Autism Academy

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					Autism Academy
Autism Academy
 Session One: Characteristics
Session 1 Agenda
• Core Triad of ASD Characteristics
  – Impairments in social interaction
  – Impairments in communication
  – Restricted, repetitive, and stereotyped
    patterns of behavior, interests, and
    activities
• Additional learning characteristics
• Theory of Mind
                                              3
What is ASD
• The term autism spectrum disorders (ASD) is
  used to describe a collection of disabilities
  that share similar characteristics.
• Generally, ASD is interchangeable with the
  term pervasive developmental disorders
  (PDD), a category of disorders defined in the
  Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV-TR; American Psychiatric
  Association [APA], 2000).


                                              4
The PDD Umbrella
(a) Autistic disorder,
(b) Asperger disorder,
(c) Rett’s disorder,
(d) childhood disintegrative disorder, and
(e) Pervasive developmental disorder, not
    otherwise specified (PDD-NOS)



                                         5
 Brief History of Identification of
 Autism Spectrum Disorders (ASD
• Leo Kanner (1943), an American psychiatrist, wrote in-depth
  case studies of 11 children with characteristics that would fit
  the current definitions of autism, and that he believed
  comprised a disorder unique from others including mental
  retardation and schizophrenia. He called this disorder early
  infantile autism. The characteristics included (a) difficulties
  relating to others, (b) language delays, such as inability to
  develop speech, echolalia, and literal interpretation of
  language; and (c) unusual behaviors, such as obsessions,
  insistence on routine and sameness, and self-stimulatory
  behaviors. Kanner’s work sparked interest in the disorder
  and lead to further research on characteristics and
  treatment.
• At about the same in Germany, Hans Asperger (1944)
  described children who demonstrated social deficits similar
  and maybe milder than those in children with autism, but
  who had average or better cognitive functioning. Asperger’s
  work was largely ignored outside of Germany until recently .
                                                                6
Prevalence
• Current estimates of prevalence of autism
  is estimated to be one in every 91 children,
  a significant increase from the previous 2007
  estimate of one in 150. (Centers for Disease
  Control Prevention, 2009)
• That currently translates to about 673,000
  American children with some form of
  autism.
• Approximately 44-67% of children with
  autistic disorder also have mental
  retardation
• The ratio is 4 boys to every girl diagnosed
  with ASD (some studies 2.2 boys to every
  girl)
                                                  7
Characteristics Activity
•   Social Skills
•   Communication Skills
•   Repetitive Patterns of Behavior
•   Sensory Issues




