Autism spectrum disorder

Autism Spectrum Disorder

aka Autism, Aspergers, etc.

ByBrenda McCreight Ph.D.

Training Series

Definition – sort of

• Autism spectrum disorders are:

– Lifelong neurological developmental disability– Usually evident before age three – Referred to as a spectrum disorder because there are physical

differences in the brain of every person which create: • different neurological structures • a variety of symptoms• a range of severity

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Who gets a.s.d.?

• Autism spectrum disorders occur across all socioeconomic, ethnic, cultural and geographic groups

• The incidence of a.s.d. is higher among males than females

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Communication challenges• Children with a.s.d. will have communication problems that

go beyond speech and language to other aspects of social communication, both receptively and expressively.

• They have difficulty understanding the meaning of language spoken by others

• They have difficulty sharing thoughts or feelings and difficulty communicating their own • Children with a.s.d. try to communicate, but we don’t always recognize their attempts for what they are

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• People with a.s.d. have challenges with interacting with other people

• They cannot attain or maintain reciprocal relationships

• They may become distressed when dealing with change and transitions • They might perseverate on routines and on objects, sometimes they will even perseverate on people, or types of people

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Sensory Processing

• People with a.s.d. demonstrate unusual, inconsistent, or repetitive reactions to sounds, sights, smells, tastes, touch or movement

• Their neural structure makes their sensory systems over or under sensitive to the environment

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How does a.s.d. present?

• Repetitive motor movements such as hand flapping or obsessive fidgets

• Challenges in adaptive and daily life skills

• Challenges with executive functioning ie sequencing, organization, sustaining and shifting attention, etc.

• Inconsistent performance • Brenda McCreight training series

• Challenges with nonverbal communication such as eye contact, hand gestures or facial expressions

• Can’t initiate actions• Incessant or obsessive chatter on a limited topic• Repetitive mimicking of sounds or words or phrases• Disruptive communication ie interrupts,• talks out, talks over

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• May lack interest in interacting with people• May have a preoccupation with a special

interest, an object, or aspects of internal or external environment

• Challenges in understanding others’ perspectives• Can’t shift attention or change focus

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Neurobiology of a.s.d.

• Studies have found children with autism have increased white matter in their brains

• White matter is the part of the brain that carries information from one section of the brain to another.

• The increased white matter is located in areas of the brain that are close to each other and on the same side of the brain

• Some have theorized that the increase in connections within each side of the brain makes communication between the hemispheres more difficult

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• Brain areas are often bigger on the side to which they are lateralized (meaning: localization of a function, such as speech, to the right or left side of the brain)

• For example, language is lateralized to the left brain, and the areas of the brain which handle language processing are bigger on the left than the right side.

• Studies have shown that children with autism have a reversed brain asymmetry - there

are more areas that are bigger on the right than the left side of the brain• This is opposite of what is found in the brains of neurotypical people

WHAT THIS ALL MEANS

• In other words:• A.s.d. in any form is a neurodevelopmental disability

that is lifelong • It impairs the person’s ability to relate to others in a

way that other’s can understand• It impairs the individual’s ability to engage in reciprocal

relationships• The symptoms can be different in different people –

some are more severe than others• Some people with a.s.d. have very high IQ’s while

others have very low IQ’s• A.S.D. can co-exist with other conditionsBrenda McCreight Ph.D. training workshops

TREATMENTS

• There are many, many forms of treatment for a.s.d. Here are a few approaches:

• Biomedical• Behavioural• Communication• Sensory• AlternativesBrenda McCreight Ph.D. training series

Biomedical

• The biomedical approach to autism is based on the belief that autism has a biological cause ie – heavy metal poisoning, yeast infections, food sensitivities, nutrition

• Leaders in this field are Dr Bernard Rimland of the Autism Research Institute (ARI), Dr Bernard Rimland

• Studies have shown that some people with autism have recovered fully or significantly from this approach

• Other people with autism have not responded at all to this treatment

Behavioral

• There are many different behavioral approaches including:

• ABA • Greenspan Method • Miller Method• Pivotal Response Therapy• SCERTS

• APPLIED BEHAVIOUR ANALYSIS (ABA)

• Applied behaviour analysis (ABA) is the process of systematically applying interventions based on the to improve socially significant behaviours

• Teaches social, motor, and verbal behaviours as well as reasoning skills.

• The ABA approach can be used by a parent, counselor, or certified behaviour analyst.

• ABA uses behavioural observation and positive reinforcement or prompting to teach each step of a behaviour.

• The person’s behaviour is reinforced with a reward when he or she performs each of the steps correctly

• The goal is to identify the triggers of a behaviour, and what happens after that behaviour to reinforce it

• The task is to remove these triggers and reinforcers from the child's environment.

• New reinforcers teach the child a different behaviour in response to the same trigger.

Greenspan Method• Dr. Greenspan utilizes the D.I.R. (Developmental, Individual-

difference, Relationship-based) Model or Developmental Approach to therapy

• This is a systematic way of working with children to help them climb the developmental ladder

• D.I.R. takes children back to the very first milestone they may have missed and begins the developmental progress anew.

