Understanding Autism Spectrum Disorders and an Overview of Strategies to Support Learning in the Student with Autism

Transcription

1 Understanding Autism Spectrum Disorders and an Overview of Strategies to Support Learning in the Student with Autism Lorraine McMullen Leet, Ed.S & Lisa Reid, Psy.S Jefferson County Public Schools

2 Overview What is Autism What causes Autism What are the characteristics of Autism How is Autism diagnosed How does a student meet special education eligibility for Autism What are the most effect strategies to support learners with Autism in the classroom setting?

3 Person First Language Identity First Language vs Person First Language Disabled Person vs Person with a Disability Autistic Child vs Child with Autism

4 What is Autism Spectrum Disorder (ASD)? ASD is a developmental disorder that impacts the way individuals communicate and interpret their environment, often resulting in challenges with social interactions and processing information. The term spectrum refers to the wide range of symptoms, skills, and levels of impairment that people with ASD can have.

5 What is ASD? ASD affects people in different ways and can range from mild to severe. People with ASD share some symptoms, such as difficulties with social interaction, but there are differences in when the symptoms start, how severe they are, the number of symptoms, and whether other problems are present. The symptoms and their severity can change over time. The signs of ASD begin in early childhood, usually in the first 2 years of life, although a small minority of children may show hints of future problems within the first year of life.

6 What is ASD? First described by Leo Kanner in 1943 as early infantile autism The word autism has its origin in the Greek word autos, which means self. For next 30 years, considered to be an emotional disturbance Very likely neurological in origin not emotional, not the refrigerator mom

7 What is ASD? One in every 68 children in the US has autism (read CDC March 2014 Study). It is estimated that almost 2 million individuals in the U.S. has autism. These statistics are endorsed by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics, and other federal agencies.

8 What is ASD? Autism prevalence figures are growing More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States. ASD is estimated to affect more than 2 million individuals in the U.S. Approximately 100 individuals are diagnosed every day with autism in the U.S. Boys are four times more likely than girls to have autism Source:

9 What is ASD? Autism is the fastest-growing serious developmental disability in the U.S. Autism costs the nation over $238 billion per year, a figure expected to significantly increase in the next decade Autism receives approximately 5% of the government research funding of many less prevalent childhood diseases Source: 2/

10 Children with ASD might Not point at objects to show interest Not look at objects when another person points at them Have trouble relating to others or not have an interest in other people at all Appear to be in their own world Avoid eye contact and want to be alone Have trouble understanding other people s feelings or talking about their own feelings Repeat actions over and over again Play with toys or objects non-functionally Have trouble adapting when a routine changes Have unusual reactions to the way things smell, taste, look, feel, or sound Have unusual motor movements. Resist change in routine Have difficulty communicating nonverbally, such as through hand gestures, eye contact, and facial expressions.

11 DSM-V ASD Criteria Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text): Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

12 DSM-V ASD Criteria Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day). Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

13 DSM 5 ASD Criteria Continued Symptoms must be present in early childhood Symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

14 How is Autism Diagnosed No definitive medical test Teams use interviews, observation, specific checklists developed for this purpose Team might include psychologist, speech language pathologist, occupational therapist, developmental pediatrician, neurologist, etc. Team must rule out cognitive disability, hearing impairment, behavior disorders, or eccentric habits

15 IDEA Definition of Autism Autism, as defined by Individuals with Disabilities Education Act (IDEA), refers to 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.

16 When Red Flags Are Raised Please consult with your building school psychologist when you have students who present with significant developmental delays and/or demonstrate characteristics of ASD The school psychologist can consult with the teacher of record regarding their concerns and can work with the teacher of record to develop an appropriate intervention plan

17 If you ve met one person with autism, you ve met one person with autism. Dr. Stephen Shore

18 Characteristics Communication/Language Social Interaction Behaviors Sensory and movement disorders Resistance to change (predictability) Intellectual functioning

19 Communication/Language The ability of children with ASD to communicate and use language depends on their intellectual and social development. Some children with ASD may not be able to communicate using speech or language, and some may have very limited speaking skills. Others may have rich vocabularies and be able to talk about specific subjects in great detail. They also may be unable to understand body language and the meanings of different vocal tones. Taken together, these difficulties affect the ability of children with ASD to interact with others, especially people their own age.

