis relies primarily on the data and records obtained from four major articles. These articles deal with the interventions and provide evidence why the interventions are considered the most appropriate and effective for the treatment and management of ASD in the society’s population. Below, these articles are discussed. The discussions are based on the overall indication of the studies, how the interventions are effective according to the evidence provided by the study, the limitations of the study and the future steps for the studies.
Harris, S. L., & Handleman, J. S. (2000). Age and IQ at Intake as Predictors of Placement for Young Children with Autism: A Four-to Six-year Follow-up. Journal of Autism and Developmental Disorders, 30(2), 137-142.
Summary
This article tries to examine the effectiveness of applied behavioral analysis as an intervention and treatment for individuals with autism. In its examination, the IQ and the predictive power were observed. Also, the age of admittance to an intensive treatment program with the use of applied behavioral analysis were studied with a 4 to 6-year follow-up of instructive placement. The children used for this analysis were 27 in number and between the age of 31 and 65 months. There IQs at the time of the admission were recorded at a range between 35 and 109. This admission was at the Dou-glass Development Centre which is a care center that tries to apply the intervention to help children with autism. The study was followed-up 4 to 6 years after leaving first examination institutions. The results of the study were positive in that 6 out of the 27 children recorded an adjustment in their IQs from the state of psychological retardation to average. In essence, the intervention worked on the 6 children and a positive outcome was realized. Of the 6 children, 4 were between the age of 4 and 6 and 2 were between the age of 3 and 5 at the time of joining the program. A follow-up study was carried out which confirmed that 3 of the 6 children finished the program when in special education, 2 of the children finished the program at integrated classrooms while being supported and 1 was completely included in the integrated classrooms with no support whatsoever.
Overall Indication of the Study
The study in this article indicates that the intervention of applied behavioral analysis works on a number of children with autism. With the adjustment of the children’s IQs, there is strong evidence to prove that applied behavioral analysis is effective and works for some children. However, the results of the study highlight the importance of early interventions for children with this disorder. In fact, the results of this study demonstrated an assessable and significant gain in IQ for older children with lower IQ.
The Effectiveness of the Intervention
The efficacy of this type of intervention is dependent on the desired results and the period within which it is administered. As the study suggest, the intervention works best on children below the age of 5 years which mean that the intervention should be applied at the initial stages of an individual’s development rather than wait for the child to become older. Also, the intervention works well when under the care of a qualified behavioral psychologist and that is why positive results were recorded when the study was carried out at the Dou-glass Developmental Center which is known to have professional psychologists and trained children care practitioners. As such, the intervention or treatment is efficient when used or applied at the early stages of the children’s development as evidenced by the results shown in the study.
Limitations of the Study
The limitation of the study is the inconsistency seen in the results. However, these inconsistencies are in relation to the different responses given by the children during the process of intervention. Ideally, individuals with autism react differently to treatment and interventions which make it hard to make conclusions about the efficacy of the treatment or intervention. For instance, in the study above, only 6 children out of the 27 showed results of the intervention process with the other children showing no positive or negative changes in their IQs. As such, the inconsistency and the rigidity of some patients to the treatment process are the major limitations of this study.
Future Study
The next step for future studies is the focus on older patients. Most studies have focused on younger patients with an aim to establish the early intervention mechanisms are ignoring the older patients with autism. In fact, data from the Center for Disease Control and Prevention (CDC) recommends that the disorder is diagnosed more on older patients as opposed to younger patients.
Eldevik, S., Hastings, R. P., Jahr, E., & Hughes, J. C. (2012). Outcomes of behavioral intervention for children with autism in mainstream pre-school settings. Journal of autism and developmental disorders, 42(2), 210-220.
Summary
This article evaluates the effectiveness, and the benefits of Early Intensive Behavioral Intervention applied on individuals with autism. In the study, the evaluation was premised on the outcomes of the 31 children diagnosed with autism, with ages between 2 and 6. These children received behavioral intervention in conventional pre-school settings and the outcomes evaluated against those of 12 other children undergoing usual treatments. The evaluation was based on the score of their IQs, and whether after the intervention was carried out, the children’s IQs adjusted positively or negatively. The results shown in the study demonstrated a positive outcome indicating that the individual child data achieved change at a consistent IQ level by showing 19.4% result.
