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AUTISTIC SPECTRUM DISORDERASD
GERRY BROPHY
TALKING LIFE
GROUND RULES
Confidentiality We have the right to make
mistakes and not know things
Take responsibility for your learning by asking questions and giving feedback
Allow others to have their say, challenge the views not the person
You can leave the room at any time, without explanation
AIMS
What is Autistic Spectrum Disorder(ASD) How does ASD impact on individuals? How these conditions can affect behaviours
What support is needed in order to lead fulfilling lives.
FULFILLING AND REWARDING LIVES FOR ADULTS WITH AUTISM
The guidance focuses on 4 important areas where health and social care can practically change the way they support adults with autism:
increasing understanding of autism amongst staff
strengthening diagnosis and assessment of needs
continuing to improve transition support ensuring adults with autism are included within
local service planning
WHAT ARE AUTISTIC SPECTRUM DISORDERS
Life long developmental disabilities causedby neurobiological dysfunction that typically:
Appears during first three years of life and
prevents individuals from properly understanding what
they see, hear and sense.
This results in problems in communication,
social relationships, and behaviour.
The History of Autism Spectrum
DisordersThe labels 'autism' and 'autistic' come from the Greek
word autos, meaning self, and were coined in 1911 by
psychiatrist, Eugene Bleuler.
He used the terms to describe an aspect of
schizophrenia, where an individual withdraws totally
from the outside world into himself.
Causes
Theories about the causes of autism have changed markedly over the years. Many professionals, believed that inadequate parenting was the primary culprit.
Recent increases in the numbers of children diagnosed with autism have also led to a search for possible environmental causes.
However, there is no evidence that environmental factors such as vaccinations (notably the MMR vaccine), pollutants, dietary additives, and so on, are in any way responsible.
CAUSES contd.
The causes of autistic spectrum disorder are
not clearly understood but include genetic
factors, chromosomal abnormalities,
complications of pregnancy and child birth
leading to organic brain damage.
The condition is associated with epilepsy in up
to 30% of cases.
Adults with autistic spectrum disorder may develop
mental health condition such as depression, anxiety,
compulsive behaviours, tics etc.
Diagnosis and treatment of conditions such as
depression/anxiety can be difficult in those with
communication problems.
Adolescents and young adults with Asperger's
syndrome have a higher suicide rate than those of
the same age group in the general population
Autism can co-exist with many other diagnoses, including: depression, social anxiety, obsessive compulsive disorder, attention deficit and hyperactivity disorder, Tourette’s syndrome/tic disorder, developmental coordination disorder, catatonia, eating disorders ,gender identity disorder, personality disorder, psychosis.
Pervasive Developmental Disorders
Asperger’s Syndrome
Autism
PDD – Not Otherwise Specified
Rett's Syndrome
Childhood Disintegrative Disorder
What differentiates?•Number of characteristics
•Age of onset
•Genetic factors
•Pattern of behaviors
•A certain diagnosis does not mean a “lesser”
set of concerns, this does not address severity
of any behavior.
ASPERGER'S SYNDROME
First described in the 1940s
Most people with Asperger's syndrome are within the normal range of intelligence but may have difficulties with social interaction and a restricted range of activities and interests.
Their speech can be well developed and fluent but language may be used in unusual ways.
Rett syndrome Typically, children with Rett syndrome begin by developing fairly normally but go through a period of regression, losing acquired skills; this can be accompanied by distress and anxiety.
At least one in every 10,000 females born has Rett syndrome. It is believed to be the second most common cause of severe and profound learning disability in girls.
A large proportion of people who have Rett syndrome have a mutation, or fault, on the MECP2 gene on the X chromosome.
There are substantial communication and mobility issues for people with Rett syndrome. Most will not speak and, by adulthood, only 50% will walk. However, we are increasingly aware of people with Rett syndrome living well into their 50s and beyond.
Childhood disintegrative disorder (CDD)
Also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset (>3 years of age) of developmental delays in language, social function, and motor-skills.
No known cause for the disorder.
CDD has some similarity to autism, and is sometimes considered a low-functioning form of it, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills.
Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost.
