Learners with Autism Spectrum Disorders

1. Learners with Autism Spectrum Disorders By: Drew Burns and Barb Marko

2. What is Autism Spectrum Disorder? • It's own category ever since the Individuals with Disabilities Education Act (1990) • A group of developmental brain disorders, five similar conditions • collectively they are referred to as being on a "spectrum" • the term refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have • Autism • Asperger Syndrome • pervasive developmental disorder not otherwise specified (PDD-NOS) • Rett's Disorder • Childhood disintegrative disorder (CDD) (According to National Institute of Mental Health)

3. Autism Spectrum Disorders Cont. • The American Psychiatric Association (APA) has been working on modifying this definition • expects to publish a revised Diagnostic and Statistical Manual (DSM-V) in 2013

4. The Definition of ASD's According to the DSM-V workgroup Autism- extreme social withdrawal and impairment in communication; often includes stereotyped movements: resistance to change, and unusual responses to sensory experiences; usually manifest before age 3 Asperger Syndrome- very similar to Autism, but without significant impairments in cognition and language

5. Definition of ASD's Cont. • Childhood disintegrative disorder: normal development for at least 2 and up to 10 years, followed by significant loss of skills; more prevalent in males • Pervasive developmental disorder not otherwise specified (PDD-NOS)- persons who display behaviors typical of autism but to a lesser degree; onset later than 3 years old

6. Def. of ASD cont. • Rett Syndrome- mostly affects girls; develop normally for 6-18 months before regression and autism-like symptoms begin; difficulties with coordination, movement, and speech; no specific treatment is available yet

7. Historical Context • the study of autism began with two scientific papers- Kanner's and Asperger's • Kanner's Paper by Theo Kanner- In his time, the term autistic meant "individuals who had extreme narrow range of personal relationships and restricted interactions with their environment" • reported on the cases of 11 children from the Child Psychiatric Unit at Johns Hopkins University

8. Kanner's Paper cont. These are some of the observations that he observed: • an inability to relate to others in an ordinary manner • extreme autistic aloneness that isolated the child from the outside world • apparent resistance to being picked up or held by parents • deficits in language • obssevive desire for repetition and sameness • bizzare repetitive phyiscal movement

9. Kanner's Conclusion • These children could be distinguished from children that had schizophrenia • 3 reasons • Schizophrenia children tended to withdraw from the world; children with autism never made a connection to begin with • Children with autism exhibited unique language patterns • Reveral of pronouns • Echolalia • They seemed to not detoriate in their functioning over time

10. Asperger's Paper • Hans Asperger • reported on four cases of children in a summer camp • they preferred to play alone • They were similar to Kanner's cases, but had notable exceptions • they had average intelligences; focused intellectual pursuits on a preoccupation in narrow areas; machinery or mathematics • Thier language was perceived as normal • His work would lead to condiition being recognized later in time

11. Prevalence

12. Prevalence cont. • in the 1960's, the rate was at about 0.04% (1 out of 2,500) • stayed the same until the 2000 surveys • the prevalence rate increased to 1 in 333 • The U.S. centers for disease control: 1 in 110 • saw a 57% increase from just 2002 to 2006 • 4 times higher in boys than girls; higher in European Americans than it is for Latinos or African Americans

13. Why this increase? there are two groups/ Scientific camps • First group believes that there hasn't been increase in the number of true cases; argue increases in three factors • a widening criteria • greater awareness by the general public • "Diagnostic Substitution" • Second group believes that the first group is right but not entirely; unknown factors

14. Causes of ASD • the early theories • Hans Asperger and Theo Kanner: biological, but Kanner thought there was something to say about the parents role (they were the leading cause of their child's autism; mothers especially • refrigerator moms- Bruno Bettelheim Today's theories • Scientists don't know what's wrong with the brain, but believe the cause is neurological, and not interpersonal

15. Neurological Causes • many areas of the brain are affected • a disorder of neuronal networks; not an abnormality in one specific part of the brain • Brain cells exhibit deficient connectivity, disrupts the cell's ability to communicate with each other • increasing head size; mostly during the first two years of life; neurodevelopment stage • language, capacity for inference, sense of self awareness, complex processing

