Autism Spectrum Disorder (ASD)

1. Autism Spectrum Disorder (ASD) By: Kayla Sproule, Ashley Young, and Deanna Palma

2. What is Autism? Video Clip: https://www.youtube.com/watch?v=4mh75_u0uR8

3. Autism Spectrum Disorder • A developmental disorder characterized by abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests.

4. Defining Autism • A common misperception with autism is that they are portrayed as genius • Most learn to speak or communicate with sign language, picture symbols, and often assistive technology. • Their deficits can impair the way the show and receive affection. • Behavioral Characteristics: Hyperactivity, short attention span, impulsivity, aggressiveness, and sometimes self injurious activity.

5. Defining: An evolving Process • ASD is the least understood and most mysterious disability in special education. • Estimated that 1-1.5 million individuals in the U.S. today have autism. • Fastest growing developmental disability

6. The Early Years • Leo Kanner, a psychiatrist, identified the symptoms that characterize Autism. • He used the word autistic, which means “to escape from reality” to describe the condition. • before Kanner people were given labels such as: Childhood Schizophrenia, feebleminded, idiot, mentally retarded, and imbecile. • He also used the term autistic to describe an “inability to relate to themselves”

7. IDEA • 1990 is when IDEA was reauthorized and autism was added as a discrete category. • 2004 amendments to IDEA define autism as follows: (i) Autism means a developmental disability significantly affecting verbal and nonverbal communications and social interaction, usually evident before age three, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

8. IDEA cont. (ii) Autism does not apply if a child’s educational performance is adversely affected primarily became the child has an emotional disturbance.. (iii) A child who manifests the characteristics of autism after age three could be diagnosed as having autism if the criteria in paragraph ( c)(1) (i) of this section are satisfied.

9. American Psychiatric Association • APA periodically updates the Diagnostic and Statistical Manual (DSM) • Autism First appeared in the third edition in 1977 • The 5th edition was published in May of 2013 and that is when they revised its thinking with ASD. • There are Three levels of Severity: Level 1:Requiring support, Level 2: Requiring substantial support, Level 3:Requiring very substantial support

10. Asperger Syndrome • DSM-5 no longer classifies Asperger as a discrete disability due to considerable overlap with ASD. • First described by Hans Asperger in 1944 • Social disorder, no significant delay in language development

11. History:Psychogenic Theories • During infancy some parents, mostly mothers, withheld affection or exhibited negative feelings toward their child. • Bruno Bettelheim wrote The Empty Fortress:Infantile Autism and the Birth of Self • 1985 Bernard Rimland disputed these psychogenic theories.

12. History:Organic Theories • 1940’s and 50’s Lauretta Bender suggested that autism may be organically based and the mother's behavior was a reaction to the child’s condition. • Biological basis of autism is no longer in question because of its association with intellectual disability.

13. History:Behavioral Theories • Charles Fester was one the the first behavioral psychologists to propose that autism was environmentally determined. • Applied Behavior Analysis: Application of learning principles derived from operant conditioning; used to increase or decrease specific behaviors. • Ivar Lovass initially his work was in the area of self-injurious behavior.

14. Prevalence • Fastest growing developmental disability • 2009, 1 in 110 children ages 3-17 • 2012, 1 in 88 at age 8 • Risk is five times more likely in males than in females • 1991-1192 • 5,400 students • 2011-2012 • 407,000 student • Increase of 7,700 percent

15. Prevalence • 51,000 preschoolers as primary disability • Represents 6.8% of children with a disability • National health concern • High numbers • Financial costs • Numbers are on the rise without reasons • 4 major possibilities

16. Possibilities for Rise in Numbers • Evaluating and diagnosing more accurately including milder forms • Mandated early intervention and specialized services • IDEA added a separate category for autism • Greater public awareness in media • Changing diagnostic criteria

