Transcript Autism & Pervasive Developmental Disorders

Autism Spectrum Disorders
in the Educational Setting
Misty L. Boyd, Ph.D.
Licensed Clinical Psychologist
Presentation to
Muskogee Public Schools
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Muskogee Public Schools Professional Development
“Autism”
Defining Autism Under the Individuals with Disabilities Education Act (IDEA)
Autism means a developmental disability significantly effecting verbal and nonverbal communication and social
interaction, generally evident before age three, that adversely affects a child’s educational performance. Other
characteristics often associated with autism are engagement in repetitive activities and stereotyped movements,
resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.
Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an
emotional disturbance.
A child who manifests the characteristics of autism after the age of three could be identified as having autism if the
above criteria of this section are satisfied.
Components of a Comprehensive Evaluation for Autism Under IDEA
Medical Information
Cognitive/intellectual
Motor processing/perceptual/sensory
Academic/achievement/functional levels
Communication/language
Adaptive behavior
Social or cultural background
Behavioral functioning
Presentation by Dr. Misty L. Boyd, Ph.D.
The following information was developed by Dr. Boyd for Muskogee Public Schools. The information you will
review from her, in addition to the above information, will be the basis for the quiz you will be required to take at the
end of this presentation.
Presentation Objectives
 Increase awareness of the
characteristics of students with Autism
Spectrum Disorders (ASDs)
 Discuss resources available for
students with ASDs and their families
 Review the use of Positive Behavior
Supports with students with ASDs
Autism Spectrum Disorders (ASDs)
 Broad class of disorders involving pervasive
developmental delays
 Autistic Disorder
 Asperger’s Disorder
 Rett’s Disorder
 Childhood Disintegrative Disorder
 Pervasive Developmental Disorder (PDD) NOS
(Not Otherwise Specified)
 Difference between clinical diagnosis and
eligibility-related designation
Autism Spectrum Disorders (ASDs)
 Pervasive delays in several areas of
development:
 Reciprocal social skills
 Communication
 Stereotyped behaviors or interests
 Typically evident in the first few years of life
 Typically occur with some degree of mental
retardation (except Asperger’s)
 Can be managed with varying degrees of
success
 In Autism, approximately 10% with “good”
outcomes, 20% with “fair” outcomes, and 70%
with “poor” or “very poor” outcomes
Autistic Disorder
 At least 2 symptoms of impaired social interaction
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Impaired use of nonverbal communication
Failure to develop peer relationships
Lack of spontaneous sharing
Lack of social reciprocity
 At least one symptom of impaired communication
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Delay or lack of expressive language
Inability to initiate or sustain conversation
Stereotyped or idiosyncratic language
Lack of imaginary or imitative play
 At least one symptom of stereotyped behavior
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Preoccupation with an area of interest
Adherence to fixed routines
Stereotyped motor behavior
Preoccupation with parts of objects
Autistic Disorder
 Onset is prior to age 3
 Nonverbal abilities typically higher than
verbal abilities
 Associated features may include
 Mental retardation
 Attention deficits
 Impulsivity
 Self stimulating or injurious behavior
 Sensory sensitivities
Autistic Savants
 VERY RARE
 Display an exceptional ability, often linked
with a stereotyped interest
 Music or visual arts
 Mathematics
 Memory for certain types of facts or information
(human catalogue)
 May still be considered mentally retarded,
although typically not severely or profoundly
so
Asperger’s Disorder
 At least 2 symptoms of impaired social interaction
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Impaired use of nonverbal communication
Failure to develop peer relationships
Lack of spontaneous sharing
Lack of social reciprocity
 At least one symptom of stereotyped behavior
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Preoccupation with an area of interest
Adherence to fixed routines
Stereotyped motor behavior
Preoccupation with parts of objects
