DSM V Criteria for Autism Spectrum Disorder

Transcription

1 And Autism

2 What is Autism? Autism is a developmental disorder characterized by deficits in social skills and communication as well as stereotypical, repetitive behaviours. By definition, the symptoms must appear prior to age 3. Autism affects 4 times as many boys as girls. Some children are developmentally delayed from birth, whereas others develop typically up to a point, and then regress.

3 DSM V Criteria for Autism Spectrum Disorder 1. Persistent deficits in social communication and social interaction across multiple contexts. 2. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following. 3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). 4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

4 DSM V Criteria for Autism Spectrum Disorder These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder may co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

5 Diagnostic Domains

6 Domain: Social Interaction and Communication Some common symptoms: Poor eye contact Limited or no conversational skills Does not seek to share interest or enjoyment Inability to express or identify emotions Difficulty with making friends Deficit in verbal and/or nonverbal communication (vocal and speech and gestures

7 Domain: Restricted, repetitive patterns of behaviour Some common symptoms: Inflexible adherence to routines Inappropriate play, e.g. spinning wheels on a car instead of driving it or lining toys up Inappropriate vocalizations, e.g. talking out of context, making non-functional sounds Repetitive motor mannerisms, e.g. flapping hands, walking on tiptoes, spinning in circles Obsessive interest in a particular topic or object(s) Abnormal level of sensitivity to or interest in sensory aspects of the environment (e.g. light, texture, pain, temperature, smell)

8 Who makes a diagnosis? Paediatricians Neurologists Psychologists Educational Psychologists Psychiatrists We, as behavioural instructors, are not qualified to make diagnoses

9 The Star Academy in treating Autism

10 ABA (Applied Behavior Analysis) Applied Behaviour Analysis DEFINITION: The application of principles of behaviour to issues that are socially important to produce practical change. Early Intensive Behavioural Intervention: The implementation of a behavioural therapy program for between hours per week before the age of 4 ABA is the only empirically tested and evidence based treatment for Autism

11 Core Principal of ABA If a behaviour is followed by a desirable consequence, that behaviour will occur more often in the future. If a behaviour is not followed by a desirable consequence or is followed by an undesirable consequence, that behaviour will occur less often in the future.

12 The 3-term Contingency Antecedent Any event or stimulus that occurs immediately prior to the behaviour Behaviour Anything the child says or does Consequence Any event or stimulus that occurs immediately after the behaviour

13 Using ABA as an intervention

14 Using ABA as an intervention

15 Example of the 3-term contingency

16 Example of the 3-term contingency

17 Example of the 3-term contingency

18 Problem Behavior The children we work with frequently display communication deficits. They learn to engage in problem behaviour as a way to communicate or to get their needs met. Behaviour is considered problematic when it: Interferes with the child s ability to learn Limits the frequency and/or quality of social interaction Leads to property damage Leads to injury of self or others Often, it is not the behaviour itself that is problematic, but the duration, frequency or intensity at which the behaviour occurs.

19 Problem Behavior Some examples of problem behaviour: An 8 year old who tantrums for 10 minutes at a time when his mom says time to go bath A 2 year old who picks his nose until it bleeds A 5 year old who talks about Thomas the Tank Engine 50 times per day A child who kicks holes in the door when he is asked to do something he doesn t want to do A child who bites himself when he is not given access to an item he wants A child who constantly repeats lines from movies, even when someone else is trying to talk to him

20 Problem Behavior Whenever a child wants something, he has two choices: Try to get it in an inappropriate way Try to get it in an appropriate way Helping him have appropriate behaviour means making the choice easy, by giving him what he wants for good behaviour and not giving him what he wants for problem behaviour

21 Functions of Behavior There are four main functions of behaviour: Attention Access to tangible Escape Automatic

22 Functions of Behaviour 1. Attention: Behaviour is reinforced Fred s mom is cooking supper Fred hits his brother Fred s mom looks at him and says don t hit your brother!

23 Functions of Behaviour 2. Access to tangible: Behaviour is reinforced Jade is in the supermarket with her mom Jade cries Jade s mom gives her a lollipop to keep her quiet

24 Functions of Behaviour 3. Escape: Behaviour is reinforced Tucker s mom asks him to clean his room Tucker runs outside Tucker s mom sighs and goes back to her computer

25 Functions of Behaviour A note about automatically-maintained behaviour: Oral the child seeks sensory input in and around their mouth. They may like the taste or the feel of something in their mouth. Some examples include grinding, pica, mouthing toys. Visual the child seeks sensory input in front of or around their eyes because of the way it looks or moves. Some examples include moving their fingers in front of their eyes, looking at items over the edge of the table, looking at things using their peripheral vision. Physical the child seeks sensory input using one or more body parts because of the way it feels. Examples include tensing, rocking, handflapping, excessive heat/cold. Tactile the child seeks sensory input from the textures of various items/surfaces because of the way it feels to the touch. Examples include rubbing surfaces, playing with food. Olfactory the child seeks sensory input by smelling things. Examples include sniffing clothing, body parts, and other items with pungent odours.

26 Functions of Behaviour 4. Automatic: Behaviour is reinforced Rachel is in the garden Rachel picks some bark off a tree and puts it in her mouth Rachel s need for oral sensory input is satisfied

27 Skill Acquisition An ABA program is comprised of programs across these curricula in terms of which of them are necessary for a client in light of his or her specific challenges. Some curriculum areas may be more required for one child than others, but typically social skills and language skills are common across the vast majority of programs.

28 Skill acquisition

29 Autism in Swimming The swimming facility or teacher should either have already worked with children on the spectrum or if not they should be willing to work with these kids and also be given a run down or background on how to best handle the child. An instructor or facilitator should be present at all times during the duration of the swimming lesson. The child s specific needs should be catered to; what this means is that sometimes a child may have certain routines to do before entering the water, then both the facilitator and the swimming teacher should develop a routine that will allow the child to complete their routines before entering the water..slowly the end goal is to fade and create normal routines for the child such as arriving and entering the pool. Seeing as these children usually adapt to change slowly, it would be beneficial to use a fading procedure to adapt to the child. Swimming lessons for children on the spectrum should be individual lessons and not group lessons so that they get that undivided attention.

30 Autism in swimming Instructions should be presented one at a time and not in multi steps so that the child can be given the fair opportunity to perform best on that one instruction. As it has been seen before in swimming lessons with these children, it is better to have repetition. What this means is that if the swimming teacher would like to teach leg kicking then leg kicking should be the same and repeated process for the next 3-5 lessons even if it seems that the child has adapted to it, just to ensure consistency. Some children may suffer from medical conditions and while this should not inhibit their opportunity, it should be taken into consideration with modifications made. Reinforcement is a big deal for our kids. For some it may be the pool itself. For others it may be a certain toy or even a sweet. The swimming teacher should be made aware of this

31 Thank you!