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Autism - Topic Overview

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Topic Overview
What is autism?
Autism is a brain disorder that often makes it hard to communicate with and relate to others. With autism, the different areas of the brain fail to work to ether.

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!ost people with autism will always have some trouble relatin to others. "ut early dia nosis and treatment have helped more and more people with autism to live independently as adults.

What causes autism?

Autism tends to run in families, so e#perts think it may be somethin that you inherit. $cientists are tryin to find out e#actly which enes may be responsible for passin down autism in families. %ther studies are lookin at whether autism can be caused by other medical problems or by somethin in your child&s surroundin s.

$ome people think that childhood vaccines cause autism, especially the measles'mumps'rubella, or !!(, vaccine. "ut studies have not shown this to be true. )t&s important to make sure that your child ets all childhood vaccines. *hey help keep your child from ettin serious diseases that can cause harm or even death.

What are the symptoms?

$ymptoms almost always start before a child is + years old. ,sually, parents first notice that their toddler has not started talkin yet and is not actin like other children the same a e. $ymptoms of autism include:

A delay in learnin to talk, or not talkin at all. A child may seem to be deaf, even thou h hearin tests are normal.

(epeated and overused types of behavior, interests, and play. -#amples include repeated body rockin , unusual attachments to ob.ects, and ettin very upset when routines chan e. *here is no /typical/ person with autism. People can have many different kinds of behaviors, from mild to severe. Parents often say that their child with autism prefers to play alone and does not make eye contact with other people. Autism may also include other problems:

!any children have below'normal intelli ence.

*eena ers often become depressed and have a lot of an#iety, especially if they have avera e or above'avera e intelli ence.

$ome children et a sei0ure disorder such as epilepsy by their teen years.

ow is autism !ia"nose!?
*here are uidelines your doctor will use to see if your child has symptoms of autism. *he uidelines put symptoms into three cate ories:

Socia# interactions an! re#ationships$ 1or e#ample, a child may have trouble makin eye contact. People with autism may have a hard time understandin someone else&s feelin s, such as pain or sadness.

Ver%a# an! nonver%a# communication$ 1or e#ample, a child may never speak. %r he or she may often repeat a certain phrase over and over.

Limite! interests in activities or p#ay$ 1or e#ample, youn er children often focus on parts of toys rather than playin with the whole toy. %lder children and adults may be fascinated by certain topics, like train schedules or license plates. 2our child may also have a hearin test and some other tests to make sure that problems are not caused by some other condition.

ow is it treate!?
*reatment for autism involves special behavioral trainin . "ehavioral trainin rewards ood behavior 3positive reinforcement4 to teach children

social skills and to teach them how to communicate and how to help themselves as they row older. With early treatment, most children with autism learn to relate better to others. *hey learn to communicate and to help themselves as they row older. 5ependin on the child, treatment may also include such thin s as speech therapy or physical therapy. !edicine is sometimes used to treat problems such as depression or obsessive'compulsive behaviors. -#actly what type of treatment your child needs depends on the symptoms, which are different for each child and may chan e over time. "ecause people with autism are so different, somethin that helps one person may not help another. $o it&s important to work with everyone involved in your child&s education and care to find the best way to mana e symptoms.

ow can your &ami#y !ea# with havin" a chi#! with autism?

An important part of your child6s treatment plan is makin sure that other family members et trainin about autism and how to mana e symptoms. *rainin can reduce family stress and help your child function better. $ome families need more help than others. *ake advanta e of every kind of help you can find. *alk to your doctor about what help is available where you live. 1amily, friends, public a encies, and autism or ani0ations are all possible resources. (emember these tips:

Plan breaks. 5aily demands of carin for a child with autism can take their toll. Planned breaks will help the whole family.

7et e#tra help when your child ets older. *he teen years can be a very hard time for children with autism.

7et in touch with other families who have children with autism. 2ou can talk about your problems and share advice with people who will understand. (aisin a child with autism is hard work. "ut with support and trainin , your family can learn how to cope. 're(uent#y As)e! *uestions Learnin" a%out autism+

What is autism8 What causes it8 What are the symptoms8 Who is affected8

What are other types of developmental disorders8

What is the difference between autism and Asper er6s syndrome8

9an vaccinations cause autism8

,ein" !ia"nose!+

:ow is autism dia nosed8

Are there any tests to screen for eneral developmental disorders8

What ;uestions will the doctor ask about my child6s medical history8

Are there uidelines for makin a dia nosis8 What tests are used to e#amine a child6s behavior8

What will my child6s doctor look for durin a physical e#am8

-ettin" treatment+

What kinds of treatment are used for autism8 What are some steps parents can take to help a child with autism8

What medicines are used8 :ow do ) know if an alternative treatment is ood for my child8

On"oin" concerns+ Livin" with autism+

What kinds of trainin pro rams can help a child with autism8

What kind of support will ) need8 :ow can ) help my child in school8

What kind of care is available for adults with autism8

Author+ $abra <. =at0'Wise Me!ica# Review+ !ichael >. $e#ton, !5 ' Pediatrics

1red ?olkmar, !5 ' 9hild Psychiatry

Last Updated: 06/07/2006

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Behavioral questionnaires to help dia nose autism

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"ehavioral ;uestionnaires are commonly used to help identify autistic behaviors and to evaluate their severity. *he specific test used varies dependin on the health professional6s preference and the child6s symptoms. 9ommonly used assessments include the followin .

Mo!i&ie! Chec)#ist &or Autism in To!!#ers .M/C AT0$ *his test is used to evaluate infants who are at least 2B months old. *he !'9:A* is better than the ori inal 9:A* 39hecklist for Autism in *oddlers4 for detectin autism. *he test continues to be studied to identify milder autistic symptoms.

1ervasive 2eve#opmenta# 2isor!er Screenin"$ *his ;uestionnaire is completed by parents to evaluate early si ns of autism.

Autism Screenin" *uestionnaire$ *his test is for children B years of a e and older.

Autism ,ehavior Chec)#ist$ *his is a screenin tool completed by the child6s teacher.

