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Autism Spectrum Disorders: Presentation During School Years
Rhea Paul, Ph.D., CCC-SLPSouthern Connecticut State UniversityYale Child Study CenterFeb. 11-15, [email protected]
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Overview
Social and adaptive behaviors Play Communication Behavioral and Emotional Issues Adjustment and Achievement Outcome
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Social behaviors: Aloof
Classically autistic Avoid contact and interaction,
unresponsive Stereotypic, self-injurious behaviors Pattern most common in preschool,
but can be seen in older childen Those who persist in this pattern
often have MR
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Video Sample: Aloof JC, MK
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Social behaviors: Passive
Accept but do not seek interactions
Generally higher developmentally than aloof
Children who start out aloof may move to passive
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Video sample: Passive Karin 14:00 Hadia
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Social behaviors: Active-but-odd
Usually HFA or AS May have considerable language skills,
interested in communicating but use Repetitive questions Inappropriate touch Odd postures, gestures, facial expressions Conversations on narrow interests
Literal and concrete Little awareness of others’ thoughts, feelings,
motives Aware of differences May regress under stress to tantrums
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Video Samples: Active but Odd
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Adaptive Skills
Deficits not attributable to IQ Related to verbal skills and autistic
symptom level Typically significant discrepancy
between measures of adaptive skills and developmental level in ASD; adaptive skills are lower than IQ.
Should be targeted in educational programs
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Play Pretend play is often lacking or
delayed Play may be rigid, repetitive Games with rules may be rigidly
adhered to Motor skills may interfere with team
game participation Can be enhanced by allowing active
role in choosing games, toy, themes
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Communication
Presence of speech before age 6 is indicator of better prognosis
Echolalia may be first step toward speech, usually decreases as language skills increase Serves communicative functions
Language skills in children who speak are generally on par with mental age
Conversational skills are major area of deficit throughout school years
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Behavior and Emotion Unusual inappropriate excessive or
inadequate responses Appear to lack empathy High levels of anxiety; may lead to
maladaptive behavior High levels of attention problems,
hyperactivity, impulsivity; similar to ADHD Hyperactivity decreases w/ age Attention problems do no
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Stereotypic Behaviors Seen in other disorders, but more
prevalent in ASD more frequent in lower functioning
individuals, but can be seen in HFA May progress from repetitive sensory
motor activities to those more like OCD in higher functioning individuals
Both drug and behavioral treatments are helpful
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Adjustment and Achievement
Social disabilities, rigid cognitive style, anxiety, attention problems affect academic achievement even for most intelligent
Difficulty w/ executive functioning interferes with school success
Generally, children with autism have weaker verbal than non-verbal skills; may need visual (picture) supports
AS shows strong verbal skills, benefit from written supports
Individual assessment needed to identify academic strengths, weaknesses Reading and/or math may be precocious in HFA/AS Hyperlexia is common in ASD (20-25%)
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Adolescence Generally, improvement is seen in adolescence
Reduction in symptoms Increase in social and communicative skills
10-20% show deterioration in adolescence 25% show onset of seizures in adolescence Mood disorders may appear Difficult behaviors may remain, including
Resistance to change Unacceptable sexual behavior Tantrums Aggression Self-injury
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Outcomes Best seen in those with IQ>50, language use by
age 6 Many have difficulty with independent living and
most continue to live with parents into adulthood Residential support programs for adults are emerging
Only about 10% of people with ASD attend or graduate from college
Supported employment provided for those with MR; less often for those w/ HFA/AS
High rates or depression and anxiety in adults Education has a great effect on outcome!
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Video Sample: Outcomes
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Video Sample: Outcomes