ConnectABILITY

Autism Spectrum Disorder: Supporting Children and Youth – Module 1

Introduction to Autism Spectrum Disorders

Introduction

Autism Spectrum Disorders (autism and related ASD’s) affect a child’s rate and pattern of development. These “neurodevelopmental” (brain development) disorders are common, and may affect children to varying degrees. Children with Autism Spectrum Disorders have challenges with communication and social interaction skills and exhibit repetitive behaviours. They have learning and developmental challenges. Understanding the effects of ASD on children allows us to plan modifications to meet each child’s unique learning style. The information in this module will help you gain an appreciation for the common characteristics of children with ASD while also highlighting the diversity of children with this disorder. You will gain some insight into the environment and activities need to be modified to meet these children’s needs.

Some of us have a great deal of experience working with children with autism while others have very limited experience. Our perceptions can be shaped by what we have heard others say. Think about your perceptions of children with autism.

Objectives

After completing this module, you should be able to:

  • Recognize the common characteristics of children with ASD.
  • Identify the effects of autism on a child’s learning and development.
  • Recognize the importance of modifying the teaching strategies you use to meet the needs of children with ASD.
  • Recommend types of modifications you may need to make in your environment to support a child with ASD.

Section 1: Autism Spectrum Disorders

1. The Diagnosis

Many of us know something about autism yet continue to be somewhat baffled by the disorder. The fact that you are taking this course indicates that you know someone with the disorder and you want to know more about it. You are not alone. Even those who spend their lives researching the disorder strive to learn more. Children with autism can be confusing, unpredictable, a challenge. They can also be fun and immensely rewarding to work with. By learning more about what autism is and how it affects children’s development and learning, you can become a better teacher who can help a child reach his potential.

Autism is a lifelong, neurologically-based developmental disorder. It affects the child’s ability to communicate and interact with others, and how they perceive and respond to the world. The development of individuals with autism is both delayed and different in the areas of communication and social skills. For example, children with autism may develop some skills later than other children, for instance being late to talk. They also show different patterns of development than typical children. For example, typically-developing children learn to do many things simply by watching and copying the actions of other people, but children with autism are much less likely to imitate what other people do.

Some people with autism show little interest in social interactions, while others want to be around people but don’t understand social “rules” and may have difficulty knowing how to behave appropriately. Unusually repetitive ways of thinking and behaving are also seen in people with autism. This can take forms such as becoming overly preoccupied with narrow interests such as collecting objects, or facts about a particular topic. Some people with autism may have repetitive movements such as flicking their fingers or flapping their hands. Young children with autism usually show limited play, and may use toys in atypical ways. A classic example is the child who lines up blocks in rows rather than building with them.

The degree of difficulty that an individual has in any of these three areas of communication, socialization and thinking/behaviour can vary tremendously, from mild to severe. How autism “looks” therefore also varies greatly from one person to another. In fact, many professionals describe autism and related disorders as a spectrum, and the term “autism spectrum disorder” can be used to refer to any of these conditions. Children with any form of autism spectrum disorder will exhibit at least some of the core features of autism. In this program of instruction, “autism spectrum disorder (ASD)” will be used to refer to any child with a diagnosis within the spectrum, unless otherwise noted.

The three core areas of development affected in autism are:

  • Difficulties with communication
  • Limited social interaction or poor social skills
  • Repetitive, inflexible behaviour and interests (includes the unusual behaviour characteristics or differences we think of first, such as hand flapping, spinning, lining up objects)

Children who have an autism spectrum disorder may have intelligence well above average or may be profoundly impaired. Many children have some level of intellectual challenge; as many as 2/3 with the most “classic” form of autism will test within the range of mental retardation. Whether autism is combined with an intellectual disability makes a difference in how autism “looks” (that is, what behaviours are most characteristic of that individual). ASD can occur with other disorders affecting the functioning of the brain. Seizures are more common than in the general population; 25 to 30% of children with classic autism will develop seizures in their lifetime.

How the differences associated with autism in socializing, communication and thinking or behaving are expressed also varies widely depending on the person’s age.

  • Individuals with autism have a normal lifespan, if accidental causes are excluded.
  • Estimates of the number of children with ASD indicate that it affects 1 in at least every 250 children.
  • It is approximately four times more common in boys than in girls.
  • ASD is believed to be the third most common developmental disorder.

Making a diagnosis of ASD is difficult. There are many reasons for this, including the fact that there is no unique physical test to diagnose it (as, for example, the chromosome test for Down syndrome) and there is a great deal of variability in the expression of the disorder. That is, the nature and severity of the characteristics can vary greatly between children. The diagnosis is based on the pattern of differences from what is seen in typical development, and can be reliably detected by experienced clinicians.

