Intellectual Disabilities and Autism Spectrum Disorder

Jade Johnson, Brenna Brase, Jessica Turner

Table of Contents

Intellectual Disability2

Diagnosis2

Characteristics and Symptoms5

Causes6

Prognosis 9

Specific Needs10

Treatments 10

TR Implications11

Resources12

Autism Spectrum Disorder16

Diagnosis19

Characteristics 20

Secondary Symptoms20

Prognosis21

Specific Needs23

Treatments25

TR Implications28

Resources29

References31

Intellectual Disability/Mental Retardation

Intellectual disability is the most common type of developmental disability. It was formerly known as mental retardation until 2010 when President Barrak Obama signed a bill called Rosa’s Law. This law caused “mentally retarded” and “mental retardation” to be struck out from all federal records. These terms had come to be derogatory to those who had intellectual disabilities. Now known as “intellectual disabilities”, the conditions and populations are the same but now are titled by a nameless demeaning.

“Intellectual disability can be defined as a disability characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.” (aidd.org). People with Intellectual Disability (ID) have either a below-average intelligence functioning, or a mental ability that affects their ability to reason, learn, solve problems, and make decisions. People that have ID also lack adaptive behavioral skills which are necessary for daily life. Adaptive behavioral skills can include social skills, being able to take care of oneself, and communicating effectively. Children with ID can develop new skills and take in new information but it often takes them longer than their peers to do it. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, pg. 201-211)

Diagnosis

Deficits in intellectual functioning must be two standard deviations below the norm or an intelligence quotient (IQ) of 70-75 or less.

Four Levels of Cognitive Impairment:

1. Mild Intellectual Disability: IQ of 50-69 (AMA, 2009). This accounts for the majority (85%) of the persons with ID (Reynolds & Dombeck, 2006). These individuals can be expected to achieve the mental age of 9-12 years (World Health Organization [WHO], 2007).

2. Moderate Intellectual Disability: IQ range of 35-49 (AMA, 2009). This accounts for approximately 10% of the individuals with ID (Reynolds & Dombeck, 2006). These individuals can be expected to achieve the mental age of 6-9 years (WHO, 2007).

3. Severe Intellectual Disability: IQ range of 20-34 (AMA, 2009). This accounts for approximately 3-4% of the individuals with ID (Reynolds & Dombeck, 2006). These individuals can be expected to achieve the mental age of 3-6 years and require continuous support throughout their lives (WHO, 2007).

4. Profound Intellectual Disability: IQ range below 20 (AMA, 2009). This accounts for approximately 1-2% of the individuals with ID (Reynolds & Dombeck, 2006). These individuals can be expected to achieve the mental age below three years and have severe limitations in communication, self-care, and mobility (WHO, 2007).

The diagnosis of ID does not depend solely on IQ, but largely on adaptive behaviors.

Adaptive behavior: skills that represent an individual’s level of personal independence and social responsibility. They are based on cultural expectations of performance at various ages throughout life.

The American Association of Intellectual and Developmental Disabilities (AAIDD) identified three areas of adaptive behavior skills that challenge individuals with ID:

1. Conceptual Skills: self-direction, orientation to time, money and its value, number concepts, and language

2. Social Skills: following rules, interpersonal skills, social responsibilities, social problem solving, gullibility, ability to avoid being victimized

3. Practical Skills: occupational skills, safety, use of money, telephones, healthcare management, personal skills, activities of daily living

It is vital that those with ID are diagnosed so that they can receive the services they require. In addition, there are a large variety of other disabilities and disorders that can occur in tandem with ID.

· Angelman syndrome

· Autism Spectrum Disorder

· Cerebral Palsy

· Cornelia de Lange syndrome:

· Cri-du-chat syndrome:

· Dandy Walker syndrome:

· Down syndrome

· Fetal alcohol syndrome:

· Fragile X syndrome

· Hurler syndrome

· Hydrocephalus

· Prader-Willi syndrome

· Shaken baby syndrome

· Turner syndrome

· Williams syndrome

(Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, 201-211)

Symptoms

The identifying symptoms of intellectual disabilities are generally found in adaptive behavior (see definition above). Skills such as tying their shoes, buttoning buttons, zipping zippers, identifying shapes and colors may not come at the same time as generally expected and observed by their peers. Individuals with ID may also have trouble with their nervous system, experience motor delays or motor planning deficits, balance deficits, hypo or hypertonicity, obesity, and depending on the case also seizures, visual and/or hearing loss, and cardiac issues such as aortic regurgitation or mitral valve prolapse. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability pg. 202-203).

