autism

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					Introduction
Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's
normal development of social and communication skills

It is a spectrum condition, which means that, while all people with autism share certain
difficulties, their condition will affect them in different ways. Some people with autism are able
to live relatively independent lives but others may have accompanying learning disabilities and
need a lifetime of specialist support. People with autism may also experience over- or under-
sensitivity to sounds, touch, tastes, smells, light or colors.

Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or
above average intelligence. They have fewer problems with speech but may still have difficulties
with understanding and processing language.



DSM- IV criteria of Autism

A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each
from (B) and (C)
        (A) Qualitative impairment in social interaction, as manifested by at least two of the
        following:
                1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-
                eye gaze, facial expression, body posture, and gestures to regulate social
                interaction
                2. Failure to develop peer relationships appropriate to developmental level
                3. A lack of spontaneous seeking to share enjoyment, interests, or achievements
                with other people, (e.g., by a lack of showing, bringing, or pointing out objects of
                interest to other people)
                4. lack of social or emotional reciprocity ( note: in the description, it gives the
                following as examples: not actively participating in simple social play or games,
                preferring solitary activities, or involving others in activities only as tools or
                "mechanical" aids )

       (B) Qualitative impairments in communication as manifested by at least one of the
       following:
              1. Delay in, or total lack of, the development of spoken language (not
              accompanied by an attempt to compensate through alternative modes of
              communication such as gesture or mime)
              2. In individuals with adequate speech, marked impairment in the ability to
              initiate or sustain a conversation with others
              3. Stereotyped and repetitive use of language or idiosyncratic language
              4. Lack of varied, spontaneous make-believe play or social imitative play
              appropriate to developmental level
       (C) Restricted repetitive and stereotyped patterns of behavior, interests and activities, as
       manifested by at least two of the following:
              1. Encompassing preoccupation with one or more stereotyped and restricted
              patterns of interest that is abnormal either in intensity or focus
              2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
              3. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or
              twisting, or complex whole-body movements)
              4. Persistent preoccupation with parts of objects

(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age
3 years:
        (A) Social interaction
        (B) language as used in social communication
        (C) symbolic or imaginative play

(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative
Disorder



ICD-10 Criteria for Autism

A. Abnormal or impaired development is evident before the age of 3 years in at least one of the
following areas:

   1. receptive or expressive language as used in social communication;
   2. the development of selective social attachments or of reciprocal social interaction;
   3. Functional or symbolic play.

B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from
(1) and at least one from each of (2) and (3)

1. Qualitative impairment in social interaction are manifest in at least two of the following areas:

a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction;

b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities)
peer relationships that involve a mutual sharing of interests, activities and emotions;

c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other
people’s emotions; or lack of modulation of behavior according to social context; or a weak
integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
(e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the
individual).

2. Qualitative abnormalities in communication as manifest in at least one of the following areas:

a. delay in or total lack of, development of spoken language that is not accompanied by an
attempt to compensate through the use of gestures or mime as an alternative mode of
communication (often preceded by a lack of communicative babbling);

b. relative failure to initiate or sustain conversational interchange (at whatever level of language
skill is present), in which there is reciprocal responsiveness to the communications of the other
person;

c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;

d. lack of varied spontaneous make-believe play or (when young) social imitative play

3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are
manifested in at least one of the following:

a. An encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that are abnormal in content or focus; or one or more interests that are abnormal in their
intensity and circumscribed nature though not in their content or focus;

b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;

c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or
twisting or complex whole body movements;

d. Preoccupations with part-objects of non-functional elements of play materials (such as their
odor, the feel of their surface, or the noise or vibration they generate).

C. The clinical picture is not attributable to the other varieties of pervasive developmental
disorders; specific development disorder of receptive language (F80.2) with secondary socio-
emotional problems, reactive attachment disorder (F94.1) or disinherited attachment disorder
(F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders;
schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).
Major characteristics of autism spectrum disorder

The characteristics of autism vary from one person to another but are generally divided into three
main groups. These are:

      Difficulty with social communication
      Difficulty with social interaction
      Difficulty with social imagination

Difficulty with social communication

People with autism have difficulties with both verbal and non-verbal language. Many have a
very literal understanding of language, and think people always mean exactly what they say.
They can find it difficult to use or understand:

      facial expressions or tone of voice
      jokes and sarcasm
      common phrases and sayings; an example might be the phrase 'It's cool', which people
       often say when they think that something is good, but strictly speaking, means that it's a
       bit cold.


