Poppi, M-K. (2016). A cross-national study of childhood autism. (Unpublished Doctoral thesis, City, University of London)
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Autism is considered to be a chronic developmental disability that affects communication, relationships, emotional development and imagination (NAS, 2010). Prevalence rates for autism spectrum disorder (ASD) suggest that the rates have increased over time and recent research shows that 1 in 68 children are diagnosed with the disorder (Baio, 2014). These children’s difficulties in the areas of communication, social skills and restricted/repetitive behaviours and interests lead to the need of therapeutic support (APA, 2013) and often it falls to parents to find an appropriate treatment for their child (Marcus et al, 2005). Among recommended services to these children are speech and language therapy, occupational therapy (Johnson and Myer, 2007) and psychotherapy (Alvarez et al, 1999). There are a number of intervention approaches for children with autism that have been developed, however none have been universally accepted as being the most effective (Farrell et al, 2005). As a result, parents often find it difficult to know which is the most appropriate approach for their child.
This study aims to explore the development of children with autism over time in the areas of social skill and communication, regardless of the kind of treatment (speech and language therapy, psychoanalytic/psychodynamic psychotherapy and occupational therapy) they are receiving and to investigate the association between therapy context and the patterns of developmental change. This thesis is designed as a cross-national study in order to examine the aspects of the disorder that differ in the UK and Greece along with the differences (if any) in the developmental patterns across countries. The significance of doing a cross-national study is to explore autism from a wider international perspective and to identify any differences and similarities across the two countries.
Twenty children with autism who had completed one of two differing types of treatment in the UK (psychotherapy, n=10 and speech and language therapy, n=10) were recruited to be monitored post-therapy twice over a two-year period. Twenty children with autism who had received one of two types of treatment in Greece (occupational therapy, n=10 and speech and language therapy, n=10) were also recruited to be monitored post-therapy twice over a two-year period.
The research found that all children changed significantly over time on all aspects of measurement. Furthermore, no significant differences were found in the children from the two different countries at the start of the study and they developed in a very similar way as well. The results suggested though that based on the ADOS-Social (p=0.008) and ADOS-Imagination (p=0.008) children in the UK improve faster in the areas of social skill, imagination and the CDI-no of words understood and produced (p=0.015) showed an increase in their ability to understand and say words compared to the children in Greece. However, the CDI-no of words understood (p=0.027) showed that the children in Greece improved faster in the area of comprehension. The children who received SLT are also mainly developing in a very similar way across the two countries. Most measures showed change over time, except for the SCQ (p=0.081), ADOS-Ster (p=0.050) and CDI-U (p=0.141|). Also, only the ADOS-Social (p=0.021) and the Social Communication Questionnaire (p=0.021) showed a significant interaction effect. Thus, the SLT group from the UK seems to improve faster in the area of social skills compared to the SLT group from Greece.
Additionally, in regards to the effect of the therapy context on the developmental pattern of children with autism, there were no differences across intervention contexts at the beginning and there were mainly non-significant interactions in the rate of change across the differing types of intervention. The findings suggested that all measures showed change over time. Only the SCQ (p=0.041) and the ADOS-imagination (p=0.033) showed a significant interaction effect before adjusting for age. Therefore, the SLT group in the UK seems to improve faster in the social communication area and the Psychotherapy group in the UK improved faster in the area of imagination.
Conclusively, the SLT groups showed more change on language and communication measures, whilst the psychotherapy and occupational therapy groups saw changes in other areas of autistic symptomatology not achieved in the SLT groups, such as imagination and stereotypical behaviour.
In summary, the current study helps parents gain better insight in different therapy choices and raises awareness of other types of therapy that are available in terms of intervention. The findings of this study can help professionals who work with children with autism further their understanding of the disorder and how it manifests through time in order to provide appropriate services based on each child’s needs. Additionally, the cross-national approach was intended to give some suggestions about the manifestation of autism across countries and about the way childhood autism is treated in each country. In regards to the more specific changes that the analysis revealed, they seem to fit well with the intervention targets of each type of therapy. Thus, the analysis suggested that certain characteristics tend to be associated with specific treatment types, which leads us to believe that sometimes the most effective course of treatment is a combination of therapies depending on the individual needs of each family. Finally, the results of this study offer original findings with respect to the outcomes of psychodynamic/psychoanalytic psychotherapy for children with autism since there is a lack of rigorous research in this field.
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