Marion Staff Training 2009

Lisa AndersonM.S. Education, Autism Consultant, CESA 8

http://video.google.com/videoplay?docid=-7057999856625517002&q=Jason+McElwain&ei=PAMMSIKPD6PsrAKkjrG6BA&hl=en

Autism Spectrum Disorders…

Pervasive Developmental Disorders

Autism is a complex neurological disorder that affects one’s communication and socialization ability.

Autism is typically evident by Age 3 (can now be diagnosed as early as 6 months old)

1 in 150 children (1 in 94 boys) are now diagnosed with autism in the U.S. In the United Kingdom, 1 in 58 children has some form of autism.

The rate of autism is highest in California of those born after 1980.

Just over a decade ago, the prevalence rate was 1 in 10,000.

Current research suggests that it is caused by the lack of coordination and proper connectivity within the brain.

Common: Rapid Brain Growth in 1st year of life (Journal of the American Medical Association, 2003) .

A new case of autism is diagnosed every 20 minutes

Autism currently affects more than 1.5 million people in the U.S. alone

http://dpi.wi.gov/sped/autdata.html

Amygdala: Memory& Emotions.

Cerebellum: Coordinated, smooth movements of the skeletal muscular system including abilities to walk, talk, eat, and to perform other self care tasks.

Temporal Lobe: Auditory Processing, visual input, semantics of language, verbal memory.

Cerebral Cortex: Most highly developed area of the brain which includes gray matter in right & left hemispheres. Activities within this area of the brain include: Thinking, Perceiving, Producing Language , Sensing & Interpreting input from various sources.

Autism impairs one’s ability to Communicate; affecting Receptive Language, Expressive Language and Pragmatic or Social Language abilities.

Autism affects socialization. Autism affects the sensory system. Autism can impact cognitive skills

where brain is wired differently.

Autism impacts every individual differently…

Children can move from one end of the spectrum to another with intensive Evidenced-Based

intervention…

Also known

as High

Functioning

Autism

or

Asperger’s

DisorderAutistic

Disorder

Wisconsin is currently a part of the project that is being done to “Promote optimal development and learning of infants, children, and youth with ASD and provide support to their families through the use of evidence-based practices .”

A-F•Computer-Aided Instruction •Differential Reinforcement •Discrete Trial Training •Extinction •Functional Behavior Assessment •Functional Communication Training M-R•Naturalistic Interventions •Parent-Implemented Interventions •Peer-Mediated Instruction And Intervention •Picture Exchange Communication System (PECS) •Pivotal Response Training •Prompting •Reinforcement •Response Interruption/Redirection S-Z•Self-Management •Social Narratives •Social Skills Training Groups •Stimulus Control •Structured Work Systems •Task Analysis •Time Delay •Video Modeling •Visual Supports

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Picture Exchange Communication System (PECS)According to the developers of PECS, it is a behaviorally based intervention that teaches the learner to use visual-graphic symbols to communicate with others (Bondy & Frost, 1994; Frost & Bondy, 2002). This module will provide information on this augmentative and alternative communication system.

Autism is now the most common childhood disability with more cases than pediatric cancer, childhood diabetes, and AIDS combined!

It is estimated that lifetime individual costs for raising a child with autism ranges from $3.5 to $5 million dollars.

The Department of Health and Human Services Projections over the next 15 years as the current wave of individuals with autism become adults…

27 Billion annually will be spent on living costs alone for the autism population by 2023; more than 1/3 of this year’s budget and larger than the entire current budget of the U.S. Energy Department.

More than 380,000 individuals expected to need extensive services, often requiring 1:1 care in many cases

The Washington Post, April 07, 2009

Nobody knows for sure!

There is no medical detection or cure for autism.

Abnormalities in the shape and structure of the brain (brain imaging)

Theories: Genetic Predisposition Environmental toxins (i.e. heavy metals)

Controversy: Immunizations Mitochondria? (Hannah Poling)

“Autism in the U.S. has reached epidemic levels, 1 in 150 children. Dr. Julie Gerberding, Director of the Center of Disease Control and Prevention has recently upgraded autism to “an urgent health threat.”

“The most contentious issue of the autism debate is the link to routine childhood vaccinations.”

“Hannah Poling v. U.S. Dept. of Health and Human Services, has changed this debate forever.

