Autism Spectrum Disorders

Date 2nd November 2012

Terms

Autism Spectrum Disorder

• Classic Autism (Kanner)

• Asperger syndrome/ High Functioning Autism

• PDD-NOS (not otherwise specified)

Demographics• Prevalence:

• 1 per 100 for ASD

• Gender:• More male:female = 4:1

• Learning disability:• in 70 % of Autistic Disorder/ 1% Asperger

Syndrome

• Onset within first 3 years of age (DSM IV)

• Neurological/organic brain origin• No single cause• No cure (but positive interventions will help)

Causes

• Genetic influences and trends

• Multiple causes/triggers noted (not proven):• Pre natal (e.g. Foetal Alcohol Syndrome, Rubella, viral

reaction)• Peri-natal (During birth, like trauma, lack of oxygen/anoxia)• Post natal (e.g. Anoxia, viral reaction, injury)• Other unknown (e.g. Effects of contaminants)

• Research continues

• Autism is not caused by poor parenting!

Characteristics

•Social interaction

•Communication

•Restricted, repetitive behaviour

Triad of Impairment

Social CommunicationAll the things we do to communicate with each other

• Processing and responding to verbal instructions. May seem to not ‘hear’ you.

• Understanding the social meaning of language. WHY we talk to each other.

• Understanding jokes/sarcasm/innuendoes. Understand language very literally.

• Understanding face & body language (emotions!) and gestures.

• One sided conversations. Obsessive interests.

Social InteractionHow we interact with each other and have friendships

• Group interaction can be stressful.• Don’t understand the unwritten rules of friendship.• Don’t listen/respond to name or other social cues.• Don’t join in. Might not let others join in.• Lack of eye contact.• High functioning: often try hard to be sociable but hard to understand non-verbal signs and social rules.

Inflexibility of Thought & ImaginationUnderstand what others are thinking/feeling & able to change

own behaviour/thoughts

• May adhere strongly to routine. Change can be difficult and upsetting.

• Obsessions with particular objects or subjects.• Difficulty in seeing another’s perspective.• Lack of awareness of the effect of their own actions

or the intentions of others. May appear naïve or rude.

• Difficulty with creative play or “pretend” play.• May focus on a detail rather than the whole. • “Patchy” abilities. Difficulties with abstract thinking.

Associated Disabilities

• ASD can occur in association with any physical, learning or psychological disability, such as Cerebral Palsy, Down’s Syndrome, Epilepsy, language disorder and mental health problems.

• Dyslexia• Dyspraxia• Specific Learning Difficulties• ADHD• Anxiety disorders• Depression

Associated Behaviours

• People with ASD may demonstrate challenging behaviour, like running away, screaming, biting or kicking people, grabbing things in shops, socially unacceptable habits, naïve and embarrassing remarks.

• This is often as a result of stress, fear or misunderstanding of social situations.

Strengths

• Visual thinkers

• Attention to detail

• Special interests

• Loyalty

• Honesty

Challenges

• Communication

• Emotions

• Social interaction

• Generalization

• Sensory sensitivity

Sensory Issues

Sensory Sensitivity

• Clothes• Food (taste) and smell• Light and colour• noise/ sensitive hearing• touch and movement• visual

Behaviour is caused by, or related to more than one sensory processing area.

Behaviour Issues

• Caused by • sensory issues• lack of communication skills

• Behaviour • serves a purpose• always has a context• result of interactions with the environment• can be changed

• Pre acquired skills decrease when sensory sensitivities are in play

Sound

Sound

• Looks like• Screams, rocking, will not listen, talks loudly,

fiddles with equipment, easily distractible, can’t pay attention, hums loudly, sometimes can’t hear you.

• What it means• “Turning out” sound• Over stimulated by sound• High frequency of sounds e.g. TV• Doesn’t know which sound to attend to

Touch

Touch

• What it looks like:– Screaming, running away, explosions of anger,

hitting, taking clothes off, wears a limited range of clothes, doesn’t like face being washed, drags hands along walls, needs to touch everything

• What it means:– I don’t like soft/hard touches, they hurt me– Seeking tactile input, where is my body?– May need more tactile input

Light

Light

• What it looks like:– Screams in shopping centres, supermarkets, can’t pay attention,

runs away, wears a hat pulled low over eyes, wants to wear your sunglasses, difficulty picking objects

• What it means:– Can’t cope with the light, hurting my eyes, I’m seeing spots

Taste

Taste• What it looks like:

– Eating dirt, chewing constantly, refuse to eat certain foods/coloured foods, tantrums at table, can’t sit for a full meal, insists food is cut the same way, messy eater, prefers fingers to utensils

• What it means:– Overwhelming sensory input– May be unable to feel the sensation around

mouth– Poor fine motor skills– Doesn’t like the feel of utensils

Visual

Visual• What it looks like:

– Hat pulled low over eyes, running away, hands covering ears, won’t use colours when colouring in, tantrums, not looking people in the eye, focusing on small objects in the room (e.g. paper on floor), squinting

• What it means:– Too much visual input– Can’t process all the information

Proprioception/ Vestibular

Proprioception/ Vestibular

• What it looks like:– Spinning:

• Themselves• Objects• Watching spinning objects (visual stim)• Someone holding onto walls as they

move down hallways– Stimming/ flapping

• What it means:– No sense of self in space.

