all about autism

All About Autism

Todd Fromhart

What is Autism?

• Neurological Disorder• Discovered in the 1940s by Leo Kanner and Hans

Asperger• Leo Kanner Described Eleven Children That Insisted

on Sameness, Displayed Repetitive Behaviors, Impaired Language and Social Withdrawal

• Hans Asperger Described Children with Little Empathy for Others, One-Sided Conversations, and Intense Interests

What is Autism?

• Complex Diagnosis Based on Behavior Observed – No Medical Test to Detect Autism

• Autism is Found Throughout the World in Families of All Racial, Ethnic, and Socioeconomic Backgrounds

• 4 times More Likely to Be Found in Males Than Females

Three Main Areas Affected

• Ability to Communicate• Ability to Form Social Relationships• Ability to Respond Appropriately to the

Environment• Characteristics Vary Across Children and

Within Individuals Over Time“If You’ve Seen One Person With Autism, You’ve

Seen One Person With Autism”

Patterns of Development

• Symptoms Present Before Age 3 and Typically Last for Life

• Two Patterns of Development Early Development is Atypical or Delayed Early Development Appears Normal but Then the Child Loses Skills or Fails to Progress

• Diagnosis May Occur at Any Time During the Lifespan

Signs of Autism

• Originally Focused on Severe Deficits in Social Interaction, Narrowly Defined Interests, and Language and Communication Deficits

• Now Criteria Also Include:-Deficits in making Eye Contact-Deficits in Nonverbal Communication-Decreased Social interactions-Difficulty with Emotions -Stereotypic Behavior Patterns

Increasing Numbers

• Before 1990 - 1/2000• 1995 – 1/500• 2004 – 1/166• 2007 – 1/150• 2009 – 1/110• Present – 1/88Data from Autism Speaks

Increase in Autism Rates

Reasons for Increase

• More Public Awareness• Change in Criteria

Children Once Diagnosed as Learning Disabled or Mentally Impaired are Now Diagnosed with Autism

• Improved Child Counts• Environmental Factors?

Causes

• Not Caused By Bad Parenting• Many Causes• Frequently There is a Genetic Basis• Many Different Genes Have Been Associated

with Autism, but One Single Gene has Not Been Identified as a Cause

• Many Suspect Environmental Factors, but None Have Been Clearly Identified

Differences in Brain Structure

• Testing Indicates Differences in Brain Development

• 20 – 30 percent Show Increased Head Size• Differences in Specific Areas of the Brain• Differences in Connections Among Brain Cells

What About Vaccines

• Vaccines Linked with Autism in 1998 Journal Article That has Since Been Retracted

• No Studies Since Have Established a Link Between Vaccines and Autism

Parental Age

• Older Parents Have a Higher Chance of Having a Child with Autism

• Possible Explanations:- Older Mothers May Be More Prone to Age-Related Chromosome Changes or Pregnancy Complications- Older Parents May Have Met and Had Children Later in Life Because of Social Challenges Making It More Likely They are Carrying Autistic Traits- Older Parents May Be More Aware of Developmental Milestones and More Likely to Seek Treatment and Diagnosis

Screening

• American Academy of Pediatrics Recommends Screening of All Children Birth Through School-Age

• Pediatrician Well-Child Visits• Monitor Developmental Milestones and Red

Flags www.firstsigns.org

Red Flags

• The National Institute of Child Health and Human Development Lists 5 Red Flags That Warrant Further Evaluation- Does Not Babble or Coo by 12 Months- Does Not Gesture(point, wave, grasp) by 12 Months- Does Not Say Single Words by 16 Months- Does Not Say 2 Word Phrases by 24 Months- Has Any Loss of Any Language or Social Skill At Any Age

Diagnostic Criteria• Diagnostic Criteria for Autistic Disorder• A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

– 1.qualitative impairment in social interaction, as manifested by at least two of the following: • 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 • failure to develop peer relationships appropriate to developmental level • 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) • lack of social or emotional reciprocity

