The current research investigated the intervention strategies after autism diagnosis among children in early years. The researcher conducted a phenomenological investigation to uncover the strategies. Fifteen respondents were chosen using purposive sampling, but 10 of them responded to the questionnaires fielded. The questionnaires designed focused solely on the study objectives to harness information appropriate for the topic and research questions. The researcher used emails to send the consent forms, which were filled and returned for actual submission of the questionnaires. After the questionnaires were sent, only 10 participants gave feedback, which was then coded and input into the NVivo software for analysis. The investigator used thematic analysis and utilised qualitative analysis to present chapter 4, the findings and discussion. It is important to indicate that the respondents included the parents and guardians of the children aged between 0-12 who had a child with ASD. The findings indicated that there are four main intervention strategies that are commonly used to intervene for children with ASD. The interventions included parent-mediated, speech therapy, classroom aid, and behavioural-related interventions. The researcher then recommended that quantitative techniques be used in future studies to align and compared the study findings.
CHAPTER 1
INTRODUCTION
ASD or commonly known as autism spectrum disorder is a developmental disability characterised by deficits in social interaction, social communication, repetitive or restricted patterns of interests, behaviour, or activities that persist in an individual’s lifespan (Baio et al. 2018, p.1). According to Anderson, Smith, and Iovannone (2018, p.108), the prevalence of autism is augmenting unprecedently. Further, Smith, and Iovannone (2018, p.108) indicate that the rates of school-going children aged 6-21 years and receiving ASD classified education have increased in tandem with the depicted prevalence and multiplying by at least ten-fold between 1995 and 2014. Certainly, these children can be found in classrooms of general teachers and special educators. Thus, it is important to investigate the intervention strategies after autism diagnosis in initial years, especial in early education.
Gunn and Delafield-Butt (2016, p.408) contend that inclusive education demands that the teachers adapt to the learning style of their learners. Children that suffer from ASD often bring challenges to instructors in the classroom because they exhibit interests that are restricted to certain topics. In essence, teachers face dilemmas with regards to either keeping the individuals off the classroom or accommodate these restricted interests. Even though children with ASD are increasingly placed in mainstream classrooms, there is little that is known regarding the challenges encountered by teachers in class (Lindsay, Proulx, Tomson, and Scott 2013, p.47). Lindsay et al. (2013, p.347) ascertain that teachers face an array of challenges including socio-cultural barriers, understanding and managing behaviors, and creating an environment that is inclusive. According to Lindsay et al. (2013, p.347), the socio-cultural barriers include inadequate resources, training, and limiting school policies while challenges associated with an inclusive environment incorporate a lack of comprehension from the parents, teachers, and students. Therefore, it is critical to investigate the intervention strategies that can be implemented after autism diagnosis in early years to ensure that the individuals are well managed and educated.
With amplified prevalence of ASD, teachers need to be aware about the aspect of autism, have adequate knowledge regarding the education of children suffering from ASD, and demonstrate positive attitudes related to autism (Demirok and Baglama 2015, p.399). Ideally, when teachers and parents have vast knowledge about a given disorder, especially autism, they demonstrate improved teaching efficacy coupled with stronger beliefs that they can be of benefit to the people affected by autism. Basically, when people realise that an individual has autism, they posses a high likelihood of demonstrating positive attitudes. Nonetheless, when the teachers maintain a positive attitude to autism learners, their expectations also become positive. Furthermore, awareness and knowledge are vital for guiding families with children suffering from ASD. Additionally, Demirok and Baglama (2015, p.399) note that when teachers have adequate knowledge with regards to ASD, they are keen to identify the irregular patterns of development; hence, they guide and inform respective families about contacting professionals, disseminate learning and teaching information about ASD individuals. Thence, it is imperative to examine intervention strategies after autism diagnosis in early years.
The researcher will remain focused on the examined topic throughout the research process. To ensure that this is accomplished, the investigator will revolve around the suggested study objective with guidance from the research question. Basically, the researcher will keep the objective and the question as the reference points because they are pivotal to the topic scrutinised.
