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AUTISM SPECTRUM DISORDERS (ASDs)

Autism is family of neurodevelopmental disabilities with different specific causes involving common symptoms to varying degrees: (1) lack of social awareness or social perceptiveness, (2) significant limitations in communication, and (3) non-functional repetitive actions or inflexible non-functional behavioral routines. If these routines are disrupted that frequently leads to emotional and behavioral outbursts. Symptom onset is before three years of age. Research evidence indicates that most cases are caused by some type of genetic error. Possible role of toxins interacting with genetic susceptibility in certain cases, such as prenatal drugs or alcohol or parental occupations involving exposure to neurotoxins (e.g. PCBs) have not been ruled out. Massive early social deprivation is also capable of producing autism symptoms, such as in some isolated nursery-reared children. Autism occurs concurrently with other developmental disorders, such as Fragile X syndrome, Prader Willi syndrome or Smith Lemi Opitz syndrome. Autism occurs three times as frequently among boys as girls.

Great gains have been made since autism was first described clinically in 1943. In 1973 about 1-2% of children with autism who received no specialized treatment developed behavior by adolescence or young adulthood similar to their typical peers or siblings. Recent studies indicate about half of children receiving Early Intensive Behavioral Intervention function similarly to their peers in most domains, though they continue to have some lingering symptoms. The other half improve as well but require continuing special educational support. This site provides up to date, accurate, trustworthy information about social, educational and behavioral issues among children and adults with autism. Each week this site updates the latest research summarized for a broad audience. Parent Perspectives provides commentary by parents of children with autism from around the world. Most of our readers are parents or practitioners.Thank you for taking the time to visit. Your comments are welcomed.

Autism:
Transition to the Adult World

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Michael Crenshaw is a 31 year old man with autism in Cicero, IL who works in a garden and gift shop tending the flowers and where he makes a productive living, with support from his employer and family [mysuburbanlife.com, Jan 18, 2012]
Kammy Kramer, a parent of two children on the autism spectrum posed the question, “What Keeps You Awake at Night,” to other parents of young people with autism in a previous issue of Autism Treatment. Kammy’s wakeless nights arose from concern about what the future held for her son and daughter. They have both profited from early behavioral intervention, but once they reach high school and beyond, what will happen? How will they do in young adulthood and in the world of work? Will they drive their own car. How about dating and marriage? That's enough to stand anyone's hair on end. Will they be able to live independently as adults or in a semi-supervised setting and hold a paying job?

When Early Intensive Behavioral Intervention began turning around the lives of many children with autism, it was still unclear what the long-term outcomes for those young people would be. Lovaas and others found that some youngsters with autism graduated from high school and went on to college while others did not. Only now are sufficient numbers of students with autism reaching high school and post-high school vocational settings that we are beginning to understand what the future holds for EIBI graduates. It appears they will fare better than other young people with autism overall, but some may continue to need supports as they adjust to the adult world.

Shattuck

A new study published in Pediatrics by Paul Shattuck, pictured above, a leader in research on transition to adult life for individuals with developmental disabilities, suggests the future is uncertain for most youth with autism, most of whom have NOT benefited from early intensive behavioral intervention. Slight over 1/3 attended college of some kind and half held paid employment in the first six years after high school. More than half who had left high school in the past two years had no employment. Youth with autism had the highest rate of no participation in employment of all disability groups. Part of this is due to the unique behavioral challenges associated with autism. However, this latter figure is a bit misleading, because many people with other developmental disabilities work in sheltered workshop settings, which is less common among high functioning individuals with autism spectrum disorders.

Similar employment figures are reported in other countries including the UK (Howlin and Moss, (2012) Canadian Journal of Psychiatry, 5:275-830 and far worse outcomes in some, such as Taiwan where less than 20% were employed (Lin et.al. (2012) Int J Rehabil Res. 35(2):109-150. Higher functioning individuals often feel that just don’t fit in, despite exhibiting many skills and having typical intellectual functioning (Griffith et.al. Autism. 2011 Sep 6. (Epub ahead of print). Lack of sufficient social and communication skills impedes successful integration into their peer employment world. In general, the type of support in mainstream vocational settings is insufficient for most individuals on the autism spectrum.

