Autism Spectrum Disorders Autism and Asperger’s Syndrome Julie K. Ivey Baylor University Presentation at the 1st Annual Texas Wide Underwriting Conference
Autism Spectrum Disorder A condition affecting the processing, integrating, and organization of information that significantly impacts communication, social interaction, functional skills, and educational performance. There are many manifestations and degrees of severity within the autism spectrum.
Discussion Video: http://www.youtube.com/watch?v=FDMMwG7RrFQ&feature=related
Fragile – Handle with Care Even though there are many things about me that are unique, in the ways that really matter I am just like other children. I learn best from people I trust, and I learn to trust when I sense that people like me. Please try to see the world through my eyes, for I can’t see it through yours. And please know that even though it may not seem so, I really am trying to adapt to a world that my neurological challenges prevent me from understanding without your help. If you keep these things clearly in mind, you will more likely be able to teach me the things I need to know so that I can function with greater understanding and competence in a world that is often inhospitable to my needs. (pg. xv)
What Do We Know? • Autism is a spectrum disorder • Children have varied but similar characteristics • Children with autism may or may not have mental retardation • ASD is a neurological disorder not psychological or environmental • No known cure • Diagnosis is based on Behavioral Criteria • Life long disability
Autism affects… behavior communication social
Statistics • Autism Spectrum Disorder 1:91 (CDC, Feb. 2010) • Not respective of class • 3-5:1 boy/girl – females tend to have lower cognitive abilities • ~75% MR • Age 5 – general predictor of verbal language • Seizures may develop in adolescence – usually lower IQ
Epidemic? • Broader definition including PDD-NOS, Asperger’s Syndrome • Closure of institutions • Children left the institutions and entered schools and doctor’s offices • Autism became categorical label for special education services (1991, IDEA) • Increased recognition • Professionals • Public - media
Clinical Features • Early onset – usually before age 3 • Social dysfunction to include imaginative play • Communication deficits • Odd or unusual behaviors
Social Dysfunction • Theory of Mind – Inability to put self “in someone else’s shoes” • Reduced joint attention – pointing, sharing • Early predictor of ASD • Lack of age appropriate peer relations • Must be taught social skills • May be indifferent to typical interest of peers • Lack of social-emotional reciprocity • Unaware of unwritten rules of social conduct
Communication Deficits • ~50% nonverbal – no attempt to compensate with gestures • ~50% verbal-marked impairment in sustaining conversation • Echolalia (immediate & delayed) • Fails to attend to social cues or contextual cues • Switches topics to those of interest to him/herself • Continues topic of interest after other person has lost interest • Interrupts conversations
Odd/Unusual Behaviors • Restricted interests – favorite toy/object (odd), lines up objects • Interest is not usually the item but the category of item • Stereotypic Behaviors - flapping, twirling, rocking, sniffing, toe walking, self-biting • Adherence to routines – need for sameness – need to impose external order on an ever changing complex world
Restricted Interests • Children with autism do not have control over their interests just as neurotypical children can’t control their interests • Typically developing kids can be “hooked” by socially mediated strategies • Find “hooks” for kids with autism in their interests • Restricted interests are a symptom of the disability
Abnormal Sensory Response • Sound – covers ears, melt down • Vision – fascinated with lights, movements, gaze peculiarities • Touch – differs; some love touch, others pull away; hypersensitivity to pain • Taste – refusal generally due to texture, pica, some very restricted diet
Sensation • All information is taken in through the senses • Distorted sensory input among the 5 senses • Touch: tactile defensiveness • Light touch • Sticky/gooey substances • Often crave deep touch (pressure) • Visual Perceptions • Trouble judging distances – PE a problem • Auditory impairments • Frequency (pitch) and intensity (loudness)
Clinical Features • Later Diagnosis • Social Dysfunction • Communication Deficits • Odd or Unusual Behaviors
Later Diagnosis • Language develops, or seems to develop normally • IQ is normal or nearly normal • Self help skills intact except social skills • Curiosity about the environment
Social Dysfunction • Difficulty forming friendships • The child truly wants to have friends and desires interaction with others but does not know how • Often ridiculed • Confusion
Social Dysfunction, cont. • Socially isolated • Inappropriate or one sided conversations • Expansive knowledge of odd topic i.e.: washing machines, trains, dinosaurs, statistics • Knowledge dominates conversation and time
Pragmatics • Appropriate topic but inappropriate comment • Primary interest is to exchange factual information • Literal interpretation
Prosody • “Professor like” • Inconsistent • Emotion expressed in volume or pitch
Odd or Unusual Behaviors • Inflexible adherence to routine – becomes stressed or anxious • Anxiety leads to pacing, withdrawal & possibly meltdowns • Interests interfere with functioning
Motor Issues • Clumsy • Poor balance, penmanship, difficulty with sports
High Functioning Autism vs. Asperger’s Syndrome HFA AS serious social difficulties serious social difficulties onset <3 onset/diagnosis >3 language deficit language “normal” insistence on sameness specific interests motor skills early OK motor skills clumsy variable family history + family history (dad)
Health Related Quality of Life Health in the United States has traditionally been measured narrowly and from a deficit perspective, often using measures of morbidity or mortality. But, health is seen by the public health community as a multidimensionalconstruct1 that includes physical, mental, and social domains.
