Creating GAS Goals

Orientation and Foundations in Autism Spectrum Disorders K-12 Intensive Training

1AgendaOrientation to the START Project Intensive Training

Foundations in Autism Spectrum DisordersLogisticsTable FoldersImportant InformationSave the DatesSub team lists / email addresses

Sub-Team Email List UpdateSign in each sessionNotify START continuity staff with changes

Graduate Credit/SCECH

3Amy Matthews, Project DirectorJamie Owen- DeSchryver, Project FacultyMaureen Ziegler, Autism Education & Intervention SpecialistKelly Dunlap, Autism Education & Intervention SpecialistJudith Shea, Project ManagerMelissa Adair, Marketing & Logistics CoordinatorMelissa Kurek, Office Coordinator

START Staff4

Latest CDC ReportIf 1 in 88 children have an autism spectrum disorder

The average elementary building will have 3-5 children with ASD

The average middle school building will have 7-9 students

The average high school will have about 14-15 students

7Autism is no longer a low incidence disorder

We need to change how we educate students

9Too Many StudentsAlways in crisis with no time for proactive strategies

No time for collaboration to improve services

10Purpose of STARTSTART serves as a coordinating and supporting entity for regional sites across the state of Michigan to increase access to local resources, training and support for students with autism spectrum disorder.

11Thinking DifferentAutism Spectrum Disorders

Training and Technical Assistance

Statewide CoordinationWhat do we want to impact?Students*ClassroomsBuildings*Districts

In sumsystems that are supporting students to have better outcomes

AllSomeFewUnderstanding a Multi-Tiered Model of Support Intensive Individualized InterventionTIER 3Targeted Intervention TIER 2Universal InterventionTIER 1

14AllSomeFewUnderstanding a Multi-Tiered Model of Support Intensive TIER 3Targeted TIER 2Universal TIER 1

Students with Autism Spectrum Disorders?15AllSomeFewUnderstanding a Multi-Tiered Model of Support Intensive TIER 3Targeted TIER 2Universal TIER 1

Students with Autism Spectrum Disorders can function at any level of the triangle with the right supports

16Dec 7, 2007CommunicationComputersFollowingDirectionsSocial SkillsScienceMathReading ComprehensionLabel behaviornot peopleNOTICE GREEN GOES IS FOR ALL17Systems ChangeBig change only happens when we change whole systems

18We may have to change how we function, how we think, what we learned or how we implementSystems ChangeWe did what we did when we knew what we knew

Once we know different, we are accountable19We may have to change how we function, how we think, what we learned or how we implementSystems ChangeSchool systems need common principles for supporting students with ASD and a systematic structure and approach for doing soPositive behavior interventions and supportsIntegration of students and peer supportTeam approach for planning, development, and implementation Training and coaching to support implementationAssessment and planning for program improvementNetworking and sharing across districts and counties20Key goals/ingredients of project for each of our sites.Getting Critical MassGetting enough people moving in the right direction in order to move the whole system forwardThis is what the START Project is all about !21START Primary Components

Team-based Intensive TrainingMost of the professional development provided by START occurs through team-based intensive training. This is multiple days of training with the same group of people and is offered at 3 levels: Early childhood, K-12, and secondary transition. This approach increases the implementation of effective practices. 23START Intensive TrainingIntensive yearlong training with multidisciplinary school based teams in the areas of teaming and problem solving, effective educational programming for students with Autism Spectrum Disorders, and systems change.24Making Professional Development EffectiveLang & Fox (2003)Traditional professional development (training without follow up to support implementation) yields a 5-10% implementation of strategies success rate

With follow up, that number can rise to 75-90%

25Training FocusNot the START Model, but

Evidence-based Practices organized into the START Training Curriculum

START Training CurriculumMod. 1 Orientation & Foundations in ASDMod. 2 Positive Behavioral Interventions & Supports Mod. 3 Looking at ASD Differently & the Teaming ProcessMod. 4 Educational Strategies and SupportsMod. 5 Peer to Peer SupportMod. 6 IEP Development & Implementation Mod. 7 Transition / Planning for Next YearMod. 8 - Systems Change through Coaching (yr 2)

Supplemental Modules Administrative Support CET/Eligibility Determination Asperger Syndrome27START Intensive Training Goals Acquire content knowledge

Apply content knowledge

Develop teaming and collaborating skills

Develop systems to assure implementation28START Intensive Training ProcessGoal of the training is to learn to apply knowledge and skills

Target students allow for application of learning

Generalize information to other students (Classroom, Building, and District level)29START Coaching GoalCoaching in every building serving students with ASD in Michigan

................................................................................................................................................................................................................................................................................................................................................................

Rationale for CoachingMove away from Crisis Mode

Build Capacity

Improve Implementation with Fidelity31RCN: EPLI Coach Coordinator(s)Districts Level EPLI District Coach LeadersBuilding COACHBuilding COACHCOACHLeaderBuilding CoachBuilding COACHBuilding COACHBuilding COACHISD / District LevelBuilding COACHBuilding COACHCOACHLeaderBuilding CoachBuilding COACHBuilding COACHBuilding COACH32START Primary Components

Regional Collaborative NetworksRCN participants: Groups of school professionals, parent representatives, and relevant community partners serving students with ASD

Purpose: Accessibility and sustainability of training opportunities, coaching to support implementation of evidence-based practices, and resources in ASD in the region34Regional Collaborative NetworksTasks: Meet regularly to develop, implement, and evaluate implementation of evidence-based practices through training opportunities, coaching, and resources accessibility

