autism spectrum disorders introductory notes for the development of an effective support service

Autism Spectrum Disorders

Introductory notes for the development of an effective support service

History of the autism label

1911– Bleuler coins ‘autism’ from the Greek for self: ‘autos’

1940s – Kanner identifies traits such as aloofness, rigidity of routine,

repetitiveness, anxiety– Asperger identifies similar traits in adolescents– Bethelheim wrongly infers mental illness

1964– Rimland identifies a neuro-behavioural condition

1994– Autistic Spectrum Disorder (ASD) is defined as a ‘pervasive

developmental disorder’

Myths about ASD

– Everyone with ASD has a special talent– Everyone with ASD is a potential genius– Everyone with ASD is mentally retarded– ASD means no emotions or attachments– “Once autistic, always autistic”– “Confrontation must be avoided at all times”– Conversely, “All behaviours must be normalised”

The truth is: Everyone is a unique human being

The three main impairments

1. To social relationships

2. To social communication

3. To imaginative thought

But the combination of impairments is individual

And other characteristics are also common:– sensory sensitivity,– monotone voice, – bowel problems– and more

ASD ‘types’ or diagnoses

Autistic Disorder (classification) Childhood Disintegrative Disorder Betts Disorder Asperger’s Syndrome Pervasive developmental disorder: not otherwise

diagnosed (a ‘typical’ autism)

What counts is the actual behaviour, not the label

Potentially relevant medical tests

Hearing Genetic EEG (tumours) Metabolism MRI CAT scan

These may augment understanding of ASD condition, or adjust diagnosis

For example, some behaviours may be due to diet or hearing impairment, not ASD

Causes of ASD (I)

Unknown…

But probably a mix of:

– Genetic make-up

– Environmental factors (eg: toxins, serotonin, viruses, possibly vaccines, etc)

Causes of ASD (II)

This mix of genetic and environmental factors then appears to affect the following:

– Sensory nervous system - sensory sensitivities

– The brain - problems understanding the world

– Gastro-intestinal tract - bowel problems are common

Research continues - it is important to support & learn from

research

Understanding behaviours (I)

Sensitivities to different senses often need to be explored

Such sensitivities may explain behaviours, such as those opposite

– Very specific food choices (or is it an allergy?)

– Avoidance of noise and talk

– Minimal reactions to touch

– Not wanting to wear clothes

Understanding behaviours (II)

How would you behave if your environment was physically painful, or made no sense?

You might display some of the behaviours opposite.

Don’t assume. Explore.

Lack of eye contact and desire for own space

Unusual body movements

Not interacting or imitating

Lining up objects / liking furniture to stay the same

Tantrums and aggression

Sensory sensitivities

Really get to know people’s issues

Strike a balance between:

– desensitising the person - and

– changing or avoiding environments

Make commonsense practical arrangements:

– Sunglasses or a visor

– Ear plugs or a walkman

– Padded chair legs

– At home, avoid fluorescent lights

To push or not to push?

Pampering people’s autistic traits may avoid short term conflict but can greatly limit their quality of life and health

People will often benefit from individual development

plans with an element of challenge

People should be challenged for Quality of Life and safety reasons – not to make them ‘normal’

It is essential that everyone is careful, sensitive, and well informed.

Treatments and Programmes

There are many different variations

“The right teacher is more important than the type of programme”

Dr Temple Grandin

Portage - home teaching

Floor Time – join person’s world

SPELL – approach of Nat Aut Soc

TEACCH -approach of Aut Ind UK

ABA – applied behavioural analysis

PECS –picture exchange comm sys

Social Stories And more…

The S.P.E.L.L programme A National Autistic Society approach

Structure Positive approaches and expectations Empathy Low arousal (a measured approach to challenging and stretching people)

Links (involving and building on family and other relationships)

Applied Behavioural Analysis

Understanding and shaping people’s behaviour

Exploring people’s environment and experiences– What happens before a behaviour– What happens after a behaviour

Keeping records and looking for patterns

ABA is an essential tool in any programme

P.E.C.SPicture Exchange Communication System

A system for developing initial understanding of language by using pictures of items and rewarding appropriate use

For example, a request for a drink using a picture of a drink is rewarded with a drink

A range of courses and materials are available for purchase

Social Stories

Social Stories are relatively short, straightforward descriptions of social situations, specifically detailing what an individual might expect from the situation and what may be expected of him.

They describe the events and rules which usually apply when (for example) shopping

They help to overcome people’s problems in understanding the world

Specialist inputs

Professions:

– Psychology

– Speech Therapy

– Occupational Therapy

Technologies:

– Assistive (Environmental) Technology

– Information Communication Technology

Assistive Technologies

Movement Sensors Floor Sensors – prone alarms Staff pagers – prone alarms Flood sensors Heat / height controls, inside and outside Bed sensors

The holistic nature of ASD

No single response will suit all or any Individualised responses are needed But with some common patterns of some

needs:– Communication impairments– Sensory sensitivities– Socialization sensitivity– Rhythms and routines etc

Individual Support PlanningCartrefi Cymru’s person-centred approach

Get to know the person– Past & present– Important relationships– Likes & dislikes– Rhythms and routines– Skills & potential– Health – Dreams & aspirations

Plan together– Build on Care Plans– Optimise participation– Real communication– Turn goals into actions– Be focused & consistent– Responsive & respectful– Celebrate achievements

Enabling people to have ties and connections

Identify useful activities and opportunities which can connect to the person’s own likes and wants

Identify the information and skills they need

Help others to be understanding and accepting

Develop safety skills and “getting around” skills, maps etc

Promote community participation in all its forms – from work and learning to leisure and relationships

Any comments or suggestions?

Email us:

enquiries@cartrefi.org