5-6 hour basic training around autism and behaviour / communication

1. LEEDS AUTISM SERVICES
The Autistic Spectrum
Trainer – Karen Worrell
 Mobile phones off / silent please!
Breaks / Toilet etc.
 Health and Safety
 Introductions

2. Autism / Asperger Syndrome
Course Objectives:
Myth busting
Develop basic understanding of ASD
Understanding the triad of impairments
 Sensory issues and autism
 Behaviour analysis
 General strategies

3. It’s just as though he’s not
listening.
He’s always ruining others’
activities!
The only place she will eat
her dinner, without
screaming, is in the I told the him we were
corridor. going to have a treat
instead of the usual day
and he starts shouting and
screaming.
She paces round and
round the TV lounge. She
doesn’t even watch it.
He just won’t leave the
lounge room door open – it If I get cross, she just
gets absolutely roasting seems to think it’s funny –
during summer! why won’t she listen?

4.  AUTISM – MYTHS AND FACTS?
 result of emotional deprivation or emotional stress
x
 a wish to avoid social contact x
 a developmental disorder involving a defect in brain
function 
 associated with unusual responses to sensory stimuli 
 a life long disability

 often linked to genius abilities
x

5.  Biological Basis
 Genetic factors
 Pregnancy and Birth 100
complications 90
80
 Viral infections 70
 Other causes – trauma, 60
male
hormonal imbalances 50
female
 Biological factors result in 40
30
The Triad of Impairment 20
 Far more males are 10
affected than females: 0

6.  Prevalence
 NAS Fact Sheet February 1997
 Autism IQ below 70 20 per 10,000
 Spectrum IQ above 70 71 per 10,000
 Total Prevalence 91 per 10,000
 Based on these figures Leeds would expect:
 5100 adults with autistic spectrum disorders.
 15% would have significant learning disabilities.
 At least 765 adults in Leeds requiring services.

7. Triad of Impairments
(The Defining Characteristics of ASDs)
Lorna Wing - 1978

8. The Triad
Social understanding
Communication Imagination

9.  THE TRIAD OF IMPAIRMENTS
 All three areas of impairment must be present for a
diagnosis
 They will be present before 36 months
 The severity of each will vary between individuals and
within individuals over time
 They will be out of keeping with their developmental
level

10. Impairment of social understanding
 aloofness and indifference to other people
 passively accepts social contact
 Spontaneous but in an odd, inappropriate, or repetitive way with little or no
attention to responses
 Interactions tend to be ‘one way traffic’ i.e. not reciprocal
 Lack of empathy (Theory of Mind)

11. Impairment of social understanding
 Expressions of emotion often inappropriate or extreme
 Expects other people to know their thoughts and feelings
 May appear withdrawn / introverted or over familiar
 Can make personal comments without understanding that this may cause offence

12. Theory of Mind...
Theory of mind is the ability to
...or knowing how to mind read! attribute mental states—
beliefs, intents, desires,
pretending, knowledge, etc.—to
oneself and others and to
understand that others have beliefs,
desires and intentions that are
different from one's own
Eye contact
Body language
Facial expressions
Tactile communication

13. Impairment of social communication
 difficulty making sense of and using all aspects of
communication i.e. verbal and non verbal
 ranges from little or no spoken language to those who
appear articulate
 lack understanding of body language e.g. tone of voice, facial
expression
 literal, pedantic, concrete understanding and use of words,
limited content of speech

14. ‘I’m on top of the world!’
‘You'd better pull your socks up!’
‘I laughed my head off!’
‘Could you keep your eye out for dad’
‘If you don’t stop doing that you’ll be in hot water!!
‘It’s on the tip of my tongue’
‘I’m tied up at the moment’
‘Don’t forget to pull the door
behind you’
‘Now we are going to toast the bride and groom’

15. Communication – How Good Are You?
Rules:
 You are not allowed to say the
name of the objects in the
drawing or use names of
components of the picture
 You are not allowed to use the
names of comparative objects
 You are not allowed to name the
purpose or use of objects in the
drawing
 i.e. – you may only use descriptive
terms such as shapes and where
they appear on the paper / in
relation to each other
 The ‘artist’ is not allowed to talk!