Some people with autism may not speak, or have fairly limited speech. They will usually
understand what other people say to them, but prefer to use alternative means of communication
themselves, such as sign language

Others will have good language skills, but they may still find it hard to understand the give-and-
take nature of conversations, perhaps repeating what the other person has just said (this is known
as echolalia) or talking at length about their own interests

Difficulty with social interaction

People with autism often have difficulty recognizing or understanding other people's emotions
and feelings, and expressing their own, which can make it more difficult for them to fit in
socially. They may:

      not understand the unwritten social rules which most of us pick up without thinking: they
       may stand too close to another person for example, or start an inappropriate subject of
       conversation
      appear to be insensitive because they have not recognized how someone else is feeling
      prefer to spend time alone rather than seeking out the company of other people
      not seek comfort from other people
      Appear to behave 'strangely' or inappropriately, as it is not always easy for them to
       express feelings, emotions or needs.
Difficulties with social interaction can mean that people with autism find it hard to form
friendships: some may want to interact with other people and make friends, but may be unsure
how to go about this

Difficulty with social imagination

Social imagination allows us to understand and predict other people's behavior, make sense of
abstract ideas, and to imagine situations outside our immediate daily routine. Difficulties with
social imagination mean that people with autism find it hard to:

      understand and interpret other people's thoughts, feelings and actions
      predict what will happen next, or what could happen next
      understand the concept of danger, for example that running on to a busy road poses a
       threat to them
      engage in imagination: children with autism may enjoy some imaginative play but prefer
       to act out the same scenes each time
      prepare for change and plan for the future
      Cope in new or unfamiliar situations.


Difficulties with social imagination should not be confused with a lack of imagination. Many
people with autism are very creative and may be, for example, accomplished artists, musicians or
writers.

The characteristics of autism vary from one person to another but as well as the three main areas
of difficulty people with autism may have,

      love of routines- This routine can extend to always wanting to travel the same way to and
       from school or work, or eat exactly the same food for breakfast
      Sensory sensitivity- This can occur in one or more of the five senses - sight, sound, smell,
       touch and taste. A person's senses are either intensified (hypersensitive) or under-
       sensitive (hypo-sensitive)
      Special interests- Many people with autism have intense special interests, often from a
       fairly young age. These can change over time or be lifelong, and can be anything from art
       or music, to trains or computers. Some people with autism may eventually be able to
       work or study in related areas. For others, it will remain a hobby, e.g., playing with
       people elder to one
      Learning disabilities- they may face certain disabilities in terms of reading, writing and
       comprehension
         Theory of mind
Theory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge
, etc.—to oneself and others and to understand that others have beliefs, desires and intentions that are
different from one's own

Theory of mind is a theory insofar as the mind is not directly observable. The presumption that others
have a mind is termed a theory of mind because each human can only intuit the existence of his or her
own mind through introspection, and no one has direct access to the mind of another. It is typically
assumed that others have minds by analogy with one's own, and based on the reciprocal nature of social
interaction, as observed in joint attention, the functional use of language, and understanding of others'
emotions and actions. Having a theory of mind allows one to attribute thoughts, desires, and intentions
to others, to predict or explain their actions, and to posit their intentions. As originally defined, it
enables one to understand that mental states can be the cause of—and thus be used to explain and
predict—others’ behavior. Being able to attribute mental states to others and understanding them as
causes of behavior implies, in part, that one must be able to conceive of the mind as a “generator of
representations”. If a person does not have a complete theory of mind it may be a sign of cognitive or
developmental impairment

        Theory of mind applied to autism
In 1985 Simon Baron-Cohen, Alan M. Leslie and Uta Frith published research which suggested
that children with autism do not employ a theory of mind, and suggested that children with
autism have particular difficulties with tasks requiring the child to understand another person's
beliefs. These difficulties persist when children are matched for verbal skills (Happe, 1995, Child
Development) and have been taken as a key feature of autism.

