1. Preparing Youth with ASD for Adulthood Phyllis Coyne YTP Regional Training NWRESD November 1, 2011

2. About Autism Spectrum Disorder (ASD) Pervasive neurodevelopmental disorder– Neuro-anatomical and MRI studies reveal differences in the brain. 1 : 110 (CDC, 2011) 70%: Average or above average intelligence Likely many causes – genes, medical conditions, environmental factors 4 : 1 (boys : girls)

3. What Are the Current Defining Characteristics of ASD? Medical Diagnosis (DSM IV R): 3 characteristic domains (social deficits, communication deficits and restricted & repetitive patterns of behavior, interests and activities)– clinician decides Educational eligibility (OARs): 4 characteristic domains (social interaction impairments, communication impairments, restricted, repetitive & stereotyped patterns of behavior, interests and activities, unusual response to sensory information)– educational team decides

4. Current 3 Main Types of ASD Autistic Disorder (Kanner's or classic): delayed or lack of development of verbal language; may have normal intelligence (e.g., Rain Man or Temple Grandin) Asperger's disorder: Normal development of verbal language and normal intelligence Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS). Don’t show all the characteristics.

5. Proposed DSM V Revision for Autism Spectrum Disorder 2 Characteristic Domains 1. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays. Includes all 3 of the following: a. Deficits in social-emotional reciprocity. b. Deficits in nonverbal communicative behaviors used for social interaction. c. Deficits in developing and maintaining relationships, appropriate to developmental level.

6. Proposed DSM V revisions continued 2. Restricted, repetitive patterns of behavior, interests, or activities. Includes at least two of the following: a. Stereotyped or repetitive speech, motor movements, or use of objects. b. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change. c. Highly restricted, fixated interests that are abnormal in intensity or focus. d. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment.

7. Proposed DSM V revisions continued Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) Symptoms together limit and impair everyday functioning. Proposed severity scale for two characteristic domain to indicate level of support needed.

8. Challenges in Social Communication and Social Interaction a. Deficits in social-emotional reciprocity: ranges 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. b. Deficits in nonverbal communicative behaviors used for social interaction: ranges 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.

9. Social/Communication Challenges continued c. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers): ranges 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.

10. Which is a balanced conversation?

11. Restricted, repetitive patterns of behavior, interests, or activities a. Stereotyped or repetitive speech, motor movements, or use of objects: simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases. b. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change: motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes.

12. Restricted/repetitive patterns continued c. Highly restricted, fixated interests that are abnormal in intensity or focus: strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests. d. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment: 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.

14. Strengths of Youth with ASD Systemizing-- analyze or build systems in order to understand and predict; order things Specific interests Hyperattention to detail Preference for sameness Concentration Strong memory for what seen & in area(s) of interest Accuracy in visual perception Unique talents and perspectives

15. Adolescence in ASD Great range in development: improve to deteriorate in behavior, rigidity, and skills Majority similar and subtler pattern of persistent problems in socialization, communication, interests, sensory reactions, and organization 40% have psychiatric symptoms: increased mood disorders, depression and anxiety Onset of seizures, especially for individuals with an intellectual disability or marked developmental regression.

16. Why a Toolkit? 92% of adults with ASD not employed or engaged in education/vocational training, and did not live independently (Billstedt, Gillberg & Gillberg, 2005). ODE/ARRA funding for materials for ASD & secondary transition Three most important topics for staff training and/or resources for staff from 2010 survey: 1) How to prepare students with ASD for adulthood 2) How to provide effective transition services 3) How to provide instruction in non-academic areas

17. Content of Toolkit Three main units: Unit 1: Transition Planning and Services for Youth with ASD Unit 2: Supports for Transition Services and Activities Unit 3: The Expanded Core Curriculum for Youth with ASD

18. 8 Interrelated Units of ECC Based in part on Recommendations from Oregon Commission on ASD’s Education Revision & InteragencyTransition Subcommittees Unit 3.1: Communication Skills Unit 3.2: Social Skills Unit 3.3: Executive Function/Organization Skills Unit 3.4: Sensory Self-regulation Unit 3.5: Self-Determination Unit 3.6: Employment Unit 3.7: Postsecondary Education Unit 3.8: Independent Living and Community Participation

