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. 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 an intellectual disability 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

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

Visual Support for Students with Autism Creating and Using Schedules and Other Aides in the Classroom

Autism: Visual Supports What are visual supports? - Visual Schedules - Activity Schedules - Environmental Picture Cues - Token Boards*

Autism: Visual Supports Why use visual supports for students with autism? - A large body of research to support its effectiveness - Helps to prevent challenging behaviors - Promotes independence

Autism: Visual Supports When to use a visual schedule –When a student is having difficulty with transitions –When a student frequently tries to escape work, “first, then” How to create a visual schedule -Include everything that the student will do that day including breaks and/or access to preferred activities -Use pictures along with text -Include a way to indicate when activities are done Helpful Hints -Use the schedule consistently even if you think the student knows the routine -Make sure the schedule travels with the student -Make sure the schedule is always in the students view -Try to alternate between high demand and low demand/preferred activities as much as possible

Autism: Visual Supports When to use an activity schedule -When you want to create more independence during either work or leisure time How to create/use an activity schedule - Use either a small three ring binder or a photo album - Use either pictures or text if the student is able to read - Choose activities/work that the student has already mastered - Choose activities with a clear end - Keep the schedule brief ; 6 activities or less - End with a reinforcing activity Helpful hints - Stand behind the student -Initially reinforce after every task completed - NO TALKING

Autism: Visual Supports When to use environmental picture cues –When you want the student to gain independence with actvities of daily living i.e. hand washing, using the toilet, etc How to create environmental picture cues - List all the steps that are needed to complete the task - Take pictures of the student engaging in each step if possible. If not use very clear pictures that depict each step - Arrange the pictures in order from either top to bottom or left to right - Post the picture strip where the student can see it. Helpful Hints - Prompt from behind - Reinforce initially after every step - NO TALKING

Autism: Visual Supports When to use a token board –When the student has difficulty waiting for reinforcement –When the student needs a very thick schedule of reinforcement –When you want to increase independence with tasks How to create a token board -Sturdy board -Velcro -Tokens that are easily reproducible Helpful Hints - start with a low number of tokens to earn before the student “cashes in” - Be consistent about expectations and schedules of reinforcement - Don’t take away tokens

Questions? Thanks everyone