Responding to the Needs of Students with Autism Spectrum Disorders

1. Responding to the Needs of Students with Autism Spectrum Disorders

2. The Center for Autism and Related Disabilities CARD- Albany is a university-affiliated resource center that brings research and practice together in community settings. CARD- Albany provides evidence-based training and support to families and professionals and, through ongoing research, contributes knowledge to the field of autism spectrum disorders

3. Objectives • Participants will become familiar with the definition, characteristics, and other related information regarding autism spectrum disorders • Participants will be able to recognize evidence- based practices in assessing students with ASD • Participants will be able to recognize components for developing an effective educational program for students with ASD • Participants will understand the importance of effective collaboration, resources, and supports for students with autism spectrum disorders

4. Definition of Autism Spectrum Disorders Question: What are some of the common characteristics that you see in each of the children portrayed in the video?

5. IDEA and Part 200Definition of ASD Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally 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.

6. Eligibility for Special Education Services from Part 200 Areas of need: • Academic achievement, functional performance, learning characteristics • Social development • Physical development • Management needs

7. Who Is Affected By Autism? • CDC currently estimates that 1 in 150 individuals have autism spectrum disorder based on study that looked at 8 year-old children across 14 states • CDC study expanded the definition of “autism” to include the diagnosis of PDD-NOS and Asperger’s Syndrome • Boys are 4 times more likely to be diagnosed but girls are more severely affected • http://www.cdc.gov/ncbddd/autism/faq_prevalence.htm

8. 2001 - Total: 7,918 2002 - Total: 9,141 2003 - Total: 10,617 2004 - Total: 12,162 2005 - Total: 13,622 2006 - Total: 15,471 2007 – Total: 17,505 NYS Children and Youth with Disabilities Receiving Special Education Programs and Services School age students (4-21) with autism • 1996 - Total: 3,416 • 1997 - Total: 4,104 • 1998 - Total: 5,142 • 1999 - Total: 5,659 • 2000 - Total: 6,752 513% INCREASE Source: NYS Department of Education

9. When Does It Occur? • Children are born with the disorder and never “outgrow” or are “cured” of their autism • Usually diagnosed in early childhood (18 months – 2 years) when a child fails to meet developmental milestones • www.cdc.gov/ncbddd/autism/actearly/interactive/index.html • http://www.autismspeaks.org/video/glossary.php

10. What Causes Autism? • Genes • Monozygotic vs. dizygotic twin studies have shown that if 1 identical twin has autism, the chance that the other twin has autism is 10 times higher than that of fraternal twins • Multiple genes are now being studied for their possible role

11. What Causes Autism? • Brain structure is different • Cause of autism is currently unknown http://www.nimh.nih.gov

12. What Causes Autism? • Other Theories: • Heavy metals • Pollutants • Toxins • Vaccines • Chemicals • Pesticides • Gastrointestinal issues • *none of these have been empirically proven to cause autism*

13. DSM-IV Diagnostic Criteria(American Psychiatric Association, 2000) Communication • Delay in, or complete lack of, verbal communication • Difficulty in initiating or sustaining conversations • Stereotyped or idiosyncratic use of language (echolalia, jargon) • Inability to engage in spontaneous, make- believe, or imitative play at the appropriate developmental level

14. DSM-IV Diagnostic Criteria Socialization • Difficulty developing peer relationships appropriate to developmental level • Impaired use of nonverbal behaviors (e.g., eye contact, facial expressions, and gestures) • Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (joint attention) • Lack of social or emotional reciprocity

15. DSM-IV Diagnostic Criteria Behavior • Preoccupation with an activity or interest that is abnormal either in intensity or focus • Inflexible adherence to nonfunctional routines or rituals • Repetitive or stereotyped movements (e.g., hand flapping) • Persistent preoccupation with parts of objects

16. Pervasive Developmental Disorders (PDD) Autism Spectrum Disorders (ASD) Lower Functioning Below Average IQ, Mental Retardation, little or no verbal language IQ < 70 Rett’s Disorder Childhood Disintegrative Disorder Autism PDD -NOS Asperger’s Syndrome Higher Functioning Average/Above Average IQ, verbal language, etc.

17. Rett’s Disorder • Early typical development followed by period of stagnation or regression • Motor and cognitive delays • Loss of purposeful hand movements • Rare: 1:10,000 females; not found in males • Occurs around 6-18 months of age • Genetically based (MECP2) • International Rett Syndrome Foundation • http://www.rettsyndrome.org

18. Childhood Disintegrative Disorder • A developmental disorder characterized by a relatively longer period of typical development (compared to Rett’s and Autism) followed by a marked regression in communication, socialization, and cognitive skills • Around 1 in 1500 births - more common in boys • Symptom onset between 2 to 4 years of age but before 10 years of age • Cause unknown • Yale Developmental Disabilities Clinic • http://info.med.yale.edu/chldstdy/autism

