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Health
Humaira Hasan

Importance of Early Intervention in Autism: Effective Strategies for Better Outcomes

BY HUMAIRA HASAN INTRODUCTION What if unlocking the complete potential of a child with Autism Spectrum Disorder is decided not solitarily by the intervention but at the age when it begins?  Autism spectrum disorder (ASD) may be defined as a developmental and neurological disorder that interferes with one’s interaction with others, learning abilities, communication, and behavior. (NIHM) The diagnostic age for Autism Spectrum Disorder has seen a decrease in the past few decades. (Daniels, A. M., et al.), however, currently, the mean age for diagnosis lies between 3 and 4 years.  A study states that in 2020, the rates of autism spectrum disorder (ASD) among Asian, Black, and Hispanic children were at least 30% higher than in 2018. (Centers for Disease Control and Prevention [CDC], 2023). Thus, with the rising numbers of individuals with diagnosed ASD, the need for early intervention has become increasingly urgent. This paper argues that early intervention for children with Autism Spectrum Disorder is essential for maximizing developmental outcomes; by evaluating the efficacy of strategies such as Applied Behavior Analysis, speech-language therapy, occupational, and music therapy. This meta-analysis highlights how early intervention can significantly enhance cognitive, social, and communicative skills while alleviating core symptoms of ASD.  DIAGNOSIS Social skills are necessary to adapt to different environments and conduct appropriate interactions with those around. However, children with ASD require external help to grasp these foundational skills (eg, social engagement, joint attention, etc). According to DSM 5- TR, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) which is a manual that assists researchers and clinicians in diagnosing mental disorders, individuals with ASD often showcase difficulty in social interactions, emotional reciprocity, repetitive behavior, and fixation on a certain interest. These individuals may be more dependent for care on others than individuals within their age groups. (Ayres, Mechling, & Sansosti) EARLY INTERVENTION There are a number of rationales when it comes to the justification of why beginning early is better in the case of intervention. The first one can be due to early neuroplasticity. There is a high rate of synapse formation during the stage that constitutes birth to 3 years of age. (Kolb & Gibb, 2011) The rising prevalence of Autism Spectrum Disorder calls for the need for early intervention to adapt to social situations better. Research suggests that there is no need to delay intervention in the case of Autism Spectrum Disorder. Noteworthy improvements can be seen as a result of early intervention at as early as preschool level in oral language and reading comprehension. (Macdonald et al., 2021) Studies also show that autistic symptoms are reduced more in younger children than in older children. (Maksimović et al., 2022) EARLY INTERVENTION STRATEGIES There are a number of early intervention techniques such as speech therapy, Applied Behavior Analysis(ABA), occupational therapy, and music therapy that are discussed in detail below: APPLIED BEHAVIOR ANALYSIS The term Applied Behavior Analysis was first used by Baer et al. (1968) to comprehend and improve behavior through the use of basic behavioral principles. Visible, quantifiable, and clearly defined behavior which may either occur not frequently enough or in excess is the focus of ABA. (APA) Most study records indicated improvement in all outcome categories namely language, cognitive, social/communication, problem behavior, adaptive skills, emotional aspects, autism symptoms, and quality of life (QoL) outcomes, with 63%–88% showing positive results across different measures. In comparison, 0%–2% reported worsening, 13%–36% showed mixed results, and 0%–13% indicated no change. (Gitimoghaddam et al., 2022) In another recent research, significant improvements in verbal behaviors due to ABA on 11 out of the 13 VB-MAPP(Verbal Behavior Milestones Assessment and Placement Program) scales, highlighting the importance and effectiveness of early interventions using ABA. A great increase in Tacting skills, matching-to-sample, Visual perceptual, and interverbal skills was also observed. (Pater et al., 2022) MUSIC THERAPY Parent-child cooperative music can be defined as a therapeutic activity that assists in alleviating symptoms in children with autism. Through extensive research, it has been observed that parent-child cooperative music therapy combined with ABA has proved effective in reducing the core symptoms of Autism in children. (He et al., 2022) In another study, focusing on the “Papageno Music Therapy Program” (PMTP), it was observed that children with autism displayed improvements in their social interactions which were not just limited to their therapy sessions, showing evidence that PMTP improves social behavior. (Pater et al., 2022) SPEECH LANGUAGE THERAPY On conducting research on the effectiveness of speech-language therapy, it was found that while younger children showed better speech and language development after a year of therapy, there was no significant difference in language abilities between younger(aged 36–47 months old) and older children(48–60 months old). (Maksimović et al., 2022) This implies that although early intervention is helpful, one year may not be enough time to see significant improvements in speech and language skills, particularly when development is significantly delayed. (Maksimović et al., 2022) OCCUPATIONAL THERAPY Occupational Therapy is a type of treatment for individuals with autism that focuses on decreasing impairing symptoms and enhancing functioning in both children and adults. (Stornelli, 2015) Occupational therapy looks at how a person responds poorly to sensory experiences and adjusts the environment in order to lessen the negative responses to sensory stimulation. (ASD Clinic, n.d.) Looking at the research findings, it was observed that relationship-building abilities, body and object usage, sensory, social, self-care, and language skills significantly improved with early intervention. However, these benefits were particularly evident during the early stages of occupational therapy with the rate of improvement declining over time. (Jaicks, 2024) Another study states that occupation therapy through joint attention-based interventions and a child-centered approach, depict significant improvement in the reduction of ASD-related behaviors while enhancing social communication and visual perception in children with ASD.(Özkan et al., 2023) These research findings underscore the importance of early intervention in individuals with Autism Spectrum Disorder.  CONCLUSION This paper aims to highlight the importance of early intervention in order to improve outcomes for children with Autism Spectrum Disorder. The evidences suggest

