1. Understanding Autism Amanda Frary

2. Identifying Students with Autism Variability in behaviors, skills, preferences, functioning, and learning needs 1 in 110 children diagnosed with Autism Spectrum Disorder (ASD) Third most common developmental disability A neurological disability

3. Triad of Deficits Communication Interests and Activities Socialization Why Communication, Socialization, and Interests/ Activities? Leo Kanner- Early infantile Autism -Benchmark of clinical description Hans Asperger- Autistic Psycopathy Childhood Schizophrenia- DSM 1952 and 1968 Michael Rutter’s Definition (1978) Pervasive Developmental Disorder 1980 IDEA 1994 and Revision of DSM IV Awaiting new DSM update for 2010

4. DSM The American Psychiatric Association has provided a classification system for differences in behavior and learning since 1951. Diagnostic and Statistical Manual Of Mental Disorders or the DSM - currently in the fourth addition (DSM IV-TR) Behavior diagnosis vs. biological /physiological diagnosis Current trends in diagnosis: categorical vs. continuous

5. DSM Criteria for Diagnosis Qualitative impairments in social interaction (need at least 2 or more): Impairment in use of multiple nonverbal behaviors to regulate social interaction (i.e. eye-to-eye gaze, gestures) Failure to develop developmentally appropriate peer relationships Lack of spontaneous seeking to share enjoyment, interests, achievements with others Lack of social/ emotional reciprocity

6. Criteria cont. Qualitative impairments in communication (need at least 1 or more): Delay in, or lack of, spoken language (not accompanied by alternate modes) If speech present, impaired ability to initiate or sustain conversation with others Stereotyped / repetitive use of language or idiosyncratic use of language Lack of spontaneous make-believe play or social imitative play appropriate to developmental level

7. Criteria cont. Restrictive repetitive and stereotyped patterns of behaviors, interests, activities (need at least 1 or more): Encompassing preoccupation with 1 or more interests, abnormal in intensity or focus Inflexible adherence to non functional routines, rituals Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects

8. Diagnosing ASD Need total of 6 or more symptoms Onset delay occurs prior to age three Not Rett’s or Childhood Disintegrative Disorder

9. Diagnosing ASD cont. No biological markers or medical tests to diagnose ASD Behavioral diagnoses based on observations and interviews No two children with ASD are alike An appropriate diagnosis includes: - Documentation of behaviors (triad of behaviors) - Complete history of child, including medical - Information on current and previous levels of functioning - Any type of IQ testing (usually required to base prognosis on) - Adaptive assessments

10. Communication Varies from total lack of spoken language to highly sophisticated language -Research by Bryson (1996) cites that at least 1/3 of all children with ASD fail to develop spoken language Those students with spoken language develop obvious differences in their language: -Immediate Echolalia versus Delayed Echolalia - Vocal inflection and Intonation - Difficulty with pragmatics - Inability to understand nonliteral language (idioms, figures of speech, abstract concepts) - Pronoun reversal - Impairments in non verbal communication (lack of gestures and/ using others as “tools”

11. Socialization The “defining” component Current research is focusing on diagnosing ASD in children as young as 12 months May show deficits in: – Eye gaze – Be oblivious to the presence of others – Show disregard to social convention – Prefer to share only facts about favorite topics – Fail to orient to another’s voice – Have few reciprocal relationships

12. Interests and Activities May have narrow range of interests (often prefer objects over people) Perseverations- activities repeated for long periods of time Somewhere around 42-80% of persons with ASD demonstrate some type of unusual sensory responses - can be either OVER responsive or UNDER responsive Restricted activities and interests are characterized by: - Unusual interests that are few in number - Interest in parts of objects or isolated facts - Insistence on sameness - Perseverative behaviors - Repetitive motor movements (sterotypies or self-stim behaviors) - Unusual responses to stimuli

13. Subtypes The DSM IV lists five subtypes of ASD: - Autistic disorder - Asperger’s disorder - Rett’s Disorder - Childhood Disintegrative Disorder - PDD-NOS Subtypes help account for heterogengeneity

