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AUTISM
What it is, is not, and how we treat
it effectively
Marisa R. Leyden, M.A., BCBA
Autism: Facts
• At present, 1 in 88 children in the United States are
diagnosed with an autism spectrum disorder. This
number is similar throughout the world.
• It is 4 to 5 times more likely to be diagnosed in boys than
girls.
• Most cases manifest by age 3 with reliable diagnosis
possible as early as age 2.
• 1 in 49 children in New Jersey are diagnosed with an
autism spectrum disorder.
• Currently 80 children in the Perth Amboy school district
carry an autism classification
Autism: Myths
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All people with autism have mental retardation
People with autism can’t speak
Autism and schizophrenia are the same
People with autism are savants
Autism is caused by “refrigerator mothers”
Autism is caused by the MMR vaccine
People with autism rock back and forth all the
time
What is Autism?
• According to the DSM IV the essential features of autistic
disorder are;
• Markedly abnormal or impaired development in social
interaction and communication
• A markedly restricted repertoire of activities and
interests
(DSM – IV – TR, 2000)
What is Autism?
• Autism is considered a spectrum disorder, meaning that
a wide range of symptoms are expressed by those
people diagnosed “on the spectrum”.
• The 5 disorders which make up the autism spectrum are;
- Autism (aka; classic autism, early infantile autism,
childhood autism, etc.)
- Asperger’s Disorder
- Pervasive Developmental Disorder – Not
Otherwise Specified (PDD – NOS)
- Rett’s Disorder
- Childhood Disintegrative Disorder
What is Autism?
• The core features of the autism spectrum
disorders are;
- Impairment in social interaction
- Impairment in communication
- Restricted, repetitive, stereotyped patterns
of behavior, interests and activities
Autism: Social Impairment
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Marked impairment in non-verbal behavior
Failure to develop peer relationships
Lack of joint attention
Lack of social or emotional reciprocity
Autism: Communication
• Delay or lack of speech, with no non-verbal
compensation
• Where there is speech, lack of ability to initiate
or sustain conversation
• Stereotyped, repetitive and idiosyncratic
language
• Lack of varied, spontaneous, make-believe or
social imitative play
Autism: Behavior
• Preoccupation with one or more
stereotyped and restricted patterns of
interest that is abnormal or intense
• Rigid adherence to specific non-functional
routines
• Stereotyped and repetitive motor
mannerisms
• Preoccupation with parts of objects
What is Autism?
• REMEMBER – Just becoming familiar with
the diagnostic criteria and a list of
symptoms will not help us to truly
understand autism.
• “When you have met an individual with
autism you have met one individual with
autism.” (Stephen Shore, Ed.D., a person
on the spectrum)
What is Autism?
• What causes autism?
• Is autism treatable?
• If so, how do we treat it effectively?
Autism: Research
• Much of today’s research focuses on a genetic
link to autism. The most convincing finding in
this line of research is the number of
monozygotic (identical) twins that are both
diagnosed with autism. There is a 60%
concordance rate for classic autism and a 92%
concordance rate when a broader autism
phenotype is studied (Muhle, Trentacoste &
Rapin, 2004)
Autism: Research
• Current research suggests that there are
multiple abnormalities that are spread out
over several different genes that vary from
one individual to another.
• Less than a quarter of cases can be
accounted for by a single genetic defect
(i.e., Fragile X syndrome) or environmental
insult (i.e., congenital rubella)
Autism: Treatment
• 1987 – O. Ivar Lovaas publishes his study
“Behavioral Treatment and Normal
Educational and Intellectual Functioning in
Young Autistic Children”
• Compared two groups of “similarly
constituted” young, autistic children. One
group received behavioral treatment and
the other did not.
Autism: Treatment
• Of the group that received behavioral
treatment,47% achieved normal range IQ
scores and were successfully placed in 1st
grade classrooms in public schools.
• Only 2% of the non-treatment group
achieved normal educational and
intellectual functioning
Autism: Treatment
• The 11 Established Treatments listed by The National Standards
Project are:
- Antecedent Package
- Behavioral Package
- Comprehensive Behavioral Treatment for Young Children
- Joint Attention Intervention
- Modeling
- Naturalistic Teaching Strategies
- Peer Training Package
- Pivotal Response Treatment
- Schedules
-Self-management
-Story-based Intervention Package
Autism: Treatment
• All of these established treatments have at
least some basis in the behavioral
literature and/or make use of strategies
described in the behavioral literature
• They all employ the following:
- Use of positive reinforcement (R+)
- Individualized instruction
-Data based decision making
Teaching Language to
Students with Autism
The Theory of Verbal Behavior
Autism: Verbal Behavior
• Developed by Skinner in his 1957 book
“Verbal Behavior” and described
extensively by Dr. Mark Sundberg in his
publications.
• Differs from traditional linguistics in that it
treats speech and language as a behavior
under the control of antecedents and
consequences
Autism: Verbal Behavior
• Four of the verbal operants in the behavioral
classification of language are:
- Mand – asking for reinforcers i.e., Asking for “water”
when you are thirsty.
- Tact – Naming or identifying objects, actions, events,
etc. i.e., Saying “water” because you see it.
- Echoic – Repeating what is heard i.e., Saying “water”
after someone else says “water”.
- Intraverbal – Answering questions or having
conversations where your words are controlled by other
words i.e., Saying “Patten school” after someone says
“Where do you work?”
Autism: Verbal Behavior
• The mand is an especially important verbal
operant for individuals on the autism spectrum.
- Those individuals with language may have an
extensive list of tacts (labels) but no ability to ask
for what they want.
- For those individuals who develop a mand
repertoire, they may only be able to ask for
desired items/activities when they are present.
- For many who have no communicative
behaviors, the only “mand” they have is to
engage in maladaptive behaviors.
Autism: Verbal Behavior
• There are various types of mands:
-Items
-Activities/Termination of an Activity
-Missing Items
-Information
-Changes in the Environment
-etc.
Autism: Treatment
• How can we teach individuals on the autism spectrum to
mand?
- Observe their behavior in the natural environment to
determine what items/activities they like best and/or do a
formal preference assessment
- Assess the individuals best modality for communication
- Capture and contrive motivation
- Provide reinforcement immediately following the
desired behavior and on an appropriate schedule
- Set up the environment for learning
- Practice in a variety of settings and situations to
promote generalization
Questions?
Thanks everyone