Autism Spectrum Disorder - Central Washington University

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Autism Spectrum Disorder - Central Washington University Powered By Docstoc
					What Should CWU’s Master Plan Be?

HIGH FUNCTIONING INDIVIDUALS ON THE
AUTISM SPECTRUM ATTENDING COLLEGE
BACKGROUND
Ø First, many higher-functioning adults on the autism
  spectrum are never formally diagnosed and thereby
  often do not qualify for services during their K-12 years.
Ø Second, incidence of autism is increasing, making the
  number of adults that are somewhere on the spectrum
  and in need of support higher than ever before.
Ø Third, higher-functioning adults on the autism spectrum
  are enrolling in college and other post-secondary
  training institutions at higher rates than ever before.
Ø Fourth, although data aren’t available, there are some
  who believe these students drop out at higher-than-
  typical rates because they aren’t adequately supported.
Transitions to Adulthood

AUTISM SPECTRUM DISORDER: DIAGNOSIS
Both tables are from the Centers for Disease Control and Prevention Website
INCIDENCE OF ASPERGER’S SYNDROME
Ø Studies vary in their estimates of the incidence of
  Asperger’s syndrome among children in the United
  States from
   Ø 2 out of every 10,000 children to
   Ø 30–40 of every 10,000 children have this condition.
Ø Asperger's syndrome affects boys more often than girls,
  and siblings of children with the disorder are at
  increased risk.
DEFINITION AND CLASSIFICATION—DSM V
Ø Currently, autistic disorder and Asperger’s syndrome are
  separately defined and classified.
Ø However, in the upcoming revision to the Diagnostic and
  Statistical Manual of Mental Disorders (DSM), the
  diagnostic encyclopedia of American psychiatry, that’s
  about to change.
Ø Following are the criteria, which are anticipated to be
  voted on in June, that are proposed for the combined
  diagnosis, autism spectrum disorder.
DSM V – PROPOSED LANGUAGE
A.   Persistent deficits in social communication and social
     interaction across contexts, not accounted for by
     general developmental delays, and manifested by all
     three of the following:
     1. Deficits in social-emotional reciprocity; ranging from
        abnormal social approach and failure of normal
        back-and-forth conversation, through reduced
        sharing of interests, emotions, and affect and
        response, to total lack of initiation of social
        interaction,
DSM V – PROPOSED LANGUAGE
A.   Persistent deficits in social communication and social
     interaction across contexts, not accounted for by
     general developmental delays, and manifested by all
     three of the following:
     2. Deficits in nonverbal communicative behaviors used
        for social interaction; ranging from poorly
        integrated verbal and nonverbal communication,
        through abnormalities in eye contact and body
        language or deficits in understanding and use of
        nonverbal communication, to total lack of facial
        expression or gestures.
DSM V – PROPOSED LANGUAGE
A. Persistent deficits in social communication and social
   interaction across contexts, not accounted for by
   general developmental delays, and manifested by all
   three of the following:
   3.  Deficits in developing and maintaining
       relationships appropriate to developmental level
       (beyond those with caregivers); ranging from
       difficulties adjusting behavior to suit different
       social contexts, through difficulties in sharing
       imaginative play and  in making friends,  to an
       apparent absence of interest in people.
DSM V – PROPOSED LANGUAGE
B.   Restricted, repetitive patterns of behavior, interests, or
     activities as manifested by at least two of  the
     following:
     1.   Stereotyped or repetitive speech, motor
          movements, or use of objects (such as simple
          motor stereotypies, echolalia, repetitive use of
          objects, or idiosyncratic phrases); 
DSM V – PROPOSED LANGUAGE
B.   Restricted, repetitive patterns of behavior, interests, or
     activities as manifested by at least two of  the
     following:
     2.   Excessive adherence to routines, ritualized
          patterns of verbal or nonverbal behavior, or
          excessive resistance to change (such as motoric
          rituals, insistence on same route or food, repetitive
          questioning or extreme distress at small changes);
DSM V – PROPOSED LANGUAGE
B.   Restricted, repetitive patterns of behavior, interests, or
     activities as manifested by at least two of  the
     following:
      3.  Highly restricted, fixated interests that are
          abnormal in intensity or focus (such as strong
          attachment to or preoccupation with unusual
          objects, excessively circumscribed or perseverative
          interests);
DSM V – PROPOSED LANGUAGE
B.   Restricted, repetitive patterns of behavior, interests, or
     activities as manifested by at least two of  the
     following:
     4.   Hyper-or hypo-reactivity to sensory input or
          unusual interest in sensory aspects of environment
          (such as apparent indifference to pain/heat/cold,
          adverse response to specific sounds or textures,
          excessive smelling or touching of objects,
          fascination with lights or spinning objects).
DSM V – PROPOSED LANGUAGE
C.   Symptoms must be present in early childhood (but may
     not become fully manifest until social demands
     exceed limited capacities).
D.   Symptoms together limit and impair everyday
     functioning.