16. Imagination
noun
the faculty or action of forming new ideas, or images or concepts of external objects not
present to the senses:she’d never been blessed with a vivid imaginationher story
captured the public’s imagination
[mass noun] the ability of the mind to be creative or resourceful:she was set in her ways
and lacked imagination
the part of the mind that imagines things:a girl who existed only in my imagination
- Oxford English Dictionary definition
“Imagination is more important than knowledge. For knowledge is
limited to all we now know and understand, while imagination embraces
the entire world, and all there ever will be to know and understand.”
- Albert Einstein

18. Impairment of imagination
 Difficulty with creative, open-ended activities, and more
abstract ideas
 Rigidity and inflexibility in thinking and behaviour
 restricted range of interests and skills pursued in a repetitive
manner
 Rituals and obsessions, and an insistence on sameness

19. George Orwell – Author;
Albert Einstein – Physicist; One of
His troubled life went along with social
the greatest minds of the 20th interaction problems. Wrote a “Such,
century. Reportedly couldn’t tie Such were the Joys” a bitter account of
his days in boarding school in which he
his own shoelaces describes many of the traits related to
Asperger Syndrome.
Nikola Tesla - Inventor
Andy Warhol – Artist;
Was able to mentally picture very detailed
Credited with creating the pop-art
mechanisms; spoke 8 languages; was never
movement. Also reported to have
married; was very sensitive to touch and had an
had an obsessive personality, be
acute sense of hearing and sight; was obsessed
unable to adapt to different social
with the number three; was disgusted by
situations and frequently described
jewelery and overweight people and also had
by contemporaries as ‘odd’.
several eating compulsions
Dan Aykroyd - Actor / Comedian; Diagnosed with
Asperger’s and Tourettes
“Well, it was mostly physical tics, the classic
Tourette's type syndrome, that type of thing. But
by the time I was 14 it was allayed and I really
haven't had too much occurrence except on the
Asperger's side, where I have a fascination with
police, and I always have to have a badge with
me. ... I have a fascination with law
enforcement and the police. “

20. Why the obsession with rituals
and routines?

21. How important is your routine?

23. Sensory Difficulties
(The Fourth Characteristic)

24.  Abnormal responses to environmental stimuli.
 An individual with autism may be:
 hyposensitive or
 hypersensitive
 All senses may be affected.
 Over stimulation can be a trigger for those “out of the blue”
reactions.

25. ‘School was a nightmare! I was so easily caught away with
life's interruptions. It might have been a child coughing, a
bus passing by on the road outside, a bird singing, or
simply my own thinking trying to work out words from a
previous conversation’.
Wendy Lawson

26. SENSORY QUIZ
IFNOSPACESARELEFTBETWEENWORDSITSDIFFICULTT
OSEE
ORIF TH EWO RDS BEG INA NDE NDI NPLA CEST HAT
DON TMAK ESE NSE
TEWO E O CE D
H R S EM T N U AN OW
DS DA P N

27. Who is this?

28. What everyday task are you being
taught in the audio clip?

29. SENSORY QUIZ - ANSWERS
IFNOSPACESARELEFTBETWEENWORDSITSDIFFICULTT
OSEE
If no spaces are left between words it’s difficult to see
ORIF TH EWO RDS BEG INA NDE NDI NPLA CEST HAT
DON TMAK ESE NSE
...or if words begin and end in places that don’t make sense
TEWO E O CE D
H R S EM T N U AN OW
DS DA P N
The words seem to dance up and down

