Analysis of Two Articles on Autism and Screening Tools

For an assignment, I chose two articles to study, analyze, and review on autism to understand some of the differences in focus and rhetoric used by writers to educate and hold their desired target audience. The first article was originally published in Valley Health Magazine in April 2014 and was written by Amanda Nicolson Adams. The primary focus of this article is to discuss autism and its prevalence along with the causes, screening tools, and treatments that are available for those who are diagnosed. The author has broken the article into sections so that she can concisely and specifically cover these topics without a lot of overlap or potential confusion. I chose this article for its well laid out design which is quite user friendly as well as its even tone and concisely listed information.
Dr. Adams begins the article with a quick overview on the increase of autism diagnoses in the United States and what the diagnosis actually describes in terms of its behaviors, physical and language difficulties, and the classification of ASD as a neurological disorder. The article states that hard numbers concerning the prevalence of individuals affected by autism can only be estimated due to the differences in sources and environments that affect diagnosis and treatment. “However, even conservative estimates place autism as more prevalent in pediatrics than cancer, diabetes, spina bifida, and Down syndrome combined.” Though research has confirmed that there are some biological and genetic markers, none of them are fully reliable for accurate diagnosis. A short discussion on the potential causes of autism that researchers have been able to identify make it clear that this disorder is widely misconstrued, and even with the enormous amounts of research that have been performed to discover and tabulate the precise causes, there is no clear consensus and no clear preventative measures that can be taken by parents and caregivers.

When discussing screening tools, Adams focuses on giving parents the information to begin the process of screening their children as soon as they recognize potential signs that their children may not be developing among the normal guidelines. The two tools that she recommends are the M-CHAT (Modified Checklist for Autism in Toddlers) and CARS (Childhood Autism Rating Scale). Both tools can be scored fairly quickly and the two potential negatives that she sees for these tests are that the tests can potentially create high false positives towards diagnosis and that some parents see the possibility that their child could potentially be wrongly diagnosed as a reason for not utilizing the screening tools. Her recommendation to “Screen anyway, treat anyway” is followed by the idea that early intervention treatment has no downside for the child and would help any child whether neuro-typical or autistic.

The article then closes with a discussion of treatments that are recommended for use in early intervention including ABA (Applied Behavioral Analysis), Floortime/ Relationship Development Model (RDI), Complementary and Alternative Medicine (CAM), and sensory based treatments. Her consensus is that ABA is the most effective treatment model with decades of research supporting it and that it works for children with autism “exceptionally well because of its precise teaching methodology and focus” on the strengths and weaknesses of each individual participant.

The second article for this assignment is titled, “The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorder.” It was originally published in 2001 when the M-CHAT was being developed and studied for effectiveness and flaws. While the article is not the most current on this particular screening tool, I found myself continuously drawn back to it due to its uniqueness. In my experience, it is uncommon to find an article that discusses new research and ideas and how they are presented with the openings and recognition that newer, more comprehensive research may modify and transmute the original research into a new object altogether. Being able to look at a tool that is widely used now while in its infancy seemed like a wonderful opportunity that I have always have the ability to do, but have never felt motivated enough to attempt and complete. How could I ignore this perfect circumstance?

The article quickly summarized what autism disorder is and how important early intervention is for children in order to achieve more positive outcomes as they grow up, ending with “…there is no standard and easily administered screening instrument for young children.” Discussion on the gap between a parent’s first concerns about their child’s development and a visit to a specialist followed by a diagnosis suggests that having a quick, accurate, and easy way to identify children that need intervention as early as possible is an important and needed tool for both parents and professionals in the hopes of being able to intervene with at risk children as quickly as possible in their lives.

The paper continues on discussing the correlation with deficits and problem behavior that early intervention can minimize or change whereas behaviors can be harder or impossible to change when the individual is older and the brain has less flexibility. Recognizing that many of these at risk individuals also have unusual sensory responses to their environment and that many ‘signs’ of autism that are used to diagnose a child at 20+ months could be tracked and looked for at 18 months, the authors agree that a tool that would specifically help pediatricians more easily determine and refer at risk toddlers for early intervention would be optimal. The paper discusses the known useful characteristics of a screening device and then mentions the current tools available for use which include the Autism Behavior Checklist, the E-2 Form of the Diagnostic Checklist, the Behavior Rating Instrument for Autistic and Atypical Children, and the Autism Diagnostic Observation Schedule- Generic. Continuing by discussing the problems with the current screening tools used, the authors guide the discussion to the newest tool under development called the M-CHAT (Modified Checklist for Autism in Toddlers). It is an extension for one of the older tests which has been modified to not rely only on the observations of the pediatrician or heath care professional, but also on the observations and thoughts of the parent/caregiver. The rest of the article places its focus on how the M-CHAT works and evidence for its usefulness.

Both of these articles covered some of the same information to make sure that their audience understood the terms and concerns of the author. Both articles discussed Autism Spectrum Disorder, the behavior and deficits that are typically manifest in it (regardless of individual differences), and the importance of early intervention. The authors of these articles wanted to stress the use of screening tools to get children who are at risk into early intervention programs quickly- preferably as infants and toddlers so that there is less ‘wasted’ intervention time and more opportunity for positive change for the individual. As the article from Valley Health appears to be targeted to the average individual or parent, the author keeps the information pretty simple. The journal paper is targeted to a different audience, but also keeps the focus of its information on its chosen topic of the M-CHAT as a screening tool. The audiences that are targeted by the writings are very different and so will tend to be more variable for the targeted group. Lastly, both pieces of writing mention that while there are many kinds of treatment for autism available, the safest and most effective treatments are those that have been scientifically studied and tested.

In some ways, there were significant differences in the articles. In the Valley Health article, Adams made the case for treatments and tests that she preferred over others (the M-CHAT was a preferred screening tool.) The Journal article mentions many screening tools, but spends its focus on the M-CHAT as the article is written to share the initial research and information collected on its use. Adams uses her article to introduce autism and many basic questions people have – her focus is to really answer many basic questions that people have while the M-CHAT article is more focused on the screening tool itself and its differences from other tools available for use.

A few things that I learned from reading these articles was how differently articles are written based on their target audience. Even when the information is the same and agreed upon by both sources, the presentation and information about the topics can be very different. The Valley Health article was more generalized, which makes sense if you think that its target audience is the general public while the journal article was much more focused and had a more precise scope on the information it shared. It was useful to discover how many different screening tools there are to try and assess children and their strengths and weaknesses. I appreciated the recognition of both articles of how much parents themselves need to be involved in the process of diagnosis and treatment. A useful assignment indeed.

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