   Two numerical scales of severity are planned to
   locate each individual on the continuum.
HOW IS THIS DIFFERENT THAN DSM –IV?
     DSM – IV: Pervasive Developmental Disorders (also
    known as Autism Spectrum Disorders)     
       The current DSM lists five diagnoses within the
       PDD (ASD) category.
             299.00 Autistic Disorder
             299.80 Pervasive Developmental Disorder,
                   Not Otherwise Specified
             299.80 Asperger's Disorder
             299.80 Rett's Disorder
             299.10 Childhood Disintegrative Disorder
WHY THE CHANGE?
The intent:
Ø To make things cleaner and easier for those who will
   be using the criteria. (Dr. Gil Tippy, Clinical Director
   of The Rebecca School, Manhattan, New York)
Ø To ensure that autism “is not used as a fallback
   diagnosis for children whose primary trait might be,
   for instance, an intellectual disability or aggression.”
   (Task force member Catherine Lord)
WHAT CATEGORIES ARE ELIMINATED?
Ø Asperger’s Syndrome (AS)
Ø Pervasive Developmental Disorder - Not Otherwise
  Specified (PDD-NOS)
Ø Non-Verbal Learning Disability (NLD)
CONCERNS ABOUT NEW LANGUAGE
Ø   The current edition of the DSM — DSM IV — gives Asperger’s,
    along with several other subgroups of autism, its own labels.
Ø   It’s widely agreed that these subgroups have been poorly
    defined, thus generating a fair amount of confusion and
    subjectivity around diagnosis.
Ø   Concerns have been voiced primarily from the Asperger’s
    community, who believe that the new language will reduce
    the number of “higher functioning” autistic individuals—those
    on the “right side” of the spectrum—who are diagnosed and
    have access to appropriate treatment.
CONCERNS ABOUT NEW LANGUAGE
Ø This is, at least in part, due to the later onset of
  symptoms that are easily identified and to the current
  tendency for this diagnosis to be made considerably
  later in life than is the Autistic Disorder or Pervasive
  Developmental Disorder, Not Otherwise Specified.
Ø In other words, many adults are now being diagnosed
  with Asperger’s Syndrome. In the past, however, very
  few adults were diagnosed with autism disorder.
 DIAGNOSTIC CRITERIA FOR 299.80 ASPERGER’S
 DISORDER – DSM IV
(I) Qualitative impairment in social interaction, as manifested by
    at least two of the following:

  (A) marked impairments in the use of multiple nonverbal
      behaviors such as eye-to-eye gaze, facial expression, body
      posture, and gestures to regulate social interaction
  (B) failure to develop peer relationships appropriate to
      developmental level
  (C) a lack of spontaneous seeking to share enjoyment, interest
      or achievements with other people, (e.g., by a lack of
      showing, bringing, or pointing out objects of interest to
      other people)
  (D) lack of social or emotional reciprocity.
 DIAGNOSTIC CRITERIA FOR 299.80 ASPERGER’S
 DISORDER – DSM IV

(II) Restricted repetitive & stereotyped patterns of behavior,
    interests and activities, as manifested by at least one of the
    following:
    (A) encompassing preoccupation with one or more stereotyped
         and restricted patterns of interest that is abnormal either in
         intensity or focus
    (B) apparently inflexible adherence to specific, nonfunctional
         routines or rituals
    (C) stereotyped and repetitive motor mannerisms (e.g., hand or
         finger flapping or twisting, or complex whole-body
         movements)
    (D) persistent preoccupation with parts of objects.
 DIAGNOSTIC CRITERIA FOR 299.80 ASPERGER’S
 DISORDER – DSM IV

(III) The disturbance causes clinically significant impairments in
    social, occupational, or other important areas of functioning.
(IV) There is no clinically significant general delay in language
   (e.g., single words used by age 2 years, communicative phrases
   used by age 3 years)
(V) There is no clinically significant delay in cognitive
   development or in the development of age-appropriate self
   help skills, adaptive behavior (other than in social
   interaction) and curiosity about the environment in
   childhood .
(VI) Criteria are not met for another specific Pervasive
   Developmental Disorder or Schizophrenia.
 THE GOOD NEWS

Ø The American Psychiatric Association and clinicians are
  already watching to see how or if the new criteria will
  affect service availability.
Ø Their greatest fear is that insurance companies may use
  the revision to find ways to deny services to higher
  functioning individuals on the autism spectrum and so
  they have vowed to ensure this doesn’t happen.
Ø It remains to be seen.
Transitions to Adulthood

AUTISM SPECTRUM DISORDER
WHAT HAPPENS WHEN CHILDREN WITH AUTISM
BECOME ADULTS WITH AUTISM?

