Transcript Autism Spectrum Disorders - St Philip & St James Chatham

Autism Spectrum Disorders
Elliott Clarke
Elizabeth Pole
March 2011
Outline
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Background / History
Triad of Impairments
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Communication
Social Relationships
Rigidity of thought, behaviour and play
Sensory issues
Parents’ perspective
Discussion
Strategies
Autism Spectrum Disorder
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Developmental disorder affecting children from birth
or the early months of life.
Exact cause remains unknown, but generally felt to
be neurological in origin.
Lifelong condition.
Can be a ‘hidden disability’.
No ‘cure’, but the right support at the right time can
make an enormous difference to people’s lives.
Often accompanied by additional learning difficulties
(about 75%).
The National Picture
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Over half a million people in the UK with
autism - that's around 1 in 100. If you include
their families, autism touches the lives of over
2 million people every day.
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Over 40% of children with autism have been
bullied at school.
Background / History
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Leo Kanner (USA) Child Psychiatrist
Paper published in 1943 based on study of 11 cases.
Resulted in identification of a separate condition – Autism.
He wandered about smiling, making stereotyped movements with his
fingers, crossing them about in the air. He shook his head from side to
side...humming the same three-note tune. He spun with great pleasure
anything he could seize upon to spin….When taken into a room, he
completely disregarded the people and instantly went for objects,
preferably those that could be spun….( Kanner 1943)
Background / History
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Hans Asperger (Austria) Physician.
Identified similar group to Kanner.
1944 – published dissertation on ‘autistic
psychopathy’ in childhood.
Published in German and in middle of Second
World War - it took nearly 50 years before it was
translated (Wing 1981)
Many similarities with Kanner – use of ‘autistic’
Background / History
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Lorna Wing – research with Judy Gould (1979)
Identified ‘threads of commonality’ amongst
groups of children referred for psychiatric help
who were socially impaired.
Wing’s ‘Triad of Impairments’
1988 ‘The Autistic Continuum’
1996 ‘The Autistic Spectrum’ – broader
classification
Triad of Impairments
Social
Relationships
Social
Communication
ASD
Rigidity of Thought,
Behaviour and Play
(Social Understanding)
Communication
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Difficulties learning language – some children
may never use spoken language or use limited
language.
May have difficulties understanding concepts
e.g. time ‘later’, ‘before’.
May have a very literal understanding of
language – leading to misunderstanding.
I’m tearing my hair out
Adapted from ‘Mystifying Metaphors & Smiley Similes’ by Sadie Lewis
Laughing their heads off
Adapted from ‘Mystifying Metaphors & Smiley Similes’ by Sadie Lewis
Communication
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Echolalia – immediate (repeat back what have
just heard). The child has not necessarily
‘processed’ the language and will not
necessarily understand what they are saying.
Delayed echolalia - Repetition of chunks of
language heard in other situations/DVDs.
May not be able to USE the language they
have e.g. know the word ‘ball’ but not be able
to use this word to make a request.
Communication
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Inability to ask questions to establish another person’s
viewpoint, but may ask repetitive questions e.g.
What's your name? This may mask unspoken
anxieties in the child or indicate that they have not
understood.
May not understand subtle conversational cues e.g.
tone of voice, facial expressions indicating surprise,
anger.
Some children may use unusual intonation with
stereotypical, stilted speech (or a sing-song intonation
pattern).
Social Relationships
• Child may display general awkwardness in
social situations
• May be unable to interact appropriately with
peers
• Difficulty in making friends – may initiate
and want social contact, but lack
understanding and skills to carry through
• Unusual facial and/or physical gestures
(smiles, grimaces, eye-contact)
Social Relationships
• Problems with social “distance”
• May have difficulties with conventional turn-taking
and sharing.
• May start/finish conversations abruptly or fail to
answer appropriately.
• May not see self as a part of group
• Motivation – may not be rewarded by success at
tasks or by pleasing others.
Rigidity of thought, play and
behaviour
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Play may be learnt and repetitive. Initially the child’s play
skills may appear appropriate, but over time it is apparent that the
child’s play sequences are not extending.