What to Look For…

No big smiles or warm, joyful expressions by six months or thereafter

No back and forth sharing of sounds, smiles, or other facial expression by 9 months or thereafter

No babbling by 12 months

No back and forth gestures such as pointing, showing, reaching, or waving by 12 months

No words by 16 months

No two-word meaningful phrases (without imitating or repeating) by 24 months

Any loss of speech or babbling or social skills at any age

Autism Society of America

1. Insistence on Sameness2. Difficulty in expressing needs; uses

gestures instead of words3. Repeating words or phrases in place

of normal responsive language4. Laughing, crying, showing distress

for reasons not apparent to others5. Prefers to be alone, aloof manner6. Tantrums

7. Difficulty mixing with others8. May not want to cuddle or be cuddled9. Little or no eye contact10.Unresponsive to normal teaching

methods11.Sustained odd play12.Spins objects13. In appropriate attachment to objects14.Apparent over-sensitivity or unsenstivity

to pain

15.No real fear of danger16.Noticeable physical over-activity or

extreme under-activity17.Uneven gross/fine motor skills18.Not responsive to verbal cues; acts as

if deaf although hearing tests in normal range

ASA…if over half of these characteristics, then autism is possible

http://www.talkaboutcuringautism.org/video/hope-video.htm

Children with autism don’t make eye contact. They do and can. It may look different

than neuro-typical children

Children with autism do not show affection. Children with autism do show affection

and may be extremely loving of others

Children with autism cannot communicate effectively They may develop good, functional

language skills where it may be difficult to distinguish them from others

Parents are your BEST RESOURCE and best source of information…they know their child better than anyone else. But, they go through a grieving process when informed that something may be wrong with their child.

Help parents feel comfortable and assist them through the diagnostic process

Grieving Process…1.Shock - What? 2.Denial - Autism…No way! You

are crazy! They like to be held…they smile, laugh, look at us…they are just late talkers!

3.Anger - How dare you…? 4.Bargaining - God, please let

them be wrong!5.Acceptance - Where do we go

from here?Try not to take uncomfortable parent

reactions personally!!!

The grieving process is ONGOING…

Consider the emotional aspects of raising a child with autism

Autism Everyday…- http://www.youtube.com/watch?

v=FDMMwG7RrFQ&feature=related

Medical Consideration: Medical Diagnosis NOT

REQUIRED in Wisconsin to determine educational disability of autism

Medical information, if available, should be considered as part of an education evaluation…not sole component

School cannot require parents to obtain medical diagnosis during an educational diagnosis

Medical terms such as Asperger’s Disorder, PDD, and others do not automatically qualify students under the educational disability category of autism.

Labels do not transfer between systems (i.e. education and medical)

What distinguishes Autism from Asperger’s is the severity of symptoms and…

By definition: There is an absence of language delays with individuals with Asperger’s Syndrome

Individuals with Asperger’s Syndrome cannot possess a “clinically significant” cognitive delay and must possess average to above average intelligence

Individuals with Asperger’s Syndrome may be only mildly affected and they frequently have good language and cognitive skills

Individuals with Asperger’s Syndrome usually want to “fit in” and have interaction with others…they just don’t know how to do it.

Individuals with Asperger’s Syndrome may appear to be socially awkward and clumsy. They may lack empathy, may display limited eye contact, may talk about interests excessively and may not understand gestures

Autism Children with Autism are frequently seen

as aloof and uninterested in others

Many individuals with autism display cognitive delays (though it is difficult to obtain accurate IQ scores as they experience significant difficulties with language ability

Children can receive a diagnosis of autism when young and make substantial progress. They appear to look more like individuals with Asperger’s as they get older (move on the continuum)…Developmental history is important for diagnosis of Autism vs. Asperger’s

* Some claim recovery…reversing effects possible.

Neuro-pathways can be changed with autism. Brain Plasticity…Early intervention can

strongly impact progress. Cure??? Not so Sure!!! Improve and live a relatively “normal” life is

VERY Possible! Several reports of children “overcoming”

autism. Not “Gloom and Doom” as once thought.

Neuroplasticity, a.k.a. “plasticity” is the lifelong ability of the brain to reorganize neural pathways based on new experiences.

The Brain in NOT Hardwired from Birth

We all have a lifelong power to change

As we learn, we acquire new knowledge and skills through instruction or experience.

The ability of the brain to change with learning is what is known as neuroplasticity.

Neuroplasticity occurs in the brain under two primary conditions:

1. During normal brain development when the immature brain first begins to process sensory information through adulthood (developmental plasticity and plasticity of learning and memory).

2. As an adaptive mechanism to compensate for lost function and/or to maximize remaining functions in the event of brain injury.

The environment plays a key role in influencing plasticity.

