Running head: AUTISM 1

Autism Among Preschool Children and the Interventions to Help Them

Michelle L. Dunham

Liberty University

Counseling 502 Human Growth and Development

Dr. Richard Pace

December 5, 2010
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Abstract

Autistic spectrum disorder (ASD) can cause preschool children to have social and development

difficulties that can keep them from being able to function properly in their day to day life. With

the increase of preschool aged children being diagnosed with ASD in recent years one needs to

understand the best means of helping these children and keep them from having serious problems

as they get older. By reviewing research on ASD one will be able to understand how to assess an

ASD child’s social skills and behaviors, whether early intervention, therapy and/or parent

involvement are successful in the process of helping ASD children to build better social and

communication skills and if there is comorbidity among preschool aged children with ASD. It is

found that preschool aged ASD children should be assessed using the Behavioral Assessment of

Social Interactions in Young Children to help in setting goals and examines treatment progress.

Research has shown patterns of comorbidity among these preschool aged children and these

comorbid disorders need to be considered when treating these ASD children. Combining early

intervention with parent involvement has shown to be the most effective in helping preschool

ASD children to build better social and communication skills.

Keywords: Autism, Autism Spectrum Disorder, Early intervention, Parent involvement, ASD
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Autism spectrum disorder (ASD) is a very complex neurobiological disorder of

development which lasts throughout an individual’s life causing them problems with social

interaction and communication. According to Gillis and Butler (2007) individuals with ASD

exhibit deficits in several fundamental areas including social development and social skills,

language and communication skills, and repetitive, ritualistic, stereotyped behaviors, which can

range from very mild to very severe. The symptoms of autism usually begin and are noticed

before age three, the preschool years, and can cause delays or problems in the above listed skills

and development that are gained through infancy to adulthood. Some consider autism a

developmental disability because it usually starts before age three, the preschool years which is

the developmental period of a child’s life. The signs and symptoms of ASD cause the preschool

aged children to have problems in their communication skills including: both verbal or spoken

communication and non-verbal or unspoken communication, such as pointing, eye contact, and

smiling, and social skills which causes the child to have problems in areas such as sharing their

emotions and feelings, understanding how others think and feel, and holding and maintaining a

meaningful conversation. Another sign and symptom of ASD is the child having some form of

routine or repetitive behavior, some call this stereotyped behaviors, which may involve the child

repeating words or actions, obsessively following routines or schedules, and playing toys or

objects in repetitive and sometimes inappropriate ways, or having very specific and inflexible

ways of arranging items.

Since autism may affect each child differently one child may not have the same type of

problems and/or developmental issues as the next child with autism and the severity of their

problems and issues may be completely different. One child with autism might have problems
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talking with you, or they might not look you in the eye when you talk to them. Another child

may have to line up their pencils before they can pay attention to you, or they may say the same

sentence again and again to calm themselves down. Other children may flap their arms to tell

you they are happy, or they might hurt themselves to tell you they are not. Some children with

autism are unable to learn how to talk or can talk but they are the only ones that know or

understand the language they speak. The behaviors, problems and developmental issues these

preschool aged autistic children have not only make life challenging for them, but it also presents

challenges for all those around them including: their families, health care providers, teachers, and

all others that they comes in contact with during day to day activities.

Because different children with autism may have very different features and/or symptoms

associated with their autism, health care providers think of autism as a spectrum disorder which

means it is a condition that involves a group of disorders with a range of similar features. Based

on the specific strengths and weaknesses of the child with ASD they may present with mild

symptoms or more serious severe symptoms but no matter the severity of the symptoms the child

still has ASD as long as they fall under the diagnostic criteria for autism disorder according to

the Diagnostic and Statistical Manual-IV.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) gives individuals

the exact criteria for diagnosing a preschool child with autism. The individual needs to present

with a total of six or more items from criteria A, B, and C, with at least two symptoms from

criteria A, and at least one symptom from criteria B and C.

