Autism Spectrum Disorders

Autism
Neurodevelopmental disabilities impact people in two ways: social communication and
restrictive or repetitive patterns of behavior.

Social Communication

Social and Emotional Reciprocity

1) Abnormal social approach and failure of convos
2) Reduced sharing of interests/emotions
3) Failure to initiate or respond to social interactions

Non-Verbal Communicative Behavior

1) Poor integrated verbal and nonverbal communication
2) Abnormal eye contact and body language
3) Lack of facial expression/gestures

Developing and maintaining relationships.

1) Difficulties in adjusting behavior appropriately to social
2) Difficulty in sharing, imaginative play
3) Interest in other people.

Restrictive Patterns of Behavior

1) Stereotyped motor movements/use of objects and speech
2) Insistence on sameness/ritualized patterns of behavior
3) Restricted fixed interests
4) Hypo/hyper reactivity to sensory input.

To be considered on the spectrum, you must have 2 of the following.

There’s a range of expressions in repetitive behavior

1) Motor stereotypes
2) Echolalia (repetitive speech)
3) Idiosyncratic speech

Inflexibility
1) Extreme distress at small changes
2) Difficulty with transitions
3) Rigid thinking patterns
4) Rituals related to greeting
5) Insisting on same route/food choices
6) Strong attachments to unusual objects
 7) Excessive interests in subjects the person investigates or talks about

Hypo/Hyper Reactivity to Sensory Input

1) Indifference to pain/temp
2) Adverse response to certain sounds/textures
3) Obsessive touching/smelling objects
4) Visual fascination of object movements or lights

WHY AUTISM IS CONSIDERED A SPECTRUM DISORDER AND HOW IT’S DIAGNOSED

Because of the variability of the symptoms, autism is considered a spectrum disorder.

DSM-V lists level of support required for Autism spectrum disorder.

Level 1
1) Requires support.
a. May be verbal but has difficulty initiating and sustaining interaction with others
b. May have disinterest in interacting with others

Level 2
1) Substantial support
a. Marked deficits in social interactions, even with supports in place
b. Restrictive and repetitive behaviors are obvious to the casual viewer and may
interfere with functioning in many contexts and cause distress when directed or
redirected

Level 3
1) May require very substantial support
a. May have severe deficits in social and verbal interaction
b. Very limited initiation response to social overtures from others
c. Restrictive repetitive behaviors interfere with functioning across all contexts

How are disorders diagnosed?

Diagnosis is made by a trained, licensed medical or mental health professional using the DSM-V

Comprehensive evaluations include

1) Behavioral observations
 2) Interviews with caregivers
3) A comprehensive medical history
4) Other tests to rule out certain conditions (to rule out hearing loss, or other conditions
that could cause similar symptoms)

Medical diagnoses helps determine the medical course of action or the type of medical
response available to parents.

In CA, for instance, a diagnosis is required in order for an individual to qualify for the
developmental disabilities regional system.

Private insurers can also provide behavior health treatment with a medical diagnosis.

HOW TO QUALIFY FOR SPECIAL EDUCATION SERVICES

An individual with autism may also qualify for and receive special education services through
the public education system but there are distinct differences in the process for medical
diagnosis and process for determining special education services.

Not all school-aged children with autism don’t require special education system.

Level 1 may access general education services with minimal supports.

Autism is 1 of 13 qualifying disabilities in the Individuals Disability Education Act.

The IDEA describes autism as “Developmental disability significantly affecting verbal and non-
verbal communication and social interaction generally evident prior to the age of three that
adversely affects the child’s educational performance.”

Autism does not apply if the child does not display the characteristics described above
(repetitive movements/obsessions, etc.). If the child merely has an emotional disturbance, that
does not qualify.

Educational performance does not only mean academic performance. They include
Development, Academic, Behavior and/or Social domains.

An assessment for services can happen at any point in time. Often children transitioning at the
age of 3 are evaluated for their ongoing access to special education.
Even if a child doesn’t qualify early on in life, they may qualify later because of ongoing
evaluation. As academic and social domains grow more rigorous, it may become clear that
social and academic challenges are growing and the child requires support.

WHAT ARE THE IMPACTS OF INCREASING AUTISM RATES?

The need for training/resources/supports and additional reports on causal

According to the CDC, the prevalence of Autism Spectrum Disorders was 1 in 68 children.

70% of children on the ADS also have 1 co-existing condition. The most common of which is an
intellectual disability.

Around 54% of individuals with autism also have an intellectual disability.

Mental health conditions are also common.

