Download autism - Talking Life

GERRY BROPHY
TALKING LIFE
AUTISM
GROUND RULES
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Confidentiality
We have the right to make mistakes
and not know things
Take responsibility for your learning by
asking questions and giving feedback
Allow others to have their say,
challenge the views not the person
You can leave the room at any time,
without explanation
AIMS
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What is Autistic Spectrum Disorder(ASD)
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How does ASD impact on individuals?
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How these conditions can affect behaviours
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What support is needed in order to lead fulfilling lives.
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What communication tools can be used with people who
are autistic?
FULFILLING AND REWARDING LIVES FOR
ADULTS WITH AUTISM
The guidance focuses on 4 important areas where
health and social care can practically change the
way they support adults with autism:
 increasing understanding of autism amongst staff
 strengthening diagnosis and assessment of needs
 continuing to improve transition support
 ensuring adults with autism are included within
local service planning
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WHAT ARE AUTISTIC SPECTRUM DISORDERS
Life long developmental disabilities caused
by neurobiological dysfunction that typically:
Appears during first three years of life and
prevents individuals from properly understanding what
they see, hear and sense.
This results in problems in communication,
social relationships, and behaviour.
Causes
Theories about the causes of autism have changed markedly
over the years.
Many professionals, believed that inadequate parenting was
the primary culprit.
Recent increases in the numbers of children diagnosed with
autism have also led to a search for possible environmental
causes.
However, there is no evidence that environmental factors such
as vaccinations (notably the MMR vaccine), pollutants, dietary
additives, and so on, are in any way responsible.
CAUSES contd.
The causes of autistic spectrum disorder are not clearly
understood but include genetic factors, chromosomal
abnormalities, complications of pregnancy and child
birth leading to organic brain damage.
The condition is associated with epilepsy in up to 30% of
cases.
Pervasive Developmental Disorders
Asperger’s Syndrome
Autism
PDD – Not Otherwise Specified
Rett's Syndrome
Childhood Disintegrative Disorder
What differentiates?
•Number of characteristics
•Age of onset
•Genetic factors
•Pattern of behaviors
•A certain diagnosis does not mean a “lesser” set of
concerns, this does not address severity of any behavior.
ASPERGER'S SYNDROME
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First described in the 1940s
Most people with Asperger's syndrome are
within the normal range of intelligence but may
have difficulties with social interaction and a
restricted range of activities and interests.
 Their speech can be well developed and fluent
but language may be used in unusual ways.
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Rett syndrome
Typically, children with Rett syndrome begin by developing fairly normally but
go through a period of regression, losing acquired skills; this can be
accompanied by distress and anxiety.
At least one in every 10,000 females born has Rett syndrome.
It is believed to be the second most common cause of severe and profound
learning disability in girls.
A large proportion of people who have Rett syndrome have a mutation, or
fault, on the MECP2 gene on the X chromosome.
There are substantial communication and mobility issues for people with
Rett syndrome. Most will not speak and, by adulthood, only 50% will walk.
However, we are increasingly aware of people with Rett syndrome living well
into their 50s and beyond.
Childhood disintegrative disorder (CDD)
Also known as Heller's syndrome and disintegrative psychosis, is a rare
condition characterized by late onset (>3 years of age) of developmental delays
in language, social function, and motor-skills.
No known cause for the disorder.
CDD has some similarity to autism, and is sometimes considered a lowfunctioning form of it, but an apparent period of fairly normal development is
often noted before a regression in skills or a series of regressions in skills.
Some children describe or appear to be reacting to hallucinations, but the
most obvious symptom is that skills apparently attained are lost.
Triad of Impairments
Social
Relationships
Social
Communication
ASD
Rigidity of Thought,
Behaviour and Play
(Social Understanding)
COMMUNICATION
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Some may not use spoken language to communicate, and
may use non-verbal means instead, e.g. pushing, biting,
squealing, crying.
May not understand subtle conversational clues e.g. facial
expressions indicating surprise, anger etc. and may
therefore not know to look contrite.
May have difficulties with concepts e.g. more / less, time
(including the need to wait)
Inability to ask questions to establish another persons view
point, but may ask repetitive questions e.g. What's your
name?
COMMUNICATION
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Some may use unusual intonation with stereotypical, stilted
speech (or a sing-song intonation pattern)
May have a very literal understanding of speech - therefore
may fail to follow instructions
Repetition of chunks of language heard in other
situations/videos - may sound clumsy or odd
Social Relationships
• may display general awkwardness in social
situations
• May be unable to interact appropriately with peers
• Difficulty in making friends – may initiate and want
social contact, but lack understanding and skills to
carry through
• Unusual facial and/or physical gestures (smiles,
grimaces, eye-contact)
Social Relationships
• Problems with social “distance”
• may have difficulties with conventional turn-taking and
sharing. May start/finish conversations abruptly or fail to
answer appropriately.
•may not see themselves as a part of group
• Motivation – may not be rewarded by success at tasks
(They
are not being lazy or obstinate!)
