Contents

pages

Abstract

Introduction

Addressing autism spectrum disorder

Defining recovered

Intensive behavioural interaction

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The lack of intensive interaction

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Conclusion

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Reference

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Is it possible to cure children of their autism? Critically evaluate Dr. Deborah Feins claim that 1/10 can no longer meet diagnostic criteria. http://www.telegraph.co.uk/health/children_shealth/5298367/One-in-10children-with-autism-overcome-condition-by-age-nine-study-finds.html Abstract It is argued that it is possible to cure autistic children that they no longer meet the criteria of autism condition. In a recent article, Dr Deborah Fein suggests that intensive behavioural therapy is the best treatment and that this intervention helps autistic children to overcome the condition. This essay will critically evaluate this claim by talking about autism in general and defining recovery as suggested in Feins article. In addition, this essay will explain interventions and behaviour interaction and the aspects of intervention which may require further research. The main results were that most of the research has confirmed there is no known cure for autistic children, but there are some steps which may help the autistic child to overcome the condition in some particular aspects.

Introduction: Autism is a serious psychological disorder with onset in early childhood (Lovaas, 1987, P.3). Lovaas explained autism in this way and many others researcher would agree with him, it is a serious disorder and usually appear in early childhood. The number of cases of autism spectrum disorder has rapidly increased in recent years (Yazbak, 2004). However, there are some studies in Britain which mention that the autism spectrum currently affects between 60 and 100 per 10,000 children under the age of eight (Guldberg, 2010, P.168; (Irvine, 2009). As a result of this increase, most recent research talks about interventions and how it might help.
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Knowledge and understanding of the causes of the emergence of autism is certainly a challenge to current research and has important implications for practice, and theories, from both of which future research may be directed to a different area of Autism (Perez, Gonzalez, Comi, & Nieto, 2007). However, as long as there are different kinds of interventions such as the intensive behavioural therapy, the TEAACH approach (Treatment and Education of Autistic and Communication related Handicapped Children), the Picture Exchange Communication System and Social Stories (Guldberg, 2010), there will be different views on the best approach for an individual child . Contributing to this debate on what is the best intervention methods for autism spectrum disorders, Dr Deborah Fein suggests that intensive behavioural therapy is the best treatment and that this intervention helps autistic children to overcome the condition (Irvine, 2009). Although Fein admits that treatment takes long time before recovery can be seen, she added that they were at a very early stage(Irvine, 2009). This essay therefore aims to talk about intensive behaviour interaction as treatment for autism as it can help them to recover - Fein claims studies have shown the range for children recovering from autism is 10 percent to 20 percent (Irvine, 2009). Some studies have indicated that autistic students often respond positively to interventions that aim to develop social interaction skills with peers (Jones, 2007). From this standpoint, we can say that as long as the intervention goes well with the child, as well as the interaction, it is likely that the child will be able to overcome the condition of autism, but we should acknowledge that this depends on an individual child and what the causes are. Most of the research centred on the fact that intensive early intervention has a significant positive impact on the autistic to

the point that makes them engages with the regular educational environment (Harris, 2007; Howlin, 2003; Remington et al., 2007). It is worth noting that the scope of this research is not fully inclusive and is not intended to be(Humphrey & Parkinson, 2006). Considering what Dr Deborah Fein claims, that 10 to 20 percent of autistic children no longer meet the criteria for autism after undergoing years of intensive behaviour therapy, this essay will try to cover aspects of autism spectrum disorder, such as the definition and some of the features and causes as well as trying to describe or define recovery as in Dr Deborah Feins study. Further, the essay will discuss very carefully the intensive behaviour interaction and the lack of this intervention using various studies which have been carried out.

