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Language is a human phenomenon, but communication is a feature of all animal groups. Language may make communication easier but it is not the only way we connect with our environment and the people around us. Whether through eye contact, affectionate or aggressive touch, smiles or tears, we rely on more than words to deliver and interpret messages. Even before babies can wrap their tongues around their language they use everything else available to them to tell their parents how they are feeling and what they need. For children with Autism however, communication and social interaction do not come easily, nor are they necessarily desired.
Autism belongs to a group of disorders referred to as Pervasive Developmental
Disorders (PDDs). PDDs are defined in the DSM-IV (Diagnostic and Statistical
Manual of Mental Disorders – Fourth Edition) as being an umbrella for five
disorders with similar features: Autism, Asperger’s syndrome, Rett’s Disorder,
Childhood Disintegrative Disorder and Pervasive Developmental Disorder Not
Otherwise Specified (PDD-NOS). It is useful to group these disorders because
although they comprise slightly different symptoms their similar treatments
acknowledge that they are all the result of poor neurological (brain)
Autism also heads a more common and specific group referred to as Autistic Spectrum Disorders, labelled as such because Autism and similar disorders can vary in degree and type across individuals. This means that although the diagnostic label may be the same, one child may exhibit most of the possible symptoms where another child will only exhibit a few, and one child may experience severe symptoms where another child may experience much milder versions. This is why Autism is often defined as either a low-functioning type (many symptoms or severe effects) or a high-functioning type (few symptoms or mild effects). Autism causes many problems but the most obvious are those of poor communication and impaired social functioning. The third area affected by the condition is that of imaginative play. Though this may not seem as fundamental as the first two areas it is a crucial developmental stage. One of the defining features of Autism is that children seem oblivious to others or uninterested in social contact.
Language is a vital tool for engaging in social interaction and many autistic children have limited speech. Though pronunciation is rarely an issue, the ability to receive and use language effectively can be almost non-existent. Children with Autism sometimes do not respond to familiar stimuli such as hearing their own name. Nonverbal communication is often also poor, with autistic children frequently avoiding eye contact or physical touch. In some cases they will actively resist a parent’s affection, though it is important to mention that many children who have Autism do demonstrate some nonverbal gestures and attempt to engage with their environment.
Autistic children have a tendency to repeat words or phrases constantly though not with the aim of communicating a message. Repetition may also extend to motor movements such as continuous spinning, rocking or hand flapping. Children with Autism often show strict adherence to rituals that serve no functional purpose – some children have to have certain everyday tasks done in the same way every day or choose to eat a particular food in an unusual way. Whatever the ritual, it tends to be exercised without any flexibility or tolerance for change.
Unusual responses to sensory stimulation may also be a feature of Autism and this is mainly observed with regard to the auditory or tactile systems. The child may display extreme reactions to neutral stimuli (such as screaming in response to a gentle touch) or neutral reactions to extreme stimuli (preference for high-pitched sounds). This hypersensitivity or hyposensitivity is a reflection of poor sensory integration – that is, problems with the way sensory information is being transmitted to and interpreted by the brain. This is yet another symptom of developmental delay. Another common resultant is that fine and gross motor skills are often very poor and cognitive ability is lower than normal. The majority of autistic children have significant intellectual impairment but some autistic children are unusually talented in specific areas where language is not required such as mathematics or music.
There seem to be two main ways in which Autism appears in children. Either the condition is present from birth and all facets of the child’s development are delayed, or the child demonstrates normal development for the first 2–3 years before regressing in speech and social interaction. Autism, like all developmental disorders, reflects a problem with the way the brain develops. The number of symptoms and degree of their severity depends on the individual and its causes remain a unknown – while it seems that there is a genetic element there may also be biochemical reasons or issues that occurred before, during or after birth.
Autism and Asperger’s Syndrome are often discussed in the same breath but it is
important to understand their distinction. Occasionally Asperger’s is
as a high-functioning form of Autism but this does not reflect the major
difference between the two disorders. Children with Asperger’s Syndrome do not
experience the same language or cognitive deficits as children with Autism and
for this reason are able to interact more with the people around them and
demonstrate interest or knowledge in particular subjects. While children with
Autism often (but not always) have some form of intellectual disability,
children with Asperger’s Syndrome do not, by definition, have significant
intellectual problems. This means that children with Asperger’s also have a
better chance of living more independently as they grow older.
