Pervasive Developmental Disability Autism & it’s Intervention

1. Pervasive Developmental DisabilityAutism & it’s Intervention By: Prof. Mallika Banerjee Dept. of Psychology, University of Calcutta

2. What is Developmental Disability is attributable to a mental or combination of mental and physical impairments; is manifested before age 22; is likely to continue indefinitely; results in substantial functional three or more of the following areas of major life activity

3. The areas self-care receptive and expressive language learning mobility self-direction capacity for independent living economic sufficiency.

4. DEVELOPMENTAL DISABILITY PERVASIVE OTHER DEVELOPMENTAL DEVELOPMENTAL DISORDER DISORDER 1) Autism 1) Mental Retardation 2) Asperger 2) Specific Learning Disability 3) Retts’ 3) Other acquired Disorder 4) Childhood Disintegrative Behaviour 5) PDD NOS

5. Autism :Historical Aspects Leo Kanner first identified autism in 1943 when he described 11 self-absorbed children who had "autistic disturbances of affect contact." At first, autism was thought to be an attachment disorder resulting from poor parenting. This has been proved to be a myth. Most specialists now view autism as a brain disorder that makes it difficult for the person to process and respond to the world. Therefore, many scientists believe that, at least in some individuals, autism may be genetic

6. AUTISM A lone even with others U nusual play T widdle and twirl object I ndifference to other people S trange movements and mannerism M ost have a learning disability

7. OTHER SPECIAL CHARACTERISTICS I nappropriate social behaviour S peech impaired or absent O bsessive routins and rituals L ack of normal eye-contact A nxious and distressed by change T antrums and disruptive behaviour E cho words in a meaningless way S ometimes possess a special talent

8. What is Autism? Autism is the most common of a group of conditions called pervasive developmental disorders (PDDs). PDDs involve delays in many areas of childhood development. The first signs of autism are usually noticed around the age of three.

9. Autism is three to four times more likely to affect boys than girls. • Autism occurs in individuals of all levels of intelligence. Approximately 75 percent are of low intelligence while 10 percent may demonstrate high intelligence in specific areas such as math.

10. Some more information Autism begins at early childhood and persists throughout adulthood affecting three crucial areas of development: verbal and nonverbal communication social interaction creative or imaginative play.

11. The very early symptoms of autism • Does not babble, point, or make meaningful gestures by 1 year of age. • Does not speak one word by 16 months. • Does not combine two words by 2 years. • Does not respond to name. • Loses language or social skills. Having any of these five symptoms leads the parent and professionals to have further evaluations for the child by a multidisciplinary team that may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or other professionals knowledgeable about autism.

12. Is there a single cause for autistic symptomology? Social impairments The triad Autism Communication impairments Restricted interests

13. Language Impairment All children with autism display some degree of language impairment. About one-third of children with autism never develop speech and remain mute throughout life. Mutism with severe delay or total lack of speech development. If speech is present atypical or deviant behavior in terms of various aspects of spoken language are seen as the following:

14. Voice, articulation and prosodic abnormalities seen as: poor and inappropriate pitch, loudness and quality, misarticulations, inappropriate rate and rhythm in speech.

15. Stereotyped and repetitive use of language such as echolalia, use of stock phrases on few topics only, repeated questions etc.

16. Pronoun difficulties as in the confusion with pronouns, pronominal reversal as in the use of 'you' for 'I'. Atypical vocabulary development seen as patchy acquisition of vocabulary on a single or a few topics. Ex. Names of objects, fascination with alphabet, date, numbers, etc. Example: a. A child could come out with names of 18 eatables at a stretch. b. Recitation of Sanskrit slokas.

17. Idiosyncratic use of words as in the use of utterances the meaning of which is obscure to others indicating communicative failures. Failure to respond to the communication of others and failure to initiate (spontaneously) and sustain communication indicating problems with interpersonal two-way communication. Semantic and conceptual difficulties as in "case in concrete" use of learnt words and concepts, difficulties with conceptualization and comprehension of heard language, etc.

18. Abnormalities in the use of nonverbal communication as seen in the poverty of facial expressions and gestures as pointing and showing, impaired emotion recognition and expression, etc. Morpho syntactic and Pragmatic Errors telegraphic speech, poor PNG markers, poor comprehension, imaginary observation.