RESEARCH OBJECTIVES
i. To identify the specific intervention strategies after autism diagnosis in early years in London, the UK
ii. To determine the steps undertaken after a child has been diagnosed with ASD in London, the UK
iii. To ascertain the legislation that governs the aspect of ASD in London, the UK
iv. To elucidate the support available for kids, schools, and families regarding ASD in London, the UK
RESEARCH QUESTION
i. What are the specific intervention strategies after autism diagnosis in early years?
ii. What steps are taken after a child is diagnosed with ASD?
iii. What legislation is in place to govern the aspect of ASD?
iv. What support is available for children and families regarding ASD?
TERMINOLOGIES
Autism Spectrum Disorder- A developmental disorder marked by difficulties in interacting, socialising, and communicating with others Li, Lee, and Rabitz 2018, p.1).
CHAPTER 2
LITERATURE REVIEW
Autism Spectrum Disorder (ASD) is a condition attributed to substantial treatment costs, special education arrangements, and accommodations during adulthood (Penner, Rayar, Bashir, Roberts, Hancock-Howard, and Coyte 2015, p.2833). The upsurge of ASD incidences coupled with substantial use of resources throughout the lifespan have placed enormous costs on governments. As such, there is a need for novel researches delving into the aspect of autism in early education, which is aimed at devising intervention strategies with regards to early diagnosis to ensure a sustained life. In this chapter, the researcher identifies the relevant literature regarding the intervention strategies after autism diagnosis among children, especially during those in early education. Chapter 2, the literature review, provides an in-depth look into the autism condition and synthesises the relevant literature while identifying the strategies for intervention among those individuals suffering from autism in their early ages.
In this chapter, the researcher presents the literature using several subtitles including autism in early education, awareness of the parents of early diagnosis of ASD and interventions, and early interventions in autism. In addition, the investigator focuses the impact of early interventions on ASD children, early intervention treatment programmes, challenges facing children with autism, and challenges of teaching children with autism. The chapter finally presents the theoretical framework and then closes with an insightful summary of the entire section.
AUTISM IN EARLY EDUCATION
Nguyen, Leytham, Whitby, and Gelfer (2015, p.71) ascertain that literacy skills imparted when individuals are in their primary grades are imperative building blocks, which bolster their subsequent literacy progress. Basically, learners with ASD have increased time spent in education. Demirok and Baglama (2015) initiated a study that investigated the viewpoints education students regarding ASD in Northern Cyprus. The investigation was aimed at indicating autism awareness among education students in Northern Cyprus, in particular, the study was to harness information regarding the awareness, knowledge, and attitudes of the students about autism. The researchers randomly selected the respondents from among the learners in the faculty of education drawn from a private campus in Northern Cyprus. The researchers adopted a questionnaire “The Autism Awareness of College of Education Students in Turkey,” which was designed by Yasar and Cronin in 2014 to collect information for analysis. The results indicated that students in the faculty of education have awareness about autism and that the condition can be improved via education.
According to Glynne-Owen (2010, p.405), autism is a prevalent developmental disorder classed by varied impairments including communication, interaction, social awareness, and flexibility of routine and thought. Wilson, Dykstra, Watson, Boyd, and Crais (2012, p.98) indicate that early interventions and education for children suffering from ASD demand for individual consideration because of the augmenting prominence, complexity, and constantly evolving models for service delivery. Wilson et al. (2012, p.97) conducted a pilot study that investigated training in early education aimed at serving those individuals with autism. Wilson et al. (2012, p.97) ascertain that coaching has garnered attention and is considered a professional development method to early education. Nonetheless, many educators rely on techniques, which are inconsistent in effectiveness such as workshops and one-time training. The researchers focused on the Advancing Social-communication and Play (ASAP). The researchers assigned two early education groups to different categories including those that received the ASAP training, those that were ASAP trained and coached, and another group that was a control (the group did not receive any training). Wilson et al. (2012) used descriptive analysis to analyse both quantitative and qualitative information harnessed. The findings indicated that coaching affected adherence and collaborative practices of the teams to the core intervention elements.
