Autism Spectrum Disorders in the Educational Setting

1. Autism Spectrum Disorders in the Educational Setting Misty L. Boyd, Ph.D. Licensed Clinical Psychologist Presentation to Muskogee Public Schools

2. Muskogee Public Schools Professional Development • “Autism” • Defining Autism Under the Individuals with Disabilities Education Act (IDEA) • Autism means a developmental disability significantly effecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. • Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance. • A child who manifests the characteristics of autism after the age of three could be identified as having autism if the above criteria of this section are satisfied. • Components of a Comprehensive Evaluation for Autism Under IDEA • Medical Information • Cognitive/intellectual • Motor processing/perceptual/sensory • Academic/achievement/functional levels • Communication/language • Adaptive behavior • Social or cultural background • Behavioral functioning • Presentation by Dr. Misty L. Boyd, Ph.D. • The following information was developed by Dr. Boyd for Muskogee Public Schools. The information you will review from her, in addition to the above information, will be the basis for the quiz you will be required to take at the end of this presentation.

3. Presentation Objectives • Increase awareness of the characteristics of students with Autism Spectrum Disorders (ASDs) • Discuss resources available for students with ASDs and their families • Review the use of Positive Behavior Supports with students with ASDs

4. Autism Spectrum Disorders (ASDs) • Broad class of disorders involving pervasive developmental delays • Autistic Disorder • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder (PDD) NOS (Not Otherwise Specified) • Difference between clinical diagnosis and eligibility-related designation

5. Autism Spectrum Disorders (ASDs) • Pervasive delays in several areas of development: • Reciprocal social skills • Communication • Stereotyped behaviors or interests • Typically evident in the first few years of life • Typically occur with some degree of mental retardation (except Asperger’s) • Can be managed with varying degrees of success • In Autism, approximately 10% with “good” outcomes, 20% with “fair” outcomes, and 70% with “poor” or “very poor” outcomes

6. Autistic Disorder • At least 2 symptoms of impaired social interaction • Impaired use of nonverbal communication • Failure to develop peer relationships • Lack of spontaneous sharing • Lack of social reciprocity • At least one symptom of impaired communication • Delay or lack of expressive language • Inability to initiate or sustain conversation • Stereotyped or idiosyncratic language • Lack of imaginary or imitative play • At least one symptom of stereotyped behavior • Preoccupation with an area of interest • Adherence to fixed routines • Stereotyped motor behavior • Preoccupation with parts of objects

7. Autistic Disorder • Onset is prior to age 3 • Nonverbal abilities typically higher than verbal abilities • Associated features may include • Mental retardation • Attention deficits • Impulsivity • Self stimulating or injurious behavior • Sensory sensitivities

8. Autistic Savants • VERY RARE • Display an exceptional ability, often linked with a stereotyped interest • Music or visual arts • Mathematics • Memory for certain types of facts or information (human catalogue) • May still be considered mentally retarded, although typically not severely or profoundly so

9. Asperger’s Disorder • At least 2 symptoms of impaired social interaction • Impaired use of nonverbal communication • Failure to develop peer relationships • Lack of spontaneous sharing • Lack of social reciprocity • At least one symptom of stereotyped behavior • Preoccupation with an area of interest • Adherence to fixed routines • Stereotyped motor behavior • Preoccupation with parts of objects • No clinically significant delay in language, adaptive behaviors, or curiosity about the external environment

10. Asperger’s Disorder • Mental retardation is rare, and generally mild if present • Verbal abilities typically higher than nonverbal abilities • Associated features may include • Clumsiness or impairment in gross or fine motor development • Symptoms of ADHD • Depression

11. Rett’s Disorder • Normal development through at least the first 5 months, up to 4 years • Onset of all of the following after a period of normal development: • Deceleration of head growth • Loss of acquired hand skills • Loss of social engagement (may return) • Loss of motor coordination in gait and trunk movements • Severe psychomotor retardation • Severely impaired expressive and receptive language • Typically have severe or profound mental retardation

12. Childhood Disintegrative Disorder • Normal development for at least the first two years of life • Clinically significant loss in at least two skill areas prior to age 10 • Expressive or receptive language • Social skills or adaptive behavior • Bowel or bladder control • Play • Motor Skills • Abnormalities in at least 2 of the following areas: • Social interaction • Communication • Stereotyped behavior • Usually associated with severe mental retardation

13. Pervasive Developmental Delay NOS • “Not Otherwise Specified” • Conditions that are clearly PDD but do not fit the criteria for a specific disorder • Includes “Atypical Autism” • Late onset • Atypical or sub-threshold symptomatology

14. Prevalence • Established prevalence of autism is around 5 per 10,000 individuals (0.05%) • The prevalence of other PDDs has not generally been established • Recent studies indicate the prevalence for PDDs as a group may have doubled in since the mid 1990’s • There are a number of proposed explanations

15. Etiology • It is generally accepted that PDDs are the result of neurological problems in the brain • However, it is not agreed upon whether these are structural (e.g., tissue), functional (e.g., neurotransmitter, brainwave), or both • Multiple factors have been implicated in the etiology of PDDs including genetics and prenatal exposure to teratogens • Regardless of the physical cause of PDDs, the result is significant impairment in social and communication skills

16. Etiology • People with PDDs have a hard time grasping the emotional or other subtle content of other people’s behaviors • Find it hard to read others’ emotions • Don’t get sarcasm or innuendoes • May adhere to routines as a way of organizing an otherwise confusing social world • “Theory of Mind” • Ability to attribute mental states (knowledge, intentions, beliefs, feelings) to oneself and others • Empathy and “emotional intelligence” • Is mediated and driven by social communication

17. Etiology • “Mirror Neurons” • Found in different areas of the brain • Primary function is imitation, which provides a rich source of learning • In non-clinical adults, activation of mirror neurons is associated with activation of limbic system, but limbic activation is not seen in adults with autism • No emotional salience for autistic individuals?

