Learners with Autism Spectrum Disorders

By: Drew Burns and Barb Marko

• It's own category ever since the Individuals with Disabilities Education Act (1990)

• A group of developmental brain disorders, five similar conditions• collectively they are referred to as being on a "spectrum" • the term refers to the wide range of symptoms, skills, and levels of

impairment, or disability, that children with ASD can have Autism Asperger Syndrome pervasive developmental disorder not otherwise specified

(PDD-NOS) Rett's Disorder Childhood disintegrative disorder (CDD)

(According to National Institute of Mental Health)

What is Autism Spectrum

Disorder?

Autism Spectrum Disorders Cont.

• The American Psychiatric Association (APA) has been working on modifying this definition • expects to publish a revised Diagnostic

and Statistical Manual (DSM-V) in 2013

The Definition of ASD's

According to the DSM-V workgroupAutism- extreme social withdrawal and

impairment in communication; often includes stereotyped movements: resistance to change, and unusual responses to sensory experiences; usually manifest before age 3

Asperger Syndrome- very similar to Autism, but without significant impairments in cognition and language

Definition of ASD's Cont.

• Childhood disintegrative disorder: normal development for at least 2 and up to 10 years, followed by significant loss of skills; more prevalent in males• Pervasive developmental disorder not

otherwise specified (PDD-NOS)- persons who display behaviors typical of autism but to a lesser degree; onset later than 3 years old

Def. of ASD cont.

• Rett Syndrome- mostly affects girls; develop normally for 6-18 months before regression and autism-like symptoms begin; difficulties with coordination, movement, and speech; no specific treatment is available yet

Historical Context

• the study of autism began with two scientific papers- Kanner's and Asperger's • Kanner's Paper by Theo Kanner- In his

time, the term autistic meant "individuals who had extreme narrow range of personal relationships and restricted interactions with their environment" • reported on the cases of 11 children

from the Child Psychiatric Unit at Johns Hopkins University

Kanner's Paper cont.

These are some of the observations that he observed:

an inability to relate to others in an ordinary manner

extreme autistic aloneness that isolated the child from the outside world

apparent resistance to being picked up or held by parents

deficits in language obssevive desire for repetition and

sameness bizzare repetitive phyiscal movement

Kanner's Conclusion

• These children could be distinguished from children that had schizophrenia• 3 reasons

Schizophrenia children tended to withdraw from the world; children with autism never made a connection to begin with

Children with autism exhibited unique language patterns

o Reveral of pronounso Echolalia

They seemed to not detoriate in their functioning over time

Asperger's Paper

• Hans Asperger• reported on four cases of children in a

summer camp they preferred to play alone

• They were similar to Kanner's cases, but had notable exceptions

they had average intelligences; focused intellectual pursuits on a preoccupation in narrow areas; machinery or mathematics

Thier language was perceived as normal His work would lead to condiition being

recognized later in time

Prevalence

Prevalence cont.

• in the 1960's, the rate was at about 0.04% (1 out of 2,500)• stayed the same until the 2000 surveys • the prevalence rate increased to 1 in

333• The U.S. centers for disease control: 1

in 110 • saw a 57% increase from just 2002 to

2006• 4 times higher in boys than girls;

higher in European Americans than it is for Latinos or African Americans

Why this increase?

there are two groups/ Scientific camps• First group believes that there hasn't

been increase in the number of true cases; argue increases in three factors

a widening criteria greater awareness by the general public "Diagnostic Substitution"

• Second group believes that the first group is right but not entirely; unknown factors

Causes of ASD

• the early theories Hans Asperger and Theo Kanner:

biological, but Kanner thought there was something to say about the parents role (they were the leading cause of their child's autism; mothers especially

refrigerator moms- Bruno Bettelheim Today's theories • Scientists don't know what's wrong

with the brain, but believe the cause is neurological, and not interpersonal

Neurological Causes

• many areas of the brain are affected• a disorder of neuronal networks; not an

abnormality in one specific part of the brain • Brain cells exhibit deficient connectivity,

disrupts the cell's ability to communicate with each other• increasing head size; mostly during the

first two years of life; neurodevelopment stage• language, capacity for inference, sense

of self awareness, complex processing

Neurological Cont.

