Autism Spectrum Disorders within the School. Autism Spectrum Disorders Pervasive Developmental Disorders (DSM-IV) Asperger’s DisorderAutistic Disorder.

Autism Spectrum Disorders

within the School

Autism Spectrum Disorders

within the School

Autism Spectrum DisordersAutism Spectrum Disorders

Pervasive DevelopmentalDisorders (DSM-IV)

Asperger’s Disorder Autistic DisorderPervasive Developmental

Disorder – Not Otherwise Specified

Rett’s DisorderChildhood

DisintegrativeDisorder


• Asperger’s Disorder Qualitative impairment in social interaction. Restricted repetitive and stereotyped patterns

of behavior, interests, and activities. Significant impairment in social, occupational

or other important areas of functioning. No cognitive impairment. The qualitative impairment in communication

is not met as there is no significant general delay in language.


• Autistic Disorder Qualitative impairment in

social interactions Qualitative impairment in

communication Restricted repetitive and

stereotyped patterns of behaviors, interests, and activities

Onset prior to 3 years of age

• PDD:NOS or Atypical Autism Severe or pervasive

impairment in reciprocal social interaction, OR

Verbal and nonverbal communication, OR

Stereotyped behaviors, interests, and activities

Criteria are not met for another Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder or Avoidant Personality Disorder

What is PDD or Autism Spectrum Disorder?

What is PDD or Autism Spectrum Disorder?

• Autism Society of America (2000)• Autism is a complex developmental

disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain.

• Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. Family income, lifestyle and educational levels do not affect the chance of autism’s occurrence.

Definition cont…Definition cont…

• Autism interferes with normal development of the brain in the areas of social interaction and communication skills. Children and adults typically have difficulties in verbal and non-verbal communication, social interactions and leisure or play activities.

• The disorder makes it hard for them to communicate with others and relate to the outside world. They may exhibit repeated body movements, unusual responses to people or attachments to objects, and they may resist changes in routines.

PrevalencePrevalence

• Over one half million people in the U.S. today have some form of autism. Its prevalence rate now places it as the third most common developmental disability more common than Down syndrome.

• ASD occurs in 1 of every 200 – 250 births. Some estimates are now 1 of every 166 births.

Data Source: MN Dept. of Education/Special Education-Unduplicated Child Count Data Data Source: MN Dept. of Education/Special Education-Unduplicated Child Count Data http://education.state.mn.us

What are the trends ?What are the trends ?

Identification of Autism Spectrum Disorders MN Child Count Data (B-21 yrs.)

12841730

22422814

3759

4786

5929

7307

8691

9929

0

2000

4000

6000

8000

10000

12000

Years 1997 - 2006

State Total

http://education.state.mn.us/


Where are they educated ?Where are they educated ?

MN Placement Data for ASD by Federal Instructional Settings

Dec.1, 2006

45%

29%

19%

7%

0%

0%

0%

0%

Regular Classroom

Resource Room

Separate Classroom

Public Separate Day

Private Separate Day

Public Residential

Private Residential

Hospital/Homebound


More questions about the trends…More questions about the trends…

• Are we over identifying ? No, there is evidence we are still under identifying in early years..

• Are other states finding the same rates ? Only one state is higher (Oregon) than Minnesota

• Will the ASD Child Count continue to increase? Analysis of MDE Child Count and NIH data predicts continued increase.

• What forecasts or estimates can be made ? 1/500 to 1/166 births (NIH, 2004 and CDC, 2006) Increase of secondary-age students 2x by 2010


Age Distribution of Autism Spectrum Disorders MN Child Count Dec. 1, 2006

0100200300400500600700800900

1 3 5 7 9 11 13 15 17 19 21Ages Birth-21 Years old

Number of Individuals


Local PrevalenceLocal Prevalence

• There has been a 400% increase in students identified with Autism in the last four years. The students range from “high functioning” to

more classical Autism. Anecdotal evidence suggests recent increases

in “high functioning” students.

Theories of CausationTheories of Causation

• Genetic Four times more males than females. Does tend to occur more frequently in families.

• Immunizations Research indicates no connection between

immunizations and Autism. Studies that implied a connection were methodologically flawed.

• Environment Likely that there is an environmental trigger or

influence.

