autism spectrum disorders

Title, EditionISBN

© 2009 Pearson Education, Inc.All rights reserved.

Exceptional Children: An Introduction to Special Education, 9th EditionISBN 013514454X

© 2009 Pearson Education, Inc.All rights reserved.

Chapter 7Autism Spectrum Disorders

© 2009 Pearson Education, Inc.All Rights Reserved.2

Exceptional Children: An Introduction to Special Education, 9th EditionHewardISBN 013514454X


Focus QuestionsWhat are the defining features—the clinical symptoms—for a diagnosis of autism spectrum disorder?How might some of the characteristic behaviors of autism spectrum disorders become assets for the child as a learner?What factors might account for the enormous increase in the prevalence of autism spectrum disorders in recent years?How have etiologic theories and the search for causes of autism changed from the first reports of the disability to today?




Focus Questions ContinuedWhy are research and development of tools for early screening and diagnosis of autism spectrum disorders so critical?What skills are most important for teachers of children with autism spectrum disorders?What features of an educational environment (a general education classroom, resource room, or special class) will enable a child with autism spectrum disorders to benefit optimally from placement in that setting?Why are fads and unproven interventions so prevalent in the education and treatment of children with autism?

Key Terms and ConceptsAutism: IDEA Definition, Characteristics (included, not included)Echolalia, Savant SyndromeAutism Spectrum Disorders: Autism, PDD-NOS, Asperger syndromeDefinitions

Warning signs, Characteristics, Joint Attention Ways to diagnose and identify Child Autism Rating Scale (how used) Causes, genetic risks Therapies (Scientifically validated research support)

Sensory processing disorder (what, examples)Behaviors (PICA, Stereotypy)Lovaas - Intervention studyLRE and reasons to place student in general education classroomApplied Behavioral Analysis – ABASocial Stories




IDEA DefinitionAutism is a developmental disability affecting verbal and nonverbal communication and social interaction, generally before age 3, that adversely affects a child’s performance.Developmental disability- child does not develop like their same aged peers

Other characteristics are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual response to sensory experiencesAutism does not apply if the child has a serious emotional disturbance

Note: Definition does not include cognitive deficits. They may be present but are not always a symptom of autism.




NJAC 6A:14 Definition Autistic- pervasive developmental disability which

significantly impacts verbal and nonverbal communication and social interactions that adversely affects a student’s educational performance. Onset is generally evident before age three. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routine, unusual responses to sensory experience and lack of responsiveness to others.

Excludes: emotional disturbance Required to have a speech/language evaluation and a

medical diagnosis (neurodevelopmental assessment)




DSM-5 combines two core deficit areas:• impairments in social interaction and • impairments in communication

into a single domain of social/communication deficits and subsumes Asperger’s disorder into a single diagnostic category of autism spectrum disorder

A child diagnosed with autism spectrum disorder will be ascribed one of three levels of severity based on the amount of support requiredPage 238

Proposed DSM-5 Definition of Autism Spectrum Disorder




Autism Spectrum Disorder Reflects a consensus in the field that the social and

communication impairments fall on a spectrum or continuum of severity with autistic disorder representing the most severe and Asperger disorder representing the mildest form




DSM-IV DefinitionsAutistic Disorder - marked by three defining features, with onset before age 3: 1) impaired social interaction

Lack of reciprocity Inability to relate to others

2) impaired communication Delay or absence of spoken language Lack of functional communication (communicate needs/wants)

3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities

Preoccupation with parts of objects (ex. Wheels on a car) Behavioral excesses (ex. Self-stimulation)

DSM-IV DefinitionsAsperger Syndrome - impairments in all social areas, particularly an inability to understand how to interact socially. These children do not have general language delay, and most have average or above-average intelligence.Characteristics:•Generally average/above average intelligence•Intense interest in a particular subject•Clumsiness, difficulty with fine- and/or gross-motor activities•Inflexible adherence to routines•Fascination with maps, globes, and routes•Superior rote memory, tendency to amass many related facts•Speech and language impairments in the areas of semantics, pragmatics, and prosody; pedantic, odd speech patterns; formal style of speaking•Difficulty understanding others’ feelings•Extensive vocabulary•Perfectionist, frustrated when asked to submit work one feels is below standard•Difficulty developing and maintaining friendships




