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Changing the Way We View Autism
Presentation for Sigma Gamma Rho
Palm Springs, California
July 15, 2010
Emily Iland, M.A.
President, Autism Society of Los Angeles
& Educational Consultant
[email protected]
[email protected]
www.asdAtoZ.com
Our agenda: Change our view of autism
1. Understand typical development and the
signs of ASD
2. Promote understanding and acceptance
3. Watch over the children
4. Think about adults you know
Tom
• His progress
• How we got here
• What we learned
An Equal Opportunity Disability
Current Incidence
• 1 in 110 eight-year-olds
• 1 in 70 boys
• NOT Rare
• Was 1 in 150 a year ago
• Was 1 in 10,000 ten years ago
More autism or better diagnosis?
What is the cause?
Different views
Developmental Differences
Don’t do things
they should do
Do things they
should not do
The
Triad
Plus
Sensory
Issues
Social
R&R
Behavior
Communication
Diagnostic features:
the “pattern of differences”
Differences in reciprocal social interaction
Differences in both verbal and non-verbal
communication
Restricted, repetitive activities and
intensely focused interests
The pattern of differences has a name Will it
be called…
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Autism
Asperger Syndrome
PDD-Pervasive Developmental Disorder
PDD.NOS-Pervasive Developmental
Disorder
Not Otherwise Specified
• “High-functioning autism,” Rett’s Disorder,
Childhood Disintegrative Disorder
The Natural Connection
Typical babies
Regulate social interaction with
 Eye contact
 Facial expression
 Body postures and body language
 Gestures
Little Ones Socialize
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Shared interest and attention
Shared enjoyment
Showing things
Look where someone points
Shared Attention
Pointing and Referencing
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Shared attention & shared enjoyment
Looking when others talk
Looking when their name is called
Checking in (referencing faces &
reactions)
Social Attention
in children age 2 to 4 years
• Watch and copy other children
• Bring objects to share attention with others
• Use the names of other children in
conversation & to get their attention
Imitation
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Watching and copying
Follow a leader
Keep pace
Social Expectations
Social roles
How little ones play
• Imitative play
• Play is imaginative,
invented, new
Play is NOT
• Re-creating a scene/video
• Always the same
• Directing others
• Only done a specific way
Know the Signs of Autism
Some early indicators of possible
ASD in young children:
Not “referencing” the face of others for
information
Lack of eye contact
Lack of a social smile
Doesn’t respond to his or her name
Doesn’t cooperate/negotiate with others
Doesn’t show affection for peers
Visit www.cdc.gov
Other indicators of possible ASD patterns
Difficulty following directions
Difficulty sequencing, breaking tasks into
steps
Difficulty transitioning between activities
Sensory sensitivities
Motor problems
Meltdowns
Checklist for Autism in
Toddlers (CHAT) 5 Key Items
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Pretend play with toys
Imaginative play
Bring items to share interest
Point to share interest (Look!)
Follow another person’s point (Look!)
http://www.aheadwithautism.com/chat_screeni
ng.html
http://depts.washington.edu/dataproj/chat.html
Other ways to describe ASD
• A “pattern of differences” in socialization
communication and behavior.
• An uneven pattern of development, with
strengths in some areas and difficulty in
other areas
• Asynchronous development, where a
person’s development does not match his
calendar age.
