Students with Autism Spectrum Disorder

Chapter 10

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Development of the Field

Early belief in “refrigerator mothers”1981 –distinguished autism and Asperger

syndrome1990 – Autism category added to IDEA1994 – Autism added to the DSM IV2013 – DSM only Autism Spectrum

Disorder. Dimensional system.

IDEA Definition of Autism Spectrum Disorder

…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.

Autism Spectrum Disorder

Persistent deficits in social communication and social interaction across multiple contexts

◦ 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.

Autism Spectrum Disorder

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:◦ 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 of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same 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 interests).

◦ Hyper- or hyporeactivity to sensory input or unusual interest 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).

With or without accompanying intellectual impairment With or without accompanying language impairment

Characteristics Language Development

Ranging from no verbal communication to complex communication Delayed Language Receptive vs Expressive Skills Echolalia

Social Development Delays in social interaction and social skills

Lack of peer relationships Failure to spontaneously share enjoyment,

interests, and achievements Lack of reciprocity Lack of Proxemics

Common characteristics Repetitive behavior

Fixations, tics, and perseverations. Self stimulatory.

Problem behavior Self-injurious behaviorStudies indicate the less communication needs are met, the more self-injurious behavior

Aggression Need for environmental predictability/sameness Sensory and movement disorders Intellectual functioning

Approx. 75% have intellectual disabilities

Prevalence of Autism Spectrum Disorder

Much controversy about prevalence. No consensus exists.

Some organizations say 1 : 166 children; others 1:100

IDEA estimates ~5% of studentsDSM-V reported rate of 1% of population Males outnumber females 4 to 1 Increased prevalence in last decade

Greater public awareness More refined diagnostic procedures

Causes of ASD

Biological Brain-Based Environmental

May be inherited Abnormalities in cerebellum

Controversy over

immunization

Higher frequency of siblings with

autism

Abnormalities in frontal and

temporal lobes

NOTHING has been

established!No single gene

responsible

Autistic Savant◦About 10% of the population with autism have splintering skills in areas such as Mathematical calculationsMemory featsArtistic and musical abilitiesReading ◦Hyperlexia– ability to read without formal instruction

Cognitive and Academic Characteristics

Cognitive abilities vary widely

Over-reliance on rote memory

Lacking a theory of mind

Problem solving challenges

Behavior Characteristics

Stimulus overselectivity

Generalization difficulties

Assessment

Intellectual◦75 % of individuals with autism have mental retardation; IQ norms between 35-50

Behavioral◦Behavior screening examplesChildhood Autism Rating Scale; Autism Diagnostic Interview (ADI)

◦Functional behavior assessment Required by IDEA

Functional Assessment◦Measures skills needed for independent living

Early Childhood Education

Typical programs often include:

Intervention prior to age 3

20 – 45 hours of intervention weekly

Active family involvement

Focus on communication and development

Individualized interventions

Educational Placements of Students Ages Six to Twenty-One Who Have Autism Spectrum Disorders

(in percentages)

Planning for the Transition to Adulthood

Teach work skillsTeach self-help skillsTeach play, leisure and

recreation skillsTeach social skillsTeach home management skills

Recommended Educational Practices

Environmental supports◦Visual supports

Assistive technologyInstructional practices

◦Priming - familiarize students with academic material ahead of time

◦Discrete trial training (DDT) - highly specialized approach to teaching skills

◦Prompting - providing physical or verbal cues to specific behaviors

Interventions

Applied Behavior Analysis (Lovaas)

Discrete Trial Training (DTT)

(1) Discriminative Stimulus - the trainer's command

(2) the child's response(3) the consequence (reward)(4) a short pause between the consequence

and the next instruction (between interval trials).

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InterventionsPsychological and Medical Services

Sensory Perception Programs address issues of tactile defensiveness or extreme reaction to auditory stimulus

Medications used to alleviate symptoms such as aggression, anxiety, or obsessive compulsive disorder, ADHD

Technology◦Apps for tablets◦Manual sign language◦PECS: Picture Exchange

Communication System

Social Skills Supports

Instruction in social skills

Social storiesSOCCSS

◦Situation◦Options◦Consequences◦Choices◦Strategies◦Simulation

Perspectives of Parents and FamiliesParents need information and support

◦Need for intensive, early intervention for child

◦Role of parent is very demandingSiblings also need support

◦Siblings play an important role◦Need resources appropriate to age

Current Needs in the Field of Autism Spectrum Disorder

Better techniques for early diagnosis and assessment

Evidence-based interventions

More programs to train professionals