The traits of ASD can be divided
into three main groups or Triad.
They are:
Social interaction,
Social communication,
Social imagination.
CHARACTERISTICS
Triad of Impairments
Social Relationships
Social Communication
(Social Understanding)
ASD
Social interaction
A person who has an ASD may find it hard to relate to other people.
They may:
Seem distant or detached,
Have little or no interest in other people,
Find it difficult to make friends,
Not seek affection in the usual way, or resist physical
contact, such as kissing and cuddling,
Social interaction contd.
Find it difficult to make eye contact with other people,
Want to have social contact but have difficulty
knowing how to initiate it,
Not understand other people's emotions, and have
difficulty managing their own emotions,
Prefer to spend time alone.
Social Communication
A person who has ASD may have difficulty using verbal and non-verbal skills, and some people may remain non-verbal throughout their lives.
People with ASD who do speak, may to others, appear to use speech in an over-complicated way, using odd phrases, or odd choices of words.
They may also make up their own words or phrases, and use more words than are necessary to explain simple things.
Social Communication contd.
Someone with ASD may also have difficulty:
Expressing themselves well,
Understanding gestures, facial expressions, or tones
of voice,
Using gestures to communicate,
Understanding instructions.
Some people with ASD may develop echolalia,
where they repeat words that have little meaning,
or repeat what has been said to them.
Social imagination
Children with ASD may:
Have limited imaginative play,
Play the same games over, or play with games designed for
children younger than themselves,
Get upset if their daily routines are interrupted in any wayShow repetitive behaviours, such as hand flapping or spinning.
In addition, children and adults may develop obsessions, for example,
Specific objects
Lists
Timetables
Routines.
.
Beyond the Triad of ImpairmentsThe Sensory World of Autism
• Senses provide us with the unique experiences which allow us to interact & be involved with others• Senses play a significant role in determining our responses to a particular situation
• Many individuals with autism experience either an intensification or absence of sensory integration
Hyper— Hypo—
The Sensory World of Autism
The Five Senses• Touch (includes balance and body awareness)
Tactile: relates to touch ,pressure, pain, hot/coldHypo- Holding others tightly
(Social aspect)Sensitivity to certain clothing/textures
High pain thresholdSelf-harming (biting, gouging etc.)
Hyper- Finds touch painful/uncomfortable
Dislike of having things on hands/feet
The Sensory World of AutismThe Five Senses
• Touch (includes balance and body awareness)
Vestibular: informs where body is in spaceHypo- The need for rocking, swinging, spinning
Hyper- Difficulties in activities which include movement (sport, dance)
Difficulties in stopping quickly or during an activity
The Sensory World of AutismThe Five Senses
• Touch (includes balance and body awareness)
Proprioception: where & how body is movingHypo- Proximity – personal body space in relation to others.
Navigating rooms – avoiding obstructions.
Hyper- Fine motor difficulties, manipulating small objects (buttons, threading, shoe laces etc).
Moves whole body to look at something.
The Sensory World of AutismThe Five Senses
• Sight
Visual: helps to define objects, colours, spaceHypo- Peripheral vision (central vision blurred)
Poor depth perception (throwing/catching)
Hyper-Fragmentation of images (too many sources)
Focussing on particular detail (rather than whole).
The Sensory World of AutismThe Five Senses
• Hearing
Auditory: informs about sounds around usHypo- Partial or complete absence of hearing
Enjoys noisy places/activities (bangs things)
Hyper- Magnification or distortion of sounds
Unable to filter out external sounds
The Sensory World of AutismThe Five Senses
• Smell
Olfactory: Is the first sense we rely onHypo- May be oblivious to strong odours
May lick things indiscriminately
Hyper- Smells appear intensified/overpowering.
Toileting problems
The Sensory World of AutismThe Five Senses
• Taste
Gustatory: Informs about various tastesHypo- Likes very spicy/salted foods
May eat anything (soil, grass, material etc)Hyper- Prefers bland (white) food
Texture of food may be problematic (lumps)
TreatmentThere is no treatment that can cure autistic
spectrum disorder (ASD).
However, there are many ways that a person with
ASD can get help and support in order to manage
their condition (interventions).
