Amanda Tipkemper, M. Ed.

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• Amanda Tipkemper, M. Ed.
• Associate Principal
• High School for Students with Autism Spectrum
  Disorders

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The Childrens Home of Cincinnati

• Since 1864, The Childrens Home of Cincinnati
  has provided services and programs that transform
  the lives of vulnerable children and their
  families. We are a private, nonprofit
  organization and a leading provider of education
  and mental health treatment for children facing
  significant social, behavioral, and learning
  challenges. Last fiscal year, our services and
  programs impacted the lives of over 6,600
  children and their families.

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Learning Objectives

• ASD criteria characteristics
• The Student with ASD
• Getting the DX
• LUNCH
• Common ASD Services
• Techniques Interventions
• Local and National Resources
• Q A

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ASD Criteria characteristics
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STATS

• http//www.cdc.gov/ncbddd/autism/data.html

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299.00 Autistic Disorder

• An autism screening tool must meet all three
  primary areas defined by the DSM-IV description
  for autistic disorder ('s 1-3 under A below) to
  qualify for a positive rating from First Signs
• A. A total of six (or more) items from (1), (2),
  and (3), with at least two from (1), and one each
  from (2) and (3)
• (1) qualitative impairment in social interaction,
  as manifested by at least two of the following
• (a) marked impairment in the use of multiple
  nonverbal behaviors, such as eye-to-eye gaze,
  facial expression, body postures, and gestures to
  regulate social interaction
• (b) failure to develop peer relationships
  appropriate to developmental level
• (c) a lack of spontaneous seeking to share
  enjoyment, interests, or achievements with other
  people (e.g., by a lack of showing, bringing, or
  pointing out objects of interest)
• (d) lack of social or emotional reciprocity
• (2) qualitative impairments in communication, as
  manifested by at least one of the following
• (a) delay in, or total lack of, the development
  of spoken language (not accompanied by an attempt
  to compensate through alternative modes of
  communication such as gesture or mime)
• (b) in individuals with adequate speech, marked
  impairment in the ability to initiate or sustain
  a conversation with others
• (c) stereotyped and repetitive use of language or
  idiosyncratic language
• (d) lack of varied, spontaneous make-believe play
  or social imitative play appropriate to
  developmental level
• (3) restricted, repetitive, and stereotyped
  patterns of behavior, interests, and activities
  as manifested by at least one of the following
• (a) encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• (b) apparently inflexible adherence to specific,
  nonfunctional routines or rituals
• (c) stereotyped and repetitive motor mannerisms
  (e.g., hand or finger flapping or twisting or
  complex whole-body movements)
• (d) persistent pre-occupation with parts of
  objects
• B. Delays or abnormal functioning in at least one
  of the following areas, with onset prior to age 3
  years (1) social interaction, (2) language as
  used in social communication, or (3) symbolic or
  imaginative play.
• C. The disturbance is not better accounted for by
  Rett's disorder or childhood disintegrative
  disorder.

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299.80 Asperger's Disorder (or Asperger Syndrome)

• An Asperger/HFA screening tool must meet all six
  areas defined by the DSM-IV description of
  Asperger Syndrome (A-F below) to qualify for a
  positive rating from First Signs
• A. Qualitative impairment in social interaction,
  as manifested by at least two of the following
• (1) marked impairment in the use of multiple
  nonverbal behaviors, such as eye-to-eye gaze,
  facial expression, body postures, and gestures
  to regulate social interaction
• (2) failure to develop peer relationships
  appropriate to developmental level
• (3) a lack of spontaneous seeking to share
  enjoyment, interests, or achievements with other
  people (e.g., by a lack of showing, bringing, or
  pointing out objects of interest to other people)
• (4) lack of social or emotional reciprocity
• B. Restricted, repetitive, and stereotyped
  patterns of behavior, interests, and activities,
  as manifested by at least one of the following
• (1) encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• (2) apparently inflexible adherence to specific,
  nonfunctional routines or rituals
• (3) stereotyped and repetitive motor mannerisms
  (e.g., hand or finger flapping or twisting, or
  complex whole-body movements)
• (4) persistent preoccupation with parts of
  objects
• C. The disturbance causes clinically significant
  impairment in social, occupational, or other
  important areas of functioning.
• D. There is no clinically significant general
  delay in language (e.g., single words used by age
  2 years, communicative phrases used by age 3
  years).
• E. There is no clinically significant delay in
  cognitive development or in the development of
  age-appropriate self-help skills, adaptive
  behavior (other than in social interaction), and
  curiosity about the environment in childhood.
• F. Criteria are not met for another specific
  pervasive developmental disorder or
  schizophrenia.

