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Testing has been administered before the knowledge of autism in the patient and throughout the knowledge of its existence as well. Testing has also been administered to control the chemical aspects of autism in patients of all ages. Therapists have gone so far as to believe that a hands off approach would "free the child by the therapist assuming responsibility for adult values" (Pinney, 1985). With the vast amount of symptoms and behaviors in accordance with autism, testing has proven itself invaluable to the treatment of autistic patients. Because of the social impairment in children with autism, most standardized testing is unreliable; therefore, the best results may therefore be obtained from a standardized observation protocol (Longhurst, 1997). In some instances it may take a little more than a year of evaluations and testing to successfully diagnose someone with autism. For this reason, researchers are working on different ways to assess children to isolate causes at an early age. Dr. Teitelbaum, a psychologist at the University of Florida, and other researchers discovered that autistic children appear to have subtle abnormalities in body movements that can be diagnosed as early as 3 months (Blakeslee, 1999). Dr. Teitelbaum made assessments from a number of infants that later either grew to be normal or autistic and compared their movements when they were either rolling over, sitting up, crawling, or walking. What he discovered from his testing was that autistic infants showed abnormalities in these movements. For instance, normal babies use a corkscrew motion to go from back to stomach or vice versa. However, autistic babies either didn’t learn to roll over or did in a peculiar fashion. They would roll to their stomach or back by raising their head or pelvis and then throw the upper legs forward and topple over, moving all body segments together. Unlike healthy babies, autistic babies would lose balance easily from a sitting position and would fail to break their falls with their hands. Also during the testing Dr. Teitelbaum discovered that autistic babies showed an asymmetrical lack of support in the arms or legs and when they crawled supported themselves on their forearms rather than on their hands. One baby crawled by scooting his left knee on the floor but used his right foot to push himself forward. What Dr. Teitelbaum and his colleagues found is the beginning of what has long been a goal of autism researchers, early diagnosis. From this beginning, others will be able to expand testing to encompass more specific areas of autistic development at an early age. However, until this is done, tests have been conducted to help screen toddlers who are potentially autistic. The CHAT (Checklist for Autism in Toddlers) is performed by general practitioners or health visitors during the 18 month developmental check-up. It consists of 2 sections: one for the parent and one for the toddler. Section A consists of a number of questions asked by the administrator to the parent such as the following: 1. Does your child enjoy being swung, bounced on your knee, etc.? 2. Does your child take an interest in other children? 3. Does your child ever use their index finger to point, to indicate Section B consists of a number of questions in observations asked by the administrator to the toddler such as the following: 1. Get the child’s attention, then point across the room at an interesting object and say, "Oh look! There’s a (name of toy)!" Watch the child’s face. Does the child look across to see what you are pointing at? 2. Say to the child, "Where’s the light?", or "Show me the light." Does the child point with their index finger at the light (The British Journal of Psychiatry, 1996)? The CHAT is used only as a screening test for toddlers. If the toddler tests positive on the CHAT it only warrants more testing to determine the severity of the autism. The CHAT is an excellent way for parents to confirm any fears they may about their child, but what signs should they take notice to? Parents of autistic children in America were asked by the Autism Society of America to evaluate their children for a week and take notes on their behavior as opposed to that of a normal childs’ behavior. From the parents’ assessment the Autism Society of America obtained a list of abnormal behavior. The following list portrays some of the parents’ findings: 1. Inappropriate laughing or giggling. 4. Difficulty in interacting with others. 6. Does not make eye contact with parent/caregiver. 7. Lack of speech and/or had words and lost them. This generic testing has actually proven very beneficial. A concerned parent may first want to contact the Autism Society of America before they wish to see a general practitioner or psychologist and this simple list is most of the time just what they need (Autism Society of America, 1999). Other tests have been conducted to assess the different aspects of autism. A recent study was completed in the selective attention deficits of persons with autism. A forced-choice reaction time (RT) was used to assess the filtering component of selective attention in mental-age matched groups of persons with autism as compared to mental retardation and normality (no handicap). The RTs of he persons with autism improved relative to the other groups in the presence of the window without distracters, but this