Outline Chapter 21
Autism Spectrum Disorders
Definition: It is a neurological disorder impacting the areas of social engagement, language, sensory processing and restricted interests. It is lifelong.
Data: 1 in 68 children, more prevalence in boys (1 in 42) than girls ( one in 189). Occurs in all racial, ethnic, and socioeconomic groups.
Other factors: suffer from gastroenterological distress ( constipation, diarrhea, reflux). There are no medications, diets or nutritional supplements that cure autism.
Risk Factors: Parents who have a child with ASD have a 2%–18% chance of having a second child. Prevalent in certain genetic conditions. Children born to older parents are at a higher risk.
• Diagnostic criteria categories
a) Differences in joint attention and social engagement
b) Differences in sensory processing and need for sameness
(Child must have deficits in each area in order to receive full diagnosis, not caused due to another disability and they should be evident early in life)
Other developmental disabilities with some of the characteristics of Autism:
Anxiety disorder
Obsessive-compulsive disorder
Attention deficit disorder
Intellectual disability
• Levels of diagnosis
1) Level 1- requires support
2) Level 2- requires substantial support
3) Level 3- requires very substantial support
Typical/Atypical development
Social engagement/don’t like to be held
Eye contact/lack of eye contact
Smiles/low affect
Cooing in response to caregiver interaction/no response to social approach
Joint attention/lack of interaction
Pointing to objects/not interested in objects
Vocalizing and looking at adult/lack of reciprocal interaction
Back and forth conversations/no response to conversation
Turn taking/no social connections
Sharing /not sharing, challenging behaviors
Expansion of play, imitating others/self-absorbed
Problem solving actions/challenging behaviors
Play skills/stereotypical use of objects ( lining, spinning)
Peer play and interaction/unaware of peers and/or move away from peers
Parallel play/fail to understand rules of social interactions
Development of language/ lack of spoken language ( sometimes echoing or words have no connection to the conversation)
Sensory processing
Issues with responses to sensory input from visual, auditory, taste, smell, tactile, proprioceptive (position of body parts in relation to one another), and vestibular (sensors in the inner ear about gravity and movement) senses.
Oversensitive or hyposensitive
Lethargic and non-responsive or constantly in motion ( spinning, flapping, staring, crashing, bumping)
Sensory Needs
Need to maintain routines
Need to have objects in the same place
Need repetitiveness of activity
Need to use objects in the same way
Need continuity of patterns
Need to focus only on one thing ( difficulty in transitioning)
Difficulty in motor planning ( steps sequences)
Interventions for support of sensory integration challenges
With the support of an OT, create a sensory diet (a carefully designed, personalized activity plan that provides the sensory input a person needs to stay focused and organized throughout the day)
Arrange environment to support child’s sensory style and challenges
Early Intervention and services must include:
Focus on building skills in joint attention, imitation, language comprehension, speech development, social interactions, development of play.
Intentional teaching environment with generalized strategies .
Build on predictability and routines
Supportive techniques to decrease challenging behaviors.
Transition plan from early intervention services to preschool and from preschool to kindergarten
Supportive guidelines for family
Adequate intensity of interventions based on developmentally appropriate assessments
Focus on building independence, initiative, and turn taking
Interventions for support of the development of language
1) To teach pragmatics or social rules to communicate-> directly show how to get individual’s attention, take turns during a conversation, ask for help, read other’s cues, give and accept compliments. Use modeling, role play, and visuals
2) To decrease echolalia-> work on modeling scripts for different types of conversations, expand vocabulary.
3) To provide functional spoken language for non-verbal children-> develop an augmentative communication system ( sign language, laminated pictures, computer devices)
Use of DIR (developmental, individualized, relationship-based approach)->individualized goals, understanding child’s needs and learning styles. Focus on “floortime” approach.
Floortime session in the natural environment includes:
a) Multiple brief sessions
b) Goal-oriented play
c) Follow child’s lead
d) Open and expand circles of communication
Floortime main goals are:
1) Attention
2) Engagement
3) Intimacy
4) Two-way communication
5) Logical thinking
6) Ability to express feelings
Interventions for support of the development of social skills
Develop spontaneous reciprocal interactions
Support their experiences and encourage to engage with other people
Provide concrete information about social rules
Help them feel comfortable in the proximity of others
Help them to observe and imitate actions
Help them engage in parallel play
Help them to initiate interactions and responses through modeling
Behavioral Interventions
ABA ( applied behavioral analysis)- discrete trial training. It includes
a) Analysis of the skill to determine steps to teach
b) Teaching the skill by prompting, waiting for response
c) Reinforcement of response
d) Recording data
e) Repeating process to practice
f) Off –task behaviors are ignored or redirected
Techniques to improve child’s behavior:
1) Use Time to Decrease Transitional Tantrums
2) FIRST/THEN: first we clean, then we go outside
3) Reward positive behavior
4) Focus on what you want the child to do, not what you want them to STOP doing.
5) Remain CALM
Functional Behavior Assessment: it leads the observer beyond the “symptom” (the behavior) to the underlying motivation for it.
1) describes and defines the target behavior in specific, concrete terms
2) collects information on possible functions of the target behavior
3) categorize behavior—Is it linked to a skill deficit or a performance deficit?
4) analyze information to form a hypothesis
5) determine interventions
Picture Exchange Communication System (PECS)
Pivotal Response Training
Derived fromABA, it is play based and child initiated. Uses natural reinforcers ( no food)
The goals are:
Respond to multiple cues
Be motivated
Self-management
Self-initiation of social interactions
Social stories: individualized to describe social situations to give appropriate ways to respond
Social Skills trainings:
Teaching basic social concepts, role playing, practice communication, promote positive interaction with peers.
Visual Supports:
Provides information about activities, routines, appropriate behaviors, reminders, transition cues.
Relationship between parent and providers
Be honest about observations
Listen with empathy to their concerns
Check for understanding
Refer for further evaluation
Emphasize child and family’s strengths
Develop a plan to meet outcomes along with family
Provide community resources
Classroom techniques:
• Allow the child to sit in a rocking chair or beanbag chair. Rocking provides comforting sensory input. The pressure of the beanbag chair on the child’s body calms and focuses the child.
• Consider using this time for a meaningful activity such as playing in another center with the instructional aide.
• Develop and use symbols, pictures, icons, or sign language to cue the child for particular circle time activities.
• Keep noise levels down. Use quiet music rather than loud music.
• Adapt movement activities by making them less rowdy and more controlled, and sing in soft voices or even a whisper.
During art center activities place thick paint, mustard, or ketchup in a zip closure baggie. The child then can use his finger or a popsicle stick to draw designs over the surface.
Child might first look and smell, or watch the teacher and other children play with the materials.
Use hand-over-hand assistance.
Allow him to stand at the art table to work.
For the block area, provide the child with the opportunity to play with blocks in another area of the room that seems “safe” to the child. This safe area might be inside a large box that the child is already familiar with.
Cardboard blocks fall more quietly than wooden or plastic blocks.
Use pictures to communicate.
Counting as the child builds a tower with blocks helps the child stay focused on the activity.