CDC - Act Early Curriculum Videos -Language outcome in autism: randomized comparison of joint attention and play interventions.
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):125-37. doi: 10.6X.76.1.125.Language outcome in autism: randomized comparison of joint attention and play interventions.1, , , .1Psychological Studies in Education, University of California Los Angeles, Los Angeles, CA 90095, USA. kasari@gseis.ucla.eduAbstractThis study reports results of a randomized controlled trial aimed at joint attention (JA) and symbolic play (SP) in preschool children with autism, with prediction to language outcome 12 months later. Participants were 58 children (46 boys) with autism between 3 and 4 years of age. Children were randomized to a JA intervention, an SP intervention, or control group. Interventions were conducted 30 min daily for 5-6 weeks. Assessments of JA skills, SP skills, mother-child interactions, and language development were collected at 4 time points: pre- and postintervention and 6 and 12 months postintervention by independent testers. Results indicate that expressive language gains were greater for both treatment groups compared with the control group, and results could not be explained by differences in other interventions in which children participated. For children beginning treatment with the lowest language levels, the JA intervention improved language outcome significantly more than did the SP or control interventions. These findings suggest clinically significant benefits of actively treating JA and SP skills in young children with autism.Comment inPMID:
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External link. Please review our .Infants with autism: an investigation of empathy, pretend play, joint attention, and imitation.
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):781-9.Infants with autism: an investigation of empathy, pretend play, joint attention, and imitation.1, , , , , .1Department of Psychology, University College London, England.AbstractSystematic studies of infants with autism have not been previously carried out. Taking advantage of a new prospective screening instrument for autism in infancy (S. Baron-Cohen et al., 1996), the present study found that, compared with developmentally delayed and normally developing children, 20-month-old children with autism were specifically impaired on some aspects of empathy, joint attention, and imitation. Infants with autism failed to use social gaze in the empathy and joint attention tasks. Both the infants with autism and the infants with developmental delay demonstrated functional play, but very few participants in either group produced spontaneous pretend play. In the developmental delay group, but not the autism group, pretend play was shown following prompting. The implications of these findings for developmental accounts of autism and for the early diagnosis of the disorder are discussed.PMID: 9300211
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External link. Please review our .Autism, disorder that severely impairs development of
person’s ability to communicate, interact with other people, and
normal contact with the outside world. The disorder was first described
1943 by American psychiatrist Leo Kanner. One of the most common
developmental
disabilities, autism affects 2 to 5 out of every 10,000 children and
before the age of three. It is four to five times more common in males
in females.
CHARACTERISTICS
often referred to as a spectrum disorder—that is, a disorder in
symptoms can occur in any combination and with varying degrees of
Symptoms of autism usually begin during infancy. Autistic infants may
or go limp when picked up by parents rather than clinging or cuddling
to them. Autistic infants often show little or no interest in other
and lack typical social behaviors. For example, they may not smile at
mother’s voice or make eye contact with caregivers. Autistic children
to develop normal relationships with their parents, brothers or
and other children. Often they seem unaware of the needs and feelings
other people, and may not respond if another person is hurt or in
They also fail to make friends.
with autism usually play alone. Often they engage in repetitious
activities, such as arranging objects in meaningless patterns, flipping
a light switch on and off, or staring at rotating objects. Some engage
in repetitious body
movements, such as spinning, flapping their arms, swaying, rocking,
their fingers, and clapping or flapping their hands. In some cases
movements may be harmful, involving repeated biting of their wrists or
their head. Children with autism frequently become upset at minor
in their surroundings and daily routines.
children also have difficulties with language. Some never learn to
develop very limited speech. An autistic child may say "you" when he
"I" and produce incorrectly formed sentences. For example, when the
wants a drink he may say, "You want a drink." Autistic children may
demonstrate echolalia, mechanically repeating words or phrases
other people say.
