AUTISTIC SPECTRUM DISORDERASD

GERRY BROPHY

TALKING LIFE

GROUND RULES

Confidentiality We have the right to make

mistakes and not know things

Take responsibility for your learning by asking questions and giving feedback

Allow others to have their say, challenge the views not the person

You can leave the room at any time, without explanation

AIMS

What is Autistic Spectrum Disorder(ASD)  How does ASD impact on individuals?  How these conditions can affect behaviours

What support is needed in order to lead fulfilling lives.

 

FULFILLING AND REWARDING LIVES FOR ADULTS WITH AUTISM

The guidance focuses on 4 important areas where health and social care can practically change the way they support adults with autism:

increasing understanding of autism amongst staff

strengthening diagnosis and assessment of needs

continuing to improve transition support ensuring adults with autism are included within

local service planning

WHAT ARE AUTISTIC SPECTRUM DISORDERS

Life long developmental disabilities causedby neurobiological dysfunction that typically:

Appears during first three years of life and

prevents individuals from properly understanding what

they see, hear and sense.

This results in problems in communication,

social relationships, and behaviour.

The History of Autism Spectrum

DisordersThe labels 'autism' and 'autistic' come from the Greek

word autos, meaning self, and were coined in 1911 by

psychiatrist, Eugene Bleuler.

He used the terms to describe an aspect of

schizophrenia, where an individual withdraws totally

from the outside world into himself.

Causes

Theories about the causes of autism have changed markedly over the years. Many professionals, believed that inadequate parenting was the primary culprit.

Recent increases in the numbers of children diagnosed with autism have also led to a search for possible environmental causes.

However, there is no evidence that environmental factors such as vaccinations (notably the MMR vaccine), pollutants, dietary additives, and so on, are in any way responsible.

CAUSES contd.

The causes of autistic spectrum disorder are

not clearly understood but include genetic

factors, chromosomal abnormalities,

complications of pregnancy and child birth

leading to organic brain damage.

The condition is associated with epilepsy in up

to 30% of cases.

Adults with autistic spectrum disorder may develop

mental health condition such as depression, anxiety,

compulsive behaviours, tics etc.

Diagnosis and treatment of conditions such as

depression/anxiety can be difficult in those with

communication problems.

Adolescents and young adults with Asperger's

syndrome have a higher suicide rate than those of

the same age group in the general population

Autism can co-exist with many other diagnoses, including: depression, social anxiety, obsessive compulsive disorder, attention deficit and hyperactivity disorder, Tourette’s syndrome/tic disorder, developmental coordination disorder, catatonia, eating disorders ,gender identity disorder, personality disorder, psychosis.

Pervasive Developmental Disorders

Asperger’s Syndrome

Autism

PDD – Not Otherwise Specified

Rett's Syndrome

Childhood Disintegrative Disorder

What differentiates?•Number of characteristics

•Age of onset

•Genetic factors

•Pattern of behaviors

•A certain diagnosis does not mean a “lesser”

set of concerns, this does not address severity

of any behavior.

ASPERGER'S SYNDROME

First described in the 1940s

Most people with Asperger's syndrome are within the normal range of intelligence but may have difficulties with social interaction and a restricted range of activities and interests.

Their speech can be well developed and fluent but language may be used in unusual ways.

Rett syndrome Typically, children with Rett syndrome begin by developing fairly normally but go through a period of regression, losing acquired skills; this can be accompanied by distress and anxiety. 

At least one in every 10,000 females born has Rett syndrome. It is believed to be the second most common cause of severe and profound learning disability in girls.

A large proportion of people who have Rett syndrome have a mutation, or fault, on the MECP2 gene on the X chromosome.

There are substantial communication and mobility issues for people with Rett syndrome.  Most will not speak and, by adulthood, only 50% will walk.  However, we are increasingly aware of people with Rett syndrome living well into their 50s and beyond.

Childhood disintegrative disorder (CDD)

Also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset (>3 years of age) of developmental delays in language, social function, and motor-skills.