effect was negated when distracters were also presented. The performance of the persons with autism was the most impaired in the presence of distracters (Burack, 1994). The regarding factor was the tension between effective selective attention and distraction. The specific task used here was a forced-choice RT task adapted for use with persons with autism. All stimuli were in the form of simple geometric designs, as opposed to letters, to avoid confounding effects related to group differences in familiarity with letters. The conditions varied with regard to a) presence or absence of a spatial window highlighting the central area of the screen in which the target stimulus was presented, b) number of distracters and, c) proximity of the distracters to the target stimulus. Both the window and the distracters were presented simultaneously with the target stimulus. The location of the target stimuli was kept constant to eliminate the need to search for the target and to reduce the unpredictability of stimulus presentation that is thought to be associated with impaired attentional functioning and arousal modulation in persons with autism. With regard to number of distracters, more distracters would incur greater filtering costs and lead to greater interference with performance. Conversely, we expected that distracters farther from the target would interfere less with performance in that the cost of visual filtering would be minimized with distracters in the periphery of the attentional lens. All stimuli were presented on an IBM-XT computer with a color monitor, to which a keyboard with two response buttons was attached. In each trial, on of the target stimuli was presented in the center of the screen. The presence or absence of a window and the number and location of distracters varied by condition. In half of the trials, a window was imposed in the center section of the screen. In these trials, the window area was light gray, and the outer section of the screen was black. In the other half of the trials, there was no window, and the entire screen was light gray. Participants were individually tested four times within a 1-week period. The first session was a practice session, in which participants were taught the basic requirements of the task. In a very few cases, subjects participated in an extra practice session. Sessions 2-4 were the testing sessions. In the practice session, the participants were administered 50 trials with baseline conditions. Each trial was preceded by a tone approximately 1 second that sounded to alert the child to the presentation of the stimuli. The stimuli were displayed immediately on termination of the tone and remained on the monitor until the subject responded by pressing one of the two response buttons. After each trial, there was a delay of approximately 1 second before the tone sounded to begin the next trial. During the first 20 trials, participants were given verbal feedback on he accuracy of their responses. After the session, subjects were offered a choice o small prizes, regardless of level of performance. The test sessions began with 10 practice trials, with each of the 10 test conditions being presented once. These practice trials served to reacquaint the participant with the task and to allow for questions. The practice trials were followed by 60 test trials. During the testing sessions the experimenter sat to the left of the subject. He noted at the beginning of each trial whether or not the subject was looking at the computer monitor. In addition, he noted any occurrences that may have distracted the subject from the experimental task. Trials were deleted if non-task related distractions interfered with the subject’s performance. Although RT tasks often provide interesting information about accuracy versus speed trade-offs, the minimal number of errors committed by the subjects in this study precludes an examination of this issue. The low error rate resulted from the relative simplicity of the forced-choice tack, which was designed to ensure that even nonverbal subjects could participate in the study. In general, RTs were faster in the presence of a window, slower with distracters close to the target stimulus, and unaffected by distracters far from the target. Apparently, the presence of a window diminishes the costs related to size adjustments or focusing of the attentional lens, or both. Conversely, the filtering of distracters close to the target entails costs that are reflected in slower RTs. An interesting notion from these findings is the possible relation of overarousal in person with autism and their impaired ability to filter extraneous information. An inefficient lens can be viewed as detrimental to the effective processing of information in the real world for two reasons: 1. The intake of relevant information from the environment is less than optimal. Therefore, persons with autism are leaa able to learn from and relate to the surrounding environment. 