Best Practices for Students with Autism: Predictable, Engaging Learning Environments

1. Best Practices for Students with Autism: Predictable, Engaging Learning Environments Mary K. (Kathy) Brinker ; M.S.Ed., CAPE, NBCT Adapted Physical Education Instructor Cooperative Association for Special Education Glen Ellyn, Illinois AAHPERD National Convention March 30, 2010 San Diego, California

2. OBJECTIVES • To obtain a basic understanding of terminology of Autism Spectrum Disorder (ASD) • To obtain knowledge of a variety of instructional techniques/strategies for students on the spectrum including: PECS, use of visuals, decreased verbal and choicemaking, use of technology • To develop an understanding of strategies and instructional techniques for individuals with autism specific to a physical education

3. Autism Spectrum Disorder Currently under the DSM-IV,TR,2000 there are 5 categories listed that fall under the umbrella of (Autism Spectrum Disorder) 1. Autistic Disorder 2. Asperger’s Disorder 3. Pervasive Developmental Disorder–Not Otherwise Specified PDD-NOS 4. Rett’s Disorder 5. Childhood Disintegrative Disorder (DSM-IV-TR, 2000)

4. Autism Spectrum Disorder American Psychiatric Association is in the process of public review of the DSM-5 It is scheduled for release in May 2013 If adopted with current wording the DSM-5 would: Remove Rett’s disorder as a category Subsume both Asperger’s and PDD-NOS under the category of Autism Spectrum Disorder Refer to American Psychiatric Association DSM-5 Development Website http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

5. Autism Spectrum Disorder Revised January 26, 2011 Autism Spectrum Disorder Must meet criteria A, B, C, and D: A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2.  Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and  in making friends  to an apparent absence of interest in people Taken directly from American Psychiatric Association DSM-5 Development Website http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

6. Autism Spectrum Disorder Revised January 26, 2011 Autism Spectrum Disorder Must meet criteria A, B, C, and D:  B.    Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of  the following: 1.  Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).  2.  Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3.  Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4.  Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). C.   Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning. Taken directly from American Psychiatric Association DSM-5 Development Website http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

7. The current facts…… • Prevalence rates are estimated at 1:110 (Center for Disease Control, 2009). • Boys are 3-4 times more likely to have autism • There appears to be a genetic link • There is no cause or cure currently • Prevalence rates are consistent world-wide • Current trend theory is that there is a genetic link coupled with an environmental link that may be causing increases

8. Scenario taken directly from the Eligibility Criteria for Adapted Physical Education Services Joint Position Statement, NASPE and AAPAR (2010) Fourth-grader Yuki has autism. Although she is above the 85th percentile, or 1.0 standard deviations above the mean on her psychomotor tests, she has a difficult time in a GPE class with 60 children, two teachers and her paraeducator. The noise and student movement cause her to retreat, curling up in a corner. A more appropriate placement for Yuki would be a much smaller class with several trained peer tutors. The joint position further suggested that behavior, socialization, and ability to be in group, should be significant factors in considering the child’s least restrictive environment in a physical education setting.

9. NASPE Standard 5 • Standard 5: • Exhibits responsible personal and social behavior that respects self and others in physical activity settings. • Affective Domain can be very difficult with a possible limited scope of interest, difficulty in nonverbal communication, and decreased sensory regulation

10. Skills needed in play in a physical education setting (not all inclusive) Understanding of chase and flee/avoiding obstacles and others Reciprocal play turn taking Understanding of roles in game play Understanding cause and affect and switch in roles Understanding of boundaries Understanding of directionality Understanding of touch and appropriate touch Understanding of when the game is over (how long?) Basic object control and locomotors skills involved in game play

11. Motor Characteristics of Individuals with Autism • May possess low levels of physical fitness (literature in inconclusive). High degree of variability. • Activity may increase attention span in individuals with autism (Rosenthal-Malek, & Mitchell, 1997) • Vigorous activity along with behavior management programs may reduce inappropriate behaviors ( Lavay, French & Henderson, 1997) & Reed O. Elliott, Anjanette R. Dobbin, Gordon D. Rose and Henry V. Soper (1994) • Uneven motor development (may be due to lack of exposure to certain activities). Not allow as much access time to appropriate play behaviors.

12. Evidence-Based Practiceand Autism in the Schools • http://www.nationalautismcenter.org/affiliates/ The NAC (National Autism Center) has recently released national data describing appropriate evidence based practices particularly for schools. Follow the link below to download a free pdf of the 160 pg. document. National Autism Center (2009). National Standards Project-Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center, Author.

13. Established Treatments per NAC study (not all inclusive) • Behavioral Package: task analysis, delayed contingencies, shaping, choice, positive behavior supports. • Modeling: live and video modeling. • Peer training package: usually components of other treatment packages with trained peers implementing. • Schedules: written, picture, workstations. • Self management: setting ones’ goals, checklist, wrist counters, visual prompts, tokens. • Story based intervention package: Social stories, and other stories to take the “perspective” of someone else. • National Autism Center (2009). National Standards Project-Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center, Author.

14. Emerging Treatments per NAC study (not all inclusive) • Augmentative and Alternative Communication (AAC) Device : pictures, symbols, communication books, iPods, ipads. • Exercise • Peer tutoring • Picture exchange communication system (PECS)- teaching functional communication • Scripting • Structured Teaching (TEACCH model) • Therory of Mind Training (taking the perspective of another person) • National Autism Center (2009). National Standards Project-Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center, Author.

15. Unestablished Treatments per NAC study (not all inclusive) • Gluten- Free Casein Free diets • Facilitative communication • Sensory integration (OT’s) • Auditory Integration National Autism Center (2009). National Standards Project-Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center, Author.

16. Instructional Strategies in a physical education setting • Use of visuals (PECS) • Pictoral schedules • Choice making boards (teach to strengths and interests) • Specific short verbalizations( for class management and specific instructional feedback) • Instructional sequences • Quiet area • System of cues and prompts • Single sensory modality at a time • Use of routines • Predictable environmental design- structured teaching based on the TEACCH model • Get it right the first time-one time learners