Funding: Provided funds through START to meet established priorities based on the specific needs of the region.35

36RCN Key ComponentsShared Mission, Philosophy, and Goals consistent with STARTTeaming Structure and ProcessConnections and Collaborations with StakeholdersImplement and Evaluate Effective PracticesTraining Model with Local Technical AssistanceResource AccessibilityConnection to GVSU START Project and MDE, OSE

37RCN GoalsProfessional Development with Impact

Coaching for Implementation of Evidence-based Practices

Secondary Transition

Peer to Peer Support

38Regional Collaborative Networks (RCN)Statewide Autism Resources and Training Project (START)SMARTLake sideOCANSMACWest MACLEANMACWayneRACEWIN4AutismCAN4GCACMACUPANThumbKentCANCRANNANGreat Lakes

Intermediate & Local School District Trainers & Coach LeadersStudent and FamilySchool Building Coaches & TeamsSTART Primary Components

Annual START Conference, Leadership Meetings, Summer Institute

START Website (www.gvsu.edu/autismcenter)

Products and Materials developed by START partners (i.e. RCN)

Annually, we have many opportunities for communicating information statewide such as our state conference. We also meet twice a year with all regional leaders to address critical issues such as coaching and transition. 41START Primary Components

EBP ResourcesNational Autism Center: National Standards Project

43EBP Resourceshttp://autismpdc.fpg.unc.edu/content/ebp-update

44Key ConceptsEvidence-Based Practices (NPDC)IndependenceSelf-managementStructured work systems

SocialPeer-mediated interventionSocial skills training groups

MotivationFunctional behavior assessmentFunctional communication training

BehavioralDiscrete trial training (DTT)Differential reinforcementExtinctionPromptingReinforcementResponse interruption/ redirectionStimulus controlTask analysisTime delay

45Evidence-Based Practices (NPDC)CommunicationSpeech generating devicesPECS

TechnologyComputer-aided instruction

ParentParent-implemented interventions

VisualVisual supportsVideo modelingSocial narratives

Natural environmentPivotal Response Training (PRT)Naturalistic interventions

Additional Resources for EBPNational Autism Center -- National Standards Project:http://www.nationalautismcenter.org/nsp/dissemination.php

National Professional Development Center on ASDhttp://autismpdc.fpg.unc.edu/content/ebp-update

Classroom / Building Tools:USAPT (Universal Supports Assessment & Planning Tool)-- Building Tool: http://www.gvsu.edu/autismcenter/usapt-15.htm

Georgia State Universitys EIC-ASD (Enhancing Instructional Contexts for Students with ASD)Classroom Tool: http://education.gsu.edu/autism/index.htm

MIND Institute ADEPThttp://media.mindinstitute.org/education/ADEPT/Module1Menu.html

Texas Statewide Leadership for Autism Traininghttp://www.txautism.net/manual.html

Association for Science in Autism Treatmenthttp://www.asatonline.org/treatment/treatments_desc.htm

48Key Concepts

49Evidence-Based PracticeNOT just about interventions found to have strong research support (Cook et al., 2009)

Decision making process that informs all professional decisions (Sakett et al., 2000)

Professional wisdom is part of selecting, adapting, monitoring, and implementing EBP (Cook et al., 2008)

Use the best available evidence (Slocum, et al., 2012)

Effective Educational PracticesCore elements of effective, comprehensive educational programs for students with ASD (Iovannone, Dunlap, Huber, & Kincaid, 2003):

Individualized supports and services for students and families

Systematic instruction

Comprehensible/structured learning environments

Specialized curriculum content (communication & social)

Functional approach to problem behavior

Family involvement

52All practices must align withLawIDEA

Literature Evidence Based Practice

Student DataOutcomes53Assessment ToolsProfile of Change (POC) for Intensive TrainingStudent

Universal Supports Assessment and Planning Tool (USAPT) 3 levelsBuildingClassroom Student

54Target Student Profile of Change (POC)Target Student POC for Intensive Training

Current level of performance

Long term goals for target student

Short term tasks, strategies and monitoring

55

56Building Level USAPT AreasBuilding Level Supports

Supports considered critical for the majority of students with ASD

OrganizationSystems Level SupportsStrategies57Building Level USAPT AreasGuiding PrinciplesParent and Family SupportTeam ProcessEducational Strategies and SupportsVisual and Organizational SupportsFunctional Communication SystemAdult SupportsPeer SupportsPositive Behavior Interventions and Supports

58Building Level USAPTInformation about the USAPT and how to register can be found on the START website under USAPTUSAPT Online

You may enter USAPT data twice a year:Fall Spring

New USAPT and online data system coming!Sample Scoring Guide from Building Level USAPT

606162Ultimate Vision of STARTSustainable, systematic support for students with Autism Spectrum Disorder across the state of Michigan.63Intensive Training14-1564Getting STARTed8:30-3:30 Lunch provided with am and pm breaks

Sign in for SCECHs65Logistics: MaterialsSub Team Binder (bring to every module)

Flash Drive

Module Binder / Folder

Coach Kit Resources

66Getting STARTedEach module you will work as a team to learn new content and apply it to your target student and building

Complete Profile of Change (POC) for target student at each training; leads to IEP Development

Action plan completed at each module

Year 2 - expand application of the content to your building and district, complete USAPT

67START Program Evaluation: Year 1Pre-training questionnaire (turn in today)

Target student baseline data (turn in at PBIS module) and end of the year summary data form (complete at end of training)

