Autism 101 For Home and Community

1. Autism 101 For Home and Community Presented by BHSSC: Ronda Feterl, MS Shirley Hauge, MA SLP CCC Connie Tucker, Ed.Sp.

2. The “wh…” questions? What is Autism, Autism Spectrum Disorder, PDD-NOS, and Asperger’s Syndrome? What is the Prevalence of Autism? Who first described Autism? When was Autism and the other forms of it first described? Why does it need to be identified as soon as possible? Where is it best identified?

3. What is Autism? • It is not a disease! • It is a very heterogeneous developmental disorder characterized by dysfunction in these 3 areas: • Impairment in reciprocal social interaction • Qualitative abnormalities in communication • Restricted, repetitive, and stereotyped patterns of behaviors, interests, and activities Other forms of Autism have different degrees of the above dysfunctions.

4. Social Phobia Schizoid-Schizotypal Social Impairment Asperger’s Disorder OCD Autism Communication Impairment Restricted Interests & Compulsivity

5. Autism Statistics Onset of symptoms before 36 months of age Males > females by 4-5:1 Seizures may develop in 25 - 33% 70 - 75% identified as MR (assessment means and requirement of communication? Eating abnormalities, sleep disorders Exaggerated reaction to sensory stimulation High incidence of non-right handers

6. Sound and Sensitivity • My hearing is like having a sound amplifier on maximum loudness. • My ears are like a microphone that picks up and amplifies sound. • Sudden loud noises hurt my ears---like a dentist’s drill hitting a nerve. A sudden noise (even a faint one) will often make my heart race. • Autistics may fear dogs and babies because barking dogs and crying babies may hurt their ears. Dogs and babies are unpredictable, and they can make a hurtful noise without warning. • It is impossible for an autistic to concentrate in a classroom if he is bombarded with noises that blast through his brain like a jet engine. Temple Grandin

7. Visual Stimulation • I like the visual stimulation of watching automatic sliding doors; whereas another child might run and scream when he sees an automatic sliding door. • When I look at moving sliding doors, I get the same pleasurable feeling that used to occur when I engaged in rocking or other stereotypical autistic behavior. Temple Grandin

8. Tactile Experiences I pulled away when people tried to hug me, because being touched sent an overwhelming tidal wave of stimulation through my body. I wanted to feel the comforting feeling of being held, but then when somebody held me, the effect on my nervous system was overwhelming. Small itches and scratches that most people ignore were torture. A scratchy under ware was like sand paper rubbing my skin raw. Hair washing makes my scalp hurt. I wear long pants because I dislike my legs touching each other. Temple Grandin

9. Atypical - behaviors Eye contact - Visual tracking Lack of visual attention - Orienting to name (6 months) Social smiling (4-6 months) -Reactivity Imitation – babble at 6 mo – imitating by 9-10 months Social interest and affect – different kinds of cry Sensory oriented behaviors Withdrawn - Display poor social initiative Lack of emotional modulation - Looking at others Lack of showing/pointing - Failure to orient to name 87.5% display symptoms in the 1st year 91% of cases were correctly identified

10. Early temperament Marked passivity and decrease activity at 6 months. Followed by extreme distress reactions. Tendency to fixate on particular objects in the environment. Decrease expression of positive affect by 12 months.

11. Young Children with Autism Less likely to: Respond to social bids (hard to reach) Smile responsively (in response to praise or smile) Reciprocate affection (return a hug) Establish eye contact during interactions Imitate the actions of others (wave good-bye) Repeat actions that produce attention or laughter (show off) Show interest in other children Use gestures to communicate (point to request, shake head ‘no’ to protest) Understand language or gestures Engage in broad repertoire of functional play activities Create simple play schemes or sequences with toys Engage in function play with dolls Engage in imaginative play

12. Young Children with Autism May: Engage in repetitive play activities Lining up toys, opening/closing doors, playing with wheels Demonstrate repetitive motor behaviors Spinning self, finger posturing Respond inconsistently to sounds Seems deaf Show unusual visual interests Spinning objects, studying objects

13. Parental Concerns – Absolute indications No babbling by 12 months No gesturing (pointing, waving bye-bye, etc by 12 months) No single words by 16 months No 2 word spontaneous (not echolalia) phrases by 24 months Any loss of language or social skills at any age Filipek et al, 1999

14. What were Parents’ initial concerns 78% concerned about their child’s language (18 months noticed) 35% concerned about ‘no attention to caregiver’ 30% identified ‘poor socialization’ Only 16% concerned about lack of eye contact A few parents endorsed stereotypical behaviors, lack of pointing, lack of imitative play Young et al, 2003

15. Young et al, 2003 On average parents notice developmental signs of ASD at 15 months These same parents sought professional assistance at 26 months These children were diagnosed with an ASD at 41 months

16. Movement disturbances (Teitelbaum et al, 1998) Used Eshkol-Wachman Movement Notation (to understand abnormal movement) Compared: patterns of lying, righting from back to stomach, sitting, crawling, standing and walking Conclusions: All 17 children with autism showed disturbances of movement Detection occurs as early as 4-6 months, and even sometimes at birth No generalized disturbance across all children; each had something wrong but not everything was compromised in every child

