Learning Learning disorders: Autism disorders: Autism

and ADHDand ADHDA brief overviewA brief overview

Autistic childrenAutistic children

Behavior modificationBehavior modification A woman from India has developed a A woman from India has developed a

new technique with lots of talking, new technique with lots of talking, direction, one-on-one. Great direction, one-on-one. Great improvements. improvements. Autistic children require more Autistic children require more

environment support. Tangible rewards environment support. Tangible rewards and highly structured environments. and highly structured environments. (Merzenich, Jenkins). (Merzenich, Jenkins).

Autism is on the increase—Autism is on the increase—why.why.

Learning in Autistic kids. Learning in Autistic kids.

What is easy for them to learn and What is easy for them to learn and what is hard for them to learn?what is hard for them to learn?

Some are intellectually gifted, some Some are intellectually gifted, some are retarded.are retarded.

Debate on whether inoculations can Debate on whether inoculations can cause autismcause autism

Dr. Leo KannerDr. Leo Kanner

A psychologist at Johns Hopkins A psychologist at Johns Hopkins University was the first to use the University was the first to use the term autism in a paper (1943). term autism in a paper (1943).

His definition: A group of children His definition: A group of children who were self-absorbed and who had who were self-absorbed and who had severe social, communication, and severe social, communication, and behavioral problems. behavioral problems.

Autism in the DSMAutism in the DSM

Autism first appeared in the DSM III, Autism first appeared in the DSM III, as Separated Infantile Autismas Separated Infantile Autism

Before then, it was known as a Before then, it was known as a childhood-type of schizophrenia. childhood-type of schizophrenia.

In the ’50s and ’60s the medical In the ’50s and ’60s the medical community blamed autism on community blamed autism on “refrigerator mothers” -- detached “refrigerator mothers” -- detached and uncaring parenting. and uncaring parenting.

Major Major CharacteristicsCharacteristics

InfantsInfants

Avoiding physical Avoiding physical contactcontact Arching their back Arching their back

away from away from caregivercaregiver

Failing to Failing to anticipate being anticipate being picked uppicked up Become limpBecome limp

Begin self Begin self stimulatory stimulatory behaviorsbehaviors Rocking and/or Rocking and/or

banging head banging head inside the crib. inside the crib.

ChildrenChildren

As toddlers, As toddlers, children with children with autism may reach autism may reach developmental developmental “milestones”. “milestones”. Talking, crawling, Talking, crawling,

and walking much and walking much earlier than earlier than average children. average children.

Children continuedChildren continued

Regressive AutismRegressive Autism About 50% of About 50% of

children with children with autism develop autism develop normally until normally until about 1 ½ to 3 about 1 ½ to 3 years of age before years of age before autistic symptoms autistic symptoms begin to emerge. begin to emerge.

Children continuedChildren continued

May fall behind May fall behind same-aged peers in same-aged peers in communication, communication, social skills, and social skills, and cognition. cognition.

Dysfunctional Dysfunctional behaviors begin to behaviors begin to appear. appear. Self stimulatorySelf stimulatory

Rocking, hand Rocking, hand flappingflapping

Self injurySelf injury Hand-biting, head-Hand-biting, head-

bangingbanging

Other dysfunctional Other dysfunctional behaviorsbehaviors

Sleeping and eating problems, poor eye Sleeping and eating problems, poor eye contact, insensitivity to pain, hyper/hypo-contact, insensitivity to pain, hyper/hypo-activity, and attention deficits. activity, and attention deficits.

Insistence on sameness Insistence on sameness overly insistent on routines (i.e. overly insistent on routines (i.e.

drinking/eating same foods at every meal, drinking/eating same foods at every meal, wearing certain clothing, insisting others wearing certain clothing, insisting others wear same clothing, going to school using wear same clothing, going to school using the same route the same route

Reason: inability to cope with novel Reason: inability to cope with novel situations situations

AdolescenceAdolescence

AdolescenceAdolescence

Individuals with autism sometimes Individuals with autism sometimes have difficulty with the transition have difficulty with the transition into puberty.into puberty. 25% have seizures (may be due to 25% have seizures (may be due to

hormonal changes)hormonal changes) Behavior problems become more Behavior problems become more

frequent and/or severefrequent and/or severe However! Other individuals experience However! Other individuals experience

puberty with relative ease. puberty with relative ease.