Addressing autism spectrum disorder: First of all, there are many definitions for autism which all outline the same features as below being the most appropriate one made by the American Psychological Association. Autism Spectrum Disorders (ASD) are a group of related development disorders that are characterized by impairments in reciprocal social interaction, language development and intentional communication, and restricted interests and stereotyped motor behaviours (American Psychological Association 1994) (Helt et al.,2008,P.339). One of the most important aspects, after defining autism, is knowing the age at which it can be identified. Nowadays, most children with autism are identified between the ages of 2 and 4 years as having major deficits in social communication, even though some parents have noticed the difference in the first
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year of life (Lord & Richler, 2006; Perez et al., 2007). Generally, the first symptoms are observed by the parents and the earliest symptoms sometimes show before the parents are aware that something is wrong but usually it is difficult to be observed before the close of the first year (Perez et al., 2007). In other words, the first and most recurrent to be observed, most of the time by parents as pointed out earlier, is the regressive and fluctuating behaviours (Perez et al., 2007). After we talk briefly about the age and the symptoms we should, however, talk a little bit about diagnosis. According to Lord and Richler (2006, p.39) A diagnosis of autism is based on symptoms in three areas: difficulties in reciprocal social interaction, difficulties in communication, and the presence of restricted and repetitive behaviours or interest Alongside symptoms are the deficits which might affect most of the children with autism. Researchers noted that children with autism have deficits in social and communication skills which can be organized into two main areas: the first difficulty is in concentration, which reflects the common difficulty of interest among people and objects at the same time (Wetherby, 2006). The second difficulty is in the use of symbols which reflect traditional or common meanings and the difficulty of learning these codes as well (Wetherby, 2006). Other research represents other features that appear in autistic children which is that they prefer isolated activities and stand beside spending a long time in aimless behaviours or engaging in problematic behaviours rather than in social interaction (Harris, 2007). Furthermore, researchers noted that it is important to take into account that children with autism spectrum disorder develop differently from their peers (Guldberg, 2010). So, often researchers do not expect the same outcome from the children with autism as their peers. Moreover, researchers pointed out that there are different types of autism, including lower-functioning
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autism and some of them have accompanying learning difficulty; there is another type like Asperger's Syndrome and high-functioning autism (Humphrey & Parkinson, 2006). In addition, some research indicates that those autistic children sometimes are able to gain educational and language skills easier than social and emotional skills (Harris, 2007). So, as we can see, there are many different features and deficits and so on but if we want to know what causes these deficits it may be hard to find. There is no doubt that all the studies and research prove that the causes of autism are unknown and it is possible that the causes of neurological or genetic conditions present many possible causes (Hayward, Eikeseth, Gale, & Gale, 2009; Lovaas, 1987; Pelios & Lund, 2001). However, the fact is nobody yet knows exactly or for sure what causes autism. To explain more about what is going on with autistic children, this essay will talk about some personal characteristics. According to Wetherby, (2006), children with autism communicate, but for, reasons other than social and communication it is often aimless. The strong indicators of very young autism is language delay which is often first concern for parents (Lord & Richler, 2006). However, the most common thing for parents to say about their childs difficulty is the deficits in social and communication skills, lack of self-help skills and sleeplessness (Dillenburger, Keenan, Doherty, Byrne, & Gallagher, 2010). In addition, there are other problems facing this category of autistic children and their family in addition to a lack of self-help skills and sleeplessness, such as educating them and creating community awareness of how to deal with them and so on. Nonetheless, Dillenburger et al. (2010) argue that despite the increasing number of autistic students joining the mainstream learning environment, the teachers and professional sometimes do not have enough experience for this
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category and other impacts can occur from having a child with autism in the classroom. As well as this, they are generally not trained in carrying out intervention behaviour therapy or any other treatments (Dillenburger et al., 2010). This discussion about autism, from the definition to some of the problem is in order to be able to evaluate what Professor Deborah Fein claims about autistic children; that children with autism can recover, in order to agree with that we need to know what exactly the meaning of recovery equates to in her study.

Defining recovered: Some researchers have assumed that the construction of a special environment, intensive and comprehensive education of very young children with autism, might allow them to be as their normal peers (Lovaas, 1987). And that is exactly what Dr Deborah Fein claims: Although the right support at the right time can make an enormous difference (Irvine, 2009). So both suggest that intervention should be early, intensive and in a special environment in order to see the impact on the child. However, there will always be questions remaining for each of these assumptions; How? While some of the other researchers say that the treatment succeeded because they were originally non-autistic (Lovaas, 1987) this is another variable and reverses the previous theory. According to Helt et al. (2008) what they meant by recovery is losing the behavioural characteristics of ASD. This essay, as mentioned earlier, will define and discuss what Dr Deborah Fein meant by recovery in her study in order to see to what extent this might be true. Helt et al. (2008) point out that studies have documented improvement of all aspects of behaviour, including academic life, language, adaptive skills and
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misconduct, but there are other studies which have not documented improvement in these skills and behaviour. From this point, it appears that researchers still cannot be sure that autistic children can recover or that they might overcome some aspects, such as the level of IQ, language delay and academic skills (Howlin, 2003; Remington et al., 2007). On the other hand, they use specific elements for recovery: The first element by history which means the child was diagnosed with ASD in early childhood and the second element by current functioning which means they have slightly different criteria like difficulties with attention, organization or specific academic difficulties (Helt et al., 2008) so we could say they are not really autistic or they do not show the usual autistic symptoms or deficits. Although most of the studies argue that autistic children undergo diagnosis between the ages of 2 to 4 years (Perez et al., 2007) others believe that it could appear later so this age range is no longer a key condition (Pelios & Lund, 2001). If so, that means the element for recovery no longer meets those who diagnose after the ages of 2 or 4 years. According to The Telegraph, Those with Asperger Syndrome may have their conditions diagnosed later than the age described sometimes until their teens or adulthood (Irvine, 2009). To explain more, this would not meet the element by history that Professor Deborah Fein and her colleague described before. Clearly, what makes recovery or overcoming the autism condition really hard is that we still do not know what exactly causes autism spectrum disorder, until we know this; we might say that there are such treatments for autism.