AWARENESS OF PARENTS OF EARLY DIAGNOSIS OF ASD AND INTERVENTIONS
A study conducted by Carlon, Carter, and Stephenson (2015, p.285) investigated how parents having children suffering from ASD make decision about early intervention. The researchers selected 75 parents with pre-school aged children to complete surveys developed to recognise factors considered when choosing an approach to intervene in the ASD condition. For parents to decide to utilise an intervention, the technique has to be related to a child’s individual needs. Several other factors were identified including intuition feelings and staff attributes to reject or accept an intervention. The researchers indicate that when these factors were individually grouped pragmatically, those indicating service features such as staff attributes and ASD-specific intervention were ranked higher in importance compared to other categories. Further, recommendations and advice from others also influenced the parents’ decision-making regarding which intervention to select for their children.
Connolly and Gersch (2013, p.393) conducted a study that investigated ways of providing support to parents that are waiting for diagnosis of their children for the ASD condition. According to Connolly and Gersch (2013, p.393), parents of the kids waiting for an assessment to ascertain whether they are suffering from ASD experience anxiety and distress. The study was undertaken in a multidisciplinary therapeutic setting in Ireland. The researchers utilised FGDs to harness information that was analysed via thematic content analysis. Themes were identified to foster the development and assessment of pilot parent-education group. Accordingly, the findings indicated that ASD starts when the condition is suggested as a possibility and parents need information and the children should be diagnosed. Basically, a majority of the parents are not aware of ASD condition and they require information regarding how they can intervene for their children.
In essence, understanding the reactions of parents towards the diagnosis of their children with ASD is an important step. Lopez, Yue, Magana, and Guzman’s (2018, p.41) study exained the reactions of families and mothers towards ASD diagnosis. The study was a comparison of the reactions between those of Latina and White mothers. The researchers selected 44 Latina and 52 White mothers. Whereas both groups showcased reactions with intense emotions, White mothers were indicated relieve from guilt while Latina mothers’ guilt augmented after they received their diagnosis. The problem was seen to increase as the Latina mothers reported as having limited knowledge regarding ASD. Further, the findings indicate that service providers should ensure culturally-sensitive information for Latino parents and their respective communities regarding ASD.
STEPS TAKEN AFTER AUTISM DIAGNOSIS
Suma, Adamson, Bakeman, Robins, and Abrams (2016, p.2720) assert that a strong consensus exists that intervening early, particularly when targeting specific deficits leads to improved outcomes among children suffering from ASD. Fundamentally, Suma et al. (2016, p.2720) indicate that early interventions often decrease developmental delays and atypical behaviours; besides, they augment critical skills such as joint engagement, symbolic play, and communication. There are five steps taken after an individual realises that his or her child is suffering ASD. These steps include: Early intervention, elimination of distractions, finding funds, reach out, and grieve. Basically, after a child is diagnosed of ASD a parent is advised to intervene early so that the affected kid can received specialised interventions. Intervening early means that the parent is taking appropriate actions towards ensuring that the child’s problem is addressed and he or she avoids the challenges accompted ASD. Further, it is important the environment is void of distractions as these children are often interrupted in case of any distraction. The parents should also look for funding to enable them effectively their child’s condition. Besides, they are required to reach out to support groups where they can learn from experienced individuals with regards to ASD in early years. The parents are also expected to grieve with regards to the unexpected condition in their children and then accept the situation accordingly. Accepting the situation helps the relevant caretakers to focus their attention on intervening for the child to avoid unnecessary disturbances.
LEGISLATION GUIDING AUTISM IN THE UK
There are various policies and legislation that govern the aspect of autism among the UK nationals. They include The Autism Act of 2009, a statute that has put novel duties on the national bodies to bolster autism outcomes (learn.canvas.net 2016, p.1). The Autism Strategy of 2010, which focuses on supporting adults with autism. The legislation emphasises the element of training among staff of social and health care settings and states that evaluation ought to ensure person-centredness needs. The Children’s and families Act of 2014 is focused on children to foster support to the vulnerable kids and their families. The law is in place to ensure that all kids succeed irrespective of the backgrounds (learn.canvas.net 2016, p.1). The final legislation is the
Think Autism, which is an update regarding the government’s adult autism strategy.
