Transcript Slide 1

Pervasive Developmental
Disorders
Autism Spectrum Disorders
Rett Syndrome
Childhood Disintegrative Disorder
Other non specified
Teresa Krawczyk
EDN 410 fall 09
PDD
(Pervasive Developmental Disorders)
In general this category of disorder and its
subcategories are characterized by:
impaired social interactions
Impaired communication skills
poor verbal abilities
limited number of interests
poor imaginative activity
activities that tend to be highly repetitive
(Vaughn 2007)
Autism
- Autism Spectrum Disorders(ASD)
Autism is also called classical autism. According to
Vaughn (2007) it is a developmental disability
characterized by extreme withdrawal and
communication difficulties.
The National Institute of Neurological Disorders and
Stroke (NINDS) a sub group of the National Institute
of Health (NIH) tells us it is “a range of complex
neurodevelopment disorders.”(2009)
Autism
-Characteristics (NIH 2009)
 Impaired social interaction
 Little smiling or response
 Does not make friends
 Lack of social play
 Misreads social cues
 Avoids eye contact
 Repetitive behaviors:
 Rocking
 Twirling
 Hand flapping
 Clicking
 Poor language skills
 Using memorize phrases to
communicate (canned
speech)
 Inflexible in routines or
ritualistic in behaviors.
 Fixation on object or subject.
 Poor or no imaginative play
 Lacks empathy
 Excessive object organizing
 Lining up toys or objects
 Third person speech
 Baby does not point or babble
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm
Autism
-Etiology and Prevalence
(NIH 2009)
 There is no concrete cause of autism. The only thing
that has been ruled out is bad parenting. Everything
else is theoretical.
 There may be a hereditary predisposition to autism.
 Some studies link environment as well as genetics as
causes. Much misinformation is available and source
materials must be scrutinized carefully.
 NIH reports 3 to 6 of every 1000 children have autism.
This reduces to 1 in a range of 167 to 334 children.
(NIH 2009)
www.autism.org
This website contains a variety of links
ranging from issues (e.g., autistic savant,
self-injurious behavior, social behavior, and
self-stimulatory behavior) to interventions for
individuals with autism (e.g., auditory
integration training, music therapy, physical
exercise and autism, and self-management).
www.autism-pdd.net
This website is the autism and pdd support
network, which provides information on the key
issues associated with autism and pervasive
developmental disorders. It contains information
regarding diagnosis and testing, treatment,
TEACCH, IDEA, computer technology, and so
on. I was impressed with the webinars offered.
* (It also has a link to the CDC report on Thimeserol and
vaccine related issues.)
www.autism-society.org
“The Autism Society of America serves the
needs of individuals with autism and their
families through advocacy, education, public
awareness, and research. This website also
contains a variety of resources on individuals
with autism (various state agencies,
downloadable information packages covering
various topics from diagnosis to transitional
services, etc.).” (Vaughn 2007)
Asperger
Syndrome
History
Sometimes called high functioning autism this
syndrome has only recently been accepted by
professionals. In 1940 Hans Asperger published
his first paper on his observations. He followed that
paper with another in 1944 which prompted
Asperger Syndrome’s (AS) addition to the
Diagnostic and Statistical Manual of Mental
Disorders.(DSM IV)
(Kirbey 2007)
Asperger
Syndrome
Characteristics
 Normal or even high IQ:
 Children are often said to sound like
small adults or teachers
 Normal language development
 May exhibit autistic mannerisms
 Deficient social skills:
 Recognizing personal space
 Poor peer relationships
 Extreme Naiveté
 Deficient communication skills:
 Difficulty with transition or change
 Tend to eat the same things in the same
way each day.
 Hyper awareness of sensory input:
 Hears things most do not such as
electronic devices, clock mechanisms
and metal stress in air vents.
 See things most do not notice such as
Florescent light flickers or dust glare
 Often need softer clothing for touch
sensitivity. Cotton sheets on the bed can
cause sleep difficulty.
 Difficulty understanding sarcasm or  Fixations on one subject/ object:
figurative speech
 May become expert on one subject
 Preoccupation with parts of objects.
 Takes over conversation or breaks
in whether appropriate or not.
(Kirbey 2007)
Asperger
Syndrome
Causes
Is primarily thought to be caused by the
same things that cause classical autism and
the prevalence is typically imbedded in that
group. (NIH 2009)
There are several studies including drug
trials and scans of the brain looking for
changes in function that are causal.(NIH
2009)
http://www.ninds.nih.gov/disorders/asperger/asperger.htm
O.A.S.I.S.
Online Asperger Syndrome Information and Support
www.udel.edu/bkirby/asperger
This website provides information and support for
individuals and families with Asperger syndrome.
