Autistic disorder is categorized as a Pervasive developmental disorder, according to the DSM –IV TR; it is usually diagnosed in the toddler and/or early childhood years. According to Ben J. Atchison (2007), Autism falls in the Autistic Spectrum Disorder (ASD) umbrella, alongside other developmental disorders such as Rett’s disorder, Asperger’s disorder and etc, each varying in the degrees of their severity. Autistic disorder is marked by detachment and impairment in social, communication and behavioral skills and development.
Autism is usually detected by the age of three; however Atchison (2007) notes “characteristics of autism noticeably emerge between 12 to 36 months of age” when specific developmental mile stones are not reached or regression occurs. Regression involves the typical development of an infant/child followed by degeneration and loss of skills. Diagnosis can occur later in children for those who are labeled at a higher functioning form of autism. Autism is characterized by challenges and delays in language, social and behavioral development. Autistic children display impediments in verbal and nonverbal communication and interaction; according to Atchison (2007) “approximately half of children with autistic disorder remain nonverbal or struggle with severely impaired speech as adults.” Other core characteristics include difficulty with social interactions, lack or limited use of eye contact, and understanding and interpreting social gestures, facial expressions, etc. Overall an Autistic child displays atypical developmental skills that lag behind typical developmental highlight. Other common characteristics include indulgence in severe repetitive self stimulating movements and behaviors, severe sensory distortion, limited or repetitive play routines, absent and/or limited pretend/imaginative play skills, and preference for playing alone. In general autism involves an intense inter directedness and lack of ability to communicate, engage and understand the outside world.
The incidence of its prevalence has been on an extreme rise within the recent years; according to Center for Disease Control and Prevention (2008) 1 in every 150 children in the United States will be diagnosed with an autistic spectrum disorder. It is the third most common developmental disorder occurring more often than Down syndrome and congenital malformations. A disproportionably higher number of males are diagnosed with autism, with three to four males diagnosed for every one female (Atchison 2007).
2. Biological Systems:
Physically, autistic children have no outside characteristics that may point out their disorder; most are born quite healthily in appearance, weight and etc. In addition newborns autistic children score equally as well on assessments, such as the APGAR, in comparison to normal developing newborns. The discrepancy in biological development tends to become more apparent in the later months following birth, as motor, adaptive, social and language skills fail to develop and/or are non existent. For example, at eighteen months, a child is able to walk, feed him/herself, imitate adults, there vocabulary consists of three to fifty words, can understand language to some extent, attempt to “talk” with frequent chatter of jargon, and understands and respond to his/her name and simple commands. An autistic 18 month old may not completely be up to par with such developmental markers, he/she may not be walking or feeding his/herself, may not say any words at all, may also not respond to his/her name or simple directed commands and may not show eye contact and interest in others including other similar aged children. Children with autism demonstrate varying degrees of delayed skills in all the different areas of development, all diverse ages and stages, making each case unique when considering the different areas of developmental impediments.
There is no concrete agreed upon cause of Autism, researchers in the area know there is strong connection to genetic, hereditary influences with this neurodevelopmental disorder. According to Atchison (2007), the general population has a 0.2% of having autism, where as individuals with an autistic male sibling have a 3%-7% chance of autism and if sibling is female, a 7%-14% chance exists. Other researchers focus on environmental factors that may contribute to such abnormalities, including but not limited to pre/post natal influences, viruses, bacterias, exposure to toxic chemicals, metabolic imbalances and trauma during delivery and/or pregnancy. These neurological, biological and environmental factors may all strongly influence autism and its characteristics and more significantly the high rise of this epidemic.
3. Psychological System:
Cognitive abilities in Autistic children tend to only slightly vary from that of typical developing children, depending on the severity and mental IQ of the Autistic child.
Jean Piaget’s first state of cognitive development involves, the sensorimotor period from birth to roughly 2 years of age. The sensorimotor stage involves an understanding and awareness of the senses in which the can contain information from the outside world/environment, goal directed behavior, object permanence, representation, etc. In the preoperational thought period, symbolic representation is brought into phase as children use symbols and mental images to depict objects, situations and circumstances. In concurrence with new language development children use there new founded words to describe objects and situations. They also seem to understand grouping objects and ideas based on shared abstract qualities. Around the age group of both the sensorimotor and preoperational stages, autistic children tend to show less impairment in theses areas of cognition. For example, some exceptional autistic children may be able to complete puzzles for children of twice their age, group items impressively by colors, sizes and shapes, may be able to read at early ages or may be extremely talented in the areas of music, memorization and etc. Cox (1993) explains, “It is when cognitive development becomes more symbolic and less concrete, as in the development of language, that autistic children usually show major deficits.”
4. Social Systems:
According to the Center for Disease Control and Prevention, “race, ethnicity, family income and educational levels do not affect the chance of the disorder’s occurrence.” Societal factors may not influence the occurrences of autism however it does significantly influence Autistic children and their families in terms of diagnosis, treatment, and services. Early diagnosis is an important factor in putting autistic children on an early intervention strategic plan. However, race, ethnicity and socioeconomic status notably affects when and how early diagnosis will occur, if treatment is available and etc. For example, with non-English speaking clients there may be a lack of non-English educational brochures and literature, group parent advocacy groups, language barriers etc. Autistic minorities of low socio-economic statuses may experience lack of access to facilities and services, or may not have legal residency to apply for such services. These issues significantly affect how and to what extent the disorder will be served and handled. This creates a repertoire of problem for minority individuals with autisms and there families who cannot afford high rated specialist and test, but merely qualify for Medicaid programs with limited options and available programs to serve the autistic population. Significant disparities exist in terms of equal access of diagnosis, services and treatment for minorities with Autism and their families.
