The Importance of Autism Aducation

Early and intensive autism education can help children grow and learn new skills. The goal of this education is to help with the difficult symptoms of autism in a child and to improve the child’s skills that help him or her talk, interact, play, learn, and care for his or her needs.

Where to Find Education for those with Autism

For every child eligible for special programs, each state guarantees special education and related services. The Individuals with Disabilities Education Act (IDEA) is a federally mandated program that assures a free and appropriate public education for children with diagnosed learning deficits. Usually, children are placed in public schools, and the school district pays for all necessary services. These will include, as needed, services provided by the following:

• Speech therapists
• Occupational therapists
• School psychologists
• Social workers
• School nurses
• Aides.

By law, the public schools must prepare and carry out a set of instruction goals or specific skills for every child in a special education program. The list of skills is known as the child’s Individualized Education Program (IEP). The IEP is an agreement between the school and the family on the child’s goals. When your child’s IEP is developed, you will be asked to attend the meeting. Several people will be at this meeting, including a special education teacher, a representative of the public schools who is knowledgeable about the program, other individuals invited by the school or by you (you may want to bring a relative, a child care provider, or a supportive close friend who knows your child well). Parents play an important part in creating the program, as they know their child best. Once your child’s IEP is developed, a meeting is scheduled once a year to review your child’s progress and to make any alterations to reflect his or her changing needs.

If your child is under three years of age, he or she should be eligible for an early intervention program; this program is available in every state. Each state decides which agency will be the lead in the early intervention program. These services are provided by workers qualified to care for toddlers with disabilities and are usually in the child’s home or a place familiar to the child. The services provided are written into an Individualized Family Service Plan (IFSP) that is reviewed at least once every six months. The plan will describe services that will be provided to the child, but will also describe services for parents to help them in daily activities with their child and for siblings to help them adjust to having a brother or sister with an autism spectrum disorder.

Misinformation about autism is very common. Claims of a cure for autism are constantly presented to families of autistic individuals. There are various treatment models found within both the educational and clinical settings. Yet, there is only one treatment approach that has prevailed over time and is effective for all persons, autistic or not. That treatment model is an educational program that is suitable to a student’s developmental level of performance. For adults, that treatment model refers to a vocational program that is suitable to the individual’s developmental level of functioning.

Under the Individuals with Disabilities Educational Act (IDEA) Act of 1990, students with a handicap are guaranteed an “appropriate education” in the Least Restrictive Environment (LRE), which is generally considered to be as normal an educational setting as possible. As a result of this legislation, autistic children have generally been placed in a mainstreamed classroom and pulled out for whatever supplementary services were needed. Depending on the child’s needs, he or she could be placed up to 100% of the school day in a mainstreamed or a special education setting or any combination of the two.

There is an increasing trend, however, among the advocates for autistic children, to segregate these children into small, highly structured and controlled academic settings that are almost free from auditory and visual stimulation. All instruction is broken down into manageable segments. Information is presented in tiny units and the child’s response is immediately sought. A classic stimulus-response approach is used to maximize learning. Each unit of information is mastered before another is presented. A fundamental behavior such as putting hands on the tabletop, for example, must be mastered before the child is required to perform any other tasks, or before more information is presented. The long-term effects of this type of treatment as well as the ability of the child to transfer this to a broader context continue to be evaluated.

Autistic individuals must be taught how to communicate and interact with others. This is not a simple task, and it involves the entire family as well as other professionals. Parents of an autistic child or adult must continually educate themselves about new treatments and keep an open mind. Some treatments may be appropriate for some individuals but not for others. Many treatments have yet to be scientifically proven. Treatment decisions should always be made individually after a thorough assessment and based on what is suitable for that child and his or her family.

It is important to remember, despite some recent denials, that autism is virtually a lifelong condition. Treatment will change as the individual develops. Families must beware of treatment programs that give false hope of a cure. Acceptance of the condition in a family member is a very critical, foundational component of any treatment program and is understandably quite difficult.

Several medications have been tried or are under current scrutiny for the treatment of autism. No medication has consistently proven to be of benefit in closely controlled clinical trials. In the past, a piece on a television news show prompted a great deal of interest in the hormone secretin as a treatment for autism. An autistic child with chronic gastrointestinal complaints showed dramatic improvement following some routine testing performed by a gastroenterologist during which a small dose of secretin was administered. The family and their physicians felt that the secretin may have resulted in the improvement in the symptoms of autism. Many physicians began prescribing secretin, which can be costly for their autistic patients. However, studies published appear to completely refute the claim that secretin treatment benefits autistic patients. This example underscores the importance of good clinical trials in determining whether a drug will help patients with autism.

Autism At A Glance

• Autism is characterized by impaired development in social interaction, communication, and behavior.
• The degree of autism varies from mild to severe.
• Severely afflicted patients can appear to have a profound intellectual disability.
• The cause of autism is unknown.
• The optimal treatment of autism involves an educational or vocational program that is suited to the developmental level of the child or adult, respectively.

