Autism and Its Treatment in China

Introduction

Autism is classified as a developmental disorder which means that it is conditions a child is believed to be born with or born with a potential for developing. Autism is the result of an abnormality in the structure and function of the brain. Technology still does not allow researchers to see much of how nerve cells grow or come together in the brain, or how information is passed from nerve to nerve, there is increasing evidence that the problems associated with autism and the other forms of autism are the result of structural differences in the brain that arise during pregnancy–either due to something that injures the brain or due to a genetic factor that interferes with typical brain growth. In China, autism is one of the main problems affecting 100,000 children.

Main body

Autism is defined as “a developmental disorder that affects many aspects of how a child sees the world and learns from his or her experiences. Children with autism lack the usual desire for social contact. The attention and approval of others are not important to them in the usual way. Autism is not an absolute lack of desire for affiliation, but a relative one” (Jepson 5). Researchers (Schmidt 404) admit that depending on the definition of autism that is used, slightly more or slightly fewer children will be considered autistic, or be considered to have another form of PDD. (In addition to the DSM-IV definition of autistic spectrum disorders used here, there is also a slightly different international set of diagnostic standards, as well as older sets of diagnostic standards like DSM-III-R and DSM-III.)

In addition, the prevalence of non-autistic forms of PDD is less well studied than the prevalence of autism itself. Most experts generally agree, though, that if cases of both autism and non-autistic PDDs are considered together, and a fairly liberal definition of autism is applied, autistic spectrum disorders occur in approximately ten to fifteen out of every 10,000 children. (Jepson 25).

According to statistical results, “a report by China Central Television (CCTV) said China has at least 1.8 million people, including 400,000 children, suffering from autism” (Autism in China 2006). Usually, autism affects boys four to five times as often as they affect girls. Asperger’s syndrome may affect boys as much as ten times more often than girls. In fragile X syndrome, some children are affected with autism as well as other behavioral difficulties not necessarily associated with autism. Clearly, some families have an inherited form of autism, and in those families, girls seem more often affected (only about two autistic boys for each autistic girl instead of four or five) (Zhang et al 55).

Children thought to have a genetic form of autism have either an autistic sibling or an autistic first cousin. It is not yet well understood how autism is inherited, and autistic children with more distant autistic relatives are now believed to have a genetic form of the disorder as well. The only time that symptoms of PDD occur more often in girls is when the girls are primarily affected by a disorder called Rett’s syndrome. In addition to possible genetic causes of autism, cases of autism have been linked to a variety of risk factors associated with pregnancy and delivery. A “risk factor,” however, is not the same thing as a “cause,” and it can be very difficult to say with confidence what “caused” any specific case of autism (Zhang et al 55).

The progression of autism in China is alarming. The main problem is that many children cannot receive medical and psychological help because of poor financial resources and the lack of funding spent on the medical sector. “Doctors say children with autism should receive treatment between the ages of two and 12. However, there are only a few institutions in the country with adequate funding to give special treatment to autistic children, and “a lot of autistic children miss prime opportunities for treatment because of inadequate institutions and funds”, according to Jia Meixiang, deputy chairman of BRAAC” (Autism in China 2006).

The progression of autism in China is caused by the fact that autistic spectrum disorders constitute a syndrome, which means that affected individuals will not have all the associated signs and symptoms. Before their child is diagnosed with autism or PDD, parents often say that their child did not resemble the children they read about in books on autism. This is because no two autistic children are alike, any more than two normally developing children are alike. Following Huang and Wheeler: “it is reasonable to estimate that approximately 75 to 80 percent of the 1.95 million individuals with autism have not yet been identified or diagnosed properly” (356).

There may be certain striking similarities between two children in terms of very specific behaviors, but because they differ in other ways, it does not mean that both cannot be autistic. In a child with autism, a very careful evaluation needs to be undertaken in making the diagnosis in order to understand what behaviors are part of the child’s autism, what may be a reflection of some degree of mental retardation, what is the child’s personality, and what is a reflection of the way the child acts as a means of compensating for his or her disability (Szecsi and Giambo 336). That is why it is important for a professional to consider why the child does what he does, and explain the meaning of unusual behaviors to parents in terms of what the child is trying to accomplish through his actions (Jepson 39).