A small sample of the content:
 Definition and Diagnostic scales
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Social implications
Strategies
Summer camp opportunities
Legal resources
Assistive software programs
Rett Syndrome
A very rare disorder affecting primarily females. The onset
of symptoms typically begins between five months and
four years of age. (Vaughn 2007) Typically symptoms
appear after a period of seemingly typical development.
Most parents report a stagnation of skills near age two.
The syndrome causes problems with brain functions
controlling cognitive, sensory, emotional and even
autonomic systems. ( IRSF 2009)
(Vaughn 2007)
Rett Syndrome
-Characteristics
(NIH 2008)
 Decelerated head growth after  Toe walking or an unstable gait
some post natal normal
or stiff legged gait.
 Teeth grinding
development
 Hand skills regression to
 Abnormal sleep patterns
repetitive hand motions.
 Difficulty swallowing
 Loss of social engagement
 Irritability or agitation
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 Chilled extremities
severely impaired receptive
and expressive communication  Joint contracture worsening with
skills
age.
 Shaking of the torso
http://www.ninds.nih.gov/disorders/rett/detail_rett.htm#118323277
Rett Syndrome
History
A Viennese pediatrician, Dr. Andreas Rett saw
similarities of symptoms between some of his female
patients in 1954. He began searching for others with
similar symptoms in other areas of Europe. He
published his study in 1966 in a German Journal with
little widespread notice. Finally in 1983 the syndrome
was named for Dr. Rett. (IRSF 2008)
Rett Syndrome
-Etiology and Prevalence
 Rett is an X-linked dominant disorder thus it is typically thought
of as a female disorder. (NIH 2008)
 Although genetic in origin it is random in occurrence and is not
hereditary. (NIH 2008)
 Any one of approximately 200 different mutations appear in the
MECP2 gene, which is found on the Xq28 site of the X
chromosome. Scientists believe the MECP2 gene contains
instructions for making methyl cytosine binding protein 2
(MeCP2). This protein signals other genes to function. When
this communication breaks down it is we see symptoms. (NIH
2008)
 1 of every 10,000 to 15,000 live female births worldwide is
affected. Race or Ethnicity do not seem to be factors. (NIH 2008)
http://www.ninds.nih.gov/disorders/rett/detail_rett.htm#118323277
Rett Syndrome
Dr. Rett once said "they feel all the love given to
them. They have a great sensitivity for love. I
am sure of this. There are many mysteries, and
one of them is the girls’ eyes. I tell all the
parents to look at their eyes. The eyes are
talking to them. I am sure the girls understand
everything, but they can do nothing with the
information." (IRSF 2008)
Rett Syndrome
http://www.rettsyndrome.org/
The International Rett Syndrome Foundation
web site has more information about Rett
Syndrome as well as possible testing and
treatment suggestions. It is primarily a
fundraising and research site.
Childhood
Disintegrative
Disorder
The neurological condition where normal
development occurs until age two which is followed
by a severe deterioration of mental and social
functioning, until it regresses to autism symptoms.
(Vaughn 2007)
It is also sometimes known as Heller’s syndrome
after Theodore Heller. (Hendry 2000)
Hendry CN (January 2000). “Childhood disintegrative disorder: should it be considered a
distinct diagnosis". Clinical Psychology Review. 20 (1): 77–90.
Childhood
Disintegrative
Disorder
- Characteristics (Mayo 2008)
 Loss in expressive
language skills
 Loss of receptive
language skills
 Regressing social skills
 Regressive self-care
abilities including bladder
and bowel control.
 Loss of motor skills
 Failure to make friends
 Sharing is foreign
 No empathy
 Lack of imaginary play
 Repetitive, ritualistic
routine driven.
 Catatonia
 Fixations
http://mayoclinic.com/health/childhood-disintegrative-disorder/DS00801/DSECTION=symptoms
Childhood
Disintegrative
Disorder
Etiology and Prevalence
There is no definitive cause of CDD, although it is thought to
stem from similar problems like autism. Current research is
suggesting that an autoimmune response might be causing the
body’s immune system to attack normal components as if they
were foreign entities. (Mayo 2009)
According to the NIH fewer than 2 of every 100,000 children
diagnosed with ASD are CDD. Thus for the general population
the children at risk will be a little less than 1 child in 8.3 million.
A rare disorder indeed. (NIMH 2009)
http://www.nimh.nih.gov/health/publications/autism/introduction.shtml
PDD - NOS
Children with Not Otherwise Specified PDD show
stereotypical behaviors or delays in social
interaction or communication ability, but do not fit
the other PDD subcategories. (Vaughn 2007)
Yale School of Medicine calls it a “subthreshold
condition” having some but not all PDD symptoms.
