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Pervasive Developmental Disability Autism & it’s Intervention By: Prof. Mallika Banerjee Dept. of Psychology, University of Calcutta.

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Presentation on theme: "Pervasive Developmental Disability Autism & it’s Intervention By: Prof. Mallika Banerjee Dept. of Psychology, University of Calcutta."— Presentation transcript:

1 Pervasive Developmental Disability Autism & it’s Intervention By: Prof. Mallika Banerjee Dept. of Psychology, University of Calcutta

2 What is Developmental Disability is attributable to a mental or combination of mental and physical impairments; is manifested before age 22; is likely to continue indefinitely; results in substantial functional three or more of the following areas of major life activity

3 The areas self-care receptive and expressive language learning mobility self-direction capacity for independent living. economic sufficiency.

4 DEVELOPMENTAL DISABILITY PERVASIVE OTHER DEVELOPMENTAL DEVELOPMENTAL DISORDER DISORDER 1) Autism 1) Mental Retardation 2) Asperger 2) Specific Learning Disability 3) Retts’ 3) Other acquired Disorder 4) Childhood Disintegrative Behaviour 5) PDD NOS

5 Autism :Historical Aspects Leo Kanner first identified autism in 1943 when he described 11 self-absorbed children who had "autistic disturbances of affect contact."Leo Kanner first identified autism in 1943 when he described 11 self-absorbed children who had "autistic disturbances of affect contact." At first, autism was thought to be an attachment disorder resulting from poor parenting. This has been proved to be a myth.At first, autism was thought to be an attachment disorder resulting from poor parenting. This has been proved to be a myth. Most specialists now view autism as a brain disorder that makes it difficult for the person to process and respond to the world.Most specialists now view autism as a brain disorder that makes it difficult for the person to process and respond to the world. Therefore, many scientists believe that, at least in some individuals, autism may be geneticTherefore, many scientists believe that, at least in some individuals, autism may be genetic

6 AUTISM A lone even with others U nusual play T widdle and twirl object I ndifference to other people S trange movements and mannerism M ost have a learning disability

7 OTHER SPECIAL CHARACTERISTICS I nappropriate social behaviour S peech impaired or absent O bsessive routins and rituals L ack of normal eye-contact A nxious and distressed by change T antrums and disruptive behaviour E cho words in a meaningless way S ometimes possess a special talent

8 What is Autism? Autism is the most common of a group of conditions called pervasive developmental disorders (PDDs).Autism is the most common of a group of conditions called pervasive developmental disorders (PDDs). PDDs involve delays in many areas of childhood development.PDDs involve delays in many areas of childhood development. The first signs of autism are usually noticed around the age of three.The first signs of autism are usually noticed around the age of three.

9 Autism is three to four times more likely to affect boys than girls.Autism is three to four times more likely to affect boys than girls. Autism occurs in individuals of all levels of intelligence. Approximately 75 percent are of low intelligence while 10 percent may demonstrate high intelligence in specific areas such as math.Autism occurs in individuals of all levels of intelligence. Approximately 75 percent are of low intelligence while 10 percent may demonstrate high intelligence in specific areas such as math.

10 Some more information Autism begins at early childhood and persists throughout adulthood affecting three crucial areas of development:Autism begins at early childhood and persists throughout adulthood affecting three crucial areas of development: verbal and nonverbal communicationverbal and nonverbal communication social interactionsocial interaction creative or imaginative play.creative or imaginative play.

11 The very early symptoms of autism Does not babble, point, or make meaningful gestures by 1 year of age. Does not speak one word by 16 months. Does not combine two words by 2 years. Does not respond to name. Loses language or social skills. Having any of these five symptoms leads the parent and professionals to have further evaluations for the child by a multidisciplinary team that may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or other professionals knowledgeable about autism.