Chi#!hoo! Autism Ratin" Sca#e$ *his test rates how much a child6s behavior varies from that of other children the same a e 3older than 2B months4.

Autism 2ia"nostic Interview$ Parents provide information about their child6s behaviors durin this wide'ran in , structured interview.

Autism O%servation Sche!u#e$ 5urin this test, a health professional observes a child as he or she performs several activities involvin communication, social interaction, play, interests, and other behaviors.

Last 3p!ate!
Author+$abra <. =at0'Wise Me!ica# Review+ !ichael >. $e#ton, !5 ' Pediatrics

>une C, 2AA@

1red ?olkmar, !5 ' 9hild Psychiatry

Last Updated: 06/07/2006

1995-2007, Healthwise, Incorporated, !"! #o$ 19%9, #oise, I& %'701! (LL )I*H+, )-,-).-&!

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Symptoms
Core symptoms
*he severity of symptoms varies reatly between individualsD however, all people with autism have some core symptoms in the areas of:

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Socia# interactions an! re#ationships$ $ymptoms may include: $i nificant problems developin nonverbal communication skills, such as eye'to'eye a0in , facial e#pressions, and body posture.

1ailure to establish friendships with children the same a e. <ack of interest in sharin en.oyment, interests, or achievements with other people.

<ack of empathy. People with autism may have difficulty understandin another person6s feelin s, such as pain or sorrow.

Ver%a# an! nonver%a# communication$ $ymptoms may include: 5elay in, or lack of, learnin to talk. As many as EA% of people with autism never speak.F

Problems takin steps to start a conversation. Also, people with autism have difficulties continuin a conversation once it has be un.

$tereotyped and repetitive use of lan ua e. People with autism often repeat over and over a phrase they have heard previously 3echolalia4.

5ifficulty understandin their listener6s perspective. 1or e#ample, a person with autism may not understand that someone is usin humor. *hey may interpret the communication word for word and fail to catch the implied meanin .

Limite! interests in activities or p#ay$ $ymptoms may include: An unusual focus on pieces. 2oun er children with autism often focus on parts of toys, such as the wheels on a car, rather than playin with the entire toy.

Preoccupation with certain topics. 1or e#ample, older children and adults may be fascinated by train schedules, weather patterns, or license plates.

A need for sameness and routines. 1or e#ample, a child with autism may always need to eat bread before salad and insist on drivin the same route every day to school.

$tereotyped behaviors. *hese may include body rockin and hand flappin .

Symptoms !urin" chi#!hoo!

$ymptoms of autism are usually noticed first by parents and other care ivers sometime durin the child6s first + years. Althou h autism is present at birth 3con enital4, si ns of the disorder can be difficult to identify or dia nose durin infancy. Parents often become concerned when their toddler does not like to be heldD does not seem interested in playin certain ames, such as peekabooD and does not be in to talk. *hey also may be confused about their child6s hearin abilities. )t often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant back round noise, such as the whistle of a train.

With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they row older. 9ontrary to popular myths about children with autism, very few are completely socially isolated or /live in a world of their own./

Symptoms !urin" a!o#escent an! teen years

5urin the teen years, the patterns of behavior often chan e. !any teens ain skills but still la behind in their ability to relate to and understand others. Puberty and emer in se#uality may be more difficult for adolescents and teens with autism than for others this a e. *eens are at a sli htly increased risk for developin problems related to depression, an#iety, and epilepsy.

Symptoms in a!u#thoo!
$ome adults with autism are able to work and live on their own. *he de ree to which an adult with autism can lead an independent life is related to intelli ence and ability to communicate. At least ++% are able to achieve at least partial independence.2 $ome adults with autism need a lot of assistance, especially those with low intelli ence who are unable to speak. Part' or full'time supervision can be provided by residential treatment pro rams. At the other end of the spectrum, adults with hi h'functionin autism are often successful in their professions and able to live independently, althou h they typically continue to have some difficulties relatin to other people. *hese individuals usually have avera e to above'avera e intelli ence.

Other symptoms

!any people with autism have symptoms similar to attention deficit hyperactivity disorder 3A5:54. "ut these symptoms, especially problems with social relationships, are more severe for people with autism. 1or more information, see the topic Attention 5eficit :yperactivity 5isorder. About FA% of people with autism have some form of savant skillsGspecial limited ifts such as memori0in lists, calculatin calendar dates, drawin , or musical ability.F !any people with autism have unusual sensory perceptions. 1or e#ample, they may describe a li ht touch as painful and deep pressure as providin a calmin feelin . %thers may not feel pain at all. $ome people with autism have stron food likes and dislikes and unusual preoccupations.

Other con!itions
Autism is one of several types of pervasive developmental disorders 3P55s4, also called autism spectrum disorders 3A$54. )t is not unusual for autism to be confused with other P55s, such as Asper er6s disorder or syndrome, or to have overlappin symptoms. A similar condition is called pervasive developmental disorder'H%$ 3not otherwise specified4. P55' H%$ occurs when children display similar behaviors but do not meet the criteria for autism. )t is commonly called .ust P55. )n addition, other conditions with similar symptoms may also have similarities to or occur with autism.
Author+ $abra <. =at0'Wise

Me!ica# Review+ !ichael >. $e#ton, !5 ' Pediatrics

1red ?olkmar, !5 ' 9hild Psychiatry

Last Updated: 06/07/2006

1995-2007, Healthwise, Incorporated, !"! #o$ 19%9, #oise, I& %'701! (LL )I*H+, )-,-).-&! +his in/or0ation is not intended to replace the ad1ice o/ a

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35IA6 36TT37 7A6A7/7A6A7 A3TISMA E8ams an! Tests

*he American Academy of Pediatrics 3AAP4 recommends screenin children for autism durin re ularly scheduled well child visits. *his policy helps health professionals identify si ns of autism early in its course. -arly dia nosis and treatment can help the child reach his or her full potential.