DSM-IV DefinitionsChildhood disintegrative disorder - shares characteristics with autistic disorder, but doesn’t begin until after the age of 2 and sometimes not until age 10Medical complications are commonPrognosis for significant improvement is very poor




DSM-IV DefinitionsPervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - diagnosis given to children who meet some, but not all, of the criteria for autistic disorderMust have impairments in socialization with difficulties in either communication or restricted interestsMay be misdiagnosed if difficulties are the result of another impairment (ADD, emotional)

General Characteristics Impaired social relationshipsCommunication and Language deficits - Many children with

autism do not speak; echolalia is common among those who do talk – repeating what what just said (versus answering a question)

Varying levels of intellectual functioning, uneven skill development

Unusual responsiveness to sensory stimuli Insistence on sameness and perseverationRitualistic and stereotypic behaviorAggressive or self-injurious behavior




Impaired Social Relationships Difficulty perceiving the emotional state of

others, expressing emotions, forming relationships

Fail to exhibit social gestures (showing, pointing to objects, waving, nodding)

Deficits in joint attention- social communication skills were two people use gestures and gaze to share attention with respect to interesting objects of events Child looks where mother looks Child looks where someone is pointing




Communication/Language Deficits About half are mute Speech consists mostly of echolalia Echolalia- verbatim repetition of what people

around them have said; noncontextual speech phrases without any apparent communicative purpose

Some have impressive vocabulary, but do not use it correctly

Concrete or literal processing of verbal information Understand straight forward cause-and-effect

relationships and questions Struggle with abstract concepts, humor, idiomatic

expressions




Intellectual Functioning Autism occurs across full range of intellectual disabilities (low

functioning, high functioning). 70% and 80% also meet the diagnostic criteria for intellectual disabilities

Uneven skill development Splinter skills- areas of superior performance that are

unexpected considering overall cognitive functioning Autistic savants- extraordinary ability in an area-

memorization, mathematical calculation, musical ability- with low average cognitive functioning

Overselectivity- focus on a minute feature of an object or a person rather than the whole; interferes with students ability to interpret relevant meaning from new learning

Obsessive attention on a specific object or activity (trains, cars), student will only want to play with that object which impacts social interaction/play with other children

Strong rote memory- repeat a script, name all teams in a game




Autistic Savant http://www.youtube.com/watch?

v=dAfaM_CBvP8




Unusual Responsiveness to Sensory Stimuli Overesponsiveness (hypersensitivity)

may not be able to stand certain sounds may dislike being touched or feel of certain

textures may refuse to eat foods with certain smells or

tastes Underresponsive (hyposensitivity)

Do not feel pain in a normal way Underrespond to spinning, rocking, rubbing or

pushing things into skin which create higher forms of stimulation

May display characteristics of over and under responsiveness to stimuli.




Perservation Obsessive need for sameness May throw a tantrum when routines at

home or school or changed Insist on having everything in the same

place all the time Preoccupation with certain subjects or

areas of interest Talk incessantly about one topic Ask same question over and over




Repetitive, Ritualistic, and Unusual Behavior Patterns

Stereotypy- pattern of persistent (and repetitive) Behaviors Rocking Twirling Flapping Humming Gazing at hands Staring at lights Spinning objects Clicking a pen




Severe Behavior Problems Property destruction Aggression toward others Self-injury Situation-specific Sleep problems- do not sleep long enough, night

walking Eating problems- narrow food preferences, sensory

based, refusal to eat Pica- compulsive recurrent consumption of nonfood

items (paper, dirt, pebbles, feces, hair)The frequent, high-intensity, and sometimes dangerous behavior

problems of some children with autism create stress on parents and can lead to family dysfunction if not brought under control