29% w/clinical anxiety

28% ADD/ADHD
28% Oppositional defiant disorder

Boys are 5 times more likely to have autism than girls. 1 in 42 boys are identified with autism. 1
in 189 girls.

White and Caucasian children are more likely to be identified than Black or Hispanic.

1 in 63 whites
1 in 81 black
1 in 93 Hispanic

Less than half of children with ASD are identified by the age of 3. On average, children are not
diagnosed until at the age of 4, even though it can be diagnosed as early as 2 years old (or
earlier if there are known familial history)

If you have one child with autism in a family, there’s probably a 20% chance of having a second.
That risk can go much higher if they’re able to identify something relating to genetics that
they’ve identified as relating to ASD. But the science isn’t great on that yet.

Why the increase in ASD?

The diagnostic criteria has been fine tuned (better diagnosis)
An increase in community awareness and interest
Doctors are more likely to make a ASD level 1 diagnosis than they were before (the stigma isn’t
there)

There’s been a substantial increase in the diagonisis of children with autism per capita.

In 1980, autism diagnoses reached 1 in 10,000.

Today it is 1 in 68

There are other reasons for the rise, too. We know this because autism is genetics. Genetic
susceptibility is a thing.

There are things in the environment that impact genetic susceptibility.

Disregulation ouf our immune systems are a problem, particularly for the maternal immune
system. But more research is needed for definitive answers.

Speculation includes:
1) Swapping of diagnostic labels (people who were previously diagnosed as retarded are
morel ikely to be diagonised with ASD)
a. There’s no proof of this though because other diagnoses have not decreased
with autism’s increase

IMPACT OF THE INCREASE

Needs: Increased awareness and training for daycare/child care providers

Additional resources for educators
Additional support and training for behavioral health providers
Need for more transition specialists (to help individuals as they age out of the education
system)

Increase in awreness has helped in increasing funding and resources. There are more training
and professional development opportunities.

Significant research into causes and treatments for ASD.

Current research is looking at genetics and environmental factors that may put infants at risk of
developing ASD.

There may be multiple ediologies for autism.

IMPORTANCE OF EARLY IDENTIFICATION

Less than half of children are identified by age of 3. The current average age of diagnosis is 4
years of age.

This is concerning because the earlier we identify characteristics of autism and the earlier for
treatment and interventions, the better the outcomes.

The earlier the diagnosis, the better the prognosis.

When kids are missing out on social learning opportunities because of a spectrum disorder, it
snowballs. The earlier we can intervene, we can change development trajectories because of
neuroplasticity of very young children.

If diagnosis is delayed, other secondary difficulties develop in terms of family interaction, etc.
Families are typically confused by their child and that interaction can lead to frustration, and all
kinds of negative reinforcements for the child. It can essentially infect the family dynamic and
become difficult to alter.

Systematic screening is important – not just kids that are really obvious or kids that parents are
concerned. It should become a routine early childhood care for these screenings.

Some kids will have an atypical screening for ASD but not autism. They may have other
developmental or cognitive problems. These false positives will ultimately identify a problem
with the child and allow for early intervention.

INDICATORS OF ASD IN INFANTS/TODDLERS

Because we know that the siblings of a child already diagnosed with ASD are more likely to have
ASD themselves, it has led to an influx of research into very early childhood incidactors.

Indicators for Infants

1. No big smile or warm, joyful expressions by 6 months old
2. No back and forth sharing of sounds, smiles or facial expressions by 9
months
3. No babbling by 12 months
4. No use of back and forth gestures (such as pointing, showing, reaching
or waving) by 12 months
5. No words by 18 months of age
 6. No two-word meaningful phrases by 24 months
7. Any noted loss of speech, babbling or social interaction by 24 months is
also a noted red flag for autism.

Indicators for Toddlers

1. Lack or delay in spoken language is often the first sign/symptom
2. Limited use of gestures or pointing to reference objects
3. Limited pretend play or inappropriate play with objects (such as lining things up or
engaging in repetitive patterns of behavior with toys and objects)
4. Limited interest in other kids and limited sharing of enjoyment or reciprocity
5. Sensory avoidant behaviors (refusing to eat certain things, wear certain things)
6. Extreme tantrums where the child is simply inconsolable.

INDICATORS OF ASD IN PRESCHOOLERS

Indicators for Preschoolers

1. Lack of joint attention, imitation and social referencing
2. Delay in spoken language or they may have communication but thrre may be differences
in communication
3. Parents often seek out support in the preschool years because of the noted delay in
language or the extreme tantrums and problematic behaviors the child exhibits
4. Child may not play with toys in the manner they were designd for (and may be extreme
distress if someone tries to get the child to play with the toys as intended)
5. Lack of spontaneous functional play
6. Limited range of affect/emtion
7. Restricted area of interst
8. Difficulty anticipating events and dealing with change
9. A delayed use of pointing and other gestures in order to get and sustain the attention of
others

INDICATORS OF ASD IN K-12

Many children begin 1st grade without an official diagnosis.

