Chapter 11 Autistic Disorder

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Chapter 11Autistic Disorder

• Mclaughlin and Wehman
• 2nd Edition

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Functional Description

• Autistic disorder, or autism, has had a
  relatively brief history marked by confusion,
  controversy, and change.
• More than 50 years ago, when Kanner first
  described it, autism was considered a rare type
  of childhood psychosis
• Today it represents the most prevalent severe
  emotional disorder of childhood

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Various labels used over the years

• Childhood psychosis
• Childhood schizophrenia
• Atypical personality development
• Symbiotic psychosis
• Pervasive Development Disorder (PDD)
• Included infantile autism, childhood onset PDD,
  atypical PDD

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DSM IV (1994)

• Autism is listed as one of five PDDs
• Autism
• Retts disorder
• Childhood disintegrative disorder
• Aspergers disorder
• PDD NOS

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Differential Diagnosis

• Autism is rare (roughly 2 to 15 per 10,000 in the
  population)
• One of the reasons it is often misdiagnosed
• Autism shares a number of characteristics with
  other disorders.
• About 75 of people with autism and all people
  with mental retardation exhibit low IQs.
• Both may manifest stereotypic body movements

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Differential Diagnosis, cont

• The person with autism may appear to hearing
  impaired
• Speech and language disorders common
• Usually demonstrate severe disorders in more than
  one domain, thus appear to be multidisabled
• Lack of stable classification system has caused
  confusion

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Characteristics

• Five factors commonly ascribed to children with
  autism
• Affective and cognitive indifference
• Expressive affect
• Passive affect
• Anxiety/Fear
• Cognition

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Affective and Cognitive Indifference

• Avoidance of eye contact, blank expression, lack
  of emotion, preference for being left alone,
  dislike for hugging
• Hand and body use (e.g., finger flicking, hand
  shaking, rocking, staring at hands close up)
• Sensory stimulation (e.g., spinning jar lids,
  plates playing with spinning tops fascination
  for rushing air and crinkly sounds unusual
  interest in textures

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Affective and Cognitive Indifference, cont

• Peculiar mannerisms (e.g., unwillingness to use
  hands unusual sensitivity to smells, making
  peculiar sounds inside mouth)
• Fascination for objects (e.g., saving or hoarding
  materials carrying one particular object at all
  times fascination for elevators, fans, lawn
  mowers, etc.
• No response to pain

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Affect

• This factor characterized individuals with autism
  who were relatively outgoing and readily
  interacted with the environment, but in quite
  distorted ways.
• Eating (e.g., not eating everything on the plate,
  unusually picky eater
• Aggression and conduct (e.g., biting, pulling
  hair, or scratching others banging head, biting
  own hand whining, crying, or screaming when
  desires were not met noncompliant

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Affect, cont

• Distorted affect (e.g., crying on happy
  occasions, crying without vocalizing
• Anxiety/fear (e.g., overreacting to changes in
  the environment, believing harmless entities to
  be dangerous, excessive fear of loud noises,
  anxiety around water, fearfulness in crowds
• Noncommunicative vocalizations (e.g., uttering
  vocalizations as if they were real words, using
  little or no functional speech

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Cognition

• About 75 if autistic people (sic) exhibit low
  levels of cognitive ability (i.e., IQs lt 70) and
  a sizable portion of the autistic population
  remains mute
• Savant behavior (extreme skills in one area)
• Speech (echolalia, misusing pronouns, loud,
  wooden)
• Skill development (e.g., spontaneous use of skill
  that lags behind elicited use of skill, uneven
  skill development, exhibiting surprising skill at
  times

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Cognition, cont

• The factors of autism reflect the three major
  human attributes the arousal, affective, and
  cognitive domains
• Unlike many other disabilities, the condition is
  not characterized by slow development that
  mirrors usual developmental sequence

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Cognition, cont

• Instead the individual with autism displays a
  unique behavioral topography that may be fairly
  described as strange, distorted, even bizarre

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Rules of Thumb

• Of those properly labeled as autistic, the
  individual who shows more social and emotional
  contact has a better prognosis than one who shows
  little or no inclination to interact with others
• The person who has relatively good cognitive
  ability has the best prognosis among the
  population of individuals with autism

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Case one Affective and Cognitive Indifference

• Case example John (pgs. 204-205)

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Treatment of Self-Injurious Behavior

• Preliminary Considerations
• Genetic screening to test for anomalies
• Lesch-Nyhan and de Lange syndromes
• Other medical problems
• Environmental explanations

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Behavior Analysis 101

• B.F. Skinners behavior analysis is referred to
  as operant conditioning because it operates
  on the environment.
• Classical conditioning, associated with Pavlov,
  deals primarily with autonomic responses (the
  salivating dog) pairing unconditioned responses
  (salivation) with a conditioned response (bell
  ringing that leads to uncontrolled salivating)

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Behavior Analysis 101, cont

• Four causes of behavior
• (need functional analysis
• Tangibles
• Attention seeking
• escape/avoidance
• Self stim
• What do we want to do with behavior?
• Increase (or maintain) or
• Decrease

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Behavior Analysis 101, cont

• Increase behavior (Reinforcement)
• Positive reinforcement stimulus
• Negative reinforcement - stimulus
• Decrease behavior
• Punishment stimulus
• Time-out (or extinction) - stimulus

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The Dynamic Duo

• Positive reinforcement and active ignoring
  (time-out)
• Simple and effective if planned for and carried
  out consistently
• Almost always appropriate unless target behavior
  is dangerous

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Differential Reinforcement

• Differential Reinforcement of Other behavior
  (DRO)
• Differential Reinforcement of Incompatible
  behavior (DRI)
• Differential Reinforcement of Alternative or
  Appropriate behavior (DRA)

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Treatment of Self-Injurious Behavior, cont

• Selecting Treatment Variables
• Drug therapy
• Behavior management plan
• Defining Treatment Procedures
• Designing the treatment plan
• Response cost

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Case Two Expressive Affect

• Case example Shaka

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Treatment of Aggression, Noncompliance, and
Profanity

• Preliminary Considerations
• Was Shakas behavior learned?
• Selecting Treatment Variables
• Using aggression, noncompliance, and profanity to
  control ones surroundings
• Defining Treatment Procedures
• So what would you do?

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Case Three Cognitive Behavior

• Case example Rodney

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Speech and Language Acquisition

• Preliminary Considerations
• Facilitated Communication EEKS!!
• Selecting Treatment Variables
• Defining Treatment Procedures