1. Autism Spectrum Disorders
Getting to Know Your Students
Presenter: Teresa May
CBRSD Autism Specialist

2. A developmental disability significantly affecting verbal and nonverbal communication and social interaction.
Source: A Guide to Federal and State Education Requirements in Massachusetts, 2000

3. What is Autism Spectrum Disorder?
ASD is a neurological condition that affects a person’s ability to effectively communicate and interact with others.
It is a Pervasive Developmental Disorder that effects boys four times more often than girls.
It is a “spectrum disorder” that affects individuals differently and to varying degrees

4. Pervasive Developmental Disorder
Autism spectrum disorders lie under the umbrella of Pervasive Developmental Disorders. They include Autistim, Asperger’s, CDD, Retts, and PDD-NOS. The spectrum ranges from profoundly severe to high functioning/asperger syndrome.
Profound (severe) Autism Moderate Mild (High Functioning) Asperger Syndrome

5. Autism Continuum Measured I.Q. Severe Gifted
Social- Emotional Interaction
Aloof Passive Active but Odd
Communication
Non-verbal Verbal
Motor Skills
Awkward Agile
Fine Motor
Uncoordinated Coordinated
The symptoms of autism fall on a continuum from mild to severe in many domains. Each individual is affected differently. It is common for a child to exhibit an extremely uneven profile.
IQ: For example, a child with a low measured IQ may have above average word recognition or spelling skills. They may be able to read or spell the word “big” but unable to choose the big object. One child loves to read VCR manuals but would be unable to program a VCR or explain the directions. Another child may have a high measured IQ but be unable to function successfully in the social environment of the classroom without extensive assistance and modifications. Cognitive assessment of these students is complex and the measured IQ is typically an underestimate, particularly at younger ages.
Social ranges from isolation to active but not typical.
Communication ranges from nonverbal to quite chatty but lacks development of fluent reciprocal communication.
Gross and fine motor skills are quite varied.
Sensory impairments reflect actual sensory differences and are unique to each student.
Sensory
Hypo Hyper

6. Asperger Syndrome (AS)
First described by Hans Asperger in 1944 (Mildest and highest functioning end of ASD)
Abnormalities noted in 3 broad aspects of development
 Social interaction and emotional relatedness
 Unusual patterns of narrow interests
 Behavioral and stylistic characteristics involving repetitive /perseverative features

7. Asperger Syndrome (con’t)
Students more likely found in general education classrooms and often undiagnosed or misdiagnosed as ADD, ED, LD, or just odd
Genetic factors more prevalent in AS. Often family history of autism, most often on the father’s side

8. Characteristics: Higher cognitive abilities (average to superior)
Lucid language by 4 years
Present with considerable pragmatic language difficulties
Speech often stilted and repetitive; conversations revolve around rote, factual topics

9. Additional Characteristics
Often engage in rituals
Worry excessively when they do not know what to expect

10. Core Areas of Deficit Speech and Language Deficits Non-Verbal
Echolalic/sterotypical language
Hyper-Verbal
Social Skill Deficits
Range from isolative to indiscriminately social
Limited/Repetitive Behavioral Repertoire
Self Stimulation
Rigidity
Perseverative
Inflexibility

11. Communication Deficits
Severe delay or complete absence of speech
Immediate or delayed echolalia
Poor auditory processing
Odd voice quality/volume
Understanding of language is literal/concrete
(e.g., “listen up.” “That’s cool.”
“Knock it off.”)
May repeat sounds/questions/phrases

12. Strategies to address Communication needs
Language occurs throughout day and is taught by everyone
Use augmentative communication to stimulate verbal language (e.g. PECS)
Use visual cues to facilitate understanding of abstract concepts (e.g. pictures, drawings, written words)
BE CONCRETE
Symbols for the, to, for, with…

13. Communication Strategies (con’t)
Teach for generalization by teaching in variety of settings, using different materials (e.g., color red: apple, stop sign, shirt, crayon)
Auditory processing deficits: allow extra time for student to respond

