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An SLP Guide to the Autism Spectrum

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Title: An SLP Guide to the Autism Spectrum


1
An SLP Guide to theAutism Spectrum
  • Jennifer Collier CCC-SLP
  • ASHA 2006

2
(No Transcript)
3
A Brief History of Autism Spectrum Disorder and
Treatment
  • Dr. Leo Kanner 1943 11 children study
  • Hans Asperger 1944 autistic psychopathies
  • Considered an emotional disorder paired with
    mental illness such as schizophrenia.
  • Conscious decision to withdraw from the world.
  • Bruno Bettelheim caused by mothers
    mistreatment.
  • Pre1960s treatment psychotherapy and drugs.
  • No education or family involvement.
  • 1960s neurological and biochemical causes.
  • ABA therapy
  • Speech/Language Therapy based on other presenting
    factors.

4
Autism Today
  • 1354 increase since 1990
  • 1/167
  • 90 billion (2003) 200-400 billion (2010)

5
Pervasive Developmental Disorders
  • Autistic Disorder
  • Retts Disorder
  • Childhood Disintegrative Disorder
  • Aspergers Disorder
  • Pervasive Developmental Disorder Not Otherwise
    Specified (PDD-NOS)

6
Autistic Disorder
  • Qualitative impairment in social interaction. (2
    characteristics)
  • Qualitative impairments in communication.
    (1characteristic)
  • Restricted repetitive and stereotyped patterns of
    behavior, interests and activities. (1
    characteristic)
  • Onset before age 3.
  • Not Retts or Child Disintegrative Disorders.

7
Retts Disorder
  • Primarily found in females
  • Normal development for first 6-18 months.
  • Onset indicators
  • Deceleration of head growth
  • Loss of hand skills
  • Loss of social engagement
  • Poor gait/trunk movements
  • Severely impaired expressive and receptive
    language skills

8
Childhood Disintegrative Disorder
  • Extremely rare regression in multiple areas of
    functioning following 2 years of normal
    development.
  • Loss of acquired skills
  • Language
  • Social skills / Adaptive behavior
  • Bowel / bladder control
  • Play
  • Motor Skills
  • Abnormal Functioning
  • Social Interaction
  • Communication
  • Restricted, repetitive and stereotyped patterns
    of behavior
  • Not better accounted for by another specific PDD

9
Aspergers Disorder
  • Qualitative impairment in social interaction.
  • Restricted repetitive and stereotyped patterns of
    behavior, interests and activities.
  • Disturbance cause clinically significant
    impairment in social, occupational or other
    important areas of functioning.
  • No significant language or cognitive delay nor
    delay in development of self-help skills,
    adaptive behavior or curiosity about environment.
  • Motor Problems.

10
Aspergers Syndrome
  • A social disease
  • Egocentric and sensitive to others criticism but
    simultaneously oblivious others feelings
  • Typically a later diagnosis
  • Higher Verbal IQ than HFA
  • Higher IQ but not always students
  • Argumentative / less flexible
  • Conspicuously lacking in common sense
  • Less developed Right Brain

11
Pervasive Developmental Disorder Not Otherwise
Specified (PDD-NOS)
  • Just what it says
  • Not Autism-Lite
  • Can change into other PDD disorder in time.

12
High Functioning AutismPDD-NOS
  • Behavior Issues due to
  • Sensory
  • Anxiety
  • Fight/flight
  • Orientation
  • Communication
  • Executive Functioning Impairments
  • Communication
  • Non Verbal
  • Verbal
  • Pragmatics

13
Language Skills in HFA
  • Strengths
  • Word/nonsense
  • word decoding
  • Spelling
  • Vocabulary
  • Fluency
  • Weaknesses
  • Comprehension of
  • Sentences
  • Idioms
  • Metaphors
  • Stories
  • Processing

14
Latest Findings
  • Social Emotional Immaturity
  • Neurological Impairment
  • ASD brains bigger and heavier
  • Communication within brain different
  • Default to Fight/Flight
  • Language Intervention Not Clear Cut

15
Autism group has less activation in Brocas
area than the control group and more in
Wernickes area Results are consistent with
poorer comprehension of complex sentences,
coupled with good word reading. From Just,
M.A., Cherkassky, V.L., Keller, T.A., Minshew,
N.J. (2004). Cortical activation and
synchronization during sentence comprehension in
high-functioning autism evidence of
underconnectivity. Brain, 127, 1811-1821. Used
with permission.
16
Treatments and Interventions
17
Pharmacology
  • Highly effective in treatment of neuropsychiatric
    disorders
  • 60 of ASD have attention problems
  • 17-74 have anxiety or fears
  • No Autism Pill
  • Secretin
  • MegaVitamins
  • Special Diets / Food Allergies

18
Sensory Integration
19
Sensory Issues
  • Visual
  • Auditory
  • Olfactory
  • Taste
  • Texture
  • Movement
  • People
  • Emotions
  • Mands/tasks

20
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21
Augmentative Alternative Communication
  • AAC

22
ABA
23
Applied Behavioral Analysis
  • B.F. Skinner
  • Task analysis / behavior shaping
  • A-B-C
  • Discrete trial training
  • Presentation
  • Response
  • Consequence
  • Pause
  • Environment Manipulation
  • Structure allows for learning

24
Lovaas
  • Mold and reward desired behavior and ignoring or
    discouraging undesirable
  • actions.
  • 30-40 hours week basic language,
  • behavior and academic training.
  • 4-6 hours of therapy 11 5-7 days a week.
  • 50 of children demonstrate remarkable progress.
    90 show some progress.
  • Earlier the intervention, better the results.

