Autism:What it is and how to interact with a person with Autism
Presented by Amy Wilcox, M.S., BCBA, ECSE
Who I am
Amy WilcoxBoard Certified Behavior AnalystProvide behavior consultation to families and school teamsEarly Childhood Special Education TeacherWork for Infant Toddler Services of Johnson County providing therapy to children birth to 3 years oldFormally worked in the Early Childhood Special Education Autism classrooms in the Olathe School District and Gardner School District
What will be covered today:
What is Autism Spectrum DisorderMyths, Facts and StatisticsHow to interact with a child or adult with autism in your practice
Focus on Autism
A big buzz word these days!Early intervention is critical making it important to be aware of “red flags” to assist families in knowing when to seek professional supportUnderstanding how Autism can effect a person can help other professionals interacting with them have more successful interactions
What is Autism
Autism spectrum disorder (ASD) is a complex developmental disabilitySigns typically appear during early childhood and affect a person’s ability to communicate, and interact with othersASD is defined by a certain set of behaviors and is a “spectrum condition” that affects individuals differently and to varying degreesThere is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomesThe diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity.
Developmental Red Flags That Warrant a Referral – Ages Birth to 36 Months
Every child develops at a their own unique paceIt is important to be aware that with most development there is usually an age range in which we expect to see certain skills beginIf you feel like a child is not meeting one or more milestone within an expected age range, this is a good time for a referral to an agency such as Infant Toddler Services or their pediatrician.
Red Flags – may indicate a child is at risk for ASD
No big smiles or other warm, joyful expressions by six months or thereafterNo back-and-forth sharing of sounds, smiles or other facial expressions by nine monthsNo babbling by 12 monthsNo back-and-forth gestures such as pointing, showing, reaching or waving by 12 monthsNo words by 16 monthsNo meaningful, two-word phrases (not including imitating or repeating) by 24 monthsAny loss of speech, babbling or social skills at any age
Additional Red Flags to watch for:
Screening for Autism - MCHAT
https://m-chat.org/20 questions – answers are yes or noFollow up screening if there are too many grey areasCan be completed on-line by parent or by a doctor or therapistScore indicates a risk rangeScreening is not diagnostic
A medical diagnosis is made by a physician based on an assessment of symptoms and diagnostic testsMost frequently made by a physician according to theDiagnostic and Statistical Manual(DSM-5,released 2013) of the American Psychological Association. This manual guides physicians in diagnosing autism spectrum disorder according to a specific number of symptoms.A brief observation in a single setting cannot present a true picture of someone’s abilities and behaviors. The person’s developmental history and input from parents, caregivers and/or teachers are important components of an accurate diagnosis.
Significant difficulty using nonverbal behaviors (eye contact, personal space, facial expression)Inability to develop appropriate peer relationshipsFailure to spontaneously seek interaction with othersPoor social or emotional reciprocity
Delay or lack of spoken language developmentUse speech, but significant impairment in initiating/maintaining conversationUse of stereotyped, repetitive, or idiosyncratic languageLack of varied imaginative or imitative play
Preoccupation with stereotyped or repetitive behaviorInflexible adherence to nonfunctional routinesStereotyped or repetitive motor movementsPreoccupation with objects/components
There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function.Brain scans show differences in the shape and structure of the brain in children with autism compared to in neurotypical children.Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems.
In many families, there appears to be a pattern of autism orrelated disabilities, further supporting the theory that the disorder has a genetic basis.While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited.It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single “trigger” that causes autism to develop.
Autism tends to occur more frequently than expected among individuals who havecertain medical conditions, including fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria (PKU).Some harmful substances ingested during pregnancy also have been associated with an increased risk of autism
Autism is treatableChildren do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomesWhile there is no known cure for autism, there are treatment and educational approaches that can address some of the challenges associated with the condition. Intervention can help to lessen disruptive behaviors, and education can teach self-help skills for greater independenceBut just as there is no one symptom or behavior that identifies people with autism, there is no single treatment that will be effective for everyone on the spectrumIndividuals can use the positive aspects of their condition to their benefit, but treatment must begin as early as possible and focus on the individual’s unique strengths, weaknesses and needs.