– 2.qualitative impairments in communication as manifested by at least one of the following: • delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through

alternative modes of communication such as gesture or mime) • in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • stereotyped and repetitive use of language or idiosyncratic language • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

– 3.restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

• encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

• apparently inflexible adherence to specific, nonfunctional routines or rituals • stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements) • persistent preoccupation with parts of objects

• Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

• The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Signs of Social Interaction Deficits

• Infrequent Response to Name• More Interest in Objects Than People• Lack of Social Play (Peek-A-Boo)• Lack of Orienting to Others• Lack of Enjoyment of Others • Lack of Interest in Peers

Lack of Imitation

• Children Less Likely to Imitate:- Other Children’s Play- Facial Expressions- Adult Activities- Physical Actions

• Skills Must be Taught Explicitly Because They Are Not learned by Watching Others and Engaging Socially

Social Characteristics of High Functioning Autism

• Lack of Social Awareness or Socially Appropriate Behavior (Sitting in Circle, Standing in Line)

• Inability to Read Behavioral Cues from others• Lack of Give and Take in Social Interactions

Communication

• Concerns May Be Observed Before Language Develops

• Pre-Language Characteristics:- Lack of babbling by 9 Months- Lack of Gestures ( Pointing, Waving)- Lack of Joint Attention

Typical Behavior in the First Year

• Child Shifts Gaze from Toys to People• Child Follows Someone Point• Child Monitors the Gaze of Others• Child will Show Toys to Others• Child will Point to Objects or Events to Share

Interest

Communication Deficits

• Lack of Interest in Communication with Others• Lack of Intentionality in Communication• Lack of Ability to initiate, Maintain, and End

Communication with Someone• Robotic Speech• Some Individuals with Autism Will Develop No

Verbal Language Abilities

Asperger’s and Communication

• No Significant Language or Cognitive Delays• Communication Challenges:

- Talk Excessively About Own Special Interest- Perseveration (Stuck On One Idea)- Decreased Abstract Language (Go Fly a Kite)- Inappropriate Social Remarks- Difficulty Understanding Humor- Difficulty With Conversational Skills

Theory of Mind

• Ability to understand your Own and other People’s Beliefs, Desires, intentions, and Emotions

• Making Inferences About What Others Believe Allows One to Predict What They Will Do

• It Has Been Proposed That Lacking a Theory of Mind May Explain the Social and Communication Difficulties of Some Individuals with Autism

Restricted Behaviors, Interests, and Activities

• Rigid Routines• Inconsolable When Changes Happen• Head Banging, Hand Flapping, Other Unusual

Movements• Unusual Favorite Objects• Rarely Engages in Pretend Play• Plays with Toys in Idiosyncratic Ways

- Lines Things Up, Focuses on Parts of Objects, Does Not Use Toys for Intended Purpose

High Quality Environment

• High Level of Student Engagement• Positive Classroom Environment and

Interactions• Access to Preferred Activities and Rewards• Access to Typically Developing Peers• Immediate and Effective Communication

Systems

Learning Environment

• Environmental Organization- Everything has a Place

• Visual Schedules- Tells Child When Activities Occur

• Visual Work/Activity Systems- Tells Child How to Complete Activity

Rationale for Environmental Organization

• Promotes Learning and Optimal Performance• Provides Visual information About What to

Expect• Reduces Distractions and Over-Stimulation• Reduces Anxiety

Organizing the Environment

• Arrange Furniture to Create Visually Defined Spaces for Particular Activities

• Materials and Resources Should Be Organized and Readily Accessible

• Designate a Quiet Area For Regrouping (Safe Haven or Home Base)

