Open access peer-reviewed chapter
Abstract
Autism spectrum disorder is one of the most strange neuro developmental disorders in which symptoms such as stereotypical habits and behaviors, social skills problems and odd verbal communication skills can be observed. According to the studies and researches, these kind of symptoms also characteristics such as sensory integration problems, empathy problems, odd cognitive and perceptual problems can be the main problems in the family and also the family members will be affected to the secondary psychological problems like anxiety and depression. One of the most problems which can be experienced by the autistic children’s parents and family is the academic problem and the quality of learning environment. Therefore in this chapter, we will discuss about the sensory integration process and the family-based programs which are necessary factors for theses children’s learning environment.
Keywords
- autism spectrum disorder
- sensory integration
- learning
- environment
- family-based
- brain structure
1. Introduction
1.1 History of autism spectrum disorder, definitions and symptoms
Until the middle of the twentieth century, there was no name for the disorder that is now known as autism spectrum disorder, and Henry Moseley was the first psychiatrist who, in 1867, seriously treated children with severe mental disorders and delays. A development was investigated and studied, and it was observed that these children are different from other children with mental disorders; but in the middle of the twentieth century, i.e. 1943, Dr. Leo Connor studied a group of 11 children at Hopkins Hospital who had characteristics such as loneliness, developmental delays, difficulty in learning cognitive concepts, repetition or echo of pronoun inversion. Using the third person singular pronoun instead of the first person singular or “I”) monotony of speech and voice, parrot-like and normal memory, restrictions on all kinds of spontaneous movements, behaviors and formal expressions, insisting on the uniformity of the environment and preventing changes in it, contact eyes, weak, unnatural relationship with others, inanimate images and objects, and isolationism. Although for years, Leshukani has diagnosed these children with autism or isolation, which in some books and sources is called Canary autism or classical autism, but until 1980, some experts in the field of psychology and psychiatry thought that autism, mental retardation and childhood schizophrenia are one and the same, and autism was not considered a separate disorder [1, 2]. Since the 1980s and at the same time as the third revision and diagnostic version of mental disorders, the disorders of autism, mental retardation and childhood schizophrenia were distinguished from each other and it was believed that although these disorders are separate from each other, a child with autism can to some extent suffering from mental retardation and schizophrenia; but a schizophrenic or mentally retarded child is not necessarily autistic. According to the latest studies, today children with autism spectrum disorder are considered to be a group of children with developmental disorders who are observed until the age of 3 with two sets of symptoms and qualitative defects in social interactions and communication skills, as well as the presence of stereotyped behaviors, movements and interests. These symptoms have adverse and negative effects on communication, speech and language, cognitive, perceptual, emotional, behavioral, motor and social functions and create disturbances, and sometimes the symptoms start after three years of age [2, 3].
In the past and in the 1990s, when the fourth diagnostic and statistical manual of mental disorders entered the market, pervasive developmental disorders or autism were classified into five groups, which included classic autism (conner autism), Asperger’s syndrome (Asperger’s syndrome), Ret’s syndrome, childhood disintegrative disorder and autistic disorder not otherwise specified; but today, all the sufferers of these disorders are called autism spectrum disorder, and perhaps the goal is to try to reduce the set of signs and symptoms of the disorder instead of demarcations, and increase the communication, behavioral, learning, speech, and cognitive functions of these children [1, 4].
These disorders are common in the set of special symptoms such as quality impairment in social interactions, verbal communication skills, limited, weak, complex and strange, as well as the lack of variety and uniformity in behaviors, movements and interests, or in other words stereotypical interests and movements, but these symptoms are common in them. It has strength and weakness from the same source despite the studies and research conducted in the field of autism and the disorders involved in this area, the main and definitive causes and factors of this disorder are not yet known as it should be, but experts have identified a set of biological, genetic, social and psychological causes and factors. Cognitive is considered to be effective in the occurrence of this disorder [2, 5].
About 75% of children with autism spectrum disorder have some degree of mental retardation, although this mental retardation sometimes causes these children to be confused with children with intellectual disabilities [6].
