Transcript Autism Academy - Comallie-Caplan Counseling and Consulting

Autism Academy
Autism Academy
Session One: Characteristics
Session 1 Agenda
• Core Triad of ASD Characteristics
– Impairments in social interaction
– Impairments in communication
– Restricted, repetitive, and stereotyped
patterns of behavior, interests, and
activities
• Additional learning characteristics
• Theory of Mind
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What is ASD
• The term autism spectrum disorders (ASD) is
used to describe a collection of disabilities
that share similar characteristics.
• Generally, ASD is interchangeable with the
term pervasive developmental disorders
(PDD), a category of disorders defined in the
Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR; American Psychiatric
Association [APA], 2000).
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The PDD Umbrella
(a) Autistic disorder,
(b) Asperger disorder,
(c) Rett’s disorder,
(d) childhood disintegrative disorder, and
(e) Pervasive developmental disorder, not
otherwise specified (PDD-NOS)
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Brief History of Identification of
Autism Spectrum Disorders (ASD
• Leo Kanner (1943), an American psychiatrist, wrote in-depth
case studies of 11 children with characteristics that would fit
the current definitions of autism, and that he believed
comprised a disorder unique from others including mental
retardation and schizophrenia. He called this disorder early
infantile autism. The characteristics included (a) difficulties
relating to others, (b) language delays, such as inability to
develop speech, echolalia, and literal interpretation of
language; and (c) unusual behaviors, such as obsessions,
insistence on routine and sameness, and self-stimulatory
behaviors. Kanner’s work sparked interest in the disorder
and lead to further research on characteristics and
treatment.
• At about the same in Germany, Hans Asperger (1944)
described children who demonstrated social deficits similar
and maybe milder than those in children with autism, but
who had average or better cognitive functioning. Asperger’s
work was largely ignored outside of Germany until recently .
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Prevalence
• Current estimates of prevalence of autism
is estimated to be one in every 91 children,
a significant increase from the previous 2007
estimate of one in 150. (Centers for Disease
Control Prevention, 2009)
• That currently translates to about 673,000
American children with some form of
autism.
• Approximately 44-67% of children with
autistic disorder also have mental
retardation
• The ratio is 4 boys to every girl diagnosed
with ASD (some studies 2.2 boys to every
girl)
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Characteristics Activity
•
•
•
•
Social Skills
Communication Skills
Repetitive Patterns of Behavior
Sensory Issues
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Overview of Autism
The definition of autism, or autistic disorder as it is
referred to in the DMS-IV-TR (APA, 2000), describes
individuals with impairments that are evident prior
to 36 months of age. Those diagnosed with autism
are on the more severely impaired end of the
spectrum and many also have mental retardation
(Simpson & Myles, 1998).
Impairments in autism can be described within
three categories: (a) social skills; (b)
communication; and (c) repetitive, restrictive, and
stereotyped behavior.
Social Skills
• They may have deficits or differences in nonverbal
communication skills, such as use of eye contact, body
language, gestures, and facial expressions. While they
may use some eye contact, it is not as frequent or
sustained \ as in their typical peers (Janzen, 2003). Some
children with autism do not appear to notice others, failing
to look at or initiate contact with others.
• The often do not build relationships with others their age
at a level expected considering their overall development.
• They rarely share attention with others, such as by
showing something, pointing, or pointing out interests or
accomplishments.
• They do not demonstrate emotional reciprocity. They
infrequently take turns in play or conversation (Janzen,
2003). For example, typical 18-month-olds spontaneously
hold out food for their caregivers to share a bite, but
children with autism have to be directly taught to do so.
They also rarely spontaneously imitate the actions of
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others in play or otherwise.
Communication Skills
• They may have delayed speech, or no speech at all,
make no effort to make up for these deficits with
nonverbal communication (APA, 2000). Instead of
compensating for their lack of expressive speech
through gestures, individuals with ASD use fewer
gestures and those they use are limited in function
(Ogletree, 1998).
• Those who speak are unable to open or keep
conversations going (APA, 2000).
• They frequently engage in repetitive or stereotypic
speech or vocalizations, such as echolalia (APA,
2000). Echolalia, repeating utterances of others, is
common in students with autism (Janzen, 2003).
• They may lack pretend play of the same quality,
quantity, and variety of their same-age peers (APA,
2000).
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Specific Communication
Differences
• Generally, across the spectrum, the higher a
child’s measured IQ, the better his or her
language skills are; however, some
individuals with lower IQs demonstrate
normal language skills (Kjelkaard & TagerFlusberg, 2001).
