Understanding Autism

Understanding Autism April is Autism Awareness Month Rey Vera

I am first and foremost a person • I have Autism, I am not primarily Autistic. • People first language

Background • The CDC defines Autism Spectrum Disorders (ASDs) as a group of developmental disabilities defined by significant impairments in social interaction and communication and the presence of unusual behaviors and interests. Many people with ASDs also have unusual ways of learning, paying attention, or reacting to different sensations. The thinking and learning abilities of people with ASDs can vary – from gifted to severely challenged. ASD begins before the age of 3 and lasts throughout a person's life. It occurs in all racial, ethnic, and socioeconomic groups and is four times more likely to occur in boys than girls.

Background • ASD’s include: • Autistic disorder • Pervasive developmental disorder-not otherwise specified-not otherwise specified (PDD-NOS) including atypical autism) • Asperger’s Syndrome • Rett Syndrome • Childhood Disintegrative Disorder (CDD)

Autistic Disorder • A complex neurobiological disorder that typically lasts throughout a person's lifetime. Autism impairs a person's ability to communicate and relate to others. It is also associated with rigid routines and repetitive behaviors, such as obsessively arranging objects or following very specific routines. Symptoms can range from very mild to quite severe.

Asperger’s Syndrome • A developmental disorder on the autism spectrum defined by impairments in communication and social development, and by narrow interests and repetitive behaviors. Unlike individuals with typical autism, individuals with Asperger's Syndrome have no significant delay in language or cognitive development.

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) • PDD; A group of disorders characterized by delays in the development of socialization and communication skills. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings; and repetitive body movements or behavior patterns. Autism is the most characteristic and best studied PDD; other types include Asperger's Syndrome (AS), Childhood Disintegrative Disorder (CDD), Rett's Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).

Rett Syndrome • is a childhood neurodevelopmental disorder characterized by normal early development followed by loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, gait abnormalities, seizures, and mental retardation. It affects females almost exclusively. Individuals with Rett Syndrome often exhibit autistic-like behaviors.

Childhood Disintegrative Disorder (CDD) • A fairly rare condition occurring in 3 to 4 year olds who, having developed normally until age 2, experience a marked deterioration in intellectual, social, and language functioning. Children with CDD come to resemble children with autism, but only after a relatively prolonged period of normal development.

A child or adult with an ASD might: • not play “pretend” games (pretend to “feed” a doll) • not point at objects to show interest (point at an airplane flying over) • not look at objects when another person points at them • have trouble relating to others or not have an interest in other people at all • avoid eye contact and want to be alone • have trouble understanding other people’s feelings or talking about their own feelings • prefer not to be held or cuddled or might cuddle only when they want to • appear to be unaware when other people talk to them but respond to other sounds

A child or adult with an ASD might: • be very interested in people, but not know how to talk, play, or relate to them • repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language (echolalia) • have trouble expressing their needs using typical words or motions • repeat actions over and over again • have trouble adapting when a routine changes • have unusual reactions to the way things smell, taste, look, feel, or sound • lose skills they once had (for instance, stop saying words they were using)

Autism Rates in Maryland • In an average week 1429 babies are born in MD, 8.6 will be diagnosed with Autism. • In MD, children with Autism are increasing by 18% a year. • There are 7510 students with Autism in MD schools. • In Baltimore County 1 of every 98 kids has Autism. • In Baltimore City 1 of every 187 kids has Autism. • Information from Baltimore - Chesapeake Chapter Autism Society of America

Part 2-Education & ASD • Intensive intervention can have such a huge impact on the symptoms of the disorder, it makes the quality of the intervention for children with autism of the utmost importance. • ASDs are unique when compared to other developmental disorders in that early intervention= reduction in deficits.