14. Deficits in Pragmatic Language
Turn-taking skills (within play and conversation)
Gestalt processing (seeing the big picture)
Perspective-taking
Problem solving
Organization

15. Additional Issues with Pragmatics
Social Expectations
Proximity, eye contact,
intonation
Conversational skills
- Talking too much
- Interrupting
- Changing topics without
transition
(From Gail Hallenberg, M.S.,CCC-SLP)

16. Strategies to Improve Pragmatic Language
Teach rules of communication
Teach conversational skills step by step, using visual aides and representations
Role playing
Start with easier tasks and
add complexity as the student gains skills and confidence

17. Strategies to Improve Pragmatic Language
Work on different contexts and generalization
Repetition/practice
Always explain “why”
-- Helps students see the perspective of
others
(From Gail Hallenberg, M.S., CCC-SLP)

18. Social Skill Deficits
Infants/children irritable and hard to comfort
Isolative
Poor/no eye contact; odd eye gaze
Inappropriate giggling or laughing
No understanding of “friendship”

19. Social Challenges for Students with AS
Self observation/ evaluation of impact on others
Perspective taking; empathy
Applying problem solving skills
Dealing with change/novel stimuli
Body awareness/personal space

20. Additional Social Challenges
Coping with change/not getting your own way
Understanding subtle/ complex verbal and nonverbal communication
Processing and understanding emotion
Mastering the increasing complexity of games and rules
Learning to enjoy social contact

21. Strategies for Improving Social Skills
Shape desired behaviors
Teach and practice appropriate social skills in natural environments
Establish a “friendship system” for community integration
Have neurotypical peers or adults prompt/cue appropriate social skills
Capitalize on child’s strengths in integrated settings

22. Addressing Social Skills in the School
Social Stories
Model desired social skill
Social skill scripting
Social skills discussion
Direct teaching of desired social skill

23. Application to Natural Settings
Opportunities to apply new skills in a natural peer context
Start with more structured situations and then try with less structures; provide enough support to ensure success
Coaching should still be given before and after, as needed
Should be practiced across all settings
School clubs, teams, activity groups
Recess, P.E., lunch
Mainstreaming classroom

24. Academic Challenges
Children adapt poorly to others and changes in routines
Do not use toys for intended purpose (e.g., spins, lines up, flips, etc.)

25. Academic Challenges (con’t)
Uneven development of skills: - Decodes words but unable to comprehend meaning - Good computation skills, but unable to apply - Excellent visual matching skills - Gross/fine motor skills range from superior to very poor

26. Academic Challenges Verbal abilities higher than performance skills
Lack higher level abstract thinking and comprehension skills
Impressive vocabularies give false impression that they understand (may be parroting what read or hear)

27. Academic Challenges (con’t)
Excellent rote memory skills, but mechanical in nature
Exhibit poor problem solving skills
Literal and concrete thinkers
Reading
Writing
16 X 3 = 48

28. Strategies that Address Academic Challenges
Avoid surprises
Visual Schedules assist with daily routines and transitions
Provide predictable structured, safe, environments
Use priming techniques
Visual supports

29. Visual Supports Today’s Schedule Breakfast Speech – Ms. Jane
OCR – Ms. Nelson
Written Language
Recess
Math
Social Studies
Lunch
Reading Comprehension
Art or Music
Homework Review
Dismissal

30. Strategies that address Academic Challenges
Break tasks into smaller parts
Teach how to use toys/games appropriately
Stress “functional use” of academic skills
Fade cueing

31. Educational Strategies for Academic Challenges
Individualized academic programming designed to offer consistent success
Make learning rewarding, not anxiety provoking
Redirect away from following their own impulses
Insure student’s understanding of presented material via his/her demonstration of it

32. Academic Strategies (con’t)
Break reading comprehension into smaller parts and analyze 1 section at a time
Expectations must be set for amount and quality of work produced. Start small and increase as skills develop
Earning time toward doing what interests them is often a good motivator to do what is expected.
Big job:
Clean your desk
Little chunks:
1. Put pencils in pencil box
2. Close covers of all books
3. Throw away all wrinkled/
torn papers
4. Put important papers in a folder
5. Put books in a neat stack

33. Sensory Deficits Sensitivity to environmental conditions
Hyper or hypo sensitivity to auditory, visual, smell/taste, tactile/kinesthetic

34. Response to Sensory Input
Under/over reaction to sound
Eye contact avoidance
Focus on details of objects
Avoids specific foods/odors/textures, etc.

