INTRO TO AUTISM: DIFFERENT PERSPECTIVES Marion Staff Training 2009 Lisa Anderson M.S. Education, Autism Consultant, CESA 8 VIDEO: “J-MAC” http://video.google.com/videoplay?docid=7057999856625517002&q=Jason+McElwain&ei=PAMMSIKPD6PsrAK kjrG6BA&hl=en Autism Spectrum Disorders… WHAT DOES THIS MEAN? AUTISM SPECTRUM DISORDERS Pervasive Developmental Disorders WHAT IS AUTISM? (A.K.A. AUTISM SPECTRUM DISORDERS OR ASD) Autism is a complex neurological disorder that affects one’s communication and socialization ability. Autism is typically evident by Age 3 (can now be diagnosed as early as 6 months old) 1 in 150 children (1 in 94 boys) are now diagnosed with autism in the U.S. In the United Kingdom, 1 in 58 children has some form of autism. The rate of autism is highest in California of those born after 1980. Just over a decade ago, the prevalence rate was 1 in 10,000. Current research suggests that it is caused by the lack of coordination and proper connectivity within the brain. Common: Rapid Brain Growth in 1st year of life (Journal of the American Medical Association, 2003) . WHAT IS AUTISM? (CONTINUED) A new case of autism is diagnosed every 20 minutes Autism currently affects more than 1.5 million people in the U.S. alone http://dpi.wi.gov/sped/autdata.html NEUROLOGICAL DISORDER Cerebral Cortex: Most highly developed area of the brain which includes gray matter in right & left hemispheres. Activities within this area of the brain include: Thinking, Perceiving, Producing Language , Sensing & Interpreting input from various sources. Amygdala: Memory & Emotions. Temporal Lobe: Auditory Processing, visual input, semantics of language, verbal memory. Cerebellum: Coordinated, smooth movements of the skeletal muscular system including abilities to walk, talk, eat, and to perform other self care tasks. WHAT IS AUTISM? (CONTINUED) Autism impairs one’s ability to Communicate; affecting Receptive Language, Expressive Language and Pragmatic or Social Language abilities. Autism affects socialization. Autism affects the sensory system. Autism can impact cognitive skills where brain is wired differently. AUTISM SPECTRUM DISORDERS Autism impacts every individual differently… AUTISM SPECTRUM DISORDERS Children can move from one end of the spectrum to another with intensive Evidenced-Based intervention… Wisconsin is currently a part of the project that is being done to “Promote optimal development and learning of infants, children, and youth with ASD and provide support to their families through the use of evidence-based practices .” NATIONAL PROFESSIONAL DEVELOPMENT CENTER FOR AUTISM SPECTRUM DISORDERS EVIDENCE BASED PRACTICE BRIEFS A-F •Computer-Aided Instruction •Differential Reinforcement •Discrete Trial Training •Extinction •Functional Behavior Assessment •Functional Communication Training M-R •Naturalistic Interventions •Parent-Implemented Interventions •Peer-Mediated Instruction And Intervention •Picture Exchange Communication System (PECS) •Pivotal Response Training •Prompting •Reinforcement •Response Interruption/Redirection S-Z •Self-Management •Social Narratives •Social Skills Training Groups •Stimulus Control •Structured Work Systems •Task Analysis •Time Delay •Video Modeling •Visual Supports Login Login EmailPassword [ Forgot password? ] [ Create an account ] Picture Exchange Communication System (PECS) According to the developers of PECS, it is a behaviorally based intervention that teaches the learner to use visual-graphic symbols to communicate with others (Bondy & Frost, 1994; Frost & Bondy, 2002). This module will provide information on this augmentative and alternative communication system. WWW.AUTISMINTERNETMODULES.ORG WHAT IS AUTISM? Autism is now the most common childhood disability with more cases than pediatric cancer, childhood diabetes, and AIDS combined! It is estimated that lifetime individual costs for raising a child with autism ranges from $3.5 to $5 million dollars. FUTURE AUTISM EXPENDITURES The Department of Health and Human Services Projections over the next 15 years as the current wave of individuals with autism become adults… 27 Billion annually will be spent on living costs alone for the autism population by 2023; more than 1/3 of this year’s budget and larger than the entire current budget of the U.S. Energy Department. More