19. Where can I learn more about ECC? Columbia Regional Program’s ASD and Transition webpage-- http://www.crporegon.com/content/secondary- transition-project-asd http://www.crporegon.com/content/secondary- transition-project-asd Includes Preparing Youth with ASD for Adulthood: An Educator’s Toolkit, Putting Feet on My Dreams Self Determination Curriculum, Manual for Adolescents with Asperger's Piloting Social Success (MAAPSS), Higher Functioning Adolescents and Young Adults with Autism: A Teacher’s Guide and more.

20. Let’s Look at Web page Secondary Transition Project for ASD

21. How to Use Toolkit Bookmark http://www.crporegon.com/content/secondary- transition-project-asd http://www.crporegon.com/content/secondary- transition-project-asd Read introduction Get familiar with how units are organized Go to and return to units as you need information and tools Explore Unit 3 at a minimum before Units 3.1 – 3.8. Be prepared to work around broken links

22. What is in Most Units of Toolkit? Free, accessible practical information & tools Links to free guidebooks or comprehensive information on the topic of the unit Sample list for different grade levels Assessment tools and/or links to Lesson plans and/or links to “how to” tools Links to websites with “how to” videos List of practical books available on loan List of online and/or local training Glossary of terms

23. Let’s See What a Unit Looks Like Sample Unit Unit 3.6: Employment

24. What Are the Evidence Based Strategies for Youth with ASD? Antecedent-Based Interventions (ABI) Computer-Aided Instruction Differential Reinforcement Functional Behavior Assessment Functional Communication Training Naturalistic Intervention Peer-Mediated Intervention Prompting Reinforcement Response Interruption/Redirection Self-Management Social Narratives Speech Generating Devices/VOCA Structured Work Systems Task Analysis Time Delay Video Modeling Visual Supports

25. Where can I learn more about EBP? Effectiveness of strategies for teaching specific skills– Appendix 3B: Evidence Based Practice in Preparing Youth with ASD for Adulthood http://www.crporegon.com/content/seco ndary-transition-project-asdhttp://www.crporegon.com/content/seco ndary-transition-project-asd How to implement-- National Professional Development Center on ASD Evidence Based Practices Briefs http://autismpdc.fpg.unc.edu/content/briefs and Autism Internet Modules http://www.autisminternetmodules.org/ http://autismpdc.fpg.unc.edu/content/briefs http://www.autisminternetmodules.org/

26. Unit 2: Supports for Success

27. Where can I learn more about Supports? Unit 2: Supports in Preparing Youth with ASD for Adulthood http://www.crporegon.com/content/secondary- transition-project-asd http://www.crporegon.com/content/secondary- transition-project-asd Autism Web Course http://cdd.unm.edu/swan/autism_course/modules/sens ory/index.htm http://cdd.unm.edu/swan/autism_course/modules/sens ory/index.htm Transition to Adulthood Guidelines for Individuals with ASD http://www.ocali.org/_archive/pdf_trans_guide/Trans_G uide.pdf http://www.ocali.org/_archive/pdf_trans_guide/Trans_G uide.pdf Life Journey Through Autism: An Educator's Guide to Asperger Syndrome http://www.researchautism.org/resources/OAR_Guide_ Asperger.pdf http://www.researchautism.org/resources/OAR_Guide_ Asperger.pdf

28. From Jim Sinclair, Self Advocate “Even if an autistic person has the same goals as a non- autistic person he or she might need to follow a different procedure to get there…” -

29. More Important Online Resources Autism Spectrum Disorders and the Transition to Adulthood http://www.doe.virginia.gov/special_ed/disabilities/a utism_transition_guide.pdf. http://www.doe.virginia.gov/special_ed/disabilities/a utism_transition_guide.pdf Adult Autism & Employment http://www.dps.missouri.edu/Autism/Adult%20Auti sm%20&%20Employment.pdf http://www.dps.missouri.edu/Autism/Adult%20Auti sm%20&%20Employment.pdf