Target Student POC complete at each module

Individual Student Data Collection (engagement, independence, social interaction, social assessment) - submit at beginning, middle, and end of year

68START Program EvaluationPresenter evaluations (complete at each training)

End of the training survey

69What you need to get startedParent permission form

Target student information

Picture of target student

You will keep all of this information in your sub team binder

70Preparing for Training Days: ActivityDevelop Guiding Principles for this trainingEstablish confidentiality / trustCreate a positive learning environment

EXAMPLES:Turn off cell phones (make calls only during breaks / lunch) Keep laptop closed except during breaks and lunchAttend all trainings from beginning to end (be on time)Give constructive feedback to your sub team members, presenters and START reps71What are you going to get out of this training?Novice

Intermediate

AdvancedWe are getting everyone on the same pageHow can you share this info with othersNew informationMore knowledge to share with parents or to know as much as parentsNew research to build on what you already knowUsing what you knowBig Ideas for the Year

Least Restrictive EnvironmentIndependence / SocializationData-Based Decision-MakingEvidence-Based PracticesUse the ASD to the Students AdvantageFamilies as Active Team MembersPeers as Critical Role ModelsUniversal SupportsTeam Process and Problem SolvingProactiveAccountability73

Integrated in the School and Local CommunityAll students should be integrated into their school and with their peers most of the day because being with peers offers the best opportunity for learning skills that will be needed throughout a lifetime. 74

Peer support has changed the culture of schools for many students.75Goals for Students with ASDSocialization Skills

Independence

Participation in the General Education Curriculum76Section 8Looking at ASD DifferentlySlide SummaryLooking at ASD DifferentlySection 8 Time Estimate: 1 1/2 hours

Content SlideKey ConceptsTwo primary goals for students with ASDSocialization SkillsIndependent FunctioningBoth are critical to the development of goals, programs and services. If the skill is not going to lead the student toward the development of socialization skill development or independent functioning then the skill may not be relevantTraining ActivitiesNoneMaterials NeededNoneFamilies as Team MembersGuiding PrinciplesChildren live in a system called family.Families are dynamic constantly changing and responding to situations.

Focus on family strengths and accept their differences.

Families need resources: financial, emotional, physical. If a family struggles, so will the child.

Families need skills and knowledge.

Families have skills and knowledge.

Families will search for answers and direction.

Family-centered collaboration is necessary and leads to more effective teaming and planning.

77How many of youhave had your car break down, had a close family member who was ill and needed care, lost a jobhow did that impact your family

Families should be acknowledged as key team members. Use the information in the slides to create a discussion about each of the issues. Discuss the importance of families as team members. Describe concept of family systems. Emphasize family as in NEED of resources, training, and support, but also a SOURCE of resources, training, and support.Family input is critical to get complete information about the student and understand the history, strengths and current needs of the student.It is important to understand the resources needed by the family to adequately support the family, which will in turn improve the ability of the family to support the student. But also note that families can be a tremendous source of support for the educational professionals working with the student. Families often have knowledge not only about their child, but also about resources in the local community and even the larger autism community. Families can volunteer for classroom activities, assist with education of others about autism, and much more. Families can teach the educational professionals as much as the educational professionals can teach the families.Benefits to Families as Team MembersEarly connection with parents can set a foundation for a positive working relationship throughout school years (Stoner et al., 2005).

Improvements in the childs socialization, communication, and behavior during caregiver-child interactions (Symon, 2005)

Parents learning of teaching techniques in turn improving the childs language skills (Ingersoll & Dvortcsak, 2010)

Better parental mental health (Tonge, et al., 2006)

Families as Team MembersParent-Professional PartnershipCollaborate to identify educational goals for the child

Co-implement strategies / practices across school, home, and community

Increase knowledge of evidence-based approaches

Others?

Ruble et al., 2013; Stoner et al., 200579

Statewide Autism Resources and Training (START)Foundations in Autism Spectrum Disorders80Changing Rate of ASD19942014DSM IVCDC4-5 in 10,000(1 in 2,000)1 in 6881Brain Development in ASD during PregnancyResearchers at the University of California, San Diego School of Medicine and Autism Center of Excellence and the Allen Institute for Brain Science published a study that gives clear and direct new evidence that autism begins during pregnancy.

The study was published in the March 27, 2014 online edition of the New England Journal of Medicine. By Rich Stoner, Eric Courchesne, & Ed Lein.

