1. Autism Spectrum Disorders (ASD)
Welcome!
St. Clair College, Educational Assistants Program
welcome
Congratulations and thank you to the small committee of parents, Cathy Coppens who got this started - Jodie Goulet - her idea! Amazing to get 8 agencies to co-operate on anything! And yet so much
Notes from my talk are on Summit Centre website – URL on bottom of each page
who are in audience (parents, professionals)?
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 1

2. What are ASD’s? Behaviour Social Communication and
difficulty with change
intense interests
repetitive
“sticky”
no/delayed speech
2-way conversation
not reciprocal
weak nonverbal
weak play
and
Social
low social interest
friendships for level
not reciprocal
weak sharing
eye contact
weak nonverbal
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 2

3. What are ASD’s? Behaviour Social Sensory Issues Anxiety Communication
difficulty with change
intense interests
repetitive
“sticky”
no/delayed speech
2-way conversation
not reciprocal
weak nonverbal
weak play
and
Social
low social interest
friendships for level
not reciprocal
weak sharing
eye contact
weak nonverbal
Sensory Issues
Anxiety
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 3

4. Autism is… a spectrum disorder developmental
from very delayed to above average abilities
from mild to moderate to severe autistic behaviours
developmental
abilities & symptoms may improve with good programming
Everyone with autism is an individual
They don’t stay the same - almost always see improvement, sometimes more rapid improvement in preschool years with intensive early intervention
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 4

5. Autism: Associated Features may occur, not required for diagnosis
cognitive; deficits, strengths & weaknesses (50-70% intellectual impairment)
unusual motor behaviours
unusual sensory behaviours
eating, sleeping, drinking
attention; joint, shifting, focus
mood; anxieties & fears
medical conditions, seizures
medical conditions – 6% have 7 clearcut medical disorders potentially causally associated with autism (cerebral palsy, Fragile X, Tuberous Sclerosis, PKU, neurofibromatosis, congenital rubella, Down’s Syndrome)
- other medical events of potential etiological significance (encephalitis, congenital anomalies, other rare medical syndromes)
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 5

6. Early Signs of ASD
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 6

7. Red Flags immediate evaluation if
no babbling by 12 months
no gesturing by 12 months
no single words by 16 months
no 2-word phrases by 24 months (not just echolalic)
any loss of any language or social skills at any age (30%)
Guideline. A recommendation for patient management that reflects moderate clinical certainty
Further developmental evaluation is required whenever a child fails to meet any of the following milestones (Guideline): babbling by 12 months; gesturing (e.g., pointing, waving bye-bye) by 12 months; single words by 16 months; two-word
spontaneous (not just echolalic) phrases by 24 months; loss of any language or social skills at any age.
Practice parameter: Screening and diagnosis of autism: Report of the Quality Standards Subcommittee of the
American Academy of Neurology and the Child Neurology Society
P.A. Filipek, MD; P.J. Accardo, MD; S. Ashwal, MD; G.T. Baranek, PhD, OTR/L; E.H. Cook, Jr., MD; G. Dawson, PhD; B. Gordon, MD, PhD; J.S. Gravel, PhD; C.P. Johnson, MEd, MD; R.J. Kallen, MD; S.E. Levy, MD; N.J. Minshew, MD; S. Ozonoff, PhD; B.M. Prizant, PhD, CCC-SLP; I. Rapin, MD; S.J. Rogers, PhD; W.L. Stone, PhD; S.W. Teplin, MD; R.F. Tuchman, MD; and F.R. Volkmar, MD NEUROLOGY 2000;55:468–479
Filipek et al, Amer. Acad. Neurology, 2000
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 7

8. First Signs of Autism: Behaviour At 12 months of age, may see unusual
eye contact
visual tracking
disengagement of visual attention
orienting to name
imitation
social smiling
reactivity, social interest & affect
sensory behaviors d
Zwaigenbaum, Bryson, Rogers, Rogerts, Brian & Szatmari, 2005
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 8

9. First Signs of Autism: Other
Temperament:
6 months, marked passivity & low activity level
12 months, extreme distress, fixating on particular objects, & rarely in a positive mood
Delayed expressive & receptive language
Zwaigenbaum, Bryson, Rogers, Rogerts, Brian & Szatmari, 2005
Challenging behaviours may be the first sign of high functioning autism d
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 9

10. Early Diagnosis of Autism
Why?
early intervention  better prognosis
so parents know
connect to autism community
support for families
early diagnosis resulting in early, appropriate and consistent intervention has been shown to be associated with improved long-term outcomes - AAP ISSUES GUIDELINES ON DIAGNOSIS AND MANAGEMENT OF AUTISM
Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP). May 7th, 2001
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 10

11. Early Identification What we are doing already is NOT good enough for
& intervention!
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 11

12. Causes of Autism neurological disorder 4.6 boys to every girl
genetic susceptibility
environmental triggers?
not related to parenting or learning
not related to MMR vaccine or preservatives in vaccines d
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 12

13. Recent Genetics News
Stephen Scherer, a senior scientist in genetics at Sick Kids - Windsor native
Autism Genome Project
> 1,600 families participated worldwide
137 researchers from 8 countries
region on chromosome 11, gene neurexin 1, part of a family of genes important in communication between neurons, particularly during brain’s development.
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 13

