Transcript Document
Lisa Kunelius School Psychologist Prepared for AVW October 31, 2012 This workshop will provide a good start to understanding the challenges that persons with Autism Spectrum Disorder (ASD) encounter. Because children with autism are on a broad spectrum, we will learn about children along the spectrum, their skills and unique needs. We will look at the research by leaders in the field of autism (Stanley Greenspan, Kathleen Quill, Tony Attwood and others), discuss the key concepts we need to know and consider when working with students with ASD, and how to apply them when working with students. This workshop is appropriate for general education and special education teachers who want a foundation from which to build their knowledge and skills about ASD. Paraprofessionals are especially welcome to attend Autism was first described in US literature by Leo Kanner in 1943 He called the syndrome “early infantile autism” Autism was also often misdiagnosed as early childhood schizophrenia Early psychologists hypothesized that children became autistic due to ‘cold and unnurturing mothers. This theory was proven false in 1979. Autism: Between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have an ASD Autism prevalence figures are growing (the current annual growth rate is 10-17%) More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined Autism is the fastest-growing serious developmental disability in the U.S. Autism costs the nation over $35 billion per year, a figure expected to significantly increase in the next decade Recent studies have estimated that the lifetime cost to care for an individual with an ASD is $3.2 million Autism receives less than 5% of the research funding of many less prevalent childhood diseases Boys are four times more likely than girls to have autism There is no medical detection or cure for autism Typically manifests around the ages of 18 months to 3 years Is found throughout the world in families of all racial, ethnic and social backgrounds There is no cure, but lots of research is currently being done. There are lots of treatments, and from researched based evidence, educational treatment is the most effective. Autism remains throughout a person’s lifetime, although with proper intervention symptoms can lesson. Genetics are a factor in the cause Environmental triggers are also a factor Dr Wakefield discredited for his research linking autism and vaccinations….also can no longer practice medicine in the UK Probability of 2nd twin being diagnosed after 1st diagnosed Diagnosing autism spectrum disorders (ASDs) can be difficult, since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis ASDs can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.[1] However, many children do not receive a final diagnosis until much older. This delay means that children with an ASD might not get the help they need. Diagnosing an ASD takes two steps: All children should be screened for developmental delays and disabilities during regular well-child doctor visits at: •9 months •18 months •24 or 30 months •Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons. In addition, all children should be screened specifically for ASDs during regular well-child doctor visits at: •18 months •24 months •Additional screening might be needed if a child is at high risk for ASDs (e.g., having a sister, brother or other family member with an ASD) or if behaviors sometimes associated with ASDs are present The second step of diagnosis is a comprehensive evaluation. This thorough review may include looking at the child’s behavior and development and interviewing the parents. It may also include a hearing and vision screening, genetic testing, neurological testing, and other medical testing. What developmental milestone is this child displaying? What developmental milestone is this child displaying? What developmental milestone is this child displaying? What developmental milestone is this child displaying? What developmental milestone is this child displaying? http://www.cdc.gov/CDCTV/BabySteps/index. html Open hyperlink Begin to smile at people Can briefly calm self Tries to look at parent Coos, makes gurgling sounds Turns head towards sounds Pays attention to faces Begins to follow things with eyes and can recognize people at a distance Begins to act bored (fussy) if activity does not change Knows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to others emotions and often seems happy Likes to look at self in the mirror Responds to sounds by making sounds Strings vowels together Responds to own name Makes sounds to show joy and displeasure Shows curiosity about things and tries to get things out of reach Shy or nervous w/ strangers Cries when mom or dad leave Has favorite things and people Shows fear in some situations Hands you a book when he wants to hear a story Repeats sounds or actions to get attention Plays simple games such as peek a boo Cooperates w/ dressing Responds to simple spoken requests Uses simple gestures like bye bye Makes sounds with change in tone Says mama or da da or Uh oh! Tries to imitate words heard Explores things in different ways Finds hidden things easily Looks at the right picture when its named Follows simple directions Copies others especially adults and older children Gets excited when with other children Plays beside other children, but is beginning to include other children such as chase games Points to things/pictures when named Repeats words overheard in conversation Points to objects in books Names items in book such as cat, bird or dog • Autistic Disorder • Asperger’s Disorder • Childhood Disintegrative Disorder • Rhett’s Disorder • PDD:NOS Feeding problems, such as poor nursing ability. Apathetic and unresponsive – showing little or no desire to be held or cuddled. Constant