SPLED461:

Introduction and Objectives

To complete this lesson, please do the following things:

• Read the textbook (Chapter 1).
• Read all content provided in this lesson.
• Complete all associated self-check activities, discussions, and assignments.

Lesson 1 Objectives 

• At the end of this lesson, you should be able to do the following things specified in the textbook:
  • Describe the characteristics of autism spectrum disorders. 
  • Explain how autism spectrum disorders are identified and diagnosed.
  • Identify the changes in the definition of autism spectrum disorders.
  • Discuss causal theories associated with autism.
  • Describe instructional planning for students with autism.

Autism Spectrum Disorders

Individuals with autism are a very heterogeneous group. You may personally know someone with autism—you may work, go to school, have a friend, or have an acquaintance with autism. As you no doubt know, each person's characteristics make them who they are. Although we’ll be discussing common characteristics, teaching strategies, and other educational issues related to autism, generalizations about characteristics can be inaccurate or can mask uniqueness. Remember that no size fits all; throughout your life, you’ll interact with unique and special individuals with autism.

Before we begin, let’s talk about language and terminology. You may hear a lot of terms associated with autism. At present, the term autism spectrum disorders (or ASD) is used to replace such diagnoses as autism, classic autism, or Asperger’s. The new term ASD emphasizes that autism is a “spectrum” disorder, with a lot of variability in strengths and needs among those with the disorder.

This lesson's readings will provide you with an overview of ASD. First you will read about recent changes made to the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. The DSM is published by the American Psychiatric Association (APA) and is the primary manual used by clinicians to provide a formal diagnosis. The DSM outlines specific criteria needed to receive a diagnosis, provides labels or names for the diagnosis, and lists the numerical codes that are sometimes used by insurance companies to bill for services. Essentially, the DSM provides the standard guidelines for clinicians to use for a formal diagnosis. After you read about the DSM, the lesson will cover potential causes of ASD, characteristics of the population with ASD, and instruments used to diagnose ASD. Finally, you'll look at the general parts of an individualized education plan (IEP) and how one might write a goal for a person with ASD. Let’s start with the DSM.

The DSM-V

The latest edition, the DSM-V, was published in 2013; it covers many different disability and diagnostic categories (such as intellectual disabilities, attention-deficit disorder, and other medical conditions). Most of the diagnostic categories have remained unchanged. However, in the recent edition of the DSM (V), there have been major changes to how ASD is diagnosed. Why was the DSM changed? Well, clinicians wanted to make the ASD diagnosis more specific to provide greater sensitivity, so that true cases would be identified. They also wanted the criteria to be more reliable (so that clinicians would agree on who had ASD), to be valid (accurate), and to really reflect that ASD is a set of behaviors. As seen in the DSM-V, ASD is characterized not by separate symptoms, but by a particular set of behaviors that manifest themselves together.

The changes in the DSM are relatively new; in fact, they're the first substantial changes to the manual in 13 years. As you can imagine, the systematic use of the DSM-V will take time. You may continue to hear terms that are no longer in the DSM-V (like Asperger’s). However, for accuracy, we will be using only the new terms and criteria. Below, you will find two charts; one outlines the changes made to the ASD diagnosis from the DSM-IV to the DSM-V. If you’ve had contact with individuals having ASD, you’ve likely seen a great deal of variability in how well each person is able to function. As outlined in the diagnostic criteria, there are two central deficit areas: social communication deficits, and restricted interests and repetitive behaviors. Recently added to the latest version of the DSM is a rating (from one to three) of the severity of the deficit areas. For example, an individual may be diagnosed as Level 3 in the area of social communication, but have less-severe symptoms of repetitive behaviors, which need only a moderate level of support (Level 2). Currently, there are no specific guidelines on how to assign a severity level. 

Adapted from Diagnostic Criteria for Autism Under the DSM-5, by G. Vivanti, O. Tennison, and D. Pagetti Vivanti, 2016. In Autism Europe: About Autism. 

The second chart shows the recently added severity scale, which describes the impact of ASD on everyday function. 