Many individuals classified as having autism have severe difficulty assigning mental states to
others, and they seem to lack theory of mind capabilities Researchers who study the relationship
between autism and theory of mind attempt to explain the connection in a variety of ways. One
account assumes that theory of mind plays a role in the attribution of mental states to others and
in childhood pretend play. According to Leslie (2007), theory of mind is the capacity to mentally
represent thoughts, beliefs, and desires, regardless of whether or not the circumstances involved
are real. This might explain why individuals with autism show extreme deficits in both theory of
mind and pretend play. However, Hobson proposes a social-affective justification, which
suggests that a person with autism deficits in theory of mind result from a distortion in
understanding and responding to emotions. He suggests that typically developing human beings,
unlike individuals with autism, are born with a set of skills (such as social referencing ability)
which will later enable them to comprehend and react to other people’s feelings
     Assessment and screening procedures in autism
Accurate identification of autism spectrum disorder requires analysis of both qualitative and
quantitative data from a number of sources. As such, a quality assessment is dependent on the
clinician – the most important component of any evaluation process. A growing body of research
suggests that autism can be accurately diagnosed by age 2 (Bishop et al., 2008; Charman & Baird,
2002). The case history format first of all provides good measure of it in the initial stages. A number
of tools are available for screening and diagnosis/identification of autism spectrum disorders.
Certain tests are as follows,
     a) The Asperger Syndrome Diagnostic Scale (ASDS; Myles, Bock, & Simpson, 2001) is a norm-
         referenced measure consisting of 50 yes/no items. The ASDS yields scores in five areas:
         cognitive, maladaptive, language, social, and sensor motor, as well as an Asperger
         Syndrome Quotient (ASQ). The five subtests provide information comparing the behaviors
         of the individual to the behaviors of individuals diagnosed with Asperger Syndrome (AS).
     b) The Autism Behavior Checklist (Krug, Arick, & Almond, 2008) is a 57-item questionnaire
         completed by parents or teachers. It is one component of the Autism Screening Instrument
         for Educational Planning-Third Edition (Krug et al., 2008). The ABC is divided into five
         subscales: sensory behavior, social relating, body and object use, language and
         communication skills, and social and adaptive skills
     c) The Autism Spectrum Screening Questionnaire (ASSQ; Ehlers, Gillberg, & Wing, 1999) is
         designed to screen for symptoms related to AS and other high-functioning disorders (HFA)
         along the autism spectrum. The checklist consists of 27 items that are rated on a 3-point
         scale.
     d) The AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS/ADOS-G) (Lord, Rutter, DiLavore,
         & Risi, 2001) is a semi-structured, standardized observational assessment tool designed to
         assess autism spectrum disorders in children, adolescents, and adults. The ADOS-G was
         developed from the original ADOS (Lord et al., 1989) and the Pre-Linguistic Autism
         Diagnostic Observation Schedule
     e) The Checklist for Autism in Toddlers (CHAT); Baron-Cohen, Allen, & Gillberg, 1992; Baron-
         Cohen et al., 1996) is a brief screening questionnaire that is completed by parents and a
         physician during the child’s 18-month check-up. Five key items are indicative of the risk of
         developing autism: pretend play, proto declarative pointing (expressing interest), following
         a point, pretending, and producing a point.
     f) The Childhood Autism Rating Scale (CARS); Schopler, Reichler, & Renner, 1988) identifies
         the presence of autism in children. Fifteen domains are rated on a 7-point Likert scale
         (assigned values range from 1 to 4 – 1, 1.5, 2, 2.5, 3, 3.5, 4): Relating to people; Imitative
         behavior; Emotional response; Body use; Object use; Adaptation to change; Visual response;
         Listening response; Perceptive response; Fear and anxiety; Verbal communication;
         Nonverbal communication; Activity level; Level and consistency of intellective relations; and
         General impressions. Ratings from within normal limits to severely abnormal are based on
         observation, parent interview, and other records. The Total Score, generated from the 15
         domains, provides a rating in one of three categories – non autistic, mild to moderately
         autistic, or severely autistic. We have used it in our practicum work also.
Experienced clinicians never rely strictly on a screening or diagnostic instrument. While assessment
tools can provide valuable information, no tool interprets itself
Objective
To assess an autistic child using CARS test and comparing the performance of the child it autism
with the so called normal on theory of mind task

Methodology
     Participant
The participant child is an 8 year old child namely, Auraka. He studies in a special school, and is a highly
intellectual child; according to his teachers they praise him for his well behaved mannerisms, and ability
to understand things faster than other special children. He has been clinically diagnosed with mild
autism. According to his teachers the support of his parents has today improved his intelligence and
work abilities much more than it was five years ago. He is a good child and empathizes well with his
friends and teachers.

