1 Autism How Autism Differs from an Intellectual Disability and Mental Illness Part I – December 3, 2018 PRESENTER: MONICA MEYER M MEYER CONSULTING, INC. HTTP://.MONICAMEYER.COM 12/2/18 MONICA MEYER CONSULTING, INC. [email protected]The First Use of the Word Autism The word autism comes from the Greek word autos meaning self. In 1911 a psychiatrist by the name of Eugen Bleuler coined the term “autism” and “autistic” to describe an aspect of schizophrenia in which a person withdraws from the outside world into himself. (Sicile-Kira, 2004) 12/2/18 MONICA MEYER CONSULTING, INC. [email protected]“Classic Autism” - Leo Kanner In 1943 Leo Kanner, psychiatrist, used the term autistic in his publication describing eleven children with characteristics similar to how we define autism today To view Kanner’s publication in it’s entirety: http://www.neurodiversity.com/library_kanner_1943.pdf 12/2/18 MONICA MEYER CONSULTING, INC. [email protected]History and Causes Understanding an “If you’ve seen one person with autism…You’ve seen one person with autism.” Temple Grandin Never assume that “one-size-fits-all” 12/2/18 MONICA MEYER CONSULTING, INC. [email protected]
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AutismHow Autism Differs from an Intellectual Disability and Mental IllnessPart I – December 3, 2018
P R E S E N T E R :
M O N I C A M E Y E RM M E Y E R CO N S U LT I N G , I N C .
The First Use of the Word AutismThe word autism comes from the Greek word autos meaning self.In 1911 a psychiatrist by the name of Eugen Bleuler coined the term “autism” and “autistic” to describe an aspect of schizophrenia in which a person withdraws from the outside world into himself.
“Classic Autism” - Leo KannerIn 1943 Leo Kanner, psychiatrist, used the term autistic in his publication describing eleven children with characteristics similar to how we define autism todayTo view Kanner’s publication in it’s entirety:http://www.neurodiversity.com/library_kanner_1943.pdf
What is Autism?Autism is a developmental disability that is life long and typically appears in the first three years of life.Autism is a neurological disorder that affects functioning of the brain (not an emotional-psychological disorder/mental illness)
Autism is five times more common in boys than in girls.Autism knows no boundaries and has been found throughout the world, in families of all racial, ethnic and social backgrounds.
No Physical Attribute or Blood Test that Differentiates AutismThere is nothing about how people with ASD look that sets them apart from other peoplePeople with ASD may communicate, interact, behave, and learn in ways that are different from most other people.
Alarming Statistics The CDC has announced that autism is the fastest growing serious developmental disability in the United States.
On March 27, 2014, the Centers for Disease Control and Prevention (CDC) released new data on the prevalence of autism in the United States. This surveillance study identified 1 in 68 children (1 in 42 boys and 1 in 189 girls) as having autism spectrum disorder (ASD).
Currently, it is estimated that 1.77 million Americans are affected by autism.
What is Autism?Autism is five times more common in boys than in girls.Autism knows no boundaries and has been found throughout the world, in families of all racial, ethnic and social backgrounds.
Heredity and GeneticsPattern of autism or related disabilities in families supporting a genetic basis to autism
No one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited
Heredity and GeneticsIt also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single "trigger" that causes autism to develop.
Whatever the cause…It is clear that children with autism and PDD are born with the disorder or born with the potential to develop it. It is not caused by bad parenting. Autism is not a mental illness. Children/people with autism are not unruly people who choose not to behave. No known psychological factors in the development of the child have been shown to cause autism (I.e. Refrigerator Mother).
Alarming Statistics The CDC has announced that autism is the fastest growing serious developmental disability in the United States. Currently, it is estimated that 1.77 million Americans are affected by autism.
How Autism Differs from an Intellectual Disability
How Autism Differs from an Intellectual DisabilityAutism cases vary in IQ range, with both below and above average test results. In fact, it is quite common for people with severe autism to have an IQ of 70 or below, while some people may have high IQs, while a small population are considered genius level. This differs from people with intellectual disability who generally have IQs of 70.