Autism is originally a Greek word. The literal meaning of autism is selfishness. The word autism is a compound word that is the result of the combination of the two words auto and ism. Autism is a type of personality and mental disorder in which a person becomes more introverted and distanced from the environment and people around him, even his or her families. Autism appears mostly in childhood, and most of the time, its symptoms appear before the age of 3. It is interesting to know that the main cause of autism has not been discovered yet [7].
In general, children with autism spectrum disorder do not show their disabilities and abnormalities at the same time, that is a child may show weakness in verbal and writing skills at the age of 8, and another child may be slower or faster in perceptual processes. In general, these differences become more apparent in kindergarten and academy settings.! In different educational environments, students on the autism spectrum usually have selective attention when doing their homeworks, that is they pay more attention to details than generalities and sometimes get distracted. And they cannot concentrate enough in doing academic activities, and this factor causes them to be sometimes labeled as (attention deficiency hyperactivity disorder, ADHD). In a word, they pay more attention to some sensory stimuli and less to some other stimuli. In addition, people with autism spectrum disorder consider changes in their living and working environment unpleasant. In academic environments, teachers may complain about the performance of these people, but it is important to consider the conditions of these students. Now, with the knowledge that teachers must acquire in this field and the presence of psychologists in academic environments such as schools is considered necessary, we should not ignore the fact that some of them (autism) show extraordinary abilities such a parrot-like memory in memorizing poems, (without paying attention to its meaning and meaning), or quick calculations in division and multiplication, which are considered some of their learning abilities and skills that should be paid attention to in order to develop in the right way
Symptoms of autism spectrum disorder include difficulty maintaining eye contact, carrying on a conversation, making friends, interpreting jokes or sarcasm, and understanding other people’s emotions. People with autism spectrum disorder have many repetitive behaviors. For example, specific hand movements and interest in having a specific structure and routine are examples of repetitive behaviors. Also, a person may show interest in a certain subject, such as math, and talk about it constantly or practice it hard. People with autism spectrum disorder may also be distracted by certain sounds, images, or textures. Because the symptoms of autism spectrum disorder are milder in some people, they are sometimes difficult to detect.
1.2 Brain structure in autism spectrum disorder
The causes of autism spectrum disorder are generally unknown, and many theories have been proposed in this field. Current theories and research testify to abnormalities in the structure of the brain, which can be a factor in causing this disorder and disabilities in the mind and overall performance.
Today, with the advances in radiological imaging, it is possible to study the brain: computed tomography (CT), tomography by sending positrons (PET), tomography by sending photons (spect), and magnetic resonance imaging (MRI) is a method that can be used to examine the brain structure of people with abnormal brain disorders, including autism spectrum disorder [8, 9] anyway the neuropsychological studies and researchers the brains function in an autistic child can be strange the both hemispheres may work different from each other for example: a child with autism spectrum disorder may have a lot of potentials in musical learning and it means that his or her left hemisphere works well, but this child cannot write or draw well because the problems in visual perceptual skills related to the right occipital lobe. According to the neuropsychological studies, the autistic child’s brain can be similar to islands and the function of the brains parts will be different. Some of the children with autism spectrum disorder can do the logical operation due to the parietal lobe function or can learn a lot of musical instruments as soon as possible or can learn lots of numerical and telephone numbers. It means that the information processing can be done rapidly. According to the researches and studies, the memory processing is different in children with autism spectrum disorder and also the visual memory is better [1, 2, 10]. In addition some evidence states that it is due to biological reasons and genetic patterns.
In a large study conducted on twins, the concordance rate in monozygotic twins was 92% [1, 3]. To say more, relatives in families that have more than one person in them show more social and communication deficiencies [1, 3]. Also, abnormalities in chromosome 7, 15, 16 have caused a disorder in the brain structure of people with autism spectrum [11].
One of the most important causes of autism spectrum disorder is due to neuroanatomical factors. MRI studies of people in the study show an increase in the total volume of their brains, and the largest increase in size is related the occipital, parietal, and temporal lobes of these people. There is no difference in the frontal lobes, the reason for the increase in brain volume can be found in three possible reasons:
1.3 Environment and learning in autism spectrum disorder
In addition to educational environments, including schools, preschools, academic environments, or also other environments, such as: streets, stores where these people are present, which have potential effects on the experiences and learning of these people with autism spectrum disorder, especially the home and family environments. In family environments, with the modernization of lifestyles, children interact with their mothers most of the time in the family environment, and this issue makes the conditions of mothers or in general, any person who interacts with these people challenging.