14. Autistic Disorder Reflective of Kanner’s original observations: - Inability to relate normally to other people/ situations - Delayed speech and language development - Failure to use developed language for communication purposes (echolalia, pronoun reversal, extreme literalness) - Normal physical growth and development - Obsessive insistence on sameness - Perseveration on objects of parts of objects - Stereotypic, repetitive, and other self-stimulatory responses - Visually oriented High Functioning Autism Only 25-30% of individuals with ASD have a measured intelligence in the average or above average range Epilepsy/ seizure disorders appear in more then 1/3 of persons ASD

15. Asperger’s Syndrome Typical language development -Often have extensive vocabularies and can talk for long periods of time Essential feature is impaired social interaction- lack of eye gaze, not picking up on social cues, “Little Professors” Higher Functioning in adaptive behavior (no delay in cognitive abilities, adaptive abilities, or language development) Excellent Memories Vast knowledge on particular topics May have difficulty with motor skills (clumsiness, difficulty writing) Often poor students because they follow their own interests

16. Heller’s Syndrome Also called Childhood Disintegrative Disorder Behaviors similar to Autism Different from Autism in that the age of onset is generally after age 3 and before age 10 Characterized by: loss of previously acquired skills in at least 2 areas – Expressive/ receptive language – Social skills – Adaptive behavior – Bowel/ bladder control – Play – Motor skills

17. Rett’s Syndrome Disorder of females- identified by genetic testing Normal development until onset between 6 to 18 months of development Characterized by: - Head growth slowing - Loss of acquired motor skills - Stereotypic hand wringing or hand washing - Various motor impairments - Social and Communication Impairments Loss of skills is permanent and progressive Prognosis is poor Very rare- prevalence is 1/15,000

18. Pervasive Developmental Disorder- Not Otherwise Specified Vague definition Children who have - severe and pervasive impairment in reciprocal social interaction - verbal/nonverbal communication skills - exhibit stereotyped behavior, interests, and/or activities

19. Asperger’s / ASD also at-risk for other Psychiatric Problems: ADHD- 28%OCD- 19% Neurocutaneous (CNS and Skin) 2 to 9 % Tourette Syndrome- 9- 50% Psychotic Symptoms- 17% Epilepsy- 30% probably higher Affective Disorder- 23%

20. Social Impairment Interests and Activities Communication Impairment Autism Social Phobia Asperger’s Syndrome OCD Schiziod- Schizotypal Tourette’s Syndrome

21. Causes / Common Myths Causes Vaccines / Thermerisol Metabolic disorders Cold family attitudes (refrigerator mother) Neurological theories (deficits in brain activity in several areas of the brain) see Schultz et al., 2000 or Pierce, 2001 for additional info Common Myths All children with ASD are geniuses ASD can be outgrown If a child smiles and is affectionate, s/he doesn’t have ASD Children with ASD cannot learn

22. ASD and the Classroom Students with ASD often demonstrate relative strengths in -concrete thinking -rote memory -understanding of visual-spatial relationships

23. ASD and the Classroom Children with autism will have difficulty with: -attention - information processing - social-cognition - reciprocal communication

24. Attention In order to attend, it is necessary to feel comfortable, filter out distractions, and know what is relevant Children with ASD may: - show hypersensitivities or atypical responses to sensory stimulation - have trouble processing and organizing sensory input *this can lead to students being hyper focused or repeating things over and over; repetition is creating order in chaos - have trouble in a classroom where learning involves attention to multiple environmental features - have trouble shifting attention from visual to auditory stimuli In order to understand someone’s message, we attend to the speaker’s words, facial expression, tone of voice, body gestures, and social contexts

25. Information Processing Cognitive processing is a multilayered system in which information is analyzed, organized, stored, and remembered in complex ways May have difficulty integrating information into meaningful and flexible ways This may be due to: - over selectivity- tendency to process information one piece at a time - information that is fixed in space is easier to process than rapidly occurring events - material is often remembered and stored as a whole rather than re- organized and integrated in a flexible manner

26. Information processing cont. Children with ASD may: - attend only to specific, observable information - cannot always break information down in a flexible way (ex. Pledge of allegiance) - be “visual thinkers” (Grandin, 1995) - have difficulty processing rapidly changing social events inherent in social interaction - rote memory and recognition tasks are strengths

