Children With Special Learning Needs: Autism

Autism

• In its purest form the definition of autism is a mental condition, present from early childhood, characterized by great difficulty in communicating and forming relationships with other people and in using language and abstract concepts. Special usage: a mental condition in which fantasy dominates over reality, as a symptom of schizophrenia and other disorders.

Under the umbrella of autism

• Autism Spectrum Disorders is a group of 5 childhood developmental disorders characterized by varying degrees fo impairment in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.

• The disorders can often be accurately detected by 3 years of age and sometimes earlier to 1 year of age. Warning signs of ASD is reason enough to not wait and have a child evaluated by a professional specializing in these disorders.

Types of Autism• There are three main types of autism spectrum

disorder, and two rare, severe autistic-like conditions:

• Asperger's syndrome• Pervasive developmental disorder, not otherwise

specified (PDD-NOS)• Autistic disorder• Rett's syndrome• Childhood disintegrative disorder

Asperger’s Syndrome• Asperger's Syndrome• The mildest form of autism, Asperger's syndrome

affects boys three times more often than girls. Children with Asperger's syndrome become obsessively interested in a single object or topic. They often learn all about their preferred subject, and discuss it nonstop. Their social skills are markedly impaired, though. They are often awkward and uncoordinated physically.

• Because Asperger's syndrome is mild compared to other autism spectrum disorders, some doctors call it "high-functioning autism." As children with Asperger's syndrome enter young adulthood, though, they are at high risk for anxiety and depression.

• This mouthful of a diagnosis applies to most children with autistic spectrum disorder. Children whose autism is more severe than Asperger's syndrome but not as severe as autistic disorder are diagnosed with PDD-NOS.

• Autism symptoms in kids with PDD-NOS vary widely, making it hard to generalize. Overall, compared to children with other autistic spectrum disorders, children with PDD-NOS have:

• impaired social interaction -- like all children with autistic spectrum disorder

• better language skills than kids with autistic disorder, but not as good as those with Asperger's syndrome

• fewer repetitive behaviors than children with Asperger's syndrome or autistic disorder

• a later age of onset• However, no two children with PDD-NOS are exactly alike in their

symptoms. In fact, there are no agreed-upon criteria for diagnosing PDD-NOS. In effect, if a child seems autistic to professional evaluators but doesn't meet all the criteria for autistic disorder, he or she has PDD-NOS.

Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

Autistic Disorder• Children who meet more rigid criteria for a

diagnosis of autism have autistic disorder. They have more severe impairments involving social and language functioning, as well as repetitive behaviors. Often, they have mental retardation and seizures as well.

• There are two rare, severe forms of autistic spectrum disorder that are considered separately from the others: Rett's syndrome and childhood disintegrative disorder.

Rett’s Syndrome• Almost exclusively affecting girls, Rett's syndrome

is rare. About one in 10,000 to 15,000 girls develop this severe form of autism. Between 6 and 18 months of age, a little girl stops responding socially, wrings her hands habitually, and loses language skills. Coordination problems appear and can become severe.

• Rett's syndrome is usually caused by a genetic mutation. The mutation usually occurs randomly, rather than being inherited. Treatment focuses on physical therapy and speech therapy to improve function.

Childhood Disintegrative Disorder• The most severe autistic spectrum disorder, childhood

disintegrative disorder (CDD), is also the least common.• After a period of normal development, usually between

age 2 and 4, a child with CDD rapidly loses multiple areas of function. Social and language skills are lost, as well as intellectual abilities. Often, the child develops a seizure disorder. Children with childhood disintegrative disorder are severely impaired and don't recover their lost function.

• Fewer than two children per 100,000 with an autistic spectrum disorder meet criteria for childhood disintegrative disorder. Boys are affected by CDD more often than girls.

Statistics

• Changes in criteria for diagnosis, along with increased recognition by professsionals and the public has increase the number of children diagnosed with ASD.

• Risk is 3-4 times higher in males than females.

• 3.4/1000 children between ages 3-10 years are affected.

Genetics• Because of its relative inaccessibility, scientists have only

recently been able to study the brain systematically. But with the emergence of new brain imaging tools—computerized tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI), study of the structure and the functioning of the brain can be done. With the aid of modern technology and the new availability of both normal and autism tissue samples to do postmortem studies, researchers will be able to learn much through comparative studies.

• Postmortem and MRI studies have shown that many major brain structures are implicated in autism. This includes the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem. Other research is focusing on the role of neurotransmitters such as serotonin, dopamine, and epinephrine and genetic rearrangements.