30. What everyday task are you being
taught in the audio clip?

31. Who is this?

32. Visual
Hypersensitive
 Covers eyes / looks down
 Looks at minute particles / dust
 Frightened by flashes of light
 Dislikes dark / light
Hyposensitive
 Stares at bright lights
 Moves fingers or objects in front of eyes
 Fascinated with reflections or bright coloured objects
 Runs hand round edge of objects

33. Aural
Hypersensitive
 Covers ears
 Makes repetitive noises
 Isolates self in areas such as toilet, store cupboards etc.
 Dislikes thunderstorms, crowds, having haircut etc.
Hyposensitive
 Bangs doors / objects
 Seeks noises
 Makes loud vocalisations
 Delayed / no response to aural cues

34. Tactile
Hypersensitive
 Resists touch
 Cannot tolerate new clothes / damages clothing
 Dislikes foods with certain textures
 Avoids people
Hyposensitive
 Seeks pressure
 Prefers tight clothing
 Prone to self injuries
 Little response to extremes of temprature

35. Olfactory (Smell)
Hypersensitive
 Toileting problems
 Moves away from people
 Refusal to wear new clothes / frequent changing
 Avoidance of certain smells
Hyposensitive
 Sniffs / smells objects or people
 Smears / plays with faeces
 Seeks out odours
 Bedwetting / urinary ‘incontinence’

36. Gustatory (Taste)
Hypersensitive
 Very limited food repertoire
 Gags / vomits easily
 Poor eater
 Uses tip of tongue for tasting
Hyposensitive
 Regurgitates food / intentional vomiting
 Mouths / licks objects
 Eats inappropriate materials
 Mixes food e.g. Main course and desert

37. Interoceptive / vestibular /
proprioceptive
Hypersensitive
 Places body in strange positions
 Seeks pressure
 Unsteady on feet
 Extreme reactions to heat or cold
Hyposensitive
 Incontinence
 Appears ‘floppy’ / low muscle tone
 Constantly seeks food / drinks
 Rocking / spinning

39. “That tension that I have to live with every
dang minute... I have to take naps through the
Quotes - feelings
day because I wear myself out just
being...constantly startled is a good way to put
it.” - Phil Wheeler
“I experience life in themes. I have tremendous
difficulty filtering out the essential from
nonessential. I have trouble prioritizing the
relevant pieces of information.” - Dena Gitlitz

41. Analysing Behaviour

42. poor concept of
time
changes in does not know /
routine understand
rules
unsure what is anxious about
going to happen failure
STRESS
difficulties with
communication sensory
difficulties
literal
interpretation of
situation

43. AGGRESSION ICEBERG
Pushing Hitting
Specific
Behaviours Spitting Throwing
Shouting Swearing
• unaware of social rules
• unaware of others feelings
Underlying
Deficits • over sensitive to noise
• frustration through inability to
communicate appropriately
• inappropriate reaction to others

44. OVER PASSIVE ICEBERG
Seems lazy
Specific Unmotivated
Behaviours Waits for prompts
Over dependent
• Unaware of other people
Underlying
Deficits
• Poor concept of time
• Does not understand future rewards
• Unmotivated by usual rewards
• Does not understand expectations

45. Analysing Behaviour: The ABC Approach

46. ABC Recording Sheet

47. Addressing Challenging Behaviour
 Record the behaviour (actions)
 Analyse the underlying causes (setting and triggers)
 Analyse the consequences (results)
 Alter the triggers and / or results
 Analyse the function of the action and teach more
appropriate responses

48. Behaviour Support Plans
 Identify behaviour/s of concern
 Known triggers
 Management strategies
 Reducing impact of incidents
 Response strategies at each stage
 Follow up / debrief
 Review / evaluate
 Agreements / multi-agency consistency

49. Practical Suggestions

50. Practical Suggestions
• Incorporate a routine
• Minimise unstructured time
• Be aware of the environment
• Use practical problem solving
• Think about an individual in terms of their autism
• Involve everyone
• Ensure consistency
Early intervention is key -
Prevention is better than cure!!!