than 380,000 individuals expected to need extensive services, often requiring 1:1 care in many cases The Washington Post, April 07, 2009 WHAT CAUSES AUTISM??? WHAT CAUSES AUTISM? Nobody knows for sure! There is no medical detection or cure for autism. Abnormalities in the shape and structure of the brain (brain imaging) Theories: Genetic Predisposition Environmental toxins (i.e. heavy metals) Controversy: Immunizations Mitochondria? (Hannah Poling) EPIDEMIC EPIDEMIC “Autism in the U.S. has reached epidemic levels, 1 in 150 children. Dr. Julie Gerberding, Director of the Center of Disease Control and Prevention has recently upgraded autism to “an urgent health threat.” “The most contentious issue of the autism debate is the link to routine childhood vaccinations.” “Hannah Poling v. U.S. Dept. of Health and Human Services, has changed this debate forever. What to Look For… EARLY SIGNS WHAT TO LOOK FOR…(EARLY SIGNS) No big smiles or warm, joyful expressions by six months or thereafter No back and forth sharing of sounds, smiles, or other facial expression by 9 months or thereafter No babbling by 12 months No back and forth gestures such as pointing, showing, reaching, or waving by 12 months No words by 16 months No two-word meaningful phrases (without imitating or repeating) by 24 months Any loss of speech or babbling or social skills at any age Autism Society of America AUTISM CHARACTERISTICS AUTISM CHARACTERISTICS… 1. 2. 3. 4. 5. 6. Insistence on Sameness Difficulty in expressing needs; uses gestures instead of words Repeating words or phrases in place of normal responsive language Laughing, crying, showing distress for reasons not apparent to others Prefers to be alone, aloof manner Tantrums AUTISM CHARACTERISTICS (CONT.) 7. 8. 9. 10. 11. 12. 13. 14. Difficulty mixing with others May not want to cuddle or be cuddled Little or no eye contact Unresponsive to normal teaching methods Sustained odd play Spins objects In appropriate attachment to objects Apparent over-sensitivity or unsenstivity to pain AUTISM CHARACTERISTICS (CONT.) 15. 16. 17. 18. No real fear of danger Noticeable physical over-activity or extreme under-activity Uneven gross/fine motor skills Not responsive to verbal cues; acts as if deaf although hearing tests in normal range ASA…if over half of these characteristics, then autism is possible PARENTS’ PERSPECTIVE http://www.talkaboutcuringautism.org/video/h ope-video.htm MYTHS ABOUT AUTISM MYTHS Children with autism don’t make eye contact. Children with autism do not show affection. They do and can. It may look different than neurotypical children Children with autism do show affection and may be extremely loving of others Children with autism cannot communicate effectively They may develop good, functional language skills where it may be difficult to distinguish them from others WORKING WITH FAMILIES THROUGH THE DIAGNOSTIC PROCESS… WORK CLOSELY WITH PARENTS/FAMILIES Parents are your BEST RESOURCE and best source of information…they know their child better than anyone else. But, they go through a grieving process when informed that something may be wrong with their child. Help parents feel comfortable and assist them through the diagnostic process WORKING WITH PARENTS/FAMILIES Grieving Process… 1. Shock - What? 2. Denial - Autism…No way! You are crazy! They like to be held…they smile, laugh, look at us…they are just late talkers! 3. Anger - How dare you…? 4. Bargaining - God, please let them be wrong! 5. Acceptance - Where do we go from here? Try not to take uncomfortable parent reactions personally!!! THE AUTISM EMOTIONAL ROLLER-COASTER… The grieving process is ONGOING… Consider the emotional aspects of raising a child with autism Autism Everyday… http://www.youtube.com/watch?v=FDMMwG7 RrFQ&feature=related - MEDICAL DIAGNOSIS VS. EDUCATIONAL ELIGIBILITY MEDICAL DIAGNOSIS VS. EDUCATIONAL CRITERIA Medical Consideration: Medical Diagnosis NOT REQUIRED in Wisconsin to determine educational disability of autism Medical information, if available, should be considered as part of an education evaluation…not sole component MEDICAL DIAGNOSIS VS. EDUCATIONAL CRITERIA School cannot require parents to obtain medical diagnosis during an educational diagnosis Medical terms such as Asperger’s Disorder, PDD, and others do not automatically