غربالگری اولیه برای اختلالات طیف اوتیسم: یک پرایمر برای عمل مددکاری اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34636||2011||9 صفحه PDF||سفارش دهید||8572 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Children and Youth Services Review, Volume 33, Issue 2, February 2011, Pages 265–273
Early identification of autism spectrum disorders has been demonstrated to result in material benefits to children, their families, and society by reducing problem behaviors, improving academic achievement and school outcomes, and increasing social participation. Early intervention also reduces the costs and associated morbidity of autism spectrum disorders across the life span. Despite significant advances in the ability of screening tools to detect autism spectrum disorders in young children, previous research has found that most children are not identified until they are in school, and past the age at which early intervention services are most beneficial. Social workers, given their presence across a wide range of service settings, are uniquely positioned to identify preschool children with autism spectrum disorders and refer them for additional diagnostic services and evidence-based interventions. In this paper, a basic primer on autism spectrum disorders is provided, along with descriptions of the various screening tools appropriate for children ages 3 and younger that social workers can implement in their own practice settings. Policy and practice implications are discussed.
Autism spectrum disorders are complex neurodevelopmental problems distinguished by deficits in social interaction and communication, as well as the presence of repetitive behaviors (American Psychiatric Association, 2000). Over 1% of US children have a diagnosed autism spectrum disorder (Centers for Disease Control and Prevention, 2009 and Kogan et al., 2009). Males are disproportionately affected at a rate of 1 in 70 (Centers for Disease Control and Prevention, 2009 and Kogan et al., 2009). The 2006 overall prevalence estimate of approximately one in every 110 children represents a significant increase from previous epidemiological surveys (Centers for Disease Control and Prevention, 2009 and Kogan et al., 2009). The precise causes of autism spectrum disorders have not been identified, although scientists believe they have a strong genetic component along with environmental influences (Muhle et al., 2004 and Pinto et al., 2010). The increasing prevalence of autism spectrum disorders is clearly a public health and social concern. In general, children with disabilities and their families face high levels of burden, especially when compared to nondisabled children (Parish, Rose, Grinstein-Weiss, Richman, & Andrews, 2008). Economic burdens are particularly pervasive in families raising children with autism spectrum disorders, including lower incomes, higher expenses, and more work-related difficulties (Liptak, Stuart and Auinger, 2006, Montes and Halterman, 2008a and Montes and Halterman, 2008b). Lifetime costs of caring for an individual with autism are estimated to be more than $1.6 million (Landrigan, Schechter, Lipton, Fahs, & Schwartz, 2002), while societal costs reach $3.2 million, and include expenditures for lost productivity as well as medical and support service costs (Ganz, 2007). Financial burdens and other factors, including children's behavior, social problems, and elevated needs for specific types of therapies and ancillary services, contribute to parental stress, negative coping strategies, and depression, particularly for parents of young children with autism spectrum disorders (Davis & Carter, 2008). These factors are subsequently associated with a multitude of negative child outcomes (e.g., behavioral) that persist through adolescence and perpetuate parental stress (Lecavalier, Leone, & Wiltz, 2006). However, in addition to the emotional and financial impact on families, it is important to recognize the strengths children with autism spectrum disorders and their families possess (Else, 2001 and Welteroth, 2001). Over the past decade, researchers have made significant strides to improve reliable early detection of children with autism as early as age two (Cox et al., 1999, Lord, 1995 and Stone et al., 1999), with screening measures being validated for children as young as 16 months (Dumont-Mathieu & Fein, 2005). Recent research has focused on the development of a tool to reliably identify 12-month old children at-risk of autism (Reznick, Baranek, Reavis, Watson, & Crais, 2007). Nonetheless, a recent study found only 10% of children aged nine to 24 months who are eligible for federal Part C early intervention services for developmental delays actually received services before reaching two years of age (Rosenberg, Zhang, & Robinson, 2008). Some children with autism spectrum disorders fail to receive services well into their school years, particularly youth with strong verbal abilities (Yeargin-Allsopp et al., 2003). Key surveillance research reports the median age of diagnosis to be 5.7 years old, well beyond the age where autism spectrum disorders can be reliably diagnosed (Shattuck et al., 2009). Additionally, multiple studies have noted parents often are concerned about their child's development well before the child's second birthday (Coonrod and Stone, 2004, De Giacomo and Fombonne, 1998 and Young et al., 2003). Although research has found the mean time between a parent noting concern and seeking professional advice is less than five months (average age of 23 months) (Coonrod & Stone, 2004), the gap between parent concern and actual receipt of diagnosis continues to be wide, at about 34 months (Young et al., 2003). This trend of late detection is alarming. Diagnosis is often the gateway to educational interventions and other therapeutic services in the United States. If children are not screened earlier, then the diagnosis of autism spectrum disorders will continue to appear at later developmental time periods, missing critical opportunities to promote optimal development. Additionally, access to early intervention can dramatically assist young children with autism spectrum disorders to overcome barriers in learning and transition when they reach school (National Research Council, 2001). Timely treatment is critical for the child's caregivers as well, given that lifelong costs of caring for individuals with autism spectrum disorders are estimated to decrease by two-thirds with appropriate access to services (Jäbrink & Knapp, 2001). Additionally, both mothers and fathers of newly-diagnosed toddlers with autism spectrum disorders have significantly elevated levels of stress (Davis & Carter, 2008). When compared to mothers of children with other intellectual disabilities, mothers with preschool children with autism reported considerably more stress (Eisenhower, Baker, & Blacher, 2005). These findings suggest special attention should be paid to the caregivers of young children with autism spectrum disorders due to their increased risk of negative emotional outcomes. Social workers are uniquely positioned to respond to the dramatic increase in the prevalence of autism. Social workers encounter children with autism spectrum disorders in a vast range of arenas, including child welfare settings, schools and daycares, social service organizations, governmental benefit offices, hospitals, clinics, mental health treatment centers, and primary care offices. Despite the potential for early and regular exposure to children at-risk for autism spectrum disorders, most social workers are not trained to recognize or intervene on behalf of these children and their families. Furthermore, a limited investigation on social worker beliefs found inaccuracies regarding the understanding of diagnostic methods and characteristics associated with autism spectrum disorders (Preece & Jordan, 2006). The paucity of research on autism spectrum disorders in social work practice journals provides some evidence of this deficiency, and illustrates the critical need for training and professional development in this area. The current paper has three basic aims. First, it provides a general overview of the national movement to increase awareness of autism spectrum disorders. Key characteristics of autism spectrum disorders are described as a primer for social workers. Second, it describes available screening instruments in detail, with an eye toward guiding future clinical practice and increased involvement of the field of social work in autism screening, detection and intervention. Finally, a brief discussion of policy and practice implications of early screening emphasizes the advocacy potential for social workers outside of the clinical realm, and the potential positive impact that the field of social work can have in the area of autism spectrum disorders.