Autism in Children: Systematic Literature Review of Research on Autism

Autism in children is a widely expanding research topic, as scholars continue to research on how factors like education, psychotherapy, and parenting affect children with autism. This systematic literature review provides a descriptive review of existing research on autism in children and the effect of educational interventions on the developmental behavior of children with autism.

Autism in Children: Overview of  Autism spectrum disorder (ASD)

autism awareness ribbonAutism spectrum disorder is a pervasive developmental disorder that causes severe impairment and abnormal functioning of language, social and imaginative development in children within the first three years in life, deviating from the typical development pattern experienced by people of a similar age (Brentani, et al., 2013).

It’s diagnosed by carrying out a compressive and systematic assessment of a patient’s strengths and weaknesses. According to Brentani, diagnostic criteria for autism focuses on the impairment of social interactions, qualitative impairment of communication skills, and restricted or repetitive behavior patterns, activities, and interests.

According to Tchaconas, & Adesman, (2013), the autism spectrum disorder (asd) is among the most prevalent autism disorders in children and has been an issue of attention and research interest in recent years. Tchaconas, A., & Adesman, further estimate that the severity of autism can be reduced through early diagnosis and application of appropriate interventions.

Researchers remain speculative on the actual cause of autism in children. Generally, the condition is attributed to genetic factors. However, recent advanced technologies such as genetic testing, neuroimaging, metabolic testing and electroencephalogram, etc, have significantly assisted in the medical evaluation of autism in children and the determination of appropriate treatment interventions (Tchaconas, & Adesman, 2013).

Lindgren, & Doobay, (2011) further adds that autism in children can be identified using common observable symptoms like poor reading skills, lack of clue on social factors, and lack of interest in developing peer relationships. Lindgren & Doobay, demonstrates the need for evidence-based interventions for developmental disorders such as autism is rising, and legislation is promoting appropriate interventions to support the learning of children diagnosed with autism disorders.

Development behavior of children with autism

Several researchers have continued to explore development behaviors associated with autism in children, with an aim of understanding how they affect the functioning of affected children. According to Dominick, (2007), typical behaviors are key diagnostic indicators for autism in children. Diagnostic behaviors for autism in children include eating difficulties, abnormal sleeping patterns and self-injury behavior and aggressive as well as temper tantrums behavior.

A study carried by Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, (2007) to investigate how these behaviors were related to language, autistic symptoms and depression found out that there is a strong correlation between cognitive and language ability with these repetitive behaviors.

According to Grofer Klinger, Ence, & Meyer, (2013) most appropriate approaches to managing these repetitive behaviors are behavior interventions that target communication skills, social skills and responsiveness. This observation is founded on the fact that one of the most challenging behaviors to improve in children with autism is communication skills. Therefore, intervention programs should focus on enhancing communication skills like spontaneous language use and enhanced verbalization to reduce problematic behaviors associated with the disorder.

In addition to communication, interventions for autism in children should also aim at developing social skills. A systematic review carried out by White, Keonig, & Scahill, (2007) on various interventions acknowledges that a lack of social skills is the core feature which affects individuals with autism directly and indirectly. The systematic review studied research reports published by 2006 that described the interventions for autism in children of school age to adolescence. The review showed that group-based interventions were the most appropriate for developing social skills in children diagnosed with autism.

Furthermore, Neitzel (2010) acknowledged that positive behavior support is among effective approaches to reduce challenging behaviors that children with autism experience. According to Neitzel, children with autism have a high risk of disruptive behaviors, which may hinder their development thus limiting their capability to learn essential social, communication and academic skills.

Therefore, adopting positive interventions enables children with autism to socialize and engage in meaningful activities with others. These positive interventions include adopting conducive and quality learning environments, which emphasize on building positive student relationships. Positive interventions reduce the possibility of interfering behavior reoccurring by addressing them more efficiently.

However, inadequate knowledge on the communication abilities of affected children and their social functions is a potential barrier to appropriate behavioral interventions for autism in children (Boyd, McDonough, & Bodfish, 2012). Such knowledge gaps necessitate extensive research on autism in children to identify evidence and psychosocial based interventions for addressing repetitive behaviors in children with autism.

Educational Interventions and the Developmental Behavior of Autistic Children

teaching children with autism
Education has been identified as one of the fundamental development factors because of its role in enriching people’s understanding of the society. Lal & Shahane, (2011) acknowledged that autism affects the perception of affected persons on society and the world at large. Similarly, education plays a significant role in the development of autistic children. It provides them with an opportunity to develop positive social behaviors and acquire knowledge.

However, children with autism disorders acquire education differently compared to neuro-typical children. Obrusnikova & Dillon (2011) acknowledged that educating children diagnosed with autism is more challenging than educating neurotypical children. This challenge is aggravated by the fact that more than one in every 110 children have autism, and the majority of affected children are taught general physical education.