12 Is there a single cause for autistic symptomology? The triad Social impairments Communication impairments Restricted interests Autism

13 Language Impairment All children with autism display some degree of language impairment.All children with autism display some degree of language impairment. About one-third of children with autism never develop speech and remain mute throughout life.About one-third of children with autism never develop speech and remain mute throughout life. Mutism with severe delay or total lack of speech development.Mutism with severe delay or total lack of speech development. If speech is present atypical or deviant behavior in terms of various aspects of spoken language are seen as the following:If speech is present atypical or deviant behavior in terms of various aspects of spoken language are seen as the following:

14 Voice, articulation and prosodic abnormalities seen as:Voice, articulation and prosodic abnormalities seen as: poor and inappropriate pitch, loudness and quality,poor and inappropriate pitch, loudness and quality, misarticulations,misarticulations, inappropriate rate and rhythm in speech.inappropriate rate and rhythm in speech.

15 Stereotyped and repetitive use of language such asStereotyped and repetitive use of language such as echolalia,echolalia, use of stock phrases on few topics only,use of stock phrases on few topics only, repeated questions etc.repeated questions etc.

16 Pronoun difficulties as in the confusion with pronouns, pronominal reversal as in the use of 'you' for 'I'.Pronoun difficulties as in the confusion with pronouns, pronominal reversal as in the use of 'you' for 'I'. Atypical vocabulary development seen as patchy acquisition of vocabulary on a single or a few topics.Atypical vocabulary development seen as patchy acquisition of vocabulary on a single or a few topics. Ex. Names of objects, fascination with alphabet, date, numbers, etc. Example: a. A child could come out with names of 18 eatables at a stretch. b. Recitation of Sanskrit slokas.Ex. Names of objects, fascination with alphabet, date, numbers, etc. Example: a. A child could come out with names of 18 eatables at a stretch. b. Recitation of Sanskrit slokas.

17 Idiosyncratic use of words as in the use of utterances the meaning of which is obscure to others indicating communicative failures.Idiosyncratic use of words as in the use of utterances the meaning of which is obscure to others indicating communicative failures. Failure to respond to the communication of others and failure to initiate (spontaneously) and sustain communication indicating problems with interpersonal two-way communication.Failure to respond to the communication of others and failure to initiate (spontaneously) and sustain communication indicating problems with interpersonal two-way communication. Semantic and conceptual difficulties as in "case in concrete" use of learnt words and concepts, difficulties with conceptualization and comprehension of heard language, etc.Semantic and conceptual difficulties as in "case in concrete" use of learnt words and concepts, difficulties with conceptualization and comprehension of heard language, etc.

18 Abnormalities in the use of nonverbal communication as seen in the poverty of facial expressions and gestures as pointing and showing, impaired emotion recognition and expression, etc.Abnormalities in the use of nonverbal communication as seen in the poverty of facial expressions and gestures as pointing and showing, impaired emotion recognition and expression, etc. Morpho syntactic and Pragmatic Errors telegraphic speech, poor PNG markers, poor comprehension, imaginary observation.Morpho syntactic and Pragmatic Errors telegraphic speech, poor PNG markers, poor comprehension, imaginary observation.

19 SOCIAL SYMPTOMS IMPAIRMENT IN USE OF EYE GAZE, FACIAL EXPRESSION, BODY POSTURES AND GESTURES. DEFICITS IN JOINT ATTENTION SKILLS. LACK OF IMMITATION. LACK OF DRIVE FOR SOCIAL ENGAGEMENT LACK OF INITIATION IN INTERACTION LACK OF RELATING TO PEOPLE

20 SENSORY INTEGRATION DYSFUCTION IT CAN BE DEFINED AS INABILITY OF THE BRAIN TO CORRECTLY PROCESS INFORMATION BROUGHT IN BY THE SENSES. CHILDREN WITH SENSORY INTEGERATION DYSFUNCTION MAY BE HYPERACTIVE OR HYPOACTIVE. THE SYMPTOMS OF SENSORY INTEGRATION DYSFUNCTION CAN BE SUBDIVIDED INTO VARIOUS DOMAINS:

