1. Autism Spectrum Disorders within the School

2. Autism Spectrum Disorders Pervasive Developmental Disorders (DSM-IV) Asperger’s DisorderAutistic Disorder Pervasive Developmental Disorder – Not Otherwise Specified Rett’s Disorder Childhood Disintegrative Disorder

3. Autism Spectrum Disorders Asperger’s Disorder  Qualitative impairment in social interaction.  Restricted repetitive and stereotyped patterns of behavior, interests, and activities.  Significant impairment in social, occupational or other important areas of functioning.  No cognitive impairment.  The qualitative impairment in communication is not met as there is no significant general delay in language.

4. Autism Spectrum Disorders Autistic Disorder  Qualitative impairment in social interactions  Qualitative impairment in communication  Restricted repetitive and stereotyped patterns of behaviors, interests, and activities  Onset prior to 3 years of age PDD:NOS or Atypical Autism  Severe or pervasive impairment in reciprocal social interaction, OR  Verbal and nonverbal communication, OR  Stereotyped behaviors, interests, and activities  Criteria are not met for another Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder or Avoidant Personality Disorder

5. What is PDD or Autism Spectrum Disorder? Autism Society of America (2000) Autism is a complex developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain. Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. Family income, lifestyle and educational levels do not affect the chance of autism’s occurrence.

6. Definition cont… Autism interferes with normal development of the brain in the areas of social interaction and communication skills. Children and adults typically have difficulties in verbal and non-verbal communication, social interactions and leisure or play activities. The disorder makes it hard for them to communicate with others and relate to the outside world. They may exhibit repeated body movements, unusual responses to people or attachments to objects, and they may resist changes in routines.

7. Prevalence Over one half million people in the U.S. today have some form of autism. Its prevalence rate now places it as the third most common developmental disability more common than Down syndrome. ASD occurs in 1 of every 200 – 250 births.  Some estimates are now 1 of every 166 births.

8. Data Source: MN Dept. of Education/Special Education-Unduplicated Child Count Data http://education.state.mn.us http://education.state.mn.us What are the trends ?

9. Data Source: MN Dept. of Education/Special Education-Unduplicated Child Count Data http://education.state.mn.us http://education.state.mn.us Where are they educated ?

10. More questions about the trends… Are we over identifying ?  No, there is evidence we are still under identifying in early years.. Are other states finding the same rates ?  Only one state is higher (Oregon) than Minnesota Will the ASD Child Count continue to increase?  Analysis of MDE Child Count and NIH data predicts continued increase. What forecasts or estimates can be made ?  1/500 to 1/166 births (NIH, 2004 and CDC, 2006)  Increase of secondary-age students 2x by 2010

11. Data Source: MN Dept. of Education/Special Education-Unduplicated Child Count Data http://education.state.mn.us http://education.state.mn.us

12. Local Prevalence There has been a 400% increase in students identified with Autism in the last four years.  The students range from “high functioning” to more classical Autism.  Anecdotal evidence suggests recent increases in “high functioning” students.

13. Theories of Causation Genetic  Four times more males than females.  Does tend to occur more frequently in families. Immunizations  Research indicates no connection between immunizations and Autism. Studies that implied a connection were methodologically flawed. Environment  Likely that there is an environmental trigger or influence.

14. Specific Characteristics of ASD

15. Skills of Individuals with ASD Vary from Individual to Individual Some individuals have average intelligence but a delay in social skills. Some individuals may be significantly delayed in all areas with no verbal skills. Some individuals may be verbal but exhibit delays in communication as well as having difficulties with social interaction and a wide range of interests. The range of areas of concerns within each of these disorders varies from mild to severe depending on the individual. No two individuals are alike with their range of abilities!

16. ASD is a Neurological Disorder It is a disorder of the brain Involves a number of brain functions. Research has shown that the brains of individuals with ASD are formed differently from other individuals. Brain dysfunction involves abnormalities in interpreting facial expressions, organizing sequences, planning (executive function), compulsivity and problems in language (Travis Thompson, Making Sense of Autism 2007) ASD is a lifelong disorder but not progressive; it does not get worse over time.

17. Brain Structure Findings Face Processing & Gaze Fixation in Autism Deficits in attention, learning & discrimination of human faces, Disproportionate attention to the mouth versus eyes More attention to specific details rather than facial configuration Social brain function in autism (Simon Baron-Cohen et al 1999) Assigning mental states to eyes-only facial stimuli usually activates amygdala, cingulate and frontal brain regions NOT among individuals with high functioning ASDs

18. Brain Structure Findings Amygdala is involved in Gaze Fixation & Understanding Facial Emotions Amygdala damage impairs recognition of emotional facial expressions People who have amygdala tumors don’t look others in the eye when talking to them Brain Imaging: Amygdala is typically activated by emotional facial expressions, especially eyes

19. Brain Structure Findings Abnormalities in Brain Areas Related to Obsessive Compulsive Disorder Prefrontal cortex does not process information properly, which is required for problem-solving, flexibility and planning Dysfunction in brain areas that cause symptoms of Obsessive Compulsive Disorder (OCD) lead to rigidity and intolerance for changes in routines.