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299.80 Pervasive Developmental Disorder, Not
Otherwise Specified PDD-NOS (PDD-NOS)

• This category should be used when there is a
  severe and pervasive impairment in the
  development of reciprocal social interaction or
  verbal and nonverbal communication skills, or
  when stereotyped behavior, interests, and
  activities are present, but the criteria are not
  met for a specific pervasive developmental
  disorder, schizophrenia, schizotypal personality
  disorder, or avoidant personality disorder. For
  example, this category includes "atypical autism"
  --presentations that do not meet the criteria for
  autistic disorder because of late age of onset,
  atypical symptomatology, or sub-threshold
  symptomatology, or all of these.

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Autism via IDEIA

• (i) Autism means a developmental disability
  significantly affecting verbal and nonverbal
  communication and social interaction, generally
  evident before age three, that adversely affects
  a child's 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.
• (ii) Autism does not apply if a child's
  educational performance is adversely affected
  primarily because the child has an emotional
  disturbance, as defined in paragraph (c)(4) of
  this section.
• (iii) A child who manifests the characteristics
  of autism after age three could be identified as
  having autism if the criteria in paragraph
  (c)(1)(i) of this section are satisfied.

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Diagnostic Features of Autism Spectrum Disorder

• Language
• Mute
• Echolalic
• Unusual speech patterns
• Social
• Rejecting/ Aloof
• Passive
• Interested but atypical

• Self-Stimulatory Behavior
• Body
• Object
• Obsessions
• Sensory Systems
• Hypo-active
• Hyper-active

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Video Break

• http//www.autismspeaks.org/what-autism/video-glos
  sary

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The student with ASD
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General Characteristics of the Student with ASD

• Challenges
• Motivation
• Auditory instructions
• Understanding expectations
• Focus on what? For how long?
• Flexibility
• Maintenance
• Generalization
• Fluency
• Multi- tasking
• Endurance
• Speed

• Strengths
• Patterns
• Closure
• Visuals
• Repetition
• Structure
• Rote memory
• Logical thinking
• Rule driven
• Interest areas

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Theory of Mind

• http//www.educateautism.com/infographics/sally-an
  ne-test.html

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Issues to Consider

• Relationship Building
• Stimulus-to-stimulus pairing
• Skill Mastery
• Practice makes permanent.
• Task analysis- building strong foundations
• Prompt Dependency
• Skills should be monitored for independence, with
  a systematic decrease in the type and frequency
  of prompts given to a student
• Generalization
• All skills should be monitored for maintenance
  across environments, instructors, and stimuli

• Maintenance
• Skills that are considered mastered should be
  placed on a maintenance schedule based on a
  students individual demonstrated level of
  retention
• Skill deficit vs. Performance deficit
• Isolation versus application
• Continuity from year to year
• Building on technique instead a re-making the
  wheel see generalization
• Working with Families
• You cant teach what you dont own.
• Self-Advocacy
• Asking for help
• Feeling sick localizing the issue
• Bullying

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Getting the Diagnosis
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Medical DX where to start

• Family doctor/ pediatrician referral
• Childrens Hospital Medical Center CCHMC
• Division of developmental behavioral pediatrics
  DDBP
• The Kelly OLeary Center for ASDs TKOC
• STAY IN THE LOOP
• If you wait longer than 3 years for a re-eval,
  you must begin the process from the top

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Medical DX where to startcontd

• Central Clinic
• Dayton Childrens
• Nationwide Childrens
• Weisskopf Center _at_ University of Louisville
• Private psychiatrist/psychologist
• At the Childrens Home!

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Educational DX where to start

• http//www.edresourcesohio.org/files/etr_process_c
  hart.pdf

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Mozart the Whale

• http//www.youtube.com/watch?vDuGTGEAXvQUfeature
  sharelistPL3140A1F2BD91EFED

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Lunch!!!
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Common Services for ASDs
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Treatment Types

• The different types of treatments can generally
  be broken down into the following categories
• Behavior and Communication Approaches
• Dietary Approaches
• Medication
• Complementary and Alternative Medicine

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Working Together

• Parent/Caregiver
• General Educator
• Intervention Specialist
• Speech Pathologist
• Occupational Therapist
• Physical Therapist
• Specials Teachers

• Pediatrician
• Developmental Specialist
• Psychiatrist
• Psychologist
• Therapist
• Specialists vision, dietary, etc.

