1. LEEDS AUTISM SERVICESThe Autistic SpectrumTrainer Karen Worrell Mobile phones off / silent please!Breaks / Toilet etc. Health and Safety Introductions

2. Autism / Asperger SyndromeCourse Objectives:Myth bustingDevelop basic understanding of ASDUnderstanding the triad of impairments Sensory issues and autism Behaviour analysis General strategies 3. Its just as though hes not listening.Hes always ruining othersactivities!The only place she will eat her dinner, without screaming, is in the I told the him we were corridor. going to have a treat instead of the usual dayand he starts shouting and screaming. She paces round and round the TV lounge. She doesnt even watch it. He just wont leave the lounge room door open itIf I get cross, she just gets absolutely roastingseems to think its funny during summer!why wont she listen? 4. AUTISM MYTHS AND FACTS? result of emotional deprivation or emotional stress x a wish to avoid social contact x a developmental disorder involving a defect in brain function associated with unusual responses to sensory stimuli a life long disability often linked to genius abilities x 5. Biological Basis Genetic factors Pregnancy and Birth100complications 9080 Viral infections70 Other causes trauma,60 malehormonal imbalances 50 female Biological factors result in4030The Triad of Impairment 20 Far more males are10affected than females: 0 6. Prevalence NAS Fact Sheet February 1997 Autism IQ below 70 20 per 10,000 Spectrum IQ above 70 71 per 10,000 Total Prevalence91 per 10,000 Based on these figures Leeds would expect: 5100 adults with autistic spectrum disorders. 15% would have significant learning disabilities. At least 765 adults in Leeds requiring services. 7. Triad of Impairments (The Defining Characteristics of ASDs)Lorna Wing - 1978 8. The TriadSocial understandingCommunication Imagination 9. THE TRIAD OF IMPAIRMENTS All three areas of impairment must be present for a diagnosis They will be present before 36 months The severity of each will vary between individuals and within individuals over time They will be out of keeping with their developmental level 10. Impairment of social understanding aloofness and indifference to other people passively accepts social contact Spontaneous but in an odd, inappropriate, or repetitive way with little or noattention to responses Interactions tend to be one way traffic i.e. not reciprocal Lack of empathy (Theory of Mind) 11. Impairment of social understanding Expressions of emotion often inappropriate or extreme Expects other people to know their thoughts and feelings May appear withdrawn / introverted or over familiar Can make personal comments without understanding that this may cause offence 12. Theory of Mind... Theory of mind is the ability to...or knowing how to mind read!attribute mental states beliefs, intents, desires, pretending, knowledge, etc.to oneself and others and to understand that others have beliefs, desires and intentions that are different from ones ownEye contactBody languageFacial expressionsTactile communication 13. Impairment of social communication difficulty making sense of and using all aspects ofcommunication i.e. verbal and non verbal ranges from little or no spoken language to those whoappear articulate lack understanding of body language e.g. tone of voice, facialexpression literal, pedantic, concrete understanding and use of words,limited content of speech 14. Im on top of the world!Youd better pull your socks up!I laughed my head off!Could you keep your eye out for dadIf you dont stop doing that youll be in hot water!!Its on the tip of my tongue Im tied up at the moment Dont forget to pull the door behind you Now we are going to toast the bride and groom 15. Communication How Good Are You?Rules: You are not allowed to say thename of the objects in thedrawing or use names ofcomponents of the picture You are not allowed to use thenames of comparative objects You are not allowed to name thepurpose or use of objects in thedrawing i.e. you may only use descriptiveterms such as shapes and wherethey appear on the paper / inrelation to each other The artist is not allowed to talk! 16. Imaginationnounthe faculty or action of forming new ideas, or images or concepts of external objects not present to the senses:shed never been blessed with a vivid imaginationher story captured the publics imagination[mass noun] the ability of the mind to be creative or resourceful:she was set in her ways and lacked imaginationthe part of the mind that imagines things:a girl who existed only in my imagination- Oxford English Dictionary definitionImagination is more important than knowledge. For knowledge islimited to all we now know and understand, while imagination embracesthe entire world, and all there ever will be to know and understand.