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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
  • Transcript

    • 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. 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.  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. Five factors associated with successful inclusion (Webber, 1997)
    • 5. 1. Sense of Community and Social Acceptance “I am as good as others here” “Everyone makes a valuable contribution to our group”
    • 6. 2. Appreciation for Diversity “I like to learn about how we’re different.”
    • 7. 3. Attention to Curricular Needs “What I teach meets the needs of my learners”
    • 8. 4. Effective Management and Instruction “I know what works” “Everything about my class helps me learn”
    • 9. 5. Personnel Support and Collaboration “I have the support of my team.”
    • 10. Learning about our learners with special needs: * Autism Spectrum Disorders * Language Delays * Sensory Processing Problems * Learning Difficulties * Attention and Impulsivity Problems
    • 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.  Prevalence Rates  What is Autism  Recognizing Autism in the Classroom  Latest Research  Autism in inclusion classrooms
    • 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.  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. 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. Maenner and Durkin, 2010, Pediatrics
    • 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.  Autism/Autistic Disorder  Asperger’s Syndrome  Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)  Autism Spectrum Disorder  **Nonverbal Learning Disability**
    • 19. Social Impairment Repetitive Behaviors & Restricted Interests Speech/ Communication Deficits
    • 20. Social Impairment Repetitive Behaviors & Restricted Interests Speech/ Communication Deficits Autism Language Disorders Asperger’s Sensory Integration problems
    • 21.  Broad range of…. › Intellectual functioning › Social Interest and motivation › Social competence › Language ability › Repetitive, unusual, challenging behaviors
    • 22. http://www.cdc.gov/nc bddd/autism/signs.html
    • 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.  Eye contact  Communicative use of gestures/body language  Directed facial expressions  Flat or limited range of facial expression  Inappropriate facial expressions
    • 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.  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.  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. 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.  Language delay  Inability to sustain a conversation  Stereotyped, repetitive, idiosyncratic language use  Lack of varied make-believe, or social imitative play
    • 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.  Conversation may be one-sided  Limited in flexibility or range of topics  Back and forth of interchange may be limited  Minimal “social chat”
    • 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.  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.  Excessive preoccupation with stereotyped pattern of interest  Inflexible adherence to routine and rituals  Persistent preoccupation with parts of objects  Stereotyped repetitive motor mannerisms
    • 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.  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.  Hand flapping  Finger flicking  Repetitively bouncing or spinning
    • 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.  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. Oversensitivity Undersensitivity
    • 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.  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.  Higher rate of oversensitivity in clinical populations › ASD – 56% › ADHD – 69%  Undersensitivity also very common in ASD
    • 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.  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. Comprehension of language Speech sound disorders Phonological disorders
    • 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.  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. Consideration of:  Cognitive functioning  Receptive language  Expressive language  Self-regulation  Social abilities  Emotional maturity
    • 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.  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.  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. 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.  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.  Low levels of cooperation  Being regarded as shy  More help-seeking Jones & Frederickson, 2010, Journal of Autism and Developmental Disorders
    • 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.  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.  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.  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.  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.  Explicit social instruction  Education about differences  Peer mediated intervention  Teacher prompting, modeling, support
    • 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.  Select tasks that require social interaction – e.g. frequent requests for more materials  Adult supported group activities
    • 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.  By Kindergarten › Not associating sounds with letters › Trouble with rhyming › Confusing similar-looking letters
    • 66.  End of first grade › Delay in reading and writing skills  Tested and found to have a learning disability
    • 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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