Secondary Problems

Intellectual disabilities are often comorbid with other disorders. For example, 50% of individuals with Autism, and 50% of individuals with cerebral palsy always have ID. Almost every individual with Down syndrome has ID as well. Under the heading “Diagnosis” is a list of other disorders or disabilities that are commonly diagnoses alongside ID.

Individuals with ID also have a greater predisposition to developing Alzheimer’s disease as they age -specifically those with Down syndrome. It is not uncommon to have sensory processing deficits as well. These are identified by hyperactivity, attention problems, stereotypic behaviors, self-stimulation, avoidance of touch or movement, disregard for others, and the inability to interact with others. Other secondary problems that may occur include seizure activity, physical disability and neuromuscular impairments, mental illness, and occasionally criminal behavior. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability pg. 203-204).

Causes

There are 5 main causes of ID which are genetic conditions, problems during pregnancy, problems at birth, problems after birth, and poverty and cultural deprivation.

1. Genetic Conditions: Genetic abnormalities inherited from the parents. This could include errors in the combining or grouping of genes, damage to genetic material during pregnancy (due to overexposure to X-rays), or chromosome abnormalities. Some examples of genetic conditions are:

a. Down Syndrome- As the most common genetic origin of intellectual disabilities, Down syndrome is caused by an error in cell division during prenatal growth and results in an extra chromosome 21. To know for sure if a child has Down syndrome, a blood test must be done to show if an extra chromosome 21 is pregnant. Some symptoms of Down syndrome cause the brain to be shaped differently, resulting in a smaller total volume of the brain. 1 in 800 children will be born with Down syndrome (the other one).

b. Williams Syndrome- Williams Syndrome is caused by a mutation of chromosome 7 which causes a fragment of the chromosome to be missing. This causes a delay in speaking, walking, becoming independent and developing physically. They also can have difficulties focusing (https://williams-syndrome.org/what-is-williams-syndrome)

2. Problems during pregnancy: This could include malnutrition or illnesses that the mother developed during pregnancy such as AIDS, syphilis, rubella, and toxoplasmosis. Also drugs and alcohol used by the expectant mother can cause intellectual disability.

a. Toxoplasmosis is caused by a parasite. Although the parasite can be found throughout the world in warm-blooded animals, in the United States it is found mostly in cat feces. The parasite can live in the ground and can spread to humans by people getting dirt in their mouths. For this reason, pregnant women are advised not to garden and not to clean cat litter boxes during pregnancy. The symptoms are invisible to the pregnant women, but can manifest themselves in the newly born child in the form of jaundice, rashes, and an enlarged spleen and liver. Symptoms of an intellectual disability will manifest themselves in the child months or years later.

b. Rubella is commonly referred to as the “German Measles”, and can cause serious birth defects in a developing baby if the mother is infected. These defects include heart problems, loss of hearing and eyesight, and intellectual disability. (https://www.cdc.gov/rubella/pregnancy.html)

3. Problems at birth: Delivery problems that cause oxygen deprivation or birth injuries, such as meconium aspiration or intracranial hemorrhage, low birth weight, prematurity.

a. Meconium Aspiration Syndrome is a respiratory distress in a newborn child who has breathed meconium (which is its first stool) into the lungs before or around birth. Fetuses can pass stools caused by stress (such as having a lack of oxygen). This stress may cause them to inhale reflexively which in turn causes them to inhale meconium. The meconium can cause a block in the lungs which in turn block the oxygen to the brain causing possible brain damage which can turn into an intellectual disability. (http://www.merckmanuals.com/home/children-s-health-issues/problems-in-newborns/meconium-aspiration-syndrome)

b. Intracranial Hemorrhages are also known as brain bleeds and are caused by traumatic birth injury. They can be caused by medical negligence which could include trauma during delivery, mistakes that cause oxygen deprivation in the infant, misuse of vacuum extractors and improper delivery techniques. This causes abrupt, rapid bleeding within the skill of the newborn baby. Intracranial Hemorrhages are more common in premature babies. https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/traumatic-birth-injuries/intracranial-hemorrhages/

4. Problems after birth: Oxygen deprivation caused by near drowning, mercury or lead poisoning, head injuries, cerebrovascular accidents in children, brain damage caused by shaken baby syndrome, diseases such as encephalitis and meningitis.

a. Traumatic Brain Injuries can be caused by a blow to the head, a fall, an auto accident or being dropped. Many of these injuries can be prevented.

b. Encephalitis is an inflammation of the brain itself. It can be caused by many things including parasites, viruses, bacteria and autoimmune reactions.