Overall Indication of the Study
Generally, the study indicates that children receiving Early Intensive Behavioral Intervention under the recent conventional pre-school model made considerable gains in adaptive behavior and IQ combined after employing the intervention for 2 years, as opposed to the other group receiving usual treatment. This means that compared to the usual treatments of the ASD, EIBI is more appropriate and effective in helping children adjust their IQ and manifest adaptive behaviors. Thus, children undergoing programs that employ EIBI are more likely to yield positive results within two years as compared to when they are put under their usual treatments.
Effectiveness of the Intervention
With the evaluation done by this study, the results indicate that EIBI is very effective when applied to children below the age of 6. This requires that the disorder is established at an early age for the intervention to work. The process makes the child develop adaptive behaviors which in turn makes him or her socially active. This, in turn, adjusts his or her IQ from the state of retardation to the average level which can enable him or her to perform normal duties as any other child.
Limitations of the Study
The drawback of this article is in relation to the evaluation. For instance, reaching the normally suggested weekly hours of intervention was not easy due to the contending emergencies on the staff in the conventional program. Also, the staff and the management were unfamiliar with the intervention making the research team spend more time in explaining the specifics of the research and study. Lastly, the behavioral intervention was different in the pre-school. The close supervision and the monitoring of the staff were intense thus did not give the research team enough space to complete successfully the study. In essence, the results recorded in the evaluation were not the best possible results considering the factors associated with this study.
Future Study
To achieve more comprehensive and conclusive results of this study, research team should concentrate more on settings that have systems that are more flexible and aware of the interventions. This is to reduce the time spent on the staff and management about the interventions.
Mirsky, M. E. (2014). The Importance of Effectively Teaching Social Skills to Students with High-Functioning Autism.
Summary
This study examines the effectiveness of using social skills training for students or children with autism. It examines the intervention itself and the characteristics that make the intervention effective in children with autism. The examination is based on information gathered from the educational and care professionals and who are familiar with teaching social skills or employing this intervention to individuals who have a high-functioning autism disorder. The results of this study indicate a necessity for the development of effective and structured interventions that focus on the unique social aspects of these children.
Overall Indication of the Study
Generally, the study signifies that the available interventions are inadequate to deal with the distinctive needs of individuals with autism. Socially, these children are very different. For this reason, it is hard to have a universal intervention that will deal with the common needs of the individuals considering their unique and changing nature. As such, social skills training can only be effective on some children with other children being unresponsive to the intervention. Nevertheless, social skill intervention is very important in dealing with the social aspect of the ASD. Other interventions are not able to address these social aspects making the social skill training essential as an intervention mechanism. For instance, children that undergo usual treatments for autism never have the social aspect of the disorder fully treated. As such, most have their IQs are adjusted but still end up having social issues. Thus, social skill training is important.
Effectiveness of Social Skill Training
This intervention is more effective in dealing with the social aspect of ASD. With the other evidence-based interventions focusing more on the adjustment of the patients’ IQ level, the social aspect is, in most, cases neglected and is among the most vital aspects. This is because the patient’s ability to utilize their social skills makes them deal with the disorder on their own which is another important form of intervention that has been recommended by most researchers.
Limitations of the study
The drawback of this article is based on the uniqueness of social abilities of autism patients. Every patient has a different social ability and finding a social skill training that suits every patient is difficult. As such, the results recorded here mainly favor some patients and cannot be universally applied to all patients with autism.
Future Study
With regards to this topic, future studies should focus more on employing or finding the most effective and appropriate intervention that deals with the specific and unique social aspects of the disorder. This is because the usual treatments have failed to address this aspect of the disorder and the aspect differs from patient to patient which makes the social skill training hard to apply universally. As such, the future studies should focus more on identifying the most effective Interventions that will deal with these unique social aspects of ASD.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive-behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224-234.