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When a developmental delay is reco ni0ed in a child, further testin can help a health professional determine whether the problem is related to autism, another pervasive developmental disorder 3P554, or a condition with similar symptoms, such as lan ua e delays or avoidant personality disorder. )f your primary care provider does not have specific trainin or e#perience in developmental problems, he or she may refer your child to a specialistGusually a developmental pediatrician, psychiatrist, speech therapist, or child psychiatristG for the additional testin .

,ehaviora# assessments. ?arious uidelines and ;uestionnaires are used to help a health professional determine the specific type of developmental delay a child has. *hese include:2

!edical history. 5urin the medical history interview, a health professional asks eneral ;uestions about a child6s development, such as whether a child shows parents thin s by pointin to ob.ects. 2oun children with autism often point to items they want, but do not point to show parents an item and then check to see if parents are lookin at the item bein pointed out.

5ia nostic uidelines for autism. *hese uidelines are the main assessment criteria for autism and were established by the American Association of 9hild and Adolescent Psychiatry 3AA9AP4. *hey are desi ned for children a e + and older.

%ther behavioral ;uestionnaires. Additional dia nostic tests focus on children youn er than a e +.

9linical observations. A health professional may want to observe the developmentally delayed child in different situations. *he

parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.

5evelopmental and intelli ence tests. *he AA9AP also recommends that tests be iven to evaluate whether a child6s developmental delays affect his or her ability to think and make decisions.

1hysica# assessments an! #a%oratory tests$ %ther tests may be used to determine whether a physical problem may be causin symptoms. *hese tests include:

Physical e#amination, includin head circumference, wei ht, and hei ht measurements, to determine whether the child has a normal rowth pattern.

:earin tests, to determine whether hearin problems may be causin developmental delays, especially those related to social skills and lan ua e use.

*estin for lead poisonin , especially if a condition called pica 3in which a person craves substances that are not food, such as dirt or flecks of old paint4 is present. 9hildren with developmental delays usually continue puttin items in their mouth after this sta e has passed in normally developin children. *his practice can result in lead poisonin , which should be identified and treated as soon as possible.

Additional laboratory tests may be done under specific circumstances. *hese tests include:

9hromosomal analysis, which may be done if mental retardation is present or there is a family history of mental retardation. 1or e#ample, fra ile I syndrome, which causes a ran e of below'normal intelli ence problems as well as autistic'like behaviors, can be identified with a chromosomal analysis.

An electroencephalo raph 3--74, which is done if there are symptoms of sei0ures, such as a history of starin spells or if a person reverts to less mature behavior 3developmental re ression4.

A ma netic resonance ima e 3!()4, which may be done if there are si ns of differences in the structure of the brain.

Ear#y !etection
All health professionals who see infants and children for well child visits should watch for early si ns of developmental disorders. 5evelopmental screenin tools, such as the A es and $ta es Juestionnaire or the !odified 9hecklist for Autism in *oddlers 3!'9:A*4, can help assess behavior. )f a health professional discovers the followin obvious si ns of developmental delays, the child should immediately be evaluated:+

Ho babblin , pointin , or other estures by F2 months Ho sin le words by F@ months Ho 2'word spontaneous phrases by 2B months, with the e#ception of repeated phrases 3echolalia4

Any loss of any lan ua e or social skills at any a e

)f there are no obvious si ns of developmental delays or any unusual indications from the screenin tests, most infants and children do not need further evaluation until the ne#t well child visit. :owever, children who have a siblin with autism should continue to be closely monitored, because they are at increased risk for autism and other developmental problems. )n addition to the evaluations at well child visits, these children should under o testin for lan ua e delays, learnin problems, poor sociali0ation skills, and any symptoms that mi ht su they have an#iety or depression.+ Autism - Treatment Overview
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est

Provided by: C9% of users found this article helpful.

Treatment Overview
-arly dia nosis and treatment helps youn children with autism develop to their full potential. *he primary oal of treatment is to improve the overall ability of the child to function.

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$ymptoms and behaviors of autism can combine in many ways and vary in severity. )n addition, individual symptoms and behaviors often chan e over time. 1or these reasons, treatment strate ies are tailored to individual

needs and available family resources. )n eneral, however, children with autism respond best to hi hly structured and speciali0ed treatment. A pro ram that addresses helpin parents and improvin communication, social, behavioral, adaptive, and learnin aspects of a child6s life will be most successful. *he American Academy of Pediatrics 3AAP4 recommends the followin strate ies for helpin a child to improve overall function and reach his or her potential:B

,ehaviora# trainin" an! mana"ement$ "ehavioral trainin and mana ement uses positive reinforcement, self'help, and social skills trainin to improve behavior and communication. !any types of treatments have been developed, includin Applied "ehavioral Analysis 3A"A4, *reatment and -ducation of Autistic and (elated 9ommunication :andicapped 9hildren 3*-A99:4, and sensory inte ration.

Specia#i9e! therapies$ *hese include speech, occupational, and physical therapy. *hese therapies are important components of mana in autism and should all be included in various aspects of the child6s treatment pro ram. $peech therapy can help a child with autism improve lan ua e and social skills to communicate more effectively. %ccupational and physical therapy can help improve any deficiencies in coordination and motor skills. %ccupational therapy may also help a child with autism to learn to process information from the senses 3si ht, sound, hearin , touch, and smell4 in more mana eable ways.

Me!ications$ !edications are most commonly used to treat related conditions and problem behaviors, includin depression, an#iety, hyperactivity, and obsessive'compulsive behaviors.

Community support an! parent trainin"$ *alk to your doctor or contact an advocacy roup for support and trainin . $tories about alternative therapies, such as secretin and auditory inte ration trainin , have circulated in the media and other information sources. When considerin any type of treatment, it is important to know the source of information and to ensure that studies are scientifically sound. Accounts of individual success are not sufficient evidence to support usin a treatment. <ook for lar e, controlled studies to validate claims. -#perts have not yet identified a way to prevent autism. Public concern over stories linkin autism and childhood vaccines has persisted. :owever, numerous studies have failed to show any evidence of a link between autism and the measles'mumps'rubella 3!!(4 vaccine.E )f you avoid havin your children immuni0ed, you put them and others in your community at risk for developin serious diseases, which can cause serious harm or even death.
Author+ $abra <. =at0'Wise Me!ica# Review+ !ichael >. $e#ton, !5 ' Pediatrics

1red ?olkmar, !5 ' 9hild Psychiatry

Last Updated: 06/07/2006

Autism - !ome Treatment

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Lampiran 7

ome Treatment
:avin a child with autism re;uires takin a proactive approach to learnin about the condition and its treatment while workin closely with others involved in your child6s care. 2ou also need to take care of yourself so that you are able to face the many challen es of havin a child with autism.