     Administration
The administration of entire practicum was done in an educational setting, namely frontline Special
School, in New Delhi. Before starting the test, a try was made to build rapport with the child. However,
due to time constraints, proper rapport was built possibly. Nevertheless, the teacher was requested to
be a part of the tasks, so that important information(s) is not missed. After this the observation of CARS
item started. We started doing observations of behaviors of the child in various terms according to the
respective scales of the test. Wherever possible, the child was asked to do certain tasks, like drawing, or
singing a poem, or recalling the alphabets, etc, just to make observation more concrete and correct.
May times in between certain questions about daily school behavior were obtained from the teacher
also. The observations carried on throughout the task, and in between we also administered the theory
of mind tasks. First we did the content based task, and then the location based task. In the content
based task the child was first shown a box of gems, and was asked, “What do you think this box has?”.
Following his response, the box was opened and shown to instead been having rubber bands and not
gems. Now a question was asked, “suppose my friend comes from outside, and I show her this box. I ask
her, what she feels this box has. What do you think, will she say?” Whatever, the child answered; he was
then asked the reason for the same

Next location based task was done. Two big boxes, one blue color, and other orange color, were taken,
along with a handkerchief. The handkerchief was placed initially in the blue box and was covered. I did
this when my colleague was outside. Now my colleague came inside. She transferred it to another box.
Now she went back outside and the teacher asked him, “what do you feel where will the alisha (me)
search the object?” Whatever, the child answered; he was then asked the reason for the same.
Accordingly, the child’s responses were noted down. Like this the interview and the task were done.
However, due to time constraints, some areas could not be probed in depth. Nevertheless, most of the
observations required for a diagnostic assessment were made
       Measures

Childhood Autism Rating Scale (CARS) is a behavior rating scale intended to help diagnose
autism. CARS was developed by Eric Schopler, Robert J. Reichier, and Barbara Rochen Renner
CARS was designed to help differentiate children with autism from those with other
developmental delays, such as mental retardation

CARS is a diagnostic assessment method that rates children on a scale from one to four for
various criteria, ranging from normal to severe, and yields a composite score ranging from non-
autistic to mildly autistic, moderately autistic, or severely autistic. The scale is used to observe
and subjectively rate fifteen items.

       relationship to people
       imitation
       emotional response
       body use
       object use
       adaptation to change
       visual response
       listening response
       taste-smell-touch response and use
       fear and nervousness
       verbal communication
       non-verbal communication
       activity level
       level and consistency of intellectual response
       general impressions

This scale can be completed by a clinician or teacher or parent, based on subjective observations
of the child's behavior. Each of the fifteen criteria listed above is rated with a score of:

       1 normal for child’s age
       2 mildly abnormal
       3 moderately abnormal
       4 severely abnormal
            o Midpoint scores of 1.5, 2.5, and 3.5 are also used

Total CARS scores range from a fifteen to 60, with a minimum score of thirty serving as the
cutoff for a diagnosis of autism on the mild end of the autism spectrum.

Internal consistency of the CARS was high, with a coefficient alpha of .94 (Schopler et al.,
1988), indicating the degree to which all of the fifteen scale criteria scores constitute a unitary
phenomenon, rather than several individual behaviors. Inter-rater reliability was established
using two raters for 280 cases. The average reliability of .71 indicated good overall agreement
between raters.
Twelve-month test-retest data was also collected, with a finding that the means were not
significantly different from the first testing to the second.

Criterion-related validity was determined by comparing CARS diagnoses to diagnoses made
independently by child psychologists and psychiatrists. Diagnoses correlated at r = .80, which
indicated that the CARS diagnosis was in agreement with clinical judgments.

CARS has also been shown to have 100% predictive accuracy when distinguishing between
groups of autistic and intellectually disabled children, which was superior to the ABC and
Diagnostic Checklist (Teal & Wiebe, 1986).