No known cause for the disorder.

CDD has some similarity to autism, and is sometimes considered a low-functioning form of it, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills.

Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost.

The traits of ASD can be divided

into three main groups or Triad.

They are:

Social interaction,

Social communication,

Social imagination.

CHARACTERISTICS

Triad of Impairments

Social Relationships

Social Communication

(Social Understanding)

ASD

Social interaction

A person who has an ASD may find it hard to relate to other people.

They may:

Seem distant or detached,

Have little or no interest in other people,

Find it difficult to make friends,

Not seek affection in the usual way, or resist physical

contact, such as kissing and cuddling,

Social interaction contd.

Find it difficult to make eye contact with other people,

Want to have social contact but have difficulty

knowing how to initiate it,

Not understand other people's emotions, and have

difficulty managing their own emotions,

Prefer to spend time alone.

Social Communication

A person who has ASD may have difficulty using verbal and non-verbal skills, and some people may remain non-verbal throughout their lives.

People with ASD who do speak, may to others, appear to use speech in an over-complicated way, using odd phrases, or odd choices of words.

They may also make up their own words or phrases, and use more words than are necessary to explain simple things.

Social Communication contd.

Someone with ASD may also have difficulty:

Expressing themselves well,

Understanding gestures, facial expressions, or tones

of voice,

Using gestures to communicate,

Understanding instructions.

Some people with ASD may develop echolalia,

where they repeat words that have little meaning,

or repeat what has been said to them.

Social imagination

Children with ASD may:

Have limited imaginative play,

Play the same games over, or play with games designed for

children younger than themselves,

Get upset if their daily routines are interrupted in any wayShow repetitive behaviours, such as hand flapping or spinning.

In addition, children and adults may develop obsessions, for example,

Specific objects

Lists

Timetables

Routines.

.

Beyond the Triad of ImpairmentsThe Sensory World of Autism

• Senses provide us with the unique experiences which allow us to interact & be involved with others• Senses play a significant role in determining our responses to a particular situation

• Many individuals with autism experience either an intensification or absence of sensory integration

Hyper— Hypo—

The Sensory World of Autism

The Five Senses• Touch (includes balance and body awareness)

Tactile: relates to touch ,pressure, pain, hot/coldHypo- Holding others tightly

(Social aspect)Sensitivity to certain clothing/textures

High pain thresholdSelf-harming (biting, gouging etc.)

Hyper- Finds touch painful/uncomfortable

Dislike of having things on hands/feet

The Sensory World of AutismThe Five Senses

• Touch (includes balance and body awareness)

Vestibular: informs where body is in spaceHypo- The need for rocking, swinging, spinning

Hyper- Difficulties in activities which include movement (sport, dance)

Difficulties in stopping quickly or during an activity

The Sensory World of AutismThe Five Senses

• Touch (includes balance and body awareness)

Proprioception: where & how body is movingHypo- Proximity – personal body space in relation to others.

Navigating rooms – avoiding obstructions.

Hyper- Fine motor difficulties, manipulating small objects (buttons, threading, shoe laces etc).

Moves whole body to look at something.

The Sensory World of AutismThe Five Senses

• Sight

Visual: helps to define objects, colours, spaceHypo- Peripheral vision (central vision blurred)

Poor depth perception (throwing/catching)

Hyper-Fragmentation of images (too many sources)

Focussing on particular detail (rather than whole).

The Sensory World of AutismThe Five Senses

• Hearing

Auditory: informs about sounds around usHypo- Partial or complete absence of hearing

Enjoys noisy places/activities (bangs things)

Hyper- Magnification or distortion of sounds

Unable to filter out external sounds

The Sensory World of AutismThe Five Senses

• Smell

Olfactory: Is the first sense we rely onHypo- May be oblivious to strong odours

May lick things indiscriminately

Hyper- Smells appear intensified/overpowering.