They analyzed 25 genes in post-mortem brain tissue of children with and without autism. These included genes that serve as biomarkers for brain cell types in different layers of the cortex, genes implicated in autism and several control genes.Building a babys brain during pregnancy involves creating a cortex that contains six layers, Courchesne said. We discovered focal patches of disrupted development of these cortical layers in the majority of children with autism. Stoner created the first three-dimensional model visualizing brain locations where patches of cortex had failed to develop the normal cell-layering pattern.The most surprising finding was the similar early developmental pathology across nearly all of the autistic brains, especially given the diversity of symptoms in patients with autism, as well as the extremely complex genetics behind the disorder, explained Lein. During early brain development, each cortical layer develops its own specific types of brain cells, each with specific patterns of brain connectivity that perform unique and important roles in processing information. As a brain cell develops into a specific type in a specific layer with specific connections, it acquires a distinct genetic signature or marker that can be observed. The study found that in the brains of children with autism, key genetic markers were absent in brain cells in multiple layers. This defect, Courchesne said, indicates that the crucial early developmental step of creating six distinct layers with specific types of brain cells something that begins in prenatal life had been disrupted.Equally important, said the scientists, these early developmental defects were present in focal patches of cortex, suggesting the defect is not uniform throughout the cortex. The brain regions most affected by focal patches of absent gene markers were the frontal and the temporal cortex, possibly illuminating why different functional systems are impacted across individuals with the disorder.The frontal cortex is associated with higher-order brain function, such as complex communication and comprehension of social cues. The temporal cortex is associated with language. The disruptions of frontal and temporal cortical layers seen in the study may underlie symptoms most often displayed in autistic spectrum disorders. The visual cortex an area of the brain associated with perception that tends to be spared in autism displayed no abnormalities. The fact that we were able to find these patches is remarkable, given that the cortex is roughly the size of the surface of a basketball, and we only examined pieces of tissue the size of a pencil eraser, said Lein. This suggests that these abnormalities are quite pervasive across the surface of the cortex.Data collected for the Allen Brain Atlas, as well as the BrainSpan Atlas of the Developing Human Brain was developed by a consortium of partners and funded by the National Institute of Mental Health. It allowed scientists to identify specific genes in the developing human brain that could be used as biomarkers for the different layer cell types.Researching the origins of autism is challenging because it typically relies upon studying adult brains and attempting to extrapolate backwards. In this case, Lein noted, we were able to study autistic and control cases at a young age, giving us a unique insight into how autism presents in the developing brain. The finding that these defects occur in patches rather than across the entirety of cortex gives hope as well as insight about the nature of autism, added Courchesne.According to the scientists, such patchy defects, as opposed to uniform cortical pathology, may help explain why many toddlers with autism show clinical improvement with early treatment and over time. The findings support the idea that in children with autism the brain can sometimes rewire connections to circumvent early focal defects, raising hope that understanding these patches may eventually open new avenues to explore how that improvement occurs.

82Foundations of ASDAutism identified in 1943 by Leo Kanner

Asperger Syndrome identifed in 1944 by Hans Asperger

83Autisms First ChildThe Atlantic Monthly

In 1943, Donald Triplett of Forest, Mississippi became the first person to be diagnosed with ASD. His parents chose not only to accept him as he was, but created a hometown environment of love and friendship that refused to allow others to misinterpret or misrepresent him or his oddity.VideoThe days agenda thus far has included morning coffee with friends, a long walk for exercise, a Bonanza rerun on TV, and now, at 4:30, this short drive down Route 80 to get in some golf. I noticed, he mentions, you have a Lafayette County sticker on your car. Hes broken a long silence with that comment, a reference to the registration decal on the rental we parked in his driveway. His words hang there for a moment, and then he adds: That means it comes from Lafayette County. Thats all. Nodding to himself, Donald goes silent again, his focus returning to the road ahead, or tuned to some inner monologue. Given his tendency to close his eyes for long moments when he speaks, this is probably the safest choice. Actually, Donald is there every day, weather permitting. And almost every day, he golfs alone. Way to hit that ball, Kenneth! Way to hit that ball, Lori! Way to hit that ball, Elk! At times he would entertain variations, marrying his partners names with words from his own private vocabulary: Hey, Elkins the Elk! Hey, Mary Cherry! Okay, thank you, Kenneth the Senneth! Most of the time, however, Donald remained silent. This is in keeping with the decorum of the game, of course. But Donald appears comfortable with silence, and in a larger sense, content with the life hes leading, which resembleswith the car and the coffee and the golf and the TVa retirement communitys brochure version of how to live out the golden years. Donald has freedom, independence, and good health. All in all, life has turned out well for autisms first child. Donald was institutionalized when he was only 3 years old. Records in the archives at Johns Hopkins quote the family doctor in Mississippi suggesting that the Tripletts had overstimulated the child. Donalds refusal as a toddler to feed himself, combined with other problem behaviors his parents could not handle, prompted the doctors recommendation for a change of environment. At the time, institutionalization was the default option for severe mental illness, which even his mother believed was at the root of Donalds behavior: she described him in one despairing letter as her hopelessly insane child. Being in an institution, however, didnt help. It seems, his Johns Hopkins evaluator later wrote, he had there his worst phase. With parental visits limited to twice a month, his predisposition to avoid contact with people broadened to everything elsetoys, food, music, movementto the point where daily he sat motionless, paying no attention to anything. Their little boy, Oliver wrote, had almost never cried to be with his mother. He appeared to have withdrawn into his shell, to live within himself, to be perfectly oblivious to everything about him. Entirely uninterested in human beingsincluding his parents, for whom he displayed no apparent affectionhe nevertheless had several obsessions, including a mania for spinning blocks and pans and other round objects. He was fascinated with numbers, musical notes, pictures of U.S. presidents, and the letters of the alphabet, which he enjoyed reciting in reverse order. Still, its clear that Donald reached his potential thanks, in large part, to the world he occupiedthe world of Forest, Mississippiand how it decided to respond to the odd child in its midst. Peter Gerhardt speaks of the importance of any communitys acceptance of those who have autism. In Forest, it appears, Donald was showered with acceptance, starting with the mother who defied experts to bring him back home, and continuing on to classmates from his childhood and golfing partners today. Donalds neighbors not only shrug off his oddities, but openly admire his strengthswhile taking a protective stance with any outsider whose intentions toward Donald may not have been sufficiently spelled out. On three occasions, while talking with townspeople who know Donald, we were advised, in strikingly similar language each time: If what youre doing hurts Don, I know where to find you. We took the point: in Forest, Donald is one of us. For a time, Donalds care was literally shifted out into the community. Kanner believed that finding him a living situation in a more rural setting would be conducive to his development. So in 1942, the year he turned 9, Donald went to live with the Lewises, a farming couple who lived about 10 miles from town. His parents saw him frequently in this four-year period, and Kanner himself once traveled to Mississippi to observe the arrangement. He later said he was amazed at the wisdom of the couple who took care of him. The Lewises, who were childless, put Donald to work and made him useful. They managed to give him [suitable] goals, Kanner wrote in a later report. They made him use his preoccupation with measurements by having him dig a well and report on its depth When he kept counting rows of corn over and over, they had him count the rows while plowing them. On my visit, he plowed six long rows; it was remarkable how well he handled the horse and plow and turned the horse around. Kanners final observation on this visit speaks volumes about how Donald was perceived: He attended a country school where his peculiarities were accepted and where he made good scholastic progress. Likewise, during high school, when Donald was again living back home with his parents, it appears his ways were mostly taken in stride.

