Autism Spectrum Disorders: Presentation During School Years

Rhea Paul, Ph.D., CCC-SLPSouthern Connecticut State UniversityYale Child Study CenterFeb. 11-15, 2008rhea.paul@yale.edu

Overview

Social and adaptive behaviors Play Communication Behavioral and Emotional Issues Adjustment and Achievement Outcome

Social behaviors: Aloof

Classically autistic Avoid contact and interaction,

unresponsive Stereotypic, self-injurious behaviors Pattern most common in preschool,

but can be seen in older childen Those who persist in this pattern

often have MR

Video Sample: Aloof JC, MK

Social behaviors: Passive

Accept but do not seek interactions

Generally higher developmentally than aloof

Children who start out aloof may move to passive

Video sample: Passive Karin 14:00 Hadia

Social behaviors: Active-but-odd

Usually HFA or AS May have considerable language skills,

interested in communicating but use Repetitive questions Inappropriate touch Odd postures, gestures, facial expressions Conversations on narrow interests

Literal and concrete Little awareness of others’ thoughts, feelings,

motives Aware of differences May regress under stress to tantrums

Video Samples: Active but Odd

Adaptive Skills

Deficits not attributable to IQ Related to verbal skills and autistic

symptom level Typically significant discrepancy

between measures of adaptive skills and developmental level in ASD; adaptive skills are lower than IQ.

Should be targeted in educational programs

Play Pretend play is often lacking or

delayed Play may be rigid, repetitive Games with rules may be rigidly

adhered to Motor skills may interfere with team

game participation Can be enhanced by allowing active

role in choosing games, toy, themes

Communication

Presence of speech before age 6 is indicator of better prognosis

Echolalia may be first step toward speech, usually decreases as language skills increase Serves communicative functions

Language skills in children who speak are generally on par with mental age

Conversational skills are major area of deficit throughout school years

Behavior and Emotion Unusual inappropriate excessive or

inadequate responses Appear to lack empathy High levels of anxiety; may lead to

maladaptive behavior High levels of attention problems,

hyperactivity, impulsivity; similar to ADHD Hyperactivity decreases w/ age Attention problems do no

Stereotypic Behaviors Seen in other disorders, but more

prevalent in ASD more frequent in lower functioning

individuals, but can be seen in HFA May progress from repetitive sensory

motor activities to those more like OCD in higher functioning individuals

Both drug and behavioral treatments are helpful

Adjustment and Achievement

Social disabilities, rigid cognitive style, anxiety, attention problems affect academic achievement even for most intelligent

Difficulty w/ executive functioning interferes with school success

Generally, children with autism have weaker verbal than non-verbal skills; may need visual (picture) supports

AS shows strong verbal skills, benefit from written supports

Individual assessment needed to identify academic strengths, weaknesses Reading and/or math may be precocious in HFA/AS Hyperlexia is common in ASD (20-25%)

Adolescence Generally, improvement is seen in adolescence

Reduction in symptoms Increase in social and communicative skills

10-20% show deterioration in adolescence 25% show onset of seizures in adolescence Mood disorders may appear Difficult behaviors may remain, including

Resistance to change Unacceptable sexual behavior Tantrums Aggression Self-injury

Outcomes Best seen in those with IQ>50, language use by

age 6 Many have difficulty with independent living and

most continue to live with parents into adulthood Residential support programs for adults are emerging

Only about 10% of people with ASD attend or graduate from college

Supported employment provided for those with MR; less often for those w/ HFA/AS

High rates or depression and anxiety in adults Education has a great effect on outcome!

Video Sample: Outcomes

Video Sample: Outcomes