In contrast to many countries, the Chinese government and medical centers advise parents to involve autistic children in general education. When speaking of children with developmental disabilities, the term “education” is often used more broadly than it is with nonhandicapped children. Usually, it is interpreted to include early skills that usually do not first emerge in school, like learning to talk, and can also include adaptive behaviors such as becoming toilet-trained or learning to eat with utensils or, for older students, learning to ride a bus or hold a job (Schmidt 404). Academic subjects are, of course, included too, and can be taught either in the usual way or with more of a functional focus. As an autistic child matures, parents are faced with a couple of critical points when educational goals may need to be scrutinized with particular care (Jepson 23).

After that, many children progress more or less smoothly through a system of teachers and school staff who provide continuity in planning and goals. Other times when it is important to examine closely a child’s educational progress and future goals are when a child moves from a preschool to an elementary school program, or from an elementary to a middle school, or from middle school to high school.

Children grow at different rates, too–partly as a function of their capacity, partly as a function of their teaching. So there are times when a child’s educational progress in his current program seems stalled, and parents and school personnel will have to consider carefully whether a change in curriculum focus is needed. There are points at which a child may need to shift from a more academic to more functional skills focus, or from more verbal to a more nonverbal focus (Schmidt 404).

These are really sensitive periods when all involved have to look carefully at objective measures to feel justified that “downsizing” a child’s long-term objectives is not read by parents as a lack of interest on the school’s part in trying to help the student achieve more. “In practice, students with disabilities, including autism, in regular schools use the same curriculum as typically developing students, but are exempt from taking tests designed for their typically developing peers (Sun, 1990). This practice also impedes the proper documentation and assessment of their behavioral and academic progress” (Huang and Wheeler 356).

In contrast in the USA, most developmental services agencies assign each child a representative who may be referred to as a case manager, caseworker, social worker, client program coordinator, or so on, depending on what that person’s qualifications and duties are. The caseworker is someone who knows the system that a person needs help from. Some developmental services agencies provide families with funding for developmental assessment or actually do developmental assessment in-house (Jepson 62). At the very least, a thorough developmental assessment should be provided at the time of initial intake to determine eligibility for various sorts of services.

Many agencies provide periodic reassessment, especially when eligibility or appropriateness for further services come into question. In China, many children “with severe, multiple disabilities and mental retardation are still being institutionalized and kept away from community life” (Huang and Wheeler 356).

Thus, Chinese authorities introduce behavior intervention services in order to support families with autistic children. Developmental agencies sometimes provide therapists or pay for therapists who are specially trained to use behavioral methods to address behavioral problems the parents may be having with the child at home. For younger children, problems that behavior therapists can help with may include throwing tantrums, toilet training, self-injurious behavior, or “self-stimulation” behaviors. Sometimes behaviorists work on helping the child develop better means of communication as a way of reducing tantrums (Jepson 29).

In school-aged children, behaviorists may help with issues of compliance, table manners, and grooming. For adolescents, behaviorists are often called in to help the adolescent learn socially acceptable ways of expressing sexual desires. Other behaviorists work specifically with young adults around skills needed for living in the mainstream, like travel training, having responsible work habits, and social skills development (Szecsi and Giambo 338).

Another big help that developmental service agencies may provide parents is respite care (Szecsi and Giambo 338). Generally, families are allocated a certain number of respite hours per month (for example, in California it’s hypothetically sixteen hours), and these can be used on a regular basis–like one afternoon a week–or the hours can be saved up so that parents or parents plus other siblings can get away for a couple of days a few times a year (Jepson 99).

Because some agencies are so overwhelmed, there is sometimes more demand for a respite than there are care providers or funds for respite care. Sometimes it’s possible to have a friend or relative who is good at caring for a child become authorized to receive respite payments for taking care of him. In some locales, respite care is a free service, and in other places, it is provided as a sliding scale subsidy.

