Autism, the Treatments, and the Society
Introduction
The purpose of this research paper is to obtain basic knowledge on the types andpossible causes of autism in children, the therapies that are available to them to improvetheir condition, the efficacies of the therapies, and the role of society in providing thetherapies to those who are in need of them. Since the research focuses on the issues
regarding the development of autistic children, it will mention little about the effective
therapies applied to autistic adults.
Over the past few decades some very important findings and establishments oftherapies, treatments, and interventions for autistic children came about. In addition, theefficacy of the interventions was assessed, and the refinements of the therapies werecarried out based on the evidence based research. The research has shown that suchintervention does have positive effect in helping autistic children develop the impaired
social skills. With these effective therapies and intervention programs established, thesociety should work to help those who are in need of such programs have easier accessto them.
What is Autism
The word autism was brought up by an Austrian-American pediatric psychiatrist

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Leo Kanner (Koegel, Koegel, and Brookman 341). Kanner “chose the term (auto, “self”,-ism, “condition”) to refer to the child’s apparent self-absorption” (Carlson 594). He
observed eleven autistic children, and found that although precise details on each are
different, all eleven children shared some common characteristics in their behaviors(Kanner 242). One of them was their “inability to relate themselves in the ordinary way
to people and situations” (Kanner 242) such as not paying attention to anyone they wereaccompanied with (Kanner 242).
People with autistic disorder tend to not respond to attention directed at them or
pay attention to others, or initiate attention (Yamamoto). Nor are they comfortable with
eye-to-eye contact (Yamamoto 1). Pierce’s group examined the brain functioning of
normal and autistic people’s activities in fusiform ‘face area’ (FFA)1 and found thatthose of autistic people were weaker compared to those of normal people (Pierce,
Müller, Ambrose, Allen, and Courchesne 2067). Instead of using FFA, autistic people
use different parts of the brain when looking at people’s faces (Pierce, Müller, Ambrose,
Allen, and Courchesne 2067-2068).
The word “Pervasive Developmental Disorder” (PDD) is used to express a varietyof characteristics of autism (Okuzumi 61). The term “autism” refers to the type which1

the areas in brain which functions most actively when processing someone’s face2

only one-word utterance or no verbal skill develops and it lies under the Autistic
Spectrum which is also the term that shows the wide variety of autism (Okuzumi 61).
There is also a type called High Functioning Autism which the symptoms are lesssevere in terms of mental retardation and verbal skills. In general, the term Autistic
Spectrum is used to conceptualize the autistic disorder as a range of spectrum whereas
the term Pervasive Developmental Disorder is used to categorize the types of autism(Okuzumi 61).
Other characteristic of autism is a sensory sensitivity (Okuzumi 61). One of theboys Kanner observed “had failed to adjust his body to being held” (Kanner 225) byhis mother. Mothers in fact sometimes find it uneasy to hold her autistic baby. The
reason for this can be accounted on by the tendency of autistic children to dislike
physical contact because of sensory sensitivity2. Also, they tend to be very sensitive toloud noises, having hard times catching and discriminating important sounds such as
speakers’ voices from other irrelevant surrounding noises (Okuzumi 61).
According to the Diagnostic Statistical Manual for Mental Disorders 4th Edition(DSM-IV), the three diagnostic behavioral standards to diagnose autism are
qualitative

impairmentsinsocialinteractions,inverbalandnonverbal

An explanation from Mr. Takeuchi, the teacher of Developmental Clinical Psychology
at Keio University
2

3

communications, and restricted, repetitive, and stereotyped patterns of behaviors,interests, and activities (Koegel, Koegel, and Brookman 341; Lovaas and Smith 325;
Yamamoto 2007). The qualitative impairments in social interactions is such that thechild does not respond to person who is calling his name, or makes any eye contacts(Yamamoto 1). An example of impairments in verbal and non-verbal communications
is that a child can not ask for something but instead shows tantrum in order to havesomeone do something what he wants. Rocking his body repeatedly is an example ofrestricted, repetitive, and stereotyped patterns of behaviors and activities.
Autistic children having lower IQ scores are commonly known but it is not quite
an accurate fact. The scores are used as a standard to judge the severity of the child’sautism, but the IQ scores depend on various factors such as the experience they have
had. Among the eleven children Kanner observed, some of them had IQ score ofabove 100 (Kanner 232-234; Nakane 517-518). Therefore, IQ score is not included asa criterion for diagnosing autism. However, it is used as a measure to compare and see
the improvements made as an effect of the intervention programs.
The Causes
Since the publication of Kanner’s article, many theories on causes were made.
One of the earliest theories was the parental causal theory (Koegel, Koelgel, and4

