Autism Spectrum Disorder: Best Practices and Strategies in ......Autism Spectrum Disorder – DSM-V ´ A. Persistent deficits in social communication and social interaction across
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Autism Spectrum Disorder: Best Practices and Strategies
in the Classroom Setting
Brittany Lyman, PsyD
Autism Spectrum Diagnostics & Consulting
November 10, 2017
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Learning Objectives
´ Identify the core deficits in individuals with ASD
´ Identify common comorbid conditions and disorders seen in children and adolescents with ASD
´ Explain how and by whom comorbid conditions are assessed in the school setting
´ Distinguish appropriate and effective accommodations and services to
be implemented in a 504 Plan, IEP, or classroom to address co-occurring conditions.
´ Recognize the importance of a whole-child approach and
collaboration across specialists in addressing a child’s challenges and facilitating progress
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
What is Autism Spectrum Disorder (ASD)?
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Rise in Prevalence Rates
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Etiology ´ Research indicates:
´ No single cause
´ Most cases a gene-environment interaction
´ Identified risk factors
´ Genetic and physiological
´ Heritability
´ Gene mutations
´ Brain structure abnormalities
´ Broader Autism Phenotype
´ Environmental
´ Advanced parental age (both parents)
´ Exposure to valproate
´ Prematurity with low birth weight
´ Oxygen deprivation at birth
(http://www.cdc.gov/ncbddd/autism/facts.html; Campbell, Chang, & Chawarska, 2014) Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Autism Spectrum Disorder – DSM-V
Social Interaction Social Communication
Restricted, Repetitive Behaviors
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Autism Spectrum Disorder – DSM-V
´ A. Persistent deficits in social communication and social interaction across contexts
´ Not accounted for by general developmental delays
´ Needs 3 out of 3 symptoms
´ B. Restricted, repetitive patterns of behavior, interests or activities
´ As manifested by 2 of 4 symptoms
´ C. Symptoms present in early childhood
´ D. Symptoms limit and impair every day functioning. Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Autism Spectrum Disorders – DSM-V: Criteria A
Persistent deficits in social communication and social interaction across contexts
Impaired social communication
Social-emotional reciprocity
Non-verbal communication
Developing and
maintaining relationships
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
A1- Social Initiation and Response
´ Unusual social approach
´ Intrusive touching, licking
´ Use of others as a tool
´ Failure of to and fro conversation
´ Reduced sharing of interest
´ Reduced sharing of emotions
´ Social smile, response to praise, showing pleasure from social interaction, no offer of comfort
´ Lack of initiation of social interaction
´ Poor social imitation
Impaired social communication
Social-emotional reciprocity
Non-verbal communication
Developing and maintaining relationships
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
A2 - Nonverbal Communication
´ Impairments in eye contact
´ Use of body postures
´ Use and understanding of gestures
´ Abnormal volume, pitch, intonation, rate, rhythm stress or volume of speech
´ Abnormalities in use and understanding of affect
´ Lack of coordinated verbal and nonverbal communication
´ Lack of coordinated nonverbal communication
Impaired social communicatio
n
Social-emotional reciprocity
Non-verbal communication
Developing and
maintaining relationships
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
A3 - Social Awareness and Insight as Well as Broader Concepts of Social Relationships
´ Deficits in developing and maintaining relationships appropriate to developmental level
´ Lack of Theory of mind (>4yo)
´ Difficulties adjusting behavior to suit social contexts
´ Difficulties in sharing imaginative play
´ Difficulties in making friends
´ Absence of interest in others
Impaired social communicatio
n
Social-emotional reciprocity
Non-verbal communication
Developing and
maintaining relationships
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Restricted, Repetitive Patterns of Behavior, Interests or Activities (2 out of 4 Symptoms)
Repetitive/Restricted patterns of behavior
Stereotyped repetitive speech/
movement/ play
Excessive adherence to
routines
Restricted and fixated interests
Hyper or hypoactivity to sensory input
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
B1 - Atypical Speech, Movements and Play ´ Stereotyped or repetitive speech
´ Stereotyped or repetitive motor movements
´ Hand movements, rocking, body tensing
´ Stereotyped or repetitive use of objects
´ Lining up, dropping, waving
Repetitive/Restricted patterns of behavior
Stereotyped repetitive speech/
movement/ play
Excessive adherence to
routines
Restricted and fixated
interests
Hyper or hypoactivity
to sensory input
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
B2 - Rituals and Resistance to Change ´ Adherence to routine
´ Unusual multi-step routines
´ Insistence on rigid routines (except bed time)
´ Ritualized patterns of verbal and nonverbal behavior
´ Excessive resistance to change
´ Rigid thinking
´ No humor, irony. Rule bound behaviors or thoughts.