RIGIDITY OF THOUGHT, PLAY AND BEHAVIOUR
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May find activities difficult when imagination or pretend
skills are needed, e.g. home corner, role play games
Difficulty coping with adult direction and imposed routines
Difficulties with understanding changes in routine and new
situations
RIGIDITY OF THOUGHT, PLAY AND BEHAVIOUR
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Some exhibit fixed interests and may become
obsessional about these
Attentional problems on tasks chosen by others
Difficulties with problem solving, e.g. finding an
item that is not in its usual place
Seeing 'part' rather than 'whole' - not the 'bigger
picture‘, e.g. focusing on a specific part of a picture
Rigidity of thinking and behaviour
Perseveration - the need to repeat words, actions,
activities etc
DIAGNOSTIC MANUALS
INTERNATIONAL CLASSIFICATION OF DISEASES
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The ICD-10 is the most commonly-used diagnostic manual in
the UK.
It presents a number of possible autism profiles, such as
childhood autism, atypical autism and Asperger syndrome.
These profiles are included under the Pervasive Developmental
Disorders heading, defined as
"A group of disorders characterized by qualitative
abnormalities in reciprocal social interactions and in patterns
of communication, and by a restricted, stereotyped, repetitive
repertoire of interests and activities. These qualitative
abnormalities are a pervasive feature of the individual's
functioning in all situations".
A revised edition (ICD-11) is expected in 2018 and is likely to
closely align with the latest edition of the American Diagnostic
and Statistical Manual (DSM).
DIAGNOSTIC TOOLS
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The DSM and ICD-10 criteria create the foundation for
diagnostic tools such as the DISCO (Diagnostic Interview
for Social and Communication Disorders), the ADIR (Autism Diagnostic Interview - Revised), and
the ADOS (Autism Diagnostic Observation Schedule).
These, and other diagnostic tools, are used to collect
information in order to help to decide whether someone is
on the autism spectrum or not. The criteria form the basis
for the diagnosis, but the individual clinician’s judgement
is crucial.
The DISCO diagnostic tool does not rely on the algorithms
for ICD-10 and DSM-5. The approach is dimensional rather
than categorical. The DISCO not only gives a diagnosis but
gives an understanding of the profile and needs.
Beyond the Triad of Impairments
The Sensory World of Autism
• Senses provide us with the unique experiences which
allow us to interact & be involved with others
• Senses play a significant role in determining our
responses to a particular situation
• Many individuals with autism experience either an
intensification or absence of sensory integration
Hyper—
Hypo—
The Sensory World of Autism
The Five Senses
• Touch (includes balance and body awareness)
Tactile: relates to touch ,pressure, pain, hot/cold
Hypo-
Hyper-
Holding others tightly
High pain threshold
Self-harming (biting, gouging etc.)
Finds touch painful/uncomfortable
(Social aspect)
Sensitivity to certain clothing/textures
Dislike of having things on hands/feet
The Sensory World of Autism
The Five Senses
• Touch (includes balance and body awareness)
Vestibular: informs where body is in space
Hypo- The need for rocking, swinging, spinning
Hyper- Difficulties in activities which include
movement (sport, dance)
Difficulties in stopping quickly or during an activity
The Sensory World of Autism
The Five Senses
• Touch (includes balance and body awareness)
Proprioception: where & how body is moving
Hypo- Proximity – personal body space in relation to
others.
Navigating rooms – avoiding obstructions.
Hyper- Fine motor difficulties, manipulating small objects
(buttons, threading, shoe laces etc).
Moves whole body to look at something.
The Sensory World of Autism
The Five Senses
• Sight
Visual: helps to define objects, colours, space
Hypo- Peripheral vision (central vision blurred)
Poor depth perception (throwing/catching)
Hyper-Fragmentation of images (too many sources)
Focussing on particular detail (rather than whole).
The Sensory World of Autism
The Five Senses
• Hearing
Auditory: informs about sounds around us
Hypo- Partial or complete absence of hearing
Enjoys noisy places/activities (bangs things)
Hyper- Magnification or distortion of sounds
Unable to filter out external sounds
The Sensory World of Autism
The Five Senses
• Smell
Olfactory: Is the first sense we rely on
Hypo- May be oblivious to strong odours
May lick things indiscriminately
Hyper- Smells appear intensified/overpowering.
Toileting problems
The Sensory World of Autism
The Five Senses
• Taste
Gustatory: Informs about various tastes
Hypo- Likes very spicy/salted foods
May eat anything (soil, grass, material etc)
Hyper- Prefers bland (white) food
Texture of food may be problematic (lumps)
REPETITIVE AND STEREOTYPED BEHAVIOUR
The triad of impairments is often
accompanied by a need to carry out familiar,
repetitive activities, this may show as anxiety
and upset when the preferred routine is
broken, or fascination with specific hobbies
or interests.
 Behavioural difficulties may happen when
there are changes to the routine and can be
used as a way of coping with anxiety.
