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AUTISM SPECTRUM DISORDER Reporter: Quennie Telen AUTISM SPECTRUM DISORDER Definition Characteristics and Indicators Prevalence Causes Strategies AUTISM SPECTRUM DISORDER Albert Einstein Temple Grandin Satoshi Tajiri Gabby Atienza Thristan Mendoza Autism SD first described by Leo Kanner in 1943. early infantile autism (Simpson, 2005) Autism SD characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, the presence of stereotyped behavior, interests and activities. (DSM-IV-TR of APA, 2000) Autism SD Studies on autism have led some researches to conclude that individuals with autism lack theory of mind. In a series of publication, Baron-Cohen, Leslie, U. Frith, and colleagues have argued that a defining feature of the autistic syndrome is the failure of individuals with autism to develop what Premack and Woodruff termed a theory of mind – a capacity of attribute mental states (e.g. intentions, desires, thoughts, beliefs) to other persons in order to make sense of their behavior. The theory of mind hypothesis of autism holds that in children with autism, this ability fails to develop in normal way, resulting in the observed social and communication abnormalities in behavior. (Hetherington, 2003) and (Baron-Cohen, 1993) Autism SD The fact that children with autism have difficulties in understanding the perspective, intentions, beliefs, and knowledge of others may explain why they seem to understand so little of their of their social environment. (Schreibman, 2005). Autism SD In a recent study on autism, Mitchell and O’Keefe (2008) concluded that individuals with autism seemed not to recognize themselves as the authority on knowing themselves. There is a possibility that the participants in their study have adopted a view expressed to them by teachers and carers, who might, unwittingly or otherwise, have conveyed that they lack self insight. They also stated that if CWA have self-concept expressed through their significant others, individuals would recognize that there is room for improvement in their level of self insight. Mitchell and O’Keefe believe that there is a need to seek or accept and try to do something about improving CWA’s self-concept. Autism is a pervasive developmental disability affecting verbal and nonverbal communication, social interaction and educational performance initially evident between ages 2 and 3 and confirmable at ages 3 to 3.6. (Dizon, 2000) Autism SD Complex developmental disability that typically appears during the first 3 years of life and is a result of a neurological disorder that affects the normal functioning of the brain. (Hourigan, 2009) SPECTRUM Autism Asperger Syndrome Rett Syndrome Childhood Disintegrative Disorder Pervasive Developmental Disorder PDD Autism/Autistic Disorder this applies to individuals who have social interaction impairments, communication impairments, and repetitive, stereotypic, and restricted interests and activities prior to 36 months of age DSM-IV-TR, 2000 (Simpson, 2005) Asperger Syndrome Impairments in social interaction are the primary characteristic. Hans Asperger, 1944 (identified a group of high-functioning CWA) (Smith, 2007) Asperger Syndrome They develop language and speech but other aspects of communication affect the person They understand language but have difficulty conceptualizing ideas, understanding jokes, or interpret behavior of others. Unusual interest. The majority of this group of individuals have normal intelligence. (Smith, 2007) Rett Syndrome Rare condition that occurs only in females. Appears between 1 and 2. Characterized by head growth deceleration, loss of previously acquired hand movements and other motor skills, stereotypic hand wringing or hand washing, various motor impairments and social and communicative impairments. (Simpson, 2005) Rett Syndrome Different from autism because there is loss of motor skills and they have hand wringing. They have better social skills than CWA. May develop mental retardation and results in cognitive disabilities typically more severe than those observed win people with autism. (Smith, 2007) Childhood Disintegrative Disorder They have behavior patterns similar to those of CWA. The