Understanding Autism

1. Understanding Autism Using Assistive Technology to support student Learning By Jeanne Swain

2. Objectives Define autism and the symptoms (communication, social interaction, and restricted interests and activities) Develop an awareness of the Autism Spectrum Disorders Identify assistive technology supports for children with autism Relate assistive technology to classroom activities

3. What is Autism? Definition Autism is a lifelong neurological and developmental disability characterized by deficits in communication, social interaction, and interests and activities.

4. Incidence and Prevalence • 1 in 150 individuals is diagnosed with autism • Why such a prevalence? • broader definition • more awareness (news reports) • educated doctors • access of services/treatments • Occurs 4 times more often in boys than girls • Prevalence of having a boy with autism is 1 in 94 (www.autismspeaks.org)

5. Etiology There is no known cause but studies indicate: • Medical Factors • Genetic link • Twin studies (Heflin, 2007, pg. 67) • Identical twins: 60% chance • Fraternal twins: 0-10% chance • Sibling studies (2-8%) • Immune system involvement • Brain abnormalities (Taylor, 2006, pg. 514) • large head size • increased white matter • Environmental factors (Rodier & Hyman, 1998) • Vaccines (toxins) • Exposure to infectious diseases in-utero

6. Autism Spectrum Disorders Image from: aspierhetor.com/2009/02/02/mixed-metaphors/

7. Autism Spectrum Disorders • Asperger’s disorder • Children exhibit typical language development • These children often have difficulty with social interaction and may have a limited interests which become the focus of their interactions • Autistic disorder • Children demonstrate deficits in all three areas: communication, social, and behavior • PDD-NOS • Children demonstrate deficits in communication, socialization, and/or interests and activities • It is not required that children present all three symptoms to be classified as PDD-NOS

8. Autism Spectrum Disorders Cont… • Rett’s disorder • Rare disorder occurring in about 1 in 15,000 births • Affects females; proven fatal in males • Rett’s is the only ASD “identified as a genetic disorder linked to a single gene defect” (Heflin, 2007,pg. 15) • Childhood disintegrative disorder • Rare disorder • Children have typical growth and development until two years of age when deficits begin to occur

9. Symptoms of Autism Autism is characterized by deficits in: Socialization Communication Restricted Interests and Activities (behaviors)

10. Characteristics: Social Interaction • Being oblivious to the presence of others • not recognizing another person is next to them • stepping on someone when walking past • not looking when a name is called • not looking when spoken to • more interest in objects over people • Showing disregard for social conventions • Lacks a social smile, eye gaze, face to face contact, proximity to another person • Failing to orient to another’s voice • difficulty following an eye gaze or give an eye gaze (Heflin, 2007, pg. 6)

11. Characteristics: Social Interactioncont… • Lack of joint attention and social referencing • Not following a point or showing an object to another person to tell about it • not getting another person involved • Preferring to share only facts about favorite topics with others • Talking about one thing only: example-Cars movie or letters and numbers • Having few reciprocal relationships • Having limited give and take interactions; lack of true friends (Heflin, 2007, pg. 6)

12. Strategies for Social Interaction • Getting down on the child’s level to play; interacting with another person • Practice initiating play, turn taking, ending the activity • Create rules • how to play a game • “Don’t be alone” (wandering) • Encourage structured group activities (circle, songs, games) • Practice making conversation • Generating topics • Starting a conversation • Commenting • Develop group activities in the classroom • Priming: before the activity happens in real life (Koegel, 2004)

13. Assistive Technology Considerations Addressing Social Interaction • Social Stories • Help with priming • Define a rule • Help students understand a social situation (i.e. going to the library) • Conversation books • Provide students with a topic to initiate a conversation • Allows others to see accomplishments or a recent event • Cue Cards • Help individual generate a topic • Start/end a conversation • Voice output device • Allows individual to have a voice • Communication books/boards • Allows the individual to use pictures or written word to communicate with others (Quill, 2000)

14. Characteristics: Communication • Absent or delayed verbal language • Language delay; not talking or using words • Failure to use alternative forms of communication such as gesturing • Failure to demonstrate joint attention, gestures (pointing), facial gestures, eye gaze • Using others as “tools” • Taking someone's hand to a toy; also known as “autistic leading” • Echolalia (immediate or delayed) • Immediate: repeating what you say right after you say it • Delayed: stating parts of a movie, running lines in a book • Difficulty with gestures, eye gaze, facial expression (Heflin, 2007, pg. 5)

15. Characteristics: Communicationcont… • Pronoun reversal • might hear child say “you want a cookie” instead of “ I want a cookie” • Difficulty understanding nonliteral language • Difficulty with catch phrases such as “hop to it” • Impairments in nonverbal communication • Difficulty with gestures, eye gaze, facial expression (Heflin, 2007, pg. 5)

16. Strategies for Communication • Encourage activities that are motivating: something to communicate for • Reinforce approximation or attempts for words and gestures right away • Simple language: model the words you want the child to use • Expand language the child already uses • Child say “more” and “cookie” encourage “more cookie” • Encourage and teach initiations using picture, gestures, words • Use echolalia to teach appropriate responses (Koegel, 2004)