Brookman 341-342). According to this theory, children become autistic because of badparenting and mothers were blamed at for their children’s social disability. Kanner did
mention in his paper how “there are very few really warmhearted fathers and mothers”(Kanner 250) among those he observed. However, whether this accounts for such achild’s condition he left as a question (Kanner 250). The contemporary notion regarding
this theory is that this is not the case, and in fact, parents should actively involve intraining their children (Autism Conference Nippon 2006; Koegel 386; Koegel, Koegel,and Brookman 342).
It is said that malfunctioning in central nervous system causes autism (Okuzumi
62; Carlson 597-598). Kanner did mention in his paper about the difference in size ofthe head and other physical features of autistic children that are different from ordinary
people. This suggested the possibility of biological factor that is causing the autism(Carlson 596). Lately, studies on developing brains have been carried out using various
instruments such as Magnetic Resonance Imaging (MRI).
Courchesne’s group examined the brain growth of sixty autistic children using the
MRI and found abnormal patterns in their brain growth (Courchesne et al. 247-249,
251). In this study, Courchesne and his group found many abnormal developmental
patterns in autistic children’s brains, including the growth rate at different ages5

(Courchesne et al. 247-249)3
The disorder is known to be genetic, with much evidence to support it.
About 2 to 3% among those people who have autistic siblings are autistic (Carlson 597).
This is 50~100 times higher than the frequency of having autism within regular group(Carlson 597). A study on twins regarding the genetic factors of autism was done in thepast by Flostein and Rose-Scheidly (Carlson 597). The findings were such that chancesof both of the twin being autistic was as high as 70% among identical twins, whereas
0% among fraternal counterparts (Carlson 597).

Therapies
Since the growing interests in the subject of autism, ways to cure it wereattempted to establish. Some of the therapies and treatment were established based on
untrue theories such as the one mentioned earlier. And some that were establishedshowed no strong evidence to show that the therapy was actually effective (Richman
14-18).
3

For more details, please refer to the article: Courchesne, E., C.M. Karns, H.R. Davis,

R. Ziccardi, R.A. Carper, Z.D. Tigue, H.J. Chisum, P. Moses, K. Pierce, C. Lord, A.J.
Lincoln, S. Pizzo, L. Schreibman, R.H. Haas, N.A. Akshoomof, and R.Y. Courchesne.
“Unusual brain growth patterns in early life in patients with autistic disorder: An MRI
Study.” Neurology. 57 (2001): 245-254.

6

In 1960s a psychologist O. Ivar Lovaas came up with a treatment therapy using
applied behavioral analysis. Behavioral analysis is a study of behavior including
learning. Lovaas used the principle of “Operant Conditioning”4 in coming up withtreatments for autistic children. He applied the behavioral analysis to teach autistic
children appropriate behavior and reduce inappropriate ones (Lovaas 621-622). The
discovery of autistic children’s ability to learn and the application of behavioral analysis
to the treatment of autism, was the significance of Lovaas’ findings in establishing histreatment therapy (Lovaas 622).
Lovaas attached importance on inductive and empirically supported therapy
rather than those of mere theory-based (Lovaas 617). He carried out an experiment
where that the therapists would “teach” 38 mute autistic children who were around theage of 4 at the time of intake which was aimed to improve the children’s language
ability as well as social skills (McEachin, Smith, and Lovaas 361). Lovaas “provided
approximately 40 hours per week one-on-one behavioral treatment for a period of 2
years or more” (McEachin, Smith, Lovaas, 360). According to the follow up research
for the experiment, Lovaas reports that the experimental group had a higher average IQ
score compared to those of control group, lower Maladaptive Behavior, and in contrast,
4