Some people with ASD will require specialist care
and support throughout their lives, whereas others
will require limited support at different times in their
lives.
As there is such a large number of interventions
available for people with autism, parents and
healthcare professionals may find it difficult to decide
which approach is best suited to their particular
circumstances.
Any approach should be positive, build on people's
strengths, and help to discover their potential,
increase their motivation, and provide the opportunity
for them to develop their skills.
Key Issues
Stimulus Over-Selectivity
Central Coherence
Executive Functioning
Idiosyncrasies in Attention
Literalness or Concreteness
Stimulus Over-Selectivity
Refers to the trend to respond only to part of a
stimulus rather than the whole object or to the
whole social setting.
Group examples
Central CoherenceImplies an inability to use context to make full sense of
what is presented (e.g. words with similar appearance
but different meanings and pronunciations like
" There is a tear in my shirt /There is a tear in my eye“
Group work
How many more can you think of?
Executive Functioning
Lacks the ability to plan ahead, or to bring together
bits of information from different sources, and to
generalise or learn for experience, may be limited.
Idiosyncrasies in AttentionThe individual with ASD may be able to focus well
upon certain activities, especially those that he or
she has chosen.
but will probably have problems in shifting attention
from one task to the next especially if the type of
attention required is also changing.
Group examples
Literalness or Concreteness In receptive language nothing can be taken for granted
in the individual’s understanding of instructions that
are not specific. Humour or figurative speech will be
very confusing.
A request such as “Would you like to finish that writing
now?” may only evoke the answer "No" ….
(And this might be wrongly interpreted as provocative
when this was not intended).
FAMILY AND CARERS
The impact of autism is keenly felt on relationships within the family including the parental relationship, the impact on other siblings and spousal relationships.
Advice and help from services and from other families and carers of individuals with autism is valued highly.
Parents also report a struggle to come to terms with a new identity as a carer of a person with autism and the sense of isolation or ostracism that came from this.
AUTISM ASSESSMENT Build the relationship slowly, do the assessment in several
parts over a few weeks • Making sure your assessments are person-centred is vital,
so take a step back to question whether you achieved that. Dr Lorna Wing [a leading expert in autism] said: "Once you
have met one person with autism, you’ve met one person with autism."
That is the phrase to remember because everybody is so different in the way the elements of autism impact on them.
You need a broad understanding of the experience of people on the spectrum, but you also need to understand how the individual is relating to other people and the world because that will influence how you adjust your assessment content.
The programme for any given person
will be based upon individual
observations and assessments,
but basic strategies could well include
some or many of the following:
•Providing a clear structure and set daily routines
•Visual timetables and picture boards to provide
checks on tasks to be covered
•Providing warnings of impending changes of activity
or interruption to routine
•Use of clear and unambiguous language
•Addressing requests or directions directly to the
person, and not assuming that s(he) will adhere to
group directions
•Teaching what "finished" means
•Repeating instructions and checking understanding
•Using a range of means of presenting ideas ….
Visual, peer-modelling, etc.
•Specific teaching and practising of social skills
like turn-taking
•Minimising distractors
•Exploring the use of computer-based learning
and word-processing
•Not insisting on those activities which the
person particularly dislikes, such as games
REFERENCES
Rosenblatt, M (2008). I Exist: the message from adults with autism in England. London: The National Autistic Society, p3, pp5-72 Baird, G et al (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP).The Lancet, 368 (9531), pp210-2153 Rosenblatt, M op.cit. p376 Batten, A et al (2006). Autism and education: the reality for families today. London: The National Autistic Society, p39 Rosenblatt, M op.cit. p311 Redman, S et al (2009). Don't Write Me Off: Make the system fair for people with autism. London: The National Autistic Society, p8
HANDOUTS 1. Visit the website: www.talkinglife.co.uk
2. Select TRAINING BUTTON
3. Select PROFESSIONAL LOG-IN BUTTON on left hand side of this page
4. Select Southwark LOG-in
5.Sign in as follows: email address: [email protected] password: southwark1
6. Select option: View Professional Log in information
7. Select course and follow links to various handouts and presentations for Southwark.