6/9/2015. M - Mimics, Moody, Manageable. Working with young children with Autism Spectrum Disorder in the regular education preschool classroom

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1 Working with young children with Autism Spectrum Disorder in the regular education preschool classroom Wanda Bruce M.A., Early Childhood Education Ed.S., Special Education A - Alone, Awkward, Amazing U - Unyielding (resistant), Unhappy, Unique T - Tantrums, Things, Thinks in pictures I - Introverted, Inflexible, Intelligent S - Sensory, Social deficits, Sensitive (lights, sounds, changes in environment) M - Mimics, Moody, Manageable The word autism derives from the Greek word autos, meaning self, describing a condition in which a person is withdrawn from social interaction - an isolated self. A child with Autism seems to exist in his or her own world, a place characterized by repetitive routines, profound difficulty in communicating with others, and deficits in social interaction. It is defined and diagnosed behaviorally. 1

2 Autism is a complex developmental disability that typically appears during the first three years of life. It is the result of a neurological disorder that affects the normal functioning of the brain. It is defined and diagnosed behaviorally. It impacts development in the areas of social interaction and communication skills. Children with Autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism Society of America Autism is estimated to affect 1 in 68 births. It is four times more prevalent in boys than in girls. It affects 1 in every 58 boys 1% of population of children in U.S., ages 3-17, have Autism Spectrum Disorder An estimated 50 children are diagnosed with Autism every day Autism occurs in all racial, ethnic, and social groups Autism occurs on a continuum from mild to severe The Diagnostic and Statistical Manual of Mental Disorders, 5 th ed. (DSM-5) provided new criteria for Autism diagnoses (effective May 2013). The following disorders disappear: X Asperger Syndrome X Autistic Disorder X PDD-NOS (Pervasive Developmental Disorder, Not other Specified) Autistic Disorder, Asperger Syndrome, and PDD are combined into one disorder entitled Autism Spectrum Disorder A separate disorder entitled Social Communication Disorder has been added. It is not listed as a Autism Spectrum Disorder 2

3 1.) Persistent deficits in social communication and social interaction across multiple contexts Deficits in social-emotional reciprocity (failure to use back & forth conversation, failure to initiate or respond to social interactions) Deficits in nonverbal communicative behaviors for social interaction (poor eye contact, lack of facial expressions, not able to read body language) Deficits in developing, maintaining, and understanding relationships (difficulty adjusting behavior to suit social contexts, difficulty sharing imaginative play or making friends) 2.) Restricted, repetitive patterns of behavior, interests, or activities. Stereotyped or repetitive motor movement, use of objects, or speech. Insistence on sameness, inflexible adherence to routines, ritualized patterns of behavior (extreme distress at small changes, transitions, rituals) Highly restricted, fixated interests that are abnormal in intensity or focus (preoccupation with objects or interests) Hyper or hypo reactions to sensory input or unusual interests in sensory aspects of the environment. 1. Persistent difficulties in the social use of verbal and nonverbal communication Deficits in using communication for social purposes such as greetings, sharing information in a manner appropriate for the social context. Difficulties changing communication to match the context or needs of the listener. Difficulties following rules for conversation and storytelling such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal/nonverbal signals to regulate interaction Difficulties in understanding what is not explicitly stated (making inferences, idioms, humor, metaphors, etc.) There is no known cause for autism but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with Autism vs. neuro-typical children. 3

4 In many families, there appears to be a pattern of autism or related disabilities between generations, supporting a genetic basis to the disorder. Researchers have not yet identified a single trigger that causes autism to develop. The best research available does not support the theory that childhood vaccines cause autism. Though there is no single known cause or cure, autism is treatable! Children do not outgrow autism, but studies show that early diagnosis and intervention can lead to significantly improved outcomes. For many children, autism symptoms improve with treatment and with age and many grow up to lead normal or near-normal lives. Some of the world s greatest historical figures have been speculated to be on the Autism Spectrum. Albert Einstein Michelangelo Issac Newton Charles Darwin Wolfgang Mozart Adolph Hitler Early life: Diagnosed with brain damage at age 2- her mother did not accept the diagnosis Attended a structured nursery school Hired a nanny who played lots of turn-taking games Speech therapy from an early age Later life: Ph.D. in animal sciences Professor at Colorado State University and consultant to the livestock industry on animal behavior Author/speaker in both animal sciences and autism Movie made about her life by HBO 4