Health Related Quality of Life *Personal Level: Health risks and conditions, functional status, social support, and socioeconomic status. *Community level: resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.
Quality of Life- Definition Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. What makes it challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, individuals and groups can define it differently
Other Domains for QOL: *jobs *housing *schools *neighborhood *culture *values *spirituality
What we know about Persons with ASD: Greater QOL= *Support (formal & informal) *Higher Intelligence (above 70) *Better communication skills *Live independently *Have job *Have relationships
Assessment *Team approach *Deficits in: Social interaction Language as used in social communication Symbolic or imaginative play
Treatments ABA- Applied Behavioral Analysis TEACCH Method Play Therapy Floor Time Educational/Collaborative Services Diet Medication Others?
Co-Morbidity: ADHD Mental Retardation Anxiety Obsessive Compulsive Disorder Motor Clumsiness Sensory Issues Seizures
Families: Family issues; parents tend to experience: Guilt Depression Shame Consider normal physical appearance Unrealistic expectations Consider splinter skills
Video Examples: http://www.youtube.com/watch?v=p3n7Pm9UkJg&mode=related&search http://www.youtube.com/watch?v=yqcICjgp7oE&feature=related http://www.youtube.com/watch?v=R07LZwdQOPU&feature=related
The Autism Paradox • It’s easy to recite an entire book but difficult to make up a story • It’s easy to line up toys but difficult to stay in line • It makes perfect sense to climb on the sofa but little sense to sit on it • Memorizing the presidents in order – 10 minutes…Packing a school bag – 10 hours • Family pictures on the wall ore boring but that speck of dust next to it, now that’s fascinating?
Talking about weather patterns – piece of cake. Talking about my day…impossible! • Ability to focus on spinning objects – timeless. Ability to focus on homework – 3 seconds • Being called by name, can’t hear it. Some owl hooting in the distance – clear as a bell • How to operate the remote control – zero instruction. How to button up pants – intensive instruction • Navigating social rules – poorly skilled. Navigating from the back seat of the car – highly skilled • Author unknown
References • Eckenrode, L., Fennell, P., & Hearsey, K. (2005). Tasks Galore Making Groups Meaningful. • Goldstein, Sam & Reynolds, Cecil R. (Eds.). (1999). Handbook of Neurodevelopmental and Genetic Disorders in Children. New York, NY: The Guilford Press. • National Education Association. (2006). The puzzle of autism. • Simmons, K. L. (2006). The official autism 101 manual. Alberta, Canada: Autism Today. • Tilton, Adelle Jameson. (2004). The Everything Parent’s Guide to Children with Autism. Avon, MA: Adams Media Corporation. • Twachtman-Cullen, D. (2006). How to be a Para Pro. Higganum, CT: Starfish Specialty Press, LLC. • Volkmar, F. (2006, May). Asperger’s Disorder and Autism: An update on understanding and intervention. Presented by New England Educational Institute.