16. Neurological Cont. • Brain growth; possibly linked to the elevated levels of growth hormones • androgen- found in the amniotic fluid before birth • Extreme Male Brain (EMB) • researchers are skeptical

17. Genetic Causes • Hereditary link • if child is diagnosed, the younger sibling has a 15% chance of being diagnosed • Monozygotic vs dizygotic • family members • Gene Mutations • more research needs to be conducted

18. Identification • Diagnosis is made by a psychiatrist • established by the APA • they must meet the following criteria: • Clinically significant, persistent deficits in social communication and interactions, as manifested by the following: • Marked deficits in nonverbal and verbal communication used for social interaction; • Lack of social reciprocity [give and take]

19. Id Cont. • Failure to develop and maintain peer relationships appropriate to developmental level • Restricted, repetitive patterns of behavior, interests, and activities, manifested by at TWO of the following: • Stereotyped motor or verbal behaviors, or unusual sensory behaviors • Excessive adherence to routines and ritualized patterns of behavior • Restricted, fixated interests

20. Cont. • Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) (APA:DSM-V Development, 2010). • Two standardized test • Autism Diagnostic Observation Schedule • Autism Diagnostic Interview-Revised

21. Early signs of ASD Autism- begins at 3 years and sometimes earlier, autistic regression Asperger syndrome- takes longer because the symptoms don't appear as severe Parents can see a difference, usually after 3 years old 6 months: no big smiles other joyful expressions 9 months: no back-and-forth sharing of sounds, smiles, or other facial expressions

22. Early Signs Cont. 12 months old: • no consistent response to own name • no babbling • no back-and-forth gestures; pointing, showing, reaching, waving, or three pronged gaze 16 months old: • No words 24 months old: • No two-word meaningful phrases Any loss of speech or babbling or social skills at any age

23. Psychological/ Behavioral Char. • impaired Social Interaction • deficits in social responsiveness • Asperger Syn.: They can't read social cues. H.C. • Impaired communication • 50% are thought to be mute • if they develop speech, they show abnormalities • volume, rate , content- pragmatics • robotic • echolaia- parroting what they hear • joint attention • Repetitive behavior • ritualistic motor behaviors

24. cont. • extreme fascination with objects • upset if the environment is changed • want sameness, same routine • impaired cognition • difficulty coding and categorization • example of shopping • excel at activities like puzzles • Autistic Savants- remarkable talent- playing music,drawing, calculating,etc. • react poorly to verbal comprehension and expressive language • Abnormal Sensory perceptions • hypersensitivity - lights, sounds

25. Construct Unifying theory of ASD's • Three theories • Executive function • working memory, self-regulation of emotions, plan ahead • central coherence • get caught up in the details • Theory of mind • ability to know what others are thinking • intentions • feelings • beliefs • desires

26. Autism Speaks: Videos http://autismspeaks.player.abacast.com/asdvideoglossary-0.1/player/autismspeaks

27. Educational Considerations • No set treatment • Experimental treatment • However educational programs should include • Direct Instruction • Instruction in natural settings • Behavioral management

28. Educational Considerations: Direct Instruction • APA - Applied Behavior Analysis • Highly structured approach that focuses on teaching functional skills and continuous assessment of progress • Developed in the 1960's • Emphasizes the positive desired behaviors • Do not use punishment as a way to teach ASD children right from wrong

29. Educational Considerations: Instruction in a Natural Setting • It is important to have the ASD students in a normal setting where students without ASD or a disability learn • Keeping them in the general ed classroom with guided instruction may be better than complete isolation

30. Educational Considerations: Behavioral Management • Two forms of treatment of behavior • Functional Behavior Assessment (FBA) • Determine: Consequences, Antecedents, and Setting Events • AKA --- A-B-C Approach --- (App) • Antecedents - tired, sick, lack of structure, too long waiting time, not getting attention • Behavior - type and degree of aggression • Consequences - result of behavior - child punished, ignored, what were the reactions of other students • Positive Behavior Intervention and Support (PBIS) • Focuses on supporting the positive behaviors rather than punishing the negative

