Autism Spectrum Disorder

1. Autism Spectrum Disorder “The fact that the Autism Spectrum represents so much variation from one individual to another makes it difficult to prescribe any one-size-fits-all programming. Some Children or teens with an ASD condition are cognitively very high-functioning. Others have serious congitive impairments. Some children have greater social interest. Others have no social interest at all. Some adolescents have better communication skill than others. Some commmunicate in very odd ways. Some children and adolescents with ASD conditions read nonverbal cues better than others. Some are less emotionally responsive to other people. One could make a long list of such social variations.” -Gerry D. Blasingame, Psy.D.- Kyle Bringhurst, LCSW Program Manager

2. Neurological Differences for Children on the Autism Spectrum

3. Five main areas of brain development that have been identified for neurological differences: Amygdala Hippocampus Frontal Lobe Corpus Callosum Cerebellum Brandon Condie, LPC, BCBA, Kyle Bringhurst, LCSW

4. Amygdala Function: Limbic System - evaluates threat, emotional control, stress response, aids hippocampus in memory • Topography: Fancy word for physical or natural features of an object. • Topography: Enlarged • General: Strength – Improved memory for interests, and details Weakness – Low tolerance for stress and/or anxiety Brandon Condie, LPC, BCBA, Kyle Bringhurst, LCSW

5. Hippocampus Function: Limbic System: Memory, sending stored memories to cerebral centers • Topography: Enlarged • General: • Strength – Logical, systems oriented • Weakness – Perseveration Brandon Condie, LPC, BCBA Kyle Bringhurst, LCSW

6. Cerebellum Function: Physical coordination, sensory and motor activity, anticipating events • Topography: Overloaded white matter • General: • Strength – Need for routine, become expert at task • Weakness – Unsteady, delayed physical or verbal response, anxiety surrounding sudden change. Brandon Condie, LPC, BCBA Kyle Bringhurst, LCSW

7. Frontal Lobe Function: Executive Functions, problems solving, planning, control , moral reasoning, and attention. • Topography: Enlarged Frontal Lobe due to excessive white matter • General: • Strengths – Visual Learners Mirror/rorriM Neurons • Weakness – Difficulty with abstract thought Brandon Condie, LPC, BCBA Kyle Bringhurst, LCSW

8. Corpus Callosum Function: Links the left and right hemispheres of the brain • Topography: Significantly undersized hindering effective communication between the two hemispheres • General: • Strengths – Hyper-focus on detail (e.g., numbers, pictures) • Weakness – missing the “bigger picture” being able to bring concepts together (e.g., facial expression, and events correlation with an emotion) Brandon Condie, LPC, BCBA Kyle Bringhurst, LCSW

9. WHY Does this Matter? Diagnosis of an Autism Spectrum Disorder Involve the Following • Impairments in Communication • Impairment in Social Interactions • Restricted Repetitive and Stereotyped Patterns of Social Behavior Kyle Bringhurst, LCSW

10. Mental Health Challenges Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence • Mental Retardation • Learning Disorders • Motor Skills Disorder • Communication Disorders • Autism Spectrum Disorders • Attention-Deficit/Hyperactivity Disorder (ADHD) Other Disorders to Consider • Mood Disorders • Depression • Bipolar • Anxiety Disorders • Anxiety • Post Traumatic Stress Disorder (PTSD) • Obsessive Compulsive Disorder Kyle Bringhurst, LCSW

11. WHAT do I Do? • Treatment Interventions • Behavioral Interventions • Applied Behavior Analysis (ABA), FloorTime, TEACCH (Picture schedules), Behavior Management, etc. • Cognitive Interventions • Social Stories, Cognitive Behavioral Therapy, social skills, academics, etc. • Medical Interventions • Medical exams, medication Kyle Bringhurst, LCSW

12. Evidenced Based Treatment The 11 Established Treatments are: • Antecedent Package • Behavioral Package • Comprehensive Behavioral Treatment for Young Children • Joint Attention Intervention • Modeling • Naturalistic Teaching Strategies • Peer Training Package • Pivotal Response Treatment • Schedules • Self-management • Story-based Intervention Package National Autism Center: National Standards Project

13. Foundations for Behavior ChangeLevels of Intervention Self-Fulfillment Needs: Achieving one’s full potential Psychological Needs: Love, Intimate Relationships, Friends, Feelings of accomplishment Basic Physiological Needs: Food, Water, Warmth, Rest, Security, Safety Kyle Bringhurst, LCSW

14. Applied Behavior Analysis (ABA) • Applied Behavior Analysis is the design, implementation, and evaluation of environmental modifications to produce socially significant improvements in human behavior. • Includes: • Direct observation • Measurement • Functional Analysis of the relations between environment and behavior • Based on the findings of descriptive assessments and functional analysis, ABA uses antecedents & consequences to produce practical change.

15. Applied Behavior Analysis • ABA is based on sound scientific principles derived from EAB It has a solid research foundation that proves its effectiveness. It uses procedures that have been validated. • Based on the belief that an individual’s behavior is determined by past and current environmental events in conjunction with organic variables. • Thus it focuses on explaining behavior in terms of external (extrinsic) events (that can be manipulated) rather than internal (intrinsic) constructs (that are beyond our control). • Relies on environmental explanations rather than mentalisms.

