Hello, and welcome to Autism Spectrum Disorders 101. I am Julie Short, a regional coach for OCALI, the Ohio Center for Autism and Low Incidence, specializing in Autism Spectrum Disorders and low incidence disabilities. Today I’m going to give you the basics about Autism Spectrum Disorders and some resources you can access to extend your learning. We are going to begin with a definition and description of Autism Spectrum Disorders and then talk about characteristics you might see in individuals with autism. The first exposure many people had to autism was the movie Rainman and although that movie depicts some characteristics you will see in some people on the autism spectrum it doesn’t give an overall view of how every individual with autism will appear. The statement on this slide is how some people assess whether a person is on the spectrum or not. You will hear today that there is really more to Autism Spectrum Disorders than what you saw in the movie Rainman.
Autism is a neurological disorder, what that means is that the brain structure and functions are different from the typical population. These differences will affect how they communicate, how they interact socially and how their patterns of behavior, interests and activities are exhibited. Although the terminology we will use today for autism may soon be changing when the new Diagnostic and Statistical Manual comes out we will to talk about Autism as a spectrum disorder. So individuals may be on the classic end of spectrum and can be very affected by their autism while other individuals may be at the high functioning or Asperger’s end of the spectrum and may be mildly affected by their autism and still others will be in between these extremes with varying strengths and challenges.
As of now, the Centers for Disease Control or CDC cite the prevalence rate to be one incidence of Autism Spectrum Disorder in each 110 births so that this point there are at least 1.5 million Americans with an Autism Spectrum Disorder. The incidence rate is about four males to every one female affected by ASD. Individuals with autism typically live a normal lifespan. Autism occurs across all boundaries: race, income, education levels, where you live. To be identified with autism, the individual must show characteristics before the age of 3 and at this time the CDC states that the average age for diagnosis is 4.5 to 5.5 years of age, although the majority of parents had concerns about their child prior to that 3 years of age. The CDC also reports that an average of 41% of individuals with ASD have an IQ score that identifies them as having an intellectual disability but keeping in mind that autism is a spectrum disorder and there are many individuals on the autism spectrum with average to gifted abilities.
These children and young adults all have Autism Spectrum Disorder. Some have classic autism, some have high functioning autism and others have Asperger’s Syndrome. No two are alike yet all have Autism Spectrum Disorder. With that in mind, really no two educational programs will be identical. Therefore, it is extremely important to assess their specific needs and become familiar with their strengths in order to develop an educational program that will appropriate for each of them. Steven Shore, he’s an author, a speaker and an adult on the autism spectrum. He’s credited with saying “if you’ve seen one person with autism you’ve seen one person with autism.” Each person is unique and needs to be treated as an individual and a person first.
These are the eight domains associated with autism. All Autism Spectrum Disorders share three common features of symptoms: social differences, communication differences, and restricted patterns of behavior, interests and activities and these are present regardless of the level of functioning but they might be expressed a little differently depending on the individual characteristics. The first three will meet the present diagnostic criteria and the other five are associated features, which means they are really not necessary with diagnosis but they are often present in individuals diagnosed with ASD.
The first characteristic that we are going to look at is social differences. These are some of the social challenges you may see in an individual with autism spectrum disorder. Not all will be present and the characteristics will vary in different individuals. Some individuals may have difficulty recognizing the feelings and thoughts of others, which is also known as mind blindness. Not realizing others have thoughts about an interaction can make socializing difficult. Some might use poor eye contact or not orient to others. Some persons with autism have reported that having to look at someone they are talking to while processing what they are saying is really an impossible task. Some may have a difficult time maintaining their personal space. You might have kids that get really close to talk to you or may seem to be standing too far away. Some individuals might have a difficult time joining in an activity, such as maybe like a kickball game or kids playing a board game. Just keep in mind that “wait” is that 4 letter word and really might prove to be difficult for those on the spectrum. Persons with autism might have a difficult time understanding others’ nonverbal communication, such as body language and facial expressions. They process faces and bodies with the same part of the brain that processes objects, so they don’t catch the subtle changes that we use to interact socially. These difficulties can make our guys and gals with autism easy targets for teasing and bullying.
