Transcript Document

Kanner discovered the disorder in 1943 and his name is used to
describe “full-blown autism” which we won’t see in BRGS.
Hans Asperger (1944) realised that the symptoms of intelligent
autistic children were very different and that these children could
go on to lead relatively normal lives.
At the time, autistic children were very rare, about 1 in a million.
In BRGS, we see children with Asperger’s Syndrome and as there
are now better ways to help these children, the SPELL, the
TEACCH and the ABA system, we will see more and more.
A few people with Asperger's syndrome are very successful and
until recently were not diagnosed with anything but were seen as
brilliant, eccentric, absent minded, socially inept, and a little
awkward physically.
Diagnostic Criteria For 299.80 Asperger's Disorder (DSM IV)
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
1.
marked impairments in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate social interaction
2.
failure to develop peer relationships appropriate to developmental level
3.
a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
(e.g. by a lack of showing, bringing, or pointing out objects of interest to other people)
4.
lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behaviour, interests, and activities, as manifested
by at least one of the following:
1.
encompassing preoccupation with one or more stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus
2.
apparently inflexible adherence to specific, non-functional routines or rituals
3.
stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or
complex whole-body movements)
4.
persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important
areas of functioning
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years,
communicative phrases used by age 3 years)
E. There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behaviour (other than social interaction), and curiosity
about the environment in childhood
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia
Estimated population of autism spectrum disorders in
the UK
The estimated numbers have been worked out from the
population of the UK as given in the 2001 census:
58,789,194, of whom 13,354,297 were under 18.
The figure for children is based on the 1 in 100 prevalence
rate and corrected to the nearest 100. The estimated number
of children under 18 with an autism spectrum disorder
(ASD) is 133,500.
We had four ASD students in school in September, but
one left this term, unable to cope.
In 1998, Paul Boateng asked for local authorities to report on the numbers of
ASD children in their area. These are the local responses.
Health Authorities North West England
Bury & Rochdale: has no data. Uses two published rates of incidence, then
applies these to the total local population. This implies that there are between 8
and 348 cases in Bury, and between 10 and 434 cases in Rochdale (no typing
errors here).
East Lancashire: does not have data on incidence of autism. Aware of increase in
Aspergers, but ascribes this to better assessment.
ASDs (Autistic Spectrum |Disorders) are
caused by a disorder in the brain, where
the amygdala, which is supposed to
unconsciously recognise faces, read
body language and assess if a situation
is dangerous, fails to sort the data
properly and spreads the sensory data to
the wrong parts of the brain.
As the amygdala is part of the fight or
flight response, it constantly keeps the
cerebellum in a state of alert, causing
sensory overload and a state of fear, which
the ASD student has to control.
Anomalies in the amygdala and other structures of the medial temporal lobe
have been demonstrated repeatedly in autism spectrum disorders, suggesting
involvement of the temporal pathway for visuoperceptual processing.
Functional magnetic resonance imaging (fMRI) of people with autism
spectrum disorders demonstrates reduced activation in the fusiform gyrus,
the portion of the brain associated with facial recognition, and increased
activation of adjacent portions of the brain associated with recognition of
objects.
fMRI also suggests that, in some individuals with Asperger syndrome and
high-functioning autism, dysfunctional connections among limbic and
paralimbic regions, the cerebellum, and the extrastriate visual cortices occur
during the process of identification of the emotion expressed by faces and
the gender of the face.
For the scientists!
Discovering that your child is autistic is described as being similar to a
bereavement, in that the parent has lost the child that they could have had.
This is compounded by frustration, anger and even, possibly, guilt.
Parents of ASD students only become annoyed with staff if the teacher is
ignorant about what the child requires or is insensitive to the child’s needs.
Parents of ASD children have a strong emotional link to their child because
their child is so needy and the relationship between the teacher and the
parent can easily be compromised if the teacher regards the parent as being
precious, whilst the parent regards the teacher as callous and lacking
understanding.
What mood are these
people displaying?
“Well they all look
pretty happy to me” –
BRGS student.
“Sometimes I feel it
coming. I have to
rationalise it. I have to
keep it on a very short
chain.”
Student at BRGS.
Genes
A number of genes are implicated in the disorder, specifically a region of
chromosome 11 and a specific gene called neurexin 1.
There are a number of possibilities:
•One gene is at fault.
•A combination of genes is at fault.