Validity of the CARS under different settings is of particular importance to the present study.
CARS scores of 41 children taken through parent interview were compared to scores derived
from direct observation. Mean scores under the two conditions were not significantly different
and the correlation of r = .83 further indicated good agreement.

In addition, diagnoses based on parent interview and direct observation agreed in 90% of the
cases. The authors suggest that valid CARS ratings and diagnoses can be achieved through
parent interview (Schopler et al., 1988)
Case analysis
The CARS test was administered via the option of interviewing and observations. Some of the
ratings were given on combined information of both, whereas others were rated on the basis of
sole information which the teacher provided us. Let us see the ratings that have been given
and what has been observed on each particular scale of CARS.

Relating to people= the child avoids eye contact to bit extent, especially with strangers. Teacher
said that the child takes time to have interaction with the other person and hence it’s not before
months have been spend with the child that the child will make eye contact. The child does no
shoe extreme fussiness or extreme shyness, but shows some irritation if forced for interaction. He
does not cling too much towards parents or loved ones, neither is he very atypical of others.

Imitation= the child imitates only part of the time and requires some persistent help from the
adults to stop this imitation. Mostly the child performs much of imitation in front of strangers.
One reason for this can be the fear of doing or saying something incorrect. Hence repetition
gives the child an assurance that he is responding correctly. There I specifically repetition of
longer sentences, hence showing difficulty in comprehending long words/sentences. This nature
of imitation has helped him in imitating simple as well as complex music sounds, which has
enriched his ability to learn and practice music in a much rapid way.

Emotional response= there is mild abnormality of emotional response. It is only occasssionally
that the child demonstrates a somewhat inappropriate response. Mostly his reactions are related
to objects or events around. Also, the child has developed good empathizing skill, and the
teacher also praises him for his sensitivity towards others. The teacher also mentioned how much
he fears whenever he is given a punishment of being locked up in the bathroom. The teacher also
demonstrated it in front of us. When the child was said, that he should do the sum, else he will be
locked up; he made a very anxious face and said that he will surely do the question. There is no
reported or observed nature of tantrumming or over excitation to minor events. However, the
child does certain tantrumming (to a bit extent), at home settings in front of parents.

Body use= there is very mild, almost near to normal body use, i.e., coordination and
appropriateness of bodily movements. The child moves with the same age, agility, and
coordination of a normal child of the same age. There is some slight forms of repetitive
movements present but that too even is not to a very disturbing extent. Hence the bodily
movements of the child are quite normal.

Object use= this is a rating of child’s interest in toys or other objects and his uses of them. The
child shows mild disinterest in toys, specifically which are a bit complex. There is no as such
childish way of handling them which is evident in him. There is no as such preoccupations with
the things around that is notice or reported.
Adaptation to change= there is moderate abnormality in this arena. The child does become
angry on change of routine tasks. The child actively resists changes in routine, and tries to
continue old activities. For instance, if for a particular class, some other teacher has come, the
child will not actively participate in the class. Also, he likes to sit in his fixed place.

Taste, smell and touch response and use= the child has underdeveloped response to touch;
hence he does not like being caressed or touched or hugged. However, other senses of taste and
smell are perfectly fine. There is an overreaction to touch stimulus, hence we shall say that the
child has mild impairment in this area.

Visual response= the child’s visual response is has to be occasionally reminded to look at
objects. For example, whenever the teacher gives a task to do in his notebook, he has to be told
not to look up in space or towards other things, but focus on the notebook page. The child shows
more interested in looking at other things like the desk, or teacher or into space. Also, frequently
the child avoids looking people in the eye.

Fear or nervousness= the child occasionally shows too much or too little fear or nervousness
compared to the reaction of a so called normal child of the same age in a similar situation. There
is no observed o reported signs of extreme crying, screaming hiding or nervous giggling.

Listening response= the child’s listening behavior is normal and is appropriate for children of
the same age. There is no overreaction to fear demonstration on unusual or loud sounds.

Verbal communication= there is an overall speech retardation. Most of his speech is
meaningful. However, some echolalia, and pronoun reversals are present in his daily speech.
Also, he repeats the words repeatedly, which might not make meaning. But his ability to learn
new words quickly is amazingly wonderful.