Criterion (A): the child has a qualitative impairment in social interaction, as manifested

by at least two of the following: 1) Marked impairments in the use of multiple nonverbal

behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate

social interaction. 2) Failure to develop relationships with peers and others that are appropriate

for their particular developmental stage. 3) A lack of them naturally seeking to share enjoyment,

interests, or achievements with other individuals, an example is the child not showing, bringing,

or pointing out objects of interest to other people. 4) A lack of social or emotional reciprocity, an

example of this is that the child does not actively participate in simple social play or games,

preferring solitary activities, or involving others in activities only as tools or mechanical aids

(American Psychiatric Association [DSM-IV-TR], 2000 & Gillis, et. al, 2007)

Criterion (B): the child has a qualitative impairment in communication as manifested by

at least one of the following: 1) The child has a delay in, or complete lack of, the development of

spoken language, which is not accompanied by an attempt to communicate through alternative

methods of communication such as using gestures or mimes. 2) The child has adequate speech

but has a marked impairment in the ability to initiate or sustain a conversation with others

individuals. 3) The child has the stereotyped and repetitive use of language or uses a language

that they invented and very few people know or understand. 4) The child has a lack of variety in

their spontaneous make-believe play or social imitative play appropriate to their particular

developmental stage (DSM-IV-TR, 2000).

Criterion (C): the child has a restricted repetitive and stereotyped patterns of behavior,

interests and activities, which is exhibited by at least two of the following: 1) The child has an

encompassing obsession with one or more stereotyped and restricted patterns of interest that is
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abnormal either by the intensity of it or it focus. 2) The child has a very inflexible adherence to

certain, nonfunctional routines and/or rituals. 3) The child has a stereotyped and repetitive motor

mannerism, which may include flapping or twisting of fingers, hands or legs, and/or multifaceted

bodily movements. 4) The child has a persistent obsession with certain parts of objects (DSM-

IV-TR, 2000).

If the onset of autism occurs after three years of age there needs to be a delay or abnormal

functioning in at least one of the following areas of development: social interaction, language

which the individual would use for social communication, and/or symbolic or imaginative play.

Also when diagnosing an individual with ASD other disorders need to be considered to make

sure the diagnosis for these other disorder do not better account for the symptoms this individual

is having. When diagnosing preschool aged child there are two other disorders that need to be

considered to make sure the child’s symptoms do not better meet the criteria for which are;

Rhett’s Disorder and/or Childhood Disintegrative Disorder.

According to Denkyirah & Agbeke (2010) there has been an increasing amount of

children being diagnosed with autism. Researchers are unsure to the exact reasoning to why it

seems as though the number of children being diagnosed with autism has been increasing. It is

unsure if it is because people are becoming more informed and educated in the signs and

symptoms of autism which is making it easier for children to be more accurately diagnosed.

Another possible reason for the increase could be because the definition of ASD was changed in

the DSM which made it to where even children with mild symptoms could now be diagnosed

with ASD. With an increase in the amount of children being diagnosed with ASD and the fact

that to date there is no cure for autism there is a need to find the best means of helping these
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preschool aged children, so that they will have the less amount of difficulty as they get older and

will be able to function on their own in society.

Research has shown that early diagnosis and interventions that are delivered early in life,

especially when delivered during the preschool period of a child’s life. When interventions are

started during this preschool period it is more likely for the child to have better results and more

positive effects on later skills and symptoms. The sooner a child begins to receive interventions,

the more opportunities they will have for learning the skills they need to be successful. Because a

young child’s brain is still developing, early intervention gives children the best possible start

and the best chance of developing to their full potential. Though it is most beneficial to start

interventions during the preschool years even if an individual is not diagnosed with autism till

they are an adult it is not too late to start treatment because they will still benefit from it. People

of all ages with ASD at all levels of ability commonly respond positively interventions as long as

they are well designed.

When a child has the signs and symptoms of ASD they need to be properly assessed

before the proper interventions for the child can be determined. There are few methods available

to assess ASD children, so goals can be made for them and interventions determined. There are

two assessment that were found in research to be widely used in children with ASD, they are the

Behavioral Assessment of Social Interactions in Young Children (BASYC) and Social Orienting

Continuum and Response Scale (SOC-RS). According to Gillis, Callahan & Romanczyk, 2011)

the BASYC is at this time an instrument that is simple to administer, differentiates well between

children with and without ASD based on their social behaviors and may help in setting goals and
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monitoring the progress of social skills treatment that was chosen for the ASD child. It uses a

direct behavioral observation method which is to be done in a natural, semi-structured setting

and measures two different typical areas of social interaction: social initiation, and social

responsivity. The SOC-RS is process of assessing an ASD child’s social oriented behaviors

through video-recorded Autism Diagnostic Observation Schedule (ADOS) sessions. The SOC-

RS concentrations on four typical social orienting behaviors which include: social referencing,

joint attention, orienting to name, and social smiling (Mosconi, Reznick, Mesibov & Piven,

2009). Though SOC-RS did show in research that it is was a valid process of assessing ASD

children it is not as easily administered as BASYC.