EARLY INTERVENTIONS STRATEGIES IN AUTISM
Parent-mediated interventions
Nevill, Lecavalier, and Stratis (2016, p.84) conducted a meta-analysis focusing on parent-mediated interventions among children with ASD. The researchers reviewed 19 articles, which investigated parent-mediated interventions and were randomised clinical trials among 1-6 aged children suffering from ASD. Basically, the outcomes for meta-analysis were ASD symptoms including socialisation, severity, cognition, and communication-language. The quality of the information collected was rated as “very low” with regards to socialisation and moderate for cognition, communication language, and symptom severity. Further, the weighted Hedges’ g differed from 0.18 to 0.27 with regards to communication-language and socialisation respectively and it averaged at 0.23 across the domains. The researchers concluded that while most of the outcome domains regarding parent-mediated intervention were attributed to small impacts, research quality improved significantly.
A study led Tachibana, Miyazaki, Ota, E., Mori, Hwang, Kobayashi, and ... Kamio (2017, p.1) undertook a meta-analysis and systematic review regarding inclusive intervention for ASD pre-school children. The researchers aimed at comparing three models and investigating weaknesses and strengths for every type of intervention and identify techniques used to ensure successful outcome for ASD children. According to Tachibana et al. (2017, p.1), achieving unbiased and high-quality evidence regarding ASD interventions, it is imperative to review studies that are as a result of quality standards and varied interventions. In Tachibana et al.’s (2017, p.1) study, the researchers classed ASD interventions as multimodal development, behavioural, and social-communication founded on Howlin’s categorisation of ASD with regards with early intervention. The systematic and meta-analysis included children suffering from ASD children aged 6 years and below. The researchers used a random impacts framework to present the effects estimated for the outcomes. The researchers used a meta-analysis to conduct a systematic review. They included 14 out of 32 RCTs reviewed, which had 594 children (Tachibana et al. 2017, p.1). However, they ascertained that there was no significant statistical difference with relation to the impact on ASD symptoms evinced between the multimodal development model and the social-communication-focused framework. The study findings indicated that reciprocity of social interactions affected other interactions such as parental synchrony. They concluded that parental synchrony is a promising strategy to intervene for ASD children.
Temperament interventions
Temperament atypicalities have been reported among infants and early development in kids that develop ASD (Rosario, Gillespie-Lynch, Johnson, Sigman, and Hutman 2014, p.381). Rosario et al.’s (2014, p.381) study investigated whether differences in developmental trajectories with regards to temperament that exist between toddlers and infant that do not have ASD. Carey Temperament Scales were filled by parents whose children had ASD with ages of 36, 24, 18, 12, and 6 months. Findings denoted that kids with ASD had increased temperament trajectories over time with decreased adaptability and technique behaviours in relation to those children without ASD.
Ting and Weiss (2017, p.680) claim that children suffering from ASD exhibit problems with emotions that are related to regulation of emotions. Further, the researchers assert that parental co-regulation is connected with regulation of emotions in children and other emotional problems. The study focused on parent co-regulation and emotion regulation in ASD children. In perspective, the research investigated the correlation of child emotional regulation, parent co-regulation, and externalising and internalising problems among 51 parents and ASD school-aged kids (Ting and Weiss 2017, p.680). The results insinuated that child emotional regulation and parent scaffolding are projected externalising issues; however, this involved control of IQ and age of the children. They suggested that future longitudinal studies should be conducted n this topic and pre-post data on intervention may examine parent’s co-regulation as a technique to explicate treatment effectiveness in ASD children (Ting and Weiss 2017, p.680).
Another study initiated by Berkovits, Eisenhower, and Blacher (2017, p.67) studied regulation of emotions among young children with ASD. The researchers indicate that little research has focused on connecting frequent behavioural problems with underlying emotional developments among young children with ASD. Basically, the study investigated emotional regulation stability and the connection with varied aspects of functioning in children. The investigators included 108 ASD kids aged 4-7 together with their respective caregivers. Further, they assessed language/cognitive abilities and ASD symptoms. The parents described emotional regulation, behavioural problems, and social skills. Emotion dysregulation was found to be stable and strongly correlated to behavioural and social functioning; however, it was dependent on IQ. Further analyses demonstrated that dysregulation of emotions projected an increase in behavioural and social problems across time.