17. Etiology • Suspected factors: • genetic predispositions and abnormal brain chemistry • environmental variables • Family and Twin Studies • supported an underlying genetic vulnerability to ASD • Fragile X syndrome and tuberous sclerosis

18. Etiology • Neuroimaging studies implicate structural abnormalities of the brain • regions: cerebellum, cerebral cortex, and brain stem • multiple regions are likely involved rather one

19. Assessing ASD • ADS should ideally be evaluated by multidisciplinary team including a neurologist, psychologist, developmental pediatrician, speech-language pathologist, and special educator • Intellectual assessment • Screening and Diagnosis

20. Characteristics • Described: mild, moderate, or severe • May exhibit a full range of cognitive development • Many exhibit some degree of intellectual impairment • 10% of individuals with ASD demonstrate extraordinary skills and talents in areas such as math, memory, artistic or musical abilities, and reading.

21. Characteristics • Common Characteristics • repetitive style of playing • might not want to look people in eyes • may prefer to be alone • might have trouble speaking • prefers following the same routine • may repeat words • may enjoy spinning objects • may have trouble playing or talking with others.

22. Social Interaction • Social impairments significantly affect their involvement with others in educational, vocational, and social settings. • Deficits include significant impairment in the use of multiple nonverbal behaviors, failure to develop age-appropriate peer relationships, a lack of spontaneous sharing with others, and the absence of social or emotional exchanges. • Joint Attention • They may fail to take social norms or the listener's feelings into account. • May rely on limited conversational strategies or stereotyped expressions, elaborating on some interest or echoing a previous statement.

23. Communication • 25-30% of children never develop language. • may not be functional or fluent and may lack communicative intent. • Typical communication deficits • delay in receptive and expressive language • improper use of pronouns • marked impairment in conversational skills • stereotypes and repetitive use of language • echolalia or “parroting” the speech of others • Abnormal in rhythm, has an odd intonation or inappropriate pitch, and may sound toneless or mechanical. • Deficits in the pragmatic or social use of language are also common. • Approximately 25-30% of youngsters begin to use words and then suddenly cease to speak, often between 15 and 25 months of age.

24. Communication Deficits • Some of the early prespeech deficits that may facilitate an early diagnosis and early intervention include: • lack of recognition of mother or father's voice • disregard for vocalizations, yet keen awareness of environmental sounds • delayed onset of babbling past 9 months of age • decreased or absent use of prespeech gestures • lack of expressions • lack of interest in or response of any kind of neutral statements.

25. Repetitive and Restrictive Behaviors • Preoccupation with at least one stereotyped and restricted pattern of interest to an abnormal degree, strict adherence to nonfunctional rituals or routines, stereotyped and repetitive motor mannerisms, and preoccupation with parts of objects. • Individuals with ASD may: • play with toys in an unintended fashion • be rigid about routines or object placements • eat few foods or only foods with certain texture • smell food • be insensitive to pain • be unaware of danger • show unusual attachment to inanimate objects • exhibit repeated body movements (hand flapping, rocking, finger licking, spinning, etc.)

26. Education Considerations • 2011-2012 • one-third of school age students with ASD received services in a self-contained classroom • Four out of ten students were assigned to the general education classroom

27. Instructional Approaches • Require a diversity of educational interventions and teaching strategies • Structured, predictable, and geared to persons level of functioning • Appropriate behaviors in structured situations are associated with better outcomes • Programs that being early and are intensive, continuous, and multidisciplinary are most successful • No one instructional strategy is effective with all students • Emphasis on developing functional communication abilities and appropriate social skills is characteristic of most approaches • IEPs might focus on self-help skills along with functional academics • Instructional interventions aim to maximize the individual's independence and future integration in the community.

