Categories
Autism Spectrum Disorder

Drama Therapy – Skill Development in ASD

Individuals with Autism Spectrum Disorder (ASD) often have difficulties developing skills connected to the concept of Theory of Mind.  According to Psychology Today, Theory of Mind involves “understanding another person’s knowledge, beliefs, emotions, and intentions and using that understanding to navigate social situations.”  A creative strategy known as Drama therapy is used to help build these skills, which is supplemented with more traditional treatments in clinical settings such as Applied Behavioral Analysis.  MSR News Online describes the techniques seen in Drama therapy as “exercises commonly practiced in the theatre such as scene acting, improvisation, and physical acting.”  This outlet provides a fun atmosphere for individuals with ASD to develop skills in a fun environment with their peers.

Drama Therapy works to improve Theory of Mind in individuals with ASD by allowing them to take on the role of a character.  It encourages adolescents to get in the mind of fictitious characters within social interactions. This helps individuals develop skills in empathy and understand the feelings and behaviors of others through these theatrical transformations. As described in, “The Effects of Drama Therapy for Children with Autism Spectrum Disorders,” a study conducted as an honors thesis at Bowling Green State University by Katie O’Leary, “Children on the spectrum want social connections as well, and drama therapy helps a child learn how to relate to others by actually becoming another person through a character on stage (Bailey, 2010).”

In O’Leary’s study, she describes exactly how Theory of Mind skill can be achieved through drama therapy.  She states that “various social situations can be modeled and role-played giving the child a solid level of comfort and familiarity with the situation so that when social interaction is encountered in real life, the child can engage in a more normal manner.”  Drama Therapy works to prepare individuals for social interactions which they will ultimately encounter in their own lives.  Handling these social situations while working towards certain developmental steps in a fun and expressive way allows those with ASD to master these skills.  O’Leary asserts that the drama therapy improved their individuals’ skills for, “working with others, interacting and engaging with peers, learning parts for the performance, concentrating his physical body in games and exercises, and learning how to behave through a different character that each student was assigned as an actor.” The benefits obtained by drama therapy give these individuals more confidence in their social interactions outside of the theatre. Having more confidence will lead to a more fulfilling and successful social experience.

The benefits of drama therapy are not only limited to the acquisition of skills related to Theory of Mind. According to MSR News Online, individuals who participate in drama therapy experience, “increased self-confidence, improve self-esteem and pride in their accomplishments, improve recognition of emotions in others, improve identification and labeling of their own emotions, enjoy new leisure-time activity in a group where they can be successful, enjoy a new awareness of volume levels and beginning modulation of vocal levels, enjoy new skills for functioning as part of a group, enjoy new skills for following directions, improve the ability to interact with peers.”  The benefits of this type of therapy are invaluable for persons on the spectrum.  

References: 

MD, Dr. Charles Crutchfield III, et al. “Home.” MSR News Online, 24 Nov. 2017, spokesman-recorder.com/2017/11/24/drama-therapy-new-tool-help-autism/

O’Leary, Katie. “The Effects of Drama Therapy for Children with Autism Spectrum Disorders.” Scholarworks.bgsu.edu, 16 Dec. 2013, scholarworks.bgsu.edu/cgi/viewcontent.cgiarticle=1002&context=honorsprojects

Thompson, Brittany. “Theory of Mind: Understanding Others in a Social World.” Psychology Today, Sussex Publishers, 3 July 2017, www.psychologytoday.com/blog/socioemotionalsuccess/201707/theory-mind-understanding-others-in-social-world

Categories
Autism Spectrum Disorder

Tablet Games: A Possible Future Diagnostic Technique for ASD

Diagnostic techniques for Autism Spectrum Disorder (ASD) often fall short of perfect because they rely on observation of behavioral and developmental progress by a physician (Screening and Diagnosis).  This subjectivity leads to a large population of undiagnosed individuals.  A study was recently conducted which aims to provide an effective supplemental tool in diagnosing and tracking the progress of therapy in ASD in children by Kołakowska, Landowska, Anzulewicz, and Sobota.  