Types of Treatment
Applied Behavior AnalysisVerbal BehaviorPivotal Response TrainingEarly Start Denver ModelFloortimeRelationship Development InterventionTEACCHSCERTS
Therapies and other treatments
Speech Language TherapyOccupational TherapyPhysical TherapySensory Integration TherapySocial Skills TrainingPicture Exchange Communication System and other Assistive speech devicesAuditory Integration TherapyGluten Free, Casein Free diets
Facts and Stats
About 1 percent of the world population has autism spectrum disorderPrevalence in the United States is estimated at 1 in 68 birthsMore than 3.5 million Americans live with an autism spectrum disorder.Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68)Autism is the fastest-growing developmental disabilityPrevalence has increased by 6-15 percent each year from 2002 to 2010.Autism services cost U.S. citizens $236-262 billion annuallyA majority of costs in the U.S. are in adult services – $175-196 billion, compared to $61-66 billion for children
More Facts and Stats
Cost of lifelong care can be reduced by 2/3 with early diagnosis and interventionThe U.S. cost of autism over the lifespan is about $2.4 million for a person with an intellectual disability, or $1.4 million for a person without intellectual disability.35 percent of young adults (ages 19-23) with autism have not had a job or received postgraduate education after leaving high schoolIt costs more than $8,600 extra per year to educate a student with autismIn June 2014, only 19.3 percent of people with disabilities in the U.S. were participating in the labor force – working or seeking work. Of those, 12.9 percent were unemployed, meaning only 16.8 percent of the population with disabilities was employed. (By contrast, 69.3 percent of people without disabilities were in the labor force, and 65 percent of the population without disabilities was employed.)
Childhood cancerJuvenile DiabetesPediatric AidsCOMBINED!
Autism is more common then…..
Boys tend to receive a diagnosis 3-4x more often then girlsIn the US it is estimated that 1 out of every 70 boys has autismWhy an increase in prevalence rates?Two possible explanations for an increase in prevalence ratesBetter diagnostic criteria and trainingEnvironmental influencesAutism has been found around the world in families of all racial, ethnic and social backgroundsFamilies with one child with autism are 20-60% more likely to have another child with an ASD
Did you know?
Children with Autism…Do not make progressDo not smile at youAre not affectionateAre retardedDo not make eye-contactDo not relate to peers or adultsCannot be tested by conventional methodsDemonstrate behaviors that cannot be changedDo not notice people or things in their environmentCan out grow autism
Myths: What Autism is NOT
While all individuals diagnosed as having an autism spectrum disorder havesimilarcharacteristics no two individuals are alike.“When you have met one person with autism, then you have metoneperson with autism”
Autism Speakswww.autismspeaks.orgAutism Societywww.autism-society.orgAutism Society of the Heartlandwww.asaheartland.org
Interacting with a child or adult with Autism
When interacting with a child or adult with Autism is it important to learn about their communication abilities. There are two main areas of language development that should be considered which are receptive and expressive languageReceptive language– Our understanding of words and their meanings. Includes being able to find items when named, point to pictures in a book and follow directions.Expressive language– Our ability to verbally say words. Requires receptive language before expressive language can be used meaningfully.
Some people with Autism communicate verbally by saying words while others use alternative forms of communication.Verbal– uses words to communicateNon-verbal– can include a variety of forms of communication that do not include verbal wordsGestural – pointing or reaching or showing items that are wanted or neededSign – using sign language gesturesPictures – handing pictures to communication partners to express thoughts, wants and needsElectronic or voice output devicesiPads and other devices that includes pictures that are pressed either individually or in combination to create an audio output. The audio output becomes the person’s voice.
Many people with Autism interpret language by others very literally. Their brains process information in very concrete forms, therefor, sometimes making if more difficult for them to understand figures of speech, jokes and other subjective information.