84What Is Autism? 1. Autism is a spectrum disorder.

2. Autism is a developmental disorder. As with any other child, children with autism will change and mature as he/she grows older.

3. Autism is a neurobiological disorder.

4. Many infants with autism may appear to be different from birth (avoid physical contact, become limp, passive/overly agitated, rock, bang heads on crib, can develop normally then regress). Retrospective diagnosis.85Previous DSM-IV Definition of Autism(MI definition)Restricted & Repetitive BehaviorImpairment in SocializationImpairment in Communication86Autism Spectrum Disorder DSM 5 Definition (2013)Deficits in social communication and social interaction across multiple contexts*12 Combinations of 7 criteria across 2 core features can arrive at a diagnosis

Restricted, repetitive patterns of behavior, interests, or activities87SpecifiersWith or without intellectual impairmentWith or without language impairmentAssociated with known medical or genetic condition or environmental factorAssociated with another neurodevelopmental, mental, or behavioral disorder

Severity LevelDimensional Ratings for DSM 5 ASDSocial CommunicationRestricted, Repetitive Patterns of BehaviorRequires very substantial support

Severe deficits in social communication, severe impairment in functioningInflexibility, extreme difficulty with change, severe impairment in functioningRequires substantial supportMarked deficits in social communication apparent even with supports, limited initiations and responsesInflexibility, difficulty with change apparent to casual observer, interferes with functioning in variety of contextsRequiring supportWithout supports, deficits in social communication are noticeable. Difficulty initiating and successfully responding. Inflexibility causes significant interference in functioning in one or more contexts. Problems with organization and planning. DSM 5 (May 2013)Autism Spectrum DisorderAutistic DisorderCDDRetts DisorderPDD-NOSAspergerDSM IV (1994-2013)PERVASIVE DEVELOPMENTAL DISORDERSWhy the ChangeDiagnosticians are good at distinguishing ASD vs. not ASD but lack of consistency regarding autism vs. PDD-NOS vs. Asperger

No consistent research evidence for separation of Asperger from autism

Diagnostic biases by race and SES

Goals is to be more SENSITIVE (correct inclusion) and more SPECIFIC (correct exclusion)14 states PDD NOS and AS do not quality for services91Social (Pragmatic) Communication Disorder (NEW to DSM 5)Impairment of pragmatics

diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts

which affects the functional development of social relationships and discourse comprehension and

cannot be explained by low abilities in the domains of word structure and grammar or general cognitive abilityRule out Autism Spectrum DisorderMust be present in early childhoodNote: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Aspergers disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Conceptual FrameworkSocial ImpairmentSpeech/Communication DeficitsRepetitive Behaviors & Restricted InterestsAutism Spectrum DisorderIntellectual DisabilityLanguage DisordersOCDSocial AnxietyADHDContinuum of Autism Spectrum Disorders

Cognitive AbilitySocial Interest and AbilityMotor SkillsCommunication Interest and AbilitySensory Experiences95Autism: What do we know? Autism occurs 4 times as often in males than in females

Differences in girls

96Autism: What do we know? Symptoms must be present in the early developmental period [but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life] (DSM-V, 2013)

97Autism: What do we know? Historically 70-75% were thought to have some degree of intellectual impairment; recent estimates closer to 40-50%

Testing of cognitive abilities continues to be a challenge98Neurbiological disorder that impacts:ProcessingAttention and shiftingBasic social behaviorsInteraction with the environment LearningLord, 2010

Processing DifferencesAn individual with autism is like a Mac in a PC-dominated environment. It is hard-wired differently. Not incorrectly just differently.

-- Ellen Notbohm

ASD Changes Over TimeWhat is manifested as autism changes with development and Development is affected by having autism (narrow life) andDevelopment is impacted by interventions

Autism is more than the sum of its parts (i.e. diagnostic criteria)Lord, 2010OutcomeParent participation in any form of early treatment with professional involvement over 3 months was associated with better adaptive and verbal skills at age 5 & 9

Lord, 2010

Socialization Skills and Development

104Autism Spectrum Disorder: Diagnostic CriteriaDeficits in social communication and social interaction

Deficits in social-emotional reciprocity

Deficits in nonverbal communicative behaviors used for social interaction

Deficits in developing, maintaining, and understanding relationshipsSocial-Emotional ReciprocityReciprocityBack and forth sharing

Joint attentionChild does not show, bring, or point to items of interest

Emotions and Emotional Contagion

Perspective Taking/Theory of MindAutism is a Social Learning DisabilityWe are wired to read social information into everythingSocial information is protective since it enables us to distinguish positive and negative situationsWe are experts on faces and emotions most of the time107Emotional Contagion/MirroringCan a person change their behavior or emotions based on what others are doing?