•The faulty gene(s) is(are) activated by an external event.
Supporting evidence
•Identical twins tend to both have ASD if one is affected, though to different degrees.
•Autism runs in families. (One woman had 6 ASD children!!!!!)
•Someone with an ASD has an 8% chance of having a child with an ASD.
•Boys are 4:1 more likely to have an ASD than girls
Last Updated: Monday, 19 February 2007, 03:15 GMT
Autism gene breakthrough hailed
Scientists have found new autism genes by scanning the largest collection of
families with multiple cases of autism ever assembled.
The monumental task of studying the 1,200 families took more than 120 scientists
from more than 50 institutions across 19 countries.
The work, described in Nature Genetics, implicates a region of chromosome 11 and
a specific gene called neurexin 1.
"There will almost certainly be an interaction between several genes so this one
discovery doesn't provide a complete answer and may not lead straight to a genetic
test but it could be a key step in development for effective treatments as it provides
a target for drug development."
Skuse (2000) has suggested that the gene or genes for autism are
located on the X chromosome. Girls inherit X chromosomes from
both parents, but boys only inherit one, from their mothers.
Skuse’s hypothesis is that the X chromosome which girls inherit
from their fathers contains an imprinted gene which "protects"
the carrier from autism, thus making girls less likely to develop
the condition than boys.
Some children who have developed normally and happily
have regressed dramatically at 15 months when given the
MMR jab. Parents naturally blamed the jab and the
government and drugs companies came out in force to refute
that assertion.
Some parents went to court on the issue and found that they
could not pursue the case because they had lost their legal aid.
The Government has refused to offer single jabs which has
compounded matters.
Anyone who speaks against the MMR is forced to recant or
has to find work in America.
As a result, no research on the causative factors for ASDs,
other than genetics, is happening in the UK.
The Government needs to have a take-up of 95% of children to
keep the population safe. Most children are completely
unaffected by the MMR jab and it is far more effective to have
the three jabs as a combo, as some parents could choose which
single jabs to avoid, leaving the population at risk.
•The measles virus (same DNA) has been found in the gut and spinal fluid of some
children with ASD.
•The MMR jab, in the UK, used to be (not since 2004) stabilised with Thimerosal, a
mercury compound. Mercury poisoning has similar symptoms to ASD. ASD children
often show raised levels of heavy metals in their systems, showing an inability to
detoxify themselves.
•The Japanese offered single jabs, but the autism levels rose. They still used Thimerosal
in their jabs.
•The government has urged pregnant women not to eat more than two portions of oily
fish a week because of the mercury levels in the fish.
•A Danish study has been quoted as proving that MMR does not lead to ASDs, but the
Danes had previously stopped using the mercury. Further claims that the figures in
Denmark had increased when the Thimerosal was not being used, were confused by the
fact that the Danes were calculating their cases in a different way.
•Pre and Post 2004 figures for the UK are not available.
Children who have not had the jab still get ASDs. The MMR jab is not the whole answer.
Historically, mothers took their children to
parties to catch the viruses that we inoculate
against, because it was safer to catch the
viruses young rather than as an adult. The
dangerous effects like blindness, for measles,
and deafness, for mumps, were rare because
the mothers knew how to deal with the
infections and could call the doctor out. Times
have changed.
Would a teenage mother now know what to
do?
It is easy to see why the Government is
desperate for children to be fully immunised.
A large range of possibilities has been suggested:
• Child development - It just happens, because the child is at a specific stage of
brain growth.
•Gut problems – children with ASD tend to have intestinal problems that could
lead to gut leakage into the bloodstream. However, the question arises as to
whether the autism led to the gut problem or vice versa.
•Viruses – autism is linked to at least 6 different viruses – with long names!
•Genetic abnormalities during pregnancy; we are better at saving babies that
would have miscarried in the past.
•Problems in deliveries.
•Too much foetal scanning – ASD linked to twins.
In the 1960s lack of parental warmth was blamed for causing autism – this has
been totally discredited.
Cognitive function: Autism occurs at all
intelligence levels.
Although about 50% of autistic individuals have
an intelligence quotient (IQ) below average, the
other 50% have an average or above average
intelligence. The performance IQ is generally
higher than the verbal IQ. A small
percentage have high intelligence in a specific
area such as mathematics.
(National Autistic Society)
ASD children cannot read other people’s body language and
therefore they can’t empathise. There is a common
misconception that they lack emotions. The opposite is true.
