Elias is a 9-year-old boy who was diagnosed with moderate autism at age 3. He displays characteristics common in autism including difficulties with social interaction, communication, and repetitive behaviors. He receives support through an ABA program, aide support at school, and a modified academic program. While he struggles with change, noise sensitivity, and social skills, he enjoys reading, spelling, and math. Early intervention and support are helping Elias develop skills and manage challenges.

1. Autism Spectrum Disorders EPSE 317

2. 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.

3. 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.)

4. Elias was a lovely baby Never cried Slept through the night Never fussed if his parents left the room Learned to walk early

5. 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

6. Hamid and Zorah suspected autism Seen at autism clinic at Sunny Hill Health Centre for Children Developmental paediatrician Psychologist Sure enough, a diagnosis of moderate autism Elias was eligible for the provincial Early Intensive Behaviour Intervention program. Program was effective:

7. ABA sessions http://www.youtube.com/watch?v=NbVG8lYEsNs&NR=1

8. 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

9. 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

10. 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.

11. Joey watching video http://www.youtube.com/watch?v=OhNhb40hPH0&feature=related

12. What can we do for Elias?

13. Autism Spectrum Disorder Autism Childhood Disintegrative Disorder Asperger’s syndrome Rett’s Syndrome Pervasive Developmental Disorder not otherwise specified (PDD-NOS)

14. 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.

15. Three Areas of Impairment Social interaction Communication “Restrictive, repetitive, and stereotyped patterns of behaviour” Sometimes cognitive impairment but not always.

16. May present with other neurological disorders including epilepsy

17. Autism Cognitive deficits (often) Behavioural deficits Unable to relate to others Lack of functional language Sensory processing deficits or anomalies Behavioural excesses Self-stimulation Resistance to change Bizarre and challenging behaviours Self-injurious behaviours

18. 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)

19. 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

20. 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

21. No clinically significant general delay in language No clinically significant general delay in cognitive development or age appropriate self-helps skills.

22. 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.

23. 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.

24. Childhood disintegrative disorder Rare Onset between 2 and 10 years DSM-IV— 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 Play motor skills

25. 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.

26. That Was the Bad News…(or most of it) Here’s the Good News: Strong Advocacy High public profile Early intervention available

27. 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

28. 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

29. 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..” http://www.youtube.com/watch?v=YPA5qB_lQvg

30. Social Skills Can be linked with Speech-Language Or explicit Social Skills courses “Social Stories”

31. 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.

32. 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.

33. Echolalia --Speech that echoes Immediate: How are you, Charlie ..You Charlie? Delayed Quotes from TV ads, repetetive phrases, etc. Can have communicative importance “You deserve a break.”

34. Self-stimulatory behaviour“Stimming” Repetitive behaviour Rocking Manipulating something Calming intent Is this limited to people with autism? Find acceptable “stims”

35. Socialisation Link with mutual enjoyment of intersts, or activities Music Art Birding Computers

36. Build on Strengths Build on interests Introduce change in tiny increments Recognise distress as real even if stimulus is odd

37. Relate, enjoy! http://www.youtube.com/watch?v=2wt1IY3ffoU