20. Consequences of Brain Dysfunction in ASDs Unable to understand facial expressions, especially emotions Unable to grasp gestures, their meaning and often very difficult to imitate gestures Unable to anticipate social consequences of their actions

21. Speech/Language Dysfunction The two primary speech areas in the brain do not work well in coordination, i.e. Broca’s and Wernicke’s As a result, very slow processing of speech sounds compared with other sounds Even in youngsters with large vocabularies, they may have difficult processing speech of other people

22. Behavior is Not Intentional People with ASDs and related disabilities don’t wake up in the morning thinking of ways to drive their parents & teachers to the brink. They are doing the best they can to create control over a world that seems disorderly, chaotic and impossible to understand

23. Early Behavioral Intervention Dysfunctional brain areas in children with ASD contain more tightly packed immature brain cells but very few synapses. Fewer synapses may lead to excessive neural cell pruning Early intervention promotes brain development (synaptic connections) Early intervention prevents loss of brain function that will occur otherwise Research has consistently demonstrated that intensive behavioral intervention is superior to other approaches: ABA, DTT, PECS, and PRT have a relatively strong evidence (National Research Council, 2001; Rogers, 1998).

24. Impairments in Social Interaction Limited use joint attention and limited use of facial expressions directed towards others. Does not show or bring things to others to indicate an interest in activities. Demonstrates difficulty in relating to people, objects, and events. Demonstrates a gross impairment in the ability to make friends. Significant vulnerability and safety issues due to social naiveté. May appear to prefer isolated or solitary activities. Misinterprets others’ behaviors and social cues. Is unresponsive.

25. Looks Like This Extreme distress for no apparent reason Difficulty making eye contact Difficulty relating to others Indifference to others Rule of Thumb: “Social/Emotional” age is 2/3 of chronological age

26. Impairment in Communication Does not use a finger to point or request. Uses others’ hand or body as a tool. Shows lack of spontaneous interaction or lack of varied imaginative play. Has absence or delay of spoken language. Has limited understanding of non-verbal communication skills such as gestures, facial expression or tone of voice. Demonstrates odd production of speech, including intonation, volume, rhythm or rate. Demonstrates repetitive or idiosyncratic language or inability to initiate or maintain a conversation when speech is present. Has limited imitation of action or sounds. Repeats or echoes words or phrases. Does not seem to understand word meaning. Has limited eye contact.

27. Looks Like This Indicates needs by gestures, OR does not use gestures Echolalia (Immediate & Delayed) Behaves as if deaf OR hypersensitive Inappropriate laughter or giggling

28. Restricted Repertoire of Activities and Interests Demonstrating distress or resistance to change. Insistence on following routines. Repetitive hand or finger mannerisms. Shows lack of true imaginative play versus reenactment. Over reactions or under reaction to sensory stimuli. Uses rigid or rule bound thinking. (Always black and white…right or wrong) Has an intense, focused preoccupation with a limited range of play, interests or conversation topics.

29. Looks Like This Inappropriate attachment to certain objects Prefers to be alone Preoccupied by obsessive games or topics Resists changes in routine Inconsistent gross/fine motor Fascinated by spinning objects or other self- stimulatory behaviors Seemingly insensitive to pain Resists cuddling (sometimes)

30. Educational Criteria vs. Medical Diagnosis Educational Criteria Meet specific behavioral indicators on a checklist.  AND Demonstrate educational need. Evaluation includes parent information and information from other environments and individuals. Medical/Clinical Criteria Meet specific behavioral indicators on a checklist.  DSM-IV Often based upon parent report and brief interaction with child.

31. Educational Criteria vs. Medical Diagnosis Having a medical diagnosis of Autism does not automatically qualify a student for special education service. Educational evaluation must document evidence of a disability AND educational need.

32. Educational Needs of Learners with Autism Spectrum Disorders Students with ASD must learn:  The ability to attend to elements of the environment  The ability to imitate others  The ability to comprehend and use language  The ability to play appropriately with toys  The ability to interact socially with peers  The ability to learn self-regulation skills  The ability to organize and plan activities

33. ASD Learner needs include… A highly supportive teaching environment with opportunities to generalize skills to typical settings Structured and predictable environments A functional approach to problem behaviors Transition planning as the students advances in their education

34. Social Skills vs. Curriculum Social skills are just as, and often more, important than math, reading or other academic skills. Our job is to provide students with the skills to get along in society. It takes months and years of consistent programming for children with ASD to learn these skills.

35. Classroom Strategies Be direct, don’t use figurative language. Simple concrete directions Stay calm. Use neutral facial expressions and body language. Don’t overreact. Integrate various strategies into school day. Provide opportunity for constructive movement, breaks and fidgets.

36. Classroom Strategies Visual Cues  Organize our lives  To get information  Make choices  Communicate with others  Organize thinking  Organize environments and facilitate learning

37. Individual Schedules

38. If/Then Helps to teach consequence Can be positive or negative Proactive strategy

39. First/Then Beginning schedule Teaches order and expectations Helps to decrease anxiety

40. Building Upon Interests Use interests to complete work (First work, Then you can tell me about Sponge Bob!) – also known as the Premack Principle Use interests in assignments (Speech on Famous American – Bill Gates)

41. Mini Schedule To follow a routine Mini Schedule for part of a day (music class)

42. Small 3 ring binder

43. Summary Students with Autism are complex and their behavior is often confusing. However……  Behavior is lawful  Positive alternative behaviors can be taught  There are no magical strategies  Students with Autism learn in much the same manner as other children.