                                      8
Overview of Autism
The definition of autism, or autistic disorder as it is
referred to in the DMS-IV-TR (APA, 2000), describes
 individuals with impairments that are evident prior
 to 36 months of age. Those diagnosed with autism
    are on the more severely impaired end of the
  spectrum and many also have mental retardation
              (Simpson & Myles, 1998).
   Impairments in autism can be described within
        three categories: (a) social skills; (b)
  communication; and (c) repetitive, restrictive, and
                stereotyped behavior.
Social Skills
• They may have deficits or differences in nonverbal
  communication skills, such as use of eye contact, body
  language, gestures, and facial expressions. While they
  may use some eye contact, it is not as frequent or
  sustained \ as in their typical peers (Janzen, 2003). Some
  children with autism do not appear to notice others, failing
  to look at or initiate contact with others.
• The often do not build relationships with others their age
  at a level expected considering their overall development.
• They rarely share attention with others, such as by
  showing something, pointing, or pointing out interests or
  accomplishments.
• They do not demonstrate emotional reciprocity. They
  infrequently take turns in play or conversation (Janzen,
  2003). For example, typical 18-month-olds spontaneously
  hold out food for their caregivers to share a bite, but
  children with autism have to be directly taught to do so.
  They also rarely spontaneously imitate the actions of
  others in play or otherwise.                               10
Communication Skills
• They may have delayed speech, or no speech at all,
  make no effort to make up for these deficits with
  nonverbal communication (APA, 2000). Instead of
  compensating for their lack of expressive speech
  through gestures, individuals with ASD use fewer
  gestures and those they use are limited in function
  (Ogletree, 1998).
• Those who speak are unable to open or keep
  conversations going (APA, 2000).
• They frequently engage in repetitive or stereotypic
  speech or vocalizations, such as echolalia (APA,
  2000). Echolalia, repeating utterances of others, is
  common in students with autism (Janzen, 2003).
• They may lack pretend play of the same quality,
  quantity, and variety of their same-age peers (APA,
  2000).
                                                     11
Specific Communication
Differences
• Generally, across the spectrum, the higher a
  child’s measured IQ, the better his or her
  language skills are; however, some
  individuals with lower IQs demonstrate
  normal language skills (Kjelkaard & Tager-
  Flusberg, 2001).
• While articulation skills may not be impaired,
  content and grammar frequently are delayed.
  Specifically, many children with autism have
  a rigid understanding of words (Janzen,
  2003). They may have difficulty with the
  concept that objects can have more than one
  name and that words may have more than
  one meaning.
                                               12
Restrictive, Repetitive, and
Stereotyped Behavior
• They may have an unusually strong or focused
  interest or fixation.
• They may be overly drawn to routines and rituals
  and be unable or unwilling to be flexible in adhering
  to these routines.
• They may demonstrate repetitive complex body or
  other motor movements, such as spinning, rocking,
  or finger flicking. These self-stimulatory behaviors
  may occur so frequently that they interfere with
  engagement in productive activities and may take up
  the majority of a child’s waking hours if allowed
  (Simpson & Myles, 1998).
• They may show intense interest in parts of objects,
  as opposed to using the entire toy or object (APA,
  2000).                                                13
Overview of Aspergers
Asperger Syndrome (AS), called Asperger disorder
 in the DSM-IV-TR, is similar to autism, except that
individuals with AS do not demonstrate the severe
   impairments in speech and language evident in
     those with autism (APA, 2000). That is, they
  generally speak in one-word utterances by age 2
    and phrases by age 3, but they do have socio-
      communicative impairments. In addition,
 individuals with AS are rarely also diagnosed with
  mental retardation. Impairments characteristic of
  AS fall within two categories: (a) social skills and
(b) repetitive, restrictive, and stereotyped behavior.
   Social Skills
• As in autism, children with AS may have deficits or
  differences in nonverbal communication skills, such as
  use of eye contact, body language, gestures, and facial
  expressions (APA, 2000). Janzen (2003) has noted that
  individuals with AS frequently have difficulty using and
  interpreting communication that involves nonverbal cues
  or paralanguage. They take others’ speech literally and
  have difficulty interpreting tone of voice (e.g., sarcasm,
  humor) and body language (e.g., facial expressions of
  boredom or confusion), often mistakenly basing their
  understanding solely on the words spoken.
• They often do not build relationships with others their
  age to the extent expected based on level of
  development (APA, 2000). Many individuals with AS
  desire socialization, but have difficulties understanding