51. VISUAL CUES
People with ASD are visual learners so visual
ways to facilitate communication are
explored:
What I do is write everything I have to do
down. That visual support is very useful for
me. My to do list is like a ritual to me. Some
people pray at night, I write a to do list.
Dena Gitlitz

52. Visual Learning – What Are
the Benefits?
• Develops understanding
•Aids retention
• Provides alternative to social imagination
• Provides reference point
• May assist in developing ownership of agreed
actions

53. VISUAL COMMUNICATION TEST
 Do you have a diary or calendar that you write things on to
help you organize your life?
 Do you have a list of “things to do” on your fridge or at work?
 Have you ever pointed to a picture in an advertisement or a
menu to show someone what you want?
 Do you write a shopping list before you go to the
supermarket?

54. 

55. Work Systems
A work system is a
concrete, visual way to tell
the person:
1) What they have to do
2) How much they have to do
3) When they are finished
4) What happens next

56. Setting up schedules/ timetables
WHAT
vertical grids
The visuals go down
the side as seen in this
morning schedule.

57. Visual Structure

59. Social Stories
 Visual – symbols, photos, writing
 Fewest points possible
 Permanent - allow individual to revisit
 Simple language – whether written or spoken
 Based on knowledge of individual
 Explicit – do not make assumptions
 Factual – stick to known outcomes; consequences must
be agreed and carried out
 Definite – avoid use of ‘maybes’

61. GENERAL STRATEGIES
Communication
 Limit language used – clear, precise and slow
 The ‘implicit’ should be made ‘explicit’
 Be aware of the literal – explain idioms, don’t ask
unless there is a genuine option
 Cannot assume understanding – check ensure / cue
attention

62. GENERAL STRATEGIES
Social Interaction
 Social skills need to be ‘taught’ not ‘caught’
 ‘Unwritten’ or ‘unspoken’ rules will need to be made
explicit

63. GENERAL STRATEGIES
 Need to be aware of structure and routines -what’s now /
what’s next
 Flexibility in thinking – the more inflexible the individual
is, the more flexible the staff will need to be!
 Visual cues – easier to understand and also ‘permanent’
reminder
 ‘Free’ unstructured / transitional time may need planning
 Abstract or open ended activities may need to be made
more concrete or specific

64. GENERAL STRATEGIES
Behaviour and Obsessions
 Clear consistent guidelines and boundaries
 Ensure rules are understood
 Emphasis on what we want the individual to do rather
than what we don’t want them to do
 ‘Desirable’ behaviour may need teaching – be patient
 Distract and divert
 Obsessions – cannot eliminate but limit or use as
motivation

65. GENERAL STRATEGIES
Working Together
 Maintain a dialogue with parents and carers
 Ensure that all staff are fully informed
 Use written plans / scripts where appropriate
 Consider how other service users can understand the
nature of the disability
 Think about unstructured times and transitions
 Limit choice so it is manageable to the individual

66. Golden Rules
 Know the individual
 Understand ASD
 Structure the environment
 Reduce your language
 Recognise anxiety / build up

67. It’s just as though he’s not
listening.
He’s always ruining others’
activities!
The only place she will eat
her dinner, without
screaming, is in the I told the him we were
corridor. going to have a treat
instead of the usual day
and he starts shouting and
screaming.
She paces round and
round the TV lounge. She
doesn’t even watch it.
He just won’t leave the
lounge room door open – it If I get cross, she just
gets absolutely roasting seems to think it’s funny –
during summer! why won’t she listen?

68. Further Resources
Useful Websites
• www.nas.org.uk
• www.through-the-maze.org.uk
• www.bild.org.uk
• www.autismuk.com
Suggested Reading
• Autism and Asperger Syndrome – Simon Baron Cohen
• A History of Autism – Adam Feinstein
• The Curious Incident of the Dog in the Night-Time – Mark Haddon
• Thinking in Pictures – Temple Grandin