Speech therapy
Autism affects the aspect of social contact, especially interests and non-verbal and verbal communication. A study Tamanaha, Chiari, and Perissinoto (2015, p.552) investigated the efficacy of language therapy and speech among ASD individuals. The researchers randomly selected 11 children and divided them into two groups of five and six. The group that had six children received both indirect and direct interventions while the one with five kids had an exclusive indirect intervention. Tamanaha, Chiari, and Perissinoto (2015, p.552) used selected sections of the ASIEP-2 to further their investigation. In particular, they utilised autism behavioural checklist and sample of vocal behaviours and interaction assessment thrice at an interval of 6 months. The results indicated an increased evolution in therapy group-TG with regards to autism behavioural checklist, samples of vocal behaviours, and interaction assessment. Further, the speech pathologists and the mothers perceived behaviour change (Tamanaha, Chiari, and Perissinoto 2015, p.552). The investigators then concluded that the propensity of performing well among the children in the group that received both interventions indicated that the association is imperative.
A case study conducted by Neeley, Pulliam, Catt, and Mcdaniel (2015, p.371) examined the effects of interrupted usage of devices that generate speech on the aspect of communication among ASD children. In essence, the case study investigated the original and new effects of an ASD child. The researchers conducted the study in a period of 6 years and implemented the usage of 2 interrupted speech generating gadgets (Neeley, Pulliam, Catt, and Mcdaniel 2015, p.371). The communication behaviour of the child was analysed. The findings denoted that therapeutic usage of speech generating devices bolstered the ability of the child to communicate through augmenting the natural verbalisation of the respective words in an obligatory environment compare to therapy by the use of gestures and pictures.
Classroom aide
According to Watson and DiCarlo (2016, p89), instructors often spend the initial days in the school to teach routines, which will help the learners in transitioning between varied activities. In most cases, when children face difficulties, they either move slowly with regards to classwork or/and require teacher interventions. As such, the researchers used interventions that encompass scheduled picture activities to aid a boy aged 5 years to complete three routine tasks in a kindergarten classroom (Watson and DiCarlo 2016, p89). The findings demonstrated that the picture schedules helped the kid’s dependent completion of the routines and decreased the demand of prompting from a teacher.
Mazurik-Charles and Stefanou (2010) also conducted a study that investigated the use if professionals in teaching social skills among the ASD children with a general education setting. The study’s purpose was to determine whether training ASD children on social skills result in perceived increase of social skills. The findings of Mazurik-Charles and Stefanou’s (2010) study indicated that a myriad area of social reactions increased due to short run interventions. Nonetheless, sustained improvements were problematic to detect. The research extends the investigation on social skills development among kids with ASD through the examination of perceptions regarding social responsiveness instead of noting how often kids engage in prosocial mannerisms. Further, it extends the study by studying the effectiveness of utilising trained professionals to ensure inconspicuous intervention among ASD children in general education settings.
Behavioural support
Storch, Nadeau, Rudy, Collier, Arnold, Lewin, and ... Murphy (2015, p.184) conducted a case study research on cognitive behavioural therapy increase in antidepressant medications for nervousness among ASD children. The study projected to establish a preliminary estimate of efficiency with regards to cognitive-behavioural therapy (CBT) in the treatment of anxiety in ASD children whose anxiety was clinically problematic regardless of an adequate pharmacotherapy course. The researchers conducted the research among 7 youths with ASD and suffering from at least one comorbid nervousness disorder. These individuals were partial or non-responders to the reuptake of serotonin inhibitor treatment that was delivered by community providers. The sample population had an age range of 12-15 years and had 16 sessions of CBT on a weekly basis (Storch et al. 2015 p.184). The assessments were undertaken at the baseline, 17 weeks after the baseline sessions, and after CBT. These were baseline, pre-treatment and post-treatment respectively. It was founded that 4 of the 7 contributors responded to treatment at the post-treatment. Six-seven severity ratings by clinicians declined due to CBT (Storch et al. 2015 p.184). Further, anxiety rated by ASD signs and parents were not reduced significantly. The researcher concluded that the study provided preliminary support towards CBT use in increasing SRI treatments among youths with anxiety and ASD.