20 Communication/Language Common impairments: Delayed language Echolalia (immediate or delayed) Repetitive or rigid language Narrow interests and exceptional abilities Uneven language development. Often use language in atypical ways Difficulty with the give and take of normal conversation

21 Communication/Language Difficulty with understanding body language, tone of voice, or phrases of speech Their body language can also be difficult to interpret. Movements, gestures, facial expressions may not match what they are saying Tone of voice may not reflect true feelings A high-pitched, sing song, or flat, robot-like voice is common

22 Social Interaction Difficulty learning to engage in the give-and-take of everyday human interactions Slower to learn how to interpret what others are thinking and feeling Lack of peer relationships Failure to spontaneously share enjoyment, interests, etc. with others Lack of reciprocity Theory of mind Seeing things from another person s perspective Common for children with ASD to have difficulty regulating their emotions

23 Behaviors Repetitive Behaviors, including obsessions, tics, and perseveration Impeding behaviors (impede their learning or learning of others) Will need positive behavior supports Self-Injurious behavior Aggression

24 Sensory and Movement Very common Over- or under-sensitive to sensory stimuli Abnormal posture and movements of the face, head, trunk, and limbs Abnormal eye movements Repeated gestures and mannerisms

25 Predictability Change in routine is very stressful May insist on sameness (i.e., food at meals, TV shows) Interventions need to focus on preparing students for change if possible

26 Intellectual Functioning Autism occurs in children of all levels of intelligence, from those who are gifted to those who have cognitive impairment Verbal and reasoning skills are difficult

27 Physical and Medical Issues That May Seizure Disorder (Epilepsy) Accompany Autism Over 1/3 of people with Autism develop seizures People with autism may experience more than one type of seizure activity Recurrent seizure activity is called epilepsy Genetic Disorders A small number of children with autism may also have a neuro-genetic condition such as Fragile X Syndrome, Angelman s Syndrome, Tuberous Sclerosis, etc

28 Physical and Medical Issues That May Accompany Autism Allergies, Gastrointestinal Disorders, Pain Due to the inability to communicate, pain in a child with autism is sometimes recognized only because of patterns of changes in behavior Co-occurring conditions can include gastritis, chronic constipation, colitis, celiac disease, etc Some students may be under the care of a GI specialist or allergist who recommends specific protocols for diet or parents may chose to employ specific nutritional protocols or popular dietary interventions used in autism (Gluten free, dairy free, etc).

29 Physical and Medical Issues That May Sleep Dysfunction Pica Accompany Autism Trouble falling asleep, experience night waking, seem to function on considerably less sleep than is usually considered normal Lack of sleep can impact attention, learning, and ability to benefit form therapeutic interventions Eating disorder involving persistently eating things that are not food (i.e., dirt, clay, chalk, paint chips, etc).

30 Unique Abilities That May Accompany Autism Strong visual skills Ability to understand and retain concrete concepts, rules, sequences, and patterns Good memory of details or rote facts Long-term memory Computer and technology skills Musical ability or interest

31 Unique Abilities That May Accompany Autism Intense concentration or focus, especially on a preferred activity Artistic Ability Mathematical Ability Ability to decode written language Strong encoding (spelling) Honesty Problem Solving ability (when you cannot ask for something you want, you can get pretty creative about getting your hands on it yourself)

32 Strategies for Classroom Success

33 Evidence Based Practices (EBP) Antecedent-based Intervention (ABI) Cognitive Behavioral Intervention (CBI) Differential Reinforcement (DR) Discrete Trial Training (DTT) Exercise Extinction Functional Behavior Assessment (FBA) Functional Communication Training Modeling Naturalistic Intervention Parent-implemented Intervention Peer-mediated Instruction and Intervention Picture Exchange Communication System Pivotal Response Training Prompting Reinforcement Response Interruption/Redirection Scripting