27. Social- Cognition Typically developing children have predisposed sensitivity to the feelings of others (Theory of Mind) - allows children to predict, interpret, anticipate, and comprehend the feelings of others Children with ASD have Theory of Mind deficit: - difficulty taking into account what someone else knows or expects in order to predict his/her behavior - unable to respond with conversational skills or more social insight - unable to adapt to ongoing information

28. Reciprocal Communication May have difficulty: - initiating social contact - maintaining direct eye gaze - waiting for a response Communicative reciprocity is not absent, but is less spontaneous and flexible Children with ASD are better at responding to communication than initiating conversation

29. Teaching students with Asperger’s Syndrome AS is characterized by a qualitative impairment in social interaction Although children with AS usually speak fluently by the time they enter Kindergarten, they often have problems with the complexities of language, including: -pragmatics (the use of language in social contexts) - semantics (multiple meanings) - prosody (the pitch, stress, and rhythm of speech) Demonstrate relative weaknesses in comprehension and abstract thought, as well as in social cognition Consequently, they do experience some academic problems, particularly with: reading comprehension problem solving organizational skills concept development making inferences and judgments

30. AS cont. People with AS may have problems communicating with others because they do not naturally learn the rules of conversation. They may: interrupt or talk over the speech of others make irrelevant comments have difficulty initiating and terminating conversations use speech characterized by a lack of variation in pitch, stress and rhythm use overly pedantic or formal speech, particularly as the student reaches adolescence stand too close when talking to someone stare, use abnormal body posture, or use other strange body language fail to understand gestures and facial expressions of others

31. Instructional Strategies ASD can challenge traditional instructional techniques Cover topics in educational research: - Environmental Supports - Behavioral Supports - Academic Supports Goal for students with ASD is to create an environment that - fosters learning opportunities - instructional approaches that facilitates language acquisition, behavior management, social skills, and targeted academic goals

32. Environmental Supports Labels Decrease the likelihood of worry and agitation Items to label: - furniture and objects in the classroom or specific areas of the room - allows for independence - facilitates language development - visual cue to pair with teacher’s verbal cue

33. Boundary Settings Helps students to know what expectations are in specific settings Helps students to know where to remain during a given activity Ex: Table with cloth covering- math time; table without cloth covering- reading time

34. Visual Supports Provides students with overview of day’s activities and events by depicting what occurs throughout the day Visual supports help to: - present abstract concepts such as time in a more concrete and manageable form - allows students to develop and understand time - allows students to predict change in routine - stimulates communicative exchanges - used to increase on-task behavior while teaching independence - most importantly…we are capitalizing on the visual strengths of students with ASD

35. Level of Visual Representation The more abstract the visual schedule, the higher the level of visual representation- it is important to pair the level of representation that the student is on with the next higher level The continuum of representation is: -real objects -photographs -line pictures -icons -written words -sentences

36. Arrangement of Visual Representation Consider how you want to arrange visual schedules: - left to right or top to bottom? - how long will you use this schedule? - how durable should the schedule be? -how permanent does the schedule need to be?

37. Mini-Schedules and Task Organizers This can compliment a whole class visual schedule by giving more specific cues and creating more individualized plans Ideas: - task organizers provide a task analysis of the steps required to complete a specific activity - should only be used when students need extra structure to understand activities - provides choice making opportunities - provides decision making - encourages independence level

38. Behaviorally Based Communication Tools Teacher oriented techniques used to enhance communication with students and provide behavioral support Remember to use the right level of visual representation

39. Picture Card Files Set of cards in a graphic format that assign different tasks to be accomplished during a specific period of time Could be used for transitions within a given activity Can help to organize behavior Can help student to remain focused and allow for appropriate response to teacher

40. Teacher Mini-books Groupings of pictures and/or words for generic items for student direction that are used throughout the day Can be divided into categories- academic skills, behavioral skills, transition skills Ex. Teacher gives student a direction along with a picture that represents the targeted direction

41. Teacher Notebooks A 3-ring binder that contains pages of visuals to use during a specific activity Good idea for small groups

