Autism Basics Bev Long Diagnostic Center, Central California.

Autism BasicsAutism BasicsBev LongBev Long

Diagnostic Center, Central CaliforniaDiagnostic Center, Central California

[email protected]

Autism research and publishing isat an all time high

OverviewOverview

Autism is a life-long developmental disorder that Autism is a life-long developmental disorder that seriously affects the way individuals communicate seriously affects the way individuals communicate and interact with those around them. and interact with those around them.

It usually manifests itself during the first three years It usually manifests itself during the first three years

of life.of life.

Autism is a “spectrum disorder,” meaning that its Autism is a “spectrum disorder,” meaning that its symptoms and characteristics can present symptoms and characteristics can present themselves in a variety of combinations, ranging themselves in a variety of combinations, ranging from mild to quite severe.from mild to quite severe.

Impaired communication and social interaction are the Impaired communication and social interaction are the most fundamental symptoms of autism. most fundamental symptoms of autism.

As many as 50% of individuals with autism are non-As many as 50% of individuals with autism are non-

verbal and up to 80% are intellectually challenged. verbal and up to 80% are intellectually challenged.

A small percentage is gifted with extreme artistic, A small percentage is gifted with extreme artistic, intellectual or technical ability.intellectual or technical ability.

Common behaviors include: Common behaviors include: seemingly purposeless repetitive behaviorseemingly purposeless repetitive behavior unusual responses to people unusual responses to people attachments to objectsattachments to objects resistance to change resistance to change extreme sensory sensitivity.extreme sensory sensitivity.

Currently 1 in every 250 children are Currently 1 in every 250 children are diagnosed with autism.diagnosed with autism.

1.5 million people with autism in the US.1.5 million people with autism in the US. Autism is the fastest growing developmental Autism is the fastest growing developmental

disability. In the US, autism increased by disability. In the US, autism increased by 172% during the 1990’s.172% during the 1990’s.

33% of children also have a seizure 33% of children also have a seizure disorder.disorder.

Autism spectrum disorders are now more Autism spectrum disorders are now more common than Down Syndrome, childhood common than Down Syndrome, childhood cancer, cystic fibrosis, multiple sclerosis, cancer, cystic fibrosis, multiple sclerosis, blindness and deafness.blindness and deafness.

Only mental retardation and cerebral palsy Only mental retardation and cerebral palsy rank ahead of autism as a developmental rank ahead of autism as a developmental disability.disability.

Families with one autistic child have a 2-8 Families with one autistic child have a 2-8 percent chance of having another autistic percent chance of having another autistic child.child.

Boys are 3-4 times more likely to be Boys are 3-4 times more likely to be diagnosed with an ASD.diagnosed with an ASD.

There is no definitive cause or cure for There is no definitive cause or cure for autism, but current research suggests a autism, but current research suggests a genetic base to the disorder and links it to genetic base to the disorder and links it to neurological differences in the brain.neurological differences in the brain.

Controversy over incidence:Controversy over incidence:Labeling or Epidemic???Labeling or Epidemic???

As the numbers of students classified as autistic As the numbers of students classified as autistic increases, the number of students classified as increases, the number of students classified as mentally retarded and learning disabled has mentally retarded and learning disabled has decreased.decreased.

Institutions such as the Mind Institute at Davis Institutions such as the Mind Institute at Davis believe that reclassifying and/or broadening the believe that reclassifying and/or broadening the definition of autism cannot in any way account definition of autism cannot in any way account for the increase in the number of children being for the increase in the number of children being diagnosed.diagnosed.

PDDPDD

PERVASI VE DEVELOPMENTAL DISORDERS

AUTISTIC SPECTRUM DISORDERS

AUTISM ASPERGER SYNDROME

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Real Kids…The rangeReal Kids…The range

The child with no eye contact, no means of The child with no eye contact, no means of communication, no awareness or others around communication, no awareness or others around him. Absent. him. Absent. Classic AutismClassic Autism..

The child who is aware of others in the The child who is aware of others in the environment, may or may not have some words, environment, may or may not have some words, watches, but does not interact.watches, but does not interact.

The Range…The Range…

The child who approaches others in odd, non-The child who approaches others in odd, non-productive ways. Unexpected touching, productive ways. Unexpected touching, standing too close, uncomfortable eye standing too close, uncomfortable eye contact. contact. High functioning autismHigh functioning autism..

The child who desires social contact, can The child who desires social contact, can even talk about feeling sad that he doesn’t even talk about feeling sad that he doesn’t have friends . . .seems “clueless,” talks too have friends . . .seems “clueless,” talks too much, doesn’t consider the listener’s desires, much, doesn’t consider the listener’s desires, doesn’t read other’s body language. doesn’t read other’s body language. Asperger SyndromeAsperger Syndrome..

Two Categories of Causes of Autism

Internal Causes

Genetic – recent genome Project shows that as many as 20-30 genes may be involved.

Congenital – condition that just occurs as the nervous system of the unborn or young child develops

External Causes

Environmental – child is exposed to a specific environmental element (toxin) before birth or during infancy that causes pervasive changes or damage to the nervous system.

