Autism Spectrum Disorders Ayanna Peake CCS School Psychologist and Autism Support Staff –

1. Autism Spectrum Disorders Ayanna Peake CCS School Psychologist and Autism Support Staff – Burns Zone Wendy Fitch CCS Lead School Psychologist and Autism Support Staff- Shelby and Crest zones BCBA

2. Autism Support Framework for Cleveland County Schools Burns Zone Ayanna Peake AU Psychologist Crest Zone Wendy Fitch AU Psychologist ADOS Team Intervention Classes Preschool (Jefferson) Elementary (Marion) Middle School (SMS) High School (KMHS) Transition Class Elementary (Marion) Self-Contained Classes Elementary (NSS) Middle School (NSS) High School (NSS) System Wide ABA Tech Shelby Zone Wendy Fitch AU Psychologist Kings Mountain Zone Summer Bachman AU Psychologist

3. About autism spectrum disorders and interventions…. • Think about the disability • Consider environmental supports • Target skills to teach

4. “Autism spectrum disorders are lifelong conditions that require intervention throughout the lifespan. Only when a basic level of health and comfort is established, reinforcement is available, the environment is made predictable through structure and visual/ tactile supports, and task demands are carefully designed can skills be effectively taught and demonstrated.” (Aspy and Grossman, 2008)

5. What is autism? • A developmental disorder of neurobiological origin that is defined on the basis of behavioral and developmental features • Present from birth or very early in development

6. Autism affects essential human behaviors: • Communication • Social Interaction • Behavior

7. Communication Impairment • Delay in or total lack of development in spoken language (with no attempts to communicate through other methods such as gestures or mime) • If they have speech, marked impairment in the ability to initiate or sustain a conversation with others • Stereotyped & repetitive use of language or idiosyncratic language • Lack of varied, spontaneous make believe play or social imitative play appropriate to developmental level • A person with autism will have at least one of these characteristics

8. Common communication differences • Makes sounds repeatedly or states word or phrases repeatedly (e.g., humming, “you know”) • Immediate or delayed echolalia (reciting lines from movies, repeating another person’s questions or statements, repeating sounds) • Interprets words/conversations literally/ difficulty understanding figurative language/multiple meanings/ humor/sarcasm/synonyms • Difficulty with rules of conversation (interrupting; asking inappropriate questions; difficulty maintaining conversations) • Difficulty using gestures/ facial expressions • Difficulty asking for help • Makes irrelevant comments • Difficulty expressing thoughts and feelings • Speaks in an overly formal way

9. Social Interaction Impairment • Marked impairment in the use of multiple, nonverbal behaviors (eye to eye gaze, facial expressions, body postures & gestures to regulate social interaction) • Failure to develop peer relationships appropriate to developmental level • Lack of spontaneous seeking to share enjoyment, interests, or achievements with others (lack of showing, bringing, or pointing out objects of interest) • Lack of social or emotional reciprocity • A person with autism will demonstrate at least two of these

10. Common Social Differences • Difficulty recognizing the feelings and thoughts of others (“mind blindness”/ can’t take another’s perspective) • Can have different emotional response than is expected for social situations • Uses poor eye contact • Has difficulty maintaining personal space/ physically intrudes on space of others • Lacks tact or appears rude • Has difficulty making/ keeping friends • Has difficulty joining an activity • Is naïve/ easily taken advantage of or bullied

11. Tends to be less involved in group activities than most same aged individuals • Has difficulty understanding others’ nonverbal communication (e.g., facial expressions, body language, tone of voice) • Has difficulty understanding jokes • “Rule” bound and can tend to lecture others • Talks at people instead of with them • May display potentially “challenging” behavior to escape uncomfortable/ difficult situations

12. Restricted Repetitive and Stereotyped Patterns of Behavior, Interests, and Activities • Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in either intensity or focus • Apparently inflexible adherence to specific, nonfunctional routines or rituals • Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) • Persistent preoccupation with parts of objects • A person with autism will display at least one of these

13. Restricted patterns of behavior, interests, and activities • Expresses strong need for routine or sameness • Expresses desire for repetition • Has eccentric or intense preoccupations/ absorption in own unique interests • Asks repetitive questions • Seems to be unmotivated by customary rewards • Displays repetitive motor movements (flaps hands, paces, flicks fingers, etc.) • Has problems handling transition and change • Has strong need for closure or difficulty stopping a task before it is completed

14. Autism is: • Best characterized as a spectrum of disorders that varies in: • Severity of symptoms • Age of diagnosis • Association with other disorders (intellectual disability, attention deficit disorder, OCD, bipolar disorder, etc.)