General TreatmentsGeneral Treatments

MedicationsMedications No primary drug has been shown to be No primary drug has been shown to be

consistently effective in treating autistic consistently effective in treating autistic symptomssymptoms

Ritalin: most widely prescribed drugRitalin: most widely prescribed drug Used to treat attention deficit problemsUsed to treat attention deficit problems

Treatments continuedTreatments continued

Vitamin B-6 with magnesium Vitamin B-6 with magnesium supplementssupplements Has been shown to increase general Has been shown to increase general

well-being, awareness and attention in well-being, awareness and attention in 45% of autistic children.45% of autistic children.

Di-methylglycine (DMG)Di-methylglycine (DMG) Helps general well-being.Helps general well-being. Also, a few reports on enhancing Also, a few reports on enhancing

communication skills. communication skills.

Treatment for Autism in Treatment for Autism in Applied Behavior Analysis Applied Behavior Analysis

ABA is the systematic approach ABA is the systematic approach to the study of behavior… and how to to the study of behavior… and how to change it using scientific change it using scientific methodologymethodology

Three main principles in Three main principles in ABA:ABA:

ReinforcemeReinforcementnt

PunishmentPunishment ExtinctionExtinction

Johnny did Johnny did his his homework. homework. He gets a He gets a sticker!sticker!

EW! Bad Fluffy! EW! Bad Fluffy! (spank)…not (spank)…not the carpet!the carpet!

Feeding the Feeding the dollar into a dollar into a broken coke broken coke machine…machine…

Autism and ABAAutism and ABA

ABA is the most effective Treatment ABA is the most effective Treatment known for autism today known for autism today

Highly structured environment Highly structured environment Reinforce appropriate behaviors, extinguish Reinforce appropriate behaviors, extinguish

problem behaviors (intervention)problem behaviors (intervention) Setting and generalizationSetting and generalization Focus on specific behaviorsFocus on specific behaviors

Problem Problem BehaviorBehavior

InterventionIntervention Appropriate Appropriate BehaviorBehavior

Inappropriate Inappropriate behaviors:behaviors:

Grabbing, Grabbing, reaching for reaching for

itemsitems

Remove SR+Remove SR+

PromptPrompt““Please, can Please, can

I…”I…”

•Token Economy:

•Typing letters

In Conclusion…In Conclusion…

Autism is a very complex disorder; Autism is a very complex disorder; although people with autism do not although people with autism do not have exactly the same symptoms and have exactly the same symptoms and deficits and the needs of these deficits and the needs of these individuals vary greatly, they tend to individuals vary greatly, they tend to share certain social, motor, and share certain social, motor, and sensory problems that effect their sensory problems that effect their behavior in predictable ways. behavior in predictable ways.

What is ADHD?What is ADHD? ADHD stands ADHD stands

for Attention for Attention Deficit Deficit Hyperactive Hyperactive DisorderDisorder..

Specific Symptoms of Specific Symptoms of ADHDADHD

Often fidgets with hands and feet or Often fidgets with hands and feet or squirms in seat.squirms in seat.

Often leaves seat in classroom or in Often leaves seat in classroom or in other situations in which remaining other situations in which remaining seated is expected.seated is expected.

Often runs about or climbs Often runs about or climbs excessively in situations in which excessively in situations in which remaining seated is expected. remaining seated is expected.

Symptoms cont.Symptoms cont.

Often has difficulty playing or Often has difficulty playing or engaging in leisure activities quietly.engaging in leisure activities quietly.

Is often “on the go” or acts as if Is often “on the go” or acts as if “driven by a motor”“driven by a motor”

Often talks excessively, often blurts Often talks excessively, often blurts out answers, has difficulty awaiting out answers, has difficulty awaiting a turn. a turn.

What causes ADHDWhat causes ADHD

Bad parenting Bad parenting cannotcannot be blamed for be blamed for the causes of ADHD. Problems in the the causes of ADHD. Problems in the home and certain parenting styles can home and certain parenting styles can add to a child’s frustrations but cannot add to a child’s frustrations but cannot cause the disorder. cause the disorder.

Genetics: Studies show a strong Genetics: Studies show a strong genetic link in the causes of ADHD. A genetic link in the causes of ADHD. A child is 70% more likely to have child is 70% more likely to have Attention Deficit Hyperactive Disorder Attention Deficit Hyperactive Disorder if they have a parent with the disorder.if they have a parent with the disorder.