Repetitive/Restricted patterns of behavior
Stereotyped repetitive speech/
movement/ play
Excessive adherence to
routines
Restricted and fixated
interests
Hyper or hypoactivity
to sensory input
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
B3 - Preoccupations with Objects or Topics
´ Preoccupations, obsessions
´ Abnormally intense interests
´ Narrow range of interests
´ Preoccupation with numbers/letters/symbols
´ Attachment to unusual inanimate object
´ Having to carry around an object
´ Unusual fears Repetitive/
Restricted patterns of behavior
Stereotyped repetitive speech/
movement/ play
Excessive adherence to
routines Restricted and fixated interests
Hyper or hypoactivity to sensory input
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
B4 - Atypical Sensory Behaviors
´ Pain tolerance
´ Preoccupation with texture or touch
´ Unusual visual exploration
´ Odd response to sensory stimuli (all domains)
´ Touch, smell, taste, vestibular, visual
´ Unusual sensory exploration
´ Lick, touch, smell, (not part of a ritual)
Repetitive/Restricted patterns of behavior
Stereotyped repetitive speech/
movement/ play
Excessive adherence to
routines Restricted and fixated interests
Hyper or hypoactivity to sensory input
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Severity Levels for ASD
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Gender Differences in Symptom Presentation
´ Diagnostic criteria based on behavioral symptoms of boys with ASD
´ Girls are often misdiagnosed
´ ADHD, OCD, Bipolar Disorder, Anorexia
´ Differences in brain studies
´ Girls
´ Better social awareness and imitation of others
´ Restricted interests more “typical”
´ Reading, fantasy, animals, dolls
´ Better at pretend play
´ Trouble with social hierarchies and social chit-chat
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Strengths of Children with ASD ´ Unique and special talents
´ Detail oriented
´ Thrive in routine and structure
´ Often rule-abiding
´ Genuine
´ Passionate
´ Caring and involved families
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Associated Features
´ Pragmatic language deficits
´ Adaptive skill deficits
´ Sleep difficulties
´ Gastrointestinal Symptoms
´ Seizures
´ Hyperactivity/Impulsivity
´ Aggression
´ Self-injurious behavior
´ Inattention
´ Elopement Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Intellectual Disability
´ Most common co-occurring disorder with ASD
´ Strong predictor of prognosis
´ Comorbidity rate of about 31% with ASD
´ Higher rates in girls with ASD
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Comorbidity of ASD and Other Psychopathology
´ Simonoff and colleagues (2008) found that ~71% of children with ASD met criteria for at least one comorbid psychiatric dx
´ 41% with ≥2 comorbid dx
´ 24% had 3 or more diagnoses
´ Anxiety and Depression are very common in teens
´ Thought to be higher in those with average to above average IQ
´ ADHD
´ 1 in 3 children with ASD also diagnosed with ADHD
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Prognostic Factors
´ Early identification/diagnosis
´ Cognitive Ability
´ Early Treatment
´ Intensity and quality of treatment
´ Language Abilities
´ Severity of behaviors
´ Comorbid conditions
´ Parent involvement
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Evidenced-Based Treatment National Standards Project – Phase 2 (National Autism Center, 2015) ´ Update from the original NSP in 2009 ´ Identify the strength of evidence supporting educational and behavioral treatments
for individuals with ASD across the lifespan
´ Ratings: ´ Established
´ Emerging
´ Unestablished
´ Ineffective/Harmful
´ Show the strength of evidence based on treatment name, focus of treatment, age, and diagnostic classification
http://www.nationalautismcenter.org/national-standards-project/phase-2/)
(
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
14 Established Treatments for Individuals Under Age 22
´ Behavioral Interventions