  social situations (Janzen, 2003). Specifically, they may
  not comprehend others’ points –of –view, and find it
  difficult to determine social responses to fit a wide      15

  variety of situations (Myles & Simpson, 2002).
Social Skills
• They rarely share attention with others, such as by
  showing something, pointing, or pointing out
  interests or accomplishments (APA, 2000; Janzen,
  2003).
• They do not demonstrate social reciprocity (APA,
  2000). That is, students with AS may learn to initiate
  greetings and conversations, but lack the ability to
  extend such interactions (Myles & Simpson, 2002).
  They may conduct one-sided conversations,
  monopolizing or failing to contribute to
  conversational turn-taking (Myles & Southwick,
  1999). Young children with AS often seem
  uninterested in or unable to participate in play with
  peers (Attwood, 1998). They tend to boss other
  children around or get angry when the others do not
  play according to their rules.                         16
Repetitive, Restrictive, and
Stereotyped Behavior
• They may have an unusually strong or focused
  interest or fixation. Myles and Simpson (2002) have
  noted that in those with AS, these interests may
  seem similar to those of same-age peers, but differ
  in intensity, extent of knowledge, or interest in the
  topic to the exclusion of other interests.
• They may be overly drawn to routines and rituals,
  and be unable or unwilling to be flexible in adhering
  to these routines (APA, 2000).
• They may demonstrate repetitive complex body or
  other motor movements, such as spinning, rocking,
  or finger flicking. However, this is thought to occur
  less often in those with AS compared to those with
  autism.
• They may show intense interest in parts of objects,
  as opposed to using the entire toy or object.
                                                          17
Overview of PDD NOS
       Children are diagnosed with pervasive
 developmental disorders, not otherwise specified
 (PDD-NOS) when they do not meet enough of the
  criteria for specific ASD, but demonstrate some
similarities to others on the autism spectrum (APA,
   2000). Thus, these children are an especially
                heterogeneous group.
Additional Learning
Characteristics
In addition to the criteria specified in the DSM-
    IV-TR (APA, 2000), students with autism
    spectrum disorders (ASD) may display a
    wide variety of other learning characteristics
    (Janzen, 2003; Simpson & Myles, 1998)
    that can be described under the following
    categories:
(a) general cognitive and academic functioning,
(b) attention,
(c) generalization,
(d) visual thinking, and
(e) problem solving.                             19
Attention
• Many individuals with ASD display difficulties
  in attention (Janzen, 2003). Specifically, they
  have difficulty regulating attention, similar to
  individuals with attention deficit hyperactivity
  disorder (Myles & Southwick, 1999).
  Examples include
   – daydreaming
   – difficulty completing complex directions due to a
     loss of focus in the early stages of the task In
     addition,
   – may not be able to easily shift attention between
     two items.                                          20
Generalization
• Individuals with ASD often have trouble
  generalizing information to new settings,
  people, and materials as a result of
  difficulties organizing information
  meaningfully (Janzen, 2003; Simpson &
  Myles, 1998). Consequently, tasks mastered
  in only one teaching environment are not
  automatically demonstrated in others.
  Therefore, academic planning should include
  specific attention to ensuring generalization
  takes place.
                                              21
Problem Solving
• Students with ASD have difficulty with the flexible
  thinking involved in solving problems (Janzen, 2003).
• They find it challenging to creatively generate a
  variety of options, think about multiple pieces of
  information at once, and evaluate possibilities.
• Often, when students with AS have learned a solution
  to a problem, they continue to try that solution even if
  it does not work (Myles & Southwick, 1999).
• Even when they have learned multiple solutions to
  problems through discussion and role-play, the have
  difficulty retrieving or generalizing them to authentic
  situations.
• These deficits in problem solving extend to
  academics, involving problems such as with math
  word problems and estimation.                            22
Pop Quiz
1. Current prevalence studies estimate a
   rate of approximately _______ births.
  A. 1:150
  B. 1:91
2. Impairments in autism are generally
   described within which of the following
   categories:
  A. Communication, motor, social skills
  B. Social skills, communication, repetitive
     restrictive stereotypical behavior
                                                23
Pop Quiz
3. Self-stimulatory behaviors include:
     A. Spinning
     B. Not making eye contact
4. Individuals with ASD often have intense
     interests that are unusual in terms of:
     A. Topic Area
     B. Extent of knowledge
5. Specific difficulties related to attention are
     found in individuals with ASD include:
     A. Stimulus under-selectivity
     B. Difficulty regulating attention