Genetic Predisposition

Congenitalfactors

Environmental factors

AutisticSpectrum

MisconceptionsMisconceptions Autistic children never have eye contactAutistic children never have eye contact

Autistic children don’t have feelings or emotionsAutistic children don’t have feelings or emotions

Autistic children don’t smile or seek physical comfortAutistic children don’t smile or seek physical comfort

Autism is a mental disorderAutism is a mental disorder

Autism is caused by bad parentingAutism is caused by bad parenting

Autistic children choose to be difficult to annoy parents and teachersAutistic children choose to be difficult to annoy parents and teachers

We are talking about students who We are talking about students who are:are:

Somebody’s childSomebody’s child Somebody’s Somebody’s

grandchildgrandchild Somebody’s sister Somebody’s sister

or brotheror brother Somebody who is Somebody who is

loved and for loved and for whom many tears whom many tears have been shedhave been shed

Early SignsEarly Signs

Signs that may be seen in infancySigns that may be seen in infancy as early as 8 months as early as 8 months

Two kinds of autistic babies:Two kinds of autistic babies: Placid, undemanding baby who rarely criesPlacid, undemanding baby who rarely cries Screaming baby who is difficult to pacifyScreaming baby who is difficult to pacify

Peculiarities in gaze:Peculiarities in gaze: Avoidance of eye contactAvoidance of eye contact Gaze may be brief and out of the corner of the Gaze may be brief and out of the corner of the

eyeeye Fails to shift gaze from object to personFails to shift gaze from object to person

Peculiarities of hearing:Peculiarities of hearing: May appear deaf but have normal hearingMay appear deaf but have normal hearing Unaffected by audible changes in the Unaffected by audible changes in the

environmentenvironment May be fascinated by particular soundsMay be fascinated by particular sounds Common sounds may cause distressCommon sounds may cause distress

Peculiarities in social development and Peculiarities in social development and play:play: Lack interest in early social interaction with Lack interest in early social interaction with

parentsparents Lack of shared interestLack of shared interest Do not take an active part in baby gamesDo not take an active part in baby games

RockingRocking Head bangingHead banging Scratching or tapping blanketScratching or tapping blanket Fascination for shiny or twinkling objectsFascination for shiny or twinkling objects Fixated on an object such as a piece of Fixated on an object such as a piece of

string string

Red Flag BiggiesRed Flag Biggies

Does not babble or coo by 12 months of ageDoes not babble or coo by 12 months of age Does not gesture (point, wave, grasp) by 12 Does not gesture (point, wave, grasp) by 12

months of agemonths of age Does not say single words by 16 months of ageDoes not say single words by 16 months of age Does not say two-word phrases on his or her Does not say two-word phrases on his or her

own (rather than just repeating what someone own (rather than just repeating what someone says to him or her) by 24 months of agesays to him or her) by 24 months of age

Has ANY loss of ANY language or social skill at Has ANY loss of ANY language or social skill at ANY ageANY age

History History

19111911

Eugen Bleuler, a Swiss psychiatrist first Eugen Bleuler, a Swiss psychiatrist first coined the term “autism.” He applied the coined the term “autism.” He applied the term to adult schizophrenia.term to adult schizophrenia.

19431943 Dr. Leo Kanner of Johns Dr. Leo Kanner of Johns

Hopkins University Hopkins University described autism for the described autism for the first time. He based his first time. He based his discovery from 11 discovery from 11 children he observed children he observed between 1938 and between 1938 and 1943. He grouped these 1943. He grouped these children because they children because they “withdrew from human “withdrew from human contact” as early as age contact” as early as age 1.1.

19441944 Austrian psychiatrist Dr. Hans Austrian psychiatrist Dr. Hans

Asperger describes a disorder that Asperger describes a disorder that later becomes known as Asperger later becomes known as Asperger disorder. Viennese physician.disorder. Viennese physician.

Published “Autistic Psychopathology Published “Autistic Psychopathology in Childhood” in 1944, one year after in Childhood” in 1944, one year after Kanner.Kanner.

Because of war, he probably didn’t Because of war, he probably didn’t know of Kanner’s work.know of Kanner’s work.

He believed in a biological, rather He believed in a biological, rather than a psychological cause.than a psychological cause.

He described verbal youngsters with He described verbal youngsters with milder symptomsmilder symptoms

1940’s – 1960’s1940’s – 1960’s

The medical community felt that children The medical community felt that children who had autism were schizophrenic. This who had autism were schizophrenic. This lack of understanding of the disorder led lack of understanding of the disorder led many parents to believe that they were at many parents to believe that they were at fault. fault.

Bruno BettelheimBruno Bettelheim

During the 1950s and 1960s, the medical During the 1950s and 1960s, the medical establishment, thanks to Bruno Bettleheim, establishment, thanks to Bruno Bettleheim, blamed autism on the child's mother for failing to blamed autism on the child's mother for failing to bond with her child. These mothers were called bond with her child. These mothers were called a "refrigerator mother." Thousands of autistic a "refrigerator mother." Thousands of autistic children received gloomy therapies based on children received gloomy therapies based on this theory. Many children were taken away from this theory. Many children were taken away from their parents. Their mothers endured a difficult their parents. Their mothers endured a difficult period of blame, guilt and self-doubt. period of blame, guilt and self-doubt. "the precipitating factor in infantile autism is the "the precipitating factor in infantile autism is the parent's wish that his child should not exist." parent's wish that his child should not exist."