Social difficulties are central to the challenges faced by those with ASD. Impairment in the ability to think about and understand thoughts and feelings of others is challenging. We know that typically developing infants learn early on that the face is a critical source of info about the thoughts and feelings of others. Eye gaze and pointing to objects to encourage another to look at the same thing are seen early in development. Theory of Mind allows us to know how to interact with others—for instance here’s an example, a teenager knows that swearing around friends is probably okay and pretty cool while swearing in front of the principal or a teacher is really going to have some consequences. Well a person with autism spectrum disorder may need that rule taught and they are not necessarily going to pick it up on their own. Knowledge of mind blindness is critical for those who work and live with individuals with ASD. Mind blindness limits the ability to explain and predict the behavior of others, therefore making it difficult to differentiate between accidental and intentional behaviors.
We’re going to take a look at a video that is going to demonstrate some social differences. [Video Clip Plays]. This little guy is in the middle of an active group of children who are interacting and playing at a birthday party. In the midst of this play, this little fellow appears to be really in his own world. He wants to eat, so he is giving cues by getting his plate and sitting and he is not orienting towards others or making eye contact; he is not trying to join the other children’s activities. He appears to want to be away from the group by sitting at the end of the table. This is one example of how some individuals with autism have difficulty knowing how to interact socially.
These are some of the underlying characteristics of restricted patterns of behavior, interests and activities. Some individuals with ASD have a strong need for sameness. They tend to prefer things to be predictable and the same in their environment. Therefore, change from one activity to another, or even from one person to another could cause distress. Restricted behaviors tend to look different in individuals with ASD. With more classic forms of autism, you might see some hand flapping, clapping, rocking or fascination with movement or parts of objects. In higher functioning autism, you may also see some of those behaviors but preoccupation with specific areas of interest tend to be the most dominant forms of repetitive behavior. Often times these interests may be unusual or not shared with others of the same age, so for instance you might have someone who really may love vacuum cleaners or World War II battleships or a 13 year old may love playing with LEGOS or be fascinated with Blues Clues. Faced with unpredictable events, individuals with ASD may experience anxiety and could result in behaviors such as meltdowns, social withdrawal, and repetitive questions. This next video that we’re going to take a look at displays a young boy demonstrating a repetitive behavior in a store. [Video Plays] He was repeating motor movements, the recording of the toy, and was appearing to be in his own world. This is an unusual preoccupation that other kids his age would not engage in and this is not how this object was really intended to be used. And as I mentioned before, transitioning a child on the spectrum who is engaged in a repetitive behavior can create anxiety and could result in a meltdown. His mom handled that well by giving him a warning and then she used physical proximity and redirected him to the next activity.
OCALI has a free resource called Autism Internet Modules. As of this webinar, there are over 20 modules available including topics such as structured teaching, preparing individuals for employment, and self-management. One of the OCALI AIMs is on Restricted Patterns of Behavior, Interests, and Activities. There is detailed information about this characteristic, including videos, discussion questions, and even extension activities.
These are some of the communication differences you may see in an individual with ASD. This domain has a great impact on individuals with ASD. Again, this varies according to each individual’s underlying characteristics. You might have someone with little or no speech who needs a communication system; some may not respond or will show a delayed response when their name is called; others may ask repetitive questions as they try to process information or relieve anxiety; some individuals may fail to initiate or respond to greetings; following instructions can be a challenge unless the directions are supported with visuals; some individuals may display immediate or delayed echolalia, such as reciting lines from movies and TV shows or repeating another person’s questions or statements; conversation rules need to be taught, as they are difficult for persons on the spectrum who may interrupt others, have a difficult time maintaining conversation, know when to start or end a conversation, or use poor eye contact; and many will struggle with identifying emotions, their own and even other peoples, so again visual supports and teaching are needed. This next video shows a little guy who is verbal. He is repeating what is said to him, which as I explained earlier is called echolalia. [Video Plays] He did not orient towards the speaker and did not understand how to answer a question. He also has an unusual rhythm to his speech, which is a common characteristic in those with communication differences.