35. Strategies to Address Sensory Differences
Remove environmental conditions, if reasonable (e.g., odors)
Desensitize in small steps (consulting with O.T.)
Implement sensory diet, as prescribed by O.T.
Artist Director activity

36. Lunch Break

37. Behavior Support
First Then

38. Strategies
Simplify abstract concepts. Use visuals as much as possible
Teach the difference between general knowledge and personal ideas to help with writing skills
Love

39. Emotional Vulnerability
Often don’t have the emotional resources to cope with the demands of the classroom (esp. from 3rd grade on)
Easily distressed due to inability to be flexible and lack of organizational skills
Intolerant of making mistakes, low self-esteem
Prone to depression
Rage and tantrum reactions common response to stress and frustration

40. Educational Strategies: Emotional Vulnerability
Provide high level of consistency to prevent outbursts
Teach students strategies to cope with their stress:
Make list of concrete steps to follow when they become upset (e.g., 3 deep breaths, count fingers of left hand 3 times, ask to take a break outside of classroom, write steps on card, etc.)
Be alert to changes in behavior that signal depression: More disorganized, inattentive, isolative, crying/suicidal remarks, increased levels of stress, etc.

41. Troubleshooting Problem Situations
Approach problem situations with an open mind, and reserve (behavioral) judgments!
Analyze problem situations, taking into account knowledge of both the student and his/her disability
Develop an action plan based upon the student’s needs
Be proactive in the application of supports

42. BEHAVIOR Basic Overall Guidelines
All behavior is a form of communication
Investigate WHY its occurring
Inability to communicate
Confusion/fear caused by change, sensory stimuli
Pain caused by sensory stimuli, illness, accident
Frustration/anger due to limited communication/social skills
Get something desired (food, toy, attention)
End disliked activity
Meet sensory need (increase or decrease input)
Opportunity to make a comment
Habitual not having alternative

44. All behavior communicates.
What may appear to be an act of willful noncompliance, may be, in actuality, the student’s idiosyncratic attempt to send a message that s/he is unable to get across in any other more conventional way. Moreover, since it is the caregiver’s judgments that determine how the student will be perceived, what the caregiver does not know can, and often does, jeopardize the student’s learning.

45. Behavior
If you try to force negative behaviors to stop without understanding WHY then
The behavior will increase in occurrence and intensity
Another negative behavior will emerge to replace
Replace with appropriate behavior based on needs of child
Focus on instruction rather than discipline
Provide alternate acceptable behavior useful to student

46. Behavior Coordinate all personnel – consistency is essential
Reinforce appropriate behavior frequently
Use meaningful reinforcements
During crisis
Move to quiet calm space
Provide familiar people, places, objects
Allow calming, repetitive, stereotyped activities

47. Behavior If child loses it Engage pre-planned intervention
Keep voice calm, actions simple and visible
Assure class student is OK
Get closure when calm (sequence paper, books, charts, clean up/apologize, transition)
Break

48. Difficulties encountered
Organization requires an understanding of what one wants to do and a plan for implementation. These requirements are sufficiently complex, interrelated, and abstract to present formidable obstacles for students with autism.
Developing systematic habits and work routines, checklists, visual schedules, and visual instructions concretely showing autistic students what has been completed, what remains to be done, and how to proceed.

49. Difficulties encountered
Distractibility takes many forms in the classroom: reacting to outside car noises, visually following movements in the classroom, or studying the teacher’s pencil on the desk instead of completing the required work.
Identifying what is distracting. it might be visual stimuli, it might be auditory. environmental modifications can be made to the physical make-up of a student’s work area, the presentation of work-related tasks, or many other possibilities.