19641964

Dr. Bernard Rimland further delineates the Dr. Bernard Rimland further delineates the clinical features of autism. Specifically, he clinical features of autism. Specifically, he provided a definitive review of the provided a definitive review of the empirical evidence which established that empirical evidence which established that autism was a biological disorder.autism was a biological disorder.

19661966

Dr. Andreas Rett first describes Rett Dr. Andreas Rett first describes Rett disorder as a distinct clinical condition. disorder as a distinct clinical condition.

19771977 Sir Michael Rutter and Sir Michael Rutter and

Dr. Susan Folstein Dr. Susan Folstein published the first autism published the first autism twin study, revealing twin study, revealing evidence for a genetic evidence for a genetic basis for autism. Both Sir basis for autism. Both Sir Rutter and Dr. Folstein Rutter and Dr. Folstein have made major have made major contributions to further contributions to further refining the clinical refining the clinical phenotype associated phenotype associated with Autistic Disorder and with Autistic Disorder and Pervasive Developmental Pervasive Developmental Disorders. Disorders.

19781978

Drs. Michael Rutter and Eric Schopler Drs. Michael Rutter and Eric Schopler continue to publish and redefine the signs continue to publish and redefine the signs and symptoms of autism.and symptoms of autism.

19811981

Asperger's syndrome was named by Asperger's syndrome was named by Lorna Wing in a 1981 medical paper, after Lorna Wing in a 1981 medical paper, after Dr. Hans Asperger, an Austrian Dr. Hans Asperger, an Austrian psychiatrist and pediatrician who would psychiatrist and pediatrician who would not be recognized internationally until not be recognized internationally until 1990. 1990.

1988-19911988-1991

Multiple research studies published Multiple research studies published showing evidence for a genetic basis for showing evidence for a genetic basis for autism.autism.

19911991

Autism Diagnostic Interview published by Autism Diagnostic Interview published by Drs. Catherine Lord, Sir Michael Rutter, Drs. Catherine Lord, Sir Michael Rutter, and Ann Le Couteur.and Ann Le Couteur.

19921992

American Psychiatric Association refines American Psychiatric Association refines the diagnostic criteria for Autistic disorder.the diagnostic criteria for Autistic disorder.

1991-19971991-1997

Multiple case reports of individuals with Multiple case reports of individuals with chromosome 15 anomalies observed in chromosome 15 anomalies observed in children with autistic disorder.children with autistic disorder.

19981998

First report of genetic linkage on First report of genetic linkage on chromosome 7q for Autistic disorder and chromosome 7q for Autistic disorder and first genomic screen -- IMGSAC.first genomic screen -- IMGSAC.

Theory of MindTheory of Mind

Thinking About Thinking About Thinking Thinking

Theory of MindTheory of Mind

So commonplace that until recently we haven’t So commonplace that until recently we haven’t investigated it at all.investigated it at all.

The ability to think about other people’s The ability to think about other people’s thinking…and, further, to think about what they thinking…and, further, to think about what they think about our thinking…and, even further, to think about our thinking…and, even further, to think about what they think we think about their think about what they think we think about their thinking, and so on….thinking, and so on….

Theory of Mind..say it another Theory of Mind..say it another way…way…

The ability to appreciate that other people The ability to appreciate that other people have mental states:have mental states: IntentionsIntentions NeedsNeeds DesiresDesires BeliefsBeliefs

And these may be different than MINE!!And these may be different than MINE!!

The Sally / Anne TestThe Sally / Anne Test

Designed by Simon Baron-Cohen in 1985Designed by Simon Baron-Cohen in 1985 Experiment carried out with:Experiment carried out with:

Normal 4 year oldsNormal 4 year olds Children with Autism, older than 4Children with Autism, older than 4 Children with Down Syndrome with mental Children with Down Syndrome with mental

ages of 4ages of 4

Sally / Anne TestSally / Anne Test

Sally / Anne Test Sally / Anne Test

Sally / Anne TestSally / Anne Test

What Did We Learn?What Did We Learn?

By 4 years, normally developing children know By 4 years, normally developing children know that Sally will guess that the marble is in the that Sally will guess that the marble is in the basket.basket.

Developmentally delayed, non-autistic children Developmentally delayed, non-autistic children know when their mental age is 4.know when their mental age is 4.

Autistic children do not understand until much Autistic children do not understand until much later (rarely younger than 11). They will say that later (rarely younger than 11). They will say that Sally will guess that it is in the box.Sally will guess that it is in the box.

More able children develop a superficial More able children develop a superficial understanding by 9-14 years of age.understanding by 9-14 years of age.

May never reach the stage of knowing that May never reach the stage of knowing that others not only have thoughts and others not only have thoughts and feelings, but that they can feelings, but that they can reflectreflect on these. on these.

Autism and ToMAutism and ToM

Implications of Theory of Mind Implications of Theory of Mind ImpairmentsImpairments

Problems Understanding the Problems Understanding the Perspectives of Others.Perspectives of Others.

Can’t “stand in another’s shoes.”Can’t “stand in another’s shoes.”

Can’t imagine what another person is thinking.Can’t imagine what another person is thinking.

Can’t guess about how or why a person will respond/act.Can’t guess about how or why a person will respond/act.

Problems Understanding how Problems Understanding how Others Think and FeelOthers Think and Feel

May have no connection between their May have no connection between their actions and others’ reactions to them.actions and others’ reactions to them.

Can’t imagine that others think about Can’t imagine that others think about them.them.

