Intellectual Disabilities and Autism Spectrum Disorder

Jade Johnson, Brenna Brase, Jessica Turner

Table of Contents

Intellectual Disability 2

Diagnosis 2

Characteristics and Symptoms 5

Causes 6

Prognosis 9

Specific Needs 10

Treatments 10

TR Implications 11

Resources 12

Autism Spectrum Disorder 16

Diagnosis 19

Characteristics 20

Secondary Symptoms 20

Prognosis 21

Specific Needs 23

Treatments 25

TR Implications 28

Resources 29

References 31

1

Intellectual Disability/Mental Retardation

Intellectual disability is the most common type of developmental disability. It was formerly

known as mental retardation until 2010 when President Barrak Obama signed a bill called Rosa’s

Law. This law caused “mentally retarded” and “mental retardation” to be struck out from all

federal records. These terms had come to be derogatory to those who had intellectual disabilities.

Now known as “intellectual disabilities”, the conditions and populations are the same but now

are titled by a nameless demeaning.

“Intellectual disability can be defined as a disability characterized by significant limitations in

both intellectual functioning and in adaptive behavior, which covers many everyday social and

practical skills. This disability originates before the age of 18.” (aidd.org). People with

Intellectual Disability (ID) have either a below-average intelligence functioning, or a mental

ability that affects their ability to reason, learn, solve problems, and make decisions. People that

have ID also lack adaptive behavioral skills which are necessary for daily life. Adaptive

behavioral skills can include social skills, being able to take care of oneself, and communicating

effectively. Children with ID can develop new skills and take in new information but it often

takes them longer than their peers to do it. (Recreational Therapy for Specific Diagnoses and

Conditions: Intellectual Disability, pg. 201-211)

Diagnosis

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Deficits in intellectual functioning must be two standard deviations below the norm or an

intelligence quotient (IQ) of 70-75 or less.

Four Levels of Cognitive Impairment:

1. Mild Intellectual Disability: IQ of 50-69 (AMA, 2009). This accounts for the majority

(85%) of the persons with ID (Reynolds & Dombeck, 2006). These individuals can be

expected to achieve the mental age of 9-12 years (World Health Organization [WHO],

2007).

2. Moderate Intellectual Disability: IQ range of 35-49 (AMA, 2009). This accounts for

approximately 10% of the individuals with ID (Reynolds & Dombeck, 2006). These

individuals can be expected to achieve the mental age of 6-9 years (WHO, 2007).

3. Severe Intellectual Disability: IQ range of 20-34 (AMA, 2009). This accounts for

approximately 3-4% of the individuals with ID (Reynolds & Dombeck, 2006). These

individuals can be expected to achieve the mental age of 3-6 years and require continuous

support throughout their lives (WHO, 2007).

4. Profound Intellectual Disability: IQ range below 20 (AMA, 2009). This accounts for

approximately 1-2% of the individuals with ID (Reynolds & Dombeck, 2006). These

individuals can be expected to achieve the mental age below three years and have severe

limitations in communication, self-care, and mobility (WHO, 2007).

The diagnosis of ID does not depend solely on IQ, but largely on adaptive behaviors.

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Adaptive behavior : skills that represent an individual’s level of personal independence and social

responsibility. They are based on cultural expectations of performance at various ages

throughout life.

The American Association of Intellectual and Developmental Disabilities (AAIDD) identified

three areas of adaptive behavior skills that challenge individuals with ID:

1. Conceptual Skills: self-direction, orientation to time, money and its value, number

concepts, and language

2. Social Skills: following rules, interpersonal skills, social responsibilities, social problem

solving, gullibility, ability to avoid being victimized

3. Practical Skills: occupational skills, safety, use of money, telephones, healthcare

management, personal skills, activities of daily living

It is vital that those with ID are diagnosed so that they can receive the services they require. In

addition, there are a large variety of other disabilities and disorders that can occur in tandem with

ID.