Adapted from DSM-5 Diagnostic Criteria, by Autism Speaks, Inc., 2016. In Autism Speaks: What Is Autism?

Diagnosing Autism Spectrum Disorders

Making an accurate diagnosis of ASD can be challenging. Often, many individuals are involved in the diagnostic process, including physicians, psychologists, teachers, parents, and sometimes the individual with ASD him- or herself. A variety of instruments can be used to aid in diagnosis. Typically, instruments called screeners are used initially to see if an issue does indeed exist. Screeners are often given to parents and teachers to begin the diagnostic process. If the child does show characteristics of ASD, a formal diagnosis can begin. The physician or parent can contact a psychologist (privately or in the school in which the child is enrolled) and make a formal request for an evaluation. Whoever conducts the evaluation will likely use the DSM-V to make a diagnosis. Once a formal diagnosis of ASD is given, the child can begin to receive services.

Causes of Autism Spectrum Disorders

Historical Context

In the 1960s, a psychologist named Bruno Bettelheim did quite a bit of damage by relating the cause of ASD to “refrigerator mothers.” The mothers of children with ASD were characterized as cold and distant (but only the mothers!). The mothers were often stereotyped as being highly educated and more career oriented than other mothers. This theory did a lot of damage by blaming parents; sometimes, you will still hear that poor parenting or a cold mother is the cause of a child having ASD, even though the theory has been soundly disproven.

Genetics

As your text states, research clearly has indicated that genetics strongly influence the risk of developing ASD. Unfortunately, we still do not know the extent of the relationship or the exact gene(s) that may be causing ASD. However, we do know that siblings have a greater risk of developing ASD. This is particularly true if we look at twins; if one twin has autism, there is a 90% chance that the other will as well. This provides a very strong indication of a genetic link, since identical twins are so similar. We also find that, if we look back in time, very often, a child who's diagnosed with ASD will have a family member with some characteristics, even if he or she wasn't formally diagnosed. So, we're seeing a strong genetic link occurring, but at this juncture we can't pinpoint the exact gene(s).

Role of the Environment

Although genetics plays a part in the development of ASD, it is generally acknowledged that genetic makeup alone does not account for all incidences. Many believe that the environment may also play a role. Environmental factors can include such toxins as pesticides or household cleaning agents, though the role of toxins still is widely debated. In fact, there still is controversy about whether the mercury in vaccines (now absent) causes ASD. Despite resounding evidence to the contrary, the theory of this environmental toxin continues to this day. Because environmental factors can refer to anything other than changes in a gene’s DNA, environmental risk factors for ASD may also include things like parental age at conception, maternal nutrition, infection during pregnancy, and prematurity.

Characteristics of Autism Spectrum Disorders

“Universities are renowned for their tolerance of unusual characters, especially if they show originality and dedication to their research. I have often made the comment that not only are universities a 'cathedral' for worship of knowledge, they are also 'sheltered workshops' for the socially challenged.”
– Tony Attwood, The Complete Guide to Asperger's Syndrome

Language Deficits

Not all children with ASD will display language deficits. Ability to communicate will vary by age and by individual. Some children with ASD may not be able to speak, while others may have rich vocabularies and be able to talk about specific subjects in great detail. Some children with ASD may display echolalia, in which they repeat words or phrases rather than engage in typical conversation. Echolalia can be immediate or delayed. An example of immediate echolalia would be when I say, "Good morning," and you say, "Good morning." I say, "How are you?" and you say, "How are you?" With delayed echolalia, the child can verbatim state a phrase that occurred some time ago. Some children can watch a movie (seems like it’s often Disney!) and can give you the entire script a few hours or even days later.

Additionally, the individual with ASD may have limited or delayed speech, such as single-word utterances or approximations of words. For example, instead of saying “ball,” the child says “ba.” The limited or delayed speech might mean that the individual with ASD has adequate speech, but difficulty with forms of language. His or her prepositions might be off; pronouns might be different. You might also see individuals with ASD who have no functional speech. They might be using other forms of communication, such as augmentative and alternative communication (AAC). For example, they might be using sign, a communication board with pictures, or a voice-output electronic system for communication.

