Introduction to Learning Exceptionalities

Autism Spectrum DisorderDr. Patricia Peterson

What is Autism?

IDEA: A developmental disability

significantly affecting verbal and nonverbal communication an social interactions, generally evident before age 3, that adversely affects a child’s educational performance (34C.F.R. 300.7[c][1](i))

DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders

Qualitative impairment in social interaction

Qualitative impairment in communication

Restricted, repetitive and stereotyped patterns of behavior, interests, and activities

Delays or abnormal functioning in:

Social interaction Language as used in social

communication Symbolic or imaginative play

Triad of Impairment

Lorna Wing, 1979

Characteristics Unconventional or inappropriate communication

behaviors Use of echolalia (the imitation of speech of

others) May eventually break down echolalic chunks into

smaller meaningful units as part of the process of transitioning to a rule governed, generative language system

Lack of varied, spontaneous make-believe play is one of the four possible features of the impairment in communication in the DSM-IV

Woods & Wetherby, 2003

Causes

Not yet identified 700% increase in last 10 years

Causes for increase? 1 in 166-250 children have ASD

Autism Spectrum Disorder Autistic Disorder PDD-NOS Rett’s Syndrome Asperger Syndrome Childhood Disintegrative Disorder

Autistic Disorder Failure to develop peer relationships Lack of spontaneous seeking to share

enjoyment, interests Lack of social reciprocity Communication impairment Lack of varied spontaneous make-believe play Restricted, repetitive and stereotyped patterns

of behavior Onset prior to age three Language and intelligence are strong predictors

of prognosis

Pervasive Developmental Disorder, Not Otherwise Specified (PDD NOS)

• Collection of features that resemble autism disorder but may not be as severe or extensive

• “Catch-all” diagnosis• DSM: Presentations that do not meet

the criteria for autistic disorder because of:

• Late age of onset• Atypical symptoms

Rett’s Disorder Reported only in females Development of multiple specific impairments after a

period of normal development Deceleration of head circumference growth between

5-48 months Loss of hand skills between 5 and 30 mos. Typically associated with severe or profound mental

retardation Interest in social interaction decreases after onset

but returns later Problems in gait and trunk movement Severe communication and psychomotor deficits

Childhood Disintegrative Disorder Marked regression in multiple areas following at

least two years of normal development Significant loss of previously acquired skills Exhibits Autistic Disorder symptoms in social,

interaction, communication deficits and restricted, repetitive behaviors

Onset prior to age ten Potential early signs include increased activity

level, irritability, followed by loss of speech

Asperger Syndrome Impairments in social relationships; verbal and

nonverbal communication Restrictive, repetitive patterns of behavior,

interests, and activities No clinically significant delays in cognitive

development in the first three years Impairment in reciprocal interaction Failure to develop peer relationships Lack of spontaneous seeking to share

enjoyment/interests Strengths in vocabulary and rote memory Challenges in visual-motor and visual-spatial skills

Early Indicators/Red Flags Failure to develop an anticipatory reach Absence of pointing Loss of language between 18 and 36 months Does not look at others Does not show interest in other children Does not orient to name Does not show objects Does not demonstrate symbolic play Does not show an interest in or joint attention to

games for pleasure or connection with another

Woods & Wetherby,2003

Assessment Assessment should include:

Observations Interviews Record review

Skill areas to be assessed Play Social-emotional Sensory motor Behaviour Health and self-care Communication

Play Normally developing play may

include: Activity across environments, partners

and objects Range and flexibility of topics/routines

and interests Manipulation of objects Symbolic (imaginary)

Social/Emotional Assessment Social interaction with all in

environment Attachment Range of emotional themes and

stability (effects of stress) Initiation

Sensory Motor Assessment Hearing Vision Motor strength, balance and

endurance Sensitivity to light, sound, touch,

taste and smell

Prelock, 1999

Behavioral Assessment Attention Temperament Motivation Anxiety

Health and Self-Care Considerations Toileting Sleep Nutrition Seizures Daily living skills

Communication Strategies Four strategies that can be implemented throughout

the school day to assist with the development of communication in individuals with autism include:

1. Increase awareness of and respond to all communication attempts.

2. Teach students with autism that their actions have distinct consequences associated with them.

3. Provide positive supports and learning opportunities. 4. Encourage interactions by providing individuals with autism

the opportunity to socialize in environments with age-appropriate peers.

Koegel and Koegel,1995

Evaluating the Effectiveness of the Curriculum and Environment

Does the curriculum content: Support the student’s ability to attend to the

elements in his/her environment? Encourage imitation or modeling of others? Develop the student’s ability to comprehend

and use language? Facilitate the child’s ability to play

appropriately with toys? Provide opportunities for social interaction

with peers?

Adapted from Dawson & Osterling, 1997

Are there transitions that teach survival skills? Is there family involvement? Does the program foster independence, initiative

and choice making? Is there a highly supportive teaching

environment that Supports direct teaching of core skills? Maximizes student’s attention to relevant stimuli? Facilitates social interaction?

Intervention Intervention provided before age three has a

much greater impact than intervention provided after age five.

Emphasis on successful communication interactions is one of the most critical components of educational programs for children with ASD.