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E!ucate yourse#& a%out autism

Ask your health professional or contact autism or ani0ations to find trainin about autism and how to mana e symptoms. Parent and family education has been shown to reduce family stress and improve a child6s functionin .B ,nderstandin the condition and knowin what to e#pect is an important part of helpin your child develop independence.

"ecome informed about your child6s educational ri hts. 1ederal laws re;uire services for handicapped children, includin those with autism. )n addition, there may be state and local laws or policies to aid children with autism. 1ind out what services are available for your child in your area. <earnin about autism will also help prepare you for when your child reaches adulthood. $ome adults with autism can live by themselves, work, and be as independent as other people their a e. %thers need continued support.

Wor) c#ose#y with others who care &or your chi#!

9lose communication with others involved in your child6s education and care will help all concerned. *he best treatment for children with autism is a team approach and a consistent, structured pro ram. -veryone involved needs to work to ether to set oals for:@

-ducation. )dentifyin and mana in symptoms of autism and any related conditions.

"ehavior and interactions with family and peers, ad.ustment to different environments, and social and communication skills. Work closely with the health professionals involved in your child6s care. )t is important that they take time to listen to your concerns and are willin to work with you.

Ta)e care o& yourse#&

<earn ways to handle the normal ran e of emotions, fears, and concerns that o alon with raisin a child with autism. *he daily and lon 'term challen es put you and your other children at an increased risk for depression or stress'related illnesses. *he way you handle these issues influences other family members.

7et involved in a hobby, visit with friends, and learn ways to rela#. $eek and accept support from others. 9onsider usin respite care, which is a family support service that provides a break for parents and siblin s. )n addition, support roups for parents and siblin s are enerally availableD people who participate in support roups can benefit from others6 e#periences. 1or more information on support roups in your area, contact the Autism $ociety of America at http:KKwww.autism' society.or .

*alk with a health professional about whether counselin would help if you or one of your children is havin trouble handlin the strains related to havin a family member with autism.
Author+ $abra <. =at0'Wise Me!ica# Review+ !ichael >. $e#ton, !5 ' Pediatrics

1red ?olkmar, !5 ' 9hild Psychiatry

Last Updated: 06/07/2006

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Autism and ABA

EI,I Saves 3p to :;<=>><>>>
S"##AR$% Cost-&ene'it Estimates 'or Earl( Intensive Behavioral Intervention 'or $oun Children with Autism

John W. Jacobson, James A. Mulick, and Gina Green In Behavioral Interventions, 1998, Volume 1 , !"1#!!$

ublic and private spending for specialized human services has increased dramatically

over the past two decades. o have concerns about the investment of public resources in these services. !or e"ample# research has shown that without effective intervention# most people with autism and other pervasive developmental disorders $%&&' re(uire lifelong specialized educational# family# and adult services# at a total cost that is estimated at upwards of )4 million in some states. *very year# millions of dollars are spent on interventions for autism+%&& that have little or no proven efficacy. ,t is prudent# therefore# to as- how investments in services are li-ely to pay off in the long run# and how to ma-e the best use of the limited resources available for educating and treating people with autism+%&&.

/esearch with children who have# or are at ris- for# various disabilities has shown that effective early intervention can substantially reduce their need for specialized services later on. 0o be effective# however# 1uralnic- $233.' and /amey and /amey $233.' found that early intervention must be $2' comprehensive# $2' intensive# $3' e"tended over time# $4' individualized# and $5' delivered directly to children. 4f course# such intervention is neither cheap nor easy# so it is important to determine how this -ind of intervention is li-ely to pay off not only in benefits to particular children and families but also in financial savings.

%arl& Intensive Behavioral Intervention '%IBI(

tudies have demonstrated that intensive early intervention using the principles and methods of applied behavior analysis $565' can produce substantial benefits for many children with autism+%&& $5nderson et al.# 23.77 6irnbrauer 8 Leach# 23337 !ens-e et al.# 23.57 Lovaas# 23.77 9c*achin# mith# 8 Lovaas# 2333'. 5lthough there were some variations in procedures across studies# the interventions generally met the five criteria listed as essential by 1uralnic- $233.' and /amey and /amey $233.'. 0he interventions:

F. emphasi0ed skill development throu h positive reinforcementD 2. started with an assessment of each child6s current skills and deficitsD instructional ob.ectives, teachin methods, pacin , skill se;uences, and reinforcers were all customi0ed to the characteristics and needs of each childD +. addressed all skill domainsD B. used fre;uent direct observation and measurement of individual performance to determine if pro ress was occurrin , and ad.ust instructional methods accordin lyD E. included parents as co'therapistsD and

@. were directed and supervised by individuals with post raduate trainin in behavior analysis plus e#tensive hands'on e#perience in providin A"A intervention to youn children with autism.
5mong the studies published to date# the best outcomes ; achievement of normal or near<normal functioning in all s-ill domains ; were documented for children who received this -ind of intervention for at least 3= hours per wee- year around for 2<3 years# starting before they reached the age of 6. ,n the longest and best documented study# Lovaas and colleagues $Lovaas# 23.77 9c*achin# mith# 8 Lovaas 2333' found that 47> of the children receiving *,6, were able to function independently and successfully in regular classrooms. 5nother 4=> or so made substantial improvements but continued to need some specialized intervention7 and about 2=> made minimal gains and continued to need intensive intervention. !or a review# see 1reen $2336'.

