Dr. Black’s presentation is based on his expertise with autism and as a pediatric neuropsychologist,
and is not acting in ...
Major trends in education
1. Inclusion of special needs learners at
every level
2. Larger population in early education
se...
 Teachers may feel unprepared to cope
with special needs learners…
 Parents may wonder what is best for their
child…
 S...
Five factors associated with successful
inclusion (Webber, 1997)
1. Sense of Community and Social
Acceptance
“I am as good as others
here”
“Everyone makes a valuable
contribution to our g...
2. Appreciation for Diversity
“I like to learn about how we’re different.”
3. Attention to Curricular Needs
“What I teach meets
the needs of my
learners”
4. Effective Management and Instruction
“I know what works”
“Everything about my class helps me
learn”
5. Personnel Support and Collaboration
“I have the support of my
team.”
Learning about our learners with special
needs:
* Autism Spectrum Disorders
* Language Delays
* Sensory Processing Problem...
 What it is
 What it looks like in the early education
setting
 What the science tells us
 Classroom strategies that w...
 Prevalence Rates
 What is Autism
 Recognizing Autism in the Classroom
 Latest Research
 Autism in inclusion classroo...
 Rate of autism is ~1%
› 2008: CDC Estimates 1/110 diagnosed with autism
› 2007: UK Adult Psychiatric Comorbidity study e...
 Rates have been steadily increasing over
past 20+ years
 Recent study of special education
enrollment data in Wisconsin...
Number (per 1,000) of children aged 6–17 who were served
under the IDEA with a diagnosis of autism, from 1996 through
2007.
Maenner and Durkin, 2010, Pediatrics
 ~90% of cases, we don’t know
 ~10% of cases associated with known
chromosomal or genetic disorders
 Most heritable of ...
 Autism/Autistic Disorder
 Asperger’s Syndrome
 Pervasive Developmental Disorder, Not
Otherwise Specified (PDD-NOS)
 A...
Social
Impairment
Repetitive
Behaviors &
Restricted
Interests
Speech/
Communication
Deficits
Social
Impairment
Repetitive
Behaviors &
Restricted
Interests
Speech/
Communication
Deficits
Autism
Language
Disorders
Asp...
 Broad range of….
› Intellectual functioning
› Social Interest and motivation
› Social competence
› Language ability
› Re...
http://www.cdc.gov/nc
bddd/autism/signs.html
Includes:
 Deficits in nonverbal communication
 Failure to develop peer relationships
 Spontaneously seeking to share
e...
 Eye contact
 Communicative use of gestures/body
language
 Directed facial expressions
 Flat or limited range of facia...
 Unable to sustain reciprocal friendships
 Lack of interest/oblivious
 Lack of responsiveness when other
children appro...
 Limited social initiation
 Lack of bringing or showing objects
 Unlikely to share interest or excitement of
activities...
 Lack of social awareness
 Little interest in social interaction
 Tends to be more “object oriented” than
“socially ori...
Impaired ability to …
 Make social predictions
 Grasp impact of actions on others
 Imagine thoughts and feelings of oth...
 Language delay
 Inability to sustain a conversation
 Stereotyped, repetitive, idiosyncratic
language use
 Lack of var...
 Understanding spoken language
 Communicating verbally
 Lack of compensation through other
means*
› Gesture
› Facial ex...
 Conversation may be one-sided
 Limited in flexibility or range of topics
 Back and forth of interchange may be
limited...
 Scripted, repetitive use of speech
 Echolalic speech
 Unusual use of language
 Neologisms
 Pedantic “little professo...
 Play tends to literal, functional, concrete
 Difficulty ascribing agency to figures
› E.g. Elmo feeding Buzz Light Year...
 Excessive preoccupation with
stereotyped pattern of interest
 Inflexible adherence to routine and
rituals
 Persistent ...
 Fixated interest
 May be odd – doors, bumpers on cars
 May be a conventional interest but
extreme – obsession with din...
 Rigid adherence to routines
 Transition between activities (even
preferred activities) very difficult
 Unusual compuls...
 Hand flapping
 Finger flicking
 Repetitively bouncing or spinning
 Non-function use of a part of an object –
spinning wheels, opening/closing doors
 Sensory interest in objects
› Smellin...