- Albert Einstein 17. Impairment of imagination Difficulty with creative, open-ended activities, and moreabstract ideas Rigidity and inflexibility in thinking and behaviour restricted range of interests and skills pursued in a repetitivemanner Rituals and obsessions, and an insistence on sameness 18. George Orwell Author; Albert Einstein Physicist; One of His troubled life went along with social the greatest minds of the 20th interaction problems. Wrote a Such,century. Reportedly couldnt tie Such were the Joys a bitter account of his days in boarding school in which he his own shoelaces describes many of the traits related to Asperger Syndrome.Nikola Tesla - InventorAndy Warhol Artist;Was able to mentally picture very detailedCredited with creating the pop-artmechanisms; spoke 8 languages; was nevermovement. Also reported to havemarried; was very sensitive to touch and had an had an obsessive personality, beacute sense of hearing and sight; was obsessedunable to adapt to different social with the number three; was disgusted by situations and frequently described jewelery and overweight people and also had by contemporaries as odd.several eating compulsionsDan Aykroyd - Actor / Comedian; Diagnosed withAspergers and TourettesWell, it was mostly physical tics, the classic Tourettes type syndrome, that type of thing. Butby the time I was 14 it was allayed and I really havent had too much occurrence except on the Aspergers side, where I have a fascination with police, and I always have to have a badge withme. ... I have a fascination with law enforcement and the police. 19. Why the obsession with rituals and routines? 20. How important is your routine? 21. Sensory Difficulties (The Fourth Characteristic) 22. Abnormal responses to environmental stimuli. An individual with autism may be: hyposensitive or hypersensitive All senses may be affected. Over stimulation can be a trigger for those out of the bluereactions. 23. School was a nightmare! I was so easily caught away with lifes interruptions. It might have been a child coughing, a bus passing by on the road outside, a bird singing, or simply my own thinking trying to work out words from a previous conversation.Wendy Lawson 24. SENSORY QUIZIFNOSPACESARELEFTBETWEENWORDSITSDIFFICULTTOSEEORIF TH EWO RDS BEG INA NDE NDI NPLA CEST HATDON TMAK ESE NSE TEWO E O CE D H R S EM T N U AN OWDS DAPN 25. Who is this? 26. What everyday task are you being taught in the audio clip? 27. SENSORY QUIZ - ANSWERSIFNOSPACESARELEFTBETWEENWORDSITSDIFFICULTT OSEE If no spaces are left between words its difficult to seeORIF TH EWO RDS BEG INA NDE NDI NPLA CEST HAT DON TMAK ESE NSE...or if words begin and end in places that dont make senseTEWOE O CE D H R S EM T N U AN OWDSDAPNThe words seem to dance up and down 28. What everyday task are you being taught in the audio clip? 29. Who is this? 30. VisualHypersensitive Covers eyes / looks down Looks at minute particles / dust Frightened by flashes of light Dislikes dark / lightHyposensitive Stares at bright lights Moves fingers or objects in front of eyes Fascinated with reflections or bright coloured objects Runs hand round edge of objects 31. AuralHypersensitive Covers ears Makes repetitive noises Isolates self in areas such as toilet, store cupboards etc. Dislikes thunderstorms, crowds, having haircut etc.Hyposensitive Bangs doors / objects Seeks noises Makes loud vocalisations Delayed / no response to aural cues 32. TactileHypersensitive Resists touch Cannot tolerate new clothes / damages clothing Dislikes foods with certain textures Avoids peopleHyposensitive Seeks pressure Prefers tight clothing Prone to self injuries Little response to extremes of temprature 33. Olfactory (Smell)Hypersensitive Toileting problems Moves away from people Refusal to wear new clothes / frequent changing Avoidance of certain smellsHyposensitive Sniffs / smells objects or people Smears / plays with faeces Seeks out odours Bedwetting / urinary incontinence 34. Gustatory (Taste)Hypersensitive Very limited food repertoire Gags / vomits easily Poor eater Uses tip of tongue for tastingHyposensitive Regurgitates food / intentional vomiting Mouths / licks objects Eats inappropriate materials Mixes food e.g. Main course and desert 35. Interoceptive / vestibular /proprioceptiveHypersensitive Places body in strange positions Seeks pressure Unsteady on feet Extreme reactions to heat or coldHyposensitive Incontinence Appears floppy / low muscle tone Constantly seeks food / drinks Rocking / spinning 36. That tension that I have to live with every dang minute... I have to take naps through theQuotes - feelings day because I wear myself out just being...constantly startled is a good way to put it. - Phil WheelerI experiencelife in themes. I have tremendousdifficulty filtering out the essential fromnonessential. I have trouble prioritizing therelevant pieces of information. - Dena Gitlitz 37. Analysing Behaviour 38. poor concept oftimechanges in does not know /routineunderstandrules unsure what is anxious aboutgoing to happen failureSTRESS difficulties with communication sensorydifficulties literal interpretation of situation 39. AGGRESSION ICEBERG Pushing HittingSpecificBehavioursSpittingThrowing Shouting Swearing unaware of social rules unaware of others feelingsUnderlyingDeficits over sensitive to noise