Research• Higher than normal levels of serotonin may contribute to the

development of autism spectrum disorders. According to The National Autistic Society in the U.K., between 30 percent and 50 percent of children with autism have higher than normal blood serotonin levels.

• It appears that children with autism produce an overabundance of serotonin and their brains aren't able to utilize it effectively.

• Serotonin is a neurotransmitter that contributes to the healthy -development of the central nervous system. At healthy levels, it is best known for its enhancement of well-being and improvement of mood.

• Serotonin has significant effects on sensory perception, in the functions of sensation, sight, sound, smell and taste.

• Serotonin also affects regulation of body temperature and energy levels. It influences aggression, sleep and social behavior.

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Serotonin• Serotonin is manufactured by the body from an

amino acid called tryptophan. Foods high in tryptophan are bananas, pecans, pineapples, plums and tomatoes as well as breads, pastas, some cheeses, nuts and seeds. Avoiding these foods can help to reduce serotonin levels.

Early Signs• Children may seem different right from birth or

may develop normally then will withdraw. Research has shown that parents are usually correct about noticing some developmental problem even though they may not understand the specific nature of what is different or not right about the child.

• A young child may become withdrawn or

unresponsive to social situations and one-on-one contacts. autism may be accompanied by sensory disturbances, seizures and mental retardation.

Common traits• All children with ASD have difficulty with social

interactions, verbal and non-verbal communications, and repetitive behaviors or interests. Additionally, they may have unusual responses to sensory experiences. The symptoms can be mild or severe and present in each child differently. Presentation of the symptoms can be seen at birth but more often between 12 and 36 months.

Indicators• Possible Indicators of ASD in infants and toddlers:

• Does not babble, point, or makes meaningful gestures by 1 year of age.

• Does not speak one word by 16 months.

• Does not combine two or more words by 2 years.

• Does not respond to name.

• Loses language or social skills.

Other Indicators• Poor eye contact.

• Does not seem to know how to play with toys.

• Excessively lines up toys or other objects.

• Is attached to one particular toy or object.

• Does not smile.

• At times seems to be hearing impaired.

Social Symptoms• Difficulty learning to engage in give and take every day human

interactions.

• Seem indifferent to people. Seldom see comfort or resists attention or cuddling.

• Miss subtle social clues such as a wink or a smile. Common phrases have no emotional context. For example: Come here whether said with upbeat excitement or with frustration/anger is the same to the child.

• Cannot understand another person's viewpoint, leaving them without the ability to interpret someone's intentions.

• May have difficulty regulating their own emotions. Labeled as immature.

Diagnosis• The earlier the diagnosis the better. Research

over the last 15 years indicates that intense early intervention for at least 2 years during preschool age improved outcomes in most young children with ASD.

• As part of a child’s well child checkup, a developmental screening should be done. There are several tools that are available for toddlers and preschoolers to evaluate for potential or actual developmental problems. If a problem is noted the next step is to have a full evaluation by experts in the field.

Treatment• There is no specific treatment. Experts agree that

the earlier the start in a well structured special program the better. The child should have an IEP or Individual Educational Plan which is tailored to the specific strengths and weaknesses of the child.

Working with an Autistic Child• Be consistent. Children with autism have a hard

time adapting what they’ve learned in one setting (such as the therapist’s office or school) to others, including the home. Creating consistency in the child’s environment is the best way to reinforce learning. Find out what the child’s therapists/parents/teachers are doing and continue their techniques as closely as possible.

• Stick to a schedule. Children with autism tend to do best when they have a highly-structured schedule or routine. If there is an unavoidable schedule change, prepare your child for it in advance.

Working with an Autistic Child• Reward good behavior. Positive reinforcement

can go a long way with children with autism, so make an effort to “catch them doing something good.

• Create a home safety zone. Carve out a private space where the child can relax, feel secure, and be safe. This will involve organizing and setting boundaries in ways the child can understand. Visual cues can be helpful (colored tape marking areas that are off limits, labeling items with pictures). May also need to safety proof the environment, particularly if the child is prone to tantrums or other self-injurious behaviors.

Non-verbal Ways to Connect• Look for nonverbal cues. Pay attention to the kinds of

sounds they make, their facial expressions, and the gestures they use when they’re tired, hungry, or want something.

• Figure out the need behind the tantrum. When children with autism act out, it’s often because the caretaker is not picking up on their nonverbal cues. Throwing a tantrum is their way communicating their frustration and getting your attention.

