Autism Spectrum Disorder

1. Autism Spectrum Disorder NikiFanjul and James Aldred

2. Definition of Autism • Autism = “Living self” in Greek. • IDEA 04 definition: • Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change in daily routines, and unusual responses to sensory experiences. • Autism is one of 5 disorders part of Autism Spectrum Disorder (ASD). • Mild functioning form Severe functioning form

3. Why is it a spectrum disorder? • Autism spectrum disorders (ASD) / Pervasive developmental disorders = 5 specific disorders • Autistic disorder (autism) • Asperger syndrome (Asperger disorder) • Rett syndrome (Rett disorder) • Childhood disintegrative disorder • Pervasive developmental disorders not otherwise specified (PDD-NOS) • It is a spectrum disorder which means it can occur in a mild or high functioning form. E.g.: subtle to severe. • Point to note: This has potentially affected the increased prevalence in the diagnosis of Autism

4. Prevalence of Autism • U.S. Centers for Disease Control and Prevention (CDC) – 2009 • 1 % of the population, 1/110 children of 8 years of age (2006) • Is differentiated for boys and girls plus those from ethnically diverse backgrounds • Prevalence in boys was found to be 4.5 times higher in males than females. The report states one in 70 boys and one in 315 females have autism.  • Increases in prevalence among minority population were significant, with a 91 percent increase in Hispanic children (with 144 percent increase in Arizona contributing to this) and 41 percent in black non-Hispanic. There was a 55 percent increase in White non-Hispanic.

5. Prevalence of Autism • “Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US,” (2009) conducted by the Department of Health and Human Services National Survey of Children’s Health,used data from the Centers for Disease Control and Prevention. • The report was conducted via a telephone survey of over 78,000 parents, and determined a point prevalence of 110 per 10,000 respondents, roughly 1 percent of the population of children in the United States.

6. Prevalence of Autism, International perspective, UK • 2009: Professor Simon Baron-Cohen of the Autism Research Centre at Cambridge University, found that for every three diagnosed cases of autism, there are two that are not diagnosed – meaning the true prevalence in the U.K. could be as high as 1 in 64.

7. Critical eye • Critical eye: • Variations in study methods could have impact the prevalence figures. • Study by Department of Health and Human Services National Survey of Children’s Health, was a telephone based study. • - Issues of gathering an accurate depiction of the targeted respondents. • Cambridge University study, was a school based study with far greater attention to detail: • - Researchers sent diagnostic surveys to the parents of 11,700 children ages 5-9 in participating schools. Based on the scores, children were brought in for further assessment, with researchers finding a number of undiagnosed cases.

8. Etiology/Causes • There is no specific causal factor • Despite research proving inconclusive, numerous causes have been hypothesized. • Speculative theories: • Lack of warm heartedness in the family – ‘refrigerator mom’ • Common childhood vaccine- measles virus causes a bowel inflammation =toxins to leak into the brain • Preservative thimerosal – another vaccine which contains mercury (a nerve-cell poison) • -------Thought to be neurological or brain based----– • Brain and Autism: • Autism has been linked to abnormalities in the brain’s structure or how the brain functions.

9. The brain and autism • Children with autism have larger heads that individuals who do not have autism (10% larger)- reasoning ‘growth dysregulation hypothesis caused by genetic brain growth factors. • Areas of the brain targeted by research as being associated with autism are: • Limbic system –emotion, memories • Cerebellum – regulating attention and motor and behavior initiation.

10. The brain and autism • Twin studies associated with genetic causes of brain abnormalities • Identical twins- identical twin of an individual with autism = 60% chance of also having autism. • Only 5% for fraternal twins. • Family with a child with autism = much higher percentage of having another child with autism (1 of 20). • Specificity to certain genes – hard to pinpoint – likely multiple gene abnormalities

11. Non genetic causes of Autism/ environmental factors • As a development disorder it has been reasoned that autism must have a ‘trigger’ that results in some children having the disorder. • Seems likely environmental factors coupled with genetic susceptibility could equate to a child developing autistic characteristics. • Again no definitive set of environmental factors have been identified. Poor parenting could be a trigger as well as problems during pregnancy, viral infections and even seizures at infancy.

12. Assessment and diagnosis • Autism is primarily diagnosed using the DSM-IV-TE: • 1. Qualitative impairment in social interaction, as manifested by at least two of the following: • (a) Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction • (b) Failure to develop peer relationships appropriate to developmental level • (c) A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) • (d) Lack of social or emotional reciprocity • 2. Qualitative impairments in communication, as manifested by at least one of the following: • (a) Delay in or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) • (b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • (c) Stereotyped and repetitive use of language or idiosyncratic language • (d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

13. Assessment and diagnosis • 3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following: • (a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • (b) Apparently inflexible adherence to specific, nonfunctional routines or rituals • (c) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements) • (d) Persistent preoccupation with parts of objects • Total of 6 or more items from 1,2,3 with at least 2 from 1. And one each from 2. and 3.

