Family Consultation for children with Communication

Family  Consultation for children with Communication Disorders. 

Dr.Theodora Papadopoulou

Special Education Department at NYC

www.nyc.gr

2103225961

Family consultation for children who belong to the autistic spectrum is very essential.

Parents of children with autism often face unique challenges when attempting to understand and address their children's difficulty. Although professionals have used functional assessment to help design interventions that match the communicative intent of challenging behaviour, parents often do not have this skill.

Both parents and the individual himself need counseling in order to cope with all the difficulties that the disorder causes and strengthen themselves enough to be able to provide help and support to people in need. The family struggling with the difficulties of an autistic child needs a team of experienced and dedicated individuals to help them ‘think outside the box’. In other words, family members need a professional to help them escape from grief and pain and eventually manage to understand the way autistic children think. Since it is impossible to make autistic people comprehend the way normally developed people think and express themselves, it is of highly importance to make family members understand the way autistic individuals comprehend the world.

 In addition, a lot of people with an autism spectrum disorder experience problems at some time in their lives. They are more vulnerable to experiencing depression and anxiety than other people, especially in late adolescence and early adult life.

Mothers and fathers of children with autism report significantly more stress than do parents of children without disabilities or parents of children with other disabilities, including chronic illnesses (Hastings, Kovshoff, Ward, Espinosa, Brown, & Remington, 2005; Gray, 2002; Hastings & Beck, 2004).

According to Gray (2002), more than half of the mothers reported persistent career problems, indicating that their child’s autism prevented them from working at all or restricted the number of hours they could be employed. On the positive side, parents reported an overall reduction of stress over time. For example, two-thirds of the parents indicated that their present situation was better than it had been a decade earlier. However, several exceptions to this finding involved the report of ongoing high stress levels among parents whose children were aggressive.

On the side of coping, Singh and colleagues (2006) suggested that stress levels can be reduced by teaching parents how to handle problem behaviours, including aggression. Hastings and Beck (2004) also noted that when interventions result in children’s language acquisition and in the reduction of problem behaviours, parents experience a greater sense of well-being and a reduction in reported stress levels.

Counsellors trained in Cognitive and Behavioural counselling believe that if an individual changes the way that they think about themselves and other people (and about past or future events) then they will be able to function better in daily life.

People with autism spectrum disorders have more of a tendency to think in a way that hinders their ability to cope with everyday situations. These are called cognitive distortions and are also seen in people experiencing anxiety and depression who don't have an autism spectrum disorder.

A Cognitive Behavioural counsellor can guidance the autistic individual to control his/her moods or your behaviour, taking into highly consideration the difficulties that he/she is experiencing. This type of counselling will help him/her start looking at the way his/her thoughts affect his/her emotions and actions.

Other ways of counselling may also help. Some research has shown that a counsellor or psychologist using Personal Construct Theory may be able to assist. Alternatively, some people may prefer to see a Person Centred counsellor. These types of counsellors talk about feelings more than Cognitive Behavioural Counsellors. Therefore, people who talk more about how they feel rather than how they think may find this approach useful.

Whatever approach the counsellor uses, it is worth asking what awareness and experience the counsellor has in working with your particular difficulty, and if they know what an autism spectrum disorder is.

Parents of a child who belongs to the autistic spectrum are exposed to a great amount of stress and frustration. They are often overwhelmed with feelings of guilt, denial and anger. This results from the realisation that they do not have a ‘normal’ child who can interact and communicate with them successfully.

Feelings of shame and disappointment are there to add to the general negative psychological background of the parents. A typical feeling experienced by the parents of a child who belongs to the autistic spectrum is sadness at loss of hopes and dreams for the child. Social isolation is often a result of having an autistic child. Friends and relatives are mostly unwilling to try to understand the needs and behaviour of an autistic child and thus prefer to stop interacting with them and their families. To make matters worst, parents also experience a heavy financial strain since most autistic children are in need of special educators and caretakers to help them in their everyday life. Family members find themselves in a new reality which requires fast adjustment and appropriate action. This is why family consultation is the only way to help parents and siblings of an autistic individual cope with the new situation they have to face.

References

Barbera, M.L. & Rasmussen, T. (2007). The Verbal Behavior Approach: How to teach children with autism and related disorders. London: Jessica Kingsley Publishers.

Dillenburger, K., Keenan, M., Gallager, S., & McElhinney, M. (2002). Autism: Intervention and parent empowerment. Child Care in Practice, 8, 216-219.