The problems and conditions of these children sometimes challenge many aspects of the lives of parents and other family members and even cause differences between couples [1, 12, 13].
Anyway, academic learning needs reinforcement in the areas such as: cognitive, perceptual, emotional, motional, languages and communicational skills, in which all of the children can be perfected. This kind of skills are different in children with autism spectrum disorder cognition skills such as; reasoning, judgment, insight, abstract, thinking, attention, concentration and memory or orientation are strange and also the visual and auditory perceptual skills that are necessary for learning are not same like other normal children. The children with autism spectrum disorder cannot show their emotional in normal ways instead of they show stereotypical behaviors and habits. Stereotypical patterns can be observed in their motional patterns. Another big problems in these children can be the language of communicational skills problems in which can lead to impairments in the social skill training the children with autism spectrum disorder have problems in body language, body gesture, posture, sensory integration processing and eye contact that can have negative effects in their communication with their teacher [2, 4] beside the routine education, the children with autistic spectrum disorder can benefit from interventions such as ABA (applied behavioral analysis), art therapy, sensory integration and massage techniques, vestibular system techniques, PECS (picture exchange communication system), teach and etc. In addition, these interventions are the scientific applied interventions can have an important roles in facilitation. According to the classroom rules and occupational therapist, speech therapist, exceptional children psychologists, social workers and also the parents should be as the team members in interventional learning process. Because the dynamic association and collaboration of these practitioners and parents can lead to family-based programmers that are necessary in the children with autism spectrum disorder learning process.
And one of the suitable solutions for parents to cope with the conditions and compromise with these people with emotional problems, learning problems and problems in the perception of these people, families should participate in a series of intervention activities and educational solutions. Because the education of families and the family-centeredness of rehabilitative educational programs and interventions, and in better words, the active participation of families, increases the learning performance of these people with autism spectrum disorder. The Figures 1 and 2 show art therapy classroom for these children in which I have tried for training of theatre techniques to them. In this environment, we applied sensory integration techniques and family-based art therapy program for better learning.
Figure 1.
Training of theatre techniques in teens with autism spectrum disorder.
Figure 2.
Theatre training environment with my clients.
1.4 The role of family members in autism spectrum disorder learning (family-based programs)
The main problems of the child with autism spectrum disorder is impairment in communication and social skills with his or her parents and the other family members.
The cooperation and support of parents plays a significant role in the perceptual-cognitive progression of these people and also reduces the psychological pressures such as stress, anxiety and depression of these people and even reduces the psychological pressure of the families and increases the hope of the families [1, 2, 14, 15].
To say more, according to the psychological studies and researches, the active collaboration and dynamic association of the mothers and fathers as the autistic child’s parents in the family base programmes can lead to better findings because the parents can learn teaching and training to their children beside the teachers, and the other team members mentioned before in this dynamic process can lead to the learning and training triangle like blow child with autism spectrum disorder (ASD) [16, 17].
To make long story short, what is important is that the family is a valuable and natural source of support for children with autism spectrum disorder and any child with special needs disorders. And the role of psychologists is to organize families and create a healthy, hopeful and supportive atmosphere for parents in accepting the problems of children with disorders such as; autism spectrum disorder, useful and beneficial interventions and solutions for parents and children in order to improve the conditions. In Figure 3
Figure 3.
Schematic figure for learning and family n autism spectrum disorder.
2. Sensory integration and autism spectrum disorder
2.1 Sensory processing difficulties in autism spectrum disorder
Difficulty in processing sensory information and, in particular, extreme sensitivity or insensitivity to sensory input from the environment is common in autism [18], with prevalence estimates of 90–95% [19, 20, 21]. Such difficulties may exacerbate social communication deficits and increase the frequency of restrictive and repetitive behaviour, and may occur because of impaired regulation of central nervous system arousal [22]. Hyper-reactivity, reflecting the autonomic nervous system ‘fight or flight’ response, may result in behaviours such as aggression, hypervigilance or withdrawal (owing to poor tolerance of noise, touch, smell or movement), or additional ‘safe space’ needs. Hyporeactivity, in contrast, is characterised by reduced awareness of sensory stimuli within the environment [23]. Impaired sensory processing may also result in poor motor control, affecting participation in daily life.