75 percent of autistic children have mental retardation. Most have
moderate mental retardation, with an intelligence quotient (IQ) ranging
from 35 to
50. About 10 percent, however, have extraordinary talents such as the
to memorize long lists of information, make lightning-fast mathematical
calculations,
or play musical instruments. Experts call such individuals autistic
Scientists
once regarded autism as a psychological disorder caused by traumatic
experiences that forced a child to retreat into a world of fantasy.
Some theorized that
parents caused autism by unconsciously rejecting a child, or by failing
bond emotionally. These theories caused enormous guilt in parents and
any scientific validity. Scientists today still do not know what causes
but they have discredited and rejected theories about a parental cause.
indicates that autism results from biological abnormalities in brain
structure and function. Studies have found that autistic people have
abnormally low blood flow to certain parts of the brain and reduced
numbers of certain brain
cells. These studies suggest that mutations in genes are important in
autism. Studies of families also support this possibility. For example,
with one autistic child are more likely to have a second autistic
Other studies have linked some cases of autism with prenatal exposure
the rubella virus and lack of oxygen during birth.
theory sees autism mainly as a problem of cognition. In this view,
autism results from an inability to think in ways necessary for normal
communication, sharing of experiences, and expression of emotions.
Supporters argue that autistic people lack "a theory of the mind"—that
is, they do not realize that
other people have feelings, beliefs, needs, and an inner life. Without
conception of the minds of others, autistic people cannot predict or
the behavior of others and have severe problems in social interaction.
experts criticize this theory, noting that autism appears at an early
when no children have a conception of the minds of others.
no cure for autism. But treatment may reduce symptoms and help people
autism function better. Experts disagree over the effectiveness of
treatments. Many treatments seemed promising when first introduced, but
proved disappointing. Because individuals respond in different ways, no
treatment works for everyone. Treatments include behavior modification,
medication,
facilitated communication, vitamin and mineral supplements, auditory
and vision therapy.
modification involves analyzing the cause of an undesirable
behavior, then using rewards and punishments or other approaches to
replace the behavior with a more appropriate response. For instance,
children who spin or flap their arms because of anxiety about a
situation can be taught to say "stop" or point to a symbol for "stop."
Parents often collaborate with therapists in providing behavior
therapy. Very intensive behavior programs, modeled on
the teaching methods of American psychologist O. Ivar Lovaas, have
yielded some of the best results. In such programs parents may provide
therapy at
home seven days a week for several years.
Physicians
sometimes prescribe antipsychotic drugs, beta-blockers,
anticonvulsants, and
other medications to reduce self-abusive behavior, such as head banging
wrist biting. Some individuals with autism benefit from drugs that
levels of serotonin, a brain chemical. These medications, which include
fenfluramine
(Pondimin), fluvoxamine (Luvox), and clomipramine (Anafranil), may
compulsive behavior and body movements. Other drugs that improve
in some patients include naltrexone (ReVia), which blocks the action of
opiate-like compounds in the brain, and haloperidol (Haldol), which
interferes
with the function of the neurotransmitter dopamine.
Facilitated
communication is based on the idea that people with autism are
unable to communicate because of impaired body coordination. In this
technique, a
trained professional, or facilitator, supports the person’s hand over
alphanumeric keyboard. The person with autism learns to type messages
responses to questions. Critics maintain that the facilitator, rather
the person with autism, is the true source of the messages.
treatments for autism include supplements of vitamin B6 auditory training
individuals who are hypersensitive to certain
training to correct eyesight problems.
in the United States requires that states provide early intervention
for children aged one to three with autism and other disabilities.
services try to help children with autism develop academic and social
in the hopes of lessening the disorder’s long-term effects. States also
provide an individual education plan when these children begin school.
with autism may attend regular or special schools.