- Angelman syndrome

- Autism Spectrum Disorder

- Cerebral Palsy

- Cornelia de Lange syndrome:

- Cri-du-chat syndrome:

- Dandy Walker syndrome:

- Down syndrome

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- Fetal alcohol syndrome:

- Fragile X syndrome

- Hurler syndrome

- Hydrocephalus

- Prader-Willi syndrome

- Shaken baby syndrome

- Turner syndrome

- Williams syndrome

(Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, 201-211)

Symptoms

The identifying symptoms of intellectual disabilities are generally found in adaptive

behavior (see definition above). Skills such as tying their shoes, buttoning buttons, zipping

zippers, identifying shapes and colors may not come at the same time as generally expected and

observed by their peers. Individuals with ID may also have trouble with their nervous system,

experience motor delays or motor planning deficits, balance deficits, hypo or hypertonicity,

obesity, and depending on the case also seizures, visual and/or hearing loss, and cardiac issues

such as aortic regurgitation or mitral valve prolapse. (Recreational Therapy for Specific

Diagnoses and Conditions: Intellectual Disability pg. 202-203).

Secondary Problems

5

Intellectual disabilities are often comorbid with other disorders. For example, 50% of

individuals with Autism, and 50% of individuals with cerebral palsy always have ID. Almost

every individual with Down syndrome has ID as well. Under the heading “Diagnosis” is a list of

other disorders or disabilities that are commonly diagnoses alongside ID.

Individuals with ID also have a greater predisposition to developing Alzheimer’s disease

as they age -specifically those with Down syndrome. It is not uncommon to have sensory

processing deficits as well. These are identified by hyperactivity, attention problems, stereotypic

behaviors, self-stimulation, avoidance of touch or movement, disregard for others, and the

inability to interact with others. Other secondary problems that may occur include seizure

activity, physical disability and neuromuscular impairments, mental illness, and occasionally

criminal behavior. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual

Disability pg. 203-204).

Causes

There are 5 main causes of ID which are genetic conditions, problems during pregnancy,

problems at birth, problems after birth, and poverty and cultural deprivation.

1. Genetic Conditions: Genetic abnormalities inherited from the parents. This could include

errors in the combining or grouping of genes, damage to genetic material during

pregnancy (due to overexposure to X-rays), or chromosome abnormalities. Some

examples of genetic conditions are:

a. Down Syndrome- As the most common genetic origin of intellectual disabilities,

Down syndrome is caused by an error in cell division during prenatal growth and

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results in an extra chromosome 21. To know for sure if a child has Down

syndrome, a blood test must be done to show if an extra chromosome 21 is

pregnant. Some symptoms of Down syndrome cause the brain to be shaped

differently, resulting in a smaller total volume of the brain. 1 in 800 children will

be born with Down syndrome (the other one).

b. Williams Syndrome- Williams Syndrome is caused by a mutation of chromosome

7 which causes a fragment of the chromosome to be missing. This causes a delay

in speaking, walking, becoming independent and developing physically. They

also can have difficulties focusing

(https://williams-syndrome.org/what-is-williams-syndrome)

2. Problems during pregnancy: This could include malnutrition or illnesses that the mother

developed during pregnancy such as AIDS, syphilis, rubella, and toxoplasmosis. Also

drugs and alcohol used by the expectant mother can cause intellectual disability.

a. Toxoplasmosis is caused by a parasite. Although the parasite can be found

throughout the world in warm-blooded animals, in the United States it is found

mostly in cat feces. The parasite can live in the ground and can spread to humans

by people getting dirt in their mouths. For this reason, pregnant women are

advised not to garden and not to clean cat litter boxes during pregnancy. The

symptoms are invisible to the pregnant women, but can manifest themselves in

the newly born child in the form of jaundice, rashes, and an enlarged spleen and

liver. Symptoms of an intellectual disability will manifest themselves in the child

months or years later.

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b. Rubella is commonly referred to as the “German Measles”, and can cause serious

birth defects in a developing baby if the mother is infected. These defects include

heart problems, loss of hearing and eyesight, and intellectual disability.

(https://www.cdc.gov/rubella/pregnancy.html)

3. Problems at birth: Delivery problems that cause oxygen deprivation or birth injuries, such

as meconium aspiration or intracranial hemorrhage, low birth weight, prematurity.

a. Meconium Aspiration Syndrome is a respiratory distress in a newborn child who

has breathed meconium (which is its first stool) into the lungs before or around

birth. Fetuses can pass stools caused by stress (such as having a lack of oxygen).

