Introduction to Autism Spectrum Disorder (ASD)

1. Introduction to Autism Spectrum Disorder (ASD) Presented by Michelle Antle, Simpson Co.; Marty Boman, WKU Paula Borland, CESC; Connie Miller, Warren Co.; Debra Myers, CESC; & Amanda Reagan, Allen Co.

2. Autism Spectrum Disorders: Agenda • What is PDD & Autism? • The Characteristics of Autism • Current Evidence-based Strategies • General Teaching Tips • Summary • Resources Prepared by KY Coop Network January 2010

3. What is Pervasive Developmental Disorder? Prepared by KY Coop Network February 2010 • A specific group of Developmental Disabilities • Start by age 3 and last through a person's life • Symptoms may improve over time. • Symptoms within the first few months of life in some. In others, symptoms might not show up until 24 months or later. • Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

4. What is Pervasive Developmental Disorder? Prepared by KY Coop Network February 2010 • A Neurodevelopmental disorder • Handle information in their brain differently than other people.  • A Spectrum Disorder • Students vary in symptoms & abilities from very mild to severe. • each person affected in different ways • differences in when the symptoms start, how severe they are, and the exact nature of the symptoms

5. Autism Numbers? • Incidence • Estimate: 1 in 150 (Center for Disease Control, 2007) • 4 times more often in boys • No racial, ethnic, or social boundaries • Most recent numbers • 1 in 110 (CDC, 2009) • 1 in 91 (Pediatrics, 2009) • Findings based on parent report Content prepared and organized by the Kentucky Autism Training Center

6. Etiology?Factors considered Prepared by KY Coop Network February 2010 • Genetics • Double recessive gene • Family history • Environment • Exposure to pollution & toxins. • Severe infections during pregnancy (e.g. rubella) or early infancy. • Neurobiology

7. Diagnostic Criterions • Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV-TR) • Individuals with Disabilities Education Act (IDEA) • Kentucky Administrative Regulations Prepared by KY Coop Network February 2010

8. Autism Spectrum Disorders • Autism • Asperger’s syndrome • Pervasive Developmental Disability- not otherwise specified (PDD-NOS) Under PDD, but not ASD: • Rett syndrome • Childhood disintegrative disorder Content prepared and organized by the Kentucky Autism Training Center

9. Autism:Diagnostic Criteria for Eligibility DSM-IV-TR • Qualitative impairment in SOCIAL INTERACTION • Qualitative impairments in COMMUNICATION • RESTRICTED and STEREOTYPED behaviors, interests and activities Content prepared and organized by the Kentucky Autism Training Center

10. Asperger Syndrome:Diagnostic Criteria for Eligibility • Qualitative impairment in SOCIAL INTERACTION • RESTRICTED and STEREOTYPED behaviors, interests and activities • No clinically significant delay in • Language development • Cognitive development Content prepared and organized by the Kentucky Autism Training Center

11. Asperger’s Syndrome (AS) • Higher functioning Autism????? • New to DSM in 1994 • First described by Hans Asperger, a Viennese pediatrician (1944) • More common than “classic” autism • Famous persons- e.g.: Albert Einstein, Thomas Jefferson ??? Prepared by KY Coop Network February 2010

12. Other ASD • Pervasive Developmental Disability- not otherwise specified (PDD-NOS) • This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes atypical autism --- presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these. Content prepared and organized by the Kentucky Autism Training Center for Autism Initiative

13. PDDs • Rett syndrome • Onset of all of the following after the period of normal development: • deceleration of head growth between ages 5 and 48 months • loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing) • loss of social engagement early in the course (although often social interaction develops later) • appearance of poorly coordinated gait or trunk movements • severely impaired expressive and receptive language development with severe psychomotor retardation Content prepared and organized by the Kentucky Autism Training Center for Autism Initiative

14. Other PDDs • Childhood Disintegrative Disorder • Normal development for at least the first 2 years after birth • Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas: • expressive or receptive language • social skills or adaptive behavior • bowel or bladder control • play • motor skills • Abnormalities of functioning in at least two of the following areas: • qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity) • qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play) • restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms Content prepared and organized by the Kentucky Autism Training Center for Autism Initiative