Automatic Recognition of Therapy Progress Among Children with Autism studied the behavioral data of individual users while engaging in tablet games that monitored user activity through features such as touch screen sensors, accelerometer trackers, and a gyroscope that is able to record behavioral characteristics continuously. These features track the behavioral data of the user, which are incredibly accurate at predicting ASD in children at an early age, as well as track the progress of their therapy.  When the study was replicated, the authors found that this technique can be used to “identify children with autism with up to 93% accuracy.” Early diagnosis is crucial for the individual’s future development.  This research is important because it offers unique insights in the form of quantifiable data of behavioral characteristics of ASD, thereby eliminating some human error that may result in traditional diagnostic and progress checks alone.

Tablet games are useful for therapy progress because they focus on, “particular issues by teaching specific skills–e.g. expressing needs, learning certain behaviors, improving verbal communication, answering questions, interacting with other people in typical situations, recognizing and expressing emotions.” The detection of eye movement while engaging in a tablet game is a feature of this therapy.  The software records eye movements of the individual during gaming in order to capture the individual’s behaviors. Data collected from changes or lack thereof in eye movement can help the interpretation of other factors, such as motor deficiencies, making diagnosis more precise and evidence-based  The software can track motor deficiencies in individuals and record “the way a particular movement is prepared, in the velocity, acceleration, and jerks while specific types of arm movements are performed, or in different distributions of grip force over time”.  The data collected can then be used as a supplemental tool by the diagnostician.

Another advantage that tablet game platforms offer to diagnostic practices is that it provides data through a stress-free platform, not typically seen in traditional settings such as a questionnaire in a clinical interview. The DSM-5 illustrates the “insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior” often seen in individuals with ASD. Tablet games utilize this tendency through computer technology, which provides a “predictable framework” in which children with ASD are often comfortable with.  

 A unique aspect of the tablet game approach is that it provides a wealth of raw data that eliminates some human error seen in visual analysis of behavior alone. Though further research should be done to reassure the effectiveness of these tablet programs, experts should consider working this technique into their diagnostic practices in order to add evidence to their diagnosis and assure that they are being as accurate as possible.  

References:

Kołakowska, Agata, et al. “Automatic Recognition of Therapy Progress among Children with Autism.” Nature News, Nature Publishing Group, 24 Oct. 2017, www.nature.com/articles/s41598-017-14209-y

“Neurodevelopmental Disorders.” Neurodevelopmental Disorders | Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association Publishing, 2013, dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm01#x98808.2728600

Categories
Autism Spectrum Disorder

Person-First Language: The Right Way, Right?

As the importance of rhetoric remains a controversial topic today in political discourse, a split has risen in the Autism Spectrum Disorder (ASD) Community over the issue of person first language.  Person-First Language reaffirms the idea that those who are affected by disabilities are not defined by them, and have unique identities that are often overshadowed by the harmful language used to describe them.  Whether or not you have been exposed to this type of language may not have been obvious to you at the time. Have you ever heard or read references to someone on the spectrum as a “person with autism” as opposed to an “autistic person”, if so then you have experienced its implementation first hand.  

Person-first language advocates believe that the words we choose to use truly do have an impact on society’s attitude towards those with autism and their ultimate treatment.  This belief is further explored in the article “Put me first: The importance of person-first language by Mary Tobin. Tobin states that , “Person-first language is a philosophy of putting individuals before their disability. As you will see, this is about more than just language; it goes deeper into our attitudes toward others and how those attitudes translate into action” (Tobin, 2011).  The goal of this language is to change the attitude of defining a person by their condition, into celebrating that person. While there is large support for the use of this type of language to describe individuals with ASD, there is a controversy that this line of thinking has the reverse of its intended effect.

