Introduction to Neuro Developmental, Locomotor and Multiple Disabilities

Unit 3: Autism Spectrum Disorder: Nature, Needs and Intervention

3.1 Definition, Types and Characteristics
3.2 Tools and Areas of Assessment
3.3 Instructional Approaches
3.4 Teaching Methods
3.5 Vocational Training and Career Opportunities
What is Autism?
• Autism is a complex developmental disability that typically appears during the first three
years of life.
• Autism and its associated characteristics have been estimated to occur in as many as 1 in
150 individuals.
• Autism is four times more prevalent in boys than girls and knows no racial, ethnic or
social boundaries. Family income, lifestyle and educational levels do not affect the
chance of autism’s occurrence.
• Autism impacts the normal development of the brain in the areas of social interaction and
communication skills.
Autism spectrum disorders affect three different areas of a child's life:
1. Social interaction
2. Communication -- both verbal and nonverbal
3. Behaviours and interests
Dr.LeoKanner described Infantile autism in the year 1943

Every person with autism is different. However, there are some common characteristics of
individuals on the autism spectrum that may occur:
 Difficulty in using and understanding language
 Difficulty in using social skills and navigating social situations
 Over or under sensitivity to sound, sight, taste, touch, or smell
 Highly-focused restriction of interests and activities
 Repetitive behaviours such as spinning or lining up objects
 Difficulty with changes to surroundings or routines
 Uneven pattern of intellectual development
 Anxiety, abnormal fears and/or lack of appropriate fear of real dangers
Autism is a spectrum disorder. In other words, the symptoms and characteristics of autism
can present themselves in a wide variety of combinations, from mild to severe. Although
ASD is defined by a certain set of characteristics, children and adults can exhibit any
combination of these characteristics in any degree of severity. Two children, both with the
same diagnosis, can act very differently from one another and have varying skills.
However, when most people talk about the autism spectrum disorders, they are referring to
the three most common PDDs:
– Autism
– Asperger's Syndrome
– Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)
Childhood disintegrative disorder and Rett Syndrome are the other pervasive developmental
disorders. Because both are extremely rare genetic diseases, they are usually considered to be
separate medical conditions that don't truly belong on the autism spectrum

Depending on the child's & symptoms and their severity, the diagnostic assessment may also
include speech, intelligence, social, sensory processing, and motor skills testing. These tests
can be helpful not only in diagnosing autism, but also for determining what type of treatment
the child needs:
• Speech and language evaluation – A speech pathologist will evaluate your child's
speech and communication abilities for signs of autism, as well as looking for any
indicators of specific language impairments or disorders.
• Cognitive testing – Your child may be given a standardized intelligence test or an
informal cognitive assessment. Cognitive testing can help differentiate autism from other
disabilities.
• Adaptive functioning assessment – Your child may be evaluated for their ability to
function, problem-solve, and adapt in real life situations. This may include testing social,
nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing
and feeding him or herself.
• Sensory-motor evaluation – Since sensory integration dysfunction often co-occurs with
autism, and can even be confused with it, a physical therapist or occupational therapist
may assess your child's fine motor, gross motor, and sensory processing skills.
The team of specialists involved in diagnosing your child may include:
1) Child psychologists
2) Child psychiatrists
 3) Speech pathologists
4) Developmental pediatricians
5) Pediatric neurologists
6) Audiologists
7) Physical therapists
8) Special education teachers
Diagnosing an autism spectrum disorder is not a brief process. There is no single medical test
that can diagnose it definitively; instead, in order to accurately pinpoint your child's problem,
multiple evaluations and tests are necessary.
There is only one diagnostic category under the new DSM-5, Autism Spectrum Disorder.
This diagnosis will take the place of the 4 previously separate disorders - autistic disorder,
Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder
–not otherwise specified (PDD-NOS). Those diagnosed with one of the 4 disorders from the
DSM-4 should be given the new diagnosis of an autism spectrum disorder.
• . There are two domains to be observed for imapirments
1) social interaction and social communication and
2) restricted interests and repetitive behaviours.
• To receive a diagnosis, an individual must display a total of 5 out of the 7 possible
impairments. All 3 criteria under the social interaction and social communication domain
must be displayed and at least 2 out of the 4 criteria under the restricted interests and
repetitive behaviour domain must be displayed.
• Sensory differences were added under the restricted and repetitive behaviours domain.
• The DSM-5 requires a severity rating be given for each domain. Ratings are not intended
to determine eligibility for services. Ratings include:
– Level 3: Requiring very substantial support
– Level 2: Requiring substantial support
– Level 1: Requiring support
• The DSM-5 also added Social (Pragmatic) Communication Disorder, a new related
diagnosis to the manual. This diagnosis would be given when an individual shows
impairment in the social communication domain but does not display restricted interests
and repetitive behaviours.
DSM-5 Criteria for ASD
A. Persistent Deficits in Social Communication and Social Interaction across Contexts, not
accounted for by General Developmental Delays, and Manifest by 3 of 3 Symptoms:
A1. Deficits in social‐emotional reciprocity; ranging from abnormal social approach and
failure of normal back and forth conversation through reduced sharing of interests,
emotions, and affect and response to total lack of initiation of social interaction.
A2. Deficits in nonverbal communicative behaviours used for social interaction; ranging from
poorly integrated‐ verbal and nonverbal communication, through abnormalities in eye

