The focus of this Bachelor's thesis is the comparison of early childhood autism with Asperger's syndrome. I work out successively how these disorders differ and how social workers can act professionally through methodical procedures and programmes. Even though the causes of autism spectrum disorders are not yet clearly defined, the symptoms can be compensated for through targeted support. The studies focus on the treatment of these disorders.
Therefore, the bachelor's thesis elaborates how social workers can contribute in a supportive and accompanying way to compensate for the symptoms of autism spectrum disorders in childhood. The central task is the early recognition of the corresponding disorder in order to be able to intervene in a targeted manner. This can be done through screening in early childhood, but in Germany the diagnosis of early childhood autism is often not made until the age of four. The diagnosis of Asperger's syndrome is sometimes more delayed because children develop normally in the first months and years of life. This gave rise to the following questions, which are discussed below: What are the similarities and differences between early childhood autism and Asperger's syndrome and how do they manifest themselves? Which support options for building social and communicative skills can compensate for autistic behaviour and how can social workers intervene?
Table of contents
1. Introduction
2. Definitions and historical change of the concept of autism
3. Autism spectrum disorders
3.1 Early childhood autism
3.1.1 Diagnostic criteria according to ICD-10 and DSM-IV
3.1.2 Epidemiology
3.1.3 Symptomatology
3.1.4 Diagnostics
3.1.5 Course and prognosis
3.2 Asperger's syndrome
3.2.1 Diagnostic criteria according to ICD-10 and DSM-IV
3.2.2 Epidemiology
3.2.3 Symptomatology
3.2.4 Diagnostics
3.2.5 Course and prognosis
4. Developmental disorders of autistic children and resulting social problems
4.1 Peculiarities of verbal and non-verbal communication
4.2 Abnormalities in social behaviour
4.3 Stereotypes and repetitive behavior
4.4 Cognitive development, special interests and talents
5. Etiology
5.1 Genetic factors
5.2 Brain damage and brain dysfunction
5.3 Biochemical peculiarities
5.4 Unusual weight regulation
5.5 Damage caused by vaccination
6. Promoting autistic children through social work
6.1 Promotion of social and communicative skills
6.2 The TEACCH approach
6.3 Foundations and objectives of the TEACCH approach
6.4 Principles of the TEACCH approach
6.5 Application in social work
6.6 Criticism
7. Summary
Bibliography
Annex
Annex I: Diagnostic criteria according to ICD-10 - Early childhood autism
Annex II: Diagnostic criteria according to ICD-10 - Asperger's syndrome
Annex III: Diagnostic criteria according to DSM-IV - Early Childhood Autism
Annex IV: Diagnostic criteria according to DSM-IV - Asperger's syndrome
1. Introduction
"From a pedagogical point of view, children's growing up can be seen as a sequence of sometimes more, sometimes less successful developmental steps, and it is above all the less successful developmental steps that traditionally receive the most attention" (Wustmann 2004, 9). This quote addresses a topic that has been discussed in the past as well as in the present. The dynamics of a changing society demand that boys and girls adapt to it quickly. But some children cannot cope with this. The social fabric and the associated interaction with the social environment seem to be at risk.
Problem outline
The phenomenon of autism is also gaining importance in the media due to current findings regarding research into the causes. The public's interest is mostly focused on the special interests, whereby the fact that only a small proportion of autistic people exhibit these is ignored. For a long time, historically, scientific opinion tended towards the hypothesis that the emotionless behaviour of mothers was the trigger of autism. Currently, genetic causes are suspected, which are modified by brain damage. However, detailed relationship studies are needed to scientifically prove this (Sonnenmoser 2004, 40).
Objectives and questions
The focus of this Bachelor's thesis is the comparison of early childhood autism with Asperger's syndrome. I work out successively how these disorders differ and how social workers can operate professionally through methodical procedures and programmes. Even though the causes of autism spectrum disorders are not yet clearly defined, the symptoms can be compensated for through systematic support. The studies focus on the treatment of these disorders. Therefore, the bachelor's thesis elaborates how social workers can contribute in a supportive and accompanying way to compensate for the symptoms of autism spectrum disorders in childhood. The central task is the early recognition of the corresponding disorder in order to be able to intervene in a targeted manner. This can be done through screening in early childhood, but in Germany the diagnosis of early childhood autism is often not made until the age of four. The diagnosis of Asperger's syndrome is sometimes more delayed, as children develop normally in the first months and years of life. This gave rise to the following questions, which are discussed below:
What are the similarities and differences between early childhood autism and Asperger's syndrome and how do they manifest themselves?
