Supporting Individuals with Autism Spectrum Disorder-Level 1

1. Supporting Individuals with Autism Spectrum Disorder-Level 1 Dr. David Irwin, CCC-SLP, ASHA Fellow Director Speech-Language Pathology Program and Director of the Autism Center at the University of Louisiana-Monroe Irwin@ulm.edu 318.342.3190, Sugar Hall Room 104/106 www.ulm.edu/autismcenter

2. Disclosure • I do not receive any financial compensation for this presentation from LSHA • Use of various websites and other sources of electronic information included in this presentation are not an endorsement. These are strictly for informational purposes. www.ulm.edu/autismcenter

3. The Autism Center at University of Louisiana-Monroe (AC-ULM)

4. Purposes of the AC-ULM • Purposes • The Autism Center at the University of Louisiana at Monroe shall provide the following for individuals from one year to adulthood (18 years): • 1. A variety of comprehensive evaluations conducted by licensed and certified speech-language pathologists, occupational therapists, and related professionals with the assistance of graduate and undergraduate students; • 2. Consultative and direct services to a variety of agencies/organizations on the specialized needs of individuals with Autism Spectrum Disorders (ASD); and • 3. Classes or seminars for speech-language pathologists, educational and medical professionals, paraprofessionals, students and parents including the northeast Louisiana region and beyond.

5. Objectives for Presentation • At the end of the presentation, participants will be able to: • Describe the components of individuals with ASD • Describe strategies for individuals for social situations • Discuss how to help individuals with ASD being more successful www.ulm.edu/autismcenter

6. What’s new? • Autism Spectrum Disorder (ASD) now replaces Pervasive Developmental Disorder • Eliminates differentiation of: • Autistic Disorder • PDD-NOS • Asperger Disorder • Childhood Disintegrative Disorder • No differentiation with ASD among disorders of etiology such as Rett Syndrome, Fragile X, and other known genetic disorders www.ulm.edu/autismcenter

7. In 2013 the American Psychiatric Association changed DSM-V criteria • Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and social interaction and the presence of restricted, repetitive behaviors. • Social communication deficits include impairments in aspects of joint attention and social reciprocity, as well as challenges in the use of verbal and nonverbal communicative behaviors for social interaction. Restricted, repetitive behaviors, interests, or activities are manifested by stereotyped, repetitive speech, motor movement, or use of objects; inflexible adherence to routines; restricted interests; and hyper- and/or hypo-sensitivity to sensory input. www.ulm.edu/autismcenter

8. Levels of Severity for ASD • According to the DSM-5, individuals who meet the specified criteria are given the diagnosis of "autism spectrum disorder (ASD)" with one of three levels of severity. • Level of severity is defined in terms of the amount of support needed in the area of social communication and with restricted, repetitive behaviors, recognizing that severity may vary by context and fluctuate over time. • Severity ratings are used for descriptive purposes only and not to diagnose or determine eligibility for services (American Psychiatric Association, 2013).

9. Social Communication Domain Category A • A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifested by all 3 of the following: • Deficits in social-emotional reciprocity • Deficits in nonverbal communicative behaviors used for social interaction • Deficits in developing and maintaining relationships appropriate to developmental level (beyond those with caregivers); ranging from difficulties in shared imaginative play and in making friends to an apparent absence of interest in people. www.ulm.edu/autismcenter

10. Restricted Interests and Repetitive Behaviors (RRBs) Category B • B. Restricted Interests and Repetitive Behaviors Domain, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: • Stereotyped or repetitive speech, motor movements, or use of objects • Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change • Highly restricted, fixated interests that are abnormal in intensity or focus;(such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests • Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling, touching of objects www.ulm.edu/autismcenter

11. Categories C and D • C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). • D. Symptoms together limit and impair everyday functioning www.ulm.edu/autismcenter

12. Severity Levels • Level 1: Requiring some support • Level 2: Requiring substantial support • Level 3: Requiring very substantial support • All of the levels of support are related to social communication and/or restricted interests and repetitive behaviors • Depends upon how much support is provided is related to the daily functioning environment of the individual • Individuals with HFA usually require level 1 or level 2 support www.ulm.edu/autismcenter

13. Social Communication Disorder (SCD) • A. Persistent difficulties in pragmatics or the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social reciprocity and social relationships… • B. Persistent difficulties in the acquisition and use of spoken language, written language, and other modalities of language (e.g., sign language) for narrative, expository and conversational discourse… • C. Rule our Autism Spectrum Disorder • D. Symptoms must be present in early childhood.. • E. … result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination www.ulm.edu/autismcenter