contact and body‐language, or deficits in understanding and use of nonverbal

communication, to total lack of facial expression or gestures.
A3. Deficits in developing and maintaining relationships, appropriate to developmental
level (beyond those with caregivers); ranging from difficulties adjusting behaviour
to suit different social contexts through difficulties in sharing imaginative play and in
making friends to an apparent absence of interest in people
B. Restricted, Repetitive Patterns of Behavior, Interests, or Activities as Manifested by at
least 2 of 4 Symptoms:
B1. Stereotyped or repetitive Speech motor movements, or use of objects; (such as simple
motor stereotypies, echolalia, repetitive use ofobjects, or idiosyncratic phrases).
B2. Excessive adherence toroutines, ritualized patterns of verbal or nonverbal behaviour, or
excessive resistance to change; (such as motoric rituals, insistence on same route or food,
repetitive questioning or extreme distress at small changes).
B3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong
attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
B4. Hyper‐or hypo‐reactivity to sensory input or unusual interest in sensory aspects of
environment; (such as apparent indifference to pain/heat/cold, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination with
lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until
social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.
Causes of Autism

 Not yet clear

 Researchers believe that autism may be caused due to
 both genetics and environment factors
 neurological problems
Characteristics of Autism

1. Inability to relate

 Prefer to be alone; appear unaware of other people’s existence

 Appear to avoid gaze or show unusual eye contact

 Not respond to name

2. Speech and language disorder
 Show delay or lack of language development or loss of early acquired language
 Rarely or not use gestures to communicate
  Reverse pronouns
 Echo words or phrases
 Have difficulty in initiating and sustaining conversation
3. Resistance to change
 Like sameness in everyday routines
 May shoe resistance to change in routines or surroundings
4. Impaired non-verbal communication

 Not imitate adults’ action

 Not pretend to play house, talk on phone
 Have unusual or repetitive play, lack or have limited pretend play
5. Odd behaviour and mannerisms
 Display repetitive actions and ask repetitive questions
 Display unusual behaviour or body movement such as spinning, hand flapping, head
banging, or rocking
6. Emotional labile
 Have extreme unusual fears or have poor awareness or danger or not show fear
 Show extreme distress for no apparent reason
7. Over activity
8. Distractibility
9. Difficulties in eating, sleeping and toileting
10. Lack in organization and sequencing - Involves integration of several elements at a time
which they feel difficult. It is easy to understand individual concepts rather than concepts
put together
11. Unusual responses to sensory stimuli
12. Associated motor problems
 Poor muscle tone
 Poor motor planning
 Toe walking
Management of Autism
1. Educational Management
a) TEACCH Method (Treatment and Education of Autistic and related Communication
Handicapped Children)
 Focuses on structured teaching which has two goals
  increasing the individual skill
 making the environment more comprehensive and more suited to individual needs
b) PECS (Picture Exchange Communication System) – In this method the behaviours are
expressed non-verbally through pictures
c) Millers Method – Goals of Miller Method
• To assess the adaptive significance of the children’s disordered behaviour
• To transform disordered behaviour into functional activity
• To expand and guide the children form closed ways of being into social and
communicative exchanges
• To teach professionals and parents how to guide the children toward reading,
writing, number concepts, symbolic play and meaningful inclusion within typical
classrooms
d) Greenspan and floor time Method
Greenspan advocates the D.I.R (Developmental, Individual difference, Relationship-
based) model or Developmental Approach to therapy. The therapy takes the child
through the developmental ladder, starting with the very first milestone he may have
missed. The six functional milestones in
Greenspan method are:
a) Self-regulation and interest in the world
b) Intimacy
c) Two-way communication
d) Complex communication
e) Emotional ideas
f) Emotional thinking
Greenspan advocated what he calls “Floor time”’ an intensive’ 20 to 30 minute period
when you get down on the floor with the child one –to one, interact and play in a
spontaneous and fun manner, interacting in ways that capitalize on his emotions – by
following is interests and motivations – the child is helped to climb the developmental
ladder.