This stress may cause them to inhale reflexively which in turn causes them to

inhale meconium. The meconium can cause a block in the lungs which in turn

block the oxygen to the brain causing possible brain damage which can turn into

an intellectual disability.

(http://www.merckmanuals.com/home/children-s-health-issues/problems-in-newb

orns/meconium-aspiration-syndrome)

b. Intracranial Hemorrhages are also known as brain bleeds and are caused by

traumatic birth injury. They can be caused by medical negligence which could

include trauma during delivery, mistakes that cause oxygen deprivation in the

infant, misuse of vacuum extractors and improper delivery techniques. This

causes abrupt, rapid bleeding within the skill of the newborn baby. Intracranial

Hemorrhages are more common in premature babies.

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https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/traumatic-bi

rth-injuries/intracranial-hemorrhages/

4. Problems after birth: Oxygen deprivation caused by near drowning, mercury or lead

poisoning, head injuries, cerebrovascular accidents in children, brain damage caused by

shaken baby syndrome, diseases such as encephalitis and meningitis.

a. Traumatic Brain Injuries can be caused by a blow to the head, a fall, an auto

accident or being dropped. Many of these injuries can be prevented.

b. Encephalitis is an inflammation of the brain itself. It can be caused by many

things including parasites, viruses, bacteria and autoimmune reactions.

5. Poverty and cultural deprivation: Children raised in poverty have higher risk for

malnutrition and disease, and are exposure to environmental hazards which put them at

risk for Intellectual Disability. Impoverished conditions hinder children from being

exposed to healthy, stimulating environments that are required for proper neurological

development. (Recreational Therapy for Specific Diagnoses and Conditions: Intellectual

Disability, pg. 201-211)

a. Malnutrition can affect a child both before birth and after. If the mother is

malnourished during pregnancy it can hinder the development of the fetus

because they are unable to get the right nourishment. This malnutrition is also

dangerous for young children whose brains are growing and developing rapidly

and need proper nutrition to do so.

b. Environmental hazards (for example, even something as simple as mold growing

in the house) can cause problems in developing children. Children exposed to

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environmental hazards are more likely to develop serious upper respiratory tract

infections, dyspnea, and asthma and sinus infections. The lack of oxygen to the

brain caused by these things in early childhood can have long term effects on the

brain.

Prognosis

Prognosis varies depending on the level of ID and associated handicapping conditions.

Individuals with mild intellectual disability should be able to live in the community with

supervision for finances, home maintenance, and vocational assistance. The main barriers that

occur are social and language. One with a moderate ID will generally require in

home-maintenance -they require support for community-based leisure participation including

set-up, planning, organization structure, and supervision. Those with Severe ID will generally

require foster care or a residential setting for significant daily support. This population will often

have physical development deficits, and speech and language deficits. They will require great

supervision. Profound ID also requires foster care or a residential setting for treatment. However,

they generally require one-on-one care 24 hours a day. They will need lots of assistance verbally

and physically. The best way to determine an individual’s prognosis is to evaluate their

functional ability, not their measured IQ. Because of medical advances, those diagnosed with ID

tend to live longer and have a higher quality of life. (Recreational Therapy for Specific

Diagnoses and Conditions: Intellectual Disability pg. 204).

Specific Needs

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Those with Intellectual Disabilities vary in the degree of assistance and support required.

Despite the severity of impairment, a support team consisting of family members, school

teachers, medical staff, and therapists is critical to teaching as many skills as possible. Early

intervention can identify the individual needs for each child. In addition, special education

programs, day programs, and transition services provide additional support and resources along

the way. Among these services, individuals with ID need an advocate that is educated on the

rights of their child to inclusive services. As individuals with ID are included into the

community, not only will their quality of life increase but also the quality of the lives around

them as they grow in empathy and connection.

Treatment

There is no cure for intellectual disability. It is a disability that people must live with their entire

lives. Although, with the right help, they can become functioning and contributing members of

society. The goal is for them to become independent and to advocate for themselves. They can

learn to understand social and communication skills, and to take care of themselves physically.