15. IDEA Reauthorization • Prior to 1991, no specific classification for autism. • In 1991, IDEA specified autism as a disability for the first time. • Soon after individual states included Autism as a disability in state regulations (e.g. KY in 1993) Prepared by KY Coop Network February 2010

16. IDEA 2004 Prepared by KY Coop Network February 2010 A developmental disability that significantly affects • verbal and nonverbal communication • Social interactions Evident before age 3 Adversely effects educational performance 34 CRF 300.8(c)(1)

17. IDEA Prepared by KY Coop Network February 2010 • Other characteristics associated • Repetitive activities & Stereotyped movements • Changes in daily routine • Unusual responses to sensory experiences 34 CRF 300.8.c.1

18. Kentucky Administrative Regulations ARC shall determine that a student has the disability of autism and eligible for specially designed instruction and related services if evaluation information verifies: • Difficulties in developing and using verbal or nonverbal communication • Difficulties in social interactions Prepared by KY Coop Network February 2010

19. In consideration of ALL DISABILITIES Is there an adverse effect on educational performance? Is it due to lack of reading/math instruction? Is it due to Limited English proficiency? Prepared by KY Coop Network February 2010

20. Adverse Affect Prepared by KY Coop Network February 2010 Means that the progress of the child is impeded by the disability to the extent that the educational performance is significantly and consistently below the level of similar age peers. 707 KAR 1:280 Section 1 (2)

21. Educational Performance • Determined on an individual basis. • Education is more than academics. May include non-academic and academic skills. • No single procedure used as sole criterion for determining. • ARC may consider information about outside or extra learning support provided to the child. Prepared by KY Coop Network February 2010

22. Video Prepared by KY Coop Network February 2010 Autism: The Hidden Epidemic (2005). Autism Speaks. Chapter 1: Early Signs of Autism Chapter 2: Possible Causes of Autism

23. Co-morbid Conditions Are you aware that 65% of individuals with Autism Spectrum Disorders (ASD) have at least one other co-occurring psychiatric disorder? What do you think those might be? What are you seeing in your districts, esp. around students with Aspergers? Resources: Silverman & Weinfeld (2007); Smith-Myles (2005)

24. Co-morbid Conditions for Aspergers… Mood Disorders (e.g., depression, bipolar disorder) Anxiety Disorders Obsessive-Compulsive Disorder Tourette syndrome Resources: Silverman & Weinfeld (2007); Smith-Myles (2005)

25. …Co-morbid Conditions ADHD Learning Disabilities (written expression, reading comprehension) Epilepsy Resources: Silverman & Weinfeld (2007); Smith-Myles (2005)

26. Where are students with ASD served? Full inclusion Collaborative support Self-contained LBD MSD ASD In schools Did not meet school eligibility General education + Resource Special programs Across a continuum of educational programming needs Content prepared and organized by the Kentucky Autism Training Center

27. Who is serving students with ASD? Typical amount of autism training Teachers MSD certified Psychologists Speech language pathologists Occupational therapists Teachers LBD certified Teachers Gen. education certified Administrators Content prepared and organized by the Kentucky Autism Training Center

28. What interventionists need to know? Two Priorities • How the characteristics of individuals with autism effect daily performance • Evidenced- based practices for instructing students with ASD • Practices that have accumulated sufficient research evidence of their efficacy Content prepared and organized by the Kentucky Autism Training Center

29. Tip of the Iceberg is generally all you see…….. But what is underneath is often more important

30. Characteristics of Learners with ASD “If you know one child with autism, you know one child with autism” Each individual with an ASD brings his/her own unique way of interacting with the environment Each individual brings his/her own reinforcement history Each individual with an ASD is more like his/her peers than different Content prepared and organized by the Kentucky Autism Training Center

31. Domain Areas-Diagnostically Prepared by KY Coop Network February 2010 • Communication • Social Interaction & Relatedness • Restricted and Stereotyped behaviors, interests and activities

32. Other Domain Areas Prepared by KY Coop Network February 2010 Cognitive Processes Academic Skills Sensory Processing Emotional Vulnerability Motor