Which support options for building social and communicative skills can compensate for autistic behaviour and how can social workers intervene?
Methodical approach
The structure of the bachelor thesis begins methodically in the main section with an explanation of the definitions of autism, early childhood autism as well as Asperger's syndrome, which implies the historical change of the terms. The intention of the third chapter is to describe the autistic spectrum. The focus is on a detailed description of the criteria for the presence of the disorders, which are explained according to the ICD-10 and DSM-IV classification instruments. In addition, a differentiated explication of the epidemiology, the symptoms, the diagnosis and the progression is elementary in order to obtain a detailed presentation of the disorders. This is supplemented by an insight into the prognosis of early childhood autism and Asperger's syndrome. The fourth chapter presents possible developmental disorders of autistic children and the resulting social problems. The focus is on difficulties in the verbal and non-verbal areas as well as social, stereotypical and repetitive behaviour. The cognitive development, special interests and talents are described schematically. Subsequently, possible causes for the occurrence of autism spectrum disorders are presented. Here, the current findings from science and research are taken into account, which suspect genetic factors, brain damage and brain dysfunction or biochemical abnormalities. Furthermore, unusual weight regulation and damage caused by vaccinations are scientifically and critically debated as triggers of autism and are therefore part of this bachelor thesis. Finally, the support of autistic children through social work is discussed. However, in order to present this, it must first be clarified what is understood by socially competent behaviour. One method for promoting communicative and social skills is the TEACCH approach, which is described according to its principles and objectives. I will examine whether this approach can be applied in social work with autistic children and highlight critical points. In summary, I will answer the research questions.
The data for this bachelor’s thesis was collected, collated, evaluated and compared by means of literature research. Using the databases DBIS (Database Information System), Worldcat or GVK (Common Union Catalogue), I was able to obtain an overview of publications and specialist books. In order to expand my knowledge of current research results and reports, the professional journal Deutsches Ärzteblatt offered scientifically sound articles on autism spectrum disorders. Furthermore, discussions took place with social workers, autistic people and their family members. Due to the positive experiences of those affected as well as professionals, I decided on the life-long TEACCH approach. I acquired theoretical knowledge about this method through the book The TEACCH Approach to Supporting People with Autism - Introduction to Theory and Practice.
In order to ensure the transparency of the bachelor’s thesis, I only compare the disorders of early childhood autism and Asperger's syndrome. Atypical autism and high-functioning autism are only mentioned to complete the picture. Furthermore, I focus on an age range from birth to primary school age.
2. Definitions and historical change of the concept of autism
In the following chapter, the definitions of early childhood autism and Asperger's syndrome are given, with a focus on the historical change of these terms.
Autism
The term autism is derived from the Greek word autos (meaning self) and ismos (meaning state). The Swiss psychiatrist Eugen Bleuler (1857 - 1939) first coined the terms autism and autistic in 1911, which he described as self-referential thinking or withdrawal into the inner world of thought and characterised as a basic symptom of schizophrenia (Remschmidt 2008, 9).
At the beginning of the 20th century, the psychosis concept and not the developmental aspect was paramount, which meant that "the autism concept was transferred from adult psychiatry to childhood psychoses" (Kusch; Petermann 2001, 11). Only age at onset was considered as a developmental aspect. The diagnosis consisted solely of establishing a valid demarcation between early psychoses and late childhood psychoses. He called this clinical picture dementia praecox (premature dementia) (Kehrer 2005, 9).
Early childhood autism
The Austro-American child psychiatrist Leo Kanner (1896 - 1981) revisited the developmental aspect in his research three decades later. In 1943, in his book Disorders of the Affective Channel, he described eleven children (three girls and seven boys) who were characterised by their parents as living in a shell or as being happiest when left alone (Remschmidt 2008, 10). These children showed disturbances in social behaviour, little or no language development, social isolation and monotonous movements. Kanner called this appearance early childhood autism. From his studies he concluded that these children "(...) are not able to relate to other people from birth" (Sigman; Capps 2000, 11).
