All About Autism

1. All About Autism Todd Fromhart

2. What is Autism? • Neurological Disorder • Discovered in the 1940s by Leo Kanner and Hans Asperger • Leo Kanner Described Eleven Children That Insisted on Sameness, Displayed Repetitive Behaviors, Impaired Language and Social Withdrawal • Hans Asperger Described Children with Little Empathy for Others, One-Sided Conversations, and Intense Interests

3. What is Autism? • Complex Diagnosis Based on Behavior Observed – No Medical Test to Detect Autism • Autism is Found Throughout the World in Families of All Racial, Ethnic, and Socioeconomic Backgrounds • 4 times More Likely to Be Found in Males Than Females

4. Three Main Areas Affected • Ability to Communicate • Ability to Form Social Relationships • Ability to Respond Appropriately to the Environment • Characteristics Vary Across Children and Within Individuals Over Time “If You’ve Seen One Person With Autism, You’ve Seen One Person With Autism”

5. Patterns of Development • Symptoms Present Before Age 3 and Typically Last for Life • Two Patterns of Development Early Development is Atypical or Delayed Early Development Appears Normal but Then the Child Loses Skills or Fails to Progress • Diagnosis May Occur at Any Time During the Lifespan

6. Signs of Autism • Originally Focused on Severe Deficits in Social Interaction, Narrowly Defined Interests, and Language and Communication Deficits • Now Criteria Also Include: -Deficits in making Eye Contact -Deficits in Nonverbal Communication -Decreased Social interactions -Difficulty with Emotions -Stereotypic Behavior Patterns

7. Increasing Numbers • Before 1990 - 1/2000 • 1995 – 1/500 • 2004 – 1/166 • 2007 – 1/150 • 2009 – 1/110 • Present – 1/88 Data from Autism Speaks

8. Increase in Autism Rates

9. Reasons for Increase • More Public Awareness • Change in Criteria Children Once Diagnosed as Learning Disabled or Mentally Impaired are Now Diagnosed with Autism • Improved Child Counts • Environmental Factors?

10. Causes • Not Caused By Bad Parenting • Many Causes • Frequently There is a Genetic Basis • Many Different Genes Have Been Associated with Autism, but One Single Gene has Not Been Identified as a Cause • Many Suspect Environmental Factors, but None Have Been Clearly Identified

11. Differences in Brain Structure • Testing Indicates Differences in Brain Development • 20 – 30 percent Show Increased Head Size • Differences in Specific Areas of the Brain • Differences in Connections Among Brain Cells

12. What About Vaccines • Vaccines Linked with Autism in 1998 Journal Article That has Since Been Retracted • No Studies Since Have Established a Link Between Vaccines and Autism

13. Parental Age • Older Parents Have a Higher Chance of Having a Child with Autism • Possible Explanations: - Older Mothers May Be More Prone to Age-Related Chromosome Changes or Pregnancy Complications - Older Parents May Have Met and Had Children Later in Life Because of Social Challenges Making It More Likely They are Carrying Autistic Traits - Older Parents May Be More Aware of Developmental Milestones and More Likely to Seek Treatment and Diagnosis

14. Screening • American Academy of Pediatrics Recommends Screening of All Children Birth Through School-Age • Pediatrician Well-Child Visits • Monitor Developmental Milestones and Red Flags www.firstsigns.org

15. Red Flags • The National Institute of Child Health and Human Development Lists 5 Red Flags That Warrant Further Evaluation - Does Not Babble or Coo by 12 Months - Does Not Gesture(point, wave, grasp) by 12 Months - Does Not Say Single Words by 16 Months - Does Not Say 2 Word Phrases by 24 Months - Has Any Loss of Any Language or Social Skill At Any Age

16. Diagnostic Criteria • Diagnostic Criteria for Autistic Disorder • A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): • 1.qualitative impairment in social interaction, as manifested by at least two of the following: • 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 • failure to develop peer relationships appropriate to developmental level • 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) • lack of social or emotional reciprocity • 2.qualitative impairments in communication as manifested by at least one of the following: • 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) • in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • stereotyped and repetitive use of language or idiosyncratic language • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level • 3.restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • apparently inflexible adherence to specific, nonfunctional routines or rituals • stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements) • persistent preoccupation with parts of objects • Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. • The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

17. Signs of Social Interaction Deficits • Infrequent Response to Name • More Interest in Objects Than People • Lack of Social Play (Peek-A-Boo) • Lack of Orienting to Others • Lack of Enjoyment of Others • Lack of Interest in Peers

18. Lack of Imitation • Children Less Likely to Imitate: - Other Children’s Play - Facial Expressions - Adult Activities - Physical Actions • Skills Must be Taught Explicitly Because They Are Not learned by Watching Others and Engaging Socially

19. Social Characteristics of High Functioning Autism • Lack of Social Awareness or Socially Appropriate Behavior (Sitting in Circle, Standing in Line) • Inability to Read Behavioral Cues from others • Lack of Give and Take in Social Interactions

20. Communication • Concerns May Be Observed Before Language Develops • Pre-Language Characteristics: • Lack of babbling by 9 Months • Lack of Gestures ( Pointing, Waving) • Lack of Joint Attention

21. Typical Behavior in the First Year • Child Shifts Gaze from Toys to People • Child Follows Someone Point • Child Monitors the Gaze of Others • Child will Show Toys to Others • Child will Point to Objects or Events to Share Interest