Sensory modulation difficulties (i.e. difficulty recognising and/or integrating sensory information) in children with autism probably pose substantial burden to children and families, limiting participation in leisure activities [24, 25], and are linked to problems with activities of daily living, such as eating, sleeping, dressing, toileting and personal hygiene . Such difficulties represent a long-term challenge for health services in terms of treating potential consequences, such as behaviours that challenge and mental health disorders. Awareness and management of sensory difficulties in mainstream educational settings is also likely to affect peer relationships and educational outcomes. The potential pathway of effect is unconfirmed (i.e. the mechanism(s) by which sensory difficulties affect key outcomes [26]), but it is plausible that reducing sensory processing difficulties (SPDs) could lead to improvements across behavioural, social and educational domains.
2.2 The importance of sensory integration systems and techniques in children with autism spectrum disorder
As Ayres [27] mentioned about the sensory integration system, it can be observed as a dynamic system and process which can be effective in motor behavior vestibular system can coordinate the head-body position in space, muscular, tonisity and also, eye movement control. Also, this system has relationship with limbic system and reticular formation system that lead to emotional and feeling control and response to the environmental change [27, 28].
The proprioceptive system in which it’s receptors are found in the joints, bones, muscles and tendons, are very important parts in the sensory integration process. Its main role is regulation of information for control and bilateral coordination of central nervous system that lead to the integrated outputs. The proprioceptive system can lead to body schema and body image that are necessary for adaptation ad learning in their life’s environment [17, 23, 27, 28].
The tactile system has two subsystems as following: protective subsystem and discriminatory subsystem. The first subsystem has responsibility for receiving information from the pain temperature and touch receptors and finally this subsystem can protect person in activities of daily living. The second subsystem duties are the identification of the touch points, two points discrimination, steregnosis and graphesthesis. This kind of subsystem can be as a suitable base for fine motor skills in the hands [2, 17, 28].
In children with autism spectrum disorder these three systems cannot work as well as other normal children. Then, we can observe the main autism spectrum disorders symptoms such as stereotypical behaviors, social skills impairment, or odd verbal skills and also, due to dysfunction in sensory integration process we can observe another issues such as hypo-sensitivity, hypersensitivity, problems in sleeping, eating, bathing and the other activities of daily living, emotional problems, play, and etc. [1, 17].
According to rehabilitation studies, regular and logical instructions in the field of sensory integration process and focus on tactile, proprioceptive and vestibular techniques can help to reduction of these symptoms and they can communicate in environment and learn better than previous. Regular massage therapy during the classroom activities with similar plays with color balls, board, tilt-board, balance-beam and sport movements in which proprioceptive and vestibular receptors can activated will be suggest strangely, if the children with autism spectrum disorder received a sensory integration techniques regularly they will show normal behaviors and can communicate well [1, 17, 23, 28].
3. Methodology
In this review chapter we have used a library researches in which a lot of main studies, researches and books have been used for investigation of learning in children with autism spectrum disorder. According to researches and studies sensory integration and family-based intervention can lead to better cognition and perception that are necessary for education and learning for example: Ayres [27] has applied sensory integration techniques in the form of group rehabilitation for children with autism spectrum disorder and the findings show that sensory integration techniques can activate the vestibular and tactile and proprioceptive systems which can lead to better cognitive functions in academic skills. He showed that sensory integration techniques can be effective in learning [27]. Rafei [29] has studied about the role of massage therapy (as one of the sensory integration methods) in improvement of children with autism spectrum disorder. Their findings showed that massage can lead to learning of motor control in the environment [29].
Moghaddam et al. [2] have studied about the role of family-based art therapy program on the improvement of autism spectrum disorder symptoms and the results showed that the family activities in the art therapy programs can lead to better communication with environment and also control of the stereotypical behaviors. Also, they showed that art therapy modalities as a sensory integration techniques can enrich the learning environment of these children [2].