Can they read what someone else is thinking or feeling?Emotional ContagionEver notice that you feel happy around happy people and sad around sad people, or even agitated around anxious people?

Research shows that if you spend enough time with people, their emotions will actually rub off on you.

This is known as "emotional contagion" and is facilitated by an interconnected network of cells in the brain that make up the Mirror Neuron System (MNS).It is present from birth. In a daycare setting, one crying infant will set off a wave of crying in the others. Studies show that infants and children mirror the facial expressions of their parents. This suggests they feel the same emotions or perhaps their nervous system is reacting to the emotions of the parent.

Emotional ContagionYawning is contagious. A tendency to catch other people's yawns may depend on empathy.

Yawning (Senju et al., 2007; Helt et al, 2010)

Video - 2:58-4:34111Emotional Contagion: Mirror Neurons

Video up to 2:00 and 4:34 to end

112Perspective Taking

What is Perspective Taking?The ability to intuit another persons thoughts, feelings, and inner mental states is surely among the most impressive of human mental faculties. Adopting anothers perspective requires the ability to represent the self as distinct from others, the development of a theory of mind to realize that others have mental states in the first placeand the explicit recognition that others mental states and perceptions could differ from ones own

Epley, N., & Caruso, E. M. (2009). Perspective Taking: Misstepping Into Others' Shoes.Handbook of Imagination and Mental Stimulation(pp. 297-311). New York, NY: Psychology Press, Taylor and Francis GroupPerspective Taking and Theory of MindWhat can you do with it?Understand others emotionsPredict and explain other peoples behaviorBe compassionateKeep a secretTell a lieBe sarcastic and understand sarcasmUnderstand inference in communicationTheory of MindDeficits involve difficulty

understanding and appreciating the thoughts and feelings of others

understanding that others have beliefs, desires and intentions that are different from one's own

116

Theory of MindSally Anne TestTheory of MindWhat I see is what others see.What I know is what others know.What I feel is what others feel.What I believe is what others believe.

118ImaginationIf we want to understand another person or group of people, we do not only read about them, or even physically join them to experience their reality for ourselves, but that we also use our imagination.-Moira Von Wright, 2002. Studies in Philosophy and Education

Practicing Theory of MindLearning to predict

Reading emotions

Understanding the difference between what is said and what is thought (comic strip conversations)Social ThinkingSocial thinking is what we do when we interact with people: we think about them. How we think about people affects how we behave, which affects how others respond to us, which affects our own emotions.

Most of us have developed our social thinking skills from birth by observing and acquiring social information and learning how to respond to people. However for some individuals, this process does not come naturally.Garcia-Winner, 2012www.socialthinking.com

Reading Literary Fiction Improves Mind-Reading Skills

Reading literary fiction can temporarily increase someone's capacity for empathy. Repeated exposure to literary fiction, an exercise in mind-reading and mind-construction, may have long-term positive effects. Literary fiction focuses less on the plot, and more on the mental life of the characters, where the reader has to infer what their intentions, emotions, thoughts, and motivations are. David Kidd and Emanuele Castano published in Science (Oct 2013)Social Deficits and DifficultiesSocial reciprocity and perspective taking

Responding to social bids

Social initiation

Social repair

Social isolation

123Difficulty initiating conversation, unless about area of interestCant identify emotions until they are escalated

Social Rules Dont know how to function in a group, in hall, at lunchAttention class????? Area of interestSocial CharacteristicsMay desire interaction, but lack the social skills needed to initiate and reciprocate appropriately

May not desire social interaction

Choice vs. Skill deficit

124People expect cognition and social functioning to be equally developed. When kids with Aspergers Syndrome experience difficulty they wrongly assume it is deliberate misconduct.(A. Klin and F. Volkmar, 1997)

Communication

126Communication Range of Communication challenges in students with ASD

Non-speaking (with or without the ability to speak)

Minimal speaking or echolalia

Highly verbalDifficulty initiating and sustaining a conversationDiffculty with pragamatics

127CommunicationDelay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate

About 40% of children with an ASD do not talk at all.

About 25%30% of children with an ASD have some words at 12 to 18 months of age and then lose them.

Remaining children speak, but sometimes not until later in childhood and/or non-functional speech.http://www.cdc.gov/ncbddd/autism/signs.htmlCommunicationImpairment in Pragmatics:

The ability to initiate, sustain, or engage in reciprocal conversation with others

a. Using language for varying purposes (e.g. greeting, informing, promising, requesting, etc.)

b. Changing language according to the needs of the listener or situation (e.g., giving background information to an unfamiliar listener, speaking differently in a classroom than on a playground)

c. Following rules of conversations and storytelling (e.g., taking turns in conversation, staying on topic, rephrasing when misunderstood, proximity, use of eye contact

Social-CommunicationLimited appropriate use of nonverbal behaviors in social situations (e.g., eye gaze, gestures, body language)

Difficulties recognizing and responding to subtle social nuances, cues, and unspoken messagesIdentifying and responding to peoples tone of voice, facial expressions, posture, etc.

130Nonverbal CommunicationStudents with ASD often have difficulties with the nonverbal communication in the classroom.

These students dontunderstand the look that is given to them from a teacher.

131Communication ConsiderationsIn ASD expressive language and receptive language are not equal

132Language ChallengesI didnt say she stole my money.I didnt say she stole my money.I didnt say she stole my money.I didnt say she stole my money.I didnt say she stole my money.I didnt say she stole my money.I didnt say she stole my money.

