Accommodating Autism

1
Accommodating Autism

• Jennifer Collier CCC-SLP
• ASHA 2008

2
Initial Evaluation
USF / 7-10-2003 Eddie 2y10m (34m)

• Mullen Scales of Early Learning
• Visual reception 24m
• Fine motor 26m
• Receptive language 23m
• Expressive language 18m
• Composite Standard Score 55(/- 7) 1st percentile

• Alpern Boll Developmental Profile II
• Physical 36m
• Self-help 26m
• Social 28m
• Academic 22m
• Communication 28m
• Impressions/Diagnosis
• Global developmental Delay
• Behavioral difficulties
• Avoided eye contact and no joint attention

3
Speech/Language Evaluation

• Central FL Speech and Hearing Center 8/6/2003
• Receptive-Expressive Emergent Language Scale-2
  (REEL-2)
• Receptive Language 19 months quotient 54
• Expressive Language 19 months quotient 54
• Moderate-Severe delays in both receptive and
  expressive language.
• Age appropriate articulation skills
• Behaviors observed
• Avoid situations where he felt uncomfortable or
  didnt know answer
• Self-stimulating and controlling behaviors to
  manipulate environment (avoid unfamiliar)

4
Early Language Characteristics

• Limited verbal (telegraphic)
• Gestures
• Strong visual skills but lacked non-verbal
  communication skills
• Expressive output - labels and very concrete
• Limited conversation / social communication
  skills
• Differences in prosody
• Pitch, rate, volume
• Speech sounds rote, mechanical, scripted
• Speech could be duplicated from media
• Language for personal reference not communication

5
Initial Challenges

• Behavior
• Following others routine
• Accepting the unfamiliar
• Difficulties due to
• Sensory
• Anxiety
• Fight/Flight
• Orientation
• Communication

• Communication
• Functional
• Non verbal
• Social
• Learning Environment

6
Learning Environment

• Addresses learning issues across all life
  environments.
• Deliberate 25-40 hours of language, behavior and
  academic training/therapy
• Identifies and develops strategies
• Flexible yet consistent

7
Eddies 1st Formal Program

• VE PreK classroom
• 8 children, teacher and assistant
• Very routine schedule
• Group/small group/individual time
• Participation in Regular Ed
• Field trips/assemblies
• Therapy
• SLP / OT
• Twice a week pull out and in class
• CARD (Center for Autism and Related Disorders)
• Home

8
Home ProgramPre-Language Skills

• Attention
• Something to say
• Cause and effect
• Desire
• Means
• Someone to listen and respond

9
Home ProgramPlay

• Exposure to outside world
• If first you dont succeed try, try again
• High interest stimuli
• Modeling and scaffolding
• Balance developmentally appropriate with age
  appropriate
• Create an environment which encourages
  interaction
• Pseudo Floortime Model

10
Home ProgramStructure Environment

• Problem behaviors caused by
• Stimulation
• Confusion and uncertainty
• Order and expectation
• Disorganization
• Compulsiveness

• Increase Meaning
• Reduce Anxiety
• Develop Self-Efficacy
• Provide Structure
• Physical structure
• Daily Schedule
• Activity systems
• Visual schedule

11
Eddies Room
12
Visual Schedule
13
Testing (A Year Later)

• Speech Language Evaluation
• ROWPVT SS 83 13th percentile
• EOWPVT SS 93 27th percentile
• Speech Language Evaluation II
• PLS-4 AC SS 75 EC SS 60 TC SS 64
• EVT SS 100
• Cognitive Evaluation
• DAS
• Verbal Cluster 81
• Nonverbal Cluster 85
• General Conceptual Ability 82

14
Sensory Issues

• Self Stimulation Behaviors

15
Why?

• People
• Emotions
• Mands/tasks

• Visual
• Auditory
• Olfactory
• Taste
• Texture
• Movement

16
Sensory Issues

• Need for Sensory

17
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Sensory Issues

• Some Solutions

19
Eddie Today

• Aspergers Syndrome
• Re-evaluation in July
• GARS 102 very likely
• ASDS 107/118 Aspergers very likely
• School Evaluation
• No WISC-IV / WPPSI-III VIQ 106/ PIQ 112 / IQ 112
• Achievement high 80s math / everything else 100

20
Speech/language evaluation

• CELF-4
• Core Language 82
• Receptive Language 94
• Expressive Language 87
• Semantic Language Quotient 106
• Syntax Language Structure 92
• PPVT-III 105 / EVT 95
• GFTA-2
• SS 83 /r/, /th/
• Pratting Pragmatic Protocol
• 36 (above 20 severe impairment)

21
Education

• Regular Education 2nd Grade
• Reads gt100 words a minute
• As on grade level / Principals List
• Outstanding behavior in reading and science
• Third Grade
• Still regular
• A in science, Cs in reading, math and writing
• Not on grade level for math or writing
• Behavior point sheet / Satisfactory behavior

22
Aspergers Syndrome

• Egocentric and sensitive to others criticism but
  simultaneously oblivious to others feelings
• Typically a later diagnosis
• Higher Verbal IQ than Performance IQ
• Higher IQ but wants to learn what he wants
• Argumentative / less flexible
• Conspicuously lacking in common sense