21 VESTIBULAR SYMPTOMS: HYPO- THE NEED FOR ROCKING, SWINGING AND SPINNING. HYPER- DIFFICULTIES IN ACTIVITIES, WHICH INCLUDE MOVEMENT, SPORT,DIFFICULTIES IN STOPPING QUICKLY OR DURING AN ACTIVITY. PROPRIOCEPTIVE HYPO: PROXIMITY- STANDING TOO CLOSE TO OTHERS, NOT KNOWING PERSONAL BODY SPACE, NAVIGATING ROOMS AVOIDING OBSTRUCTIONS, BUMPING INTO PEOPLE. HYPER – DIFFICULTIES IN FINE MOTOR SKILLS, MANIPULATING SMALL OBJECTS.

22 SMELL (ALFACTORY) HYPO- NO SENSE OF SMELL, FAIL TO NOTICE EXTREME ODOURS. HYPER- TOILETING PROBLEM, DISLIKES SHAMPOOS AND PERFUMES. VISION HYPO- MAY SEE THINGS IN DARK, CONCENTRATE ON PERIPHERAL VISION COZ CENTRAL VISION IS BLURRED. HYPER- DISTORTED VISION, FRAGMENTATION OF IMAGES, FOCUSING ON PART THAN ON WHOLE.

23 HEARING HYPO – HEARING CONVERSATION OR SOUND WHICH OTHERS CANNOT HEAR (BELOW AUDIBLE DB) HYPER - CAN’T TOLERATE SOUNDS IN WHICH OTHER’S HAVE NO DIFFICULTY. TOUCH HYPO- HOLDS OTHERS TIGHTLY, HAS HIGH PAIN THRESHOLD, SELF HARMING, ENJOYS HAEVY OBJECTS ON TOP OF THEM. HYPER- TOUCH IS PAINFUL, DISLIKES BRUSHING AND WASHING HAIR. LIKES CERTAIN TEXTURE OF CLOTH.

24 Emotional expression of Autistic children Typically, autistic children do not show any need for affection or contact with anyone They do not understand others’ emotions properly Can’t express their own emotion in a sociable way. Have characteristic ways of showing physical affection toward parents, caregivers and/or adults.

25 Summary Autism is not a single condition but rather there is a spectrum of conditions The core behavioural features observed in autism are actually relatively independent & each can be observed in isolation – related conditions (e.g. PLI) may reflect expression of just one of these features Autism is apparently increasing in prevalence – this is likely due to advances in understanding/diagnosis rather than a true increase

26 Differential Diagnosis MENTAL RETARDATION Appearance – Strikingly intelligent physiognomic of Autistic  Early Skill Performance  Memory – Excellent Rote Memory  Spatial Ability  Motor and Manual Ability  Special Ability – Idiot Savant Performance

27 CHILDHOOD SCHIZOPHRENIA  Onset & Course – CS follow an initial course of normal development than CA CA innate Course lifelong in case of CA in comparison to CS.  Health & Appearance – CS poor health from birth – contrast to CA  EEG – CS considerably high abnormality in comparison to CA  Physical Responsiveness – Impaired in CA in comparison to CS  Autistic aloneness – failing to adjust with others – in both emotional and postural aspects.  Preservation of sameness is common to autistic than CS

28 Hallucination is common to CS but not CA Motor performance better in CA than CS Language impaired in CA – not in CS Idiot savant performance Personal Orientation – CS realizes that he is confused – disoriented but CA is unoriented. Conditionability – Conditioning hard to establish with CA, CS conditioned easily. Twin – both monozygotic and dyzygotic, more in autism than in schizophrenic. Family Background – Low divorce rate, high educational background- dramatically different in CS Family Mental Disorder – Low incidence in CA than CS.

