Early Intervention for Young Children with Autism Spectrum Disorders

Autism spectrum disorders are becoming more and more prevalent as the years pass. Children with autism show impairments in socialization, communication, and restricted patterns of behavior (R. Koegal & L. Koegel, 2006). Children with autism begin showing symptoms at ages early as 6 to 9 months. Parents don't often express concern until about 18 months and children aren't diagnosed usually until 3 years old. Due to the fact that autism is very different from individual to individual, it can be hard to diagnose and assess (R. Koegal & L. Koegel, 2006). Being diagnosed as early as possible will allow for early intervention which will provide for the best outcomes in the child's recovery. Breakthrough research on prevalence rates, early symptoms, and type/outcomes of early intervention will be explored.

There are many different theories as to why children develop autism. Many people have blamed the mercury in vaccines or attribute the development of autism to a "cold" mother (R. Koegal & L. Koegel, 2006). The truth is no scientific evidence has ever been discovered to support either of these theories or any others for that matter. What is certain is the fact that autism in children is on the rise with as many as 1 in every 150 births being a child with autism. The prevalence for autism in younger birth cohorts cannot be explained by an across the board increase in mental retardation as other forms of mental disability are not increasing (Newschaffer, Falb, & Gurney, 2005) . Due to autism becoming a category for diagnosis in 1992, another explanation for these findings is through diagnostic shifting which is children in other categories of mental retardation being reclassified as having autism (Newschaffer et. al, 2005) . Research has shown no decrease in any other category of mental retardation so this explanation can be ruled out. The only safe conclusion from this research is that autism in children is becoming more prevalent (Newschaffer et, al, 2005) . The increase in autism calls for an increase in attentiveness to early symptoms and signs so intervention can start as soon as possible.

During the development of a child with autism visible signs occur as early as 6 to 9 months. At very young ages, parents are best at recognizing impairments in their children and should be an advocate for their child's health (Lord & Risi, 2000). Pediatricians and other adults in the child's life may write off early symptoms as simply being specific to that child's personality. Diagnosing a child with autism is most accurate at age 2. At age 2, children will often exhibit symptoms such as not bringing objects to parent's in order to attain joint attention, lack of response to name, not understanding words out of context, a lack of pretend play, and not responding to neutral statements without prompting (Lord & Risi, 2000). At age 2, social criteria is most effective at diagnosing autism (Lord & Risi, 2000). At age 3, children with autism exhibit more social deficits, not using words meaningfully, and repetitive behaviors such as self stimulation (Lord & Risi, 2000). Overall, social reciprocity and ability to communicate based on standardized observations were the best indicators of autism (Lord & Risi, 2000). A neurological sign is also present in children with autism at birth and early on in life. Children with autism have reduced brain sizes at birth, a dramatic increase in brain size during their first year of life, and then a plateauing effect that allows the majority to have the same brain size as any other adult in the normal range (Redcay & Courchesne, 2006). Following the slightly reduced brain size at birth, a postnatal brain overgrowth may be due to increased myelin. An increase in myelination could explain an in increase in white matter volumes and heavier brains in children with autism (Redcay & Courchesne, 2006). Recognizing early neurological signs of autism as well as visible behavioral signs are important in diagnosing and beginning behavioral intervention as soon as possible.

As soon as the child has been diagnosed intervention can begin. One type of intervention is called Pivotal Response Treatment (PRT) (R. Koegal & L. Koegel, 2006) . PRT is an intervention method that focuses on removing learned helplessness and allowing the child to see the connection between their behaviors and the consequences for them. The PRT model is as follows: antecedent- provide an opportunity for child to respond, behavior- the child responds, consequence- provide a reinforcer contingent upon the child's response (R. Koegal & L. Koegel, 2006) . Another major aspect of PRT is parent support, intervention, and education. One study found educating parents about PRT methods to be effective on a large scale, community wide with families of different ethnicities (Baker-Ericsen, Stahmer, & Burns, 2007). The same study also found that young children had the least impairment at intake and showed the greatest improvement post-intervention; older children showed the most impairment at intake and the least improvement post-intervention (Baker-Ericsen et. al, 2007). This study is evidence that early intervention is very important and that PRT can work for many different types of families. PRT specifically focuses on the pivotal areas of motivation, multiple cues, initiations, self-management, and empathy. Pivotal areas are areas that are focused on specifically so there will collateral changes in broader areas of behavior (Koegal, 1999). One especially important pivotal area that can be focused on as soon as intervention begins is self-initiations. It is found often times that children with autism only use verbal words when requesting an action or something and protesting. Previous methods of intervention before PRT focused on adult initiation and did not provide for joint attention/child initiation. In a study by R. Koegal, L. Koegal, Shoshan, and McNerney (1999) it was found that children who exhibited more self initiations before intervention were associated with better outcomes post intervention. The second part of the study focused on whether or not children could learn a variety of self initiations during intervention. Results indicated that children could learn many self-initiations during intervention and that it would lead to better intervention outcomes (Koegal et. al, 1999). If autism is diagnosed at an early age and PRT is started right away then the child will most likely have favorable intervention outcomes.

Through exploring prevalence rates, early symptoms, and type/outcomes of early intervention many conclusions can be drawn. First, that autism in children is on the rise and it cannot be explained by an overall increase in mental disability (Newschaffer et. al, 2005). Second, that the many symptoms of autism at an early age should be payed attention to and explored. Lastly, early intervention is of the utmost importance. One of the best intervention techniques out there is PRT and it can work for a variety of different people. It should be noted that self-initiations are especially important during PRT intervention (Koegal et. al, 1999). A future direction for this area of autism research could seek to examine what other symptoms show up earliest in the child's life and what can be done to decrease the time of diagnose to as early as a few months.

References

- Baker-Ericzen, M. J., Stahmer, A.C., & Burns, A. (2007). Child demographics associated with outcomes in a community-based pivotal response training program. Journal of Positive Behavior Interventions. 9 , 52-60.
- Koegal, L. K., Koegal, R.L., Shoshan, Y., McNerney, E. (1999). Pivotal response intervention II: Long-term outcome data. The Association for Persons with Severe Handicaps. 24(3), 186-198.
- Koegal , R., & Koegal, L. (2006). Pivotal response Treatments for autism: Communication, social, and academic development. Baltimore, Maryland: Paul H. Brooks Publishing Co.
- Lord C, Risi S. Diagnosis of autism spectrum disorders in young children. In: Wetherby A, Prizant B, eds. Autism spectrum disorders: a transactional developmental approach. Baltimore, Md: Paul H. Brooks Publishing Co; 2000:11-30.
- Newschaffer, C.J., Falb, M.D., Gurney, J.G. (2005). National autism prevalence trends from united states special education data. Pediatrics. 115, 277-282.
-Redcay, E., Courchesne, E. (2005). When is the brain enlarged in autism? A meta-analysis of all brain size reports. Society of Biological Psychiatry. (3), 1-9.