Intensive behavioural interaction: In order to address intensive behavioural interaction this section will talk briefly about the background of this intervention. As Humphrey & Parkinson (2006) pointed out The many variants of early intensive behavioural intervention in autism originates from the work of Lovaas (1987), who pioneered the UCLA Young Autism Project (Pelios & Lund, 2001, P.77). Early intensive behavioural intervention (EIBI) using applied behaviour analysis (ABA) has by far been the intervention choice which has been put under the spotlight arousing interest in this field for researchers and professionals. Indeed for many parents and professionals it has become a much sought-after and preferred treatment. This intrigued many researchers, not least because of the claims of learning recovery and improvement in disability in a substantial minority of children chosen to receive this intervention. (Butter, Mulick, & Metz, 2006). Nevertheless, to discuss this intervention it should be considered more carefully what it means and what the conditions of work are, and is the intensive behavioural interaction actually helps autistic spectrum disorder to overcome or not. To define intensive behavioural interaction, one must consider what is meant by intensive. Generally, it means behavioural treatments that are delivered in high doses. For example, 40 hours per week in many children on a daily basis (Schreibman, 2000). To address the meaning of intensive interaction we realise that there are many definitions but they are not really so different. However, according to Firth, Elford, Leeming and Crabbe (2008, p.58) Intensive Interaction is an approach to developing the pre-verbal communication and sociability of people with severe or profound and multiple learning disabilities and autism.

This program reinforces the theory that human behaviour is subject to precedents and consequences, it focuses on specific behaviours and assumes that it is possible for children to learn new skills through amendments and to provide encourage for the immediate good behaviour strengthening, as well as this is what happening with children between the ages of two and four years (Humphrey & Parkinson, 2006; Schreibman, 2000). To explain more, intensive behaviours interaction, based on principles derived from more than 60 years of ABA research, underpin the teaching methods of EIBI and include the use of the practice and promotion of functional analysis and single case experimental designs (Butter et al., 2006). Some of the studies have argued that early intensive interaction should involve of a minimum of around 15 to 20 hours a week lasting at least 6 months (Howlin, 2003). Others think that the minimum number of hours of the intensive behaviour interaction should be around 30 to 40 per week including activities for 3 years or more and children may be enrolled on this programme from as young as 2 years old (Butter et al., 2006). Of the most important factors in the diagnosis and treatment of autism effective communication is cooperation between parents, teachers and other specialists (Dillenburger et al., 2010). Scheibman (2000) indicates the same factors in her study and emphasises the great role played by parents, siblings and peers and others, and the inclusion of daily appropriate environmental aspects including the home, classroom and the community as being the most important benefits of this quality of intervention (Howlin, 2003). Also, not forgetting the importance of effective training programs and the enhanced treatment benefit achieved (Schreibman, 2000). One important characteristic of intensive interaction is to enable children with autism to raise the level of social interaction between the skilled and the less skilled (Barber, 2007; Harris, 2007), mainly because the
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autistic children will try to copy others or as Barber (2007) pointed out, that intensive interaction depends somewhat on imitation. Moreover, although there are a number of parents who have achieved success with a variety of different approaches and learned their benefits and shortfalls, most of them clearly preferred ABA-based intervention (Dillenburger et al., 2010). In fact many researchers have emphasised the success of this intervention in many cases (Butter et al., 2006; Lord & Richler, 2006). It has also been argued in a lot of research that around 40% of the children involved in such intensive interactions treatment become indistinguishable from their normally developing peers (Howlin, 2003; Lovaas, 1987). Furthermore, other studies emphasise the positive aspects of behavioural treatment that can build complicated behaviours such as language and can help to suppress pathological behaviours such as aggression (Lovaas, 1987). Clearly, intensive behaviours interaction has huge benefits with children with autism but still not reliable and we need more studies using this approach. For this reason next section will consider some lack or problems facing this intervention.

