© 2013, 2009, 2006, 2003, 2000 Pearson Education, Inc. All rights reserved. William L. Heward Exceptional Children An Introduction to Special Education Tenth Edition

Chapter 7 Autism Spectrum Disorder

Focus Questions  What are the defining features—the clinical symptoms—for a diagnosis of autism spectrum disorder?  How might some of the characteristic behaviors of autism spectrum disorders become assets for the child as a learner?  What factors might account for the enormous increase in the prevalence of autism spectrum disorders in recent years?  How have etiologic theories and the search for causes of autism changed from the first reports of the disability to today? Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-2

Focus Questions (cont.)  Why are research and development of tools for early screening and diagnosis of autism spectrum disorders so critical?  What skills are most important for teachers of children with autism spectrum disorders?  What features of an educational environment (a general education classroom, resource room, or special class) will enable a child with autism spectrum disorders to benefit optimally from placement in that setting?  Why are fads and unproven interventions so prevalent in the education and treatment of children with autism? Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-3

IDEA Definition  Autism is a developmental disability affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s performance.  Other characteristics are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual response to sensory experiences  Autism does not apply if the child has a serious emotional disturbance Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-4

DSM-IV Definitions Autistic Disorder - marked by three defining features, with onset before age 3: 1) impaired social interaction, 2) impaired communication, and 3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities Asperger Syndrome - impairments in all social areas, particularly an inability to understand how to interact socially. These children do not have general language delay, and most have average or above-average intelligence Childhood disintegrative disorder - shares characteristics with autistic disorder, but doesn’t begin until after the age of 2 and sometimes not until age 10 Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - diagnosis given to children who meet some, but not all, of the criteria for autistic disorder Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-5

Proposed DSM-5 Definition of Autism Spectrum Disorder  DSM-5 combines two core deficit areas: impairments in social interaction and impairments in communication into a single domain of social/communication deficits and subsumes Asperger’s disorder into a single diagnostic category of autism spectrum disorder  A child diagnosed with autism spectrum disorder will be ascribed one of three levels of severity based on the amount of support required Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-6

Characteristics Impaired Social Relationships Extreme aloofness Deficits in joint attention Communication and Language Deficits About half of children with autism do not speak Echolalia is common among those who do talk Concrete or literal processing of verbal information is common Repetitive, Ritualistic, and Unusual Behavior Patterns Some children exhibit stereotypy-a pattern of persistent and repetitive behaviors Insistence on Sameness and Perseveration Children with autism often have issues about routines Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-7

Characteristics Unusual Responsiveness to Sensory Stimuli About 70-80% exhibit abnormal reactions to sensory stimulation-hypersensitivity or hyposensitivity Varying Levels of Intellectual Functioning, Uneven Skill Development 70% and 80% also meet the diagnostic criteria for intellectual disabilities About 10% to 15% exhibit “splinter skills”-areas of relatively superior performance that are unexpected compared to other domains of functioning About 10% have savant syndrome-an extraordinary ability or knowledge in a particular area Many exhibit overselectivity-focusing on a minute feature of an object/person rather than the whole Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-8

Characteristics Problem Behavior Some students exhibit property destruction, aggression toward others, and even self-injury Many experience a variety of sleep problems Some have extremely narrow food preferences Some engage in pica-the compulsive, recurrent consumption of nonfood items The frequent, high-intensity, and sometimes dangerous behavior problems of some children with autism create stress on parents and can lead to family dysfunction if not brought under control Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-9

Asperger Syndrome Characteristics Intense interest in a particular subject Clumsiness, difficulty with fine- and/or gross-motor activities Inflexible adherence to routines Fascination with maps, globes, and routes Superior rote memory, tendency to amass many related facts Speech and language impairments in the areas of semantics, pragmatics, and prosody; pedantic, odd speech patterns; formal style of speaking Difficulty understanding others’ feelings Extensive vocabulary Perfectionist, frustrated when asked to submit work one feels is below standard Difficulty developing and maintaining friendships Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-10

Prevalence – Recent estimates - Autism occurs in as many as 30–121 in 10,000 people – Some states have reported the incidence of autism as an epidemic – Rise in autism prevalence is an international phenomenon – Boys are affected about 4 to 5 times more often than girls – In the school year, 333,022 students ages 6 to 21 received special education services under the IDEA category of autism – Autism is the fastest-growing category in special education Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-11

Causes – Autism is a neurodevelopmental disorder with no medical or physiological marker – In 90-95% of cases, the cause of autism is unknown – No causal link between parenting style and autism has ever been discovered – There is a clear biological origin of autism in the form of abnormal brain development, structure, and/or neurochemistry – Autism clearly has a genetic component – No evidence of childhood vaccinations causing autism Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-12

Identification and Assessment Early diagnosis is highly correlated with dramatically better outcomes Professional assessment of behavioral characteristics is used to determine whether ASD is present in a child Autism can be reliably diagnosed at 18 months of age Screening Tools Checklist for Autism in Toddlers (CHAT) Modified Checklist for Autism in Toddlers (M-CHAT) Social Communication Questionnaire (SCQ) Autism Spectrum Screening Questionnaire (ASSQ) Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-13

Identification and Assessment (cont.) Diagnosis, for those who fail screening tests, should be given by a professional with expertise in autism Childhood Autism Rating Scale (CARS2) Autism Diagnostic Interview-Revised (ADI-R) Autism Diagnostic Observation Schedule (ADOS) Asperger Syndrome Diagnostic Scale (ASDS) Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-14

Educational Approaches Children with autism are among the most difficult students to teach Early Intensive Behavioral Intervention The work of Ivar Lovass Applied Behavior Analysis (ABA) Discrete Trial Training Visual Supports Picture Activity Schedules Social Stories Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-15

Social Stories Purpose Social stories explain social situations and concepts and the expected behaviors of the persons involved in a format understandable to an individual with ASD. Format Social stories are written at the student’s level of comprehension and usually contain the following four basic types of sentences written from the perspective of the student. Descriptive sentences Perspective sentences Directive sentences Affirmative sentences Social stories are usually constructed with one sentence per page Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-16

Educational Placement Alternatives Students with autism are increasingly placed in general education classrooms for the purpose of improved social integration During the 2008–2009 school year: approximately 36% of students with autism were educated in the general education classrooms 18% served in resource room programs 36% in separate classes About 10% of students with autism attended special schools or residential facilities Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-17

General Education Classrooms and Students with ASD  Students with autism are increasingly placed in general education classrooms for the purpose of improved social integration.  Success in the general education classroom for a student with ASD depends on the child’s ability to reliably do the following: Display near-zero levels of problem behavior Participate and learn in group lessons Complete assigned tasks independently Interact with peers appropriately Comply with classroom rules/follow the teacher’s directions Get the teacher’s attention/assistance appropriately Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-18

Unproven Treatments for ASD Facilitated Communication A process by which a communication partner provides physical support to assist an individual who cannot speak or whose speech is limited to typing on a keyboard or point at pictures, words, or other symbols on a communication board Little or no scientific evidence support the claims of improvement using facilitated communication Secretic Therapy Secretin is an amino acid hormone released within the proximal duodenum in response to gastric acid secretion. Intravenous infusions of purified secretin was provided to children with autism experiencing gastrointestinal problems. Studies found no significant difference on different measures of language, behavior, or autism symptom severity after treatment with secretin Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved. 7-19