Positive Attributes Excessive interests can lead to

positive outcomes- sharing extensive knowledge of subject area

Many are loving, caring, thoughtful and creative- contribute to a positive classroom environment




PrevalencePrevalence

Recent estimates - Autism occurs in as many as 30–121 in 10,000 peopleSome states have reported the incidence of autism as an epidemicRise in autism prevalence is an international phenomenon Boys are affected about 4 to 5 times more often than girlsIn the 2009-2010 school year, 333,022 students ages 6 to 21 received special education services under the IDEA category of autism Autism is the fastest-growing category in special educationNJ: 1 in 49 according to CDC study released in 2012. 1 in 88 nationwide




CausesAutism is a neurodevelopmental disorder with no medical or physiological marker

In 90-95% of cases, the cause of autism is unknown

No causal link between parenting style and autism has ever been discovered

There is a clear biological origin of autism in the form of abnormal brain development, structure, and/or neurochemistry

Autism clearly has a genetic component. When there is one child in the family with autism, higher likelihood that future children will have autism

No evidence of childhood vaccinations causing autism




Screening Early diagnosis is highly correlated with dramatically better outcomesEarly warning signs include:

Obsession/ unusual interest in one object Not responding to name Lack of vocabulary development(less vocabulary than same aged peers – cannot communicate needs) Lack of smiling Repeating certain behavior over and over; saying scripted verse from something familiar again and again




DiagnosisProfessional assessment of behavioral characteristics is used to determine whether ASD is present in a childAutism can be reliably diagnosed at 18 months of ageScreening Tools

Checklist for Autism in Toddlers (CHAT) Modified Checklist for Autism in Toddlers (M-

CHAT) Social Communication Questionnaire (SCQ) Autism Spectrum Screening Questionnaire

(ASSQ)




DiagnosisDiagnosis, for those who fail screening tests, should be given by a professional with expertise in autism

•Childhood Autism Rating Scale (CARS2)•Autism Diagnostic Interview-Revised (ADI-R)•Autism Diagnostic Observation Schedule (ADOS)•Asperger Syndrome Diagnostic Scale (ASDS)




Educational Approaches Lovaas (1987) began early intervention project which used applied behavioral analysis (ABA)

Intensive behavioral intervention Scientific approach to designing, conducting and evaluating instruction based on empirically verified principles functional relationships between environment and learningEarly intervention program of 40 hours a week for 2 years or more before age 4. Numerous subsequent studies duplicated results and showed that results were sustained years later.

ABA uses behavioral principles such a positive reinforcement to teach children skills in a planned, systematic mannerChildren receive repeated opportunities across the day, settings, people, and materials to practice their new skills




Applied Behavior Analysis (ABA) – scientifically validated research support

Discrete Trial Training Picture Exchange Communication System (PECS) Peer-mediated interventions Errorless discrimination learning Self-management strategies Functional assessment of challenging behavior Functional Communication Training Naturalistic language strategies

Effective for all students, regardless of ability Teaching methods use a planned and systematic approach

based on positive reinforcement

Educational Approaches (cont) p 256




Discrete Trial Training Teacher prepares a set of problems to present to a student

one at a time Sequence is in an optimum order for teaching and learning Student responds or fails to respond to each problem Teacher responds to each of the student’s responses or

nonresponses: rewarding or acknowledging correct responses; ignoring incorrect responses either ignoring or prompting responses after

nonresponses Cumulative effect of this teaching is to impart a new set of

integrated facts, a concept or a skill Discrete Trial: http://www.youtube.com/watch?v=cp_gzUTCm8g

http://www.youtube.com/watch?v=cp_gzUTCm8g




ABA - Demonstrationhttp://www.youtube.com/watch?v=iyCx-OLzgJw

PECS/Proloquo2go:http://www.youtube.com/watch?v=c9ywf0WDoj0http://www.youtube.com/watch?v=E2LnUxFAaMQ&feature=related