5. Poverty and cultural deprivation: Children raised in poverty have higher risk for malnutrition and disease, and are exposure to environmental hazards which put them at risk for Intellectual Disability. Impoverished conditions hinder children from being exposed to healthy, stimulating environments that are required for proper neurological development. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, pg. 201-211)

a. Malnutrition can affect a child both before birth and after. If the mother is malnourished during pregnancy it can hinder the development of the fetus because they are unable to get the right nourishment. This malnutrition is also dangerous for young children whose brains are growing and developing rapidly and need proper nutrition to do so.

b. Environmental hazards (for example, even something as simple as mold growing in the house) can cause problems in developing children. Children exposed to environmental hazards are more likely to develop serious upper respiratory tract infections, dyspnea, and asthma and sinus infections. The lack of oxygen to the brain caused by these things in early childhood can have long term effects on the brain.

Prognosis

Prognosis varies depending on the level of ID and associated handicapping conditions. Individuals with mild intellectual disability should be able to live in the community with supervision for finances, home maintenance, and vocational assistance. The main barriers that occur are social and language. One with a moderate ID will generally require in home-maintenance -they require support for community-based leisure participation including set-up, planning, organization structure, and supervision. Those with Severe ID will generally require foster care or a residential setting for significant daily support. This population will often have physical development deficits, and speech and language deficits. They will require great supervision. Profound ID also requires foster care or a residential setting for treatment. However, they generally require one-on-one care 24 hours a day. They will need lots of assistance verbally and physically. The best way to determine an individual’s prognosis is to evaluate their functional ability, not their measured IQ. Because of medical advances, those diagnosed with ID tend to live longer and have a higher quality of life. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability pg. 204).

Specific Needs

Those with Intellectual Disabilities vary in the degree of assistance and support required. Despite the severity of impairment, a support team consisting of family members, school teachers, medical staff, and therapists is critical to teaching as many skills as possible. Early intervention can identify the individual needs for each child. In addition, special education programs, day programs, and transition services provide additional support and resources along the way. Among these services, individuals with ID need an advocate that is educated on the rights of their child to inclusive services. As individuals with ID are included into the community, not only will their quality of life increase but also the quality of the lives around them as they grow in empathy and connection.

Treatment

There is no cure for intellectual disability. It is a disability that people must live with their entire lives. Although, with the right help, they can become functioning and contributing members of society. The goal is for them to become independent and to advocate for themselves. They can learn to understand social and communication skills, and to take care of themselves physically. With support, many are able to hold jobs and provide for themselves financially.

Physical recreation and exercise have been shown to improve strength, mood, and overall health in individuals with ID. Exercise also helps them to eat healthier and keep weight gain at bay. The blood flow stimulates their brain and body and helps them to have energy to perform daily functions.

Because many people with ID have a hard time functioning in social settings, it is important for them to have practice and experience interacting with other people. Social skills can be hard to grasp for some and easier for others. Each individual with ID needs individualized help.

Support systems are crucial. Supports can be professionals, family, friends or community. Service systems can provide support such as job coaching to give people with ID a little extra help on the job. This help can also be provided by a parent, sibling, or co-worker. Supports can help people with ID achieve the goal to be independent. http://www.thearc.org/learn-about/intellectual-disability/treatment

TR Implications

The most frequent recreational activities for those with Intellectual Disability are television, music, phone conversations, crafts, walks, shopping, and car rides. Changing leisure participation will increase health since these individuals generally have a sedentary life style. Barriers to additional recreational activities include the “lack of transportation, finances, recreational skill, personal attitudes, the disability itself, lack of partners, and a lack of empowerment or control over leisure time” (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, pg. 201-211). In order to best aid individuals to achieve self-determination and quality of life, it is vital that TR professionals aid individuals to overcome these barriers through leisure education and skill training. As individuals with ID increase the number of activities that they can participate in, the connections with other individuals during participation, and the skills needed to participate, they will increase in their self-efficacy and fulfillment. With leisure education, functional skills, and knowledge of resources, individuals will be able to maximize their independence in the community.

