Autism Academy. Session One: Characteristics 3 Session 1 Agenda Core Triad of ASD Characteristics –Impairments in social interaction –Impairments in.

Autism Academy

Autism Academy

Session One: Characteristics

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Session 1 Agenda

• Core Triad of ASD Characteristics– Impairments in social interaction– Impairments in communication– Restricted, repetitive, and stereotyped

patterns of behavior, interests, and activities

• Additional learning characteristics• Theory of Mind

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What is ASD

• The term autism spectrum disorders (ASD) is used to describe a collection of disabilities that share similar characteristics.

• Generally, ASD is interchangeable with the term pervasive developmental disorders (PDD), a category of disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000).

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The PDD Umbrella(a) Autistic disorder,

(b) Asperger disorder,

(c) Rett’s disorder,

(d) childhood disintegrative disorder, and

(e) Pervasive developmental disorder, not otherwise specified (PDD-NOS)

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Brief History of Identification of Autism Spectrum Disorders (ASD

• Leo Kanner (1943), an American psychiatrist, wrote in-depth case studies of 11 children with characteristics that would fit the current definitions of autism, and that he believed comprised a disorder unique from others including mental retardation and schizophrenia. He called this disorder early infantile autism. The characteristics included (a) difficulties relating to others, (b) language delays, such as inability to develop speech, echolalia, and literal interpretation of language; and (c) unusual behaviors, such as obsessions, insistence on routine and sameness, and self-stimulatory behaviors. Kanner’s work sparked interest in the disorder and lead to further research on characteristics and treatment.

• At about the same in Germany, Hans Asperger (1944) described children who demonstrated social deficits similar and maybe milder than those in children with autism, but who had average or better cognitive functioning. Asperger’s work was largely ignored outside of Germany until recently .

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Prevalence

• Current estimates of prevalence of autism is estimated to be one in every 91 children, a significant increase from the previous 2007 estimate of one in 150. (Centers for Disease Control Prevention, 2009)

• That currently translates to about 673,000 American children with some form of autism.

• Approximately 44-67% of children with autistic disorder also have mental retardation

• The ratio is 4 boys to every girl diagnosed with ASD (some studies 2.2 boys to every girl)

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Characteristics Activity

• Social Skills

• Communication Skills

• Repetitive Patterns of Behavior

• Sensory Issues

Overview of AutismThe definition of autism, or autistic disorder as it is referred to in the DMS-IV-TR (APA, 2000), describes individuals with impairments that are evident prior to 36 months of age. Those diagnosed with autism

are on the more severely impaired end of the spectrum and many also have mental retardation

(Simpson & Myles, 1998). Impairments in autism can be described within

three categories: (a) social skills; (b) communication; and (c) repetitive, restrictive, and

stereotyped behavior.

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Social Skills• They may have deficits or differences in nonverbal

communication skills, such as use of eye contact, body language, gestures, and facial expressions. While they may use some eye contact, it is not as frequent or sustained \ as in their typical peers (Janzen, 2003). Some children with autism do not appear to notice others, failing to look at or initiate contact with others.

• The often do not build relationships with others their age at a level expected considering their overall development.

• They rarely share attention with others, such as by showing something, pointing, or pointing out interests or accomplishments.

• They do not demonstrate emotional reciprocity. They infrequently take turns in play or conversation (Janzen, 2003). For example, typical 18-month-olds spontaneously hold out food for their caregivers to share a bite, but children with autism have to be directly taught to do so. They also rarely spontaneously imitate the actions of others in play or otherwise.

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Communication Skills• They may have delayed speech, or no speech at all,

make no effort to make up for these deficits with nonverbal communication (APA, 2000). Instead of compensating for their lack of expressive speech through gestures, individuals with ASD use fewer gestures and those they use are limited in function (Ogletree, 1998).

• Those who speak are unable to open or keep conversations going (APA, 2000).

• They frequently engage in repetitive or stereotypic speech or vocalizations, such as echolalia (APA, 2000). Echolalia, repeating utterances of others, is common in students with autism (Janzen, 2003).

• They may lack pretend play of the same quality, quantity, and variety of their same-age peers (APA, 2000).

