Autism
What is autism
Autism is characterized by difficulties in social interaction, and verbal and nonverbal communication, as well as the presence of repetitive behaviours. Symptoms in these areas occur in varying degrees in children affected by autism.
Symptoms may include a loss of eye contact, flapping hands, walking on toes, not playing constructively with toys, not being on target with age appropriate language skills, not responding to their name, or not orienting to environmental sounds.
Autism could mean that a child is lacking in the basic skills needed to function without assistance. It could mean that a child is not able to speak, or struggles to sleep or eat, may not go to school, may not have friends, or may not lead an independent life.
Often, these children engage in severe aggressive behaviour as they have no way of communicating their frustration and the pain they experience in their inflamed bowels. They are trapped, unable to communicate their needs and feelings.
However, early intensive behavioural intervention is an evidence-based approach which can improve outcomes.
Current Autism Statistics
• About 1 in 59 children has been identified with autism spectrum disorder (ASD)
• ASD is reported to occur in all racial, ethnic, and socioeconomic groups.
• ASD is about 4 times more common among boys than among girls.
• Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of between 1% and 2%.
• Source: https://www.cdc.gov/ncbddd/autism/data.html
The Star Academy Autism Treatment School
The Star Academy is a leading expert in instruction for children with an autism diagnosis. The Academy is a public benefit organisation and a company not for profit, which specialises in creating individualised programmes to assist the specific needs of each child diagnosed with an Autism Spectrum Disorder (ASD). The method of instruction utilised is Applied Behaviour Analysis (ABA), an empirically-based cutting-edge instruction designed for children with autism.
What sets the Academy apart is its unique ability to provide individualised education programmes tailor-made to address the specific needs of each child. We are dedicated to being an Academy of excellence, maintaining the highest standards of service delivery to the children attending our Academies. The Star Academy is an affiliate of the USA-based Center for Autism and Related Disorders (CARD), world leaders in autism treatment.
Each team of ABA instructors works with the children assigned to them daily to catch up skills deficits or developmental delays and to help them to become functional and independent members of our community.
As a top educational service provider, The Star Academy’s instructional programme extends nationally in South Africa and across Africa, benefitting children at centres in Zimbabwe, Rwanda, Ghana, and Mauritius. The Academy empowers parents by hosting workshops which provide a strong community support network.
The Star Academy provides training for professionals who work with children with autism including, teachers, care givers, occupational therapists, speech therapists, and psychologists. Parent training forms part of the services provided, as does vocational skills for adolescents. Training of school facilitators to facilitate children who are falling behind in the classroom is also a service provided by The Star Academy. The Star Academy is responsible for creating an awareness of what autism is, and educating the greater community on the condition in order to foster better understanding and acceptance of individuals with a difference. The Star Academy regularly hosts presentations and conferences by international speakers, thereby bringing the latest treatment options and information on the condition to South Africa.
Applied Behaviour Analysis (ABA) for Autism Treatment
As the only research-based intervention for children with autism, ABA plays a vital role in changing the lives of these children. Studies, which have been conducted and replicated, show that 47% of children who receive early intensive behavioural intervention will recover from autism (Lovaas, 1987; Sallows & Graupner, 2005). Recovery means that the child scores in the average range on standardised IQ tests, functions independently in a mainstream classroom, and is no longer diagnosable on the autism spectrum.
ABA is an effective methodology because it is outcomes-based, which means that the Academy is results-driven rather than process-driven, an essential key factor in autism treatment. Working with children with autism often means trying to close a developmental gap. You need to work passionately, and you need to work fast. They need an effective intervention if they are to catch up their developmental delays.
ABA is an intervention which assists in learning skills such as looking, listening, and imitating, as well as complex skills such as reading, conversing, and understanding another person’s perspective. Through decades of research, techniques have been developed to assist in promoting beneficial behaviours, and reducing those behaviours that may cause harm or interfere with learning. ABA is an empirically proven technique endorsed by the American Surgeon General as an effective and medically necessary intervention in assisting children with autism.