Moghaddam and Mohammadi have studied about family art therapy program in which family paintings techniques can be effective on better improvements of social skill training learning [30].
Chitgarzadeh et al. have investigated about mental health in the mothers of children with autism spectrum disorder and the results showed that any program in which parents are activated will be effective in children’s learning and Improvement of depression and anxiety in their mothers [31].
Rajabi Behjat has investigated an art therapy program on the social skill training in students which autism spectrum disorder and the findings showed that art therapy can lead to better environment for their learning [32].
Bahman Zadeh et al. have investigated the effect of social skill training on behaviors and social development of children with autism spectrum disorder and the results showed that family-based social skill training program can be effective on the social development of these children [33].
Samadi and Mcconkey have spoken about the importance of family role in families with autism spectrum disorder [34]. Wall has studied about the effect of family-based training programs for parents of children with autism spectrum disorder and the results showed that in this programs children with autism spectrum disorder can learn better [35].
Case Smith has investigated about the sensory integration disorders and she has explained that autism spectrum disorder is one of the disorders in which sensory integration systems such as vestibular, tactile and proprioceptive should be activated for better learning in their life environment [17]. Farahbod has emphasized in her book titled “Occupational Therapy for Mental Retardation” that visibular, tactile and proprioceptive systems with and without visual system can be effective in learning process of all of the exceptional children such as autism spectrum disorder [28]. Khodammi et al. have investigated that family-based puppet therapy in which mothers play with their autistic children can lead to better social skills leaning in their life environment [36].
4. Conclusion
As mentioned before autism spectrum disorder is one of the most strange disorders in the children. According to the neuropsychological studies and researches, autism is a neurodevelopmental disorder in which the brain’s function will be affected. Some parts of these children’s brain can work well and other parts may have impairments in their function. In the learning process, we can observe transferring and registration in the students and finally the generalization of the educated materials will be occurred. But, in the children with autism spectrum disorder, learning process can have delay or may be rapid due to the level of disorder. Also, the autistic children’s abilities are different from each others. Their brain function are different and some brain lobes activity are not coordinated with the others. Another issue in their learning, is the role of family members especially their parents. If the educations are family-centered or family-based, the learning will be better. Therefore, we need to dynamic role of their parents. They can be trained with interventions such as ABA (applied behavioral analyses), art therapy, massage therapy, PECS, TEACCH and etc. If these interventions are educated in a family-centered way, the children with autism spectrum disorder’s learning will be occurred rapidly and they can learn better than previous. One of the other interventions which can be effective in the learning process of these children is sensory integration, which its techniques can be applied alone by therapist or can be educated to parents as family-based intervention. In this intervention the three main systems as: vestiular, tactile and proprioceptive will be reinforced via systematic exercises by therapist, then their symptoms will be reduced and the children with autism spectrum disorder’s learning will be improved. Therefore, for better learning, application of sensory integration techniques and family-based programs beside the other autism spectrum disorder training methods in training environments such as preschools and schools should be concentrated. Figures 4–11 are the family-based art therapy techniques that we have applied for these children at exceptional school ad clinic.
Figure 4.
Family-based painting in Maziar (one of my clients) teen with autism spectrum disorder who has a lot of sensory problems.
Figure 5.
Family-based painting in Maziar a teen with autism spectrum disorder.
Figure 6.
Family-based painting of Jina (one of my clients) a girl with autism spectrum disorder who has a lot of sensory problems.
Figure 7.
Family-based painting of Davood (one of my clients) a boy with autism spectrum disorder who has a lot of sensory problems.
Figure 8.
Family-based painting of Moammad Amin (one of my clients) a boy with autism spectrum disorder who has a lot of sensory problems.
Figure 9.
Design activity in which sensory integration will be reinforced.
Figure 10.
Design activity in which sensory integration will be reinforced.
Figure 11.
Design activity in which sensory integration will be reinforced.
Appendix
Autism Spectrum Disorder.
Brain function.
Environment.
Family-based.
Learning.
Sensory integration.
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