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REPETITIVE AND STEREOTYPED BEHAVIOUR
People with an autistic spectrum disorder often
have sensory problems, in that the brain is unable
to process sensory information in a typical way,
either being over-sensitive, under-sensitive or
having an inappropriate reaction to stimulation.
 This may show up as extreme agitation or distress
in dealing with discomfort.
 Other ways of dealing with sensory problems
include repetitive actions such as spinning,
jumping or flicking of objects, which may be a way
of getting some sensory input.
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Literalness or Concreteness
In receptive language nothing can be taken for granted in the
individual’s understanding of instructions that are not specific.
Humour or figurative speech will be very confusing.
A request such as “Would you like to finish that writing now?” may
only evoke the answer "No" ….
(And this might be wrongly interpreted as provocative when this
was not intended).
You can communicate more effectively with a person
who has ASD by:
Avoiding using metaphors and sarcasm,
Saying exactly what you mean,
Using visual cues where necessary (for example, a fork
for mealtimes, or a towel for bath time).
Education
When a child is diagnosed with ASD, they should have an
assessment of their educational needs.
Some children may need to attend a specialist school for children
with ASD, whereas others may be able to attend a mainstream
school, but require some extra support during lessons.
In some cases, it might be more appropriate for your child to be
educated at home.
Most schools that educate children with autism have adopted the
TEACCH approach
Treatment and Education of Autistic and
Communication handicapped Children (TEACCH).
It is based on the principle that people with autism learn
better in a structured educational environment
The TEACCH approach is grounded in theories of cognition and
behaviour.
Understanding the causes of unwanted behaviour is important in
the process of trying to reduce it.
The physical learning environment in which the person is learning
is organised in a structured way to help them learn what
activities take place in particular areas, and to avoid sensory
distractions.
They are given clear instructions for every stage of an activity,
usually presented in a visual way. people with autism tend to be
visual learners
FAMILY AND CARERS
The impact of autism is keenly felt on relationships
within the family including the parental
relationship, the impact on other siblings and
spousal relationships.
 Advice and help from services and from other
families and carers of individuals with autism is
valued highly.
 Parents also report a struggle to come to terms
with a new identity as a carer of a person with
autism and the sense of isolation or ostracism
that came from this.
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WHAT CAN WE OFFER
Offer families, partners and carers of adults with
autism an assessment of their own needs
including:
 Personal, social and emotional support
 Support in their caring role, including respite care
and emergency plans
 Advice on and support in obtaining practical
support
 Planning of future care for the person with autism.
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If the person with autism wants their family,
partner or carer(s) to be involved, encourage
this involvement and:
 negotiate between the person with autism
and their family, partner or carer(s) about
confidentiality and sharing of information on
an ongoing basis
 explain how families, partners or carers can
help support the person with autism and
help with care plans
 Ensure that no services are withdrawn
because of involvement of families, partners
or carers, unless this has been clearly agreed
with both the person with autism and their
family, partner or carer(s).
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Give all families, partners and carer(s)
(whether or not the person wants them to
be involved in their care) verbal and written
information about:
 autism and its management local support
groups and services specifically for
families, partners and carers
 Their right to a formal carer's assessment
of their own physical and mental health
needs, and how to access this.
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Intervention and Management
The major issue is concerned with reducing any stress
which might otherwise stem from some uncertainty
over what is expected
or from communication breakdown, and which might
be reflected in what appears to be
non-compliant or challenging behaviour.
The programme for any given person will be
based upon individual observations and
assessments,
but basic strategies could well include some
or many of the following:
•Providing a clear structure and set daily routines
•Visual timetables and picture boards to provide checks on
tasks to be covered
•Providing warnings of impending changes of activity or
interruption to routine
•Use of clear and unambiguous language
•Addressing requests or directions directly to the person, and
not assuming that s(he) will adhere to group directions
•Teaching what "finished" means
•Repeating instructions and checking understanding
•Using a range of means of presenting ideas ….
modelling, etc.
Visual, peer-
•Specific teaching and practising of social skills like turntaking
•Minimising distractors
•Exploring the use of computer-based learning and wordprocessing
•Not insisting on those activities which the person
particularly dislikes, such as games
The National Autistic Society indicates that there are
a number of problems, which require specific
consideration when assessing the needs of people
with ASD.
All the following difficulties have a potential impact
on living and working environments:
• “Resistance to change;
• Obsession or ritualistic behaviour;
• High level of anxiety;
• Lack of motivation;
• Inability to transfer skills from one setting to another;
• Vulnerability and susceptibility to exploitation;
• Depression;
• Challenging behaviour;
• Self injury.”
https://www.camden.gov.uk/ccm/content/co
ntacts/categories/contacts-for-autism/
HANDOUTS AND POWERPOINT
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1. Visit the website: www.talkinglife.co.uk
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2. Select TRAINING BUTTON
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3. Select Client LOG-IN BUTTON on left hand side of this page
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4. Select Isle of Tower Hamlets
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5.Sign in as follows: username: LBTH3396
password: 06.06.2016
Go to I’ not a robot and verify 3 images
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tel 0151 6320713