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Autism 101 Presented by Kara Bratton

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1 Autism 101 Presented by Kara Bratton
Lutheran Special Education Ministries

2 Let me begin by saying, autism is a HUGE topic because it covers such a big spectrum of need. I am going to try to cover a lot of ground on this topic during this hour tonight, but there is also a lot I know I won’t have time to address beyond these slides, so please contact me if you have further questions or if you have specific questions on a student you know or work with. I’m starting with this quote because it is important for even the most experienced professional to remember, because I think, more than any other disability or diagnosis, it is very true and each individual with autism has a very unique profile. No matter how many students with autism you meet, each will be different and teach you something new. If a particular strategy works for one student with autism, it could very well be a disaster for the next student you have. Don’t be discouraged by this, just realize that autism is a huge spectrum and it’s important to get to know each individual child. Each one will surprise you in different ways 

3 Autism: Definition Autism is a bio-neurological developmental disability that generally appears before the age of 3 These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors “With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ”(http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf) Autism covers a huge spectrum, from very high functioning to non-verbal and very low functioning individuals. That’s why autism is often referred to as the autism spectrum, or you’ll hear people say a child is “on the spectrum”. There was not one specific definition of autism I found that I liked for this presentation, so I put together a few ideas that appear in many different “definitions” and are common to describing what autism is. First, autism is a neurological disability the does appear before the age of 3. Sometimes, the signs will not be noticed that early, but even looking back, the signs will have been there. (read second bullet point)- we’ll talk more in depth about these areas of difficulty coming up, and the last bullet point is important because the diagnosis of autism is changing. Whereas it used to be that specific subtypes of autism were specified, such as PDD, asperger syndrome, etc., with the release of the updated Diagnostic Statistical Manual of Mental Disorders 5 in May of 2013, this changed. Now, just the general umbrella label of ASD (autism spectrum disorders) is being used. There is still a huge continuum of ASD, but you’ll see less specific disagnoses than previously used.

4 Autism: Definition “People with ASD tend to have communication deficits, such as responding inappropriately in conversations, misreading nonverbal interactions, or having difficulty building friendships appropriate to their age. In addition, people with ASD may be overly dependent on routines, highly sensitive to changes in their environment, or intensely focused on inappropriate items. Again, the symptoms of people with ASD will fall on a continuum, with some individuals showing mild symptoms and others having much more severe symptoms. This spectrum will allow clinicians to account for the variations in symptoms and behaviors from person to person.” Read through this definition

5 Autism: Characteristics
Difficulty relating to peers/social skills Unusual play with toys and other objects “Obsessive” about area of interest (trains, vacuums, etc.) Difficulty with changes in routine or surroundings Repetitive body movements, behaviors and language Difficulty using and understanding language/communication We’ll start off with some general characteristics you may see in many individuals with ASD, no matter what their age. The first is difficulty relating to peers and also difficulties with social skills. With younger children you may see children trying to play with others, but end up playing NEAR them instead of actually interacting and playing with them. Social skills, knowing how to read body language, facial expressions and other social skills are generally very difficult for individuals with ASD. Individuals with ASD may also play in unusual ways with toys or other objects and become almost obsessive about certain areas of interest or topics. For whatever reason, trains, vacuums, maps and family history seem to be topics/objects I’ve commonly seen. Individuals with ASD may talk about talk about their area of interest despite the conversation being about something totally different, and if you try to steer the subject to something else, they’ll continue talking about their area of interest. Having difficulty with changes in routines or changes in their surroundings is another characteristic commonly seen. Individuals with ASD generally do better when they know a routine and that routine is followed ALL THE TIME NO MATTER WHAT. If something in that routine suddenly changes, they will obsess over the change and many times have difficulty working around it. We’ll talk later about some strategies to help with that, but preparing these individuals for changes well in advance is the biggest help you can give. Another characteristic is sometimes repetitive body movements such as rocking or hand flapping, or repetitive language used over and over. Many times, the movement and repetitive language and behavior is used for self-soothing and calming. Another common characteristic may be difficulty with language and communication. This again depends largely on the individual, but understanding idioms, sarcasm and other less direct types of communication are what is often difficult for individuals with ASD.

6 Autism: Characteristics
About 40 percent of individuals with ASD have average to above average intellectual abilities. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. In addition to the characteristics just discussed, I often hear some misconceptions about the intellectual abilities of individuals with ASD; hearing things like “people with autism are geniuses or savants”. While it may be true in some cases, it is not always true as shown by these statistics.

