Autism 1

Deficits

100

Social Communication Deficits include

- impairments in joint attention

- Impairments in social reciprocity

- Challenges in the use of verbal & nonverbal communicative behaviors for social interaction.

200

Common Reception and Processing Problems

1. The individual is unable to modulate and process or integrate sensory stimulation (narrow range of optimal stimulation)

2. The individual has decreased ability to scan an area or environment to identify and focus consistently on the important elements or events

Trouble controlling attention on one thing

3. A. Chunks of info that occur simultaneously or very close together in time are quickly associated and remembered

Gestalt processing - holistic, one thing, big chunks

4. Information is not retrieved in the correct sequence

5. Time concepts and time perception are impaired

6. Language is understood and used literally

7. Auditory info is not processed efficiently or reliably

8. Meaning is not automatically attached to visual info

9. The individual is unable to solve problems and generate new or alternative solutions to fit varied or changing situations.

10. The individual is unable to totally and automatically control motor responses. Motor response problems include

CAS co-occurs with ASD

11. The individual is unable to understand the perspective of others, that people have different perspectives= Theory of Mind, which is a core deficit

300

Higher - Level Challenges include

• Some individuals with autism do well in early years but difficulties show up around 3rd or 4th grade because
  • Homework demands increase
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  • Difficulty with analyzing, organizing, integrating info
  • Difficulty with problem solving/making decisions, cause and effect
  • Mostly verbal instruction
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  • Social situations
    • Social expectations increase
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  • Difficulty with “theory of mind” issues
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  • Co-existing disorders
    • ADHD, OCD, Anxiety, vision, and hearing problems
    • 65% with mild ASD have a psychiatric disorder
    • Most common co-occurring disorder=ADHD
    • ASD is lifelong and learn throughout
    • Ability to make inferences (affects communication and social interaction)
  • Rigidity of language
  • Gestalt (take in a large chunk of words, but don’t usually process it all at the same time) processing (vs. analytic approach to language)
  • Metaphoric language use (utilize language with private meanings)
  • Literal vs. implied/nonliteral meanings

400

Advance Social Skills:

• Social Difficulties Due to Inability to:

1.Understand the perspective of others (which may be different from their own perspective)

2.Identify & make sense of social info

3.Generate or formulate an appropriate response

4. Exhibit social judgment

Effects of These Deficits:

Social rules learned rigidly & inflexibly (difficult to adapt to change)

Public behavior tends to be the same as private behavior

Conventional behavior may seem startling

Inability to manage free time

Tend to focus on irrelevant info in group activities

Misunderstand humor and jokes

500

Common communication and overall deficits include

• Common deficits include: Lack of eye contact, minimal facial expression, rigid posture, limited gestures/verbalizations, lack of initiation, limited sharing, egocentrism, and lack of joint attention.
• Common communication deficits include: significant delays in language acquisition, AOS, Echolalia, verbal perseveration, monotone, jargon/idiosyncratic speech, lack of discourse, lack of imaginative play, difficulty with abstract language, and failure to comprehend suprasegmental aspects of speech.

Definitions

100

Autism Spectrum Disorder (ASD) is

 a neurodevelopmental disorder characterized by deficits in social communication & social interaction and the presence of restricted, repetitive behaviors.

• They also have restricted and repetitive patterns of behavior, interests, or activities, such as flipping objects, echolalia, or excessive smelling or touching of objects

200

The three parts of autism that help with a differential diagnoses include:

1) communication 2) social skills 3) repetitive/stereotypical behaviors.

300

Why the increase in ASD?

• Increased awareness of autism
• More screening tools and services
• Changes in how autism has been defined and diagnosed
• Increased prevalence due to increase in various environmental factors

400

Theory of Mind is

The perspective of others, which shapes our behavior & actions. The sense of perspectiveteaches: what I see vs. what others see; what I know vs. what others know; what we feel & believe; what the group thinks; what other people know about other people. .

• ASD = Never realize power of language
• Receptive exceeds Expressive

Theory of mind and deficits:

Ask yourself, can this child…

Predict behavior

Infer mental states

Adjust own behavior to compensate

Est. joint attention

Take turns

Play symbolically

Recognize and understand emotions

Use pragmatic language skills

Recognize character goals in stories

Recognize false beliefs

Understand deceptions

500

4 broad behavior concepts of ASD include:

Behavior is communication. It’s a logical response to a current situation and an effort to regulate conditions that do not match need (ex. Hungry baby cries for food)

Behavior is a logical response to the environment in which the behavior was first learned. Find the why of the behavior

Behavior is an attempt by the brain to keep itself stimulated or in equilibrium (ex. Hand flapping)

Behavior is an outward expression of an inward state

Definitions cont.

100

Types of play include:

Use symbolic play- object is something else

Use functional play- use toys and objects as made

Use parallel play- play among kids but not with them

Associative play- play that's loosely organized on shared interests or materials

Cooperative- highest level, sustained and complex; common goals

Young kids: solitary play and decreased interest in developing friendships or interacting with peers

Older kids: lack of social conventions that hinders relationship development; continued solitary activities

Other characteristics: lack of social reciprocity, lack of spontaneous seeking to share enjoyment/interests, failure to develop appropriate peer relationships, impairment in nonverbal communication

Prognosis: social skills emerge slowly over time with support and intervention; social interaction occurs less frequently and may remain somewhat impaired and highly challenging throughout life; achievement in social-emotional dev. and attainment of key social skills have been identified as 2 of the strongest predictors of dev. outcomes for people with ASD

Pretend play and creativity is limited

Children are isolated and exhibit repetitive actions on objects with few variations (lack of flexibility)

Less play overall and less elaborate

200

Boys or girls typically have more ASD diagnosis?

