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ASD ASD Presentation Transcript

  • Autism Spectrum Disorders
    EPSE 317
  • Auntie Lizzie’s Story Time, Cont’d:
    This is the story of Elias, a wonderful nine-year old boy whose parents and kid sisters love him immensely.
  • Elias’s Family
    Mom: Zoreh, teaches in the faculty of cultural studies at SFU
    Dad: Hamid, is a dentist
    Two younger sisters:
    Ester, 5, is in kindergarten
    Hannah is 3
    (They both seem to be developing just fine.)
  • Elias was a lovely baby
    Never cried
    Slept through the night
    Never fussed if his parents left the room
    Learned to walk early
  • But by three, Elias’s parents began to worry
    They came from large families, so had seen many toddlers
    Elias was different
    Strange play:
    Lined up toys over and over
    Spun things
    Wasn’t talking at all at three
    Stiffened when anyone tried to hug him
    Hours-long tantrums; inconsolable, no matter what his parents tried
  • Hamid and Zorah suspected autism
    Seen at autism clinic at Sunny Hill Health Centre for Children
    Developmental paediatrician
    Sure enough, a diagnosis of moderate autism
    Elias was eligible for the provincial Early Intensive Behaviour Intervention program.
    Program was effective:
  • ABA sessions
  • When Elias started school he could:
    Use speech to communicate
    Still somewhat echolalic
    He could take part in parallel play with one peer
    Groups caused him distress
    He was toilet trained
    He could read and print, although comprehension was limited
  • Attends Lord Amherst Elementary School in Vancouver
    Elias has had an aide in his classroom since kindergarten
    He takes part in a modified academic program
    Reads and spells accurately, but can’t write a paragraph.
    Math computation is strong (he loves math) but he has difficulty with story problems
  • Socialisation and Behaviour are the Problems
    Can’t deal with change in routine
    Screams and hits himself in the face
    Has head-butted aides who tried to restrain him from self-injury
    Loud noises cause him extreme distress
    He can fixate on lights, staring at them and moving his head to and fro and resists attempts to draw him from this behaviour
    Anxious, asking repetitively “will there be a fire drill?” when he is uncertain of a situation.
  • Joey watching video
  • What can we do for Elias?
  • Autism Spectrum Disorder
    Childhood Disintegrative Disorder
    Asperger’s syndrome
    Rett’s Syndrome
    Pervasive Developmental Disorder not otherwise specified (PDD-NOS)
  • ASDs
    Neurologically based
    Incidence is debated—from 1 in 500 to 1 percent. Often said to be on the increase.
    Can appear in a variety of combinations
    Can vary in severity from mild to very severe.
  • Three Areas of Impairment
    Social interaction
    “Restrictive, repetitive, and stereotyped patterns of behaviour”
    Sometimes cognitive impairment but not always.
  • May present with other neurological disorders including epilepsy
  • Autism
    Cognitive deficits (often)
    Behavioural deficits
    Unable to relate to others
    Lack of functional language
    Sensory processing deficits or anomalies
    Behavioural excesses
    Resistance to change
    Bizarre and challenging behaviours
    Self-injurious behaviours
  • Autistic people, often
    Can present with “splinter skills,” an offensively dismissive term for areas of strength.
    May be apparently uneven in gross- and fine-motor development.
    Have no eye contact or very odd eye contact.
    Show oddities in emotion; laugh or cry for no apparent reason
    Have tantrums (autistic rage)
  • Asperger’s Syndrome
    Impaired social interaction
    Non-verbal communication (eye-gaze, posture, facial expression)
    Failure to develop peer relationships appropriate to developmental level
    Doesn’t spontaneously seek contact with others
    Lacks social and emotional reciprocity
  • Restricted or stereotyped patterns of behaviour
    Abnormally intense or focused preoccupation with one or more areas of interest
    Insistence on sameness or nonfunctional rituals
    Stereotyped and repetitive motor mannerisms
    Persistent preoccupation with parts of objects
    Clinically significant impairment in social, occupational or other important areas of function
  • No clinically significant general delay in language
    No clinically significant general delay in cognitive development or age appropriate self-helps skills.