133Communication (MARSE Criteria)Stereotyped, repetitive, idiosyncratic language

Idiosyncratic = contextually irrelevant or not understandable to the listener; may have private meaning / be understood by the speaker or to those familiar to the situation (e.g. movie lines)

Can include:Flat or exaggerated prosody, overly formal / pedantic, too loud / soft voice volume or rate of speechEcholalia (processing the utterance as a whole chunk, not as individual words)Facial expression does not augment Communicative intentRepeating video or movie linesNonsense languageVerbal Fascinations

Communication-Stress & AnxietyUnderstanding and communicative expression breaks down under stress-

Even if a student has verbal language, it may be difficult for him to communicate when upset

A student under stress needs more visual and less verbal input

135Use examples of everyone struggling with fast comm when stressedpassenger in car and about to crashStop, stop, stopOr in an argument, often have difficult finding the right words to communicate thoughts and feelingsVisual systems are especially important in stressful situations even if the person has verbal languageChildren with delays in language development are at risk for using challenging behaviors as a way to communicate their needs and wants

Florida State University , 2005136Communication ConsiderationsAugment verbal instruction with visuals (write it down).

Ensure access to an augmentative system at all times (e.g. visual communication system, assistive technology)

Get out your math book.I need help.137Difficulty with abstract concepts and seeing the big picture or getting the gistDifficulty interpreting idiomatic language

Difficulty recognizing important features

Understand the words literally, but not the tone of voice that changes the meaningDriving me up the wall.Killing two birds with one stone.That was a great choice. (stated with sarcasm)Can recite names of all 14 characters in the book read for English class, but cant identify the main character.

138SECTION ONEIntroduction to Autism

Slide SummaryThis Slide:Learning Characteristics: Abstract Concepts CONTENT slide

Key ConceptsHelp participants to understand the difficulties of this group of students who may have excellent rote memory skills, and very high content knowledge in a specific area, but who have difficulty in applying this knowledge in a broader contextTraining ActivitiesCan have participants provide their own examples of how students with ASD had difficulty understanding concepts (either language, social, or academic) due to unique learning styles)

Materials NeededNoneRestricted and Repetitive Patterns of Behavior

139Autism Spectrum Disorder: Diagnostic CriteriaRestricted, repetitive patterns of behavior, interests, or activities (at least 2)Stereotyped or repetitive motor movements, use of objects, or speech Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior Highly restricted, fixated interests that are abnormal in intensity or focus Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environmentCognitive InflexibilityDifficulty with changeInsistence on samenessRule-governedRoutines/ritualsConcrete thinkingDifficulty letting go of thought and ideasOver-focus on details (weak central coherence)Key Concepts:Because of the brain differences, students with AS are often inflexible in their thinking.The bulleted list includes behaviors that we may see as a result of cognitive inflexibility.Considerations:Chapter 9 in the Attwood book (Cognitive Abilities) is a good foundation for presenting this slide. Pages 241-244 is excellent for explaining the concept of central coherence (Having strong central coherence means that a person can easily determine what information is relevant in a situation. The person has an internal priority system. For example, during this presentation, most participants primarily focus their attention on the presenters and the screen versus the pattern of the carpeting or the stitching on the chair in front of them. Students with AS are less able to determine what information is relevant or important and dont seem to have the same internal priority system. This is considered weak central coherence)Trainers should not read the bulleted list, but pick a couple of items and provide examples. Application:We use the example of developing and relying on routines and rituals. These tend to develop because they have worked for the person with AS. The routines and rituals comfort them when they dont understand whats going on. During an evaluation, an elementary student would go up to the door and rub his hand on it before answering a question that I asked him. Then, he would sit back down, I would ask another question, he would go to the door and rub it, and the ritual was repeated until we were done. This was not a ritual that the child had done before; he likely created it because he was anxious or confused about what was going on or worried about what he was missing in his typical school day schedule.I like to share an excerpt from The Curious Incident of the Dog in the Night, in which the character with AS describes going on a country drive with his family and stopping for lunch in a field. He talks about that the typical person would notice the lovely grasses and the cows in the field and maybe one or two other things, but would then move on to thinking about other things. He, however, talks about noticing that there were 7 different colors of cows, that the field tends to shift to the south before tilting toward the west, that there were 5 pieces of string, 2 empty paper cups, and 5 wrappers laying around in the field, x number of tree species, and on and on. In being over-focused on the details, he was unable to see the gestalt, the whole. How exhausting!!

Cognitive StrengthsProcessing whole chunks of information quicklyGood rote memoryGood long-term memoryProcess visual information meaningfullyUnderstand and use context-free information and rulesKey Concepts:While there are cognitive differences in AS that we need to understand and support, there are also general cognitive strengths that we can use to support the student.

Considerations:Again, trainers do not have to read each item. Pick a couple and give an example or two.I give the example of the ability to understand and use context-fee information and rules. I knew a student who was so good at this that you really had to be careful what rules were established. In trying to teach him manners, his mother taught him that we say, Please, when asking something of others and, Thank you, after they do it. This second grader became unglued when his teacher told the class to get out their math books. The student yelled, But, you have to say please! You are being rude, you have to say please!