Very few high school programs have sufficiently developed social skills training and peer support systems for students with autism, which are neither costly nor overly time consuming. Carolyn Hughes (below left) and Erik Carter have developed highly effective “Peer Buddy Programs for Successful Secondary School Inclusion” which teaches social skills to youth with ASD and simple strategies with which peers can help support their friends with autism. Though there have been high school vocational programs for many years, only recently have they been tailor made to accommodate students with autism. Paul Wehman (below right) and Colleagues’ book, Autism and the Transition to Adulthood?Success Beyond the Classroom, is a great starting place.

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There is much more need for providing community-based instruction at naturally occurring times, so it's easier for students to learn and generalize new skills. Too many high schools continue to attempt to incorporate youth with autism exclusively within the instructional framework of regular classroom routines, which are often inadequate for students with autism. While all young people need help planning for college, for youth with autism heading for higher education the need is much more acute. Assistance with college preparation, from choosing a college to preparing for, and managing academic and social demands is necessary. For the majority of students with autism, supported and/or customized employment strategies may be most appropriate to help the establish satisfying careers that play to their strengths. Above all, young people on the autism spectrum need ongoing help with social skills and communication appropriate to community workplace settings.

Sink-or-Swim

We have learned that though about half of the children receiving EIBI therapy function sufficiently like their peers in elementary school to be successfully integrated, by high school social, communication and academic demands become real challenges for many. The “sink or swim” strategy of placing them in regular education high school classrooms and hoping for the best, or sending them out for job interviews and hoping something will work out, has proven unsuccessful for many. About half the students sink rather than successfully swim in the work wold. Less intensive, ongoing college and vocational preparation combined with continued social skills and communication training will be required to address this need.

Bibiliography

Hughes, C and Carter, E W (2008) Peer Buddy Programs: For successful secondary inclusion. Baltimore: Paul H. Brookes

Shattuck, PT et. Al. (2012) Postsecondary Education and Employment Among Youth With an Autism Spectrum Disorder. Pediatrics. 2012 May 14. [Epub ahead of print]

Wehman, P (2006) Essentials of transition planning. Baltimore: Paul H. Brookes

PARENT PERSPECTIVES

Stanislas & Béatrice: A French Success Story

Béatrice Bolling*

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Stanislas Bolling Age 5-1/2

I am the mother of Stanislas, my name is Béatrice Bolling. Stan is five and a half. He has high functioning autism. He goes to an ordinary school with class-mates of his age. He starts reading, counts fantastically well, has great academic skills. Stan has even won the last “Diamond Heart” award at school for having helped with great patience and kindness another student. Stan plays judo wrestling, draws as no other child I know, and is fond of music just like any other Bolling family member.

Stan has been under ABA treatment for 3 years now, which we start fading. All that would be just very normal and current in the US, I assume.

It’s not in France.

STORY CONTINUED HERE

Beatrice Bolling and her sons Stanislas and 11 year old Adrien live in Senlis (Oise) , between Lille and Paris, and is an international marketer. Among her avocations are blogging (autismeinfantile.com). The boys' grandfather is the famous jazz pianist, Claude Bolling. Vinca Riviere is an assistant professor at Charles DeGaullle University, Lille III, France. She was one of the founders of Step by Step Behavioral Support Services for Children and adult with Autism and The Federation of Associations for the development of behavioral science called "ABA-France" is a group of nonprofit organizations which helps to create awareness, and educational development of scientifically proven behavioral methods. Dr. Riviere is co-director of the only ABA masters degree and PhD degree training program in France. 
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Individual Autism Intervention for Young Children: Blending Discrete Trial & Naturalistic Strategies published by Paul H. Brookes Publishing Company is now available from the publisher. Thanks to the Minnesota Early Autism Project, especially Lisa Barsness, Clover Anderson who took the cover photo, Amy Bohannan, Beth Burggraff and Patti Dropik who contributed to this volume. Thanks to the parents of the children featured in this volume, especially the mother and father of the amazingly cute child on the cover, all of whom granted permission for their families to be discussed in the book

Review in Midwest Book Review, Vol.6, No. 7, July 2011

Individualized Autism Intervention for Young Children is a pick for educator and health collections alike, discussing two different approaches to use with young children with autism and helping professionals consider two competing behavioral models to respond to an autistic child's individual needs. This approach was developed by one of the nation's leading experts on autism and provides a fine set of practical tools and case studies to thoroughly teach and understand the different approaches.
Order now from Paul H. Brookes