Putting Autism in Perspective

Transcription

1 Putting Autism in Perspective Stephanie Eger Childcare Enhancement With A Purpose UCP of Huntsville 1856 Keats Drive Huntsville, AL Ext. 106 seger@ucphuntsville.org WHAT IF: You couldn t tell someone else what you are thinking? You d be frustrated and display temper tantrums. WHAT IF: Noises (like fan running or refrigerator humming) bothered you? Shadows on the wall distracted you? Bright lights gave you a headache? You d have a hard time paying attention to your teacher. 1

2 WHAT IF: People made faces you could not understand: Someone smiles/ frowns/cries/sighs? You would start to ignore other people. WHAT IF: You only feel safe when you know exactly what will happen next and exactly how you are to respond? You would panic when changes happen in your routine or schedule. WHAT IF: You really don t like people touching you, but you must spend time standing in line or sitting at crowded table? You might scream or cry when touched. 2

3 WHAT IF: You like to play with cars by lining them up (all the blue ones and then the red ones) but other children keep coming over and taking cars away? You might hit or kick those children. WHAT IF: Rocking, swinging or running around in circles makes you feel good, but your teacher/parent keeps telling you: Stop that, sit still? You might just keep on rocking. WHAT IF: you had autism? You would need some extra help to make it through each day. 3

4 Although commonly just referred to as AUTISM, there are really several different disorders Although commonly just referred to as AUTISM, there are really several different disorders Effective in May 2013 DSM-5 a research planning task force manual American Psychiatric Association s (APA) Diagnostic and Statistical Manual of Mental Disorders Clients will no longer be diagnosed as having autism versus PPD-NOS or Asperger Syndrome as all of these different classifications will officially go away. However, individuals with Autism Spectrum Disorder (ASD) will be referred to as having one of three severity levels. Individuals whose severity falls outside the bandwidth of these three levels but who exhibit significant social communication challenges with then possibly be diagnosed as having Social Communication Disorder. 4

5 American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Must meet criteria A, B, C, and D: A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction. 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people. American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Must meet criteria A, B, C, and D: B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Must meet criteria A, B, C, and D: C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning. 5

6 American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Severity Level for ASD: Level 3 Requiring very substantial support Social Communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others. Restricted Interests & Repetitive Behaviors: Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly. American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Severity Level for ASD: Level 2 Requiring substantial support Social Communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others. Restricted Interests & Repetitive Behaviors : RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB s are interrupted; difficult to redirect from fixated interest. American Psychiatric Association DSM-5 Development Autism Spectrum Disorder Severity Level for ASD: Level 1 Requiring support Social Communication: Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. Restricted Interests & Repetitive Behaviors: Rituals and repetitive behaviors (RRB s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB s or to be redirected from fixated interest. 6

7 Autism affects 1 child in every 68 children born today Five times more prevalent in boys than girls: 1 in every 42 boys born today will develop autism Autism Speaks Autism Facts: Autism information: Research is finding genetic links (clusters of genes/triggers) associated with autism Autism appears to run in families cousins, siblings, twins (one twin may have it, the other does not) What does Autism do? Affects the way the brain interprets information received through the senses. Affects a child s language and social development. 7

8 How hearing may be effected: Every sound comes in at same volume level there is no background noise that child can ignore Background noise (hum of fan or A.C.) may be overwhelming to person with autism Certain sounds may cause fear --ones we don t even notice Sudden temper tantrums may be triggered by a disturbing noise How to help In loud busy places, create area for quiet break Give advance warning about upcoming sounds From: My Friend with Autism by Beverly Bishop My friend s ears work really well. He can hear sounds I may not even hear. He is almost always first to hear an airplane coming.this is why he sometimes covers his ears even when things don t sound loud to me. 8

9 How child s sense of vision may be distorted Sees light patterns, individual specks of color (rather than the whole picture ), not perceived by others May experience physical discomfort when in bright light How to help Sunglasses or hat to shade eyes Recognize that child putting head down or closing eyes may be response to overstimulation Shaded areas Child with autism s sense of touch is often affected Sensitivity often swings between over-reaction and under-reaction, so child may respond differently in each new situation For some, any unexpected touch is uncomfortable 9

10 How to help A pat on head, or a light (stroking) touch may be distressing rather than reassuring/use firm touch In group settings: fear of touch (end of line better than being in the middle) When children with autism are overwhelmed by a situation -They may crave DEEP PRESSURE TOUCH (firm, even pressure over large area). This will calm them down. -To achieve this they may wrap themselves up in a blanket or put on more clothing. Use of weighted vests might be recommended by the occupational therapist: provides deep pressure Bean bag chairs also provide deep pressure while child is sitting How to help 10