As with all individuals, it is vital to assess the severity of disability in order to best meet the needs of the individual. Common skills taught through therapeutic recreation are social skills, fine motor skills, recalling rules, attending to tasks, following directions, making decisions, problem solving, meal preparation, money management, computer usage, and so on (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, pg. 201-211).

Resources

Local

· IEP’s in school systems

· http://www.utahparentcenter.org/disability-resource-book/

· Courage Reins Therapeutic Riding Center- www.couragereins.org

· Recreation and Habilitation Services - www.rahservices.org

· TURN Community Services - www.turncommunityservices.org

· University Accessibility Center - https://uac.byu.edu/

State of Utah

· Utah Parent Center- http://www.utahparentcenter.org/disabilities/id/

· Division of Services for People with Disabilities- http://dspd.utah.gov/resources/

· Utah Association for Intellectual Disabilities- http://www.uaidutah.org/

· http://www.snrproject.com/Resource/Links/UTAH

· Mutual Respect, Advocacy, and Understanding of Utah - www.mrau.org

National and International

American Association on Intellectual and Developmental Disabilities (AAIDD)

An advocacy group promoting research, best practices, progressive policies, and universal human rights for people with intellectual and developmental disabilities. www.aaidd.org

Special Olympics International

Non-profit organization supporting recreation and sport participation for people with ID. www.specialolympics.org

The Arc

Advocacy and research group. www.thearc.org

Best Buddies

Best Buddies® is a nonprofit 501(c) (3) organization dedicated to enhancing the lives of people with intellectual disabilities by providing opportunities for one-to-one friendships and integrated employment. Best Buddies has six formal programs for individuals with intellectual disabilities at various ages and stages of life. www.bestbuddies.org

Center for Disability and Development

Dept. of Educational Psychology

Web: cdd.tamu.edu

Elwyn

Elwyn is a non-profit human services organization recognized nationally and internationally as experts in the education and care of individuals with special challenges and disadvantages. Their goal is to help people with special needs maximize their potential and live happier, meaningful lives through residential services, education, rehabilitation, and vocational and employment services.

www.elwyn.org

National Association for Down syndrome

NADS is the oldest organization in the country serving individuals with Down syndrome and their families. Their mission is to ensure that all persons with Down syndrome have the opportunity to achieve their potential in all aspects of community life by offering information, support, and advocacy.

Web: www.nads.org

TASH (formerly The Association for Persons with Severe Handicaps)

TASH is a civil rights organization for, and of, people with intellectual disabilities, autism, cerebral palsy, physical disabilities and other conditions that make full integration a challenge. They provide information, linkage with resources, expert assistance toward fighting inequities, legal expertise, and targeted advocacy.

www.tash.org

Voice of the Retarded

Voice of the Retarded (VOR) is the only national organization that advocates for a full range of quality residential options and services for persons with intellectual disabilities, medically fragile conditions, and challenging behaviors. They advocate for appropriate placement and watches and acts when legal actions in any state threatens residential choice or guardianship issues.

Web: www.vor.net

Other websites with great information:

· http://www.parentcenterhub.org/repository/intellectual/

· https://www.lds.org/topics/disability/list/intellectual-disability?lang=eng&_r=1

· http://www.projectidealonline.org/v/intellectual-disabilities/

· http://www.rhd.org/Programs/IntellectualDisabilities.aspx

· http://prntexas.org/intellectual-disability/

· http://www.apdda.org/resources.aspx

· List of organizations national and international

· http://www.clearhelper.org/resources/cwa/sites/orgs/id/US/

· National list

Autism Spectrum Disorder

“ASD is a neurodevelopmental disorder that is diagnosed on behavioral and developmental characteristics rather than medical, anatomic, or specific genetic markers…. There is no single behavior that is always seen in ASD, nor is there a single behavior that can disqualify an individual from being diagnosed with ASD… it’s the collection of social communication, and behavioral impairments.” (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum Disorder, pg. 39-49) Autism spectrum disorder includes:

1. Communication and social interaction deficits.

2. Social-emotional reciprocity, maintaining relationships

3. Nonverbal cues and communication

4. Interests or activities that are repetitive and restricted

5. Sameness insistence, inflexibility to change

6. Fixed interests of high intensity and focus

7. Hyper-sensitivity or hypo-sensitivity to sensory input

“ASD now encompasses the previous DSM-IV Autistic Disorder (autism), Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (APA, 2013).” (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum Disorder, 39-49)

According to the DSM-5, there are three levels of severity of the ASD:

Level 1, requires support: Impairments exist in initiating and sustaining social interactions because of social communication deficits. These behaviors interfere with functioning abilities.