With support, many are able to hold jobs and provide for themselves financially.

Physical recreation and exercise have been shown to improve strength, mood, and overall health

in individuals with ID. Exercise also helps them to eat healthier and keep weight gain at bay. The

blood flow stimulates their brain and body and helps them to have energy to perform daily

functions.

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Because many people with ID have a hard time functioning in social settings, it is important for

them to have practice and experience interacting with other people. Social skills can be hard to

grasp for some and easier for others. Each individual with ID needs individualized help.

Support systems are crucial. Supports can be professionals, family, friends or community.

Service systems can provide support such as job coaching to give people with ID a little extra

help on the job. This help can also be provided by a parent, sibling, or co-worker. Supports can

help people with ID achieve the goal to be independent.

http://www.thearc.org/learn-about/intellectual-disability/treatment

TR Implications

The most frequent recreational activities for those with Intellectual Disability are

television, music, phone conversations, crafts, walks, shopping, and car rides. Changing leisure

participation will increase health since these individuals generally have a sedentary life style.

Barriers to additional recreational activities include the “lack of transportation, finances,

recreational skill, personal attitudes, the disability itself, lack of partners, and a lack of

empowerment or control over leisure time” (Recreational Therapy for Specific Diagnoses and

Conditions: Intellectual Disability, pg. 201-211). In order to best aid individuals to achieve

self-determination and quality of life, it is vital that TR professionals aid individuals to overcome

these barriers through leisure education and skill training. As individuals with ID increase the

number of activities that they can participate in, the connections with other individuals during

participation, and the skills needed to participate, they will increase in their self-efficacy and

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fulfillment. With leisure education, functional skills, and knowledge of resources, individuals

will be able to maximize their independence in the community.

As with all individuals, it is vital to assess the severity of disability in order to best meet

the needs of the individual. Common skills taught through therapeutic recreation are social skills,

fine motor skills, recalling rules, attending to tasks, following directions, making decisions,

problem solving, meal preparation, money management, computer usage, and so on

(Recreational Therapy for Specific Diagnoses and Conditions: Intellectual Disability, pg.

201-211).

Resources

Local

- IEP’s in school systems

- http://www.utahparentcenter.org/disability-resource-book/

- Courage Reins Therapeutic Riding Center- www.couragereins.org

- Recreation and Habilitation Services - www.rahservices.org

- TURN Community Services - www.turncommunityservices.org

- University Accessibility Center - https://uac.byu.edu/

State of Utah

- Utah Parent Center- http://www.utahparentcenter.org/disabilities/id/

- Division of Services for People with Disabilities- http://dspd.utah.gov/resources/

- Utah Association for Intellectual Disabilities- http://www.uaidutah.org/

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- http://www.snrproject.com/Resource/Links/UTAH

- Mutual Respect, Advocacy, and Understanding of Utah - www.mrau.org

National and International

American Association on Intellectual and Developmental Disabilities (AAIDD)

An advocacy group promoting research, best practices, progressive policies, and

universal human rights for people with intellectual and developmental disabilities.

www.aaidd.org

Special Olympics International

Non-profit organization supporting recreation and sport participation for people

with ID. www.specialolympics.org

The Arc

Advocacy and research group. www.thearc.org

Best Buddies

Best Buddies® is a nonprofit 501(c) (3) organization dedicated to enhancing the lives of

people with intellectual disabilities by providing opportunities for one-to-one friendships

and integrated employment. Best Buddies has six formal programs for individuals with

intellectual disabilities at various ages and stages of life. www.bestbuddies.org

Center for Disability and Development

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Dept. of Educational Psychology

Web: cdd.tamu.edu

Elwyn

Elwyn is a non-profit human services organization recognized nationally and

internationally as experts in the education and care of individuals with special challenges

and disadvantages. Their goal is to help people with special needs maximize their

potential and live happier, meaningful lives through residential services, education,

rehabilitation, and vocational and employment services.

www.elwyn.org

National Association for Down syndrome

NADS is the oldest organization in the country serving individuals with Down syndrome

and their families. Their mission is to ensure that all persons with Down syndrome have

the opportunity to achieve their potential in all aspects of community life by offering

information, support, and advocacy.