17. Assistive Technology ConsiderationsAddressing Communication • Picture Exchange Communication System (PECS) • Provide individuals with a structured approach to communicating with pictures • Can be used to request food items, toys out of reach, make a comment/request • “Strong visual-spatial strengths of individuals with autism…” support the “…use of visual-spatial symbols such as photographs or line drawings for expressive communication” (Mirenda, 2001, pg. 143). • Sign language/gestures • Voice output device • Allows the student to have a voice (make a request/comment) • Touch Screens • Help those students with fine motor difficulties complete activities • Keyboards and alternate keyboards • Possible use for completing classroom activities and tasks on the computer instead of writing (motivator to communicate) • Switches • Making choices with a software program to complete independent work tasks (communicate understanding of material) • Need a “structured interaction with the environment” (The Alliance for Technology Access, 2004, pg. 193). • Cue Cards • Communication books

18. Characteristics: Restricted interests and activities • Interest in parts of objects or isolated facts • Child looking at the wheel of the car instead of the entire car as a whole • Preservative engagement in favorite activities • Going to the same toy everyday to play; not changing the activity (pushing a car back and forth on the table) • Insistence in sameness • Wanting things to stay the same; order of schedule or change in work box (Heflin, 2007, pg. 8)

19. Characteristics: Restricted interests and activitiescont… • Repetitive motor movements • Rocking, spinning, hand movements, jumping etc… • Unusual responses to sensory stimuli • Resistance to textures in food or touch etc… • Unusual interests (narrow and limited) • Having a preschooler interested in facts about the Titanic (Heflin, 2007, pg. 8)

20. Strategies for Restricted Interests and Activities • Structured environment • Provide warnings for changes in routine • Providing sensory integration techniques • Vestibular • Tactile • Auditory • Proprioceptive • Vision • Defining the function of the behavior • Using restricted interests to motivate learning and communication

21. Assistive Technology ConsiderationsAddressing Restricted Interests and Activities • Picture Schedules (Siegel, 2003) • Structure daily routine • help the student understand classroom expectations and changes • Social Stories • Changes in routine • Priming to prepare for a change • Timers • Helping student know when to end an activity

22. Assistive Technology ConsiderationsAddressing Restricted Interests and Activities Cont… • Sensory Considerations • Auditory sensitivities • Noise reducing headphone or ear plugs • Carpet squares in the classroom • Tactile Considerations • Provide gloves of tools for those resistant to touching textures • Bead bag chair or pillows (deep pressure) • Seating considerations (away from others) • Visual Considerations • Sunglasses (sensitivity to light) • Seating (away from others visual distractions) • Vestibular and Proprioceptive Considerations • Rocking chair • Therapy ball • Seat cushions • Trampoline • Tunnel (Kluth, 2003)

23. Relating AT to Classroom ActivitiesExample 1 Scenario: A child with autism in a kindergarten classroom has difficulty with transitions from one activity to the next. He often gets upset during these changes and demonstrates tantrum behavior Solutions: Use a picture schedule to help prepare the student for changes Use a first/then picture card to show the student what the current expectation is and what will happen next.

24. Relating AT to Classroom ActivitiesExample 2 Scenario: A child with autism in a preschool classroom has difficulty expressing his food preferences during snack time. He will often get upset when given a non preferred choice but he does not have the words to tell you what he wants. Solution: Provide the student with a communication book (with 2-4 snack choices) Use a voice output device with picture symbols indicating his food choices

25. Relating AT to Classroom ActivitiesExample 3 Scenario: A child with autism is in an Infant and Toddler program classroom. The classroom gets very loud with the young children crying, musical toys, and the air conditioning turning on and off. The student often covers his ears and will get upset (starting to scream) Solution: Provide the student with headphones to reduce the sounds he hears Use ear plugs (smaller and less noticeable) Put carpet squares around the room to help muffle the noise Provide the student with a quiet area (small box) to calm down

26. References Heflin, L., & Alaimo, D. (2007). Students with autism spectrum disorders: Effective instructional practices. Columbus: Pearson Merrill Prentice Hall. Kluth, P. (2003). You're going to love this kid: Teaching students with autism in the inclusive classroom. Baltimore: Paul H. Brookes. Koegel, L.K., & LaZebnik, C. (2004). Overcoming autism: Finding the answers, strategies, and hope that can transform a child's life.New York: Penguin Books. Mirenda, P. (2001). Autism, augmentative communication and assistive technology: What so we really know?. Focus on autism and other developmental disabilities, 16, 141-151. Quill, K.A. (2000). Do watch listen say: Social and communication intervention for children with autism. Baltimore: Paul H. Brookes.

27. References cont… Rodier, P.M., & Hyman, S.L. (1998). Early environmental factors in autism. Mental retardation and developmental disabilities research reviews, 4, 121-128. Siegel, B. (2003). Helping children with autism learn: Treatment approaches for parents and professionals. Oxford: Oxford University Press. Taylor, B. (2006).Vaccines and the changing epidemiology of autism. Child: care, health and development, 32, 511-519. The Alliance for Technology Access, (2004). Computer resource for people with disabilities: A guide to assistive technologies, tools and resources for people of all ages (4th ed.). Alameda, CA: Hunter House Inc. (2009). Facts about autism. Retrieved June 18, 2009, from Autism Speaks Web site: http://www.autismspeaks.org/whatisit/facts.php