Impaired Social Interaction

IMPAIRED COMMUNICATION

Restrictive and Repetitive Behaviours and

Interactions

Autism Spectrum Disorder DSM V

According to the DSM-V Autism Spectrum Disorder is a disorder that includes persistent deficits in social communication and social interaction as well as restricted repetitive patterns (ritualistic) of behaviour including interests, activities, use of object or speech and movement .

1. Impaired Social Interaction: Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.

2. Restrictive and Repetitive Behaviours and Interactions: Rituals and repetitive behaviours that inhibit functioning in contexts. Resists attempts by others to interrupt or to be redirected from fixated interest.

AUTISM DEFINED

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.

4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humour, metaphors, multiple meanings that depend on the context for interpretation).

5. Difficulty understanding non-verbal communication (physical cues/body language).

4. http://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

IMPAIRED SOCIAL INTERACTION

1. Stereotyped patterns of behaviour.

2. Preoccupation with one or more patterns of interest that is abnormal either in intensity or focus.

3. The so-called “perfectionist streak” may be a form of repetitive and restrictive behaviour.

4. Apparently inflexible adherence to specific non-functional routines or rituals

5. Stereotyped and repetitive motor mannerisms e.g.: hand or finger flapping or twisting, or complex whole-body movements.

http://www.med.monash.edu.au/spppm/research/devpsych/actnow/download/factsheet48.pdf

RESTRICTIVE AND REPETITIVE BEHAVIOURS

THE AUTISM SPECTRUMSEVERITY LEVEL Social Communication Restricted & Repetitive Behaviours

Level 3‘Requiring Substantial

Support’

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal responses to social overture from others.

Preoccupations, fixated rituals and/or repetitive behaviours markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.

Level 2‘Requiring Substantial

Support’

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of asocial interaction and reduced or abnormal response to social overtures from others.

RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRBs are interrupted; difficult to redirect from fixated interest.

Level 1‘Requiring Support’

* Asperger’s Syndrome*

Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.

Rituals and repetitive behaviours (RRBs) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRBs or to be redirected from fixated interest.

*Although Autism Spectrum Disorder does not necessarily include intellectual impairment, expressive or receptive language disorders or psychiatric illness, it is frequently associated with intellectual impairment and structural language disorder (i.e., an inability to comprehend and construct sentences with proper grammar).

About 70% of individuals with ASD may have one comorbid mental disorder, and 40% may have two or more comorbid disorders. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1803025/pdf/nihms17710.pdf

IS THAT ALL THERE IS TO AUTISM?

In a 2006 paper by the American National Institute of Health, it is noted that although the criteria for ASD is limited to social communication and repetitive behaviour, there is a growing body of evidence to suggest that “other areas or domains of cognitive and neurologic functioning beyond this diagnostic dyad are integrally involved in this syndrome”. For example, studies of gross motor abilities have documented a range of problems with motor praxis, motor planning, and imitation that now appear to be an integral element of this syndrome”. In addition, “an entire area of research describing the unique features of memory dysfunction in autism has evolved”. Although “only a few studies, primarily survey-based, have been published about the sensory issues in autism … these suggest that disturbances in this area are also elements”. “Neurologic studies of the postural control system have demonstrated involvement of neural systems outside those previously thought to be involved on the basis of traditional behavioural observations. The paper suggests that models of autism must expand conceptually to consider broader cognitive, neurologic, and brain involvement in autism”. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1803025/pdf/nihms17710.pdf

Individuals with ASD are also thought to have executive functioning issues, a set of mental processes that helps connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space. http://www.du.edu/psychology/dnrl/Executive%20function%20deficits%20in%20high-functioning%20autistic.pdf

ISN’T AUTISM MORE THAN THAT?

There is insufficient research to make definitive claims about the nature of Autism Spectrum Disorder beyond the DSM-V: Generally speaking however, associated features of individuals with Autism Spectrum Disorder are believed to include:

1. Imaginative & Abstract Thought: Students struggle with abstract concepts and find it difficult to generalise from the concrete to the general and vice versa.

2. Sensory Processing: sensory integrative dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behaviour.http://www.autism.com/index.php/symptoms_sensory_overview

3. Difficulty with Non-literal Language: Metaphorical language can be confusing and lead to misunderstanding. [“How are you going? “By car! But I’m not leaving yet. I just got here!?”]