Specific Characteristics of ASD

Specific Characteristics of ASD

Skills of Individuals with ASD Vary from Individual to

Individual

Skills of Individuals with ASD Vary from Individual to

Individual• Some individuals have average intelligence but a

delay in social skills.

• Some individuals may be significantly delayed in all areas with no verbal skills.

• Some individuals may be verbal but exhibit delays in communication as well as having difficulties with social interaction and a wide range of interests.

• The range of areas of concerns within each of these disorders varies from mild to severe depending on the individual. No two individuals are alike with their range of abilities!

ASD is a Neurological Disorder

ASD is a Neurological Disorder

• It is a disorder of the brain• Involves a number of brain functions.• Research has shown that the brains of individuals with

ASD are formed differently from other individuals.• Brain dysfunction involves abnormalities in

interpreting facial expressions, organizing sequences, planning (executive function), compulsivity and problems in language (Travis Thompson, Making Sense of Autism 2007)

ASD is a lifelong disorder but not progressive; it does not get worse over time.

Brain Structure FindingsBrain Structure Findings

• Face Processing & Gaze Fixation in Autism• Deficits in attention, learning & discrimination of human faces,• Disproportionate attention to the mouth versus eyes• More attention to specific details rather than facial configuration• Social brain function in autism (Simon Baron-Cohen et al 1999)• Assigning mental states to eyes-only facial stimuli usually activates

amygdala, cingulate and frontal brain regions• NOT among individuals with high functioning ASDs


• Amygdala is involved in Gaze Fixation & Understanding Facial Emotions

• Amygdala damage impairs recognition of emotional facial expressions

• People who have amygdala tumors don’t look others in the eye when talking to them

• Brain Imaging: Amygdala is typically activated by emotional facial expressions, especially eyes


• Abnormalities in Brain Areas Related to Obsessive Compulsive Disorder

• Prefrontal cortex does not process information properly, which is required for problem-solving, flexibility and planning

• Dysfunction in brain areas that cause symptoms of Obsessive Compulsive Disorder (OCD) lead to rigidity and intolerance for changes in routines.

Consequences of Brain Dysfunction in ASDs

Consequences of Brain Dysfunction in ASDs

• Unable to understand facial expressions, especially emotions

• Unable to grasp gestures, their meaning and often very difficult to imitate gestures

• Unable to anticipate social consequences of their actions

Speech/Language DysfunctionSpeech/Language Dysfunction

• The two primary speech areas in the brain do not work well in coordination, i.e. Broca’s and Wernicke’s

• As a result, very slow processing of speech sounds compared with other sounds

• Even in youngsters with large vocabularies, they may have difficult processing speech of other people

Behavior is Not IntentionalBehavior is Not Intentional

• People with ASDs and related disabilities don’t wake up in the morning thinking of ways to drive their parents & teachers to the brink.

• They are doing the best they can to create control over a world that seems disorderly, chaotic and impossible to understand

Early Behavioral InterventionEarly Behavioral Intervention

• Dysfunctional brain areas in children with ASD contain more tightly packed immature brain cells but very few synapses.

• Fewer synapses may lead to excessive neural cell pruning

• Early intervention promotes brain development (synaptic connections)

• Early intervention prevents loss of brain function that will occur otherwise

• Research has consistently demonstrated that intensive behavioral intervention is superior to other approaches: ABA, DTT, PECS, and PRT have a relatively strong evidence (National Research Council, 2001; Rogers, 1998).

Impairments in Social Interaction

Impairments in Social Interaction

• Limited use joint attention and limited use of facial expressions directed towards others.

• Does not show or bring things to others to indicate an interest in activities.

• Demonstrates difficulty in relating to people, objects, and events.

• Demonstrates a gross impairment in the ability to make friends.

• Significant vulnerability and safety issues due to social naiveté.

• May appear to prefer isolated or solitary activities.

• Misinterprets others’ behaviors and social cues.• Is unresponsive.

