Autism 101 HCISD Autism Team: Debbie Pena, Educational Diagnostician, Amanda Schulz, LSSP, Jessie Leal, LSSP, Connie Britten, Speech Therapist, Sara Parsons, Speech Therapist, Jan Demro, Educational Diagnostician, Brenda Lyne, Educational Diagnostician, Marisol Aguilar, Speech Pathologist

Goals for today….. Today’s information will provide a good start towards understanding the challenges that persons with Autism Spectrum Disorder (ASD) encounter. Because children with autism are on a broad spectrum, we will learn about children along the spectrum, their skills and unique needs. We will look at the research by leaders in the field of autism (Stanley Greenspan, Kathleen Quill, Tony Attwood and others), discuss the key concepts we need to know and consider when working with students with ASD, and how to apply them when working with students. This information is appropriate for general education and special education teachers who want a foundation from which to build their knowledge and skills about ASD. Paraprofessionals are especially welcome!

What is autism? Autism is defined as a complex developmental disability which is neurological in nature. Neurological=based in the brain, the brain is “wired” differently. The brain does not make the same connections in the same way as other people’s brains.

History of Autism Autism was first described in US literature by Leo Kanner in 1943 He called the syndrome “early infantile autism” Autism was also often misdiagnosed as early childhood schizophrenia Early psychologists hypothesized that children became autistic due to ‘cold and unurturing’ mothers. This theory was proven false in 1979.

CDC census data

A common language Pervasive Developmental Disorders Asperger’s Disorder PDD:NOS Rett’s Disorder Autistic Disorder Childhood Disintegrative Disorder

Facts on Autism-From CDC 2010 Between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have an ASD Autism prevalence figures are growing (the current annual growth rate is 10-17%) More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined Autism is the fastest-growing serious developmental disability in the U.S.

FACTS: Continued Autism costs the nation over $35 billion per year, a figure expected to significantly increase in the next decade Recent studies have estimated that the lifetime cost to care for an individual with an ASD is $3.2 million Autism receives less than 5% of the research funding of many less prevalent childhood diseases Boys are four times more likely than girls to have autism There is no medical detection or cure for autism

Facts: Continued Typically manifests around the ages of 18 months to 3 years Is found throughout the world in families of all racial, ethnic and social backgrounds There is no cure, but much research is currently being done There are many treatments; and from researched based evidence, educational treatment appears to be the most effective Autism remains throughout a person’s lifetime, although with proper intervention symptoms can lesson

Facts: Continued Genetics are a factor in the cause Environmental triggers are also a factor Probability of a 2nd twin being diagnosed after 1st diagnosed

What autism is NOT Some individuals with autism do express affection, smile and laugh, and show a variety of other emotions. The degree of this expression may vary. Some individuals with autism would like to have friends; they may not have the skills to make friends.

What autism is NOT Children with autism are not “spoiled” or unruly children with behavior problems. Most individuals with autism are not savants, like Dustin Hoffman in Rain Man.

Screening and Diagnosis Diagnosing autism spectrum disorders (ASDs) can be difficult, since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis ASDs can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until a much older age. This delay means that children with an ASD might not get the early intervention they need Diagnosing an ASD takes two steps:

Developmental Screening Ideally, all children should be screened for developmental delays and disabilities during regular well-child doctor visits at: •9 months •18 months •24 or 30 months •Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons

**Referrals to HCISD Special Education In addition, all children may be screened specifically for ASDs during regular well-child doctor visits at: •18 months •24 months •Additional screening might be needed if a child is at high risk for ASDs (e.g., having a sister, brother or other family member with an ASD) or if behaviors sometimes associated with ASDs are present **Referrals to HCISD Special Education Department are accepted before the age of 3 years

Comprehensive Diagnostic Evaluation The second step of diagnosis is a comprehensive evaluation. This thorough review may include looking at the child’s behavior and development and interviewing the parents. Harlingen CISD has a district autism team that conducts formal assessments through standardized evaluations, direct observations, interviews with professional staff working with the student and parent/caregiver interviews.

Developmental Milestones What developmental milestone is this child displaying?

Developmental Milestones What developmental milestone is this child displaying?

Developmental Milestones What developmental milestone is this child displaying?

Developmental Milestones What developmental milestone is this child displaying?

Developmental Milestones What developmental milestone is this child displaying?

