Lee M. Marcus

Brief report: Two case studies using virtual reality as a learning tool for autistic children

SummaryThe children complied with most requests. Some of our teaching goals were limited by technology or space while others were limited by the difficulty of presenting a task to the children in a way that was understandable within their environment. However, the opportunity to introduce this technology to children was an important first step in exploring the potential VR offers to understanding the perceptual processes involved in autism.Our results indicate that the children will accept a VR helmet and wear it, identify familiar objects and qualities of these objects in their environment while using the helmet, and locate and move toward objects in their environment while wearing the helmet.More research is necessary to verify the potential in this area, especially to discover if learning experiences through VR generalize to other environments, but it appears virtual reality may provide a useful tool for furthering our understanding of autism and guiding efforts at treatment and intervention.

Comparison of DSM-III-R and Childhood Autism Rating Scale Diagnoses of Autism.

The purpose of this study was to clarify the issue of whether DSM-III-R (American Psychological Association [APA], 1987) over-or underdiagnoses autism by comparing this diagnostic system to a well-established objective measure of diagnosis, the Childhood Autism Rating Scale (CARS). A secondary goal was to determine which of the 16 criteria are the best discriminators of autism. DSM-III-R, CARS, and clinical diagnoses of 138 consecutive admissions to a statewide program for the diagnosis and treatment of autistic and related communication-handicapped individuals (Division TEACCH in North Carolina) were compared. Results indicated a generally high degree of agreement on the diagnosis of autism using the three systems. Within this tratment-oriented program, the CARS and clinical ratings diagnosed a greater number of cases as autistic than did the DSM-III-R criteria, suggesting that DSM-III-R slightly underdiagnosed autism. The criteria that most strongly related to the diagnosis of autism regardless of the system were lack of awareness of others, abnormal social play, an impaired ability to make friends, abnormal nonverbal communication, stereotypic body movements, and restricted range of interests.

Neuropsychological characteristics of school-age children with high-functioning autism: performance on the NEPSY.

Utilizing standardization and validation data from the NEPSY, this study presents a reanalysis of the High-Functioning Autism (HFA) versus Typical samples using IQ as a covariate. The reanalysis in the present paper should prove important to clinicians and researchers by (1) determining if the original findings can be replicated for the HFA sample when controlling for IQ, and (2) providing neuropsychological description for children with HFA versus Typical children across the NEPSY variables. The sample included 23 children with HFA who ranged in age from 5 years 5 months to 12 years 11 months (Mean = 9.59 years). The HFA Group comprised 19 males, 22 Caucasians, and was 87% right handed. All of the parents had between 12 to 15 years of education. A Typical Group was selected from the standardization sample of the NEPSY and matched on the variables of chronological age, race, gender, parental education, and region of the country. A MANCOVA revealed significant group differences on 8 of the 14 core subtests of the NEPSY, with the HFA Group performing lower than the Typical Group. While these findings significantly overlapped with those from the original validation study, significant group differences also were uncovered for the subtests of Phonological Processing, Auditory Attention and Response Set, and Speeded Naming; Comprehension of Instructions and Narrative Memory were no longer significant after controlling for IQ. When the groups were compared with respect to the number of cases falling below the 10th percentile, the HFA Group showed a higher rate of occurrence on each subtest, but only significantly so on the Arrows Subtest. These findings provide additional support for the phenotypic neurocognitive presentation of individuals with HFA, and they suggest that the NEPSY can contribute to the neuropsychological description of children with HFA.

Issues in Early Diagnosis and Intervention with Young Children with Autism

In the past few years, the reported incidence of autism has increased at a remarkably high rate across the world. There are at least two reasons for this: broader boundaries of the definition, including high functioning persons with autism (and Asperger’s syndrome) and the diagnosis of very young children (Filipek et al., 1999; Stone et al., 1999). These two trends have increased the numbers from the historical 4–5 per 10,000 to as high as 1 per 200 (depending on how loosely the criteria are applied). This dramatic explosion in the number of diagnoses may be attributable to more knowledge of the parameters, better trained clinicians, a broader definition of the condition, an actual increase in affected cases, and possibly false-positives diagnoses. Nonetheless, the practical reality is that this disorder and its variants have shifted from a low-incidence problem to a significant diagnostic and treatment challenge to the wide professional community. This rise is especially noted in the area of early intervention, which has become both a fertile ground for the development of innovative and effective techniques (Dawson & Osterling, 1997; Harris & Handleman, 1994; Hurth, Shaw, Izeman, Whaley, & Rogers, 1999) and a battleground for controversial claims and disputes (Gresham & MacMillan, 1998; see Schopler, Chapter 2, this volume). Although it is not exactly clear what differentiates effective from ineffective early intervention, there is little doubt that providing education and treatment to very young children can have a very positive effect on their future development and prognosis (Rogers, 1996). There is consensus that early intervention should target those areas of weakness (social, communicative, cognitive) that form the constellation of characteristics of autism (Dawson & Osterling, 1997). It appears equally true that although there are many programs and approaches that report good outcomes, no comparative studies exist, so that at this stage in our knowledge it would be premature and unwise to consider any one method a treatment