Some of those children are identified with having a speech or language delay and may receive
help for that but it’s not comprehensive enough.

Students are often referred for consideration with a medical professional because education
professionals believe there may be an ADD/ADHD diagnosis looming.

To better catch ASD early, school professions should look for

1) Social communication challenges
2) Signs or indicators of restricted or repetitive patterns of behavior or rigidity
Indicators for Younger School Aged Children:
1) Social defecits that impact participation in activities
2) Restricted interest may consume time and attention
3) Protest shifting from one activity to another (or doing tasks that require more
inferenceing or demonstration of a social comprehension)
4) Deficits of empathy and may use vocabulary or language above their age level

Middle/High School Problems:

1) Social challenges and sophisticiation of social relationships become very complex
2) Bullying and victimization are often reported at higher rates
3) Coexisting mental health issus (particularly anxiety and depression) become a bigger
issue
4) For students that were able to keep up with their academic demands in middle school
and earlier, it often becomes increasingly difficult to do so in high schoo while also
developing social and single living skills.

It’s particularly important for a child with ASD to learn how to talk about their disability and the
supports they need. In college and beyond, there were be less of a support system – if they’re
able to live on their own – so advocating for oneself is very important.

WHAT HAPPENS AFTER HIGH SCHOOL?

ADULT DEVELOPMENT

A child ages out educationa system at 18/when they graduate from high school or at age 22
when they age out of the mental health support system.

The statistics are bad.

Only 15-20% of adults live independently and work without supports (regardless of their
cognitive abilities).

Many experience mal-employment – working at a job far below their skill level.

44% participate in some sort of post-secondary education (CC, Uni, trade or technical school).

A high percentage of ASD students gravitate towards STEM majors.

For those that go to college, there are many challenges they face:
They require many academic accomodations – including test taking and writing.
This requires a level of self-awareness and self-advocacy that most don’t possess. Many don’t
have the skills to self-disclose upon exiting K-12 (often by a lack of opportunity to practice).
Organzation and time management are also very difficult
As are social relationhips

A lot of kids with autism learn better from visuals than from listening.

TRANSITION FROM SCHOOL TO WORK

One of the major barriers for people with ASD, is that the people in power don’t know what
kinds of supports ASD folks need. We know what kind of supports a blind person needs or a
handicap person needs but many are not educated on what ASD folks need.

It’s important for the advocates of people with ASD to assess the strengths and interests of the
person in their care in order to match them to employment opportunities that match their
strength, passions and interests.

Find volunteer and internship opportunities.

Developing a portfolio or website that showcases one’s talents and interests

Explore resources available to adults with disabilities (such as the Disabled Student Service
Center, the Department of Rehabilitation or your local state disabilitiy services)

Don’t be afraid to let them take rists.

Ask the person with ASD what they view their strengths are and what their challenges are.

One fallacy is the concept of the Readiness Model.

People say that it’s important to make sure people with disabilities they need to be ready
before we let them go on and do a task (such as self-advocacy or finding a job) but more often
than not, people are not ready for the situations they’re put in (this is true of people with
disabilities and with normal function). We rise up to the challenge when it is something we’re
maybe not ready for but have been preparing for.

FOR INTERVIEW WITH AUNT NINI

1. When did you suspect that your child was developing differently?
2. How did you receive the actual diagnosis (Who, When, Where)
3. Since receiving the diagnosis, what therapies and treatments have you tried? Which do you
feel have benefited your child/family the most?
4. What would your advice be to a parent who suspects their child has developmental
differences?

STRENGTHS AND WEAKNESSES IN SCHOOL

Because autism is a spectrum disorder, there is wide variability of expression of the disorder
and of ASD folks’ functioning. Still, we see some typical patterns when it comes to learning

STRENGTHS
1) Ability to memorize and recall facts
2) Ability to follow concrete rules and procedures
3) Ability to make use of different visual learning and visual information

WEAKNESSES
1) Flexibility, organization and time management
2) Work within groups or other situations that require social communication
3) Auditory processessing and ability to make use of verbal information
4) Ability to generalize skills learned in one context or situation and adapt it to different or
novel contexts and situations

When it comes to reading, these strengths and weaknesses show themselves across the board.

