AUTISM The Basics. Pervasive Developmental Disorders (PDD’S) §Autism §Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) §Asperger’s.

AUTISMThe Basics

Pervasive Developmental Disorders(PDD’S)

AutismPervasive Developmental Disorder – Not

Otherwise Specified (PDD-NOS) Asperger’s Disorder (Asperger’s Syndrome)Childhood Disintegrative DisorderRett’s Syndrome

HISTORY

LEO KANNER KANNER a psychiatrist first described autism in 1943

His article “Autism Disturbance by Affective Contact” descibes and discusses 11 case studies of children “whose condition differs so markedly uniquely from anything reported so far, that each case merits a detailed consideration of it’s fasinating peculiarities.”(Pg.1)

Kanner’s cases common characteristics

Inability to relate to other in an ordinary manner Extreme autism aloneness that seemingly isolated the child from the

outside world Resistance to being held or picked up by parents Deficits in language including mutism and echolalia In some cases excellent rote memory Early specific food preferences Extreme fear reactions to loud noises Obsessive desire for repetition and maintenance sameness Few spontaneous activities such as play behavior Bizarre and repetitive physical movement such as spinning and rocking Normal physical appearance

Autism Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV,1994) provides diagnostic guidelines developed by the American Psychiatric Association.

The International Classification of Diseases, 10th edition (ICD-10,1993) give diagnostic guidelines by the World Health Organization.

What is Autism?

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, and characterized by a triad of impairments in the areas of communication, socialization, and behavior.

Autism is a life long disability with no known cause or cure. Autism affect 4 time more boys than girls. Autism is a spectrum disorder and severity varies from person to person. It is estimated that half of those diagnosed with autism have mental retardation and the other half with average intellegence or higher.

More about Autism

Person has significant difficulties in all three key areas: communication, socialization, and behavior.

Some individuals with autism may have severe impairments in all areas, while more mildly affected people may have only minor impairments or a combination of mild and moderate impairments.

Communication

Social Behavior/Interests

Theory of MindSensory issues

Triad of Impairments in Autism including associated features

Communication

Communication and social deficits are the primary symtoms of autism

Language development is delayed and once aquired progresses slowly

About half of the people with autism do not develop functional language

Children with autism show deficits in both receptive and expressive language

Social IssuesSocial skills deficits are one of the primary

characteristics of autism. They include deficits in:

theory of mind skills social attention shared attention social regulation imitationorganizationplay skillsgroup skillscommunity skills (Quill, 2000)

Behavioral Issues

The characteristics of autism can be categorized as either behavioral deficits or behavioral excesses

Behavioral excesses are disturbing to those around them and are sometimes dangerous to the child or others

Behavioral deficits are behaviors that are not displayed adequately

(Scheuermann & Webber, 2002)

Behavioral Excesses

TantrumsScreamingSelf-StimulationSelf-AbuseAggression

Bizarre BehaviorEcholaliaPerseverationRefusing to follow

directions

(Scheuermann & Webber, 2002)

Behavioral Deficits

Attending ImitatingCommunicative IntentSocial SkillsReceptive LanguageExpressive LanguageEye Contact

Self-Care SkillsAuditory/Visual

DiscriminationWork SkillsLeisure/Play SkillsAcademic Skills

(Scheuebermann & Webber, 2002)

Theory of mind

Concerns the ability of people with autism to (a) understand their own mental states and the mental states of others-such as beliefs, desires, intentions, knowledge, pretence, and perceptions and (b) to understand the link between mental states and action.

(Baren-Cohen et al., 1997)

Deficits in theory of mind may result in: Insensitivity to others feeling Inability to take into account what others know Inability to negotiate friendships by reading and responding to

others intentions Inability to read the listener’s level of interest Inability to detect a speakers intended meaning (misinterpret) Inability to anticipate what others might think of ones actions Inability to understand misunderstandings Inability to deceive or understand deception Inability to understand reasons behind people’s actions Inability to understand “unwritten rules” or convention (Bashe & Kirby, 2001)

Autism involves sensory impairments

Individuals with autism have great difficulty in interpreting the information they get from their senses (sight, hearing, touch, etc.)

Many individuals with autism are either hyper-sensitive (hearing, touch, etc. actually causes physical pain) or hypo-sensitive (they do not feel pain or have a delayed response).

Sensory Issues

Sensory issues vary from child to childSensory problems can be addressed with

occupational therapyIncrease motor activities/movement can

help sensory issuesABA is helpful for some sensory problemsSome sensory issues may not change and

should be addressed with understanding and tolerance

Adaptive skills/Self-helpChildren with autism have significant

developmental delays in adaptive and self-help skills. They need direct instruction of of these skills such as potty training, dressing, and other self-care and daily living skills. Deficits in these areas often result in meeting the criteriea of mental retrdation

Teaching daily living skills an self-help skills are very important

Education

Deciding what to teach children with autism can seem overwhelming. There are a multitude of specific skills that each child could benifit from. Prioritizing the need for each child is essential.

Skills in the areas of communication, social skills, behavior and daily living/self-help should always be taught.