crying or unusual absence of crying. Disinterested in people and surroundings. Repetitive movements, such as hand shaking, prolonged rocking and spinning, head banging. Sleeping problems. Insistence on being left alone. Difficulties in toilet training. Odd eating habits and preferences. Late speech, no speech, or loss of previously acquired speech. Sleeping problems, such as requiring only a few hours of sleep each night. Does not have anticipatory response to be picked up. Seems to “tune out” a lot. Prolonged tantrums. Doesn’t play appropriately with toys. Seems to have a good memory. Fails to respond to the affection of others. May use an adult’s hand like a tool for accomplishing tasks. Does not spontaneously imitate the play of other children. Tendency to spend inordinate amounts of time doing nothing or pursuing ritualistic behaviors. Difficulty with changes in environment and routine. Does not seek opportunities for interaction with others. A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging 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, 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging 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. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging 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 B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as 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). C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning. (See chart) New name for category, autism spectrum disorder, which includes autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. •Differentiation of autism spectrum disorder from typical development and other "nonspectrum" disorders is done reliably and with validity; while distinctions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder. •Because autism is defined by a common set of behaviors, it is best represented as a single diagnostic category that is adapted to the individual’s clinical presentation by inclusion of clinical specifiers (e.g., severity, verbal abilities and others) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability and others.) A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”. Three common Characteristics of autism include: ◦ Deficits or differences in socials skills ◦ Deficits or differences in communication skills ◦ Deficits or differences in routines/behaviors/sensory http://www.5min.com/Video/Early-Signs-ofAutism-6777 Lack of awareness of the existence or feelings of others Severe impairment in the ability to relate to others Aloof and distant from others Appears to not listen when spoken to Challenges in producing appropriate facial affect to specific occasions Avoid or fleeting eye contact Challenges with changes in environment and routine Challenges in seeking opportunities to interact with others Unwillingness and/or inability to engage in cooperative play Challenges in using and understanding both verbal and non-verbal language Failure to initiate or sustain conversational interchange Abnormalities in the pitch, stress, rate, rhythm and intonation of speech Poor receptive and expressive skills May echo words (echolalia) either immediate or delayed May use screaming, crying, tantrums, aggression or self abuse as ways to communicate Repeating words or phrases in place of normal, responsive language (TV talk) Unusual and repetitive movements of the body that interfere with the ability to attend to tasks or activities, such as hand flapping, finger flicking, rocking, hand clapping, grimacing or eye gazing. Marked distress over changes in seemingly trivial aspects of the environment Laughing, crying, or showing distress for reasons not apparent to others Unreasonable insistence on following routines in precise detail Unresponsive to normal teaching methods Acts as if deaf Apparent over or under sensitive to pain No fear of real danger Uneven gross and fine motor skills May have difficulties cuddling Inappropriate attachment with objects Inappropriate play Noticeable physical over or under activity http://www.youtube.com/watch?v=rXgUl1qPd Mg Communication: pictures and picture schedule; simple sign language; assigment notebook; teach the meaning of idioms; use short verbal phrases; allow wait time (just how long is a minute?); alert students to key phrases (This is important!) Social: use mixed grouping; use social stories or social scripts; use pictures with words to present choices; allow students to work in pairs; integrate team building; teach awareness early Behavioral: use seating charts; classwide and school wide behavioral plan; develop each personalized behavioral plan; teach self monitoring (5 point scale); review schedule often; model positive behavior; be generous with specific praise; provide direct feedback Environmental: post daily activities; use preferential seating; allow dedicated space for student; avoid sudden changes in routine; label desks; maintain consistent routine; provide movement breaks; use study carrols; keep unnecessary material away Visual: write information on board or desk; provide notes; give written information for assignments/projects; use pictures in support of verbal and written directions; make artifacts so child can copy Sensory: assess students sensitivity (Get the OT!!); allow stress balls or fidget items; use inflatable seat cushions; provide regular breaks; make chewies available; have a relaxation room Dec 6, 2012: Strategies to Support Persons with Autism Spectrum Disorders and Other Kids Who Have Social Cognitive Disorders Check out: Friday, October 12, 2012: Smartboards, Boardmaker and iPads...Oh My! #126-13 with Marcia Obukowicz!!!!!!!! Resources http://www.udel.edu/bkirby/asperger/ http://www.firstsigns.org/ http://www.autism-society.org/ http://www.autismspeaks.org/ http://icdl.com/