Introduction to Autism

1. Introduction to Autism John C. Burke, Ph.D. Shawn Henry, M.A.

2. Hello and welcome to Autism: Methods and Strategies, my name is Dr. John Burke. This course is designed to provide you with a solid understanding of autism. In particular, we will be focusing on understanding the unique characteristics of autism and designing and implementing effective intervention strategies to target communication, social skills, behavior, academics, as well as community based life skills.

3. Along with myself, we will be having several other guests including professionals and parents who will share their insight, knowledge and experiences in working with individuals with autism. • Before proceeding, I would like to introduce my co-instructor, Mr. Shawn Henry. Welcome Shawn. • Shawn: Thank you and it is good be here with you.

4. John: Before we proceed, lets introduce ourselves to our participants. Shawn would you like to go first. • Shawn: I am Field Training Coordinator at the Kentucky Autism Training Center. I work with teams of professionals and parents and provide training in establishing programs. At KATC, I also coordinate our conferences and assist on numerous projects. I have been co-teaching with Dr. Burke for 4 years. Before being hired at KATC, I served in the public schools for five years as a resource teacher. In total, I have 12 years experience with autism. I look forward to working with you and getting to know you.

5. John: Thanks Shawn, I am the Director of the KATC and an Associate Professor in Teaching and Learning and Pediatrics. I Received my Ph.D. in 1987 after completing the requirements of a joint doctoral program involving the University of California, Santa Barbara and the UCSF Medical School. Officially, my doctorate is in Speech and Hearing Sciences with core areas of study also in Education, Psychology, and Neurophysiology.

6. In 1987, I was invited to Johns Hopkins University as a Fellow in Pediatrics and the Kennedy Krieger Institute. Before coming to the University of Louisville in 1997, I was Johns Hopkins University for ten years and served as faculty, mainly in the Departments of Education and Psychiatry. I was the Director of Outpatient Services in the Department of Behavioral Psychology at the Kennedy Krieger Institute.

7. Shawn, like you I am very eager to work with our students this semester and to get to know them. Every semester, we have students from across our own state, across the US, as well as often students from several regions of the globe. Even though we are not in one traditional classroom, we are in a virtual classroom and we would like you as students to get to know each other. As such, we would like each of you to send us a brief biography and a picture that will be placed in our virtual classroom.

8. Shawn: This will allow all of us to put a “face to a name”. Sometimes people send in pictures that also depicts some other aspect of their life such as them working in their garden. For more information on how to send them, please check our announcement page. • John: In this first class we would like to set the stage by providing an overview of the unique characteristics associate with autism and preview of some of the strategies we will be discussing in later sessions.

9. John: From a formal perspective, autism is considered to be a Spectrum Disorder. It is one of five categories under “Pervasive Developmental Disorders”. Along with autism are four other categories, “PDD-NOS”, NOS means Not Otherwise Specified, which we will explain, “Asperger’s Disorder”, “Retts Syndrome”, and “Childhood Disintegration Disorder”. The term “autism” was first used by Dr. Leo Kanner, who in 1943 published a paper describing 11 individuals whom he felt were distinctively different from all of his other clients.

10. Autism is a Spectrum Disorder Great Diversity Pervasive Developmental Disorders Five Categories Autism Childhood Disintegrative Disorder. Retts Syndrome N.O.S. Asperger's Syndrome

11. In 1943, Dr. Leo Kanner published a report on a group of 11 children he observed which could not be classified using any existing diagnoses or previously described syndromes. These 11 children were much like each other, but quite different from any other group of children diagnosed with childhood disorders. Kanner described these children as having an inability to develop normal relationships with people, a delay in speech, if it developed at all, pronominal reversal (e.g., substituting "you" for "I").

12. Autism Was first described by Dr. Kanner - 1943 Johns Hopkins University

13. Kanner also noted that these children often showed a compulsiveness to maintain sameness in their environment, repetitive and stereotyped play activities and a overall lack of imagination. From a physical perspective, Kanner described them as having normal physical appearance, while noting the presence of abnormalities in infancy such as the lack of responsiveness when held. Since Kanner's initial publication, the essential criteria for autism has remained relatively unchanged.