Summary
This study seeks to examine the effectiveness of Cognitive-Behavior Therapy by testing the modular Cognitive Behavior Therapy program for individuals with ASD. In the test, a regular CBT program is improved with several treatment processes intended to contain or remediate the adaptive skill and social deficits of individuals with ASD that could create obstacles to the reduction of anxiety. The test is done on children with ages between 7 and 11 who are indiscriminately dispensed to 16 CBT sessions on a 3 months waitlist. In the results, 78.5% of the individuals undergoing CBT attained the Global Impressions-Improvement scale standards for affirmative treatment reaction at post-treatment, as opposed to the waitlist group who were only 8.7%. CBT also performed better than the waitlist on the outcomes of diagnosis and the report of parents about anxiety, but not individual’s self-reports. Treatment results were sustained at 3-month follow-up.
Overall Indication of the Study
According to the results of this study, there is a strong indication that the diminution of anxiety disorders come out as an attainable goal among the high-functioning individuals with autism. In essence, CBT being the first ever intervention to be employed in patients with autism, it has proved to be effective enough on children above the age of 7 as opposed to other interventions that focus more on children below the age of 6.
Effectiveness of the Intervention
The intervention is very effective in treating children with autism with ages ranging from 7 to 11 years. In essence, the intervention can be used where the other interventions have failed to make it the most effective evidence-based intervention. In other words, the other evidence-based intervention serves to identify the potentials of the patients at a younger age and provide the necessary intervention, and in cases where the responses from patients are negative, the CBT is recommended for the care facilities to use on the patients making it an important intervention. Also, compared to the normal treatment of autism, CBT has proved to be more effective and reliable, and most parents and families prefer sending their children to care homes that employ the CBT as their interventions as opposed to taking them for the usual treatments.
Limitations of the Study
For this study, two major limitations are worth mentioning. First, there was significant heterogeneity in the apprehension concerns in the test, ranging from social anxiety to separation anxiety to GAD to OCD, to a combination of some of each. The MASC does not determine the symptoms of OCD and GAD and thus cannot evaluate the changes some of the individuals may have undergone. In the future, alternative evaluation procedures might entail more inclusive self-report evaluations more appropriate to this heterogeneity. Secondly, a major effect of the treatment or intervention team was not yielded by Child-report MASC scores in big part because there was a decline in MASC scores in both groups. It is recommended that children with ASD make use of self-report anxiety procedures in a distinctive way.
Future Study
For the future studies, research focusing on this intervention should be more specific to groups of individuals with autism. In fact, the individuals should be categorized to make the results more comprehensive and conclusive.
Interventions Explained
Applied Behavioral Analysis (ABA)
This is the method of employing the standards of behavior to modify a particular behavior and at the same time assess the efficacy of the treatment or intervention. It stresses both remediation and prevention of a problem. Significant interest is given to the physical and social environment, as well as the precursor conditions and results that bring out and maintain behavior. Many experiential studies have recognized the effectiveness of ABA applied to persons with ASD. These interventions should characteristically be given under the care and direction of a qualified behavioral analyst or behavioral psychologist (Dawson, 2008). The research proposes that the most desired results occur when ABA is instigated early, if possible before age 5. There is a continuing debate about the extent of ABA required in order for it to be more effective, with suggestions usually ranging between 15 and 40 hours every week, depending on how or whether the intervention is being applied to inclusive educational programs in the institutions or to a specific behavioral treatment program (Harris & Handleman, 2000). Training personnel to provide this intervention in the community or home setting is an essential part of this program; teleconsultation is also proving to be a helpful and effective approach for providing this intervention in rural areas. In fact, this intervention provided as little as an hour a week, and with parent training, it can be effective in decreasing behavior problems and help in building social interaction in individuals with ASD.
