DNE: Lecture 2***

• Autism Spectrum Disorders (ASD)


  Neurodevelopmental disorder – affects central nervous system or impairment of growth and development of brain

  
• Autism Spectrum Disorder

  Disorder of brain function that affects emotion, learning ability, self-control and memory

  
• Diagnostic features of Autism Spectrum Disorder

  • Persistent impairment in reciprocal social communication and interaction
  • Restricted, repetitive patterns of behavior, interests, activities
  • Symptoms must be present in the early developmental period
  • Symptoms cause clinically significant impairment in social, occupational, or other functioning
  • Not better explained by intellectual disability or global developmental delay

  
• Deficits in social communication and social interaction


  • Reduced sharing of own emotions/affect
  • Reduced sharing of interests
  • Failure of normal back and forth conversation
  • Lack of initiation or response of social interaction
  • Unusual social approach
• Deficits in nonverbal communication behaviors used for social interaction


  • Fail to coordinate verbal and non-verbal communication
  • Fail to understand and use of gestures
  • Abnormalities in use and understanding of affect
  • Abnormal eye contact and body language
  • Unusual intonation, rhythm or pitch in speech
• Deficits in develop, maintain & understand relationships

  • Do not take another person's perspective
  • Lack of imaginative play with others
  • Difficulty understanding what behavior is appropriate in one situation but not other
  • Do not show interest in peers
  • Problems of making friends
• Restricted & Repetitive Behaviors, Interests or Activities

  • Repetitive or stereotyped motor movements
  • Repetitive or stereotyped use of objects
  • Repetitive or stereotyped speech
  • Excess adherence to routines
  • Ritualized patterns of verbal or nonverbal behavior
  • Restricted interests – abnormal intensity
  • Fascination and routines related to sensory input
• Dimension of Severity - Level 1 "Requiring support"


  • Deficits in social communication cause noticeable impairments
  • Difficulty initiating social interactions, unsuccessful responses to social overtures of others
  • Unsuccessful attempts to make friends
  • Appear odd
  • Inflexibility cause significant interference with one or more context
  • Difficulty switching between activities
  • Problems organizing and planning independence
• Dimension of Severity - Level 2 "Requiring substantial support"


  • Marked deficits in verbal and nonverbal social communication skills
  • Social impairments apparent even with supports
  • Limited initiation of social interactions
  • Reduced or abnormal responses to social overtures from others
  • Narrow special interests
  • Odd nonverbal communication
  • Inflexibility of behavior
  • Difficulty coping with change
  • Restricted/repetitive behavior appear frequently
  • Distress or difficulty changing focus or action
• Dimension of Severity - Level 3 "Requiring very substantial support"


  • Severe deficits in verbal and nonverbal social communication skills
  • Severe impairment in functioning
  • Limited initiation of social interactions
  • Minimal response to social overtures from others
  • Makes unusual approaches to meet needs only and responds to only very direct social approaches
  • Inflexibility of behavior
  • Extreme difficulty coping with change
  • Restricted/repetitive behaviors interfere with functioning in all spheres
  • Great distress/difficulty changing focus or actions
• Diagnose


  1. Based on the related criteria stated in Diagnostic and Statistical Manual of Mental Disorders (DSM-V)

  2. Observing the child's behaviors

  3. Interview with caregivers

  4. Medical history

  5. Other tests for ensuring the disorder is not caused by other conditions
• Other disorders might be overlapped with ASD, e.g. ADHD, Language impairments, Intellectual Disability
• The cause of ASD remains unknown
• Causes of ASD


  • Neurological Impairment - Brain structure and function, Biochemistry/ Immunology
  • Genetic
• Teaching Strategies and Treatment


  • Social skills programs
  • Academic programs
  • TEACCH (Treatment and Education of Autistic and Communication related handicapped Children)
  • ABA (applied behavior analysis)
  • Antipsychotic drugs e.g. risperidone - reduce emotional distress, aggression
  • Speech therapy, Music therapy, Occupational therapy
• Communication Teaching Strategies


