AN INTRODUCTION TO AUTISM AND APPLIED BEHAVIOR ANALYSIS

WHAT IS AUTISM SPECTRUM DISORDER? A developmental disorder characterized in

varying degrees by difficulties in social interaction, communication, and repetitive behaviors.

DSM-V merged autistic disorder, Asperger’s and Pervasive Developmental Disorder-Not otherwise specified (PDD-NOS) into one umbrella term: Autism Spectrum Disorder (ASD)

Current statistics identify 1 in 68 American children as on the autism spectrum Prevalence is higher in boys than girls, 1 out of 42

boys and 1 out of 189 girls are diagnosed with autism spectrum disorder

www.autismspeaks.org/what-autism, www.cdc.gov

DSM-V DIAGNOSTIC CRITERIAA. Persistent deficits in social communication and social interaction

across multiple contexts, as manifested by the following, currently or by history

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.

Deficits in nonverbal communicative behaviors 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.

Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers

www.cdc.gov

DSM-V DIAGNOSTIC CRITERIAB. Restricted, repetitive patterns of behavior, interests, or

activities, as manifested by at least two of the following, currently or by history

Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

www.cdc.gov

DSM-V DIAGNOSTIC CRITERIAC. Symptoms must be present in the early

developmental periodD. Symptoms cause clinically significant impairment

in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level www.cdc.gov

EARLY SIGNS AND SYMPTOMS OF AUTISM: POSSIBLE RED FLAGS Not respond to their name by 12 months Not point at objects to show interest by 14 months Not play pretend game by 18 months Avoid eye contact and want to be alone Have trouble understanding other people’s feelings or

talking about their own feelings Have delayed speech and language skills Repeat words or phrases over and over (Echolalia) Give unrelated answers to questions Get upset by minor changes Have obsessive interests Repetitive behaviors (flapping hands, rocking body, spinning) Have unusual reactions to the way things sound, smell,

taste, look, or feelwww.cdc.gov

EARLY SIGNS AND SYMPTOMS OF AUTISM: SOCIAL SKILLS DEFICITS Does not respond to

name by 12 months of age

Avoids eye-contact Prefers to play alone Does not share interests

with others Only interacts to achieve

a desired goal Has flat or inappropriate

facial expressions Does not understand

personal space boundaries

Avoids or resists physical contact

Is not comforted by others during distress

Has trouble understanding other people's feelings or talking about own feelings

www.cdc.gov

EARLY SIGNS AND SYMPTOMS OF AUTISM: COMMUNICATION DEFICITS Delayed speech and

language skills Repeats words or

phrases over and over (echolalia)

Reverses pronouns (e.g., says "you" instead of "I")

Gives unrelated answers to questions

Does not point or respond to pointing

Uses few or no gestures (e.g., does not wave goodbye)

Talks in a flat, robot-like, or sing-song voice

Does not pretend in play (e.g., does not pretend to "feed" a doll)

Does not understand jokes, sarcasm, or teasing

www.cdc.gov

EARLY SIGNS AND SYMPTOMS OF AUTISM: REPETITIVE BEHAVIOR Lines up toys or other objects Plays with toys the same way every time Likes parts of objects (e.g., wheels) Is very organized Gets upset by minor changes Has obsessive interests Has to follow certain routines Flaps hands, rocks body, or spins self in

circles

www.cdc.gov

CAUSES AND RISK FACTORS We do not yet know exactly what causes ASD.

However, progress has been made in identifying some factors that make a child more likely to have an ASD.

There seems to be a genetic factor. Children who have a sibling with ASD are at a higher risk for also having ASD.

The prescription drugs valproic acid and thalidomide have been linked with ASD when taken during pregnancy.

Children born to older parents are at a greater risk for having ASD.

Research continues to search for risk factors and causes of ASD. www.cdc.gov

I THINK MY CHILD MAY HAVE AUTISM, WHAT SHOULD I DO? See your child’s primary care physician Write things down (questions, concerns,

observations) Start early Ask questions Trust your instincts See your local Regional Center

I THINK MY CHILD MAY HAVE AUTISM, WHAT SHOULD I DO? Early Intervention

(0-3) If your child is under

the age of 3, they qualify for early intervention services

The Regional Center and/or insurance company will fund all serivces

School Age (3+) Children 3 and older enter

the school system An IEP will be created, and

the child will receive services through the school district, whether this is speech and occupational therapy, and/or special education services.

