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Introduction to Autism Spectrum Disorder (ASD)

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Introduction to Autism Spectrum Disorder (ASD) Presented by Michelle Antle, Simpson Co.; Marty Boman, WKU Paula Borland, CESC; Connie Miller, Warren Co.; – PowerPoint PPT presentation

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Title: Introduction to Autism Spectrum Disorder (ASD)


1
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.

2
Autism Spectrum Disorders Agenda
  • What is PDD Autism?
  • The Characteristics of Autism
  • Current Evidence-based Strategies
  • General Teaching Tips
  • Summary
  • Resources

3
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.

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4
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

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5
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

6
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

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7
Diagnostic Criterions
  • Diagnostic and Statistical Manual for Mental
    Disorders Fourth Edition (DSM-IV-TR)
  • Individuals with Disabilities Education Act
    (IDEA)
  • Kentucky Administrative Regulations

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8
Autism Spectrum Disorders
  • Autism
  • Aspergers syndrome
  • Pervasive Developmental Disability- not otherwise
    specified (PDD-NOS)
  • Under PDD, but not ASD
  • Rett syndrome
  • Childhood disintegrative disorder

9
AutismDiagnostic Criteria for Eligibility
  • DSM-IV-TR
  • Qualitative impairment in SOCIAL INTERACTION
  • Qualitative impairments in COMMUNICATION
  • RESTRICTED and STEREOTYPED behaviors, interests
    and activities

10
Asperger SyndromeDiagnostic Criteria for
Eligibility
  • Qualitative impairment in SOCIAL INTERACTION
  • RESTRICTED and STEREOTYPED behaviors, interests
    and activities
  • No clinically significant delay in
  • Language development
  • Cognitive development

11
Aspergers 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 ???

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12
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.

13
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

14
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

15
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)

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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)

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IDEA
  • Other characteristics associated
  • Repetitive activities Stereotyped movements
  • Changes in daily routine
  • Unusual responses to sensory experiences
  • 34 CRF 300.8.c.1

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18
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

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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?

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Adverse Affect
  • Means 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 1280 Section 1 (2)

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21
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.

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22
Video
  • Autism The Hidden Epidemic (2005). Autism
    Speaks.
  • Chapter 1 Early Signs of Autism
  • Chapter 2 Possible Causes of Autism

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23
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?

24
Co-morbid Conditions for Aspergers
  • Mood Disorders (e.g., depression, bipolar
    disorder)
  • Anxiety Disorders
  • Obsessive-Compulsive Disorder
  • Tourette syndrome

25
Co-morbid Conditions
  • ADHD
  • Learning Disabilities (written expression,
    reading comprehension)
  • Epilepsy

26
Where are students with ASD served?
  • Across a continuum of educational programming
    needs

Full inclusion Collaborative support
Self-contained LBD MSD ASD
General education Resource
In schools Did not meet school eligibility
Special programs
27
Who is serving students with ASD?
Typical amount of autism training
Teachers MSD certified Psychologists Speech
language pathologists Occupational
therapists Teachers LBD certified Teachers Gen.
education certified Administrators
28
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

29
Tip of the Iceberg is generally all you see..
But what is underneath is often more important
30
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

31
Domain Areas-Diagnostically
  • Communication
  • Social Interaction Relatedness
  • Restricted and Stereotyped behaviors, interests
    and activities

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Other Domain Areas
  • Cognitive Processes
  • Academic Skills
  • Sensory Processing
  • Emotional Vulnerability
  • Motor

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33
Activity 1 What comes to mind when you think
of Autism?
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34
Strengths in Students with ASD
  • Good knowledge of facts
  • Good long term memory once information is
    processed
  • Musical or special talents (obsessive)
  • Visual thinkers

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35
Communication
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36
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

37
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?

38
Videos
  • First Signs- Joint Attention
  • http//www.firstsigns.org/asd_video_glossary/asdvg
    _about.htmVideos
  • Eye Contact Study-Yale
  • http//www.msnbc.msn.com/id/7019005/ns/nightly_new
    s/

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39
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

40
Communication
  • May demonstrate difficulties with
  • Verb tense and articles (Bartolucci, Pierce,
    Streiner, 1980)
  • Pronoun reversal
  • You want cookie
  • Prosody
  • Unnatural tone in voice

41
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.

