Why Is It Difficult to Identify Children Who Are at the Mild End of the Autistic Spectrum - Essay Example

Running Head: WHY IS IT DIFFICULT TO IDENTIFY CHILDREN WHO ARE AT THE Why is it difficult to identify children who are at the mild end of the autistic spectrum [Writer's Name] [Institution's Name] Why is it difficult to identify children who are at the mild end of the autistic spectrum Introduction This paper shall discuss why is it difficult to identify children who are at the mild end of the autistic spectrum. Autism literally means living in terms of the self. To an observer, a child in a state of autism appears to be self-centered since he shows little response to the outside world. However, paradoxically, the child in such a state has little awareness of being a 'self'. In 1960, autism was reported in 4 to 5 cases per 10,000 children. The prevalence of cases rose to 5 to 31 cases per 10,000 children in 1990 (Iovannone, Dunlap, Huber, & Kincaid, 2003). Discussion Autism is usually detected in children, and it has some very unique characteristics which identify an autistic child. Difficulties in areas of communication are the core of autism. Autism is a developmental disorder affecting social interaction, verbal and non-verbal communication skills. (Norbury& Bishop 2002) Autistic children typically do not follow the usual patterns of childhood development and while most cases can be detected before the age of three, not all cases are diagnosed so early. Typically, parents first notice that their child does not interact, babble, talk or respond like other children, sometimes suspecting hearing problems before autism is diagnosed. (Couteur et al. 2005) Detection of children who are at the mild end of the autistic spectrum is at times a very difficult task. Most autistic children do not make eye contact and have poor attention duration. They are often unable to use gestures, either as a primary of communication, as in sign language, or to accompany verbal communication such as pointing to the object that they want. (Letts & Leinonen, 2001) Some autistic children speak in a high-pitched voice or use robot-like speech. They are often unresponsive to the speech of others and may not respond to their own names. For many, speech and language develop, to some degree, but not to a normal ability level. The development is usually uneven. (Frith 1991) This is a normal condition. There is little awareness of the outside world as such, which is experienced in the mode of the infant's bodily organs, processes and zones. A normal infant emerges from this state because of an innate disposition to recognize patterns, similarities, repetitions and continuities. (Smith et al. 1998) Detection of children who are at the mild end of the autistic spectrum is difficult, as the raw materials for such mental processes as recognition, classification, object creation and empathy. Through these processes, the child builds an inner representation of commonly agreed reality and becomes self-conscious. The study of children who have failed to emerge satisfactorily from the state of normal primary autism brings home to us the complexity and delicacy of the time-consuming process of becoming aware of the world and its objects, persons and other minds. (Gerlach 1996) When things have gone grossly wrong with these early cognitive processes we say that the child is psychotic. The degree to which he is out of touch with reality distinguishes the psychotic from the neurotic child. However, it is important to make the point that the normal healthy infant who starts life by being out of touch with reality is not psychotic. But he is autistic. (Hollander et al. 2001) Autism is a "spectrum disorder," meaning that it manifests itself differently in each child. However, Detection of children who are at the mild end of the autistic spectrum is not an easy task. Like a row of dominoes, if an early aspect of development is affected in a particular case of autism, other later-emerging aspects of development will be affected too. As a result, each case of autism presents a slightly different profile of learning abilities and learning disabilities. (Newport, 2002) Each learning ability and each learning disability may influence how a particular child with autism may or may not learn something the way other children without autism may learn that same thing. These autism-specific learning barriers are referred here as autistic learning disabilities. The autism-specific learning strengths are referred to as autistic learning styles. (Gernsbacher et al. 2005) Related to differential diagnosis, the cognitive profiles of children with autism spectrum disorders (ASD) have been a subject of considerable interest to practitioners and researchers. Both groups have recognized the diagnostic import of identifying unique and distinguishing ASD characteristics. Thus, several researchers have attempted to determine whether the profiles obtained from the Wechsler scales (Wechsler, 2001) could discriminate among Asperger syndrome, autism, and other conditions such as attention disorders, head injury, schizophrenia, and dyslexia (Asarnow, Tanguay, Bott, & Freeman, 2000; Dennis, Lockyer, Lazenby, Donnelly, Wilkinson, & Schoonheyt, 1999; Ehlers et al., 1997; Rumsey & Hamburger, 2003). Lincoln, Courchesne, Kilman, Elmasian, and Allen (2000) found a consistent, uneven pattern in the cognitive profiles of children with high-functioning autism, including a significantly higher Performance IQ when compared to Verbal IQ scores. Children with high-functioning autism obtained their