Dunlap, G., & Fox, L. (1999). Supporting families with young children with autism. Infants and Young Children, 12(2), 48-54.

Glass, P. (2001). Autism and the family: A qualitative perspective. Dissertation Abstracts International,65 (09), 3287A.

Gray, D. E. (2002). Ten years on: A longitudinal study of families of children with autism. Journal ofIntellectual and Developmental Disabilty, 27(3), 215-222.

Hastings, R. P., Kovshoff, H., Ward, N. J., Espinosa, F., Brown, T., & Remington, B. (2005). Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism. Journal of Autism and Developmental Disorders, 35(5), 635-644.

Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behaviour interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disabilities, 32(5), 423-446.

Howlin, P. (1997). Autism: Preparing for Adulthood. London: Routledge (ISBN: 0 415115 32 9)

Hutton, A. M., & Caron, S. L. (2005). Experiences of families with children with autism in rural New England. Focus on Autism and Other Developmental Disabilities, 20(3), 180-189.

Lawson, W. (1998). Life behind glass. London: Jessica Kingsley Publishers (ISBN: 1 85302 9114)

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Maurice, C. (1993). Let me hear your voice: A family’s triumph over autism. New York: Knopf.

Maurice, C., Green, G. & Luce, S.C. (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed.

Shook, G. L., Johnston, J. M., & Mellichamp, F. (2004). Determining essential content for applied behavior analyst practitioners. The Behavior Analyst, 27, 67-94.

‘The cognitive profile of autism’, Dr Theodora Papadopoulou

 ‘The cognitive profile of autism’

Dr. Theodora Papadopoulou

Special Education Department at New York College

                          www.nyc.gr, 2103225961

Asperger syndrome (AS) and autistic disorder are two subtypes of pervasive developmental disorders (PDD), but there has been considerable debate over whether AS and autistic disorder without mental retardation (IQ ≥ 70), called high-functioning autism (HFA), are distinct conditions or not. There is an argument among scientists  whether there is an unusual degree of unevenness in the cognitive abilities of children with autism spectrum disorder (ASD) and whether different cognitive profiles among children with ASD might index etiologically significant subgroups.

The argument focuses on whether there is any relevance of IQ to the etiology and symptomatic expression of autism. According to scientific results approximately three-quarters of individuals with autism have below-average IQ (< 70). On the other hand though, autism can occur with equal severity in individuals of average and above-average IQ. There has also been a longstanding interest in the uneven intellectual abilities of individuals with autism (Bailey, Phillips, & Rutter, 1996).

Autism was first described by Leo Kanner almost 60 years ago. He described a severe form of autism, typified by the silent and aloof child. Hans Asperger about 15 years ago described children with another form of autism. The children he described could produce speech and were active participants in social interactions. In 1994 the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provided diagnostic criteria for Asperger's syndrome. According to DSM IV in 2000, Asperger's syndrome could be differentiated from autism by an examination of the child's early development and the existence of some characteristics that were rare in children with autism. It is considered that early language and cognitive skills are not delayed significantly in children with Asperger's syndrome. There is also no clinically significant delay in age-appropriate self- help skills, adaptive behaviour and curiosity about the environment in childhood.

There is general agreement that children with Asperger's syndrome may not show any conspicuous cognitive delay in early childhood. It is true that some individuals with Asperger syndrome can be quite talented in terms of learning to read, numerical abilities and in some aspects of their constructive play and memory. Individuals with autism, on the other hand, can be recognised as having developmental delay in their cognitive abilities from infancy. They are diagnosed at the age of 18 months. Children with Asperger's syndrome are often not diagnosed until after they start school with a mean age of diagnosis of eleven years (Howlin and Asgharian 1999). It should be noted that the signs of Asperger's syndrome in very young children may be more subtle and not easily discernible at home and school.

Many researches have been conducted which included comparison of the cognitive profile of adolescents with autism and Asperger's syndrome. The studies have examined the cognitive profile of what is referred to as 'High Functioning Autism', that is children with a diagnosis of autism with an Intelligence Quotient in the normal range, i.e. above 70. The cognitive abilities of this group of children were then compared to the cognitive profile of children with Asperger's syndrome, who did not have a history of early cognitive or language delay. The results of the research has not established a distinct and consistent profile for each group. Ehlers, Nyden, Gillberg, Dahlgren Sanberg, Dahlgren, Hjelmquist and Oden (1997) found that only a minority of each diagnostic group showed a characteristic profile.

