Transcript An Introduction to Autism Spectrum Disorders

Introduction to
Learning Exceptionalities
Autism Spectrum Disorder
Dr. Patricia Peterson
What is Autism?
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IDEA:
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A developmental disability
significantly affecting verbal and
nonverbal communication an
social interactions, generally
evident before age 3, that
adversely affects a child’s
educational performance (34C.F.R.
300.7[c][1](i))
DSM-IV-TR, Diagnostic and Statistical
Manual of Mental Disorders
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Qualitative impairment in social
interaction
Qualitative impairment in
communication
Restricted, repetitive and
stereotyped patterns of behavior,
interests, and activities
Delays or abnormal
functioning in:
Social interaction
 Language as used in social
communication
 Symbolic or imaginative play
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Triad of Impairment
Lorna Wing, 1979
Characteristics
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Unconventional or inappropriate communication
behaviors
Use of echolalia (the imitation of speech of
others)
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May eventually break down echolalic chunks into
smaller meaningful units as part of the process of
transitioning to a rule governed, generative language
system
Lack of varied, spontaneous make-believe play is
one of the four possible features of the
impairment in communication in the DSM-IV
Woods & Wetherby, 2003
Causes
Not yet identified
 700% increase in last 10 years
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Causes for increase?
1 in 166-250 children have ASD
Autism Spectrum Disorder
Autistic Disorder
 PDD-NOS
 Rett’s Syndrome
 Asperger Syndrome
 Childhood Disintegrative Disorder
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Autistic Disorder
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Failure to develop peer relationships
Lack of spontaneous seeking to share
enjoyment, interests
Lack of social reciprocity
Communication impairment
Lack of varied spontaneous make-believe play
Restricted, repetitive and stereotyped patterns
of behavior
Onset prior to age three
Language and intelligence are strong predictors
of prognosis
Pervasive Developmental Disorder,
Not Otherwise Specified (PDD NOS)
Collection of features that resemble
autism disorder but may not be as
severe or extensive
“Catch-all” diagnosis
DSM: Presentations that do not meet
the criteria for autistic disorder because
of:
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Late age of onset
Atypical symptoms
Rett’s Disorder
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Reported only in females
Development of multiple specific impairments after a
period of normal development
Deceleration of head circumference growth between
5-48 months
Loss of hand skills between 5 and 30 mos.
Typically associated with severe or profound mental
retardation
Interest in social interaction decreases after onset
but returns later
Problems in gait and trunk movement
Severe communication and psychomotor deficits
Childhood Disintegrative Disorder
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Marked regression in multiple areas following at
least two years of normal development
Significant loss of previously acquired skills
Exhibits Autistic Disorder symptoms in social,
interaction, communication deficits and
restricted, repetitive behaviors
Onset prior to age ten
Potential early signs include increased activity
level, irritability, followed by loss of speech
Asperger Syndrome
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Impairments in social relationships; verbal and
nonverbal communication
Restrictive, repetitive patterns of behavior,
interests, and activities
No clinically significant delays in cognitive
development in the first three years
Impairment in reciprocal interaction
Failure to develop peer relationships
Lack of spontaneous seeking to share
enjoyment/interests
Strengths in vocabulary and rote memory
Challenges in visual-motor and visual-spatial skills
Early Indicators/Red Flags
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Failure to develop an anticipatory reach
Absence of pointing
Loss of language between 18 and 36 months
Does not look at others
Does not show interest in other children
Does not orient to name
Does not show objects
Does not demonstrate symbolic play
Does not show an interest in or joint attention to
games for pleasure or connection with another
Woods & Wetherby,2003
Assessment
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Assessment should include:
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Observations
Interviews
Record review
Skill areas to be assessed
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Play
Social-emotional
Sensory motor
Behaviour
Health and self-care
Communication
Play
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Normally developing play may
include:
Activity across environments, partners
and objects
 Range and flexibility of topics/routines
and interests
 Manipulation of objects
 Symbolic (imaginary)
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Social/Emotional
Assessment
Social interaction with all in
environment
 Attachment
 Range of emotional themes and
stability (effects of stress)
 Initiation
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Sensory Motor Assessment
Hearing
 Vision
 Motor strength, balance and
endurance
 Sensitivity to light, sound, touch,
taste and smell
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Prelock, 1999
Behavioral Assessment
Attention
 Temperament
 Motivation
 Anxiety
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Health and Self-Care
Considerations
Toileting
 Sleep
 Nutrition
 Seizures
 Daily living skills
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Communication Strategies
Four strategies that can be implemented throughout
the school day to assist with the development of
communication in individuals with autism include:
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Increase awareness of and respond to all communication
attempts.
Teach students with autism that their actions have distinct
consequences associated with them.
Provide positive supports and learning opportunities.
Encourage interactions by providing individuals with autism
the opportunity to socialize in environments with ageappropriate peers.
Koegel and Koegel,1995
Evaluating the Effectiveness of the
Curriculum and Environment
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Does the curriculum content:
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Support the student’s ability to attend to the
elements in his/her environment?
Encourage imitation or modeling of others?
Develop the student’s ability to comprehend
and use language?
Facilitate the child’s ability to play
appropriately with toys?
Provide opportunities for social interaction
with peers?
Adapted from Dawson & Osterling, 1997
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Are there transitions that teach survival skills?
Is there family involvement?
Does the program foster independence, initiative
and choice making?
Is there a highly supportive teaching
environment that
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Supports direct teaching of core skills?
Maximizes student’s attention to relevant stimuli?
Facilitates social interaction?
Intervention
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Intervention provided before age three has a
much greater impact than intervention provided
after age five.