This next domain is sensory differences. For those who experience sensory processing difficulties daily routines can be very challenging. In some individuals with ASD, the differences only affect one sensory area. In others, multiple senses may be impacted.
An individual with sensory differences may react in unexpected ways as they process sensory input. They may exhibit some of the following behaviors when they are over responsive or even under responsive to input. For instance for sounds, you might have some individuals that may hold their ears to sounds that do not bother others such as telephones ringing, vacuum cleaners, fire alarms going off, or even flushing toilets. Or if an individual is under responsive they could seek out those loud sounds. They could putt their ear to toys that make loud noises. For pain, if a person is over responsive, for example, excessive crying or a meltdown after falling in something as soft as a sandbox might occur, or if under responsive, a person may have no idea they have a serious injury like a broken bone. Taste: they might prefer certain textures. You might have kids who prefer brands or colors of foods; may only eat foods that are white or are square or foods that are pureed. And someone who is under responsive may eat very spicy foods without a typical reaction of needing milk and eyes watering. Light or color: Someone who is under responsive may prefer bright lights and be drawn to the TV or flashlights while someone who is over responsive may cover or squint their eyes when lighting really seems normal. Temperature: Those who are under responsive may prefer to wear heavy clothing on warm sunny days or may under dress on cold, wintery days. And those who are over responsive may not tolerate heat or cold very well. Smells: Some who are under responsive may prefer to smell things that most people would find unpleasant. An individual may seek deep pressure and may run up to you and literally crash into you for a strong hug. Another individual on the spectrum may react unfavorably to a light touch on the shoulder. Often children on the spectrum will hum or make a noise repeatedly to help regulate their sensory system. In this video, you will see a young fellow seeking sensory input. [Video Plays] This little guy was engaging in an activity that provided touch through the sand sifting. He was seeking an activity that provided movement through pacing. And he was preoccupied with sensory exploration and made continuous humming and singing noises. And this is just one example of sensory seeking behaviors.
These are some of the underlying characteristics you might see in the area of cognitive differences. As autism is a spectrum disorder, cognitive differences are also on a spectrum. You can see individuals who are identified as gifted, typical, or delayed intelligence, but even with these identifications, they may learn differently from their neurotypical peers. You will most often see a strength in remembering facts, lists, and details. Abstract thinking may be a challenge. Many individuals on the spectrum show some unevenness in their cognitive abilities, such as being excellent at addition and subtraction but getting lost in story problem solving. This may result in some academic difficulties. Knowing what to pay attention to can be tough, such as listening to the teacher talking when trying to finish reading a story. And these are the kids who have the messiest desk and who have trouble remembering to take what they need for homework. They may also have difficulty generalizing, or being able to carry over a skill to a different environment. Next I’m going to talk about two theories that can affect cognitive differences.
Executive dysfunction theory examines the difficulty people with ASD have in developing the structure they crave. They can have troubles processing information, completing tasks, and handling change. Being able to regulate behavior in different situations or environments can be a challenge, such as laughing loudly laughing for too long. Knowing how to plan and organize is difficult and then, once plans are set, being able to accept changes and adjusting the plans will be a challenge. Knowing how to set up materials for work, getting out the correct book, paper, writing assignment, and arranging them to work efficiently on the desk can be an impossible task without direction. Strategies and interventions that target these deficits can be of great benefit for an individual with ASD. For instance, being able to problem solve can be tough for persons on the spectrum. An individual who can only remember one or two steps of a multi-step process may be having problems with Executive Dysfunction, so giving him or her picture directions of all the steps to follow can help with organization.
