Autism

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Autism

Stephen G. Viola, Ph.D. University of
Missouri-St. Louis One University Drive 201
EAB St. Louis, MO 63121 314-516-5332 viola_at_umsl.ed
u
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Autism Definition

• Autism means a developmental disability
  significantly affecting verbal or nonverbal
  communication and social interaction, generally
  evident before age 3, that adversely affects a
  childs educational performance. Other
  characteristics often associated with autism are
  engagement in repetitive activities and
  stereotyped movements, resistance to
  environmental change or change in daily routines,
  and unusual responses to sensory experiences.

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Autism Definition (cont)

• The term does not apply if a childs educational
  performance is adversely affected primarily
  because the child has an emotional disability as
  defined in this document.
• A child who manifests the characteristics of
  autism after age three could be diagnosed as
  having autism if the criteria above are satisfied.

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Autism Definition (cont)

• A child displays autism when
• A. Through evaluation that includes a review of
  medical records, observation of the childs
  behavior across multiple environments, and an
  in-depth social history, the following behaviors
  are documented

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Autism Definition (cont)

• 1. Disturbances of speech, language-cognitive,
  and nonverbal communication The child displays
  abnormalities that extend beyond speech to many
  aspects of the communication process.
  Communicative language may be absent or, if
  present, language may lack communicative intent.
  Characteristics may involve both deviance and
  delay. There is a deficit in the capacity to use
  language for social communication, both
  receptively and expressively.

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Autism Definition (cont)

• 2. Disturbance of the capacity to relate
  appropriately to people, events, or objects The
  child displays abnormalities in relating to
  people, objects, and events. There is a deficit
  in the capacity to form relationships with
  people. The capacity to use objects in an age
  appropriate or functional manner may be absent,
  arrested, or delayed. The child may seek
  consistency in environmental events to the point
  of exhibiting rigidity in routines.

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Autism Definition (cont)

• The condition adversely affects the childs
  educational performance.
• The autism is not a result of an emotional
  disability as defined in this document.

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Autism Definition (cont)

• Other Behaviors Which the Child May Exhibit
  Include
• A. Disturbance of developmental rates and
  sequences The child may also exhibit delays,
  arrests, or regressions in physical, social, or
  learning skills. Areas of precocious skill
  development may also be present, while other
  skills may develop at normal or extremely
  depressed rates. The order of skill acquisition
  frequently does not follow normal developmental
  patterns.

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Autism Definition (cont)

• B. Disturbances of responses to sensory
  stimuli The childs behavior may also range
  from being hyperactive to being unresponsive to
  people and objects in their environment and can
  alternate between these two (2) states over
  periods ranging from hours to months.
  Disturbances may be apparent in auditory, visual,
  olfactory, gustatory, tactile, and kinesthetic
  responses. The child may respond to stimulation
  inappropriately and in repetitive or
  nonmeaningful ways.

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Prevalence Rates

• 1/166 children
• (or 60 our of 10,000)

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Autism Spectrum Disorders

• Autism
• Aspergers Disorder
• Pervasive Developmental Disorder

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Perception Patterns

• Can perceive detail but has difficulties
  separating detail from the whole of the object
  that is being perceived. The child might be able
  to describe a house in the smallest detail, but
  not know where the house is.
• Have very few environmental impressions due to
  their lack of exploration.
• Perception difficulties are more noticeable
  around the second half of primary school when
  more formal-operation thinking is required.

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Perception Patterns

• Learns little from experience. Every, even
  slightly different situation, is perceived as a
  new one.
• In facing new situations, the child relies on
  verbal memories.
• The concept of time is difficult for them.
• Sensory style is often hyper-sensitive,
  especially sensitivity to sound. Some
  researchers hypothesize that this is because they
  primarily use their auditory sense to process
  information and this becomes a heightened sense.
  Often hypersensitive to tactile stimulation.

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Exploration Patterns

• Visually and spatial impaired in their
  exploration prefers to explore though listening
  and through asking many questions.
• Often stares due to visual overload.
• Shows very little interest in creative lessons
  like art or dance.

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Psychomotor Patterns

• Both basic coordination and finer coordination
  skills often develop very slowly and lag behind.
• At young ages, child tries to avoid crossing the
  two sides of his body for example, not crossing
  legs or arms.
• Problems with balance.
• Poor posture and difficulty maintaining posture
  when attention is focused elsewhere, for example,
  he forgets about posture and slumps when eating
  or reading.

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Emotional Patterns

• Children with autism seem to have difficulty
  recognizing their own and other peoples
  emotions.
• Physical contact is often difficult for them.
• Often appear as anxious.
• Their visual-spatial and planning weaknesses have
  a negative impact on their social interaction.
  They do not understand non-verbal reactions
  (signs, facial expression, body language, the
  pitch of someones voice).