For children who do not talk, it is important to develop a nonverbal means to initiate interactions. (Woods, J.J. & Wetherby, A.M.,2003)

Picture Exchange Communication System (PECS)

Uses pictures to create a functional nonverbal communication system

Child taught to exchange picture of desired item for actual item

Empirically sound method that develops communication skills to children who are nonverbal or limited in use of communication

http://www.pecs.com

Visual Schedules Offers form of environmental support Assists in organization. Prediction of events/ understanding

expectations Helps child to anticipate changes, make

choices and function independently Identify sequence and time of daily

activities Used with task organizers to identify steps

in a process

Safety in the Home by Care Shangton

                 

 

http://www.symbolworld.org/learning/pse/safety/safety1.htm

Copyright © 2005 Bridget A Taylor All Rights Reserved

Copyright © 2005 Bridget A Taylor All Rights Reserved

“Our highest human virtue is our connection with other humans, and social activity is basic to our health and happiness” (John Ratey, 2002)

As we educate the “whole child” to his or her highest potential, we must never fail to provide opportunities for social and communicative inclusion.

Teaching Social Skills Social goals are as important as

academic and life skills goals Generalization and maintenance

must be integrated into the program

Powers, 2004

Assessing social skills Which problems are potentially

dangerous? Which are most detrimental to social

inclusion? What are key skills needed? What are reasonable goals for the

year relative to the individual’s development?

Prioritizing Social Needs Independence Participation Functionality Age-appropriate Important to parents Interaction

Powers, 2004

Social Stories Short stories describe a situation using relevant

social cues/responses, providing a child with accurate and specific information about what occurs in a specific situation and why

Use descriptive, directive and perspective sentences (Who they are, what is the behavior, and what is the consequence to those around them)

Identify difficult situations for child Used to emphasize social skills and to teach

routine

Theory Of Social Stories

1. Presents information visually2. Identifies relevant social cues and provides

accurate information3. Makes the abstract social rules more concrete

Oliver Sacks: An Anthropologist on Mars4. Describes expected behavior5. Subtracts social interference to maximize

learning

What are Social Stories? Tool for teaching social skills to children Provide an individual with accurate information about

those situations that he may find difficult or confusing Situation is described in detail and focus is given to a few

key points: the important social cues the events and reactions the individual might expect to

occur in the situation the actions and reactions that might be expected of

him, and why. Goal of the story is to increase the individual’s

understanding of, make him more comfortable in, and suggest some appropriate responses for the situation in question.

Jason M. Wallin

Writing a Social Story Usually a first-person, present-tense

story used to provide as much information about a social situation as possible, so the child is better prepared to face, and act appropriately in that situation.

Types of Sentences Descriptive sentences

objectively address the “wh” questions

where the situation takes place,

who is involved, what they are doing, and why they may be doing it.

Perspective sentences give a peek into the minds of

those involved in the story; they provide details about

the emotions and thoughts of others.

Directive sentences suggest desired responses

tailored to the individual – “gentle” direction

Control sentences Helps student remember the

story or deal with the situation.

Not used in every story Typically used only with fairly

high functioning children.

Lining Up – A Sample Social Story

At school, we sometimes line up. (Descriptive) We line up to go to the gym, to go to the library,

and to go out to recess. (Descriptive) Sometimes my friends and I get excited when we

line up, because we’re going someplace fun, like out to recess. (Perspective)

It is okay to get excited, but it is important to try to walk to the line. Running can cause accidents, and my friends or I could get hurt. (Perspective)

I will try to walk to the line. (Directive) When my teachers says “Line up!”, I will remember

to walk to the line. (Control)

Exercise

Working in pairs, design a social story to address the following scenario:

Amanda is a 12 year old girl with PDD-NOS. She is verbal and reads at a fifth grade level. In the gym, Amanda tends to become aggressive during physical games, pushing other children and sometimes leaving bruises. Write a social story to help Amanda understand the rules of play in the gym.

References Holmes, A. & Holmes, D. (2003) Autism: An Introduction to Behavioral Teaching Strategies. Eden

Family of Services

http://www.derbyps org

Kepley, S., Accelerated Learning, LLC- conference 11-24-03, 2-24-04, 4-1-04

Powers, M.D., (2004) Teaching Social Skills to Students with Autism Spectrum Disorders: Assessment, Curriculum Development, Intervention, and Evaluation Conference, Cromwell CT

Prelock, P. (1999).Serving Children With autism Spectrum Disorders and Their Families: Strategies for Assessment, Treatment, and Curriculum Planning. American Speech-Language-Hearing Association (p.p.9-105)

Prizant, B.M., Wetherby, A.., Rubin, E.., Laurent, A.C., & Rydell, P. (2002) The SCERTS Model Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum Disorder. National Professional Resources, Inc., and Paul H. Brookes Publishing Co. (p.p. 1-13)

Ratey, John J. MD. A User’s Guide to the Brain. Perception, Attention, and the Four Theaters of the Brain. Vintage Books, New York. 2002.

Woods, J. J., & Wetherby, A. M. (2003).Early Identification of and Intervention for Infants and Toddlers Who are at Risk for Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools, 34 (p.p.180-193)