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Specific Communication Differences• Generally, across the spectrum, the higher a

child’s measured IQ, the better his or her language skills are; however, some individuals with lower IQs demonstrate normal language skills (Kjelkaard & Tager-Flusberg, 2001).

• While articulation skills may not be impaired, content and grammar frequently are delayed. Specifically, many children with autism have a rigid understanding of words (Janzen, 2003). They may have difficulty with the concept that objects can have more than one name and that words may have more than one meaning.

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Restrictive, Repetitive, and Stereotyped Behavior • They may have an unusually strong or focused

interest or fixation. • They may be overly drawn to routines and rituals and

be unable or unwilling to be flexible in adhering to these routines.

• They may demonstrate repetitive complex body or other motor movements, such as spinning, rocking, or finger flicking. These self-stimulatory behaviors may occur so frequently that they interfere with engagement in productive activities and may take up the majority of a child’s waking hours if allowed (Simpson & Myles, 1998).

• They may show intense interest in parts of objects, as opposed to using the entire toy or object (APA, 2000).

Overview of AspergersAsperger Syndrome (AS), called Asperger disorder in the DSM-IV-TR, is similar to autism, except that individuals with AS do not demonstrate the severe

impairments in speech and language evident in those with autism (APA, 2000). That is, they

generally speak in one-word utterances by age 2 and phrases by age 3, but they do have socio-

communicative impairments. In addition, individuals with AS are rarely also diagnosed with mental retardation. Impairments characteristic of AS fall within two categories: (a) social skills and

(b) repetitive, restrictive, and stereotyped behavior.

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Social Skills• As in autism, children with AS may have deficits or

differences in nonverbal communication skills, such as use of eye contact, body language, gestures, and facial expressions (APA, 2000). Janzen (2003) has noted that individuals with AS frequently have difficulty using and interpreting communication that involves nonverbal cues or paralanguage. They take others’ speech literally and have difficulty interpreting tone of voice (e.g., sarcasm, humor) and body language (e.g., facial expressions of boredom or confusion), often mistakenly basing their understanding solely on the words spoken.

• They often do not build relationships with others their age to the extent expected based on level of development (APA, 2000). Many individuals with AS desire socialization, but have difficulties understanding social situations (Janzen, 2003). Specifically, they may not comprehend others’ points –of –view, and find it difficult to determine social responses to fit a wide variety of situations (Myles & Simpson, 2002).

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Social Skills • They rarely share attention with others, such as by

showing something, pointing, or pointing out interests or accomplishments (APA, 2000; Janzen, 2003).

• They do not demonstrate social reciprocity (APA, 2000). That is, students with AS may learn to initiate greetings and conversations, but lack the ability to extend such interactions (Myles & Simpson, 2002). They may conduct one-sided conversations, monopolizing or failing to contribute to conversational turn-taking (Myles & Southwick, 1999). Young children with AS often seem uninterested in or unable to participate in play with peers (Attwood, 1998). They tend to boss other children around or get angry when the others do not play according to their rules.

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Repetitive, Restrictive, and Stereotyped Behavior • They may have an unusually strong or focused

interest or fixation. Myles and Simpson (2002) have noted that in those with AS, these interests may seem similar to those of same-age peers, but differ in intensity, extent of knowledge, or interest in the topic to the exclusion of other interests.

• They may be overly drawn to routines and rituals, and be unable or unwilling to be flexible in adhering to these routines (APA, 2000).

• They may demonstrate repetitive complex body or other motor movements, such as spinning, rocking, or finger flicking. However, this is thought to occur less often in those with AS compared to those with autism.

• They may show intense interest in parts of objects, as opposed to using the entire toy or object.

Overview of PDD NOSChildren are diagnosed with pervasive

developmental disorders, not otherwise specified (PDD-NOS) when they do not meet enough of the criteria for specific ASD, but demonstrate some

similarities to others on the autism spectrum (APA, 2000). Thus, these children are an especially

heterogeneous group.

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Additional Learning Characteristics In addition to the criteria specified in the DSM-

IV-TR (APA, 2000), students with autism spectrum disorders (ASD) may display a wide variety of other learning characteristics (Janzen, 2003; Simpson & Myles, 1998) that can be described under the following categories:

(a) general cognitive and academic functioning, (b) attention, (c) generalization, (d) visual thinking, and (e) problem solving.

