Discussion of Ritchie’s Situation Although ASD was once thought to be a rare dis

Discussion of Ritchie’s Situation
Although ASD was once thought to be a rare disorder, more recent estimates show an increase in its prevalence. Previous estimates indicated a rate as low as 60 per 10,000 people, whereas a survey reported in 2013 indicated that as many as 1 in 50 school-aged children in the United States had a diagnosis under the category of ASD (Blumberg, Bramlett, Kogan, Schieve, & Jones, 2013). The dramatic increase in prevalence is likely due to changes in the DSM definition of ASD over time and because health professionals and parents have become more adept at recognizing the signs of the disorder. Worldwide, rates of ASD are roughly 4 times higher in males than in females (Fombonne, Quirke, & Hagen, 2011; Shattuck, 2006). The reasons for this sex difference are unknown (Volkmar, Szatmari, & Sparrow, 1993). No other demographic differences in the prevalence or nature of ASD (e.g., racial, cultural) have been firmly established.
In addition to the features that make up the formal DSM-5 definition of ASD, the disturbance is frequently associated with other problematic symptoms. For instance, persons with ASD may have a range of behavioral problems, including hyperactivity (as was true for Ritchie); short attention span; poor impulse control; aggressive, self-injurious behaviors (e.g., head banging); and temper tantrums. Children with ASD may display peculiar or unusual reactions to various forms of environmental stimulation (e.g., high pain threshold, extreme aversion to being touched). Disturbances in mood or the expression of emotions are common associated features of ASD (e.g., laughing or crying for no apparent reason). Moreover, persons with ASD may show no emotional reaction to situations or objects that most individuals would react to (e.g., display no fear to a large, aggressive dog) yet respond with excessive emotionality to harmless or trivial objects or situations (e.g., extreme distress upon discovering that a piece of furniture has been moved). In adolescence or early adulthood, persons with ASD who have the intellectual capacity for insight have been observed to develop depression in response to realizing their serious impairment.
The symptoms of ASD are typically recognized during the child’s second year of life. Once it emerges, ASD follows a continuous course (i.e., unlike some disorders, it is not generally characterized by alternating periods of improvement and recurrence). Nevertheless, the long-term course of ASD is variable across individuals. Some children with ASD deteriorate behaviorally when they reach adolescence, whereas others show improvement. Research has indicated that language skills (i.e., the ability for communicative speech) and higher overall all intelligence may strongly predict a more positive long-term prognosis. Nevertheless, research on the long-term course of ASD indicates that only a small proportion of these children enter adulthood with the capability of living and working independently. Those who do achieve some degree of independence nonetheless continue to display problems with social interaction and communication, along with constricted interests and activities (American Psychiatric Association, 2013).
Thus far, there are no powerful treatments for ASD. Most of the treatments developed to date have focused on problematic associated features of the disorder, such as disruptive or self-injurious behaviors. Biological treatments such as psychoactive drugs (e.g., Ritalin, frequently used in the treatment of ADHD; serotonin-specific reuptake inhibitors) and vitamin therapy (e.g., vitamin B6) have not produced significant or lasting improvements in intellectual level, sociability, or hyperactivity (Broadstock, Doughty, & Eggleston, 2007; West, Brunssen, & Waldrop, 2009). Many psychosocial interventions for ASD have relied heavily on the learning theory principles of reinforcement and punishment to improve patients’ living skills and curtail behavior problems. As was illustrated in Ritchie’s case, these treatments have been used to improve the communication skills of children with ASD (Durand, 2014; Lovaas, 1977). In addition, such treatments have been employed to improve socialization skills (i.e., increase the interest and frequency of social interaction with other people). Whereas behavior therapy has increased the frequency of social behaviors, such as playing with toys or other children, these treatments have not shown considerable positive effects in changing the quality of these interactions (e.g., the ability to initiate and maintain friendships with other children). However, studies of highly time-intensive behavioral treatments (e.g., more than 40 hours per week for more than 2 years) have found that psychological interventions can produce meaningful and lasting improvements in the intellectual and social abilities of children with ASD (Lovaas, 1987; Matson & Smith, 2008). For instance, Lovaas (1987) reported that 47% of children with ASD who were treated with the intensive program had achieved normal intellectual and educational functioning by the 1st grade (compared to none of a group of children with ASD who received a less intensive treatment). Despite these promising results, some researchers have noted that these treatments may be seriously limited by their poor practicality (i.e., very expensive and time-intensive); others have argued that, given the potential for substantial benefits (i.e., intellectual functioning within the normal range), the “ends” provide resounding support for the intensive “means.” Nevertheless, considerable work must be done in the future to develop more effective and practical treatments for ASD (Matson & Smith, 2008).
Question 8: Given the clear evidence for the strong role of genetic, neurological, and biological factors in ASD, what justifies the use of behavioral treatments for this disorder? (Provide a response in three to four sentences).
Question 9: What do you believe is the best approach to educating children with neurodevelopmental disorders within the public educational system? What do you believe are the advantages and disadvantages of special education programs versus programs aiming to integrate these students into normal classes? (Provide a response in three to four sentences).
Question 10: A significant change in the DSM-5 was eliminating the Asperger’s disorder diagnosis, which is now subsumed under the new diagnostic category, ASD. Asperger’s disorder shares several features with autism, such as significant difficulties in social interaction and nonverbal communication and restricted or repetitive patterns of behavior and interests. However, Asperger’s disorder differed from autism because individuals with this diagnosis had normal linguistic and cognitive development. In DSM-5, the diagnoses of Asperger’s disorder and autism were collapsed into the ASD category based on the rationale that they reflected the same disorder at varying degrees of severity. What do you think about this change in classification? What are the arguments for and against combining these disorders into a single category? What positive and negative consequences do you think this diagnostic re-organization might have? Provide a response with at least five to six sentences (1 to 2 paragraphs at most).
Question 14: As Ritchie grows older, will it be easy or challenging for him to make friends? ( Provide a Response of two to three sentences).