Errorless Discrimination Learning:

http://www.youtube.com/watch?v=h5_zJIm1B_k&feature=related

Self Management Strategieshttp://www.youtube.com/watch?v=03O5mDMQ2D4

Functional Communication Traininghttp://www.youtube.com/watch?v=hoF1UJ9YBUY

http://www.youtube.com/watch?v=iyCx-OLzgJw

http://www.youtube.com/watch?v=c9ywf0WDoj0

http://www.youtube.com/watch?v=E2LnUxFAaMQ&feature=related

http://www.youtube.com/watch?v=03O5mDMQ2D4

http://www.youtube.com/watch?v=hoF1UJ9YBUY




Educational Approaches Benefits of ABA

Scientifically based approach Planned and systematic use of

positive reinforcement Can be applied to benefit students

with and without disabilities




Educational Approaches (continued) Picture Activity Schedules

Use of pictures to prompt/cue a student to perform a specific task, or series of tasksIncreases independence in selecting and carrying out a sequence of activities in the classroom

Picture Activity Schedule




Educational Approaches (continued)Social Stories

Explain social situations and concepts, including expected behaviors of the persons involved, in a form understandable to an individual with autismAnswer a child’s questions about social behavior that he/she is not likely to ask for or obtain in other waysDescribe a situation and expected behaviors, explain simple steps for achieving certain goals or outcomes, teach new routines and anticipated actionsCan decrease a child’s anxiety, improve behavior and help them understand the event from the perspective of others




Educational Approaches (continued) Social Stories

Written at student’s level of comprehension One sentence per page photographs or line drawings depicting key information Should be used with other interventions Contain four types of sentences

Descriptive sentences that identify the contextual variables of the target situation

Directive sentences that describe the desired behavior with respect to a specific social cue or situation

Perspective sentences that describe the reactions and feelings of others about the situation

Affirmative sentences that express shared beliefs or reference a rule or law about the situation to reassure the individual

Social Stories

Additional Educational ApproachesMiller Method: http://millermethod.org/

“The Miller Method addresses children's body organization, social interaction, communication and representation issues in both clinical and classroom settings. Cognitive-developmental (c-d) systems theory assumes that typical development depends on the ability of the children to form systems -- organized "chunks" of behavior -- that are initially repetitive and circular but which become expanded and complicated as the children develop. Becoming aware of the distinction between themselves and their immediate surroundings, children's systems, previously triggered only by salient properties of the environment, gradually come under their control. Children then combine their systems in new ways that permit problem solving, social exchanges and communication with themselves and others about the world.”

Method is used at Crossroads School in Westfield, NJ

http://millermethod.org/

The CUBE

Additional Educational Approaches cont.DIR/Floortime http://stanleygreenspan.com/ “The Greenspan Floortime Approach is a system developed by the late Dr. Stanley Greenspan. Floortime meets children where they are and builds upon their strengths and abilities through creating a warm relationship and interacting. It challenges them to go further and to develop who they are rather than what their diagnosis says.In Floortime, you use this time with your child to excite her interests, draw her to connect to you, and challenge her to be creative, curious, and spontaneous—all of which move her forward intellectually and emotionally. (As children get older, Floortime essentially morphs into an exciting, back-and-forth time of exploring the child’s ideas.)For any age child, you do three things:

Follow your child’s lead, i.e. enter the child’s world and join in their emotional flow;

Challenge her to be creative and spontaneous; and Expand the action and interaction to include all or most of her senses and

motor skills as well as different emotions.”

Method is used at Celebrate the Children (school) in Wharton and Dover, NJFeatured in the video: Autistic-Like: Graham’s Story Greenspan Floortime approach http://www.youtube.com/watch?v=vApghedypFc

http://stanleygreenspan.com/

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




Teaching and Learning p240-241

Learning by ObservationAlbert Bandura (1962) - acquisition of knowledge of new responses by observing the behavior of a model.

Skills required:Attend – child needs to be able to look at the people performing complex actions for extended periods of timeImitate – child needs to duplicate the behavior demonstrated by modelDiscriminate – child needs to know the difference between positive feedback (praise) and negative (corrective) feedback




Teaching and Learning cont p 246-247

Behavior TrapsStudents with Asperger syndrome are enthralled with particular subjects or things. These special interest areas (SIA) can be utilized by teachers as a way to facilitate learning instead of being viewed as a deficit.

