Critical Thinking in Psychology

Autism can be defined as “a neurodevelopmental disorder characterized by impairment in emotional expression and recognition, difficulty with social relationships, delayed and/or abnormal language and communication, and preoccupation with repetitive, stereotyped behaviors or interests” (Slaughter, 2016).  The exact cause of autism is not known; however extensive research has determined that it is “caused by an abnormality in the development of the brain” (Autism, 2016) and has nothing to do with parental and/or environmental influences which is why early intervention is necessary.  Early detection of autism allows medical providers to establish intervention techniques to improve communication abilities and social skills which is why research was conducted to study the age of recognition of symptoms and their correlates in children that were diagnosed.  My current position as a Behavior Technician working with young children diagnosed with autism prompted the selection of this topic so a better understanding can be established on the importance of early intervention.

Summary of the Article

Literature Review

            The peer-reviewed article that I selected was featured in The Journal of Indian Association for Child & Adolescent Mental Health in which a study was conducted using records retrieved from a health care center located in India “to find the age of recognition (AOR) of symptoms by parent and delay in diagnosis and seeking professional help in children with autism” (Bagal, Kadam, & Parkar, 2016, p. 1).  The purpose of the study was to provide evidence that supports the belief that early detection and intervention of autism “can significantly improve the social and communication abilities in children” (Bagal, Kadam, & Parkar, 2016, p. 1).  The focus of the research was to demonstrate the need for “more awareness about ASD to be spread among general population; the need for proper training amongst health care professionals for diagnosis ASD and adequate referral mechanism; and, monitoring the development of child should be mainstreamed into primary health care services for early diagnosis and intervention” (Bagal, Kadam, & Parkar, 2016).

Methods Section

            The first step to conducting the study was submitting a proposal to the Investigation Review Board detailing the purpose of the research.  Once the proposal was approved researchers collected data from case records located in several different locations in India, one being the Child Guidance Clinic of Department of Psychiatry.  Researchers selected case records from fifty children diagnosed with autism between 2007-2013 and excluded the case records of “children with intellectual disability with autistic features as primary diagnosis” (Bagal, Kadam, & Parkar, 2016, p. 1).  The study was conducted over a three-month period in which information was retrieved from case records pertaining to the age autism was detected, symptoms, pregnancy complications, birth and developmental history.  After the information from the case records was compiled together it had to be measured and researchers used “non-parametric test such as Kruskal-Wallis test, and multiple regression analysis was applied using SPSS 16.0” (Bagal, Kadam, & Parkar, 2016, p. 296).

Results Section

            The data collected during the study identified fifty patients that were diagnosed with Autism in which “82% were male and 18% were female which corresponds to the male: female ratio of nearly 4:1 as stated by study done by Indring et al which was a record-linkage study done in Sweden” (Bagal, Kadam, & Parkar, 2016, p. 296).  Early detection was a key factor to the study which is why age of recognition was taken from each record and that information determined that parents normally recognize symptoms of autism around three years and six months and the average age of diagnosis was six years and six months. Researchers examined each record for pregnancy related complications to determine if there was a relation between those complications and autism and of those records only 36% identified pregnancy related complications such as “hypoxia, meconium stained liquor, torsion of the neck and delayed labor” (Bagal, Kadam, & Parkar, 2016, p. 298).  Prior abortions, intellectual disability, family history of mental illness and medical complications were other categories that data was collected.  A decrease in social interactions was the most common symptom that was noticed by parents first and the study retrieved that information from 32% of the cases.  Delayed speech was the most common symptom noticed by parents in a previous study, however only 26% of the cases noted that as the first noticeable symptom.  The information retrieved was categorized by symptoms that were present in women that displayed pregnancy related complications and concluded that there is no solid evidence that “pregnancy related complications, medical complications, intellectual disability and behavioral problems during childhood are independent risk factors for autism” (Bagal, Kadam, & Parkar, 2016, p. 303) and that further research is needed to make a final determination.

