(A) Lways (U) Nique (T) Horoughly (I) Ntriguing (s) Ometimes (M) ysterious

1. (A) Lways (U) Nique (T) Horoughly (I) Ntriguing (s) Ometimes (M) ysterious Allison Coggins (Special Education Teacher, Spann), Amy Stokes (School Psychologist, Spann), Kimberly Ives (Preschool Psychologist), Sara McKee (School Psychologist, FDES), Sarah Eargle (School Psychologist, JPES)

2. Mission and Vision Mission: Dorchester School District Two leading the way, every student, every day, through relationships, rigor, and relevance. Vision: Dorchester School District Two desires to be recognized as a “World Class” school district, expecting each student to achieve at his/her optimum level in all areas, and providing all members of our district family with an environment that permits them to do their personal best.

3. Food for thought “In an ideal world the scientist should find a method to prevent the most severe forms of autism but allow the milder forms to survive. After all, the really social people did not invent the first stone spear. It was probably invented by an Aspie who chipped away at rocks while the other people socialized around the campfire. Without autism traits we might still be living in caves.” – Temple Grandin, Thinking in Pictures, Expanded Edition: My Life with Autism

4. Warm Up • Write down 5 things you know (or think you know) about autism • Share with your neighbor

5. agenda • Defining Autism • Defining Autism Within the School Setting • How Autism Impacts a Student • Our Role as Educators • 10 Things Your Student with Autism Wishes You Knew

6. Defining autism • The Autism spectrum • Did you know? • Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5)

7. The autism spectrum • Each individual with autism is unique • Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills • About 40 percent of persons with autism have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world • Others with autism have significant disability and are unable to live independently • About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means

8. Did you know? • Autism now affects 1 in 88 children and 1 in 54 boys • Autism prevalence figures are growing • Autism is the fastest-growing serious developmental disability in the U.S. • Autism costs a family, on average, $60,000 a year • Autism receives less than 5% of the research funding of many less prevalent childhood diseases • Boys are nearly five times more likely than girls to have autism • There is no medical detection or cure for autism • Total 2012 NIH budget: $30.86 billion • Of this, only $169 million goes directly to autism research. This represents 0.55% of total NIH funding Stats from www.autismspeaks.organd http://www.cdc.gov/ncbddd/autism/index.html

9. Diagnostic and statistical manual of mental disorders – fifth Edition

10. DSM-5 Main Tenets • Persistent deficits in social communication and social interaction across multiple contexts, currently or by history • Restricted, repetitive patterns of behavior, interests, or activities, currently or by history • Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning • These disturbances are not better explained by intellectual disability or global developmental delay • Note: Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level Information taken from www.dsm5.org

11. A: Persistent deficits in social communication and social interaction • Deficits in social-emotional reciprocity (abnormal social approach and failure of normal back-and-forth conversation; reduced sharing of interests, emotions, or affect; failure to initiate or respond to social interactions) • Deficits in nonverbal communicative behaviors used for social interaction (poorly integrated verbal and nonverbal communication; abnormalities in eye contact and body language, deficits in understanding and use of gestures; or a total lack of facial expressions and nonverbal communication) • Deficits in developing, maintaining, and understanding relationships (difficulties adjusting behavior to suit various social contexts; difficulties in sharing imaginative play or in making friends; absence of interest in peers) Information taken from www.dsm5.org

12. B: Restricted, repetitive patterns of behavior, interests, or activities • Must exhibit at least 2 of the following: • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases) • Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day) • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest) • Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement) Information taken from www.dsm5.org

13. Defining autism Within The School Setting • Standards for Evaluation and Eligibility Determination • Comprehensive Evaluation

14. Standards for evaluation and eligibility determination (SEED) • There is evidence that the child has any of the Pervasive Developmental Disorders, such as • Asperger’s Disorder • Autistic Disorder • Pervasive Developmental Disorder – Not Otherwise Specified

15. Asperger’s disorder • There is evidence that the child demonstrates impairments in social interaction, fails to develop peer relationships, lacks spontaneous seeking to share enjoyment, interests, or achievements with other people, or lacks social or emotional reciprocity; and • Restricted repetitive and stereotyped patterns of behavior, interests, and activities, such as encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus, apparently inflexible adherence to specific, non-functional routines or rituals, stereotyped and repetitive motor mannerism, persistent preoccupation with parts of objects. • The adverse effects of the Asperger’s Disorder on the child’s educational performance require specialized instruction and/or related services.

16. Autistic Disorder • 1. In addition to the characteristics listed for Asperger’s, there is also evidence that the child demonstrates impairments in communication, such as a delay in, or total lack of, the development of spoken language. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others, stereotyped and repetitive use of language, or lack of varied, spontaneous make-believe play or social imitative play. • 2. The adverse effects of the Autistic Disorder on the child’s educational performance require specialized instruction and/or related services.