According to Obrusnikova & Dillon, there is need for the education of children with autism to focus on specific factors with unique learning attributes that help such children to develop social and communicative skills. The significant challenges identified in the study by Obrusnikova and Dillon are classified into competitive, corporative, and individual learning situations.

Similarly, Myers & Johnson (2007) demonstrated that education interventions for autism in children should focus on maximizing the child’s functional independence and guide them to optimize their quality of life. According to Myers, & Johnson, (2007) educational interventions for autism in children are alternative to pharmacological and nonpharmacological interventions. Myers & Johnson further states that educational interventions are the cornerstone of managing autistic disorders, and enhancing their social development skills.

Psycho-educational Interventions for Autism in Children

Research evidence shows that intensive behavioral interventions for children with autism have a significant influence on their developmental behavior. According to an environmental design study carried out by Eikeseth (2009), psychoeducational interventions show considerable success in improving the adaptive behaviors of children diagnosed with autism. The study was carried out between March 2005 and 2010 on children diagnosed with autism disorders.

The experimental group was treated normally, while the comparison group was subjected to special education procedures by special education teachers. The comparison group was taught communication skills, social and self-help skills, and reducing aberrant behaviors. The outcome measure was variable in the adaptive behavior, measured using a maladaptive behavior scale and a childhood autism rating scale. The autism rating scale indicated the severity of the disorder and the behavior exhibited by each child.

Results of the study showed that a comparison group, subjected to the special education procedures had significantly higher scores in all the scales when compared to the participants who received normal treatment.

Bosa (2006) agrees with the experimental results in that psychoeducational interventions are effective in enhancing developmental behaviors of children with autism. According to Bosa, these interventions aim to foster communication and social
development, problem-solving, and helping families of affected children to cope with the disorder.

However, Bosa, acknowledges that psychoeducational interventions are most effective in fostering social and communication skills development. This is because they provide autism affected children with an alternative form of communication, depending on the child’s needs and the degree of impartment. In addition, psychoeducational approaches widely use symbols, which mostly improve the limited cognitive abilities of affected children.

McCredie (2013) acknowledges that psycho-educational approaches for addressing autism in children are effective in supporting the developmental of children diagnosed with autism. McCredie notes that psych-educational approaches eliminate the erratic behaviors experienced by autistic children within their frame of expression. This is because children with autism process information in a way that is different from normal children.

Existing research on autism in children shows that children with autism have limited physiological and neurological responses, which results in the challenging behaviors that are portrayed by patients. Therefore, psychoeducational approaches for autism in children impact on their behavior because they focus on enhancing the unusual sensory inputs which form part of the functioning of autistic children (Patra, Arun, & Chavan, 2015).

Inclusive Education in Children with Autism

In the last century, major changes were effected in the education sector to accommodate children with special needs, such as those diagnosed with autism. Research on autism in the United States by Lal (2005) to evaluate the impact of inclusive educational placements on social and language development with autism, found out that there is a positive correlation between teaching strategies and the development of social behaviors and language skills in children diagnosed with autism.

The study included 80 randomly selected participants from general schools. It revealed that affected students have severely impaired social skills, which makes it difficult for them to interact with other students and to develop critical life skills. In addition, students with autism disorders show significant challenges in both verbal and non-verbal skills, making it difficult to develop effective language and communication skills.

This argument is upheld by Von Tetzchner, & Grindheim (2013) which notes that inclusive education plays can help children with autism experience an active life and, in turn, facilitate their learning and development. Inclusive education provides affected children with an opportunity to learn and evelop social skills, hence enabling them to interact more with others.

According to Timmons, Breitenbach, & MacIsaac (2005) children with autism can learn from their peers if learning activities are well structured. Therefore, inclusive education has to be properly reinforced for interactions between autistic children and their peers to yield benefit. Denning & Moody (2013) further states that special educators who implement inclusive education for autistic children require additional information on handling autistic children for their interventions to be beneficial.

Denning &Moody (2013) proposes the inclusion of the three features of inclusive education; engagement, expression, and representation in the learning activities of autistic students in order to impact their developmental behaviors. One of the requirements of favorable inclusive learning environments is support for all children both from peers and teachers.

Ochs, Kremer‐Sadlik, Solomon, & Sirota (2001) noted that inclusion is a federal policy for ensuring the integration of children with disability or disorders such as autism in the regular educational settings. Therefore, education settings should not neglect students with challenges such as those diagnosed with autism.

According to Ochs, Kremer‐Sadlik, Solomon, & Sirota, overlooking autism in children may include failure to pay attention or disregard for affected children who have special needs. Autistic students are likely to be neglected because of their negative behaviors such as withdraw. Other negative inclusion factors such as rejection and scorn have a negative impact on what is originally intended to be achieved by inclusive education interventions.

