introduction to autism spectrum disorder (asd) presented by michelle antle, simpson co.; marty...

Introduction to Autism Spectrum Disorder (ASD)

Presented by

Michelle Antle, Simpson Co.; Marty Boman, WKU

Paula Borland, CESC; Connie Miller, Warren Co.;

Debra Myers, CESC; & Amanda Reagan, Allen Co.

04/19/23

Autism Spectrum Disorders: Agenda

I. What is PDD & Autism?

II. The Characteristics of Autism

III. Current Evidence-based Strategies

IV. General Teaching Tips

V. Summary

VI. Resources

Prepared by KY Coop Network January 2010

What is Pervasive Developmental Disorder?

• A specific group of Developmental Disabilities– Start by age 3 and last through a person's life– Symptoms may improve over time. – Symptoms within the first few months of life in some.

In others, symptoms might not show up until 24 months or later.

– Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

Prepared by KY Coop Network February 2010

What is Pervasive Developmental Disorder?

• A Neurodevelopmental disorder– Handle information in their brain differently

than other people.

• A Spectrum Disorder – Students vary in symptoms & abilities from very

mild to severe.– each person affected in different ways– differences in when the symptoms start, how

severe they are, and the exact nature of the symptoms


Autism Numbers?

• Incidence– Estimate: 1 in 150 (Center for Disease

Control, 2007)– 4 times more often in boys

– No racial, ethnic, or social boundaries• Most recent numbers– 1 in 110 (CDC, 2009)– 1 in 91 (Pediatrics, 2009)

– Findings based on parent report

04/19/23Content prepared and organized by the Kentucky Autism Training

Center

Etiology? Factors considered

• Genetics– Double recessive gene – Family history

• Environment– Exposure to pollution & toxins.– Severe infections during pregnancy (e.g.

rubella) or early infancy.

• Neurobiology Prepared by KY Coop Network

February 2010

Diagnostic Criterions

• Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV-TR)

• Individuals with Disabilities Education Act (IDEA)

• Kentucky Administrative Regulations


Autism Spectrum Disorders

• Autism

• Asperger’s syndrome

• Pervasive Developmental Disability- not otherwise specified (PDD-NOS)

Under PDD, but not ASD:

• Rett syndrome

• Childhood disintegrative disorder


Center

Autism:Diagnostic Criteria for

EligibilityDSM-IV-TR• Qualitative impairment in SOCIAL

INTERACTION • Qualitative impairments in

COMMUNICATION

• RESTRICTED and STEREOTYPED behaviors, interests and activities


Center

Asperger Syndrome:Diagnostic Criteria for

Eligibility• Qualitative impairment in SOCIAL

INTERACTION• RESTRICTED and STEREOTYPED

behaviors, interests and activities

• No clinically significant delay in – Language development

– Cognitive development

04/19/23

Content prepared and organized by the Kentucky Autism Training

Center

Asperger’s Syndrome (AS)

• Higher functioning Autism????? • New to DSM in 1994• First described by Hans Asperger, a

Viennese pediatrician (1944) • More common than “classic” autism• Famous persons- e.g.: Albert Einstein,

Thomas Jefferson ???


Other ASD• Pervasive Developmental Disability- not

otherwise specified (PDD-NOS)– This category should be used when there is a

severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes atypical autism --- presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.


Center for Autism Initiative

PDDs• Rett syndrome

– Onset of all of the following after the period of normal development:

• deceleration of head growth between ages 5 and 48 months

• loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing)

• loss of social engagement early in the course (although often social interaction develops later)

• appearance of poorly coordinated gait or trunk movements

• severely impaired expressive and receptive language development with severe psychomotor retardation

04/19/23



Other PDDs• Childhood Disintegrative Disorder

– Normal development for at least the first 2 years after birth– Clinically significant loss of previously acquired skills (before age

10 years) in at least two of the following areas: • expressive or receptive language • social skills or adaptive behavior • bowel or bladder control • play • motor skills

– Abnormalities of functioning in at least two of the following areas: • qualitative impairment in social interaction (e.g., impairment in nonverbal

behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)

• qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

• restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

04/19/23



IDEA Reauthorization

• Prior to 1991, no specific classification for autism.

• In 1991, IDEA specified autism as a disability for the first time.