Quiet Area

• Beneficial for Many Individuals with ASD• Quiet Place With Comfortable Seating, Room

to Pace, and Calming Activities• Establish a Routine for Requesting to Go to the

Area, Amount of Time to Stay, and Returning to Activity

• Teach Individual to Recognize When Quiet Time is needed and to Request It

Helping Child Understand Verbal Communication

• Get Child’s Attention Before Giving Directions• Be Brief and Use Simple Terms• Repeat Instructions If Necessary• Break Instructions Down Into Smaller Parts• Use Positive Terms – Tell Child What To Do,

not What Not To Do• Avoid Non-Literal Language

Using Prompts

• Verbal Prompts – Statements Made to Help a Child Acquire a New Skill

• Gestural Prompts – Movements Made to Cue a Student to use a Skill

• Model Prompts – Performing the Behavior the Student is Expected to Perform

• Physical Prompts – Touching Student to Engage Them in a Behavior

• Visual Prompts – Using Visual or Written Cues

Promoting Independence with Visual Supports

• Visual Supports are Helpful in Helping Students Understand- What Activities are Associated With a Space- When Activities Occur- The Order of Activities

Visual and Written Schedules

• Used by Most of Us to Organize Our Time• Used to Help Individuals with ASD with Problems

with Organization, Sequential Memory, Understanding of Time

• Can Be used to Give Instructions Visually• Facilitate Transitions, Cope with Change• Reduce Anxiety• Enhance Cooperation• Promote Greater Independence

Visual Schedules

• Visual Schedules May Use - Actual Objects- Pictures- Words- Combination of Pictures and Words

Base the Type of Schedule on Developmental LevelWhat Will This Child Be Able to Understand,

Especially When Upset?

Object Schedules

• Lunch box = Lunch• Helmet = Bike• Backpack = Home• Water Bottle = Drink• Keys = Play Area• Juice Can = Snack• Toilet Paper = Bathroom• Plastic Tub = Art• Bead = Work With Teacher• Ring = Work Alone At Table

Object Schedules

• The Ring Goes On The Ring Stack and The Toilet Paper Goes In The Container.

Picture Schedule

Visual Choice Boards

Visual promptsFinished product

Visual Prompts Enhancing Independence

Visual PromptsWritten

You are going to write a four paragraph paper about your trip to California. It will take 4 days to complete this assignment. Today, you will write one paragraph.1. Take this instruction sheet to the computer

desk2. Open Microsoft Word3. Put your title at the top of the page. Center

and underline it.4. Hit Enter and left align the rest of your text5. Answer these questions: Where did you

go? Who went? How did you get there? 6. Save your document by clicking on the disk

icon-when the ‘save’ window opens, look for ‘save in’ and click on the blue down arrow-select the folder that says ‘Joey’s Work’-click ‘save’

7. Put this sheet in your “Finished Work” folder

Visual PromptsBreaking Tasks Into Smaller Units

Visual PromptsClarity

DUSTING THE LIVING ROOM__Take items off table beside couch. Put on PURPLE TOWEL___Spray polish___Wipe table beside couch with GREEN RAG__ Put items back on table beside couch__ Take items off television table. Put on PURPLE TOWEL___Spray polish___Wipe television table with GREEN RAG___Spray television screen with WINDOW CLEANER___Wipe with paper towel___Put items back on television table

Social Story

• Short, Individualized Stories That Provide Specific Behavioral Response Cues

• Written From the Child’s Perspective • Depicts a Social Situation and the Appropriate

Behavior• Use Text and Pictures

Waiting While Riding in the Car

This Social StoryTM begins on the following page. Before using, please read the notes for parents on the last page. Thank you.

© 2011. PositivelyAutism.comVisit www.PositivelyAutism.com and http://daily-autism-

freebie.blogspot.com/ for more autism teaching resources.

Waiting While Riding in the Car

Insert picture of your child or student here.

My name is William.

© 2011. PositivelyAutism.com

Sometimes, I ride in the car with my mom.

© 2011. PositivelyAutism.com

The car is moving most of the time. But sometimes, we have to stop and wait.

© 2011. PositivelyAutism.com

There might be lots of cars on the road. This is called a traffic jam or being stuck in traffic.

© 2011. PositivelyAutism.com

A traffic jam means that there is not enough room for all of the cars to drive fast. We drive slowly so that we can share

the road with other cars.

