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Autism Spectrum Disorders: Presentation During School Years. Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu. Overview. Social and adaptive behaviors Play Communication Behavioral and Emotional Issues
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Autism Spectrum Disorders: Presentation During School Years Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu
Overview • Social and adaptive behaviors • Play • Communication • Behavioral and Emotional Issues • Adjustment and Achievement • Outcome
Social behaviors: Aloof • Classically autistic • Avoid contact and interaction, unresponsive • Stereotypic, self-injurious behaviors • Pattern most common in preschool, but can be seen in older childen • Those who persist in this pattern often have MR
Video Sample: Aloof • JC, MK
Social behaviors: Passive • Accept but do not seek interactions • Generally higher developmentally than aloof • Children who start out aloof may move to passive
Video sample: Passive • Karin 14:00 • Hadia
Social behaviors: Active-but-odd • Usually HFA or AS • May have considerable language skills, interested in communicating but use • Repetitive questions • Inappropriate touch • Odd postures, gestures, facial expressions • Conversations on narrow interests • Literal and concrete • Little awareness of others’ thoughts, feelings, motives • Aware of differences • May regress under stress to tantrums
Adaptive Skills • Deficits not attributable to IQ • Related to verbal skills and autistic symptom level • Typically significant discrepancy between measures of adaptive skills and developmental level in ASD; adaptive skills are lower than IQ. • Should be targeted in educational programs
Play • Pretend play is often lacking or delayed • Play may be rigid, repetitive • Games with rules may be rigidly adhered to • Motor skills may interfere with team game participation • Can be enhanced by allowing active role in choosing games, toy, themes
Communication • Presence of speech before age 6 is indicator of better prognosis • Echolalia may be first step toward speech, • usually decreases as language skills increase • Serves communicative functions • Language skills in children who speak are generally on par with mental age • Conversational skills are major area of deficit throughout school years
Behavior and Emotion • Unusual inappropriate excessive or inadequate responses • Appear to lack empathy • High levels of anxiety; may lead to maladaptive behavior • High levels of attention problems, hyperactivity, impulsivity; similar to ADHD • Hyperactivity decreases w/ age • Attention problems do no
Stereotypic Behaviors • Seen in other disorders, but more prevalent in ASD • more frequent in lower functioning individuals, but can be seen in HFA • May progress from repetitive sensory motor activities to those more like OCD in higher functioning individuals • Both drug and behavioral treatments are helpful
Adjustment and Achievement • Social disabilities, rigid cognitive style, anxiety, attention problems affect academic achievement even for most intelligent • Difficulty w/ executive functioning interferes with school success • Generally, children with autism have weaker verbal than non-verbal skills; may need visual (picture) supports • AS shows strong verbal skills, benefit from written supports • Individual assessment needed to identify academic strengths, weaknesses • Reading and/or math may be precocious in HFA/AS • Hyperlexia is common in ASD (20-25%)
Adolescence • Generally, improvement is seen in adolescence • Reduction in symptoms • Increase in social and communicative skills • 10-20% show deterioration in adolescence • 25% show onset of seizures in adolescence • Mood disorders may appear • Difficult behaviors may remain, including • Resistance to change • Unacceptable sexual behavior • Tantrums • Aggression • Self-injury
Outcomes • Best seen in those with IQ>50, language use by age 6 • Many have difficulty with independent living and most continue to live with parents into adulthood • Residential support programs for adults are emerging • Only about 10% of people with ASD attend or graduate from college • Supported employment provided for those with MR; less often for those w/ HFA/AS • High rates or depression and anxiety in adults • Education has a great effect on outcome!