Early Intensive Interventions
Intensive early intervention programs that give ABA strategies, frequently in a blend with developmental strategies have demonstrated improvements in communication, behavior and cognitive abilities (Eldevik, Et. al, 2012). Lovaas-based techniques are the most commonly used and have the most reliable research base hence far for this type of programs. A randomized restricted examination of the Early Start Denver Model, which employs a blend of an ABA-developmental model, also has produced affirmative results for children with ASD. A successful randomized examination for the Alternative Program and Learning Experiences for Parents and Pre-scholars has been finished as well. Even though these studies lack methodological limitations, the NAC assessment selected inclusive behavioral treatment for children using this type of program as an “established treatment.”
Social Skills Training
Unlimited social interaction is a serious problem in ASD. There is evidence that interventions to train social skills and are effective. These are interventions such as Social Skill Training (White, Keonig & Scahill, 2007). The increase of pro-social behaviors is a typical result in Social Skill Training and ABA interventions. Both the NAC and the NCPC standards also see social mechanisms as useful for the social skills training. The application of peer-mediated interventions to create social skills is well recognized as well. There is proof that particular aspects of social interaction, such as eye contact, can be achieved with this training.
Cognitive-Behavioral Therapy
The scientific basis for cognitive behavior therapy (CBT) use with adults and children with adjustment or mood problems is far-reaching and diverse (Vismara & Rogers, 2010). In fact, CBT is the most extensively used non-pharmacologic intervention for persons with emotional and mental disorders, particularly depression, and it is applied to persons with autism spectrum disorders. CBT centers on replacing ineffective or negative patterns of behavior and thoughts with well thought-out strategies that are efficient in improving adaptive functioning and mood.
Conclusion
ASD is unique from person to person. As such, the intervention and treatment plans must be based on individuals with a focus on the individual and family needs of the patients (Odom, Et.al, 2010). In this regard, studies have proved that early interventions of the disorder can be the difference made in improving the social and cognitive development of individuals with ASD, and rigorous, well thought-out educational programs that are based on the applied behavior analysis (ABA) principles which are the standards for initial autism treatment. The major focus should be on the individual’s achievement of social, play, communication and academic skills. A general agreement has been arrived at that well thought-out programming should be offered throughout the year at a concentration of roughly 25 hours every week. Further, as is proper for any person with a severe neurodevelopmental disorder, providing a “medical home” that ensures parent training, care coordination and family support is seriously important to an inclusive plan of care. For older people with ASD, job coaching, vocational training, and interventions to adjust behavioral and social skills are essential to maintaining independence in working and living in society setting. Although differences have been pointed out between ASD services that are “habilitative” or “rehabilitative,” the laws have questioned the merit of these differences. Therefore, the present thinking is in favor of the 23 need for medical, preventive and remedial services in cases where these interventions have been suggested by a medical care practitioner for the diminution of a mental or physical disability and for enabling the best achievable level of performance.
References
Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and psychopathology, 20(03), 775-803.
Eldevik, S., Hastings, R. P., Jahr, E., & Hughes, J. C. (2012). Outcomes of behavioral intervention for children with autism in mainstream pre-school settings. Journal of autism and developmental disorders, 42(2), 210-220.
Harris, S. L., & Handleman, J. S. (2000). Age and IQ at Intake as Predictors of Placement for Young Children with Autism: A Four-to Six-year Follow-up. Journal of Autism and Developmental Disorders, 30(2), 137-142.
Lindgren, S., & Doobay, A. (2011). Evidence-based interventions for autism spectrum disorders. The University of Iowa.
Lord, C., Cook, E. H., Leventhal, B. L., & Amaral, D. G. (2000). Autism spectrum disorders. Neuron, 28(2), 355-363.
Mirsky, M. E. (2014). The Importance of Effectively Teaching Social Skills to Students with High-Functioning Autism.
Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing school failure: Alternative education for children and youth, 54(4), 275-282.
Simpson, R. L. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20(3), 140-149.
Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: what do we know?. Annual review of clinical psychology, 6, 447-468.
White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of autism and developmental disorders, 37(10), 1858-1868.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224-234.