• Brain growth; possibly linked to the elevated levels of growth hormones

androgen- found in the amniotic fluid before birth

• Extreme Male Brain (EMB)• researchers are skeptical

Genetic Causes

• Hereditary link if child is diagnosed, the younger sibling

has a 15% chance of being diagnosed Monozygotic vs dizygotic family members

• Gene Mutationso more research needs to be conducted

Identification

• Diagnosis is made by a psychiatrist• established by the APA • they must meet the following criteria: • Clinically significant, persistent deficits

in social communication and interactions, as manifested by the following:• Marked deficits in nonverbal and verbal

communication used for social interaction;• Lack of social reciprocity [give and

take]

Id Cont.

o Failure to develop and maintain peer relationships appropriate to developmental level

• Restricted, repetitive patterns of behavior, interests, and activities, manifested by at TWO of the following:o Stereotyped motor or verbal behaviors, or

unusual sensory behaviorso Excessive adherence to routines and

ritualized patterns of behavioro Restricted, fixated interests

Cont.

• Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) (APA:DSM-V Development, 2010). • Two standardized test

Autism Diagnostic Observation Schedule Autism Diagnostic Interview-Revised

Early signs of ASDAutism- begins at 3 years and sometimes

earlier, autistic regression Asperger syndrome- takes longer because

the symptoms don't appear as severeParents can see a difference, usually after

3 years old 6 months: no big smiles other joyful

expressions9 months: no back-and-forth sharing of

sounds, smiles, or other facial expressions

Early Signs Cont.

12 months old:o no consistent response to own nameo no babbling o no back-and-forth gestures; pointing, showing,

reaching, waving, or three pronged gaze16 months old:

o No words24 months old:

o No two-word meaningful phrases Any loss of speech or babbling or social skills at any age

Psychological/ Behavioral Char.

• impaired Social Interactiono deficits in social responsivenesso Asperger Syn.: They can't read social cues.

H.C.• Impaired communication

o 50% are thought to be muteo if they develop speech, they show

abnormalities volume, rate , content- pragmatics robotic echolaia- parroting what they hear

o joint attention• Repetitive behavior

o ritualistic motor behaviors

cont. • extreme fascination with objects

o upset if the environment is changedo want sameness, same routine

• impaired cognitiono difficulty coding and categorization o example of shoppingo excel at activities like puzzleso Autistic Savants- remarkable talent- playing

music,drawing, calculating,etc.o react poorly to verbal comprehension and

expressive language• Abnormal Sensory perceptions

o hypersensitivity - lights, sounds

Construct Unifying theory of

ASD's • Three theories

o Executive function working memory, self-regulation of

emotions, plan aheado central coherence

get caught up in the detailso Theory of mind

ability to know what others are thinking• intentions• feelings• beliefs • desires

Autism Speaks: Videos

http://autismspeaks.player.abacast.com/asdvideoglossary-0.1/player/autismspeaks

Educational Considerations

• No set treatmento Experimental treatment

• However educational programs should includeo Direct Instructiono Instruction in natural settingso Behavioral management

Educational Considerations:

Direct Instruction

• APA - Applied Behavior Analysis o Highly structured approach that focuses on

teaching functional skills and continuous assessment of progress

o Developed in the 1960's o Emphasizes the positive desired behaviorso Do not use punishment as a way to teach ASD

children right from wrong

• It is important to have the ASD students in a normal setting where students without ASD or a disability learn

• Keeping them in the general ed classroom with guided instruction may be better than complete isolation

Educational Considerations:

Instruction in a Natural Setting

Educational Considerations:

Behavioral Management

• Two forms of treatment of behaviora. Functional Behavior Assessment (FBA)

Determine: Consequences, Antecedents, and Setting Events

AKA --- A-B-C Approach --- (App)• Antecedents - tired, sick, lack of structure, too long

waiting time, not getting attention• Behavior - type and degree of aggression • Consequences - result of behavior - child punished,

ignored, what were the reactions of other studentsb. Positive Behavior Intervention and Support

(PBIS) Focuses on supporting the positive

behaviors rather than punishing the negative

Educational Considerations:

Examples of Educational

Programs• Picture Exchange Communication

System (PECS)o Use pictures to help student initiate and

maintain functional communication without being verbal

• Social Storieso Used for students who may be able to

verbally communicate but do not understand or interpret social cues

o Teachers use real life learning situations to teach students the proper way to act or react in the form of a narrative

Educational Considerations:

Examples of Educational

Programs• Pivotal Response Teaching (PRT)o Based on the assumption that some skills are

critical/pivotal for function in other areaso Emphasizes using ABA's (direct instruction)

structured approach of continuous assessment and reliance on behavior learning theory

o Four Areas1. Motivation - natural rewards of child's choosing2. Self-Management - leads to autonomy and independence from control of others3. Initiations - Asking questions, start conversations4. Responding to multiple cues - i.e. going to grab a green shirt

Assessment of Progress

1. Language Development

a. Natural language samples collected in various communicative contexts

b. Parent report via questionnaire or interviews

c. Direct assessment through structured measures

Language Development

Assessment

• MacArthur-Bates Communicative Development Inventory Second Edition (CDI-II)o Works for kids eight to thirty monthso The CDI-III works with kids up to 37 monthso Monitors progress of language development

• Clinical Evaluation of Language Fundamentals-4 (CELF-4)o Works for kids 5 to 21 o Measures receptive, expressive, grammatical,

and semantic skills

Assessment of Progress

Continued2. Social/Adaptive Behavior

a. Maladaptive behaviors assessedi. Sensory/perceptual approach behaviorsii. Ritualisms/resistance to changeiii.Social pragmatic problemsiv.Semantic/pragmatic problems v. Arousal regulation problems vi. Specific fearsvii.Aggressiveness

b. Adaptive behaviors assessedi. Receptive social communication abilitiesii. Expressive social communication abilities

Social/Adaptive Behavior

Assessment • Social Responsiveness Scale (SRS)

o Used for ages 4 to 18o Monitors progress in:

Social awareness, Social Information Processing, Reciprocal social communication, Social anxiety, and Avoidance

• Autism Social Skills Profile (ASSP)o Used to assess social skills of children with ASD such as Social

Reciprocity, Social Participation/Avoidance, and Detrimental Social Behaviors

• Childhood Autism Rating Scale (CARS)o Used for ages above 2 o Mainly used for screening and diagnostic purposes o Focuses on behaviors that deviate from normal development

Early Intervention

• Most programs focus on severe ASD for early intervention• No intervention

program has been proven to help overcome childrens ASD

• National Research Council (NRC) on successful programso Entry into intervention programs as soon as an

autism diagnosis has been established o Active engagement for a full day, five days a

week, for a whole year o One on one teacher-student interactions - small

group worko Parent involvemento Low student-teacher ratio (1:2)o Assessment and adjustment

• Early Intensive Behavioral Interventions (EIBI)

Transition to Adulthood

• Autism: o Majority do not live independently o Depends on level of cognitive functioningo Person-centered planning

Make own decisionso Small residential facilitieso Supported livingo Competitive and Supportive Competitive

Employment

Transition to Adulthood

• Asperger's:o Focuses on social

interaction skills Peer Connections

o Focus on the minimum survival skills needed for independence

o Misunderstood - difficulties adjusting to jobs

Success Story

• Temple Grandino Born August 29, 1947o High-functioning Autismo Diagnosed with autism at age 4 o Early interventiono American Doctor of Animal Scienceo Professor at Colorado State Universityo Advocate for Autism o Never been married "the part of other people

that has emotional relationships is not part of me”

Awareness

Clips of show Parenthood on NBChttp://movies.netflix.com/WiPlayer?movieid=70157304&trkid=3325853Season One: Pilot 17:20 and 34:00Season Two: Episode 18 35:49

Autism Speaks websitehttp://www.autismspeaks.org/

Resources • Temple Grandin

http://en.wikipedia.org/wiki/Temple_Grandin• Textbook:

o Hallahan, Daniel P., James M. Kauffman, and Paige C. Pullen. "Chapter 9: Learners with Autism Spectrum Disorders." Exceptional Learners: An Introduction to Special Education. 12th ed. Upper Saddle River: Pearson Education, 2012. 232-63. Print.

• Netflix • Autism Speaks http://www.autismspeaks.org