17. Zwaigenbaum, Bryson, Rogers, Roberts, Brian, Szatmari 2005Early Identification (Canada) Autism Observation Scale for Infants – first standardized checklist designed to measure autism-related behaviors in young infants 11/13 children who exhibit 7 or more of the 16 behavioral marker on the AOSI will have a diagnosis of autism by age 2 Families with 1 child with autism have a 5-10% chance of having a 2nd child being diagnosed

18. Questions for Parents Does your child enjoy being swung, bounced on your knee, etc? Does your child take an interest in other children? Does your child like climbing on things (i.e. stairs)? Does your child enjoy playing peek-a-boo / hide-and-seek? Does your child pretend (i.e. make a cup of tea using a toy cup and teapot, or other things)?

19. Questions (continued) Does your child ever use his/her index finger to point to “ask” for something? Does your child ever use his/her index finger to indicate interest in something? Can your child play properly with small toys (i.e. cars of blocks) without just mouthing, fiddling, or dropping them? Does your child ever bring objects to you to show something?

20. Classification South Dakota ARSD 24:05:24.01:13 Autism is a lifelong developmental disability of biological origin that significantly affects verbal and non verbal communications and social interactions and results in adverse effects on the students educational performance. Other characteristics include: engagement in repetitive behaviors, resistance to change, unusual response to sensory.

21. What is the Prevalence of Autism? Before 1980, the prevalence was 4-5/10,000 births using Kanner’s Criteria. In the 1980’s, prevalence of 13-16/10,000 using the DSM-III criteria. In 1990’s Autism and ASD were differentiated and the ratio was 1 child with autism to 2-3 with ASD using DSM-III criteria (67/10,000 with Autism to 8-15/10,000 with ASD In 2007, the prevalence was 1/149 with ASD

22. Who first described Autism? Leo Kanner, the “father” of child and adolescent psychiatry, first described what is now known as “classis” autism in 1943. Hans Asperger, an Austrian psychiatrist, described an “abnormality of personality” that he called autistic psychopathy in 1944. It was not translated into English until the early 1970’s but was not until the late 1980’s that Asperger’s syndrome was diagnosed much in this country.

23. When was Autism first described Kanner first described “classic” autism in 1943 Hans Asperger first described the syndrome that bears his name a year later. It was not widely known in this country for another 35-40 years. The DSM-III first described PDD in 1980. It was later revised and corrected in the DSM-III-R in 1987.

24. Whydoes autism need to be identified as soon as possible? The only proven treatment is intensive behavioral and Early Communication Intervention The neuro-developmental window for social and communication development closes very rapidly

25. Early Diagnosis is Stable Can diagnose usually 2-4 years with accuracy But much research is suggesting that this is even too late Clinicians can agree on whether a child is on the spectrum Where on the spectrum is much more difficult and often depends upon experience ¾ of children diagnosed @ age 2 have diagnosis @ age 9 (June 2006)

26. Where is it best identified? • The “classic” form of autism can be recognized as young as 18-24 months. • Milder forms of autism (PDD-ASD) can be diagnosed between 24-36 months. • All forms of autism can be recognized in the doctors office.

27. Therapy Approaches • Structured Teaching • Applied Behavior Analysis • Visual Strategies/PECS • Skill-Based Assessment (Play)

28. Structured Teaching Physical Structure Daily Schedule Activities/Play Systems

29. Why utilize Structured Teaching? Helps the child understand the world. Helps the child be calmer, less agitated and therefore increase skills. Helps the child learn better because their attention is focused. Helps the child achieve independence

30. Physical Structure How a space is organized. Helps person with autism understand what is expected. Defines the environment using natural occurring boundaries.

31. Physical or Visual Boundaries Defines the beginning and ending of a space. Establishes context and function of each area.

32. Basic Teaching Areas Group/Snack Area Play/Leisure/Break Work areas: - 1:1 instruction area - Independent work area Transition Area A neutral place to receive information. A place for the daily schedule.

33. Classroom Plan

34. Group Area

35. Snack

36. Snack

37. Play

38. Play

39. Work Set

40. 1:1 Teaching Area

41. Transition

42. Daily Schedule Tells What Happens Next and Where. Tells the child the concept of discreet events and the difference between activities. Decreases “Power Struggles”. Teaches the child how to anticipate events.

43. Types of Daily Schedules Object to object sequence Single photos Part day pictures or photos All day picture/photo All day picture cards and written List All day written and written lists

44. Schedule Considerations: Type of visual cue. Object, photo/label, picture symbol, word Length of Schedule. Single, partial, half day, whole day Arrangement of Schedule Left to Right/Top to Bottom How manipulated/where located/travel

45. Object

46. Left to Right Object Schedule

47. Left to Right Photo Schedule

48. Picture Symbol Top to Bottom Schedule

49. Work Sets A systematic way for children to receive and understand information. Helps children understand the concept of finished. Teaches cause and effect. Increases productivity. Allows for Independence!

50. Types of Work Sets • Left to Right----Finished Box • Matching: Colors or Shapes-Sequencing • Matching Symbols-Alphabet of Numbers • Written