  • Verbal communication - Modeling, Making request, Communication Temptation
• ABA (applied behavior analysis)


  Reduces emotional distress, aggression
• Therapies


  • Speech therapy
  • Music therapy
  • Occupational therapy
• Verbal communication


  • A child imitates a teacher's verbal pronunciation (e.g. "Ball")
  • Provide the object the child requested as reinforcement to the child's speech
  • Extend verbal imitation into more comprehensive sentence (e.g. I want the ball)
• Making requests

  • A child needs to make a request or ask for things he/she wants
  • The child is given the requested object after making the request
• Communication Temptation


  • Creating a situation to facilitate the child to make spontaneous language
  • E.g. place the wanted object in unreachable distance/give an unwanted object/create a play scenario to attract the child
  • The child has to use speech to request for object/ to refuse /to ask for joining
• Augmentative and Alternative Communication (AAC) Systems


  • Any form of communication, but verbal communication
  • AAC system should be tailored made to meet the needs of the children
  • Unaided communication systems e.g. facial expression
  • Aided communication systems e.g. paper and pens
• Picture Exchange Communication System (PECS)

  • Use pictures to develop a child's non-verbal communication
  • For children with no or little communication ability
• PECS Phase I: How to Communicate

  Children learn to exchange single pictures for items or activities they really want
• PECS Phase II: Distance and Persistence


  Still using single pictures, children learn to generalize this new skill by using it in different places, with different people and across distances
• PECS Phase III: Picture Discrimination

  Children learn to select from two or more pictures to ask for their favorite things. These are placed in a communication book, a ring binder with Velcro strips where pictures are stored and easily removed for communication
• PECS Phase IV: Sentence Structure

  Children learn to construct simple sentences on a detachable sentence strip using an "I want" picture followed by a picture of the item being requested
• PECS Phase V: Answering Questions


  Children learn to use PECS to answer the question, "What do you want?"
• PECS Phase VI: Commenting

  Children learn to make up sentences starting with I see, I hear, I feel, It is a, etc.
• Teaching Interaction


  1. Describes the target behaviour

  2. Provides the rationale for performing target behaviour

  3. Describes the situation and characteristics of the behaviour which should be performed

  4. The teacher demonstrates the target behaviour by role play

  5. The teacher provides prompts to facilitate the child to perform the target behaviour

  6. The teachers provides feedback on the child's performance

  7. The child rehearses the newly learned behaviour gradually without prompts

  8. The child will perform the target behaviour in a naturalistic setting (e.g. in a playground with peers)
• DIR - Floor Time

  • The aims of Floor time are to help children to reach six developmental milestones: self-regulation and interest in the world, intimacy or engagement in human relations, two-way communication, complex communication, emotional ideas, emotional thinking
  • A therapist and the parents engage a child in the activities which the child enjoys on the floor
  • The therapist and parents enter the child's games and follow the child's lead
  • Encourage back and forth, and more complex play interaction between the child and the parents / the therapist
  • It fosters eye contact, imitation and joint attention during play
• TEACCH (Treatment and Education of Autistic & Related Communication Handicapped Children)


  • TEACCH is a framework to support children with Autism to achieve their academic and therapeutic goals
  • The TEACCH method provides the child with structure and organization, so that the child can understand their surrounding
• TEACCH framework


  • Physical organization
  • Individualized schedules
  • Work (Activity) system
  • Visual structure of materials in tasks and activities
• TEACCH Activity Procedures


  1. Place baskets systematically

  2. Pick up the task basket according to the task schedule

  3. Work on the task independently

  4. Put the task basket back after finishing the task
• Visual Schedule


  • It uses the children's visual strengths to increase their understanding
  • It helps the children remain calm and reduce inappropriate behaviors, develop independence and result self-esteem, communicate
  • It can be used for communicating a routine, sequence, activity or transition to a child
• Visual rules/cues


  Use visual cues to increase the children's understanding