14. Assessment and diagnosis • There is no medical test for Autism Spectrum Disorders, meaning a heavy reliance on qualitative observations as well as parental interviews, developmental histories and speech and language assessments. • The nature of Autism spectrum disorders requires a multidisciplinary evaluation of identification involving the child’s parents, psychologists and medical personnel if needed. • N.B: Children with autism may also have another developmental disability or mental health problem

15. Assessment and diagnosis • - Early screening is dependent on the child and parental awareness of their child’s behavior patterns. • Signs of autism in infants include nonspecific characteristics in infants such as hyperactivity, lack of initiative, sleep and feeding problems. • Key point: For the adults to document the age at which these characteristics are evident • Both formal and informal screening instruments can be used to help identify a child who may have Autism.

16. Assessment and diagnosis • One example: • The Childhood Autism Rating Scale • Ages 2 and upwards. The diagnostic areas are all related to Autisms main characteristics of problems socializing and communication skills: • Areas covered include: relating to people, adaptation to change, visual response, listening response, verbal communication, nonverbal communication, activity level, general impressions. • + Universal appeal –Translated into Japanese and Swedish • - Tendency to over identify individuals as having autism.

17. Assessment and diagnosis • Informal checklists can also be completed by a parent around the home. • Example of signs include: • Little or no eye contact • Not responsive to verbal cues • Inappropriate attachment to objects • Oversensitivity or under-sensitivity to pain • Aloof manner, struggles to play/ interact with other children or adults. • Have trouble relating to others or not have an interest in other people at all. • Difficulty expressing needs using typical words or motions • It is very important to remember that a child with ASD: • May be very interested in people, but not know how to talk to, play with, or relate to them.

18. Major characteristics

19. ‘Triad of social impairments’: • - Difficulty interacting with other people in a social context. • - Difficulty communicating with others, verbally and non-verbally. • - Rigid and restrictive behavioral repertoire and imaginative skills.

20. Major characteristics • Social: • Social interaction problems are evident irrespective of a child’s I.Q level. • Joint attention – the limited ability to share interests or achievements with others. • Decreased facial recognition of others is also a common social interaction problem associated with children with ASD

21. Communication characteristics of Autism: • Very common and results in children with autism often struggling to build and maintain friendships with their classroom peers • 2 categories: • Deviations in language development – • Echolalia – repeating phrases ‘Yes I am very well how are you” • Palilalia – child repeats their own words • Echopraxia – repetition of other’s words or movements • Neologism- using made up words. • Deficits in communicative intent • Problems trying to successfully convey what they intended to say or mean

22. Major Characteristics • Behavioral characteristics of Autism: • Repetitive and stereotypic behavior – motor stereotypies/ repetitive motor movements, e.g. clicking or rocking back and forth. Self injury. Hours spent on an activity • Need for routine- insistence on ‘sameness’, if something changes = tantrums, regulating emotions is difficult. • Interest in certain activities or items and/ or abnormal motor functions – could have a real bond with any type of object. Plus preoccupation with parts of objects. • Specific sensory and motor characteristics – abnormal response to sensory stimuli (including sound) • Plus reduced sensitivity to pain and hot and cold. The child may be abnormally active or inactive and may exhibit unusual eating and or sleeping patterns.

23. Behavioral characteristics of Autism continued: • Savant syndrome – in up to 10% of individuals with Autism • - extraordinary abilities in the individual to do math, play music or produce works of art. • Rain Man

24. Major Characteristics • Despite not appearing on the DSM-IV diagnostic criteria there are a few cognitive • characteristics associated with Autism: • Low IQ: Roughly 70% of individuals with Autism have an intellectual disability also. • Difficulty in executive functioning: • Involved planning, shifting attention and using your working memory. Often = repetitive behaviors, problems when presented with a situation or scenario that is new to them, plus a lack of flexibility of thought

25. Major Characteristics Continuation… • Cognitive characteristics continued: • Deficits in theory of mind: • ‘Theory of mind” – the ability of an individual to see the world from the perspective of others’. Child with autism will struggle to make first-order or second-order attributions • Implications: Seen as having a lack of empathy, deficits in social interaction and problems with pretend play • Still a debated topic though as some researchers believe individuals with autism can develop advanced theory of mind abilities

26. Strengths in visual skills • General observation: • Individuals with autism are stronger visual processors than verbal processors, often thinking visually.