Developmental Milestones @ 2 months Begin to smile at people Can briefly calm self Tries to look at parent Coos, makes gurgling sounds Turns head towards sounds Pays attention to faces Begins to follow things with eyes and can recognize people at a distance Begins to act bored (fussy) if activity does not change

Developmental Milestones @ 6 months Knows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to others emotions and often seems happy Likes to look at self in the mirror Responds to sounds by making sounds Strings vowels together Responds to own name Makes sounds to show joy and displeasure Shows curiosity about things and tries to get things out of reach

Developmental Milestones @ 1 year Shy or nervous w/strangers Cries when mom or dad leave Has favorite things and people Shows fear in some situations Hands you a book when he wants to hear a story Repeats sounds or actions to get attention Plays simple games such as peek a boo Cooperates w/dressing

Milestones @ 1 year: Cont. Responds to simple spoken requests Uses simple gestures like bye-bye Makes sounds with change in tone Says “mama” or “dada” or “Uh oh!” Tries to imitate words heard Explores things in different ways Finds hidden things easily Looks at the right picture when its named Follows simple directions

Developmental Milestones @ 2 years Copies others especially adults and older children Gets excited when with other children Plays beside other children, but is beginning to include other children such as chase games Points to things/pictures when named Repeats words overheard in conversation Points to objects in books Names items in book such as cat, bird or dog

Early Symptoms – Birth to 18 Months Feeding problems, such as poor nursing ability Apathetic and unresponsive – showing little or no desire to be held or cuddled Constant crying or unusual absence of crying Disinterested in people and surroundings Repetitive movements, such as hand shaking, prolonged rocking and spinning, head banging Sleeping problems Insistence on being left alone

Early Symptoms – 18 Months to 3 Years Difficulties in toilet training Odd eating habits and preferences Late speech, no speech, or loss of previously acquired speech Sleeping problems, such as requiring only a few hours of sleep each night

Early Symptoms – Other Indications Does not have anticipatory response to be picked up Seems to “tune out” a lot Prolonged tantrums Doesn’t play appropriately with toys Seems to have a good memory Fails to respond to the affection of others

Early Symptoms – Other Indications May use an adult’s hand like a tool for accomplishing tasks Does not spontaneously imitate the play of other children Tendency to spend inordinate amounts of time doing nothing or pursuing ritualistic behaviors Difficulty with changes in environment and routine Does not seek opportunities for interaction with others

Autism Spectrum Disorder Must meet criteria A, B, C, and D: A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

Autism Spectrum Disorder Must meet criteria A, B, C, and D: B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases) 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes) 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests) 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects)

Autism Spectrum Disorder Must meet criteria A, B, C, and D: C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning

Rationale for changes: New name for category, autism spectrum disorder, which includes autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. •Differentiation of autism spectrum disorder from typical development and other "non-spectrum" disorders is done reliably and with validity; while distinctions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder. •Because autism is defined by a common set of behaviors, it is best represented as a single diagnostic category that is adapted to the individual’s clinical presentation by inclusion of clinical specifiers (e.g., severity, verbal abilities and others) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability and others.) A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”.

Common Characteristics of Autism Three common Characteristics of autism Deficits or differences in social skills Deficits or differences in communication skills Deficits or differences in routines/behaviors/sensory

Learning Social Behavior Neurotypical (non-autistic) children learn basic socialization skills simply by exposure to social situations. They see mom and dad interacting with each other and with others at home and in the community and learn appropriate ways to talk to and play with children their age.

Learning Social Behavior Children with autism often require direct, explicit instruction in order to learn the same skills. They have difficulty generalizing between what they see to how they should act.

Social skill challenges http://www.5min.com/Video/Early-Signs-of- Autism-6777 Lack of awareness of the existence or feelings of others Severe impairment in the ability to relate to others Aloof and distant from others Appears to not listen when spoken to

Social skill challenges: Cont. Challenges in producing appropriate facial affect to specific occasions Avoid or fleeting eye contact Challenges with changes in environment and routine Challenges in seeking opportunities to interact with others Unwillingness and/or inability to engage in cooperative play

Social Behavior in the Classroom Individuals with autism may: have trouble controlling emotions and anxieties be inattentive, act as if deaf, does not respond to name laugh at inappropriate times make irrelevant comments and interrupt conversations be naïve lack tact

Supporting appropriate social behavior… Use a visual schedule or other environmental support Object schedule Photograph schedule Picture schedule Written schedule Mini-schedules

Visual Schedules/Supports Children with autism require these schedules and supports to help them: Follow rules Understand what they are supposed to do Understand how to complete work or play activities and tell someone they are finished Move from on activity to another Make choices about what they want to do Making Visual Supports, Jennifer L. Savner & Brenda Smith Myles

Classroom Schedules

Classroom set-ups

Communication skills challenges Challenges in using and understanding both verbal and non-verbal language Failure to initiate or sustain conversational interchange (ask/answer questions) Abnormalities in the pitch, stress, rate, rhythm and intonation of speech

Communication skills: Cont. Poor receptive and expressive skills May echo words (echolalia) either immediate or delayed May use screaming, crying, tantrums, aggression or self abuse as ways to communicate Repeating words or phrases in place of normal, responsive language (TV talk)

Supporting appropriate social behavior… Integrate visual supports with explicit training Cue cards/ note cards Social Stories Power Cards “Hot Pass” Talk Prompters Reminder Cards A mini-schedule is a kind of support that does a “task-analysis” of an activity. To help children with autism remember the rules of the “hidden curriculum” cues cards can be used. Talk prompters are cards with ideas on how to open and extend conversations (can be practiced in a group situation) Note-cards of how to act in certain social situations A “hot pass” is a card to be used to remind children with autism where they need to go and who they need to see if they are feeling overwhelmed.