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Video Break

• http//www.autismspeaks.org/what-autism/video-glos
  sary
• http//www.autisminternetmodules.org/user_mod.php

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Effective, emerging Un-established Techniques
interventions
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Academics National Standards Project

• Goal of National Standards Project to provide
  critical information about which treatments have
  been shown to be effective for individuals with
  ASD.
• 11 Established Treatments treatments that
  produce beneficial outcomes and are known to be
  effective for individuals on the autism spectrum.
  The overwhelming majority of these interventions
  were developed in the behavioral literature
  (e.g., applied behavior analysis, behavioral
  psychology, and positive behavior support).
• 22 Emerging Treatments treatments that have
  some evidence of effectiveness, but not enough
  for us to be confident that they are truly
  effective.
• 5 Un-established Treatments treatments for
  which there is no sound evidence of
  effectiveness. There is no way to rule out the
  possibility these treatments are ineffective or
  harmful.

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Effective Treatments

• The following interventions are Established
  Treatments
• Antecedent Package
• Behavioral Package
• Comprehensive Behavioral Treatment for Young
  Children
• Joint Attention Intervention
• Modeling
• Naturalistic Teaching Strategies
• Peer Training Package
• Pivotal Response Treatment
• Schedules
• Self-management
• Story-based Intervention Package

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Emerging Treatments

• The following treatments have been identified as
  falling into the Emerging level of evidence
• Augmentative and Alternative Communication Device
  14 studies
• Cognitive Behavioral Intervention Package 3
  studies
• Developmental Relationship-based Treatment 7
  studies
• Exercise 4 studies
• Exposure Package 4 studies
• Imitation-based Interaction 6 studies
• Initiation Training 7 studies
• Language Training (Production) 13 studies
• Language Training (Production Understanding) 7
  studies

• Massage/Touch Therapy 2 studies
• Multi-component Package 10 studies
• Music Therapy 6 studies
• Peer-mediated Instructional Arrangement 11
  studies
• Picture Exchange Communication System 13
  studies
• Reductive Package 33 studies
• Scripting 6 studies
• Sign Instruction 11 studies
• Social Communication Intervention 5 studies
• Social Skills Package 16 studies
• Structured Teaching 4 studies
• Technology-based Treatment 19 studies
• Theory of Mind Training 4 studies

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Un-Established Treatments

• The following treatments have been identified as
  falling into the Unestablished level of evidence
• Academic Interventions
• Auditory Integration Training
• Facilitated Communication
• Gluten- and Casein-Free Diet
• Sensory Integrative Package

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Links

• Applied Behavior Analysis
• http//www.youtube.com/watch?viyCx-OLzgJw
• PECS
• http//www.pecsusa.com/
• Social Stories
• http//www.educateautism.com/social-stories.html
• http//www.thegraycenter.org/
• Structured Teaching
• http//www.specialed.us/autism/structure/str10.htm
  
• http//teacch.com/educational-approaches/structure
  d-teaching-teacch-staff

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PECS
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Structured Teaching
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Visuals
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Visuals
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Visuals
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Visuals
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Visuals
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Tech Visuals
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Visuals
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Local national resources
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Local Resources

• http//www.autismcincy.org/
• http//www.cincinnatichildrens.org/service/k/autis
  m/default/
• www.familieswithasd.org
• http//www.familieswithasd.org/yellow-pages
• http//www.got-autism.com/Home-12.html
• http//impactautism.org/
• http//www.sst13.org/Pages/default.aspx
• www.ucucedd.org/respite

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More Local Resources

• http//www.ocali.org/
• http//www.ode.state.oh.us/GD/Templates/Pages/ODE/
  ODEPrimary.aspx?Page2TopicRelationID849
• http//odmrdd.state.oh.us/Pages/default.aspx

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National Resources

• http//www.autism-society.org/
• http//www.autismspeaks.org/
• http//www.autismspeaks.org/family-services/tool-k
  its/100-day-kit
• http//www.cdc.gov/ncbddd/autism/index.html
• http//www.ninds.nih.gov/disorders/autism/detail_a
  utism.htm?cssprint
• http//www.tacanow.org/

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Q A
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FAQs

• http//autismcenter.org/autism_faq.aspxq9
• http//www.centerforautismresearch.com/autism_faq/
  
• Cause
• http//www.autism-society.org/about-autism/causes/
  
• Increase in Diagnosis
• http//www.jhsph.edu/research/centers-and-institut
  es/wendy-klag-center-for-autism-and-developmental-
  disabilities/_archive/Facts/autism.htmlhow_long_e
  xisted

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Amanda Tipkemper, M.Ed.Associate PrincipalThe
Childrens Home of CincinnatiHigh School for
Students with ASDs5050 Madison Road Cincinnati,
Ohio 45227Phone [phone] ext.
3209atipkemper_at_thechildrenshomecinti.org