Reading for example –

STRENGTHS IN READING
1) Phonics and decoding
2) sight reading (Which requires memorization of letters, words and sounds)

WEAKNESSES:
1) Reading comprehension
2) Synthesis
3) Recalling relevant information fro the text
Strengths can mask weaknesses
A child may be a fluent reader and have a high vocabulary, which can mask their difficulty with
comprehension.
Children with autism will show strengths with grammar, punctuation and spelling since it’s easy
to memorizd the rules and procedures. But this can mask weaknesses in writing legibility and
organization of ideas.

Mathmatics as example
Strengths in calculation and memorizing facts
Weaknesses in concepts and real world application of math

ATTENTION
Strengths – Ability to sustain attention of specific task
Weaknesses – Ability to divide or shift attention between different activities (which is likely
related to the sensory differences or challenges that people with ASD struggle with)

MEMORY
Strengths – Rote memory
Weaknesses – Working memory (the ability to hold onto one thought or concept while
continuing to process or think about something else, which is required in the manipulation and
organization of ideas) – Working memory is necessary to prioritizing

Working memory is a component of executive function

Strengths – ability to inhibit certain responses
Weaknesses – Organizing, panning, prioritizing and flexability

THEORY OF MIND

One of the characteristics of ASD is the lack of or delay of the development in theory of mind,
which is the recognition that other people have different thoughts, ideas and feelings from our
own.

It impacts one’s ability to show empathy, to take others’ perspectives and to interpret or
predict others behaviors.
Typical children develop the knowledge of self in the first 18 to 24 months of their life. They
recognize themselves in the mirror, engage in symbolic play and simple acts of altruism (giving
toys) and reciprocal cooperation and comments about failure or success of self-generated
plans. Mastery smiles occur upon completion of a difficult task and use of metnal state
terminology (I want, mine, yours, you do, etc.) is used.

Typical children also develop between 3 and 5 the idea of false belief. They understand that
beliefs are individual mental representations. They also understand that others may hold
beliefs that differ from their own.

The Sally Anne Test is a well-known false belief test. In the test, two dolls are used – one named
Sally and one Anne. Sally has a marble she keeps in a basket. She leaves to go play and Anne
steals it and hides it in her box. Children with ASD will often say that when Sally returns from
play, she will check the box for the marble (because they’re unable to comprehend that Sally
doesn’t have the same information they have. They kow the marble is in the box therefore Sally
would also know and she’d check the box instead of her own basket wher she left it).

80% of children on the autism spectrum fail this test.

Children with language impairments and children with Down Syndrome are much more
successful because they develop the Theory of the Mind.

This can lead to obvious dilemmas down the road. An example: a friend or coworker cuts their
hair. A person with ASD may state how they liked it the previous way without considering their
friend’s feelings.

A lack of understanding of the Theory of the Mind also presents a challenge because it leads to
the inability to recognize that other people may have a different solution to the same problem.
They often believe there is only one right way for a problem – their way.

FOCUS ON THEIR STRENGTHS

1) Make things more visual

2) Use their desire and adherence to rules to support the situation
3) To infuse and incorporate their passion and interests
4) To keep our social expectations reasonable for a person who may lack higher degrees of
social cognition/understanding

WHAT ARE THE DIAGONSTIC FEATURES OF AUTISM

Hyper/Hypo Reactivity

It is long recognized that those with ASD have differences in their ability to process and tolerate
sensory experiences.

They may have hypersensitivity (overreaction) to certain types of sensory input. They may have
an adverse reaction or response as they attempt to avoid or escape a situation that makes them
physically uncomfortable.

They may also have hyposensitity (underraction) to sensory input.

tHIS MAY include a long delay in reacting to certain types of input (such as pain) or they may
require high intensity of certain input in order to register that type of activity or experience. For
example, they may need intense flavors to taste.

They may seek out intense physical movement (swinging/rocking/etc.) in order to register
where their body is in space.

Many individuals on the aautism spectrum have tactile difficulties.

TACTILE DEFENSIVENESS is an adverse or exaggerated response to light touch or certain

textrures. This may lead to avoidance of certain types of clothing, fabrics, tags, seams or
wearing shoes.

They may also refuse certain types of foods or textures. They may refuse to touch certain types
of objects. They may act out to avoid certain tactile experiences.

Two aspects to our sensory nervous system besdies the 5 basic senses, that may be effected for
those on the Autism spectrum. These are PROPRIOCEPTION AND VESTIBULAR types of input.

Proprioception is the internal feedback that we get from our muscles and joints. It gives us info
about force and pressure, how much resistance there is and the weiht of objects. It’s also
important to our body awareness.