Those opposed to person-first language prefer to be called an “autistic person” because they believe having ASD is a beautiful and unique aspect of their identity, and to change the semantics ultimately chalks up their identities to misfortune and devalues them. Others would argue that this type of language is actually harmful to the identities of those with ASD.  They believe that being “an autistic person” is inseparable from their person. To make a distinction is to reinforce that having ASD, creates an idea that they are somehow less than. This sentiment is explained by an article, “The Significance of Semantics: Person-First Language: Why It Mattersby Lydia Brown.  Brown states that “ when we say ‘person with autism,’ we say that it is unfortunate and an accident that a person is Autistic. We affirm that the person has value and worth, and that autism is entirely separate from what gives him or her value and worth. In fact, we are saying that autism is detrimental to value and worth as a person, which is why we separate the condition with the word ‘with’ or ‘has’” (Brown, 2011).  This side of the argument has the same goal as person-first language, yet it uses different logic which produces the opposite execution.        

Another point of view believes that our focus should not be on language, but the intention of the individual should be the focus of the conversation. This argument is voiced by a mother whose son has ASD.  She uses both kinds of language when talking about her son.  She describes her opinion in her article, “Has Autism” versus “Is Autistic”; A muddled debate.  She states, “I’m far more interested in the substance of what someone says rather than getting hooked up on whether they used “autistic” or “has autism” (2011).  While she displays rejection to both sides of the argument, her main objective is to allow her son a positive experience with his identity and experiences with those around him.

After reading an overview of the central points of both arguments, where do you stand?  While I believe that rhetoric and semantics do have an impact on the world and its attitudes,  I do agree with the logic used by both sides of the debate.  Consider, that the most beneficial point of view to keep in mind could be the person you’re talking with. Ask them how they feel about the subject and what makes them comfortable.  In the end, isn’t the underlying theme of both arguments to keep the individual in mind?

References:

Brown, L. (2011, August 04). The Significance of Semantics: Person-First Language: Why It Matters. Retrieved October 01, 2017, from http://www.autistichoya.com/2011/08/significance-of-semantics-person-first.html

Tobin, M. (2011, May 23). Put me first: The importance of person-first language. Retrieved October 01, 2017, from http://www.ttacnews.vcu.edu/2011/05/put-me-first-the-importance-of-person-first-language/

“Has Autism” versus “Is Autistic”; A muddled debate. (2011, July 26). Retrieved October 01, 2017, from https://autismandoughtisms.wordpress.com/2011/07/25/has-autism-versus-is-autistic-a-muddled-debate/

White Alphabet Dice. (n.d.). Retrieved October 01, 2017, from https://www.pexels.com/photo/toys-letters-pay-play-48898/

Categories
Schizophrenia

Autism or Schizophrenia: A Common Misdiagnosis

If a child is socially withdrawn and does not make eye contact when communicating with others, is the diagnosis schizophrenia or autism (Dvir & Frazier, 2011)? The two overlap because in most cases of schizophrenia, patients are often diagnosed during late adolescence to early thirties (WebMD, 2016). Therefore, a diagnosis earlier in age is rare and often becomes misdiagnosed. According to the DSM-5, schizophrenic symptoms are categorized as either positive or negative and include delusions, hallucinations, disorganized speech, and catatonia, which is an irregularity in motor movement (APA, 2013). Although this disorder is commonly diagnosed in young adults during late adolescence, there have been rare cases of schizophrenia in youth, which are those under the age of eighteen. While the likelihood of typical schizophrenia is 1% of people globally, the likelihood of childhood schizophrenia is 1 in 40,000 (Gochman, Miller, & Rapoport, 2011).

When a child is being evaluated by a psychologist, most often their early onset schizophrenia can be misdiagnosed as autism spectrum disorder, due to their overlap in social dysfunction symptoms (University of Texas at Dallas, 2012). In the first two editions of the DSM (APA, 1952 & 1968), autism spectrum disorder was a subcategory under schizophrenia . It was considered, “schizophrenia, childhood type” (Barlati, Deste, Ariu, & Vita, 2016). It was not until the publication of the third DSM that autism became its own category called “Infantile Autism”, which eventually was given the more expressive term, “Autism Disorder” (Project Autism, n.d).