Some individuals might have problems with what we call pragmatics, meaning that they might not understand the social norms related to language. One common issue is misunderstanding sarcasm (as in, "Oh sure, I’d love to do that…"). Individuals with ASD may also use language in unusual ways, such as inappropriately using formal words, describing things in odd ways, having difficulty in conversation, or lecturing in a formal tone during informal discussions.

One common language deficit is the inability to comprehend idioms. As you know, idioms are expressions or figures of speech that aren’t to be taken literally. If you’ve ever interacted with someone from a different country, you know that idioms often differ from country to country. Idioms can be very difficult for individuals with ASD to understand; they might think it’s literally raining cats and dogs!

Individuals with ASD can also have difficulty understanding nonverbal communication, facial expressions, gestures, and/or proximity. For example, individuals with ASD might not interpret someone stepping back as a sign they're standing too close. They might also present with a very flat affect. For example, they might not display facial expressions in response to someone who's telling a very animated story. We don’t always think of nonverbal communication, but it is very important in conveying a message. Lastly, individuals with ASD might have difficulty processing language in distracting environments, such as a noisy environment or an environment with a lot of stimuli (like a cafeteria or a loud mall).

Now that you have read about the language deficits related to ASD, watch the following videos to get an idea of what these language deficits might look like in action.

Social Differences

Next, your text discusses social differences related to ASD. Individuals with ASD may have deficits in what has been called theory of mind. This is sometimes referred to as mind blindness. Mind blindness is the inability of the individual to take the perspective of someone else. Much like the Greek word auto, which means being involved in oneself, individuals with ASD might not understand what others are thinking or perceiving or that their perceptions might differ from others'. For example, if they're frustrated with something, they assume that everyone else is frustrated with it as well. If they are okay with things, they assume everyone else is as well.

Motor Deficits

Individuals with ASD often have what is called dyspraxia, or difficulty with motor planning. Some individuals may have balance issues or awkward movements, may walk on their toes, or may have delayed developmental milestones. Motor issues can be categorized based on the fine motor skills or the gross motor skills. Fine motor skills center on small muscle movements—things like buttoning a shirt or getting the cap off of a tube of toothpaste. Gross motor skills involve large muscle groups, typically dealing with ambulation (walking) and being able to move one’s arms in a wide circle.

Gross Motor Skills

Motor issues are addressed through occupational therapy (OT) or physical therapy (PT). Occupational therapists often work with children with ASD on handwriting issues, helping them hold the pencil or pen correctly and helping them learn the amount of pressure to use when putting the pen to paper. Physical therapists may help individuals with ASD walk properly. Below, you will see a video of a child engaging in toe-walking, a gross motor skill.

Learning Challenges Associated With ASD

Generalization and Maintenance

Individuals with ASD may require explicit, systematic instruction. The ultimate goal of instruction for individuals with ASD is generalization, or the transfer of skills. When designing instruction, you want to make sure that the skills you teach will be transferred or generalized to other environments and with other people. For example, you might hear teachers say, “You know, he'll only sit in his seat with me” or “He will only respond appropriately with me.” You might think that this is a sign of success, but it's really not. You want the student to be able to respond with you, with his or her parents, and/or with a community worker out in the world. If you work with a student on telling time, you'll want him or her to be able to tell time on different clocks/watches. I You'll also want him or her to tell time at home, at school, and in the community. Remember, the ultimate goal of instruction is making sure the students can function anywhere they go based on the skills that have been taught.

Additionally, once a child learns a skill, it is important for him or her to maintain the skill over time (maintenance). Individuals with ASD often display deficits in maintaining previously acquired skills, so the ability to perform a particular skill over time cannot be assumed. Individuals with ASD need explicit training for generalization and maintenance to occur.  