• Soon after individual states included Autism as a disability in state regulations (e.g. KY in 1993)


IDEA 2004

A developmental disability that significantly affects

• verbal and nonverbal communication

• Social interactions

Evident before age 3

Adversely effects educational performance

34 CRF 300.8(c)(1)Prepared by KY Coop Network

February 2010

IDEA

• Other characteristics associated– Repetitive activities & Stereotyped

movements– Changes in daily routine– Unusual responses to sensory

experiences

34 CRF 300.8.c.1


Kentucky Administrative Regulations

ARC shall determine that a student has the disability of autism and eligible for specially designed instruction and related services if evaluation information verifies:

• Difficulties in developing and using verbal or nonverbal communication

• Difficulties in social interactions


In consideration of ALL DISABILITIES

Is there an adverse effect on educational performance?

Is it due to lack of reading/math instruction?

Is it due to Limited English proficiency?


Adverse AffectMeans that the progress of the child is impeded by the disability to the extent that the educational performance is significantly and consistently below the level of similar age peers.

707 KAR 1:280 Section 1 (2)


Educational Performance•Determined on an individual basis.•Education is more than academics. May include non-academic and academic skills.•No single procedure used as sole criterion for determining.•ARC may consider information about outside or extra learning support provided to the child.


Video

Autism: The Hidden Epidemic (2005). Autism Speaks.

Chapter 1: Early Signs of Autism

Chapter 2: Possible Causes of Autism


Co-morbid Conditions

• Are you aware that 65% of individuals with Autism Spectrum Disorders (ASD) have at least one other co-occurring psychiatric disorder?

• What do you think those might be?

• What are you seeing in your districts, esp. around students with Aspergers?

Resources: Silverman & Weinfeld (2007); Smith-Myles (2005)

Co-morbid Conditions for Aspergers…

• Mood Disorders (e.g., depression, bipolar disorder)

• Anxiety Disorders

• Obsessive-Compulsive Disorder

• Tourette syndrome


…Co-morbid Conditions

• ADHD

• Learning Disabilities (written expression, reading comprehension)

• Epilepsy


Where are students with ASD served?

• Across a continuum of educational programming needs

04/19/23


Center

Full inclusion

Collaborative support

Full inclusion

Collaborative support

General education

+Resource

General education

+Resource

Self-contained

LBDMSDASD

Self-contained

LBDMSDASD

In schoolsDid not meet

school eligibility

In schoolsDid not meet

school eligibility

Special programs

Special programs

Who is serving students with ASD?


Center

Teachers MSD certifiedPsychologists

Speech language pathologistsOccupational therapistsTeachers LBD certified

Teachers Gen. education certifiedAdministrators

Teachers MSD certifiedPsychologists

Speech language pathologistsOccupational therapistsTeachers LBD certified

Teachers Gen. education certifiedAdministrators

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What interventionists need to know?

Two Priorities

• How the characteristics of individuals with autism effect daily performance

• Evidenced- based practices for instructing students with ASD• Practices that have accumulated sufficient

research evidence of their efficacy

04/19/23


Center

Tip of the Iceberg is generally all you see……..

But what is underneath is often more important

Characteristics of Learners with ASD

“If you know one child with autism, you know one child with autism”

Each individual with an ASD brings his/her own unique way of interacting with the environment

Each individual brings his/her own reinforcement history

Each individual with an ASD is more like his/her peers than different


Center

Domain Areas-Diagnostically

• Communication• Social Interaction & Relatedness• Restricted and Stereotyped

behaviors, interests and activities


Other Domain Areas

• Cognitive Processes

• Academic Skills

• Sensory Processing

• Emotional Vulnerability

• Motor


Activity 1: What comes to mind

when you think of Autism?


Strengths in Students with ASD

• Good knowledge of facts• Good long term memory once

information is processed• Musical or special talents

(obsessive)• Visual thinkers


Communication


Pre-linguistic skills

Some learners with ASD have difficulty acquiring the building blocks of communication– Joint attention

• Joint attention is the process by which one alerts another to a stimulus via nonverbal means, such as gazing or pointing

– “Child looks at a ball which cues the teacher to look at the ball”

– Turn taking– Anticipating a routine


Center

Pre-linguistic skills• Eye contact

– There has been some debate as to how to teach eye contact and whether it is a necessity especially to individuals who may find it aversive,

• But, consider the importance of eye contact in typical face to face interactions

• How do you react when a peer does not give eye contact, what does it make you think?

• Imitation skills– Many students with ASD demonstrate

weaknesses in imitation skills– Why is this critical in instructional environments?