42
Picture Exchange Communication Systems
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Activity 2 Think, Pair, Share
  • In small group, think about how kids deliver
    unspoken messages
  • Be prepared to share out

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44
Social Interactions Relatedness
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45
Pragmatic issues
  • Many individuals with ASD demonstrate
  • A lack of spontaneity
  • Decreased ability to recognize a speakers intent
  • Decreased ability to reciprocate during
    conversation
  • Decreased ability to respond with the appropriate
    amount of information (Scheuermann Webber 2002)

46
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).

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47
Theory of Mind
  • The ability to make inferences about what other
    people believe to be true
  • Sally- Ann Study (Baron-Cohen, Leslie, Frith,
    1985)

48
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

49
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.

50
KATC Video
  • Young Adult Panel- Discussion of Educational
    Experience

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51
Restrictive and Stereotypic Behaviors, Interests
and Activities
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52
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.

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53
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

54
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?

55
Activity 3 Stereotyped or repetitive behaviors
  • In a small group, discuss how might these
    behaviors or interests impact daily functioning?
  • Chart on T-Chart provided using post it notes
    under the appropriate heading below
  • Social interaction
  • Academic performance
  • Motivation

56
Rainman
  • Chapter 6- The Brothers Meet

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57
Cognitive Processes
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58
Cognitive Processes
  • Prefer Order, Predictability, and Familiarity
  • Overselectivity
  • Gestalt thinking or chunking
  • Time Management
  • Uneven Skill Development
  • Problem-solving

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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

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60
Overselectivity
  • Individuals 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 doesnt recognize them.
  • What was Sally attending to?

61
Overselectivity
  • Consider how attending to a limited piece of the
    big picture may impact daily functioning.
  • Social Behavior
  • Language acquisition
  • Learning new skills
  • Safety Cant see the forest for the
    trees.

62
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 wouldnt be able to make sense of it.

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63
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

64
Video
  • Bing Commercials

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65
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

66
Time Management
  • Many students with large skill repertoires,
    including those with Aspergers 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.

67
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.

68
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.

69
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 Aspergers syndrome decides
    to not do homework because he feels he will get a
    poor grade anyway.

70
Sensory Processing
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Sensory Processing
  • Activity 4
  • Alphabet activity

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Sensory Differences
  • Some 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?

73
Sensory Area
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Academic Skills
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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

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Academic Challenges
  • Student with ASD syndrome often present
    challenges in multiple academic areas
  • Students with HFA/Aspergers Syndrome may present
    weaknesses in
  • Reading and listening comprehension
  • Written expression
  • Numerical operations
  • Problem solving (Whitby Mancil, 2009)

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77
Emotional Vulnerability
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Emotional Vulnerability
  • Easily stressed-worries obsessively
  • Unusual fear responses
  • Difficulties tolerating mistakes
  • Low frustration tolerance
  • Difficulties identifying, expressing or
    controlling emotions.
  • Exhibits meltdowns reactions

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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

80
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

81
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

82
Video
  • Autism The Hidden Epidemic. (2005). Autism
    Speaks.
  • CNBC
  • Part 5 Nobel Laureate Vernon Smith on Living
    with Aspergers Syndrome

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83
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

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84
Reward Choice Menu
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85
Token Board
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86
Motor Skills
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Motor Skills
  • Poor motor coordination
  • Awkward gait
  • Unusual body postures, movements, facial
    expressions
  • Handwriting difficulties
  • Resists or refuses handwriting tasks

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88
Characteristics of Autism
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89
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

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90
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)

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91
Video
  • Autism The Hidden Epidemic. (2005). Autism
    Speaks.
  • Chapter 6 Educational Interventions

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92
In Summary
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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.

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94
General Teaching Tips
  • 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.

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95
General Teaching Tips
  • 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.

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96
General Teaching Tips
  • 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.

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97
General Teaching Tips
  • 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

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98
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)

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99
Putting it Together
  • Or Structure for Us!!!

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100
Guidelines for Success
  • Make it CONRETE
  • Present it VISUALLY
  • Give it - STRUCTURE

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101
Temple Grandin Thinking in Pictures.
  • 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.

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102
Carol Gray October, 2000
  • If the student with
  • autism does not see it,
  • You did not say it.


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103
Local Parent Support Groups
  • Autism Society of the Heartland - Radcliff
  • Stephanie Ridge 270-877-6849
  • Autism Society of Western Kentucky - Henderson
  • Nancy 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

104
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.louisvi
    lle.edu/medschool/katc/
  • Indiana Resource Center for Autismhttp//www.isdd
    .indiana.edu/irca
  • NBC (2005) The Hidden Epidemic. New York NBC

Prepared by KY Coop Network February 2010
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