2. Behavioural Management - ABA analysis

 Applied behavioural analysis otherwise known as Lovaas technique
 Based on behavioural theories which promotes social and language development
  Focuses on teaching tasks one-on-one using the behaviourist principles of stimulus,
response and reward
 Support person with autism to
- increase desirable behaviours
- teach new skills
- maintain behaviours
- generalise or to transfer behaviour from one
situation or response to another
3. Medical Management – overactive behaviours and behaviours which cannot be managed
through modification technique, which creates great impact on self or others can
bemedically managed
Steps in Educating Children with ASD
National Research council report (2001) has listed the following steps which are proven to
be effective for education of children with ASD:
 Begin as early as possible
 Use curriculum focusing on communication, social, play, cognitive, behavioural,
motor, self help goals
 Include planning for generalization and transition to next setting
 Involve families actively
 Teaching specific goals in settings with typical peer whenever possible
 Use data based decision making process
Key elements of successful educational programmes for children with ASD include:
a) Supportive teaching environments
b) Plans for generalization
c) Predictable and routine schedules
d) Functional approaches to address problem behaviours
e) Supports for programme transitions
f) Family involvement

Related signs and symptoms of autism spectrum disorders

• While not part of autism’s official diagnostic criteria, children with autism spectrum
disorders often suffer from one or more of the following problems:
• Sensory problems – Many children with autism spectrum disorders either under react or
overreact to sensory stimuli. At times they may ignore people speaking to them, even to
 the point of appearing deaf. However, at other times they may be disturbed by even the
softest sounds. Sudden noises such as a ringing telephone can be upsetting, and they
may respond by covering their ears and making repetitive noises to drown out the
offending sound. Children on the autism spectrum also tend to be highly sensitive to
touch and to texture. They may cringe at a pat on the back or the feel of certain fabric
against their skin.
• Emotional difficulties – Children with autism spectrum disorders may have difficulty
regulating their emotions or expressing them appropriately. For instance, your child may
start to yell, cry, or laugh hysterically for no apparent reason. When stressed, he or she
may exhibit disruptive or even aggressive behavior (breaking things, hitting others, or
harming him or herself). The National Dissemination Center for Children with
Disabilities also notes that autistic kids may be unfazed by real dangers like moving
vehicles or heights, yet be terrified of harmless objects such as a stuffed animal.
• Uneven cognitive abilities – The autism spectrum disorders occur at all intelligence
levels. However, even kids with normal to high intelligence often have unevenly
developed cognitive skills. Not surprisingly, verbal skills tend to be weaker than
nonverbal skills. In addition, children with Autism spectrum disorders typically do well
on tasks involving immediate memory or visual skills, while tasks involving symbolic or
abstract thinking are more difficult.
• Savant skills in autism spectrum disorders
Approximately 10% of people with autism spectrum disorders have special “savant”
skills, such as Dustin Hoffman portrayed in the film Rain Man. The most common savant
skills involve mathematical calculations, artistic and musical abilities, and feats of
memory. For example, an autistic savant might be able to multiply large numbers in his or
her head, play a piano concerto after hearing it once, or quickly memorize complex maps.

Tools used to Diagonose Autism Spectrum Disorder

1) Autism Diagnosis Interview – Revised (ADI-R)
A clinical diagnostic instrument for assessing autism in children and adults. The
instrument focuses on behaviour in three main areas: reciprocal social interaction;
communication and language; and restricted and repetitive, stereotyped interests and
behaviors. The ADI-R is appropriate for children and adults with mental ages about 18
months and above.
2) Autism Diagnostic Observation Schedule – Generic (ADOS-G)
 A semi-structured, standardized assessment of social interaction, communication, play,
and imaginative use of materials for individuals suspected of having ASD. The
observational schedule consists of four 30-minute modules, each designed to be
administered to different individuals according to their level of expressive language.
3) Childhood Autism Rating Scale (CARS)
Brief assessment suitable for use with any child over 2 years of age. CARS includes items
drawn from five prominent systems for diagnosing autism; each item covers a particular
characteristic, ability, or behaviour.
CARS is a 15 item behavioural rating scale developed to identify children with autism as
distinct from children with learning/developmental disability without autism. It is a
hybrid, collecting information from a variety of people and situations, including reports
from parents and teachers alongside school and clinic observations. The child’s behaviour
is compared with that of a normal child of the same age noting the peculiarity, frequency,
intensity and duration of abnormal behaviour.
A new edition includes two rating scales. The standard version (CARS2-ST) is
comparable to the original CARS and is for use with young children or those with
communication or intellectual difficulties. The ‘High Functioning’ version (CARS2-HF)
is for more able individuals, older than 5 years and verbally fluent. There is also a
separate questionnaire for parents/caregivers.
4) Gilliam Autism Rating Scale – Second Edition (GARS-2)
Assists teachers, parents, and clinicians in identifying and diagnosing autism in
individuals ages 3 through 22. It also helps estimate the severity of the child’s disorder.
5) Indian Scale for Assessment of Autism
ISAA is an objective assessment tool for persons with autism which uses observation,
clinical evaluation of behaviour, testing by interaction with the subject and also
information supplemented by parents or caretakers in order to diagnose autism. ISAA
consists of 40 items rated on a 5-point scale ranging from 1 (never) to 5 (always). The 40
items of ISAA are divided under six domains as given below.
Domain-I Social Relationship and Reciprocity
Domain-II Emotional Responsiveness
Domain-III Speech - Language and Communication
Domain-IV Behaviour Patterns
Domain-V Sensory Aspects
Domain-VI Cognitive Component