Autistic Spectrum Disorders

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Autistic Spectrum Disorders
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Kanner discovered the disorder in 1943 and his
name is used to describe full-blown autism
which we wont see in BRGS. Hans Asperger (1944)
realised that the symptoms of intelligent
autistic children were very different and that
these children could go on to lead relatively
normal lives. At the time, autistic children
were very rare, about 1 in a million. In BRGS, we
see children with Aspergers Syndrome and as
there are now better ways to help these children,
the SPELL, the TEACCH and the ABA system, we will
see more and more.
A few people with Asperger's syndrome are very
successful and until recently were not diagnosed
with anything but were seen as brilliant,
eccentric, absent minded, socially inept, and a
little awkward physically.
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• Diagnostic Criteria For 299.80 Asperger's
  Disorder (DSM IV)
• A. Qualitative impairment in social interaction,
  as manifested by at least two of the following
• marked impairments in the use of multiple
  nonverbal behaviours such as eye-to-eye gaze,
  facial expression, body postures, and gestures to
  regulate social interaction
• failure to develop peer relationships appropriate
  to developmental level
• a lack of spontaneous seeking to share enjoyment,
  interests, or achievements with other people
  (e.g. by a lack of showing, bringing, or pointing
  out objects of interest to other people)
• lack of social or emotional reciprocity
• B. Restricted repetitive and stereotyped patterns
  of behaviour, interests, and activities, as
  manifested by at least one of the following
• encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• apparently inflexible adherence to specific,
  non-functional routines or rituals
• stereotyped and repetitive motor mannerisms
  (e.g., hand or finger flapping or twisting, or
  complex whole-body movements)
• persistent preoccupation with parts of objects
• C. The disturbance causes clinically significant
  impairment in social, occupational, or other
  important areas of functioning
• D. There is no clinically significant general
  delay in language (e.g., single words used by age
  2 years, communicative phrases used by age 3
  years)
• E. There is no clinically significant delay in
  cognitive development or in the development of
  age-appropriate self-help skills, adaptive
  behaviour (other than social interaction), and
  curiosity about the environment in childhood
• F. Criteria are not met for another specific
  Pervasive Developmental Disorder or Schizophrenia
  

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Does Autism matter?
Estimated population of autism spectrum disorders
in the UK The estimated numbers have been worked
out from the population of the UK as given in the
2001 census 58,789,194, of whom 13,354,297 were
under 18. The figure for children is based on
the 1 in 100 prevalence rate and corrected to the
nearest 100. The estimated number of children
under 18 with an autism spectrum disorder (ASD)
is 133,500. We had four ASD students in school
in September, but one left this term, unable to
cope.
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How Many Autistic Children Are There Locally?
In 1998, Paul Boateng asked for local authorities
to report on the numbers of ASD children in their
area. These are the local responses. Health
Authorities North West England Bury Rochdale
has no data. Uses two published rates of
incidence, then applies these to the total local
population. This implies that there are between 8
and 348 cases in Bury, and between 10 and 434
cases in Rochdale (no typing errors here). East
Lancashire does not have data on incidence of
autism. Aware of increase in Aspergers, but
ascribes this to better assessment.
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ASDs (Autistic Spectrum Disorders) are caused by
a disorder in the brain, where the amygdala,
which is supposed to unconsciously recognise
faces, read body language and assess if a
situation is dangerous, fails to sort the data
properly and spreads the sensory data to the
wrong parts of the brain.
As the amygdala is part of the fight or flight
response, it constantly keeps the cerebellum in a
state of alert, causing sensory overload and a
state of fear, which the ASD student has to
control.
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Anomalies in the amygdala and other structures of
the medial temporal lobe have been demonstrated
repeatedly in autism spectrum disorders,
suggesting involvement of the temporal pathway
for visuoperceptual processing. Functional
magnetic resonance imaging (fMRI) of people with
autism spectrum disorders demonstrates reduced
activation in the fusiform gyrus, the portion of
the brain associated with facial recognition, and
increased activation of adjacent portions of the
brain associated with recognition of objects.
fMRI also suggests that, in some individuals
with Asperger syndrome and high-functioning
autism, dysfunctional connections among limbic
and paralimbic regions, the cerebellum, and the
extrastriate visual cortices occur during the
process of identification of the emotion
expressed by faces and the gender of the face.
For the scientists!
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Parents
Discovering that your child is autistic is
described as being similar to a bereavement, in
that the parent has lost the child that they
could have had. This is compounded by
frustration, anger and even, possibly,
guilt. Parents of ASD students only become
annoyed with staff if the teacher is ignorant
about what the child requires or is insensitive
to the childs needs. Parents of ASD children
have a strong emotional link to their child
because their child is so needy and the
relationship between the teacher and the parent
can easily be compromised if the teacher regards
the parent as being precious, whilst the parent
regards the teacher as callous and lacking
understanding.
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What mood are these people displaying?
Well they all look pretty happy to me BRGS
student.
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Sometimes I feel it coming. I have to
rationalise it. I have to keep it on a very short
chain. Student at BRGS.
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Whodunnit?