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Attention

• Many individuals with ASD display difficulties in attention (Janzen, 2003). Specifically, they have difficulty regulating attention, similar to individuals with attention deficit hyperactivity disorder (Myles & Southwick, 1999). Examples include – daydreaming – difficulty completing complex directions due to a

loss of focus in the early stages of the task In addition,

– may not be able to easily shift attention between two items.

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Generalization

• Individuals with ASD often have trouble generalizing information to new settings, people, and materials as a result of difficulties organizing information meaningfully (Janzen, 2003; Simpson & Myles, 1998). Consequently, tasks mastered in only one teaching environment are not automatically demonstrated in others. Therefore, academic planning should include specific attention to ensuring generalization takes place.

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Problem Solving • Students with ASD have difficulty with the flexible

thinking involved in solving problems (Janzen, 2003). • They find it challenging to creatively generate a

variety of options, think about multiple pieces of information at once, and evaluate possibilities.

• Often, when students with AS have learned a solution to a problem, they continue to try that solution even if it does not work (Myles & Southwick, 1999).

• Even when they have learned multiple solutions to problems through discussion and role-play, the have difficulty retrieving or generalizing them to authentic situations.

• These deficits in problem solving extend to academics, involving problems such as with math word problems and estimation.

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Pop Quiz

1. Current prevalence studies estimate a rate of approximately _______ births.

A. 1:150B. 1:91

2. Impairments in autism are generally described within which of the following categories:

A. Communication, motor, social skillsB. Social skills, communication, repetitive

restrictive stereotypical behavior

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Pop Quiz3. Self-stimulatory behaviors include:

A. SpinningB. Not making eye contact

4. Individuals with ASD often have intense interests that are unusual in terms of: A. Topic AreaB. Extent of knowledge

5. Specific difficulties related to attention are found in individuals with ASD include: A. Stimulus under-selectivityB. Difficulty regulating attention

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Case Study Activity

• Christopher: Autism Social

• Teddy: Autism Communication

• Reese: Autism Repetitive Movements

• Mari: Autism Repetitive Movements

• Jiro: Asperger Social Skills

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Theory of Mind

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Theory of Mind• Individuals with autism spectrum disorders (ASD) exhibit

challenges in difficulties regulating behavior, understanding others’ perspective and using correct social skills.

• These difficulties across domains (cognitive, behavioral, social, and emotional) may manifest in many different ways:– being naive and a target for bullying or teasing, – not understanding emotions, – being extremely literal and missing abstract content, – having a limited ability to regulate behavior based on what others

are doing or saying, and – having difficulty understanding nonverbal behavior.

• As toddlers, typically developing children begin to develop the ability to take another person’s perspective, to understand that others have separate thoughts, desires and beliefs, and to modify their own behavior by taking into account what others might be thinking or feeling. In the field of special education and psychology these skills and abilities have been called “theory of mind.”

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What is theory of mind• Richard (2000) defined theory of mind (often

referred to as TOM or ToM,) as “the ability to understand how other people think and feel” (p. 131). Howlin, Baron-Cohen and Hadwin (1999) defined theory of mind in a more complex manner as “the ability to infer other people’s mental states (their thoughts, beliefs, desires, intentions, etc.), and the ability to use this information to interpret what they say, make sense of their behavior and predict what they will do next”

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Theory of Mind Challenges• insensitivity to other people’s feelings • inability to take into account what other people know • inability to negotiate friendships by reading and

responding to intentions • inability to read the listener’s level of interest in one’s

speech • inability to detect a speaker’s intended meaning • inability to anticipate what others might think of one’s

actions • inability to understand misunderstandings • inability to deceive or understand deception • inability to understand the reasons behind people’s

actions • inability to understand “unwritten rules” or conventions

(Howlin, Baron-Cohen, & Hadwin, 1999, p. 9-11)• Difficulty explaining and predicting the behaviors and/

or emotional states of themselves and others

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Theory of Mind Challenges• Problems understanding the perspectives of others • Lack of understanding that behavior impacts how

others think and/or feel • Problems with joint attention and other social

conventions • Problems differentiating fiction from fact

(Myles & Southwick, 1999 p. 8-11)• Difficulty understanding pretending and deception • Failure to understand social interaction, leading to

difficulties with turn-taking, poor topic maintenance in conversation, and inappropriate use of eye-contact

• Difficulty taking into account what other people know or can be expected to know, leading to pedantic or incomprehensible language

• Limited sharing of attention, leading to idiosyncratic reference(Cumine, Leach, & Stevenson, 1998, p. 21-22)

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Theory of Mind Challenges• Many individuals with ASD think that what

they are thinking and feeling is what everyone else is thinking and feeling.