14. SCD continued • SCD captures children who display difficulties in social communication (similarly to ASD) but not Restrictive and Repetitive Behavior • Previously described as Semantic-Pragmatic Disorder or Pragmatic Language Impairment • Similar to Social-Reciprocity Disorder • “No date are yet available about its reliability, validity, and prevalence” Lord and Jones 2012 www.ulm.edu/autismcenter

15. Why is Social Communication so important? • Individuals who recognized the need for improved social thinking had higher salaries than those who didn’t recognize the need. Howlin, P., Alcock, J., Burkin, C (2005). An 8 year follow-up of a specialist supported employment serve for high-ability adults with autism or Asperger Syndrome. Autism 9: 533-549. • Those lacking social cognition has less positive employment experiences and showed more preference for solitary activities. • Being able to read and react to social communication may directly impact how well an individual with HFA integrates into daily living www.ulm.edu/autismcenter

16. Facial Recognition/Eye Contact • A series of studies have found that the individuals with ASD do not have a well-developed skill in recognizing facial expressions and good eye contact • Why? Some have said the Limbic System, responsible for showing, recognizing, controlling the body’s reactions to emotions may not be functioning like “Neuro-Typical” (NTs) individuals • Emotions and Memory are linked: • When remembering an emotional event, you recall not only what happened, but also how you felt—an emotional memory • Both can be triggered by something you heard, saw or smelt • Scientists think that you store early emotional memories, even if you cannot remember what actually happened. These memories may still affect you as adults. www.ulm.edu/autismcenter

17. Appropriate Social Skills Require One to: • Realize a message comes in many forms • Identify when a message is being sent • Successfully decode the message • Produce an “action plan” • Implement the plan • Look for feedback to assess it’s correctness • Revise as necessary www.ulm.edu/autismcenter

18. How often do we communicate? • 80% of waking hours are spent communicating: • Listening High • Speaking • Reading • Writing Low • Individuals with HFA usually need help when managing many different types and levels of communication each day www.ulm.edu/autismcenter

19. How do we assess these communication skills in individuals with HFA? • Nonverbal communication • Non-literal language • Speech prosody • Social-pragmatic communication www.ulm.edu/autismcenter

20. Some Recommended Procedures • Nonverbal Communication Procedures: • Eye gaze • Gestures • Non-literal Procedures: • Metaphor • Irony • Absurdity • Humor www.ulm.edu/autismcenter

21. Recommended Procedures • Speech Prosody Procedures: • Melody • Volume (loudness) • Stress • Pitch • Social-pragmatic Communication Procedurs: • Turn-taking • Cues & Prompts • Social-conversational rules • Conversational coherence • Reciprocity www.ulm.edu/autismcenter

22. Some Techniques to Improve The Social Triad Interaction Communication Emotional Regulation www.ulm.edu/autismcenter

23. 50 Strategies and Recommended Procedures for Individuals with ASD Level 1

24. 1. Behavior impacts others • Sounds obvious but not to them • Concept of “Theory of Mind” • Are you “In the Zone?” www.ulm.edu/autismcenter

25. What is Theory of Mind? • 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. • By not understanding that other people think differently than themselves, many autistic individuals may have problems relating socially and communicating to other people. That is, they may not be able to anticipate what others will say or do in various situations. In addition, they may have difficulty understanding that their peers or classmates even have thoughts and emotions, and may thus appear to be self-centered, eccentric, or uncaring. • Reference: https://www.autism.com/understanding_theoryofmind

26. 2. Disability awareness • Allows class to understand the student better • Knowledge increases tolerance • 50% of discussion relates to the specific child www.ulm.edu/autismcenter

27. 3. Peer buddies • An extra hand for the teacher • Simple “helper” • Spread the wealth • http://www.ednewsdaily.com/peer-buddies-meeting-social-students-severe-disabilities/ www.ulm.edu/autismcenter

28. 4. Problem-solving • Lack of flexibility negatively impacts problem solving skills • Task analysis • Seek assistance • “Stop it” or “Mop it” • https://www.autismspeaks.org/sites/default/files/sctk_supporting_learning.pdf www.ulm.edu/autismcenter

29. 5. Structured play • How to lose a game • See-saw/teeter totter • Visual reinforcers • www.autismspeaks.org in “Search Box” type “Structured play strategies” www.ulm.edu/autismcenter

30. 6. Social stories • Identify relevant social cues • Typical reactions that you may have • Typical reactions other may expect of you • Why it happened • Why I should use this technique • https://www.autismspeaks.org/family-services/personalized-stories www.ulm.edu/autismcenter

31. 7. Social skill groups • Structured lessons are a necessity • Focus on: • Feelings and emotions • Interpersonal relationships • Communication skills • Conversation skills • https://www.autismspeaks.org/sites/default/files/social_skills_training_groups_powerpoint.pdf www.ulm.edu/autismcenter