Vestibular components of our sensory nervous system include internal feedback detected when
we move, which is primarily based on position of our head, inner ear and peripheral vision. This
system is important to balance and determining where we are in space.

Proprioception difficulties include squeezing sometning too hard, pushing too hard, etc.

They may demonstrate motor clumsiness

They often have difficulty manipulating small objects.
They may have abnormal body posture.
They may seek out input into their muscles and joints by pushing on objects
They may have dfifculty with motor planning
They may frequently seek out deep pressure input or joint compressions/contractions.

This can lead to problematic behaviors such as squeezing others, pushing/pulling others,
dropping, bumping or slamming into things or self-injurious behavior.

VESTIBULAR DIFFICULTIES

A high tolerance for certain types of vestibular input.

You may see them sseeking out vestibular input such as:
Jumping
Spinning
Climbing
Tipping back in chairs
Swinging/rocking

All in excess

Others may have low tolerance for this input. This leads to avoidance behaviors. They may
avoid certain playground equipment, have difficulty on stairs/uneven terrain, may not like being
picked up.

This may lead to a fight or flight response, leading to aggression or attempt to escape.

HOW DO SENSORY DIFFICULTIES RELATE TO EMOTIONAL AND BEHAVIORAL REACTIONS?

The relationship between sensory problems and emotional regulation problems is well noted.

Difficulty with sensory regulation can lead to a fight or flight response.

Fight can lead to aggression.

Flight can lead to an escape/anxiety reaction.

These responses are reflexive in nature. In other words, they’re not learned behaviors.
It’s important to recognize sensory differences in people on the ASD so we can teach them to
identify the sensory triggors in their envorinment and how to communicate their discomfort
with them.

The individual needs to learn to self advocate to minimize the triggers.

They need to learn to ask for a break or alternate environment to go to if they’re

uncomfortable.

They may need to learn different strategies for coping with sensory experiences.

Those working with people on the autism spectrum cannot view these reflexive fight or flight
behaviors as willful or punishable. Punishment only leads to further escalation. Instead, these
people need to learn to help them regulate and calm down. As well as to identify the triggering
sensory experience so they can help the individual develop a coping strategy.

EVIDENCE BASED PRACTICES

Services and supports for ASD people invoves many agencies.

They include family

Educational system
Medical care
Mental Healthcare
Housing
Rehabilitation Services are also available if needed

Autism is considered one of the highest cost diseases/disabilities in the US because of the cost
of education, productivity lost for caregivers and for the affected as well as residential care

Can anything reduce the impact - Intensive early intervention can reduce the cost by 2/3.

Early Start Denver Model

A method of intervention developed for very young children.

Every ten seconds there is a learning opportunity.

Tools for Social Narrative Teaching

Many on ASD have difficult to deal with change. One strategy that is helpful is SOCIAL
NARRATIVE.

Social Narratives are interventions that describe social situations in some detail by highlighting
relevant cues and offering examples of appropriate responding.

They’re aimed at helping learners adjust to changes in their routine and adapt their behavior
based on social and physical cues of a situation, or to teach specific social skills or behaviors.

Social narratives are tailored to the individual learner and often short, making use of pictures.

For children from birth to 22

There are 14 established interventions that have evidence of working
There are 18 emerging interventions that have some evidence of working but don’t meet the
national standard to be considered established
There are 13 unestablished interventions for which there are no sound evidence of
effectiveness.

The established interventions include: Behavior interventions, cognative behavioral

intervention packages, comprehensive behavioral treatment for young children, Language
training for production, Modeling, Natural teaching strategies, parent training, peer training
packages, pivitol response training, schedules, scripting, self-management, social skills packages
and story-based interventions

Emerging interventions include: Augmentative and alternative communication devicies,

developmental relationship-based treatments, exercise, exposure packages, functional
communication training, imitation baed intervention, initiation training, language training for
production and understanding, massage therapy, multicomponent packages, music therapy,
picture exchange communication system, reductive packages, sign instruction, social
communication intervention, structured teaching, technology baed intervention and theory of
mind training

Unestablished include: Animal assisted therapy, auditory integration therapy, concept mapping,
DIR/floor time, facilitated commnucation, gluten fre-casein free diet, movement-based
intervention, SENSE theatre intervention, sensory intervention packages, shock therapy, social
behavioral learning stategy, social cognition intervention, social thinking intervention

For adults 22 or older

There is 1 established intervention
There is 1 emerging intervention
There are 4 unestablished interventions

Established: Behavioral intervention

Emerging: Vocational training package
Unestablished: Cognitive-behavioral intervention packages, modeling, music therapy, sensory
integration packages