AND ADULT LIFE
individuals with autism get jobs and live independently or
semi-independently as adults. They often succeed in jobs that emphasize
specific skills, rather than those
that require complex interactions with other people. Others with autism
depend on outside support. They may live with family members, in group
or in residential care facilities.
number of other disorders may include characteristics of autism. In fragile
syndrome, which results from a defective X chromosome, people may
poor eye contact, limited speech, hand flapping, and hyperactivity.
with Asperger’s disorder may show some symptoms of autism such
difficulties in social interactions, poor eye contact, repetitive body
movements,
and an insistence on routines and rituals. However, they have normal
development and do not have mental retardation. Rett’s disorder
repetitive hand movements, social withdrawal, and impaired language
development.
The disorder appears before the age of four and affects only girls.
experts regard these disorders as mild forms of autism rather than as
disorders.
Five Early Signs of
- December 6, 2002
Timmy was the perfect baby. Quiet and complacent, at 10 months he could
play by himself for hours, allowing me to read the paper or do the
housework. Unlike our friends' children, Timmy was so much less
demanding of our attention. We just assumed he was very bright and
independent. We began to worry, however, when his older sister
celebrated her 4th birthday, and Timmy was only a year old. With all
the friends and relatives around, he suddenly seemed withdrawn,
preferring to crouch in a corner by himself, and at times crying as if
there was too much commotion for him. Over the next several months, we
began to notice other signs that concerned us. Timmy seemed not to
notice our comings and goings as much, and by 18 months, still had not
spoken a word. We talked to our pediatrician, but were told that he was
likely just a little slow to talk-boys often are, and he has a big
sister who likes to do things for him. When Timmy still was not talking
at 2, we began to look for other help....
Although autism is usually diagnosed when the child is 3 to 4 years
old, parents like the mother above often sense that something is wrong
much earlier. On average, parents start to worry about their child's
development by 18 months of age and voice some of their concerns to a
doctor or another professional by age 2.
But physicians and professionals are hesitant to diagnose autism at
very early ages. They know that the early development of children
varies, and are often uncertain if a behavior will persist into being
considered atypical, or if behaviors that should be present will
continue to be absent. If the child is labeled with a problem too
early, parents may reduce expectations for the child and restrict the
child's access to typical experiences and opportunities. Thus,
professionals may take on a "wait and see" stance that delays
diagnosis, and ultimately the commencement of intervention services.
Although such concerns are valid, the benefits of early diagnosis
vastly outweigh the risks. These benefits include the relief parents
may feel in having their concerns validated, and in their ability to
address the problem as early as possible. As many studies have now
shown, early intervention is critical for the best outcome in children
with autism, and many believe the earlier the better. Only with a
diagnosis can parents begin to obtain necessary intervention services
for their child.
Given the potential benefits of early diagnosis, is it possible to
reliably diagnose autism before age 2? The answer is yes. A number of
researchers have now studied the early development of children with
autism-a not so easy task given that the average age of diagnosis in
the United States is 3 to 4 years of age.
Early development of children with autism has been studied by:
* screening large numbers of children for autism-specific behaviors
during well-baby checks at 18
* asking parents of children with autism to remember back to whether
their child showed certain behaviors at certai
* and having parents bring in home videos of children diagnosed with
autism when these children had their first or second birthday parties
(which parents often videotape).
From these studies, five distinct areas of development are flagged for
consideration. All parents should consider these "Big Five" if they
suspect that their child may have autism.
1) Does the baby respond to his or her name when called by the
caregiver? Within the first few months of life, babies respond to
their own name by orienting toward the person who called them. Typical
babies are very responsive to the voices of familiar people, and often
respond with smiles and looks.
In contrast, infants later diagnosed with autism often fail to respond
to their own name. That is, when called by name, they tend to turn and
look at the person only about 20% of the time as found- in the
videotaped one year-old birthday parties of children with autism. They
also are often selectively responsive to sounds. They may ignore some
sounds and respond to others that are of the same loudness. Thus, they
may fail to respond to their parent calling their name, but immediately
respond to the television being turned on. It is not unusual for
parents to suspect their child has a hearing loss.
2) Does the young child engage in "joint attention"? Near the
end of the first year of life, most infants begin to join with their
caregivers in looking at the same object or event. To aid in this
process of "joint attention", typical infants begin to shift their gaze
from toys to people, follow other's points, monitor the gaze of others,
point to objects or events to share interest, and show toys to others.
