1. Autism Spectrum Disorders: Presentation During School Years Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu

2. Overview Social and adaptive behaviors Play Communication Behavioral and Emotional Issues Adjustment and Achievement Outcome

3. Social behaviors: Aloof Classically autistic Avoid contact and interaction, unresponsive Stereotypic, self-injurious behaviors Pattern most common in preschool, but can be seen in older childen Those who persist in this pattern often have MR

4. Video Sample: Aloof JC, MK

5. Social behaviors: Passive Accept but do not seek interactions Generally higher developmentally than aloof Children who start out aloof may move to passive

6. Video sample: Passive Karin 14:00 Hadia

7. Social behaviors: Active-but-odd Usually HFA or AS May have considerable language skills, interested in communicating but use Repetitive questions Inappropriate touch Odd postures, gestures, facial expressions Conversations on narrow interests Literal and concrete Little awareness of others’ thoughts, feelings, motives Aware of differences May regress under stress to tantrums

8. Video Samples: Active but Odd

9. Adaptive Skills Deficits not attributable to IQ Related to verbal skills and autistic symptom level Typically significant discrepancy between measures of adaptive skills and developmental level in ASD; adaptive skills are lower than IQ. Should be targeted in educational programs

10. Play Pretend play is often lacking or delayed Play may be rigid, repetitive Games with rules may be rigidly adhered to Motor skills may interfere with team game participation Can be enhanced by allowing active role in choosing games, toy, themes

11. Communication Presence of speech before age 6 is indicator of better prognosis Echolalia may be first step toward speech, usually decreases as language skills increase Serves communicative functions Language skills in children who speak are generally on par with mental age Conversational skills are major area of deficit throughout school years

12. Behavior and Emotion Unusual inappropriate excessive or inadequate responses Appear to lack empathy High levels of anxiety; may lead to maladaptive behavior High levels of attention problems, hyperactivity, impulsivity; similar to ADHD Hyperactivity decreases w/ age Attention problems do no

13. Stereotypic Behaviors Seen in other disorders, but more prevalent in ASD more frequent in lower functioning individuals, but can be seen in HFA May progress from repetitive sensory motor activities to those more like OCD in higher functioning individuals Both drug and behavioral treatments are helpful

14. Adjustment and Achievement Social disabilities, rigid cognitive style, anxiety, attention problems affect academic achievement even for most intelligent Difficulty w/ executive functioning interferes with school success Generally, children with autism have weaker verbal than non- verbal skills; may need visual (picture) supports AS shows strong verbal skills, benefit from written supports Individual assessment needed to identify academic strengths, weaknesses Reading and/or math may be precocious in HFA/AS Hyperlexia is common in ASD (20-25%)

15. Adolescence Generally, improvement is seen in adolescence Reduction in symptoms Increase in social and communicative skills 10-20% show deterioration in adolescence 25% show onset of seizures in adolescence Mood disorders may appear Difficult behaviors may remain, including Resistance to change Unacceptable sexual behavior Tantrums Aggression Self-injury

16. Outcomes Best seen in those with IQ>50, language use by age 6 Many have difficulty with independent living and most continue to live with parents into adulthood Residential support programs for adults are emerging Only about 10% of people with ASD attend or graduate from college Supported employment provided for those with MR; less often for those w/ HFA/AS High rates or depression and anxiety in adults Education has a great effect on outcome!

17. Video Sample: Outcomes