Autism spectrum disorder

Autism Spectrum Disorder
aka Autism, Aspergers, etc.

By
Brenda McCreight Ph.D.
Training Series

Definition – sort of
• Autism spectrum disorders are:

– Lifelong neurological developmental disability
– Usually evident before age three
– Referred to as a spectrum disorder because there are physical
differences in the brain of every person which create:
• different neurological structures
• a variety of symptoms
• a range of severity

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Who gets a.s.d.?

• Autism spectrum disorders occur across all
socioeconomic, ethnic, cultural and
geographic groups
• The incidence of a.s.d. is higher among
males than females

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Communication challenges
• Children with a.s.d. will have communication problems that go
beyond speech and language to other aspects of social
communication, both receptively and expressively.
• They have difficulty understanding the meaning of language
spoken by others
• They have difficulty sharing
thoughts or feelings and difficulty
communicating their own
• Children with a.s.d. try to
communicate, but we don’t always
recognize their attempts for what
they are

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• People with a.s.d. have challenges with interacting with
other people
• They cannot attain or maintain reciprocal relationships
• They may become distressed when
dealing with change and transitions
• They might perseverate on routines
and on objects, sometimes they will
even perseverate on people, or types
of people


Sensory Processing
• People with a.s.d. demonstrate
unusual, inconsistent, or repetitive reactions to
sounds, sights, smells, tastes, touch or movement
• Their neural structure makes their sensory systems over
or under sensitive to the environment


How does a.s.d. present?
• Repetitive motor movements such as hand
flapping or obsessive fidgets
• Challenges in adaptive and daily life skills
• Challenges with executive functioning ie
sequencing, organization, sustaining and
shifting attention, etc.
• Inconsistent performance
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• Challenges with nonverbal communication such as
eye contact, hand gestures or facial expressions
• Can’t initiate actions
• Incessant or obsessive chatter on a limited topic
• Repetitive mimicking of sounds or words or phrases
• Disruptive communication ie interrupts,
• talks out, talks over


• May lack interest in interacting with people
• May have a preoccupation with a special interest, an
object, or aspects of internal or external
environment
• Challenges in understanding others’
perspectives
• Can’t shift
attention or
change focus


Neurobiology of a.s.d.
• Studies have found children with autism have increased
white matter in their brains
• White matter is the part of the brain that carries
information from one section of the brain to another.
• The increased white matter is located in areas of the brain
that are close to each other and on the same side of the
brain
• Some have theorized that the increase in connections
within each side of the brain makes communication
between the hemispheres more difficult
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• Brain areas are often bigger on the side to which they are
lateralized (meaning: localization of a function, such as speech, to
the right or left side of the brain)
• For example, language is lateralized to the left brain, and the areas
of the brain which handle language processing are bigger on the
left than the right side.
• Studies have shown that children with autism have a reversed brain
asymmetry - there
are more areas that are
bigger on the right than
the left side of the brain
• This is opposite of what is
found in the brains of
neurotypical people

WHAT THIS ALL MEANS
• In other words:
• A.s.d. in any form is a neurodevelopmental disability that
is lifelong
• It impairs the person’s ability to relate to others in a way
that other’s can understand
• It impairs the individual’s ability to engage in reciprocal
relationships
• The symptoms can be different in different people –
some are more severe than others
• Some people with a.s.d. have very high IQ’s while others
have very low IQ’s
• A.S.D. can co-exist with other conditions
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TREATMENTS
• There are many, many forms of treatment
for a.s.d. Here are a few approaches:
• Biomedical
• Behavioural
• Communication
• Sensory
• Alternatives

Biomedical
• The biomedical approach to autism is based on the
belief that autism has a biological cause ie – heavy
metal poisoning, yeast infections, food
sensitivities, nutrition
• Leaders in this field are Dr Bernard Rimland of the
Autism Research Institute (ARI), Dr Bernard Rimland
• Studies have shown that some people with autism
have recovered fully or significantly from this
approach
• Other people with autism have not responded at all
to this treatment

Behavioral
• There are many different behavioral
approaches including:
• ABA
• Greenspan Method
• Miller Method
• Pivotal Response Therapy
• SCERTS

• APPLIED BEHAVIOUR ANALYSIS (ABA)
• Applied behaviour analysis (ABA) is the
process of systematically applying
interventions based on the to improve
socially significant behaviours
• Teaches social, motor, and verbal behaviours
as well as reasoning skills.
• The ABA approach can be used by a
parent, counselor, or certified behaviour
analyst.

• ABA uses behavioural observation and positive
reinforcement or prompting to teach each step
of a behaviour.
• The person’s behaviour is reinforced with a
reward when he or she performs each of the
steps correctly
• The goal is to identify the triggers of a
behaviour, and what happens after that
behaviour to reinforce it
• The task is to remove these triggers and
reinforcers from the child's environment.
• New reinforcers teach the child a different
behaviour in response to the same trigger.

