Autism Spectrum Disorders: A Very Brief Introduction

1. Autism Spectrum Disorders:A Very Brief Introduction Nancy N. McLean Special Services Buncombe County Schools

2. “ There is no better training program than helping people step into the shoes of our clients and see the world through their eyes.” - Dr. Ami Klin, Yale Child Study Center

3. Autism Spectrum Disorders • I. Overview • II. Characteristics • III. Structuring for Success • IV. Dealing with Problem Behaviors

4. Autism is considered a spectrum of disorders that share many characteristics – (called Pervasive Developmental Disorders in DSM-IV). • Autism • Asperger’s Syndrome • PDD/NOS • Rett’s Syndrome • Childhood Disintegrative Syndrome DSM V is likely to call these all “Autism Spectrum Disorders”

5. Autism spectrum disorders are caused by neurological differences. • Notdue to parenting styles or “cold & distant mother” • Genetic component -often more than one family member is affected • Likely no single genetic cause, more than one gene may be involved • People with ASDs can learn, but their basic neurology does not change.

6. Research is now investigating metabolic imbalances and reactions to immunization, HOWEVER: • There is no credible scientific evidence that immunizations cause or trigger autism. • There is no credible scientific evidence that special diets can cure or lessen the effects of autism.

7. Autism on the Increase • Nationally, increase ~ 3x in last 10 yrs • CDC: Incidence of 1 in 150 • 3x more common in males • Some possible causes: broader criteria for DX, more awareness • American Academy of Pediatrics now recommends screening all children at 18 & 24 mos.

8. If you know one person with autism, you don’t know them all. • They may have different combinations of characteristics. • They may have the same characteristics, but in different degrees.

9. Clinical Diagnosis vs. School Identification • Clinical diagnosis made by physician or clinical psychologist according to DSM-IV and may be autism, Asperger’s Syndrome, PDD/NOS. • School identification of Autistic made by IEP Team based on eligibility criteria set by DPI. • Clinical diagnosis does not ensure school identification for special ed. under IDEA.

10. Social interaction differences Communication differences Unusual behaviors / interests Sensory Differences Need for structure, rules, & predictability Motor differences Attention differences Cognitive style differences II. Characteristics of Autism Spectrum Disorders

11. The core issue: “theory of mind” Sharing attention/perspective with others Reading and understanding others’ verbal & nonverbal cues Figuring out those unwritten “rules” May not want interaction, may want it but not know how Aloof, passive, active/odd Eye contact Social Interaction Differences

12. Communication Differences • Nonverbal • Verbal

13. Communication Differences (Nonverbal) • Expressing oneself in nonverbal ways • Interpreting nonverbal expression of others

14. Communication Differences (Verbal): Receptive difficulty • Understanding is literal & concrete, difficulty dealing with ambiguity • Understanding of idiom • Difficulty processing large amounts of language

15. Communication Differences (Verbal): Expressive Difficulty • Tone, pitch, precision • Register: adjustment to social situation • Pragmatics (practical, social use of language) • Tangential and circumstantial speech

17. Unusual object use Repetitive behaviors, compulsions Restricted interests, obsessions Unusual Behaviors / Interests

18. Sensory Differences • Any sense or combinations • Oversensitive or undersensitive • Can be both

19. Need for Structure & Predictability • Change or ambiguity are very difficult! • Rules are carved in stone! • When things become too unpredictable or don’t follow what the child is expecting, high anxiety and possible meltdowns follow.

20. Motor Differences • Gross motor (clumsiness) • Fine motor & handwriting

21. Attention Differences • Often first diagnosis is ADD or ADD/H • Can be overfocused or underfocused • Often short attention span except for special interests

22. Cognitive Style Differences I • Variable intelligence - anywhere from brilliant to mentally handicapped and anywhere in between • Within an individual, uneven development, pronounced highs and lows • Difficulty selecting what is relevant

23. Compare these cognitive style characteristics to what the NC Standard Course of Study requires! Cognitive Style Differences II • Concrete rather than abstract • Visual rather than verbal • Inflexible rather than flexible

24. Autism as another culture: • Beamed down alone to another planet • What are the rules here? • Survival & success depend on knowing the culture. • Needed: a guide and interpreter

25. Providing Predictability Reducing Frustration Instructional Practices Explicit Teaching of Social Skills Parent - School communication III. Structuring for Success: Proactive Measures