(2009)
http://www.med.yale.edu/chldstdy/autism/pddnos.html
Effective Strategies
with Inclusion
General classrooms suggestions for children with PDD.
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Keep to a daily schedule. Post the schedule where the child can see it.
Give a warning before transitions so child can prepare for changes.
Be consistent in attitude and style.
Practice for events repeatedly before they happen (i.e. Assemblies, fire drills)
Be acutely aware of noise levels in the room.
Know your student’s family and seek their support and advise.
Know the student’s triggers and preferences and accommodate them.
Find out what sooths your student and have that available.
Use the Positive Behavior Supports (PBS)
Minimize the attention drawn by disruptive behavior.
Minimize distraction.
Support spoken instruction with written instruction.
Keep reassessing strategies and their efficacy.
Effective Strategies
with Inclusion
Specific suggestions for children with PDD.
 A daily schedule posted where the child can see it allows for less talk. Some
PDD students need a visual list to know where they are in their day. A small
pictorial or written schedule can provide their eye’s a backup to the receptive
language that they often struggle with.
 Transitions are a difficult time for most PDD students. Have a specific signal
that you give to let your students know a change is coming. They can look at
their schedule and see this is normal and follows the routine. Alternatively,
giving a child access to a timer of some sort will alert them to a coming
change without the teacher interfering.
 In higher functioning students the child could be given the responsibility to
warn the teacher when it is time to change activities. They then own the
beast that bothers them. Although this can become problematic if the child
becomes obsessive about watching the clock. Here again we must know our
student’s limitations.
Effective Strategies
with Inclusion
 PDD students have difficulty filtering environmental input or distraction in the
classroom. According to New Horizons even a parapro or intervention
teacher can be a distraction. These children cannot listen to two voices at
once. Wait until the speaker is finished before speaking to the child. (2003)
 Support spoken instruction with written instruction whenever possible. Since
much of the disorder is communication inability multiple opportunities for
exposure to the same information is critical. (New Horizons 2003)
 Be acutely aware of all noise levels in the room. It is not just people
speaking, it is ticking clocks, static from a P.A. system, electronic hum of
computers, fans, etc. Since this child may have very few filtering abilities the
noises accumulate to cause an overstimulation and possibly what parents
call melt downs. Turn off any unnecessary devices. Go into the room while it
is empty and listen carefully. What do you hear?
http://www.newhorizons.org/spneeds/autism/doyle_strategies.htm
Effective Strategies
with Inclusion
 Minimizing distractions takes on new levels of meaning with these students.
Too many decoration in a room can be terribly distracting so eliminate visual
clutter. Limit the amount of decoration on the walls to useful reference
material. Allow an area at the back of the room for displays where it is not
the student’s visual field.
 Place curtains over open shelving in the student’s field of view.
 Design visual boundaries. Autistic students do not typically segment their
environments and need a bookshelf or divider to signal a change of purpose
or activity. Even a carpet square or floor tape can help separate
spaces.(Stokes 2008) Some classrooms have story carpets or art tables;
these delineate a purposeful space.
 Only place supplies needed or work to be completed in front of the child.
They can easily become overwhelmed by too much “stuff” to deal with. They
can become preoccupied with the extras and distracted from the
task.(Stokes 2008)
Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public
Instruction. http://www.specialed.us/autism/structure/str10.htm
Effective Strategies
with Inclusion
 Practice makes perfect the old adage goes. Practice for events repeatedly
before they happen, so there is no surprise. (i.e. Assemblies, fire drills)
 Know your student’s family and seek their support and advise. They have
been living with this child and know the quirks and personal preferences.
They have ways of dealing with behaviors which if positive should be
reinforced anywhere the child goes. Consistency between home and school
is comforting.
 Know the student’s triggers and preferences and accommodate them. For
example, if we know the sound of lockers slamming is a trigger, allow the
student to where earphones during times of high locker use.
 Find out what sooths your student and have that available. An example, we
know that our Autistic 6th grader can self-calm by standing with his face in
front of a fan, so we have a small desktop fan near his desk. He can move to
the fan without question if he feels the need, or his teacher will suggest he
“find his peace,” which is his cue to use the fan.
Effective Strategies
with Inclusion
 Natural lighting can also help reduce distractions. Since florescent lights
have a mild flicker that many autistics see and a buzz they hear, the less
those lights are used the better for the child.
 Autistic students are emotionally aware of themselves and their needs so
when they are having difficulty, witnesses will compound the problem.
