Introduction to Autism

1. Introduction to Autism Session One

2. What is Autism Presented by Marc Tardif Social Skills Program Co-ordinator

3. Learning Objectives: After the workshop participants will be able to: • Label the disorders which fall under the PDD umbrella • Label the three Autism Spectrum Disorders • Describe impairments in social interaction, communication, & behaviour

4. The Latest Statistics… 1 in 165 Canadians are affected with ASD Ratio of males to females 4:1

5. Possible Causes of Autism Genetic: Current research links ASD to biological or neurological differences in the brain Organic: Some research suggests that environmental factors play a part in the expression of ASD

6. DSM IV Diagnostic Criteria • At least two impairments in social interaction • At least one impairment in communication • At least one impairment in restricted or repetitive behaviour A diagnosis requires a total of 6 or more impairments present in total

7. Impairment in Social Interaction • Impairment in the use of nonverbal behaviours • Failure to develop peer relationships appropriate to age level • Lack of spontaneous seeking and sharing • Lack of social or emotional reciprocity *requires at least two impairments from this category

8. Impairments in Communication • Delay or total lack of the development of spoken language • In individuals with adequate speech, marked impairment in ability to initiate or sustain conversation • Stereotyped, repetitive use of language or idiosyncratic language • Lack of make-believe play or social imitative play *requires at least one impairment from this category

9. Restricted, Repetitive and Stereotyped Patterns of Behaviour • Preoccupation with one or more stereotyped and restricted patterns of interest • Apparently inflexible adherence to specific, nonfunctional routines or rituals • Stereotyped and repetitive motor mannerisms • Persistent preoccupation with parts of objects *requires at least one impairment from this category

10. Diagnosis • A diagnosis is reached after an assessment is completed by a pediatrician or a psychologist • Diagnosis can take place as early as 18 months • There is no proven cause or cure for autism (Scientific American Journal, 2000)

11. Pervasive Developmental Disorder CDD Rett’s Syndrome Autism AspergerSyndrome PDD-NOS Autism Spectrum Disorders (ASDs)

12. Childhood Disintegrative Disorder • Extremely rare: Prevalence rate 1.7/100 000 • Typical development until age two • Onset usually between 36 – 46 months • Significant loss of skills • More common in boys than girls 4:1 (Canadian Journal of Psychiatry- In Review)

13. Rett’s Syndrome • 1 in 10,000-23,000 • Have normal head size at birth and normal development • Between 5 – 48 months head growth slows • Develop stereotypic hand movements • Poor coordination and social withdrawal occurs (Source: Canadian Journal if Psychiatry- In Review)

14. Pervasive Developmental Disorder –Not Otherwise Specified(PDD-NOS) • Referred to as “Atypical” autism • Do not meet criteria for full autism diagnosis • Traditionally seen as a “milder” form of autism • Is a diagnosis by exclusion of other disorders in autistic spectrum • Screening and assessment is the same as for autism

15. Asperger Syndrome • Must have both: 1. Qualitative impairment in social interaction 2. Restricted and repetitive patterns of behaviour, interests and activities • No delay in language development, though language development may be peculiar • Fail to make connection between thoughts/feelings and behaviour/actions • Symptoms may be subtle or even undetected until child is over 3 years of age

16. Facts about Asperger’s Syndrome (AS) • First identified by Dr. Hans Asperger • in 1944 • Approximately 5 out of every 10,000 • people 15,000 Canadians • More common in boys than girls (4:1) (Autism Society, 2005)

17. Autism • Usually manifests itself during the first three years of life • Problems with social interactions is the hallmark symptom as people with ASD have problems relating to others • The range and intensity of disability varies widely • Associated with developmental disability

18. High-functioning Autism (HFA) vs. Asperger’s Syndrome (AS) DSM-IV-TR criteria: • History of language delay in HFA but not in AS • Intact cognitive functioning in AS but not in HFA (Tsai, 2005)

19. Differences (Condillac, 2003)

20. Triad of Impairments Social Interaction Language and Communication Restricted, Repetitive Behaviour

21. Social Deficits • Lack of reciprocal social interactions • Unusual reaction to other’s emotions • Lack of joint attention • May not seek out the company of peer • Avoidance of eye contact

22. Social Interaction

23. Communication Deficits • Idiosyncratic use of language • Literal interpretation of language • Echolalia or delayed echolalia • Use of unusual expressions • Tend to use third person • Difficulty initiating/sustaining a conversation

24. Communication Deficits Thank you MGM. Rain Man Best Picture 1988

25. Communication Deficits Literal Interpretation http://www.boreme.com/boreme/funny-2007/police-helps-kid-p1.php

28. Temple Grandin “During the last couple of years I have become more aware of a kind of electricity that goes on between people. I have observed that when several people are together and having a good time, their speech and language follow a rhythm. They will all laugh together and then talk quietly until the next laughing cycle…” “I have always had a hard time fitting in with this rhythm, and I usually interrupt conversations without realizing my mistake. The problem is that I can’t follow the rhythm.” (Grandin, 1995)

29. Behavioural Deficits • Insistence on sameness • No real fear of dangers • Hand or arm flapping • Spins objects • Tantrums • Inappropriate attachment to objects • Uneven gross or fine motor skills

30. Triad + 2 Restricted and Repetitive Behaviours Social Interactions Language and Communication Sensory Anxiety

31. Anxiety and PDD • Neurological differences responsible for anxiety coping • Anxiety is a subjective response to stimuli • Difficulty using “buffers” • Behaviours quickly become an anxiety reduction tool Kevin Baskerville (2005)