 Developmental delay/Intellectual deficits
 Splinter strengths
 Language deficits
 Poor self-regulation
 Weaknesses i...
Oversensitivity
Undersensitivity
 Difficulty with the processing of sensory
input
› Sight, sound, taste, texture, proprioception
 Oversensitivity or unde...
 Oversensitivity: Aversion to
› Texture (play dough, rice, finger paint, grass)
› Light (fluorescent light, bright sunlig...
 Higher rate of oversensitivity in clinical
populations
› ASD – 56%
› ADHD – 69%
 Undersensitivity also very common in A...
 Oversensivity has been associated with
› Anxiety/internalizing problems
› Difficulty modulating response to input
 If d...
 Birth cohort study n=925
› Developmental disorders excluded
 16% of elementary children reported
tactile sensitivity – ...
Comprehension of language
Speech sound disorders
Phonological disorders
 Impairment in comprehension and/or
use of language
› Speech sound disorders very common
 8% of kindergarteners have a s...
 Affects boys 1.5 times more than girls
 20-40% have family history of SLI
 Associated with future learning disorders
›...
Consideration of:
 Cognitive functioning
 Receptive language
 Expressive language
 Self-regulation
 Social abilities
...
 Social motivation: highly aloof children
may not do as well
 Ability to follow basic social rules and
direction
 Funct...
 Minimal research available
 Research is largely based on case
studies and a handful of group studies
 Many studies are...
 Inclusion better for younger than older kids
(4th grade)
› Older children Less tolerant of “differences”
 Paradox: ther...
K-1st Grade 2nd-3rd Grade 4-5th Grade
Typical ASD Typical ASD Typical ASD
Social network
Centrality Status*
95% 55% 92% 57...
 Misperceptions of social involvement
 Typical peers become less tolerant of
differences and aberrant behavior
 Limited...
 Low levels of cooperation
 Being regarded as shy
 More help-seeking
Jones & Frederickson, 2010, Journal of
Autism and ...
 Concerns:
› Takes away teacher time
› Decreases classroom instruction
› Typical children may feel uncomfortable
 Resear...
 School is stressful and anxiety provoking
 Social isolation & bullying are common
 High risk for deliberate teasing
 ...
 Quiet classrooms, hand-pick teachers
 Time out/break from busy classrooms
 Try not to treat ASD kids differently,
espe...
 Peer relationships more important than
teacher for inclusion success
 Facilitate development of peer
relationships
› St...
 Training to:
› Individualize instruction
› Modify curriculum
› Manage the social and self-regulation needs
 Disorder sp...
 Explicit social instruction
 Education about differences
 Peer mediated intervention
 Teacher prompting, modeling, su...
 Case study of two kids with ASD
 Intervention:
› 4-5 minute training of whole classroom
› Adult prompting throughout da...
 Select tasks that require social
interaction – e.g. frequent requests for
more materials
 Adult supported group activit...
•A little slow to talk
•Unclear articulation, mixing up
syllables (“aminals”)
•Preschool:
•Alphabet, nursery rhymes,
memor...
 By Kindergarten
› Not associating sounds with letters
› Trouble with rhyming
› Confusing similar-looking letters
 End of first grade
› Delay in reading and
writing skills
 Tested and found to
have a learning
disability
Definition – Controversies and
Changes!
* 1960’s: “minimal brain dysfunction”
* 1970’s-2004:
IQ-Achievement “discrepancy”
...
Evaluating Autism Spectrum Disorders with the ADOS
Evaluating Autism Spectrum Disorders with the ADOS
Evaluating Autism Spectrum Disorders with the ADOS
Evaluating Autism Spectrum Disorders with the ADOS
Evaluating Autism Spectrum Disorders with the ADOS
Evaluating Autism Spectrum Disorders with the ADOS
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Evaluating Autism Spectrum Disorders with the ADOS

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  • SLI are pure language disorders, not caused by other condition
  • Not clear who what children are best suited for intervention
  • Evaluating Autism Spectrum Disorders with the ADOS

    1. 1. Dr. Black’s presentation is based on his expertise with autism and as a pediatric neuropsychologist, and is not acting in an official capacity for the National Institutes of Health.