Center

Videos

First Signs- Joint Attentionhttp://www.firstsigns.org/asd_video_glossary/asdvg_about.htmVideos

Eye Contact Study-Yale

http://www.msnbc.msn.com/id/7019005/ns/nightly_news/


Communication • Many individuals with ASD do not develop

functional communication (Miranda- Linne & Melin, 1997)

• May use idiosyncratic language– Student says “ I want popcorn” to indicate he

wants to go to the movies

• May have literal understanding of language– Teacher says, “Sit down”– Student sits on the floor


Center

Communication

May demonstrate difficulties with– Verb tense and articles (Bartolucci, Pierce, &

Streiner, 1980)

– Pronoun reversal• “You want cookie”

– Prosody• Unnatural tone in voice

04/19/23


Center

Communication

Some individuals with ASD may not accurately read nonverbal communication or may not

use corresponding nonverbal cues when speaking

List some of the ways that you deliver “unspoken messages”

Carol Gray, the creator of social stories™, suggested that maybe for some individuals

with ASD social interaction is often like being on the outside of an inside joke.


Center

Picture Exchange Communication

Systems


Activity 2: Think, Pair, Share

• In small group, think about how kids deliver unspoken messages

• Be prepared to share out


Social Interactions & Relatedness


Pragmatic issuesMany individuals with ASD demonstrate – A lack of spontaneity– Decreased ability to recognize a speaker’s

intent– Decreased ability to reciprocate during

conversation– Decreased ability to respond with the

appropriate amount of information (Scheuermann & Webber 2002)


Center

Social Interactions & Relatedness

• Higher interest in objects than with people.

• Inability to understand social rules, social engagement, and maintaining interactions.

• Poor empathy.• Bluntly honest. • Withdrawal tendency - Prefer to be alone.• Difficulties making friends.• Difficulty with time (off pace with others).


Theory of MindThe ability to make inferences about what other people believe to be true

• Sally- Ann Study (Baron-Cohen, Leslie, & Frith, 1985)


Center

Theory of Mind

Consider how an impairment in theory of mind might impact daily functioning– Appearance of being blunt or rude– Ability to lie – Understanding sarcasm– Negotiating– Compromising– Relationship development


Center

Bullying

Many students with ASD are victims of bullying.

(Montes & Halterman, 2007)

This may increase the aversive qualities of school contexts for students with ASD.

04/19/23


Center

KATC Video

Young Adult Panel- Discussion of Educational Experience


Restrictive and Stereotypic Behaviors, Interests and Activities


Restricted Range of Interests

Characteristics:• Unusual attachments to objects.• Preference for routines or rituals (need for sameness).• Perseverative behaviors. • Eccentric preoccupations. • Trouble letting go of ideas.• Single channeled (Focused on one idea).• Difficulties understanding the concept of finished.


Stereotyped or repetitive behaviors

• Individuals with ASD may engage in behaviors that are automatically reinforced– Hand flapping– Video talk– Spinning part of toys

• Individuals with ASD may present a limited range of interests and insist on interacting around preferred topics– Young man wants only to talk to his peers

about their experiences with narrow gauge steam engines


Center

Stereotyped or Repetitive Behaviors

How might these behaviors or interests impact daily functioning?– Social interaction– Academic performance– Motivation

Some individuals with ASD have noted that it is typical to have hobbies and interest?


Center

Activity 3: Stereotyped or repetitive behaviors

1. In a small group, discuss how might these behaviors or interests impact daily functioning?

2. Chart on T-Chart provided using post it notes under the appropriate heading below– Social interaction– Academic performance– Motivation


Center

Rainman

Chapter 6- The Brothers Meet


Cognitive Processes


Cognitive Processes

• Prefer Order, Predictability, and Familiarity

• Overselectivity

• Gestalt thinking or chunking

• Time Management

• Uneven Skill Development

• Problem-solving


Prefer Order, Predictability, and Familiarity

• Need for sameness• Like order.• Engages in repetitive behaviors or rituals.• Difficulties making transitions or resistive to

change.• Easily overwhelmed by minimal changes.• Rote learners


OverselectivityIndividuals with ASD may attend to a limited number of cues in their environment – They may attend to an irrelevant part of an

instructional stimuli• (Lovaas, Schreibman, Koegel, & Rehm, 1971)

Example:– Mrs. Johnson teaches Sally 10 new sight words to

a 100% criterion.– Mrs. Johnson presents the same 10 words in a

different font and Sally doesn’t recognize them.– What was Sally attending to?


