1. Autism Spectrum Disorders Elliott Clarke Elizabeth Pole March 2011

2. Outline Background / History Triad of Impairments – Communication – Social Relationships – Rigidity of thought, behaviour and play Sensory issues Parents’ perspective Discussion Strategies

3. Autism Spectrum Disorder Developmental disorder affecting children from birth or the early months of life. Exact cause remains unknown, but generally felt to be neurological in origin. Lifelong condition. Can be a ‘hidden disability’. No ‘cure’, but the right support at the right time can make an enormous difference to people’s lives. Often accompanied by additional learning difficulties (about 75%).

4. The National Picture Over half a million people in the UK with autism - that's around 1 in 100. If you include their families, autism touches the lives of over 2 million people every day. Over 40% of children with autism have been bullied at school.

5. Background / History Leo Kanner (USA) Child Psychiatrist Paper published in 1943 based on study of 11 cases. Resulted in identification of a separate condition – Autism. He wandered about smiling, making stereotyped movements with his fingers, crossing them about in the air. He shook his head from side to side...humming the same three-note tune. He spun with great pleasure anything he could seize upon to spin….When taken into a room, he completely disregarded the people and instantly went for objects, preferably those that could be spun….( Kanner 1943)

6. Background / History Hans Asperger (Austria) Physician. Identified similar group to Kanner. 1944 – published dissertation on ‘autistic psychopathy’ in childhood. Published in German and in middle of Second World War - it took nearly 50 years before it was translated (Wing 1981) Many similarities with Kanner – use of ‘autistic’

7. Background / History Lorna Wing – research with Judy Gould (1979) Identified ‘threads of commonality’ amongst groups of children referred for psychiatric help who were socially impaired. Wing’s ‘Triad of Impairments’ 1988 ‘The Autistic Continuum’ 1996 ‘The Autistic Spectrum’ – broader classification

8. Triad of Impairments Social Relationships Social Communication Rigidity of Thought, Behaviour and Play (Social Understanding) ASD

9. Communication Difficulties learning language – some children may never use spoken language or use limited language. May have difficulties understanding concepts e.g. time ‘later’, ‘before’. May have a very literal understanding of language – leading to misunderstanding.

10. I’m tearing my hair out Adapted from ‘Mystifying Metaphors & Smiley Similes’ by Sadie Lewis

11. Laughing their heads off Adapted from ‘Mystifying Metaphors & Smiley Similes’ by Sadie Lewis

12. Communication Echolalia – immediate (repeat back what have just heard). The child has not necessarily ‘processed’ the language and will not necessarily understand what they are saying. Delayed echolalia - Repetition of chunks of language heard in other situations/DVDs. May not be able to USE the language they have e.g. know the word ‘ball’ but not be able to use this word to make a request.

13. Communication Inability to ask questions to establish another person’s viewpoint, but may ask repetitive questions e.g. What's your name? This may mask unspoken anxieties in the child or indicate that they have not understood. May not understand subtle conversational cues e.g. tone of voice, facial expressions indicating surprise, anger. Some children may use unusual intonation with stereotypical, stilted speech (or a sing-song intonation pattern).

14. Social Relationships Child may display general awkwardness in social situations May be unable to interact appropriately with peers Difficulty in making friends – may initiate and want social contact, but lack understanding and skills to carry through Unusual facial and/or physical gestures (smiles, grimaces, eye-contact)

15. Social Relationships Problems with social “distance” May have difficulties with conventional turn-taking and sharing. May start/finish conversations abruptly or fail to answer appropriately. May not see self as a part of group Motivation – may not be rewarded by success at tasks or by pleasing others.

16. Rigidity of thought, play and behaviour Play may be learnt and repetitive. Initially the child’s play skills may appear appropriate, but over time it is apparent that the child’s play sequences are not extending. May find activities difficult when imagination or pretend skills are needed, e.g. home corner, role play games. May prefer activities such as lining toys up, moving trains around track, sensory play. Difficulty coping with adult direction and imposed routines. Difficulties with understanding changes in routine and new situations.

17. Rigidity of thought, play and behaviour May have fixed interests and may become obsessional about these. Attention problems on tasks chosen by others. Difficulties with problem solving e.g. finding an item that is not in its usual place. Seeing 'part' rather than 'whole' - not the ‘bigger picture’ e.g. focusing on a specific part of a picture. Rigidity of thinking and behaviour – being a ‘class policeman’. Perseveration - the need to repeat words, actions, activities etc.

18. The Sensory World of Autism Senses provide us with the unique experiences which allow us to interact & be involved with others. Senses play a significant role in determining our responses to a particular situation. Many individuals with autism have sensory problems including problems making sense of sensory information (sensory integration). Hyper- (over sensitive) Hypo- (under sensitive)

19. Touch ( includes balance + body awareness) Tactile: relates to touch, pressure, pain, hot/cold Hypo- Holding others tightly (social aspect) Sensitivity to certain clothing/textures High pain threshold Self-harming (biting, gouging etc.) Hyper-Finds touch painful/uncomfortable Dislike of having things on hands/feet

20. body awareness Touch (includes balance + body awareness) Proprioception: where the body is in space Hypo- Proximity – personal body space in relation to others. Navigating rooms – avoiding obstructions. Hyper- Fine motor difficulties, manipulating small objects (buttons, threading, shoe laces etc). Moves whole body to look at something.

21. balance Touch (includes balance + body awareness) Vestibular: sense of how the body is moving Hypo- The need for rocking, swinging, spinning Hyper- Difficulties in activities which include movement (sport, dance) Difficulties in stopping quickly or during an activity

22. Vision Visual: helps to define objects, colours, space Hypo- Peripheral vision (central vision blurred) Poor depth perception (throwing/catching) Hyper- Fragmentation of images (too many sources) Focussing on particular detail (rather than whole).

23. Hearing Auditory: informs about sounds around us Hypo- Partial or complete absence of hearing Enjoys noisy places/activities (bangs things) Hyper- Magnification or distortion of sounds Unable to filter out external sounds

24. Smell Olfactory: Is the first sense we rely on Hypo- May be oblivious to strong odours May lick things indiscriminately Hyper- Smells appear intensified/overpowering. Toileting problems

25. Taste Gustatory: Informs about various tastes Hypo- Likes very spicy/salted foods May eat anything (soil, grass, material etc) (pica) Hyper- Prefers bland (white) food Texture of food may be problematic (lumps) Restricted diet

26. Parents What are your child’s strengths? What do they enjoy? What difficulties does your child have in the following areas: – Communication/language? – Social Interaction/relationships? – Rigidity of thoughts, play and behaviour? – Senses?

27. Discussion In small groups, discuss someone you know who has ASD. What are their strengths? What do they enjoy? What difficulties have you noticed in the following areas: – Communication/language? – Social Interaction/relationships? – Rigidity of thoughts, play and behaviour? – Senses?

28. At Church What things do we already do to help? What things might be challenging for those who have ASD? What might be challenging for those around the person with ASD? What else could we be doing? – As a whole church – As leaders/youth workers

29. Strategies Ensure they know what is happening – Clear explanations, repeat if necessary – Visual timetables Simplify language, think about the key words. Support language visually e.g. signs, gestures, photos, pictures, symbols. Be aware of difficult concepts. Say exactly what you mean. Learn best by ‘doing’ (rather than being told)

30. Strategies 2 Find what motivates them, use their interests. Make it clear exactly what is required of them. May need to teach things that other children learn automatically e.g. how to understand facial expressions/emotions. Talk to parents Find out their ‘sensory profile’ REFLECTION – how did I communicate? How did they respond? What could I do next time?

31. PRAY!