• Genes
• A number of genes are implicated in the disorder,
  specifically a region of chromosome 11 and a
  specific gene called neurexin 1.
• There are a number of possibilities
• One gene is at fault.
• A combination of genes is at fault.
• The faulty gene(s) is(are) activated by an
  external event.
• Supporting evidence
• Identical twins tend to both have ASD if one is
  affected, though to different degrees.
• Autism runs in families. (One woman had 6 ASD
  children!!!!!)
• Someone with an ASD has an 8 chance of having a
  child with an ASD.
• Boys are 41 more likely to have an ASD than girls

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Last Updated Monday, 19 February 2007, 0315
GMT Autism gene breakthrough hailed Scientists
have found new autism genes by scanning the
largest collection of families with multiple
cases of autism ever assembled. The monumental
task of studying the 1,200 families took more
than 120 scientists from more than 50
institutions across 19 countries. The work,
described in Nature Genetics, implicates a region
of chromosome 11 and a specific gene called
neurexin 1. "There will almost certainly be an
interaction between several genes so this one
discovery doesn't provide a complete answer and
may not lead straight to a genetic test but it
could be a key step in development for effective
treatments as it provides a target for drug
development."
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Why it's better to be a girl....
Skuse (2000) has suggested that the gene or genes
for autism are located on the X chromosome. Girls
inherit X chromosomes from both parents, but boys
only inherit one, from their mothers. Skuses
hypothesis is that the X chromosome which girls
inherit from their fathers contains an imprinted
gene which "protects" the carrier from autism,
thus making girls less likely to develop the
condition than boys.
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The MMR Debate
Some children who have developed normally and
happily have regressed dramatically at 15 months
when given the MMR jab. Parents naturally blamed
the jab and the government and drugs companies
came out in force to refute that assertion.
Some parents went to court on the issue and found
that they could not pursue the case because they
had lost their legal aid.
The Government has refused to offer single jabs
which has compounded matters.
Anyone who speaks against the MMR is forced to
recant or has to find work in America.
As a result, no research on the causative factors
for ASDs, other than genetics, is happening in
the UK.
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The MMR Problem
The Government needs to have a take-up of 95 of
children to keep the population safe. Most
children are completely unaffected by the MMR jab
and it is far more effective to have the three
jabs as a combo, as some parents could choose
which single jabs to avoid, leaving the
population at risk.
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However,

• The measles virus (same DNA) has been found in
  the gut and spinal fluid of some children with
  ASD.
• The MMR jab, in the UK, used to be (not since
  2004) stabilised with Thimerosal, a mercury
  compound. Mercury poisoning has similar symptoms
  to ASD. ASD children often show raised levels of
  heavy metals in their systems, showing an
  inability to detoxify themselves.
• The Japanese offered single jabs, but the autism
  levels rose. They still used Thimerosal in their
  jabs.
• The government has urged pregnant women not to
  eat more than two portions of oily fish a week
  because of the mercury levels in the fish.
• A Danish study has been quoted as proving that
  MMR does not lead to ASDs, but the Danes had
  previously stopped using the mercury. Further
  claims that the figures in Denmark had increased
  when the Thimerosal was not being used, were
  confused by the fact that the Danes were
  calculating their cases in a different way.
• Pre and Post 2004 figures for the UK are not
  available.
• Children who have not had the jab still get ASDs.
  The MMR jab is not the whole answer.

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The Government's Problem
Historically, mothers took their children to
parties to catch the viruses that we inoculate
against, because it was safer to catch the
viruses young rather than as an adult. The
dangerous effects like blindness, for measles,
and deafness, for mumps, were rare because the
mothers knew how to deal with the infections and
could call the doctor out. Times have
changed. Would a teenage mother now know what to
do? It is easy to see why the Government is
desperate for children to be fully immunised.
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Other Possibilities

• A large range of possibilities has been
  suggested
• Child development - It just happens, because the
  child is at a specific stage of brain growth.
• Gut problems children with ASD tend to have
  intestinal problems that could lead to gut
  leakage into the bloodstream. However, the
  question arises as to whether the autism led to
  the gut problem or vice versa.
• Viruses autism is linked to at least 6
  different viruses with long names!
• Genetic abnormalities during pregnancy we are
  better at saving babies that would have
  miscarried in the past.
• Problems in deliveries.
• Too much foetal scanning ASD linked to twins.
• In the 1960s lack of parental warmth was blamed
  for causing autism this has been totally
  discredited.