Web: www.nads.org

TASH (formerly The Association for Persons with Severe Handicaps)

TASH is a civil rights organization for, and of, people with intellectual disabilities,

autism, cerebral palsy, physical disabilities and other conditions that make full integration

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a challenge. They provide information, linkage with resources, expert assistance toward

fighting inequities, legal expertise, and targeted advocacy.

www.tash.org

Voice of the Retarded

Voice of the Retarded (VOR) is the only national organization that advocates for a full

range of quality residential options and services for persons with intellectual disabilities,

medically fragile conditions, and challenging behaviors. They advocate for appropriate

placement and watches and acts when legal actions in any state threatens residential

choice or guardianship issues.

Web: www.vor.net

Other websites with great information:

- http://www.parentcenterhub.org/repository/intellectual/

- https://www.lds.org/topics/disability/list/intellectual-disability?lang=eng&_r=1

- http://www.projectidealonline.org/v/intellectual-disabilities/

- http://www.rhd.org/Programs/IntellectualDisabilities.aspx

- http://prntexas.org/intellectual-disability/

- http://www.apdda.org/resources.aspx

- List of organizations national and international

- http://www.clearhelper.org/resources/cwa/sites/orgs/id/US/

- National list

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Autism Spectrum Disorder

“ASD is a neurodevelopmental disorder that is diagnosed on behavioral and developmental

characteristics rather than medical, anatomic, or specific genetic markers…. There is no single

behavior that is always seen in ASD, nor is there a single behavior that can disqualify an

individual from being diagnosed with ASD… it’s the collection of social communication, and

behavioral impairments.” (Recreational Therapy for Specific Diagnoses and Conditions: Autism

Spectrum Disorder, pg. 39-49) Autism spectrum disorder includes:

1. Communication and social interaction deficits.

2. Social-emotional reciprocity, maintaining relationships

3. Nonverbal cues and communication

4. Interests or activities that are repetitive and restricted

5. Sameness insistence, inflexibility to change

6. Fixed interests of high intensity and focus

7. Hyper-sensitivity or hypo-sensitivity to sensory input

“ASD now encompasses the previous DSM-IV Autistic Disorder (autism), Asperger’s Disorder,

Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise

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Specified (APA, 2013).” (Recreational Therapy for Specific Diagnoses and Conditions: Autism

Spectrum Disorder, 39-49)

According to the DSM-5, there are three levels of severity of the ASD:

Level 1, requires support : Impairments exist in initiating and sustaining social interactions

because of social communication deficits. These behaviors interfere with functioning abilities.

Level 2, requires substantial support: Distress is caused when change is required. Repetitive,

restrictive behaviors are obvious, as are social impairments, even when social support is in place.

Level 3, requires very substantial support: Very limited initiation and response in social

interactions. Repetitive, restrictive behaviors are extremely inflexible. The difficulty to change

focus interferes with functioning in activities.

Autism is commonly divided into sections of “low functioning” and “high functioning.” Low

functioning individuals on the Autism Spectrum Disorder demonstrate little awareness of those

around them, appear to be mentally handicapped, often socially impaired, less able to function in

daily living, and has less research. High functioning individuals on the Autism Spectrum

Disorder are socially aware, have good language skills, and appear relatively “normal”.

“Each individual with autism is unique. Many of those on the autism spectrum have exceptional

abilities in visual skills, music and academic skills. About 40 percent have average to above

average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their

distinctive abilities and “atypical” ways of viewing the world. Others with autism have

significant disability and are unable to live independently. About one third of people with ASD

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are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to

improve the lives of all those on the autism spectrum. For some, this means the development and

delivery of more effective treatments that can address significant challenges in communication

and physical health. For others, it means increasing acceptance, respect and support.” (Autism

Speaks)

Because the Autism spectrum is so broad, “There is no single behavior that is always seen in

ASD, nor is there a single behavior that can disqualify an individual from being diagnosed with

ASD.” (Recreational Therapy for Specific Diagnoses and Conditions: Autism Spectrum

Disorder, 39-49)

Demographic information:

● Intellectual ability of children with ASD varies greatly. About half of the children have

average or above-average intellectual ability (i.e., IQ above 85) compared to only

one-third 10 years ago.