42. Activity Completion Signals Helps student know when to focus their attention to another task, when to finish, etc. Ideas: - turning a visual schedule around so it is facing backwards - placing an object or an icon in a “finished” box - crossing out a word or phrase written on a smart board or white board - setting a timer for a specified period of time

43. Choice Boards Provides students with decision making opportunities Use objects, pictures, words, or icons to represent a menu of activities or reinforcers Use during choice time, break time, or to select a personal activity Placement of board varies

44. Waiting Supports Waiting to difficult, especially for students with ASD Ideas: - role playing or practice sessions - should be taught in a variety of settings - peer models can be helpful - pictures representing “wait” (give to student to hold) -setting a timer - placing chairs

45. Transition Supports Students with autism often demand consistency in their environments, but change is necessary Transition difficulties may be influenced by an inability to understand what is happening and may cause confusion and unpredictability Ideas: - give students lots of information (both visual and verbal) - time limit warnings /alerts - place a colored card on a students desk or on the board to let students know “1 more minute”

46. Transition cont. Make transitions a planned part of the student’s routine - teach students to put away items before moving onto next activity (natural cue) - place preferred activities after a non preferred task (encourages task completion)

47. Academic Supports No one method works for all students These approaches are considered “whole language” approaches- meaning that they are based on natural language learning, facilitate the learning of language, and promote achievement of communication goals

48. Language Experience Activities Utilizes students’ language as the basis for reading instruction -Teacher selects topic -Students dictate an experience to the teacher, who transcribes a story using students’ own words -Story is used for reading, spelling, language, and writing instruction -Non-verbal students can select pictures or icons

49. Incidental Teaching Using naturally occurring opportunities for instruction throughout the student’s day -research demonstrates greater skill acquisition and stronger skill generalization across environments -fosters spontaneous speech When using this technique: - observe - attempt to gain focused attention of student - if attention is not gained, initiate verbalization or manipulation of object - once attention is gained, engage in a brief conversation about the item/object

50. Joint Action Routines Social routines that occur in contexts that are familiar and well learned Types: 1. naturally occurring around a plot or story line or 2. naturally occurring cooperative turn taking Should include: - a meaningful /recognizable theme - two designated roles - a predictable and logical sequence with clear beginning and end - opportunities for turn taking

51. Social Stories Mini book describing a social situation and the appropriate response Written using descriptive, directive, perspective, and control sentences

52. Discrete Trial Training A technique derived from principles of Applied Behavior Analysis Teacher gives a prompt for the student to attend to and a command for the student to perform, then reinforces the student for performing the desired behavior This concept works well for shaping desired behaviors by pairing non-verbal and verbal cues

53. Ideas for Environment Sensitivity to smells (Wet shoes of classmate, hand lotion, musty locker, hamster cage, rubber cement) Avoid using perfumes or heavy lotions Seat student near open door or open window in rooms with strong smells (art room) Ask custodians to order and use unscented cleaning supplies Sensitivity to sounds (Air conditioner, shuffling of feet, scratching of pencils, certain tones of music) Move student away from sounds Use soft voice when possible Have student use earplugs or comfortable headphones (when appropriate) Install carpeting or carpet remnants Put material under desk legs Prepare student for sounds (before bell rings, fire drills) Gradually teach tolerance to sounds Sensitivity to light, particularly fluorescent lights Lower levels of light Turn off overhead lights Try different colors of light Have student use sunglasses or baseball cap Move student’s seat from reflections on wall Use bulbs that do not flicker

54. Easily distracted by sights and sounds Seat student in low traffic area of classroom Use carpeting Face desks away from windows and doors Designate a home base area to escape classroom stimulation for a while Teach child when he or she can and cannot use computer; some teachers cover the computer to indicate it’s not time to use it Seat students away from toys and books Help child to learn how to handle distractions over time Problematic or acting-out behavior * Disclaimer- you should be looking at the function of that behavior and designing appropriate intervention** Have a recreation area or playground nearby for student to let off steam Identify a home base area to escape classroom stimulation for a while Need for sameness and difficulty with transitions Define classroom areas: Create individual work areas, free time areas, and open areas for discussion using bookcases, cabinets Keep classroom consistently organized Choose designated seat for student Keep daily schedule in one place in classroom Develop a visual agenda to help the student understand the agenda in advance