Don’t understand that others remember Don’t understand that others remember things about them.things about them.

Problems with Joint Attention and Problems with Joint Attention and Other Social ConventionsOther Social Conventions

No sharing of attention..leads to idiosyncratic No sharing of attention..leads to idiosyncratic references.references.

Difficulty with turn taking.Difficulty with turn taking.

Poor topic maintenance.Poor topic maintenance.

Inappropriate eye contact.Inappropriate eye contact.

Difficulty Understanding Difficulty Understanding EmotionsEmotions

May only understand a May only understand a limited number of emotions.limited number of emotions.

There is little understanding There is little understanding of subtleties.of subtleties.

They have difficulty even They have difficulty even recognizing their own recognizing their own feelings.feelings.

Difficulty explaining own Difficulty explaining own behaviorsbehaviors

Even highly verbal individuals will have Even highly verbal individuals will have difficulty explaining why they did difficulty explaining why they did something….that requires one to think something….that requires one to think about motivation and intention.about motivation and intention.

Difficulty predicting others’ Difficulty predicting others’ behavior or emotional statesbehavior or emotional states Have no idea how someone will act or feel.Have no idea how someone will act or feel.

Do not see the connection between what is Do not see the connection between what is happening and how someone may act.happening and how someone may act.

Leads to fear and avoidance of other Leads to fear and avoidance of other people.people.

Preference for activities that do not depend Preference for activities that do not depend on others.on others.

Difficulty Reading the Intentions Difficulty Reading the Intentions of Othersof Others

Do not know the difference between Do not know the difference between being laughed at and being part of the being laughed at and being part of the joke.joke.

Do not understand when they are Do not understand when they are being taken advantage of.being taken advantage of.

Inability to deceive, or to understand Inability to deceive, or to understand deception.deception.

Other ProblemsOther Problems Difficulty Understanding ‘Pretend.’Difficulty Understanding ‘Pretend.’

Difficulty differentiating Fact from Fiction.Difficulty differentiating Fact from Fiction.

Inability to read and react to the listener’s Inability to read and react to the listener’s level of interest in what is being said.level of interest in what is being said.

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

SENSORY DIFFICULTIES SENSORY DIFFICULTIES

40% of children with autism have 40% of children with autism have sensory difficultiessensory difficulties

Students have difficulty modulating Students have difficulty modulating responses to sensory inputresponses to sensory input

Over-responsivenessOver-responsiveness

Under-responsivenessUnder-responsiveness

Maintaining optimal arousal & attentionMaintaining optimal arousal & attention

What Might I See These Students Do?What Might I See These Students Do?

They may be intimidated or over stimulated by They may be intimidated or over stimulated by the large numbers of other students.the large numbers of other students.

They may be confused by the movement of They may be confused by the movement of others.others.

They may become disoriented.They may become disoriented.

They may be overwhelmed by the sounds of They may be overwhelmed by the sounds of others (especially in the cafeteria/gymnasium).others (especially in the cafeteria/gymnasium).

What Might I See These Students What Might I See These Students Do?Do?

They may be uncomfortable in hallways if they They may be uncomfortable in hallways if they are brushed up against by others.are brushed up against by others.

They may do unusual things such as rub their They may do unusual things such as rub their hands on the walls, hold their bodies in strange hands on the walls, hold their bodies in strange positions, touch others inappropriately or make positions, touch others inappropriately or make unusual sounds.unusual sounds.

They may cry or scream for no apparent reason.They may cry or scream for no apparent reason.

They may walk through groups of students.They may walk through groups of students.

What Might I See These Students Do?What Might I See These Students Do? Isolate themselves completely.Isolate themselves completely.

May be overly “friendly” and have very poor May be overly “friendly” and have very poor boundaries or social skills.boundaries or social skills.

Talk obsessively about the same topic to anyone Talk obsessively about the same topic to anyone (or no one).(or no one).

Tell others inappropriate things such as, “you Tell others inappropriate things such as, “you are too fat.” “you have a bugger on your nose.” are too fat.” “you have a bugger on your nose.” “My mom says that you are stupid.”“My mom says that you are stupid.”

Why?????Why?????

Because…..Because….. Their Their sensory systemssensory systems are disordered...some are disordered...some

senses are overly acute, some are under senses are overly acute, some are under reactive. Touch may HURT, movement around reactive. Touch may HURT, movement around may disorient.may disorient.

They do not interpret They do not interpret social informationsocial information…they …they may not realize that three people talking may not realize that three people talking together are in a group...may be unable to read together are in a group...may be unable to read facial expressions and body language…may not facial expressions and body language…may not recognize unkind behavior.recognize unkind behavior.

Language is disorderedLanguage is disordered. They may not . They may not understand even simple directions or questions. understand even simple directions or questions. They may be unable to respond with words to They may be unable to respond with words to even the simplest requests.even the simplest requests.

They strongly desire for things to remain They strongly desire for things to remain predictablepredictable and familiar so they may do things and familiar so they may do things that are repetitive and familiar even if there that are repetitive and familiar even if there doesn’t seem to be a reason for the action or doesn’t seem to be a reason for the action or behavior. behavior.

How can we work together as a How can we work together as a team?team?