Once the assessment has been properly administered goals need to be set and the type of

intervention(s) decided upon. When deciding on goals and interventions all signs, symptoms and

comorbid disorder need to be considered. It was found by Hayashida, Anderson, Paparella,

Freeman & Forness (2010) that many ASD children have comorbid psychiatric diagnoses which

include: attention deficit hyperactivity disorder, anxiety disorders, depression, and oppositional

defiant or conduct disorders. Considering comorbid disorder can help in determining the most

appropriate goals and type of intervention(s) that will give the child the most improvements and

progress.

There are many different interventions and programs that can be used to help preschool

aged children with ASD. It is shown in research that early intervention is very effective and the

earlier the interventions and programs are started the better it will be because the younger the

child is the more opportunities there will be to improve their development and social skills. As

stated in the study that was done by Akshoomoff, Stahmer, Corsello, & Mahrer (2010) there is an
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increasing amount of children being diagnosed with ASDs before they reach their third birthday,

and thorough early behavioral intervention has shown to improve the child’s development and

social skills. There are several early intervention programs many which are school based which

includes programs such as: Early Risers Program, First Step to Success, Incredible Years,

Regional Intervention Program and Children Toddler School Program that have been researched

and been shown to be successful (Magg & Katsiyannis, 2010). All these programs involve the

parents and family in the process of helping the child, which can help tremendously improve the

child’s progress and likelihood of being able to live a happy and successful life. “ It is essential

to include parent training in early intervention programs because parents generally represent the

most proximal and powerful environmental influence during early childhood and without

parental participation gains in children’s development are unlikely to be maintained” (Oosterling

et al., 2010).

Whether the child is involved in a school-based program or other type of intervention

program there are several ways of involving the parent but the most researched parent

involvement is focus parent training and brief parent training. The focus parent training is a

home-based parent-training program that concentrates on helping the parent to promote

obedience, shared enjoyment, joint attention and language development. The brief parent training

program is similar to the focus parent training except for the fact that the training is less intensive

six hour training sessions instead of the twenty five to one hundred eighty hours of training that

is done for the focus parent training. While it has not been shown yet if brief parent training

really helps to improve the ASD child’s treatment progress parents have stated that they feel it

was a very helpful experience that was well worth the time (Coolican, Smith, & Bryson, 2010).
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One of the main areas that parent training concentrates on is joint attention skills. Joint

attention skills are an aspect of social thought processing that has been linked to the development

of language and communication. It is the process that gives an individual the ability to

synchronize their attention between individuals and objects (Sullivan et al., 2007). When it

comes to joint attention there are two types of joint attention: response to others joint attention

and initiation of joint attention. ASD child usually have impairments in both of the two areas of

joint attention and these impairments can cause the child to have many missed opportunities to

learn new social skills due to the inability to share experiences with others. It also can cause the

child to become more developmentally delayed due to all the miss opportunities. Because of the

importance of joint attention there has been research done on whether parents can be taught to

help train their ASD child in joint attention. The study by Jones and Feeley (2010) showed that

parents could not only effectively implement the intervention and successfully teach their

preschool ASD child joint attention skills but in the process they could teach them both the

response to others and the initiation of joint attention skills to their child. It was found that with

both the more intense training and the brief parent training the parents could help their children

to improve their joint attention skills and other social and communication skills as long as the

parent understood the training and how to go about teaching it to their ASD child.

In conclusion ASD is definitely a complex disorder which should be taken seriously.

Once a child is diagnosed with ASD the child’s parents, health care provider and teachers should

work together to ensure the child gets the treatment and interventions needed in order to be able

to gain the social and development skills they need to live a happy and successful life. In order to

do this the proper assessment needs to be done and correct treatments and interventions started as
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early as possible. The best means of assess the ASD child is through the use of the BASYC.

After assessment consideration of any comorbid disorder needs to be taken and the child’s goals

and interventions should be set accordingly. It is very important to involve the parents and family

member of the preschool aged ASD child in the treatment and intervention process though there

is a need for more research in the area of parent involvement.

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