AUTISM

1. AUTISM What it is, is not, and how we treat it effectively Marisa R. Leyden, M.A., BCBA

2. Autism: Facts • At present, 1 in 88 children in the United States are diagnosed with an autism spectrum disorder. • It is 4 to 5 times more likely to be diagnosed in boys than girls. • Most cases manifest by age 3 with reliable diagnosis possible as early as age 2. • 1 in 49 children in New Jersey are diagnosed with an autism spectrum disorder. • Currently 80 children in the Perth Amboy school district carry an autism classification

3. Autism: Myths • All people with autism have an intellectual disability • People with autism can’t speak • Autism and schizophrenia are the same • People with autism are savants • Autism is caused by “refrigerator mothers” • Autism is caused by the MMR vaccine • People with autism rock back and forth

4. What is Autism? • According to the DSM IV the essential features of autistic disorder are; • Markedly abnormal or impaired development in social interaction and communication • A markedly restricted repertoire of activities and interests (DSM – IV – TR, 2000)

5. What is Autism? • Autism is considered a spectrum disorder, meaning that a wide range of symptoms are expressed by those people diagnosed “on the spectrum”. • The 5 disorders which make up the autism spectrum are; - Autism (aka; classic autism, early infantile autism, childhood autism, etc.) - Asperger’s Disorder - Pervasive Developmental Disorder – Not Otherwise Specified (PDD – NOS) - Rett’s Disorder - Childhood Disintegrative Disorder

6. What is Autism? • The core features of the autism spectrum disorders are; - Impairment in social interaction - Impairment in communication - Restricted, repetitive, stereotyped patterns of behavior, interests and activities

7. Autism: Social Impairment • Marked impairment in non-verbal behavior • Failure to develop peer relationships • Lack of joint attention • Lack of social or emotional reciprocity

8. Autism: Communication • Delay or lack of speech, with no non-verbal compensation • Where there is speech, lack of ability to initiate or sustain conversation • Stereotyped, repetitive and idiosyncratic language • Lack of varied, spontaneous, make-believe or social imitative play

9. Autism: Behavior • Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal or intense • Rigid adherence to specific non-functional routines • Stereotyped and repetitive motor mannerisms • Preoccupation with parts of objects

10. What is Autism? • REMEMBER – Just becoming familiar with the diagnostic criteria and a list of symptoms will not help us to truly understand autism. • “When you have met an individual with autism you have met one individual with autism.” (Stephen Shore, Ed.D., a person on the spectrum)

11. What is Autism? • What causes autism? • Is autism treatable? • If so, how do we treat it effectively?

12. Autism: Research • Much of today’s research focuses on a genetic link to autism. The most convincing finding in this line of research is the number of monozygotic (identical) twins that are both diagnosed with autism. There is a 60% concordance rate for classic autism and a 92% concordance rate when a broader autism phenotype is studied (Muhle, Trentacoste & Rapin, 2004)

13. Autism: Research • Current research suggests that there are multiple abnormalities that are spread out over several different genes that vary from one individual to another. • Less than a quarter of cases can be accounted for by a single genetic defect (i.e., Fragile X syndrome) or environmental insult (i.e., congenital rubella)

14. Autism: Treatment • 1987 – O. Ivar Lovaas publishes his study “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children” • Compared two groups of “similarly constituted” young, autistic children. One group received behavioral treatment and the other did not.

15. Autism: Treatment • Of the group that received behavioral treatment,47% achieved normal range IQ scores and were successfully placed in 1st grade classrooms in public schools. • Only 2% of the non-treatment group achieved normal educational and intellectual functioning

16. Autism: Treatment • The 11 Established Treatments listed by The National Standards Project are: - Antecedent Package - Behavioral Package - Comprehensive Behavioral Treatment for Young Children - Joint Attention Intervention - Modeling - Naturalistic Teaching Strategies - Peer Training Package - Pivotal Response Treatment - Schedules -Self-management -Story-based Intervention Package

17. Autism: Treatment • All of these established treatments have at least some basis in the behavioral literature and/or make use of strategies described in the behavioral literature • They all employ the following: - Use of positive reinforcement (R+) - Individualized instruction -Data based decision making

18. Visual Support for Students with Autism Creating and Using Schedules and Other Aides in the Classroom

19. Autism: Visual Supports What are visual supports? - Visual Schedules - Activity Schedules - Environmental Picture Cues - Token Boards*

20. Autism: Visual Supports • Why use visual supports for students with autism? - A large body of research to support its effectiveness - Helps to prevent challenging behaviors - Promotes independence

21. Autism: Visual Supports • When to use a visual schedule • When a student is having difficulty with transitions • When a student frequently tries to escape work, “first, then” • How to create a visual schedule • Include everything that the student will do that day including breaks and/or access to preferred activities • Use pictures along with text • Include a way to indicate when activities are done • Helpful Hints • Use the schedule consistently even if you think the student knows the routine • Make sure the schedule travels with the student • Make sure the schedule is always in the students view • Try to alternate between high demand and low demand/preferred activities as much as possible

22. Autism: Visual Supports • When to use an activity schedule -When you want to create more independence during either work or leisure time • How to create/use an activity schedule - Use either a small three ring binder or a photo album - Use either pictures or text if the student is able to read - Choose activities/work that the student has already mastered - Choose activities with a clear end - Keep the schedule brief ; 6 activities or less - End with a reinforcing activity • Helpful hints - Stand behind the student -Initially reinforce after every task completed - NO TALKING

23. Autism: Visual Supports • When to use environmental picture cues • When you want the student to gain independence with actvities of daily living i.e. hand washing, using the toilet, etc • How to create environmental picture cues - List all the steps that are needed to complete the task - Take pictures of the student engaging in each step if possible. If not use very clear pictures that depict each step - Arrange the pictures in order from either top to bottom or left to right - Post the picture strip where the student can see it. • Helpful Hints - Prompt from behind - Reinforce initially after every step - NO TALKING

24. Autism: Visual Supports • When to use a token board • When the student has difficulty waiting for reinforcement • When the student needs a very thick schedule of reinforcement • When you want to increase independence with tasks • How to create a token board • Sturdy board • Velcro • Tokens that are easily reproducible • Helpful Hints - start with a low number of tokens to earn before the student “cashes in” - Be consistent about expectations and schedules of reinforcement - Don’t take away tokens

25. Questions? Thanks everyone