The lack of intensive interaction: Interventions for autism have come a long way since the condition was described by Kanner in the 1940s (Howlin, 2003, P.250). Even though intensive interaction has been known and practised for so long, it is still not well established and more work, with more appropriate samples, is needed. It is crucial that most of the studies do not really have an appropriate sample, for example, in some of the studies their sample was taken randomly, while in others their sample was really small and there were many variables in the given examples which resulted in the studies not being of a very exact specification. According to Butter et al.(2006) the
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combination of a lack of well-controlled studies, producing conflicting information about the natural course and variability of functioning for children with autism, as well as the fact that attempts at replicating the original Lovaas findings were somewhat haphazard, questions still remain concerning behavioural intervention. In my opinion, one of the most confusing points in these interventions is that it is indicated or referred to differently in various research, , for instance, some of the research calls it Early Intensive Behavioural Interaction (EIBI) (Butter et al., 2006; Humphrey & Parkinson, 2006) other intensive interaction (Harris, 2007) and intensive behavioural treatment (Schreibman, 2000). And many other examples which make the researcher think that although all of them agreed about intensive, there is different belief in the importance of early and so on. This intervention is considered in spite of success with many cases (Butter et al., 2006), but it lacks established rules and basic principles which would make it possible to intervention effectively to cases of autism spectrum disorder. The researcher Harris (2007) pointed out, that there is evidence to document the modest benefits of early intensive intervention. As well as, some research have explained that despite the success and benefits of this approach, but it has lacks in some of the philosophical, practical and organizational adoption of this approach (Firth, Elford, Leeming, & Crabbe, 2008). Another researcher was also caution with use of the word overcome or recover and mentions that there is not much evidence that very early intensive interventions could considerably alter the longterm course of the disorder (Howlin, 2003). To support this more, Hayward et al. (2009) also pointed out that in his research the result were very disappointing the participants showed no significant change in IQ as well as none of them obtained best outcome rank. In addition, according to Howlin (2003) who argue that there is a risk that focus on the importance of early pre-school interventions would affect
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older children. Moreover, Pelios and Lund (2001) have argued that many kinds of treatments, not in the prescribed standards of scientific validation, but instead are rooted theories and false assumptions regarding the causes and nature of autistic disorder. Clearly, as some studies claim that early intervention programmes are still required longer term evaluations as well as covering many different aspects of functioning to be more effective programmes (Howlin, 2003). Also some studies have also unanimously agreed that it is difficult to predict the results are not based on age or on anything else (Hayward et al., 2009). The reason for this probably because the lack in our knowledge of what is the causes of autism. On the other hand, according to Humphrey and Parkinson (2006) there is another concern about this research in this area it is the common focus on the variables and outcomes among children and its consequences for every child. But this trend is difficult for several reasons, first because it reinforces the notion that the root of the problem lays within the child and the second the impact of environmental factors (Humphrey & Parkinson, 2006). In other hand, some research stated that some children with higher functioning have a tendency to do better over the long term without being enrolled in an intensive behaviour intervention program (Butter et al., 2006). Conclusion In conclusion, returning to the original question: Is it possible to cure children of their autism? The answer must be probably but we still lack the data to prove this (Howlin, 2003, P.257). This what Dr Deborah Fein would agree with as she warned that even after lots of therapy, most autistic children remain autistic, adding that recovery was "not a realistic expectation for the majority of kids
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(Irvine, 2009). Furthermore, that what most of the research conclude with the fact that were not the expectations of this intensive behaviour interaction intervention realistic. Although at the large number of excellent research in this area, but it is still needs more research to be done (Humphrey & Parkinson, 2006). Also as many researcher point out that even if the teachers already committed to inclusive they do feel that they do not have enough training for the autism (Humphrey & Parkinson, 2006). It is important to note that currently the need to address issues related to autism spectrum is huge (Humphrey & Parkinson, 2006) and this is likely explain the growing number of people with autism, as noted earlier. Since 1990, ABA has been recommended as useful intervention for many children with autism (Hayward et al., 2009; Lovaas, 1987) and regarding this it is recommended that a lot more research is done in this specific area. However, as Schreibman (2000) argues, these interventions have played a huge role in influencing children with autism; they have been successful in changing some of the behaviours and social life and increasing the language and academic skills and reducing some severe behavioural problems. In fact, most of the research confirmed the importance of early intervention success with autistic children and agree that it helps them to be integrated into mainstream schools more and more (Lovaas, 1987). As also indicated some research argued that IQ gains are possible for children with autism at the very least and intensive behaviour intervention may help to strengthen these gains (Butter et al., 2006).Finally, but perhaps most importantly, this area still needs further research to try to reach more clear results (Hayward et al., 2009; Humphrey & Parkinson, 2006).In addition, according to Howlin (2003, P.260) We need many more studies to look at what is going on with the autistic children growing up that may account for the differences within the groups. In
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conclusion, this research pointed to some clear evidence that at present there is no known cure even though as we mentioned earlier that the right support at the time can make big different to autistic children (Irvine, 2009).