The Star Academy Team
The Star Academy has a dedicated, close- knit team working with each child. Team members have a commitment to excellence, belief in the children they work with every day, and expertise and skill which continues to make a monumental difference in the lives of the children who attend the Academies. Lighting the way for the children, they work tirelessly to ensure that every child receives the best possible chance to learn new skills, overcome their challenges, and catch up their delays.
In 2015, all members of The Star Academy achieved accreditation as Board Certified Autism Technicians (BCAT), which certifies the degree of excellence of the staff’s education levels, experience, and knowledge in ABA, and in treating the challenges and behaviours associated with autism spectrum disorder.
Based in America, the BCAT was established in 2013 to promote the highest standards of treatment for individuals with ASD. It is the first and only autism-specific credential that is accredited by the National Commission for Certifying Agencies (NCCA), an independent body accredited by the American National Standards Institute as a standards developer.
The Star Academy Values for Autism Treatment
Education is at the heart of the Academy, nurturing skills development for the children and educating families on treatment options to help each child reach their potential in order for them to be as independent as possible and to lead happy and fulfilled lives.
The Academy upholds the values of hope, dedication, and commitment, as illustrated by our team, who are continuously striving to uplift the lives of the children and their families.
The Academy’s Thembisa Autism Outreach Programme
The Academy has collaborated with the Thembisa Hospital and established the Thembisa outreach programme, which extends instruction to the poverty-stricken township of Thembisa, providing essential assistance to children diagnosed with autism, by employing and upskilling residents with skills to help these children. We have a dedicated ABA team working in the area, making ABA possible for underprivileged children in Thembisa.
If I could communicate one thing to General Practitioners, it would be that AUTISM IS TREATABLE.
Applied Behaviour Analysis (ABA) is the only empirically-validated method of intervention for ASD. In 1987, Dr O. Ivar Lovaas conducted the first controlled study to evaluate long-term, intensive, early ABA treatment for children with autism. This study compared a group of children who received intensive (40 hours per week) ABA treatment to two control groups; one who received 10 hours per week of ABA treatment and one who received 10 hours per week of non-ABA. All children received their respective treatments for 2 or more years. Assignment to groups was not random, it was based on availability of staff to provide the intensive ABA therapy, however the groups did not vary significantly on any measures at intake. At follow-up, 47% of the children in the intensive ABA group achieved both normal IQ and successful grade one placement in normal education classrooms. Children in the control groups, however, made much smaller gains, with only 2% of children across both control groups achieving normal educational and intellectual functioning.
In 1993, McEachin, Smith, and Lovaas published a follow-up study, wherein participants in the intensive ABA group of the original Lovaas study were re-evaluated at a mean age of 11.5 years. Eight of the nine participants demonstrated intellectual and adaptive functioning in the normal range. Subsequent studies on intensive ABA have produced similar results. Sallows and Graupner (2005) found that 48% of children who had received 4 years of intensive early ABA scored in the normal range on measures of IQ and adaptive behaviour and were able to transition to regular education with no support. Eikeseth, Smith, Jahr, and Eldevick (2007) extended previous research by evaluating intensive ABA treatment for slightly older children with autism, ages 4-7 at intake. The ABA group attained statistically significant increases in IQ and adaptive functioning, when compared to a control group whose members received standard “eclectic” special education services for the same number of hours per week and for the same duration.
In summary, research demonstrates that ABA, when conducted at a high intensity (typically between thirty and forty hours per week for several years), produces significantly superior gains to eclectic intervention or low-intensity intervention. Services initiated at any age are beneficial for the acquisition of skills and management of challenging behaviour, but with early intervention some individuals can recover from ASD. Perhaps that sounds like a bold statement? Let’s clarify what “recovery” means.
“Recovery” means that (a) a child previously diagnosed with ASD can be re-evaluated by a medical doctor or psychologist, and the clinician’s conclusion is that the child no longer qualifies for any diagnosis on the autism spectrum, (b) the child scores in the average range or higher on standardised tests of intelligence, language, socialisation, and daily living skills, and (c) the child earns passing grades in a mainstream classroom environment with no specialised supports.