The concept of autism changed over the years. In comparison to Bleuler, Kanner distinguished schizophrenia from autism. According to Kanner, autistic children live primarily (from birth) in a state of inner withdrawal, whereas those with schizophrenia actively withdraw from existing relationships. This represented a change in meaning. Kanner writes: "It is not a withdrawal from initially existing relationships or participation in previously existing communication, as is the case with schizophrenic children or adults. Rather, from the very beginning it is a case of autistic aloneness, which disregards, ignores and excludes everything that affects the child from the outside" (Remschmidt 2008, 9 f). He assumes that these children "(...) came into the world with an innate inability to establish normal and biologically intended affective contacts with other people" (Remschmidt 2008, 10).
Leo Kanner thus hypothesizes that a child with this clinical picture, which he considered to be Prototype of early childhood psychoses named, strive, "(...) to enter into a world in which it was a stranger from the beginning" (Kusch; Petermann 2001, 15). He described childhood schizophrenia as a disorder of late childhood, as well as adolescence, in which the child tries to solve problems himself, "(...) by stepping out of the world to which it once felt a part" (Kush; Petermann 2001, 16). In doing so, he triggered another discussion regarding the development perspective. The description of Kanner's disorder was established in the current literature. His research on early childhood autism (Kanner syndrome) gained international interest and was the basis for further investigations (Wiesbrock 2005, 5).
Asperger's syndrome
The Austrian paediatrician and curative teacher Hans Asperger (1906 - 1980) described the term autism in 1944, independently of Leo Kanner. He examined a group of four boys who appeared intelligent but introverted and had problems with social norms. He published the results in the book Die autistischen Psychopathen im Kindesalter ( The Autistic Psychopaths in Childhood ) and identified six common features: lack of empathy, difficulties in establishing social contacts, lack of eye contact, linguistic fluency, highly developed special interests and motor disorders (Kusch; Petermann 2001, 115). Asperger's publication was initially hardly noticed. This could be due on the one hand to the events of the Second World War, and on the other hand to the fact that he published his book in German (technical language was English). Asperger initially referred to the condition as autistic psychopathy. Lorna Wing, an English psychiatrist, replaced the term with that of Asperger's syndrome in 1981. It was not until the 1990s that Asperger's research gained international recognition as it was translated into English (Carstensen 2009, 15).
The definition of autism that Asperger coined differs from Leo Kanner's definition. Asperger's subjects showed hardly any language developmental delays compared to Kanner's survey group. The children were on average more intelligent and had motor coordination difficulties, which occur in early childhood autism only if another disorder is present. Despite the many differences in the behaviour of the children studied, Kanner was convinced that only two characteristics were significant for the diagnosis of autism. The most striking characteristic is autistic isolation, which is not to be confused with shyness or avoidance of social contact. Furthermore, he described compulsive insistence on monotony as the second characteristic of autism (Kehrer 2005, 10).
Kanner and Asperger both, independently of each other, came to the assumption that a contact disorder of the children was present on a deep, affective or libidinal level. Other corresponding aspects are the peculiarities of the ability to communicate and the difficulties in adapting to the social environment (Kusch; Petermann 2001, 14).
3. Autism spectrum disorders
"Today, autism researchers are confronted with an immense diversity and numerous variations of autistic disorders" (Kuhles 2007, 15). The difficulty lies in making a diagnosis, as autism is associated with a diverse spectrum of possible symptoms. The term autism spectrum disorders covers early childhood autism, Asperger's syndrome and atypical autism, which belong to the group of profound developmental disorders (Kusch; Petermann 2001, 18). Characteristic features of this disorder are impaired communication and interaction as well as a restricted, repetitive and stereotypical spectrum of behaviour and interests, which can, however, vary greatly in their manifestations (Sinzig 34, 2011).
Atypical autism, which is listed under the key F84.1 of ICD-10, differs from early childhood autism on the one hand by the deviating age at the onset of the disease and on the other hand by the fact that the three diagnostic criteria are not met in all core areas. Impairments in development often manifest themselves only after the third year of the child's life. Furthermore, atypical autism often occurs in severely impaired children. The low level of function rarely allows for deviant behavior (Dilling et al. 2005, 281 f).