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Health
Kimneicheing Houkip

Neuropsychology of Opioid Use Disorder

By Kimneicheing Houkip Neuropsychology of Opioid Use Disorder Opioids are a sort of medication used to treat and manage pain. (Cohen B., 2023) They are composed of chemicals that may be found in natural, semi-synthetic, or fabricated states. These chemicals interact with receptors in the body and brain and act to reduce pain perception. Opioids are generally prescribed, therefore, to treat acute and chronic pain. They are used also in active-phase cancer treatment, palliative care and end-of-life care. While reducing the perception of pain, opioids bring about an extreme sense of euphoria which is a major cause of its addictive nature.  However, once the pleasurable feelings fade out with time after continuous use, users become tolerant of them and try to regain that euphoria or “high” by taking them more frequently and in larger amounts. This then leads to varying degrees of addiction and cessation results in withdrawal symptoms.  The American Psychological Association specifies that Opioid use disorder (OUD) consists of a pattern of opioid use that is problematic and leads to significant distress and dysfunction. Symptoms include failure or inability to quit, misusing more than intended, and excessive cravings. It may consist of tolerance for the drug and showing symptoms of withdrawal.   Prevalence A report given by The Ministry of Social Justice and Empowerment, Government of India titled, “Magnitude of Substance Use in India, 2019.” has found that opioid use in India is 2.1% of the country’s population which is three times the global average. (Om Prakash Singh, 2020) Opioid usage varies across Indian states with Uttar Pradesh having the highest number of people with opioid use disorders. Mizoram and Nagaland stand as the worst affected states. (Singh, Rao, 2021)  Singh & Rao notes that India may be “going through an opioid epidemic” (Singh, Rao, 2021) This is no surprise as the country is located between the world’s two main illicit opium-producing regions, the “Golden Crescent” and the “Golden Triangle,” making it susceptible to being the route and destination of the substances. Moreover, India is itself one of the biggest legal opium producers which is why it is no surprise that India has a well-established pattern of opioid drug use. As a result, opioid dependence is a significant problem in many areas of India. (United Nations Office on Drugs and Crime, n.d. 2005) Causal Factors Though the exact cause of opioid misuse is still unknown, factors that may contribute to it include family history, environmental and lifestyle factors, as well as how opioids affect a person’s brain. The use of drugs causes chemical changes in the brain, behaviour, and motivational hierarchy in a process called neuroplasticity (Gold et. al, 2020) Neuroplasticity is “the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganising its structure, functions, or connections.”(Matt Puderbaugh; Prabhu D. Emmady., 2023)  Neurotransmitters like dopamine can be lacking in patients, which increases their propensity to seek out external sources of endorphins. Given that these drugs bring about intense feelings of pleasure and act as burst dopamine by triggering the same biochemical processes of reward in the brain,  people may use opioids to self-correct this shortcoming. Constant rewards-seeking behaviour like long-term self-administering opioids leads to a decrease in dopamine receptors, leading to a decrease in sensitivity to rewarding stimuli.(Wise & Robble, 2020; Koob, 2020) Moreover, it leads to alterations in brain functions with negative side effects such as dysphoria, anhedonia, and depression. (Lee et. al, 2023) Individuals with substance use disorder find it extremely challenging to maintain abstinence as it involves resisting powerful cravings and habitual behaviours.(Beaulieu et al. 2021; Parvaz et al. 2022) Aversion plays a role in addiction where users drive out unpleasant feelings (withdrawal symptoms) to avoid discomfort. (Wise; Robble, 2020) Several researches show that a patient has a greater likelihood to develop an opiate use disorder (OUD) if they have first-degree relatives who suffer from a substance use disease (SUD) Patients with opioid use disorders who are exposed to opioid usage may be more susceptible to developing drug addiction disorders. (Dydyk et. al. 2024)  Peer relationships or a doctor’s prescription for a prior injury may have an environmental influence on opiate addiction. As well as individuals with histories of childhood trauma mental distress, and abuse, patients with comorbidities are prone to engage in substance misuse (Cruden and Karmali 2021) Opioid dependence can be physical, mental, or even both. According to studies, even the first dose can have physiologic effects that increase a person’s risk of developing an opioid use problem. Users can become physically dependent on opioids in as little as 4 to 8 weeks of opioid use; with the body beginning to struggle to function without them and an abrupt cessation leading to the experience of withdrawal symptoms. Because these sentiments are so strong, utilising opioids to prevent withdrawal is strongly driven by them (Wise; Robble, 2020) Effects The use of opioids in the United States (U.S.) and other countries led to a large number of opioid use disorders (OUD). A recurrent disorder driven by neural circuits that inflict detrimental emotional states and trigger relapses (Strang et al., 2020) and could lead to overdose (Schiller et al., 2021). Patients with opioid use disorder often show cognitive deficits (Blackwood, 2021) Opioid use affects memory (verbal, episodic,  and working memory),  fluency, and decision-making abilities. Studies show that toxic levels of oxycodone, which is a type of opioid, can cause damage to the brain of both children and adults, with MRI scans exhibiting grey and white matter defects. OUD also leads to damage to neuronal axons. (Blackwood et. al, 2021) Recent studies delve into certain brain cells, called glial cells, that affect addiction and worsen opioid effects through inflammation, disrupting brain balance and increasing pain sensitivity.  (Spencer et. al, 2022) Addiction impacts the brian way beyond the reward system to severely damage the prefrontal cortex (PFC) which is responsible for higher-order functioning (Cecili et. al, 2022) Mortality in opioid dependence is generally caused by respiratory depression, and a

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