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SD-draft-Understanding Autism (10/03/15)

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Shaun Durkin

on 4 September 2015

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Transcript of SD-draft-Understanding Autism (10/03/15)

Trainers are ...
Understanding Autism
Understanding Children and Adults on the Autism Spectrum
Understanding the triad of impairments
Impairments in communication
Difficulty with language
speech repetitive/echolaic
confused pronoun use - 'I', 'me', 'you'
difficulty with 'wh' words, e.g. 'why', 'where', 'who', 'when'
control of pitch, tone and volume
delay in processing language
may make factual comments, out of social context
Literal understanding
It doesn't just apply to metaphors, which many people do eventually 'get'
What are the phrases we use every day that can be misleading or confusing for people who only understand the literal meaning of what we say?
For example: 'I'll do it in a minute'
Response: '1, 2, 3, 4 ... 58, 59, 60 ...'
Literal understanding extends to writing, not just spoken word
What does autism look/feel like?
Do you know someone with autism?
What is the first thing that comes into your head when you think about that individual?
Children with autism usually look very 'normal' and appear to be developing well until about 18 months
Not all manifestations present in all people - diversity within the spectrum
Can lead to a misunderstanding of the nature of autism and of people's needs
Diagnosis of autism
Presence
of unusual development features. Examples:
Rigidity, insistence on sameness
Obsessive or narrow all-absorbing interests
Difficulty in shifting attention
Exceptional rote or visual memory
Unusual or precocious ability with numbers/calculations
Repetitive behavious
Absence
of usual developmental or behavioural features. Examples:
Lack of interest in people
Difficulty in recognising faces and facial expressions
Failure to develop joint attention and pretend play
Failure to develop adaptive strategies - for example, deception
Poor motor co-ordination
Literal understanding
Co-occuring conditions
:
Neuropsychological conditions, e.g. ADHD, dyspraxia, sensory processing problems
Learning disabilities and difficulties
Neurological disorders, epilepsy
Health problems, e.g. bowel, skin, allergies
Sleep disorders
Psychiatric disorders, e.g. anxiety, depression, bipolar disorder, Tourette's
The triad of impairments
Social interaction
Difficulty recognising or understanding others' emotions and feelings
Difficulty expressing their own
Problems with unwritten social rules, e.g. how close to stand - context
Lack of empathy/sensitivity
May prefer their own company
Attempts at social behaviour seen as 'strange', naive or inappropriate
Social impairment (Wing, 1996)
Aloof
: avoids, resists or does not respond to contact with others except perhaps to have their needs met
Passive:
will respond to social contact but does not initiate contact
Active but odd:
makes social approaches but these are inappropriate, bizarre, naive, one-sided
Social imagination
Difficulty with:
instinctive understanding of mental states (thoughts, feelings, desires)
predicting events and behaviours
understanding danger
engaging in imaginative or joint play
preparing for change and planning for the future
coping in new and unfamiliar circumstances
shifting attention
abstract concepts (world seen in concrete terms)
Can be very creative - not a lack of imagination per se
Other characteristics
Prefer routines and find it difficult to cope when these are not adhered to
Special interests (e.g. dinosaurs, railway timetables, buses, UFOs, recycling etc)
Uneven IQ profile
Behaviour that challenges
Can have exceptional or 'savant' skills (drawing, music, rote memory, calculus) but that is not present in the majority
Sensory sensitivity and processing
Heightened or reduced sensitivity to noise/sound, heat, touch, taste, sight/light, movement, balance etc
Perceptual problems (seeing things from a particular perspective, understanding scale etc)
Difficulty screening out unwanted sensory stimuli or discriminating specific sensory inputs
Overload
Delayed processing (20 second rule)
Low 'registration' in some individuals (e.g. pain)
Theories to explain autism
Theory of mind/mindblindness
The innate ability to understand what other people think, believe, feel and to predict behaviour on the basis of those thoughts, beliefs, feelings
Individuals can learn theory of mind intellectually but not through instinct of emotion
In many instances the person understands that others have their own feelings and beliefs that are different to theirs - but this understanding is unreliable
Theory of mind - development:
Following others' gaze
Using eye contact
Pretend play
Teasing
Joking
Deception and lying
Understanding knowledge
Understanding beliefs
Understanding false beliefs
Sally-Ann test
Importance of the eyes:
The eyes tell us a lot about what people are thinking, feeling, wanting etc
People with autism are otten 'blind' to the importance of the eyes
Some people with autism report that looking in people's eyes is scary as they don't see what we see
= 'mindblindness'
Context blindness:
Problems in understanding social context
Behaviours learnt in one situation are incorrectly applied in another
May lead to impaired 'internal schemas' or ways of interpreting the world, e'g. girl stares at me - she is interested in me - therefore she wants me to talk to her and for me to go on a date with her
Executive function dysfunction hypothesis
Problems with sequencing
Problems organising and planning ahead
Problems with overriding automatic responses and inhibiting inappropriate actions
Weak central coherence
Problems linking parts to make a whole
Pay attention to detail not the overall picture
Difficulty understanding cause and effect
Difficulty generalising what you have learnt in one situation to another where some aspects might be different
How do you deliver a telephone message?
Neurodiversity