18. Neurophysiological Model (Waterhouse et al., 1996) • ASD features accounted for by four key dysfunctions in overlapping neural systems • Canalesthesia - the fragmentation of cross-modal information processing and memories, due to excessive cell-packing density in the hippocampus • Impaired assignment of the affective, reinforcing significance of stimuli, due to abnormal amygdala • Asociality due to aberrant functioning of neuropeptide and neurochemical systems • Extended selective attention resulting from abnormal temporal and parietal association areas

19. Asperger’s vs. High-Functioning Autism • Often difficult to separate the two • It has been argued that they are not separate disorders, with some research to support this theory • However other research points to different patterns of impairment in verbal vs. nonverbal abilities, suggesting that they are distinct

20. Associated Features: Asperger’s • Early development will appear normal • Circumscribed interests usually focus on amassing large amounts of factual information • Delayed motor skills and motor awkwardness or clumsiness • Attempts to engage in social interactions but with great difficulty navigating the social environment

21. Associated Features: Asperger’s • Communication skills are likely to be distinctive in three ways: • Poor prosodic skills • Speech seems tangential, possibly egocentric • Marked and persistent verbosity

22. Associated Features: ASDs • Sensory and perceptual abnormalities • Hyper- or hyposensitivity to sounds, lights, textures, or odors • High pain threshold • Overselective attention or impaired shifting of attention • Cross-modal integration impairments • Social deficits are much lower than would be expected based on overall developmental level or intellectual functioning

23. Treatment of ASDs • Often long-term and intensive in order to be effective • Earlier intervention associated with better outcomes • Objectives may include: • Self-care skills • Reasonable degree of compliance with instructions and simple rules • Basic social and affective behaviors • Communication of needs and wants • Appropriate play • Reduction of harmful behaviors • Domestic living and work-related skills

24. Treatment of ASDs • Additional objectives may include emphases on • Fluent verbal language • Age-appropriate social interactions with peers • Behaviors and skills expected in regular classrooms

25. Treatment of ASDs • In addition to working with the child, treatment may (should) focus on teaching parents how to teach basic skills, how to control inappropriate behaviors, and how to solve problems that may arise between systems and service providers

26. Resources for Students with ASDs and Their Families • Local resources: • Hope Foundation for Children with Autism http://www.easternokautism.com • Hope Kids Therapy Center http://www.hopekidstherapy.com • Oklahoma Family Center for Autism http://www.okautism.org

27. Autistic Disorder at School • Academic strengths in nonverbal areas • Disinterest in relationships • Language deficits • Reliance on fixed, non-functional routines • Very limited behavioral repertoire

28. Asperger’s Disorder at School • Academic strengths in verbal areas • Avoidance, defiance, other behavior problems • Difficulty with transitions or changes in routines • Poor relationships with peers • “Little Professor”

29. Managing ASDs at School • Manage the symptoms, including: • Inattention • Overactivity • Social problems • Behavior problems • May wish to consider special education eligibility • Functional behavioral analysis (FBA) and behavior intervention planning (BIP) are important tools

30. Managing ASDs at School • Main tasks to focus on: • Building rapport with student and family • Teaching learning readiness skills such as sitting in a chair, attending to the teacher, looking at and manipulating task materials • Minimizing behaviors that interfere with learning, including tantrums, aggression, and noncompliance

31. Positive Behavior Supports (PBS) for Students with ASDs • “Positive Behavior Support (PBS) is based on a problem-solving model and aims to prevent inappropriate behavior through teaching and reinforcing appropriate behaviors. . . PBS offers a range of interventions that are systematically applied to students based on their demonstrated level of need, and addresses the role of the environment as it applies to development and improvement of behavior problems.” - OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports (www.pbis.org)

32. PBS for Students with ASDs • Characteristics of PBS plans: • Assessment-based • Prevention • Comprehensive • Normalization and inclusion • Team-based • Person-centered values • Long-term planning • Broad view of intervention success • Contextual fit

33. PBS for Students with ASDs: Potential Target Behaviors • Destructive Behaviors • Aggression • Self-Injurious Behavior • Property Destruction • Disruptive Behaviors • Long tantrums • Loud, Repetitive Noises • Running, etc. • Irritating & Interfering Behaviors • “Self-stim” • Repetitive and perseverative speech or actions

34. PBS for Students with ASDs: Remember FBA and BIP • All behavior is communication -- what is the student communicating with this behavior? • Examples include dislike, boredom, discomfort • Consequences can alter patterns of behaviors • Reinforce appropriate behavior to increase its frequency/duration • Use undesired consequences to decrease the frequency/duration of inappropriate behavior • Reinforcers must be individualized • Remember sensory sensitivities and asociality that are common in individuals with ASDs

35. Additional Resources for Educators Autism Center for Autism and Related Disabilities http://card-usf.fmhi.usf.edu/ Autism Society of America www.autism-society.org Positive Behavior Support FL - PBS Project http://flpbs.fmhi.usf.edu RRTC-PBS www.rrtcpbs.org OSEP Center on PBIS www.pbis.org