19. PDD-NOSPervasive Developmental Disorder – Not Otherwise Specified • Individual exhibits many of the behaviors and characteristics of autism but not enough to meet the full criteria of autism • Not the same has “high functioning autism” or Asperger’s Syndrome • Individuals can range from high to low functioning

20. Asperger’s Syndrome • Distinguished from Autism and PPD-NOS by the lack of language delay • Normal to above-average intelligence • Social interest present but understanding and skills are lacking • Often verbose but may use language in different ways and lack pragmatics • Patterns of speech may be unusual • Often motor skill delays and appear physically awkward, clumsy Autism Society of America , www.autism-society.org

21. 3 Core Deficits Across the Spectrum Diagnostic Overlap Diagnostic Overlap Adapted from Christine Peterson Autism PDD-NOS Asperger’s Disorder Verbal/lacks pragmatic Aspects of communcation Communication Non-Verbal/ Echolaic Scripts/lacking Functionality Parallel Play/lacks Age appropriate skills Appears unaware/ no interest Interest/lack of social understanding Socialization Physical rocking/ Head banging Preoccupation with parts/ Spinning objects Repetitive Patterns of Behavior Over focus on topic

22. Implications for the ClassroomCommunication • Wide range of communicative ability • Non-verbal to verbose but lacking in pragmatics • Often more behavioral communication than intentional, social, or verbal communication • Receptive language difficulties - expectations, directions, comments need to be clear, concrete, simple, direct, and visual • Expressive language difficulties – even highly intelligent students may struggle to speak up or become frustrated trying to share thoughts, feelings, and ideas • Written communication difficulties – from the mechanics of writing to organizing thoughts and getting them to paper

23. Video: Social Difficulties in Asperger’s Syndrome

24. Implications for the ClassroomSocial Deficits • Social imitation (academic & non-academic) is lacking – explicit instruction required • Perception and interpretation of body language and social cues lacking – watch for social misunderstandings • Subtle and arbitrary social rules not recognized, understood, or valued – may need to explain or explicitly instruct; rules should be functional to make sense • Will need significant assistance with establishing and maintaining social relationships; self-advocacy, and integration into the school community • Often victims of bullying – be aware • Lack “Theory of Mind” – doesn’t realize others may think and feel differently

25. Theory of Mind

26. The Sally Ann Test

27. Implications for the ClassroomRepetitive Behavior and Interests • Adherence to inflexible routine or rules common – striking a balance of structure and teaching flexibility key • Often preoccupied with activity or particular interest – can you turn activity or opportunity to discuss interest into a reinforcer for pro-social and good work habits? • May engage in odd repetitive behavior – behavior extinction not always the best approach

28. Related CharacteristicsSensory Issues Processing sensory information • Over or under-sensitivity to noises, lighting, odors, tastes, textures, pain • Sensory over-selectivity • Failure to respond • Hidden “senses” • vestibular (movement and balance) • proprioceptive (feedback on how much force or pressure to apply when picking up something or holding an item)

29. Video Clip of sensory sensitivities leading to repetitive behaviors

30. Related CharacteristicsCognitive Issues • Difficulty drawing conclusions • Difficulty with incidental learning • Often excellent rote memory • Slower at retrieving information • Slower processing speed • Problems with working memory • Trouble predicting outcomes (e.g., people’s reactions) • Often do not see cause-effect

31. Related CharacteristicsCognitive Issues • Problems with executive function • Issues with shift: moving freely from one activity/situation to another, transitions, flexible problem solving • Issues with initiation; can’t begin tasks • Issues with planning, organizing, sequencing, setting goals/objectives • Issues with seeing “big picture” or main idea • Issues with evaluating activity; pace, completion, • Issues with modulating emotional response • Issues with controlling impulses

32. Evidence-Based Instructional Methods/Interventions

33. What is Evidence-Based Practice? Review and synthesis completed by Simpson, et. al (2005) Scientifically-based: possess “significant and convincing empirical efficacy and support” Promising: programs that have emerged as having “efficacy and utility with individuals with ASD” NCLB (2002) • Effective education practices • Scientifically based research • Rigorous peer review • Positive results

34. Why Do Students with ASD Require Special Learning Environments? • Core symptoms & associated features challenge students to learn from more typical environments, so they often require: • Structured learning environments that include social communication training and behavior supports • Structure and enhancement of relevant stimuli to increase attending • Scope and sequence of skills • Repeated learning trials • Specific intervention for generalization • Continuous opportunities to learn and apply skills across multiple contexts Magyar, C., (2008, November). Developing a system of support for students with autism spectrum disorders: A classroom model. Presentation given at the 7th Annual Conference sponsored by CARD-Albany, Albany, NY.