Challenges Associated With Core Deficits of ASD

• Executive Functioning

  Executive functioning is the ability to organize and plan using working memory, inhibiting and controlling impulses, time-management priorities, and new strategies based on what happens in the current situation or what has happened in the past. Deficits in executive functioning can affect your ability to know that you'll have to put your math supplies in your backpack before you go to class, where you'll need them. You might also forget the steps of a sequence ("I’m supposed to do four steps in this task, but I can’t remember past Step 2"). This can be very difficult for students with ASD, making it hard for them to complete tasks that require sequential steps.

• Stimulus Overselectivity

  Students with ASD may display stimulus overselectivity, wherein they focus on a small detail but are unable to see the big picture. You may also hear this described as "tunnel vision." Because the person is focusing on one small aspect, he or she is unable to pay attention to other parts of an object or other things taking place in the environment. For example, when looking at a car, a child with ASD would not focus on the car as a whole—including the color, shape, and individual parts—but, rather, would overselect, focusing only on the wheels.

  Let’s look at another example. Look at the picture below and ask yourself, “What’s the picture about?” Then check the answer to see if you’re correct.
  
  
  
  Answer

  A child’s closet.

  Now think about how someone with ASD who displays stimulus overselectivity would answer the question. What would he or she say this picture is about?
  
  
  
  Answer

  A teddy bear or, perhaps, a heart.

   

• Hyper/Hyposensitivity

  Individuals with ASD often appear to sense the world in different ways than others. They may misinterpret everyday sensory information, such as touch, sound, and movement. For example, some individuals with ASD may find certain sounds or colors disturbing, while other individuals may not even hear the sound or notice the color at all. Both of these examples can cause learning challenges for individuals with ASD in the area of attention. Two common terms you may hear are hypersensitive and hyposensitive.

  Individuals who are hypersensitive (oversensitive) receive too much information from their senses, so their brains become overloaded. This means they may see, hear, feel, smell, or taste things in a more extreme manner than other people. Some individuals with ASD have intense sensitivity to sound and may find certain sounds painful. Sometimes individuals will cover their ears or wear noise-cancelling headphones to help them tolerate noises.

  Individuals who are hyposensitive (undersensitive) receive too little information, so the brain struggles to make sense of what little information there is. This means they may see, hear, feel, smell, or taste the world in a more muted way than other people. For example, an individual with ASD’s sense of touch may be lower than normal, and he/she won’t be able to feel light touches or even pain and temperature extremes.

  Here is an interesting video designed to illustrate how hypersensitivity might feel to someone with ASD as he or she enters a store. Many of the sounds you may not have even noticed before become magnified. Please take a look at the Sensory Overload Simulation video.

Development of the Individualized Education Program

If a child has been diagnosed as having ASD, he or she will likely receive specialized services or accommodations in school settings. The document that details a plan for the provision of special services is called the individualized education plan (IEP). An IEP is a legal document that lists what services the child will receive, who is responsible for carrying out the services, how often the services will be received, and how data will be collected. Teachers, parents, specialists, medical personnel, and the individual with ASD can all be part of the team that develops this important document. The IEP is used as a blueprint for the instruction that will occur. Critical to the IEP are the goals and objectives that are developed for the student. These goals and objectives outline the activities and skills the student will be working on. Below, you'll find a primer on the parts of the IEP. You'll also see samples of well-written goals and objectives.

Six Required Parts of the IEP

Creating Goals and Objectives

When writing goals and objectives, you are specifying the details of what you're trying to accomplish. Goals and objectives must be measurable and observable; this is critical for data collection and the ability to report student progress.

Well-written objectives must contain four pieces of information:

• the learner: Who is performing the behavior? Be specific and list the student's name.
• the behavior: This is the specific, operationally defined (i.e., observable, measurable, and repeatable) behavior that the learner will be required to display.
• the condition: Under what settings will the learner be expected to perform the behavior? Be specific as to what cues, materials, settings, and other people will be present.
• the criteria: These define how it will be determined that the student has displayed the behavior. Criteria can include number of times the learner must perform the behavior, the level of independence that must exist during the performance, and the time period across which the performances must occur.