Post on 03-Jan-2016
Understanding special needs
15th February 2011
Introduction
ASD or PDD First identified in 1943 – Leo Kanner They are a range of complex, lifelong
developmental disabilities which vary in severity
Includes autism, Asperger’s syndrome, Rett syndrome, atypical autism and childhood disintegrative disorder
Introduction Exact number of children with autism is
unknown - ? 6 in every 1000 If one child has autism, more likely that sibling
will develop autism Rise in recognition of the condition Unproven link with MMR Effects all social and racial groups Boys more affected than girls About 75% of children with autism also have a
learning disability No cure, but there are effective management
strategies and educational programmes
What happens
A child will demonstrate difficulties in 3 areas (Wing and Gould 1979)
Impairment of social interaction Impairment of social communication Impairment of social imagination
Key features of autism
Social interaction Cannot make sense of people Relates better to objects than people Will only tolerate being approached or
approaching people that they know really well
May only see people as a means to an end Is usually unaware of simple rules and
conventions
Key features of autism
Social communication Slow to develop speech or no speech at all Uses words out of context or without
communicative intent Echolalia May use words and then lose them Poor eye contact Rarely understands or uses gestures May use pointing to indicate need rather
than to share an experience
Key features of autism Social imagination and flexibility of though
Finds it hard to make sense of a sequence of activity Loves routine Stereotypical body movements Often resists new experiences Poor symbolic play Often pays attention to particular details May be hypersensitive to sound
Every child’s profile is different
Associated features and disorders Intellectual disability – moderate range Behavioural difficulties e.g. hyperactivity,
short attention span, impulsiveness, aggressiveness and tendency to self injury
Odd responses to sensory stimuli High threshold for pain Hypersensitivity to sounds or touch Exaggerated response to light or smells Fascination to certain stimuli
Associated features etc. Abnormalities in eating e.g. limiting diet
to a few foods or pica Abnormalities of mood e.g. giggling or
weeping for no reason No sense of danger Excessive fearfulness to harmless
objects Adolescents may become depressed Seizures develop in about 25% of
children usually in adolescence
Diagnosis
‘a signpost, not a label’ Exley No simple test Multi-disciplinary team over a period of
time and in several settings Must show signs in all 3 areas Early diagnosis preferable but difficult to
be accurate under 18 months Hearing test often undertaken to exclude
deafness
DSM IV – Diagnostic criteria 3 sections – A.B and C Must display a total of six items from A,
B and C with at least 2 from A and one each from B and C
Must be delays or abnormal functioning in at least one of the triad areas with onset prior to 3 years of age
The difficulties are nor caused by Rett’s syndrome of childhood disintegrative disorder
Asperger’s syndrome – diagnostic features Severe and sustained impairment in
social interaction Restricted, repetitive patterns of
behaviour interests and activities No significant delays in language No significant delays in cognitive
development Must not be any other type of autism or
schizophrenia
Asperger’s
Later onset than autism Motor delays or motor clumsiness may
be noted in preschool years difficulties in social interaction may not
be noted until child is at school It is then that ‘odd’ interests may be
noted e.g. fascination with train timetables
Asperger’s
Adults may have problems with empathy and appropriate social interaction
Usually lifelong Increased frequency of Asperger’s
among family members of individuals who have the disorder
Childhood disintegrative disorder
Rare condition Normal development until 2 yrs and then
rapid regression i.e. later regression than autism
Loss of previously acquired communication, play, social abilities, cognitive and motor skills
Rett syndrome
Development disorder affecting girls Normal development in first 12 months followed
by period of rapid regression Loss of purposeful hand movements – replaced
by stereotypical hand movements such as hand wringing and clapping
Poor trunk or gait co-ordination Loss of social engagement Cognitive skills, receptive and expressive
language skills are severely impaired
Atypical autism
Diagnosis by exclusion of other ASD Symptoms of autism may only be
partially present in number or degree or where the age of onset was over 36 months
Very similar behaviour patterns to typical autism
Intervention approaches
Many different approaches each stemming from a particular belief e.g. biological versus behavioural
No one approach works for all children Elizabeth Newson 1979 believes it is
important to address ‘the whole nature of autism’
Very important to check evidence base
TEACCH – treatment and education of autistic and related communication handicapped children
Whole life approach – began in 1966 in North Carolina
Requires that adaptations must happen in 3 areas of a child’s life – home, school, and community
Based on structured teaching Physical structure Schedules Work systems Visual clarity
Musical interaction
Aim is to engage each child in the process of interaction
Based on the way parents naturally play with children
Emphasis is on helping the child develop communicative intent
Focuses on what the child can do and builds on this
Non - invasive
PECS – picture exchange communication system
Developed in the USA in 1985 Aim is for children to acquire key
communication skills especially initiating communication in a social exchange
6 distinct phases of teaching Combines knowledge from ABA and SLT
PECS continued
Initially 2 adults needed using a strong motivator for the child
Children can go on to develop spontaneous speech
Increase in communicating leads to a decrease in frustration
Can be used from 14 months and can be used with adults
Can be used with other disabilities also
The Earlybird project Set up by the National Autistic Society in
Barnsley Early intervention key Working through parents vital Aims to put parents in control, empower
parents, support parents and assist parents in establishing good practice in managing their child at an early age
6 families at a time for a 6 week programme – 3 hour sessions
Day time training sessions plus home visits
Applied behavioural analysis – ABA, (Lovaas) Should start before child is 42 months Intensive interaction for up to 40 hours a week Delivered by all significant people who work
with the child Periodic and objective assessment,
reinforcement, skilled staff Most of research done by Lovaas himself Much criticised for having too narrow a focus
and for being inappropriate but parents seem to like it
Other approaches
Intensive interaction SPELL Son-rise program (option approach) Daily life therapy (Higashi) Auditory integration training Diet (Opiod Excess Theory) Secretin Irlen
Choosing an approach – questions to ask On which theory of autism is the approach
based How long has the approach been used Was the approach specifically designed for
children with autism What does it involve Who is involved in delivering the approach How is the approach introduced to the child Is it invasive to the child
Questions to ask
What skills does the approach aim to develop in the child
Has the approach been evaluated Can the approach be used with other
approached To what extent will it effect the family lifestyle How much does it cost Home based? School based? Or both? How will you know it is successful What happens if it doesn’t work
General guidelines for the management of ASD- communication Speak clearly and directly using simple words
and language Try not to use metaphorical speech or
exaggeration – remember the child will take your words literally
Use songs and rhymes, especially those to which the child has previously shown a response. Encouraging clapping and beating a rhythm.