High-functioning autism, which does not belong to the group of profound developmental disorders, involves individuals who show the characteristic symptoms of early childhood autism, but who have a high intellectual capacity (Dilling et al. 2005, 284).
3.1 Early childhood autism
This section explains the diagnostic criteria according to the ICD-10 and DSM-IV classification instruments. In the following, the terms epidemiology, symptomatology, diagnostics as well as the course and prognoses are listed.
3.1.1 Diagnostic criteria according to ICD-10 and DSM-IV
Autism spectrum disorders are listed in the tenth version of the International Statistical Classification of Diseases and Related Health Problems (ICD).
This diagnostic classification instrument of medicine is a globally recognised and elementary method for identifying diseases, which has been published by the WHO (World Health Organisation) since 1948. The German translation was published for the first time in 1980 (Dilling et al. 2005, 281 f).
"Autistic disorders have a special status in the classification of developmental disorders. They form the main category in the class of profound developmental disorders" (Kusch; Petermann 2001, 15). In the current edition of the ICD-10, early childhood autism is described in more detail under the code F84.0 (Wiesbrock 2005, 12). The criteria for the presence of this clinical picture are described in Appendix I. The ICD-10 simplifies the dialogue between different professions through its descriptions of diseases and diagnostic guidelines (Dilling et al. 2005, 281 f).
The Diagnostic and Statistical Manual of Mental Disorder s (DSM-IV) is a classification tool of the American Psychiatric Association (APA). This diagnostic and classification system was created to provide a uniform, scientifically based description of mental disorders that links science and practice. The DSM-IV classifies early childhood autism under diagnosis code 299.00. The diagnostic criteria for fulfilling this clinical picture are listed in Appendix III (Rollett 2010, 214 f).
In contrast to the DSM-IV, the ICD-10 lists non-specific symptoms such as fears, phobias, sleeping and eating disorders, outbursts of anger, aggression or self-injury. Compared to the ICD-10, the DSM-IV does not list atypical autism, as the criterion of age specification at onset is not a determining factor for the diagnosis (Kusch; Petermann 2001, 16). Furthermore, the DSM-IV records gender-specific differences (Wiesbrock 2005, 12).
3.1.2 Epidemiology
"The term epidemiology refers to the study of the distribution of a disease in time and space as well as the factors that influence this distribution" (Kusch; Petermann 2001, 31). Furthermore, epidemiological studies distinguish between two frequency characteristics for diseases. The first is incidence, which records the number of new cases of disease occurring in a specific period of time. The other is prevalence, which refers to the number of cases of the disease. This is further subdivided into period prevalence (incidence on a specific day) and time prevalence (incidence in a defined period of time) (Kusch; Petermann 2001, 32).
With regard to early childhood autism, numerous epidemiological studies are available. "Data on the frequency (prevalence) of each disorder naturally depend on the definition" (Remschmidt 2008, 50). Since these are quite different, the data of the individual studies vary. Whereas just a few years ago it was assumed that autism spectrum disorders were rare, current studies show higher prevalence rates. In studies concerning the intelligence of autistic children, it was found that not three quarters of all those affected have an intellectual disability, as previously assumed, but only 20 to 50 percent (Roy et al. 2009, 60). The prevalence of the entire autism spectrum is 60 to 65 per 10,000 school children. Early childhood autism has a rate of 11 to 18 per 10,000 school children. The incidence is 100 to 150 new cases per year (for the entire autistic spectrum). The sex ratio (male:female) is about 3:1 (Kusch; Petermann 2001, 49). Kanner already described eleven autistic children whose parents were described by him as intellectual.
The impression that the upper social classes were overrepresented has persisted for a long time, since - just as in Africa - autistic children from lower social classes were presented to experts less frequently" (Kehrer 2005, 105). Due to the increasing awareness of childhood autism in the last twenty years, children from all social classes have been examined. The result of this research was that all children are equally affected. Autism is therefore not a culture-specific disorder (Janetzke 1993, 35).
3.1.3 Symptomatology
Leo Kanner described the following behavioural problems: Difficulties in social behaviour and interaction, stereotypical behaviour and abnormalities in verbal and non-verbal communication. "As a rule, autistic children cannot be recognised by their disorder" (Kuhles 2007, 33). Since the outward appearance does not indicate their illness, outsiders often react with incomprehension to the children's behaviour, which they perceive as strange. Deviations from the norm are often interpreted as mistakes in upbringing (Kusch; Petermann 2001, 118 f).
