1. Chapter 13 Persons with Autism Spectrum Disorder

2. National Institute of Child Health and Development (2003) Autism is a complex biological disorder of development that lasts through a person’s lifetime People with autism have problems with social interaction and communication, so they may have trouble having a conversation with you, or they may not look at you in the eye They sometimes have behaviors that they have to do or that they do over and over, like not being able to listen until their pencils are lined up or saying the same sentences again and again They may flap their arms to tell you they are happy, or they might hurt themselves to tell you they are not

3. Initial Definition Leo Kanner,1943, used the term autistic as a descriptor –Meaning withdrawal of relationships or “escape from reality” Early definitions distinguished autism from schizophrenia in three areas: –Extreme aloneness from the very beginning of life –Attachment to objects –Powerful desire for aloneness or sameness

4. IDEA, 1997 Amendments Definition of autism –Developmental disability –Significantly affecting verbal and non verbal communication and social interaction –Usually evident before age of 3 –Adversely effects child’s educational performance –Engagement in repetitive activities and stereotypical movements –Resistance to environmental change in daily routine –Unusual response to sensory experiences Exclusionary clause- serious emotional disturbance

5. Classification Eligibility for educational services occurs through evaluation by a multidisciplinary team Testing and criteria to establish eligibility –DSM-IV-TR –IDEA 1997 Medical testing rules out neurological disorders and specific disorders such as hearing or vision but provides no specific test to diagnose autism

6. Pervasive Developmental Disorders Autism Rett Syndrome Childhood Disintegrative Disorder Asperger’s Syndrome Pervasive Developmental Disorder Disorders not otherwise specified (NOS)

7. Autism Age of onset- prior to age 3 More males than females Communication and socialization deficits Repetitive and restrictive behavior 75% moderate to severe mental retardation No expected regression

8. Rett Syndrome Age of onset between 5 and 48 months Predominantly manifests in females Communication deficits Repetitive and restrictive behaviors Severe/profound mental retardation Expected regression Increasing seizure frequency

9. Childhood Disintegrative Disorder Age of onset- after age 2 and before 10 More males than females Communication and socialization deficits Repetitive and restrictive behavior Severe mental retardation Expected regression Increasing seizure frequency

10. PDD, NOS Age of onset- unknown Male to female ration- unknown Communication and socialization deficits Repetitive and restrictive behavior Retardation varies from case to case No expected regression

11. Asperger’s Syndrome Age of onset- after age 3 More males than females Normal language, socialization deficits Repetitive and restrictive behavior Normal intelligence No expected regression

12. Asperger’s Syndrome Differs from high functioning autism –Better prognosis for personal, social, and occupational functioning –Less pronounced deficits in communication, socialization –Less pronounced presence of repetitive patterns and restrictive behaviors –No significant delay in language –More motor clumsiness and sensory perceptual deficits –Most education will occur in general education setting

13. Autistic Savant Dr. Bernard Rimland introduces terminology –About 10% of the population with autism have special skills in areas such as Mathematical calculations Memory feats Artistic and musical abilities Reading –Hyperlexia– ability to read without formal instruction

14. Associated Medical Conditions Tuberous sclerosis Fragile X syndrome Tourette syndrome Angelman syndrome Landau-Kleffner syndrome Williams syndrome Down syndrome

15. History of the Field Autism Spectrum Disorders Psychogenic theories –Inappropriate or “ bad parenting” Organic theories –Bender Behavioral theories –Applied Behavior Analysis –Lovaas therapy

16. Prevalence 79,000 pupils between the ages of 6-21, (2000 - 2001) Growth reported as annual rate of 1000% National Institute of Health declares autism a national health problem –Possible reason for incident rise More accurate diagnosis Better neonatal care ECI brings more individuals to attention of schools Change in criteria prior to DSM-III

17. Etiology Chromosomal and genetic factors –25% associated with genetic disorders Insults during pregnancy –Anoxia, encephalitis, maternal diseases Structural abnormalities of the brain –Neuroimaging indicates possible dysfunctions in cerebellum, limbic system, and temporal lobe of the brain Autoimmune and environmental factors –Speculation about food allergies, vitamin deficiencies, and immune dysfunction

18. Characteristics Qualitative impairment in: –Social interaction –Communication Restrictive, repetitive, and stereotyped patterns of behavior, interest, or activities Onset of delays or abnormal functioning prior to age 3

19. Social Interaction Delays Marked impairment in the use of nonverbal behaviors –Eye contact, facial expression, gestures Failure to develop age-appropriate peer relations Lack of social or emotional reciprocity “Theory of Mind”– inability to realize that other people have their own unique point of view

20. Communication Delays Lack of spoken language development Stereotyped or repetitive use of language Lack of spontaneous age-appropriate imaginative play 50% of individuals with autism are mute Unusual patterns –Echolalia, reversals, abbreviated phases Pervasive pragmatic deficits

21. Repetitive and Restrictive Patterns Inflexible adherence to routine Repetitive motor mannerisms Preoccupation with parts of objects Hand flapping, finger flicking, rocking Licking mouth or objects Sniff and touch body to experience odors

22. Self-Injurious Behaviors Self-injurious behaviors refer to any behavior that can cause tissue damage, bruises, redness, or open wounds –Head banging –Finger, hand, or wrist biting –Excessive scratching or rubbing

23. Abnormal Patterns of Behavior Eating –Limited diet; pica Sleeping Mood or affect –Life changing events can precipitate depression; bereavement, staff changes, illness, or change of school placement Sensory perception deficits –Tactile defensive; hypersensitivity of hearing

24. Assessment Intellectual –50-70% of individuals with autism have mental retardation; IQ norms between 35-50 Behavioral –Behavior screening examples Childhood Autism Rating Scale; Autism Behavior Checklist –Functional behavior assessment Required by IDEA Functional Assessment –Measures skills needed for independent living

25. Figure 13.1 Educational Placement of Students with Autism

26. Instructional Approaches TEACH LEAP programs Lovaas Young Autism Project Applied Behavior Analysis Program Denver Health Sciences Programs

27. Educational Services Early intervention potentially decreases need for restrictive placements in the future Structured preschool programming with special adaptations according to individual needs reduces interfering behaviors Inclusion with collaborative support makes learning possible in the least restrictive environment

28. Issues of Adulthood 1/3 of adult individuals with autism are able to live or work independently Options exist for residential care placement, day treatment, institutional or group home settings Supervised apartment living may require –Home helpers, case managers, financial assistance, and adaptive equipment or home modifications Adult foster care is another possibility

29. Employment If the adult with autism cannot work independently –Sheltered workshops –Job coaching Supportive employment Transportation assistance Liaisons between individuals with autism and the employer Technology training

30. Technology High-Tech Devices –Communication aids –VOCA: Voice Output Communication Aids –Screen readers, word recognition software Low-Tech Devices –Manual sign language –PECS: Picture Exchange Communication System

31. Trends, Issues, and Controversies I Sensory Perception Programs address issues of tactile defensiveness or extreme reaction to auditory stimulus Side effects of the medications used to alleviate symptoms such as aggression, anxiety, or obsessive compulsive disorder Vitamin therapy Autism as a reaction to the MMR vaccination

32. Trends, Issues, and Controversies II Food allergies: yeast and gluten products Auditory Integration Training Facilitated Communication Secretin Music therapy Visual treatment Temple Grandin’s Hug Machine