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.

Do You have Sensory Problems?

I do... have for as long as I can remember. I didn't always understand why some parts of me were different from other people nor do I always understand some of the ways I respond now. Some ways that my body may respond to a stimulus I still do not understand... but I accept it and sometimes laugh about it... and sometimes cry about it... and sometimes I just shake my head and shrug. In the end, my processing challenges are a part of me and make me the unique and wonderful individual that I am. That said, I was in my thirties before I was even heard the term sensory processing disorder / sensory integration disorder and researchers are still trying to understand how these disorders work. I thought that I would take a few minutes to talk about the basic human sensory system and leave you with a small list of questions that you can read and, if interested, can use to look at your own behavior and responses to different stimuli and determine if you too, might have some sensory processing challenges. :)

When I was growing up, I learned about the five senses: touch, taste, sight, hearing and smell. The sense of touch as processed through our skin and taste processed inside of our mouths.... the sense of sight which is processed through our eyes and sound through our ears... and the sense of smell through our nose. And each of these organs sends the information to the brain for final processing so that we can use the information. In the processing the information is organized in the brain so that we can use it to make appropriate responses to external stimuli. For those with disorders of the sensory system, the organized information may not create the correct responses.... the child who reaches toward a snarling cat and is genuinely confused when the cat hurts it... the person in whom fear causes hyperactivity or out of control behavior, etc...

So let's start with some basic questions. Here is how the questions work. Each question should be looked at by thinking of how often you perform the behavior in question. The more often you do it, the more likely it is that your brain is having some difficulty processing the information in a 'neuro-typical way'. Is that a problem? Not necessarily... it really depends on how my your behavior in this regard affects your quality of life.

1. Do you prefer the dark, happily avoid bright light and feel happier in dim light? Do you find that you are bothered by light when others feel comfortable?

2. Is it difficult for you to accurately visualize images or objects in messy or cluttered backgrounds? Do you end up staring at objects overly long to process the information?

3. Do you find it more challenging or impossible to complete tasks with noise or music in the background? Do you find yourself easily distracted by noise or even seek out noise or make sounds simply to have noise around you?

4. Do you avoid noise or sounds? Are you slow to respond to sounds around you that are relevant and important... an inability to recognize what sounds are important and to block out sounds that are not?

5. Do you have difficulty processing really strong smells? An inability to smell odors that the people around you can?

6. Do you find yourself feeling large amounts of anxiety or anger when your expectations or your routine has to change? Do you find yourself doing tasks in inefficient ways because it feels more comfortable to you? Do you move from one activity to another not completing any of them very quickly?

7. Do you prefer to be alone? Prefer quiet activities? Quiet areas and places?

8. Do you have problems with textures in food and limit what you eat based on what the food feels like? Do you crave certain foods due to flavor or strong smells or will you only eat certain foods?

9. Do you have problems with touching or being touched? Do you react emotionally when being touched by people or things such as water, unnatural fabrics, etc.. or do you crave touch and will touch too much and too often?

10. If something touches you such as clothing, are you able to 'forget' the touch.... or do you feel the clothing and its touch all day in part of your mind? Do you go barefoot because shoes feel uncomfortable? Do you fill your hands with things so avoid people touching your hands?

11. Do you seem to have an awareness – or lack of awareness- to pain or temperature that is different from most other people? Can you injure yourself and find that the pain is not at the level that it should be for the injury? Do you feel comfortable in a snowy environment in short sleeves?

I could definitely go on and healthcare providers who try to help their patients with sensory issues will ask many more questions than this.

One challenge that comes with sensory problems is that as someone struggles with them and they find the way they respond is so different from other people, it affects the individual's emotional well being. People with sensory problems appears to be more likely to develop low self esteem and self critical behavior. They are more likely to exhibit socially inappropriate behavior as well as difficulty expressing emotions in a healthy way. The odds of having problems with anxiety are a lot higher in this population making a challenging situation sometimes worse. I will admit that I find it challenging sometimes myself.

This post is so basic that I beg of you to not make any diagnosis or take to much out of it. I just wanted to take a little time to introduce the topic to start a little basic awareness. If you want more information, please feel free to leave any questions you want answered in the comments or speak to a medical professional about your thoughts. Both of these diagnoses are still debated by healthcare professionals so if you would like more information, be sure to find a provider who has studied and has knowledge of both sensory processing disorder and sensory integration disorder and the nuances between them. Thanks for sharing. :)