The reason that communication deficiencies are not noted in children who have Asperger’s Syndrome is because it has a later onset – initial development of language and cognition has generally taken place which allows basic communication to occur. Although children with Asperger’s may use language to communicate more than those with Autism, they still tend to lack much of the social awareness that would make their interactions as effortless and adaptive as those of children with no developmental disorder.
Speech and language develop in synchrony with the growing brain. So do motor skills, balance, coordination and sensory integration. If any part of this process is disturbed, it is highly likely that the resulting problems will not be restricted to only one developmental domain. Children with Autism rarely have hearing problems but do tend to display abnormal listening patterns. Children with Autism can be hypersensitive to certain sounds and can shut themselves off from auditory stimulation either from their own voice or from the outside environment. This may lead to an unwillingness to communicate both verbally and physically.
The Auditory Training Program has been shown to assist some children with Autism and some of the improvements commonly seen are a normalization of listening patterns and a greater tolerance for many sounds – this in turn may lead to an increased desire to communicate where children begin to attend to the sound of their voice and the voice of their parents and family leading to greater experimentation at language and improvements in receptive and expressive language.
The Auditory Training Program is not a cure for Autism but is known to assist in attenuating the severity of symptoms and behaviours. Other positive changes that have been documented include: decreased tactile defensiveness, increased adaptation to change, improved listening response to verbal and non-verbal communication, better eye contact, improved emotional response, improved social skills and a decrease of repetitive behaviour.
Many children with developmental disorders also suffer from neurosensory dysfunction. This is a weakness in the way sensory information from various parts of the body is integrated and transmitted to the brain and is particularly obvious in autistic children in terms of their hypersensitivity or hyposensitivity to touch or sounds. Sensory systems should not be purely thought of as abilities to hear, see, feel, smell or taste in isolation of each other. Our senses are only useful when the connections from the organ to the brain are operating normally. Because the vestibule is where the initial sensory integration takes place, the Auditory Training Program is often combined with a program of Developmental Movement Exercises so that the body is stimulated through both sound and sensory input.
When children are born, they emerge from the womb with primitive reflexes – physical responses that are initiated without conscious thought or intention. These reflexes allow the child to cope with the influx of new sensory information from the post-utero environment, but should soon be overtaken and inhibited by voluntary actions – these are referred to as postural reflexes or postural control. It has been found that problems with neurosensory integration may be attributed to partially uninhibited primitive reflexes. The rationale behind Developmental Movement Exercises is that sensory systems and reflexes are indivisible, and that any existing partially retained primitive reflexes can be actively inhibited by exercising the postural reflexes. Postural reflexes have the effect of maintaining and controlling posture, physical actions and equilibrium.
Developmental Movement Exercises involves a program of movements designed to retrace motor development as it ideally should have been experienced and has been shown to be of considerable benefit to children with Autism. Children often demonstrate a greater desire to be held by their parents and actively seek more tactile interactions.
Speech Therapy is provided in conjunction.
A child’s brain develops and forms neural connections through sensory input. Importantly, the foundations of language are acquired in early life with auditory processing of simple sounds. The skills of encoding sounds and assigning meaning need to be well established for more advanced speech and language skill acquisition to commence. If any part of this maturation process is interrupted or compromised, the establishment of language and communication will be affected. The emphasis on the development of the auditory pathways and language, in combination with Developmental Movement exercises to allow children to revisit their earliest sensory experiences, create an intensive stimulus driven therapy.
Neurofeedback training is another therapy that has been shown to assist children with Autism. The areas of improvements that have been documented are: verbal, physical and social communication. Clinical evidence has shown improvements in speech, verbal and non-verbal responsiveness, understanding and appropriate facial expressions, decreased sensory sensitivities, balance and coordination.
Please refer to the “Programs and Therapies” section.
In order to recommend the most appropriate intervention it is necessary to attend an assessment at the centre.
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