34 Evidence Based Practices (EBP) Self-Management Social Narratives Social Skills Training Structured Play Groups Task Analysis Technology-aided Instruction and Intervention Time Delay Video Modeling Visual Supports

35 School Environments can be challenging for students with ASD Transitions Require multiple changes Predictable and yet still unpredictable Sights and sounds of hallway Noise and commotion can be overwhelming After navigating the hallways students are often stressed and unsettled Students with ASD often have difficulty Picking out important information from the environment Understanding what they are supposed to do

36 Activities that are often challenging for students with autism Multiple-step directions and activities Following verbal directions Circle time, since it generally means sitting, listening to auditory information and verbal output Center time Free play, because it involves social skills, co-operative play and verbal skills with very little structure Assemblies, music, and PE classes for students with sensory issues

37 Think About This What are the aspects of your school that may make it a challenging environment for students with ASD? Write down 5 examples Share with a colleague

38 Strategies for Success Be calm and positive Model appropriate behavior Establish clear routines and habits to support regular activities and transitions. Alert the student to changes in routine, staffing, etc, in advance, whenever possible Be tuned into sensory issues that may effect the student in your particular class Provide pictures of expectations of behavior in the classroom Use descriptive praise to build desired behaviors (i.e., I like the way you put your trash in the trash can! ) Give positive directions/minimize the use of don t and stop. (i.e., Please sit in your seat ) This lets the student know exactly what you would like him to do.

39 Strategies for Success Make sure to have classroom materials prepared ahead of time Use visuals whenever possible If a student has difficulty learning a concept or skill, re-think how material is being presented Speak slowly; repeat and rephrase questions Use concrete terms and ideas; avoid slang Allow extra time for response

40 Supporting Communication Receptive Language Make sure you have the student s attention before you deliver an instruction or ask a question Avoid complex verbal directions, information, and discussion Minimize the use of don t and stop Allow wait time ( be prepared to wait for a response, whether it is an action or answer). Avoid immediately repeating an instruction or inquiry. Model and shape correct responses Supplement verbal information with pictures, visual schedules, gestures, visual examples *Always consult with the building Speech Language Pathologist on individual cases; this list is not exhaustive*

41 Supporting Communication Expressive Language Use visual supports to prompt language or give choices Teach and use scripts words, pictures, etc for communication needs or exchanges (i.e., I like. What do you like? I like ) Add visual supports to the environment as needed Be aware of echolalia. Sometimes this is seemingly self-stimulatory behavior, but many individuals with autism also use functional echolalia to comment, inform, or request Always look for a student s communicative intent For a student who is inclined to use echolalia, try to model language using language forms that would be appropriate when the student uses it so that pronoun reversals do no occur Address the language of emotions

42 Supporting Social Interaction Student s with autism often have the desire to interact with others, but do not have the skills to engage appropriately or may be overwhelmed by the process. Some students will engage in attention seeking behavior to connect with others until they build the skills they need to interact With younger children, sometimes the unpredictability and noise of the presence of others can be disconcerting. Working through sensory issues is the first place to begin

43 Supporting Social Interactions Scaffold skills in appropriate developmental sequence Be aware that free play, recess, and other unstructured times are the most difficult times for children with autism Focus on social development in the areas where the student shows interest and competence Insisting on eye contact can cause additional stress. Begin by directing the student to direct his body toward the talking partner.