Pervasive developmental disorder (PDD) is an “official” term used in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association to describe the group of Autism Spectrum Disorders. Many families and professionals find that the informal term autism spectrum disorder (ASD) is easier to understand and use; these two terms (PDD and ASD) are usually interchangeable. PDD has several subcategories:

Autism disorder is the most easily distinguished form of PDD, and is the DSM term that corresponds to our usual understanding of autism.

Pervasive developmental disorder, not otherwise specified. A child whose developmental and behavioural profile does not quite meet the DSM criteria for autism disorder, but who shares the same pattern of developmental differences, may be given a formal diagnosis of PDD-NOS.

Asperger disorder (or Asperger syndrome) is becoming a more familiar term, although there continues to be debate about how easily it can be distinguished from other Autism Spectrum Disorders. Usually, the major difference between children diagnosed with Asperger syndrome and autism is that the language skills of children with Asperger syndrome are much stronger (especially when they are young), compared with the language of children diagnosed with autism. The picture becomes more confusing in older children and adults. Some individuals who clearly met criteria for autism when they were younger may show the Asperger syndrome profile as they get older.

Rett syndrome and childhood disintegrative disorder (CDD) are much rarer forms of PDD. Rett syndrome almost exclusively affects girls, while CDD may affect children of either sex. Both of these are severe disorders involving progressive loss of developmental skills, and are readily differentiated from other autism-related disorders.

2. What Causes Autism?

Autism is a neurological disorder and there is strong evidence that there is a physical cause. Although we do not know the causes of autism, we know that it is not caused by the environment in which a child lives – parents do not make their children become autistic. Even children who are not diagnosed until later in life likely had abnormalities very early in development that went undetected.

There is strong evidence for a genetic contribution, although other factors are likely involved. If a couple has one child who has autism, there is an increased risk that their next child may have autism or a related developmental disorder. Various brain areas may be involved in a complex way; no simple brain differences have been found in all people with ASD.

3. Assessing a Child

Ideally, when a child is seen for a diagnosis of ASD a team of professionals is involved. This team may include a specialist physician (e.g., pediatrician, neurologist, psychiatrist), a clinical psychologist, a speech-language pathologist, an occupational therapist, a social worker, a nurse, a physiotherapist, an early intervention worker or an early childhood educator. Information is collected by taking a detailed history of the child, from birth, as well as a family history. Children are also often observed interacting in a structured play assessment.

Information is obtained on the child’s skills within the major developmental domains:

  • Social – interacting with other people
  • Communication – conveying ideas through words, gestures, or other means
  • Verbal cognition – problem solving using verbal concepts
  • Nonverbal cognition – problem solving without words (e.g., visual-motor, spatial skills)
  • Fine motor – hand and finger skills
  • Gross motor – larger body movements and balance
  • Self-care (e.g., sleep habits, eating habits, dressing skills, toilet skills, dental care, bathing)
  • Early academic skills (e.g., printing, letter and number knowledge)

The child’s behaviour is observed to see how the child responds to social cues, structure, use of prompts, imitation tasks, and sensory input. It is important to gauge the child’s attention span, as well as activity level and degree of impulsivity.

Parents and early childhood educators are asked to provide information about the child’s behaviour at home and in the child care setting. All members of the team provide information that can be used to decide whether the child has an Autism Spectrum Disorder. Given the variability of preschool-aged children in general and the variability of children within the spectrum, input from everyone is helpful when making this difficult diagnosis. Sometimes, the decision to make a firm diagnosis is deferred until there is more evidence of a child’s behaviour in different settings. The child care provider may play a key role in providing observations of the child.

4. Core Features

The three main areas of development affected in children with ASD are difficulties in communication, limited social skills, and repetitive and inflexible behaviour and thinking.

Communication Differences

For more information see Module 5: Developing Communication Skills.

  • Although children with ASD may show a wide range of language skills, their ability to communicate is always impaired.
  • Difficulty with expressive language skills or speech. Some children may have very little speech while others who talk and may seem to have a history of normal language development have difficulty with more advanced skills.
  • Impaired comprehension or understanding of language (receptive language)
  • Difficulty with both verbal (words) and nonverbal (gestures, body language) communication
  • Difficulty with social use of language

Common characteristics include:

  • Echolalia – repetition of words spoken by other people (echoing or parroting others)
  • Pronoun reversals (e.g., difficulty with “you” and “I”; saying “you want a drink” instead of “I want a drink”)
  • Unusual intonation patterns (e.g., loud, “mechanical” or “singsong” voice)
  • Unusual use of words (e.g., neologisms – inventing new words for things or new meanings for established words such as saying “mastuda” for triangle or odd use of words, such as saying “hot rain” for steam, or calling family members by numbers such as 17 = mom, 9 = dad)
  • Repetitive talking about their own narrow topics of interest
  • Difficulty or differences in response to and use of facial expressions
  • Difficulty using and understanding gestures
  • Literal interpretation of language (e.g., “you could have knocked me over with a feather”; “she cried her eyes out”)
  • Difficulty using language to initiate interactions with others
Social Skills Differences

For more information see Module 7: Enhancing Social Skills.

