hearing levels should then be obtained through other methods, such as auditory brainstem evoked responses (BSERs) (Klin, 1993). Certain features, such as the abrupt behavioral and developmental deterioration of a child who was previously developing normally, may suggest the importance of extensive medical investigations (Volkmar et al., 1999).

In some cases, the use of psychotropic medications may be indicated for young children (see Chapter 10). Although not curative, such medications may help to reduce levels of associated maladaptive behaviors and help children profit from educational programming. The use of such agents requires careful consideration of potential benefits and risks and the active involvement of parents and school staff (see Volkmar et al., 1999 for a review).

IMPLICATIONS FOR INTERVENTION

Many aspects of the procedures, curricula, and educational programs relevant to other children are readily applicable to children with autism and related conditions. As for all children, an intervention program must be individualized and tailored to the specific needs, strengths, and weaknesses of the individual child. In addition, children with autistic spectrum disorders often present special challenges for intervention.

From the time of Kanner’s (1943) definition of autism, social deficits have been consistently identified as an, if not the, essential feature of the condition. Social interaction requires careful attention to multiple, shifting strands of information; an ability to perceive the thoughts, feelings, and intentions of others; and coping with novel situations on a regular basis. In children with autistic spectrum disorders, social difficulties persist over time, although the nature of the social difficulties may change with age and intervention (Siegel et al., 1990). These social difficulties, as reflected in relationships with teachers and particularly in relationships with peers, are different from those seen in all other developmental disorders and present special difficulties for programming. For a child with an autistic spectrum disorder to be able to be included in mainstream settings, the child must be able to manage social experiences. This requires careful consideration on the part of school staff. While children with an autistic spectrum disorder can be served within many school environments, even for more cognitively able individuals this can be a challenge. The characteristic difficulties in social interaction require special teacher training and support beyond knowledge concerning general developmental delays or other learning disabilities.



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