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May find activities difficult when imagination or pretend
skills are needed, e.g. home corner, role play games.
May prefer activities such as lining toys up, moving
trains around track, sensory play.
Difficulty coping with adult direction and imposed
routines.
Difficulties with understanding changes in routine and
new situations.
Rigidity of thought, play and
behaviour
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May have fixed interests and may become obsessional
about these.
Attention problems on tasks chosen by others.
Difficulties with problem solving e.g. finding an item
that is not in its usual place.
Seeing 'part' rather than 'whole' - not the ‘bigger
picture’ e.g. focusing on a specific part of a picture.
Rigidity of thinking and behaviour – being a ‘class
policeman’.
Perseveration - the need to repeat words, actions,
activities etc.
The Sensory World of Autism
• Senses provide us with the unique experiences which allow
us to interact & be involved with others.
• Senses play a significant role in determining our responses
to a particular situation.
• Many individuals with autism have sensory problems
including problems making sense of sensory information
(sensory integration).
Hyper- (over sensitive)
Hypo- (under sensitive)
Touch (includes balance + body awareness)
Tactile: relates to touch, pressure, pain, hot/cold
Hypo-
Holding others tightly
High pain threshold
Self-harming (biting, gouging etc.)
Hyper-
Finds touch painful/uncomfortable
(social aspect)
Sensitivity to certain clothing/textures
Dislike of having things on hands/feet
Touch (includes balance + body awareness)
Proprioception: where the body is in space
Hypo- Proximity – personal body space in relation
to others.
Navigating rooms – avoiding obstructions.
Hyper- Fine motor difficulties, manipulating small
objects (buttons, threading, shoe laces etc).
Moves whole body to look at something.
Touch (includes balance + body awareness)
Vestibular: sense of how the body is moving
Hypo- The need for rocking, swinging, spinning
Hyper- Difficulties in activities which include
movement (sport, dance)
Difficulties in stopping quickly or during an
activity
Vision
Visual: helps to define objects, colours, space
Hypo- Peripheral vision (central vision blurred)
Poor depth perception (throwing/catching)
Hyper- Fragmentation of images (too many
sources)
Focussing on particular detail (rather than
whole).
Hearing
Auditory: informs about sounds around us
Hypo- Partial or complete absence of hearing
Enjoys noisy places/activities (bangs things)
Hyper- Magnification or distortion of sounds
Unable to filter out external sounds
Smell
Olfactory: Is the first sense we rely on
Hypo- May be oblivious to strong odours
May lick things indiscriminately
Hyper- Smells appear intensified/overpowering.
Toileting problems
Taste
Gustatory: Informs about various tastes
Hypo- Likes very spicy/salted foods
May eat anything (soil, grass, material etc)
(pica)
Hyper- Prefers bland (white) food
Texture of food may be problematic (lumps)
Restricted diet
Parents
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What are your child’s strengths? What do
they enjoy?
What difficulties does your child have in the
following areas:
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Communication/language?
Social Interaction/relationships?
Rigidity of thoughts, play and behaviour?
Senses?
Discussion
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In small groups, discuss someone you know who
has ASD.
What are their strengths? What do they enjoy?
What difficulties have you noticed in the following
areas:
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Communication/language?
Social Interaction/relationships?
Rigidity of thoughts, play and behaviour?
Senses?
At Church
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What things do we already do to help?
What things might be challenging for those
who have ASD?
What might be challenging for those around
the person with ASD?
What else could we be doing?
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As a whole church
As leaders/youth workers
Strategies
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Ensure they know what is happening
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Clear explanations, repeat if necessary
Visual timetables
Simplify language, think about the key words.
Support language visually e.g. signs,
gestures, photos, pictures, symbols.
Be aware of difficult concepts.
Say exactly what you mean.
Learn best by ‘doing’ (rather than being told)
Strategies 2
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Find what motivates them, use their interests.
Make it clear exactly what is required of them.
May need to teach things that other children learn
automatically e.g. how to understand facial
expressions/emotions.
Talk to parents
Find out their ‘sensory profile’
REFLECTION – how did I communicate? How did
they respond? What could I do next time?
PRAY!