The theory of Weak Central Coherence is about seeing the whole. As problem solvers, we generally put together the pieces of the puzzle in order to “get the big picture.” Individuals with autism many times can see the individual parts, but have difficulty relating the parts back to something they already know. They can list facts about the Vietnam War, but if you ask them how the war changed the United States you will probably get a blank look. We need to help them make connections to the big picture using visuals like the graphic organizers you are seeing on the screen.
Most individuals diagnosed with ASD have significant motor differences.
They may have weak handwriting skills, which come from difficulty holding writing utensils properly or being able to press hard enough or forming the letters. This can result in poor handwriting or refusal to write. We can provide alternative ways of producing written text, such as a word processing device and/or alternative activities. These individuals may show balance difficulties and could appear clumsy. These are your kids who may run into desks and fall off of their seats. They may show poor motor planning and are very frustrated in participating in athletic activities but remember this also could be sensory or social related. They may also display atypical activity levels and appear over-active or under- active. Some may walk with an awkward gait and might hold their body a certain way when they move. They might lean to one side when they walk or could even walk on their toes. They may also have a difficult time starting and completing actions due to motor planning challenges. Again, visual supports and practice can help.
All of the characteristics discussed so far can add to emotional vulnerability. Realizing that anxiety is a huge issue for persons with ASD and offering supports can make a difference in their lives. New situations can raise levels of anxiety. They may be fearful of things we are not aware of, such as a young student who was afraid of waxed, tile floors. He couldn’t tell if he would go through the surface, so he wanted carried. His anxiety was tremendous at these moments. These individuals may not be able to regulate their systems, which can cause them to have a panic reaction and can lead up to aggressive and even sometimes self injurious behaviors. Please remember that all behavior is communication. The world of emotions can be challenging for those affected by ASD. Not only are they less able to understand verbal and nonverbal expressions in others, they might have a hard time understanding and managing their own emotions. It may be difficult for those who do not want to make mistakes and they may be easily stressed about things that do not turn out the way that they want them to. Many realize they’re not connecting with people in a typical way and it causes a heightened state of anxiety, sometimes leading to depression. Stress from trying to communicate and socialize and learn and fit in with everyone sometimes leads to rages. At that point, we can offer safety and cool down time. Afterwards we can use visual tools to talk about the situation, like cartooning, such as this example of a young man standing on the cafeteria table because a “friend” told him it would be funny, or a social autopsy, like this example of yelling at the boss, to help them and us understand what happened and what to do next time. There is information about these interventions and others in books from the OCALI Lending Library.
This is a clip about a young man named Mickey that shows how he functions during a school day. [Video Plays]. You can see because of his motor difficulties, and possibly even some sensory issues, Mickey really had a tough time in gym class. And as the day progressed, you could see his agitation growing and could observe more of his emotional vulnerability. Mickey really needed a lot of support to make it through his day and keep learning.
The last domain to examine is medical and biological factors. There may be mood instability issues. Some may have eating and digestive issues that could impact their ability to function and learn. Many individuals with ASD could experience gastrointestinal difficulties ranging from serious constipation to frequent diarrhea. Sleep challenges may include trouble falling asleep and /or even waking up frequently during the night. And if you are listening today as a parent, you should inform the pediatrician of the difficulties and together decide what interventions would work best for your child. Those of you participating today that are educators, you need to be aware of physical factors that can have a definite impact on the student in the classroom. Think about it, A child who has not had bowel movements for days or who hasn’t gotten much sleep at night could be very uncomfortable and have great difficulty learning or could exhibit behavior problems in the classroom. Be sure to communicate with parents and see what might be going on at home. These are some of the possible biological and medical factors that may occur with ASD. If an individual is diagnosed with a medical condition, it really needs to be considered as part of the total evaluation for that person.