)ost#Bene*it Anal&sis o* %IBI

1iven the emerging evidence on the effectiveness of *,6,# and the availability of detailed information about the costs of childhood and adult services for people with autism and related disorders# it is now possible to estimate the financial costs and benefits of *,6,. ?e conducted such an analysis using information from the state of %ennsylvania available to us at the end of 2336. 0he ma@or assumptions underlying the analysis were:

F. *here is insufficient scientific evidence on which to base predictions about the likely outcome for any individual child. 2. )n any roup of children receivin -)"), between 2A% and EA% will achieve normal functionin and re;uire no speciali0ed services after enterin elementary school. About FA% will make small ains and re;uire intensive special education and adult services 3minimal effect roup4. *he remainder will make

moderate ains and need nonintensive special education and adult services 3partial effect roup4. +. Without -)"), most people with autism need lifelon special services. B. *he avera e annual cost of -)") is estimated at L++,AAA per child. *he avera e duration is estimated to be three years. E. 9hildren who reali0e partial or minimal effects will use family support services to a e 22, i.e. for FM years. @. 5urin adulthood, those who achieve partial effects will use FM years of !edicaid waiver 3or e;uivalent4 services and FE years of supported work services. C. 5urin adulthood, of those adults for whom minimal effects are obtained, MA% will use waiver services for 2A years, 2A% will use intensive community services for 2+ years, and BA% will use supported work services for FE years. )alculatin+ ,ro-ected )osts and Bene*its
?e summed the costs of all public entitlements to early intervention# education# family support# adult services# and ocial ecurity benefits for people with autism. 0hen# we factored in earnings in adulthood using the 2336 median household annual income to estimate earnings by individuals who are diagnosed with autism or %&& as young children but achieve normal functioning by adulthood# and supported employment wages for those who do not. Aosts and savings were estimated for individuals who achieve normal range effects# partial effects# and minimal effects from *,6, and for differing proportions of groups of children with autism+%&& who achieve normal functioning $i.e.# 2=># 3=># 4=># 5=>'. ,n the article we show pro@ected present value# current cost# and

cost with inflation. 5 great deal of additional information is provided regarding the e"act methods used to pro@ect costs.

.ummar& o* /esults
0able 2 *stimated Bet Aosts and avings of *,6,# 5ges 3<55 years. B*0 5C,B1 for typically developing person B*0 5C,B1 for child with autism+%&& who achieves normal functioning B*0 A4 0 for child who realizes partial effects B*0 A4 0 for child who ma-es minimal gains B*0 5C,B1 for child who realizes partial effects $)4#4=4#4.2. < )3#36.#463' )2#537#=43 )2#475#732 )3#36.#463 )4#4=4#4.2 )2#=36#=23

0he net savings for a typically developing person shows the cost benefit of providing public education D<22 to a typically developing person through adulthood# i.e.# career income minus costs of education. 0he net savings for a child with autism+%&& who achieves normal functioning has a similar basis# e"cept that costs for early intervention and preschool age support services are included. 0he net cost for a child with autism+%&& who ma-es minimal gains is the cost of services for 52 years# less income from supported wor-. Bet savings to age 55 for a child who achieves partial effects are the difference between Eminimal gainsF costs and Epartial effectsF costs. 6elow we show the range of average weighted cost benefits $savings' per child# based on differing levels of effectiveness of programs# per hundred children. !or this reason# the savings we show below cannot be calculated directly from the costs shown in 0able 2. 0he steps used to estimate these ranges are shown in the full article. Estimated Savings Per Child, 3-22 Years. 5verage savings to the educational system range from )23.#652 to )274#7=3 depending upon the proportion of children < 2=# 3=# 4= or 5=> < who achieve normal functioning levels. urprisingly# because children who achieve normal functioning continue to incur costs throughout the school years# i.e. the costs of regular education services# the largest savings actually come from the children who achieve partial or moderate gains from *,6,. 0his aspect of savings is not shown in 0able 2 but is shown in the full article. 0he average cost

savings are roughly e(ual to total regular education costs in %ennsylvania for a child from D<22. Estimated Savings per Child, Ages 3-55 Years. 0he average savings per child to age 55# again depending on the proportions of effectiveness of *,6,# range from )2#6.6#=62 to )2#.26#535. 0here are a number of factors that cause the savings to be greater through adulthood. 0he most important considerations are that a person may use adult human services for a longer period of time than they attend school during their life span# and that some adult human services have annual costs higher than the annual costs of special or intensive special education.

0iscussion
,nvesting in high<(uality *,6, for children with autism is li-ely to pay handsome dividends for the various systems that are charged with providing services to these individuals. !or the purpose of the present analysis# the initial investment was estimated at @ust under )2==#=== per child $)33#=== per year for 3 years'. 0his was the average cost in %ennsylvania in 2336. 0his figure probably is lower than present costs. Gsing )25=#===# or )5=#=== a year for 3 years# the estimated savings are still substantial. ,n either case# the overall average savings are estimated to range from well over )2 million to over )2 million per individual across the life span. 0here are a number of potentially problematic features in the assumptions we made in conducting this analysis. 0hese are discussed in detail in the published article# and involve assumptions about future costs# future service use# and levels of inflation# among other features. 5s indicated# a ma@or (ualifier is the rate of attainment of normal functioning# but it is important to note that moderate gains from *,6, result in substantial savings. 5nother (uestion is: HIow do these costs and benefits of *,6, compare with other forms of early intervention for children with autism+%&&JH 0he (uestion# unfortunately# cannot be answered# because# to date# comprehensive outcomes using non565 interventions have not been documented. ?e simply do not -now how

many# if any# children who have received other forms of early intervention have achieved normal functioning# moderate $partial' gains# or minimal benefits. Li-e effective treatments for other severe childhood disorders# such as cancer# early intensive behavioral intervention can be described as aggressive# intrusive# e"pensive# and necessitating a high level of specialized e"pertise for effective delivery. 0he decision to invest in intrusive# e"pensive treatment for childhood cancer is usually based on several factors# including the scientifically demonstrated efficacy of other treatments# and the probable conse(uences of pursuing other treatments or no treatment at all. ,f a child with a ma@or disorder needs treatment# cost is usually not a ma@or factor7 various public and private resources are typically made available to cover the costs. 9any parents and professionals are beginning to insist that the same considerations apply to the treatment of children with autism+%&. ?e should all recognize that the most e"pensive interventions are those that fail to produce meaningful# measurable# lasting benefits# regardless of cost.