5. Mezzo-level intervention:
Creating an advocacy group for minority autistic children and their families is a mezzo-level intervention that will aid in the dilemma of lack of resources for individuals of minority race, ethnicity and socio-economic status. This Autistic minority advocacy group will work with both the parents and children, more specifically with parents and getting them educated about autism, its effects, causes, diagnosis, treatment and etc. The groups will work within low socio-economic communities and will monitor autistic children and their families, working closely with other parents and staff that are sensitive to the unique needs and circumstances of minority families and will further aid in the successful treatment of autistic minority children. There will be pamphlets, brochures in all languages and well as specialist who speak different languages and have experience in successfully working with diverse racial, ethnic and cultural groups. The advocacy groups will strengthen family relationships, by setting up small meeting for parents of similar background and languages to discuss the unique needs and circumstances of their family and autistic children. For example, there will be groups for Spanish speaking parents, Chinese speaking parents, and other languages, relative caregivers, adoptive/foster caregivers. The program will also provide family counseling and referral services for parents who have just had there children diagnosed.
On the group site their will be a parent facility and a child facility. The children facility will provide learning groups for autistic children while their parents receive supportive group services. It will contain developmental disorder specialist and will work with designing plans and referrals for the unique case of each autistic child. The program will serve a vast diversity of populations and will primarily focus on educating families and individuals, while promoting and creating supportive group systems, counseling and most importantly treatment and intervention skills. A social worker in this setting will serve as an advocate and facilitator; organizing, gathering groups and providing information, defending, supporting and aiding in setting goals for the minority Autistic population.
The weakness of this intervention choice lies in the ability to have a program of this nature funded. Finding financial support to furnish a community based program of this type will be difficult, especially in our states/nations declining economical situation. Other weakness may also be finding specialist who have significant and successful experience in working with minority families and children. Overall, the main disadvantage would be in accessing funding to operate and minority Autistic advocacy program.
6. Macro-level Intervention:
A national policy that addresses and takes action in combating and working on behalf of the rising and alarming rate of Autism in America is a Macro-level approach of intervention. An insurance legislation that provides accessible health care and services for autistic children/ adults and their families will allow for a more available and approachable management in handling Autism.
The strengths of this legislation will allow for readily available communication and developmental specialists and treatment for all autistic individuals regardless of race, socio-economic status, ethnicity and etc. The legislation will work grant funds to autistic service providers and will set up policies that make sure early detection, awareness and treatment are available and accessible by having autistic service providers collaborate with schools, preschools, pediatrician, clinics, and other social service agencies where children and families come in contact with. With this Macro-level intervention a Social Worker would serve as analyst and evaluator, examining where most funding and services are needed and evaluating how well program and policies work. The analyst will also evaluate the effectiveness of the policy.
The major deficit of this Autistic insurance legislation/act is once again is financial resources. Today our nation is battling with severely heated and debated issue of health care. Also if such a policy program existed there may be a lack of monitoring the grants and the successes services and collaboration. In addition, grants and services may be unequally distributed and placed in middle/upper class community, where there exist strong lobbying efforts and large advocacy groups for autistics and families of upper, middle dominant classes. Overall there is a significant weakness and it involves having funds allocated to serve and create such a legislative initiative.
American Academy of Pediatrics, & Johnson, C. P. (2007, November 5). Identification and Evaluation of Children with Autism Spectrum Disorders. Pediatrics, 33. Retrieved May 18, 2008, from http://www.aap.org/pressroom/issuekitfiles/IDandEvaluationofChildrenwithASD
Atchison, B. J. (2007). Autism Spectrum Disorders. In Conditions in Occupational Therapy. (pp. 23-49). (3rd ed.). Philadelphia: Lippincott William & Wilkins.
Berg, K. (1998). Per’s Pages. In Catalano, R. A. (Ed.). When Autism Strikes. (pp. 1-12).New York: Plenum Press.
Capps, L, & Sigman, M. (2000). J. Bruner (Ed.). Children with Autism: A Developmental Perspective. Massachusetts: Harvard University Press.
Cox, R. D. (1993). Normal Child Development From Birth to Five Years. In E. Schopler (Ed.). Preschool Issues in Autism. (pp. 39-56). New York: Plenum Press.
Center for Disease Control and Prevention. Department of Health and Human Services. (2008, April 30). About Autism: An Overview. Retrieved May 18, 2008, from http://www.cdc.gov/ncbddd/autism/ National Center on Birth Defects and Developmental Disabilities.
National Institue of Mental Health. (2007, January). Autistic Spectrum Disorders: Pervasive Developmental Disorders. 41. Retrieved May 19, 2007, from http://www.nimh.nih.gov/health/publications/autism/nimhautismspectrum.pdfDepartment of Health and Human Services.