Toileting problems

The Sensory World of AutismThe Five Senses

• Taste

Gustatory: Informs about various tastesHypo- Likes very spicy/salted foods

May eat anything (soil, grass, material etc)Hyper- Prefers bland (white) food

Texture of food may be problematic (lumps)

TreatmentThere is no treatment that can cure autistic

spectrum disorder (ASD).

However, there are many ways that a person with

ASD can get help and support in order to manage

their condition (interventions).

Some people with ASD will require specialist care

and support throughout their lives, whereas others

will require limited support at different times in their

lives.

As there is such a large number of interventions

available for people with autism, parents and

healthcare professionals may find it difficult to decide

which approach is best suited to their particular

circumstances.

Any approach should be positive, build on people's

strengths, and help to discover their potential,

increase their motivation, and provide the opportunity

for them to develop their skills.

Key Issues

Stimulus Over-Selectivity

Central Coherence

Executive Functioning

Idiosyncrasies in Attention

Literalness or Concreteness

Stimulus Over-Selectivity

Refers to the trend to respond only to part of a

stimulus rather than the whole object or to the

whole social setting.

Group examples

Central CoherenceImplies an inability to use context to make full sense of

what is presented (e.g. words with similar appearance

but different meanings and pronunciations like

" There is a tear in my shirt /There is a tear in my eye“

Group work

How many more can you think of?

Executive Functioning

Lacks the ability to plan ahead, or to bring together

bits of information from different sources, and to

generalise or learn for experience, may be limited.

Idiosyncrasies in AttentionThe individual with ASD may be able to focus well

upon certain activities, especially those that he or

she has chosen.

but will probably have problems in shifting attention

from one task to the next especially if the type of

attention required is also changing.

Group examples

Literalness or Concreteness In receptive language nothing can be taken for granted

in the individual’s understanding of instructions that

are not specific. Humour or figurative speech will be

very confusing.

A request such as “Would you like to finish that writing

now?” may only evoke the answer "No" ….

(And this might be wrongly interpreted as provocative

when this was not intended).

FAMILY AND CARERS

The impact of autism is keenly felt on relationships within the family including the parental relationship, the impact on other siblings and spousal relationships.

Advice and help from services and from other families and carers of individuals with autism is valued highly.

Parents also report a struggle to come to terms with a new identity as a carer of a person with autism and the sense of isolation or ostracism that came from this.

AUTISM ASSESSMENT Build the relationship slowly, do the assessment in several

parts over a few weeks • Making sure your assessments are person-centred is vital,

so take a step back to question whether you achieved that. Dr Lorna Wing [a leading expert in autism] said: "Once you

have met one person with autism, you’ve met one person with autism."

That is the phrase to remember because everybody is so different in the way the elements of autism impact on them.

You need a broad understanding of the experience of people on the spectrum, but you also need to understand how the individual is relating to other people and the world because that will influence how you adjust your assessment content.

The programme for any given person

will be based upon individual

observations and assessments,

but basic strategies could well include

some or many of the following:

•Providing a clear structure and set daily routines

•Visual timetables and picture boards to provide

checks on tasks to be covered

•Providing warnings of impending changes of activity

or interruption to routine

•Use of clear and unambiguous language

•Addressing requests or directions directly to the

person, and not assuming that s(he) will adhere to

group directions

•Teaching what "finished" means

•Repeating instructions and checking understanding

•Using a range of means of presenting ideas ….

Visual, peer-modelling, etc.

•Specific teaching and practising of social skills

like turn-taking

•Minimising distractors

•Exploring the use of computer-based learning

and word-processing

•Not insisting on those activities which the

person particularly dislikes, such as games

REFERENCES

Rosenblatt, M (2008). I Exist: the message from adults with autism in England. London: The National Autistic Society, p3, pp5-72 Baird, G et al (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP).The Lancet, 368 (9531), pp210-2153 Rosenblatt, M op.cit. p376 Batten, A et al (2006). Autism and education: the reality for families today. London: The National Autistic Society, p39 Rosenblatt, M op.cit. p311 Redman, S et al (2009). Don't Write Me Off: Make the system fair for people with autism. London: The National Autistic Society, p8

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