AUTISM

1. AUTISM What it is, is not, and how we treat it effectively Marisa R. Leyden, M.A., BCBA

2. Autism: Facts • At present, 1 in 88 children in the United States are diagnosed with an autism spectrum disorder. This number is similar throughout the world. • It is 4 to 5 times more likely to be diagnosed in boys than girls. • Most cases manifest by age 3 with reliable diagnosis possible as early as age 2. • 1 in 49 children in New Jersey are diagnosed with an autism spectrum disorder. • Currently 80 children in the Perth Amboy school district carry an autism classification

3. Autism: Myths • All people with autism have mental retardation • People with autism can’t speak • Autism and schizophrenia are the same • People with autism are savants • Autism is caused by “refrigerator mothers” • Autism is caused by the MMR vaccine • People with autism rock back and forth all the time

4. What is Autism? • According to the DSM IV the essential features of autistic disorder are; • Markedly abnormal or impaired development in social interaction and communication • A markedly restricted repertoire of activities and interests (DSM – IV – TR, 2000)

5. What is Autism? • Autism is considered a spectrum disorder, meaning that a wide range of symptoms are expressed by those people diagnosed “on the spectrum”. • The 5 disorders which make up the autism spectrum are; - Autism (aka; classic autism, early infantile autism, childhood autism, etc.) - Asperger’s Disorder - Pervasive Developmental Disorder – Not Otherwise Specified (PDD – NOS) - Rett’s Disorder - Childhood Disintegrative Disorder

6. What is Autism? • The core features of the autism spectrum disorders are; - Impairment in social interaction - Impairment in communication - Restricted, repetitive, stereotyped patterns of behavior, interests and activities

7. Autism: Social Impairment • Marked impairment in non-verbal behavior • Failure to develop peer relationships • Lack of joint attention • Lack of social or emotional reciprocity

8. Autism: Communication • Delay or lack of speech, with no non-verbal compensation • Where there is speech, lack of ability to initiate or sustain conversation • Stereotyped, repetitive and idiosyncratic language • Lack of varied, spontaneous, make-believe or social imitative play

9. Autism: Behavior • Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal or intense • Rigid adherence to specific non-functional routines • Stereotyped and repetitive motor mannerisms • Preoccupation with parts of objects

10. What is Autism? • REMEMBER – Just becoming familiar with the diagnostic criteria and a list of symptoms will not help us to truly understand autism. • “When you have met an individual with autism you have met one individual with autism.” (Stephen Shore, Ed.D., a person on the spectrum)

11. What is Autism? • What causes autism? • Is autism treatable? • If so, how do we treat it effectively?

12. Autism: Research • Much of today’s research focuses on a genetic link to autism. The most convincing finding in this line of research is the number of monozygotic (identical) twins that are both diagnosed with autism. There is a 60% concordance rate for classic autism and a 92% concordance rate when a broader autism phenotype is studied (Muhle, Trentacoste & Rapin, 2004)

13. Autism: Research • Current research suggests that there are multiple abnormalities that are spread out over several different genes that vary from one individual to another. • Less than a quarter of cases can be accounted for by a single genetic defect (i.e., Fragile X syndrome) or environmental insult (i.e., congenital rubella)

14. Autism: Treatment • 1987 – O. Ivar Lovaas publishes his study “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children” • Compared two groups of “similarly constituted” young, autistic children. One group received behavioral treatment and the other did not.

15. Autism: Treatment • Of the group that received behavioral treatment,47% achieved normal range IQ scores and were successfully placed in 1st grade classrooms in public schools. • Only 2% of the non-treatment group achieved normal educational and intellectual functioning

16. Autism: Treatment • The 11 Established Treatments listed by The National Standards Project are: - Antecedent Package - Behavioral Package - Comprehensive Behavioral Treatment for Young Children - Joint Attention Intervention - Modeling - Naturalistic Teaching Strategies - Peer Training Package - Pivotal Response Treatment - Schedules -Self-management -Story-based Intervention Package

17. Autism: Treatment • All of these established treatments have at least some basis in the behavioral literature and/or make use of strategies described in the behavioral literature • They all employ the following: - Use of positive reinforcement (R+) - Individualized instruction -Data based decision making

18. Teaching Language to Students with Autism The Theory of Verbal Behavior

19. Autism: Verbal Behavior • Developed by Skinner in his 1957 book “Verbal Behavior” and described extensively by Dr. Mark Sundberg in his publications. • Differs from traditional linguistics in that it treats speech and language as a behavior under the control of antecedents and consequences

20. Autism: Verbal Behavior • Four of the verbal operants in the behavioral classification of language are: - Mand – asking for reinforcers i.e., Asking for “water” when you are thirsty. - Tact – Naming or identifying objects, actions, events, etc. i.e., Saying “water” because you see it. - Echoic – Repeating what is heard i.e., Saying “water” after someone else says “water”. - Intraverbal – Answering questions or having conversations where your words are controlled by other words i.e., Saying “Patten school” after someone says “Where do you work?”

21. Autism: Verbal Behavior • The mand is an especially important verbal operant for individuals on the autism spectrum. - Those individuals with language may have an extensive list of tacts (labels) but no ability to ask for what they want. - For those individuals who develop a mand repertoire, they may only be able to ask for desired items/activities when they are present. - For many who have no communicative behaviors, the only “mand” they have is to engage in maladaptive behaviors.

22. Autism: Verbal Behavior • There are various types of mands: -Items -Activities/Termination of an Activity -Missing Items -Information -Changes in the Environment -etc.

23. Autism: Treatment • How can we teach individuals on the autism spectrum to mand? - Observe their behavior in the natural environment to determine what items/activities they like best and/or do a formal preference assessment - Assess the individuals best modality for communication - Capture and contrive motivation - Provide reinforcement immediately following the desired behavior and on an appropriate schedule - Set up the environment for learning - Practice in a variety of settings and situations to promote generalization

24. Questions? Thanks everyone