Parental Mediated Education for Autistic Children

Existing research on autism in children shows that Parental training and education are critical  interventions for autistic children (Brookman-Frazee, Stahmer, Baker-Ericzen, & Tsai, 2006). Brookman-Frazee et al. carried out a systematic review of different parental education and training programs for children with autism and accessed interventions effective in controlling childhood behavior.

The  systematic review included 38 studies on autism in children, that had varying study designs, from 1995 to 2005. The major focus of the selected studies included behavioral observations of the affected children and parents and the structured self-report of both the affected children and parents.

The study focused on parental education interventions such as improving the relationship between the child and parent, problem-solving skills, improvement in communications skills, social skills, and functional assessment procedures.

In addition, the study on parental education intervention programs evaluated parental factors such as depression, stress and marital function of the parent. The review also categorized the participants of reviewed studies regarding age, gender and the setting in which the parental educational programs were administered. 

Other categories included in the autism in children review were the format of the parental education program, the instructional method used and conditioning principles. The studies reviewed by Brookman-Frazee et al. (2006) were classified depending on the design of the reviewed studies. The studies utilizing an experimental design comprised of 77% randomized control trial studies on autism in children and 64% single-subject design studies.

Moreover, 77% of the studies in this category focused on behavioral observations for autism in children in assessing their results, while 87% used a structured child functioning method to obtain findings. The results of the review on autism in children revealed that parental education programs played a critical role in enhancing specific skills for children with autism such as communication skills.

A randomized controlled trial by Tonge, Brereton, Kiomall, Mackinnon, King, & Rinehart (2006) investigating the effects of parental and behavior
management as an intervention for autism in children shows that parental education contributes significantly to enhancing the developmental behavior of affected children. This particular study on autism in children used a parallel group comparison study design, with children between the age of two and half years to five years diagnosed with DSM-IV of autism disorder.

Participants were drawn from a broad cross-section of ethnic and social backgrounds and had adequate language skills
that were required to complete the questionnaires and participate in the study on autism in children.
The outcome measures for the study were developed in relation to selected autistic
symptoms in children, with the primary outcome measures being a reliable developmental and behavioral checklist of 96 items.

The measures evaluated a child’s performance on seven listed domains which are standardized with a similar age equivalent and tested to ensure clinical validity. The results of the randomized control trial carried out by Tonge et al. (2006) also revealed that parental education and skills program significantly benefited parents with children diagnosed with autism, and contributed in enhancing behavioral treatments such as strengthening functional communication skills and improved child-parent interactions. 

Therefore, both researchers agree that parental education as an early
intervention for autism in children contributed significantly to enhancing behavioral development for children diagnosed with Autism. A 24-week randomized control trial carried out by Bearss, Johnson, Smith, Lecavalier, Swiezy, & Aman, et al. (2015) evaluating the efficacy of the parent education in developmental behavior for children with autism.

Similarly, Tonge et al. (2006) and Brookman-Frazee et al. (2006), that parental education programs were a critical component intervention in enhancing behavior for autistic children. The main study intervention was parental education, and primary outcome was disruptive behavior, measured using an aberrant behavior checklist irritability scale, with ranges from 0 to 45. The results of the study also revealed that parental education and a 24-week training programs were more effective in reducing disruptive behavior for children with autism.

Likewise, a systematic literature review carried out by Beaudoin, Sébire & Couture, (2014) evaluating parental education and training as interventions for autism in children further shows that parental education helped parents learn various strategies to which they influenced their children development behavior.

According to the study, autism in children is characterized by stereotyped and repetitive behaviors, with children having difficulties in social interaction and communications. A literature search was carried out in 2013, using four databases including CINAHL, ERIC, PubMed/Medline and PsycINFO and included children with the risk of autistic disorder, and at least one parent.

Outcomes of the studies reviewed was categorized on their effects of parental education on
children, parent and its influence on parent-child interactions. They reviewed included 484 children, with the mean age of 23.26 months diagnosed with autism or at risk being diagnosed with the disorder. The interventions for reviewed studies ranged from behavioral to sociopragmatic interventions, and the effect on the child’s development at follow up was the main outcome.

The results of the study on autism in children revealed that a majority of resources reviewed identified positive changes for autistic children for parental education as an intervention. These results show that children autism showed significant improvement in their communication and socioemotional functioning skills. 

Therefore, results obtained by these studies on autism in children are consistent and re-affirm
that parental education, as an intervention for children with autism, was significant in influencing their developmental behavior positively. According to Oono, Honey, & McConachie, (2013) early parental interventions have a substantial impact in reducing the non-compliant aggressive behavior. These interventions benefit both the children and their parents and are an excellent alternative to premeditated interventions in helping children diagnosed with autism develop their social and behavioral skills.

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