55. Working with Parents No words can sufficiently emphasize the vital importance of developing a working partnership with the parents of your student with autism They are your first and best source of information about their child and autism as it manifests itself in that child’s behavior and daily activities “If you open the lines of communication with parents at the beginning, they will perhaps be more open to trying new ideas that you might have for their child. I can be a better teacher by learning from my students with ASD and working with their parents.” − General education teacher

56. Parent cont. Parents of children with autism have had to learn a lot about autism on their own and, in many cases, have had to fight for their children in various settings. You may find them wary, guarded, defensive, and perhaps combative, depending on their past experiences with schools and teachers. Recognize that the frustration you are seeing revolves around those prior negative experiences. You will win them over by demonstrating your willingness to learn about autism and your positive approach to teaching their child. Try to remain neutral and diffuse any situation Reassure the parents that you have their child’s best interest in mind and that you are doing as much as you can, given your other obligations to the rest of the class Increase communication and be particularly mindful to listen to and discuss the parent’s concerns

57. Resources Web sites MAX Foundation www.maxfoundation.org The MAX Foundation promotes special education awareness. Their Web site provides a comprehensive listing of major autism organizations and informational autism sites National Information Center for Children and Youth with Disabilities (NICHCY) www.nichcy.org This national information center provides information on disabilities and disability-related issues. This is a site rich with resources, including conferences, state organizations, and information Organization for Autism Research (OAR) www.researchautism.org OAR focuses on promoting applied research and feedback on research to the autism community. It also publishes a series of community-friendly guides related to autism to include: Life Journey Through Autism: A Parent’s Guide to Research and Life Journey Through Autism: An Educator’s Guide. Future guides will include: Life Journey Through Autism: An Educator’s Guide to Asperger Syndrome and Life Journey Through Autism: A Guide for Transition to Adulthood

58. The National Institute of Child Health and Human Development (NICHD) Autism Site www.nichd.nih.gov/autism This site’s goal is to provide easy access to the most current information about NICHD research projects, publications, news releases, and other activities related to autism and similar disorders. Treatment and Education of Autistic and Communications Handicapped Children (TEACCH) www.teacch.com The TEACCH program is located at the University of North Carolina, Chapel Hill. This Web site offers information about autism as well as various educational approaches. AutismWeb www.autismweb.com/education.htm This Web site provides an overview of different educational and treatment approaches for children with autism.

59. IEP-Specific Web sites Council for Exceptional Children www.cec.sped.org The Council for Exceptional Children (CEC) has numerous books about autism and developmental disabilities and IEPs, along with information on professional development and training for teachers Schwab Learning www.schwablearning.org This Web site provides information on IEPs and managing children with autism in the classroom Wisconsin FACETS www.wifacets.org/links/iep.htm The Wisconsin Family Assistance Center for Education, Training and Support (Wisconsin FACETS) site offers general information on IEPs as well as publications specific to IEPs and autism Wrightslaw www.wrightslaw.com This is an in-depth Web site dedicated to providing information on special education law and advocacy issues for children with disabilities

60. Print Resources Asperger Syndrome: A Guide for Educators and Parents (1998) by B. S. Myles & R. L. Simpson Austin, TX: Pro-Ed Asperger’s Syndrome. A Guide for Parents and Professionals (1998) by T. Attwood London: Jessica Kingsley Publishers Behavioural Issues in Autism (1994) by E. Schopler & G. V. Mesibov (Eds.) New York: Plenum Press The Picture Exchange Communication System: Training manual (1994) by L. A. Frost & A. S. Bondy Cherry Hill, NJ: Pyramid Educational Consultants, Inc.

61. Multimedia AutismVision: Creating Classroom Connections. Silver Spring, MD: Danya International, Inc. Available at www.danya.com/autismvision.aspwww.danya.com/autismvision.asp This is a multimedia intervention, including a video and facilitator’s guide, educating typical children about autism and promoting positive social interactions toward children with autism.