• While articulation skills may not be impaired,
content and grammar frequently are delayed.
Specifically, many children with autism have
a rigid understanding of words (Janzen,
2003). They may have difficulty with the
concept that objects can have more than one
name and that words may have more than
one meaning.
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Restrictive, Repetitive, and
Stereotyped Behavior
• They may have an unusually strong or focused
interest or fixation.
• They may be overly drawn to routines and rituals
and be unable or unwilling to be flexible in adhering
to these routines.
• They may demonstrate repetitive complex body or
other motor movements, such as spinning, rocking,
or finger flicking. These self-stimulatory behaviors
may occur so frequently that they interfere with
engagement in productive activities and may take up
the majority of a child’s waking hours if allowed
(Simpson & Myles, 1998).
• They may show intense interest in parts of objects,
as opposed to using the entire toy or object (APA,
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2000).
Overview of
Aspergers
Asperger Syndrome (AS), called Asperger disorder
in the DSM-IV-TR, is similar to autism, except that
individuals with AS do not demonstrate the severe
impairments in speech and language evident in
those with autism (APA, 2000). That is, they
generally speak in one-word utterances by age 2
and phrases by age 3, but they do have sociocommunicative impairments. In addition,
individuals with AS are rarely also diagnosed with
mental retardation. Impairments characteristic of
AS fall within two categories: (a) social skills and
(b) repetitive, restrictive, and stereotyped behavior.
Social Skills
• As in autism, children with AS may have deficits or
differences in nonverbal communication skills, such as
use of eye contact, body language, gestures, and facial
expressions (APA, 2000). Janzen (2003) has noted that
individuals with AS frequently have difficulty using and
interpreting communication that involves nonverbal cues
or paralanguage. They take others’ speech literally and
have difficulty interpreting tone of voice (e.g., sarcasm,
humor) and body language (e.g., facial expressions of
boredom or confusion), often mistakenly basing their
understanding solely on the words spoken.
• They often do not build relationships with others their
age to the extent expected based on level of
development (APA, 2000). Many individuals with AS
desire socialization, but have difficulties understanding
social situations (Janzen, 2003). Specifically, they may
not comprehend others’ points –of –view, and find it
difficult to determine social responses to fit a wide
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variety of situations (Myles & Simpson, 2002).
Social Skills
• They rarely share attention with others, such as by
showing something, pointing, or pointing out
interests or accomplishments (APA, 2000; Janzen,
2003).
• They do not demonstrate social reciprocity (APA,
2000). That is, students with AS may learn to initiate
greetings and conversations, but lack the ability to
extend such interactions (Myles & Simpson, 2002).
They may conduct one-sided conversations,
monopolizing or failing to contribute to
conversational turn-taking (Myles & Southwick,
1999). Young children with AS often seem
uninterested in or unable to participate in play with
peers (Attwood, 1998). They tend to boss other
children around or get angry when the others do not
play according to their rules.
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Repetitive, Restrictive, and
Stereotyped Behavior
• They may have an unusually strong or focused
interest or fixation. Myles and Simpson (2002) have
noted that in those with AS, these interests may
seem similar to those of same-age peers, but differ
in intensity, extent of knowledge, or interest in the
topic to the exclusion of other interests.
• They may be overly drawn to routines and rituals,
and be unable or unwilling to be flexible in adhering
to these routines (APA, 2000).
• They may demonstrate repetitive complex body or
other motor movements, such as spinning, rocking,
or finger flicking. However, this is thought to occur
less often in those with AS compared to those with
autism.
• They may show intense interest in parts of objects,
as opposed to using the entire toy or object.
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Overview of PDD NOS
Children are diagnosed with pervasive
developmental disorders, not otherwise specified
(PDD-NOS) when they do not meet enough of the
criteria for specific ASD, but demonstrate some
similarities to others on the autism spectrum (APA,
2000). Thus, these children are an especially
heterogeneous group.
Additional Learning
Characteristics
In addition to the criteria specified in the DSMIV-TR (APA, 2000), students with autism
spectrum disorders (ASD) may display a
wide variety of other learning characteristics
(Janzen, 2003; Simpson & Myles, 1998)
that can be described under the following
categories:
(a) general cognitive and academic functioning,
(b) attention,
(c) generalization,
(d) visual thinking, and
(e) problem solving.