 No clinically significant delay in language, adaptive
behaviors, or curiosity about the external
environment
Asperger’s Disorder
 Mental retardation is rare, and generally mild
if present
 Verbal abilities typically higher than
nonverbal abilities
 Associated features may include
 Clumsiness or impairment in gross or fine motor
development
 Symptoms of ADHD
 Depression
Rett’s Disorder
 Normal development through at least the
first 5 months, up to 4 years
 Onset of all of the following after a period of
normal development:
 Deceleration of head growth
 Loss of acquired hand skills
 Loss of social engagement (may return)
 Loss of motor coordination in gait and trunk
movements
 Severe psychomotor retardation
 Severely impaired expressive and receptive
language
 Typically have severe or profound mental
retardation
Childhood Disintegrative Disorder
 Normal development for at least the first two years
of life
 Clinically significant loss in at least two skill areas
prior to age 10
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Expressive or receptive language
Social skills or adaptive behavior
Bowel or bladder control
Play
Motor Skills
 Abnormalities in at least 2 of the following areas:
 Social interaction
 Communication
 Stereotyped behavior
 Usually associated with severe mental retardation
Pervasive Developmental Delay
NOS
 “Not Otherwise Specified”
 Conditions that are clearly PDD but do
not fit the criteria for a specific disorder
 Includes “Atypical Autism”
Late onset
Atypical or sub-threshold symptomatology
Prevalence
 Established prevalence of autism is around 5
per 10,000 individuals (0.05%)
 The prevalence of other PDDs has not
generally been established
 Recent studies indicate the prevalence for
PDDs as a group may have doubled in since
the mid 1990’s
 There are a number of proposed explanations
Etiology
 It is generally accepted that PDDs are the
result of neurological problems in the brain
 However, it is not agreed upon whether
these are structural (e.g., tissue), functional
(e.g., neurotransmitter, brainwave), or both
 Multiple factors have been implicated in the
etiology of PDDs including genetics and
prenatal exposure to teratogens
 Regardless of the physical cause of PDDs,
the result is significant impairment in social
and communication skills
Etiology
 People with PDDs have a hard time grasping
the emotional or other subtle content of other
people’s behaviors
 Find it hard to read others’ emotions
 Don’t get sarcasm or innuendoes
 May adhere to routines as a way of organizing
an otherwise confusing social world
 “Theory of Mind”
 Ability to attribute mental states (knowledge,
intentions, beliefs, feelings) to oneself and others
 Empathy and “emotional intelligence”
 Is mediated and driven by social communication
Etiology
 “Mirror Neurons”
 Found in different areas of the brain
 Primary function is imitation, which provides a
rich source of learning
 In non-clinical adults, activation of mirror
neurons is associated with activation of limbic
system, but limbic activation is not seen in adults
with autism
 No emotional salience for autistic individuals?
Neurophysiological Model
(Waterhouse et al., 1996)
 ASD features accounted for by four key
dysfunctions in overlapping neural systems
 Canalesthesia - the fragmentation of crossmodal information processing and memories,
due to excessive cell-packing density in the
hippocampus
 Impaired assignment of the affective, reinforcing
significance of stimuli, due to abnormal
amygdala
 Asociality due to aberrant functioning of
neuropeptide and neurochemical systems
 Extended selective attention resulting from
abnormal temporal and parietal association
areas
Asperger’s vs. High-Functioning
Autism
 Often difficult to separate the two
 It has been argued that they are not
separate disorders, with some research
to support this theory
 However other research points to
different patterns of impairment in
verbal vs. nonverbal abilities,
suggesting that they are distinct
Associated Features: Asperger’s
 Early development will appear normal
 Circumscribed interests usually focus on
amassing large amounts of factual
information
 Delayed motor skills and motor
awkwardness or clumsiness
 Attempts to engage in social interactions but
with great difficulty navigating the social
environment
Associated Features: Asperger’s
 Communication skills are likely to be
distinctive in three ways:
Poor prosodic skills
Speech seems tangential, possibly