Sensory toys

Use sensory toys

• To distract• To ease the way• As distracters• As rewards

• Use • In pockets• On shelves• To play • As shields (trying to ignore something/

someone)

Considerations

1. When hyper/hypo aroused will have difficulty with:

• Attending to you/and instructions• Completing structured tasks• Initiating activities• Remaining alert

Considerations

2. Inappropriate behaviours need to bereplaced not extinguished

with appropriate ways to satisfy their sensory cravings

3. Don’t use a potentially reinforcing event such as music or deep massage immediately after an undesirable behaviour. It might increase that behaviour because of the consequence

Considerations

4. Behaviour is caused by or related to more than one sensory processing area

5. Give lots of sensory input to practice – but beware of overload

Our Journey........

Luke was our second gorgeous son,. When Luke was a baby he used to only have a bowel motion when we his nappies were off. The Plunket nurse said he would be toilet trained by the time he was a year old!...............

Luke was diagnosed with Autism when he was 2 years 2 months old, our lives changed forever

After educating ourselves about Autism by reading books, attending parent education programmes, Early Bird, SPELL and the national Autism NZ Conference we were ready to tackle and give anything a go, to help Luke learn strategies to help him make sense of our world.

Luke usually vomited after he ate food, and when he was younger we had to follow him around with a bowl, hoping to be successful in being in the right place at the right time.

Luke is non verbal

As he got older around 4 years old, Luke was able at times to get himself to the toilet to vomit. It was time also to try and get Luke toilet trained.He would not sit on the “Potty” so we decided to go straight to the toilet

Our first problem...... Luke was used to using the toilet for other reasons, so we had to desensitise him to that aspect of the toilet and teach him what it was really for

We used a social story with pictures of us all sitting on the toilet, and sequencing visual prompts around the walls in the toilet.

Once we got Luke sitting on the toilet, we used a visual timer 15 seconds for the first week, a 3 minute timer next, then we made it to a 10 minute timer, (as we had found out that many children with autism are visual learners!)

We had to find a motivator to reward Luke each time he sat on the toilet, we found a tickle me Elmo that sat on the window ledge in the toilet that Luke got to play with for 5 minutes ONLY if he sat on the toilet for the right amount of time, there were lots of tantrums as he really wanted to play with it more, but these were the rules!

We did this for about 18 months, no success. When Luke had done ‘Poos” he would take off his nappy and if you were not quick enough he would smear poo all over the place. After a while Luke changed his routine and started having a bowel motion overnight................

Welcome to POO PAINTING, yes I do mean poo painting, as I look back this would have been the most challenging time for us. You would go into Lukes’ room in the morning and there was poo over duvet, windows, chest of draws, in shoes, all over carpet, this wears you down after a while, I remember having to take the door off to clean under the door as poo had gone under onto the carpet when I opened the door

We actually had to rip up the carpet in Lukes’ room till we had this sorted, had to buy the biggest washing machine because sometimes I was washing duvets and blanket 3 or 4 times a week. We asked for a referral to Southern Behaviour Support as we needed help – I was going nuts!

I was talking to Luke’s new specialist teacher, she suggested a toilet training programme from the Downs Syndrome Society in Australia. I came home and went online and found the kit “toms toileting triumph”. It was very expensive!

While online I found another product from America. This was a round disc that I put into Luke’s nappy.

When it got wet it would start playing Old Macdonald had a farm, so now I could accurately record when he was actually going to the toilet, don’t forget Poo painting was still happening!

Luke loved the DVD “Toms Toileting Triumph” this is an animated story about how to use the toilet, Poo Painting is still happening, yay finally had the behaviour specialist on board to help after an 18 month wait..

Finally after 6 months of behaviour services and suggestions, we decided between us all, that maybe Luke only smears after using the night time nappy, because he does not like the sensation it causes, should we try taking the nappy away altogether and see what happens.....

Golly I was really nervous about this plan but I was desperate at this stage

It worked!!!!!!!!!!!!!!!!!!!!!!!!

We have not had another experience with Poo Painting, and Luke has carpet back in his room.

Luke watched Tom’s Toileting DVD lots and lots, it actually become his “Special Interest” . But after two weeks of continually watching this he went to the toilet and SUCCESS. Luke could now speak a few words, but amazingly he could speak the whole DVD - he had rote learnt this!

The next challenge was to get Luke to do poos on the toilet. First of all we cut a hole in his nappy and with help from the continence nurse specialist we had the use of a toilet training seat that had a step on the front, so Luke had something to put his feet on, over time we removed the nappy altogether and encouraged Luke to blow bubbles or blow a balloon up as we were told that this activity relaxes the mussels required, we also used to have Luke sit on the toilet at school break times as part of his routine.

Where are we today?

Luke can use the toilet and also say when he wants to go. He has to be prompted to remind him to shut the toilet door, and wash his hands. We did have a little set back with Luke just going to the toilet anywhere but we made another “social story” for him to teach him where it is appropriate to go to the toilet. We also had a small card with a picture of a toilet so he could show people when he needed to go!

We still do have to help Luke with wiping, he has a go first and then we have to help, he will call out from the toilet “Help Please”

If Luke has a set back, we just get Tom out of the cupboard

I feel that this is the biggest challenge that we have had to cope with, Now that we are 99% there it is fantastic. Now the next challenge is to get Luke to eat more than the five things he eats to help with constipation..... But that is a new chapter

I hope that this will help you understand about the challenges families face when they have a child with extra needs

The Plunket Nurse was wrong Luke was toilet trained 12 years later than she anticipated!