Contents pages

Abstract 4

Introduction 4

Addressing autism spectrum disorder 6

Defining recovered 9

Intensive behavioural interaction 11

The lack of intensive interaction 13

Conclusion 15

1

Reference 17

Is it possible to cure children of their autism? Critically evaluate Dr. Deborah Fein’s claim that 1/10 can no longer meet diagnostic criteria. http://www.telegraph.co.uk/health/children_shealth/5298367/One-in-10-children-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 Fein’s 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.

2

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.

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

3

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

4

definition and some of the features and causes as well as trying to

describe or define recovery as in Dr Deborah Fein’s 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 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

5

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

6

from the children with autism as their peers. Moreover,

researchers pointed out that there are different types of autism,

including lower-functioning 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 child’s

difficulty is the deficits in social and communication skills, lack of

7

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 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

8

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

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,

9

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

10

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”.

11

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

12

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 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.

13

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 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

14

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 long-

term 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 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

15

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” (Irvine, 2009). Furthermore, that what most of

16

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

17

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

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).

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