19. SOCIAL SYMPTOMS IMPAIRMENT IN USE OF EYE GAZE, FACIAL EXPRESSION, BODY POSTURES AND GESTURES. DEFICITS IN JOINT ATTENTION SKILLS. LACK OF IMMITATION. LACK OF DRIVE FOR SOCIAL ENGAGEMENT LACK OF INITIATION IN INTERACTION LACK OF RELATING TO PEOPLE

20. SENSORY INTEGRATION DYSFUCTION IT CAN BE DEFINED AS INABILITY OF THE BRAIN TO CORRECTLY PROCESS INFORMATION BROUGHT IN BY THE SENSES. CHILDREN WITH SENSORY INTEGERATION DYSFUNCTION MAY BE HYPERACTIVE OR HYPOACTIVE. THE SYMPTOMS OF SENSORY INTEGRATION DYSFUNCTION CAN BE SUBDIVIDED INTO VARIOUS DOMAINS:

21. VESTIBULAR SYMPTOMS: HYPO- THE NEED FOR ROCKING, SWINGING AND SPINNING. HYPER- DIFFICULTIES IN ACTIVITIES, WHICH INCLUDE MOVEMENT, SPORT,DIFFICULTIES IN STOPPING QUICKLY OR DURING AN ACTIVITY. PROPRIOCEPTIVE HYPO: PROXIMITY- STANDING TOO CLOSE TO OTHERS, NOT KNOWING PERSONAL BODY SPACE, NAVIGATING ROOMS AVOIDING OBSTRUCTIONS, BUMPING INTO PEOPLE. HYPER – DIFFICULTIES IN FINE MOTOR SKILLS, MANIPULATING SMALL OBJECTS.

22. SMELL (ALFACTORY) HYPO- NO SENSE OF SMELL, FAIL TO NOTICE EXTREME ODOURS. HYPER- TOILETING PROBLEM, DISLIKES SHAMPOOS AND PERFUMES. VISION HYPO- MAY SEE THINGS IN DARK, CONCENTRATE ON PERIPHERAL VISION COZ CENTRAL VISION IS BLURRED. HYPER- DISTORTED VISION, FRAGMENTATION OF IMAGES, FOCUSING ON PART THAN ON WHOLE.

23. HEARING HYPO – HEARING CONVERSATION OR SOUND WHICH OTHERS CANNOT HEAR (BELOW AUDIBLE DB) HYPER - CAN’T TOLERATE SOUNDS IN WHICH OTHER’S HAVE NO DIFFICULTY. TOUCH HYPO- HOLDS OTHERS TIGHTLY, HAS HIGH PAIN THRESHOLD, SELF HARMING, ENJOYS HAEVY OBJECTS ON TOP OF THEM. HYPER- TOUCH IS PAINFUL, DISLIKES BRUSHING AND WASHING HAIR. LIKES CERTAIN TEXTURE OF CLOTH.

24. Emotional expression of Autistic children Typically, autistic children do not show any need for affection or contact with anyone They do not understand others’ emotions properly Can’t express their own emotion in a sociable way. Have characteristic ways of showing physical affection toward parents, caregivers and/or adults.

25. Summary Autism is not a single condition but rather there is a spectrum of conditions The core behavioural features observed in autism are actually relatively independent & each can be observed in isolation – related conditions (e.g. PLI) may reflect expression of just one of these features Autism is apparently increasing in prevalence – this is likely due to advances in understanding/diagnosis rather than a true increase

26. Differential Diagnosis MENTAL RETARDATION Appearance – Strikingly intelligent physiognomic of Autistic ·        Early Skill Performance ·        Memory – Excellent Rote Memory ·        Spatial Ability ·        Motor and Manual Ability ·        Special Ability – Idiot Savant Performance

27. Onset & Course – CS follow an initial course of normal development than CA CA innate Course lifelong in case of CA in comparison to CS. Health & Appearance – CS poor health from birth – contrast to CA EEG – CS considerably high abnormality in comparison to CA Physical Responsiveness – Impaired in CA in comparison to CS Autistic aloneness – failing to adjust with others – in both emotional and postural aspects. Preservation of sameness is common to autistic than CS CHILDHOOD SCHIZOPHRENIA

28. Hallucination is common to CS but not CA • Motor performance better in CA than CS • Language impaired in CA – not in CS • Idiot savant performance • Personal Orientation – CS realizes that he is confused – disoriented but CA is unoriented. • Conditionability – Conditioning hard to establish with CA, CS conditioned easily. • Twin – both monozygotic and dyzygotic, more in autism than in schizophrenic. • Family Background – Low divorce rate, high educational background- dramatically different in CS Family Mental Disorder – Low incidence in CA than CS.

