An SLP Guide to the Autism Spectrum

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An SLP Guide to theAutism Spectrum

• Jennifer Collier CCC-SLP
• ASHA 2006

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A Brief History of Autism Spectrum Disorder and
Treatment

• Dr. Leo Kanner 1943 11 children study
• Hans Asperger 1944 autistic psychopathies
• Considered an emotional disorder paired with
  mental illness such as schizophrenia.
• Conscious decision to withdraw from the world.
• Bruno Bettelheim caused by mothers
  mistreatment.
• Pre1960s treatment psychotherapy and drugs.
• No education or family involvement.
• 1960s neurological and biochemical causes.
• ABA therapy
• Speech/Language Therapy based on other presenting
  factors.

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Autism Today

• 1354 increase since 1990
• 1/167
• 90 billion (2003) 200-400 billion (2010)

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Pervasive Developmental Disorders

• Autistic Disorder
• Retts Disorder
• Childhood Disintegrative Disorder
• Aspergers Disorder
• Pervasive Developmental Disorder Not Otherwise
  Specified (PDD-NOS)

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Autistic Disorder

• Qualitative impairment in social interaction. (2
  characteristics)
• Qualitative impairments in communication.
  (1characteristic)
• Restricted repetitive and stereotyped patterns of
  behavior, interests and activities. (1
  characteristic)
• Onset before age 3.
• Not Retts or Child Disintegrative Disorders.

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Retts Disorder

• Primarily found in females
• Normal development for first 6-18 months.
• Onset indicators
• Deceleration of head growth
• Loss of hand skills
• Loss of social engagement
• Poor gait/trunk movements
• Severely impaired expressive and receptive
  language skills

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Childhood Disintegrative Disorder

• Extremely rare regression in multiple areas of
  functioning following 2 years of normal
  development.
• Loss of acquired skills
• Language
• Social skills / Adaptive behavior
• Bowel / bladder control
• Play
• Motor Skills
• Abnormal Functioning
• Social Interaction
• Communication
• Restricted, repetitive and stereotyped patterns
  of behavior
• Not better accounted for by another specific PDD

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Aspergers Disorder

• Qualitative impairment in social interaction.
• Restricted repetitive and stereotyped patterns of
  behavior, interests and activities.
• Disturbance cause clinically significant
  impairment in social, occupational or other
  important areas of functioning.
• No significant language or cognitive delay nor
  delay in development of self-help skills,
  adaptive behavior or curiosity about environment.
• Motor Problems.

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Aspergers Syndrome

• A social disease
• Egocentric and sensitive to others criticism but
  simultaneously oblivious others feelings
• Typically a later diagnosis
• Higher Verbal IQ than HFA
• Higher IQ but not always students
• Argumentative / less flexible
• Conspicuously lacking in common sense
• Less developed Right Brain

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Pervasive Developmental Disorder Not Otherwise
Specified (PDD-NOS)

• Just what it says
• Not Autism-Lite
• Can change into other PDD disorder in time.

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High Functioning AutismPDD-NOS

• Behavior Issues due to
• Sensory
• Anxiety
• Fight/flight
• Orientation
• Communication
• Executive Functioning Impairments
• Communication
• Non Verbal
• Verbal
• Pragmatics

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Language Skills in HFA

• Strengths
• Word/nonsense
• word decoding
• Spelling
• Vocabulary
• Fluency

• Weaknesses
• Comprehension of
• Sentences
• Idioms
• Metaphors
• Stories
• Processing

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Latest Findings

• Social Emotional Immaturity
• Neurological Impairment
• ASD brains bigger and heavier
• Communication within brain different
• Default to Fight/Flight
• Language Intervention Not Clear Cut