29 RETT’S Disorder  Apparently normal psychomotor and other physical development upto 5 months after birth.  Stereotyped hand movements  Loss of social engagement early in the course.  Severely impaired expressive and receptive language Unlike Autistic  Deceleration of head growth between 5 to 48 months.9  Loss of previously acquired purposeful handskills bet ages 5 –30 months  Appearance of poorly coordinated gait or trunk movements  Severe psychomotor retardation

30 ASPERGER’s Disorder Marked impairment in the use of multiple nonverbal behaviours  Lack of social and emotional reciprocity  Lacks in eye-contact, socially approved facial expression, body posture and gesture to regulate social and emotional interaction.  Failure to develop peer relationship.  Lack of spontaneous seeking to share enjoyment, interest and achievements with other people.  Restricted, repetitive and stereotyped pattern of behaviour.  Apparently inflexible adherence to specific, non-functional routines and rituals  Stereotyped and repetitive motor mannerism (hand flapping etc.)

31 UNLIKE AUTISM No clinically significant general delay in language No clinically significant general delay in No clinically significant general delay in self help and adaptive behaviour (other than social interaction).

32 CHILDHOOD DISINTEGRATIVE BEHAVIOUR Apparently normal development up to 2years of age.  Qualitative impairment in communication, both verbal and non-verbal  Restricted, repetitive, and stereotyped pattern of behaviour  Motor stereotype and mannerism UNLIKE AUTISM  Clinically significant loss of previously acquired skills, viz, language, social, bowel and/or bladder control, play, motor skills etc. before age 10 years.

33 A "Theory of Mind" (TOM) A A "Theory of Mind" (TOM) "Theory of Mind" (TOM) TOM is a specific ability to read the Intentions, Beliefs, Feelings, Emotions and desires of others from their external behaviour. TOM proposes that all humans are, by nature, mind-reader, i.e., can interpret other’s mind in terms of theoretical concepts of intentional states such as own beliefs and desires.

34 In recent years, the phrase "theory of mind" has more commonly been used to refer to a specific cognitive capacity: the ability to understand that others have beliefs, desires and intentions that are different from one's own.

35 ToM for AUTISTIC INDIV. Theory of mind refers to the notion that many autistic individuals do not understand that other people have their own plans, thoughts, and points of view. Furthermore, it appears that they have difficulty understanding other people's beliefs, attitudes, and emotions.

36 Autistic people see others as extensions of themselves because they do not have a coherent, independent self that "separates" them from other people. Hence, they instinctively expect others to perceive, think, feel, sense and behave like them.

37 INTERVENTION Behaviour Modelling - LOVAAS Technique - Applied behaviour Analysis - TEACCH - Higashi - Dietary Therapy

38 Recent trend Sensory Integration & Praxis Speech Therapy Emotional Stimulation Dance – Movement Therapy Health & Sex Education Play Therapy Music Therapy

39 Sensory Therapy & Praxis

40 Sensory Integration SI is an innate neurobiological process by which the brain organizes and interprets sensory inputs from different modalities.  SI is both “a neurological process and a theory of the relationship between neurological process and behavior.”

41 SI Therapy SI impairment – successful integration of sensory input requires treatment  This treatment is comprised of vestibular, proprioceptive, tactile, visual and auditory stimulation, developed over the last 30 years by Dr. A. Jean Ayres.

42 Motor Deficits in ASD Gross motor delaysGross motor delays Unusual postures, clumsiness, and motor planning problemsUnusual postures, clumsiness, and motor planning problems Motor abnormalities, especially organization and sequencing of movementsMotor abnormalities, especially organization and sequencing of movements Difficulties with preparation phases for movement patternsDifficulties with preparation phases for movement patterns Difficulties with imitationDifficulties with imitation

43 Praxis is the neurological process by which cognition directs motor action; motor or action planning is that intermediary process which bridges ideation and motor execution to enable adaptive interactions with the physical world. (Ayres, 1985)Praxis is the neurological process by which cognition directs motor action; motor or action planning is that intermediary process which bridges ideation and motor execution to enable adaptive interactions with the physical world. (Ayres, 1985)

44 Types of SI Tactile - Various Brushing Technique - Cushion sandwich. - Vibration from a hand-held device. Proprioception Jumping, Riding a swing. Vestibular Riding a static cycle. Ground Tunnel Activities. Walking on a stepper/walker. Visual- Attending to visual specific visual patterns. Auditory- Auditory Integration Therapy

