Introduction
Autism is a neural disorder that affects development of a person right from childhood through youth to adulthood. The disorder affects how nerves relay impulses and coordinate with the brain thus alters the normal functioning of the nervous system. Impaired communication, abnormal repetitive behaviours, and atypical socialization are major characteristics of autism. Although autism is a congenital disorder, it does not develop clinically before the age of two years, because the neural development in children is still undifferentiated, and thus presents only latent signs of the disorder. Autism is a complex health issue because its causes, treatment, and management are still debatable. Medical experts hold that autism is a genetic condition that occurs due to predisposition to carcinogenic substances such as vaccines, heavy metals, and pesticides. According to Autism Developmental Disabilities Monitoring Network (2005), about 1% of the children in the United States are suffering from Autism and increasing prevalence may be due to exposure to predisposing factors and enhanced diagnosis (p.4). The increasing prevalence of Autism in the United States and across the world is attracting great attention from the healthcare sector to design critical programs tailored to stem the disorder in terms of prevention, treatment, and management. Despite great efforts of the healthcare sector to prevent, treat, and manage autism, there have been social, political, cultural, technological, ethical and economic forces that hinder appropriate resolution of the disorder in the society.
Social Forces
Since autism impairs normal behaviour and communication, it consequently affects socialization ability its victims. Poor or lack of socialization skills has detrimental effects to the socialization ability in autistic people, which has led to the wrong perception towards autism and autistic people in the society. At family level, misunderstanding of the autistic condition by family members leads to undue negligence of the autistic children at their critical stages of development where they can learn language, develop behaviours, and acquire social skills. Normally, during childhood, autistic infants do not respond to social aspects such as smiling at others, maintaining eye contacts, responding to calls, using gestures and interacting appropriately for they perceive the world differently from normal people. Therefore, their inability to socialize effectively obligates family members to neglect them, thus exacerbating the disorder. Myers and Johnson (2007) argue that, early psychological and behavioural interventions during childhood are very important in alleviating progression of the disorder and improving social, communication, and behavioural development (p.1163). Therefore, negligence of the autistic infants and children at family level due to their condition is a social issue that affects prevention, treatment, and management of the condition.
Moreover, education systems seem to discriminate against autistic children for they do not provide sufficient facilities and favourable environment to facilitate socialization and learning. Psychological studies reveal that children learn best through social interaction, but autistic children are unable to socialize appropriately among themselves or with other children for they see the word differently. Normal children at schools do not like socializing with autistic children for they consider them abnormal, leaving them in isolation, and therefore they do not develop social and communication skills necessary for effective interaction in life. More often, autistic children stay in isolation from the other students, thus they do not get opportunity to learn through social interaction. Border (2008) argues that, due to discrimination in schools, many autistic children drop out of school or are excluded in teaching programs for they deem to have severe mental disabilities (p.2). Therefore, unfavourable school and learning environments are social factors that affect integration of the autistic children into a special education system that suit their needs.
Political Forces
Political forces play significant role in formulation of policies and legislations as part of affirmative action geared at enhancing position of autistic people in the society. Given that autistic children require special education programs that gather for their unique needs, it is the responsibility of the government to ensure proper establishment of appropriate educational programs. The United Kingdom passed Disability Discrimination Action that recognized autism as a disability and thus autistic people require affirmative support in their pursuit of education and employment. However, due to poor implementation of legislations that protect against discrimination, autistic children continue to suffer. According to Border (2008), for children to qualify as autistic and receive maximum support in the provision of special education, they must receive certification of Special Education Need, which is a bureaucratic process that eventually leads to negligence (p.4). Even though autistic children have medical records from the healthcare institutions showing that they are autistic, bureaucratic process in the Special Education Need does not guarantee full provision of education. In this instance, lack of political will to ensure implementation of the affirmative action in the provision of special education to autistic children is a hindrance.
In addition to discrimination in education, autistic people also experience discrimination in employment and workplaces. Employers consider autistic employees as incompetent and ineffective in performing certain duties; therefore, they give them a chance to perform odd responsibilities or they do not employ them in their organizations. Such discriminations in employment and workplaces affect management of the autistic condition in the society, as they do not only make autistic people become dependent, but also isolated thus enhancing ostracism amongst this minority group. Border (2008) argues that, discrimination of autistic people in employment and in workplaces indicates inefficient political policies and legislations that do not protect and advocate for the special needs of the autistic people in the society (p.9). Therefore, inefficient policies and legislations affect management of autistic people in the society due to exposure to discrimination in schools, employment, and in workplaces.