26. Daily written or picture schedule The scheduleis the routine. Activity checklists Providing Predictability (I) SCHEDULE Hang upcoat Sharpen pencil Daily oral language Number of the day BREAK

27. Advance warning of changes Limited, structured choices Left-right progression, start/finish boxes Providing Predictability (II)

28. Building in breaks/downtime Providing a quiet area (relaxing, not punishment) Use of music or repetitive/preferred activities Reducing Frustration (I) SCHEDULE Hang up coat Sharpen pencil Daily oral language Number of the day BREAK

29. Be positive. Use short simple sentences. Watch to catch things before they get out of hand. Watch for sensory overload. Look at alternatives to stressful activities. Reducing Frustration (II)

30. VISUAL, concrete presentation of information (graphic organizers, thinking maps) Repetitive formats, formulas for some tasks Limit amount of new information at a time Instructional Practices (I)

31. Use interests & enthusiasms. Preteach concepts and vocabulary. Gradually reduce prompts/structures to increase independence. Look at long-term needs of student. Instructional Practices (II)

32. Structured pair-ups (buddies) Teach the other children about autism so they will understand this child. New skills in known situations, known skills in new situations Teach Social Skills Explicitly

33. Social Stories & comic book conversations(Carol Gray) Superflex Curriculum (Stephanie Madrigal and Michelle Garcia Winner ) Mind the Gap Teach Social Skills Explicitly

34. 2-5 of these: Descriptive sentences state a simple fact - “My name is...” Perspective sentences refer to thoughts, feelings, opinions, health - “People like it when I smell good.” Affirmative sentences stress important points, refer to a law or rule - “I will try to keep my seat belt fastened. This is very important.” 0-1 of these: Directive sentences identify a suggested response or choice of responses - “I will try to stay in my chair.” Social Stories give accurate information (missing link) about social situations.

35. Social Detective and Superflex Curriculum • Behavior is “expected” or “unexpected.” • Expected behavior causes others to have good/comfortable thoughts about you • Unexpected behavior causes others to have negative/uncomfortable thoughts about you • Superhero “Superflex” helps keep the Team of Unthinkables (Rock Brain, Glassman, etc.) from taking over your brain - comic book characters appealing to kids

36. Identify the behaviors to address Identify child’s internal signs Make 3 lists with the child: behaviors, signs, positive alternatives Draw map with 2 destinations & attach lists, use child’s interests to name destinations “Mind the Gap” (as described in Catherine Faherty’s book) Negative Behaviors Positive Alternatives The Gap Signs

37. Notebook Checklist Phone Keep Close Communication with Parents

38. Questions to ask yourself Developing a plan Redirection vs. confrontation Removal to quiet area IV. Dealing with Problem Behaviors

39. What is the function of the behavior? Why is it happening NOW? How much of it can the student control? How else can this function be satisfied? Questions to Ask Yourself

40. Based on answers to questions from last slide What will we do if? What do we need? Use team approach! Developing a Plan

41. Be matter of fact. Use short sentences. Write or draw rather than talk. Limit touch and talk. Confrontation will likely escalate behavior. Redirection vs.Confrontation

42. Within room or outside of room Not a punishment, but a calming time. This is not “giving in!” Removal to Quiet Areas

43. Points to Remember • Each child is different, and changes. • Analyze the problem, then apply your knowledge of autism and of that child to plan solutions. • Go for prevention first! • Use a team approach. • Be flexible enough for both of you. • Constantly reevaluate & adjust your approach.

44. Resources • TEACCH (www.teacch.com) • OASIS (Online Asperger Syndrome Information and Support) (www.udel.edu./bkirby/asperger) • Future Horizons, Inc (www.FutureHorizons-autism.com) publishes & sells books on autism • Asperger’s Syndrome by Tony Attwood and www.tonyattwood.com • Asperger’s Syndrome: What Does It Mean to Me? By Catherine Faherty

45. Resources, ctd. • Asperger Syndrome & Difficult Moments: Practical Solutions for Tantrums, Rage, & Meltdowns by Brenda Smith Myles & Jack Southwick • Thinking in Pictures by Temple Grandin and www.templegrandin.com • The New Social Stories Book by Carol Gray and www.thegraycenter.org • Navigating the Social World: A Curriculum for Individuals with Asperger’s Syndrome, High Functioning Autism, and Other Disorders by Jeannie McAfee • www.socialthinking.com (Superflex & Social Detective programs)

46. Thank you.