´ CBT Intervention Package
´ Comprehensive Behavioral Treatment for Young Children
´ Language Training
´ Modeling
´ Naturalistic Teaching Strategies
´ Parent Training Package
´ Peer Training Package
´ Pivotal Response Treatment
´ Schedules
´ Scripting
´ Self-Management
´ Social Skills Package
´ Story-Based Intervention Package
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Impact of Comorbid Symptoms in the School Setting
Assessment of Comorbid Symptoms
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Factors That Impact School Performance
´ Learning Style
´ Communication Skills
´ Social Skills
´ Executive Functioning
´ Behavioral Challenges (e.g., anxiety, emotion dsyregulation)
´ Sensory Processing Difficulties
´ Transition to Adulthood
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Identifying the Appropriate Educational Plan
´ Presence of comorbid conditions will impact the type of plan and services the child requires
´ Ex. Child with a speech and/or language disorder will require special education services in the school setting
´ Question to ask:
´ Are the child’s comorbid conditions and/or challenges impacting their ability to learn and access the curriculum?
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Who Should be Involved in the Evaluation? ´ Speech and Language
Pathologist ´ Assessing the child’s receptive,
expressive, and pragmatic language skills
´ Occupational Therapist ´ Assessing the impact of sensory
processing on the child’s ability to learn
´ School Psychologist ´ Learning difficulties
´ Assessing the child’s cognitive and academic skills
´ Emotional and behavioral assessment
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Who Should be Involved in the Evaluation?
´ School Counselor
´ Providing counseling and support related to symptoms of anxiety and other behaviors
´ Facilitating social skills and/or friendship groups
´ Behavior Specialist
´ Involved in assessment and treatment of behavioral challenges
´ Functional Behavioral Assessment
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Role of Educational Staff
´ Thorough understanding of the child and ASD presentation
´ Individualized recommendations
´ Ensure that the strategies used across services and environments are in line with the child’s current level of communication and social skills
´ Facilitation of accommodations and services
´ Collaboration across team members to ensure generalization of skills
´ Ex. OT sharing strategies with the classroom teacher
´ Communication and collaboration with the child’s family
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Appropriate accommodations and supports to be implemented in a 504 plan, IEP, or classroom
Impact of Comorbid Symptoms in the School Setting
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Classroom Management Strategies
´ Use of Visual Supports
´ Provide Daily Schedules
´ Routines & Structure
´ Transition Warnings
´ Give the Child Choices and Control
´ Provide Clear Rules & Expectations
´ Use of First, Then Statements
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Differences in Learning Style
´ Language-Based Learning Difficulty Supports: ´ Provide important information/directions in both a written and
oral format
´ Multi-sensory instruction (i.e., visual, auditory, and tactile)
´ Read aloud when writing on the board
´ Keep instructions brief and uncomplicated
´ Provide study guides or review sheets
´ Multiple methods for class/course assessments ´ Exam/write a paper, work alone or in a group, deliver an oral,
written, or videotaped project presentation
´ Use captioned videos Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Differences in Learning Style
´ Nonverbal Learning Difficulty Supports: ´ Pairing verbal instructions with all visual materials to ensure comprehension of
material. ´ Reviewing past information before presenting new concepts, and using
language and discussion to connect new situations to previous learning.
