Supporting children with autism

1. Supporting children with autism Colin Smith

2. What is Autism? • Short Quiz • A definition of autism:

3. A definition: • Autism is thought to be a spectrum of neurodevelopmental conditions, characterised by difficulties in the development of social relationships and communication skills and the presence of unusually strong narrow interests, and repetitive behaviour.

4. History • Leo Kanner 1943 • Hans Asperger 1944 • Lorna Wing 1981

5. Aetiology Fashion Cycles • Affective/Parenting style (Psychoanalysis) • Mental ill-health/Childhood Schizophrenia/Infantile psychosis (Psychogenic 50’s-70’s) • Developmental disorder established in 1970’s

6. 2 Diagnostic systems are used: • WHO ICD10 World Health Organisation – used in Europe • DSM-IV American Psychiatric Association – used in USA Virtually the same criteria are used. One slight difference with one of the ‘labels’. Diagnostic criteria will be rewritten in 2013.

7. What’s in the criteria they measure my child against? • Typically it is a list of behaviours showing deficits in three key areas:            • Verbal and non-verbal Communication            • Social awareness and interactions             • Imaginative play (restricted or special interests and behaviours). Commonly known as The Triad of Impairments

8. Terminology?? • Pervasive Developmental Disorder • Autism • Childhood Autism or Infantile Autism • Profoundly Autistic • Atypical Autism • High Functioning Autism • Aspergers • Pervasive Developmental Disorder Not Otherwise Specified • Autistic/Autism Spectrum Disorder • Is it any wonder we like wine?

9. PDA • www.pdacontact.org.uk • 0114 2589670

10. Let’s clear this label nonsense up! • Your child is still your child • He or she has had and will continue to have Additional Support Needs and may not receive additional ‘support hours’ in school following diagnosis • It will help you with some benefits and supports • Hopefully it will contextualise for you the way your child behaves

11. What causes ASD’s? • Myriad of studies completed within genetic, cognitive and neural levels. • No known cause has been identified. • 1998 Dr Andrew Wakefield & MMR – • (Ashraf, 2001) (GMC 2010) • Currently – ASD is a complex disorder with core aspects having distinct causes that often co-occur.

12. In short: • It wasn’t something you did or didn’t do that caused your child to have an ASD • Nature has intended it this way • Your child’s genetic cellular make up is DIFFERENT to the typical population which then impacts on their cognitive processes and subsequent behaviour • Children and adults with ASD are just as individual as you and I

13. Prevalence • 60-110 per 10,000 population • Boys 4 : Girls 1 for autism 10:1 AS • In Scotland 60:10,000 children (Public Health Institute of Scotland 2001) with no adult prevalence study!

14. Accompanying Conditions: • AD/(H)D Attention Deficit (Hyperactivity) Disorder • Dyspraxia • Learning Disability • Epilepsy • Tourettes

15. AD/HD A child can have both autism and ADHD, but both are separate conditions. The symptoms can be confused and be interlinked but experts are clear that the apparent similarities will separate out as the child gets older. Symptoms of ADHD include: • Inattention • Impulsivity • Hyperactivity 28% of children with autism also have ADHD

16. Dyspraxia • Dyspraxia: affects the way that the brain processes information, which results in messages not being properly or fully transmitted; it affects people's motor co-ordination, and the ability to organise or to plan. Unknown prevalence rates, but very common in Aspergers

17. Learning Disability Learning disabilities can affect all aspects of someone's life, from studying in school, to learning how to make a meal. People with autism can have different degrees of learning disability. It is thought 75% of people with autism have associated learning disabilities.

18. Epilepsy Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures due to abnormal or excessive neuronal activity in the brain. It is usually controlled, but not cured, with medication. There is a heightened risk of development at puberty. It is thought around 25% of children with autism have epilepsy.