    2. 2. Major trends in education 1. Inclusion of special needs learners at every level 2. Larger population in early education settings than ever before 3. Stakes are higher than ever
    3. 3.  Teachers may feel unprepared to cope with special needs learners…  Parents may wonder what is best for their child…  Some students are less able to benefit from inclusion…
    4. 4. Five factors associated with successful inclusion (Webber, 1997)
    5. 5. 1. Sense of Community and Social Acceptance “I am as good as others here” “Everyone makes a valuable contribution to our group”
    6. 6. 2. Appreciation for Diversity “I like to learn about how we’re different.”
    7. 7. 3. Attention to Curricular Needs “What I teach meets the needs of my learners”
    8. 8. 4. Effective Management and Instruction “I know what works” “Everything about my class helps me learn”
    9. 9. 5. Personnel Support and Collaboration “I have the support of my team.”
    10. 10. Learning about our learners with special needs: * Autism Spectrum Disorders * Language Delays * Sensory Processing Problems * Learning Difficulties * Attention and Impulsivity Problems
    11. 11.  What it is  What it looks like in the early education setting  What the science tells us  Classroom strategies that work: Tips and Tricks for all kinds of special needs kids
    12. 12.  Prevalence Rates  What is Autism  Recognizing Autism in the Classroom  Latest Research  Autism in inclusion classrooms
    13. 13.  Rate of autism is ~1% › 2008: CDC Estimates 1/110 diagnosed with autism › 2007: UK Adult Psychiatric Comorbidity study estimate 1% › 2007: National Survey of Children's Health (sample size: 78,037)  Gender ratio: 4-5:1 male: female  No differences across racial/ethnic groups › Some research suggests African American children diagnosed later, however  59% (range 49-70%) have IQ > 70 › CDC, 2007; 2002 surveillance data
    14. 14.  Rates have been steadily increasing over past 20+ years  Recent study of special education enrollment data in Wisconsin suggest the increase may be leveling off in some areas (Maenner and Durkin, 2010).
    15. 15. Number (per 1,000) of children aged 6–17 who were served under the IDEA with a diagnosis of autism, from 1996 through 2007.
    16. 16. Maenner and Durkin, 2010, Pediatrics
    17. 17.  ~90% of cases, we don’t know  ~10% of cases associated with known chromosomal or genetic disorders  Most heritable of all neuropsychiatric conditions › Identical twin concordance: 60-96% › Sibling risk: 2-8%  Poor parenting practices DO NOT cause autism  Research has NO LINK between vaccines and autism CDC.gov, 11.3.2010
    18. 18.  Autism/Autistic Disorder  Asperger’s Syndrome  Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)  Autism Spectrum Disorder  **Nonverbal Learning Disability**
    19. 19. Social Impairment Repetitive Behaviors & Restricted Interests Speech/ Communication Deficits
    20. 20. Social Impairment Repetitive Behaviors & Restricted Interests Speech/ Communication Deficits Autism Language Disorders Asperger’s Sensory Integration problems
    21. 21.  Broad range of…. › Intellectual functioning › Social Interest and motivation › Social competence › Language ability › Repetitive, unusual, challenging behaviors
    22. 22. http://www.cdc.gov/nc bddd/autism/signs.html
    23. 23. Includes:  Deficits in nonverbal communication  Failure to develop peer relationships  Spontaneously seeking to share enjoyment  Lack of social or emotional reciprocity  Impaired social cognition
    24. 24.  Eye contact  Communicative use of gestures/body language  Directed facial expressions  Flat or limited range of facial expression  Inappropriate facial expressions
    25. 25.  Unable to sustain reciprocal friendships  Lack of interest/oblivious  Lack of responsiveness when other children approach  Avoidance of peer interactions  Preference to play alone  Overly rule bound in social interaction  Lack of sharing
    26. 26.  Limited social initiation  Lack of bringing or showing objects  Unlikely to share interest or excitement of activities  No reaction to praise  No desire to please
    27. 27.  Lack of social awareness  Little interest in social interaction  Tends to be more “object oriented” than “socially oriented”  Excessively directive or rigid in social interactions  Does not notice another’s lack of interest