qualify students under the educational disability category of autism. Labels do not transfer between systems (i.e. education and medical) AUTISM VS. ASPERGER’S AUTISM VS. ASPERGER’S What distinguishes Autism from Asperger’s is the severity of symptoms and… By definition: There is an absence of language delays with individuals with Asperger’s Syndrome Individuals with Asperger’s Syndrome cannot possess a “clinically significant” cognitive delay and must possess average to above average intelligence Individuals with Asperger’s Syndrome may be only mildly affected and they frequently have good language and cognitive skills AUTISM VS. ASPERGER'S Individuals with Asperger’s Syndrome usually want to “fit in” and have interaction with others…they just don’t know how to do it. Individuals with Asperger’s Syndrome may appear to be socially awkward and clumsy. They may lack empathy, may display limited eye contact, may talk about interests excessively and may not understand gestures AUTISM VS. ASPERGER’S Autism Children with Autism are frequently seen as aloof and uninterested in others Many individuals with autism display cognitive delays (though it is difficult to obtain accurate IQ scores as they experience significant difficulties with language ability Children can receive a diagnosis of autism when young and make substantial progress. They appear to look more like individuals with Asperger’s as they get older (move on the continuum)…Developmental history is important for diagnosis of Autism vs. Asperger’s IS THERE A CURE??? CURE? * Some claim recovery…reversing effects possible. Neuro-pathways can be changed with autism. Brain Plasticity…Early intervention can strongly impact progress. Cure??? Not so Sure!!! Improve and live a relatively “normal” life is VERY Possible! Several reports of children “overcoming” autism. Not “Gloom and Doom” as once thought. RESEARCH REWIRING THE BRAIN NEUROPLASTICITY Neuroplasticity, a.k.a. “plasticity” is the lifelong ability of the brain to reorganize neural pathways based on new experiences. The Brain in NOT Hardwired from Birth We all have a lifelong power to change As we learn, we acquire new knowledge and skills through instruction or experience. The ability of the brain to change with learning is what is known as neuroplasticity. NEUROPLASTICITY 1. Neuroplasticity occurs in the brain under two primary conditions: During normal brain development when the immature brain first begins to process sensory information through adulthood (developmental plasticity and plasticity of learning and memory). 2. As an adaptive mechanism to compensate for lost function and/or to maximize remaining functions in the event of brain injury. The environment plays a key role in influencing plasticity. NEUROPLASTICITY Brain changes can occur with… Positive or negative environments Exercise Nurturance Learning Other experiences… RESEARCH : LOVAAS Applied Behavior Analysis – research based…positive results for nearly half of children who received intensive therapy at a young age (between ages 3-8) Original research in peer-reviewed journals indicating that 90% of children substantially improved when utilizing the Lovaas Model of Applied Behavior Analysis, compared to the control group. Close to half attained a normal IQ and tested within the normal range on adaptive and social skills. RESEARCH: LOVAAS This research reported that 47% of those children that had received 30–40 hours of intensive therapy were mainstreamed into regular classrooms, and were classified as "indistinguishable" from their peers in follow-up studies. Wisconsin Waiver Program supports this Early intervention is imperative to future outcomes RESEARCH: LOVAAS Intensive In-home therapy and schools working together…strengthens generalization of skills, gets everyone on the same page. Learn from on another! TRADITIONAL AND NON-TRADITIONAL INTERVENTIONS… INTERVENTIONS Traditional Behavioral approaches (Discrete Trial Training…ABA) Relational Development Intervention Floortime Medical Interventions School Programs/Therapies/Activities Numerous Evidence-Based Interventions (i.e. Visual Supports, Peer Mediated programs, PECS, Social Skills Groups, Social Stories etc.) Non-Traditional Gluten/Casien Free Diet Vitamin Therapy Heavy Metal Detoxification (i.e. chelation) Sensory Integration Therapy Auditory Integration Training Vision Therapy Yoga Chiropractic Reflex Inhibition Programs (Physical Therapy) Martial Arts Music Therapy Hyperbaric Oxygen Therapy Many More Options… INTERVENTIONS… 1. 