  • Rett Syndrome
    Limited to girls (on X chromosome)
    Typical development until 8 to 16 months
    6-18 months reduced eye contact, hand wringing
    (1-4 years) Rapid loss of fine motor and spoken language, difficulty in initiating motor movement
    2-10 years on—motor problems, seizure disorders
    Thereafter—can last for decades, reduced mobility, muscle weakness, rigidity, eventual death.
  • Childhood disintegrative disorder
    The final pervasive developmental disorder diagnosis is called Childhood Disintegrative Disorder. This is a very rare disorder that makes itself known between the ages of two and ten years old. Affected children display sudden behavioral regression and loss of previously mastered skills in at least two of the following areas: communication, play, social or motor skills. Criteria for childhood disintegrative disorder are as follows (quoted from the DSM-IV-TR):
    A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.
    B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
    (1) expressive or receptive language (2) social skills or adaptive behavior (3) bowel or bladder control (4) play (5) motor skills
    C. Abnormalities of functioning in at least two of the following areas:
    (1) qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
    (2) qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)
    (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms
    D. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.
  • Childhood disintegrative disorder
    Onset between 2 and 10 years
    Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.
    Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
    expressive or receptive language
    social skills or adaptive behavior
    bowel or bladder control
    motor skills
  • Pervasive Developmental Disorder, Not Otherwise Specified(PDD-NOS)
    Typically for children with late onset of characteristics of autism or Aspergers.
    “Atypical autism” --some symptoms not present or to very mild extent
    Not due to schizophrenia, schizotypal personality disorder, or avoidant personality disorder.
  • That Was the Bad News…(or most of it)
    Here’s the Good News:
    Strong Advocacy
    High public profile
    Early intervention available
  • Ministry of Education and ASDs
    ASDs are categorised as Level II on the supplementary funding listing
    Many children with ASD diagnoses have full-time aide support
    Provincial Outreach Program for Autism and Related Disorders is well established
  • Kids with ASDs Need
    Language support (often, even with kids with Aspergers)
    Socialisation –
    Adapted academic programming
    Support for sensory issues
    Support for emotional-behavioural issues
  • Language Support
    Initially directed by SLP assessment
    Often provided by classroom aide
    Aide should have support from SLP
    In-class, or out of class
    “My name is..”
  • Social Skills
    Can be linked with Speech-Language
    Or explicit Social Skills courses
    “Social Stories”
  • Using my Quiet Spot 
    Sometimes, when people touch me, I get really upset.
    Sometimes, where there are lots of people around me, I start to feel upset.
    I feel like I need to run away.
    I feel like I need to yell!
    I can tell my teacher or (insert aide’s name here) I need to go to my quiet spot to calm down.
  • I can say, ‘Quiet spot!’ when I feel as if I am upset.
    I can also show a picture of my quiet spot to my teacher or (insert aide’s name here) when I feel that I need to go to my quiet spot.
    I should try to go to my quiet spot before I shout, cry or hit someone.
    I will try to tell my teacher or (insert aide’s name here) when I need my quiet spot. If I can’t, I will show them a picture card of my quiet spot.
    The will know what I mean.
    I can stay calm at school.
    My quiet spot helps me.
  • Echolalia
    --Speech that echoes
    How are you, Charlie
    ..You Charlie?
    Quotes from TV ads, repetetive phrases, etc.
    Can have communicative importance
    “You deserve a break.”
  • Self-stimulatory behaviour“Stimming”
    Repetitive behaviour
    Manipulating something
    Calming intent
    Is this limited to people with autism?
    Find acceptable “stims”
  • Socialisation
    Link with mutual enjoyment of intersts, or activities
  • Build on Strengths
    Build on interests
    Introduce change in tiny increments
    Recognise distress as real even if stimulus is odd
  • Relate, enjoy!