    28. 28. Impaired ability to …  Make social predictions  Grasp impact of actions on others  Imagine thoughts and feelings of others  Develop, maintain, and repair a social interchange  Recognize social mishaps  Recognize/follow social convention  Recognize distress in others
    29. 29.  Language delay  Inability to sustain a conversation  Stereotyped, repetitive, idiosyncratic language use  Lack of varied make-believe, or social imitative play
    30. 30.  Understanding spoken language  Communicating verbally  Lack of compensation through other means* › Gesture › Facial expression › Bringing of objects *Differs in children with ASDs and language delay
    31. 31.  Conversation may be one-sided  Limited in flexibility or range of topics  Back and forth of interchange may be limited  Minimal “social chat”
    32. 32.  Scripted, repetitive use of speech  Echolalic speech  Unusual use of language  Neologisms  Pedantic “little professor” speech  Odd intonation, rhythm, or pitch to vocal quality
    33. 33.  Play tends to literal, functional, concrete  Difficulty ascribing agency to figures › E.g. Elmo feeding Buzz Light Year  Impacts social play and cooperative play  In young children, functional play skills may also be limited
    34. 34.  Excessive preoccupation with stereotyped pattern of interest  Inflexible adherence to routine and rituals  Persistent preoccupation with parts of objects  Stereotyped repetitive motor mannerisms
    35. 35.  Fixated interest  May be odd – doors, bumpers on cars  May be a conventional interest but extreme – obsession with dinosaurs, maps, or a favorite movie  Excessively perfectionistic  Socially interfering, limiting other activities
    36. 36.  Rigid adherence to routines  Transition between activities (even preferred activities) very difficult  Unusual compulsion or rituals with routine events  Catastrophic reaction to minor changes in environment  Lining up objects
    37. 37.  Hand flapping  Finger flicking  Repetitively bouncing or spinning
    38. 38.  Non-function use of a part of an object – spinning wheels, opening/closing doors  Sensory interest in objects › Smelling people or objects › Preoccupation with texture › Close visual inspection › Seeking proprioceptive input
    39. 39.  Developmental delay/Intellectual deficits  Splinter strengths  Language deficits  Poor self-regulation  Weaknesses in executive functioning  Poor motor planning/graphomotor control  Sensory sensitivity/sensory integration weaknesses
    40. 40. Oversensitivity Undersensitivity
    41. 41.  Difficulty with the processing of sensory input › Sight, sound, taste, texture, proprioception  Oversensitivity or undersensitivity  No formal criteria to diagnosis  Usually identified by an occupational therapist
    42. 42.  Oversensitivity: Aversion to › Texture (play dough, rice, finger paint, grass) › Light (fluorescent light, bright sunlight) › Sound (classroom noise, lots of children talking, loud music) › Being touched  Undersensitivity usually to pain, but also to hot and cold
    43. 43.  Higher rate of oversensitivity in clinical populations › ASD – 56% › ADHD – 69%  Undersensitivity also very common in ASD
    44. 44.  Oversensivity has been associated with › Anxiety/internalizing problems › Difficulty modulating response to input  If distracted by sensory input, then harder to respond in a socially appropriate, well-modulated manner
    45. 45.  Birth cohort study n=925 › Developmental disorders excluded  16% of elementary children reported tactile sensitivity – 4 tactile sensations › May not be impairing, however  Oversensitivity  › 4-fold increase in internalizing problems › Less social competence (empathy, prosocial behavior) Ben-Sasson, Carter, Briggs-Gowan, 2009, Journal of Abnormal Child Psychology
    46. 46. Comprehension of language Speech sound disorders Phonological disorders
    47. 47.  Impairment in comprehension and/or use of language › Speech sound disorders very common  8% of kindergarteners have a specific language impairment (SLI)  5% of 1st graders have a recognizable speech (phonological) disorder › Range from sound substitutions to impaired communication http://www.nidcd.nih.gov/StaticResources/about/Plans/strategic/strategic06-08.pdf
    48. 48.  Affects boys 1.5 times more than girls  20-40% have family history of SLI  Associated with future learning disorders › Especially reading › Phonological disorders associated with math and written language weaknesses  Common in autism  Early intervention effective in treating language disorders http://www.asha.org/research/reports/children.htm