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Attention
• Many individuals with ASD display difficulties
in attention (Janzen, 2003). Specifically, they
have difficulty regulating attention, similar to
individuals with attention deficit hyperactivity
disorder (Myles & Southwick, 1999).
Examples include
– daydreaming
– difficulty completing complex directions due to a
loss of focus in the early stages of the task In
addition,
– may not be able to easily shift attention between
two items.
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Generalization
• Individuals with ASD often have trouble
generalizing information to new settings,
people, and materials as a result of
difficulties organizing information
meaningfully (Janzen, 2003; Simpson &
Myles, 1998). Consequently, tasks mastered
in only one teaching environment are not
automatically demonstrated in others.
Therefore, academic planning should include
specific attention to ensuring generalization
takes place.
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Problem Solving
• Students with ASD have difficulty with the flexible
thinking involved in solving problems (Janzen, 2003).
• They find it challenging to creatively generate a
variety of options, think about multiple pieces of
information at once, and evaluate possibilities.
• Often, when students with AS have learned a solution
to a problem, they continue to try that solution even if
it does not work (Myles & Southwick, 1999).
• Even when they have learned multiple solutions to
problems through discussion and role-play, the have
difficulty retrieving or generalizing them to authentic
situations.
• These deficits in problem solving extend to
academics, involving problems such as with math
word problems and estimation.
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Pop Quiz
1. Current prevalence studies estimate a
rate of approximately _______ births.
A. 1:150
B. 1:91
2. Impairments in autism are generally
described within which of the following
categories:
A. Communication, motor, social skills
B. Social skills, communication, repetitive
restrictive stereotypical behavior
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Pop Quiz
3. Self-stimulatory behaviors include:
A. Spinning
B. Not making eye contact
4. Individuals with ASD often have intense
interests that are unusual in terms of:
A. Topic Area
B. Extent of knowledge
5. Specific difficulties related to attention are
found in individuals with ASD include:
A. Stimulus under-selectivity
B. Difficulty regulating attention
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Case Study Activity
•
•
•
•
•
Christopher: Autism Social
Teddy: Autism Communication
Reese: Autism Repetitive Movements
Mari: Autism Repetitive Movements
Jiro: Asperger Social Skills
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Theory of Mind
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Theory of Mind
• Individuals with autism spectrum disorders (ASD) exhibit
challenges in difficulties regulating behavior,
understanding others’ perspective and using correct
social skills.
• These difficulties across domains (cognitive, behavioral,
social, and emotional) may manifest in many different
ways:
–
–
–
–
being naive and a target for bullying or teasing,
not understanding emotions,
being extremely literal and missing abstract content,
having a limited ability to regulate behavior based on what others
are doing or saying, and
– having difficulty understanding nonverbal behavior.
• As toddlers, typically developing children begin to develop
the ability to take another person’s perspective, to
understand that others have separate thoughts, desires
and beliefs, and to modify their own behavior by taking
into account what others might be thinking or feeling. In
the field of special education and psychology these skills
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and abilities have been called “theory of mind.”
What is theory of mind
• Richard (2000) defined theory of mind (often
referred to as TOM or ToM,) as “the ability to
understand how other people think and feel”
(p. 131). Howlin, Baron-Cohen and Hadwin
(1999) defined theory of mind in a more
complex manner as “the ability to infer other
people’s mental states (their thoughts,
beliefs, desires, intentions, etc.), and the
ability to use this information to interpret what
they say, make sense of their behavior and
predict what they will do next”
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Theory of Mind Challenges
• insensitivity to other people’s feelings
• inability to take into account what other people know
• inability to negotiate friendships by reading and
responding to intentions
• inability to read the listener’s level of interest in one’s
speech
• inability to detect a speaker’s intended meaning
• inability to anticipate what others might think of one’s
actions
• inability to understand misunderstandings
• inability to deceive or understand deception
• inability to understand the reasons behind people’s
actions
• inability to understand “unwritten rules” or conventions
(Howlin, Baron-Cohen, & Hadwin, 1999, p. 9-11)
• Difficulty explaining and predicting the behaviors and/
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or emotional states of themselves and others
Theory of Mind Challenges
• Problems understanding the perspectives of others
• Lack of understanding that behavior impacts how
others think and/or feel
• Problems with joint attention and other social
conventions
• Problems differentiating fiction from fact
(Myles & Southwick, 1999 p. 8-11)
• Difficulty understanding pretending and deception
• Failure to understand social interaction, leading to
difficulties with turn-taking, poor topic maintenance in
conversation, and inappropriate use of eye-contact
• Difficulty taking into account what other people know or
can be expected to know, leading to pedantic or
incomprehensible language
• Limited sharing of attention, leading to idiosyncratic
reference
(Cumine, Leach, & Stevenson, 1998, p. 21-22)
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Theory of Mind Challenges
• Many individuals with ASD think that what
they are thinking and feeling is what
everyone else is thinking and feeling.