Center

OverselectivityConsider how attending to a limited piece of the big picture may impact daily functioning.– Social Behavior– Language acquisition– Learning new skills– Safety Can’t see the

forest for the trees.


Center

Gestalt Thinking or Chunking

• Some learners with autism may pair stimuli together in “chunks” without consideration of smaller units– Problem with stimulus control

We see either faces or a vase but children with ASD wouldn’t be able to make sense of it.

04/19/23 Prepared by KY Coop Network February 2010

Gestalt Thinking or Chunking

Consider how “chunking” might impact daily functioning.

– Learning new skills• E.g. Reading: Sentence level to word level to

phonics.

– Adjusting to changes in routines– Pairing individuals with certain stimuli


Center

Video

Bing Commercials


Time Management

Many individuals with ASD may demonstrate difficulties– In understanding the passing of time

• Waiting• Using a clock to signal activity change

– Breaking tasks into manageable chunks


Center

Time Management• Many students with large skill repertoires,

including those with Asperger’s syndrome, may perform poorly in academic contexts due to the inability to plan and organize their time.

• Without explicit instruction in these areas it is unreasonable to expect that these students will acquire these critical skills.


Center

Uneven Skill Development

It is important to note that student with ASD may demonstrate “islands of precocity”. That is, they may be gifted in some areas while demonstrating severe deficits in others.

For example

The uniquely erudite plebeian disparaged the concatenation of vernacular squandered by the cosmopolitan statesman on the entreatments for benefactions.


Center

Uneven Skill Development

• This uneven development increases the difficulty in assessing student abilities

• It may lead teachers to make false assumptions about what a student should be able to do.


Center

Problem-solving

• Some students with ASD may appear logical, but their logic is based on students perspective

• May not view a problem as having multiple solutions (Myles, 2007)

e.g., Student with Asperger’s syndrome decides to not do homework

because he feels he will get a poor grade anyway.

04/19/23 Kentucky Autism Training Center,

2009

Sensory Processing


Sensory Processing

Activity 4:

Alphabet activity


Sensory DifferencesSome individuals may over respond or under respond to sensory stimuli– As a result certain things in the environment

might be exceptionally reinforcing or aversive to some individuals with ASD.

– How might these differences impact daily functioning

• In learning?• In interaction?• In behavior?


Center

Sensory Area


Academic Skills


Academic Skills• Extensive knowledge in narrow areas of

interest.• Strong rote memory skills• Strong decoding with weaker comprehension

skills.• Knows facts/details but difficulty with abstract

reasoning.• Difficulties applying learned skills in new

situations. • Easily distracted


Academic Challenges

• Student with ASD syndrome often present challenges in multiple academic areas

• Students with HFA/Asperger’s Syndrome may present weaknesses in– Reading and listening comprehension– Written expression– Numerical operations– Problem solving (Whitby & Mancil, 2009)


Emotional Vulnerability


Emotional Vulnerability

• Easily stressed-worries obsessively

• Unusual fear responses

• Difficulties tolerating mistakes

• Low frustration tolerance

• Difficulties identifying, expressing or controlling emotions.

• Exhibits “meltdowns” reactions


Problem Behaviors

Students with ASD may exhibit problem behavior due to skill deficits that serve as barriers to accessing reinforcement.

Behavior is communication– I want a break– I need your attention– I want to eat– This is too hard


Center

Problem Behaviors

• Students may also have a difficult time controlling behaviors

Activity 5

• Take out a piece of paper and a pencil. When I say start, you will have one minute to write the pledge of the allegiance.– But, You must follow the subsequent rules


Center

Pledge Activity!

• When you write the word “the” you must scratch it out or erase it one time. Then rewrite it and proceed.

• When you write the word “to” tap your desk 2x with your pencil

• When I clap 1x : Look up at the light for a count “one one thousand”

• When I clap 2x: Look at me and say “ When is lunch”


Center

Video

Autism: The Hidden Epidemic. (2005). Autism Speaks.

CNBC

Part 5: Nobel Laureate Vernon Smith on Living with Asperger’s

Syndrome


Reinforcement Reminders

• Reinforcement increases the likelihood of a behavior

• “The way positive reinforcement is carried out is more important than the amount.”