45 Speech & Language Therapy

46 Self TalkSelf Talk Parallel talkParallel talk Improving eye contact (eye to eye, nose to nose, finger to nose, finger to finger).Improving eye contact (eye to eye, nose to nose, finger to nose, finger to finger). To follow simple commandsTo follow simple commands Auditory trainingAuditory training To follow complex commands (to follow two part commands)To follow complex commands (to follow two part commands)

47 Big and small conceptBig and small concept Left & right conceptLeft & right concept Colour conceptColour concept Body parts conceptsBody parts concepts Imitation of vocal behaviorsImitation of vocal behaviors Imitation of body movement (gross & fine).Imitation of body movement (gross & fine).

48 Sentence elongation (ami bhat khabo, ami ekhon bhat khabo, ami ekhon garam bhat khabo, ami ekhon garam bhat ar manso khabo)Sentence elongation (ami bhat khabo, ami ekhon bhat khabo, ami ekhon garam bhat khabo, ami ekhon garam bhat ar manso khabo) Yes/ No optionsYes/ No options Understanding questionsUnderstanding questions Ask questionsAsk questions Comprehension of storiesComprehension of stories

49 Two step, three step and four step storiesTwo step, three step and four step stories Action words (who, when, where and why)Action words (who, when, where and why) Verb play (eso, jao, khao etc.)Verb play (eso, jao, khao etc.) Request assistanceRequest assistance Request informatives (what?)Request informatives (what?) Name of objectsName of objects Defining objects in terms of functionsDefining objects in terms of functions Offers resistance (ma nebe)Offers resistance (ma nebe)

50 Justifies own action (tumi ki korcho?)Justifies own action (tumi ki korcho?) Problem SolvingProblem Solving Situational talkSituational talk Question and answers (random)Question and answers (random) Topic maintainenceTopic maintainence Story tellingStory telling Develop semanticsDevelop semantics Talk about experiencesTalk about experiences

51 SequencingSequencing Before/afterBefore/after Why/becauseWhy/because Comprehension of a passage/story/eventComprehension of a passage/story/event Turn takingTurn taking SocializationSocialization Share ideas/suggestionsShare ideas/suggestions Give / take (dao/nao)Give / take (dao/nao)

52 Picture descriptionPicture description Complex sentence formationComplex sentence formation Complex story following questiuon and answerComplex story following questiuon and answer Abstract ideasAbstract ideas Providing sufficient information (Brush & paste etc)Providing sufficient information (Brush & paste etc) ExplanationsExplanations

53 How conceptsHow concepts Many/singleMany/single Tense conceptTense concept Verb formVerb form Story tellingStory telling Emotional speechEmotional speech Continuation of a topic (tarpar)Continuation of a topic (tarpar) Make sentencesMake sentences

54 Repair strategiesRepair strategies Imaginative talkImaginative talk Make sentences (complex) two wordMake sentences (complex) two word Use of oppositesUse of opposites Use of prepositionUse of preposition Use of conjunctionsUse of conjunctions What happens then (tahole ki hobe?)What happens then (tahole ki hobe?) Comprehend a question – simple/complexComprehend a question – simple/complex

55 Reinforcement scheduleReinforcement schedule Time conceptTime concept Age conceptAge concept Money conceptMoney concept Why questions?Why questions? Past event description (recent/very recent/past/too past)Past event description (recent/very recent/past/too past) Sense of humourSense of humour

56 Tea makingTea making Daily routinesDaily routines Good or bad conceptGood or bad concept Rules (to obey)Rules (to obey) Missing informationMissing information Appropriate behaviorAppropriate behavior Angry situationsAngry situations Empty/fullEmpty/full