Emphasis on successful communication
interactions is one of the most critical
components of educational programs for children
with ASD.
For children who do not talk, it is important to
develop a nonverbal means to initiate
interactions. (Woods, J.J. & Wetherby, A.M.,2003)
Picture Exchange Communication
System (PECS)
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Uses pictures to create a functional
nonverbal communication system
Child taught to exchange picture of
desired item for actual item
Empirically sound method that develops
communication skills to children who are
nonverbal or limited in use of
communication
http://www.pecs.com
Visual Schedules
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Offers form of environmental support
Assists in organization.
Prediction of events/ understanding
expectations
Helps child to anticipate changes, make
choices and function independently
Identify sequence and time of daily
activities
Used with task organizers to identify
steps in a process
Safety in the Home
by Care Shangton
http://www.symbolworld.org/learning/pse/safety/safety1.htm
Copyright © 2005 Bridget A
Taylor All Rights Reserved
Copyright © 2005 Bridget A
Taylor All Rights Reserved
“Our highest human virtue is our
connection with other humans, and
social activity is basic to our health
and happiness” (John Ratey, 2002)
 As we educate the “whole child” to
his or her highest potential, we must
never fail to provide opportunities
for social and communicative
inclusion.
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Teaching Social Skills
Social goals are as important as
academic and life skills goals
 Generalization and maintenance
must be integrated into the program
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Powers, 2004
Assessing social skills
Which problems are potentially
dangerous?
 Which are most detrimental to social
inclusion?
 What are key skills needed?
 What are reasonable goals for the
year relative to the individual’s
development?
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Prioritizing Social Needs
Independence
 Participation
 Functionality
 Age-appropriate
 Important to parents
 Interaction
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Powers, 2004
Social Stories
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Short stories describe a situation using relevant
social cues/responses, providing a child with
accurate and specific information about what
occurs in a specific situation and why
Use descriptive, directive and perspective
sentences (Who they are, what is the behavior,
and what is the consequence to those around
them)
Identify difficult situations for child
Used to emphasize social skills and to teach
routine
Theory Of Social Stories
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Presents information visually
Identifies relevant social cues and provides
accurate information
3. Makes the abstract social rules more concrete
 Oliver Sacks: An Anthropologist on Mars
4. Describes expected behavior
5. Subtracts social interference to maximize
learning
What are Social Stories?
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Tool for teaching social skills to children
Provide an individual with accurate information about
those situations that he may find difficult or confusing
Situation is described in detail and focus is given to a few
key points:
 the important social cues
 the events and reactions the individual might expect to
occur in the situation
 the actions and reactions that might be expected of
him, and why.
Goal of the story is to increase the individual’s
understanding of, make him more comfortable in, and
suggest some appropriate responses for the situation in
question.
Jason M. Wallin
Writing a Social Story
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Usually a first-person, present-tense
story used to provide as much
information about a social situation
as possible, so the child is better
prepared to face, and act
appropriately in that situation.
Types of Sentences
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Descriptive sentences
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objectively address the “wh”
questions
where the situation takes
place,
who is involved,
what they are doing, and
why they may be doing it.
Perspective sentences
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give a peek into the minds of
those involved in the story;
they provide details about
the emotions and thoughts of
others.
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Directive sentences
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suggest desired responses
tailored to the individual –
“gentle” direction
Control sentences
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Helps student remember the
story or deal with the
situation.
Not used in every story
Typically used only with fairly
high functioning children.
Lining Up – A Sample Social Story
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At school, we sometimes line up. (Descriptive)
We line up to go to the gym, to go to the library,
and to go out to recess. (Descriptive)
Sometimes my friends and I get excited when
we line up, because we’re going someplace fun,
like out to recess. (Perspective)
It is okay to get excited, but it is important to
try to walk to the line. Running can cause
accidents, and my friends or I could get hurt.
(Perspective)
I will try to walk to the line. (Directive)
When my teachers says “Line up!”, I will
remember to walk to the line. (Control)
Exercise
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Working in pairs, design a social story to address
the following scenario:
Amanda is a 12 year old girl with PDDNOS. She is verbal and reads at a fifth
grade level. In the gym, Amanda tends to
become aggressive during physical
games, pushing other children and
sometimes leaving bruises. Write a social
story to help Amanda understand the
rules of play in the gym.
References
Holmes, A. & Holmes, D. (2003) Autism: An Introduction to Behavioral Teaching Strategies. Eden
Family of Services
http://www.derbyps org
Kepley, S., Accelerated Learning, LLC- conference 11-24-03, 2-24-04, 4-1-04
Powers, M.D., (2004) Teaching Social Skills to Students with Autism Spectrum Disorders:
Assessment, Curriculum Development, Intervention, and Evaluation Conference, Cromwell CT
Prelock, P. (1999).Serving Children With autism Spectrum Disorders and Their Families:
Strategies for Assessment, Treatment, and Curriculum Planning. American Speech-LanguageHearing Association (p.p.9-105)
Prizant, B.M., Wetherby, A.., Rubin, E.., Laurent, A.C., & Rydell, P. (2002) The SCERTS Model
Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum
Disorder. National Professional Resources, Inc., and Paul H. Brookes Publishing Co. (p.p. 1-13)
Ratey, John J. MD. A User’s Guide to the Brain. Perception, Attention, and the Four Theaters of
the Brain. Vintage Books, New York. 2002.
Woods, J. J., & Wetherby, A. M. (2003).Early Identification of and Intervention for Infants and
Toddlers Who are at Risk for Autism Spectrum Disorder. Language, Speech, and Hearing Services
in Schools, 34 (p.p.180-193)