AUTISM What it is, is not, and how we treat it effectively Marisa R. Leyden, M.A., BCBA

Autism: Facts At present, 1 in 88 children in the United States are diagnosed with an autism spectrum disorder. This number is similar throughout the world. It is 4 to 5 times more likely to be diagnosed in boys than girls. Most cases manifest by age 3 with reliable diagnosis possible as early as age 2. 1 in 49 children in New Jersey are diagnosed with an autism spectrum disorder. Currently 80 children in the Perth Amboy school district carry an autism classification

Autism: Myths All people with autism have mental retardation People with autism can’t speak Autism and schizophrenia are the same People with autism are savants Autism is caused by “refrigerator mothers” Autism is caused by the MMR vaccine People with autism rock back and forth all the time

What is Autism? According to the DSM IV the essential features of autistic disorder are; Markedly abnormal or impaired development in social interaction and communication A markedly restricted repertoire of activities and interests (DSM – IV – TR, 2000)

What is Autism? Autism is considered a spectrum disorder, meaning that a wide range of symptoms are expressed by those people diagnosed “on the spectrum”. The 5 disorders which make up the autism spectrum are; - Autism (aka; classic autism, early infantile autism, childhood autism, etc.) - Asperger’s Disorder - Pervasive Developmental Disorder – Not Otherwise Specified (PDD – NOS) - Rett’s Disorder - Childhood Disintegrative Disorder

What is Autism? The core features of the autism spectrum disorders are; - Impairment in social interaction - Impairment in communication - Restricted, repetitive, stereotyped patterns of behavior, interests and activities

Autism: Social Impairment Marked impairment in non-verbal behavior Failure to develop peer relationships Lack of joint attention Lack of social or emotional reciprocity

Autism: Communication Delay or lack of speech, with no non-verbal compensation Where there is speech, lack of ability to initiate or sustain conversation Stereotyped, repetitive and idiosyncratic language Lack of varied, spontaneous, make-believe or social imitative play

Autism: Behavior Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal or intense Rigid adherence to specific non-functional routines Stereotyped and repetitive motor mannerisms Preoccupation with parts of objects

What is Autism? REMEMBER – Just becoming familiar with the diagnostic criteria and a list of symptoms will not help us to truly understand autism. “When you have met an individual with autism you have met one individual with autism.” (Stephen Shore, Ed.D., a person on the spectrum)

What is Autism? What causes autism? Is autism treatable? If so, how do we treat it effectively?

Autism: Research Much of today’s research focuses on a genetic link to autism. The most convincing finding in this line of research is the number of monozygotic (identical) twins that are both diagnosed with autism. There is a 60% concordance rate for classic autism and a 92% concordance rate when a broader autism phenotype is studied (Muhle, Trentacoste & Rapin, 2004)

Autism: Research Current research suggests that there are multiple abnormalities that are spread out over several different genes that vary from one individual to another. Less than a quarter of cases can be accounted for by a single genetic defect (i.e., Fragile X syndrome) or environmental insult (i.e., congenital rubella)

Autism: Treatment 1987 – O. Ivar Lovaas publishes his study “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children” Compared two groups of “similarly constituted” young, autistic children. One group received behavioral treatment and the other did not.

Autism: Treatment Of the group that received behavioral treatment,47% achieved normal range IQ scores and were successfully placed in 1 st grade classrooms in public schools. Only 2% of the non-treatment group achieved normal educational and intellectual functioning

Autism: Treatment The 11 Established Treatments listed by The National Standards Project are: - Antecedent Package - Behavioral Package - Comprehensive Behavioral Treatment for Young Children - Joint Attention Intervention - Modeling - Naturalistic Teaching Strategies - Peer Training Package - Pivotal Response Treatment - Schedules -Self-management -Story-based Intervention Package

Autism: Treatment All of these established treatments have at least some basis in the behavioral literature and/or make use of strategies described in the behavioral literature They all employ the following: - Use of positive reinforcement (R+) - Individualized instruction -Data based decision making

Teaching Language to Students with Autism The Theory of Verbal Behavior

Autism: Verbal Behavior Developed by Skinner in his 1957 book “Verbal Behavior” and described extensively by Dr. Mark Sundberg in his publications. Differs from traditional linguistics in that it treats speech and language as a behavior under the control of antecedents and consequences

Autism: Verbal Behavior Four of the verbal operants in the behavioral classification of language are: - Mand – asking for reinforcers i.e., Asking for “water” when you are thirsty. - Tact – Naming or identifying objects, actions, events, etc. i.e., Saying “water” because you see it. - Echoic – Repeating what is heard i.e., Saying “water” after someone else says “water”. - Intraverbal – Answering questions or having conversations where your words are controlled by other words i.e., Saying “Patten school” after someone says “Where do you work?”

Autism: Verbal Behavior The mand is an especially important verbal operant for individuals on the autism spectrum. - Those individuals with language may have an extensive list of tacts (labels) but no ability to ask for what they want. - For those individuals who develop a mand repertoire, they may only be able to ask for desired items/activities when they are present. - For many who have no communicative behaviors, the only “mand” they have is to engage in maladaptive behaviors.

Autism: Verbal Behavior There are various types of mands: -Items -Activities/Termination of an Activity -Missing Items -Information -Changes in the Environment -etc.

Autism: Treatment How can we teach individuals on the autism spectrum to mand? - Observe their behavior in the natural environment to determine what items/activities they like best and/or do a formal preference assessment - Assess the individuals best modality for communication - Capture and contrive motivation - Provide reinforcement immediately following the desired behavior and on an appropriate schedule - Set up the environment for learning - Practice in a variety of settings and situations to promote generalization

Questions? Thanks everyone