57 Pronouns (ami/ amra etc.)Pronouns (ami/ amra etc.) Clarification (amake bolte hobe to)Clarification (amake bolte hobe to) Play a story (bandhu ke story bole/ han/ ki story)Play a story (bandhu ke story bole/ han/ ki story) Face readingFace reading Telephone conversationTelephone conversation Synonyms/hyponymySynonyms/hyponymy Agent+action (phal – khabo, -kinbo/ katbo)Agent+action (phal – khabo, -kinbo/ katbo) Picture – before+after (lathi marche-age/pore)Picture – before+after (lathi marche-age/pore) Listening story+’wh’ questions+answers+ask questions/give answersListening story+’wh’ questions+answers+ask questions/give answers

58 Sequesnce – storySequesnce – story Jumbled words into story-sentences into storyJumbled words into story-sentences into story Today/yesterday/tomorrow conceptToday/yesterday/tomorrow concept Environmental awarenessEnvironmental awareness Regulations (janala keno thake)Regulations (janala keno thake) Cause+effect (brishti+kada)Cause+effect (brishti+kada) CategorizationCategorization Word makingWord making

59 Fill in the gapsFill in the gaps GenderGender Sentence variationsSentence variations Association andAssociation and ORO-MOTOR EXERCISESORO-MOTOR EXERCISES

60 Oro- motor Exercises + Sensory Integration Training Tongue ExercisesTongue Exercises Lip ExercisesLip Exercises Oro-motor co-ordination TrainingOro-motor co-ordination Training Muscle TrainingMuscle Training Stress TrainingStress Training Isometric & Isotonic ExercisesIsometric & Isotonic Exercises

61 Emotional expression of Autistic children Typically, autistic children do not show any need for affection or contact with anyone They do not understand others’ emotions properly Can’t express their own emotion in a sociable way. Have characteristic ways of showing physical affection toward parents, caregivers and others.

62 Training Researchers showed that autistic children can properly express their emotion under exposure of proper affective stimulation. Through training children are stimulated to respond to stimuli that normally gives rise to pleasant stimulation and discouraged from responding emotionally to stimuli that give rise to the unpleasant emotions.

63 Dance/Movement Therapy is defined by the American Dance Therapy Association as “the psychotherapeutic use of movement as a process that furthers the emotional, cognitive, social and physical integration of the individual.” Body Attitude: - Body Awareness: Body Coordination: - Body Reflex Gestalt Interactional Synchrony: Kinesphere :- Kinesthetic Memory Movement Vocabulary: Phrasing Spatial Awareness:- Expressional Aspect:-

64 Play Therapy Play therapy was originally conceived as a tool for providing psychotherapy to young people coping with trauma, anxiety and mental illness. In that context, play becomes a way for children to act out their feelings and find coping mechanisms.

65 Stages of Play Therapy – Sensori-motor stage This stage normally develops during 6 to 8 months of age. With the aim of facilitating social interaction and communication and developing sensori-motor skills, arrangement of simple games like: ball throwing and sand play have arranged. A scientific Sand Pool with coloured balls and toys kept hidden under the sand and children would be motivated to search them, different shapes of spoons and sieves have been kept for sand poring. Thus the child has to explore at first object of his primary interest and then gradually expected to turn to culture specific social interests. After primary fulfillment of sensation with sand, a ball pool would be provided. Thus the the aim of sensori-motor stage is to facilitate whole body interaction, to reduce behavioral problems, to develop eye contact, joint attention &object permanence.

66 Organizational/ Constructive play- This type of play occurs from 6 to 9 months of age when the child has developed strategies for examining the surrounding world In autistic children to develop the strategies for understanding the world beyond their “glass shell” this stage has structured with some items, which would encourage them to take interest in the outer world,e.g., modeling with plasticine, block building, form boards of different shapes and colours, two and three piece puzzles, colour pyramid Thus, the aim of this stage is to improve concentration, stimulate creativity, provide self-sufficiency in specific and shared attention, eye contact communication and social interaction, in general.

67 Functional Play The third stage is of functional play. This play normally dominates from the age 9 months to12 months. Play items at this stage are used intentionally, according to their functions. Important part of the functional play is to acquaint them with the different objects and their functions. This process has been started with identification of the body parts and their functions followed by identification of different fruits, vegetables, transports, cooking utensils, furniture, along with their functions. Finally, the situation has been structured in such a way that the children can be provided with a male and a female doll and learnt to describe their attire. Human models of different relations with different ages and imaginative figure like fairy have been introduced as per the capacity of the child. Thus the aim of this stage is to help the children to know about their surrounding and to imitate object-oriented behaviors of others.

