Chapter 13

Persons with Autism Spectrum

Disorder
 National Institute of Child Health
and Development (2003)
• Autism is a complex biological disorder of development
that lasts through a person’s lifetime
• People with autism have problems with social interaction
and communication, so they may have trouble having a
conversation with you, or they may not look at you in the
eye
• They sometimes have behaviors that they have to do or
that they do over and over, like not being able to listen
until their pencils are lined up or saying the same
sentences again and again
• They may flap their arms to tell you they are happy, or
they might hurt themselves to tell you they are not
 Initial Definition

• Leo Kanner,1943, used the term autistic as a

descriptor
– Meaning withdrawal of relationships or “escape from
reality”
• Early definitions distinguished autism from
schizophrenia in three areas:
– Extreme aloneness from the very beginning of life
– Attachment to objects
– Powerful desire for aloneness or sameness
 IDEA, 1997 Amendments
• Definition of autism
– Developmental disability
– Significantly affecting verbal and non verbal
communication and social interaction
– Usually evident before age of 3
– Adversely effects child’s educational performance
– Engagement in repetitive activities and stereotypical
movements
– Resistance to environmental change in daily routine
– Unusual response to sensory experiences
• Exclusionary clause- serious emotional
disturbance
 Classification
• Eligibility for educational services occurs through
evaluation by a multidisciplinary team
• Testing and criteria to establish eligibility
– DSM-IV-TR
– IDEA 1997
• Medical testing rules out neurological disorders
and specific disorders such as hearing or vision
but provides no specific test to diagnose autism
 Pervasive Developmental
Disorders
• Autism
• Rett Syndrome
• Childhood Disintegrative Disorder
• Asperger’s Syndrome
• Pervasive Developmental Disorder
• Disorders not otherwise specified (NOS)
 Autism
• Age of onset- prior to age 3
• More males than females
• Communication and socialization deficits
• Repetitive and restrictive behavior
• 75% moderate to severe mental
retardation
• No expected regression
 Rett Syndrome
• Age of onset between 5 and 48 months
• Predominantly manifests in females
• Communication deficits
• Repetitive and restrictive behaviors
• Severe/profound mental retardation
• Expected regression
• Increasing seizure frequency
 Childhood Disintegrative Disorder
• Age of onset- after age 2 and before 10
• More males than females
• Communication and socialization deficits
• Repetitive and restrictive behavior
• Severe mental retardation
• Expected regression
• Increasing seizure frequency
 PDD, NOS
• Age of onset- unknown
• Male to female ration- unknown
• Communication and socialization deficits
• Repetitive and restrictive behavior
• Retardation varies from case to case
• No expected regression
 Asperger’s Syndrome
• Age of onset- after age 3
• More males than females
• Normal language, socialization deficits
• Repetitive and restrictive behavior
• Normal intelligence
• No expected regression
 Asperger’s Syndrome
• Differs from high functioning autism
– Better prognosis for personal, social, and
occupational functioning
– Less pronounced deficits in communication,
socialization
– Less pronounced presence of repetitive patterns and
restrictive behaviors
– No significant delay in language
– More motor clumsiness and sensory perceptual
deficits
– Most education will occur in general education setting
 Autistic Savant
• Dr. Bernard Rimland introduces
terminology
– About 10% of the population with autism have
special skills in areas such as
• Mathematical calculations
• Memory feats
• Artistic and musical abilities
• Reading
– Hyperlexia– ability to read without formal instruction
 Associated Medical Conditions
• Tuberous sclerosis
• Fragile X syndrome
• Tourette syndrome
• Angelman syndrome
• Landau-Kleffner syndrome
• Williams syndrome
• Down syndrome
 History of the Field
Autism Spectrum Disorders
• Psychogenic theories
– Inappropriate or “ bad parenting”
• Organic theories
– Bender
• Behavioral theories
– Applied Behavior Analysis
– Lovaas therapy
 Prevalence
• 79,000 pupils between the ages of 6-21, (2000 -
2001)
• Growth reported as annual rate of 1000%
• National Institute of Health declares autism a
national health problem
– Possible reason for incident rise