Research, no matter how robust, is often not enough to remove the scepticism about recovery in professionals. On one hand, I applaud this, because one of the key characteristics of a good scientist is a healthy dose of scepticism. On the other hand, it has been frustrating to encounter professionals and non-professionals alike who view autism as a lifelong disorder for which the best approach is to “make the child comfortable” and “start making financial provisions for the future”.
I speak from personal experience when I speak of recovery. Using the comprehensive treatment curriculum designed by the Center for Autism and Related Disorders (CARD USA), and with the collaboration of an open-minded school staff complement, and the dedicated acceptance and implementation of my recommendations by a determined mother, I saw a child shed a firm autism diagnosis in just two short years.
This child – let’s call him “Ryan” – was two years and eight months old at the time of intake. He had received a firm autism diagnosis, and his symptoms included a significant speech delay (approximately ten one-to two-word phrases), limited imitation skills (he would only imitate one person), limited social interest (distanced himself from peers), limited play skills (lined stones up, did not engage in toy play), and the presence of challenging behaviour (toe-walking, spinning in circles, and pinching people, among others).
Throughout the course of Ryan’s ABA treatment, he made steady progress. Stumbling blocks naturally arose in the progression through the CARD curriculum, but the science of ABA is like a magical toolbox where lack of progress just means you reach in and find another way, and Ryan responded positively to every treatment plan change I made. His language developed so swiftly that I recommended that he be moved to a class above his chronological age group, so that he could be exposed to the best possible language models. Ryan’s ABA treatment was dynamic, at times requiring home-based sessions and school facilitation, and at other times requiring school-based sessions and facilitated playdates.
After two years of ABA, Ryan was socially engaged, a very capable conversationalist, and benefitting from the classroom environment without a facilitator. I recommended that he be taken to an educational psychologist for assessment. This educational psychologist conducted a battery of standardised assessments in order to assess Ryan’s cognitive, scholastic, visual-perceptual, fine motor, and emotional development. She also garnered information from Ryan’s school teacher, school report, and parents. The conclusion of the psychologist’s assessments was that Ryan’s developmental profile showed that he was performing at a level congruent with or above his chronological age in many skill areas. Not so much as a hint of a diagnosis. Ryan had recovered!
I tell this story not to pretend that the road is so smooth for every child or every family. I tell this story to give hope. I tell this story to change mind-sets and put cracks in the ceilings placed on those with ASD.
Some might question whether such intensive intervention is necessary for a child with autism. The reality is, though, that we take for granted the plethora skills needed to navigate complex social interactions. We underestimate the pace at which we are registering and responding to social cues, sometimes inhibiting our gut reaction to situations in favour of more “socially appropriate” responses. We take for granted the ease with which we can problem-solve and respond flexibly to ever-changing situations.
It is common for me to observe a child at school who manages to keep up academically, especially in subjects or with teachers who tap into their special interests, but spend their days isolated and often angry. This child often misreads people’s intentions, either leaving him/her more susceptible to bullying, or leaving him/her feeling persecuted. This child struggles to regulate his/her emotions when unexpected changes arise, to tolerate the banality of small-talk, or to respond fluently to the unpredictability of peer interaction. This child is also often challenging for a teacher not to under- or over-estimate. Teachers sometimes over-estimate the child’s ability to implement all the social skills that come so naturally to his/her peers, leading to undeserved frustration towards the child. Other times, teachers under-estimate the child’s potential and capacity for growth and achievement because ASD is “a disorder” and “untreatable”.
Rest assured that any child, no matter where they fall on the spectrum, can benefit from a high quality ABA programme working within the framework of a solid curriculum which addresses behavioural excesses as well as academic, adaptive, cognitive, language, motor, social, play and other skill deficits, and go on to live a happy, independent, socially integrated life.
References:
Eikeseth, S., Smith, T., Jahr, E.& Eldevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: A comparison controlled study. Behavior Modification,31, 264-278.
Lovaas, I. O. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
McEachin, J. J., Smith T., & Lovaas, I. O. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 55, 359-372.
Sallows, G. O. & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110, 417- 438.