44 Supporting Social Interactions Reinforce what the student does well socially use behavior-specific praise (and concrete reinforcement if needed) to shape pro-social behavior Model social interaction, turn taking, and reciprocity Teach imitation, motor as well as verbal Focus on social learning during activities that are not otherwise challenging for the child Teach empathy and reciprocity through vocabulary and awareness of feelings, emotional states, recognition of others facial expressions, and non-verbal cues

45 Ideas for Preventing Behavior Recognize Behavior as Communication Establish a class wide behavior system for all students to promote expected behaviors Provide behavior specific feedback and ample praise and reinforcement Catch your students being good and reward! Communicate expectations, use daily and short term-schedules, warn of changes to routines or personnel, prepare the student for unexpected events Offer choices and provide the student some control within reason Respect the student s personal space

46 Ideas for Preventing Behavior Provide a space for the student to regroup, calm down, or escape overwhelming situations or sensory overload Utilize breaks as a way to return to a calm state or as reward for good working, but be watchful of how and when breaks are given. Provide communication options and seek to give the student an opportunity to express emotions, confusion or his perspective Teach contingencies and waiting strategies Countdown (5,4,3,2,1) First, Then, A WAIT cue card that can be implemented in a variety of settings

47 Ideas for Preventing Behavior Teach and provide the student with a list of strategies for calming when anxious, stressed, or angry Use a system that reinforces the student for exhibiting desired behaviors, especially rewarding those behaviors that replace disruptive behaviors Be aware of, and work to avoid known triggers and antecedents that may result in frustration, overload, anxiety, or manipulative behaviors. While they are occurring, ignore attention seeking behaviors as much as possible Use video modeling to show desired behaviors

48 Trouble Shooting: The Bus Visual schedules can be helpful for helping the student establish a routine and managing behavior. A custom schedule can easily be made using a digital camera to take a picture of each step or action. Provide written rules or pictures of expectations of bus behavior for the student, the school staff, and parents so they can provide additional supports Give positive directions; minimize the use of don t and stop. Please sit in your seat can be more effective than Don t stand up. This lets the student know what you would like him to do Allow a student who may be overwhelmed by noise on the bus to use earplugs or music or headphones Allow students to use a hands on sensory items, such as a squeeze toy. For a student with particularly challenging behavior, work with the school team to develop a positive behavior support plan specific to behavior on the bus

49 Trouble Shooting: Lunch Ask familiar staff to practice or help troubleshoot skills outside of the chaos of scheduled times- start the lunch routine five minutes before others arrive If necessary, use a visual menu for making choices in the cafeteria Reduce the number of choices or make a choice and practice ordering (with necessary visual supports, etc) earlier in the day. Visual schedules can be helpful in establishing and perpetuating routines, ensuring compliance (such as putting the tray and silverware in the appropriate places) and managing behavior Visual prompts and cues can be used to help a child make choices and know to initiate or respond (for example, cue card I would like peaches please ).

50 Trouble Shooting: Special Interests Many students with autism have a favorite topic or special area of interest that may interfere with schoolwork or social interactions. To shape the student s expectations and to minimize the impact of this obsession: Provide schedule opportunities to discuss this topic If appropriate, use a visual schedule Establish boundaries (when it is, or is not, appropriate to discuss this topic) Set a timer to establish duration Support strategies for expanding to other topics Reinforce the student for talking about other subjects or the absence of the topic

51 Resources 1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorder by Veronica Zysk and Ellen Notbohm (Future Horizons, 2004) Activity Schedules for Children with Autism: Teaching Independent Behavior by Lynn E. McClannahan and Patricia J. Krantz, Ph.D. (Woodbine House, 1999) An Educator s Guide to Autism (Organization for Autism Research, 2004) Solving Behavior Problems in Action by Linda Hodgdon Strategies at Hand; Quick and Handy Strategies for Working with Students on the Autism Spectrums by Robin D. Brewer, Ed.D. and Tracy G. Mueller, Ph.D. Ten Things Your Students with Autism Wishes You Knew by Ellen Notbohm

52 Resources Association for Positive Behavior Supports - Autism Internet Modules (AIM) Autism Research Institute Autism Speaks Kansas Autism Spectrum Disorders Storymovies OCALI AFIRM - Content of this power point was adapted from several sources including the Autism Speaks: School Community Toolkit

53 Local Autism Resources Families for Effective Autism Treatment (FEAT) Autism Society of Kentuckiana (ASK) Council on Developmental Disabilities KY Autism Training Center

54 Lisa Reid, Psy.S Lorraine McMullen Leet, Ed.S