    49. 49. Consideration of:  Cognitive functioning  Receptive language  Expressive language  Self-regulation  Social abilities  Emotional maturity
    50. 50.  Social motivation: highly aloof children may not do as well  Ability to follow basic social rules and direction  Functional speech  Repetitive behaviors can be redirected Ferraioli and Harris, 2010, Journal of Contemporary Psychotherapy
    51. 51.  Minimal research available  Research is largely based on case studies and a handful of group studies  Many studies are of children “trained” to produce a specific response › Unknown whether behavior will generalize  Not clear which children will benefit
    52. 52.  Inclusion better for younger than older kids (4th grade) › Older children Less tolerant of “differences”  Paradox: there is less peer acceptance of more socially competent ASD kids  Limited evidence of benefit for inclusion without additional support  With adequate support emerging research suggests inclusion models support social competence
    53. 53. K-1st Grade 2nd-3rd Grade 4-5th Grade Typical ASD Typical ASD Typical ASD Social network Centrality Status* 95% 55% 92% 57% 86% 24% Acceptance .55 -.39 -.02 -.78 .00 -.89 Rejection .55 .44 .27 .19 .42 .67 *% with nuclear/secondary status Rotheram-Fuller, Kasari, 2010, Journal of Child Psychology and Psychiatry
    54. 54.  Misperceptions of social involvement  Typical peers become less tolerant of differences and aberrant behavior  Limited cooperative play skills  Poor motor skills – social involvement of boys is largely sports oriented Rotheram-Fuller, Kasari, 2010, Journal of Child Psychology and Psychiatry
    55. 55.  Low levels of cooperation  Being regarded as shy  More help-seeking Jones & Frederickson, 2010, Journal of Autism and Developmental Disorders
    56. 56.  Concerns: › Takes away teacher time › Decreases classroom instruction › Typical children may feel uncomfortable  Research (limited): › When done appropriately, typical children develop better social competence › No adverse impact on learning  Ongoing monitoring is important
    57. 57.  School is stressful and anxiety provoking  Social isolation & bullying are common  High risk for deliberate teasing  Anxiety worse in ASD than other groups › Secondary to social deficits › Need for order, consistency, and routine Humphrey and Lewis, 2008, Autism, 12, 23-46.
    58. 58.  Quiet classrooms, hand-pick teachers  Time out/break from busy classrooms  Try not to treat ASD kids differently, especially as they get older › Provide ‘behind the scenes’ support closely integrated with classroom teacher  Leverage ‘special interests’ to motivate Humphrey and Lewis, 2008, Autism, 12, 23-46.
    59. 59.  Peer relationships more important than teacher for inclusion success  Facilitate development of peer relationships › Stick up for kids with ASD › Support positive sense of self Humphrey and Lewis, 2008, Autism, 12, 23-46.
    60. 60.  Training to: › Individualize instruction › Modify curriculum › Manage the social and self-regulation needs  Disorder specific education, support and problem-solving resources  Access to an ASD specialist Humphrey and Lewis, 2008, Autism, 12, 23-46.
    61. 61.  Explicit social instruction  Education about differences  Peer mediated intervention  Teacher prompting, modeling, support
    62. 62.  Case study of two kids with ASD  Intervention: › 4-5 minute training of whole classroom › Adult prompting throughout day › Explicit modeling, prompting, and reinforcement  Increased peer to peer interaction & social skills Banda, Hart, Liu-Gitz, 2010, Research in Autism Spectrum Disorders
    63. 63.  Select tasks that require social interaction – e.g. frequent requests for more materials  Adult supported group activities
    64. 64. •A little slow to talk •Unclear articulation, mixing up syllables (“aminals”) •Preschool: •Alphabet, nursery rhymes, memorized sequences •Letter and color names •Counting and 1:1 correspondence
    65. 65.  By Kindergarten › Not associating sounds with letters › Trouble with rhyming › Confusing similar-looking letters
    66. 66.  End of first grade › Delay in reading and writing skills  Tested and found to have a learning disability
    67. 67. Definition – Controversies and Changes! * 1960’s: “minimal brain dysfunction” * 1970’s-2004: IQ-Achievement “discrepancy” * 2000’s: Low achievement, assess Response to Intervention (RTI)
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