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Case Study Activity
•   Christopher: Autism Social
•   Teddy: Autism Communication
•   Reese: Autism Repetitive Movements
•   Mari: Autism Repetitive Movements
•   Jiro: Asperger Social Skills


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Theory of Mind




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Theory of Mind
• Individuals with autism spectrum disorders (ASD) exhibit
  challenges in difficulties regulating behavior,
  understanding others’ perspective and using correct
  social skills.
• These difficulties across domains (cognitive, behavioral,
  social, and emotional) may manifest in many different
  ways:
   – being naive and a target for bullying or teasing,
   – not understanding emotions,
   – being extremely literal and missing abstract content,
   – having a limited ability to regulate behavior based on what others
     are doing or saying, and
   – having difficulty understanding nonverbal behavior.
• As toddlers, typically developing children begin to develop
  the ability to take another person’s perspective, to
  understand that others have separate thoughts, desires
  and beliefs, and to modify their own behavior by taking
  into account what others might be thinking or feeling. In
  the field of special education and psychology these skills
  and abilities have been called ―theory of mind.‖           27
What is theory of mind
• Richard (2000) defined theory of mind (often
  referred to as TOM or ToM,) as ―the ability to
  understand how other people think and feel‖
  (p. 131). Howlin, Baron-Cohen and Hadwin
  (1999) defined theory of mind in a more
  complex manner as ―the ability to infer other
  people’s mental states (their thoughts,
  beliefs, desires, intentions, etc.), and the
  ability to use this information to interpret what
  they say, make sense of their behavior and
  predict what they will do next‖
                                                  28
Theory of Mind Challenges
• insensitivity to other people’s feelings
• inability to take into account what other people know
• inability to negotiate friendships by reading and
  responding to intentions
• inability to read the listener’s level of interest in one’s
  speech
• inability to detect a speaker’s intended meaning
• inability to anticipate what others might think of one’s
  actions
• inability to understand misunderstandings
• inability to deceive or understand deception
• inability to understand the reasons behind people’s
  actions
• inability to understand ―unwritten rules‖ or conventions
  (Howlin, Baron-Cohen, & Hadwin, 1999, p. 9-11)
• Difficulty explaining and predicting the behaviors and/
  or emotional states of themselves and others                29
Theory of Mind Challenges
• Problems understanding the perspectives of others
• Lack of understanding that behavior impacts how
  others think and/or feel
• Problems with joint attention and other social
  conventions
• Problems differentiating fiction from fact
  (Myles & Southwick, 1999 p. 8-11)
• Difficulty understanding pretending and deception
• Failure to understand social interaction, leading to
  difficulties with turn-taking, poor topic maintenance in
  conversation, and inappropriate use of eye-contact
• Difficulty taking into account what other people know or
  can be expected to know, leading to pedantic or
  incomprehensible language
• Limited sharing of attention, leading to idiosyncratic
  reference
  (Cumine, Leach, & Stevenson, 1998, p. 21-22)             30
Theory of Mind Challenges
• Many individuals with ASD think that what
  they are thinking and feeling is what
  everyone else is thinking and feeling.
• They may not understand that others have
  separate thoughts and feelings and that
  others are able to access to same
  information in the environment as they are.
• It may be difficult for those with ASD to take
  others’ perspective. In fact, because of their
  often literal thinking, the phrase ―put yourself
  in someone else's shoes‖ could leave some
  individuals with ASD bewildered, pondering
  how they could put the other person's shoes
  on their own feet.
                                                     31
Theory of Mind Components
• Step 1: inferring what another person is
  thinking, feeling, etc., by the external
  behavior that you see
• Step 2: predicting the future behavior of
  that or other individuals based on your
  inference of their mental state
• Step 3: changing/modifying your own
  behavior based upon the judgments
  that you made
                  Twachtman-Cullen (2000)
                                          32
The degrees of Theory of
Mind
• First-order belief is when you can
  describe what another person is
  thinking about actual events.
• Second-order belief is when you can
  understand what another person is
  thinking about another person’s
  thoughts.
• Higher-order belief is when you are
  able to think about what others think
  about what you are thinking about your
  own thoughts.                            33
What Is Mindblindness?
• Baron-Cohen (1995) uses the term mindblindness to
  explain why individuals with ASD have an impaired
  ability to read minds. Baron-Cohen postulates that a
  specific part of the brain that is typically responsible
  for mind reading is impaired in children with ASD.
• Powers (2003) interprets mindblindness as ―an
  inability to put oneself in the place of another and to
  see things from another person's perspective‖ (p. 11-
  12). He adds that developing a theory of mind
  ―enables the child to perceive reality from another's
  perspective … to feel empathy, to identify with
  another's feelings and point of view, and to
  understand that others don't know everything that
  the child knows. It also makes it possible for the child
  to understand pretense, sarcasm, deceit, and certain
  kinds of humor‖ (p. 11-12).                              34
Example
• A student named Johnny is walking down the street.
  He sees a group of four older boys on the other side
  of the street. They are staring at Johnny, pointing as
  well as talking to each other. After a few moments
  the boys begin to cross the street towards Johnny.
• Now, many people would have turned and gone in
  the other direction before the four thugs crossed the
  street and possibly hurt them. But it would take some
  mind reading ability to infer that since the boys were
  talking and looking at you that they might want to do
  something to you. Otherwise Johnny could just
  interpret the goings-on as a description: Four boys
  are walking down the street. They are looking at me.
  They are pointing at me. They are crossing the street
  and getting closer to me—without interpreting the
  possible intent of the four boys.

                                                       35
How Does Theory of Mind
Develop?
• By one year of age babies can detect the presence of
  eyes, tell when they and others are attending to the same
  thing, and read actions as goal directed or driven by
  desire. Toddlers can both pretend and understand
  pretense by others. (Baron-Cohen, 1995)
• Around age four, youngsters are able to work out what
  others might know, think or feel. They pass first-order
  theory of mind false belief tests. That is, they understand
  what others think about actual events. Around age six,
  children are able to understand second-order belief. That
  is, they understand ―Kathy thinks that Roger thinks …‖
  (Baron-Cohen, 1995; Perner & Wimmer, 1983; Wimmer &
  Perner, 1985)
• Between the age of seven and adolescence, children
  begin to learn and master the concepts of faux pas, irony,
  humor, sarcasm, and nonverbal body language (some of
  these skills are taught, not just picked up naturally).
  (Twachtman-Cullen, 2000)
                                                            36
Why is Theory of Mind
Important
• Theory of mind ability has ramifications in a
  wide range of areas including language,
  social skills, behavior, and perspective
  taking. Obviously, for students with an
  impaired ability to take another’s perspective
  or to think what others might be thinking or
  feeling, behavior will be affected. So the day-
  to-day inability or impaired ability to mind
  read can have continuing and severe
  consequences.

                                                37
Pop Quiz
1.   A simple definition of theory of mind might be:
     A. a way of regulating body temperature
     B. understanding how others think and feel
2. Which of the following is/are possible experiences of
     individuals who have an impaired theory of mind?
     Difficulties:
     A. predicting the future behavior of self or others
     B. listening to others
3. Mindblindness is a term that describes individuals who
     have difficulty:
     A. seeing
     B. understanding the thoughts and feelings of others
4. By age four, typically developing children can…
     A. solve first-order theory of mind tests
     B. solve very abstract problems

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