Autism Spectrum Disorders: Awareness, understanding, and treatment

1
Autism Spectrum Disorders Awareness,
understanding, and treatment

• Presented by
• Aaron Stabel, M.A., BCBA
• Behavior Consultants International

2
Etiology and Prevalence Facts and Theories

• Brain and medical research
• Genetics
• Comorbidity
• Vaccinations
• Prevalence and diagnosis

3
Brain and Medical Research

• Structural deviations Hippocampus, amygdala,
  cerebellum, brain stem, neocortex
• Increased incidence of seizure disorders
• Head circumference
• Sensory processing abnormalities

4
Genetics

• Sibling studies
• Twin studies
• Other genetic abnormalities
• Broader Autism Phenoptype (BAP)

5
Comorbidity

• Most epidemiologic studies show 75 of children
  with autism also have MR
• (Ozonoff and Rogers, 2003 National Research
  Council, 2001)
• As a spectrum disorder, symptoms are more
  continuous, and often overlap with other mental
  disorders
• ADHD, ODD, OCD, anxiety disorders, Tourettes,
  mood disorders, psychosis, seizures,
  gastrointestinal
• Current research suggests ASD as a constellation
  of disorders
• (Hendren, 2003)

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Vaccinations

• Taylor et al. (1999, 2002)
• Medical Research Council (UK) (2001)
• Dales et al. (2001)
• Wilde et al. (2002)
• Fombonne et al. (2003)
• Verstraeten et al. (2003)
• Neslon et al. (2003)
• National Institute of Medicine (2004)
• Murch et al. (2004 Wakefield retraction)
• Schechter et al. (2008)

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Prevalence

• About 1 in 150 8-year-olds classified with ASD
  (CDC)
• More boys than girls diagnosed (3/4 1)
• Rates of children diagnosed with autism have
  increased over the past several decades
• Expanded diagnostic definitions (Asperger and
  PDD-NOS)
• Diagnostic substitutions From 1994 to 2003,
  higher autism prevalence was significantly
  associated with corresponding declines in the
  prevalence of mental retardation and learning
  disabilities
• (Shattuck, 2006)

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Prognostic Indicators

• Language functioning (fluent speech before age 5)
  is the strongest predictor of outcome
• (Venter et al., 1992)
• Overall intellectual functioning
• (American Psychiatric Association, 2000)
• Age
• (LeBlanc, 2005)
• Other variables are being evaluated
• (i.e., self-initiations, joint attention)
• (Koegel and Koegel, 2006)

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Challenges to Educating Children with Autism

• Deficits in the basic learning skills
• Atypical attending patterns
• Failure to generalize learned skills
• Atypical reinforcement choices
• Cognitive delays
• Receptive and expressive communication deficits
• Peer relations
• Disruptive behaviors
• Adaptive skill deficits

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Educational Goals

• The appropriate goals for educational services
  for children with autistic spectrum disorders are
  the same as those for other children personal
  independence and social responsibility.
• (National Research Council, 2001)

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IEP Targets

• Verbal and nonverbal communication skills
• Social skills
• Adaptive skills
• Academic areas
• Gross and fine motor development
• Reduction of behavioral difficulties
• Generalization of skills across settings
• (National Research Council, 2001)

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What is ABA?
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The A-B-Cs of Learning
Trigger
ANTECEDENT
BEHAVIOR
CONSEQUENCE
Did it work?
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Effective ABA Intervention

• Operant learning strategies
• (prompt response reinforce)
• Use of motivational factors from naturalistic
  teaching
• (i.e., child choice, reinforce attempts,
  shaping, intersperse mastered tasks, natural and
  direct reinforcement)
• Repetitio est mater studiorum
• Actively promote generalization to natural
  stimuli
• Do not reinforce behaviors that interfere with
  learning
• Base program progression on collected data

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ABA Based Therapies

• Discrete trial therapy
• Lovaas Method
• Naturalistic and incidental teaching
• Pivotal Response Training
• Positive Behavior Supports
• Social skills training
• Picture Exchange Communication System (PECS)
• TEACCH
• (Floor Time/RDI)

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Comparison of DTT and NT
DTT
NT
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Advantages of Naturalistic Teaching

• Good (possibly better) language outcomes
  spontaneous language and social initiation
• Increased generalization of treatment effects
• User-friendly
• Less problem behaviors

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Characteristics of Effective Interventions

• Intensive early interventions, empirically
  supported (gently intrusive programs, Grandin)
• Individualized communication strategies
• Individualized instruction promoting cognitive
  growth
• Focus on social skills development
• Teach and generalize pivotal behaviors
• Parents as teachers and proactive collaborators
• (Stephens, 2005)
• the best bet is to learn all you can in terms of
  the science and the instructional strategies and
  then use whatever combinations work for each
  child Christina Burk

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Other Treatments

• Auditory Integration Training
• Sensory Integration Therapy
• Special Diets and Nutrition
• Medication

• Facilitated Communication
• Rapid Prompting
• Psychotherapy
• Holding Therapy
• Animal Therapy

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Sensory Problems in Autism

• Auditory
• Visual
• Smell and Taste
• Integration

Accommodate and Habituate
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Parent-Professional Collaboration

• Client-centered approach
• Compassion
• Parent empowerment
• Projected life goals
• Focus on strengths
• Resources

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References Resources

• Baker, J. (2003). Social Skills Training. Autism
  Asperger Publishing Company.
• Grandin, T. (2006). Thinking in Pictures My life
  with Autism. New York, NY Vintage Books.
• Jensen, R. W., Reavis, H. K. (1993). The Tough
  Kid Book Practical Classroom Management
  Strategies, 2nd Edition. Longmont, CO Sopris
  West.
• Koegel, R. L., Koegel, L. K. (2006). Pivotal
  Response Treatments for Autism Communication,
  Social, Academic Development. Baltimore, MD
  Paul H. Brooks. Pub.
• Ozonoff, S. et al. (2003). Autism Spectrum
  Disorders A reserch review for practitioners
  MIND Institute. Washington, DC American
  Psychiatric Publishing
• Schreibman, L. (2005). The Science and Fiction of
  Autism. Cambridge, MA Harvard University Press.
• National Research Council (2001). Educating
  Children with Autism. Washington DC National
  Academy Press.
• Watson, T. S. (2003). Conducting school-based
  functional behavioral assessments A
  practitioners guide. New York, NY The Guilford
  Press.

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Thank you very much for your attention

• Aaron Stabel, M.A., BCBA
• Behavior Consultants International
• www.behaviorsupports.com
• aastabel_at_surewest.net