How Autism Differs from an Intellectual DisabilityA person with intellectual disability develops and performs slower than his peers but he gains skills at an even pace. A person with autism's progress may not be so clear cut as a person with a intellectual disability. The person with autism may make progress in some areas easily but has difficulties with skills, such as language, communication and social interaction.Intellectual disability may present speech and vocabulary challenges but not to the same degree as a case of severe autism, which can render someone nonverbal.
How Autism Differs from an Intellectual DisabilityRoughly 25 percent of people with autism speak few or no words. A generation ago, that figure was closer to 50 percent. Most researchers agree that the decline is due to the recognition of more people with milder forms of autism, as well as to the advent of early intervention programs that have helped more children develop language than in the past……yeah!
How Autism Differs from an Intellectual Disability“One of the primary success stories of early interventions is that they promote language development,” says Helen Tager-Flusberg, director of the Research on Autism & Developmental Disorders program at Boston University. “Nevertheless,” she says, “there are clearly individuals who are diagnosed early, do have access to high-quality interventions, and still fail to acquire spoken language.”
How Autism Differs from an Intellectual DisabilityIQ is clearly a thorny issue!
Many minimally verbal and non-verbal people with autism are diagnosed with a co-morbid diagnosis of intellectual disability, but some people who could not speak, could read with fluency and comprehension.“It can be difficult to tell how intellectually impaired somebody is,” says Nancy Brady, assistant professor of speech, language, hearing sciences and disorders at the University of Kansas. “If they can’t speak, then we maybe undershoot them when we assess them and assume that they are much more impaired than they actually are.”
How Autism Differs from a Mental IllnessAutism Spectrum Disorder is a disorder, so it is not an illness. More specifically it is a neurological disorder.There is a difference between a disorder and an illness. An illness is an harmful physical or psychological deviation in an organism, more particularly in the homeostasis.
How Autism Differs from a Mental IllnessHomeostasis is the ability to keep the internal environment into balance. While a disorder is merely a deviation in the state of health of body and mind. Thus an illness can be a disorder, but not every disorder is an illness.
How Autism Differs from a Mental IllnessFor example a person with bipolar disorder experience a psychological disorder that is a mental illness.
People with bipolar disorder have times when they are depressed or manic, hence out of balance, sometimes accompanied by a psychosis.
Both psychological and physical homeostasis thus may be affected by this illness. The psychosis, depression or mania is what makes it significant, because for instance during a psychotic episode a person loses touch with reality.
How Autism Differs from a Mental IllnessA person with autism experiences a “neurological disorder.”Social functioning is impeded, that in itself may be distressing to a person with autism, but a person with autism is “aware” of it, hence it is not significant. It is also not psychological but neurological. And because homeostasis is not physically or psychologically affected by the disorder, it is also not an illness.
Poll #3Why is it important/necessary to understand the characteristics of Autism for the person you serve?
1. It isn’t really necessary, I have been a support provider for years, I’ve got this!
2. Just because I have worked with one person with autism, doesn’t mean I know how to support every person. I need to understand how they experience their autism so I can implement the appropriate strategies to meet their neurological needs.
3. One size fits all, the person with autism will need to adapt to my support strategies!
The Characteristics of Autism?Cognitive differencesDifferent learning styleSensory processing difficultiesDifficulty with social relationshipsNeed for samenessCommunication Difficulties
Cognitive DifferencesMost people with autism focus on details and are unable to see the whole, or how things fit together. They have difficulty integrating information, extracting meaning and distinguishing among relevant details
Different Learning StyleFor most people with autism, their eyes work better than their ears, they are typically strong visual learners and have more difficulty processing languagePeople with autism have difficulty organizing thoughts, tasks and process.