highest scores on Block Design and Object Assembly and their lowest scores on Comprehension and Vocabulary. Lincoln et al. (2000) inferred that the pattern of subtest scale scores they identified was reliable and robust enough to assist in correctly making a diagnosis in children, adolescents, and adults without mental retardation who are suspected of having autism. However, they advised professionals not to exclusively use the pattern of Wechsler subtest scale scores as diagnostic criteria for autism. Ehlers et al. (1997) also interpreted the results of their research to preclude using only a Wechsler profile to make a diagnosis of Asperger syndrome. More than 20 studies to date have reported an unusually uneven Wechsler subtest scale profile among children with ASD of varying ages and ability levels. Various studies have revealed a relatively consistent pattern: strong performance on the Block Design subtest of the Performance scale, and relatively weak performance on the Comprehension subtest of the Verbal scale. The Block Design subtest of the Performance scale is considered a nonverbal concept formation task that requires perceptual organization, spatial visualization, and abstract conceptualization (Sattler, 1999). It is believed to be the best measure of g, Spearman's (2001) general mental energy factor. The Comprehension subtest is designed to assess an children's understanding of social mores and interpersonal situations. Success on this task implies that the children has good social judgment, common sense, and a grasp of social conventionality (Sattler, 1999). Only 4 of the 22 studies specifically included children diagnosed with Asperger syndrome (Bowler, 1992; Dennis et al., 1999; Ehlers et al., 1997; Szatmari, Tuff, Finlayson, & Bartolucci, 2000), and the results of these studies revealed inconsistent psychometric assessment findings. Dennis et al. (1999) and Szatmari et al. (2000) found no obvious differences in IQ subtest scaled scores between children with high-functioning autism and children with Asperger syndrome. However, a statistical comparison could not be made in Dennis et al.'s (1999) study because the number of children was too small (Asperger, n = 4; high-functioning autism, n = 4). Ehlers et al.'s (1997) study reported that children with Asperger syndrome demonstrated good verbal ability and weaknesses on Object Assembly and Coding. The lowest scoring verbal subtest for the children with Asperger syndrome and autism was Arithmetic, not Comprehension, as was characteristic of almost all of the other 21 studies. As an explanation for these findings, Ehlers et al. (1997) indicated that many of Wolff and Barlow's (2000) "schizoid" children fit the Asperger syndrome phenotype and demonstrated the peaks and troughs seen in children with autism. On the other hand, Pomeroy and Friedman (2000) found that children with Asperger syndrome demonstrated weaknesses mainly in visuospatial ability (cited in Ehlers et al., 1997). Klin, Volkmar, Sparrow, Cicchetti, and Rourke (2003) suggested that children with Asperger syndrome demonstrated a cluster of neuropsychological assets and deficits seen in cognitive profiles of children with nonverbal learning disabilities. However, Bowler (1992) and Szatmari et al. (2000) did not find a significant difference between Verbal IQ and Performance IQ in children with Asperger syndrome. On the other hand, Ozonoff, Rogers, and Pennington (2000) reported that the large discrepancy found between the Verbal IQ and Performance IQ--in favor of the Verbal IQ--in 10 children diagnosed with Asperger syndrome was not found in the 13 children with high-functioning autism in their study. Children subtest scores were not reported in their research. Several theories have been proposed to explain the uneven cognitive performance among children with autism spectrum disorders and to serve as possible guideposts for assisting diagnosticians to discriminate among children with Asperger syndrome and those with high-functioning autism. Theory of mind deficits (Baron-Cohen, 1985), weak central coherence (Happe, 1994), and executive dysfunction (Ozonoff, Pennington, & Rogers, 1991) theories have received mixed results. Most research has found evidence of problems in all three of these areas among children with autism and evidence of executive dysfunction in children with Asperger syndrome (Ehlers et al., 1997). Ehlers et al. (1997) concluded that Asperger syndrome appears to share some neuropsychological dysfunction commonalities with autism, as well as deficits in attention, motor control, and perception. Conclusion Although it is difficult to identify children who are at the mild end of the autistic spectrum, however, it is not impossible. Every child is educationally and biologically unique and will need something slightly different. The challenge is to understand the range of differences that make up what are called the autistic spectrum disorders and then to understand the children differences that can be described in terms of slightly different profiles of strengths and weaknesses. The design of truly children treatment plans that exploit strengths and compensate for weaknesses begins with a detailed understanding of how learning is different for children with autism than for those without autism and how learning is different among different children with autism. References Asarnow, R. F., Tanguay, P. E., Bott, L., & Freeman, B. J. (2000). Patterns of intellectual functioning in non-retarded autistic and schizophrenic children. 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