31. Educational Considerations: Examples of Educational Programs • Picture Exchange Communication System (PECS) • Use pictures to help student initiate and maintain functional communication without being verbal • Social Stories • Used for students who may be able to verbally communicate but do not understand or interpret social cues • Teachers use real life learning situations to teach students the proper way to act or react in the form of a narrative

32. Educational Considerations: Examples of Educational Programs • Pivotal Response Teaching (PRT) • Based on the assumption that some skills are critical/pivotal for function in other areas • Emphasizes using ABA's (direct instruction) structured approach of continuous assessment and reliance on behavior learning theory • Four Areas 1. Motivation - natural rewards of child's choosing 2. Self-Management - leads to autonomy and independence from control of others 3. Initiations - Asking questions, start conversations 4. Responding to multiple cues - i.e. going to grab a green shirt

33. Assessment of Progress 1. Language Development • Natural language samples collected in various communicative contexts • Parent report via questionnaire or interviews • Direct assessment through structured measures

34. Language Development Assessment • MacArthur-Bates Communicative Development Inventory Second Edition (CDI-II) • Works for kids eight to thirty months • The CDI-III works with kids up to 37 months • Monitors progress of language development • Clinical Evaluation of Language Fundamentals-4 (CELF-4) • Works for kids 5 to 21 • Measures receptive, expressive, grammatical, and semantic skills

35. Assessment of Progress Continued 2. Social/Adaptive Behavior • Maladaptive behaviors assessed • Sensory/perceptual approach behaviors • Ritualisms/resistance to change • Social pragmatic problems • Semantic/pragmatic problems • Arousal regulation problems • Specific fears • Aggressiveness • Adaptive behaviors assessed • Receptive social communication abilities • Expressive social communication abilities

36. Social/Adaptive Behavior Assessment • Social Responsiveness Scale (SRS) • Used for ages 4 to 18 • Monitors progress in: • Social awareness, Social Information Processing, Reciprocal social communication, Social anxiety, and Avoidance • Autism Social Skills Profile (ASSP) • Used to assess social skills of children with ASD such as Social Reciprocity, Social Participation/Avoidance, and Detrimental Social Behaviors • Childhood Autism Rating Scale (CARS) • Used for ages above 2 • Mainly used for screening and diagnostic purposes • Focuses on behaviors that deviate from normal development

37. Early Intervention • Most programs focus on severe ASD for early intervention • No intervention program has been proven to help overcome childrens ASD

38. National Research Council (NRC) on successful programs • Entry into intervention programs as soon as an autism diagnosis has been established • Active engagement for a full day, five days a week, for a whole year • One on one teacher-student interactions - small group work • Parent involvement • Low student-teacher ratio (1:2) • Assessment and adjustment • Early Intensive Behavioral Interventions (EIBI)

39. Transition to Adulthood • Autism: • Majority do not live independently • Depends on level of cognitive functioning • Person-centered planning • Make own decisions • Small residential facilities • Supported living • Competitive and Supportive Competitive Employment

40. Transition to Adulthood • Asperger's: • Focuses on social interaction skills • Peer Connections • Focus on the minimum survival skills needed for independence • Misunderstood - difficulties adjusting to jobs

41. Success Story • Temple Grandin • Born August 29, 1947 • High-functioning Autism • Diagnosed with autism at age 4 • Early intervention • American Doctor of Animal Science • Professor at Colorado State University • Advocate for Autism • Never been married "the part of other people that has emotional relationships is not part of me”

42. Awareness Clips of show Parenthood on NBC http://movies.netflix.com/WiPlayer?movieid=70157304&trkid=3325853 Season One: Pilot 17:20 and 34:00 Season Two: Episode 18 35:49 Autism Speaks website http://www.autismspeaks.org/

43. Resources • Temple Grandin http://en.wikipedia.org/wiki/Temple_Grandin • Textbook: • Hallahan, Daniel P., James M. Kauffman, and Paige C. Pullen. "Chapter 9: Learners with Autism Spectrum Disorders." Exceptional Learners: An Introduction to Special Education. 12th ed. Upper Saddle River: Pearson Education, 2012. 232-63. Print. • Netflix • Autism Speaks http://www.autismspeaks.org