Operant Conditioning: a procedure of reinforcing behavior using reinforcement(Mazur 130).The most famous and well known behavioral analyst is B.F. Skinner, thefounder of Behavioral Analysis.
7higher Adaptive Behavior , claiming the treatment to be effective (McEahin, Smith, andLovaas 364-365). The findings also include that the children of experimental group“had maintained their level of intellectual functioning between their previous
assessment at age 7 and the present evaluation at mean age of 13” (McEachin, Smith,and Lovaas 367). Some of the children, described as “best out-come” subjects by
Lovaas, “were able to hold their own in regular classes (McEachin, Smith, and Lovaas
368).
As can be seen, the treatment that Lovaas experimented with had positive effecton autistic children. However, it also had defect. For example, “teaching language skills
did not usually improve peer interaction unless peer interaction skills were also taught”(Lovaas and Smith 327) and the “gains tended to be situation specific” (Lovaas andSmith 327). That is, the autistic children could show the acquired ability only in clinicalsettings, and can not apply it to home or other real life settings (Lovaas and Smith 327).
The Early Intensive Behavioral Intervention (EIBI) that is being practiced at
University of California, Los Angeles Young Autism Project (UCLA YAP), has six
stages to it (Lovaas and Smith 330-334). The first stage aims at teaching an action suchas “sitting” or “coming” when called at, without letting unwanted behaviors liketantrums to interfere, and also to be more responsive to the situation they are taught in8

(Lovaas and Smith 331). The second step aims at teaching the children receptive
language skills, imitation of actions, and imitation of facial actions (Lovaas and Smith
332). Learning how to imitate is such a beneficial gain for the children, since it will
enable the children to observe and learn how to play. From stage 3 on, the autistic
children will learn communication and social skills (Lovaas and Smith 331-334). Thereis an indication from studies that, “when implemented early (beginning prior to 5 yearsof age) and intensively (more than 20 hours a week for 2 or more years)” (Smith andLovaas 328), then the treatment will become effective with some autistic children.
As is part of Lovaas’ treatment, mainstreaming the autistic children into regularclasses is also said to be effective. A study was done by Smith, Lovaas, and Lovaas tosee how interaction with typically developing children will affect children withhigh-functioning autistic disorder (HAD). The result was such that the HAD children
showed significantly more interactive play and speech as well as other appropriate
behaviors when paired with typically developing children than with the delayed peers(Smith, Lovaas and Lovaas 140).
Another well-known program for autistic children’s treatment is Treatment and
Education for Autistic and Related Communication Handicapped Children (TEACCH),
established by an American psychologist Eric Schopler. The TEACCH program was set

9

in a college, which is an important point of the intervention program, because it allows
the findings of research and society to link with each other instead of keeping important
findings in a research room (Mesibov5). Such structures enable the college to provide
the community empirically supported effective treatment, the people in the community
to carry out the therapy, and give feedback to the college laboratory for further
assessment and refinement (Mesibov).
One of the uniqueness of TEACCH program is that it attempts to make diagnosis
of autism at an early age of an individual from various aspects in order to intervene at
an early stage, and take care of the children to their adulthood (Mesibov). Therefore, theprogram takes a lot of time in diagnosing autism, due to the belief based on the fact that“no effective diagnosis can be made without enough knowledge on autism” (Mesibov).
The good thing about intervening with autistic children at an early age is not just so they
can develop social skills effectively, but also because they experience being praised atthrough the program, developing higher self-esteem (Mesibov). Without any treatment
or intervention, they would have less opportunity to achieve goals or having sense of“accomplishing” something (Mesibov). This is very stressful with autistic children as it
is with normally developing children.

From the notes taken by Chiharu Amemiya, who has also dedicated her time and knowledge on
therapies for autism to me with my research on TEACCH as well as further understanding on autism
5

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Using the abilities that the autistic people already have, the program attempts toconstruct an environment that would make them easier to function. For example,
autistic people are not good at understanding auditory information but are good atunderstanding visual stimuli. Therefore, helping them by modifying or structuring theenvironment such as creating a schedule board is one of the strategies they use (Autism
Nippon Conference 2006; Mesibov). This way, the autistic people live not merely as
disabled, but as actually functional (Mesibov).
The ideal of TEACCH program is to change the environment to suit the autistic
children and adults to live in (Mesibov). The program envisages the future of theautistic children, all the way to their adulthood and claims the importance of life longsupport because one of the goals of this program is to have autistic people live
productive life (Mesibov). One of the examples would be to help them get jobs andchange the job environment so that they can work without any disturbances (Mesibov).
According to the Report of the Recommendations published by the New YorkState Health Department, “ongoing monitoring of the child’s progress by parents andprofessionals” (Report of the Recommendations) is recommended because if aparticular intervention seems to be not functioning effectively after a certain period oftime, then it should be altered. The report gives the intensive behavioral intervention

