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Autism Spectrum Disorders
Introductory notes for the development of an effective support service
History of the autism label
1911– Bleuler coins ‘autism’ from the Greek for self: ‘autos’
1940s – Kanner identifies traits such as aloofness, rigidity of routine,
repetitiveness, anxiety– Asperger identifies similar traits in adolescents– Bethelheim wrongly infers mental illness
1964– Rimland identifies a neuro-behavioural condition
1994– Autistic Spectrum Disorder (ASD) is defined as a ‘pervasive
developmental disorder’
Myths about ASD
– Everyone with ASD has a special talent– Everyone with ASD is a potential genius– Everyone with ASD is mentally retarded– ASD means no emotions or attachments– “Once autistic, always autistic”– “Confrontation must be avoided at all times”– Conversely, “All behaviours must be normalised”
The truth is: Everyone is a unique human being
The three main impairments
1. To social relationships
2. To social communication
3. To imaginative thought
But the combination of impairments is individual
And other characteristics are also common:– sensory sensitivity,– monotone voice, – bowel problems– and more
ASD ‘types’ or diagnoses
Autistic Disorder (classification) Childhood Disintegrative Disorder Betts Disorder Asperger’s Syndrome Pervasive developmental disorder: not otherwise
diagnosed (a ‘typical’ autism)
What counts is the actual behaviour, not the label
Potentially relevant medical tests
Hearing Genetic EEG (tumours) Metabolism MRI CAT scan
These may augment understanding of ASD condition, or adjust diagnosis
For example, some behaviours may be due to diet or hearing impairment, not ASD
Causes of ASD (I)
Unknown…
But probably a mix of:
– Genetic make-up
– Environmental factors (eg: toxins, serotonin, viruses, possibly vaccines, etc)
Causes of ASD (II)
This mix of genetic and environmental factors then appears to affect the following:
– Sensory nervous system - sensory sensitivities
– The brain - problems understanding the world
– Gastro-intestinal tract - bowel problems are common
Research continues - it is important to support & learn from
research
Understanding behaviours (I)
Sensitivities to different senses often need to be explored
Such sensitivities may explain behaviours, such as those opposite
– Very specific food choices (or is it an allergy?)
– Avoidance of noise and talk
– Minimal reactions to touch
– Not wanting to wear clothes
Understanding behaviours (II)
How would you behave if your environment was physically painful, or made no sense?
You might display some of the behaviours opposite.
Don’t assume. Explore.
Lack of eye contact and desire for own space
Unusual body movements
Not interacting or imitating
Lining up objects / liking furniture to stay the same
Tantrums and aggression
Sensory sensitivities
Really get to know people’s issues
Strike a balance between:
– desensitising the person - and
– changing or avoiding environments
Make commonsense practical arrangements:
– Sunglasses or a visor
– Ear plugs or a walkman
– Padded chair legs
– At home, avoid fluorescent lights
To push or not to push?
Pampering people’s autistic traits may avoid short term conflict but can greatly limit their quality of life and health
People will often benefit from individual development
plans with an element of challenge
People should be challenged for Quality of Life and safety reasons – not to make them ‘normal’
It is essential that everyone is careful, sensitive, and well informed.
Treatments and Programmes
There are many different variations
“The right teacher is more important than the type of programme”
Dr Temple Grandin
Portage - home teaching
Floor Time – join person’s world
SPELL – approach of Nat Aut Soc
TEACCH -approach of Aut Ind UK
ABA – applied behavioural analysis
PECS –picture exchange comm sys
Social Stories And more…
The S.P.E.L.L programme A National Autistic Society approach
Structure Positive approaches and expectations Empathy Low arousal (a measured approach to challenging and stretching people)
Links (involving and building on family and other relationships)
Applied Behavioural Analysis
Understanding and shaping people’s behaviour
Exploring people’s environment and experiences– What happens before a behaviour– What happens after a behaviour
Keeping records and looking for patterns
ABA is an essential tool in any programme
P.E.C.SPicture Exchange Communication System
A system for developing initial understanding of language by using pictures of items and rewarding appropriate use
For example, a request for a drink using a picture of a drink is rewarded with a drink
A range of courses and materials are available for purchase
Social Stories
Social Stories are relatively short, straightforward descriptions of social situations, specifically detailing what an individual might expect from the situation and what may be expected of him.
They describe the events and rules which usually apply when (for example) shopping
They help to overcome people’s problems in understanding the world
Specialist inputs
Professions:
– Psychology
– Speech Therapy
– Occupational Therapy
Technologies:
– Assistive (Environmental) Technology
– Information Communication Technology
Assistive Technologies
Movement Sensors Floor Sensors – prone alarms Staff pagers – prone alarms Flood sensors Heat / height controls, inside and outside Bed sensors
The holistic nature of ASD
No single response will suit all or any Individualised responses are needed But with some common patterns of some
needs:– Communication impairments– Sensory sensitivities– Socialization sensitivity– Rhythms and routines etc
Individual Support PlanningCartrefi Cymru’s person-centred approach
Get to know the person– Past & present– Important relationships– Likes & dislikes– Rhythms and routines– Skills & potential– Health – Dreams & aspirations
Plan together– Build on Care Plans– Optimise participation– Real communication– Turn goals into actions– Be focused & consistent– Responsive & respectful– Celebrate achievements
Enabling people to have ties and connections
Identify useful activities and opportunities which can connect to the person’s own likes and wants
Identify the information and skills they need
Help others to be understanding and accepting
Develop safety skills and “getting around” skills, maps etc
Promote community participation in all its forms – from work and learning to leisure and relationships