23
The Next Step

• Social Skills, Sensory and Surprises

24
Pharmacology

• A Study in

25
Relationship Development Intervention

• Instrumental Skills
• Pragmatics Eye contact, Turn taking
• Appropriate Behavior
• Follow Rules
• Prepare for and take tests
• Script driven
• Natural environments needed for context

• Relationship Skills
• Social Contact is the end product
• Make and keep friends
• Develop real empathy for others
• More than one way of thinking, feeling, problem
  solving
• Portable and generalizable

26
Social Stories

• A story that describes and improves social
  understanding.
• Answers the wh.
• First person and positive.
• Literally accurate and uses anxiety reducing
  vocabulary
• Concrete and motivating

27
Trip To PA
28
Dir-floortime

• Functional Emotional Developmental Milestones
  Higher Levels
• Multi-causal Thinking
• Comparative Thinking
• Internal Sense of Self
• Reflection on feeling
• Comparing how you feel vs. how you should feel
• Forms judgement

29
Successes for Eddie

• Continue to
• Address Sensory
• Structure
• Social Modeling
• A Family Affair
• Play
• Getting into His Head
• No Limits
• Treating Him Like a Neurotypical Kid

30
The End

31
Suggested Reading
Attwood, Tony, (2007) The Complete Guide to
Aspergers Syndrome. Philadelphia, PA London
Jessica Kingsley Publishers Baron-Cohen, Simon,
(1995)Mindblindness An Essay on Autism and
Theory of Mind. Cambridge, MA MIT
Press Charman,T, Stone, W, (Eds), (2006) Social
and Communication Development in Autism Spectrum
Disorders Early Identification, Diagnosis, and
Intervention. New York, NY Guilford
Press Emmons, Polly Godwin, Anderson, Liz
McKendry, (2005) Understanding Sensory
Dysfunction. Philadelphia, PA London Jessica
Kingsley Publishers Fouse, Beth, Wheeler, Maria,
(1997) A Treasure Chest of Behavioral Strategies
for Individuals with Autism. Arlington, TX
Future Horizons Grandin, Temple, (1995) Thinking
in Pictures and Other Reports from My Life with
Autism. New York, NY Vintage Grandin, T.,
Barron, S. (2005) The Unwritten Rules of Social
Relationships. Arlington, TX Future Horizons
32
Suggested Reading
Gray, Carol, (1994/2000) The New Social Story
Book Illustrated Edition. Arlington, TX Future
Horizons, Inc. Greenspan, Stanley I., Wieder,
Serena,(2006) Engaging Autism. Cambridge, MA Da
Capo Press Gutstein, Steven E., Sheely,
Rachelle K.,(2002), Relationship Development
Intervention with Young Children Social and
Emotional Development Activities for Asperger
Syndrome, Autism, PDD and NLD. London Jessica
Kingsley Kaufman, Nancy J., Larson, Vicki Lord,
(2005) Asperger Syndrome Strategies for Solving
the Social Puzzle. Eau Claire, WI Thinking
Publications Kluth, Paula, (2003) Youre Going
to Love This Kid! Teaching Students with Autism
in the Inclusive Classroom. Baltimore, MD Paul
H. Brookes Koegel, L. K., Koegel, R. L., (2006)
Pivotal Response Treatments for Autism.
Baltimore, MD Paul H. Brookes
33
Suggested Reading
Koegel, L. K., Koegel, R. L., (Eds) (1995)
Teaching Children with Autism Strategies for
Initiating Positive Interactions and Improving
Learning Opportunities. Baltimore, MD Paul H.
Brookes Koegel,L.K., LaZebnik, C., (2004)
Overcoming Autism.New York, NY Penguin
Books Kranowitz, Carol Stock, (1998) The
Out-of-Sync Child Recognizing and Coping with
Sensory Integration Dysfunction. New York, NY
Perigee Lovaas, O. Ivar, (2003) Teaching
Individuals with Developmental Delays. Austin,
TX ProEd Magnusen, Christy L., (2005) Teaching
Children with Autism and Related Spectrum
Disorders An Art and a Science. London Jessica
Kingsley Mesibov, Gary B., Shea, Victoria,
Schopler, Eric, The TEACCH Approach to Autism
Spectrum Disorders. New York, NY
Springer Prelock, P, et al (2006) Language,
Social and Cognitive Communication in Children
with Autism Spectrum Disorders. Seminars in
Speech and Language 271
34
Suggested Reading

• Shea, Victoria, Mount, Marianne, (1982) How to
  Arrange the Environment to Stimulate and Teach
  Pre-Language Skills in the Severely Handicapped.
  Austin, TX ProEd
• Sicile-Kira, Chantal, (2004) Autism Spectrum
  Disorders. New York, NYPerigee
• Simpson, Richard L., (2005) Autism Spectrum
  Disorders Interventions and Treatments for
  Children and Youth. Thousand Oaks, CA Corwin
  Press
• Tsai, Luke, (2001) Taking the Mystery Out of
  Medications in Autism/Asperger Syndromes.
  Arlington, TX Future Horizons
• Weiss, Mary Jane, Harris, Sandra, (2001)Reaching
  Out, Joining In Teaching Social Skills to Young
  Children with Autism. Bethesda, MD Woodbine
  House
• Winner, M, (2005) Think Social A Social
  Thinking Curriculum for School-Age Students. San
  Jose, CA Michelle Garcia Winner, SLP
• jcollier_cccslp_at_yahoo.com