• Make time for fun. A child coping with autism is still a kid. For both children with autism and their parents, there needs to be more to life than therapy. Figure out ways to have fun together by thinking about/listing the things that make the child smile, laugh, and come out of their shell.

Non-verbal Ways to Connect• Pay attention to the child’s sensory

sensitivities. Many children with autism are hypersensitive to light, sound, touch, taste, and smell. Other children with autism are “under-sensitive” to sensory stimuli. Figure out what sights, sounds, smells, movements, and tactile sensations trigger “bad” or disruptive behaviors and what elicits a positive response. What does the child find stressful? Calming? Uncomfortable? Enjoyable? Adjust the environment as needed.

Approaches to Learning• A good treatment/teaching plan will:• Build on the child's interests. • Offer a predictable schedule. • Teach tasks as a series of simple steps. • Actively engage the child's attention in highly

structured activities. • Provide regular reinforcement of behavior.

Involve the parents. • Source: National Institute of Mental Health

Curriculum Resources• http://www.specialed.us/autism/index2.htmAutism: Interventions and Strategies for Success • TEACCH (Information on practices and other ideas)

www.unc.edu/depts/teacch • Carol Gray (Information on Social Stories)

www.thegraycenter.org• Visual Supports and other free supplies

www.do2learn.comwww.usevisualstrategies.comhttp://card.ufl.edu/visuals

• Free online reading books/following directions for students and beginning sounds www.starfall.com

• Free Resources from the Net for (Special) Educationhttp://paulhami.edublogs.org/

This is an example of making a visual boundary on a table/area that many students share.

This is an example of a matching activity with functional signs.

This is an example for a student who needs to ask for help, the adult wears this “bracelet” and the student matches their help card to the bracelet and help is then given.

This is an example of a transition stage so the student can visually see when it is time to change activities or areas.

This is an example of a “choice” board for break/play time.

This is an example of a schedule where a student is able to use first/then, a finished envelope, and also carry needed supplies in the binder.

Montessori and Autism• The basic tenet of Montessori education is that a child learns

best in an enriched, supportive environment through exploration, discovery Children are encouraged to pursue their interests, make responsible choices for themselves and direct themselves to constructive activities.

• In Indianapolis, the public schools have a Montessori Magnet-Option schools for grades K-8. Parents in the Indianapolis Public School district with children that have Asperger's or ASD are encouraged to apply to these schools. They have shown incredible success with both the children that are profoundly autistic (they are in a separate program within the school) and those with high-functioning ASD are mainstreamed in the classrooms, with pull-out assistance for special areas.

Montessori and Autism• Montessori principles and applications can work for

autistic children with some modifications. Testimonies from parents and teachers are generally positive.

• It is similar in terms of the curriculum and classroom layout. It uses the same materials with the same task analysis techniques. The difference is how it is taught. The child is taught working one-to-one, with prompting and reinforcement schedules based on each step of the task analysis. In addition there are set programs/activities that the child must do each day. This is different to a typical Montessori approach which allows the child to have choice and to be shown a presentation before using the activity.

Locate Free Autism Services• Call the National Dissemination Center for Children

with Disabilities at 1-800-695-0285 • http://

www.nichcy.org/Pages/StateSpecificInfo.aspx?State=MA

Listings of state agencies for the state of Massachusetts• http://www.nectac.org/default.aspSearch the Early Intervention State Contact List from the National Early Childhood Technical Assistance Center.• http://idea.ed.gov/explore/homeU.S. Department of Education’s IDEA web site. Provides background on goals and regulations from DOE.

Resources• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0

002494/ PubMed/ National Center for Biotechnology Information, U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda MD, 20894 USA

• http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH)

• http://www.empowher.com/autism/content/autism-and-effects-serotonin?page=0,1

Autism and The Effects of Serotonin by Jody Smith

Resources• http://www.helpguide.org/mental/autism_help.htm Helping Children with Autism, Autism Treatment Strategies and Parenting Tips

• http://www.ninds.nih.gov/disorders/autism/detail_autism.htmNational Institute of Neurological Disorders and Stroke: Autism Fact SheetNational Institute of Neurological Disorders and Stroke: "Asperger Syndrome Fact Sheet.“

• http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

National Institute of Mental Health: "Autism Spectrum Disorders.“

• http://www.blog.montessoriforeveryone.com/the-underlying-organization-of-a-montessori-classroom.html

Montessori for Everyone