Coping with Burnout

During the past decade the topic of burnout has become increasingly popular among the helping professions as a way of describing and understanding work-related stresses (Edelwich and Brodsky, 1980; Freudenberger, 1974; Greenberg and Valletutti, 1980; Patrick, 1981; Pines, Aronson and Kafry, 1981; Welch, Medeiros, and Tate, 1982). Viewed as the end result of chronic stress, this phenomenon has generated the development of a literature that touches upon and attempts to integrate a range of psychological perspectives from Albert Ellis (Ellis and Harper, 1961) to transcendental meditation (Jaffe, 1980) to sports psychology (Nideffer, 1981). Although burnout has been observed in business executives, police officers, and lawyers (Welch et al., 1982), its widest application has been to the helping professions such as nursing, teaching, and counseling (Patrick, 1981; Pines et al., 1981; Welch et al., 1982), in which the common denominator is the impact of providing constant care and meeting the multiple needs of clienteles, often without essential agency support.

Diagnosis and Assessment of Preschool Children

Our purpose in this chapter is to provide a clinically useful discussion of the diagnosis and assessment of preschool children with autism and related disorders. The syndrome of autism is by definition a disorder which is first manifested during the preschool years, usually prior to thirty months of age (American Psychiatric Association, 1980; National Society for Autistic Children, 1978; Rutter, 1978). Thus, child development professionals in various fields need to recognize the symptoms of the condition in preschool-age children, and be prepared to assess the skills and needs of these children and their families.

Assessment of the Young Autistic Child

This chapter will cover issues and methods in the assessment of preschoolers with autism and related severe disorders of communication. Aspects of diagnosis will be reviewed as a backdrop to a review of behavioral characteristics using the current DSM-III-R (American Psychiatric Association, 1987) symptom clusters as a basis to describe empirical data and implications for clinical approaches. Following a discussion of general issues in assessment, including how both diagnosis and assessment differ between the young preschooler and the older autistic child, the final section will discuss the relationship between assessment and treatment planning.

Some findings on the use of the adaptive behavior scale with autistic children

Two studies on the use of the AAMD Adaptive Behavior Scale (ABS) with autistic children are reported. The first study compared ratings by parents and teachers on the same child. For Part I (Adaptive), significant correlations were found on total score and on 7 out of 10 individual scales. For Part II (Behavior), significant correlations were found on only 3 out of 14 scales and not on total score. The second study examined change measured by the ABS across an academic year. For Part I, significant change occurred on 5 of the 10 scales and on total score; for Part II significant differences were found on 2 of the 14 scales and not on total score. Correlations with IQ, Social Quotient (SQ), and degree of autism revealed a similar pattern. The implications of the differences between the two parts of the ABS and their utility for autistic children are discussed.

Families of Adults with Autism Spectrum Disorders

Families with adults with autism spectrum disorders (ASDs) continue to play an instrumental part in the lives of their adult relative with autism throughout the lifespan. This chapter reviews the concerns and roles of families of adults with ASD, and the impact of the stress these responsibilities have on family members. Intervention and support services for families of adults with ASD offered through the TEACCH autism program are described as a framework for the development of future service delivery systems for this growing population.

Developmental Assessment as a Basis for Planning Educational Programs for Autistic Children.

Although educational strategies and management systems have been developed and reported for working with autistic children, the utilization of assessment data to plan individualized programs has not been given much consideration. This paper describes an instrument (the Psychoeducational Profile) that provides a comprehensive evaluation of developmental functioning and behavior. The importance of integrating information about the childs unique learning characteristics with measured skill levels is emphasized. Factors involved in programming from assessment data are considered, including the understanding of the childs abilities, selection of realistic goals and methods and anticipation of potential management problems. Two case studies are presented to demonstrate the process of developing a teaching program based on information derived from the PEP. It is concluded that viewing the autistic child as developmentally disabled with specifiable handicaps and determining a starting point for educational goals from a comprehensive assessment can reduce initial uncertainty and confusion and provide a framework for ongoing education.