Activity level= the child is somewhat slow at moving in situations or activities assigned. But this
does not interfere with his performance much. Hence this is a mild abnormality seen. One
noteworthy thing to be mentioned is that though he might be slow at working, he never reports
laziness in works, and dos it till he feels perfection in his task has been achieved to its best. He is
praised for all his efforts he does, in the school, as well as at home.

Nonverbal communication= there is no immaturity in use of non verbal communication.
Sometimes, when he wishes to have something, there is a vague remark or finger pointing he
does, else, he asks for it directly. His behavior in this regard does not appear much abnormal, and
is quite similar to what a child of his same age, and not affected by autism would do.

Level and consistency of intellectual response= the child is very intelligent taken into account
that he has certain autistic signs and symptoms. H learns fast, has interest in music and does his
work at its best. His talent in music is awesome. He recites poems in a beautiful way ad his
knowledge of music rhythms is excellent, far apart from so called normal children of his age. In
fact, his parents are supportive enough of making his career in music.

General impression= this scale is intended to be an overall rating of autism based on our
subjective impression of the child. I feel, that the child demonstrate very mild symptoms of
autism. The specific presence of repetitions, imitations, echolalia, and reduced eye contact,
makes autism evident, else, he is functioning far more better than what a so called normal child
of his same age would do. His talent in music is praise worthy.

Hence a total score of 27 was obtained which actually means no presence of autism, according to
CARS. This is where a limitation of this test is reflected, that scores cannot be taken as absolute.
Even if we take the mid points, the child’s intellect and functioning level is not reflected very
well in the test, hence the result is that a good conclusion cannot be made.

Now, let us discuss the child’s performance on the theory of mind task. We shall side by side
compare it with the performance of a so called normal child.

The task was divided into two parts- “based on content” and “based on location”.

In the content based task the child was first shown a box of gems, and was asked,

“What do you think this box has?” the child answered, “gems!”

Following his response, the box was opened and shown to instead been having pastel colors and not
gems. Now a question was asked, “suppose my friend comes from outside, and I show her this box. I
ask her, what she feels this box has. What do you think, will she say?”

The child said, “Gems!” I asked this question again, and again the child answered the same thing. To
confirm, I asked him, “will she not say, it has colors in it!” to this he quickly, nodded his head to say no.
hence for this correct response, he is awarded 1 score. Now he was asked the reason for the same,
which even after several efforts, I could not obtain. He did not speak, and instead started doing his class
work. So, for not being able to give reason, he is given 0 score.

Next location based task was done. Two big boxes, one blue color, and other orange color, were taken,
along with a handkerchief. The handkerchief was placed initially in the blue box and was covered. I did
this when my colleague was outside. Now my colleague came inside. She transferred it to another box
(orange). Now she went back outside and the teacher asked him, “what do you feel where will the
alisha (me) search the object?” the child answered, “orange!” This is the wrong answer, so he is given 0
score for this. Now he is asked the reason for this, and again he was not been able to answer it, hence 0
score was given.
So, a total of 1 score is obtained. We can also say that the child passed the theory of mind in
terms of content and not based on location.

Comparing it with the so called child (not affected with autism), it is seen that this child passed
both the tasks of theory of mind but he was able to give reasons for both of them. Hence this
child obtained a score of 4 on Theory of Mind task.

A major thing to reflect upon is why the child were not able to reason out their answers. This is
not uncommon for him, and other autistic children, for that matter, to do. It’s hard for them to
take the perspective of another person and know to explain something in a way that’s
understandable. For many children with autism, sustained attention and visually-based reasoning
skills often exceed the ability to shift attention and engage in verbal reasoning tasks.