Greenspan Method
• Dr. Greenspan utilizes the D.I.R. (Developmental, Individual-
difference, Relationship-based) Model or Developmental Approach to
therapy
• This is a systematic way of working with children to help them climb the
developmental ladder
• D.I.R. takes children back to the very first milestone they may have
missed and begins the developmental progress anew.
• The six "functional milestones" are:
• self regulation and interest in the world
• Intimacy
• two-way communication
• complex communication
• emotional ideas
• emotional thinking
• Dr. Greenspan's method includes an observation chart used by the
parent to asses where the child stands on the development ladder and
which milestones need strengthening

• Dr. Greenspan developed “floor time” as an
intervention to be used by both parents and
professionals

The Miller Method
• Focuses on the child’s body organization, social
interaction and communication
• Uses two strategies to restore typical
development
• The first uses the transformation of a child's
maladaptive behaviors (such as hand flapping
or spinning ) into functional behaviours
• The second uses the repetitive involvement of
developmentally relevant people or objects

The Miller Method Elevated Square
•

Pivotal Response Therapy
• PRT was developed by Dr. Robert and Lynn Koegel
• Teaches language, decreases disruptive/self-
stimulatory behaviors, and increases
social, communication, and academic skills
• Focuses on "pivotal" behaviours that impact a wide
range of behaviors
• The primary pivotal behaviors are motivation and
child's initiations of communications with others
• The goal of PRT is to produce positive changes in the
pivotal behaviors, leading to improvement in
communication skills, play skills, social behaviors and
the child's ability to monitor his own behaviour

SCERTS
• SOCIAL COMMUNICATION/ EMOTIONAL REGULATION/ TRANSACTIONAL
SUPPORT
• An educational model developed by Barry Prizant, PhD, Amy
Wetherby, PhD, Emily Rubin and Amy Laurant
• Combines other approaches including PRT, TEACCH, Floortime and RDI.
• Promotes child-initiated communication in everyday activities
• Focuses on achieving Authentic Progress (the ability to learn and
spontaneously apply functional and relevant skills in a variety of settings and
with a variety of partners)
• SC: Social Communication - Development of spontaneous, functional
communication, emotional expression and secure and trusting relationships
with children and adults.
• ER: Emotional Regulation - Development of the ability to maintain a well-
regulated emotional state to cope with everyday stress, and to be most
available for learning and interacting.
• TS: Transactional Support - Development and implementation of supports to
help partners respond to the child's needs and interests, modify and adapt the
environment, and provide tools to enhance learning

Communication Methods
• ELECTRONIC DEVICES
• Allows a nonverbal individual to speak verbally through
an electronic device
• RELATIONSHIP DEVELOPMENT INTERVENTION
• Relationship Development Intervention (RDI®) is a
program designed to enable parents to function as
facilitators for their children's mental development
• SOCIAL STORIES
• Social stories describe normal social situation and are
written from a child's perspective
• Social stories can help a child prepare for upcoming
changes in routine, de-mystify social interactions, and
relate academic skills to real-life

Sensory
• Auditory Integration Training (AIT) is a hearing
enhancement process based on the belief that
Research on autism suggests that people with
a.sd. have sensory dysfunctions which impacts
their behavior ie withdrawal or screaming
• The training is delivered under headset
conditions with the person wearing
headphones in a contained space (minimal
movement) for 30 minutes at a time

• Sensory Integration: Occupational therapists
use sensory integration therapy to help children
with a.s.d. develop normalized play
• This includes placing a child in a room
specifically designed to stimulate and challenge
the senses
• Vision therapy: an individually prescribed
program of vision "exercises" or procedures
which can change the way you see. Vision
Therapy is aimed toward normalizing or
improving fundamental visual abilities, such as
eye focusing, eye teaming, eye movements, and
visual perception.

Alternative therapies
• Acupuncture
• Art Therapy
• Cranial Sacral
• Homeopathy
• Hyperbaric Oxygen
• Osteopathic
• Music Therapy
• Neurofeedback
• Service Dogs
• Swimming Therapy
• Therapeutic Recreation

How To Choose?
a) Learn the features and strategies of various
methods so you can match them to the unique
needs of the individual with a.s.d. as well to the
capacity of the parents to support the method in
the home
b) Make sure the professional working with the
person is well trained and certified in the form of
intervention she is using
c) Most methods will include: intense and early
intervention with a great deal of repetition and
consistent reinforcement

Basic Communication
Regardless of which method you choose to use, or not
use, there are basic communication protocols that will
enhance interaction with a person with a.s.d.
Here are some suggestions:
• Provide a safe environment
• Reduce the unexpected, make the environment
predictable
• Prepare yourself and the person with a.s.d. for change
• Reduce transitions
• Provide a consistent daily routine
• Create picture or written schedules

• Use direct, clear instructions
• Break tasks down into small units
• Provide frequent feedback, make it mostly positive
• Redirection as needed rather than criticize
• Visually show beginning and end
• The home and the classroom can provide:
a) Picture schedules
b) Task sequence charts
c) Choice boards
d) Calendars
Use these as prompts and visual reminders/reinforcers

• Get person’s attention before speaking
• Speak at his level of understanding
• Don’t demand constant eye contact
• Use touch according to the person’s ability
to tolerate it – remember sensory issues


Thank you for sharing this time with me

• You can check out other services and products at these sites:
• http://www.lifespancounselling.com
• http://www.theadoptioncounselor.com
• http://www.hazardousparenting.com
• The Hazardous Parenting facebook site
• Udemy.com (search under Brenda McCreight)
• Slideshare.com (search under Brenda McCreight)
• Amazon.com (search under Brenda McCreight)
• brendamccreight@gmail.com
• Brenda provides counselling and parent coaching worldwide via
skype,

Autism spectrum disorder

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