Parents and teacher could work together to Parents and teacher could work together to create an info sheet for each student that could create an info sheet for each student that could be given to every adult on campus. Adults such be given to every adult on campus. Adults such as bus drivers, cafeteria workers, yard duty staff, as bus drivers, cafeteria workers, yard duty staff, office staff, etc. who are most likely to come into office staff, etc. who are most likely to come into contact with students could even keep the sheet contact with students could even keep the sheet with them on a clip board.with them on a clip board.

More sophisticated students could write their More sophisticated students could write their own info sheets with some guidance.own info sheets with some guidance.

Suggested Info Sheet for a lower Suggested Info Sheet for a lower functioning studentfunctioning student

Name : Robert Oliver

I like to be called Robbie

Please don’t touch me when I am upset

I understand very little speech. Say my name and then say, “come,” or “stop,” or “no.”

If I am crying or screaming, I will usually stop if you tell me, “Robbie, go library.” I love to look at books about dinosaurs.

If I come and stand by you on the campus, it is because I feel safe with you.

If I start to smell your hair, I am telling you that I like you. Put your hand up and say, “No smell hair.” You might have to do it more than once

Suggested Info Sheet for a Suggested Info Sheet for a Higher Functioning StudentHigher Functioning Student

My name is Brad Johnson. I am 15 years old.My name is Brad Johnson. I am 15 years old. I am very intelligent and love to talk about things that interest me. I am very intelligent and love to talk about things that interest me.

These include: Dairy cows; Star Wars; the Civil War battles and These include: Dairy cows; Star Wars; the Civil War battles and the California Gold Rush. If you want me to stop talking about one the California Gold Rush. If you want me to stop talking about one of these topics, please tell me that you want to talk about of these topics, please tell me that you want to talk about something else.something else.

Please don’t make me look at you when you are talking to me. It Please don’t make me look at you when you are talking to me. It makes me very anxious. makes me very anxious.

I understand that when I am challenged, I can get very verbally I understand that when I am challenged, I can get very verbally aggressive. This often leads to trouble with peers. If you hear this aggressive. This often leads to trouble with peers. If you hear this happening, please tell me to, “choose your battles carefully.”happening, please tell me to, “choose your battles carefully.”

If I am standing too close to you, please tell me to back up a little.If I am standing too close to you, please tell me to back up a little. When I am very upset, it is hard for me to listen, talk or cooperate. When I am very upset, it is hard for me to listen, talk or cooperate.

Please tell me to find a place to sit so that I can calm down. I will Please tell me to find a place to sit so that I can calm down. I will try to do it. try to do it.

Communicating with Communicating with Children to Enhance Children to Enhance

Language DevelopmentLanguage Development

Strategies that all adults can use Strategies that all adults can use when communicating with autistic when communicating with autistic

children to children to facilitate languagefacilitate language learning.learning.

Guidelines for CommunicatingGuidelines for Communicating Adjust the complexityAdjust the complexity of your language to the of your language to the

level of the child (how you talk and what you level of the child (how you talk and what you talk about)talk about)

Avoid excessive talkingAvoid excessive talking – speak in clearly – speak in clearly articulated utterances.articulated utterances.

Attempt to Attempt to get the child’s attentionget the child’s attention before before beginning to speakbeginning to speak

Use a calm, well Use a calm, well modulated voicemodulated voice..

Guidelines for CommunicatingGuidelines for Communicating Talk about Talk about relevant topicsrelevant topics to a child. to a child.

What s/he is doing or attending toWhat s/he is doing or attending to What s/he is about to doWhat s/he is about to do What s/he had just doneWhat s/he had just done Events s/he is familiar withEvents s/he is familiar with

Use Use repetitionrepetition, redundancy and paraphrasing., redundancy and paraphrasing.

Don’t be fooledDon’t be fooled by immediate and delayed echolalia, by immediate and delayed echolalia, such utterances typically do not represent true such utterances typically do not represent true language levels. However echolalia may be used language levels. However echolalia may be used with clear intention to communicate.with clear intention to communicate.

Guidelines for CommunicatingGuidelines for Communicating

Use Use buildups and breakdownsbuildups and breakdowns to help to help your child learn about language structure.your child learn about language structure. Buildup: Put on. Shoe on. Put shoe on.Buildup: Put on. Shoe on. Put shoe on. Breakdown: “Take your spoon and eat the Breakdown: “Take your spoon and eat the

cereal.” “Take spoon, spoon (with point) take cereal.” “Take spoon, spoon (with point) take cereal, eat cereal.”cereal, eat cereal.”

Guidelines for CommunicatingGuidelines for Communicating

If possible, If possible, synchronize and relatesynchronize and relate your your utterances to objects, actions, and events in utterances to objects, actions, and events in the environment through gestures, touching, the environment through gestures, touching, and action demonstration.and action demonstration.

Clearly Clearly segmentsegment your utterances by using your utterances by using stress, intonation and pause.stress, intonation and pause.

Use Use gesturesgestures to supplement speech. to supplement speech.