Brain changes can occur with…

Positive or negative environments

Exercise Nurturance Learning Other experiences…

Applied Behavior Analysis – research based…positive results for nearly half of children who received intensive therapy at a young age (between ages 3-8)

Original research in peer-reviewed journals indicating that 90% of children substantially improved when utilizing the Lovaas Model of Applied Behavior Analysis, compared to the control group.

Close to half attained a normal IQ and tested within the normal range on adaptive and social skills.

This research reported that 47% of those children that had received 30–40 hours of intensive therapy were mainstreamed into regular classrooms, and were classified as "indistinguishable" from their peers in follow-up studies.

Wisconsin Waiver Program supports this

Early intervention is imperative to future outcomes

Intensive In-home therapy and schools working together…strengthens generalization of skills, gets everyone on the same page.

Learn from on another!

Traditional Behavioral approaches (Discrete Trial Training…ABA) Relational Development Intervention Floortime Medical Interventions School Programs/Therapies/Activities Numerous Evidence-Based Interventions (i.e. Visual Supports, Peer

Mediated programs, PECS, Social Skills Groups, Social Stories etc.)

Non-Traditional Gluten/Casien Free Diet Vitamin Therapy Heavy Metal Detoxification (i.e. chelation) Sensory Integration Therapy Auditory Integration Training Vision Therapy Yoga Chiropractic Reflex Inhibition Programs (Physical Therapy) Martial Arts Music Therapy Hyperbaric Oxygen Therapy Many More Options…

1. Look at each person individually.2. Become familiar with the major issues

related to autism.3. Believe that individuals with autism

can learn and do extraordinary things!!!

4. Understand that they are not behaving inappropriately purposefully…it’s neurological!!!

http://www.youtube.com/watch?v=U1wsiVYCqn0

It is difficult to know what is inside of a non-verbal individual with autism. Sometimes the right piece of technology that allows them to speak may open up a whole new world…

Individuals with autism often have a hard time generalizing information from one environment to another.

May learn something very well in one environment, but not be able to do it in another.

Inclusion in school and community settings is helpful to work on generalization.

Adult Support…issues with dependency.

Attention – positive or negative Escape or avoidance – get out of doing

something hard or someplace uncomfortable, escape pain/discomfort, ask for help

Power or control – of environment or people…happens when kids feel overly controlled

To get a tangible reward – food, drink, toys, etc., immediate feedback…sensory needs being met

Revenge or justice…not common with autism Expression of self – seeking independence Acceptance or affiliation – seeking social

interaction, gain acceptance from peers

ABC Analysis Antecedent – What happened immediately

before the behavior Behavior – What the exact behavior (in

objective, observable and measureable words…Johnny hit Joey with a closed fist on Joey’s bicep)

Consequence – What was the consequence (Johnny was removed from the lunch line and had to stand at the back)

Should be completed when a significant behavior is interfering with living or learning

Should be completed prior to writing a Behavior Intervention Plan

See examples of FBA’s

Sometimes the environment is so overwhelming that the student cannot learn

Distracting worksheet simulation Consider all senses…try to live through the

eyes of the child to see what they are experiencing

Sandpaper simulation

Consider potential medical issues (if cannot express him/herself, how do you know if not feeling well? That alone can cause behavior.

Social Stories and Social Scripts: Carol Gray http://www.thegraycenter.org/

NPDC-ASD: Social Narratives

Assist individuals with autism in understanding social situations

Provide instructions as to how to interact in socially appropriate ways

Always consider the person first, then the disability (not “Autistic person”…” Person with Autism”)

Focus on the individual’s strengths. What are they good at? (memorization, computers, working with hands etc.) Maximize strengths!!! But, do not forget about the weaknesses…Disconnected Kids

Use MOTIVATORS whenever faced with difficult tasks

It’s okay to give edible motivators as an instructional tool

Focus on their strengths while trying to address their weaknesses (Brain Balance)

Believe that through new experiences with repetition, we can effectively retrain their neurological pathways

Believe that they can learn ANYTHING given the opportunity…and repetition for things that don’t come easily

A different perspective on

AUTISM.

Autism Society of America, http://www.autism-society.org/site/PageServer

Autism Speaks, http://www.autismspeaks.org/ Wisconsin Department of Public Instruction: Educational

Evaluation Guide for Autism, Fall 2007 Journal of Consulting and Clinical Psychology,

55, 3-9. Lovaas, O. I. (1987). National Professional Development Center on Autism

Spectrum Disorders, http://www.fpg.unc.edu/~autismpdC/ Autism Internet Modules,

http://www.autisminternetmodules.org/ Carol Gray’s Social Stories, http://www.thegraycenter.org/ Melillo, Robert. (2009) Disconnected Kids. Penguin

Group (USA) Inc.