Cultural forces
Cultural values and beliefs significantly affect proper articulation of the autistic disorder in the society. Different societies and cultures across the world attribute differently the causes of various diseases that affect people. In the case of the autistic disorder, some cultures attribute it to familial curses while others attribute it to punishment from God. Some cultures believe that children are blessings from their departed ancestors and thus they name their children after the ancestors to receive great blessings. Thus, the well-being of a child depends on the blessings bestowed by the ancestors from one generation to another. Since autism is a congenital disorder that affects neural development in children, according to certain cultures, poor development of children from childhood connotes some familial or ancestral curse. Dimes (2009) argues that, Indians and eastern cultures perceive autism as a familial curse that runs through families and thus requires traditional intervention rather than medical intervention (p.7). Hence, cultures that perceive autism as a familial curse will not seek medical interventions making their children to languish and suffer in autism. Such perceptions affect prevention, treatment, and management of autism in certain cultures.
As aforementioned, other cultures are very religious and attribute occurrence of diseases in the society to punishment from God. Some believe that God imposes punishment to people if they do not live according to religious expectations that are central to culture. According to Dimes (2009), cultures that believe in divine punishment attribute the cause of autism as a punishment from God, and the only intervention possible is divine intervention through prayer and repentance (p.10). Such cultures hold that, autism is a divine punishment in which medical intervention does not help but serves only to aggravate the disorder because it is against the will of God. With such perceptions in the society, it is a daunting task for the medical professionals to convince people to accept autism as a medical condition, which needs medical interventions.
Technological Forces
Advancement of technology in the modern society focuses on inventing devices and programs that favour normal people while neglecting people with disabilities. Autistic people are unable to use normal technological devices for they have different perception of symbols, colours, and handling of various technological devices. Customized technological devices and programs are essential in assisting autistic people to use technology and keep abreast with technological advancement in the society. Stokes (2010) argues that, assistive technological devices and programs enhance learning in autistic children for they can actively process visual information as compared to auditory information (p.4). In spite of their ability to process visual information, technological advancement has neglected and marginalized the autistic in the design of assistive programs and devices that are critical in their learning.
Given that technological companies that design various devices and programs focus on getting profit, they are very reluctant to invest in the development of customized devices and programs, because autistic people form minority of population and will not give much returns to the expensive investment. Stokes (2010) laments that, technological companies are profit oriented in their design of devices and programs as they focus on exploiting huge markets in the population (p.12). To them, design of customized devices and programs is an expensive process that will not give viable returns to the business, therefore a waste of investment. Hence, profit focus of technological companies hinders invention and innovation of versatile devices and programs that are very helpful in learning, working, and integration of autistic people into the realm of technology.
Ethical Forces
Autistic disorder is a medical condition that has elicited ethical concerns in the society, for there is still debate as to what are the exact causes of the condition to warrant classification of autistic people as disabled. Autistic Culture Movement is a movement that advocates for the recognition of autism as a variation of human mind and not a mental disorder that requires treatment. According to the movement, it is unethical to classify autistic people as disabled and suffering from mental disorders of which the exact cause is still unknown. Solomon (2005) concurs that, autism is a variation in mental functioning that needs recognition and acceptance in the society and not a mental condition that requires cure (p.17). Hence, the perception held by the Autistic Culture Movement contradicts with medical perception on ethical grounds and thus affects prevention, treatment, and management of autism in the society.
Moreover, the Autistic Culture Movement believes that autism is a genetic disorder that results into diversity of population in terms of neural functioning and therefore, it is a natural expression of human genes and not mutation. This, probably misconstrued, perception implies that natural expression of genes needs no cure but acceptance of autistic people as minority in the society. Solomon (2005) asserts that, it is unethical to cure autism because it is a natural occurrence (p.12), meaning that, curing of autistic patients is like denying their existence and discriminating against them for they are minority members of the society with variation in mental functioning. Thus, the society needs to recognize and accept autistic people as a minority group that calls for support and appreciation in the society.
Economic Forces
Autism is a lifetime disorder that has no cure, hence needs proper management throughout the life of a person. Treatment and management of autistic people is very expensive for it demands special interaction, communication, and socialization skills during the critical stages of development. Since autistic children become symptomatic at the age of two years, parents have to be very keen in observing abnormal behaviours of their infants because early detection is imperative in the management of the condition. Zander (2004) argues that, early diagnosis of autism in infants is very important in planning treatment and management interventions aimed at alleviating progression of the condition (p. 26). Treatment and management interventions are very expensive since they entail wide consultation with psychotherapists and psychiatrists on the nature of treatment and application of varied psychotherapy measures that are also expensive. Moreover, since autistic people are dependent and require constant care, they give additional burden to their respective families. Eventually, the parents drain their financial resources while seeking treatment and caring for the autistic people without achieving any positive changes, and thus they eventually give up seeking medical attention.