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Emotional Patterns

• Children with autism also have difficulty
  estimating the space between themselves and other
  people, both physically and psychologically.
• Children with autism are often very gullible.
  They have to make an effort to realize that
  people can lie, or make sarcastic remarks, or
  just play them for a fool.
• When one considers that more than 65 of human
  communication is non-verbal, it is clear that
  children with autism miss out on most of it, or
  misinterpret a lot of it.
• Children with autism prefer speaking with an
  adult because adults answers are easier to
  predict than those of children. On the
  playground, the adult has a regulating role and
  that gives the child structure.

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Classroom Organization Strategies

• A classroom with few visual stimuli, which is not
  too big and open, is a good working environment
  for a child with autism.
• A permanent seating place gives the child an
  overview of the room.
• In order not to confront the child with
  visual-spatial limitation, he should not be
  expected to go back and forth to get items he
  needs.

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Classroom Organizational Strategies

• If the child needs to move from classroom to
  classroom, a map might be helpful or it would
  even be better to appoint another child as a
  partner.
• May need help with keeping desk, locker, backpack
  in a useable state. Use organizing supplies like
  folders and labels.
• Recommended that he have a predictable daily
  schedule as possible.
• Picture schedules will need to be verbally
  supported.

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Pedagogical-Didactical Climate

• Often requires lots of training and repetition.
  Making things habitual.
• Be careful with figurative speech, irony, and
  abstract concepts.
• If he is shown a summary of what is to follow,
  the child will understand more from the lesson.
• Give the child extra time, avoid extensive
  writing exercises, emphasizing quality instead of
  quantity in writing exercises.

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Pedagogical-Didactical Climate

• Children with autism, as a consequence of their
  visual-spatial weakness, do not trust the visual
  appearances of a word, but rather its sound.
  While learning how to spell, a strong emphasis
  must be made on learning both through sound and
  visuals. Rhymes and songs can help the NLD child
  remember the form and order of words. Games like
  word-bingo might be less suitable because of heir
  strong visual nature.

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Pedagogical-Didactical Climate

• With spelling exercise, the childs weak
  psychomotor coordination must be taken into
  account. Copying words from the blackboard is
  extremely difficult. Having the child write
  words several times would be extremely difficult.
  
• When teaching mathematics, use consistent solving
  strategies. Do not confuse the child by showing
  multiple solving methods.

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Pedagogical-Didactical Climate

• Because of weak psychomotor coordination, make
  sure that any use of manipulatives is manageable.
  Manipulatives like an abacus is often difficult
  for NLD children.
• Chose workpages with the most simple layout. The
  paper would have as little color as possible, as
  few images as possible, and more than enough
  space to write down the answers.
• Complicated structures such as graphs and tables
  will require extensive verbal guidance (not just
  pointing at them).

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Pedagogical-Didactical Climate

• For writing, a wider handwriting style can help.
  Unfortunately, most types of paper do not give
  children enough space in between lines, so pages
  with larger breaks in between lines are
  recommended.
• For typing, consider taping the unnecessary keys
  down. Keyboards with lots of function keys often
  confuse the child.
• In regard to social-emotional, prepare the child
  prior to social situations like working in groups
  or recess.

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Pedagogical-Didactical Climate

• Training in social skills, with the emphasis on
  expressing emotion and the practice of
  appropriate non-verbal behavior, should also be a
  part of the program from the child.
• In social conflict, it may be necessary to help
  immediately in finding a solution and not to get
  involved in a conversation situation until later.

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New Findings in Autism Research
Stephen G. Viola, Ph.D. University of
Missouri-St. Louis One University Drive 201
EAB St. Louis, MO 63121 314-516-5332 viola_at_umsl.ed
u
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Associated Medical Concerns

• -Seizures
• -Sleep disorders (getting to sleep and staying
  asleep)
• -GI disorders, acid reflux, chronic
  diarrhea/constipation, abdominal pain
• -Nutrition deficiencies because of poor eating
  habits
• -Endocrine/hormonal

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Medical Issues

• Most physicians often attribute everything to the
  autism and not something physical. He
• hits his ears because he
• is autistic and not
• because he has an
• earache.

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Language Development

• The key to language development is affect

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Differences in Nonverbal Behavior

• Individuals with autism look more at mouth than
  eyes.

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Behavior Management

• Many studies have shown that when you abandon
  traditional behavior management techniques,
  development is much higher.

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Emotional Development

• The best thing for children with autism is
  emotional development.
• Greenspanfor children with autism you have to
  interact with the child and the child has to lead
  (whereas in ABA the adult leads)

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Emotional Development

• Child must go through stages of emotional
  development and this happens by interactions
  where the child has to lead the majority of the
  time.
• 1. Shared attention
• 2. Engaging and relating
• 3. Back and forth interactions (affective
  signaling)
• 4. Co-regulated Emotional (shared social) Problem
• Solving
• 5. Creating emotional and meaningful symbols
• 6. Building bridges between
• meaningful ideas

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The Developmental Individual Relationship Model
(DIR)
DIR Model Developed by Stanley Greenspan,
MD Stuart Shanker, D. Phil.
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DIR Model

• DIR model looks at all of the childs
  developmental capacities in the context of his
  unique biologically based processing profile and
  his family relationship and interactive patterns.
  As a functional approach, it uses the complex
  interactions between biology and experience to
  understand behavior.