According to a case study done by Shilpa A. Telgote, Shreyas Shrikant Pendharkar, Amol D. Kelkar and Sachin Bhojane, early onset schizophrenia, as opposed to typical schizophrenia is diagnosed prior to the age of eighteen. A diagnosis  earlier than thirteen years of age is considered very early onset schizophrenia, or VEOS. In this case study, it is mentioned that the likelihood of a very early onset diagnosis increases if the patient has a family history of schizophrenia, or any schizophrenic spectrum disorders. Those diagnosed early on exhibit the same symptoms as those who are diagnosed later in life, however they tend to show signs of irregularities in language development, as well as motor and social development (Telgote, Shrikant, Pendharkar, Kelkar, & Bhojane, 2017).  

Oprah Winfrey interviewed with Dr. Judith Rapoport, the chief of the National Institute of Mental Health’s child psychiatry (Winfrey, 2009). Rapoport gives us a little more knowledge of early onset of schizophrenia. When Oprah asked the question, “How are childhood schizophrenia symptoms different than those associated with adult schizophrenics?”, her response states  that adult schizophrenia is more of sudden, whereas in childhood schizophrenia, it’s gradual. In the case study referenced before, their patient’s symptoms were also showing up gradually at the age of nine (Telgote, Shrikant, Pendharkar, Kelkar, & Bhojane, 2017). Rapoport also talks about the commonality for children to have an imaginary friend. In fact, having an imaginary friend shows that the child is functioning very well, but in the case of children suffering from schizophrenia, it becomes more of a disturbance in the home (Winfrey, 2009).

Overall, early onset schizophrenia, although rare, is possible and often mistook for autism. While the symptoms may overlap, they are considered two separate disorders in the DSM-5. It is vital that we spread awareness about this common misdiagnosis to allow children to receive the proper diagnosis so they can be treated in the best way possible.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

Barlati, S., Deste, G., Ariu, C., & Vita, A. (2016). Autism Spectrum Disorder and Schizophrenia: Do They Overlap? International Journal of Emergency Mental Health and Human Resilience, 18(01). doi:10.4172/1522-4821.1000318

Childhood Schizophrenia Q&A. (n.d.). Retrieved September 28, 2017, from http://www.oprah.com/health/childhood-schizophrenia-symptoms-and-causes/all

Dvir, Y., & Frazier, J. A. (2011, March 15). Autism and Schizophrenia. Retrieved October 03, 2017, from http://www.psychiatrictimes.com/autism/autism-and-schizophrenia

Gochman, P., Miller, R., & Rapoport, J. L. (2011). Childhood-Onset Schizophrenia: The Challenge of Diagnosis. Current Psychiatry Reports, 13(5), 321–322. http://doi.org/10.1007/s11920-011-0212-4

History of Autism. (n.d.). Retrieved September 29, 2017, from http://projectautism.org/history-of-autism

Telgote, S. A., Pendharkar, S. S., Kelkar, A. D., & Bhojane, S. (2017). Very Early-onset Schizophrenia with Secondary Onset Tic Disorder. Indian Journal Of Psychological Medicine, 39(4), 519-522. doi:10.4103/0253-7176.211739

University of Texas at Dallas. (2012, February 28). Study compares traits of autism,schizophrenia. ScienceDaily. Retrieved September 28, 2017 from www.sciencedaily.com/releases/2012/02/120228114312.htm

Categories
Autism Spectrum Disorder

“Atypical”—Suggestions to Paint a More Comprehensive Picture of Autism Spectrum Disorder