• They may not understand that others have
separate thoughts and feelings and that
others are able to access to same
information in the environment as they are.
• It may be difficult for those with ASD to take
others’ perspective. In fact, because of their
often literal thinking, the phrase “put yourself
in someone else's shoes” could leave some
individuals with ASD bewildered, pondering
how they could put the other person's shoes
on their own feet.
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Theory of Mind Components
• Step 1: inferring what another person is
thinking, feeling, etc., by the external
behavior that you see
• Step 2: predicting the future behavior of
that or other individuals based on your
inference of their mental state
• Step 3: changing/modifying your own
behavior based upon the judgments
that you made
Twachtman-Cullen (2000)
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The degrees of Theory of
Mind
• First-order belief is when you can
describe what another person is
thinking about actual events.
• Second-order belief is when you can
understand what another person is
thinking about another person’s
thoughts.
• Higher-order belief is when you are
able to think about what others think
about what you are thinking about your
own thoughts.
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What Is Mindblindness?
• Baron-Cohen (1995) uses the term mindblindness to
explain why individuals with ASD have an impaired
ability to read minds. Baron-Cohen postulates that a
specific part of the brain that is typically responsible
for mind reading is impaired in children with ASD.
• Powers (2003) interprets mindblindness as “an
inability to put oneself in the place of another and to
see things from another person's perspective” (p. 1112). He adds that developing a theory of mind
“enables the child to perceive reality from another's
perspective … to feel empathy, to identify with
another's feelings and point of view, and to
understand that others don't know everything that
the child knows. It also makes it possible for the child
to understand pretense, sarcasm, deceit, and certain
kinds of humor” (p. 11-12).
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Example
• A student named Johnny is walking down the street.
He sees a group of four older boys on the other side
of the street. They are staring at Johnny, pointing as
well as talking to each other. After a few moments
the boys begin to cross the street towards Johnny.
• Now, many people would have turned and gone in
the other direction before the four thugs crossed the
street and possibly hurt them. But it would take some
mind reading ability to infer that since the boys were
talking and looking at you that they might want to do
something to you. Otherwise Johnny could just
interpret the goings-on as a description: Four boys
are walking down the street. They are looking at me.
They are pointing at me. They are crossing the street
and getting closer to me—without interpreting the
possible intent of the four boys.
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How Does Theory of Mind
Develop?
• By one year of age babies can detect the presence of
eyes, tell when they and others are attending to the same
thing, and read actions as goal directed or driven by
desire. Toddlers can both pretend and understand
pretense by others. (Baron-Cohen, 1995)
• Around age four, youngsters are able to work out what
others might know, think or feel. They pass first-order
theory of mind false belief tests. That is, they understand
what others think about actual events. Around age six,
children are able to understand second-order belief. That
is, they understand “Kathy thinks that Roger thinks …”
(Baron-Cohen, 1995; Perner & Wimmer, 1983; Wimmer &
Perner, 1985)
• Between the age of seven and adolescence, children
begin to learn and master the concepts of faux pas, irony,
humor, sarcasm, and nonverbal body language (some of
these skills are taught, not just picked up naturally).
(Twachtman-Cullen, 2000)
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Why is Theory of Mind
Important
• Theory of mind ability has ramifications in a
wide range of areas including language,
social skills, behavior, and perspective
taking. Obviously, for students with an
impaired ability to take another’s perspective
or to think what others might be thinking or
feeling, behavior will be affected. So the dayto-day inability or impaired ability to mind
read can have continuing and severe
consequences.
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Pop Quiz
1.
A simple definition of theory of mind might be:
A. a way of regulating body temperature
B. understanding how others think and feel
2. Which of the following is/are possible experiences of
individuals who have an impaired theory of mind?
Difficulties:
A. predicting the future behavior of self or others
B. listening to others
3. Mindblindness is a term that describes individuals who
have difficulty:
A. seeing
B. understanding the thoughts and feelings of others
4. By age four, typically developing children can…
A. solve first-order theory of mind tests
B. solve very abstract problems
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