The outcomes of the experiments on theory of mind have been argued to support the ‘theory of
mind deficit’ hypothesis on the cause of autism. Proposed by Leslie in 1987, it holds that human
beings have evolved a special ‘module’ devoted specifically to reasoning about other people
minds. As such, this module would provide a cognitive underpinning for empathy. In normals
the module would constitute the difference between humans and their ancestors – indeed,
chimpanzees seem to be able to do much less in the way of mind-reading. In autists, this module
would be delayed or impaired, thus explaining abnormalities in communication and also in the
acquisition of language, if it is indeed true that the development of joint attention is crucial to
language learning


Treatments for mild autism of the child may include:

      Behavioral therapy
      Social skills activities
      Speech and occupational therapy
      Sensory Integration
      Other Therapies

Behavioral therapy is the cornerstone for autism interventions and approaches can be adapted to
suit a wide range of abilities. Applied behavioral analysis (ABA) may not be the best approach
for high functioning children, adolescents or adults but it can be an effective solution for specific
problems. ABA treatments break down tasks into doable steps that are mastered in sequential
order. Approaches in ABA programs include discreet trials that involve one-to-one exchanges
that mimic the give-and-take dynamic in social exchanges. This type of therapy may feel
artificial when working with individuals with mild autism because it strips interactions down to a
"stimulus-response" format.

Behavioral interventions include strategies for shaping behavior, as is the goal of treatments like
ABA. Behaviorally focused interventions typically seek to achieve a desired response from the
individual, using positive reinforcement as a guide. Therapists try to downplay undesired
behavior by using:
      Planned ignoring or withholding attention
      Redirecting
      Modeling
      Verbal, visual or physical prompts
      Immediate consequences for nonnegotiable behaviors

Recognizing that each behavior serves a purpose is very important. All behavior is
communication and figuring out the function of the behavior can help. Often, families dealing
with mild autism find that as communication improves, so does behavior. Ways to find the
function of behavior include:

      Observation
      Using a behavior chart to track target behaviors
      Noting the time of day, the activity and the people present
      Evaluating the consequences of the behavior

Social skill therapy can also be given using,

      Reading body language
      Understanding idioms and figurative language
      Humor
      Maintaining appropriate boundaries
      Answering "wh" questions - who, what, where, when and why

The child is getting a lot of exposure and is also been given speech and occupational therapy,
which is helping him a lot, and hence his autistic traits have improved a lot.



I learned a lot many things from this practicum. It not only gave me insights into the knowledge
about autism spectrum disorder, but also, helped me to understand the assessment of autism
cases. One thing I would like to mention is that, due to time constraints we could not built good
rapport with the child, which I feel had a major impact on the administration and the results as
well. Such a child need to be first brought into trust; else gaining co operation from him is a
difficult task to do. Also, objective tests like CARS do help in initiation of diagnosis, but their
results should not be taken conclusive, as these dimensions have been fixed a lot in terms of
scale or rates. Such objectivity fails when the child suffers from severe autism. Also, theory of
mind task requires breaking the task according to the intellect level of the child. It should be
made interesting according to child’s needs. Working with such a special child was an amazing
experience. I felt really good to see the support he is getting from his parents and teachers. Is
talent in music is wonderful, and should be nurtured well. I hope to see him achieving great
heights in whatever he does, and I am sure he will do his best
Conclusion
The aim of the present practicum was to assess an autistic child using CARS test and comparing
the performance of the child it autism with the so called normal on theory of mind task. A total
score of 27 was obtained which actually means no presence of autism, according to CARS. The
specific presence of repetitions, imitations, echolalia, and reduced eye contact, makes autism
evident, else, he is functioning far more better than what a so called normal child of his same age
would do. His talent in music is praise worthy. This is where a limitation of this test is reflected,
that scores cannot be taken as absolute. Even if we take the mid points, the child’s intellect and
functioning level is not reflected very well in the test, hence the result is that a good conclusion
cannot be made. A total of 1 score is obtained on theory of mind task. We can also say that the
child passed the theory of mind in terms of content and not based on location, as compared to the
so called normal child who passed both the test. I learned a lot many things from this practicum.
It not only gave me insights into the knowledge about autism spectrum disorder, but also, helped
me to understand the assessment of autism cases.



References
http://en.wikipedia.org/wiki/Theory_of_mind

http://www.autism.org.uk/
1.1= Graph showing performance of a non affected child with a child with autism,
on theory of mind task

 1.2


   1


 0.8


 0.6                                                                          non affected child
                                                                              child with autism

 0.4


 0.2


   0
              1                2               3                4




Where,

1= “suppose my friend comes from outside, and I show her this box. I ask her, what she feels this box
has. What do you think, will she say?”

2= “why do you think so?”

3= “what do you feel where will the alisha search the object”

4= “why do you think so?”

				
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Description: about autism