Lampiran 3

2iet an! Autism Research in!icates that a "#uten an! casein/&ree !iet may %e he#p&u# in autism$ There&ore< it wou#! %e a "oo! i!ea to try a "#uten &ree !iet &or a perio! o& a &ew wee)s in chi#!ren with autism to see i& there is any response$ Since &ish oi#s have %ene&ite! some chi#!ren with autism< it may %e a "oo! i!ea to inc#u!e more co#! water &ish in the !iet$ 6atura# supp#ement &or the treatment o& Autism / Vitamin &or autism There is a scatterin" o& research that in!icates nutrients may %e o& some %ene&it in treatin" autism< %ut much more research is nee!e! %e&ore we have a %etter un!erstan!in" the ro#e nutritiona# supp#ements in the treatment o& autism$ owever< here are some possi%#e options that I have come across that may or may not %e he#p&u#$ Chi#!ren with autism "iven carnosine showe! statistica##y si"ni&icant improvements on severa# tests inc#u!in" an improvement in voca%u#ary an! reco"ni9in" a picture$ The !ose shou#! %e pro%a%#y %e #ow &or )i!s< much much #ess than the a!u#t !ose$ Chi#!ren with autism may %e !e&icient in &ish oi#s< hence a ro#e o& !iet in autism$ A mu#tivitamin supp#ement may %e consi!ere!$ The serotonin system cou#! %e invo#ve! in autism< since there is a !i&&erent meta%o#ic response to = T1 a!ministration in chi#!ren with autism compare! to contro#s .see stu!y %e#ow0$ *$ What wou#! %e the appropriate !osa"e &or the various supp#ements that are su""este! &or autism? The chi#! is ?ust ; years o#!$ A$ Research in the area o& supp#ement use &or chi#!ren at various a"es with autism is (uite recent an! #itt#e is )nown a%out the %ene&its< ris)s< or e&&ectiveness o& these natura# supp#ements$ 1#ease consu#t with your pe!iatrician$ My %est "uess wou#! %e a%out a tenth o& =>> m" capsu#e a#thou"h I have no stu!ies to support this !osa"e recommen!ation$

Autism an! &ish oi# Chi#!hoo! autism may %e #in)e! to a !e&iciency o& &atty aci!s &oun! in oi#y &ish$ A pi#ot stu!y at the 3niversity o& Stir#in" &oun! that chi#!ren with autism ha! ce##s that %ro)e !own &atty aci!s more rapi!#y than norma# ce##s$ Autism rates in Scot#an! have risen !ramatica##y in the past ten years< a tren! mirrore! across the !eve#ope! wor#!$ In Scot#an!< an estimate! =><>>> peop#e< near#y @<>>> o& them chi#!ren< su&&er &rom autism$ ,rain ce## mem%ranes are compose! primari#y o& ome"a/A an! ome"a/B &atty aci!s< su%stances &oun! in oi#y &ish such as mac)ere# an! sa#mon$ A stu!y o& a%out ;> autistic chi#!ren #ast year revea#e! that ce## mem%ranes in their %#oo! meta%o#ise!< or processe!< &atty aci!s at a &aster rate than other chi#!ren$ The !iscovery #e! to specu#ation that a &atty aci! !e&iciency may %e partia##y responsi%#e &or the onset o& autism$ CWe have a#rea!y seen a connection %etween ome"a #eve#s an! schi9ophrenia an! !ys#e8ia<C sai! 2r -or!on ,e## o& the university$ I& ce## &unction in the %rain is chan"e!< the %ehavior o& the %rain wi## chan"e as we##$ 2r ,e## compare! ce## mem%ranes to a C%ric) wa##C o& &atty aci!s$ ,ric)s &a## out< %ut as #on" as they are rep#ace!< then the wa## ho#!s stron"$ 1ro%#ems occur when %ric)s &a## out &aster than they can %e rep#ace!$ I& the scientists con&irm this is what causes autism< they may conc#u!e that the answer is to rep#enish C%ric)sC o& &atty aci!s at a "reater rateD in short< eat more &ish$ Autism< vitamin ,B an! mu#tivitamins 1i#ot stu!y o& a mo!erate !ose mu#tivitamin E minera# supp#ement &or chi#!ren with autistic spectrum !isor!er$ > Altern 9omplement !ed. 2AAB 5ecDFA3@4:FA++'9. Adams >", :olloway 9. Ari0ona $tate ,niversity, P% "o# MC@AA@, *empe, AN ME2MC'@AA@, ,$A. 2etermine the e&&ect o& a mo!erate !ose mu#tivitaminEminera# supp#ement on chi#!ren with autistic spectrum !isor!er$ Twenty .;>0 chi#!ren with autistic spectrum !isor!er< a"es A/F years$ A -#o%a# Impressions parenta# (uestionnaire &oun! that the supp#ement "roup reporte! statistica##y si"ni&icant improvements in s#eep an! "astrointestina# pro%#ems compare! to the p#ace%o "roup$ An eva#uation o& vitamin ,.B0 #eve#s prior to the stu!y &oun! that the autistic chi#!ren ha! su%stantia##y e#evate! #eve#s o& ,B compare! to a contro# "roup o& typica# chi#!ren$ Vitamin C #eve#s were measure! at the en! o& the stu!y< an! the p#ace%o "roup ha! #eve#s that were si"ni&icant#y %e#ow avera"e &or typica# chi#!ren< whereas the supp#ement "roup ha! near/avera"e #eve#s$ The &in!in" o& hi"h vitamin ,.B0 #eve#s is consistent with recent reports o& #ow #eve#s o& pyri!o8a#/=/ phosphate an! #ow activity o& pyri!o8a# )inase .i$e$< pyri!o8a# is on#y poor#y converte! to pyri!o8a#/=/phosphate< the en9ymatica##y active &orm0$ This may e8p#ain the &unctiona# nee! &or hi"h/!ose vitamin ,.B0 supp#ementation in many chi#!ren an! a!u#ts with autism