References Barber, M. (2007). Imitation, interaction and dialogue using Intensive Interaction: tea party rules. Support for Learning, 22(3), 124-130. Butter, E. M., Mulick, J. A., & Metz, B. (2006). Eight Case Reports Of Learning Recovery In
Children With Pervasive Developmental Disorders After Early Intervention. Behavioral Interventions, 21(1), 227243.

Dillenburger, K., Keenan, M., Doherty, A., Byrne, T., & Gallagher, S. (2010).
Living with children diagnosed with autistic spectrum disorder: parental and professional views. British Journal of Special Education, 37(1), 13-23. Firth, G., Elford, H., Leeming, C., & Crabbe, M. (2008). Intensive Interaction as a Novel Approach in Social Care: Care Staffs Views on the Practice Change Process. Journal of Applied Research in Intellectual Disabilities, 21(1), 5869. Guldberg, K. (2010). Educating children on the autism spectrum: preconditions for inclusion and notions of best autism practice in the early years. British Journal of Special Education, 37(4), 168-174. Harris, S. L. (2007). Autism Intervention. Encyclopedia on Early Childhood Development, 1(1), 1-5.
Hayward, D., Eikeseth, S., Gale, C., & Gale, C. (2009). Assessing progress during treatment for young children with autism receiving intensive behavioural interventions. Autism, 13(6), 613-633. Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., et al. (2008). Can Children with Autism Recover? If So, How? Neuropsychol Rev,

18, 339-366. Howlin, P. (2003). Can early interventions alter the course of autism? Novartis Foundation Symposium, 251(1), 250-265. Humphrey, N., & Parkinson, G. (2006). Research on interventions for children and young people on the autistic spectrum: a critical perspective. Journal of Research in Special Educational Needs, 6(2), 7686. Irvine, C. (2009). One in 10 children with autism overcome condition by age nine, study finds. Retrieved 18/3/2011, 2011, from
http://www.telegraph.co.uk/health/children_shealth/5298367/One-in-10-children-with-autismovercome-condition-by-age-nine-study-finds.html 15

Jones, V. (2007). I felt like I did something good the impact on mainstream pupils of a peer tutoring programme for children with autism. British Journal of Special Education, 34(1), 3 -9. Lord, C., & Richler, J. (Eds.). (2006). Early Diagnosis of children with Autism Spectrume Disorders (First Edition ed.). New York: The Guilford Press.
Lovaas, O. I. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in young Autistic Children. Journal of Consulting and Clinical Psychology, 55(1), 3-9. Pelios, L. V., & Lund, S. K. (2001). A Selective Overview of Issues on Classification,

Causation, and Early Intensive Behavioral Intervention for Autism. Sage Publications, 25(5), 677-697.
Perez, J. M., Gonzalez, P. M., Comi, M. L., & Nieto, C. (Eds.). (2007). Eearly Manifestations of Autistic Spectrum Disorder During the first Two Years of Life. London: Jessica Kingsley Publishers. Remington, B., Hastings, R. P., Kovshoff, H., Espinosa, F. d., Jahr, E., Brown, T., et al. (2007). Early Intensive Behavioral Intervention: Outcomes for Children With

Autism and Their Parents After Two Years. AMERICAN JOURNAL ON MENTAL RETARDATION, 112(6), 418438. Schreibman, L. (2000). Intensive Behavioral/Psychoeducational Treatments for Autism: Research Needs and Future Directions. Journal of Autism and Developmental Disorders, 30(5), 373-378. Wetherby, A. M. (Ed.). (2006). Understanding and Measuring Social Communication in Children with Autism Spectrum Disorders (First Edition ed.). New York The Guilford Press. Yazbak, E. (2004). Autism seems to be increasing worldwide, if not in London. Retrieved 20/3/2011, 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC318519/

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