difference is the onset of age disability. There is a period of normal growth. But may decline after 2-5 years of apparent normal development and after 10 years may have a “clinically significant loss of previously acquired social skills or adaptive behavior, bowel or bladder control, play or motor skills. Least well understood. Pervasive Developmental Disorder PDD NOS is a vaguely defined because the criteria for other forms of pervasive developmental disorder are not met and are not clearly expressed. The symptoms do not match those of another condition found in ASD umbrella, but share ASD characteristics. (Smith, 2007) Prevalence According to the Center for Disease Control and Prevention in Atlanta, diagnoses among children jumped 57% from 2002 to 2006. Roughly 1 in 110 8-year-olds is on autism spectrum. (Gibson, 2010) Prevalence In the Philippines, it is estimated that for every 10,000 births, 13 to 23 have autism. Surveys show that 13 out of 10,000 families will more likely misdiagnose the symptoms. As a result, many CWA will grow misunderstood, unaccepted and incapable of taking care of their own needs. (Dizon, 2000) Prevalence In US, the disorder already costs about $35 billion per year for special education, medical care and assisted living. In federal level, it is already a priority. They have a budget of $60 million for autism research pool until 2018. (Gibson, 2010) Causes of Autism Neurological disorder that has a genetic basis Environmental factors such as toxins, gastrointestinal anomalies, vitamin deficiencies and vaccines. (Smith, 2007) • The new research team at Pfizer, is focusing on genes that may affect synapses in the brain. • These are the spaces where two nerve endings meet. A tiny gap neurochemicals must cross in order to transmit information. • For PWA may process spoken language more slowly than non-autistic, because the connections in the brain have too many neural connections and too little long-distance connectivity. (Gibson, 2010) Prevention Because there is still have so much to learn about the causes of autism, prevention is not currently a realistic goal. As researchers learn more about why Autism occurs, the primary basis for improving these symptoms are educational interventions. (Smith, 2007) INDICATORS OF AUTISM PHYSICAL HEALTH •Healthy child, good-looking, picky-eater, smells food/objects and put things in mouth, does not seek attention when hurt. (Dizon, 2000) INDICATORS OF AUTISM GROSS-MOTOR • Walks on tiptoe esp. during early years, hyperactive, not inhibited, fast and strong and does not tire easily, well-balanced, generally coordinated but lacks impulse control. Exhibits repetitive movements: body rocking, hand wiggling, whirling, “ritual” of walking to and fro, etc. (Dizon, 2000) INDICATORS OF AUTISM FINE-MOTOR • May have good or poor perceptual-motor skills depending on level of attention span, is absorbed by objects with tendency to get attracted to spin around/whirling objects, self-stimulates by touching surfaces/edges, arranging/aligning objects precisely/repetively. (Dizon, 2000) INDICATORS OF AUTISM PSYCHOSOCIAL • exhibits limited/fleeting eye contact, aloof, passive, prefers solitary activities, manifests inappropriate emotional responses, demonstrates unusual fear (Mexican hat), is socially immature, is maladaptive to changes in routine, clothes, arrangements, tends to be self-injurious (Dizon, 2000) INDICATORS OF AUTISM LANGUAGE/ COGNITIVE/ INTELLECTUAL/ ACHIEVEMENT • Shows deficit in the use of language, underreacts to language and visuals or overreacts to sounds, demonstrate rote learning, exhibits pronoun reversals, is echolalic, exhibits inapprpriate recall of experieces, delayed in laguage, delayed in overall intellectual response (Dizon, 2000) INDICATORS OF AUTISM SELF-HELP • Delayed in performing eating, dressing and grooming tasks, is unable to assume age-appropriate responsibilities, lags behind in discriminating and avoiding dangers. (Dizon, 2000) INDICATORS OF AUTISM • PHYSICAL HEALTH •GROSS-MOTOR • FINE-MOTOR •PSYCHOSOCIAL •LANGUAGE-COGNITIVE/ INTELLECTUAL/ ACHIEVEMENT •SELF-HELP (Dizon, 2000) Strategies in Teaching Children with Autism BEHAVIOR MANAGEMENT A. Reducing and Eliminating