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Autism group has less activation in Brocas
area than the control group and more in
Wernickes area Results are consistent with
poorer comprehension of complex sentences,
coupled with good word reading. From Just,
M.A., Cherkassky, V.L., Keller, T.A., Minshew,
N.J. (2004). Cortical activation and
synchronization during sentence comprehension in
high-functioning autism evidence of
underconnectivity. Brain, 127, 1811-1821. Used
with permission.
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Treatments and Interventions
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Pharmacology

• Highly effective in treatment of neuropsychiatric
  disorders
• 60 of ASD have attention problems
• 17-74 have anxiety or fears
• No Autism Pill
• Secretin
• MegaVitamins
• Special Diets / Food Allergies

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Sensory Integration
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Sensory Issues

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

• People
• Emotions
• Mands/tasks

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Augmentative Alternative Communication

• AAC

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ABA
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Applied Behavioral Analysis

• B.F. Skinner
• Task analysis / behavior shaping
• A-B-C
• Discrete trial training
• Presentation
• Response
• Consequence
• Pause
• Environment Manipulation
• Structure allows for learning

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Lovaas

• Mold and reward desired behavior and ignoring or
  discouraging undesirable
• actions.
• 30-40 hours week basic language,
• behavior and academic training.
• 4-6 hours of therapy 11 5-7 days a week.
• 50 of children demonstrate remarkable progress.
  90 show some progress.
• Earlier the intervention, better the results.

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PRT Pivotal Response Training

• Natural environment
• Basic skills rather than individual behaviors
• Inclusion
• Addresses improving motivation, self-management
  and self-initiation
• Lacks developmental framework/curriculum nor does
  it address sensory issues

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TEACCH
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History and Rationale

• First comprehensive state wide community based
  program of services for children and adults with
  autism and related disorders.
• Work more effectively in environment while
  reducing or removing autistic behaviors.
• Does not work on the behavior directly but on
  underlying conditions that will facilitate
  learning experiences.
• If a person better understands his/her
  environment, it becomes more predictable and less
  intimidating thus reduction of behaviors.
• By improving communication skills of a person,
  he/she has a better chance of comprehending and
  expressing thus behaving in a more appropriate
  way.

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Problem Behaviors Are Caused By

• Stimulation
• Confusion and Uncertainty
• Order and Expectation
• Disorganization
• Compulsiveness

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The Basics

• Reduce Anxiety
• Modulate stimulation
• Reduce confusion by providing clear expectations
• Organize space / environment
• Increase Meaning
• Clarify and develop connections
• Reduce confusion and improves organization
• Self Efficacy
• Need to feel competent
• Independence
• Acceptance

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Provide Structure

• Physical Structure
• Daily Schedule
• Activity Systems
• Visual Structure

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RDI
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Relationship Development Intervention

• Social Skills
• 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

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Relationship Development Intervention

• The Relationship Curriculum
• 6 levels and 24 stages
• Novice
• Apprentice
• Challenger
• Voyager
• Explorer
• Partner

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Social Stories
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What are they?

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

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Guidelines for Social Stories

• Sentence type
• Descriptive
• Perspective
• Directive
• Affirmative
• Creation steps
• Picture the goal
• Gather information
• Develop the text
• Implementation

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The Next Step

• Observe and Listen in many environments
• Chose one or several approaches individualize
  and modify as needed
• Creativity is key
• Be an active member on the team
• Educate and Inservice Knowledge is Power!

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Always Remember

• No treatment can cure Autism.
• Neurological condition
• Condition will not go away
• Autism is a dynamic condition changes occur
  over time and with intervention
• Listen to the Family their needs/wishes may not
  be what you think
• Ditto for the other significant people in his/her
  life
• Celebrate His/Her Strengths

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Questions
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The End
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Suggested Reading

• 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
• 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

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Suggested Reading

• Koegel, L. K., Koegel, R. L., Harrower, J. K.,
  Carter, C. M., (1999). Pivotal response
  intervention I Overview of approach. Journal of
  the Association for Persons with Severe
  Handicaps. 24(3), 174-185
• 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
• 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