Guidelines for CommunicatingGuidelines for Communicating

Act as an interpreter to Act as an interpreter to facilitate peer facilitate peer interactionsinteractions Coach peers by telling them about the child with Coach peers by telling them about the child with

autism and how to facilitate communication:autism and how to facilitate communication:• Getting child’s attentionGetting child’s attention• What to talk aboutWhat to talk about• How to respondHow to respond• How to persistHow to persist

Guidelines for CommunicatingGuidelines for Communicating

Shadow the child with autismShadow the child with autism• Point out a peer’s social behaviorPoint out a peer’s social behavior• Prompt child in how to respond to peers; behaviorPrompt child in how to respond to peers; behavior• Encourage perspective-takingEncourage perspective-taking• Acknowledge feelingsAcknowledge feelings• Pointing out feeling in peersPointing out feeling in peers• Prompting how to respond to peers’ feelingsPrompting how to respond to peers’ feelings

Sometimes students “appear” to Sometimes students “appear” to understand language that they understand language that they

don’t---how?don’t---how? Familiar routinesFamiliar routines (child hangs up coat upon entering (child hangs up coat upon entering

the home or classroom)the home or classroom) Environmental cuesEnvironmental cues

child goes to kitchen table when adult opens refrigerator – child goes to kitchen table when adult opens refrigerator – action cueaction cue

Child gets a ball when the ball is on the floor in a room – Child gets a ball when the ball is on the floor in a room – object cueobject cue

High probability eventsHigh probability events Child brushes his teeth when given a toothbrushChild brushes his teeth when given a toothbrush Child starts working on a puzzle when he is given one.Child starts working on a puzzle when he is given one.

Sometimes students “appear” to Sometimes students “appear” to understand languageunderstand language

Specific elements or wordsSpecific elements or words in an utterance in an utterance rather than the whole utterancerather than the whole utterance Adult: “Now it’s getting late; go to your room and go Adult: “Now it’s getting late; go to your room and go

to bed.” If child responds, it may only be to “bed.”to bed.” If child responds, it may only be to “bed.” Intonational, gestural, and/or nonverbal cuesIntonational, gestural, and/or nonverbal cues..

Adult: “Get the brush.” (said while pointing to the Adult: “Get the brush.” (said while pointing to the brush)brush)

Increasing Motivation to Increasing Motivation to CommunicateCommunicate

Arrange physical environment to increase child’s Arrange physical environment to increase child’s need to communicate.need to communicate.

Use the child’s toy, object and activity interests as Use the child’s toy, object and activity interests as opportunities to initiate communication.opportunities to initiate communication.

Use the child’s social interests as opportunities to Use the child’s social interests as opportunities to initiate communicationinitiate communication

Reinforce all attempts to communicate: accept any Reinforce all attempts to communicate: accept any and all communicative meansand all communicative means

Increasing Motivation to Increasing Motivation to CommunicateCommunicate

Make sure that the naturally occurring activity Make sure that the naturally occurring activity or interaction employed is pleasurable.or interaction employed is pleasurable.

Identify adults or peers who have successful Identify adults or peers who have successful interactions with the child and utilize their interactions with the child and utilize their interactive strategies.interactive strategies.

See every moment as a potential opportunity See every moment as a potential opportunity to build communicative interactionsto build communicative interactions..

StrategiesStrategies

Adult should follow child’s lead by imitating child’s Adult should follow child’s lead by imitating child’s behavior and attuning to child’s display of affect.behavior and attuning to child’s display of affect.

Use proximity in positioning and presentation of Use proximity in positioning and presentation of materials to enhance social referencing.materials to enhance social referencing.

For low rate communicators, design environments to For low rate communicators, design environments to provide many communicative opportunities to provide many communicative opportunities to increase child’s rate of communicating; make sure increase child’s rate of communicating; make sure that others wait and look expectantly at child.that others wait and look expectantly at child.

StrategiesStrategies

For children with adequate rates of For children with adequate rates of communication, provide natural opportunities communication, provide natural opportunities for repairs by holding out for a repetition or for repairs by holding out for a repetition or modification of communicative signal. modification of communicative signal.

Provide natural opportunities to “up-the-ante” Provide natural opportunities to “up-the-ante” by holding out for more sophisticated means to by holding out for more sophisticated means to express communicative functions which are express communicative functions which are solidly established in child's repertoire.solidly established in child's repertoire.

What about behavior problems?What about behavior problems?

The first rule in supporting students is to The first rule in supporting students is to provide the structure, predictability and provide the structure, predictability and level of visual support that they require level of visual support that they require while supporting their communication, while supporting their communication, social and sensory needs.social and sensory needs.

In general, when there is a In general, when there is a problem….refer to the next slide.problem….refer to the next slide.

Be Gentle During a CrisisBe Gentle During a Crisis

Lower your voiceLower your voice Be calmBe calm Be comfortingBe comforting Talk less-be Talk less-be

concreteconcrete Have a soft, relaxed Have a soft, relaxed

body posturebody posture Have a neutral facial Have a neutral facial

expressionexpression

Adult behaviors that can Adult behaviors that can Escalate a CrisisEscalate a Crisis

Raising voice/yellingRaising voice/yelling PreachingPreaching Backing a student into a Backing a student into a

cornercorner Using tense body Using tense body

languagelanguage Using sarcasmUsing sarcasm accusingaccusing Insisting on having the Insisting on having the

last word.last word. Holding a grudgeHolding a grudge

Acting superiorActing superior Using physical forceUsing physical force Mimicking the childMimicking the child Commanding, dominatingCommanding, dominating InsultingInsulting NaggingNagging HumiliatingHumiliating Making comparisons with Making comparisons with

otherother Confiscation of preferred Confiscation of preferred

or comforting object or or comforting object or activityactivity

No No’s!!