Self-Biting • Instruct and say “No Biting” immediately • sit and perform hand exercise: “hands on the lap, hands on head/desk, hands folded • Apply overstimulation (pushing fingers) • Hold the hands in 30 sec firmly while saying “No Biting” A. Reducing Head Banging • Place the table and chair away from the child for 10-15 sec. • Ignore the child • Pull away materials for 10-15 sec and give back the materials and praise when he begins to work •Seat a child on a chair in front of a table and hold down his head on the table for 30 seconds Strategies for BMT • Positive reinforcement. (Use reinforcements such as rewards to motivate the child. Ex. Food, toys, books, tokens, stickers, hug, praises, touching favorite object) • Shaping (Done if the child has no desired skill in his repertoire of behavior. Define beh, find beginning beh, break the beh, perform each step, continue the procedure) Strategies for BMT • Modeling • Physical/Verbal Prompting • Over-stimulation • Aversive Conditioning (Ex. Lemon juice) • Contracting (the teacher and the child specify and agree on expected behaviors for selfimprovement, and also with rewards • Token System (Colored chips or other objects) with corresponding points) Strategies for BMT • Stimulus Control (Representation of objects like belt, chair, clothespin or aural cues like “no/stop/good” • Time Out (Pulling the child out of the group for an unacceptable behavior. Placing him back when he is ready. • Ignoring the child (when he resorts to attention-getting behavior/tantrum) ABA with its roots in the Behavior Theory proven to be scientifically valid Antecedent-Behavior-Consequence Skill-based treatment PECS Picture Exchange Communication System Frost and Bondy developed this program This may be used in classroom, home, community settings Ideally integrate with functional routines and activities (meals, hygiene) Skill-based treatment TEACCH Treatment and Education of Autistic and related Communication handicapped Children Developed by Eric Schopler in 1970 the Principle is modifying the environment to accommodate the needs of individuals with ASD. Four main components: Physical Org, Visual schedules, work systems, task organization Floor time Best for Interpersonal Relationship Interventions is a play-based interactive intervention approach that emphasizes individual differences, child-centered interests, and affective interactions btw child and caregiver. Developed by Stanley I. Greenspan. Son-Rise Program best for Interpersonal relationship interventions and treatments Developed by Barry Neil Kaufman in mid1970 The teacher makes no judgment, good or bad, regarding a child’s behaviors, but rather is a facilitator of learning by allowing the child to self-direct his or her own learning. Art Therapy Designed to foster creativity and individual expression through the use of various art modalities. (Simpson, 2005) Other lists of Interventions and treatments for Interpersonal Relationship, Skill-Based, Cognitive Interventions, Physiological or Biological/ Neurological Treatments will be posted also in y group References: Simpson, Richard L. 2005. Autism Spectrum Disorder. Corwin Press, California, USA Smith, Deborah. 2007. Introduction to Special Education Making a Difference. 6th ed. Pearson Education, Inc. USA. Dizon, Edilberto. 2000. Teaching Filipino Children with Autism. UP, Dilman, QC. Philippines Gibson, Ellen. 2010. “The Hunt for Autism Drug”. Retrieved Feb. 2, 2010. Database: Ebscohost Baron-Cohen, Simon, Alan M. Leslie and Uta Frith. 1985. Does the Autistic Child have a “Theory of Mind”? Journal Article on Cognition. Retrieved on August. 31, 2009. Hourigan, Ryan and Amy Hourigan. 2009. Teaching Music to Children with Autism: Understandings and Perspectives. Retrieved Feb. 2, 2010. Database: Ebscohost Mitchell, Peter and Kelly O’Keefe. 2008. Brief Report: Do Individuals with Autism Spectrum Disorder Think They Know Their Own Minds? Journal of Autism Developmental Disorders. Retrieved on September 1, 2009. Schreibman, Laura. 2005. The Science and Fiction of Autism. Harvard University Press. USA. Hetherington, E. Mavis and Parke, Ross D. 1993. Child Psychology: A Contemporary Viewpoint. 4th ed. McGraw-Hill, Inc. USA.