68 Pretend play- The final stage in structured play is pretend play. This type of play is a valuable opening to the emotional and cognitive universe. This stage has structured with the help of a dolls’ house within which there are separate rooms for separate purposes, with suitable furniture according to the purpose of the room. The house has been so structured that upto 3-4 yrs. child can enter within the camp wall. The child, with guided participation first learnt the details of the rooms, he has been made aware about the family members of the house and finally he could pretend his daily routine with the help of the dolls. Role taking has also been facilitated. Moreover, the model dolls of human beings as used in the previous stage, has also been included with more variety of relationships and images. Thus the aim for this stage is to encourage mental representation, appropriate social interaction and communication.

69 Rules to be followed in Play therapy Use manipulative and exploratory play to show how to interact with objects and the environment around Treat autism by engaging children in tumbling and physical activity to develop motor skills. Use role-playing and social play to mimic real life situations. "Social stories" and "scripting" can develop language skills and teach social rules.

70 Contd …. Let autistic children learn games from other autistic children with integrated play Encourage autistic children to participate in symbolic or pretend play allows children with autism to develop thought flexibility. Engage children in functional play, where a child may provide appropriate sound effects and reactions for a toy or everyday object. Treat autism by choosing toys that will make a visual impact Enhance physical activity to encourage self-expression. Structure playtime so that there is continuity and repetition. Use familiar objects, but introduce new materials or different types of toys to keep activities feeling spontaneous and fun.

71 Music Therapy on Autism - Music therapy can be taken as a promising approach for intervention of autistic children. Stephen Malloch(1999) develop this into a theory called ‘communicative musicality’ – a theory of basic motivation for communication in form of musical expression. Improvising music therapy is gaining acceptance as an effective way of gaining and regulating communication with even the most recalcitrant autistic youngsters

72 Health & Sex Education Sex education for individuals with autism ranges from health and hygiene to social skills and dating. The manner and amount of detail during the instruction will depend on the functioning level of the person being taught and what teaching strategies are most effective for that individual.

73 Training concept Concepts that could be included in social/sexual training include: growth and development; modesty; public and private; respect of privacy; differentiating among friends, family, acquaintances, and strangers; doing something about sexual feelings; and learning about "safe" sex.

74 A CURRICULUM FOR HEALTH AND SEX EDUCATION (SHEC) The following program is being made as curriculum of health and sex education for the people with autism by which, it could be possible for teaching age appropriate and socially acceptable behaviors. This program is divided into 5 segments and each segment contains items related to sex and health education. Domain IBiology and Personal Appearance Domain IIPrivacy/Modesty (about sexual expression) Domain IIIHealth/Hygiene/Personal Care Domain IVRecognition of Emotion Domain VSocial Behaviour

75 Biology and Personal Appearance Identification of body parts including private parts of own body Materials - Models of male & female, Pictures of male &female. Identification of gender specific dresses (in Indian culture). Materials -Pant, Shirt, dhuti, panjabi, Shaving set. Sari, Salwar kamiz, Frock, Skirt, Blouse, Ornaments like bangle, necklace, earring, bindi, hair clip etc.

76 Identification of same sex which he/she belongs and opposite sex as well. Materials - Human being (adult & peer), Models of male and female, Pictures of male and female. Identification of gender from different ages. Materials - Various pictures of male showing of different age level, Various pictures of female showing of different age level. Differentiate sex by name like Ankit is male & Ankita is female.

77 Similarities and differences in male and female. Materials- Model of both male & female, Concept should be developed like, -Sameness, in terms of eye, nose etc. apart from private body parts. A difference in terms of private body parts and by gender specific dresses. Different developmental stages of a human being. Materials - Male and female pictures of different stages like, Infant, Early childhood,. Late childhood. Adult & Old age -Identification of each stage individually. -Understanding of younger, elder and older. -Arranging of different stages sequentially. -Arranging own photographs according to his/her chronological age.