● Boys remain more likely to be identified with ASD with one in 42 diagnosed compared

with one in 189 girls.

● Prevalence also varied by racial/ethnic group, with non-Hispanic white children 30%

more likely to be identified than non-Hispanic black children and 50% more likely than

Hispanic children.

● A greater number of black children (48%) were classified within the range of

intellectual disability vs. 38% of Hispanic and 25% of non-Hispanic white children.

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● Median age at diagnosis remains 4 years of age, although resources enable diagnosis

for some patients as young as 2 years old.

● “There are 70 Million people in the world with autism, 85% of them live in developing

countries.”

● Incidence of autism among siblings is 1:1000 but among twins increases to 1:80

● Children with autism are more likely to develop epilepsy

● http://www.aappublications.org/content/early/2014/03/27/aapnews.20140327-1

● http://www.wsj.com/articles/autism-rates-higher-among-certain-immigrants-minorities

-1403543838

- http://autism.lovetoknow.com/Low_Functioning_Autism

- http://www.brighttots.com/Autism/Low_Functioning_Autism.html

- https://www.autismspeaks.org/what-autism

- About 40% of individuals with ASD also have ID

- http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

- https://www.cdc.gov/ncbddd/autism/facts.html

- https://www.scientificamerican.com/article/autism-it-s-different-in-girls/

- http://www.asha.org/public/speech/disorders/Autism/

Diagnosis

A typical diagnostic evaluation involves a multi-disciplinary team of doctors including a

pediatrician, psychologist, speech and language pathologist and occupational therapist.

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“Autism and related disabilities, such as PDD-NOS (Pervasive Developmental Disorder –

Not Otherwise Specified), and Asperger’s Syndrome are difficult to diagnose, especially in

young children where speech and reasoning skills are still developing. Parents who suspect

autism in their child should ask their pediatrician to refer them to a child psychiatrist, who can

accurately diagnose the autism and the degree of severity, and determine the appropriate

educational measures. Autism is a serious, lifelong disability. However, with appropriate

intervention, many of the autism behaviors can be positively changed, even to the point that the

child or adult may appear, to the untrained person, to no longer have autism, and have a full

range of life experiences.”

(http://www.autism-pdd.net/diagnosing-autism-what-you-should-know)

Symptoms

These disorders are characterized, in varying degrees, by difficulties in social interaction,

verbal and nonverbal communication and repetitive behaviors

Autism appears to have its roots in very early brain development. However, the most

obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age

● 1 in 68 American children as on the autism spectrum–a ten-fold increase in

prevalence in 40 years.

● 1 out of 42 boys and 1 in 189 girls

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● Early intensive behavioral intervention involves a child's entire family, working

closely with a team of professionals. In some early intervention programs,

therapists come into the home to deliver services. This can include parent training

with the parent leading therapy sessions under the supervision of the therapist.

Other programs deliver therapy in a specialized center, classroom.

● Unlike people with other forms of autism, people with high-functioning autism or

Asperger's syndrome want to be involved with others. They simply don't know

how to go about it. They may not be able to understand others' emotions. They

may not read facial expressions or body language well. As a result, they may be

teased and often feel like social outcasts. The unwanted social isolation can lead

to anxiety and depression.

● (http://www.webmd.com/brain/autism/high-functioning-autism#1)

Secondary Symptoms

Sensory over-responsivity- “not being able to inhibit sensations effectively

(Karanowitz, 2005). Individuals tend to have “melt-downs” regularly, because they cannot

control how their brain responds to stimuli (b152 Emotional Functions, b156 Perceptual

Functions).

Sensory under-responsivity- “react less intensely to sensory information than

normally developing individuals (b2 Sensory Functions and Pain. Here it seems to take much

more neural activity to reach a responsive threshold (Kranowitz, 2005).”

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Sensory seeking- “need more intense sensory input than typically developing

children. These individuals often exhibit high levels of self-stimulation (b156 Perceptual

Functions, b160 Thought Functions) and tend to bump, press, spin, and jump more than other

children (Kranowitz, 2005).