´ Breaking down visual information into smaller, more manageable steps to increase comprehension and decrease frustration.
´ Methodically discussing the cause-and-effect relationships of events and situations
´ Reducing the number of visual displays involving manipulatives, drawings, and diagrams during instruction, and replacing them with clear verbal instruction.
´ Replacing copying of information from the board with providing copies of the notes or assignments.
´ Providing math exercises on worksheets with only a few questions and plenty of white space to reduce anxiety and impulsive responding. Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Impairments in Communication
´ Motivation to communicate
´ Greeting others
´ Commenting
´ Asking Questions
´ Initiating & Maintaining Conversations
´ Sharing Feelings & Opinions
´ Answering Questions
´ Tone of Voice
´ Receptive Language
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Communication
Impairments
Individual Therapy Group Therapy
Use of Visuals Throughout Instruction
Multisensory Instruction
Assistive Technology (e.g., Monitoring Volume)
Include the Child’s Interests/ Boundaries Related to Discussion of Interests
Avoid Complex Verbal Instructions/Information
Allow “Wait-Time”
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Social Skills Deficits
´ Nonverbal communication
´ Joint Attention
´ Reciprocity
´ Relationships
´ Group Participation/Projects
´ Perspective Taking/Theory of Mind
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Social Skills Deficits
Define Student’s Role During Group Activities & Projects
Include Familiar Peers/Buddies
Friendship Group/Lunch Bunch/ Facilitated Recess
Practicing Skills Across Settings
And Environments
Peer Feedback & Modeling
Behavioral Goals & Experiments
Self-Monitoring (e.g., Talking About
Interests)
Feedback in Real Time
Social Stories
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Executive Functioning
´ Planning & Organization
´ Difficulty starting/completing tasks
´ Distracted
´ Losing items/assignments
´ Problem solving
´ Monitoring their behavior
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Executive Dysfunction
Redirection
Allowing Extended Time To Complete Tasks And During Tests
Separate Location For Testing
Preferential Seating
Movement Breaks
Breaking Down Larger Tasks
Behavior Plan/ Use of Rewards
Use of Technology
Two Sets of Books
Time Management Skills/Binders/ Checklists
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Behavioral Challenges
´ Anxiety
´ Emotion Dysregulation
´ Irritability
´ Tantruming
´ Non-Compliance
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Behavioral Challenges
Go-To Person – Guidance Counselor/
Safe Place
Parent/Child Written Description Understanding Function of Behavior
Emotion Identification
Coping Skills
Preparation/Warnings
Behavior Plan/Reward System
Clear Directives
Use of Social Stories
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Sensory Processing Difficulties
´ Sensitivities to:
´ Noises
´ Smells
´ Textures
´ Sights
´ Can lead to:
´ Shutting down
´ Fidgeting
´ Emotion dysregulation
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Sensory Sensitivities
Occupational Therapy
Sensory Diet
Movement Breaks
Headphones
Anticipate Challenges (e.g., Fire Drill)
Self-Monitoring of Arousal States
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Transition to Adulthood
´ Hygiene
´ Daily Living Skills
´ Vocational
´ Self-Advocacy
´ Sexuality Education
´ Interpersonal Skills
´ Skills Necessary for College
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Transition To
Adulthood
Job Sampling Self-Advocacy Training
Understanding ASD Diagnosis
Customizable Employment Interviewing Skills
Money Management Time Management
Sexuality Training
Appropriate Use of Technology
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
Summary
´ Individuals with ASD vary in their presentation and needs
´ Individuals with ASD have many strengths and talents
´ Many children with ASD experience comorbid disorders and symptoms that impact their ability to learn
´ Specific interventions and accommodations are necessary in order to address the comorbid conditions
´ Collaboration and a team approach is critical in order to ensure that the child with ASD’s needs are met
Copyright 2017. Brittany Lyman, PsyD. Autism Spectrum Diagnostics and Consulting.
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