14. How do you know if a person has autism? What are the unique behaviors they typically show that sets them apart from others with different diagnoses? It is very important to understand the unique behavioral, sensory, and learning characteristics of autism and how to take these into account while building a program. Can you look at a person and say, he has autism? Let’s look at this video, does this person have autism?

15. How do we know if a person has autism? Does this person have autism? Communication and Social Skills

16. Obviously, this person wash acting as though he had autism and of course, there is much variation in autism as we will discuss in this class. • No one person with autism can represent all variations. We often like to have people with autism discuss autism from their perspective. In 1999, we had a panel of five adults with autism come together and address various topics. Let’s have them introduce themselves and they will share with you their memories of being diagnosed with autism.

17. Again, the people on this panel do not represent all people with autism. As you watch this video, you may wonder if these people really have autism, they do. By the way, while not all people with autism can verbally communicate as effectively as they do, some of them were not considered to be “high functioning” when they were young children. Even though some were considered to have severe retardation or were nonverbal, they came long way.

18. Diagnosing individuals with autism at an early age is vital for helping to promote their involvement in early intervention. How can we identify children with autism at an early age? One method is to use the screening tool called the CHAT, “The Checklist for Autism in Toddlers”. The CHAT is a very useful tool that can help identify children at 18 months who might receive the diagnosis of autism.

19. Research conducted by Baron-Cohen and colleagues (1996) found that 3 behaviors are impaired in autism which are present in typically developing children by eighteen months of age. These behaviors were: protodeclarative pointing, gaze monitoring, and pretend play. When these behaviors were not seen in children at 18 months of age, it was suggested that they were at risk for autism spectrum disorders.

20. The implementation of the CHAT by a Nurse or other professional only takes approximately 8 minutes. During the screening, the professional asks the parents a few questions and observes the young child to see if certain behaviors are either absence or present. Let’s watch a CHAT session being conducted and see if the child is demonstrating the three key behaviors.

21. The Early Identification of children with autism is vital: The next step is early intervention. Research has shown that with early intervention, children with autism are more prepared for school.

22. What type of interventions are best for children with autism and what are the most common areas of intervention? • In terms of areas of intervention, it is very common to develop early intervention programs that cover the communication, sensory, and behavioral needs. • When we establish a communication program we need to take into consideration how the child is already trying to communicate.

23. We must use a Communication Inventory to record how a child is already attempting to communicate. A child may be attempting to communicate using methods that fall into one of three general methods: (A) Appropriate methods including speech, sign language, voice output, or a picture based system; (B) Inappropriate methods including tantrums, physical outbursts, throwing objects, etc., and

24. (C) Unconventional methods including leading a person to something, pounding the table, or demonstrating hand flapping. • When we build a program we take into consideration how they attempt to communicate. In this video, you will see child a young child as he progresses through a program that is designed to increase communication. Based on his learning needs, visual supports were implemented. First, single pictures were used, then multiple pictures, then scripted language boards.

25. Intervention – “Cody” • Three video clips starting when he was very young. • We targeted both receptive and expressive language. • We used pictures to help increase receptive and expressive language.

26. As previous noted, programs for children with autism commonly need to have a focus on developing social skills. Helping children to develop social skills is key for their long-term integration in the community and for success in job placement. In fact, the number one reason why adults with autism loose their jobs is not related to content, but in fact it is related to not having the social skills that are needed to work with others.

27. Developing social skills can be taught directly. One strategy involves, using “Scripting” as a method. Scripting involves having a script that helps to guide a child through a conversational exchange. In essence, it allows for the child to practice social exchanges. The script serves as prompt to promote the social exchange. If a child uses the script at multiple appropriate times during the day, then the child can practice. An example is presented in the next video.