  • Difficulty interacting with others; both understanding other people and behaving appropriately in social situations
  • Restricted, limited, or unusual use of eye contact
  • May appear “deaf like” because of apparent lack of response to the presence of others
  • Difficulty paying attention
  • Turn-taking skills are challenging
  • Difficulty with pretend play and imaginative games
  • Lack of awareness of social cues – difficulty “reading” other people using cues like facial expressions
  • Socially inappropriate behaviour (e.g., may lack awareness of personal space and come too close to others)
  • Difficulty understanding others’ feelings
Repetitive and Inflexible Behaviour

For further discussion see Module 2: Setting the Stage for Learning.

  • There is great variability in the repetitive behaviours that children exhibit, with some children having more sensory or motor focus and others little sensory focus but strong interest in special topics (that is, their behaviour and thinking, rather than their movements, are repetitive and inflexible)
  • Behavioural characteristics do change over time, with some behaviours disappearing, often replaced by other behaviours

Common characteristics include:

  • Repetitive activities that occur repeatedly (e.g., spinning objects, smelling objects, moving hands or objects near eyes, looking at objects out of the corner of one’s eyes – use of peripheral vision, head banging, self-biting)
  • Insistence on following a particular routine (e.g., always walking the same way to day care)
  • Insistence on having objects or people in a particular location (e.g., each child has to sit at exactly the same spot at mealtime)
  • Attachment to objects (e.g., always has to carry a piece of string or a toy car in one hand)
  • Ability to repeat back, word for word, with the correct intonation, a song or even an entire videotape, exactly as it was first presented
  • Special interest in and perhaps ability to talk about a topic of interest (e.g., details of bridge building, scores of hockey games)

5. Other Common Characteristics

The following are common characteristics of ASD but they are not necessary for a diagnosis of autism.

  • Sensory differences – over or under reactive to aspects of the environment
  • Tactile defensiveness – distressed when touched by others yet may seek strong physical input, or may be easily distressed by the feeling of tags or particular clothing material
  • Auditory sensitivity – distressed by loud sounds, or specific sounds, or may be the first to hear sounds
  • Strong interest in looking at lights or distress when walking outdoors into the sunlight
  • Interest in smelling objects/people or distress when walking into a room with a smell barely detected by others
  • Great distress over temperature or seeming indifference
  • Apparent lack of reaction to pain
  • Over-attention to aspects of the environment such as visual characteristics
  • Eating difficulties – may have a restricted or limited range of food that is accepted; may be specific preferences such as refusal to eat anything other than a preferred brand name product
  • Toilet training difficulties – may take a long time to learn to use the toilet and may have particular difficulty learning to use the toilet for bowel movements
  • Sleep challenges – may have difficulty getting to sleep at night and may have frequent awakenings during the night (at times may be up for hours)
  • May be excessively active and have difficulty with attention (although attention skills may be good for activities of interest)
  • Apparent lack of awareness or appreciation of danger (e.g., may wander out into the street in the middle of traffic, may climb on the stove, may hang out of a window)
  • Specific fears that are so intense that they may interfere with the child’s ability to function during day to day activities (e.g., fear of bathing, fear of haircuts)
  • May have sudden changes in mood which occur for no apparent reason

Learning differences:

  • Need to “learn how to learn”
  • Difficulty learning by simply copying what other people do (imitation)
  • Difficulty relating skills learned in one situation to another similar situation (i.e., difficulty with generalization)
  • Uneven learning profile, typically with stronger visual learning skills – some skills may be age appropriate or even above age level while others are significantly delayed

Section 2: The Effects of ASD on a Child’s Learning and Development

1. Observation

Learning to be a good observer of behaviour is challenging. You have developed your own observation style and it is influenced by the way you see the world. We would like you to continue to develop your observation skills and start to expand them. In Module 3, you will learn additional systematic observation strategies.