28. Suggestions for the Classroom • Avoid abstract ideas whenever possible • use visual cues, such as gestures or written words • Avoid speech that students might misinterpret • double meanings or sarcasm • Break down tasks • smaller steps or present in different ways (visually, verbally, and physically) • Assist students with organizational skills • picture of a pencil or reminders of assignments due • Prepare students for change • substitute teacher, rescheduling of classes, or an assembly • Make adjustments for auditory and visual distractions • remove some visual clutter, seating changes if distracted or upset by classroom environment • Facilitate group work • draw numbers or some other way of fair pairing • Most importantly be positive, creative, and flexible!

29. Transitioning to Adulthood • Many individuals with Autism face the same issues as their peers • They show a great interest in others, yet lack the fundamental skills to form friendships

30. Transitioning to Adulthood (cont) • IDEA 2004- requires schools to assist family with transitioning planning no later than age 16 • The future is unfamiliar and full of uncertainty • Planning is based on current as well as future needs • abilities, preferences, interests • Student involvement is critical for success • Included: Daily living skills, communication/social skills, living arrangements, community participation, level of vocational competencies

31. Adults with ASD • Many individuals with Autism Spectrum Disorder are unable to live and work independently • There is no “best” or “correct” placement • Main goal is for maximum independence and integration into society • 2 Main Issues in Adulthood: • Living Arrangements • Employment Possibilities

32. Adults with ASD (cont) Living Arrangements: • If unable to live independently, adults with ASD and their families have the options of… • Residential/Institutional Care • Foster Care • Group Home Settings • Supervised Apartment Living • Living with an adult sibling or other family member

33. Adults with ASD (cont) Employment: • Many adults with ASD face unemployment, or underemployment, although fully capable of the required skills • Individuals often have a difficult time managing social requirements for the workplace • Lacking “Soft Skills” which are just as important as the actual job

34. Adults with ASD (cont) Employment Options: • Sheltered Workshops • Supervised, structured training in specific job-related skills • Disadvantages: Low wages, minimal vocational training, and lack of peer interaction • Supported Employment • The individual works alongside typical coworkers with added intensive training, assistance, and support from a “coach” or supported employment specialist • They also assist in transportation needs, provide information about ASD to coworkers, and interacts between family and the employer

35. Trends • Parents try to remain up-to-date on treatment methodologies by researching online • Susceptible to misguided information • Where to find current, accurate information? • Healing Thresholds website: Provides up-to-date scientific research • http://autism.healing-thresholds.com • National Institutes of Health: Scientifically valid information provided by the federal government • http://nccam.nih.gov

36. Trends (cont) • Information to be cautious of • Treatment based on overly simple scientific theories • Therapies claiming to be effective for multiple, unrelated conditions • Claims that children will dramatically improve, or will be “cured” • Use of reports or anecdotal data rather than carefully designed studies • Lack of peer-reviewed references, or denying the need for a controlled study • Treatments said to have no potential or reported adverse effects • There are no racial, ethnic, or social boundaries for ASD

37. Controversies • Due to so many different causes of ASD, families cannot always be matched to the appropriate treatments • Parents are exposed to a variety of ASD treatments • Many treatments promise parents of “dramatic improvement” or even “cures” for their children • Families rely on anecdotal reports

38. Controversies (cont) • Complementary and Alternative Medicine (CAM) : Unproven techniques and therapies • Includes: dietary/vitamin treatments, hormone injections, music therapy, auditory integration training, and optometric training • Research is limited and often provides mixed results

39. Issues ASD is lacking in… • Large-scale, rigorously designed, replicated intervention studies to compare different approaches • Until further, more appropriate research is provided, parents and professionals must carefully evaluate each treatment option provided

40. Issues (cont) Family Issues: • Affects the entire family • Many families usually spend numerous years talking to different professionals to find answers and related causes of ASD before receiving a diagnosis • Mothers are seen as the typical primary caregivers, while fathers are helpful on specific tasks • Many parents join support groups to cope with the added stress • Siblings should understand ASD appropriate to their age • Support groups are also common to express feelings and ask unanswered questions