The new Netflix Original—“Atypical” features Sam, a high school senior navigating love and life with Autism Spectrum Disorder.  Autism Spectrum Disorder (ASD) is characterized by, “deficits in social communication and social interaction” (American Psychiatric Association 2013).  It’s no surprise that it adds challenges to the already tricky landscape of a high school social life.  The series does a great job of asserting the point that Sam wants to experience relationships with others, he just might not know how to go about obtaining them. Netflix and Rabia Rashid, the creator and executive producer of the show, had the best of intentions in creating a protagonist with ASD.  Rashid conveys this in her interview with vulture.com when asked about her inspiration for creating a show with a protagonist on the spectrum.  “I was very aware that more people were being diagnosed with autism, and it was interesting to me that a whole generation of kids were growing up knowing that they were on the spectrum and wanting independence” (2017).  It is clear that she wanted to give a voice and representation to group of people who are marginalized in the media, unfortunately, the execution missed the mark in a few areas.  

The Mighty and The Huffington Post explores the show’s shortcomings by interviewing individuals living with Autism Spectrum disorder within their articles, “People in the Autism Community Review ‘Atypical’, Netflix’s Original Series About Autism” and “My Autistic Opinion: Atypical is a Stereotypical Representation of Autism”.  While the general consensus from those interviewed in the articles by The Mighty and The Huffington Post was approval for a number of the show’s qualities, they agreed it left some room for improvement.  As someone who does not experience Autism Spectrum disorder, my initial thoughts on the show were an overwhelming approval for what I thought was a championing voice for the community.  Although, after reading the opinions of people who are actually on the spectrum, I realize that “Atypical” is a far from perfect representation of ASD, despite good intentions.

A common criticism mentioned by several of the individuals was that Sam was a “caricature of autism” which perpetuated many of the harmful stereotypes of the disorder (Staff 2017).  One woman with ASD, Haley Moss, described her feelings on how these stereotypes might have a larger impact on public opinion in the article from The Mighty.  She states, “[the show] hurts us by falsely portraying us as creepy, insensitive, and just really awkward” ( Moss 2017).  Stereotypes in the media like these do truly have an impact on the perceptions of neurotypical people that may not be properly informed on the subject.  It is also very important to keep in mind that not everyone who experiences ASD faces the same challenges, so by using such broad stereotypes, it ultimately reduces the collective experience into a “caricature”.   As Moss points out, “Atypical” could have avoided mistakes like these if a person with Autism Spectrum Disorder was consulted during the production.  Another improvement that could have been implemented was the choice of an actor who has been diagnosed with Autism Spectrum Disorder (Staff, 2017). This decision would have allowed someone in the community to breathe more genuine and authentic qualities into Sam’s character in a nonstereotypical manner.

As with many real-life instances, Sam is often unfairly the source of humor in the show deriving from his perceived lack of insight on social cues and overall communication with others.    Moss is especially worried that the jokes in the show paint Sam as, “…inherently selfish and inconsiderate…” (Moss 2017).  This depiction is not representative of individuals on the spectrum in any way and may lead to further stigmatization.  “Atypical” may benefit the community by deriving humor elsewhere which does not capitalize on Sam’s attempt to connect with people.  This aspect of the show’s shortcomings are particularly harmful in that often times, people with ASD may have difficulty understanding others humor due to a deficit in comprehending social contexts (American Psychiatric Association 2013) .  Therefore, to use Sam as the source of humor in a show that attempts to humanize him is particularly ineffective and damaging.    

All of this is not to say that “Atypical” completely missed the mark.  It is so important to produce narratives surrounding Autism Spectrum Disorder because it is an important step in creating a more understanding atmosphere.  By showing the world this perspective it might inspire empathy and acceptance in others which might have otherwise gone ignored or right out scrutinized. “Atypical” is on the right track, the execution simply needs a few adjustments.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: American Psychiatric Publishing.