5 Direct observation Noting pattern of development Communication Social skills Inconsistent skills strengths and weaknesses present Behavioral concerns by parents and caregivers Repeats actions over and over again (hand flapping, etc) Has trouble adapting to changes in routine Has unusual reaction to smell, taste, look, feel, sound Extreme fascination with a particular topic Every person with Autism is an individual and has a unique personality and combination of characteristics. Infrequently looks to others' faces Gaze aversion Poor eye contact Decreased social smiling Absent facial expression Poor emotional modulation Delayed babbling Infrequent vocalizations Abnormal pattern of focus or attention Decreased orienting to name Seems to hear environmental sounds better than human voice Decreased monitoring of other's gaze Inability to follow a point Abnormalities in arousal to stimuli Infrequent babbling 5

6 Lack of or rare pointing Lack of or rare showing Delayed speech Repetitive or perseverative* play with objects Does not wave bye- bye (*Perseveration refers to the obsessive and highly selective interests of individuals on the autism spectrum.) Limited or scripted pretend play Lack of imitation Reduced variety of play acts (i.e., lining up toys rather than playing with them) Early signs of developmental regression As you look more closely at the list of red flags, you'll notice that they focus primarily on social relationships and communication skills. In typically developing children, social skills are usually consistent with other general developmental functioning. For children with delays, social development is usually consistent with the child's overall developmental age. But for children having ASDs, that is not the case. "For children who have autism (with or without coexisting global developmental delays), the development of social skills and language is more delayed and characteristically out of sync' with motor, adaptive and cognitive functioning. The discrepancy between the development of social skills and general development is one of the most important defining criteria" (Plauché Johnson, 2008, p. 87). 6

7 "It's hard to get his attention." "He seems to be in his own world." "Everything he does is on his own terms." "He completely ignores his baby sister." "He gets things by himself." "He can't tell me what he wants." "He takes my hand and pulls me to whatever it is he wants." "He repeats lines and songs from TV and videos but doesn't use words to ask for things." "He plays with all of his toys by lining them up." "He studies things very carefully." "He plays by dumping his blocks and then putting them back again - over and over." "He'll watch his favorite video over and over... and over and over and over and over again." 7

8 Persons with Autism may exhibit some of the following traits: Insistence on sameness/resistance to change in routine. Repeating words or phrases (echolalia) Laughing/crying/showing distress for no apparent reason Preference to being alone; aloof manner Not wanting to cuddle or be cuddled Little or no eye contact Toe walking Referring to self in the third person or use of a peculiar language Perseveration doing certain actions over and over again like repeating a phrase, shutting a door, lining up toys, rubbing hands together, spinning objects, etc. Repetitive motor mannerisms (hand or finger flapping or whole body movements) Hyper or hypo sensitivity to sound, touch, sight, pain Lack of spontaneous make-believe or social imitative play Restricted play repertoire (play with one particular toy, lining up objects, unusual objects straws) Doesn t understand reciprocity (give & take) Spinning objects Over-sensitivity or under-sensitivity to pain No apparent fear of real danger Uneven gross/fine motor skills Non-responsive to verbal cues; acts as of deaf, although hearing tests in normal range Limited food preferences Autistic diet chicken nuggets, crackers, chips, french fries Difficulty in knowing where body is in space Children with autism tend to be visual learners as a result of language processing problems. They think in pictures. Problems understanding language make consistency and routine very important. Transitions and changes in routine can be difficult and must be specifically addressed. Imitation is usually an area of weakness. Response to social praise may be different. Uneven patterns of development makes programming a challenge. 8

9 If you suspect a child has a developmental delay, possibly on the autism spectrum Talk to parents about specific behaviors you have observed Base comments on facts, and not opinions Please do not say you think their child might have autism Highlight some of the child s strengths and likes Telling the parents what the child does well communicates that you know and value their child If a parent approaches you with concerns Listen carefully; give the parent time to think and respond Ask if they have noticed the same behaviors you have Encourage parents to talk to their pediatrician Suggest parents make contact with the office of the Preschool Intervention Program for a possible referral for evaluation. * The Preschool Assessment team cannot make a diagnosis of Autism, but can consider Autism eligibility for Special Education services. * A child can be given Autism eligibility without an Autism diagnosis Early intervention has shown to have a dramatic impact on reducing symptoms and increasing a child s ability to grow and learn new skills. Preschool Intervention Services: Facility-based classroom (self-contained) Community-based services (regular ed. classroom) Speech therapy Occupational therapy Physical therapy 9