Inanimate v animate object confusion
Management – social interaction
Encourage the child to meet other children regularly
Encourage child-adult interaction and then child – child interaction
Repeat games that the child enjoys Music in a group
Management – safety and physical issues A child with ASD has a lack of natural caution –
vulnerability Be vigilant e.g. hot and cold water and food Remember the child may display inappropriate
behaviour in public such as approaching strangers and wandering off
Use the child's preference for routine to improve skills such as toilet training, dressing etc.
A firm, caring, consistent approach is important
Implications for the future
A child will continue to need considerable support through out school
The condition can be managed and the effects minimised but not cured – ASD is for life
More research!
Case study
Adam
What other signs might have indicated Adam’s ASD earlier?
How could you help Adam begin to control his ritualistic behaviour?
Including a child with ASD in the pre-school or classroom
Suggestions?
Fragile X syndrome (FRAX)
Introduction
Relatively recently discovered condition of genetic origin
Most common inherited cause of learning disability
May also be some physical characteristics Occurs in approx. 1 in 3600 males and 1 in
4000 to 6000 females Features of disability less in females Blood tests available but only after a child has
failed to develop in a ‘typical’ way Term ‘fragile’ does not mean that the child is
sickly or ill
What happens to cause FRAX?
Passed on by the X chromosome (boys XY, Girls XX) If a girl has a fragile X, she will also have an undamaged
X which is why the condition is less severe in girls A damaged or fragile X looks different under a
microscope – abnormality at the tip and appearing partially separated
Condition can be passed by unaffected male and female carriers
Development difficulties – learning difficulties
Usually present in both boys and girls, with boys being more severely affected
Severity ranges from mild educational delay to severe difficulties
Some features similar to autism
Speech and language difficulties Usually present in all children with the condition Language delay may be the first sign of a
problem Particular features are;
Word and phrase repetition, accompanied by up and down swings of pitch
Echolalia Poor control of the rhythm on speech and
inappropriate use of pauses Comprehension difficulties
Behaviour and attention
Tantrums continuing after the expected development stage
Excessive response to stimulation Overactivity/hyperactivity Impulsive Concentration problems Anxiety – avoiding eye contact
Behaviour and attention
Short term memory problems but long term memory can be quite good
Mimicry – especially specific words Ritualistic behaviour – likes routine and is
distressed by changes Repetitive behaviour – finger flicking, hand
flapping, and hand biting can occurThe severity can lessen as the child grows The older undiagnosed child may be noticed as
‘badly behaved’, just lacking in concentration or appearing unco-operative at times
Physical characteristics and health implications
These physical features may not be present in all children and may not be noticeable until a child is older Laxity of joints and muscles- late sitting and
walking Recurrent middle ear infections A long narrow face with a prominent jaw
bone Epilepsy – 20% of children Large testes in adult males
General care
Team-based, early intervention recommended
Emphasis on early speech and language therapy
Development will follow a similar pattern to any child but be slower
A child with FRAX can be routine dependant so a flexible and realistic care plan should be developed
Health problems are the same as any child
General care continued
May be strain on family if child is getting little sleep
Because child will tend to mimic – use a positive role model particularly for safety practices
The child needs to learn to be part of a group Help the child to moderate behaviour with
verbal reinforcement, praise and encouragement
General care continued
Remember the child's cognitive stage of development – do not expect him to take turns if he has not learned to share yet
Help the development of concentration by breaking down games/activities into small, achievable units
Sign systems may help e.g. Makaton
Ongoing management
Provide a distraction free area and keep noise levels low to allow for concentration
Ensure a calm, reassuring environment Keep the child close to you but alongside
you rather than facing you as eye contact can be threatening
Make sessions short – 10-15 minutes Alternate quiet and energetic sessions Use ‘time out’ as necessary
Ongoing management
Be consistent, clear and realistic Tell the child what behaviour is
unacceptable and reward positive behaviour
Be prepared to repeat instructions and check that the child understands
Use a visual approach to story telling
Ongoing management
Build the child’s self esteem with praise and encouragement for effort
Work to the child’s strengths All staff should follow similar
management approaches Maintain good home liaison Number work can be difficult but use of
computers can be valuable
Case study
Jason