78 Privacy / Modesty (about sexual expression) : Modesty: Materials: Models of male & female Gender specific dresses. - She/he has to understand the necessity of wearing garments and practice these activities with the model also. - She/he has to close the door while dressing, undressing, toileting, bathing and masturbating or touching his/her body parts. Menstruation: –Materials A particular brand of sanitary napkin, Date calendar, A set of flash cards depicting the use of napkin. Make her understand to highlight the date of every month of a calendar. -Washing the inner garment twice a day during cycle for safety. -Demonstrate the process of sanitary napkin usage.

79 Ejaculation: -The individual has to wash own inner garments after ejaculation. -Wash the genitals properly after ejaculation. -Has to learn to maintain privacy. Masturbation: Models of male& female, A peace of cloth, A set of pictures showing masturbating by closing the door. Has to learn the touching of genitals in isolation. -Covering up the nude model of own sex with a cloth for understanding -Touching of genitals in isolation.

80 Health/Hygiene / Personal care: CLEANLINESS a. Cleanliness before and after meal: Materials - Soap. Water Towel Napkin. b. Cleanliness during and after toileting: Materials - Soap.Towel Water. c. Cleanliness during menstruation: d. Cleanliness during ejaculation: e. Cleanliness during cough and cold: Materials - Napkin, Water, Basin. f. Brushing Materials - Brush & paste. Mirror. Towel. Basin. g. Cutting nails Materials = Nail cutter, Water.

81 Bathing Materials - soap.Towel. - The individual has to understand the meaning and significance of cleanliness. -These processes can be demonstrated by role-playing Using of first aid: Materials - First aid box, Sign (+). -The individual has to understand when and where to use first aid, -These processes can be demonstrated by role- playing.

82 Shaving: Materials A set of flash cards showing how to shave, Shaving kit. The individual has to arrange the shaving process sequentially, - Demonstrating the process to the child. Maintain desirable physical distance with the stranger / family members: Make aware the individual about maintaining desirable physical contact from family members and outsiders as well. -The pattern of addressing style should be like kisses on head, a pat on his backs or handshake, warm verbal praise etc,

83 Recognition of Emotion: Identification of different expression of different emotions. Materials –Happiness. –Sadness. –Fear. –Anger. –Disgust. –Surprise. Procedure: - Has to identify the each emotion card individually, - Has to identify emotion from different facial expression.

84 Social behavior: Interaction with stranger: Taking care of younger: Taking care of older: Taking care of same age: Sharing habit: Procedure: -These behaviors could be taught through role-playing.

85 Prerequisites The individual's behavioral repertoire must be assessed in the areas of observed sexual expression, development of modesty, interactions with others, awareness and acceptance of self, and self- care and hygiene.

86 Attitude toward Disability Disabled’ is used with caution to express the positive attitude.Disabled’ is used with caution to express the positive attitude. specially abled,, specially abled,, mentally challenged, mentally challenged, discover of ability’ and so on, discover of ability’ and so on, it creates little difference on the part of the distress of the persons with disability and the parents they have to bear in everyday life. it creates little difference on the part of the distress of the persons with disability and the parents they have to bear in everyday life.

87 Attitude toward disability Stages of Acceptance Denial Burgaining Blaming Support seeking Depression Acceptance

88 Attitude toward disability Breaking out of the Vicious Circle Discrimination and prejudice create the sense of being disabled that leads to further discrimination and prejudice. How can this vicious circle be broken? It is the Empathy – Not Sympathy

89 The harsh reality is that if disabled people themselves see themselves as victims, then they will be treated as victims; if they are sunk into self-pity, they will be perceived as pathetic; if they are hostile towards non-disabled people, they will be shunned; but if they refuse to see themselves as victims, if they claim their own dignity, see themselves as positive and able to contribute, they will be seen as positive and able to contribute.

90 Thank You


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