10 There is no single treatment protocol or combination of interventions that will meet the needs of every student with autism. Most students with ASD respond best to highly structured educational programs. Some children with ASD will need a self-contained special needs class to make progress. Many children with ASD respond well to peer models and benefit from being taught with typical peers in a regular preschool classroom. Students with Autism Spectrum Disorders benefit from an individualized educational program that is: Predictable consistent schedule Structured organized room and activities Consistently focuses on improving verbal and non-verbal communication social and behavior development Addresses sensory needs SENSORY AREAS Visual (sight) - flickering of fluorescent lights Auditory (hearing) - holding ears even when sounds are not too loud for most people Tactile (touch, feel) - doesn t like messy hands, high tolerance for pain Olfactory (smell) - hyper-sensitive to some smells Vestibular (spatial orientation) - spinning, swinging, rocking Proprioception (movement/body in space) - clumsy, difficulty with hand movements/finger plays, too little or too much pencil pressure, plays too rough, poor posture Avoid sensory overstimulation 10

11 Sensory Processing Disorder is a neurological disorder causing difficulties in taking in, processing, and responding to sensory information in the environment and from within one s own body Many children with an Autism Spectrum Disorder also have Sensory Processing Disorder but you can have one without the other The new ASD diagnosis now has a symptom hyper or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment that was not in earlier diagnostic criteria. Self-help, independence skills Poor frustration tolerance Following multi-step directions Repetitive interests Upset when other children do something wrong Upset when routines change, poor flexibility Difficulty initiating/engaging in social play Limited language/echolalia(repeating what is said) Generalization of academic skills Melissa Katz, Ph.D., Intervention Toolbox for Including Children with Autism into Preschools 1. Incidental teaching teachable moments 2. Visual supports helps with attention, sequencing, compliance, transitions, changes it promotes independence, takes focus off staff 3. Social/scripted stories book format to teach appropriate social skills, solve social problems 4. Modeling showing the student what you want him/her to do (peer modeling using peers to provide the model) 5. General behavior techniques providing positive reinforcement for appropriate behavior, ignoring inappropriate behavior, praise appropriate behavior of others in same proximity 11

12 Picture Schedule First/Then Work Tasks Picture Choice Snack choice Recipe Scripted Stories for Social Situations (Social Stories) help children understand social interactions, situations, expectations, social cues, the script of unfamiliar activities, and/or social rules. As the title implies, they are brief descriptive stories that provide information regarding a social situation. When children are given information that helps them understand the expectations of a situation, their problem behavior within that situation is reduced or minimized. Tucker Turtle Takes Time to Tuck and Think What Do We Do In Circle? 12

13 Center on the Social and Emotional Foundations for Early Learning Go to bottom of page For Teachers/Caregivers Scripted Stories Tucker Turtle Takes Time to Tuck and Think What Do We Do In Circle? I Can Be a Super Friend! Provide a predictable and consistent classroom schedule Use visual cues throughout the day Picture schedule First/Then Work Tasks Scripted Stories Keep transitions minimal and routine Provide 5 and 2 minute warnings before transitions Always notify the group when a change in routine is to occur use visuals if possible Use concrete language and short statements Provide instruction in small sequential steps Provide immediate and consistent feedback 13

14 Encourage choice making Allow extra processing time Don t demand eye contact Provide a peer model/ buddy Be aware of the sensory environment Avoid over-stimulating activities Be patient Stay positive! In order for an individual to develop better social/language skills they need to experience interaction with individuals that are more socially competent and that provide good language models. A typical preschool program can be a good choice for inclusion for an autistic child if he is mild to moderately affected by autism and the setting is supportive. 14

15 Earn Professional Development Certificates through Autism Internet Modules (AIM). Certificates verify your participation and completion of modules. There is a minimal cost. You can also earn graduate credit on-line for the courses through a participating university. Check it out at: Espe-Sherwindt, M. (2012). ASD-4-EI: Online training module. In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, Columbus, OH: OCALI. Autism Society of America, (2008) About Autism. CDC Fact Sheet (2010) Autism Information Center, Centers for Disease Control Espe-Sherwindt, M. (2012). ASD-4-EI: Online training module. In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, Columbus, OH: OCALI. Hart, C. (1993) A Parent s Guide to Autism, Pocket Books Koczewska,D. (2008). An Overview of Autism, Behavior Advisor.com Katz, Melissa. Intervention Toolbox for Including Children with Autism into Preschools, Children s Hospital and Health Center, San Diego, CA Levy, S. (1987) Myths and Facts about Autism, Indiana Resource for Autism, Indiana University McAfee, J. (2001) Navigating the Social World, A Curriculum for Individuals with Aspergers, High Functioning Autism and Related Disorders, Future Horizons. Pendergast, R. (2009), Autism Q & A, Just Kids, Atlanta s Guide to Special Needs Powers, M, Ed., (1989) Children with Autism: A Parent s Guide, Woodbine House Robins, D., Fein, D. & Barton, M. (1999) Modified Checklist for Autism in Toddlers (M- CHAT). Ezrine, et al., (2010) Autism: Practical Strategies and Solutions PPT presentation, Cherokee County School District. 15