New Trends and Issues

In the case of an autistic child


Introduction
Autism has recorded an alarming increase at the world level, statistics claiming that 1 child out of 68 (1 out of 61 according to other studies) is born with this disorder (autism is more frequent in the case of boys than in that of girls -a 4:1 ratio).Under the category of autistic spectrum disorders fall, according to DSM-IV-TR: the infantile autism, the Rett syndrome, the childhood disintegrative disorder, the Asperger syndrome and the pervasive developmental disorder, without other specifications (atypical autism or PDD-NOS) (American Psychiatric Association, 2003).The ICD-10 classification includes another entity, known as the overactive disorder associated with mental retardation and stereotyped movements (Rad, Costinescu & Dobrescu, 2008).The current research has not yet provided a clear delineated image of the identification of the factors that lead to the occurrence of the autistic spectrum disorder.

Main argument
Medical research indicates multiple causes which may lead to the activation of the autistic phenomenon: pathologic, organic, biochemical, immunologic, neurologic and inappropriate medical treatment.Today, Romania provides a national programme for the early diagnostic of autistic spectrum disorders and for the identification of the dysfunctions associated with this syndrome, accessible at the family doctors' offices.The family doctors will apply a standard screening questionnaire (elaborated within the framework of the National Programme of Mental Health: Prophylaxis in psychiatric and psychosocial pathology, and validated for the general population by Babes-Bolyai University of Cluj-Napoca), which includes questions for the parent and observations of the doctor, and evaluates the child's abilities at the level of interaction, non-verbal communication and emotional response.Can he sit on his bed when he is awake? 2 0 1 Does he always react when he is called?Does he turn his head when he is called?0 2 1

Family doctor's observations
The child avoids to look directly in other people's eyes/ does not support visual contact 1 0 -Obvious lack of interest in others 1 0 -After the age of 24 months: motor stereotypes (hands flapping, hops, walking on his toes, rotates, inadequate posture, etc.)However, the initial testing is just a first step in the early tracing of a child suspected of autism.For the objectiveness of the diagnostic, it is necessary that the following sources of information be taken into consideration: 1. Tests and scales applied in clinical sessions.2. Interviews and information provided by parents and teachers.3. Observations in daily instances and/or structured observations of the relations between parents and the evaluated child.

Language assessment for autistic children. Means of test selection.
Specialised literature lists the following language disorders in the case of autism: Pronunciation or utterance disorders: dyslalia and dysarthria; Speech rhythm and fluency disorders; Voice disorders: aphonia and dysphonia; Read/written language disorders: dyslexia-alexia and dysgraphia-agraphia; Polymorphic disorders: aphasia and alalia (mutism); Language development disorders elective mutism, retardation in the general speech development Language disorders based on psychic dysfunctions dyslogia, echolalia, etc.
The American researchers who tackle the identification of the structure of language in the case of autistic children claim that 60% of them also suffer from language disorders.By analysing each dimension of the message, speech therapists note that the autistic children often display deficiencies at the morphological and syntactic levels (they incorrectly use verbal tenses morphemes); at the semantic level (they fail in making up sentences which include multiple significance of some words); at the pragmatic level -social language is heavily affected (they cannot adapt contextually, unprogrammed; they cannot assume a role unless they are familiar with the situation); at the prosodic level (hypo-or hypernasality, defective voice control), whereas the echolalia level is often present.
The aim of the present study is to devise a programme for the identification of the problems of defective pronunciation of pre-school and school autistic children, so that it can become accessible both to experts and teachers.

Specific objectives:
 identification of language disorders in autistic children at the pre-school and school age;  orientation of speech therapy towards, correction, recovery, adaptation and social integration;  recommendation of exercises and games for the correction of language disorders.

Types of evaluation
Initial evaluation tests: Speech acts album, illustrated spelling book, exploratory conversations, counting and poetry reciting.
Pre-therapeutic evaluation entails establishing the level of verbal acquisitions in relation to chronological age (Galbinasu, 2011):  pronounces sounds and words;  understands the message and the verbal command;  communicates through isolated words or meaningful constructions;  uses spoken language as communication means;  establishing the language-thinking relation;  establishing the level of graphic and lexical acquisitions.
Tests: pronunciation by imitating sounds, syllables, words and sentences;  association of images and words or gestures;  indication of the images showed by the speech therapist;  using these notions in concrete situations (as speech, action and gesture);  narrating from images.
The intermediary/periodical/continuous assessment is pursued throughout the intervention.

Reception of the signals/stimuli from the environment and granting them appropriate significance:
 Testing the memory for geometric shapes (Pieron)  Testing the memory for numbers  Tests for examining the praxis (speech-language pathology)  Primary tests for perceptive abilities

Examples of therapeutic activities
Exercises of identifying the visual stimuli; Exercises of identifying objects and images; Exercises games of classification, grouping and sorting (after colour, shape, size); Exercises of recognising the olfactory and taste stimuli; Exercises of identifying various fruits or foods (smell/taste); Exercises of tactile recognition; Didactic game -recognising objects by touching (moulds of fruits and geometrical shapes).

Developing and practising the phonemic hearing
 Tests of examining the spoken language  Examination sheet of the child with alalia  Tests of phonologic awareness

Examples of therapeutic activities
Exercises of uttering syllables and words; Practising the rhythm sense (clapping, rhythmic games of motion and eurythmic structures); Exercises of auditory differentiation; Exercises of differentiating between voiced and voiceless sounds; Exercises -games of phonetic analysis, by identifying the placement of phonemes in a word.

Conclusions and recommendations
Speech therapy consists of a set of educational and medical methods systematically and gradually applied to individuals diagnosed with communication disorders.In what the language correction and improvement is concerned, the literature in the field and practice show that applying generally valid methods in all cases of communication disorders may lead to delays in the rehabilitation process.In case of autistic children, and not only, speech and rehabilitation therapy is customised and organised according to a plan devised by an interdisciplinary team.The primary method in speech therapy is imitation, but it needs to be supported by a number of other procedures meant to stimulate the language and autonomy of an individual.However, the speech therapy intervention can only take place following a complex evaluation of all areas of human development.
We recommend that the speech therapy activity be predominantly games-based and that the teaching materials used be accessible, adapted to the psycho-physical potential of the autistic children.