50. Difficulties encountered
Sequencing is another area of difficulty. These students often cannot remember the precise order of tasks because they focus concretely on specific details and do not always see relationships between them.
Consistent work routines and visual instructions compensate for these difficulties. Visual instructions can highlight sequences of events and remind autistic students of the proper order to follow. The visual picture remains present and concrete, helping the student to follow the desired sequence. The establishment of systematic work habits is also helpful; a student who always works from left to right can have work presented in the correct sequence.

51. Difficulties encountered
Difficulties with generalization. Students with autism frequently cannot apply what they have learned in one situation to similar settings. Appropriate generalization requires an understanding of the central principles in learned sequences and the subtle ways in which they are applicable to other situations. Focusing on specific details, students with autism frequently miss these central principles and their applications.

52. Some things to try Use simple, concrete language. Less is better!
Key words and phrases that work include:
“The rule is…”
“Make a good choice.”
“If…..then…..”

53. Some things to try Visuals
The importance of visuals cannot be underestimated . As Temple Grandin, who has Asperger’s Syndrome, explains in Thinking in Pictures (Vintage, 1996): ‘Words are like a second language to me’.
Use visuals for schedules, directions, introducing new activities and more.
Show examples

54. Examples of Visual Supports
First/Then schedule
Visual Class Rules “real photo” daily schedule

55. Visual Rules for desk

57. Some things to try Show, Don’t Tell
difficulty sequencing tasks means that the instruction ‘Look at the article and fill in both sections of the answer sheet’ may as well be given in Klingon. Instead of telling, show your pupil what to do and guide them through the start of the activity.

58. Some things to try Rewards
give out points for appropriate (not just “good”) behavior and effort at completing tasks. The points can be recorded on a chart. When each student gains five points they get a small reward. (prizes can be free choice time)

59. Effective Strategies Less is More
Use plain language, check that the student is clear about what he/she needs to do
Develop visual schedules, rules, instruction
Keep the routine the same. Let the student know in advance if there will be a change and go through the change with them to reduce anxiety
Handle group work in a sensitive way. Student must be clear about his/her role in the group
Use detailed and clear instructions. Communicate important information in visual form

60. General Interventions
Utilize step by step approach
Employ visuals whenever possible
Avoid power struggles
Be aware of sensory needs (need for movement)
Move at an appropriate pace
Write and provide “instruction manuals”
Structure transitions
Provide behavioral supports across areas (social, language, behavior)

61. General Interventions
Utilize the child’s strengths/interests
Improve self-awareness and self-esteem
Teach student about strengths, weaknesses, and disability awareness
Teach their classmates
Provide buddy and mentoring
Create an accepting classroom environment
Watch as opposed to listen to them
Don’t be deceived by verbal skills

62. Modifications Physical arrangements Remove/minimize stimuli
Modify requirements
Reduce length, amount, steps, complexity
Move to new space early (buddy system)
Take a Break (react to first signs of stress. Escalation is usually rapid)
quiet area
walk
calming/sensory experiences
Time to observe from distance
new activities
interactions with new objects
Don’t push – gradually move closer…fully include

63. When you tell me, I forget When you show me, I remember When you involve me, I understand

64. Fragile – Handle With Care
Even though there are many things about me that are unique, in the ways that really matter I am just like other children.

65. I learn best from people I trust, and I learn to trust when I sense that people like me. Please try to see the world through my eyes, for I can’t see it through yours.

66. And please know that even though it may not seem so, I really am trying to adapt to a world that my neurological challenges prevent me from understanding without your help

67. . If you keep these things clearly in mind, you will be less apt to label me a behavior problem, and more likely to teach me the things I need to know so that I can function with greater understanding and competence in a world that is often inhospitable to my needs.

68. RESOURCES and INFORMATION

69. RESOURCES and INFORMATION
Stephen Shore, My life with Autism
Teacch
Temple Grandin
Tony Atwood
Resources for Educators
Donna Williams – Artist with autism