• The six "functional milestones" are:• self regulation and interest in the world• Intimacy• two-way communication• complex communication• emotional ideas• emotional thinking• Dr. Greenspan's method includes an observation chart used by the

parent to asses where the child stands on the development ladder and which milestones need strengthening

• Dr. Greenspan developed “floor time” as an intervention to be used by both parents and professionals

The Miller Method

• Focuses on the child’s body organization, social interaction and communication

•  Uses two strategies to restore typical development

• The first uses the transformation of a child's maladaptive behaviors (such as hand flapping or spinning ) into functional behaviours

• The second uses the repetitive involvement of developmentally relevant people or objects

The Miller Method Elevated Square

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Pivotal Response Therapy

• PRT was developed by Dr. Robert and Lynn Koegel • Teaches language, decreases disruptive/self-

stimulatory behaviors, and increases social, communication, and academic skills

• Focuses on "pivotal" behaviours that impact a wide range of behaviors

• The primary pivotal behaviors are motivation and child's initiations of communications with others

• The goal of PRT is to produce positive changes in the pivotal behaviors, leading to improvement in communication skills, play skills, social behaviors and the child's ability to monitor his own behaviour

SCERTS• SOCIAL COMMUNICATION/ EMOTIONAL REGULATION/

TRANSACTIONAL SUPPORT • An educational model developed by Barry Prizant, PhD, Amy Wetherby, PhD,

Emily Rubin and Amy Laurant• Combines other approaches including PRT, TEACCH, Floortime and RDI.• Promotes child-initiated communication in everyday activities• Focuses on achieving Authentic Progress (the ability to learn and

spontaneously apply functional and relevant skills in a variety of settings and with a variety of partners)

• SC: Social Communication - Development of spontaneous, functional communication, emotional expression and secure and trusting relationships with children and adults.

• ER: Emotional Regulation - Development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available for learning and interacting.

• TS: Transactional Support - Development and implementation of supports to help partners respond to the child's needs and interests, modify and adapt the environment, and provide tools to enhance learning

Communication Methods

• ELECTRONIC DEVICES• Allows a nonverbal individual to speak verbally through

an electronic device• RELATIONSHIP DEVELOPMENT INTERVENTION• Relationship Development Intervention (RDI®) is a

program designed to enable parents to function as facilitators for their children's mental development

• SOCIAL STORIES• Social stories describe normal social situation and are

written from a child's perspective• Social stories can help a child prepare for upcoming

changes in routine, de-mystify social interactions, and relate academic skills to real-life

Sensory

• Auditory Integration Training (AIT) is a hearing enhancement process based on the belief that Research on autism suggests that people with a.sd. have sensory dysfunctions which impacts their behavior ie withdrawal or screaming

• The training is delivered under headset conditions with the person wearing headphones in a contained space (minimal movement) for 30 minutes at a time

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• Sensory Integration: Occupational therapists use sensory integration therapy to help children with a.s.d. develop normalized play

• This includes placing a child in a room specifically designed to stimulate and challenge the senses

• Vision therapy: an individually prescribed program of vision "exercises" or procedures which can change the way you see. Vision Therapy is aimed toward normalizing or improving fundamental visual abilities, such as eye focusing, eye teaming, eye movements, and visual perception. 

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Alternative therapies

• Acupuncture• Art Therapy• Cranial Sacral• Homeopathy • Hyperbaric Oxygen• Osteopathic• Music Therapy• Neurofeedback• Service Dogs• Swimming Therapy• Therapeutic Recreation• Brenda McCreight Ph.D. training series

How To Choose?

a) Learn the features and strategies of various methods so you can match them to the unique needs of the individual with a.s.d. as well to the capacity of the parents to support the method in the homeb) Make sure the professional working with the person is well trained and certified in the form of intervention she is usingc) Most methods will include: intense and early intervention with a great deal of repetition and consistent reinforcement

Basic Communication

Regardless of which method you choose to use, or not use, there are basic communication protocols that will enhance interaction with a person with a.s.d.Here are some suggestions:• Provide a safe environment• Reduce the unexpected, make the environment

predictable• Prepare yourself and the person with a.s.d. for change• Reduce transitions• Provide a consistent daily routine• Create picture or written schedules• Brenda McCreight Ph.D. training series

• Use direct, clear instructions• Break tasks down into small units• Provide frequent feedback, make it mostly positive• Redirection as needed rather than criticize• Visually show beginning and end• The home and the classroom can provide:a) Picture schedulesb) Task sequence chartsc) Choice boardsd) CalendarsUse these as prompts and visual reminders/reinforcersBrenda McCreight Ph.D. training series

• Get person’s attention before speaking• Speak at his level of understanding• Don’t demand constant eye contact• Use touch according to the person’s

ability to tolerate it – remember sensory issues

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Thank you for sharing this time with me

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