11

programs an A rating6 on using the ABA in the interventions. The intensity of theintervention, up to 40 hours per week, is also strongly recommended (Report of the
Recommendations). It is recommended that they be flexible and use intervention
strategies that best suits specific individual in order for the intervention to be fully
effective.
Not everything of Lovaas’ program and early intensive behavioral interventions
have a positive effect on every autistic individual. Certain things do not apply to somepeople. In order to come up with the best treatment and support for an individual
autistic child, one needs to plan a therapy program based on various factors such as
what the child could already do, the environment they live in, and the possibility ofliving in normal society (Yamamoto 44).
Autism and the Contemporary Society
The support for autism is becoming more common in Japan. In 2005, the Support
for Developmental Disorder Act was established which states the government’s support
for early diagnosis of developmental disorders, including autism and institutions to
educate and treat these disabled children (Nakayama 67-70). The significance of thisenactment is the fact it states clearly that autistic people are now the subject of supports
A rating indicates that the efficacy could be strongly supported by the research and D
ratings indicate that no strong evidence to support the efficacy can be obtained.
6

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(Nakayama 71). The governmental support for the early diagnoses and intervention for
autistic children is very beneficial not only for their quality of life, but also for thesociety itself.
It is not rare that people who lies on the autistic spectrum but do not show asstrong symptoms are left undiagnosed and those tend to be of high-functioning autistic
spectrum disorder (HFASD) (Kamio 491).They show less disability in verbal skills andintellectual abilities (Kamio 491).Even though they seem to be functioning fine, people
with HFASD do suffer high social maladaptation (Kamio 491). They start to notice thedifference and their own inability to fit into the environment in their adolescence. Manyof them were bullied at by their classmates, which mentally scarred them (Kamio 491).
Wing pointed out that grown ups with Asperger’s are likely to suffer
complications of other mental disorders and exhibit anti-social behavior that are notdevelopmental disorders (Kamio 491-492). Indeed, some social delinquencies arecaused by those having PDD (Kumagami 327-328). Those who grew without being
aware of being autistic have usually been exposed to harsh circumstance (Toichi 1111).
They were not only misunderstood by surrounding people, but in some cases, physicallyabused by their parents under the name of “discipline” (Toichi 1111). This abuse would
make the autistic people over reactive to offensive stimuli, which leads to excessive

13

panic that is beyond their control which could result in harmful behavior (Toichi 1111).
The most common delinquencies or crime committed by PDD people issex-offenses. While sex-offense consists of only 0.2% of all the juvenile crimes in Japan,
40% of offenses caused by PDD are sex-offenses (Kumagami 330). Possible reason forthis is that people with PDD have difficulty controlling their impulses, and they may
have seen the sex-offense or other sexual scenes in the media and imitated it without
knowing that it is an inappropriate behavior (Kumagami 334).
As it can be seen, types of PDD such as HFASD can lead to crime. Without
appropriate diagnosis, intervention, and behavior being taught, the individual has thelikelihood of causing social delinquency. Therefore, it is extremely important to havewell-established systems to support people suffering autism, including a program forearly detection of autism and experienced specialists (Kamio 494). This may help
reduce or prevent the crimes caused by people with developmental disorders as well as
maintain their quality of life (Kamio 494).
According to the statistics of Autism Society Japan, most people in Japan know ofautistic disorder but only 60%of them knew the actual cause of it. As much as 30 % of
the people had misconception about the causes of autism, with many of them thinking it
is a mental illness. These misconceptions on autism can cause unnecessary stress on

14

families with autistic child as well as reluctance in supporting them as a community.
The government should therefore work as a provider of accurate information in order toencourage the community to support autistic people.
Conclusion
Autism has an extremely wide range of degrees of severity in social andcommunication disabilities. Many people exhibit the conspicuous behaviors of autism,
while others are never really even suspected of it. As was discussed, some people havebeen left undiagnosed and ended up with undesired outcomes. Therefore, early
detection is very important and well-established system as well as experienced
specialists are needed (Kamio 494).
Early detection of autism and early intervention to autistic children is said to beeffective in an attempt to develop appropriate social skills, and the efficacy of ABA
approach of treatment is empirically supported and recommended. However, there arelimits. It is very rare that one grows out of autism. The majority of the people have tolive with it. Therefore, life-long support is very important for them in order to let them
live productively with a higher quality of life (Mesibov; Kamio 494).
The Japanese government is moving to support those suffering from PDD byfinancially aiding centers for social skill training and therapies. Their goal is to establish15

a system for early diagnosis and early intervention. Even though this is a very desirable
assistance, by itself is not quite enough. There are many people who havemisconceptions about autism. Providing accurate information to the people who live inthe society which autistic people also do is very important and also essential to establish
support systems.

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