Chapter 7 Autism Spectrum Disorders

1. Chapter 7Autism Spectrum Disorders

2. IDEA Definition Autism is a developmental disability affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance.

3. DSM-IV Definitions (5 sub-types) Autistic Disorder Marked by three defining features, with onset before age 3: 1) Impaired social interaction 2) Impaired communication Delayed or total absence of spoken language 3) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities Preoccupation with parts of objects Inability to relate to others Self-stimulation, bizarre and challenging behaviors

4. DSM-IV Definitions (5 sub-types) Asperger Syndrome Impairments in all social areas, particularly an inability to understand how to interact socially. - Generally do not have language delays - Most have average or above-average intelligence Other Characteristics Repetitive behaviors -- Intense interest in a particular subject or object -- preoccupation with own interests -- difficulty with fine & gross motor activities – impaired use of nonverbal behaviors (eye gaze, facial expressions, body posture) – adherence to routines – superior rote memory – difficulty judging personal space – difficulty understanding feelings – extensive vocabulary -- perfectionist

5. DSM-IV Definitions (5 sub-types) Rhett’s Syndrome A distinct neurological condition that begins between 5 and 30 months of age, marked by - A slowing of head growth - Purposeful use of hands is replaced with stereotypic hand movements (twisting) - Unsteadiness and awkward gait - Severe impairments in language and cognitive abilities - Seizures are common - Primarily affects girls

6. DSM-IV Definitions (5 sub-types) Childhood Disintegrative Disorder Shares characteristics with autistic disorder, but doesn’t begin until after the age of 2 and sometimes not until age 10. - Medical complications are common - Chance for significant improvement is very poor

7. DSM-IV Definitions (5 sub-types) Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) Diagnosis given to children who meet some, but not all, of the criteria for autistic disorder - Impairments in socialization - Difficulties in communication - Restricted interests

8. Characteristics • Impaired social relationships • Communication and Language deficits - Many children with autism do not speak; echolalia (repeating what other have said) is common among those who do talk • Varying levels of intellectual functioning– child can have severe or profound mental retardation or be intellectually gifted • Uneven skill development – areas of superior performance – artistically or musically talented

9. Characteristics • Unusual responsiveness to sensory stimuli • hypersensitive – can’t stand certain sounds, does not like to be touched, does not feel of certain textures • hyposensitive – to not react to stimuli – cannot feel pain, rub and push things into their skin – spin around • Insistence on sameness and perseveration • Throw tantrums when routines are changed • Everything must always be in the same place • Preoccupation with a certain subject

10. Characteristics • Ritualistic and Unusual Behavior Patterns • Rocking their bodies when in a sitting position • Flapping their hands at the wrists • Humming notes over and over again • Stare at his hands or objects • Repeatedly click a ballpoint pen • Aggressive toward others or self-injurious behavior • Bites self • Aggression may be directed toward parents or teachers

11. Prevalence and Causes Prevalence • Recent estimates - Autism occurs in as many as 30–121 in 10,000 people • Boys are affected about 4 times more often than girls • Autism is the fastest-growing category in special education Causes • The cause of autism is unknown • There is a clear biological origin of autism in the form of abnormal brain development, structure, and/or neurochemistry • No evidence of childhood vaccinations causing autism

12. Screening • Early diagnosis is highly correlated with dramatically better outcomes • Autism can be reliably diagnosed at 18 months of age • Many children develop normally during their first year • Signs after the first year include, lack of pointing or gestures, poor imitation of facial expressions, no words by 16 months, lack of smiling, not responding to name, loss of acquired language or social skills.

13. Screening Instruments • Checklist for Autism in Toddlers (CHAT) • Developed in UK – tests for Social Communication – used at 18 months – short questionnaire completed by parent – looks at pointing, pretend play, etc. • Modified Checklist for Autism in Toddlers (M-CHAT) • Expanded American version of CHAT – tests social readiness and communication – point with index finger, bring objects to you, imitate, does child look at object if you point to it • Social Communication Questionnaire (SCQ) • Autism Spectrum Screening Questionnaire (ASSQ)

14. Screening Instruments • Social Communication Questionnaire (SCQ) • Completed by parent – can identify children from 17 to 45 months – completed in 10 minutes • Autism Spectrum Screening Questionnaire (ASSQ) • 27 item checklist completed by parent or teacher – screens for Asperger characteristics -

15. Diagnosis • Childhood Autism Rating Scale (CARS) • Autism Diagnostic Interview—Revised • Autism Diagnostic Observation Scale—Generic • Asperger Syndrome Diagnostic Scale (ASDS)

16. Diagnosis Children who fail screening tests or whose parents have concerns undergo a complete diagnostic evaluation. A diagnosis of Autism should be given by a pediatrician, a psychologist, a psychiatrist, or a neurologist. Rating Scales • Childhood Autism Rating Scale (CARS) • Autism Diagnostic Interview—Revised • Autism Diagnostic Observation Scale—Generic • Asperger Syndrome Diagnostic Scale (ASDS)

17. Educational Approaches • Early Intensive Behavioral Intervention • Has helped some children with autism learn communication, language, and social skills to be successful in general education. • Applied Behavior Analysis (ABA) • ABA is a scientific approach to designing, conducting and evaluating instruction based on empirically verified principals describing functional relations between events in the environment and learning. • Discrete Trial Training • One-on-one sessions – a routine sequence of learning trials are presented (touch the spoon), the child responds and reinforcement is provided for the correct response.

18. Educational Approaches • Visual Supports – interventions using visual cues and prompts to help students gain greater independence. • Picture Activity Schedules • A series of separate photos, icons or words depicting activities a child can perform • Multimedia Activity Schedules • Placing images or videos on a computer depicting activities • Children with autism seem to respond to technology • Social Stories – for tolerating change • Explain social situations, including expected behaviors in a format that is understandable to the child

19. Educational Placement Alternatives Regular Classroom - 31% of children are educated in the regular classroom • Teach communication and social competence • Instead of isolating children, teach within the context of developmentally appropriate activities • Provide for independence – give choices, opportunities to respond, maintain high expectations • Promotes generalization and maintenance of skills

20. Educational Placement Alternatives Resource Room or Special Classroom - 58% of children are educated in a resource room or separate classroom • Due to the child’s severe and pervasive behavioral issues • To increase direct instructional time • Whatever the setting, involvement with parents and consistency between home and school are critical.