27. How it may affect development • Basic Functioning skills (Eating, going to the bathroom, • Social Skills (Kids afraid of child with hand movements or thought to be ignored) • BULLYING • Family related: Tension and often Divorce

28. History • Demonically -possessed • Eugenics • Segregated • Sterilized • Eugen Bleuler-1911 • Leo Kanner-1643 first described autism • U.S.A 1940s • Treatment in the 1960s • LSD, Electric Shock, behavior change techniques (pain and punishment) • American Psychiatric Association- 1980 • Considered a disability. IDEA- 1990

29. History of OrganizationsFund Research------Increase Awareness-----Advocate • Council for Exceptional Children (CEC)-1922 • The National Association for Retarded Children (ARC)—1950 • Autismspeaks.org-2005 • Nation's largest autism science and advocacy organization • Autism Society -1965 • National Autism Association

30. Teaching Students with Autism Spectrum Disorders

31. As Teachers we first need to understand all their needs and address them. Patience is required. Early Intervention "The secret of education lies in respecting the pupil." - Ralph Waldo Emerson

32. GOAL: learn how to communicate needs and desires appropriately • Prevent tantrums or self-injurious behavior • Communicate: • Verbal • Gestural/Actual • Pictorial • Relatable situations

33. Applied Behavior Analysis: Individual adjust to the environment • Individual… • Antennas! • Positive and negative reinforcement • Extinction • Familiar Environments “Tell me what you want.” “Blue Crayon” “Good talking! Here’s the blue crayon.”

34. PictureExchangeCommunicationSystem(PECS) • Voice Output Communication • http://www.youtube.com/watch?v=RO6dc7QSQb4&feature=related

35. GOAL: IMPROVE SOCIAL INTERACTIONS • Prevent Inappropriateness and/or isolation. • Participation in activities: • Incorporate obsessive interests into instructional activities. • Untold truths: • Expectations, what pleases the teacher, which kid is nice and who isn’t, cliques, negative/positive-attracting behaviors, how to play with certain toys • Videotapes, pictures, cartoons, role playing

36. SocialStories • Addresses social skill deficits in Individuals with ASD • Before novel events or every day ones • First person

37. Inclusion • LEAP • Learning Experiences: Alternative Program for preschoolers and parents. • Founded by Phillip S. Strain in 1982 • Inclusion…

38. GOAL: DEVELOP COGNITIVE AND ACADEMIC SKILLS • Prevent: Not being able to function in the outside world and/or failing school • Connect with the real world • Schedule… • Songs/Mnemonics • Transitions-same Mrs. T • Reading Time • Lectures 2+1

39. Simple Questions • Modeling • Physical activity/squishy ball • Teacher’s helper (physical movement) • Nature • Respect…Mrs. T • Consistency is key

40. TEACCH Approach • Treatment and Education of Autistic and Related • Communication Handicapped Children Marked work/play areas Desks and tables face blank wall… Low Student-Teacher Ratios Windows covered with shade *Lessen Anxiety

41. Home Base Escape stress-prevent tantrums, rage, meltdowns or shutdowns-regain control POSITIVE EXPERIENCE Takes work with them Resource room, counselor’s office, speech-language pathologist’s room Peer Buddies… Elicit social, play, and communicative responses Need to be briefed

42. DoN’TS • SARCASM… IDIOMS…DOUBLE MEANING, NICKNAMES….CUTE NAMES. (Literal thinking) • CLAPPING, WHISTLING, SCREAMING • AVOID SURPRISES • FACIAL EXPRESSIONS MIGHT NOT WORK • DO NOT TAKE MISBEHAVIOR PERSONALLY (IT’S AN EFFORT TO SURVIVE CONFUSING, DISORIENTING, OR FRIGHTENING EXPERIENCES)

43. GOAL: HAVE FAMILY INVOLVEMENT • Prevent the family from not giving proper support to the individual with ASD. • Teachers can have an extensive relationship with parents • Family-Centered Support System • Can become effective tutors

44. Transition into Adulthood

45. Might not be good at eye contact or conversation but they don’t lie, cheat at games, tattle on my classmates, or pass judgment on other people. • -Ten Things Every Child with Autism Wishes You Knew" by Ellen Notbohm

46. References • Autism Speaks. (n.d.). Family Services. Retrieved October 7, 2011. http://www.autismspeaks.org/ • Grandin, Temple. (1999). Choosing the Right Job for People with Autism or Asperger's Syndrome. Autism Research Institute. Retrieved October 7, 2011 from “http://www.autism.com/ind_choosing_job.asp • Standifer, Scott. (2009). Adult Autism and Employment. Retrieved October 07, 2011 from Missouri University, Department of Health Website: http://www.dps.missouri.edu/Autism/Adult%20Autism%20&%20Employment.pdf • Taylor, Ronald L., & Smiley, Lydia R., & Richards, Stephens B. (2009). Exceptional Students. Preparing Teachers for the 21st Century. New York: McGraw-Hill • Support Autism. http://support.autism-society.org/site/Clubs?club_id=1217&sid=9320&pg=news • First Signs, Screening. http://www.firstsigns.org/screening/DSM4.htm • First Signs, Resources. http://www.firstsigns.org/resources/web.htm#Tools • CDC. http://www.cdc.gov/ncbddd/autism/states/ADDMCommunityReport2009.pdf • Taylor, R.L., Smiley, L.R. & Richards, S.B. (2009). Exceptional Students: Preaparing teachers for the 21st century. McGraw-Hill: New York. • Taylor, Ronald L. (2006). Assessment of Exceptional Students: Educational and Psychological Procedures 7th ed. Pearson.