16. The7 Dimensions of ABA • Applied: Implementation of basic principles socially significant to clients • Behavioral: Directly observed and measured, target behavior • Analytic: relations between environment through systematic manipulations FUBA • Technological: Procedures are completely identified and precisely described, BIP • Conceptually Systematic: Linked to and described in basic principals of bx • Effective: Accountable changes in procedure are data based • Generality: Behavior generalize to other settings

17. The7 Dimensions of ABA: Applied • ABA implements basic principles to change behaviors of significance to the person (client, patient, consumer, etc.) and the people around them (i.e. society, Socially Significant) Examples: • Language acquisition • Learning self-care skills • Reducing behavior that hurts self, others, and property

18. The 7 Dimensions of ABA: Behavioral • Behavioral – Behavior is the phenomena of interest that is targeted for change. Behavior that can be directly observed and measured in the real-life environment. Examples: • Asking a staff member for assistance • Completing weekly reports by set deadlines • Washing one’s hands at the group home in the bathroom sink • Banging one’s own head at school

19. The 7 Dimensions of ABA: Analytic • Identifies functional relations between manipulated environmental events and behavior through systematic and controlled manipulations such as a Functional Analysis. • Assessment Phase: conduct a pre-treatment Functional Analysis with systematic manipulations to determine the functions of the behavior • Treatment Phase: use Single Subject Designs to evaluate the treatment effectiveness. NON-example: • Functional assessments using ONLY rating scales & interviews

20. The 7 Dimensions of ABA: Technological • In ABA, procedures are completely identified, and precisely described and defined. • Allows for replication of procedures • Allows for evaluating and fostering inter-observer agreement and procedural integrity

21. The 7 Dimensions of ABA:Conceptually Systematic • Procedures are linked to and described in terms of the basic principles of behavior. • Basic principles of behavior are the explanation of why behavior is occurring or not occurring • Development of behavior change procedures are based on the basic principles of behavior, explain the mechanisms of why the procedures work or don’t work in terms of these basic principles, etc. Ex: EO’s, SDs, reinforcement schedule, etc.

22. The 7 Dimensions of ABA:Effective • ABA is an accountable discipline and changes in procedures are data-based. • Revisions to treatment plans are based on collected data. • If the plan is not effective, revisions are made until it is effective. This is done by: • Collect data on an on-going basis • Graph data frequently • Make treatment decisions based on data • Adjust procedures until effective

23. The 7 Dimensions of ABA: Generality • Procedure Generality: ABA discovers procedures that can be applied effectively to many persons and in many settings. • Generality of Behavior Change: behavioral changes achieved should: • Maintain (be enduring, long-lasting after discharge) • Transfer to other settings (not be limited to the treatment setting, stimulus generalization) • Spread to other behaviors (by induction: if you improve one behavior, other behaviors not treated will improve)

24. BOOKS & RESOURCES • Green, R (2008). Lost at School: Why our Kids with Behavioral Challenges are Falling Through the Cracks and How we Can Help Them. • Gray, C (2008). Social Stories and Comic Strip Conversations. • Dawson, P; Guare, R (2009). Smart but Scattered. • Atwood, T (2004). Exploring Feelings Series: Cognitive Behavioral Therapy to Manage Anger/Anxiety • Fouse, B., Wheeler, M. (2005). A Treasure Chest of Behavioral Strategies for Individuals with Autism • Baker, J. (2006). The Social Skills Picture Book for High School and Beyond • Grandin, T. (2013). The Autistic Brain: Thinking Across the Spectrum

25. References Armstrong, T.; Neurodiversity: discovering the extraordinary gifts of autism, adhd, dyslexia, and other brain differences. DeCapo Press, 2010. Dawson, G., Levy, S; Autism spectrum disorder: Diagnosis and management involve time and patience: Harvard Mental Health Newsletter, 9.2010 McCord, B., Thompson, R., & Iwata, B.; Functional analysis and treatment of self-injury associated with transitions. Journal of Applied Behavior Analysis, 2001. Wallis, C. Inside the Autistic Mind: Time 5.2006 Dawson, G., et al. Randomized controlled trials of the interventions for toddlers with Autism: Early start Denver model. Pediatrics (2010) vol. 125, no. 1, pp e17 – 23. Remington, A., Swettenham, J., Campbell, R., Coleman, M., Selective attention and perceptual load in autism spectrum disorder. Psychological Science, October 14, 2009 (online publication). Ramachandran, V. S., Oberman, L.M., Broken mirrors: a theory of autism, Scientific American Mind – Neuroscience, November, 2006. pg. 63 – 69. Hirstein, W., Iversen, P., Ramanchandran, V.S.,: Autonomic responses in autistic children to people and objects. Proceeding of the royal society of London. Vol. 268. Pg. 1883-1888, 2001 Oberman, L., Hubbard, E., McCleery, J., Altschuler, E., Pineda, J., Ramanchandran, V.S.,: EEG Evidence of mirror neuron dysfunction in autism spectrum disorder. Cognitive brain research. Vol. 24, pg. 190 – 198; 2005. Herbert, W.; Extraordinary perception: Scientific American MIND, 4.2010

26. Contact Information • Kyle Bringhurst, LCSW, Program Manager • Giant Steps, Stride, XCEL Youth Day Treatment Programs • kbringhurst@wasatch.org (801) 310-4903