SUPPORT AVAILABLE FOR AUTISM RELATED CASES
For the child
Sreedasyam, Rao, Sachidanandan, Sampath, and Vasudevan (2017, p.2971) conducted a study on Aarya, a kinaesthetic device that offers companion to the ASD children. According to Sreedasyam et al. (2017, p.2971), the kinaesthetic devices provides well-being companion with ASD children that are impacted with real world conditions. Sreedasyam et al. (2017, p.2971) state that this gadget improves a child’s confidence by being open and learning varied skills. However, communication and social interaction emerged as challenges. When using Aarya, the guides utilised gesture-based interfaces (Microsoft Kinetics) to help the kids interact in a real-world setting. Further, Sreedasyam et al. (2017, p.2971) ascertained that due to the interactions, children find a companion and a get a chance to grow and improve their respective interaction abilities.
Stevenson, Jarred, Hinchcliffe, and Roberts (2015, p.341) investigated whether a dog can of help to motivate engagement and the development of social interactions with teachers among the ASD children. According to Stevenson et al. (2015, p.341), therapeutic sessions involving dogs may encourage the learners to interact with their teachers while reducing repetitive or solitary behaviours. With contemporary education interventions for ASD children to encourage intrinsic motivation to engage socially, it is probable that sessions involving dogs can be used effectively. The researchers selected 3 ASD children who received 5 sessions with their teacher and a dog Stevenson et al. (2015, p.341). A semi-standardised technique was followed by the sessions where the sessions were recorded and then coded with regards to social behaviours. Qualitative observations were also made with post and pre-measures entailing ADOS-2 evaluations and questionnaires for teachers Stevenson et al. (2015, p.341). In this case, there was an increase in social interactions with the teachers and the dogs with reduced solitary mannerisms.
For the parent
Searing, Graham, and Grainger (2015, p.3693) investigated the needs of parents that have kids with ASD. The researchers focused on perceived helpfulness and availability of support utilised by caregivers of kids with ASD in New Zealand. The study included 92 caregivers and who completed a family support scale and their comparisons were analysed using t tests. Further, free comments inscribed were analysed by inductive research. The study insinuated that the spouses offered the best support while professional helpers were somewhat helpful. In that regard, helpful support comprised caring, accessibility, and knowledge. Furthermore, informal support was highly valued while professional support needed improved development to meet the needs of the parents or the caregivers Searing, Graham, and Grainger (2015, 3693).
There is little research into the needs of fathers and mothers whose children are suffering from ASD (Hartley and Schultz 2015, p.1636). The researchers recognised and compared vital and unmet support needs among the mothers and fathers that have affected children. They then evaluated their relationship with children and family factors among 73 couples with a kid suffering from ASD (Hartley and Schultz 2015, p.1636). With regards to the mothers, there were high number of unmet needs compared to the ones needed by the fathers. The study utilised multilevel modelling, which designated that co-occurring mannerism problems, age of the kid, parent education, presence of other disorder (intellectual disabilities), and income strongly related to the support needs. The results had significant insights into the aspect of unique support and overlapping need of fathers and mothers with ASD children (Hartley and Schultz 2015, p.1636).
CHAPTER 3
METHODOLOGY
STUDY PARADIGM
O’Neil and Koekemoer (2016, p.1) depict that qualitative studies have been marked by phenomenal growth, especially in the psychology field. Qualitative studies provide insights that have proven difficult to explicate when using quantitative techniques. O’Neil and Koekemoer (2016, p.3) assert that research paradigm denotes a specific world viewpoint constituting the beliefs, methodological assumptions, and values of the researchers. Basically, paradigmatic assumptions correlate to an investigator’s epistemology, ontology, axiology, and the methodology utilised. Researchers Thanh and Thanh (2015, p.25) claim that interpretivist paradigm largely utilises the qualitative aspects of conducting studies and favour qualitative techniques such as ethnography and case studies. An interpretivist paradigm allows the researcher to harness understanding various contexts. In essence, qualitative techniques receive support from interpretivist aspects since the paradigm portrays a real-world where reality is basically complex, socially constructed, and ever-changing (Thanh and Thanh 2015, p.25). Therefore, the researcher used an interpretivism paradigm to co