Application:If you have time, you can ask participants to talk with a partner about how they might use these strengths to support their student. Do a brief report out.FascinationsAnimalsTimeTrain schedulesMonster trucksBirthdatesMiddle namesSuperheroesWater Watching fans

Vacuum cleanersDr. Seuss booksReptilesCivil WarsTrainsThomas the trainMath factsPresidentsWeatherOther CharacteristicsHypersensitivity(too sensitive)Sensitivity to bright light or the flicker of fluorescent lights Being fascinated with light and reflection Intense perception of colors The smell or taste of any food is too strong Intolerance of the texture of certain foods Painful reaction to loud and / or high noises Overreaction to hot/cold Intolerance of the feel of clothes or shoes Extreme touch sensitivity Hyposensitivity(minimally responsive)

Seems not to feel pain or temperature. Prone to inadvertent self-injury Seeks deep pressure (e.g. crawls under heavy carpets) and tight clothes Appears not to hear certain sounds The person might wave his/her hands around or rock back and forth or make strange noises in order to stimulate the senses

Signs of Sensory DifficultiesPuttinghands over ears (sensitivity to noise), vocalizing to override the soundFlicking fingers in front of eyes (visual sensitivity) Having meltdowns at the cafeteria or at an assembly (sensory overload) Not appearing to hear certain sounds or showing panic reactions to certain unexpected sounds (noise)Rocking, pacing, fleeing

146Autism Spectrum Disorders Sensory Characteristics

When I was a child, large noisy gatherings of relatives were overwhelming, and I would just lose control and throw temper tantrums.Temple Grandin

147SECTION ONEIntroduction to Autism

Slide SummaryThis Slide:Sensory CharacteristicsCONTENT slide

Key ConceptsQuotes from books about autism related to sensory characteristics.Training ActivitiesNoneMaterials NeededNoneAutism Spectrum Disorders Signs of AnxietyPacing, motor over-activitySelf-injurious behaviorPerseveration preferred topics or activities, questions askingIncreased self-talkIncreased self-stimulation (e.g. rocking, flapping)

148Autism Spectrum Disorders Signs of AnxietySocial withdrawal/avoidanceDecreased attention spanTemper outbursts

149Autism Spectrum Disorders Signs of AnxietyMany of these behaviors will look like problem behaviors

Autism Spectrum Disorders Sources of AnxietySensory under- or over-stimulationChanges in schedule, routineNew people, events, environmentsUnfamiliar task demandsImmersion in social settingsTeasing and bullying151Approach to Working with StudentsIf you can teach the skill, teach it

If you cant teach the skill, adapt it

If you cant adapt it, figure out some way around it

If you cant figure out some way around it, teach others to deal with it -P. Gerhardt

Ultimate Goals for Students with ASDGeneral or special education classes in the students home school district Development of functional communication system(s)Peer relationships Highest level of independence possible Employment153SECTIONTWOSupports

Slide SummaryThis Slide:Ultimate Goals for Students with ASDCONTENT slide

Key ConceptsCan point out that ultimate goals are not related to typical academic outcomesTraining ActivitiesNoneMaterials NeededNoneIDEA 04Almost 30 years of research and experience had demonstrated that the education of students with disabilities can be made more effective by having high expectations for such children and ensuring their access to the general education curriculum in the regular classroom, to the maximum extent possibleThe Universally Designed Classroom(2005)154Section: 1Introduction

Slide SummaryIntroduction Section: 1 Time Estimate: 15 Minutes

Content SlideKey ConceptsThis slide introduces the participants to the concept of IDEA 04 Revision:The language in the 04 IDEA revision becomes clearer. Not only should students have access to the general education curriculum but that access should occur in the regular education classroomTraining ActivitiesNoneMaterials NeededA copy of the 04 revision of IDEADATA: THE SUPERHERO Here I come to save the Day!

Complete Baseline Target Student FormReview form and complete the first few sections with reference to your target student

Finish as a team outside of training

Bring to the next module

MODULE 1: Foundations in ASD and the Teaming Process

Target Student Profile of Change (POC)

Target Student: _______________________________________________ Date: ________________Parent and Family Support

1. Family members would agree that they are supported as active participants in their childs education. Y or N2. A variety of current and appropriate resources, trainings, and services are available to family members through the school system. Y or N3. Family members are made aware of services available from community agencies and are supported in accessing those services. Y or N4. Family dynamics, needs and values are incorporated and considered in developing IEP goals (e.g. parenting style, family priorities, culture, language).Y or N5. Family-school interactions are positive and non-confrontational; Families are not blamed for issues related to their child having ASD. Y or NCurrent Description:

Goals for the Year:

Strategiesto Achieve Goals:

GUIDING PRINCIPLES

School programs supporting students with Autism Spectrum Disorders (ASD) should have a solid framework of beliefs and practices to support the education of students with ASD. These guiding principles should be based on empirically supported methods and communicated to all staff (National Research Council, 2001).

Quality Indicator4 points3 points2 points1 point0 points

1. Guiding principles have been developed and are integrated into the school culture.Guiding principles are posted in high traffic areas, are regularly reviewed with staff working with students with ASD, and are consistently followed by all staff.

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Guiding principles exist but are not posted and/or are rarely reviewed with staff working with students with ASD.

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Guiding principles have not been developed for this school building.

2. Guiding principles are based on effective practices for students with ASD.Principles promote research-based practices while simultaneously reflecting the unique aspects of the schools community.

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Only some principles reflect research based practices for students with ASD.

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Principles are not informed by research based practices.

3. A system is in place to address violations of the guiding principles. (e.g. who enforces the system & how).Staff members are familiar with and comfortable implementing a system of responding to violations of the guiding principles. The system involves additional training/support and corrective action when necessary.

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A system has been developed to address violations of the guiding principles, but the system is not used consistently.

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A formal system for addressing violations is not in place.