Stronger on systemising (knowing how things work)
Empathising (knowing how people work)
In tests: men better at the former and women better at the latter. Individuals with Asperger syndrome tend to be at the extreme end of this spectrum
Three strands working together (Frith, 2003)
Frith proposes that together these three strands of psychological theory explain both the skills and behaviours that people with autism show:
the mind-blindness accounts for social and communication problems
executive function hypothesis addresses absence of higher-level control and attention, need for routine, stereotyped behaviour, narrow interests
central coherence theory accounts for special talents, peaks in ability
Biological evidence exists to support these theories but social context is also important
Why is theory important?
To help you and others understand the child or adult:
is not being 'rude on purpose'
is not being 'selfish'
is not being 'anti-social'
lacks empathy, the ability to take others' feelings etc into consideration
doesn't understand subtle social cues
is not trying to humiliate or 'win'
To help you understand that they have strengths as well as difficulties
To help you understand why particular approaches work and others don't
To help you understand that those who are more able intellectually can learn rules to help them
Stressors for families of children with autism
Diagnostic confusion
Uneven and unusual course of development
Attractive appearance
Behaviour in public
Professional 'turfism'
Fads and unproven theories
Psychological impacts on families
Siblings' experiences:
Important not to forget other children in the family - the impact of having a sibling with autism can be enormous and variable
They may often be quite talented or have difficulties of their own, e.g. dyslexia, dyspraxia, ADHD etc
Very little sibling support available
Summary
Autism ans Asperger syndrome are not separate conditions - more variation between behaviours. As we move towards the higher functioning end, there's more variability in presentation -
neurodiversity
within the spectrum
Every child/adult is slightly different but with core difficulties
Autism comes with many strengths
Importance of individualisation of approaches
Supporting People with Autism through Structure
Background
The notion of 'neurodiversity' - A spectrum:
some of us are better at knowing how other people work
some of us are better at knowing how things work
some of us are better at working with the 'big picture'
some of us are better at detail
some of us are a bit of both or in between
Most, if not all, of us engage at some time in the same behaviours that can characterise autism. The difference is in the degree, severity and ability to inhibit.
Autism is not 'new'
It's been around for many centuries but only described scientifically in 1943 by Leo Kanner and in 1944 by Hans Asperger
It's a 'developmental disability'; a life-long condition
It can manifest itself differently at different ages and in different people - it's at one extreme end of the neurodiverse spectrum. Many of us have traits of the condition but are not autistic.
Taking an individualised approach is essential.
Kanner studied 39 children in 1943
Inability to relate to people and situations from the beginning of life
'Self-sufficient', 'happiest when left alone'
'Acting as if people weren't there'
'Language (when present) does not convey meaning'
Kanner 1943 (cont)
'Excellent rote memory - initially parents proudly think of their children as child prodigies'
'Changes of routine or order drive (him) to despair'
'Fascination with objects'
'Good cognitive potential'
Asperger 1944
'Abnormal gaze, poverty of expression'
'Unusual speech/voice production'
'Precocious or original language'
'Restricted social/emotional relationships'
'Extreme personal sensitivity - egocentricity'
'Lack of humour apart from puns'
'Idiosyncratic tastes and attachments'
The autism spectrum
Classic autism/Kanner's autism:
Can vary in IQ and severity
language and communication more seriously affected
where IQ is average or above this is sometimes called 'high-functioning autism'
Asperger syndrome:
language and communication less affected but not necessarily 'normal'. Language development not delayed in early development
usually normal or above-average IQ
main difficulties in natural social behaviour/social conventions
may have motor problems
Atypical autism
on the spectrum but not meeting full diagnostic criteria
sometimes inaccurately called 'pervasive developmental disorder, not otherwise specified' (PDD-NOS)
not the same as 'autistic like' or 'broader phenotype'
Causes of autism
Autism has many causes:
it is not a single condition
mainly biological causes
genetic factors are known to be important - but complex
there can be differences in brain size, chemistry and structure but these are not consistent
some recent developments using MRI
brain works differently
trigger factors often unknown
varying degrees of severity and ability
not caused by poor parenting!
Associations with other states and medical conditions:
phenylketonuria (pku)
fragile X
tuberous sclerosis
rubella
epilepsy
How many people on the autism spectrum?
Approximately 1 in 100 (children and adults)
More males than females (4:1 classic autism; 15:1 Asperger)
Frequently accompanied by:
rituals, compulsions, routines, obsessions or intense unusual or 'special' interests
inflexibility of thought and a resistance to change
sensory differences - hyper-sensitive or under-responsive
anxiety
Social communication
Some people on the autism spectrum can speak, others may have very good but very pragmatic speech, others may have limited or no speech whatsoever
Where speech exists there can be oddities - often in the 'social' use of speech, e.g. two-way conversations. Direct comments may be misinterpreted as blunt or rude
These difficulties are often in the instinctive use of language and are persistent across time and different situations
Marked difference between expressive language (what is said) and receptive language (what is understood)
Difficulty with common phrases and sayings that may not be 'literally' understood
Difficulty using and understanding facial expressions and tone of voice
Difficulty with understanding social context and regulating behaviour and responses accordingly
Difficulty understanding jokes and sarcasm
Strengths of autism
Visual skills - this means that we can often use visual means to communicate where verbal means have failed
Highly knowledgeable about areas of special interest
Systemising - making sense of the logical or concrete (scientific strengths)
Visual memory and factual memory skills
Focus on repetition
Precision
Accuracy
'It seems that for success in science and art, a dash of Autism is essential'.
Hans Asperger
Extreme male brain theory
(Baron-Cohen and colleagues)
Full transcript