– B.F. Skinner


Reward Choice Menu


Token Board


Motor Skills


Motor Skills

• Poor motor coordination

• Awkward gait

• Unusual body postures, movements, & facial expressions

• Handwriting difficulties

• Resists or refuses handwriting tasks


Characteristics of Autism


Practices with Confirmed Evidence Base for Individuals with ASD

(10/24/2008)

• Behavioral strategies– Prompting– Time delay – Task analysis and chaining – Reinforcement

• Computer-aided instruction• Differential reinforcement • Discrete trial training • Extinction• Functional behavior assessment • Functional Communication Training • Naturalistic interventions• Parent-implemented intervention

Prepared by KY Coop Network

February 2010

Practices with Confirmed Evidence Base for Individuals with ASD (Cont.)

• Peer Mediated Instruction/Intervention• PECS • Pivotal response training• Response interruption/redirection • Self-management • Social skills training • Social stories • Stimulus control/environ modification • Structured work systems • Video modeling• Visual supports• VOCA/SGD (speech gen. devices)


Video

Autism: The Hidden Epidemic. (2005). Autism Speaks.

Chapter 6: Educational Interventions


In Summary


General Teaching Tips

• Look at physical environment-reduce distractions.

• Use visual supports whenever possible.• Keep directions clear and concise. Avoid extra

irrelevant words.• Capitalize on strengths and interests. Develop

talents.• Encourage generalization by using a variety of

materials, settings, & people when teaching a concept.



• Use the prompt sequence to encourage correctness.

• Use errorless learning.

• Break expectations into small steps and gradually increase participation.

• Encourage partial participation.

• Encourage independent effort.



• Use age appropriate materials.

• Use concrete and hands-on activities.

• Use organizational aides and visual supports.

• Plan for transitions and prepare the student for change.



• Develop systems to motivate the student to participate (e.g. rewards, tokens, etc).

• May need to provide tangible rewards for accomplishments.

• Develop “First ____, then ____” concept.



• Tell the student expectations (what to do) and do not focus on what not to do.

• Students with autism need explicit teaching to develop social and other skills and to understand social situations.

• Label feelings/objects


The Challenge is not “How to teach”,

but “What to teach.”Resources

• The Hidden Curriculum (Miles, Trautman, & Schelvan )

• Solving Problems in Autism (Linda Hodgon)• Visual Strategies for Improving Communication

(Linda Hodgon)• Social Stories 10.0 (Carol Gray)• Power Cards ( Elisa Gagon)• Behavioral Interventions for Young Children with

Autism (Maurice, Luce & Green)• Inclusive Programming for Elementary Students

with Autism (Shelia Wagner)• Tasks Galore Series (Taskgalore.com)


Putting it Together

Or Structure for Us!!!


Guidelines for Success

• Make it –CONRETE

• Present it – VISUALLY

• Give it - STRUCTURE


“ I think in pictures. Words are like a second language to me. I translate both spoken and written words into full color movies, complete with sound, which run like a VCR tape in my head. When somebody speaks to me, his words are instantly translated into pictures.”

Temple Grandin – Thinking in Pictures.


“If the student with

autism does not see it,

You did not say it.”

Carol GrayOctober, 2000


Local Parent Support Groups

• Autism Society of the Heartland - RadcliffStephanie Ridge 270-877-6849

• Autism Society of Western Kentucky - HendersonNancy Boyett (502)826-0510

• Autism Support Group of Allen County• Amanda Reagan 270-618-3181• Hart of Autism – Hart County

Stephanie Turner 270-774-1180• TJ Sampson Hospital - Glasgow, KY

270-651-4480• WKU Kelly Autism Program Support Group –

Bowling Green Marty Boman 270-745-8833

Resources• Aspy, R & Grossman, B. (2007). The Ziggurat Model.

Shawnee Mission, KY: Autism Asperger Publishing Company. www.texasautism.com

• Center for Disease Control and Prevention• http://www.cdc.gov/ncbddd/autism/facts.html • Division TEACCH

(Treatment and Education of Autism and related Communication handicapped Children)http://www.unc.edu/depts/teacch

• Kentucky Autism Training Centerhttp://www.louisville.edu/medschool/katc/

• Indiana Resource Center for Autismhttp://www.isdd.indiana.edu/~irca

• NBC (2005) The Hidden Epidemic. New York: NBC


introduction to autism spectrum disorder (asd) presented by michelle antle, simpson co.; marty...

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