Level 2, requires substantial support: Distress is caused when change is required. Repetitive, restrictive behaviors are obvious, as are social impairments, even when social support is in place.

Level 3, requires very substantial support: Very limited initiation and response in social interactions. Repetitive, restrictive behaviors are extremely inflexible. The difficulty to change focus interferes with functioning in activities.

Autism is commonly divided into sections of “low functioning” and “high functioning.” Low functioning individuals on the Autism Spectrum Disorder demonstrate little awareness of those around them, appear to be mentally handicapped, often socially impaired, less able to function in daily living, and has less research. High functioning individuals on the Autism Spectrum Disorder are socially aware, have good language skills, and appear relatively “normal”.

“Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About one third of people with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support.” (Autism Speaks)

Because the Autism spectrum is so broad, “There is no single behavior that is always seen in ASD, nor is there a single behavior that can disqualify an individual from being diagnosed with ASD.” (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum Disorder, 39-49)

Demographic information:

· Intellectual ability of children with ASD varies greatly. About half of the children have average or above-average intellectual ability (i.e., IQ above 85) compared to only one-third 10 years ago.

· Boys remain more likely to be identified with ASD with one in 42 diagnosed compared with one in 189 girls.

· Prevalence also varied by racial/ethnic group, with non-Hispanic white children 30% more likely to be identified than non-Hispanic black children and 50% more likely than Hispanic children.

· A greater number of black children (48%) were classified within the range of intellectual disability vs. 38% of Hispanic and 25% of non-Hispanic white children.

· Median age at diagnosis remains 4 years of age, although resources enable diagnosis for some patients as young as 2 years old.

· “There are 70 Million people in the world with autism, 85% of them live in developing countries.”

· Incidence of autism among siblings is 1:1000 but among twins increases to 1:80

· Children with autism are more likely to develop epilepsy

· http://www.aappublications.org/content/early/2014/03/27/aapnews.20140327-1

· http://www.wsj.com/articles/autism-rates-higher-among-certain-immigrants-minorities-1403543838

· http://autism.lovetoknow.com/Low_Functioning_Autism

· http://www.brighttots.com/Autism/Low_Functioning_Autism.html

- https://www.autismspeaks.org/what-autism

- About 40% of individuals with ASD also have ID

- http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

- https://www.cdc.gov/ncbddd/autism/facts.html

- https://www.scientificamerican.com/article/autism-it-s-different-in-girls/

- http://www.asha.org/public/speech/disorders/Autism/

Diagnosis

A typical diagnostic evaluation involves a multi-disciplinary team of doctors including a pediatrician, psychologist, speech and language pathologist and occupational therapist.

“Autism and related disabilities, such as PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified), and Asperger’s Syndrome are difficult to diagnose, especially in young children where speech and reasoning skills are still developing. Parents who suspect autism in their child should ask their pediatrician to refer them to a child psychiatrist, who can accurately diagnose the autism and the degree of severity, and determine the appropriate educational measures. Autism is a serious, lifelong disability. However, with appropriate intervention, many of the autism behaviors can be positively changed, even to the point that the child or adult may appear, to the untrained person, to no longer have autism, and have a full range of life experiences.”

(http://www.autism-pdd.net/diagnosing-autism-what-you-should-know)

Symptoms

These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors

Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age

· 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years.

· 1 out of 42 boys and 1 in 189 girls

· Early intensive behavioral intervention involves a child's entire family, working closely with a team of professionals. In some early intervention programs, therapists come into the home to deliver services. This can include parent training with the parent leading therapy sessions under the supervision of the therapist. Other programs deliver therapy in a specialized center, classroom.