33. Activity 1: What comes to mind when you think of Autism? Prepared by KY Coop Network February 2010

34. Strengths in Students with ASD • Good knowledge of facts • Good long term memory once information is processed • Musical or special talents (obsessive) • Visual thinkers Prepared by KY Coop Network February 2010

35. Communication Prepared by KY Coop Network February 2010

36. Pre-linguistic skills Some learners with ASD have difficulty acquiring the building blocks of communication • Joint attention • Joint attention is the process by which one alerts another to a stimulus via nonverbal means, such as gazing or pointing • “Child looks at a ball which cues the teacher to look at the ball” • Turn taking • Anticipating a routine Content prepared and organized by the Kentucky Autism Training Center

37. Pre-linguistic skills • Eye contact • There has been some debate as to how to teach eye contact and whether it is a necessity especially to individuals who may find it aversive, • But, consider the importance of eye contact in typical face to face interactions • How do you react when a peer does not give eye contact, what does it make you think? • Imitation skills • Many students with ASD demonstrate weaknesses in imitation skills • Why is this critical in instructional environments? Content prepared and organized by the Kentucky Autism Training Center

38. Videos Prepared by KY Coop Network February 2010 First Signs- Joint Attention http://www.firstsigns.org/asd_video_glossary/asdvg_about.htmVideos Eye Contact Study-Yale http://www.msnbc.msn.com/id/7019005/ns/nightly_news/

39. Communication • Many individuals with ASD do not develop functional communication(Miranda- Linne & Melin, 1997) • May use idiosyncratic language • Student says “ I want popcorn” to indicate he wants to go to the movies • May have literal understanding of language • Teacher says, “Sit down” • Student sits on the floor Content prepared and organized by the Kentucky Autism Training Center

40. Communication May demonstrate difficulties with • Verb tense and articles (Bartolucci, Pierce, & Streiner, 1980) • Pronoun reversal • “You want cookie” • Prosody • Unnatural tone in voice Content prepared and organized by the Kentucky Autism Training Center

41. Communication Some individuals with ASD may not accurately read nonverbal communication or may not use corresponding nonverbal cues when speaking List some of the ways that you deliver “unspoken messages” Carol Gray, the creator of social stories™, suggested that maybe for some individuals with ASD social interaction is often like being on the outside of an inside joke. Content prepared and organized by the Kentucky Autism Training Center

42. Picture Exchange Communication Systems Prepared by KY Coop Network February 2010

43. Activity 2: Think, Pair, Share Prepared by KY Coop Network February 2010 In small group, think about how kids deliver unspoken messages Be prepared to share out

44. Social Interactions & Relatedness Prepared by KY Coop Network February 2010

45. Pragmatic issues Many individuals with ASD demonstrate • A lack of spontaneity • Decreased ability to recognize a speaker’s intent • Decreased ability to reciprocate during conversation • Decreased ability to respond with the appropriate amount of information (Scheuermann & Webber 2002) Content prepared and organized by the Kentucky Autism Training Center

46. Social Interactions & Relatedness Prepared by KY Coop Network February 2010 Higher interest in objects than with people. Inability to understand social rules, social engagement, and maintaining interactions. Poor empathy. Bluntly honest. Withdrawal tendency - Prefer to be alone. Difficulties making friends. Difficulty with time (off pace with others).

47. Theory of Mind The ability to make inferences about what other people believe to be true • Sally- Ann Study (Baron-Cohen, Leslie, & Frith, 1985) Content prepared and organized by the Kentucky Autism Training Center

48. Theory of Mind Consider how an impairment in theory of mind might impact daily functioning • Appearance of being blunt or rude • Ability to lie • Understanding sarcasm • Negotiating • Compromising • Relationship development Content prepared and organized by the Kentucky Autism Training Center

49. Bullying Many students with ASD are victims of bullying. (Montes & Halterman, 2007) This may increase the aversive qualities of school contexts for students with ASD. Content prepared and organized by the Kentucky Autism Training Center

50. KATC Video Prepared by KY Coop Network February 2010 Young Adult Panel- Discussion of Educational Experience