Mixed Sensory Processing Disorder- “They might be unable to stand loud noises,

but see physical sensory stimulation constantly (Kranowitz, 2005).”

Self-injurious behaviors- self-inflicted and causes physical injury to the individual

Prognosis

There is no known cure but treatment can greatly improve functioning.

“With the appropriate support and services, most individuals with ASD will find

employment, form relationships, and continue to learn and to develop throughout their lives

(NIMH, 2011).”

“Scientific studies have demonstrated that early intensive behavioral intervention

improves learning, communication and social skills in young children with autism. While the

outcomes of early intervention vary, all children benefit. Researchers have developed a number

of effective early intervention models.

Growing evidence suggests that a small minority of persons with autism progress to the

point where they no longer meet the criteria for a diagnosis of autism spectrum disorder (ASD).

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You may also hear about children diagnosed with autism who reach “best outcome”

status. This means they have scored within normal ranges on tests for IQ, language, adaptive

functioning, school placement and personality, but still have mild symptoms on some personality

and diagnostic tests.”

● https://www.youtube.com/watch?v=QdhwsK7E6cc -visual

● https://www.youtube.com/watch?v=K2P4Ed6G3gw -auditory

“The best established prognostic factors for individual outcomes with ASD are presence or

absence of associated intellectual disability and language impairment and additional mental

health problems.”

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(Autism Speaks)

Specific needs

The primary need in ASD, as with any disability or

disorder, is early intervention. Identifying ASD at an earlier

age will lead to greater success later in life.

- Early intervention services (0-2 years old)

- Special Education Services (3 years old and

older)

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The following "red flags" may indicate your child is at risk for an autism spectrum disorder. If

your child exhibits any of the following, please don’t delay in asking your pediatrician or family

doctor for an evaluation:

● No big smiles or other warm, joyful expressions by six months or thereafter

● No back-and-forth sharing of sounds, smiles or other facial expressions by nine

months

● No babbling by 12 months

● No back-and-forth gestures such as pointing, showing, reaching or waving by 12

months

● No words by 16 months

● No meaningful, two-word phrases (not including imitating or repeating) by 24

months

● Any loss of speech, babbling or social skills at any age

○ Taken from Autism Speaks Website

Early intervention will aim to address the following needs common to the majority of

individual on both ends of the Autism Spectrum:

1. Community integration and meaningful

relationships

2. Communication and social skills

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3. Reduce maladaptive behaviors: “Maladaptive behaviors are behaviors that interfere with

everyday activities, and include self-injurious behavior, withdrawal, uncooperative

behavior, aggression, and destruction of property. Although maladaptive behaviors are

often exhibited by people with ASD (Aman, Lam, & Collier-Crespin, 2003; Hollander,

Phillips, & Yeh, 2003; Shea et al., 2004) and are noted as an associated condition in the

DSM-IV definition of autism (APA, 2000), there has been relatively little research

documenting their prevalence and course.” Taken from:

http://www.waisman.wisc.edu/family/pubs/Autism/2007%20Shattuck%20Seltzer%20cha

nge%20autism%20symptoms%20behaviors%20in%20ASD.pdf

4. Additional medical concerns: sleep

disturbance, seizures, and gastrointestinal (GI)

distress.

5. Self-initiation, motor skills and daily living

Treatment

Although there is no known cure, it is common to treat positive symptoms of ASD which

include (and sometimes comorbid with) anxiety, aggression, depression,

attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, psychotic disorders,

bipolar disorder, and oppositional defiant disorder. It is also important to reduce sensory

exposure, increase structure, simplify expectations, and facilitate emotional awareness.

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Another way to help people on the Autism Spectrum Disorder is to educate their families.

If families are educated, they will better know how to help their family member handle the

difficulties that come with having autism. Often, people with autism struggle with

communicating how they feel. If families can know what kind of things are difficult for them,

they will be better able to be helped.

Specific Tests (Recreational Therapy for Specific Diagnoses and Conditions: Autism

Spectrum Disorder, 39-49):

- “The Modified Checklist of Autism in Toddlers (M-CHAT) is a list of

informative questions about your child. The answers can indicate whether he or

she should be further evaluated by a specialist such as a developmental

pediatrician, neurologist, psychiatrist or psychologist. (Take the M-CHAT here.)”