Schedule and routines
Many people with Autism function much better when routines and schedules are consistent and predictable.Change in routine can be difficult to process.Often when these changes are difficult the result is behavior that may seem out of place or unnecessary. It is important to view behavior or any sort as a form of communication. It may not be the best way to communicate, but when anxiety levels rise, functional communication skills tend to decrease and we see inappropriate behavior increase.Finding ways to prep an individual about the activities of the day, what might be happening next in a routine or what new activities might be coming can make for smoother transitions.
One way to help with transition in routines, daily events and new or unfamiliar activities is to use visual schedules that outline routines, events and activities. These come in many different forms and should be tailored to each individual based on their communication and cognitive abilities.
Pictures– Drawings or actual photos represent events or steps in a routine. These can be organized in many ways including across a large strip of paper attached to a wall, on a small paint stick with Velcro on the back to attach pictures, in a photo album or set out along a table where a person is doing school work or other desk type activities.Written– A written list of words describing steps in a routine, events of the day or other information such as directions for driving, recipes, and other reminders.Gestural– Holding up one finger for each step described. For example, say “first eat, 2ndbrush teeth, third get dressed” while holding up one, then two then three fingers.Electronic– Many electronic devices such as iPad, iPods and phone have apps that create visual schedules or visual reminders such as a visual countdown clock to represent the amount of time left in an activity.Portable– For most people it is helpful and important to figure out visual schedules that are portable as the need for these schedules do not typically only occur in one spot, room or place.
Another form of visual support that is helpful when people with Autism are anxious or distressed about particular events or social interactions is a social story.These are short, individualized books created to describe a scenario or situation using pictures of the situation or place as well as using the person’s name to make it a personalized story.Examples of stories that might be created include “Going to the Grocery Store”, “Using my hands nicely with my friends”, “Time for shots at the doctor” or “I’m going on an airplane”.These books should be short, 1-2 lines per page and 1-2 pictures per page. They are most helpful when read and reviewed 1-2 days before an event, the day of an event and even just a few minutes before an event.
People with Autism often display self-stimulatory behavior.The purpose, function, form and frequency of these behaviors is different for every person.Self-stimulatory behavior can be seen in times of distress, uncertainty, excitement, when happy or mad or even during times when none of these other situations seem to be occurring. Sometimes these behaviors are not as noticeable and other times they are very noticeable and attract the attention of others.
Self-stimulatory behavior can include body movements and/or vocal sounds.At times, it is possible to find competing behaviors to help a person stop but sometimes the need to engage in these behaviors is so great that redirecting is more difficult.Examples of self-stimulatory behavior include, but are not limited to:Humming, odd vocal sounds, repeating words or phrases repeatedly, hand flapping, toe walking, spinning self or objects, watching items spin or roll, looking out of the corner their eyes to follow particular patterns such as straight lines, hopping, rocking, head banging.
We all process the world through our senses of sight, touch, sound, taste and smell. For some people, sensory experiences are more pronounced or can be suppressed and harder to recognize.This often happens with people with Autism. And when this happens we tend to see behavior that we have a hard time explaining or figuring out as the person with Autism may display odd behavior in response to sensory experiences that others are not detecting.For example, in a grocery story with florescent lights, there is often a very soft humming noise emitted from these lights. Most of us do not detect this sound unless the room is otherwise silent. But for some people with Autism this sound may be magnified. If they do not know how to express this experience they may act out in a way that seems strange or unnecessary.
Another example might be smells in a restaurant. While we might notice particular smells as we enter a room, for some people with Autism these smells may be heightened and offensive.Often, we see children who seem hyper active, who move constantly by running, jumping, bumping into people and objects, crashing or falling to the floor, etc. These kids often are thought to have less awareness of where their body is in space and therefor engage in activities that give input their joints to give them feedback.On the other hand, some kids may seem extremely underactive and harder to motivate to move or to participate in activities.
For each different child it is important to try to figure out what types of experiences their sensory system needs (either revving or calming activities) in order to make them more available for participation and learning opportunities.
There are many different aspects of the world that can have an affect on people with AutismWhen meeting a person with Autism, keep in mind, they may display odd or different behavior that is hard to understand but taking time to get to know them and learn about how they communicate and process the world will help make your interactions more successful for everyone involved.
Questions or comments?
Thank you for taking time to today to learn about Autism!