7 Autism: Early Signs The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years) Most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age Any of these “red flags” does not mean a child has autism. But because the disorder’s symptoms vary so widely, a child showing these behaviors should be evaluated by a multidisciplinary team Under the DSM-5 criteria, individuals with ASD must show symptoms from early childhood, even if those symptoms are not recognized until later Like other disabilities, noticing early signs and early intervention are critical with autism. The earlier autism is diagnosed and appropriate help put into place, the better chance that child will have of developing appropriate social skills and communication and intergrating with their peers. So, we’ll go through many early signs to be on the lookout for, but first, just some general information about when signs may become apparent (read through first two bullet points). As we go through more early signs, please don’t pick out a couple of items and try to diagnose students who may show a sign or two. When many of these signs are noticed or documented though, it is important to refer to a professional or team who has the qualifications to diagnose ASD. It is also important to note that with the changes to the DSM-5, even if these signs are not noticed until later or recognized until a child is older, the sign and symptoms will have shown up in early childhood. So, even if you teach older students, don’t disregard these early signs because they may be signs parents bring up that they’ve noticed in the past, etc.

8 Autism: Early Signs No big smiles or other warm, joyful expressions by six months or thereafter No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter No babbling by 12 months No gesturing (pointing, waving bye-bye) by 12 months No words by 16 months No two-word meaningful phrases (without imitating or repeating) by 24 months Any loss of speech or babbling or social skills at any age Here are some of the early signs of autism (read through list)

9 Autism: Early Signs Doesn’t make eye contact (e.g. look at you when being fed). Doesn’t smile when smiled at. Doesn’t respond to his or her name or to the sound of a familiar voice. Doesn’t follow objects visually. Doesn’t point or wave goodbye or use other gestures to communicate. Doesn’t follow the gesture when you point things out. More early signs (read through list)

10 Autism: Early Signs Doesn’t make noises to get your attention.
Doesn’t initiate or respond to cuddling. Doesn’t imitate your movements and facial expressions. Doesn’t reach out to be picked up. Doesn’t play with other people or share interest and enjoyment. Doesn’t ask for help or make other basic requests More signs (read through list)

11 Autism: Asperger Syndrome
Major differences No speech delay in Asperger’s Children with Asperger Syndrome frequently have good language skills, just use language in different ways Speech patterns may be unusual, lack inflection or have a rhythmic nature, or may be formal, but too loud or high-pitched Children with Asperger Syndrome may not understand the subtleties of language, such as irony and humor, or they may not understand the give-and-take nature of a conversation DSM-5 now has Asperger’s fall under ASD, but you still hear many people make the distinction so it’s important to know the main differences for individuals already diagnosed with Asperger’s or for some doctors or evaluators still making the distinction. Asperger’s had been commonly referred to as a high functioning form of autism, and that brings us to the major difference which is that with Asperger’s, speech is not delayed as it may be with autism (child not speaking until later than normal, etc) (Read through other differences)

12 Autism: Asperger Syndrome
Difference in cognitive ability Some individuals with autism have intellectual disabilities, by definition, a person with Asperger Syndrome cannot have a “clinically significant” cognitive delay, and most possess average to above-average intelligence. While motor difficulties are not a specific criterion for Asperger’s, children with Asperger Syndrome frequently have motor skill delays and may appear clumsy or awkward. Another difference that could be seen in individuals previously diagnosed with Asperger’s is the difference in cognitive ability. As we saw previously, some individuals with autism may have cognitive impairments or intellectual disabilities also, but by definition (read first bullet). Also note the clinically significant phrase. So this doesn’t mean someone with Asperger’s couldn’t have any delay at all, just by definition, it can’t be enough to be considered clinicallly significant.

13 Autism: Diagnosis Needs to be done by professionals and multidisciplinary team Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) Online screening tool for toddlers months, assesses risk for ASD When it comes to diagnosing autism, it is very easy to notice a child who is “quirky” or shows one or two signs you know may be signs of autism and jump to conclusions. Please, leave the diagnosing to professionals and stick to providing input, observations and any documentation of behaviors you may have. This will be the most helpful thing to the student, the family, and the doctor. I’d also like to point out, that at least in the area I live in in Indiana, the public school system will NOT diagnose autism. If a child is referred to them for an evaluation, they may have some screeners or observe some behaviors, but the autism diagnosis has to come from a doctor. This may be different in other areas, but if autism is suspected, it would be best to refer a child to a doctor who can diagnose autism, not a public school evaluation. The M-CHAT-R is a free online screener for toddlers that can be used by parents, teachers, etc. It is a series of questions about the child and will not diagnose anything, but if behaviors are questionable as to whether an evaluation should be done between 16 and 30 months, this screener could be used for that purpose. After responding to the questions, it will either recommend the child be seen for an evaluation or whether one is not needed based on the information provided.

14 Autism: Prevalence One thing that always comes up talking about autism is how much autism diagnosis is on the rise. This chart, taken from the autism speaks website, shows the exponential growth of autism diagnoses since the year 200 to end up where it is today, which is 1 in 68 in the United States when back in 2000, it was 1 in Coming up, I’ll just briefly go over some of the theories related to the rise.