32. Sensory Issues Children with Autism tend to overreact or under react to sensory input • Under react (hyposensitive): don’t respond to small or even moderate amounts of stimulation in the area of their sensitivity (i.e., fail to respond to ordinary speech) • Over react (hypersensitive): find small or moderate amount of stimulation overloading or irritating (i.e., speech or television)

33. Sensory Issues • Auditory- hearing appears to be selective • Visual- attraction or aversion to particular visual stimuli • Tactile- attachment to objects may be related to tactile qualities • Taste- non-food items are sometimes tasted • Smell- sometimes become fixated on the smell of something

34. Sensory Overload Activity

35. Risk Markers ("Red Flags") Social • Little or no eye contact • Difficulty mixing with other children • No functional play but uses objects in a repetitive manner (lining up, stacking) • Prefers to be alone • May not want to be held or cuddled

36. Risk Markers ("Red Flags") Communication • Inappropriate laughing or giggling • Echolalia • Not responsive to verbal cues • Difficulty in expressing needs, failure to use gestures or pointing in place of words

37. Risk Markers ("Red Flags") Behavioural • Insistence on sameness, resists change in routine • No real fear of danger • Toe walking • Hand or arm flapping • Apparent insensitivity to pain • Spins objects • Noticeable physical over/under activitiy • Tantrums • Uneven gross/fine motor skills

38. Autism Speaks Video From : www.autismspeaks.org

39. Please fill out your evaluation forms

40. References Autism Society (2005). Retrieved March 12, 2005 from www.autismsocietycanada.ca American Psychiatric Association. Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA. Baron-Cohen, Simon (1995). Mindblindness. MIT Press, United States. Baskerville, Kevin (2005). Mapping your way through the ASD maze: reducing anxiety to assist individuals with ASD. Autism Inclusion Coordinator, Autism Team. Warwickshire, DISCS, England. CAIRN(2006). Canadian autism intervention research network. Retrieved May 20, 2006 from www.cairn-site.com Collins, Paul (2004). Not even wrong; adventures in autism. Bloomsbury, New York & London. Cutler, Eustacia. A Thorn In My Pocket. Gaining Face www.ccoder.com/GainingFace Gray, Carol (2005). The national autism conference presents: from kid-tastrophe to cooperation: loss, learning and students with ASD. Progress through partnership. National Autism Conference. Penn State, Pennsylvania. Gray, Carol. (2005) From Kid-tasphrope to Cooperation: Loss, Learning and Students with ASD. The Gray Center for Social Learning and Understanding, Grand Rapids, Michigan. Grandin, T. (June 2000) http://www.cdrcp.com/aut_teachingtips.html Grandin, Temple. (1995) Thinking in Pictures and Other Reports From My Life With Autism. Vintage Books, New York. Gwynne, Fred (1970). The king who rained. Windmall Books, New York. .

41. References Haddon, Mark (2003). The curious incident of the dog in the night-time. Anchor Canada. Howlin, Patricia (2000) Geneva centre international symposium on autism. Canadian Management Centre. Hodgdon, L. (2005) ASD ProvincialConference Hodgdon, L., (1995). Visual Strategies for Improving Communication – Practical Supports for School and Home. Troy, Michigan, USA: QuirkRoberts Publishing Integrated Services Division Ontario Ministry of Community, Family and Children’s Services. Intensive behavioural intervention: a manual for instructor-therapists Version 2. Jackson, Luke (2002). Freaks, geeks and asperger syndrome. Jessica Kingsley Publishers. London & Philadeplhia Leaf & McEachin (1999). A Work In Progress: Behavior management strategies and a curriculum for intensive behavioural treatment of autism. New York, NY: DRL Books, L.L.C. Metro-Goldwyn-Mayer Studios Inc (1998). Rainman. Best Picture, MGM Studios Inc. Michaels, Alex (2005). Executive functioning. Educational Consultants of New England, Inc. Waltham, MA. Retrieved May 5, 2006 from http://www.stopthatbehaviour.com/i_executive_functioning.html

42. References Ministry of Education Ontario. Special Education Monographs No.4: Students with Autism. April 1990. Retrieved October 19, 2005. http://www.edu.gov.on.ca/eng/general/elemsec/monog4.html Newport, Jerry (2005). The person is more important than the label. Progress Through Partnership. National Autism Conference. State College, Pennsylvania. Notbohm, Ellen. (2005). Ten things Every Child With Autism Wishes You Knew. Arlington, Texas: Future Horizons Perry A, Condillac R.L (2003). Evidence-based practices for children and adolescents with autism specturm disorders: review of the literature and practice guide. Children’s Mental Health of Ontario. Toronto, Ontario, Retrieved September 15th 2005. Pennsylvania, State College (2005). Progress through partnership, national autism conference. Penn State. Robledo, S.J & Ham-Kucharski, D (2005). The autism book, answers to your most pressing questions. Penguin Group Inc. New York. References

43. References Stokes, S. (2001). Structured teaching: Strategies for supporting students with autism? Written under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. http://www.cesa7.k12.wi.us/sped Tidmarsh, Lee & Volkmar, Fred (2003). The canadian journal of psychiatry-in review. Vol 48, No 8, September 2003. Pg. 518, 519 Tsai, Luke. M.D. (2005). Autism spectrum disorder and co-morbid neuorpsychiartric disorders. Progress Through Partnership. National Autism Conference. State College, Pennsylvania. Training & Inservice- Autism Module Complied by Gateway Society World Class Communication Technologies(2004). Souls, beneath and beyond autism. Books That Touch. Winter, Matt (2003). Asperger syndrome, what teachers need to know. Jessica Kingsley Publishers, London & Philadelphia.