28. The child is Leah, a 9 year old who had a history of being non-verbal until the age of five. She had a history of showing tantrums, little if any initiations, and who demonstrated below cognitive test results. • Let’s first watch while her teacher is working with her one on one. Here she is practicing using a script that she will be using with other classmates. • In this second video, she is with classmates.

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30. Using Scripting to promote social interactions • Student: Leah • Age: 9 years • Grade: 3 rd grade in school • History • Nonverbal until 5 years of age. • Many tantrums • Very little social interactions • Cognitively below average • Educated in Special Ed class and part-time inclusive education settings. • Little, if any, initiations Shawn Henry

31. Promoting Social Skills using Scripting Leah Teacher: “Do you like to go swimming?” Leah: “Yes” Teacher: “Where!” Leah: “In my Back yard”.

32. Promoting Social Skills using Scripting Here the teacher and the student (Leah) are first practicing. They are reviewing the questions that Leah will be asking her friends. Leah Teacher: “Do you like to go swimming?” Leah: “Yes” Teacher: “Where!” Leah: “In my Back yard”.

33. Promoting Social Skills using Scripting

34. Scripting with Leah - Outcome Teacher reports that “Leah”, is now a social butterfly in the morning, commenting and talking when at the beginning of the year she didn’t say one word to her classmates.”

35. Teaching Social Skills. We need to incorporate “fun” into teaching situations. If a child likes to walk around a classroom, try to pick a game that involves “walking”. During the activity, the child can learn names.

36. Another key area that we will be addressing in this class pertains to disruptive behavior. Many times children with autism demonstrate disruptive behavior for communication purposes. What is important is to know what communication function the behavior is serving. Often, disruptive behavior, serves communicative functions of escape, obtaining preferred items, expressing frustration, as well as others.

37. In this next video is a young child is demonstrating tantrums. When we looked at his behavior in a very systematic manner, it appeared that his behavior was being done to procure things and to help him escape work. • A program was established that involved teaching him two signs “more” and “finish”. In addition, we used preferred task materials and gradually increased the amount of time he was required to work.

38. In this next video, you will see him after his program was in effect for approximately 2 and ½ months. Twice a week he came to a clinic for approximately 1 – 2 hours of therapy.

39. Promoting Independence in Communication • Teach the students to initiate. • Start with “wants” and “needs”. • Must teach the student to influence the environment using communication. • Initially use tasks that are motivating & fun.

40. Denny (9 years old)…... • High Frequency of Biting and Tantrums • Very Tactile Defensive • “Sever Cognitive Challenged” • Nonverbal, but had some sounds • Extremely Noncooperative • Control??????

41. Promoting Independence through Communication • Taught him two “signs” • “more” • “finish” • Used Preferred Materials • Increased Periods of work

42. Promoting Independence through CommunicationFollow-up of “Denny” five years later… • Communication – could communicate with sign language. • Behavior – did not bite or tantrum. • Still had one problem, food stealing • Worked in the Community If he worked all day, then he got Guess where he worked?

43. In establishing programs for individuals with autism, it is very important to always try to promote independence. As will be discussed in much greater detail in a later unit, today we use “self-monitoring” strategies to help promote greater independence. • Self-monitoring strategies can be used while teaching academics or community skills. In these slides, you can see an example of how it can help.

44. A child, who could do math, would not stay on task. He was taught to do the math problems and then to check it off as he completed the work. Initially, he was only required to do one problem, then a row of problems, then a half page, and ultimately a whole page. Afterwards, he was taught to apply it to other content areas.

45. Well, I hope you have a better idea of what this class is focused on. We will be providing a wealth of information and a wide range or practical strategies that have been shown to help individuals with autism. • We will be having guest lecture participants, including professionals and parents of children with autism. We will also have additional individuals with autism participate by sharing their thoughts on a variety of topics.

46. We are looking forward to your questions and thoughts regarding the subject matter. • Please do not forget to send us a brief bio and picture. • We will see you next week.