Autism Spectrum Disorders

EPSE 317

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.

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.)

Elias was a lovely baby

• Never cried• Slept through the night• Never fussed if his parents left the

room• Learned to walk early

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

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:

• ABA sessions

• http://www.youtube.com/watch?v=NbVG8lYEsNs&NR=1

When Elias started school he could:

• Use speech to communicate– Still somewhat echolalic and had odd

prosody• He could take part in parallel play

with one peer– Groups caused him distress

• He was toilet trained• He could read and print neatly,

although comprehension was limited

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

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.

• http://www.youtube.com/watch?v=OhNhb40hPH0

A little history:• Condition was first identified in the 1940s by

Leo Kanner and Hans Asperger. • In the 50s, the primary model of treatment was

psychotherapeutic, as initally shaped by Bruno Bettleheim’s statement that the condition was due to “refrigerator mothers.”

• In the 60s, Bernard Rimland, founder of the Autism Research Institute, led the understanding of autism as a neurologically-based disorder, not related to early parenting

• Also in the 60s, Ivar Lovaas developed the method of intervention and training now called applied behaviour analysis (ABA).

Autism Spectrum Disorder

• Autism• Childhood Disintegrative Disorder• Asperger’s syndrome• Rett’s Syndrome• Pervasive Developmental Disorder

not otherwise specified (PDD-NOS)

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.

Three Areas of Impairment

• Social interaction• Communication• “Restrictive, repetitive, and

stereotyped patterns of behaviour”

Sometimes cognitive impairment but not always.

• May present with other neurological disorders including epilepsy

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

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)

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

• 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

• No clinically significant general delay in language

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

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.

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

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.

That Was the Bad News…(or most of it)

• Here’s the Good News:• Strong Advocacy• High public profile• Early intervention available

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

Diagnosis

• In order for a child to be eligible for financial support at preschool level and to bring supplementary funding to a school district, he or she must diagnosed through a specified set of standards and guidelines.

• The BC Autism Assessment Network (BCAAN) determines these guidelines, but they can be completed privately.

• www.phsa.ca/AgenciesAndServices/Services/Autism/default.htm .

Standards and Guidelines Included

• Multidisciplinary assessment must include:– Psychological assessment– Speech-language assessment– Medical evaluation

• It may also include:– Occupational therapy assessment– Comprehensive family assessment– Psychiatric assessment– Other expert assessments

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

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

Social Skills

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

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. 

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.

Echolalia

• --Speech that echoes – Immediate: • How are you, Charlie• ..You Charlie?

– Delayed• Quotes from TV ads, repetitive phrases, etc.• Can have communicative importance

– “You deserve a break.”

Self-stimulatory behaviour“Stimming”

• Repetitive behaviour • Rocking• Manipulating something• Calming intent• Is this limited to people with autism?• Find acceptable “stims”

Socialisation

• Link with mutual enjoyment of interests, or activities–Music– Art– Birding– Computers

Build on Strengths

• Build on interests• Introduce change in tiny increments• Recognise distress as real even if

stimulus is odd

What can we do for Elias?

Relate, enjoy!

• http://www.youtube.com/watch?v=2wt1IY3ffoU

A Last Caution

• Snake oil merchants are drawn to autism like flies to dung.

• http://www.asatonline.org/ The Association for Science in Autism Treatment