© 2011. PositivelyAutism.com

Another time we stop and wait in the car is at a stop sign or red light.

© 2011. PositivelyAutism.com

At a stop sign or red light, the cars take turns driving. My mom knows when it is our turn to drive.

© 2011. PositivelyAutism.com

Another time we wait in the car is if there is road construction.

© 2011. PositivelyAutism.com

Road construction means that people are fixing something on the road.

© 2011. PositivelyAutism.com

Cars have to slow down or stop to drive by the road construction workers and vehicles.

© 2011. PositivelyAutism.com

I will try to be patient while I wait in the car. I can read, listen to music, or draw while I wait.

© 2011. PositivelyAutism.com

I am learning about waiting in the car.

© 2011. PositivelyAutism.com

Notes for Parents/Teachers• It is best to customize this story for each individual child by incorporating

the child’s name and photos and altering any words and pictures to best meet your child’s learning needs and preferences.

• The point chart on the last page of the story can be printed and used to reward the child for appropriate waiting behavior. Explain to the child before you ride in the car what this looks like by reading the story, and telling the child what he or she could do to show “good waiting behavior.” Examples might be using polite words, waiting quietly, or drawing, reading, or engaging in another preferred activity while waiting. Change the picture at the bottom of the chart to reflect something the child would like to earn. Give points (in the form of stickers, checkmarks, etc. on the chart) frequently while the child is waiting nicely. When each box on the chart is filled, the reward is earned. You can alter the number of boxes as needed.

• The term Social StoriesTM is trademarked by Carol Gray. Every effort has been made to write this story according to Carol Gray’s guidelines, but no guarantee can be made. Carol Gray has not specifically endorsed this story. For more information about writing Social StoriesTM , please read: The New Social Story Book, Revised and Expanded 10th Anniversary Edition: Over 150 Social Stories that Teach Everyday Social Skills to Children with Autism or Asperger's Syndrome, and their Peers

(c) 2011. PositivelyAutism.com

Supporting Play

• Individuals with Autism Play Mostly With Manipulatives and Do Not Engage in Pretend or Social Play

• Research Shows That Social Interactions and More Involvement in Social play Can Be supported Through Setting up Intentional Interactions With Other Students

Determining Function of Behavior

• Understanding a Child’s Behavior Can Be Accomplished by Observing What Happens Just Before and Just After the BehaviorA= Antecedent – What Happens Just Before the Behavior OccursB=Behavior – What Behavior Does the Child DisplayC= Consequence – What Does The Child Get Out of Displaying the Behavior

Antecedent Exercise

• Child Engages in Physical Activity Prior to a Teaching Activity

• Moderate Levels of Physical Exercise Have Been Found to be Effective in Reducing Interfering Behaviors

Modify the Environment

• Alter Events Prior to an Interfering Behavior• Common Strategies

- Using Preferences- Organizing the Social Environment- Varying the Content of Teaching Lessons- Altering the Physical Setting or Seating Arrangements

Teach Alternative Response

• Teach an Alternative Behavior That Serves the Same Function as the Interfering Behavior

• Alternative Response Must Produce the Desired Effect and Require Little Effort to Be Successful

• Research Has Shown It Can Be Successful at Reducing Repetitive Behaviors

ReferencesMin, L.H., and Wah,L.L.(2011). Teaching of speech,

language and communication skills for young children with severe autism spectrum disorders: What do educators need to know? New Horizons in Education, Vol. 59, No. 3.

Whitaker, P. (2001). Challenging Behavior and Autism: Making Sense-Making Progress. The National Autistic Society: London.

Willis, C.(2006). Teaching Young Children with Autism Spectrum Disorder. Gryphon House, Inc. Beltsville, MD.

Wolfberg, P., Bottema-Beutel, K., and DeWitt,M.(2012). Including children with autism in social and imaginary play with typical peers: Integrated play groups model. American Journal of Play, Vol. 5, Number 1.www.autismspeaks.comwww.firstsigns.orgwww.positivelyautism.com