In contrast to China, US families receive residential treatment. Perhaps the most difficult question that parents of autistic children ever have to ask themselves (and answer) is whether the child would be better served in some sort of residential placement. Developmental services agencies, along with various other agencies, pay for part of the residential placement, and the autistic child or young adult’s case manager usually orchestrates the process. Residential placement is virtually always at the discretion of parents (Deng et al 288).

Psychoactive medications treat symptoms. There are no medications that have been found effective in the treatment of autism as a whole. When medications are used to treat an autistic child, they are used to treat a particular symptom or group of related symptoms. Symptoms of autism that sometimes improve with the introduction of medications include hyperactivity, short attention span, stereotyped motor movements, self-injurious behaviors, aggressiveness, social withdrawal, excessive anxiety, and poor sleep. Although all of these problems can occur in autistic children, none are symptoms unique to autism, nor are any of the medications used with children with autism used only for children with these two diagnoses.

There are no separate medications that are used only for autism or only for PDD. In the US, the most popular drugs are antidepressants (Tofranil, Norpramin, Pertofrane, Prozac, Anafranil) (Jepson 102). By and large, tricyclic antidepressants are the kind of antidepressant most frequently used in treating children with autism or PDD; these children may benefit from a reduction in gross motor hyperactivity, improved attention span, and a reduction in Tricyclic antidepressants may also normalize sleep patterns. Tofranil is the single most frequently used antidepressant for children with autism and the most widely studied (Jepson 99).

In China, stimulant medications are more popular. They have an opposite (paradoxical) effect in most children than they do in adults. Therefore stimulants slow hyperactive children down. Stimulant medications have been studied widely in hyperactive children with attention deficit hyperactivity disorder (ADHD). Ritalin (methylphenidate) is the most effective stimulant for slowing down children with ADHD; Dexedrine (dextroamphetamine) often works, too.

Occasionally, Ritalin or Dexedrine has the same beneficial effects for autistic children, but most doctors who frequently treat autistic children with medications put it way down on their list of choices. In autistic children, the use of stimulants can also be associated with an increase in stereotyped motor movements and the development of ties (Zhang et al 55).

Conclusion

In recent years, China follows a Western treatment method and introduces more educational classes for such children. Autistic children may be limited by an autistic class when they get to a point where their imitation is somewhat improved, substantial one-to-one is not needed for compliance, there is some responsiveness to social praise, and there is an emerging interest inappropriate play with toys (Deng et al 288). A parent-teacher relationship is a very precious, fragile thing. A parent needs to be able to depend on the teacher to do the right things with the child. The teacher needs to feel that she has the parent’s support and cooperation.

Another advantage of autistic classes for a very young child is that very small group (say, one-to-two) and one-to-one instruction is usually more available, and young autistic children need that to gain the initial imitation skills that can later be generalized to include things beyond the model that is right in front of them. Often this relationship begins the first time parents visit a class that may be an appropriate place for their child (Deng et al 288). Having a small consistent group of peers makes it easier for the autistic or PDD child to form friendships; in a larger peer group, like a preschool, a typical four-year-old will quickly give up and try elsewhere if another four-year-old he approaches don’t answer back fairly promptly.

Works Cited

Autism in China. 2006. Web.

Deng, M., Poon-Mcbrayer, K. F., Farnsworth, E. The Development of Special Education in China. Remedial and Special Education, 22 (2001); 288.

Huang, A, X., Wheeler, J. J. Including Children with Autism in General Childhood Education, 83 (2007), 356.

Jepson, B. Changing the Course of Autism: A Scientific Approach for Parents and Physicians. Sentient Publications; 1 edition, 2007.

Schmidt, Ch. W. A Deeper Look into Mental Illness. Environmental Health Perspectives, 115, (2007): 404.

Szecsi, T., Giambo, D. A., Inclusive Educational Practices around the World: An Introduction. Childhood Education, 83 (2007), 338.

Zhang, D., Wehmeyer, M. L, Chen, L.-L. Parent and Teacher Engagement in Fostering the Self-Determination of Students with Disabilities: A Comparison between the United States and the Republic of China. Remedial and Special Education, 26 (2005); 55.