Discussion Section

            The data collected examined children that were diagnosed with autism and the information in each case was separated into categories to generate statistical information that was used to determine the relation between the age of recognition and symptoms as they relate to pregnancy complications. Information pertaining to pregnancy complications, medical complications and family history of mental illness was retrieved from the records to establish risk factors, however the data collected did not establish if those risk factors were independent variables or not.  The data collected also included symptoms and when they were first noticed by parents to support the main reason for the study which was the importance of early detection in relation to intervention.

Conclusion Section

            The age of recognition in symptoms in children diagnosed with autism was studied in detailed to provide information that can support claims on the importance of spreading awareness.  The exact cause of autism has yet to be determined, however many studies have been conducted to determine possible risk factors to increase awareness in pregnant women that may be subjected to these factors such as pregnancy related complications.  Pregnancy related complications resulted in early detection of autism which made early intervention possible, however in cases where pregnancy related complications were not a factor, detection of autism was detected a later age.

Analysis of the Article

Strengths

            The purpose of the study was to demonstrate the need to increase awareness on autism in communities in India so parents, particularly women of child bearing age would understand the risk factors and receive adequate care during pregnancy and follow-up care and evaluations after the child is born and the article detailed supporting facts of this claim.  Age of recognition was the main supporting fact in which the article showed the importance of prenatal care as it relates to pregnancy related complications and symptoms of autism.  Researchers used information from the records obtained from the clinic as supporting evidence by creating groups based on symptoms and when they were noticed in which pregnancy related complications were present and not present. This information allowed the researchers to further their discussion on why increased awareness and education on autism is important.

Weaknesses

            The study was conducted using only fifty records of individuals diagnosed with autism and although the article demonstrated the necessity of increased awareness, fifty cases only laid the groundwork and established evidence that supports the claim. 

Reflections

Supported Opinions

            Pregnancy related complications have been directly related to many birth defects, however autism is partially excluded from that claim and I personally believe that because autism is a neurodevelopmental disorder it is possible that pregnancy related complications can be a contributing factor.  Prenatal care is extremely important during pregnancy because it allows health care providers to monitor the pregnancy for any problems that may arise.  Health-related problems during pregnancy can affect the fetus which can result in birth defects.  Pregnancy related complications often results in the birth of a child through C-section instead of vaginally and several studies have been conducted to determine the relation between the two.  There was a study conducted in which research demonstrated that “neonates delivered by C-section with general anesthesia were associated with a higher incidence of autism than neonates delivered vaginally or those delivered by C-section with regional anesthesia” (Chien, Lin, Shao, Chiou, & Chiou, 2015).

 Standards Check

The information provided in the article was retrieved from case records of children diagnosed with autism therefore accuracy was determined.  The information was relevant to the study because the research was to determine the importance of early recognition and the age of recognition and age of diagnosis was retrieved from the case records.  There was great depth in the information provided because the study not only focused on the age of recognition and diagnosis, but also symptoms related to autism and how they correlate with pregnancy related complications.

Conclusion

When I first began my position as a Behavior Technician I was paired with young children diagnosed with autism in a pre-school setting and it was unclear to me as to why behavior modification was so important at this early stage, however current studies are providing me with the opportunity to enhance my knowledge on the disorder as I gain clarity on the importance of early intervention.  The article demonstrated the importance of early detection, recording background information, symptoms and family history as key factors to the claim of the importance of increased awareness in the communities. Research studies are continuously being conducted on autism and the information obtained from this article is the beginning of research efforts that will better assist the development of behavior modification skills for children with autism.

References

Autism. (2016). Funk & Wagnalls New World Encyclopedia, 1p. 1.

Bagal, R., Kadam, K., & Parkar, S. (2016). To study the age of recognition of symptoms and their correlates in children diagnosed with autism spectrum disorders: A retrospective study. Journal Of indian Association For Child & Adolescent Mental health, 12(4), 291-308.

Chien, L., Lin, H., Shao, Y., Chiou, S., & Chiou, H. (2015). Risk of Autism Associated with General Anesthesia During Cesarean Delivery: A Population-Based Birth-Cohort Analysis. Journal Of Autism & Developmental Disorders, 45(4), 932-942. doi:10.1007/s10803-014-2247-y

Slaughter, V. P. (2016). Autism. Magill's Medical Guide (Online Edition).