Young Children who watch TV have Young Children who watch TV have risk of ADD by school age. For every risk of ADD by school age. For every hour of TV under the age of 3, the hour of TV under the age of 3, the deficit of ADHD increases 10%. deficit of ADHD increases 10%. Pediatric society says children uncer Pediatric society says children uncer trhe age of 2 shouldn’t watch TV at all. trhe age of 2 shouldn’t watch TV at all.

Dimitri Christakis, April issue of Dimitri Christakis, April issue of Pediatrics 2004. Pediatrics 2004.

Causes cont.Causes cont.

Diet: study after Diet: study after study show that study show that children with the children with the symptoms of symptoms of Attention Deficit Attention Deficit Hyperactive Hyperactive Disorder lack Disorder lack nutrients necessary nutrients necessary for proper brain for proper brain functioning. functioning.

Warning SignsWarning Signs Does not work to potential in school.Does not work to potential in school. Has a short attention span unless Has a short attention span unless

interested in a particular subject.interested in a particular subject. Has a family history of ADHD, ADD, Has a family history of ADHD, ADD,

learning problems or substance abuse. learning problems or substance abuse. Is easily distracted. Is easily distracted. Skips around when readingSkips around when reading Has difficulty putting thoughts on paperHas difficulty putting thoughts on paper Has poor listening skillsHas poor listening skills

Long term effectsLong term effects

NeurologicalNeurological

Unusual small brain structures in the prefrontal Unusual small brain structures in the prefrontal cortex and basal ganglia: these areas inhibit cortex and basal ganglia: these areas inhibit impulses and regulate attention and self controlimpulses and regulate attention and self control

CognitiveCognitive

Problem holding information in working memoryProblem holding information in working memory

Problem self directed speechProblem self directed speech

Controlling emotions and motivationControlling emotions and motivation

Analyzing and synthesizing behaviors in new ways Analyzing and synthesizing behaviors in new ways as to pursue goalsas to pursue goals

More effectsMore effects

BehavioralBehavioral

Tend to forget responsibilitiesTend to forget responsibilities

Speak allowed instead of giving self silent directionsSpeak allowed instead of giving self silent directions

Easily frustrated and angeredEasily frustrated and angered

If left untreated, effects may include:If left untreated, effects may include:

Academic problemsAcademic problems

Antisocial behaviorAntisocial behavior

Risky drivingRisky driving

Substance abuseSubstance abuse

Over diagnosis?Over diagnosis?

Between 1991 & 1998, Rx’s rose 2400% Between 1991 & 1998, Rx’s rose 2400% for dexamphetamine and 620% for Ritalinfor dexamphetamine and 620% for Ritalin

Currently, over 5 million children Currently, over 5 million children diagnosed with ADHDdiagnosed with ADHD

Many teachers, parents, and media say Many teachers, parents, and media say children are put on medications only to children are put on medications only to control their behaviorcontrol their behavior

Some school districts given money to Some school districts given money to treat children with ADHD/ADDtreat children with ADHD/ADD

Diagnosis cont.Diagnosis cont.

About 3-5% of children said to have About 3-5% of children said to have ADHD—a study said 8-10% of ADHD—a study said 8-10% of children taking meds for ADHD in a children taking meds for ADHD in a Virginia school districtsVirginia school districts

ADD, Attention Deficit Disorder, ADD, Attention Deficit Disorder, Inattentive, without Hyperactivity is Inattentive, without Hyperactivity is more often under diagnosed.more often under diagnosed.

In DefenseIn Defense

ADHD may be marked on forms due ADHD may be marked on forms due to FDA approved indicationsto FDA approved indications

Research has not produced sufficient dataResearch has not produced sufficient data Some research points towards over diagnosis, Some research points towards over diagnosis,

whereas other research does not—depends of whereas other research does not—depends of researcherresearcher

……cont.cont. Media may be a huge cause of controversyMedia may be a huge cause of controversy Other causes of an increase in Dx (diagnosis):Other causes of an increase in Dx (diagnosis): Increase in vaccinationsIncrease in vaccinations Mercury exposureMercury exposure Processed foodsProcessed foods Pesticide usePesticide use Television watchingTelevision watching Sugar intakeSugar intake Environmental pollutionEnvironmental pollution Fluoridated waterFluoridated water Divorce ratesDivorce rates

Other emotional instability problems at homeOther emotional instability problems at home

Questions?Questions?