Autistic Disorder (299.00):
Diagnostic Criteria:
A total of 6 of 12 features
Social
Behavior
Communication
Qualitative impairment in social
interaction (two of four features):
(a) marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to
regulate social interaction
(b) failure to develop peer relationships appropriate
to developmental level
Qualitative impairment in social interaction
(c) 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)
(d) lack of social or emotional reciprocity
Impairment in spontaneous development
of social relationships
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Friendship skills
Mutual (reciprocal) relationships
Play skills
Imagination
Don’t learn by watching & copying
Social Difficulties
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Don’t see our “invisible rules”
Don’t understand expectations
Not sure how to repair social mistakes
Feel frustrated, humiliated, confused
Qualitative impairments in communication
at least one of these four:
(a) delay in, or total lack of, the development of spoken
language (not accompanied by an attempt to
compensate through alternative mode of
communication such as gesture or mime)
(b) in individuals with adequate speech, marked
impairment in the ability to initiate or sustain a
conversation with others
Qualitative impairments in communication
at least one of four:
(c) stereotyped and repetitive use of
language or idiosyncratic language
(d) lack of varied, spontaneous makebelieve play or social imitative play
appropriate to developmental level
Communication:
Sending Messages
• Impairment in verbal exchanges (talking,
conversations, echolalia)
• 50% may be non-verbal (don’t talk)
• May have other communication systems
• May use behavior to communicate
• Problems using non-verbal communication:
Facial expression, body language, personal
space, tone of voice, volume
Communication:
Receiving Messages
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May not understand what you say
Difficulty following instructions
May miss the message or meaning
Interprets things literally
Problems understanding non-verbal
communication of others: Facial
expression, body language, personal
space, tone of voice, volume
3) restricted repetitive and stereotyped patterns of
behavior, interests, and activities,
at least one of four
(a) encompassing preoccupation with one
or more stereotyped and restricted patterns
of interest that is abnormal either in
intensity or focus
(b) apparently inflexible adherence to specific,
nonfunctional routines or rituals
3) restricted repetitive and stereotyped
patterns of behavior, interests, and activities,
at least one of four
(c) stereotyped and repetitive motor
mannerisms (e.g., hand or finger flapping
or twisting, or complex whole-body
movements)
(d) persistent preoccupation with parts of
objects
Restricted & Repetitive Behaviors
• Comforted by sameness and predictability
• Like to do the same thing again and again
• May get stuck on a preferred activity and not
be able to move on
• May get stuck talking on a preferred topic.
• Don’t read the reactions of others and stop
• Know less about other topics or
subjects
The
Triad
Plus
Sensory
Issues
Social
R&R
Behavior
Communication
The “Same or Different” Question
Autism and Asperger’s Disorder
When and why does it matter?
Understand one to understand the other
An accurate diagnosis
Explains the features that are observed
Accounts for all symptoms
Describes the person’s pattern of
differences
Identifies areas of need
Gives direction in looking for help
Is consistent among those with the same
disorder
Diagnosis is useful!
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To understand areas of need
To make sense of patterns and behaviors
To explain the facts to others
For eligibility for supports and services
In educational planning
A diagnosis clarifies
and expands opportunities to learn
A diagnosis or “label” does not:
Change who the person is or who they can
become
Take away hopes and dreams
Limit access to people, places and events
(by law).
What ASD is NOT
Autism spectrum disorders are:
Not mental illness, emotional disturbance,
or a behavior disorder
Not a disease and not degenerative
Not caused by parents or parenting
Not a lack of interest, lack of caring or lack
of desire to interact with others
Racial disparities in identification,
diagnosis and access
• Minority families and families with lower
incomes or limited education had more
difficulty entering the early intervention
system.
• Some families were not aware of a written
plan for goals and services.
From National Early Intervention
Longitudinal Study U.S. Department
of Education to SRI International
& FPG Child Development Institute
Race differences in the age at diagnosis among
medicaid-eligible children with autism
• On average, white children received the Autism
diagnosis at 6.3 years of age, compared with 7.9
years for black children.
• White children entered the mental health system at
an earlier age (6.0 versus 7.1 years)
• Black children required more time in treatment
before receiving the diagnosis.
• Latino children were diagnosed later (age 7.4) and
after more visits (8.3) than both white and black
children
Journal of the American Academy of Child and
Adolescent Psychiatry. 2002 Dec; 41(12):1447-53.
Issues of social equity
• Latino children are under represented in
special education in the category of autism
by 50%
– Due to information and language barriers
– Social and economic issues
– Cultural issues
– Language “confusion”
African-American children
• May lose their diagnosis or be exited from the
service system when they should not
(CDC, 2009)
• Are not over-represented as having autism in
the special education system in this area (as has
happened in other categories)
• http://www.child-autism-parent-cafe.com/africanamericans-and-autism.html
Be vigilant…and sensitive
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Early intervention is a key
Be positive and hopeful
Support the child and family
A person can be diagnosed at any age
www.asdAtoZ.com
Thank You!
[email protected]
www.asdAtoZ.com