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Why Should We be Concerned?
Cognitive function Autism occurs at all
intelligence levels. Although about 50 of
autistic individuals have an intelligence
quotient (IQ) below average, the other 50 have
an average or above average intelligence. The
performance IQ is generally higher than the
verbal IQ. A small percentage have high
intelligence in a specific area such as
mathematics. (National Autistic
Society)
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Emotion
ASD children cannot read other peoples body
language and therefore they cant empathise.
There is a common misconception that they lack
emotions. The opposite is true. Whereas we might
think in words or in pictures, autistic children
think through their emotions and emotional
turbulence will block their thought processes as
effectively as a dam.
When you give me a problem to solve, first it
stallsderder.. der and then happiness, and then
the answer pops into my head. BRGS Pupil
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What Are the Problems
and
What Can We Do About Them?
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People
Pupils with autism often have difficulty
recognising or understanding other people's
emotions and feelings, and expressing their own,
which can make it more difficult for them to fit
in socially.

Many people with Asperger's syndrome demonstrate
gaze avoidance and may actually turn away at the
same moment as greeting another.
They may not understand the unwritten social
rules which most of us pick up without thinking
they may stand too close to another person or too
far away for example, or start an inappropriate
subject of conversation. Their voices can be
hectoring, monotonous in tone or too loud.
They may appear to be insensitive because they
have not recognised how someone else is feeling
They may appear to behave 'strangely' or
inappropriately, as it is not always easy for
them to express feelings, emotions or needs.
They may prefer to spend time alone rather than
seeking out the company of other people
They show a lack of spontaneous seeking to share
enjoyment, interests, or achievements with other
people.
They may not seek comfort from other people
Difficulties with social interaction can mean
that people with autism find it hard to form
friendships some may want to interact with other
people and make friends, but may be unsure how to
go about this.
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Looking someone straight in the eyes,
unexpectedly, is like getting an electric shock.
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What Can We Do?
"Socialising doesn't come naturally - we have to
learn it."
Tell them kindly but firmly if they go off at a
tangent or are speaking too loudly.
Allow them to work alone if they wish to.
Organise a sensitive/patient buddy to
socialise/work with them on their terms.
Tell them verbally when they have done well.
Dont force them to do group work. Group work has
to be very structured.
Dont tell them, Look at me when I am talking to
you.
Dont expect them to read our body language.
Encourage them to involve themselves in clubs
that suit their interests.
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Social Imagination
Social imagination allows us to understand and
predict other people's behaviour, make sense of
abstract ideas, and to imagine situations outside
our immediate daily routine. Difficulties with
social imagination mean that people with autism
find it hard to
understand and interpret other people's thoughts,
feelings and actions
prepare for change and plan for the future
predict what will happen next, or what could
happen next
cope in new or unfamiliar situations
engage in imaginative role-play and activities
understand that other people dont share their
obsessions.
Difficulties with social imagination should not
be confused with a lack of imagination. Many
people with autism are very creative and may be,
for example, accomplished artists, musicians or
writers.
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What Can We Do?
Rationalise what people do and why they do it.
Let them be the judges for role-plays. Give them
criteria for judging.
Dont expect ASDs to empathise they
intellectualise.
They can cope with something new if you warn
them, and let them get out of the way if
necessary.
Have well-planned lessons where the students know
what is going to happen.
If they need to project an idea into the future,
let them use paper to intellectualise the problem.
If you plan a shock, let the ASD pupil know, even
if the others dont.
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Social Communication
People with autism have difficulties with both
verbal and non-verbal language. Many have a very
literal understanding of language, and think
people always mean exactly what they say. They
can find it difficult to use or understand

• facial expressions or tone of voice

• common phrases and sayings an example might be
  the phrase 'It's cool', which people often say
  when they think that something is good, but
  strictly speaking, means that it's a bit cold.

• jokes and sarcasm

Others will have good language skills, but they
may still find it hard to understand the
give-and-take nature of conversations, perhaps
repeating what the other person has just said
(this is known as echolalia) or talking at length
about their own interests.
"For people with autistic spectrum disorders,
'body language' can appear just as foreign as if
people were speaking ancient Greek."
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What Can We Do?
It helps if other people speak in a clear,
consistent way and give people with autism time
to process what has been said to them.
Dont tell them to pull their socks up.
Say what you mean dont assume that the pupil
can pick up the nuances of your language.
At last someone has an excuse not to laugh at
Kevins jokes.
Have a code so that they can flag to you when
they dont understand without looking foolish.
Tell them if the way they converse is not
appropriate, but kindly.
If you give an ASD student spoken instructions,
they must have a written version. Any sensory
upset will block the instructions.
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The understanding of hand gestures and eye gaze
provides crucial clues about the feelings and
intentions of others. Persons with autism
spectrum disorders exhibit deficits in facial
perception. Instead of identifying people on the
basis of overall facial configuration, persons
with autism spectrum disorders use the lower
face, the mouth, and other specific portions of
the face to identify others. Thus, people with
autism spectrum disorders actually may identify
the faces of people by focusing on the objects
that form the face rather than the whole person.
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A Warning!