15 Autism: Prevalence U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years Estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States Research shows increase is only partly explained by improved diagnosis and awareness No established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered Here are a few more statistics from the autism speaks website related to the prevalence of autism (read first two bullet points). (read 3rd and 4th bullet points). I wish there was a definite answer for the continuing increase we’re seeing autism diagnosis, and if you started searching online, you could find all kinds of info on different theories and opinions, but I’m not going to open that can of worms when nothing is known for sure.

16 Autism: Causes No one cause of autism
Most cases of autism appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development Again, no known one cause of autism, but a little more info that research has shown, according to the autism speaks website

17 Autism: Causes “In the presence of a genetic predisposition to autism, a number of nongenetic, or “environmental,” stresses appear to further increase a child’s risk. The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk.” (http://www.autismspeaks.org/what-autism) Another good quote about what little is known about the cause of autism.

18 Autism: Strategies Provide highly structured and predictable routines and procedures Prepare for new routines and places Understand any behavior “triggers” Practice transitions Practice social skills and interacting with peers (http://www.nationalautismresources.com/autism-social-skills.html) Now that we’ve gone through some of the info on what autism is, what the signs are, etc. it’s time to talk about some effective strategies that work for many individuals with autism. As I said before, if you’ve met one individual with autism, you’ve met one individual with autism, so none of these strategies are a “cure all” or surefire way to work with an individual. I’ve tried to focus on a few items that seem to be consistent with a lot of students I’ve seen with autism, although there are many more strategies depending on the individual’s profile and other needs. First, because many individuals struggle when routines are changed, it is best to provide as much structure to a classroom and to the schedule as possible. There will always be things that come up and are unavoidable, but it will be very difficult to ever get a student who needs that structure to learn to “just go with the flow”. Even something like a fire drill that may be a surprise for all the students should be prepared for with that individual student if you as the teacher know it is coming at, say, 10. The next strategy of understanding any behavior triggers can be tricky if you have a classroom full of kids. My first suggestion would be if there is anyone at school that could help, a resource teacher, principal to sit and observe the student during times meltdowns or other problems may be occurring, a pattern may emerge. For instance, I was observing a student in a kindergarten class a few years ago and the teacher indicated that this little girl would just throw herself on the rug and start crying for no apparent reason. After I observed for a while, I realized this behavior was happening whenever there was a transition that lead to all the other students moving around or the classroom becoming less controlled, like when everyone got up to get their coats for recess or when it was free time. It would be hard to notice this when trying to teach a whole class, but if at all possible, have someone observe and document and that can help bring these “triggers” to light and you can narrow down what times of the day need to be addressed. For that student, we realized transition times, like the next bullet point indicates, were times we needed to work on. Practicing transitions may seem silly, especially to teachers in older grades, but for these students who really struggle and act our during transitions, it will pay off. Figuring out what works best for that student to ease the stress of transitions will be essential. For example, it could be that you let that student get up before everyone else to line up, or get their coat first so they’re the only student by the cubbies or coat hooks and it’s not as chaotic. Having “free time” can sometimes be a disaster for a child with ASD so rather than having unlimited options, have just one or two things that student can pick from and have a designated area for that student to limit the chaos and stress of the situation. Social skills are another area that often need to be specifically practiced and practiced with real students. The website listed is a great resource for social skills materials and you can search by age group for appropriate materials. A couple important things to remember with teaching social skills are to be careful how many skills you’re working on at once, depending on the individual student. Also, don’t assume that because you practiced it once or twice that the student will remember the skill and be able to apply it to appropriate situations. Often, the social skills and social stories take a lot of repetition and a lot of practice using other students for the student with ASD to understand how to appropriate apply the skills and interact.