35. Focus of Assessment • Specific learning challenges • Cognitive ability and profile • Academic ability and profile • Ecological Assessment • Instructional context • Interaction between learning context/environment and student learning behavior (FBA) • Assessment of other skills related to learning • Adaptive • Social • Language • Emotional-behavioral • Magyar, C., (2008, November). Developing a system of support for students with autism spectrum disorders: A classroom model. Presentation given at the 7th Annual Conference sponsored by CARD-Albany, Albany, NY.

36. Linking Assessment to Intervention • Determine the student’s ability profile • Determine the contextual support elements to maximize learning • Know the curriculum/lessons and align content difficulty level with student ability, THEN select best instructional methods, activities, and format • Differentiate instruction & differentially reinforce • Evaluate progress and performance (continuous) • Problem solve • Revise • Re-assess Magyar, C., (2008, November). Developing a system of support for students with autism spectrum disorders: A classroom model. Presentation given at the 7th Annual Conference sponsored by CARD-Albany, Albany, NY.

37. Continuous Assessment Revise, Modify, Enhance Education Plan Response to Plan/Intervention Initial/Continuous Assessment and Educational Plan Magyar, C., (2008, November). Developing a system of support for students with autism spectrum disorders: A classroom model. Presentation given at the 7th Annual Conference sponsored by CARD-Albany, Albany, NY

38. Effective Components for Educational Practices Current research supports the following should be present in a quality educational programs for students with ASD: • Individualized supports and services • Systematic instruction • Comprehensible and structured learning environments • Specialized curriculum focus • Functional approach to problem behavior • Family involvement Iovannone, R.; Dunlap, G.; Huber, H.; and Kincaid, D. (2003). Effective educational practices for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities,18, 150-165

39. Effective Components for Educational Practices • Individualized Supports and Services • Students with ASD are heterogeneous in presentation of behaviors • Unique interests, preferences, & learning styles • No one program, support, or service is likely to meet the population as a whole • Flexible placement and support options are needed • Match specific practices, supports, services with each student’s unique profile and individual family differences From: Iovannone, R.; Dunlap, G.; Huber, H.; and Kincaid, D. (2003). Effective educational practices for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities,18, 150-165

40. Evidence-Based Practice Applied Behavior Analysis • Not a specific intervention, but rather a theoretical framework • Based on work of behaviorists (Skinner, etc.) • Desired behaviors are identified, taught, and reinforced • Programs are highly individualized http://www.abainternational.org

41. Effective Components for Educational Practices • Systematic Instruction • Identification of valid educational goals • Careful outlining of instructional procedures and their implementation • Evaluation of effectiveness • Adjustment of instruction based on data

42. Evidence-Based Practice Discrete Trial Training (DTT) • Trial= “single teaching unit” • Instruction, child response, consequence • Break down tasks into discrete behaviors • Each correct behavior is positively reinforced • Data is collected to drive instructional goals

43. Evidence-Based Practice • Pivotal response training • Based on principles of ABA • Targets pivotal behaviors to increase important language, play, and social behaviors(naturalistic approach) • Motivation; responsivity to multiple cues • Utilizes natural reinforcers • Data is collected to drive instructional goals http://psy3.ucsd.edu/~autism/prttraining.html Koegel et al., 1987

44. Promising Practice Incidental teaching • Instruction during typical activities based on student interest and motivation • Learning environment organized around preplanned objectives and student preference • Advantages • Skill generalization • Social initiations • Daily routines http://www.autismnetwork.org/modules/academic/incidental/index.html

45. Effective Components for Educational Practices • Comprehensible/Structured Learning Environments • Curriculum needs to be clear to both students and educational personnel • Allows student to predict what’s going to happen next • Provide a schedule of activities • Plan and provide choice-making • Provide behavior support • Define areas of classroom and school • Provide temporal relations • Facilitate transitions, flexibility, change

46. Promising Practice TEACCH – Treatment and Education of Autistic and related Communication Handicapped Children- Structured Teaching • Modifying environment to accommodate needs of individuals with ASD • Physical organization • Work schedules • Work systems • Task organization http://www.teacch.com

47. Effective Components for Educational Practices • Specialized Curriculum Focus • Focus on development of social reciprocity and communication • Systematic instruction in • Social engagement skills (initiating & responding) • Appropriate recreational or leisure skills • Language comprehension and communication

48. Evidence-Based Practice LEAP: Learning Experiences: An Alternative Program for Preschoolers and Parents • Early childhood; social development • Inclusive setting (home, school, community) • Peer mediated interventions • Behavior management • Educational approach with individualized objectives http://prekese.dadeschools.net/docs/leap/LEAPinfoflyer.pdf Kohler & Strain, 1999

49. Promising Practice Picture Exchange Communication System (PECS) • At most basic level it allows individuals to exchange picture for an item • Based on functional nature of communication http://www.pecs.com Frost & Bondy, 1994

50. Promising Practice Social Stories® • Individualized cognitive intervention that describes social cues and appropriate responses • Teaching routines and academic material; addressing behavior problems http://www.thegraycenter.org/ http://www.polyxo.com/socialstories/