17. Pervasive Developmental Disorder – Not Otherwise Specified • 1. There is evidence that the child demonstrates any of the characteristics listed for Asperger’s or Autistic Disorder without displaying all of the characteristics associated with either. • 2. The adverse effects of the PDD-NOS on the child’s educational performance require specialized instruction and/or related services.

18. Comprehensive evaluation – Asperger’s • The following are required • A social and developmental history • A diagnostic interview(s) with parent/teachers • A minimum of 3 thirty-minute direct behavioral observations of the student in at least 2 environments on 2 different days by more than 1 member of the evaluation team. Observations should be completed during both structured and unstructured activities. • A standardized instrument designed to measure autistic behavior and characteristics that is administered and interpreted in consultation with a professional with experience with autism. • A standardized adaptive behavior scale containing information provided by the parent/caregiver and teachers of the child.

19. Comprehensive Evaluation – Asperger’s (CONT.) • A measure of academic achievement that provides evidence that the student’s disability adversely impacts his/her educational performance. • Other areas which may yield evidence, but are not required, include fine and gross motor skills assessments, visual-motor skills assessments, sensory processing measures, curriculum based measures, and standardized achievement measures. • Evidence that the Asperger’s has an adverse affect on the student’s education performance.

20. Comprehensive Evaluation – Autistic Disorder • All evaluation components listed for Asperger’s are required, with the addition of: • A current communication evaluation conducted by a speech-language therapist. This should include assessment in the areas of receptive, expressive, pragmatic, and social/functional communication skills. • A developmental or cognitive assessment that includes both verbal and non-verbal components. • Other areas which may yield evidence, but are not required, include sensory processing measures, curriculum based measures, and standardized achievement measures. • Evidence that the Autistic Disorder has an adverse affect on the student’s education performance.

21. Comprehensive Evaluation – PDD-NOS • The child exhibits any of the following characteristics without displaying all of the characteristics associated with Asperger’s or Autistic Disorder: • Impairments in social interaction • Restricted, repetitive, and stereotyped patters of behavior, interest, and actions • Impairments in communication • All components of the evaluation listed for Autistic Disorder and • Evidence that the Pervasive Developmental Disorder-Not Otherwise Specified has an adverse affect on the student’s education performance.

22. How autism impacts a student • Communication • Social • Sensory • Behavior

23. Communication • Receptive Language – understanding of language • Expressive Language – use of language • Pragmatic Language – social communication I can remember the frustration of not being able to talk. I knew what I wanted to say, but I could not get the words out, so I would just scream. - Temple Grandin

24. Receptive Language • Difficulty understanding and interpreting language • Difficulty recognizing that they are being spoken to in a group • Difficulty recognizing nonverbal aspects of language (ex. nonverbal cues, eye contact, intonation, tone of voice)

25. Expressive Language • Often have a delay or lack of speech • Stereotyped or idiosyncratic speech • Abnormal pitch, intonation, rhythm, or stress • Grammatical structure appears immature • Difficulty participating in joint attention activities • Behavior may be the way they are trying to communicate

26. Pragmatic language • Difficulty with abstract language (ex. write small) • Difficulty with idioms (ex. green thumb) • Interrupt • Monopolizing conversations • Incessant speaking on preferred topics

27. Social • Difficulty with social-emotional reciprocity • Difficulty with nonverbal communicative behaviors used for social interactions • Difficulty developing, maintaining, and understanding relationships • Difficulty understanding rules related to social situations

28. Sensory • Our senses: sight, hearing, smell, taste, tactile, vestibular (inner ear, spatial orientation, balance), proprioceptive (muscles and joints, feedback that tells us about our body’s position) • Sensory sensitivity or insensitivity • Can affect attention and focus

29. Behavior • Behavior = Communication • If a functional communication system has not been put into place, their resource is behavior • Forget about the what, focus on the why; look at the events that surround the behavior • Antecedent: What events led up to the behavior? • Consequence: What happens (from the student’s perspective) as a result of the behavior that helps maintain the behavior? • Setting: What is happening around the student that may help maintain the behavior? • Sensory • Communication needs

30. Behavior • Attention: Gaining positive or negative attention from a desired person(s) • Escape: Trying to get out of a particular situation or expectation • Automatic: The action of taking part in the behavior is, in itself, reinforcing • Sensory: rubbing, biting, scratching, vocalizations • Frustration: hitting, throwing • Tangible: Trying to receive a tangible object

31. Activity – Experiencing autism

32. Our Role as educators • To Provide Support Through: • Strategies • Tools • Differentiation I cannot emphasize enough the importance of a good teacher. – Temple Grandin

33. Our role as educators - strategies • Consistent classroom routines • Sensory accommodations, adjustments, strategies to decrease anxiety • Miscellaneous strategies

34. Routines – use consistent classroom routines to decrease anxiety • Provide a clear and consistent schedule. • Build routines into daily activities (bathroom, raising hand, morning activities). • Plan for change. • Explicitly teach routines. • Even minor changes in a routine can cause anxiety – warn of inconsistencies with a visual, cue, social story, etc. • Use pictures and/or visual cues to aide the student in knowing what to expect, what is coming next and/or when the activity/day will be finished.