22. Communication Deficits • Lack of Interest in Communication with Others • Lack of Intentionality in Communication • Lack of Ability to initiate, Maintain, and End Communication with Someone • Robotic Speech • Some Individuals with Autism Will Develop No Verbal Language Abilities

23. Asperger’s and Communication • No Significant Language or Cognitive Delays • Communication Challenges: - Talk Excessively About Own Special Interest - Perseveration (Stuck On One Idea) - Decreased Abstract Language (Go Fly a Kite) - Inappropriate Social Remarks - Difficulty Understanding Humor - Difficulty With Conversational Skills

24. Theory of Mind • Ability to understand your Own and other People’s Beliefs, Desires, intentions, and Emotions • Making Inferences About What Others Believe Allows One to Predict What They Will Do • It Has Been Proposed That Lacking a Theory of Mind May Explain the Social and Communication Difficulties of Some Individuals with Autism

25. Restricted Behaviors, Interests, and Activities • Rigid Routines • Inconsolable When Changes Happen • Head Banging, Hand Flapping, Other Unusual Movements • Unusual Favorite Objects • Rarely Engages in Pretend Play • Plays with Toys in Idiosyncratic Ways - Lines Things Up, Focuses on Parts of Objects, Does Not Use Toys for Intended Purpose

26. High Quality Environment • High Level of Student Engagement • Positive Classroom Environment and Interactions • Access to Preferred Activities and Rewards • Access to Typically Developing Peers • Immediate and Effective Communication Systems

27. Learning Environment • Environmental Organization - Everything has a Place • Visual Schedules - Tells Child When Activities Occur • Visual Work/Activity Systems - Tells Child How to Complete Activity

28. Rationale for Environmental Organization • Promotes Learning and Optimal Performance • Provides Visual information About What to Expect • Reduces Distractions and Over-Stimulation • Reduces Anxiety

29. Organizing the Environment • Arrange Furniture to Create Visually Defined Spaces for Particular Activities • Materials and Resources Should Be Organized and Readily Accessible • Designate a Quiet Area For Regrouping (Safe Haven or Home Base)

30. Quiet Area • Beneficial for Many Individuals with ASD • Quiet Place With Comfortable Seating, Room to Pace, and Calming Activities • Establish a Routine for Requesting to Go to the Area, Amount of Time to Stay, and Returning to Activity • Teach Individual to Recognize When Quiet Time is needed and to Request It

31. Helping Child Understand Verbal Communication • Get Child’s Attention Before Giving Directions • Be Brief and Use Simple Terms • Repeat Instructions If Necessary • Break Instructions Down Into Smaller Parts • Use Positive Terms – Tell Child WhatTo Do, not What Not To Do • Avoid Non-Literal Language

32. Using Prompts • Verbal Prompts – Statements Made to Help a Child Acquire a New Skill • Gestural Prompts – Movements Made to Cue a Student to use a Skill • Model Prompts – Performing the Behavior the Student is Expected to Perform • Physical Prompts – Touching Student to Engage Them in a Behavior • Visual Prompts – Using Visual or Written Cues

33. Promoting Independence with Visual Supports • Visual Supports are Helpful in Helping Students Understand - What Activities are Associated With a Space - When Activities Occur - The Order of Activities

34. Visual and Written Schedules • Used by Most of Us to Organize Our Time • Used to Help Individuals with ASD with Problems with Organization, Sequential Memory, Understanding of Time • Can Be used to Give Instructions Visually • Facilitate Transitions, Cope with Change • Reduce Anxiety • Enhance Cooperation • Promote Greater Independence

35. Visual Schedules • Visual Schedules May Use - Actual Objects - Pictures - Words - Combination of Pictures and Words Base the Type of Schedule on Developmental Level What Will This Child Be Able to Understand, Especially When Upset?

36. Object Schedules • Lunch box = Lunch • Helmet = Bike • Backpack = Home • Water Bottle = Drink • Keys = Play Area • Juice Can = Snack • Toilet Paper = Bathroom • Plastic Tub = Art • Bead = Work With Teacher • Ring = Work Alone At Table

37. Object Schedules • The Ring Goes On The Ring Stack and The Toilet Paper Goes In The Container.

38. Picture Schedule

39. Visual Choice Boards

40. Visual promptsFinished product

41. Visual Prompts Enhancing Independence

42. Visual PromptsWritten You are going to write a four paragraph paper about your trip to California. It will take 4 days to complete this assignment. Today, you will write one paragraph. Take this instruction sheet to the computer desk Open Microsoft Word Put your title at the top of the page. Center and underline it. Hit Enter and left align the rest of your text Answer these questions: Where did you go? Who went? How did you get there? Save your document by clicking on the disk icon-when the ‘save’ window opens, look for ‘save in’ and click on the blue down arrow-select the folder that says ‘Joey’s Work’-click ‘save’ Put this sheet in your “Finished Work” folder

43. Visual PromptsBreaking Tasks Into Smaller Units

44. Visual PromptsClarity DUSTING THE LIVING ROOM __Take items off table beside couch. Put on PURPLE TOWEL ___Spray polish ___Wipe table beside couch with GREEN RAG __ Put items back on table beside couch __ Take items off television table. Put on PURPLE TOWEL ___Spray polish ___Wipe television table with GREEN RAG ___Spray television screen with WINDOW CLEANER ___Wipe with paper towel ___Put items back on television table

45. Social Story • Short, Individualized Stories That Provide Specific Behavioral Response Cues • Written From the Child’s Perspective • Depicts a Social Situation and the Appropriate Behavior • Use Text and Pictures