25
PRT Pivotal Response Training
  • Natural environment
  • Basic skills rather than individual behaviors
  • Inclusion
  • Addresses improving motivation, self-management
    and self-initiation
  • Lacks developmental framework/curriculum nor does
    it address sensory issues

26
TEACCH
27
History and Rationale
  • First comprehensive state wide community based
    program of services for children and adults with
    autism and related disorders.
  • Work more effectively in environment while
    reducing or removing autistic behaviors.
  • Does not work on the behavior directly but on
    underlying conditions that will facilitate
    learning experiences.
  • If a person better understands his/her
    environment, it becomes more predictable and less
    intimidating thus reduction of behaviors.
  • By improving communication skills of a person,
    he/she has a better chance of comprehending and
    expressing thus behaving in a more appropriate
    way.

28
Problem Behaviors Are Caused By
  • Stimulation
  • Confusion and Uncertainty
  • Order and Expectation
  • Disorganization
  • Compulsiveness

29
The Basics
  • Reduce Anxiety
  • Modulate stimulation
  • Reduce confusion by providing clear expectations
  • Organize space / environment
  • Increase Meaning
  • Clarify and develop connections
  • Reduce confusion and improves organization
  • Self Efficacy
  • Need to feel competent
  • Independence
  • Acceptance

30
Provide Structure
  • Physical Structure
  • Daily Schedule
  • Activity Systems
  • Visual Structure

31
RDI
32
(No Transcript)
33
Relationship Development Intervention
  • Social Skills
  • Instrumental Skills
  • Pragmatics Eye contact, Turn taking
  • Appropriate Behavior
  • Follow Rules
  • Prepare for and take tests
  • Script driven
  • Natural environments needed for context
  • Relationship Skills
  • Social Contact is the end product
  • Make and keep friends
  • Develop real empathy for others
  • More than one way of thinking, feeling, problem
    solving
  • Portable and generalizable

34
Relationship Development Intervention
  • The Relationship Curriculum
  • 6 levels and 24 stages
  • Novice
  • Apprentice
  • Challenger
  • Voyager
  • Explorer
  • Partner

35
Social Stories
36
What are they?
  • A short story that describes and improves social
    understanding.
  • Answers the wh.
  • First person and positive.
  • Literally accurate and uses anxiety reducing
    vocabulary
  • Concrete and motivating

37
Guidelines for Social Stories
  • Sentence type
  • Descriptive
  • Perspective
  • Directive
  • Affirmative
  • Creation steps
  • Picture the goal
  • Gather information
  • Develop the text
  • Implementation

38
The Next Step
  • Observe and Listen in many environments
  • Chose one or several approaches individualize
    and modify as needed
  • Creativity is key
  • Be an active member on the team
  • Educate and Inservice Knowledge is Power!

39
Always Remember
  • No treatment can cure Autism.
  • Neurological condition
  • Condition will not go away
  • Autism is a dynamic condition changes occur
    over time and with intervention
  • Listen to the Family their needs/wishes may not
    be what you think
  • Ditto for the other significant people in his/her
    life
  • Celebrate His/Her Strengths

40
Questions
41
The End
42
Suggested Reading
  • Fouse, Beth, Wheeler, Maria, (1997) A Treasure
    Chest of Behavioral Strategies for Individuals
    with Autism. Arlington, TX Future Horizons
  • Grandin, Temple, (1995) Thinking in Pictures and
    Other Reports from My Life with Autism. New York,
    NY Vintage
  • Gray, Carol, (1994/2000) The New Social Story
    Book Illustrated Edition. Arlington, TX Future
    Horizons, Inc.
  • Greenspan, Stanley I., Wieder, Serena,(2006)
    Engaging Autism. Cambridge, MA Da Capo Press
  • Gutstein, Steven E., Sheely, Rachelle K.,(2002),
    Relationship Development Intervention with Young
    Children Social and Emotional Development
    Activities for Asperger Syndrome, Autism, PDD and
    NLD. London Jessica Kingsley
  • Kaufman, Nancy J., Larson, Vicki Lord, (2005)
    Asperger Syndrome Strategies for Solving the
    Social Puzzle. Eau Claire, WI Thinking
    Publications
  • Kluth, Paula, (2003) Youre Going to Love This
    Kid! Teaching Students with Autism in the
    Inclusive Classroom. Baltimore, MD Paul H.
    Brookes

43
Suggested Reading
  • Koegel, L. K., Koegel, R. L., Harrower, J. K.,
    Carter, C. M., (1999). Pivotal response
    intervention I Overview of approach. Journal of
    the Association for Persons with Severe
    Handicaps. 24(3), 174-185
  • Kranowitz, Carol Stock, (1998) The Out-of-Sync
    Child Recognizing and Coping with Sensory
    Integration Dysfunction. New York, NY Perigee
  • Lovaas, O. Ivar, (2003) Teaching Individuals with
    Developmental Delays. Austin, TX ProEd
  • Magnusen, Christy L., (2005) Teaching Children
    with Autism and Related Spectrum Disorders An
    Art and a Science. London Jessica Kingsley
  • Mesibov, Gary B., Shea, Victoria, Schopler, Eric,
    The TEACCH Approach to Autism Spectrum Disorders.
    New York, NY Springer
  • Simpson, Richard L., (2005) Autism Spectrum
    Disorders Interventions and Treatments for
    Children and Youth. Thousand Oaks, CA Corwin
    Press
  • Tsai, Luke, (2001) Taking the Mystery Out of
    Medications in Autism/Asperger Syndromes.
    Arlington, TX Future Horizons
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