Since autism was first added to the psychiatric literature fifty years ago, there have been numerous studies and theories about its cause. Researchers still have not reached agreement regarding its specific causes. First, it must be recognized that autism is a set of a wide variety of symptoms and may have many causes. This concept is not unusual in medicine. For instance, the set of symptoms that we perceive of as a “cold” can be caused by literally hundreds of different viruses, bacteria, and even our own immune system. Autism is, undoubtedly, a biologically-based disorder. In the past, some researchers had suggested that autism was the result of poor attachment skills on the part of the mother. This belief has caused a great deal of unnecessary pain and guilt on the part of the parents of autistic children, when in fact, the inability of the individual with autism to interact appropriately is one of the key symptoms of this developmental disorder.

In support of a biological theory of autism, several known neurological disorders are associated with autistic features. Autism is one of the symptoms of these disorders. These conditions include tuberous sclerosis (an inherited disorder), the fragile X syndrome, cerebral dysgenesis (abnormal development of the brain), Rett syndrome, and some of the inborn errors of metabolism (biochemical defects). Autism, in short, seems to be the end result or “final common pathway” of numerous disorders that affect brain development. In general, however, when clinicians make the diagnosis of autism, they are excluding the known causes of autistic behaviors. However, as the knowledge of conditions that cause autism advances, fewer and fewer cases will be thought of as being “pure” autism and more individuals will be identified as having autism due to specific causes.

There is a strong association between autism and seizures. This association works in two ways: First, many patients (20% to 30%) with autism develop seizures. Second, patients with seizures, which are probably due to other causes, may develop autistic-like behaviors. One special and often misunderstood association between autism and seizures is the Landau-Kleffner Syndrome. This syndrome is also known as acquired epileptic aphasia. Some children with epilepsy develop a sudden loss of language skills–especially receptive language (the ability to understand). Many often also develop the symptoms of autism.

These children often, but not always, have a characteristic pattern of electrical brain activity seen on EEG (electroencephalogram) during deep sleep called electrographic status epilepticus during sleep (ESES). The usual age of onset of language loss or regression is around four years of age, which makes the Landau-Kleffner syndrome distinguishable from autism on these grounds, in that autism usually is first exhibited in younger children. However, in recent years, some children (very, very few) who did not exhibit overt (observable) seizures were found to have Landau-Kleffner syndrome.

The importance of these findings is that, although rare, the Landau-Kleffner syndrome can resolve spontaneously and in some cases can be treatable with prednisone, a steroid medication related to cortisone. This association between the Landau-Kleffner syndrome and autism has led many clinicians and families to search for the typical EEG pattern (ESES) in autistic individuals. This unusual EEG pattern is seen only in deep sleep, which usually requires prolonged recordings of up to 12 hours. Many, many autistic children and adults will display some abnormalities on their sleep EEG, but probably very few have true Landau-Kleffner syndrome that will respond to treatment.

It must also be noted that prednisone, in the very high doses used to treat Landau-Kleffner syndrome, almost invariably produces side effects, which may include weight gain, high blood pressure, diabetes, growth failure, stomach ulcers, irritability, destruction of the hip joint, and susceptibility to infectious disease (suppressed immune system). While most of these side effects are reversible, some of the complications of high dose prednisone therapy can be irreversible and even fatal.

Other treatments ranging from common anticonvulsant therapy to surgery have been proposed and are being tried for Landau-Kleffner syndrome. It is difficult to evaluate the true effects of any treatment for Landau-Kleffner syndrome due to the high rate of spontaneous resolution of symptoms (remission).

Hours after a baby is born, her parents are told it’s best that she receive her first shot before she leaves the hospital. And that’s just the beginning. By the child’s sixth birthday, she’ll have had at least 35 vaccinations—if she goes by government recommendations. Meanwhile, during those six years, her parents are likely to see hundreds of media reports and online message-board debates about which vaccines are necessary or even safe. It’s confusing, to say the least.

To sort through the onslaught of information and misinformation about childhood immunizations, we asked Austin, Texas-based pediatrician Ari Brown, coauthor of “Baby 411: Clear Answers and Smart Advice for your Baby’s First Year,” to debunk some of the most common vaccination myths.

Myth 1: It’s not necessary to vaccinate kids against diseases that have been largely eradicated in the United States.
Reality: Although some diseases like polio and diphtheria aren’t often seen in America (in large part because of the success of the vaccination efforts), they can be quite common in other parts of the world. The Centers for Disease Control and Prevention warns that travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations, these diseases could quickly spread throughout the population. At the same time, the relatively few cases currently in the U.S. could very quickly become tens or hundreds of thousands of cases without the protection we get from vaccines. Brown warns that these diseases haven’t disappeared, “they are merely smoldering under the surface.”