19. Tourettes • Is characterised by the presence of multiple motor (physical) tics and at least one vocal tic which vary during the lifetime and tend to wax and wane depending on lifestyle and health 28% of children with an ASD are thought to also have Tourettes

20. Psychological theories • There are 3 main theories relating to ASD which have been scientifically accepted and well researched • Theory of Mind • Central Coherence • Executive Dysfunction

21. Theory of Mind • The ability to comprehend others thought processes or that they even have a thought process at all. Also known as Mind blindness. (Baron-Cohen, Leslie & Frith, 1985)

22. How might a ToM deficit affect a person? • Predicting others’ behaviour • Understanding others and own emotions • Knowing that behaviour affects self and others • Understanding social interactions • Accounting for what others think and know • Interpreting mental state from facial expression • Interpreting intentions in response to biological motion Example

24. Central coherence • Awareness of context, seeing the bigger picture. A preference for detail rather than global processing. (Happe’, 1996)

25. How might a local central coherence affect a person? • Seeing connections • Preference for the known • Idiosyncratic focus of attention • Lack of generalising skills • Face recognition • Inattentive to new tasks Example

26. Which orange circle is bigger?

27. Executive Dysfunction • Assumes a form of frontal lobe pathology leading to perseverance or inability in shifting attention which results in observed desire for sameness and routines (Ozonoff, Rogers, Farnham & Pennington, 1993)

28. Executive Function allows: • Goal directed behaviour • Problem solving in a planned way • Flexibility in thought and behaviour • Self monitoring • Impulse control • Interpretation and regulation of emotions Examples of dysfunction

29. Make, Plan & Carry Out

30. Strengths • Great memory, recall fine detail • Poor ability to lie or deceive • Polite and rule conscious • Refreshingly frank view of the world • Encyclopaedic knowledge of subjects of a special interest • Attention to detail/perfectionist

31. Quick tips • Limit choice – free choice can cause anxiety • Make language explicit • Ensure you have the persons attention • Highlight key information • Check you have been understood • Warn about changes in routine • Specific praise • Don’t be subtle • Don’t take offence • Avoid confrontation • Back up changes required in behaviour with visuals

32. Rory’s Story

34. Different types of intervention • Parent Mediated Interventions • Communication Interventions • Social Communication & Interaction Interventions • Behavioural/Psychological Interventions • Biomedical/Nutritional Interventions • Pharmacological Interventions Scottish Intercollegiate Guidelines Network - 98

35. Biomedical/Nutritional • Casein/Gluten free diets • Vitamin B6 & Magnesium • Omega 3 & 6 fatty acids Research findings: www.nas.org.uk/nas/jsp/polopoly.jsp?d=1385&a=3368

36. Behaviour

37. Remember... • All behaviour is a communication • What is the child trying to communicate? • Challenges are often a result of the child's anxiety and not a desire to be naughty

38. McDonnell (1995) lists 9 common causes of Challenging Behaviour • Being unable to communicate a need • Being confused • Being in pain • Medication change • Inactivity • The need for contact recognition from another person • Changes in routine • Environmental effects/Sensory differences • Delusional thoughts • + • Sexuality • Bereavement

39. Triad of Impairments Communication Sensory sensitivity Imagination Social awareness and interaction

40. ABC Charts & STAR charts • Antecedent • Behaviour • Consequence • Setting • Triggers • Action • Results

41. Life after school • Anecdotal evidence of independence with support • Supported living • Supported employment • Further/Higher education

42. Resources • Partners in Play (PIP) 01698-230130 Youth clubs/advocacy • Sleep Scotland www.sleepscotland.org • Sibling support www.actionforchildren.org.uk • Carer Support Workers PRT 01236-755550 • Legal advice at Govan Law Centre www.govanlc.blogspot.com • Autism alert cards www.glasgow.gov.uk/en/Residents/Care_Support/GettingaService/AutismAlertCard.htm

43. Resources cont. • Online support sites and forums – www.wasp.uk.comwww.wrongplanet.net • Visual planners – www.autiplan.com • Social work locality offices • Education advice – www.enquire.org.ukwww.isea.org.ukwww.northlanarkshire.gov.uk/index.aspx?articleid=15956

44. Resources cont. • North Lanarkshire Supported Employment http://www.northlanarkshire.gov.uk/index.aspx?articleid=5124 01698-274500 • SOLWAY Supported Employment 01698-276206 • REMPLOY http://www.remploy.co.uk/ • Respite: www.kensingtonfoundation.comwww.phewrespite.org