Carnosine e#p&u# in Autism 'rom the !ay she was %orn< ,etty seeme! !i&&erent &rom other in&ants$ At an a"e when most in&ants en?oy interactin" with peop#e an! e8p#orin" their environment< ,etty sat motion#ess in her cri% an! !i!nGt respon! to ratt#es or other toys$ It wasnHt too #on" %e&ore ,etty was !ia"nose! with autism$ 3n&ortunate#y< mo!ern me!icine has #itt#e to o&&er as a cure &or this con!ition$ ,ut supp#ements may %e he#p&u#$ Researchers at the Autism an! Epi#epsy Specia#ty Services in La)e ,#u&&< I##inois< investi"ate! AI chi#!ren with autism in an F/wee)< !ou%#e/%#in!e! stu!y to !etermine i& carnosine wou#! resu#t in chan"es$ Carnosine is a natura# su%stance compose! o& ; amino aci!s$ It is &oun! in re#ative#y hi"h concentrations in severa# %o!y tissues< musc#es< an! nerve tissue< inc#u!in" the %rain$ The e8act ro#e o& carnosine is not we## un!erstoo!< %ut stu!ies in!icate that this nutrient has antio8i!ant potentia# an! may a#so act as a neurotransmitter .chemica# messen"er in the nervous system0$ The chi#!ren with autism receive! F>> m" o& carnosine a !ay an! were compare! with a "roup o& chi#!ren on p#ace%o$ A&ter F wee)s< chi#!ren "iven carnosine showe! statistica##y si"ni&icant improvements on severa# tests inc#u!in" an improvement in voca%u#ary an! reco"ni9in" a picture$ 2r$ Sahe#ian says+ Carnosine< a#so )nown as L/carnosine< is so#! in hea#th &oo! stores most common#y in capsu#es o& =>> m"$ It wou#! %e worthwhi#e &or chi#!ren with autism to try I>> to ;>> m" o& this nutrient %e&ore %rea)&ast an! #unch &or a &ew wee)s un!er a pe!iatricianHs supervision$

-#uten/ an! casein/&ree !iets &or autistic spectrum !isor!er$ !illward 9, 9ochrane 5atabase $yst (ev. 2AABD324:95AA+B9M. It has %een su""este! that pepti!es &rom "#uten an! casein may have a ro#e in the ori"ins o& autism an! that the physio#o"y an! psycho#o"y o& autism mi"ht %e e8p#aine! %y e8cessive opioi! activity #in)e! to these pepti!es$ Research has reporte! a%norma# #eve#s o& pepti!es in the urine an! cere%rospina# &#ui! o& persons with autism$ I& this is the case< !iets &ree o& "#uten an! Eor casein shou#! re!uce the symptoms associate! with autism$ O,5ECTIVES+ To !etermine the e&&icacy o& "#uten/ an!Eor casein/

&ree !iets as an intervention to improve %ehavior< co"nitive an! socia# &unctionin" in in!ivi!ua#s with autism$ SELECTIO6 CRITERIA+ A## ran!omise! contro##e! tria#s invo#vin" pro"rammes which e#iminate! "#uten< casein or %oth "#uten an! casein &rom the !iets o& in!ivi!ua#s !ia"nose! with autism$ As on#y one tria# &itte! the inc#usion criteria< no meta/ana#ysis is current#y possi%#e an! !ata are presente! in narrative &orm$ MAI6 RES3LTS+ The one tria# inc#u!e! reporte! resu#ts on &our outcomes$ 3nsurprisin"#y in such a sma##/sca#e stu!y< the resu#ts &or three o& these outcomes .co"nitive s)i##s< #in"uistic a%i#ity an! motor a%i#ity0 ha! wi!e con&i!ence interva#s that spanne! the #ine o& ni# e&&ect$ owever< the &ourth outcome< re!uction in autism traits< reporte! a si"ni&icant %ene&icia# treatment e&&ect &or the com%ine! "#uten/ an! casein/ &ree !iet$ REVIEWERSG CO6CL3SIO6S+ This is an important area o& investi"ation an! #ar"e sca#e< "oo! (ua#ity ran!omise! contro##e! tria#s are nee!e!$ Autism$

Lampiran 2= BAHAN BANT !EN"A#A$ YAN" B%&EH !E!BANT 'ANA'-'ANA' A T(S!A ) B%&EH *(*APAT'AN *(PASA$AN

TO# and the )D *i ures+++

...beginning with the most-simple exercises and in simple steps, this accompanies and leads the user to attaining the planned degree of learning. A number of varied units ma e ac!uiring and wor ing towards the following possible"

#olours , $orms ,%iverse conceptions, #onnection of words, #apital and small letters ,&umbers up to '(

Lampiran 22

$or the exercises neither eyboard nor mouse are necessary. )n accordance with the theories of *aria *ontessori user-friendly wooden figures are applied. +y means of pic ing up the three-dimensional, very realistic ob,ects --activity level. and the connection with the computer programme -technical level by means of the A#T)/)T0-+oard., perceptive organisation and learning is made more simple, motivating and user-friendly.

TOM Learnin" an! Therapy System

This set includes the Activity-+oard, software with user-manual and wooden-box sets -vehicles, fruit, vegetables, capital letters, numbers, forms, colours, sound-cubes and farm-animals.