4.5 times more common in boys than girls

300

Person centered planning (PCP)

Plan for the future (careers, volunteering); what to do after H.S.; have to start thinking about this at 15, but why not start earlier

Get the family and the individual with ASD involved

400

The World Health Organization (WHO) denotes three dimensions of disabilities 

„1) Impairment - what are they having trouble with

„2) Activity - what activities in real life does the child want to participate in or makes up their day, part of being functional.

„3) Participation - how do you modify in activities and provide support

500

IDEA

Individuals with Disabilities Education Act

Public schools must identify students with disabilities

Schools must provide FAPE with highly qualified teachers for ages 0-21

Developmental

100

Babies - The First Year

• Most babies have innate drive to learn language and socialize
• Tiny babies modulate how much social stimulation they receive by eye gaze and eye closing.
• Around 6 mos, they can imitate facial expressions & vocalizations
  • First turn taking
  • Listen in womb
  • Prefer mom’s voice when born
  • Modulate social stimulation
  • Automatically turn towards sound

After 6 months

• Beginnings of intentional commun: babies generate their own responses to keep caregivers engaged
• JOINT ATTENTION: coordinating attention between the caregiver & an object of mutual interest. Important step toward social competence & communication!
  • Tends to emerge before words and predicts language development
  • Coordinates communication and turn taking
  • Kids with ASD, JA is absent or decreased
  • Helpful in looking for ASD

200

12-15 Months and 2-3 years

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  • 12-15 months 
  • Babies have learned these concepts:
    • Rules of social exchanges/cause & effects
  •           Early prediction
    • People/objects have names
    • I can understand simple directions
    • I can make a variety of sounds

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  2-3 years

  • By end of third year, kids have learned:
    • Words have multiple meanings & things have multiple labels
    • Word meanings are dependent upon context, intonation, & inflection
    • How to talk in sentences that give info, to ask questions to get info, and to tell others what to do!
    • Learn that different speakers have different perspectives than their own

300

Developmental DIfferences in Meaning and Use:

• Learning is often incomplete & specific.
• There are gaps between what is expected to be learned and what is assumed to be known
• Often have trouble with these concepts:

a)Everything/everybody has a name/label.

b)Things can have multiple labels.

c)Words can have multiple meanings.

d)Context can change meanings of words.

e)Intonation/inflection can change meaning.

• Children with ASD often interpret words literally or make incorrect associations.

400

3 Communication Intentions of Infants

1. Behavior regulation- use of acts to regulate or control acts of others to obtain something
2. Social Interaction- sustain routine, greet, call attention
3. Joint Attention- direct attention if another to share an event

Social exchanges- how to learn turn taking, you can affect others behavior by what you do; learn prediction (if I do X, mom will do Y)

500

What’s different in ASD?

Early vs. late onset?

• Children with ASD generally: have difficulty with selective/shifting attention; rapidly changing environments; trial-and-error learning; and are overwhelmed with stimulation & concentrate on only specific/narrow elements.
• Also, fewer opportunities to practice- because people think they are deaf, so people don’t talk to them, too focused on playing to learn or don’t want to play with people
• ASD Individualized/different patterns of onset- some have early onset, some late, some see symptoms then no symptoms then regress back

Characteristics of ASD

100

The core features of ASD include

 (a) impairments in social communication, language, and related cognitive skills and behavioral and emotional regulation and (b) the presence of restricted, repetitive behaviors.

200

20 Red Flags for ASD include

Systematic Observation of Red Flags

• Impairments in Social Interaction:

1. Inappropriate gaze (no eye contact; but can be cultural sometimes)

2. Lack of warm, joyful expressions (don’t hug parents, don’t touch people, frown, flat affect, don’t smile)

3. Lack of sharing interests (no joint attention)

4. Lack of response to contextual cues (unaware of context; only focused on one thing)

5. Lack of response to name

6. Lack of coordination of nonverbal communication (no pointing)

• Repetitive Behavior and Fixated Interests:

7. Repetitive movements with objects

8. Repetitive movements or body posturing

9. Lack of playing with variety of toys

10. Unusual sensory exploration

11. Excessive interest in particular toys

• Impairments in Communication:

12. Lack of showing (they don’t get other people’s attention and interest in what they are doing)

13. Lack of pointing

14. Unusual prosody

15. Lack of communicative consonants

16. Using person’s hand as a tool

• Emotional Regulation:

17. Distress over removing objects

18. Difficulty calming when distressed

19. Abrupt shift in emotional states

20. Unresponsive to interactions

300

Common Abilities include

Common Abilities

1. Take in chunks of info quickly- Gestalt

2. Remember info for a long time

3. Use visual info meaningfully when taught in meaningful ways

4. Learn long routines quickly and repeat these
5. Understand and use concrete, context free info and rules
6. Concentrate on topics of specific interests

400

Common Attributes include

1. Known for innocence and honesty

Know true feelings

Tell you what they think

Straight forward

2. Not sneaky/deceptive and don’t care to impress

Not motivated by others impressions

3. Rarely complain/whine; not likely to defend selves

4. Compliant when expectations are understood

5. Perfectionists who are highly motivated

500

Common Sentence Forms include

1. Echolalia=the act of repeating or echoing words/sentences that others have said.

(Stored as chunks without analysis for meaning.)

Echolalia can be

Immediate - you say then say right back

Delayed - repeated at some point (quoting a movie), ex. After 5 min. Or 1 week later

Mitigated - immediate or delay but reflects some variation of the original; indicates understanding

2. Metaphorical language (unusual)
3. Repetitive Questions/Sentence forms