2. The additional costs incurred in focusing and filtering deplete resources for other aspects of attending and information processing. With a combination of these deficiencies, persons with autism are unable to attend efficiently to the most relevant information in the environment and therefore do not effectively learn from and relate to their surroundings. This contributes to the overall impaired functioning that is typically observed in the development of persons with autism (Burack, 1994). The last test showed an assessment of a specific area of autism but there are many tests that can be given to someone who is either autistic or may potentially be autistic. Because different assessment instruments are used nationwide, there are places that provide services for children with autism that use diagnostic checklists, interviews, and questionnaires to aid the parents of autistic children where the place has developed its own assessment tools. The following tests are tools developed from just such a method. The GARS (Gilliam Autism Rating Scale) is designed to help identify and diagnose autism in individuals ages 3-22 years old. This test offers items grouped into subtests: stereotyped behavior, communication, social interaction, and developmental disturbances. The ASIEP-2 (Autism Screening Instrument for Educational Planning) a) examines behavior in the areas of: sensory, relating, body concept, language, and social self-help; b) sample vocal behavior; c) assess interaction; d) assess communication and e) determine learning rate. This test may be used with individuals from 18 months through adulthood. The CARS (Child Autism Rating Scale) and the CHAT (Checklist for Autism in Toddlers) are both screening devices for determining whether or not a child or toddler has developing autism. Dr. Rimland’s E-2 Behavior Checklist has been used for 20 years to collect and update data on children showing autistic behavior. The PL-ADOS (Pre-Linguistic Autism Diagnostic Observation Schedule) is an observation scale designed for children less than 6 years who are suspected of having autism (Autism Society of America, 1999). There have been countless tests administered for the physical symptoms of autism. However, there is a growing trend in the research for chemical manipulation and treatment of autism. Ed Cook has led a study that revealed that autistic children "have a shortened form of the serotonin transporter gene" which leads researchers to believe this gene is a possible factor in autism (Holden, 1997). The evidence for this study lies in the antidepressants. These drugs "which increase the availability of serotonin, often suppress autism symptoms," such as those associated with aggression (Holden, 1997). Another series of tests were performed by McDougle and his colleagues to test fluvoxamine for the treatment of autistic disorders in adults. The researcher performed a 12-week double-blind, placebo-controlled trial to determine the effects of fluvoxamine on the behavior of adults with autism. The study included 30 adults (27 men and three women) with symptoms that were at least moderately severe as defined by the global severity of illness rating on the Clinical Global Impression Scale. Each patient participated in an extensive behavior analysis, using a variety of assessment scales. Patients were randomly assigned to receive either placebo or fluvoxamine, starting at a dosage of 50 mg daily. The dosage was increased by 50 mg every three to four days, to a maximum dosage of 300 mg daily, until maximum response was obtained. After 3 weeks, a maximum dosage was achieved and the patient was maintained on this dosage for at least nine weeks. Reassessment of behavior occurred at four, eight and 12 weeks after the start of the study. No significant differences in age, sex distribution, behavior or IQ scores were observed between the two groups at baseline. Beginning at week 4, there was an overall significant improvement in the fluvoxamine group that continued throughout the study period. Specifically, eight (53%) of the 15 patients in the fluvoxamine group were considered responders, versus none in the placebo group. When particular symptoms in individuals with autism were examined, fluvoxamine was found to by superior to placebo in all of the areas considered: repetitive thoughts and behaviors decreased, as did maladaptive behaviors and aggressive symptoms. Language usage also improved. From their testing, the authors conclude that fluvoxamine may be a useful treatment in adults with autism, because of its ability to improve behaviors as well as its low incidence of adverse effects (Huffman, 1997). As testing in autism increases, the reliability and validity with which general practitioners and psychologists can evaluate persons with autism will increase. Whether it be from an infant to an adult, testing in autism will always play an important role. Through testing and assessment, it is now possible to evaluate a person from many different areas and stages of their autistic development. Testing through research has been an effective means of learning more about the disorder that affects so many and will even more so in the future. The more that is learned about autism, the more that can be done to help treat it. The need for treatment in autism is growing and the only way it can be cured is through testing. Associations such as the Autism Society of America has done a good job of compiling research and offering it to the general public and to other researchers. Autism will forever be a problem in the world, but because of testing it can be controlled and hopefully in the future be cured. Bibliography: Works Cited Brooks, John. South American Handbook. 55th ed. Bath: Trade & Travel Publications, 1979. http://magicperu.com/ourcult.htm Word Count: 2758
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