Looks Like ThisLooks Like This

Extreme distress for no apparent reason

Difficulty making eye contact

Difficulty relating to others

Indifference to others

Rule of Thumb: “Social/Emotional” age is 2/3 of chronological age

Impairment in CommunicationImpairment in

Communication• Does not use a finger to point or request.• Uses others’ hand or body as a tool.• Shows lack of spontaneous interaction or lack of varied

imaginative play.• Has absence or delay of spoken language.• Has limited understanding of non-verbal communication skills

such as gestures, facial expression or tone of voice.• Demonstrates odd production of speech, including intonation,

volume, rhythm or rate.• Demonstrates repetitive or idiosyncratic language or inability

to initiate or maintain a conversation when speech is present.• Has limited imitation of action or sounds.• Repeats or echoes words or phrases.• Does not seem to understand word meaning.• Has limited eye contact.


Indicates needs by gestures, OR does not use gestures

Echolalia

(Immediate & Delayed)

Behaves as if deaf OR hypersensitive

Inappropriate laughter or giggling

Restricted Repertoire of Activities and InterestsRestricted Repertoire of Activities and Interests

• Demonstrating distress or resistance to change.• Insistence on following routines.• Repetitive hand or finger mannerisms.• Shows lack of true imaginative play versus reenactment.• Over reactions or under reaction to sensory stimuli.• Uses rigid or rule bound thinking. (Always black and white…right or wrong)• Has an intense, focused preoccupation with a limited range

of play, interests or conversation topics.


Inappropriate attachment to certain objects

Prefers to be alone

Preoccupied by obsessive games or topics

Resists changes in routine

Inconsistent gross/fine motor

Fascinated by spinning objects or other self-stimulatory behaviors

Seemingly insensitive to pain

Resists cuddling (sometimes)

Educational Criteria vs. Medical Diagnosis


Educational Criteria

• Meet specific behavioral indicators on a checklist. AND

• Demonstrate educational need.

• Evaluation includes parent information and information from other environments and individuals.

Medical/Clinical Criteria

• Meet specific behavioral indicators on a checklist. DSM-IV

• Often based upon parent report and brief interaction with child.



• Having a medical diagnosis of Autism does not automatically qualify a student for special education service.

• Educational evaluation must document evidence of a disability AND educational need.

Educational Needs of Learners with Autism Spectrum DisordersEducational Needs of Learners

with Autism Spectrum Disorders

• Students with ASD must learn: The ability to attend to elements of the

environment The ability to imitate others The ability to comprehend and use language The ability to play appropriately with toys The ability to interact socially with peers The ability to learn self-regulation skills The ability to organize and plan activities

ASD Learner needs include…ASD Learner needs include…

• A highly supportive teaching environment with opportunities to generalize skills to typical settings

• Structured and predictable environments

• A functional approach to problem behaviors

• Transition planning as the students advances in their education

Social Skills vs. CurriculumSocial Skills vs. Curriculum

• Social skills are just as, and often more, important than math, reading or other academic skills.

• Our job is to provide students with the skills to get along in society.

• It takes months and years of consistent programming for children with ASD to learn these skills.

Classroom StrategiesClassroom Strategies

• Be direct, don’t use figurative language.Simple concrete directions

• Stay calm. Use neutral facial expressions and body language. Don’t overreact.

• Integrate various strategies into school day.Provide opportunity for constructive movement,

breaks and fidgets.

Classroom StrategiesClassroom Strategies

• Visual Cues Organize our lives To get information Make choices Communicate with others Organize thinking Organize environments and facilitate learning

Individual SchedulesIndividual Schedules

If/ThenIf/Then

• Helps to teach consequence

• Can be positive or negative

• Proactive strategy

First/ThenFirst/Then

• Beginning schedule• Teaches order and

expectations• Helps to decrease

anxiety

Building Upon InterestsBuilding Upon Interests

• Use interests to complete work (First work, Then you can tell me about Sponge Bob!) – also known as the Premack Principle

• Use interests in assignments (Speech on Famous American – Bill Gates)

Mini ScheduleMini Schedule

wash hands soap dry handswash hands

To follow a routine

Mini Schedule for part of a day (music class)book listen to music musical instruments sing

Small 3 ring binderSmall 3 ring binder

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

SummarySummary

• Students with Autism are complex and their behavior is often confusing.

• However…… Behavior is lawful Positive alternative behaviors can be taught There are no magical strategies Students with Autism learn in much the same

manner as other children.

Autism Spectrum Disorders within the School. Autism Spectrum Disorders Pervasive Developmental Disorders (DSM-IV) Asperger’s DisorderAutistic Disorder.

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