What Should I Know if I Have a What Should I Know if I Have a Student with Asperger Syndrome in Student with Asperger Syndrome in

my Classroom?my Classroom?

Intricate Minds-Intricate Minds- a video designed a video designed to help us understand what it to help us understand what it

would be like to have Asperger would be like to have Asperger SyndromeSyndrome

Characteristics that Impact Characteristics that Impact Performance in the ClassroomPerformance in the Classroom

Impairment in communication Impairment in communication Literal use of languageLiteral use of language

• confused by expressions—”cat got your tongue”confused by expressions—”cat got your tongue”

• confused by shades of meaning/ambiguityconfused by shades of meaning/ambiguity

• expansive vocabulary often hides poor expansive vocabulary often hides poor understandingunderstanding

Impairment in language ‘pragmatics’Impairment in language ‘pragmatics’• lack of reciprocity in conversation--talks ‘at you’lack of reciprocity in conversation--talks ‘at you’

• misses non-verbal cues (body language)misses non-verbal cues (body language)

Characteristics that Impact Characteristics that Impact Performance in the ClassroomPerformance in the Classroom Impairment in social interactionImpairment in social interaction

difficulty negotiating with peersdifficulty negotiating with peers anxiety in social (group) situationsanxiety in social (group) situations cognitive rigidity makes ‘switching gears’ cognitive rigidity makes ‘switching gears’

difficultdifficult wants friends but doesn’t know the ‘rules’wants friends but doesn’t know the ‘rules’ often an easy target for bullying due to often an easy target for bullying due to

naïvetynaïvety

Characteristics that Impact Characteristics that Impact Performance in the ClassroomPerformance in the Classroom

Restricted repetitive and stereotyped Restricted repetitive and stereotyped patterns of behavior, interests and activitiespatterns of behavior, interests and activities self stimulation activities such as rocking, self stimulation activities such as rocking,

spinning, arm flapping, etc.spinning, arm flapping, etc. intense all-consuming preoccupation with a intense all-consuming preoccupation with a

narrow subject, ie, trains, dinosaurs, TV narrow subject, ie, trains, dinosaurs, TV characters characters

intense need for routine and consistency with intense need for routine and consistency with anxiety when routines are not followedanxiety when routines are not followed

““An Anthropologist from Mars”An Anthropologist from Mars”

Analogy for Asperger’s Syndrome Analogy for Asperger’s Syndrome

Coined by Temple Grandin in an Oliver Sachs Coined by Temple Grandin in an Oliver Sachs storystory

People with AS often feel “out of phase” or like People with AS often feel “out of phase” or like “aliens” or “changelings”“aliens” or “changelings”

““Social Blindness”Social Blindness”

The “NT” world baffles The “NT” world baffles individuals with ASindividuals with AS

“ “ Why don’t we say what we mean? . . . Why Why don’t we say what we mean? . . . Why do we so often make trivial remarks that do we so often make trivial remarks that mean nothing at all? Why do we get bored mean nothing at all? Why do we get bored and impatient when someone with [AS] tells and impatient when someone with [AS] tells us hundreds of fascinating facts about us hundreds of fascinating facts about [arcane topics]. . . Why do we care about [arcane topics]. . . Why do we care about social hierarchies--why not treat everyone in social hierarchies--why not treat everyone in the same way? . . .why are we so illogical the same way? . . .why are we so illogical compared to people with [AS]” compared to people with [AS]” Lorna Wing, in Lorna Wing, in Attwood, 1998 p.9.Attwood, 1998 p.9.

Accommodating the Accommodating the environment for ASenvironment for AS

Establish routinesEstablish routines Establish clear expectationsEstablish clear expectations Use visual supports (lists, calendars) Use visual supports (lists, calendars) Decrease stressDecrease stress Supervise unstructured timeSupervise unstructured time Develop ‘circle of friends’Develop ‘circle of friends’ Work collaboratively with parentsWork collaboratively with parents

Use of class rules-clear expectationsUse of class rules-clear expectations

Concrete rules for the class/groupConcrete rules for the class/group Displayed prominentlyDisplayed prominently Referred to frequently (“Our rule is. . . “)Referred to frequently (“Our rule is. . . “) Adapted when needed, with advanced Adapted when needed, with advanced

notice/warningnotice/warning Clearly state expectations. Make Clearly state expectations. Make

directions explicit.directions explicit.

Visual supports and schedulesVisual supports and schedules

Individual written schedule (daily/weekly)Individual written schedule (daily/weekly) Visual sequencing of tasksVisual sequencing of tasks Visual calendarsVisual calendars Written/drawn notification of changeWritten/drawn notification of change

Change – Luke JacksonChange – Luke Jackson

“ “At school everything At school everything changes so often. changes so often. Going into a Going into a classroom to find that classroom to find that we then have to join we then have to join another class because another class because the teacher is off, or the teacher is off, or move desks for no move desks for no apparent reason, all apparent reason, all adds to the hassle of adds to the hassle of school.”school.”

General Principles of Social Skill General Principles of Social Skill Development for Students with ASDevelopment for Students with AS

Believe that any/every Believe that any/every moment could be used as moment could be used as the context for social skill the context for social skill training. The more broad-training. The more broad-based and frequent the based and frequent the cues and feedback are cues and feedback are given, the more likely the given, the more likely the student will integrate new student will integrate new skills. skills.