Most parents do follow government recommendations: U.S. national immunization rates are high, ranging from 85 percent to 93 percent, depending on the vaccine, according to the CDC. But according to a 2006 study in the Journal of the American Medical Association, the 20 states that allow personal-belief opt outs in addition to religious exemptions saw exemptions grow by 61 percent, to 2.54 percent between 1991 and 2004.

Brown is concerned that parents who opt out or stagger the vaccine schedule can end up having to deal with confusing follow-up care, which could produce an increase in disease outbreaks like last summer’s measles epidemic. A 2008 study in the American Journal of Epidemiology reported that when there are more exemptions, children are at an increased risk of contracting and transmitting vaccine-preventable diseases.

Myth 2: Mercury is still in kids’ vaccines.
Reality: At the center of this issue is a preservative called thimerosal compound containing mercury) that once was a common component in many vaccines because it allowed manufacturers to make drugs more cheaply and in multidose formulations. But public concern, new innovations and FDA recommendations led to its removal from almost all children’s vaccines manufactured after 2001. Since flu vaccines are not just for children, manufacturers still put thimerosal in some flu-shot formulations. You can ask your pediatrician for the thimerosal-free version, says Brown.

If your child does not have asthma and is at least 2 years old, Brown recommends the FluMist nasal-spray vaccination over the flu shot. “It seems to have better immune protection and it could help your child avoid another shot,” she says. (Caveat: the spray does contain a live version of the virus, which can result in a slight increase in flulike symptoms).

Myth 3: Childhood vaccines cause autism.
Reality: There is no scientific evidence that this link exists. Groups of experts, including the American Academy of Pediatrics and the Institute of Medicine (IOM), agree that vaccines are not responsible for the growing number of children now recognized to have autism.

Earlier this month, the law supported scientists’ conclusions in this arena with three rulings from a section of the U.S. Court of Federal Claims, which stated that vaccines were not the likely cause of autism in three unrelated children. The U.S. Department of Health and Human Services said in an online statement following the ruling, “The medical and scientific communities have carefully and thoroughly reviewed the evidence concerning the vaccine-autism theory and have found no association between vaccines and autism.” Noting the volume of scientific evidence disproving this link, an executive member of one of the nation’s foremost autism advocacy groups, Autism Speaks, recently stepped down from her position because she disagrees with the group’s continued position that there is a connection between the vaccines and autism.

Myth 4: Getting too many vaccines can overwhelm the immune system and cause adverse reactions or even serious illness.
Reality: Children’s immune systems are capable of combating far more antigens (weak or killed viruses) than they encounter via immunizations. In fact, the jury is still out on if there’s an actual limit on how many the body can handle—though one study puts the number around a theoretical 10,000 vaccines in one day.(Visit the American Academy of Pediatrics’ site or the Network for Immunization Information for more information)

Currently, “There is even less of a burden on the immune system [via vaccines] today than 40 years ago,” says Edgar Marcuse, a professor of pediatrics at the University of Washington who works on immunization policy and vaccines. He points to the whooping-cough vaccine as an example where there are far fewer antigens in the shot than the earlier version administered decades ago. Brown says she supports following the recommended schedule for vaccinations, which outlines getting as many as five shots in one day at a couple check-ups.

The CDC reports that most vaccine adverse events are minor and temporary, such as a sore arm or mild fever and “so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.” Of all deaths reported to the Health and Human Services’ Vaccine Adverse Events Reporting site between 1990 and 1992, only one is believed to be even possibly associated with a vaccine. The Vaccine Safety Datalink Project, an initiative of the CDC and eight health-care organizations, looks for patterns in these reports and determines if a vaccine is causing a side effect or if symptoms are largely coincidental.

If you have concerns about following the recommended vaccination, schedules don’t wait until a check-up. Set up a consultation appointment with your pediatrician, or even outline a strategy for care with your doctor during your pregnancy.

Myth 5: It’s better to let my kid get chickenpox “naturally.”
Reality: Before the chickenpox vaccine was licensed in 1995, parents sometimes brought their child to a party or playground hoping that their child might brush up against a pox-laden kid to get their dose of chickenpox over since cases were usually less severe for children than adults. But pediatricians say severe complications are possible with chickenpox—including bacterial infections that could result in a child’s hospitalization or death.

Now that there’s a vaccine for chickenpox, more than 45 states require the shots (unless your child already had the chicken pox or can prove natural immunity). Two shots usually guarantees your child a way out of being bedecked in calamine lotion for two feverish weeks, but some individuals do still come down with a milder form of the pox. Most pediatricians recommend getting the shot.

Myth 6: The flu shot causes the flu.
Reality: The flu shot does not contain a live virus, so your child can’t get the flu from this shot. But, after the shot, it’s not uncommon to feel a bit achy while the immune system mounts its response. Remember that for two weeks following the shot, your child can still get the flu, so be sure to help your child avoid that feverish kid next door.