◦ Touch (could be sensitive to soft touch and would prefer a more course or firm touch)
◦ Auditory input (loud sounds may actually be painful to their ears, screaming could indicate the need to block out the other noise in the environment)
◦ Oral stimulation (I.e., food textures, hot and cold sensitivities)◦ Olfactory (Smell sensitivity).◦ Proprioceptive Input, need for movement and joint compression◦ Vestibular Input, need for swinging, spinning, etc., to develop a more
Difficulty with Social RelationshipsMost people with autism struggle with the complexities and nuances of social interaction.◦ Making friends, sometimes they do not know how, it the skills needs to be
taught.◦ Difficulty initiating conversations and volunteering information. This too is
a skill that can be taught.◦ Understanding someone else’s perspective, “Theory of Mind”, “Mind
Difficulty Socializing and Sustaining Relationships.Often times young children with autism relate better to adults, because adult typically are more predictable.It is not that people with autism do not relate, they may relate in a different way.It is not that people with autism do not want to make friends, but often times they do not know how.Knowing and developing a relationship with the person with autism is imperative
Human Interest/Social DevelopmentLack of social reciprocity, empathy, awareness of the perspective of othersDifficulty developing peer relationshipsDoes not seek to share enjoyment, interest, or achievements.
Communication DeficitsLack of conversation reciprocityDifficulty understanding non-verbal cuesDifficulty sharing a momentLanguage may sound like gibberish Understanding conceptsSome days language is easy to understand and not on others
Literal, concrete interpretationDifficulty with volume control, cadence and intonationRepetitive use of known phrasesLarge vocabulary, but not knowing what they are sayingDifficulty answering questions
Need for SamenessUnusually resistant to changeDevelop routines quicklyMay need to repeat before moving onMay have one area of special interest that is highly developed
Behavior is Communication!You cannot extinguish a behavior without understanding what the behavior is communicatingDoes the person have a functional, efficient way to communicate his/her wants or needs?Behavior is a method to avoid or obtain
“But I’m Giving in to Their Behavior.”Meeting someone’sCommunication needs does not equate to “giving in” to behavior…whenthe goal is to createteachable moments by reducing stress andanxiety so the Individualcan learn another functional, effective way of getting their need met.
Autism cases vary in IQ range, with both below and above average test results and is not a good indicator of skillThere is no typical or standard form of autism and there is often an uneven profile of skills scattered across various developmental areas.Some people with autism have high IQs
INTELLECTUAL DISABILITY
Some are considered genius level. This differs from people with intellectual disability who generally have IQs of 70 and below.A person with intellectual disability develops performs slower than his peers but gains skills at an even pace.
Co-Morbid DiagnosisIf a co-morbid disorder is present, it often cannot be treated in the same manner as when it is present in a person who is neuro-typical.
There are many conditions co-morbid to an autism spectrum disorders ranging from;◦ Concurrent psychiatric conditions ◦ Neuro-inflammation◦ Variety of colon and digestive disorders, which afflict upwards
of half of individuals with Autism Spectrum Disorder.
Co-Morbid Diagnosis Generally, before medications are introduced, non-pharmacological interventions should be considered, initialized and evaluated for efficacy.
Jessica A. Hellings, MD, Department of Psychiatry, University of Kansas Medical Center, Kansas City, KS.
Some persons with autism may be unable to communicate feelings of illness or pain verbally to caregivers …Interception, the eighth sensory system!
For example, if we feel thirsty – we get a drink; if we feel full –we stop eating; if we feel cold – we get a sweater; if we feel the need to urinate – we go to the bathroom; if we feel anxious – we seek comfort; if we feel frustrated—we seek help.If we feel that our internal balance is off, we are motivated to act, to seek immediate relief from the discomfort caused by the imbalance.
When the interoceptive system is properly working, the sensations alert us that our internal balance is off and motivates us to take action, to do something that will restore the balance and help us feel more comfortable.
Some persons with autism may be unable to communicate feelings of illness or pain verbally to caregivers…Interception!
Multiple factors involving illness may manifest as aggression or self-injury, especially if the person is pressured to continue with daily routine or work activities.Common underlying causes of a new onset of behavior problems include infections or side effects of medications. Influenza, ear infections, dental problems, migraine and pain of any kind are a few of the common causes of a re-emergence of problems.
