Autism Spectrum Disorder: Intervention

1. Autism Spectrum Disorder:Intervention Thomas Layton, Ph.D., CCC-SLP Grace Hao, Ph.D., M.D., CCC-SLP North Carolina Central University

2. How much do you know about Autism? Is everyone with autism the same? Is Autism an emotional disorder? Is Autism a rare disorder? Does Autism only affect children? Is it the case that people with autism do not like other people? Is it true that all children with autism have special gifts? Is Autism a life-long difficulty that can not be helped?

3. Autism Spectrum Disorders Basic Groundwork Neuro- developmental disability

4. Autism Spectrum Disorders Basic Groundwork Prevalence 3-5/10,000 (70s); CDC:1/150 (2007) Gender differences: 4-5 boys/girl Spectrum disorder

5. Diagnostic criteria (DSM-IV-TR) Qualitative impairment in social interaction Qualitative impairment in communication Repetitive and restricted behavior, interests, and activities

7. Qualitative impairment in social interaction Impairment in social reciprocity, as seen in: Nonverbal behaviors Peer relationships Spontaneous sharing Lack of social or emotional reciprocity Poor emotional regulation

8. Qualitative impairment in communication Delay in, or lack of, development of spoken language Impairment in conversation Stereotyped language No or limited make-believe play

9. Restricted repetitive behavior interests, and activities Encompassing preoccupation Inflexible routines Stereotyped motor mannerism Preoccupation with parts of objects

10. LanguageSubgroup:Generalized Low Performance Low in language comprehension and production Comprehension somewhat better than production Poor oral and motor imitation Mostly nonverbal Progress in treatment is slow in all modes

11. Language Subgroup: Verbal Imitators Better comprehension than production Performance in language skills good until 30 months than drop off rapidly Good oral and motor imitation Mostly verbal…some words Progress in treatment is good

12. Language Subgroup: High language Language production better than comprehension High echolalia Good oral and motor imitation Pronoun confusion Progress in treatment is good in all modes

13. but what about…? Autism vs. High Functioning Autism? HFA vs. Asperger’s syndrome?

14. Asperger’s HFAutism

15. HFA vs Asperger’s syndrome Categorization questions for the next decade Is Asperger’s a separate syndrome, or is it the high end of the autism spectrum? Are high functioning autism and Asperger’s essentially the same?

16. Assessment Scale

17. Intervention Holistic Approach

18. What are the most important skills we should teach? No matter how skilled and talented your child may be, or how much knowledge he posses; If he is inflexible and cannot handle change; If he is disorganized and requires constant prompts; If he obsesses on certain topics and cannot switch his attention; If he cannot follow directions or becomes resistant or angry when he is told what to do; -----he will sooner or later fail to keep a job Division TEACCH

20. Challenges related to autism Challenges in Learning/thinking Challenges in social interaction Challenges in communication Challenges in behavior/emotion Challenges in feeding

21. Learning Challenges Related to Autism

22. Characteristics of thinking Difficulty with the concept of meaning: Central Coherence theory Excessive focus on details (Spotlight focus) Difficulty distinguishing the relevant from the irrelevant Difficulty combining or integrating ideas

23. Example My child sees the world in boxes. When he is watching a dog, he sees one box which is the eyes, and another box which is the tail, the boxes just are not connected” Mom of a 33 month old child

24. Characteristics of thinking and learning Difficulties with theory of mind Difficulty in generalizing Concrete thinking Visual skills often a strength and frequently better than auditory skills Difficulties with imitation

25. Characteristics of thinking and learning Executive function difficulties: Difficulty with organization and sequencing/planning Understanding “finished” Set shifting/flexibility Difficulty with transitions

26. How can we help? Clearly define the environment according to activities and events = physical structure Develop routine ways of giving information about where to be and what to expect = schedule and work system Put visual supports in place = visual structure

27. Five reasons for using structure Understanding a receptive communication system Helps autistic people remain calm Helps autistic people learn better Prosthetic device for independence Behavior management

28. A successful schedule Individualized around the child need and interest Tangible Flexibility built-in Space out Portable Child involved Restructure while keeping the consistence

30. Individualizing Schedules Type of visual cue (e.g., icon words or a combination) Length of schedule Ability of schedule (e.g., on clipboard, in folder, or notebook that travels with student) or static (posted on wall, table or desk to which student returns.) Location of schedule Transitional cue (e.g., match name, color, symbol, give pencil, buzzer, bell, check schedule, etc.) Ways of manipulating schedule (“checking off”) “It is OK to mix visual cues within a schedule!”

31. How to Achieve Successful TransitionTeaching strategies Create visual and manipulative ways to teach Break down an area of learning into small steps Teach strategies for approaching problems that can be used for more than one assignment

32. What is a routine? A routine is to know whenever something happens, go and check the schedule! The best teaching is to teach adaptation

34. Challenges in Communication

35. Best Practices Communication goals should emphasize functional use Environmental arrangement should be primary strategy to foster initiations Environmental supports promote active and independent participation Approaches to challenging behavior should be fully integrated with communication Peer mediated learning is essential Level of emotional arousal and its effect on communication needs to be considered

36. Early Intervention Programs Major Goals Attention Imitation Social Interaction and intentional communication Language Development Emotional regulation

37. “I Can” Look at someone’s face, listen to what they are saying, or speak BUT I can do only one of these at a time Adult with autism (28 years old male with a master degree)

38. Communication Challenges Ecolalia Pronoun confusion Pragmatics (lack taking others into consideration) Initiation vs. responding Turn-taking Requesting Describing Demanding Role-playing dialogue

39. Challenges in Social Interaction

41. Challenges in Social Interaction Pragmatic skills Perspective of others? Behavioral issues

42. Promoting Social interaction/intentions Reciprocity and social-affective signaling Develop preverbal intentional communication – means and functions Opportunities for peer interactions and relationships

44. Challenges in Behavioral/Emotional Management

45. WHY THESE BEHAVIORS? Behavior always happens for a reason Our challenge: to figure out the message underlying a behavior problem and respond to the message To understand the message, we need to be able to understand autism and the child’s experience To intervene, we need to be able to make changes and teach skills

46. How do we help? Step 1: what is the problem? Define and describe the behavior Be specific

47. How do we help? Step 2: Why is it happening? Gather clues Collect data on the A-B-Cs (Antecedents/Behavior/Consequences)

48. How do we help? Step 3: Generate theories. Why Is this behavior occurring? Review the data Use your knowledge of autism Create icebergs (it is important to know what is going on underneath)

49. How do we help? Step 4: Design and implement intervention The intervention plan will be based on your theories, and will often include several components. Common strategies include: Modify the environment Improve schedules Modify tasks Modify method of presentation Teach skills, improve understanding Use different consequences

50. Child Throws Banana Repeatedly Go to the computer lab Throws Banana on the floor family/personal/ environmental factors Consequences Behavior Too much going on in the cafeteria Antecedents