Fernandez, M. E. (2017, August 15). Atypical Creator Robia Rashid on Autism: ‘I Had to Do a Lot of Real Learning’. Retrieved September 24, 2017, from http://www.vulture.com/2017/08/atypical-showrunner-robia-rashid-interview.html

Moss, H. (2017, August 11). My Autistic Opinion: Atypical is a Stereotypical Representation of Autism. Retrieved September 17, 2017, from http://www.huffingtonpost.com/entry/my-autistic-opinion-atypical-is-a-stereotypical- representation_us_598e2e04e4b0ed1f464c0abd

Staff, T. M., Daughter, M. &., Savely, C., Reynolds, B., Flood, T., & Burgess, M. (2017, August 1). People in Autism Community Review ‘Atypical,’ Netflix’s Original Series About Autism. Retrieved September 17, 2017, from https://themighty.com/2017/08/atypical-autism-netflix-review/

 

Categories
Autism Spectrum Disorder

Could Stem Cells Lead to an Autism Breakthrough?

Duke University recently conducted a first-of-its-kind study that sought to determine whether a transfusion of umbilical cord blood containing rare stem cells could help treat autism. The study included 25 children diagnosed with autism and the results were optimistic; two-thirds of the children, ranging from ages 2 to 6, reported improvements.

The safety trial began over a year and a half ago, which found that umbilical cord blood was not only safe, but 70% of the 25 participants had behavioral advances as described by their parents and tracked by the Duke researchers. The children traveled to Duke three times over the course of a year, and each visit included a series of evaluations including MRIs, EEGs, and autism assessments. The children received the umbilical cord blood infusion on the first visit. Each child received 1 to 2 billion cells, given through an IV in their arms or legs. The subsequent visits occurred six months and one year after the infusion.

Dr. Joanne Kurtzberg and Dr. Geraldine Dawson spearheaded the study. Kurtzberg, head of the Robertson Clinical and Translational Cell Therapy Program, and Dawson, director of the Duke Center for Autism and Brain Development, each saw the intense need for advancements in autism treatments.

Kurtzberg has been studying for years the effects of umbilical cord blood treatments on several disorders, including inherited metabolic disorders and cerebral palsy. In children with cerebral palsy who also exhibited autistic tendencies, their symptoms of autism improved with the treatments. The improvements among children with cerebral palsy gave Kurtzberg the idea to test cord blood specifically for autism.

While both doctors were encouraged by the results of the initial study, they cautioned that plenty of additional research is necessary in order to definitively state whether or not umbilical cord blood treatments improve autism symptoms. Dawson noted the study did not have a comparison group, which she stated is “very important in establishing whether a treatment is actually effective” (Drash & Sanjay, 2017).

Next up is a definitive trial — a double-blind, placebo-controlled trial involving 165 children with autism, ranging in age from 2 to 8. During this secondary phase, the children will receive either their initial umbilical cord blood infusion during their first visit to Duke, or a placebo. A battery of tests, including brain monitoring, will follow.

After six months, the children will receive a second infusion with whatever preparation they did not receive the first time. Known as a crossover trial, subjects receive both a treatment and the placebo, but in a different order. The order of the infusion is not known and researchers say it would be practically impossible to find participants if their parents knew that their children might not receive an infusion.

If this second phase of research shows that umbilical cord blood is effective in improving autism symptoms, primarily social behaviors, Dawson said the finding would be “game-changing”. Again, before any optimism can be confirmed, Kurtzberg reiterated, “we don’t want to mislead people and claim it’s working before we have definitive proof” (Drash & Sanjay, 2017).

And while such definitive proof is still up-in-the-air, these studies should, at the very least, spark hope for the future of autism research. When dealing with research concerning any disorder that lacks a known cause or cure, it is vital to remember that there may be several dead-ends before progress is actually made. Although the Duke study is extremely preliminary, it demonstrates the constant push for more knowledge surrounding autism spectrum disorder. It is this type of research that one day may uncover a breakthrough that could alter the lives of millions of people affected by autism.

References:

Drash, Wayne, and Sanjay Gupta, Dr. “Stem cells offer hope for autism.” CNN. Cable News Network, 05 Apr. 2017. Web. 09 Apr. 2017.