4. Fine Motor Control/ Gross motor skills: Difficulty with writing & typing due to limited hand strength, and sitting for study/reading may effect the ability

See Also,: http://www.autismvictoria.org.au/diagnosis/characteristics_checklist.php

ISN’T AUTISM MORE THAN THAT?

There is insufficient research to make definitive claims about the nature of Autism Spectrum Disorder beyond the DSM-V: Generally speaking however, associated features of individuals with Autism Spectrum Disorder are believed to include:

4. Hyperactivity & Poor Attention Span are often observed, usually because the child has trouble understanding instructions from the teacher. Behavioural issues are usually a consequence of student’s inability to cope within an educational setting.

5. Difficulty Transferring Skills learned in one setting to another setting, eg, school to home.

6. Behaviour Disturbance and Mood Imbalance so typical of teenagers seems to be exaggerated for those with an Autism Spectrum Disorder.

7. Executive Functioning: The ability to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space.

http://www.autismvictoria.org.au/diagnosis/characteristics_checklist.php

ISN’T AUTISM MORE THAN THAT?

Avoid metaphorical language. Repeat what you have said in a different way.

Check in with the student: Ask the student to explain/reiterate in their own words.

Make the link between concrete and abstract as explicit as possible: “You can also do this when…” (e.g., ‘when’ not ‘if’).

When communicating with student make sure there are no other distractions.

Ensure that student is able to focus for short periods of time. Provide as many visual cues/aids as possible.

http://www.autismvictoria.org.au/diagnosis/characteristics_checklist.php

1. SUPPORTS & STRATEGIES: IMPAIRMENT OF SOCIAL

COMMUNICATION

As teachers, using the student’s special interest can be a useful way to engage the student.

(Beware not to encourage overly obsessive behaviours)

Link the student’s interest into their learning program particularly at the outset of enrolment. Student Support Teachers we can encourage

students to complete Discovery learning projects on their favourite topic/interest.

Beware of the perfectionist streak! If a student is unable to send in work for example, provide the student with a time estimate of how much time they should spend to complete weekly submissions: Ask the student to

submit work that has been completed in X hours.

http://www.autismvictoria.org.au/diagnosis/characteristics_checklist.php

2. SUPPORTS & STRATEGIES: REPETITIVE BEHAVIOUR

Executive Functioning: Try to prompt reflection on prior knowledge/skills to inform current task.

Executive Functioning: Engage with student as soon as possible. ASD students tend to become disengaged quite quickly when they are unclear on what is

expected of them. Executive Functioning: Provide students with a clear visual/graphic schedule/organiser negotiated with the student. Make sure this timetable

includes: phone calls to teachers and subject study times as well as enjoyable activities.

Executive Functioning: Provide as much structure to the learning program. A physical space at home specifically for studying.

Executive Functioning: Scheduled contact times (in timetable) so that student is prepared and ready to receive calls or call teachers). For student visits provide students with a clear overview of the purpose of the meeting who they will be

meeting and what will be discussed. Make sure that the meeting includes break periods.

http://www.ncld.org/types-learning-disabilities/executive-function-disorders/what-is-executive-function

3. IMPAIRMENTS & STRATEGIES:

Abstract Thinking (Learning Styles): Think out loud with the student in an organized and compelling way to facilitate the child's development of

systematically higher levels ofthinking, and better problem solving (See abstract thinking strategy sheet

for more). Sensory Processing Issues: When meeting with the student at DECV is the

meeting conducive to the student’s sensory issues? Meet outside? Does the student have a study space that is clear of undesired sensory

stimulus? General: Ask students to create a profile about themselves. This will allow

you to find out what their needs are and share with all teachers involved with the student.

General: Provide students with a profile & picture of all their teachers. This will allow students & parents to share knowledge on how the

students learns. General: A weekly schedule & scripts including non-study activities,

breaks and fun activities. General: When passing information use concrete language for example

say when instead of if. General: Behaviour replacement: call teacher when stressed.

http://www.ncld.org/types-learning-disabilities/executive-function-disorders/what-is-executive-function

4. IMPAIRMENTS & STRATEGIES:

* This tool is not to be used for the purpose of diagnosing a student for ASD. The aim of this Planning Matrix is to guide the development and implementation of strategies to support the student.

THE ASD PLANNING MATRIX: INCLUDING PARENTS