Whereas we might think in words or in pictures, autistic
children think through their emotions and emotional
turbulence will block their thought processes as effectively as
a dam.
“When you give me a problem to solve, first it
stalls…der…der.. der and then happiness, and then the
answer pops into my head.”
BRGS Pupil
Pupils with autism often have difficulty recognising or understanding other people's
emotions and feelings, and expressing their own, which can make it more difficult for
them to fit in socially.
Many people with Asperger's syndrome
demonstrate gaze avoidance and may
actually turn away at the same moment
as greeting another.
They may appear to be insensitive
because they have not recognised
how someone else is feeling
They may prefer to spend time alone
rather than seeking out the company of
other people
They may not seek comfort from other
people
They may not understand the unwritten social
rules which most of us pick up without thinking:
they may stand too close to another person or
too far away for example, or start an
inappropriate subject of conversation. Their
voices can be hectoring, monotonous in tone or
too loud.
They may appear to behave 'strangely' or
inappropriately, as it is not always easy for
them to express feelings, emotions or needs.
They show a lack of spontaneous
seeking to share enjoyment, interests,
or achievements with other people.
Difficulties with social interaction can mean that people with autism find it hard to form
friendships: some may want to interact with other people and make friends, but may be
unsure how to go about this.
“Looking someone straight in the eyes, unexpectedly, is
like getting an electric shock.”
"Socialising doesn't come naturally - we have to learn it."
Allow them to work alone if
they wish to.
Organise a sensitive/patient
buddy to socialise/work with
them on their terms.
Don’t force them to do
group work. Group work
has to be very structured.
Encourage them to involve
themselves in clubs that suit
their interests.
Tell them kindly but firmly if
they go off at a tangent or are
speaking too loudly.
Tell them verbally when
they have done well.
Don’t tell them, “Look at me
when I am talking to you.”
Don’t expect them to read our
body language.
Social imagination allows us to understand and predict other people's
behaviour, make sense of abstract ideas, and to imagine situations outside
our immediate daily routine. Difficulties with social imagination mean that
people with autism find it hard to:
understand and interpret other
people's thoughts, feelings and
actions
prepare for change and plan
for the future
predict what will happen next, or what
could happen next
cope in new or unfamiliar
situations
engage in imaginative role-play
and activities
understand that other people
don’t share their obsessions.
Difficulties with social imagination should not be confused with a lack of imagination.
Many people with autism are very creative and may be, for example, accomplished
artists, musicians or writers.
Rationalise what people do and
why they do it.
Don’t expect ASDs to
empathise – they intellectualise.
Have well-planned lessons
where the students know what is
going to happen.
If you plan a shock, let the ASD
pupil know, even if the others
don’t.
Let them be the judges for
role-plays. Give them
criteria for judging.
They can cope with
something new if you warn
them, and let them get out
of the way if necessary.
If they need to project an
idea into the future, let them
use paper to intellectualise
the problem.
People with autism have difficulties with both verbal and non-verbal language. Many
have a very literal understanding of language, and think people always mean exactly
what they say. They can find it difficult to use or understand:
•facial expressions or tone of
voice
•jokes and sarcasm
•common phrases and sayings; an
example might be the phrase 'It's
cool', which people often say when
they think that something is good, but
strictly speaking, means that it's a bit
cold.
Others will have good language skills, but they may still find it hard to
understand the give-and-take nature of conversations, perhaps repeating what
the other person has just said (this is known as echolalia) or talking at length
about their own interests.
"For people with autistic spectrum disorders, 'body language' can appear just
as foreign as if people were speaking ancient Greek."
It helps if other people speak in a clear, consistent way and give
people with autism time to process what has been said to them.
Don’t tell them to pull their socks up.
At last someone has an excuse
not to laugh at Kevin’s jokes.
Have a code so that they can flag
to you when they don’t
understand without looking
foolish.
Say what you mean – don’t
assume that the pupil can pick
up the nuances of your
language.
Tell them if the way they
converse is not appropriate,
but kindly.
If you give an ASD student spoken instructions, they must have a
written version. Any sensory upset will block the instructions.
The understanding of hand gestures and eye gaze provides
crucial clues about the feelings and intentions of others.
Persons with autism spectrum disorders exhibit deficits in
facial perception.