35. Sensory accommodations, adjustments, strategies • Stay alert for high anxiety levels and signs of sensory integration difficulties • See sensory strategies attached. • Allow for breaks and movement times. Reevaluate expectations – how long should you expect a child to be still/complete an activity/listen without having a break? Keep the child’s age in mind and adapt the activity as needed • Provide students with a visual menu of appropriate classroom behaviors that can be used when they are anxious or overwhelmed. • Visual choices • Direct them to the menu when you see them becoming overwhelmed • Structure sensory breaks and use visuals so that they know when their time is up and what will happen next. • Remember every child is unique…some children will calm to certain activities while others get more excited.

36. Sensory accommodations, adjustments, Strategies -Sight • Lower the lights at different periods throughout the day • Use natural lighting as much as possible • Decrease visual clutter (walls, desk tops) • Seat child away from and not facing visually distracting stimuli (e.g. near front facing away from the window) • If there is an empty desk, put this desk next to the child

37. Sensory accommodations, adjustments, Strategies - Oral • Refrigerator tubing on pencil tops to chew on or other type of chew toy • Crunchy snacks • Chew gum • Drink through twisty straw

38. Sensory Accommodations, Adjustments, strategies - Smell • Limit air fresheners • Limit perfume

39. Sensory accommodations, adjustments, strategies - auditory • Seat child away from auditory stimulations • Allow for a quiet time break • Warn of upcoming fire alarms, recess bell, etc. • Earphones

40. Sensory accommodations, adjustments, strategies – vestibular and proprioceptive • Provide sensory breaks with heavy work • Re-evaluate expectations…how long should you expect a child of a certain age to be still before giving a break • Encourage active play at recess

41. Sensory accommodations, adjustments, strategies - tactile • Seat child at an end seat or next to an empty desk to create space • Place at the beginning or end of lines • Textured materials under desk or chair to manipulate (e.g. velcro) • Fidget toys • Allow doodling if it promotes focus and is not disruptive

42. Structured sensory breaks

43. Structured sensory breaks • Breaks with choices allow for students to feel in control

44. Structured sensory breaks • Students are also able to communicate their wants and needs when using pictures and/or choice boards.

45. Sensory Break • Let’s all take a sensory break! Keeping calm in the classroom exercises

46. Miscellaneous Strategies • For oral instruction/participation • Use short, succinct verbalizations (e.g., instead of “please take out your red folder”, give class directive and then to student “red folder”) • Pair verbal instruction/information with visual cues • Limit use of abstract information and non-literal language, such as idioms, puns, nuances, double entendres, and sarcasm • Provide wait time/increased response time • If speaking to the whole group, student may require an individual directive and/or a visual cue to know you’re talking to them • Use explicit instructions and affirmations (children with ASD often show a lack of incidental learning; therefore, use “nice sitting” instead of “good job”)

47. Miscellaneous strategies • For students who get stuck on a topic (typically higher functioning students with ASD who have a restricted interest)– • Set a timer for them to talk about their topic. • Have them write down what they want to talk about and then you can talk about it with them at a more convenient time. • Due to difficulties with generalization, vary cues and materials when instructing (e.g., an A is an A is an A is an A). • Transitions are hard and anxiety-provoking. Provide warnings – visual schedule, timer, verbal warning, visual cue, etc.

48. Miscellaneous strategies • Understand the need for transition time and plan for it • Be mindful of the physical structure of the room • When introducing new or difficult tasks, capitalize on interests/favorites

49. Miscellaneous strategies • Remember – Behavior is often communication • Be proactive rather than reactive by implementing visual, sensory, language, etc. strategies and tools • Reinforcement, reinforcement, reinforcement! • Determine the function of the behavior and provide a way for the student to meet that need in an appropriate way. Reinforce them for choosing the appropriate manner of meeting their need. • Use special interests as motivators. • Establish consistent expectationsand provide a visual of those expectations for the student. Show them those expectations when they require a reminder. • Give choices. • Use social stories to teach expectations and how to interact with others.

50. Our role as educators - tools • Visual Schedules • Visuals, objects, or written words to communicate expectations • Social Stories