Wing and Gould (1978) firstly identified a Triad of Impairments in people who belong to the autistic spectrum. This triad of impairments includes

• Impairment of social relationships
• Impairment of social communication, and
• Impairment of imagination

Autism arises as a consequence of the interaction of these three impairments. Thus, all three must be evident to diagnose Autism. The degree to which an individual is affected by each of the three impairments can vary significantly from person to person.

As stated above, autistic children have deficits in social cognition (theory of mind), executive functions, and central coherence. Each of these concepts should be considered in relation to the joint attention deficits that are obvious in autism.

To be more specific, joint attention is a family of social abilities ("social pragmatic abilities") that help individuals regulate, respond to, and engage in social interactions with others. These types of joint attention events are termed triadic social interactions.

There are many ways to view the repertoire of social pragmatic behaviours in the early developmental period of an individual.

It should be stated that children with autism show deficits

in the frequency and complexity of joint attention behaviours, as well as differences in the qualitative patterns of strengths and weaknesses in joint attention as related to other social pragmatic behaviours. Autism is characterized by generally poor social and communication skills. Children with autism show severe deficits in the frequency with

which they initiate joint attention bids (I}A) as well in their ability to

monitor and respond to joint attention bids of others (RJA).

Children with autism may also show deficits in the complexity of

requests. That means failure to use pointing or poor coordination of eye contact, vocalizations, and other communicative means when making requests.

SOCIAL COGNITIVE DEFICITS IN AUTISM

The ‘Theory of Mind’ is the ability of an individual to reason about the intentions and beliefs of others.

According to a research conducted by Baron-Cohen and colleagues, individuals with autism were unable to reason about the false beliefs of protagonists in a series of vignettes. This deficit has been widely replicated in following research. One influential theory argues that TOM abilities are rooted in a discrete information-processing ability hat allows children to represent the thoughts of others.

EXECUTIVE FUNCTION DEFICITS.

Executive functions (EF) are a broad class of cognitive abilities involved in the regulation of thought and action.

This class of higher cognitive abilities supports such functions as strategic planning, impulse control, working memory, organization of mean-end behaviours, and flexibility in thought and action. The frontal lobes are heavily involved in these processes.

Deficits in EF are well replicated in children with autistic disorder.

However, research indicates that autism is related to a specific pattern

of deficits in executive skills; i.e., deficits in planning efficiency and

preservative responses that indicate difficulties in shifting response set. These patterns have been found to differentiate the executive performance of autistic individuals from those with ADHD and other neuro-developmental disorders. Children with ADHD are most likely to show deficits in response inhibition, whereas autistic individuals tend not to show evidence of such dysfunction on EF batteries.

CENTRAL COHERENCE

Frith  proposed the concept of central coherence in an attempt to explain the cognitive style of individuals with autism. Central

coherence  is described as the  tendency to integrate

information to form a whole, coherent meaning, reflects a cognitive style that allows an individual to "see the forest for the trees."

This theory aimed to explain why individuals with autism perform

better on certain cognitive tasks; e.g., the embedded figures task, where an individual is required to identify a figure (e.g., a triangle) embedded in a meaningful picture.

  

Indicative References

 Attwood T. (2002). Frameworks for behavioural interventions. Child and Adolescent Psychiatric Clinics of North America. 12 (in press).

Dickerson Mayes, S. and Calhoun, S.L. (2001). Non-significance of early speech delay in children with autism and normal intelligence and implications for DSM-IV Asperger's Disorder. Autism (5), pp.81-94.

Ehler, S., Nyden A., Gillberg C. Dahlgren Sandberg A., Dahlgren S.O., Hjelmquist, E., and Oden A. (1997). Asperger syndrome, autism and attention disorders: A comparative study of the cognitive profiles of 120 children. Journal of Child Psychology and Psychiatry (38). pp. 207-217.

  

Howlin P. and Asgharian A. (1999). The diagnosis of autism and Asperger syndrome: findings from a survey of 770 families. Developmental Medicine and Child Neurology (41), pp.834-839.

  

Manjiviona, J. and Prior M. (1999). Neuropsychological profiles of children with Asperger syndrome and autism. Autism (3), pp.327-356.

  

Ozonoff S., South M., and Miller J.N. (2000). DSM-IV defined Asperger syndrome: Cognitive, behavioural and early history differentiation from High Functioning Autism. Autism (4), pp.29-46.