19 Autism: Strategies Use visual schedules (note changes to schedule visually also) Autismschedules.com I talked about on the last slide providing predictable routines and schedules. A big part of that is providing visuals in the classroom, no matter what grade you teach. I know the examples I have here may look elementary, but again depending on the individual, you may find that even in the higher grades, visual schedules with pictures may still be needed. Gage their use by the student need, not by what you think they should or shouldn’t need by a certain age. The examples shown here are from the autism schedules website listed. Magnets and schedules can be purchased from this site, or if you’re like me, you can look at this site for ideas and make your own for cheaper  Some students may also do better if instead of stock images, real pictures from their school or home be used for visual schedules so they make the connection better. One basic visual schedule (not shown) is a visual schedule of things that will happen during the school day, with visuals for the different subjects, lunch, recess, specials, etc. If the student is older or you want the schedule to be more discrete, it could be a smaller one just for that student for their desk or notebook. Or, if you have one big one for the whole class, a second smaller one for just that student could also be helpful. With a daily schedule like this, I also noted that changes to the schedule should be noted visually also. For instance, if normally on Tuesdays at 10:30, the students go to art, but today there will be an assembly instead, it may work best to keep the art visual on the schedule and put an X or “no” symbol, like the one shown, over top of art and then a visual for the assembly next to it. Then, the student understands that the assembly is replacing art and there won’t be art today as usual. If you just leave the art visual off the daily schedule and put the one for the assembly there in it’s place, I would bet you money that the student will come up and ask if the class has art today because he/she knows art is always on Tuesdays. So, even with a visual schedule where it may seem obvious what is happening, if it is something different, help the student visually understand what will be different and even prepare them for it days beforehand so they’re not surprised on Tuesday. The first example of a visual schedule shown here shows a “to do” and “done” schedule. The idea with a schedule like this is simple and could be used for independent work time or a routine that is commonly used in the classroom, like packing up for the day or arriving at school. It shows a short list of tasks to be done (don’t put too many on a visual schedule or it will be overwhelming), and the student adds a check in the “done” column after each task is complete. The middle schedule is similar, although a little hard to see, but it has a pocket or envelope underneath the visuals of the tasks that need to be completed. So, after each individual task, the student removes the visual and puts it in the pocket or envelope. Some students do better when they don’t have to see what they’ve already done, so if the visual is out of sight, it’s out of mind too and they only see the tasks that still need to be completed. The last example I put here is a “first, then” schedule. It could be used for students who need more motivation or have a reward/behavior system in place. It shows again just a few tasks that need to be completed, then shows what will happen when those tasks are completed, usually something the student would look forward to, like a reward, or recess/something positive. Any of these schedules can and should be adapted as you see needed for individual students and either for a whole day like the first schedule discussed, or created for specific times of the day when the student is struggling, like beginning or end of the day, or independent work times.

20 Autism: Strategies Find quiet place for student to go to when needed
Use sensory items (velcro, fabric books, box with pillows, weighted vests and blankets) Many times, incorporating sensory items will help destress a student with ASD and provide comfort. Items like weighted vests and blankets help soothe and calm students. This can take a lot of trial and error. The website listed here has many different options, and you may check locally to see if there is a sensory store with people that can help provide suggestions and involve parents also. Some things I’ve used easily and that are cheap are to use self-sticking velcro underneath a child’s desk so they can rub it with their fingers to help with sensory. Put both the rough and smoother velcro sides because sometimes, surprisingly, students will prefer the rougher side. Also, finding samples of fabric with different feels and textures put together in a little booklet or binder that the student could pull out and flip through can be helpful. Sometimes, a box or more confined, closed in area (with or without other sensory items like pillows) may help when the student need to get away for a few minutes and feels comforted by the more closed in space. You can also see similar sensory items on that website that seem like a cocoon the student can wrap themselves in. Depending on what is needed and what works, you may want to find a different spot in the school or space the student can go to when this is needed if it is a distraction for the rest of the students.

21 Autism: Strategies Visual Timer available through discountschoolsupply.com or Time Timer App ($2.99) Transition Box Along the same lines of providing visuals is the visual time as shown above. I know they are sold on the website listed, but may also be sold at your local school supply/teacher store. They come in a variety of sizes, a bigger one that could be displayed in front of the class, smaller ones for smaller groups or an individual desk, or even pocket sized or clip on ones that individual students can carry around. These timers basically show a visual countdown of time left until the next activity. Sometimes, you may tell a student that there are 30 minutes left until lunch, and 5 minutes later, they ask again, and again, and again. Even if the student knows the exact amount of time left, the concept of how long 30 minutes really is can be abstract and difficult to conceptualize. So, this visual timer, also available as an app, shows a visual for how much time is left and students can see the amount of red getting smaller and smaller until the timer dings for the next thing. Also shown here is something called a transition box. Some might contain numerous items, as shown here, or there may just be one thing, again, depending on the student and the need. Since transitions can be difficult, transition boxes can again help visually prepare the student for what is coming. For example, a transition box may have a box of crayons that the student carries down the hall every time he/she goes to art class as a reminder about what is happening next. Or, the transition box may have a few “comfort” items that are meaningful to the student that can be pulled out during a transition time and carried with the student or used for calming. It could also have pictures of different teachers or different people the student will be seeing in the hallway or during the next transition.

22 Autism: Resources Autism Resources, search by state:
Autism Speaks ToolKits Autism App Finder

23 Autism: Resources National Autism Resources
Autism Now Little Friends Center for Autism (Chicago)

24 Autism: Resources “Not Different Enough” by Gloria Doty
Writingbygloria.com Book can be purchased at:

25 Kara Bratton, LSEM Resource Center Director kbratton@luthsped
Kara Bratton, LSEM Resource Center Director Sign up for our FREE e-newsletters at


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