· Unlike people with other forms of autism, people with high-functioning autism or Asperger's syndrome want to be involved with others. They simply don't know how to go about it. They may not be able to understand others' emotions. They may not read facial expressions or body language well. As a result, they may be teased and often feel like social outcasts. The unwanted social isolation can lead to anxiety and depression.

· (http://www.webmd.com/brain/autism/high-functioning-autism#1)

Secondary Symptoms

Sensory over-responsivity- “not being able to inhibit sensations effectively (Karanowitz, 2005). Individuals tend to have “melt-downs” regularly, because they cannot control how their brain responds to stimuli (b152 Emotional Functions, b156 Perceptual Functions).

Sensory under-responsivity- “react less intensely to sensory information than normally developing individuals (b2 Sensory Functions and Pain. Here it seems to take much more neural activity to reach a responsive threshold (Kranowitz, 2005).”

Sensory seeking- “need more intense sensory input than typically developing children. These individuals often exhibit high levels of self-stimulation (b156 Perceptual Functions, b160 Thought Functions) and tend to bump, press, spin, and jump more than other children (Kranowitz, 2005).

Mixed Sensory Processing Disorder- “They might be unable to stand loud noises, but see physical sensory stimulation constantly (Kranowitz, 2005).”

Self-injurious behaviors- self-inflicted and causes physical injury to the individual

Prognosis

There is no known cure but treatment can greatly improve functioning.

“With the appropriate support and services, most individuals with ASD will find employment, form relationships, and continue to learn and to develop throughout their lives (NIMH, 2011).”

“Scientific studies have demonstrated that early intensive behavioral intervention improves learning, communication and social skills in young children with autism. While the outcomes of early intervention vary, all children benefit. Researchers have developed a number of effective early intervention models.

Growing evidence suggests that a small minority of persons with autism progress to the point where they no longer meet the criteria for a diagnosis of autism spectrum disorder (ASD).

You may also hear about children diagnosed with autism who reach “best outcome” status. This means they have scored within normal ranges on tests for IQ, language, adaptive functioning, school placement and personality, but still have mild symptoms on some personality and diagnostic tests.”

· https://www.youtube.com/watch?v=QdhwsK7E6cc -visual

· https://www.youtube.com/watch?v=K2P4Ed6G3gw -auditory

“The best established prognostic factors for individual outcomes with ASD are presence or absence of associated intellectual disability and language impairment and additional mental health problems.”

(Autism Speaks)

Specific needs

The primary need in ASD, as with any disability or disorder, is early intervention. Identifying ASD at an earlier age will lead to greater success later in life.

· Early intervention services (0-2 years old)

· Special Education Services (3 years old and older)

The following "red flags" may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don’t delay in asking your pediatrician or family doctor for an evaluation:

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

· No back-and-forth sharing of sounds, smiles or other facial expressions by nine months

· 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 meaningful, two-word phrases (not including imitating or repeating) by 24 months

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

· Taken from Autism Speaks Website

Early intervention will aim to address the following needs common to the majority of individual on both ends of the Autism Spectrum:

1. Community integration and meaningful relationships

2. Communication and social skills

3. Reduce maladaptive behaviors: “Maladaptive behaviors are behaviors that interfere with everyday activities, and include self-injurious behavior, withdrawal, uncooperative behavior, aggression, and destruction of property. Although maladaptive behaviors are often exhibited by people with ASD (Aman, Lam, & Collier-Crespin, 2003; Hollander, Phillips, & Yeh, 2003; Shea et al., 2004) and are noted as an associated condition in the DSM-IV definition of autism (APA, 2000), there has been relatively little research documenting their prevalence and course.” Taken from: http://www.waisman.wisc.edu/family/pubs/Autism/2007%20Shattuck%20Seltzer%20change%20autism%20symptoms%20behaviors%20in%20ASD.pdf

4. Additional medical concerns: sleep disturbance, seizures, and gastrointestinal (GI) distress.

5. Self-initiation, motor skills and daily living

Treatment

Although there is no known cure, it is common to treat positive symptoms of ASD which include (and sometimes comorbid with) anxiety, aggression, depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, psychotic disorders, bipolar disorder, and oppositional defiant disorder. It is also important to reduce sensory exposure, increase structure, simplify expectations, and facilitate emotional awareness.