15. POP QUIZ!!!! Piece of paper Number 1-10 Writing utensil

16. What comes next? OTTFFSS__

17. Autism spectrum disorder: • Group of developmental disabilities including: • Autistic Disorder • Asperger’s Syndrome • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder, NOS

18. What is the difference between autistic disorder and Asperger’s? Autistic disorder: significant impairment in social interaction and communication presence of restricted repetitive behavior • Asperger’s Syndrome: implies near normal to above average cognitive abilities and at least superficially normal expressive and receptive language skills; impairment in social interaction

19. Consideration: In Asperger’s,there are qualitative impairments in communication, including conversation skills, may ask repetitive questions, have unusual volume, pitch, or stress in vocalizations, and make literal interpretations

20. Common feature of all autism spectrum disorders is the qualitative impairment in social interaction

21. Problems with social interaction can include: • Difficulty initiating or responding to conversation • Difficulty using or responding to nonverbal gestures • Lack of or inconsistent eye contact • Impairment in responding to others’ feelings

22. The lack of social skills often exhibits itself in ways we do not attribute to a social deficit: • Yelling or calling out inappropriate statements at inappropriate times • Aggression/ destruction • Echolalia/ jargon/ scripting • Inappropriate touching of others/ inappropriate comments

23. Further complicating the issue for AD students • Often misunderstood by us because of their good verbal and cognitive skills and good academic skills • Too often, we view the atypical social behaviors as intentional or evidence of lack of impulse control rather than skill deficit

24. We know what autism looks like, right?

25. If you know one child with autism……. • You know one child with autism!!!

26. Important to remember: • Not all students who have an autism spectrum disorder are alike • Characteristics of ASD manifest themselves differently in each individual • Programming has to be individualized and monitored consistently

27. People with autism spectrum disorders typically have: • Difficulty understanding verbal and nonverbal communication and • Difficulty learning appropriate ways of relating to other people, objects, and events • Repetitive behaviors or unusual interests

28. Key Characteristics and Possible Adaptations

29. Insistence on sameness • Can be easily overwhelmed by minimal change; highly sensitive to environmental stressors • Anxious, tend to worry obsessively when they do not know what to expect

30. Insistence on Sameness • Provide a predictable/ safe environment • Minimize transitions • Offer consistent daily routine: Use schedules– either pictures or words or a combination • Avoid surprises– prepare the child in advance for any changes in the schedule

31. “And it is best if you know a good thing is going to happen, like an eclipse or getting a microscope for Christmas. And it’s bad if you know a bad thing is going to happen, like having a filling or going to France. But I think it is worst if you don’t know whether it is a good thing or a bad thing which is going to happen.”Christopher John Francis Boone, from The Curious Incident of the Dog in the Night-Time, by Mark Haddon (2003).

32. Common reasons for behavioral breakdowns • Need for sameness ; consistency • Need for predictability • Anxiety • Environmental/ sensory needs • Difficulty with movement, self-help skills,etc. • Level of coping skills • Ability to effectively communicate emotions and needs • Ability to interpret language directed to them (verbal and nonverbal)

33. The BIG “3” • Visual supports • Social skills instruction • Reinforcement

34. Importance of visual supports • Provide predictability and organization needed • Can prevent behavior difficulties • Aid in teaching skills/ facilitate learning • More easily understood by individuals with communication problems • Think of visual input and instruction as the “first language” of students with autism spectrum disorders • Allows the student to review information more than once

35. Examples of visual supports • Daily schedules- words/ pictures or combination of both • T-chart depicting contrasting information (e.g., kind/ unkind words”) • Cue card with “reminders” or classroom expectations

39. Impairment in Social Interaction • Demonstrate an inability to understand complex rules of social interaction • Talk at people instead of them • Do not understand jokes, irony, or metaphors • Poor ability to initiate and sustain conversation • Display potentially “challenging” behavior to escape uncomfortable/ difficult situations

40. Impairment in Social Interaction • Need to be taught how to react to social cues and be given repertoires of responses to use in various social situations (teach them what to say and how to say it) • Explain to them when they have been unintentionally insulting, tactless, or insensitive

41. Teaching Social Skills • We have to plan instruction for social skills just like we do other skills such as reading, math, and writing

42. Evidence based strategies for social skills instruction • Social stories • Video modeling • Role playing/ Modeling • Skills Streaming (more formal programs) • Self-monitoring checklists

43. General tips • Model two way interactions and let them role play • Encourage active socialization • Behavior specific praise • Limit time spent in isolated interests

44. Social Stories • Social stories are brief, individualized short stories that describe a social situation and provide a specific behavioral response (e.g., appropriate social responses within defined context) • Provide instruction regarding the who, what, when, where, and why of a social situation

45. Social stories: • Help ensure child’s accurate understanding of social information for a given setting and provide a “how-to” instruction for initiating, responding to, and maintaining appropriate social interactions

46. Social Stories: • Help individuals: • Adjust to changes • Adapt behavior based on social cues • Learn specific skills

47. Social Story example • Angelo: Joining in a Game I like playing with other kids at recess. The most fun times I have are when I join kids who are already playing soccer on the playground. I do this by asking in a nice, gentle voice “Can I play with you?” If they say yes, then I ask “Show me how to play.” When I join other kids who are playing, I really feel like I have friends and that I belong to the group.” (Adapted from Matson et al., 2006).

48. Writing a social story • Descriptive sentences • Perspective sentences • Directive sentences

49. A word about reinforcement • Reinforcer is any consequence that follows a behavior that makes the behavior MORE likely to occur in the future • Everyone has their own set of reinforcers

50. Reinforcement • A situation or event that follows a behavior and makes it more likely that the behavior will occur in the future • Reinforcement is essential to acquiring new skills • Reinforcement is required to maintain behavior • Sometimes avoidance of the activity is more reinforcing than participating in the activity