Like the iceberg, we can observe a small amount above the surface—work skills, communication abilities and behaviors. But beneath the surface there are many factors prompting what we see above—comprehension or level of understanding, emotions, there could be sensory issues, anxiety, or even medical considerations. We really have to look at all of those underlying characteristics that we discussed today as being below the surface to help explain what we are seeing above it. When we take into consideration all of the underlying characteristics of the individual with autism, we can then build a plan for education, transitions across the lifespan, and success at all ages, such as this next video shows.
This is a story about Michael who is living a full life. [Video Plays] Here is an adult who is working, earning money, experiencing social success at his church and in a running club, and making decisions about how to spend his money and live his life. There were people in this man’s life who helped him find success through a vocation and by using activities he enjoys to be with people. And this is the goal for every individual with Autism Spectrum Disorder.
The Ohio Center for Autism and Low Incidence provides many resources to help support those affected by ASD. These can be found on our website at www.ocali.org You can learn more about Autism Spectrum Disorders by visiting our website under the topic “Autism Spectrum Disorders”. Here you will be connected to education, research, websites, videos/DVD’s and will learn more about Ohio’s programs to support those affected by ASD. We also have developed an Autism Service Guidelines book. These guidelines offer basic concepts in providing supports for individuals with Autism Spectrum Disorder. The information and recommended strategies and modifications were compiled by committees and agreed upon by the Task Force to Develop Guidelines for Educating Individuals with ASD ages Birth to 21. The guidelines are intended to serve as a tool that can be used to help families, educators, medical professionals, care providers and other service providers make informed decisions about children and young adults with ASD. And they can be viewed as a map to the development of independence for the individual with ASD at the highest level possible in all life areas. The Guidelines are not a required standard of practice for the education of these individuals in Ohio. Ohio’s Parent Guide to ASD is a manual that provides an overview of the world of autism spectrum disorders (ASD). It was developed by Ohio parents of individuals with ASD who have a broad range of experience with interventions, resources, and services. The group's work began with this question: What do you wish you had known the first year your child was diagnosed? And this manual can be downloaded and printed off our website or parents can receive a copy of the parent guide by calling our main office at 1-866-886-2254. For those of us who might want more information on how assistive technology can help support individuals with ASD, you can review our AT resources on our website. You can go to topics and search under Assistive Technology Resources and there you can find an AT guide along with other information about AT.
We also have a free lending library available on our website. This is where you can find additional information about Autism Spectrum Disorder and all of the characteristics we discussed today. We offer books, videotapes, DVDs, and other media on Autism Spectrum Disorders and low-incidence disabilities. We also have an extensive collection of assistive technology that can be used for evaluation. The library is available to educators and parents throughout Ohio. You may keep library materials for three weeks. All you need is an account and UPS will deliver and pick up your materials. The Services and Supports database is an area on the website that allows you to search for services by the individual’s age and your zip code. OCALI gives information about providers, but does not imply endorsement.
OCALI is pleased to announce some recently added resources.
OCALI on iTunes U - iTunes U is an online learning environment available through Apple's iTunes application. Colleges/universities, non-profit organizations, K-12 schools and others have posted lectures, videos, documents and more. Users can access and download the posted content for free. Ohio was an early pioneer in iTunes U and maintains a portal that connects to education, government and community providers from across the state. OCALI can be found within the Ohio portal under Autism Resources.
There is also OCALI YouTube Channel and the OCALI YouTube channel includes video vignettes on key topics and issues, including visual supports, social skills and personal perspectives from individuals with ASD. Each video is less than five minutes in length, provides high-quality narratives for viewers with limited time or who are streaming video to their phone or mobile device. And you can also stay connected with the latest info about OCALI and their services through Facebook and Twitter.
We want to thank you for joining us today to view the webinar on Autism 101. We hope you found this information to be helpful in understanding Autism Spectrum Disorders. And if you need further assistance, you may contact OCALI’s main office at 866-886-2254.