Another way to help people on the Autism Spectrum Disorder is to educate their families. If families are educated, they will better know how to help their family member handle the difficulties that come with having autism. Often, people with autism struggle with communicating how they feel. If families can know what kind of things are difficult for them, they will be better able to be helped.

Specific Tests (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum Disorder, 39-49):

· “The Modified Checklist of Autism in Toddlers (M-CHAT) is a list of informative questions about your child. The answers can indicate whether he or she should be further evaluated by a specialist such as a developmental pediatrician, neurologist, psychiatrist or psychologist. (Take the M-CHAT here.)” (Autism Speaks)

· Autism Diagnosis Interview - Revised (ADI-R)

· Conducted with the caregiver

· Assess child’s communication, social interactions, repetitive behaviors, and age-of-onset

· Autism Diagnostic Observation Schedule (ADOS-G)

· Uncovers socio-communicative behaviors that are often delayed, abnormal, or absent in children with ASD

· Childhood Autism Rating Scale

· Evaluates the child’s body movements, adaptation to change, listening to response, verbal communication, and relationship to people

· Good for children over 2

· School Social Behavior Scales (SSBS)

· Evaluation of social skills (social competence and antisocial behavior)

Treatments found by the National Autism Center (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum Disorder, 39-49):

· Antecedent package

· Behavioral package: reduce problem behaviors and teach functional alternative behaviors. Ex: token economy strategies and task analysis

· Comprehensive behavioral treatment for young children: early interventions across all settings

· Joint attention intervention: teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactions

· Modeling: demonstrate target behavior

· Naturalistic teaching strategies: providing an stimulating environment, encouraging conversation, milieu teaching

· Peer training package: teaching children (peers or siblings) without disabilities strategies for facilitating play and social interactions with children on the autism spectrum.

· Pivotal response treatment: self-initiation or social communication

· Schedules: use lists to complete activities

· Self-management: promote independence by training individuals to regulate their own behavior

· Story-based intervention package: telling of a task, skill, or action to be accomplished in a story format

TR implications

When using therapeutic recreation to help treat those with autism or other intellectual disabilities, it is crucial to note that every individual is unique; no diagnosis is the same. It is more important to utilize the whole team to benefit the individual than to follow a set process or approach. Often treatment occurs as a part of a child’s IEP at school. These interventions should be highly structured and specialized programs -this will help reduce anxiety, provide a sense of control, and target specific needs of the child. The most important outcomes these interventions should target are: effectively supporting peer friendship development, focusing on communication and social skills, and increasing engagement and involvement in activities with peers rather than parents or other adults. Autism Speaks suggests that young children diagnosed with early signs of autism receive “structured, therapeutic activities for at least 25 hours per week.”

The APIED process is essentially a lifetime process for one with an autism or intellectual disability diagnosis. The disability will not go away, so treatment continues until they are able to apply principles themselves or feel they no longer need it to live in the manner they desire. This is almost always a whole team approach so that all needs can be met. In assessment one must understand specific needs along the spectrum (e.g. sensory profile, communication skills, cognitive processing). In planning, a more highly structured environment will allow them to focus on the task at hand. Certain activities might require too much communication, change, or stimulus and could overwhelm a child. The goal of each activity should be self-determination and efficacy. An example of an activity is a group problem solving game where only two team members can communicate. LEGO blocks are also a beneficial tool. Implementation should be done frequently -the 25 hour recommendation was mentioned above. Evaluation and documentation should continue to occur throughout until the individual’s and therapist’s goals are met completely.

Resources

A wide variety of resources are available from informative websites to programs and research centers. The greatest resources to children with intellectual disabilities and ASD are their families and communities. Those resources are generally facilitated by an Individualized Education Plan (IEP) with the school that child attends. Additional resources on the state, national, and international level provide additional support by connecting students to transition programs, other families with similar challenges, and more.

Local: IEP plan with school

State: Heritage, Scenic View, Daniel’s Academy

National:

International: Global Autism Collaboration

Additional websites for ASD:

https://www.autismspeaks.org/what-autism/world-autism-awareness-day/international-autism-organizations

http://www.autism-insar.org/

http://www.autism-resources.com/links/organizations.html

http://aspergersyndrome.org/

References:

Porter, H. R. (2015). Recreational therapy for specific diagnoses and conditions. Enumclaw, WA: Idyll Arbor.

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