• More accurate diagnosis
• Better neonatal care
• ECI brings more individuals to attention of schools
• Change in criteria prior to DSM-III
 Etiology
• Chromosomal and genetic factors
– 25% associated with genetic disorders
• Insults during pregnancy
– Anoxia, encephalitis, maternal diseases
• Structural abnormalities of the brain
– Neuroimaging indicates possible dysfunctions in
cerebellum, limbic system, and temporal lobe of the
brain
• Autoimmune and environmental factors
– Speculation about food allergies, vitamin deficiencies,
and immune dysfunction
 Characteristics
• Qualitative impairment in:
– Social interaction
– Communication
• Restrictive, repetitive, and stereotyped
patterns of behavior, interest, or activities
• Onset of delays or abnormal functioning
prior to age 3
 Social Interaction Delays
• Marked impairment in the use of nonverbal
behaviors
– Eye contact, facial expression, gestures
• Failure to develop age-appropriate peer
relations
• Lack of social or emotional reciprocity
• “Theory of Mind”– inability to realize that
other people have their own unique point
of view
 Communication Delays
• Lack of spoken language development
• Stereotyped or repetitive use of language
• Lack of spontaneous age-appropriate
imaginative play
• 50% of individuals with autism are mute
• Unusual patterns
– Echolalia, reversals, abbreviated phases
• Pervasive pragmatic deficits
Repetitive and Restrictive Patterns
• Inflexible adherence to routine
• Repetitive motor mannerisms
• Preoccupation with parts of objects
• Hand flapping, finger flicking, rocking
• Licking mouth or objects
• Sniff and touch body to experience odors
 Self-Injurious Behaviors
• Self-injurious behaviors refer to any
behavior that can cause tissue damage,
bruises, redness, or open wounds
– Head banging
– Finger, hand, or wrist biting
– Excessive scratching or rubbing
 Abnormal Patterns of Behavior
• Eating
– Limited diet; pica
• Sleeping
• Mood or affect
– Life changing events can precipitate
depression; bereavement, staff changes,
illness, or change of school placement
• Sensory perception deficits
– Tactile defensive; hypersensitivity of hearing
 Assessment
• Intellectual
– 50-70% of individuals with autism have mental
retardation; IQ norms between 35-50
• Behavioral
– Behavior screening examples
• Childhood Autism Rating Scale; Autism Behavior Checklist
– Functional behavior assessment
• Required by IDEA
• Functional Assessment
– Measures skills needed for independent living
Figure 13.1 Educational Placement of Students with Autism
 Instructional Approaches
• TEACH
• LEAP programs
• Lovaas Young Autism Project
• Applied Behavior Analysis Program
• Denver Health Sciences Programs
 Educational Services
• Early intervention potentially decreases
need for restrictive placements in the
future
• Structured preschool programming with
special adaptations according to individual
needs reduces interfering behaviors
• Inclusion with collaborative support makes
learning possible in the least restrictive
environment
 Issues of Adulthood
• 1/3 of adult individuals with autism are able to
live or work independently
• Options exist for residential care placement, day
treatment, institutional or group home settings
• Supervised apartment living may require
– Home helpers, case managers, financial assistance,
and adaptive equipment or home modifications
• Adult foster care is another possibility
 Employment
• If the adult with autism cannot work
independently
– Sheltered workshops
– Job coaching
• Supportive employment
• Transportation assistance
• Liaisons between individuals with autism and the
employer
• Technology training
 Technology

• High-Tech Devices
– Communication aids
– VOCA: Voice Output Communication Aids
– Screen readers, word recognition software
• Low-Tech Devices
– Manual sign language
– PECS: Picture Exchange Communication
System
Trends, Issues, and Controversies I
• Sensory Perception Programs address
issues of tactile defensiveness or extreme
reaction to auditory stimulus
• Side effects of the medications used to
alleviate symptoms such as aggression,
anxiety, or obsessive compulsive disorder
• Vitamin therapy
• Autism as a reaction to the MMR
vaccination
Trends, Issues, and Controversies II

• Food allergies: yeast and gluten products

• Auditory Integration Training
• Facilitated Communication
• Secretin
• Music therapy
• Visual treatment
• Temple Grandin’s Hug Machine