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D I R

• D the childs functional-emotional
• developmental level
• I childs individual differences in sensory
• reactivity, processing and motor planning
• R childs relationships and interactions
• with caregivers, family members, and others

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Floor Time-Basic Principles

• I. Follow the childs lead
• II. Join in at the childs developmental level
  and build on her natural interests.
• III. Open and close circles of communication
• IV. Create a play environment
• V. Extend the circles of communication
• VI. Broaden the childs range of interactive
  experience
• VII. Tailor your interactions to the childs
  individual differences in auditory processing,
  visual/spatial processing, motor planning and
  sequencing, and sensory modulation
• VIII. Simultaneously attempt to mobilize the six
  functional emotional developmental levels

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School ProgramThree Components

• 1. Semi-structured problem-solving interactions
  involving cognitive, language, social, and
  emotional skills.
• A cognitive curriculum should involve
  pragmatics conversation groups, cooperative
  learning, and social stories. Consider RDI and
  Skillstreaming

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School ProgramThree Components

• 2. Spontaneous, developmentally appropriate
  interactions mobilizing the six functional
  developmental capacities
• Floor Time
• Includes social interactions with teachers and
  peers, social games, and play dates with expert
  peers

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School ProgramThree Components

• Motor, sensory, and visual-spatial activities.
• Often recommended three or more 20-minutes
  sessions per day. Sessions include the following
  elements
• Sensory Integration occupational therapy
  exercises (running, jumping, spinning, massage)
• Perceptual motor exercises (throwing, catching,
  kicking, tracking)
• Visual-spatial problem-solving (hide-and-seek,
  treasure hunt and flashlight games)
• Pre-academic and academic work

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Relationship Development Intervention with
Children, Adolescents and Adults

• Social and Emotional Development Activities for
  Individuals with Asperger Syndrome, Autism, PDD,
  and NLD
• Developed by
• Steven E. Gutstein and
• Rachelle K. Sheely

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Goals of RDI

• Will act in a more flexible manner and be more
  accepting of change and transitions.
• Will be more curious about discovering new
  features of the world.
• Will be more creative in communication, play and
  problem solving.

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Goals of RDI (continued)

• Will consider several alternative solutions to
  problems.
• Will think in terms of gray areas, not just in
  right or wrong, black and white terms.
• Will seek out and value others perspective and
  options.
• Will be more aware of own identity.

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Components of RDI

• Ages 2 and above
• ASD, PDD, NVLD and ADHD, LD
• 150 activities and exercises

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Instrumental Skills

• We often think of social skills as specific
  behaviors, such as making eye contact, waiting
  your turn, smiling, shaking hands and asking
  polite questions. They are important for getting
  what you need and fitting into society, however,
  they do not lead to friendships.

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Relationship Skills

• Individuals need to be able to apply the
  appropriate behavior to the social interaction.
  He must learn how to observe his social
  environment. He must rapidly process the
  critical emotional information he sees and hears
  and use that information as a critical reference
  point for determining his actions.

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Teach vs. Coach

• You TEACH instrumental skills
• You COACH relationship skills

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Coaching

• Coaching requires careful observation. It also
  requires a different style of communication. You
  will slow down your speech, use fewer words, and
  amplify and exaggerate your non-verbal
  communication. You guide and pace, always trying
  to stay right at the edge of the persons
  competence.

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Sensory Integration Definition

• Sensory integration is a neurobiological
  activity within our bodies. It is the way the
  nervous system processes information from the
  senses. Sensory integration is the brains and
  nervous systems ability to organize stimuli.
  When sensations flow in an organized manner, the
  brain can use these sensations to form
  perceptions, behavior, and learning.

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What sensory sensations are you experiencing
right now?
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Hypersensitive
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Hyposensitive
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Sensory Integration and ADHD

• 80 of children with ADHD are found to have
  hypo-sensitivity patterns
• 20 of children with ADHD
• are found to have hyper-
• sensitivity patterns

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Sensory Integration and ASD

• By definition, individuals with Autism
  Spectrum Disorder would have patterns of
  hyper-sensitivities

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Interventions

• Choose activities to stimulate a hypo-sensitive
  child (the hyperactive child)
• Choose activities to desensitize the
  hyper-sensitive child (the hypoactive child)

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Desensitization
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Intervention-Medications
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Time-In
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Everyone benefits from proprioceptive stimulation
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Massage
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Consider seating arrangements
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Prepare for Public Time
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Homework Considerations
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Sports and Sensory Integration
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Dinner Time
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Hugs
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Bedtime Routine
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Materials
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Materials
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