• Seizures (epilepsy) may develop in 25-35 of
  children with autism and can be resistant to
  treatment. The onset of seizures peaks in early
  childhood and again in adolescence.
• There is a high incidence of suicide amongst
  students with ASDs.

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Over-sensitive to perfumes, deodorants, bad
smells etc
LIGHT
SMELL
Between 100 and 500 more sensitive to sensual
stimuli
Tend to need more personal space
PEOPLE
SOUND
Finds the sensual overload of a chaotic classroom
very intimidating
Can have an emotional reaction to sensual
stimulation that can lead to bouts of
unconsciousness, blindness and deafness
CHAOS
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(No Transcript)
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Sensory sensitivity People with autism may
experience some form of sensory sensitivity. This
can occur in one or more of the five senses -
sight, sound, smell, touch and taste. A person's
senses are either intensified (hypersensitive) or
under-sensitive (hypo-sensitive). For example, a
person with autism may find certain background
sounds, which other people ignore or block out,
unbearably loud or distracting. This can cause
anxiety or even physical pain. People who are
hypo-sensitive may not feel pain or extremes of
temperature. Some may rock, spin or flap their
hands to stimulate sensation, to help with
balance and posture or to deal with
stress. People with sensory sensitivity may also
find it harder to use their body awareness
system. This system tells us where our bodies
are, so for those with reduced body awareness, it
can be harder to navigate rooms avoiding
obstructions, stand at an appropriate distance
from other people and carry out 'fine motor'
tasks such as tying shoelaces.
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What Can We Do?
Ensure that there is no stale food in the bins.
Be sensitive to ASD students in lab experiments.
SMELL
Discourage students from using deodorant in form
rooms.
Be prepared to move rooms if there is an
unexpected issue.
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What Can We Do?
Sensitive use of the blinds now we have them.
Dont work in rooms with an undiffused
fluorescent light
LIGHT
Flashing classroom lights need to be switched off
and repaired.
Powerpoint backgrounds (colour) are better than
Promethean (white) due to the glare. Some ASDs
suffer from Irlens.
If you cant avoid the problem, warn the student
first.
Avoid flashing lights in videos, experiments etc
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What Can We Do?
Choose videos carefully or allow the student to
sit away from the noise.
Avoid sudden shouting out, particularly from
behind the student.
SOUND
Allow the student to use headphones when working
on his own.
If you know it is going to be a noisy lesson,
warn them first and let them leave if they need
to.
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What Can We Do?
The world can seem a very unpredictable and
confusing place to people with autism, who often
prefer to have a fixed daily routine so that they
know what is going to happen every day. Rules can
also be important it may be difficult for a
person with autism to take a different approach
to something once they have been taught the
'right' way to do it. People with autism may not
be comfortable with the idea of change, but can
cope well if they are prepared for it in advance.
The worst place in BRGS is the corridors. ASDs
should be allowed to use dark glasses and
earphones to block the senses and the panic.
Shouting at an ASD student is extraordinarily
counter-productive. Time-outs are better.
CHAOS
Kinaesthetic lessons must be very sensitively
handled.
Lessons should have a predictable structure,
little disruption and be calm.
There should be a quiet room, with white walls
for them to escape to.
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What Are ASD Students' Strengths?
On the whole they are Honest Brilliant
researchers Good at working on their
own Self-motivated Bright Relentless and
determined.
Self-disciplined Mature for their
age Intellectually unafraid Lateral thinkers They
have initiative
They are COOL!!
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BACKGROUND READING Autism Spectrum Disorders by
Chantal Sicile-Kira The Curious Incident of the
Dog in the Night-time by Mark Haddon Freaks,
Geeks and Asperger Syndrome A User Guide to
Adolescence by Luke Jackson www.aspergers.com
www.aswhatisit.html www.autism.jsp.htm www.
APERGERS20SCHOOL.jsp.htm www.Autism_Genetics.htm
www. Autism20BBC20genome.htm
www.Big20Picture20autism.htm www.autismfaq-hist
.html www.autism20numbers2.htm www.Autism20numbe
rs.htm and others www.autismuk.com/index4.htm
A special thank you to Terri Spokes Autistic
Unit Woodhey High School Angela Holdsworth Tor
View School And especially to Huw and Matthew.