14. More Children with Autism?
67 per 10,000 children (CDC, 2007)
1 in every 150 children
1 in every 100 boys
more children identified now
??? – better identification?
- better public awareness
- wider definition
- misdiagnoses?
increased prevalence, incidence?
Fombonne (2003). Epidemiological surveys of autism and other pervasive developmental disorders. JADD, Vol. 33(4), pp 356 – 382.
We do not know if ASDs are becoming more common in the United States.
today more children are being identified as having an ASD than in the past.
studies that have looked at how common ASDs are often used different ways to identify children with ASDs, and it is possible that researchers have just gotten better at identifying these children.
also possible that professionals know more about ASDs now and are therefore more likely to diagnose them correctly. Also, a wider range of people are now being classified as having ASDs, including people with very good language and thinking skills in some areas who have unusual ways of interacting or behaving.
Misdiagnosis may account for rise in autism cases
Important question of whether ASDs are truly becoming more common
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 14

15. Families and their Children’s ASD Diagnoses?
denial?
anger?
bargaining?
depression?
acceptance? d
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 15

16. It’s a process - it takes time!
Acceptance Spiral
It’s a process - it takes time!
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 16

17. Families: Research Shows Social Support
helps parents of children with autism
helps siblings of children with autism
AND
helps children with autism make more progress d
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 17

18. Autism brings strong families closer can drive distant families apart
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 18

19. Intervention
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 19

20. Basic Supports for All Children
Supportive Environment
basic needs: food, shelter, medical care, nurturance
access to preferred toys, activities, interests & friends
opportunities for success at the child’s level
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 20

21. Basic Supports for All Children
Supportive Caregivers
parents and teachers need to be supported too!
staff & parent relationships
professionals; attitude is more than half the battle.
don’t take things personally, avoid power struggles
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 21

22. Autism Spectrum Disorders (ASD)
Children with ASD learn differently.
They need different supports to help them learn & maintain behavioural control.
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 22

23. General Helpful Supports for Children with Autism/PDD
Make things predictable
Reduce language
Use visual supports
Broaden preoccupations
Reduce anxiety
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 23

24. 1. Make Things Predictable
develop routines so the child can predict what will happen next e.g. work, homework, bedtime and chores
teach the child to use a schedule (picture, word, object), calendar
prepare in advance for transitions & unexpected events, e.g. when playtime is over
clear expectations
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 24

25. 2. Reduce Language
use clear simple language, even if the person talks a lot
avoid slang, metaphorical language, sarcasm, rhetorical questions, etc
develop cue phrases.; talk less when he is excited or upset
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 25

26. 3. Use Visual Supports use pictures, videos, drawings, & manipulatives
visually organize materials clearly, e.g. baskets, colour coding, tape on floor
visual strategies e.g. Triangle of Choices
written language is visual for people who can read
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 26

27. 4. Broaden Preoccupations
use intense narrow, interests to teach & motivate
getting rid of preoccupations rarely works in the short term
schedule specific times for his interests e.g. dinosaur time, Dracula time
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 27

28. 5. Reduce Anxiety
use above strategies (make things predictable, reduce language, make things visual)
allow the person time -- to process, to cope, to be alone
try relaxation training, vigorous rhythmic exercise, medication
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 28

29. Intervention Components
earliest age (as soon as autism is suspected)
active engagement in intensive, 5 full-days, min. 25 hrs/wk, full-year, 1 on 1
teach social, communication, cognitive development, & play skills
systematic, individualized
generalization
parent involvement
minimum 5 days per week
-sufficient adult attention 1 on 1, small groups instruction, individualized goals
National Research Council, 2001
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 29

30. Community Resources for ASD
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 30

31. Community Resources list
4 page list of Windsor resources for children with autism
good resource to give to parents
click on “Local Autism Services”
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 31

32. The Summit Centre for Preschool Children with Autism
affiliated with U of W!
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 32

33. Summit Centre Open House
Thurs. March 8, 3:30 to 7 p.m.
Please drop in & help us celebrate;
our 10th Anniversary!
our new UNITY Intensive Parent Training; funded by a Unity for Autism grant
our long-serving volunteers!
our new location at 3735 King St. (near Prince Rd. & Sandwich St. W.)
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 33

34. All About Autism Introductory workshops
for parents of children with a diagnosis or suspicion of autism
3rd Wed. of month (except July & Aug)
same intro & different speaker
Sponsored by: ] Dedicated Parents, ] Autism Society Ontario Windsor/Essex Chapter, ] Autism Services Inc., ] Children First, ] Children’s Rehabilitation Centre, ] Ontario Early Years Centres, ] Talk to Me (Essex Preschool Speech & Language) ] The Summit Centre for Preschool Children with Autism, ] Thames Valley Children’s Centre The Autism Program South West Region
welcome
Congratulations and thank you to the small committee of parents, Cathy Coppens who got this started - Jodie Goulet - her idea! Amazing to get 8 agencies to co-operate on anything! And yet so much
Notes from my talk are on Summit Centre website – URL on bottom of each page
who are in audience (parents, professionals)?
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 34

35. Autism Resource Library
Autism Services Incorporated
books, videos, DVD’s on autism
will loan via school courier
online catalog of what is available!
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 35

36. “Even the smallest footsteps can cross great distances.”
All drawings by enrolled children
All photos with consent of parents and staff
“Even the smallest footsteps can cross great distances.”
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 36

37. Thank you! Comments? Questions? Concerns?
Marcia Gragg
© Marcia Gragg, PhD, CPsych, Feb. 23, p. 37