frustration through inability tocommunicate appropriately inappropriate reaction to others 40. OVER PASSIVE ICEBERG Seems lazySpecific UnmotivatedBehavioursWaits for prompts Over dependent Unaware of other peopleUnderlyingDeficits Poor concept of time Does not understand future rewards Unmotivated by usual rewards Does not understand expectations 41. Analysing Behaviour: The ABC Approach 42. ABC Recording Sheet 43. Addressing Challenging Behaviour Record the behaviour (actions) Analyse the underlying causes (setting and triggers) Analyse the consequences (results) Alter the triggers and / or results Analyse the function of the action and teach moreappropriate responses 44. Behaviour Support Plans Identify behaviour/s of concern Known triggers Management strategies Reducing impact of incidents Response strategies at each stage Follow up / debrief Review / evaluate Agreements / multi-agency consistency 45. Practical Suggestions 46. Practical Suggestions Incorporate a routine Minimise unstructured time Be aware of the environment Use practical problem solving Think about an individual in terms of their autism Involve everyone Ensure consistencyEarly intervention is key - Prevention is better than cure!!! 47. VISUAL CUESPeople with ASD are visual learners so visualways to facilitate communication areexplored: What I do is write everything I have to dodown. That visual support is very useful forme. My to do list is like a ritual to me. Somepeople pray at night, I write a to do list.Dena Gitlitz 48. Visual Learning What Arethe Benefits? Develops understandingAids retention Provides alternative to social imagination Provides reference point May assist in developing ownership of agreedactions 49. VISUAL COMMUNICATION TEST Do you have a diary or calendar that you write things on tohelp you organize your life? Do you have a list of things to do on your fridge or at work? Have you ever pointed to a picture in an advertisement or amenu to show someone what you want? Do you write a shopping list before you go to thesupermarket? 50. 51. Work Systems A work system is a concrete, visual way to tell the person:1) What they have to do2) How much they have to do3) When they are finished4) What happens next 52. Setting up schedules/ timetables WHAT vertical gridsThe visuals go downthe side as seen in thismorning schedule. 53. Visual Structure 54. Social Stories Visual symbols, photos, writing Fewest points possible Permanent - allow individual to revisit Simple language whether written or spoken Based on knowledge of individual Explicit do not make assumptions Factual stick to known outcomes; consequences mustbe agreed and carried out Definite avoid use of maybes 55. GENERAL STRATEGIESCommunication Limit language used clear, precise and slow The implicit should be made explicit Be aware of the literal explain idioms, dont askunless there is a genuine option Cannot assume understanding check ensure / cueattention 56. GENERAL STRATEGIESSocial Interaction Social skills need to be taught not caught Unwritten or unspoken rules will need to be madeexplicit 57. GENERAL STRATEGIES Need to be aware of structure and routines -whats now /whats next Flexibility in thinking the more inflexible the individualis, the more flexible the staff will need to be! Visual cues easier to understand and also permanentreminder Free unstructured / transitional time may need planning Abstract or open ended activities may need to be mademore concrete or specific 58. GENERAL STRATEGIESBehaviour and Obsessions Clear consistent guidelines and boundaries Ensure rules are understood Emphasis on what we want the individual to do ratherthan what we dont want them to do Desirable behaviour may need teaching be patient Distract and divert Obsessions cannot eliminate but limit or use asmotivation 59. GENERAL STRATEGIESWorking Together Maintain a dialogue with parents and carers Ensure that all staff are fully informed Use written plans / scripts where appropriate Consider how other service users can understand thenature of the disability Think about unstructured times and transitions Limit choice so it is manageable to the individual 60. Golden Rules Know the individual Understand ASD Structure the environment Reduce your language Recognise anxiety / build up 61. Its just as though hes not listening.Hes always ruining othersactivities!The only place she will eat her dinner, without screaming, is in the I told the him we were corridor. going to have a treat instead of the usual dayand he starts shouting and screaming. She paces round and round the TV lounge. She doesnt even watch it. He just wont leave the lounge room door open itIf I get cross, she just gets absolutely roastingseems to think its funny during summer!why wont she listen? 62. Further ResourcesUseful Websites www.nas.org.uk www.through-the-maze.org.uk www.bild.org.uk www.autismuk.comSuggested Reading Autism and Asperger Syndrome Simon Baron Cohen A History of Autism Adam Feinstein The Curious Incident of the Dog in the Night-Time Mark Haddon Thinking in Pictures Temple Grandin