History of Education & ASD • The Individuals with Disabilities Education Act (IDEA) (20 USCS 1400 et seq.) requires states to provide children with disabilities with a "free appropriate public education," which is defined in 20 USCS 1401(a)(18) as special education and related services that • (1) have been provided at public expense, under public supervision and direction, and without charge;

History of Education & ASD • (2) meet the standards of the state educational agency; • (3) include an appropriate preschool, elementary, or secondary school education in the state involved; and • (4) are provided in conformity with an individualized education program (IEP).

F.A.P.E. • Specifically designed instruction, at no cost to parents and guardians, to meet the unique needs of a child with a disability. • What is the definition of appropriate? • Suitable for the occasion or circumstances. • This is a big grey area that often leads to discrepancies between parents and school districts

F.A.P.E • BOARD OF EDUCATION OF THE HENDRICK HUDSON CENTRAL SCHOOL DISTRICT v. ROWLEY • IDEA provides reasonable services that enable a student to receive educational benefit. • Student was provided with services that enabled her to receive such benefits under the law. • Rowley gave parameters regarding “appropriate” as not being the absolute best/ most expensive. • Families are not satisfied with the programming their child with Autism is receiving. • Parents and LSS’ have different viewpoints about what FAPE is.

F.A.P.E and Education of Students with ASD • F.A.P.E has lead many public schools to develop special education programming that focuses on the education of students with ASD. • Local special education school programs allow school districts to keep their students in district rather than pay tuition to a school that specializes in the education of students with ASD.

FAPE and Education of Students with ASD • Issues can range from: • Reimbursement costs of speech/language and occupational therapy services • Continuation of services from IFSP to IEP • Funding of private (or non public) schools vs. leaving a student in a public school • Districts failing to implement an IEP • More services

Common Types of Treatments • Discrete Trial Therapy (DTT) • TEACCH • Picture Exchange Communication System (PECS) • Floor Time

Lovaas Therapy(UCLA, Dr. IvarLovaas) • Follows principles of applied behavior analysis (ABA) and uses child specific reinforcement to increase the likelihood of student success. • Follows 1:1 (teacher:student) instruction format. (most often beginning in the home with early intervention). • Skills are taught using discrete trial techniques paired with positive reinforcement. Once the skills are mastered, they are generalized to other settings. • Very formalized • Individualized for each student according to the student’s needs. Uses prompting, fading and shaping procedures.

T.E.A.C.C.H.(UNC Chapel Hill)“Treatment and Education of Autistic and related Communication Handicapped Children” • The main objective of TEACCH is to enable students to function as “meaningfully and as independently” as possible in the community. • Format is often one teacher leading more than one student, but it can be 1:1 (teacher: student) structure depending on the independence level of the students). • Skills are taught through the use of personal schedules, small group instruction and work systems, all of which are designed to improve visual clarity and organization for the student. • Individualized for each student according to the students needs. • Uses structure , routines, and organization to teach skills.

Picture Exchange Communication System (PECS) • Uses aided symbols (illustrations or photographs) to teach a student to exchange for a desired item or activity • Once the person can initiate the exchange with a wide variety of people and settings, the system is expanded to teach additional communicative functions such as labeling and information gathering. • 6 Phases of PECS

Floor time (Stanley Greenspan) • Follows the child’s lead with toys and activities. • Adults are persistent in the pursuit of joint attention. • Treats behaviors as intentional and purposeful. • Help the child do what they want to do. • Adults position themselves in front of children. • Join in perseverative play. • Expand, expand, expand – keep activity going, play dumb, do wrong moves.

Part 3- Education, Administration & ASD • As an administrator or supervisor what components would you look for in a typical classroom? • What components would you look for in a special education classroom? • What components would you look for in a self contained special education classroom? • Video

Reflection • Many students with Autism have difficulties understanding verbal direction and verbal language in general. • Too much ineffective prompting can make students feel the same way as the person in this game. • These are points an administrator needs to be aware of when they have a classroom with students with autism.

Sources • CDC • http://www.bcc-asa.org • Ten Things Every Child with Autism Wishes You Knew by Ellen Ntbohm

Understanding Autism