Introduction

If an infant or toddler exhibits any unusual behaviors for a day or two after behaving completely normally, it probably means that he or she is coming down with a minor illness, doesn't feel well, or is tired or under some other kind of stress. However, if the child has always had any of these characteristics, or the characteristic(s) continues over a period of time, a visit to the pediatrician or health care provider is warranted. The average age for the diagnosis of autism is 4-6 years, although most parents suspected something was wrong by 18 months and voiced their concerns by age 2 years.

• Seems distant or oblivious to surroundings
• Doesn't play or interact well with others
• Is uncommunicative
• Has problems speaking or understanding the speech of others
• Has uncontrollable temper tantrums
• Insists on sameness and routine
• Engages in repetitive or compulsive actions

The national Institute of child health and human development ( NICHD ) and experts recommend that any child be evaluated for autism who has not met the following developmental milestones:

• Not babbled or cooed by age 1 year
• Not gestured, pointed, or waved by age 1 year
• Not spoken a single word by age 16 months
• Not spoken a 2-word phrase by age 2 years
• Experiences any loss of language or social skills at any age

If even one of these statements is true of a child, resist the temptation to "just wait and see." Problems of this type may signal some type of disability, even if it is not autism. Early diagnosis and prompt intervention are very important in improving the long-term outcomes for developmental disorders of all types, including autism.

Behavioral Therapies

The majority of autism treatment regimens are built around behavioral therapy. More than 30 years of study has demonstrated the effectiveness of applied behavioral approaches in enhancing communication, learning, adaptive conduct, and appropriate social behavior in children with autism while decreasing inappropriate behavior. There is substantial evidence that these interventions are most successful when implemented early, often during the preschool years.. A range of scientifically proven behavioral treatment has been developed for children with autism. These are mainly based on the principles of applied behavior analysis.

Applied behavior analysis (ABA) is designed to both correct behavior and teach skills for dealing with specific situations. It is founded on the principle of reinforcement, which states that behavior may be modified by rewarding desired conduct and depriving unwanted behavior of reinforcement. The person will automatically repeat behaviors that are rewarded. This idea is used in a variety of contexts, including discrete trial training, accidental teaching, errorless learning, and shaping and fading. The majority of treatment programs involve a variety of ABA therapies.

These comprehensive treatment approaches differ in their specifics but are highly structured, intensive programs in which the child spends a large amount of time (15-40+ hours per week), usually in one-to-one activities with a therapist, to change behaviors.Behavioral therapists often cooperate with parents, school personnel, and community professionals to provide a complete treatment program that is tailored to each child's specific requirements.

Positive behavioral interventions and support are designed to replace problem behaviors with positive behaviors and improve the person's quality of life. Like other approaches, this approach requires examination of the individual's unique strengths and problems and development of strategies to improve his or her quality of life overall.

Education

The core tenet of education is that each person with autism has unique talents, abilities, and functioning level, and that his or her education should be individualized to fit those needs. This is not only beneficial to the child, but it is also necessary by federal law. The Individuals with Disabilities Education Act (IDEA; P.L.101-476) guarantees free a nd appropriate public education for every child with a disability. This law specifies that a written and explicit education plan (the Individualized Education Plan, or IEP) be prepared by the local education authority in consultation with the child's parents. When all parties agree on the plan, the plan must be put into place and the child's progress documented. Preparation of the plan includes a comprehensive assessment of the child's needs.

Many different options are available for educating children with autism. The basic assumption is that, whenever possible, children with disabilities should be educated with their nondisabled peers, who serve as models for appropriate language, social, and behavioral skills. Thus, some children with autism are educated in mainstream classrooms, others in special education classes within mainstream public schools, and others in specialized programs separate from mainstream public schools. Parents wanting to find the best possible program for their child are advised to work with the local education authority; full cooperation and communication are essential for meeting this goal.

The following specific programs have been developed for persons with autism:

• TEACCH is a program developed in North Carolina and is used statewide for people with autism. It encompasses many different theories and techniques to develop an individualized program for each person with autism. The underlying principle is that the environment should be adapted for the person with autism, not the other way around. This program focuses less on changing specific behaviors and more on providing the child with the skills needed to understand his or her environment and communicate his or her needs.
• Floor time is an approach that helps the child with autism progress on the natural developmental ladder. I t is based on the theory that children cannot progress to advanced learning until they have completed all the required steps of this ladder, and that children with autism have not completed the ladder.
• Social stories is an approach that uses stories to teach children social skills. In each story, a person is faced with a situation or event; the story is intended to help the child with autism understand the thoughts and emotions of the person in the story. This helps the child develop an understanding of the appropriate or expected response to the situation. The stories are tailored to the individual and often include music and illustrations.

It is important that skills learned at school are generalized outside the classroom setting. Thus, programs for children with autism must include the family and be coordinated across the child's home and community. Complementary therapies

Complementary therapies include art therapy, music therapy, animal therapy, and sensory integration therapy. These are not behavioral or educational approaches per se, but they provide another opportunity for the child to develop social and communication skills. Although there is little scientific evidence that these therapies increase skills, many parents and therapists describe noticeable improvements in a child's behavior and communication abilities, as well as a sense of enjoyment.

Complementary therapies are typically used in addition to behavioral and educational approaches.

• Art therapy offers the child a nonverbal way to express his or her feelings.
• Music therapy involving singing helps develop the child's speech and language skills.
• Animal therapy, such as horseback riding and swimming with dolphins, improves the child's motor skills while increasing self-confidence.
• Sensory integration focuses on normalizing extreme reactions to sensory input. It tries to help the child reorganize and integrate his or her sensory information so he or she can better understand the external world.

Follow-up

Once treatment begins, the multidisciplinary team will recommend regular assessments to check your child's progress. These should be built into the treatment plan.

The best thing you can do to help your child is to work with the professional team. Be informed of the issues surrounding your child's treatment and outlook. Be sure you are clear about the goals of therapy and how they are to be achieved. Be organized and cooperative in supplying all information required by the team. Communicate your questions and reservations about the treatment plan so they can be addressed.