Instead of identifying people on the basis of overall facial
configuration, persons with autism spectrum disorders use the
lower face, the mouth, and other specific portions of the face to
identify others.
Thus, people with autism spectrum disorders actually may
identify the faces of people by focusing on the objects that
form the face rather than the whole person.
•Seizures (epilepsy) may develop in 25-35% of children with
autism and can be resistant to treatment. The onset of seizures
peaks in early childhood and again in adolescence.
•There is a high incidence of suicide amongst students with
ASDs.
SMELL
Over-sensitive to
perfumes,
deodorants, bad
smells etc
Between 100
and 500% more
sensitive to
sensual stimuli
Tend to need
more personal
space
PEOPLE
Finds the sensual
overload of a
chaotic classroom
very intimidating
LIGHT
SOUND
CHAOS
Can have an emotional
reaction to sensual
stimulation that can lead to
bouts of unconsciousness,
blindness and deafness
Sensory sensitivity
People with autism may experience some form of sensory sensitivity. This can occur in one
or more of the five senses - sight, sound, smell, touch and taste. A person's senses are either
intensified (hypersensitive) or under-sensitive (hypo-sensitive).
For example, a person with autism may find certain background sounds, which other people
ignore or block out, unbearably loud or distracting. This can cause anxiety or even physical
pain.
People who are hypo-sensitive may not feel pain or extremes of temperature. Some may
rock, spin or flap their hands to stimulate sensation, to help with balance and posture or to
deal with stress.
People with sensory sensitivity may also find it harder to use their body awareness system.
This system tells us where our bodies are, so for those with reduced body awareness, it can
be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from
other people and carry out 'fine motor' tasks such as tying shoelaces.
Ensure that there is no stale
food in the bins.
Be sensitive to ASD
students in lab
experiments.
SMELL
Discourage students from
using deodorant in form
rooms.
Be prepared to move
rooms if there is an
unexpected issue.
Sensitive use of
the blinds – now
we have them.
Don’t work in rooms
with an undiffused
fluorescent light
Powerpoint
backgrounds
(colour) are better
than Promethean
(white) due to the
glare. Some ASDs
suffer from Irlen’s.
Flashing classroom
lights need to be
switched off and
repaired.
LIGHT
If you can’t
avoid the
problem, warn
the student
first.
Avoid flashing lights
in videos,
experiments etc
Avoid sudden
shouting out,
particularly from
behind the
student.
Allow the student
to use headphones
when working on
his own.
SOUND
Choose videos
carefully or allow
the student to sit
away from the
noise.
If you know it is
going to be a noisy
lesson, warn them
first and let them
leave if they need
to.
The world can seem a very unpredictable and confusing place to people with
autism, who often prefer to have a fixed daily routine so that they know what is
going to happen every day. Rules can also be important: it may be difficult for a
person with autism to take a different approach to something once they have been
taught the 'right' way to do it. People with autism may not be comfortable with
the idea of change, but can cope well if they are prepared for it in advance.
The worst place in
BRGS is the corridors.
ASDs should be allowed
to use dark glasses and
earphones to block the
senses and the panic.
There should be a quiet
room, with white walls for
them to escape to.
CHAOS
Shouting at an ASD student is
extraordinarily counterproductive. Time-outs are better.
Lessons should have a
predictable structure, little
disruption and be calm.
Kinaesthetic lessons must
be very sensitively
handled.
On the whole they are:
Self-disciplined
Honest
Mature for their age
Brilliant researchers
Intellectually unafraid
Good at working on their own
Lateral thinkers
Self-motivated
They have initiative
Bright
Relentless and determined.
BACKGROUND READING
Autism Spectrum Disorders by Chantal Sicile-Kira
The Curious Incident of the Dog in the Night-time by Mark Haddon
Freaks, Geeks and Asperger Syndrome: A User Guide to Adolescence by Luke Jackson
www.aspergers.com
www.Big%20Picture%20autism.htm
www.aswhatisit.html
www.autismfaq-hist.html
www.autism.jsp.htm
www.autism%20numbers2.htm
www. APERGERS%20SCHOOL.jsp.htm
www.Autism%20numbers.htm and
others
www.Autism_Genetics.htm
www. Autism%20BBC%20genome.htm
www.autismuk.com/index4.htm
A special thank you to:
Terri Spokes – Autistic Unit Woodhey High School
Angela Holdsworth – Tor View School
And especially to Huw and Matthew.