“National, state and local policy makers have been working
hard to meet the needs of the growing numbers of young
children identified as having an ASD,” says Paul Shattuck, PhD,
assistant professor at the Brown School at Washington
University in St. Louis. “However, there has been no effort of a
corresponding magnitude to plan for ensuring continuity of
supports and services as these children age into adulthood.”
 WHAT HAPPENS WHEN CHILDREN WITH AUTISM
 BECOME ADULTS WITH AUTISM?
Ø Shattuck’s article in the current edition of the Archives of Pediatric and
  Adolescent Medicine describes the findings of a first-of-its-kind study of
  service use among young adults with an ASD during their first few years
  after leaving high school.
Ø He found that
    39.1 percent of these young adults received no speech therapy, mental
      health, medical diagnostics or case management services.
    the odds of not receiving any services were
          more than three times higher for African-American young adults compared with
           white young adults and
          more than five times higher for those with incomes of $25,000 or less relative to
           those with incomes over $75,000.
Ø Overall rates of service use declined significantly from high school to post-
  secondary status. Specifically
       46.9% compared to 23.5% for medical services;
       46.2% compared to 35 % for mental health services;
       63.6% compared to 41.9% for case management;
       74.6% compared to 9.1% for speech therapy.
 WHAT HAPPENS WHEN CHILDREN WITH AUTISM
 BECOME ADULTS WITH AUTISM?

Ø Shattuck notes that the years immediately following the age at
  which students typically exit from high school are pivotal for all
  young adults but especially for those on the autism spectrum.
Ø Many of the higher functioning young adults on the autism
  spectrum—typically those currently bearing the Asperger’s
  diagnosis or even some never formally diagnosed—are coming
  to college.
Ø Only recently have colleges and universities begun to consider
  the ramifications of this growing number of students on the
  autism spectrum.
 WHAT ARE OTHER COLLEGES DOING?

Ø The model college program at Marshall University in
  Huntington, WV is a support program organized by the West
  Virginia Autism Training Center that provides directed
  guidance on academics, daily living, and social interaction to
  autistic college students (Tracjtenberg, 2008).
Ø Other colleges and universities that have launched autism-
  specific support programs in the last seven years include:
 Ø Western Kentucky University;
 Ø Fairleigh Dickson University in New Jersey;
 Ø University of Arizona;
 Ø University of Alabama;
 Ø Oakland University in Michigan;
 Ø Keene State College in New Hampshire.
 WHAT ARE OTHER COLLEGES DOING?

Ø Kim Ramsey, the Marshall program's director, indicated that
  the students are intellectually capable of meeting the
  university’s academic standards but that social and daily living
  issues are interfering.
Ø In response to that, the program offers tutoring, counseling, a
  quiet space to take exams, and help in the navigation of the
  bureaucracy and social world of college, i.e. how to schedule
  classes, join clubs, buy books, and replace ATM cards that
  don't work.
ACADEMIC ASSISTANCE AND ACCOMMODATION

Ø First and foremost, students who believe they are on the
  spectrum should ask for an evaluation so they may be formally
  diagnosed and eligible for services.
Ø Second, the institution’s disability support operations and other
  student services should develop familiarity with the diagnosis
  and the particular support that is needed to achieve academic
  success. This may include, but not be limited to:
   Ø Class selection and scheduling
   Ø Social networking
   Ø Support related to executive function—understand
      requirements for and completing paperwork in a timely way,
      tracking assignments and appointments.
 CLASS SELECTION AND SCHEDULING

Ø Although students on the spectrum are expected to meet the
  school’s academic requirements, some faculty and some class
  structures may work better for them than others.
Ø Similarly, some students on the spectrum may work better in a
  situation in which they have time for decompression between
  classes.
Ø Others may do better in classes that allow for tests to be taken
  with the aid of a computer.
Ø Last, some students may need support to complete certain
  class activities including, but not limited to:
   Ø Group activities
   Ø Choosing a seat that will provide the least distraction
   Ø Public speaking.
 SOCIAL NETWORKING

Ø This is a particularly vulnerable area for many students on the
  autism spectrum.
Ø Their deficits in this area may result in loneliness and,
  eventually, they may drop out of school if their needs aren’t
  met.
Ø Schools can provide
   Ø Counseling services.
   Ø Social groups that take advantage of like characteristics or
     interests.
   Ø Educational programs aimed at improving initiation and
     maintenance of relationships.
 EXECUTIVE FUNCTION

Ø Students on the autism spectrum often have difficulty in
  tracking appointments and assignments.
Ø To assist them, schools might offer
   Ø Education in the use of smart phones for scheduling and for
     reminders. This work has proven very effective for those
     with traumatic brain injury and holds great promise for
     those on the autism spectrum.
   Ø Support for developing and maintaining a workable
     schedule that accommodates required assignments, for
     example daily or weekly check-ins.
 FOR MORE INFORMATION ON TRANSITION . . .

Ø Go to the Family Services Transition Tool Kit at the Autism
  Speaks web site.
YOUR TURN….

ØWhat other services might CWU provide to
 students on the autism spectrum?

				
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