(Autism Speaks)

- Autism Diagnosis Interview - Revised (ADI-R)

- Conducted with the caregiver

- Assess child’s communication, social interactions, repetitive behaviors,

and age-of-onset

- Autism Diagnostic Observation Schedule (ADOS-G)

- Uncovers socio-communicative behaviors that are often delayed,

abnormal, or absent in children with ASD

- Childhood Autism Rating Scale

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- Evaluates the child’s body movements, adaptation to change, listening to

response, verbal communication, and relationship to people

- Good for children over 2

- School Social Behavior Scales (SSBS)

- Evaluation of social skills (social competence and antisocial behavior)

Treatments found by the National Autism Center (Recreational Therapy for Specific Diagnoses

and Conditions: Autism Spectrum Disorder, 39-49):

- Antecedent package

- Behavioral package: reduce problem behaviors and teach functional alternative

behaviors. Ex: token economy strategies and task analysis

- Comprehensive behavioral treatment for young children: early interventions across all

settings

- Joint attention intervention: teaching a child to respond to the nonverbal social bids of

others or to initiate joint attention interactions

- Modeling: demonstrate target behavior

- Naturalistic teaching strategies: providing an stimulating environment, encouraging

conversation, milieu teaching

- Peer training package: teaching children (peers or siblings) without disabilities strategies

for facilitating play and social interactions with children on the autism spectrum.

- Pivotal response treatment: self-initiation or social communication

- Schedules: use lists to complete activities

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- Self-management: promote independence by training individuals to regulate their own

behavior

- Story-based intervention package: telling of a task, skill, or action to be accomplished in

a story format

TR implications

When using therapeutic recreation to help treat those with autism or other intellectual

disabilities, it is crucial to note that every individual is unique; no diagnosis is the same. It is

more important to utilize the whole team to benefit the individual than to follow a set process or

approach. Often treatment occurs as a part of a child’s IEP at school. These interventions should

be highly structured and specialized programs -this will help reduce anxiety, provide a sense of

control, and target specific needs of the child. The most important outcomes these interventions

should target are: effectively supporting peer friendship development, focusing on

communication and social skills, and increasing engagement and involvement in activities with

peers rather than parents or other adults. Autism Speaks suggests that young children diagnosed

with early signs of autism receive “structured, therapeutic activities for at least 25 hours per

week.”

The APIED process is essentially a lifetime process for one with an autism or intellectual

disability diagnosis. The disability will not go away, so treatment continues until they are able to

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apply principles themselves or feel they no longer need it to live in the manner they desire. This

is almost always a whole team approach so that all needs can be met. In assessment one must

understand specific needs along the spectrum (e.g. sensory profile, communication skills,

cognitive processing). In planning, a more highly structured environment will allow them to

focus on the task at hand. Certain activities might require too much communication, change, or

stimulus and could overwhelm a child. The goal of each activity should be self-determination

and efficacy. An example of an activity is a group problem solving game where only two team

members can communicate. LEGO blocks are also a beneficial tool. Implementation should be

done frequently -the 25 hour recommendation was mentioned above. Evaluation and

documentation should continue to occur throughout until the individual’s and therapist’s goals

are met completely.

Resources

A wide variety of resources are available from informative websites to programs and

research centers. The greatest resources to children with intellectual disabilities and ASD are

their families and communities. Those resources are generally facilitated by an Individualized

Education Plan (IEP) with the school that child attends. Additional resources on the state,

national, and international level provide additional support by connecting students to transition

programs, other families with similar challenges, and more.

Local: IEP plan with school

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State: Heritage, Scenic View, Daniel’s Academy

National:

International: Global Autism Collaboration

Additional websites for ASD:

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https://www.autismspeaks.org/what-autism/world-autism-awareness-day/international-au

tism-organizations

http://www.autism-insar.org/

http://www.autism-resources.com/links/organizations.html

http://aspergersyndrome.org/

References:

Porter, H. R. (2015). Recreational therapy for specific diagnoses and conditions . Enumclaw,

WA: Idyll Arbor.

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