What are Social Stories? Modeling is a powerful teaching strategy with children with some form of autism. A social story is a story that depicts some particular social skill being acted out (or modeled). A good social story will focus on a particular social situation or interaction. A trip to the store, meeting a new person, or going to the school lunchroom with your class - these are all good examples of situations a social story might focus on. The story serves a number of purposes. It provides details and information for the child reading the story - important because autistic children often find social situations confusing. It provides the child with a list of the events and interactions that they will have to negotiate in a particular social setting. It spells out expected behaviors for the child and explains why those behaviors are expected. Sometimes a social story will explain the consequences of not meeting those expectations The most important aspect of a social story is that it provides an autistic student with a role model. The main character of a social story should be someone the autistic student can identify with. The main character can then model success in a social situation for autistic child that reads the story.  

Power Card Strategies Power Card Strategy involves including special interests with visual aids to teach and reinforce academic, behavioral and social skills to individuals with Autism Spectrum Disorders. Since many children with autism tend to have highly developed special interests, this strategy is especially beneficial for this population. By using their special interest, the individual is motivated to use the strategy presented in the scenario and on the power card. It is a positive strategy that is often entertaining as well as inexpensive and simple to develop

Picture Exchange Communication System (PECS) for Children with Autism A picture communication system )PECS is a form of augmentative and alternative (AAC) that uses pictures instead of words to help children communicate. PECS was designed especially for children with autism who have delays in speech development

Video Modeling Research on children with autism has shown that video modeling can be very effective in improving the following skills and target behaviors: social interaction behaviors academic and functional skills communication skills daily living skills play skills social initiations perception of emotion spontaneous requesting perspective taking Video modeling can teach target behaviors very quickly compared to other methods, and the behavior is said to be "generalized," (i.e., the child is able to exhibit the behavior in real-life situations that are similar to the research scenario). At the same time, video modeling has been proven to decrease certain problem behaviors, including aggression, tantrums and other off-task activities.

Behavioral/Sensory Challenges Unusual and repetitive movements of the body that interfere with the ability to attend to tasks or activities, such as hand flapping, finger flicking, rocking, hand clapping, grimacing or eye gazing.

Behavioral/Sensory Challenges Marked distress over changes in seemingly trivial aspects of the environment Laughing, crying, or showing distress for reasons not apparent to others Unreasonable insistence on following routines in precise detail

Behavioral/Sensory Challenges Unresponsive to normal teaching methods Acts as if “deaf” Apparent over or under sensitive to pain No fear of real danger Uneven gross and fine motor skills

Other characteristics: Cont. May have difficulties cuddling Inappropriate attachment with objects Inappropriate play Noticeable physical over or under activity

The Many Faces of Autism http://www.youtube.com/watch?v=rXgUl1qPd Mg

Classroom strategies Communication: pictures and picture schedule; simple sign language; assignment notebook; teach the meaning of idioms; use short verbal phrases; allow wait time (just how long is a minute?); alert students to key phrases (This is important!) Social: use mixed grouping; use social stories or social scripts; use pictures with words to present choices; allow students to work in pairs; integrate team building; teach awareness early

Classroom strategies Behavioral: use seating charts; class-wide and schoolewide behavioral plan; develop each personalized behavioral plan; teach self monitoring (5 point scale); review schedule often; model positive behavior; be generous with specific praise; provide direct feedback Environmental: post daily activities; use preferential seating; allow dedicated space for student; avoid sudden changes in routine; label desks; maintain consistent routine; provide movement breaks; use study carrels; keep unnecessary material away

Classroom strategies Visual: write or list information on board or desk; provide notes; give written information for assignments/projects; use pictures in support of verbal and written directions; make artifacts so child can copy Sensory: assess students sensitivity; allow stress balls or fidget items; use inflatable seat cushions; provide regular breaks; make “chewies” available; have a relaxation room

Developmental Milestones http://video.msnbc.msn.com/nightly- news/50521287

WANT MORE???!!! Contact HCISD Special Education Department Autism Team or any Autism Team Member

Thank you for coming! Additional Resources http://www.udel.edu/bkirby/asperger/ http://www.firstsigns.org/ http://www.autism-society.org/ http://www.autismspeaks.org/ http://icdl.com/