egocentric
Marked and persistent verbosity
Associated Features: ASDs
 Sensory and perceptual abnormalities
 Hyper- or hyposensitivity to sounds, lights,
textures, or odors
 High pain threshold
 Overselective attention or impaired shifting of
attention
 Cross-modal integration impairments
 Social deficits are much lower than would be
expected based on overall developmental
level or intellectual functioning
Treatment of ASDs
 Often long-term and intensive in order to be
effective
 Earlier intervention associated with better
outcomes
 Objectives may include:
 Self-care skills
 Reasonable degree of compliance with
instructions and simple rules
 Basic social and affective behaviors
 Communication of needs and wants
 Appropriate play
 Reduction of harmful behaviors
 Domestic living and work-related skills
Treatment of ASDs
 Additional objectives may include
emphases on
Fluent verbal language
Age-appropriate social interactions with
peers
Behaviors and skills expected in regular
classrooms
Treatment of ASDs
 In addition to working with the child,
treatment may (should) focus on
teaching parents how to teach basic
skills, how to control inappropriate
behaviors, and how to solve problems
that may arise between systems and
service providers
Resources for Students with
ASDs and Their Families
 Local resources:
Hope Foundation for Children with Autism
http://www.easternokautism.com
Hope Kids Therapy Center
http://www.hopekidstherapy.com
Oklahoma Family Center for Autism
http://www.okautism.org
Autistic Disorder at School
 Academic strengths in nonverbal areas
 Disinterest in relationships
 Language deficits
 Reliance on fixed, non-functional
routines
 Very limited behavioral repertoire
Asperger’s Disorder at School
 Academic strengths in verbal areas
 Avoidance, defiance, other behavior
problems
 Difficulty with transitions or changes in
routines
 Poor relationships with peers
 “Little Professor”
Managing ASDs at School
 Manage the symptoms, including:
 Inattention
 Overactivity
 Social problems
 Behavior problems
 May wish to consider special education
eligibility
 Functional behavioral analysis (FBA) and
behavior intervention planning (BIP) are
important tools
Managing ASDs at School
 Main tasks to focus on:
Building rapport with student and family
Teaching learning readiness skills such
as sitting in a chair, attending to the
teacher, looking at and manipulating task
materials
Minimizing behaviors that interfere with
learning, including tantrums, aggression,
and noncompliance
Positive Behavior Supports
(PBS) for Students with ASDs
 “Positive Behavior Support (PBS) is based on a problemsolving model and aims to prevent inappropriate behavior
through teaching and reinforcing appropriate behaviors. .
. PBS offers a range of interventions that are
systematically applied to students based on their
demonstrated level of need, and addresses the role of
the environment as it applies to development and
improvement of behavior problems.”
- OSEP Technical Assistance Center on Positive
Behavioral Interventions and Supports (www.pbis.org)
PBS for Students with ASDs
 Characteristics of PBS plans:
 Assessment-based
 Prevention
 Comprehensive
 Normalization and inclusion
 Team-based
 Person-centered values
 Long-term planning
 Broad view of intervention success
 Contextual fit
PBS for Students with ASDs:
Potential Target Behaviors
 Destructive Behaviors
 Aggression
 Self-Injurious Behavior
 Property Destruction
 Disruptive Behaviors
 Long tantrums
 Loud, Repetitive Noises
 Running, etc.
 Irritating & Interfering Behaviors
 “Self-stim”
 Repetitive and perseverative speech or actions
PBS for Students with ASDs:
Remember FBA and BIP
 All behavior is communication -- what is the
student communicating with this behavior?
 Examples include dislike, boredom, discomfort
 Consequences can alter patterns of
behaviors
 Reinforce appropriate behavior to increase its
frequency/duration
 Use undesired consequences to decrease the
frequency/duration of inappropriate behavior
 Reinforcers must be individualized
 Remember sensory sensitivities and asociality
that are common in individuals with ASDs
Additional Resources for
Educators
Autism
Center for Autism and Related Disabilities
http://card-usf.fmhi.usf.edu/
Autism Society of America
www.autism-society.org
Positive Behavior Support
FL - PBS Project
http://flpbs.fmhi.usf.edu
RRTC-PBS
www.rrtcpbs.org
OSEP Center on PBIS
www.pbis.org