• They may not understand that others have separate thoughts and feelings and that others are able to access to same information in the environment as they are.

• It may be difficult for those with ASD to take others’ perspective. In fact, because of their often literal thinking, the phrase “put yourself in someone else's shoes” could leave some individuals with ASD bewildered, pondering how they could put the other person's shoes on their own feet.

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Theory of Mind Components

• Step 1: inferring what another person is thinking, feeling, etc., by the external behavior that you see

• Step 2: predicting the future behavior of that or other individuals based on your inference of their mental state

• Step 3: changing/modifying your own behavior based upon the judgments that you made

Twachtman-Cullen (2000)

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The degrees of Theory of Mind

• First-order belief is when you can describe what another person is thinking about actual events.

• Second-order belief is when you can understand what another person is thinking about another person’s thoughts.

• Higher-order belief is when you are able to think about what others think about what you are thinking about your own thoughts.

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What Is Mindblindness? • Baron-Cohen (1995) uses the term mindblindness to

explain why individuals with ASD have an impaired ability to read minds. Baron-Cohen postulates that a specific part of the brain that is typically responsible for mind reading is impaired in children with ASD.

• Powers (2003) interprets mindblindness as “an inability to put oneself in the place of another and to see things from another person's perspective” (p. 11-12). He adds that developing a theory of mind “enables the child to perceive reality from another's perspective … to feel empathy, to identify with another's feelings and point of view, and to understand that others don't know everything that the child knows. It also makes it possible for the child to understand pretense, sarcasm, deceit, and certain kinds of humor” (p. 11-12).

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Example• A student named Johnny is walking down the street.

He sees a group of four older boys on the other side of the street. They are staring at Johnny, pointing as well as talking to each other. After a few moments the boys begin to cross the street towards Johnny.

• Now, many people would have turned and gone in the other direction before the four thugs crossed the street and possibly hurt them. But it would take some mind reading ability to infer that since the boys were talking and looking at you that they might want to do something to you. Otherwise Johnny could just interpret the goings-on as a description: Four boys are walking down the street. They are looking at me. They are pointing at me. They are crossing the street and getting closer to me—without interpreting the possible intent of the four boys.

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How Does Theory of Mind Develop? • By one year of age babies can detect the presence of

eyes, tell when they and others are attending to the same thing, and read actions as goal directed or driven by desire. Toddlers can both pretend and understand pretense by others. (Baron-Cohen, 1995)

• Around age four, youngsters are able to work out what others might know, think or feel. They pass first-order theory of mind false belief tests. That is, they understand what others think about actual events. Around age six, children are able to understand second-order belief. That is, they understand “Kathy thinks that Roger thinks …” (Baron-Cohen, 1995; Perner & Wimmer, 1983; Wimmer & Perner, 1985)

• Between the age of seven and adolescence, children begin to learn and master the concepts of faux pas, irony, humor, sarcasm, and nonverbal body language (some of these skills are taught, not just picked up naturally). (Twachtman-Cullen, 2000)

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Why is Theory of Mind Important• Theory of mind ability has ramifications in a

wide range of areas including language, social skills, behavior, and perspective taking. Obviously, for students with an impaired ability to take another’s perspective or to think what others might be thinking or feeling, behavior will be affected. So the day-to-day inability or impaired ability to mind read can have continuing and severe consequences.

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Pop Quiz1. A simple definition of theory of mind might be:

A. a way of regulating body temperatureB. understanding how others think and feel

2. Which of the following is/are possible experiences of individuals who have an impaired theory of mind? Difficulties:A. predicting the future behavior of self or others B. listening to others

3. Mindblindness is a term that describes individuals who have difficulty:

A. seeing B. understanding the thoughts and feelings of others

4. By age four, typically developing children can… A. solve first-order theory of mind testsB. solve very abstract problems