Over the course of this training program you will learn to think about autism as a disorder of development that results in children with unique strengths and weaknesses. Our hope is that you will have an appreciation for the common features of children with ASD that will make it easier for you to look at what the child with ASD that you know brings to the learning environment. You can make modifications to your environment based on the strategies that we suggest, when you are teaching children with ASD. You will learn to accommodate weaknesses while using the child’s strengths. For example, although children with ASD as a group have a lot of difficulty understanding oral instructions, they are often quite competent at following visual instructions. You may find that you will want to increase the use of visual supports (see Modules 2 and 5).

2. Strengths and Challenges

While observing, you will see that every child has his own strengths and weaknesses, unique set of skills, or ability profile. By studying many children with ASD we have found that, as a group, they often share a common set of strengths and face a common set of challenges.

Usual Strengths
  • Visual learner
  • Visual-spatial tasks
  • Respond well to structure – consistency and repetition
  • Learn new skills best in a quieter environment where fewer distractions
  • Enjoy contact with familiar adults in social play, including different forms of physical contact
  • Learn through the use of prompts – supports such as visual and verbal cues and physical guidance (e.g., hand over hand teaching)
  • Learn new skills when taught in a supportive environment (i.e., supports, not just natural contingencies or rules)
  • May have areas of relative strength in overall ability profile (e.g., puzzles, drawing, music, facts about topic of special interest)
  • Pleasure in success with a challenge/activity
  • May be cuddly and provide nice feedback when hugged
  • May smile, make eye contact, laugh, display a variety of emotions
Usual Challenges
  • Difficulty understanding and responding to oral instructions or language
  • Attention – may miss important details and may attend to irrelevant details
  • Imitation
  • Use of gestures
  • Initiating social interaction
  • Following/understanding social rules
  • Regulating response to environment, emotional regulation – may have outbursts or exhibit distress
  • Early play skills, independent play
  • Imaginative play skills
  • Transitions or shifting from one activity to another
  • Generalization of skills from one situation to another
  • Difficulty learning skills in “natural environment”

Section 3: Modifications to the Setting

For more information see Module 2: Setting the Stage for Learning

Given what we know about the core features and common characteristics of children with autism, as well as their areas of strength and the challenges they face, we need to make adaptations to help the children learn. Some of these adaptations would be helpful for all young children. Others may seem less natural and foreign to the typical child care environment. It may help to keep in mind that the child with ASD has a somewhat different way of taking in information and interacting with the world around him. These modifications to the child care environment help ensure that the child with ASD is able to attend and learn, grow and develop.

Characteristic of Child with ASD Suggested Modification
Difficulty with attention
  • Decrease distractions
  • Get eye contact by repositioning yourself and/or the child
  • Work at the child’s level
Difficulty with comprehension of language
  • Use short specific instructions – use key words (e.g., like a telegram initially)
  • Supplement oral instructions with visual supports (consider routine/context, gestures, pictures, written words)
  • Repeat pairings of words with picture/routine/object
Difficulty with imitation and use of gestures
  • Exaggerate · Provide supports, prompts (see Module 3 for detailed information) Teach these skills explicitly
Visual learner
  • Pair oral instructions with visuals (e.g., object, picture)
  • Use visual supports and visual schedules
Benefits from structured, predictable routine
  • Construct the environment
  • Provide routine
  • Set up a strong reward system: Instruction – Behaviour – Reward
  • Use Grandma’s Rule: first you do X, then you get Y
Difficulty with transitions
  • Prepare the child in advance
  • Cue with visual as well as auditory information (e.g., use visual schedules)
Difficulty identifying key details
  • Highlight key details
  • Make information stand out
  • Break tasks into smaller steps
Behavioural differences – tantrums, acting-out
  • Complete a functional assessment (see Modules 3 and 4)
  • Identify behaviour
  • Generate possible functions
  • Teach replacement skills – an alternative behaviour or a new way to communicate

Remember, each child is unique. You will learn to be an active observer and a creative teacher when you work with children with ASD.

Exercise: Reviewing the Environment

OBSERVE
Pick a time of day you find challenging for the child you are working with who has ASD. Create an observation sheet and make notes about what the child is doing.

THINK
Think about the characteristics of children with ASD and the unique strengths and challenges the child you are working with brings to your centre. See if you can identify some of the learning challenges your child has that may make this particular time of day particularly difficult.

TRY
Try to use the child’s strengths and modify the situation in which the child you are working with is having difficulty.
Click here to see a sample answer

Review

Children with ASD have difficulty with communication skills and social interaction and exhibit inflexible thinking and repetitive, sometimes unusual behaviours. They have unique learning profiles and are more likely to be visual learners. Knowing about how children with autism learn and perceive their world helps us to be better educators. We need to make modifications to our child care centres to adapt to the children’s individual strengths and weaknesses. These adaptations include environmental changes, as well as modification of our teaching methods.

Next module> Setting the Stage for Learning