Example: Student is very interested in baseball cards. They can be used to teach putting words into alphabetical order, doing mathematical calculations, learning geography (where does player live), etc.

Example: Student is interested in presidents of US. Can learn about history that took place during person’s administration, geography, math (years between administrations, budgets, etc).




Implementing Behavior TrapsHow to:Identify child’s SIAIncorporate SIA across the curriculumMake entering the trap easyStart small, and use the trap judiciouslyDon’t be in a hurry to eliminate the SIAInvolve the targeted student’s peersPeriodically change the curriculum areas associated with the SIAEvaluate the effects




Teaching and Learning cont Ipod/Ipad Applications – Increasing Independencehttp://www.livebinders.com/play/play/247178

CommunicationSocial SkillsActivity SchedulesVideo ModelingSelf-RegulationSupportsOther

http://www.livebinders.com/play/play/247178




Educational Placement AlternativesStudents with autism are increasingly placed in general education classrooms for the purpose of improved social integrationDuring the 2008–2009 school year:

• approximately 36% of students with autism were educated in the general education classrooms

• 18% served in resource room programs • 36% in separate classes • About 10% of students with autism attended

special schools or residential facilities




Educational Placement AlternativesStudents with autism are increasingly placed in general education classrooms for the purpose of improved social integration.Success in the general education classroom for a student with ASD depends on the child’s ability to reliably do the following:•Display near-zero levels of problem behavior•Participate and learn in group lessons•Complete assigned tasks independently•Interact with peers appropriately•Comply with classroom rules/follow the teacher’s directions•Get the teacher’s attention/assistance appropriately




Educational Placement AlternativesRegular Classroom

Teach Communication and Social CompetenceProvide systematic instruction in imitation skillsPlan opportunities for student with disabilities to interact directly with typically developing peers

Use Instructional Strategies that Maintain the Class’s Natural FlowUse naturalistic teaching proceduresUse different cues and prompts to ensure that each child receives adequate support

Teach and Provide Opportunities for IndependenceGive children choices whenever possible and teach choice making when necessaryPicture schedules with daily routinesMaintain high expectations

Build a Classroom Community that Includes All ChildrenUse activities that will engage children with a large range of abilitiesAllow every child to have a turn and play a role

Promote Generalization and Maintenance of SkillsTarget skills that will be useful in each child’s lifeUse instructional prompts and fade them rapidlyDistribute learning trials naturallyUse common materials for instruction

Allows for natural consequences when undesirable behavior occurs




Educational Placement Alternatives Resource Room/Special Classes/Schools

Child is pulled out of general education class for specific subject areaInstruction should be planned so that student can generalize skills in the general education classroom/communityContinuously record dataTarget specific skills with daily review of data in making curricular and instructional decisions ABA classroomAutistic classroomMultiply Disabled classroom

Related ServicesOccupational therapyPhysical TherapySocial SkillsBehavioral ConsultationsIn Home ConsultationsTransportationSpeech/language therapy




Unproven Interventions and Fads for ASDFacilitated CommunicationA process by which a communication partner provides physical support to assist an individual who cannot speak or whose speech is limited to typing on a keyboard or point at pictures, words, or other symbols on a communication board

Little or no scientific evidence support the claims ofimprovement using facilitated communication

Secretic TherapySecretin is an amino acid hormone released within the proximal duodenum in response to gastric acid secretion. Intravenous infusions of purified secretin was provided to children with autism experiencing gastrointestinal problems.Studies found no significant difference on different measures of language, behavior, or autism symptom severity after treatment with secretin

ResourcesCDC materials on Basics, Screening & Intervention, Treatments, Articles, etc. http://www.cdc.gov/ncbddd/autism/index.html

Children’s Specialized Hospital – Autism Informationhttp://www.childrens-specialized.org/kohlsautismawareness