The child may also be eligible for services outside of school through the Regional Center and/or insurance company

WHY EARLY INTERVENTION? Neural circuits, which create the foundation for learning,

behavior and health, are the most flexible during the first 3 years of life. Over time, they become increasingly difficult to change.

High quality early intervention services (25-40 hours per week, evidence-based practices) can change a child’s developmental trajectory and improve outcomes for the child and family

Intervention is more effective and less costly when provided earlier in life rather than later

Center on the Developing Child at Harvard University (2008). InBrief: The science of early childhood development. http://developingchild.harvard.edu/download_file/-/view/64/

WHAT IS ABA? Applied behavior analysis is a process of

studying and modifying behavior It is the only evidence-based procedure that

has been tested and proven effective for individuals with autism and other developmental disabilities

By changing the environment (triggers and responses to behavior) we can change the behavior

ABCS OF ABA

AAnteceden

t

BBehavior

CConseque

nce

A = Antecedent = what happens in the environment before the behavior,

what triggers the behaviorB = Behavior = what the person says or does, the responseC = Consequence = what happens in the environment after the behavior,

reinforces or punishes the behavior

HOW WILL ABA HELP MY CHILD? Decrease challenging

behaviors We will take a close look

at any challenging behaviors and determine what purpose the behavior is serving. What is the child trying to communicate with the behavior?

Then we will create a behavior plan and teach everyone involved with the child what to do to prevent the behavior and what to do if the behavior occurs.

Teach new skills A big reason why

children engage in challenging behaviors is because they do not yet have the skills to get what they want and need appropriately.

We break things down into small, manageable parts and teach them systematically until the child has the new skill mastered.

We also focus on making sure that these new skills are used in the natural environment.

HOW WILL ABA HELP MY CHILD? Increase

Independence We place a large

emphasis on functional skills (communication, interacting with others, self-care)

We are thinking about the long-term goal of having the child be as independent as possible

Increase the family’s ability to engage in typical activities We want you to be able to

do things as a family that you would typically do if you didn’t have to worry about big tantrums (e.g., going to restaurants, grocery shopping, going to movies)

We will go out into the community with you and support you in using ABA strategies in these types of situations

WHAT TO EXPECT IN A GOOD ABA PROGRAM Designed by well-qualified

professionals (BCBA) Implemented by well-qualified

professionals (RBT) Individualized and detailed

assessment of the child’s strengths and areas of need

Socially significant, comprehensive, meaningful, and objectively defined treatment goals

Data collection and review resulting in sound clinical practices

WHAT TO EXPECT IN A GOOD ABA PROGRAM

Incorporating numerous ABA techniques and principles

Emphasis on personal independence Abundant learning opportunities

within each and every session Consistent intervention practices

amongst all team members Use of positive practices Generalization of skills to other

people and other environments Regular parent training Regular meetings amongst all team

members

HOW DO I GET ABA SERVICES?

SB-946 This bill passed, requiring private insurance companies to cover

ABA as a treatment for autism Child must have a diagnosis of autism

Medi-Cal In July 2014, the Centers for Medicaid & Medicare services issued

federal guidance to the states indicating that ABA is a covered benefit for children under 21 years.

It is expected that they will begin covering ABA services around late 2015, early 2016, as they are still determining regulations and rates.

Regional Center Regional Center continues to cover services for those with Medi-

cal of self-funded plans not covering ABA services.

RESOURCES Milestone Tracker

2 months to 5 years, developed by the CDC http://www.cdc.gov/ncbddd/actearly/downloads.html

Regional Center www.lanterman.org www.elarc.org

Autism Speaks www.autismspeaks.org 100 day Kit https://www.autismspeaks.org/ family-services/tool-kits/100-day-kit

Autism Health Insurance Project www.autismhealthinsurance.org

Elevate Therapy www.elevate-therapy.com