The behavioural problems described above are only a brief overview of the diverse spectrum of symptomatology. Parents, carers, therapists and social workers report a broad repertoire of behavioural anomalies that can also occur in non-autistic children at certain stages of their development. As a characteristic feature, Kanner mentioned that half of the children studied were mutistic or had speech peculiarities (echolalia, literal understanding of language). Here, social workers methodically relied on visual aids. Therapies in which the children express themselves through drawings are often the only means of communication (Kehrer 2005, 31 f).
3.1.4 Diagnostics
"The diagnosis of early childhood autism still appears to many clinicians to be not entirely satisfactorily resolved" (Klicpera; Innerhofer 2002, 219). Based on research, there is widespread agreement on the central features that must be present for the diagnosis of early childhood autism, but the spectrum of autistic disorders is so diverse that there are numerous unresolved questions in its peripheral areas. Early recognition of autism in childhood is one of the central tasks in diagnostics. The basis for this is the criteria mentioned in the classification instruments. Furthermore, the anamnesis and observation scales, which specifically and quantitatively record different behavioural characteristics, are common diagnostic methods (Remschmidt 2008, 14).
A reliable diagnosis can be made from the second year of life. At this age, the ability to communicate and the playing behaviour can usually be reliably classified. Children who show a linguistic and cognitive developmental impairment are described as deviating from the norm. Parents of autistic children report abnormalities in social interaction, playing behaviour and communication (Remschmidt 2008, 21). They explained that their children mostly experienced pleasure in dealing with objects and not in contact with peers. Language as a means of communication was hardly used by the autistic children, as it either developed with a delay or not at all. For parents, a suspected diagnosis is complex because social behaviour and cognitive development are often difficult to assess (explicitly the understanding of gestures and facial expressions). It is important to avoid misdiagnosis. Therefore, hearing problems, for example, should definitely be examined (Kehrer 2005, 160).
Other diagnostic methods for detecting early childhood autism are standardised interviews and questionnaires. Scientific studies come mainly from the English-speaking world, for example those by the British psychologist Simon Baron-Cohen. In Great Britain, he developed a screening instrument ( Checklist for Autism in Toddlers ; in short: CHAT), which is used in screening examinations of children from the age of 18 months. The German version was largely adopted from the original by child psychologist Fritz Poustka. Here, observations of the parents and other caregivers are included in the examination. As a result, it was proven that "(...) children with early signs of autistic disorder can be recognised quite reliably" (Klicpera; Innerhofer 2002, 226).
Simultaneously, three characteristics were mentioned by the affected parents during the suspected diagnosis: "The child resisted physical touch and attention from the beginning, did not show a response smile, he did not react to calls or sounds" (Remschmidt 2008, 21).
Furthermore, screening questionnaires for early childhood autism were developed by autism researcher Hans Kehrer (Autism Questionnaire) and by psychologists Dirk Kraijer and Peter Melchers (Scale for the Assessment of Autism Spectrum Disorders in the Less Gifted). Diagnostic interviews, for example, were developed by Professor Michael Rutter et al. in 2003, with his colleague Sven Bölte producing the German version (Diagnostisches Interview für Autismus). The German paediatrician Dora Rühl established an observation scale for autistic disorders in 2004, which she took over from the psychologist Catherine Lord (Remschmidt 2008, 22).
The diagnosis is complicated by the fact that there are, for example, children who do not show all the symptoms of autism. Furthermore, psychopathological characteristics change in the course of the child's development (fear of change often only appears after the age of two, but decreases with age). In summary, it can be said that the degree of severity can vary greatly (Remschmidt 2008, 23 f).
3.1.5 Course and prognosis
Autism spectrum disorders have a chronic course and are therefore not curable (Kuhles 2007, 24). Even in case of positive development with an associated alleviation of symptoms, the living environment of autistic children is still influenced or restricted.
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- Citation du texte
- Melanie Leukert (Auteur), 2012, Autism Spectrum Disorders in Childhood, Munich, GRIN Verlag, https://www.grin.com/document/1175819
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