2. 3. 4. Look at each person individually. Become familiar with the major issues related to autism. Believe that individuals with autism can learn and do extraordinary things!!! Understand that they are not behaving inappropriately purposefully…it’s neurological!!! AUTISM IS A WORLD… http://www.youtube.com/watch?v=U1wsiVYCq n0 It is difficult to know what is inside of a non-verbal individual with autism. Sometimes the right piece of technology that allows them to speak may open up a whole new world… LEAST RESTRICTIVE ENVIRONMENT LEAST RESTRICTIVE ENVIRONMENT Individuals with autism often have a hard time generalizing information from one environment to another. May learn something very well in one environment, but not be able to do it in another. Inclusion in school and community settings is helpful to work on generalization. Adult Support…issues with dependency. BEHAVIOR ANALYSIS BEHAVIOR ANALYSIS Attention – positive or negative Escape or avoidance – get out of doing something hard or someplace uncomfortable, escape pain/discomfort, ask for help Power or control – of environment or people…happens when kids feel overly controlled To get a tangible reward – food, drink, toys, etc., immediate feedback…sensory needs being met Revenge or justice…not common with autism Expression of self – seeking independence Acceptance or affiliation – seeking social interaction, gain acceptance from peers BEHAVIOR ANALYSIS ABC Analysis Antecedent – What happened immediately before the behavior Behavior – What the exact behavior (in objective, observable and measureable words…Johnny hit Joey with a closed fist on Joey’s bicep) Consequence – What was the consequence (Johnny was removed from the lunch line and had to stand at the back) FUNCTIONAL BEHAVIORAL ASSESSMENT Should be completed when a significant behavior is interfering with living or learning Should be completed prior to writing a Behavior Intervention Plan See examples of FBA’s OTHER TIPS/TECHNIQUES TIPS/TECHNIQUES Sometimes the environment is so overwhelming that the student cannot learn Distracting worksheet simulation Consider all senses…try to live through the eyes of the child to see what they are experiencing Sandpaper simulation Consider potential medical issues (if cannot express him/herself, how do you know if not feeling well? That alone can cause behavior. TIPS/TECHNIQUES Social Stories and Social Scripts: Carol Gray http://www.thegraycenter.org/ NPDC-ASD: Social Narratives Assist individuals with autism in understanding social situations Provide instructions as to how to interact in socially appropriate ways PERSON FIRST, STRENGTH-BASED APPROACH Always consider the person first, then the disability (not “Autistic person”…” Person with Autism”) Focus on the individual’s strengths. What are they good at? (memorization, computers, working with hands etc.) Maximize strengths!!! But, do not forget about the weaknesses…Disconnected Kids Use MOTIVATORS whenever faced with difficult tasks It’s okay to give edible motivators as an instructional tool STRENGTH-BASED APPROACH Focus on their strengths while trying to address their weaknesses (Brain Balance) Believe that through new experiences with repetition, we can effectively retrain their neurological pathways Believe that they can learn ANYTHING given the opportunity…and repetition for things that don’t come easily GOAL: INDEPENDENCE A different perspective on AUTISM. HTTP://WWW.SPLENDAD.COM/ADS/SHOW/2863-GATORADE-WHATS-G-II QUESTIONS/DISCUSSION REFERENCES Autism Society of America, http://www.autismsociety.org/site/PageServer Autism Speaks, http://www.autismspeaks.org/ Wisconsin Department of Public Instruction: Educational Evaluation Guide for Autism, Fall 2007 Journal of Consulting and Clinical Psychology, 55, 3-9. Lovaas, O. I. (1987). National Professional Development Center on Autism Spectrum Disorders, http://www.fpg.unc.edu/~autismpdC/ Autism Internet Modules, http://www.autisminternetmodules.org/ Carol Gray’s Social Stories, http://www.thegraycenter.org/ Melillo, Robert. (2009) Disconnected Kids. Penguin Group (USA) Inc.