TOM Accessories
This set consists of the following" $orest and 1oo animals, small letters and the first reading cards with two sets of non-electronic capital letters. This set is an accessory to our TO* 23earning- and Therapy System4. )t can only be used with the A#T)/)T0-+oard

Lampiran 22
CA$A PEN"A#A$AN !EN"" NA'AN PE$(S(AN YAN" TE$*APAT *( PASA$AN

6ame That O%?ect / Learnin" A%out 6ouns

*his en a in interactive activity helps children of all a es learn about nouns. /Hame *hat %b.ect/ is two resources in one: *he /%b.ect ?iewer/ displays hundreds of individual ob.ects and the Hame 7ame allows players to test their ob.ect knowled e. C6ame That O%?ectC inc#u!es+ 9hoose individual ob.ects or cate ories to focus on learnin ?iew all the ob.ects in the %b.ect ?iewer Animations show the ob.ects in use Performance reports track pro ress Print all ob.ects as F/ or 2/

:;J$J=

picture cards "oth !ac and P9 compatible 5ownload and playO L29.9E

Strate+ies
*each specific skills: social, behavioral, academic and or ani0ational. *he 1acial -#pressions ame addresses one aspect of social development. Present information visually and verbally. Picture 9ards are an important resource for communicatin visually. An Activity 9hoice "oard is another e#ample of a way to present information visually. $tructure the environment to be predictable with minimal distractions. $ome children mi ht benefit from a $tudy *ent. 5evelop schedules usin visual cues of pictures and words. Prepare for chan es in routine. $ee weekend schedules for one e#ample of how to do this. Provide interaction with non'disabled peers as role models for social, lan ua e and behavior skills. Practice new skills in different environments. 5evelop a behavior mana ement system that provides structure and consistency. 1orms Lampiran 23 can help with this.

Rajah 1 : Hasil kerja seni yang boleh diajar kepada murid a\utisma

Rajah 2 : Contoh bahan software bagi pengajaran nyanyian huruf vokal

Rajah 3 : Contoh !ontoh bahan bantu mengajar bagi kanak kanak autisma yang boleh diperolehi dari pasaran

Please check our list of all resources at $ite !ap to see if there are other items that can help your child.

K 1rev

6e8t L

,oo)s 5lphabet %ractice heets < 6loc- Letters !eelings ?or-boo!ine 9otor -ills < 5ctivity 6ooIandboo- !or Bew 0eachers 5lphabet %ractice heets < &KBealian cript Learnin" Aolor 6ingo 1ame < Learning Aolors !eelings 6ingo < Learn !acial *"pressions %eople 6ingo < Learning 5bout %eople %reposition !lash Aards < Location ?ords ight ?ord !lash Aards < !irst 1rade ight ?ord !lash Aards < %reprimer ight ?ord !lash Aards < %rimer ight ?ord !lash Aards < econd 1rade ight ?ord !lash Aards < 0hird 1rade ign Language < !lash Aards ?here is 6earJ < Location ?ords 6ingo * L + *LL < Aommunication 6oards Alassroom Ielpers < !ull Aolor %rintables

)24.35 )24.35 )23.35 )34.35 )24.35 )5.35 )5.35 )5.35 )4.35 )5.35 )5.35 )5.35 )5.35 )5.35 )4.35 )5.35 )2=.35 )23.35

Learnin" So&tware !antastic !aces < *motions 8 *ye 0rac-ing )23.35 1ames !ire 8 treet afety < ,nteractive Learning )23.35 IotL IotL IotL < !ire afety 1ame )23.35 Letter 9atchL < 5lphabet 9emory 1ame )23.35 9y !urry 6est !riend < %et afety 1ame )23.35 9y Mard < ,nteractive Learning 1ame )23.35 Bame 0hat 4b@ect < Learning about Bouns )23.35 %lacing 4b@ects < !un with %repositions )23.35 %layground afety < ,nteractive Learning 1ame )23.35 plish plash < ?ater afety 1ame )23.35 ?hat ,s 0he 4rder < 0ime e(uencing 1ame )23.35 Ma)e/A/Sche!u#e 9a-e<5< chedule 4nline 9a-e<5< chedule &es-top 9a-e<5< chedule A& < &es-top A& Cersion

)43.35 )43.35 )53.35

1icture Car!s 5nimals 8 %et afety < 2H %icture Aards )7.35 &octors Cisit < %icture Aards 8 ocial tories )23.35 !ood < 2H %icture Aards )7.35 afety %icture Aards < !ire# treet 8 )3.35 %layground 24= ocial %icture Aards < 2 inch 8 2 inch )27.35 0herapy %icture Aards < 40 8 %0 )5.35 0oileting %icture Aards < 8 6athroom Ielpers )..35

S3RAT SO7O6-A6 C3TI (u.. =ami : %,!K2.F.BK2CF.2 3F4

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5en an ini dimaklumkan bahawa Peperiksaan Akhir $emester !ei 2AAM akan diadakan pada tempoh yan dinyatakan di atas. *uanKpuan dinasihatkan untuk muatturunkan daripada laman web %,!, 5a!ua# 1eperi)saan A)hir Semester Mei ;>>F< Lo)asi 1eperi)saan ba i Pusat Pembela.aran berkenaan, Ma)#umat !an Arahan 1eperi)saan O3M< 5a!ua# A)tiviti 1eperi)saan Semester Mei ;>>F !an S#ip 7e%enaran Men!u!u)i 1eperi)saan Mei ;>>F$ $ehubun an itu kami in in menasihatkan a ar tuanKpuan: a4 men ambil tindakan yan perlu ba i setiap aktiviti yan disenaraikan dalam 5a!ua# A)tiviti 1eperi)saan Semester Mei ;>>F< !an b4 memohon awal kepada !a.ikanKPen etuaK7uru "esar berkenaan untuk cutiEcuti tanpa re)o! ba i menduduki kertas peperiksaan tuanKpuan pada tarikh yan telah ditetapkan dalam 5a!ua# 1eperi)saan. Pihak %pen ,niversity !alaysia menyokon permohonan tuanKpuan untuk cutiEcuti tanpa rekod tersebut. =ami berharap tuanKpuan akan berusaha bersun uh'sun Peperiksaan $emester !ei 2AAM. Se#amat Ma?u 5aya. $ekian, terima kasih. 2an benar, uh untuk mencapai ke.ayaan dalam

TEO ,E6- 73A6 *imbalan Pen urus "esar 3Peperiksaan4

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