General Principles of Social Skill General Principles of Social Skill Development for Students with ASDevelopment for Students with AS

Provide social information that is explicit and “rule based.” Provide social information that is explicit and “rule based.” The more universal and functional, the better. The more universal and functional, the better.

Provide explicit social interaction skill instruction. Provide explicit social interaction skill instruction.

Constantly work toward generalization by providing varied Constantly work toward generalization by providing varied examples, role plays and by prompting, and giving helpful examples, role plays and by prompting, and giving helpful feedback.feedback.

Create cues to help the child remember the rule.Create cues to help the child remember the rule.

General PrinciplesGeneral Principles

Teach parents, professionals and peers how to Teach parents, professionals and peers how to support the social development of the student with support the social development of the student with AS.AS.

Assist parents, professionals and peers in Assist parents, professionals and peers in developing & maintaining reasonable social skills developing & maintaining reasonable social skills expectations. expectations.

Teaching a target skill without teaching the Teaching a target skill without teaching the prerequisite skills can be the difference between a prerequisite skills can be the difference between a rote skill and a usable integrated skill.rote skill and a usable integrated skill.

NeurologyNeurologyIf the human brain were so simple that If the human brain were so simple that we could understand it, we would be so we could understand it, we would be so

simple that we couldn't.simple that we couldn't.- Emerson M Pugh- Emerson M Pugh

Head size- 2003Head size- 2003 Children with autism experience unusually Children with autism experience unusually

rapid head growth between 6 and 14 rapid head growth between 6 and 14 months. months.

Is this an overgrowth of neuronal connections? Is this an overgrowth of neuronal connections? In normal development the brain clears out In normal development the brain clears out

biological debris as it forms new circuits. “Little biological debris as it forms new circuits. “Little twigs fall off to leave the really strong twigs fall off to leave the really strong branches.”branches.”

In kids with autism, this pruning process may go In kids with autism, this pruning process may go awryawry

Head size, con’tHead size, con’t Brain size decreases slightly around age Brain size decreases slightly around age

12, at the same time that normally 12, at the same time that normally developing children experienced a growth developing children experienced a growth spurt in cerebral volume.spurt in cerebral volume.

By adolescence and adulthood, brain By adolescence and adulthood, brain volume levels out to normal size.volume levels out to normal size.

These are unusual and perplexing findings.These are unusual and perplexing findings.

AmygdalaAmygdala The amygdala is The amygdala is

enlarged in the enlarged in the autistic brain-autistic brain-puzzling as this puzzling as this region of the brain is region of the brain is involved in the involved in the normal expression of normal expression of emotion, which is so emotion, which is so disordered in this disordered in this population.population.

The amygdala is the The amygdala is the seat of anger and seat of anger and fear. It may help us fear. It may help us understand the understand the fearful reactions that fearful reactions that many children have many children have to typical situations to typical situations (anxiety).(anxiety).

Minicolumns 2002Minicolumns 2002 A minicolumn is a basic organizational unit of A minicolumn is a basic organizational unit of

brain cells and connective wiring, allowing a brain cells and connective wiring, allowing a person to take in information, process it, and person to take in information, process it, and respond. respond.

Differences in size, number, shape or location of Differences in size, number, shape or location of minicolumns could effect the way the brain minicolumns could effect the way the brain processes information.processes information.

In the brains of autistic people, there are In the brains of autistic people, there are minicolumn abnormalities in the frontal and minicolumn abnormalities in the frontal and temporal lobestemporal lobes They are significantly smallerThey are significantly smaller There are more of themThere are more of them

AxonsAxons

Brain cell are linked by axons –long cables Brain cell are linked by axons –long cables insulated with myelin- that form the white insulated with myelin- that form the white matter. matter.

In autistic people, there are too many In autistic people, there are too many cables within local areas, but not enough cables within local areas, but not enough links from one region to another. links from one region to another.

Too many local connections, not enough Too many local connections, not enough long distance.long distance.

..

Broca’sarea

Parsopercularis

Motor cortex Somatosensory cortex

Sensory associativecortex

PrimaryAuditory cortex

Wernicke’sarea

Visual associativecortex

Visualcortex

Frontal lobesFrontal lobes

This is the home to higher reasoning.This is the home to higher reasoning. They are greatly enlarged, due mainly to They are greatly enlarged, due mainly to

excess white matter, the brain’s connector excess white matter, the brain’s connector cables. cables.

CerebellumCerebellum

Like the frontal Like the frontal lobes, is lobes, is overloaded with overloaded with white matter. white matter.

This region plays a This region plays a key role in physical key role in physical coordination, motor coordination, motor planning and planning and anticipating events.anticipating events.

Corpus callosumCorpus callosum Undersize.Undersize. This band of tissue This band of tissue

links the left and links the left and right hemispheres of right hemispheres of the brain.the brain.

Activity across Activity across diverse regions of diverse regions of the brain is poorly the brain is poorly coordinated.coordinated.

““More like a jam More like a jam session than a session than a symphony”.symphony”.

HippocampusHippocampus About 10% larger than About 10% larger than normal. This area is normal. This area is vital to memory. vital to memory.

Maybe it becomes Maybe it becomes

enlarged because enlarged because autistic children rely autistic children rely on memory to on memory to interpret situations interpret situations that most people that most people process elsewhere.process elsewhere.