11 Strength the child s proprioceptive sense Unable to be gentle Due to under-sensitivity to touch or to the feeling of pressure Plays roughly with toys or companions Inappropriate responses Hits to show affection (doesn t seem to know how to receive or give hugs) Lack of fear doesn t realize dangerous situations (will run out into street, climb on unsafe structures) How to help Create Heavy Work where child pushes/pulls/drags/ moves heavy objects such as pulling a wagon or pushing a wheelbarrow, carrying a weighty box, moves furniture, etc. Child s sense of touch may be more sensitive in the mouth than in the fingertips Child may lick items or attempt to put inappropriate items in mouth. 11

12 How to help Supervise carefully what child puts in mouth Establish repetitive phrases to use consistently Not in your mouth-- the is to Teach peers to use those phrases when with the child How does Autism affect child s language development? Some children don t talk (are nonverbal may learn sign language), others do develop speech Some children use repetitive phrases sing the jingles from commercials heard on t.v. or radio Some children engage in echolalia repeat the lasts few words spoken to them Some children exhibit incorrect pronoun usage not using I or me, but using own name in sentence Some children lack of inflection monotone, flat voice How to help Remember that verbal instructions may overwhelm the child with autism Use icons or pictures to develop language and vocabulary 12

13 Children with autism tend to be visual learners A picture is worth a thousand words so illustrate or demonstrate expectations to the child with autism. From: My Friend with Autism by Beverly Bishop Because some things are hard for my friend, we use pictures to help him understand better I can use his pictures to help him with things like sharing, changing activities, or understanding feelings. Transition times will often upset a child with autism or an unexpected change in routine may result in meltdown. Children with autism often have strong need for more structure/schedules Need to know exactly how things will happen 13

14 How to help Concrete reminders of what happens next Pictures, icons of scheduled activities Give extra time for child to transition From: My Friend with Autism by Beverly Bishop Change is hard for my friend. He gets frustrated when he has to stop doing something and start doing a new thing. I can help him by telling him what we will do next. Just before recess I tell him I am cleaning up so I can go outside. How does Autism affect a child s social development? Impulse control is not usually well developed which can make quiet time and circle time difficult for the child. 14

15 Make time visible to the child and give child quiet activity to do Reasonable amount of time Defined expectations Clear consequences Something concrete that demonstrates how long quiet time will last Child with autism often has difficulty making eye contact with others But the child may still be paying attention or listening, just not looking at the person who is speaking. From: My Friend with Autism My friend may still want to play with me even if he doesn t talk much. Sometimes it helps him when I just keep playing and talking with him, even if his words don t make sense to me. 15

16 The expression of feelings is often an area of difficulty for the child: The child may not be able to read or understand the emotions of others The child may not be able to communicate their own personal feelings How to help identify emotions for child Identify (name) emotions the child or others are expressing Relate emotion to appropriate response Remember that child may not be able to perform simple tasks when experiencing emotions From: My Friend with Autism by Beverly Bishop Understanding other people s feelings is hard for my friend. When I see a person crying I know that person is sad. But when my friend sees a person crying, he may not understand what it means (he may laugh). 16

17 Children with autism often lack the ability to empathize or to see something from another person s perspective this makes sharing a difficult concept to achieve! How to help child with autism learn to share Be concrete, (have two of the same items, and give one to another child) Use a timer to define your turn Progress around a circle taking turns (creates a routine ) Child with autism may not understand abstract concepts or pretend play It s difficult for child to join in games that require pretending Unable to discriminate between real and pretend 17

18 Child with autism may be obsessive about a particular toy or certain topic: may be more interested in lining up cars than driving cars From: My Friend with Autism by Beverly Bishop My friend is good at playing. He loves to play with cars, trucks, and trains. He loves things that spin. He plays differently than I do. I can help him by watching what he does then doing the same thing right next to him. Then I show him how I like to play and maybe he will do it my way. Occupational therapists work with children with autism on touch and proprioceptive issues Such as: Self- regulation Knowing where your body is in space Oral-motor issues 18

19 Autism is like a puzzle The child with autism needs help to put all the pieces in the right places. 19

20 References and reading material: My Friend with Autism by Beverly Bishop, 2002 Ten Things Every Child With Autism Wants You to Know by Ellen Notbohm, 2005 Teaching Young Children with Autism Spectrum Disorder by Clarissa Willis, The Out-of-Sync Child by Carol Kranowitz, M.A.,