32. Complexity & level of interaction impact ability • Foundation skills: needed for basic interaction • Eye contact • Personal space • gestures www.ulm.edu/autismcenter

33. Social Skills for Group Activities • Interaction skills: required for appropriate social interaction • Turn-taking • Conflict resolution • Initiating/terminating conversation • Topic choice www.ulm.edu/autismcenter

34. Cognitive skills: required for complex social interaction • Perceive a situation/person • Choice making • Self-monitoring • Matching behavior for immediate environment www.ulm.edu/autismcenter

35. 8. Social etiquette posters • Display social rules for all to see • Refer to rules when infractions occur • Be pro-active • http://www.impactpublications.com/basicworkplaceetiquettepostersetlaminatedunframed.aspx www.ulm.edu/autismcenter

36. 9. Social etiquette cards • Same idea as posters but smaller version • Child carries them • Have him refer to his card for assistance • Concept of “ out of sight, out of mind” • http://www.imom.com/every-moms-guide-to-good-manners-for-kids/#.WJomXm8rLcs www.ulm.edu/autismcenter

37. 10. Videotape the student • Allows for an “out of body experience” • Identify appropriate/inappropriate behavior • Allows for self-monitoring of sequential activity • https://www.iidc.indiana.edu/pages/video-self-modeling www.ulm.edu/autismcenter

38. 11. Social autopsies • Analysis of social errors • Good for positive and negative situations • Allows student to identify • Social error • Who was impacted by it • How to correct it • How to avoid it in the futureplan • http://www.texasautism.com/WorkshopFiles/Social_Supports_handouts.pdf www.ulm.edu/autismcenter

39. 12. Proactive strategies • Determine what individual needs before even occurs and give it to him • Why force him to go to the pep rally if you know loud noises are difficult to tolerate? www.ulm.edu/autismcenter

40. 13. Perspective taking • Emphasize Theory of Mind • Don’t understand other’s think about them • Not everyone approaches situations in the same manner • https://www.autismspeaks.org/family-services/tool-kits/asperger-syndrome-and-high-functioning-autism-tool-kit/executive-functioni www.ulm.edu/autismcenter

41. 14. Imaginary Camera • Take a picture to help him perceive how he is being perceived by others • Are you “In the Zone?” • Know what is important about a conversation? • Know what is not important about a conversation? • Need to take perspective of listener—Theory of Mind • Adolescents (in general) have different viewpoints from adults • Individuals with HFA have less of “social compass” www.ulm.edu/autismcenter

42. 15. Sharing • Sharing is not giving, you get it back • Try using a timer to help conceptualization • Reinforce positive moves toward spontaneous sharing • Use cue cards • Set up situations • http://www.autismtoday.com/top-10-autism-strategies-for-encouraging-better-social-skills/ www.ulm.edu/autismcenter

43. 16. Share friends • Friend making is difficult, keeping friends is harder • It was so difficult to obtain a friend, I don’t want him to engage with others • Use visual strategies • https://tp053.k12.sd.us/Friendly.htm www.ulm.edu/autismcenter

44. 17. Negotiation skills • Requires perspective taking • “Get the facts-Get the feelings” • Isolate judgmental qualities • Help him see the end goal • Brainstorm alternatives • Evaluate consequences in terms of outcomes • http://www.sciencedirect.com/science/article/pii/S1750946714002645 www.ulm.edu/autismcenter

45. 18. Responsibilities & roles • Time and place concept • If it’s good here, it’s not necessarily true that it’s good everywhere • Requires perspective taking and Theory of Mind www.ulm.edu/autismcenter

46. 19. Vocabulary of emotions • 6 basic human emotions • 600 words to describe these emotions • Good-bad • Use books and videos • http://karlamclaren.com/emotional-vocabulary-page/ www.ulm.edu/autismcenter

47. 20. Self-calming • Stress is a fact of life • Use stress relaxation techniques-google • http://praacticalaac.org/strategy/self-calming-strategies-easier-seen/ www.ulm.edu/autismcenter

48. 20. Volcano Meter • Be aware of emotions • Know that others can get emotional—you don’t have to react • Remove yourself from situations—you have a choice www.ulm.edu/autismcenter

49. 21. Avoid distractions • Be proactive • Arrange environment for optional communication • Be aware of the surroundings—noisy hall during classes not always best • Attending social events where music is played. Adjust personal space • http://www.educationandbehavior.com/behavior-strategies-for-children-with-autism/ www.ulm.edu/autismcenter

50. 22. Safe place • Reduces anxiety • Useful to: • Organize • Release stress • Escape to avoid potential meltdown www.ulm.edu/autismcenter