When Behavior Surpasses Communication.When communication needs are met and behaviors persist, a Functional Behavior Analysis is necessary to identify other definitions to aggressive, assaultive or self-injurious behavior.◦ Physiologic
◦ Pain◦ Gastrointestinal Issues
◦ Mental Health Concerns◦ Bi-Polar◦ Obsessive/Compulsivity
Functional Behavior Analysis are performed by a Psychologist who will help with the development of a Positive Behavior Support Plan.
Every effort must be made in these cases to treat the underlying condition medically and provide a supportive environment for the person without adding unnecessary psychoactive agents.
A Multi-Disciplinary Team A Multi-Disciplinary Team with:◦ Clear understanding of the characteristics of autism,◦ How the individual experiences autism◦ Has training and understanding in best practice “Autism-
Specific” strategic supportsProven to produce more predictable and successful treatment responses in comparison with simply prescribing drugs for the non-specific diagnosis of "behavioral control."
Jessica A. Hellings, MD, Department of Psychiatry, University of Kansas Medical Center, Kansas City, KS
There is no “cure” for AutismResearchers are working on finding what specifically causes autism so there is not a cure that will “fix” what is happening with the individuals brain. People with autism grow up to be adults and can get better when characteristics and symptoms are addressed. People with autism can lead happy productive lives when appropriate treatment is begun. (Autism Society of America, 1999)There is no cure for autism, but there are treatments.
The National Institute of Mental Health says;nPsychosocial and behavioral interventions are key parts of comprehensive treatment programs for Individuals with Autism.
nSome of the most common interventions include:• Applied behavior analysis (ABA)• Antecedent Based Interventions (ABI)• Discrete trial training (DTT)• Early intensive behavioral intervention (EIBI)• Incidental teaching• Pivotal response training (PRT)• Verbal behavior intervention (VBI)• Developmental, individual differences, relationship-based approach (DIR
also called Floortime)• Relationship development intervention (RDI)• Treatment and education of autistic and communication- related
The National Institute of Mental Health suggests a list of questions when planning for an individual:•How successful has the program been?•How many have gone on to be included in their community, recreation, leisure, employment•How have they performed?•How are activities planned and organized?•Are there predictable daily schedules and routines?•How much individual attention will the individual receive?
•How is progress measured?•Will the individual be given tasks and rewards that are personally motivating?•Is the environment designed to minimize distractions?•Can and will the supports be generalized into other environments?•Do staff members have training and experience in working with individuals with autism?
An Effective Treatment Program Will Build On; • Individuals interests • Predictable schedule, teach tasks as a series of simple
steps, actively engage the individual’s attention in highly structured activities• Provide regular reinforcement of behavior• Relationships are a major factor in treatment success.• Those with relationships with the individual need to work
with therapists to identify the behaviors to be changed and the skills to be taught based on the ASD characteristic deficit.
So how do we address these obstacles?Have a good knowledge of autism.◦ Spectrum Disorder ◦ Characteristics of Autism◦ Methodologies and strategies that best support
individuals with autism
Understand the person with autism;◦ Likes, Dislikes◦ Strengths, weaknesses
Understand the Underlying Characteristics of Autism•How does the individual with Autism experience their Autism•What is the implication of Supports?•Have functional communication supports in place and utilized consistently
•Consistency and training•Data•Clear training and communication with staff
Communication and Self-DeterminationCHOICE! How can a person with autism make a choice when there is a need for functional communicate or lacks the ability to make decisions?RESPONSIBILITY! With choice comes the responsibility for ones actions and decisions.Strategies that enhance the possibility for a person with Autism to make decisions and act responsible for ones life are:
◦ Structured Teaching◦ Communication Systems◦ Social Stories◦ Positive Behaviors Supports
Now what?Get to know this person in relationship to the characteristics and Supports strategies◦ Relationship◦ Assessment◦ Strengths◦ Skill Development – Life Long!◦ Strategies◦ Implementation◦ Evaluation◦ Re-assessment◦ Data