Assessment

Teaching objective should be based on assessmentAssessment identifies deficits Assessment identifies level of functioningAssessment Guidelines– most valid, reliable, and comprehensive– involvement of parent– a single coherent veiw of the child– finding reported clearly– profile of strengths and weaknesses– contact with professionals implementing

recommendations (Klin, 2005)

THE SIX CORE COMPONENTSINDIVIDUAL SUPPORTS FOR THE

STUDENT AND FAMILYSYSTEMATIC INSTRUCTIONCOMPREHENSIBLE AND/OR

STRUCTUREAL ENVIRONMENTSPECIALIZED CURRICULUMFUNCTIONAL APPROACH TO

PROBLEM BEHAVIORSFAMILY INVOLVEMENT

Individualized Support & ServicesMust consider family preferences when

determining the goals to be taught and the method by which instruction will be delivered

Must incorporate the child's preferences and special interests into the instructional program.

Must focus on the child’s strengths and weaknesses to determine the most appropriate intensity and level of instruction to meet the the child’s individual goals

Systematic Instruction

Involves carefully planning for instruction

by identifying valid instructional goals,

carefully outlining instructional procedures,

evaluating the effectiveness of the teaching

procedure, and adjusting instruction based

on data. Systematic instruction also provides a structured teaching plan for generalization

Structured Programing

Develop IEP with clear obtianable goals and objectives with long term, intermediate, and short term goals based on assessment.

Structured teachingStructuring the classroomUse of schedules and routinesMaterialsStructured lesson presentation

Direct Instruction

Keep it simple (visual or language)Everything must be directly taught.Break tasks into small stepsUses stimulus-response training (discrete trial

teaching)Continued assessment by data collection

Strategies & ProceduresStrategies using applied behavior analysis

(ABA) have been documented to be effective in systematically teaching target behaviors to students with autism.

Structured Approach - discrete trial teachingNaturalistic Approach - incidental teaching,

pivotal response trainingSelf-Management Procedures

Systematic Instruction cont.

More Teaching Stratagies

Discrete trial teachingShapingChainingGeneralization trainingMilieu teachingGrouping

(Sheuermann & Webber, 2002)

Comprehensible/Structured Learning Environments

Allows the student with ASD to predict what is currently happening within the learning process and what happens next

anticipate requirements of specific settings

learn and generalize a variety of skills

Structuring the EnvironmentOrganize the instructional settingProvide a schedule of activitiesCarefully plan and provide choice making

opportunitiesProvide behavioral supportsDefine specific areas of the classroom settingProvide temporal relationsFacilitate transitions, flexibility and change

Specific Curriculum Content Should Include

Systematic Instruction in social engagement

Initiating and responding to social bids

Appropriate recreational and leisure skills

Language comprehension and communication

Recreation and Leisure Integrated Play Group Model

Peer Mediation Technique Features 1. Natural environments

2. Inclusive settings

3. Inviting play spaces and selection of play materials based on individual characteristics and interactive potential

4. Play groups consisting of three typical peers for every one or two peers with disabilities

5. Guided participation

6. Full participation in play

Functional Approach to Problem Behavior

Use of Positive Behavior Supports to enhance the student quality of life by expanding existing behavior and adjusting the learning environment

Make problem behavior ineffective, inefficient, and irrelevant

Functional Behavior Assessment

Identify variable that predict and maintain problem behavior by gathering data by direct and indirect measures

Purposes of problem behavior: escape/avoiding people, places, events, objects, or sensory input and/or obtaining tasks, people, events, objects, or sensory input

Family Involvement The families of children with autism are the

most influential, consistent, and valuable people in the child's life. Parent witness and endure difficulties that other parents find incomprehenceable while trying a variety of interventions, and planning for the future. They are the primary source of information about their child's development and current functioning in all settings. Their input and participation is priceless and should always be welcome and appreciated.

Schools should address the unique characteristics of children with autism with strategies that are effective in treating the individual needs of the child. The “six core components” outlined here are a beginning to establish the best strategies, practices and techniques to teach children with autism. Continued research should provide more insights that will assist in the education of these children.

Teacher CharacteristicsLikes children Intuitively sensitiveConsistantPersistantFlexible/AdaptableWell developed sense of humorMastery of ABA and developmental theoryMastery of data collectionCommitment to the most effective approach

(Sheuermann & Webber, 2002)

What works best

Appropriate supports including special education programs based on research and geared toward developmental level. Training is essential.

Well implemented programs such as ABA, PECS, TEACCH, sensory integration, speech, occupational therapy, behavior intervention, medication programs

What works best

Educational programs where there is collaboration, coordination, and participation, between all involved professionals and parents.

Programs that provide in-home training and paremt training

Structured community supports

What doesn’t work

“Free time”

Explaining

Poorly planned, unstructured, inconsistent or

poorly implemented educational

environments or treatment programs

Learning from simple exposure.

Waiting on developmental milestones

Children with autism are complex, facinateing, and often misunderstood. They are frequently excluded from situations, places, and experences just for being who they are. Autism is the most misunderstood and least researched of all developmental disabilities. They have a great deal to offer society even as children. They should be treated with the same tolerance, love, and dignity as all children. Autism is a life long disability and children with autism spend more time as adults with autism. We should nurture then embrace their contributions.