In addition, schooling of autistic children is very expensive because it requires special education, which provides customized educational services to suit the unique demands of the children. Since autistic children are deficient in communication, socialization, and behavioural abilities, they have weak mental abilities unlike other students. Due to weak mental abilities, the autistic students need special educational programs that will boost their language development, communication skills, behavioural development and acquisition of socialization skills. According to Zander (2004), prompt application of educational interventions is very effective in the management of autism in children by making them undergo through a special educational program tailored to their unique education demands (p.29). Provision of special education is very expensive in that parents depend on the government to support them in schooling autistic children. At times, due to inaccessible special schools, autistic children and their respective families suffer and tolerate the ordeal of the disorder.
Strategies and Recommendations
Autism is a complex disorder that needs intervention strategies from the family, schools, society, and healthcare systems. Family plays a critical role in enhancing early diagnosis, treatment, and management of the disorder by adhering to the recommendations from the psychiatrists and psychologists. Moreover, family is the basic unit of society that harbours social, ethical, and cultural forces that prevent effective implementation of the healthcare measures. Fombonne (2009) argues that, to demystify social, ethical, and cultural perceptions of autism that hinders treatment and management of autism in the society, the healthcare systems need to carryout comprehensive education to the people in the society (p.592). Concerning political, technological and economic forces that affect resolution of autism in the society, the government, in conjunction with the healthcare system, needs to sensitive the society on the need to treat and manage autism through concerted efforts. Political will is essential in the formulation of policies and legislations that protect and promote recognition of autistic people in the society. Since autism is a lifetime disorder that places burden on families, healthcare systems and the society as a whole, it is appropriate for the government to alleviate the effects of the disorder by providing special schools, subsidizing medical bills, and formulating affirmative action to promote recognition of autistic people in employment and workplaces.
Health Policy Decisions
Although autism is a mental disorder that attracts great deal of interests from psychologists, paediatricians, psychiatrists and various specialties within the healthcare system, it has led to the formation of the Autistic Culture Movement, which is a social movement that champions for the interests of autistic people. Rogers and Vismara (2008), argue that the movement advocates that autism is a natural condition that does not need any cure but special management to enable autistic people to cope with complex environments that need effective communication and socialization (p.370). Given that the movement contradicts medical perception of the autistic disorder, integration of the movement into the healthcare system will tremendously enhance perception of autism and eventually consensus on the nature of autism in the society. Hence, if the Autistic Culture Movement and healthcare system harmonize their different perception regarding the nature of autism, then healthy policy decision will be effective since there would be no significant opposition that contradicts medical perception of autism.
Community Based Healthcare Delivery
The health issue of autism demonstrates that social, political, cultural, technological, ethical and economic factors affect healthcare delivery of services in the society. The healthcare system may have comprehensive programs of prevention, diagnosis, treatment, and management of autistic disorder, but the aforementioned factors have significant influence to the effectiveness of the comprehensive programs. The factors affecting resolution of autistic disorder prove that community based healthcare delivery of service provides a wider approach of tackling health issues because they effectively resolve issues that confound healthcare measures. Scope of autism is very expansive in that medical interventions will not effectively resolve the complex issue of autism, for it requires concerted interventions from the society and government. The issue of autism will shape future initiatives in community based healthcare delivery by encouraging wide participation of all stakeholders from political, cultural, medical, ethical, technological and social spheres of life.
Conclusion
Autism is a congenital neural disorder that affects development of a person, particularly mental ability to process information normally. The disorder occurs due to poor coordination of peripheral nervous system and central nervous system plunging the patient into mental deficiency. Abnormal behaviours, impaired communication, and atypical socialization are major characteristics of autism that occur in individuals. The autistic disorder is a lifelong disorder that has no cure but proper management can effectively reverse the progress of the condition. The healthcare system has been grappling with the challenge of designing effective programs geared at preventing, treatment and management of the autism, but it has constantly experienced great challenges emanating from social, political, cultural, technological, ethical, and economic circles. These challenges have demonstrated that health issues require comprehensive approach from all aspects of the society for their effective resolution.
References
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