These behaviors have a distinct sharing quality to them. For example,
the young infant may point to an airplane flying over head, and look to
the parent, as if to say, "do you see that!"
In contrast, young children with autism have particular difficulties in
jointly attending with others. They rarely follow another's points, do
not often shift their gaze back and forth from objects to people, and
do not seem to share "being with" the caregiver as they watch and talk
about objects, people, or events. They also tend not to "show" a toy to
the parent.
3) Does the child imitate others? Typical infants are mimics.
Very young infants can imitate facial movements (e.g., sticking out
their tongue). As early as 8-10 months, mothers and infants say the
same sounds one after another, or clap or make other movements. Indeed,
imitation is a major part of such common infant games as pat-a-cake and
So Big ("How big is baby? Soooo big!" as infant raises hands to sky).
Young children with autism, however, less often imitate others. They
show less imitation of body and facial movements (waving, making faces,
playing infant games), and less imitation with objects.
4) Does the child respond emotionally to others? Typical
infants are socially responsive to others. They smile when others smile
at them, and they initiate smiles and laughs when playing with toys and
others. When typical infants observe another child crying, they may cry
themselves, or looked concerned. Somewhat older infants may crawl near
the person, pat, or in other ways offer comfort. These latter behaviors
are suggestive of empathy and are commonly observed among children in
the second year of life.
In contrast, children with autism may seem unaware of the emotions of
others. They may not take notice of the social smiles of others, and
thus may not look and smile in response to other's smiles. They also
may ignore the distress of others. Several researchers have now shown
that when an adult feigns pain and distress after hitting herself with
a toy, or banging her knee, young children with autism are less likely
to look at the adult, or show facial concern.
5) Does the baby engage in pretend play? Someone once noted
that "play is the work of children." Young children love to pretend-to
be a mother, father, or baby, to be a firefighter or police officer.
Although children start to play with toys around six months or so, play
does not take on a pretend quality until the end of the first year.
Their first actions may involve pretending to feed themselves, their
mother or a doll, brush the doll's hair, or wipe the doll's nose.
Nearer their second birthday, children engage in truly imaginative play
as dolls may take on human qualities of talking or engaging in
household routines. Children may pretend that a sponge is a piece of
food, a block is a hat, or a plastic bowl is a swimming pool that
contains water.
In contrast, the play of children with autism may be lacking in several
ways. The young child may not be interested in objects at all, paying
more attention to the movement of his hands, or a piece of string. If
interested in toys, only certain ones may catch his interest, and these
may be used in a repetitive way that is not consistent with how most
children would play with the toy. They may be more interested in
turning a toy car upside down and spinning the wheels than pushing the
car back and forth. Overall, pretend qualities are nearly absent in the
play of children with autism under 2 years of age.
It is important to note that in each of the 5 areas we have flagged, we
are most concerned with behaviors that are absent or occur at very low
rates. The absence of certain behaviors may be more difficult to
pinpoint than the presence of atypical behaviors. But concerns in any
of the above areas should prompt a parent to investigate screening
their child for autism. Several screening measures are now available,
and information from the screener will help to determine if the parent
should pursue further evaluations. If the parent is convinced their
child has autism, then they should seek an evaluation with an expert in
autism. Most likely, this evaluation will involve an interview with the
parents to obtain a complete developmental history of the child, and
direct observations of the child in different situations.
Luckily, Timmy and his parents were able to get the diagnosis of autism
before Timmy's third birthday. They began intensive treatment with
Timmy, and he made immediate progress. They are hoping for the best
outcome, and feel confident that his early diagnosis was critical in
getting him the help he needs to reach his potential.
Autism -- Act Early
Center for Autism
http://www.nichd.nih.gov/publications/pubs/autism/factsheets/index.htm
http://www.nichd.nih.gov/publications/pubs/autism/mmr/index.htm