(Modified) Checklist for Autism in Todders (CHAT): http://www.autismspeaks.org/what-autism/diagnosis/m-chathttp://www.autism.org.uk/chat

Applied Behavioral Analysis: http://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

Dir/Floortime: http://stanleygreenspan.com/

Miller Method: http://millermethod.org/

Teacch: http://www.teacch.com/

Carly Fleischmann: Friend on Facebook, youtube videos, www.Carlyscafe.com

Autistic Like: Graham's Story (DIR/Floortime, ABA, Sensory Integration)- MOVIE http://vimeo.com/22576712

http://www.cdc.gov/ncbddd/autism/index.html

http://www.childrens-specialized.org/kohlsautismawareness

http://www.childrens-specialized.org/kohlsautismawareness

http://www.autismspeaks.org/what-autism/diagnosis/m-chat

http://www.autism.org.uk/chat

http://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

http://stanleygreenspan.com/

http://millermethod.org/

http://www.teacch.com/

http://www.carlyscafe.com/

http://vimeo.com/22576712

Resources continuedFunctional Behavioral Assessment (and BIP) and AnalysisMultimodal functional behavioral assessment: http://mfba.net/forms.html Functional Behavior Assessment Forms: http://www.1edweb.com/fba%20forms.htm

Chris Borgmeier, Ph.D. Portland State University http://www.ode.state.or.us/teachlearn/conferencematerials/sped/2006/fbabspformspacket.pdf

Functional Behavioral Analysis: http://www.tcsea.org/downlaods/FBAform.pdf

ABC http://www.nemours.org/content/dam/nemours/www/filebox/service/support/parentingtips/10behavchart.pdf ABC http://www.specialconnections.ku.edu/?q=behavior_plans/functional_behavior_assessment/teacher_tools/antecedent_behavior_consequence_chart----------------------------------------

Autism Curriculum Encyclopedia http://www.acenecc.org/ Autism Love to Know http://autism.lovetoknow.com/Main_Page Lots of fact sheets, support info, teaching methods, etc.

http://mfba.net/forms.html

http://www.1edweb.com/fba%20forms.htm

http://www.1edweb.com/fba%20forms.htm

http://www.ode.state.or.us/teachlearn/conferencematerials/sped/2006/fbabspformspacket.pdf

http://www.ode.state.or.us/teachlearn/conferencematerials/sped/2006/fbabspformspacket.pdf

http://www.tcsea.org/downlaods/FBAform.pdf

http://www.nemours.org/content/dam/nemours/www/filebox/service/support/parentingtips/10behavchart.pdf

http://www.nemours.org/content/dam/nemours/www/filebox/service/support/parentingtips/10behavchart.pdf




Resources continued Autism: Robots teaching children with Autism

http://www.today.com/video/today/50007872#50007872 http://www.youtube.com/watch?v=7T7cIY-MIxc http://www.youtube.com/watch?v=nwJsxLOilcc

A Teen's Guide to Understanding and Communicating with People with Autism http://www.youtube.com/watch?v=p9-l19CKISg&feature=youtu.be

Reason I Jump. by Naoki Higashida, KA Yoshida and David Mitchell. Book about a 13 year old young man from Japan with Autism. Excerpt: http://www.parade.com/66492/parade/excerpt-the-reason-i-jump/?utm_source=parademagazine&utm_medium=print&utm_campaign=vanity20130825

http://www.slate.com/articles/health_and_science/books/2013/09/autism_memoir_by_japanese_teenager_david_mitchell_translates_the_reason.2.html




Temple GrandinAutism – Temple Grandin – Movie scene 6.23http://www.youtube.com/watch?v=l58MffRIJUQ&feature=relatedSocial Stories – Temple Grandin Grandin about Zuckerberg and Autism 4.21http://www.youtube.com/watch?v=nwnlWX4iyj4&feature=relatedPerceptions in Communication – Thinking In Pictures - Temple Grandin (81 minutes)http://www.youtube.com/watch?v=J_3ueIBH5DI&feature=related

There are many more clips on the internet and many books