29. Apparently normal psychomotor and other physical development upto 5 months after birth. Stereotyped hand movements Loss of social engagement early in the course. Severely impaired expressive and receptive language Unlike Autistic Deceleration of head growth between 5 to 48 months.9 Loss of previously acquired purposeful handskills bet ages 5 –30 months Appearance of poorly coordinated gait or trunk movements Severe psychomotor retardation RETT’S Disorder

30. ASPERGER’s Disorder • Marked impairment in the use of multiple nonverbal behaviours • ·   Lack of social and emotional reciprocity • ·   Lacks in eye-contact, socially approved facial expression, body posture and gesture to regulate social and emotional interaction. • ·   Failure to develop peer relationship. • ·   Lack of spontaneous seeking to share enjoyment, interest and achievements with other people. • ·  Restricted, repetitive and stereotyped pattern of behaviour. • ·  Apparently inflexible adherence to specific, non-functional routines and rituals • · Stereotyped and repetitive motor mannerism (hand flapping etc.)

31. UNLIKE AUTISM No clinically significant general delay in • language •    No clinically significant general delay in • No clinically significant general delay in self • help and adaptive behaviour (other than • social interaction).

32. Apparently normal development up to 2years of age. ·        Qualitative impairment in communication, both verbal and non-verbal ·        Restricted, repetitive, and stereotyped pattern of behaviour ·        Motor stereotype and mannerism UNLIKE AUTISM ·        Clinically significant loss of previously acquired skills, viz, language, social, bowel and/or bladder control, play, motor skills etc. before age 10 years. CHILDHOOD DISINTEGRATIVE BEHAVIOUR

33. A "Theory of Mind" (TOM) A A "Theory of Mind" (TOM) "Theory of Mind" (TOM) TOM is a specific ability to read the Intentions, Beliefs, Feelings, Emotions and desires of others from their external behaviour . TOM proposes that all humans are, by nature, mind-reader, i.e., can interpret other’s mind in terms of theoretical concepts of intentional states such as own beliefs and desires.

34. In recent years, the phrase "theory of mind" has more commonly been used to refer to a specific cognitive capacity: the ability to understand that others have beliefs, desires and intentions that are different from one's own.

35. ToM for AUTISTIC INDIV. Theory of mind refers to the notion that many autistic individuals do not understand that other people have their own plans, thoughts, and points of view. Furthermore, it appears that they have difficulty understanding other people's beliefs, attitudes, and emotions.

36. Autistic people see others as extensions of themselves because they do not have a coherent, independent self that "separates" them from other people. Hence, they instinctively expect others to perceive, think, feel, sense and behave like them.

37. INTERVENTION Behaviour Modelling - LOVAAS Technique - Applied behaviour Analysis - TEACCH - Higashi - Dietary Therapy

38. Recent trend Sensory Integration & Praxis Speech Therapy Emotional Stimulation Dance – Movement Therapy Health & Sex Education Play Therapy Music Therapy

39. Sensory Therapy & Praxis

40. Sensory Integration SI is an innate neurobiological process by which the brain organizes and interprets sensory inputs from different modalities. ·SI is both “a neurological process and a theory of the relationship between neurological process and behavior.”

41. SI Therapy SI impairment – successful integration of sensory input requires treatment ·  This treatment is comprised of vestibular, proprioceptive, tactile, visual and auditory stimulation, developed over the last 30 years by Dr. A. Jean Ayres.

42. Motor Deficits in ASD Gross motor delays Unusual postures, clumsiness, and motor planning problems Motor abnormalities, especially organization and sequencing of movements Difficulties with preparation phases for movement patterns Difficulties with imitation

43. Praxis is the neurological process by which cognition directs motor action; motor or action planning is that intermediary process which bridges ideation and motor execution to enable adaptive interactions with the physical world. (Ayres, 1985)

44. Types of SI Tactile - Various Brushing Technique - Cushion sandwich. - Vibration from a hand-held device. Proprioception Jumping, Riding a swing. Vestibular Riding a static cycle. Ground Tunnel Activities. Walking on a stepper/walker. Visual - Attending to visual specific visual patterns. Auditory - Auditory Integration Therapy

45. Speech & Language Therapy

46. Self Talk Parallel talk Improving eye contact (eye to eye, nose to nose, finger to nose, finger to finger). To follow simple commands Auditory training To follow complex commands (to follow two part commands)

47. Big and small concept Left & right concept Colour concept Body parts concepts Imitation of vocal behaviors Imitation of body movement (gross & fine).

48. Sentence elongation (ami bhat khabo, ami ekhon bhat khabo, ami ekhon garam bhat khabo, ami ekhon garam bhat ar manso khabo) Yes/ No options Understanding questions Ask questions Comprehension of stories

49. Two step, three step and four step stories Action words (who, when, where and why) Verb play (eso, jao, khao etc.) Request assistance Request informatives (what?) Name of objects Defining objects in terms of functions Offers resistance (ma nebe)

50. Justifies own action (tumi ki korcho?) Problem Solving Situational talk Question and answers (random) Topic maintainence Story telling Develop semantics Talk about experiences