Minimize the attention drawn by disruptive behavior. Positive Behavior
Support can go a long way in preventing disruptions. Quietly warn or
distract the child if you see trouble starting. If intervention is needed keep it
as low key as possible. For the students sake and yours. According to New
Horizons others are looking at the teacher to gauge their own reactions to
the child’s behavior. A calm teacher lends stability to all involved.(2003)
 Be consistent always. These students need stability and structure. They
need to know they can depend on their world being what they have grown to
expect. Sudden changes in attitude or behavior on the part of the teacher
can undermine the trust of the child.
UDL and DI
inclusion
applications
Planners give personal power
In my son’s classroom, we have planners which all students are required to
fill in daily. This planner contains class times, assignments to be completed,
readings to be done and all transitional points in the day are noted. For the
typical child the planner is just an organizational tool, for our PDD student it
allows for independence within his day. He can transition with the visual help
of his planner and without the help of an intervention worker. In addition he
sees the items on his list being checked off as we complete tasks and finds
motivation in checking them off.
There are electronic visual schedules available to schools at a cost. These
can be extremely helpful to lower functioning students if the district will
purchase them. If not as a teacher we may need to supply a copy of our
daily schedule with words or pictures for the child to track their day.
UDL and DI
inclusion
applications
Health Class or Science Class
Self care skills are often an issue for PDD students so lesson plans that include
taking responsibility for self care and opportunities to practice those skills are
essential. This can be done by differentiating instruction of an inclusive lesson or
through Universal Design of a lesson.
Example: When teaching a UDL lesson about germs and viruses, the lesson plan
would call for students to read about a germ, which catches some of the visual
language learners. There is brief conversation about what they read for the auditory
learners. We would include a brief video on how germs are spread and how they
grow giving additional visual support to all learners. For the more tactile students a
physical experiment with a spray bottle of water and a paper towel will lend support
to the idea of transfer prevention as well as experiencing first hand what the video
and written material are talking about. Next would be a written/drawn reflection or
response to what was learned to deepen understanding and provide independent
practice of new skills. Here we may use an assistive technology such as Alpha Smart
or Symbols 2000 both of which are software for written work.
UDL and DI
inclusion
applications
Group Projects
 Students with PDD have difficulty with social situations so we should design
lessons that push them gently into moderate social interaction where they
can feel successful and included. This might be a research team,
cooperative math group or a peer writing conference. The severity of the
student’s disorder will determine how far we push them into the social
situation. For support in the process we should prepare them with mini
lessons on how our groups will function and what each person’s role is
within the groups. This helps all students, but specifically targets those with
socialization issues.
 Groupings can also shelter some of our PDD students from negative
stimulus. For example a science lesson on sound waves requiring the
students to listen to how sound vibrates differently depending upon the
medium. Listening to the waves may be too much for our PDD student but
the partner can describe the differences. The listening is vicarious, but
effective. Here the instruction is differentiated to accommodate a need.
UDL and DI
Tips and Resources.
A seemingly universal tip is to evaluate and
revise after each lesson. Another is to know
each student personally for best success.
http://www.cast.org/teachingeverystudent/
http://www.ocali.org/at/udl_resources.php
The Ohio Center for Autism and Low
Incedence has a wonderful page of
additional resources on UDL at this address.
Let us also fully utilize the State of
Michigan’s Positive Behavior Support
program, which supports UDL.
Click the figure for PAL/ CAST website link
http://www.michigan.gov/documents/mde/Positivebehaviorsupportpolicy_172347_7.pdf
http://www.brighthub.com/education/special/articles/15238.aspx
www.autismspeaks.org
This site gives information on ASD in addition to offering
public awareness events. They fund “global biomedical
research into the causes, prevention, treatments, and
cure for autism.” They work to give hope to families who
deal with this disorder. Their logo is the puzzle piece that
so many athletes and stars now wear or place on their
equipment.
www.ussaac.org/links
This website is for the Communication Aid
Manufacturers Association. It contains
additional helpful links to assistive
technologies and a plethora of disability
specific sites which include PDD
organizations.
www.isaac-online.org
This link will take you to the International
Society for Augmentative & Alternative
Communication. Here you will find helps and
ideas for those who, as the site says,
“communicate with little or no speech.” The
site give more information about AAC
research data and resources. This site might
be useful with children with severe speech
issues.
www.teacch.com
This website is for TEACCH (Treatment and Education
of Autistic and related Communication handicapped
Children). TEACCH is part of the curriculum at
University of North Carolina and has become a
primary source of assistance to North Carolina’s PDD
community. It prepares teachers, who work with local
students in live classrooms. It works with several other
agencies within North Carolina to both teach and
further research into PDDs.