Supporting children with autism

Colin Smith

What is Autism?

• Short Quiz

• A definition of autism:

A definition:

• Autism is thought to be a spectrum of neurodevelopmental conditions, characterised

by difficulties in the development of social relationships and communication skills and the presence of unusually strong narrow interests,

and repetitive behaviour.

History

• Leo Kanner 1943

• Hans Asperger 1944

• Lorna Wing 1981

Aetiology Fashion Cycles

• Affective/Parenting style (Psychoanalysis)

• Mental ill-health/Childhood Schizophrenia/Infantile psychosis (Psychogenic 50’s-70’s)

• Developmental disorder established in 1970’s

2 Diagnostic systems are used:• WHO ICD10World Health Organisation – used in Europe

• DSM-IVAmerican Psychiatric Association – used in USA

Virtually the same criteria are used. One slight difference with one of the ‘labels’. Diagnostic criteria will be rewritten in 2013.

What’s in the criteria they measure my child against?

• Typically it is a list of behaviours showing deficits in three key areas:

• Verbal and non-verbal Communication

• Social awareness and interactions

• Imaginative play (restricted or special interests and behaviours).

Commonly known as The Triad of Impairments

Terminology?? • Pervasive Developmental Disorder• Autism • Childhood Autism or Infantile Autism• Profoundly Autistic• Atypical Autism• High Functioning Autism• Aspergers• Pervasive Developmental Disorder Not Otherwise Specified• Autistic/Autism Spectrum Disorder

• Is it any wonder we like wine?

PDA

• www.pdacontact.org.uk• 0114 2589670

Let’s clear this label nonsense up!

• Your child is still your child

• He or she has had and will continue to have Additional Support Needs and may not receive additional ‘support hours’ in school following diagnosis

• It will help you with some benefits and supports

• Hopefully it will contextualise for you the way your child behaves

What causes ASD’s?

• Myriad of studies completed within genetic, cognitive and neural levels.

• No known cause has been identified.• 1998 Dr Andrew Wakefield & MMR – • (Ashraf, 2001) (GMC 2010)• Currently – ASD is a complex disorder with

core aspects having distinct causes that often co-occur.

In short:

• It wasn’t something you did or didn’t do that caused your child to have an ASD

• Nature has intended it this way• Your child’s genetic cellular make up is

DIFFERENT to the typical population which then impacts on their cognitive processes and subsequent behaviour

• Children and adults with ASD are just as individual as you and I

Prevalence

• 60-110 per 10,000 population

• Boys 4 : Girls 1 for autism 10:1 AS

• In Scotland 60:10,000 children (Public Health Institute of Scotland 2001) with no adult prevalence study!

Accompanying Conditions:

• AD/(H)D Attention Deficit (Hyperactivity) Disorder

• Dyspraxia

• Learning Disability

• Epilepsy

• Tourettes

AD/HDA child can have both autism and ADHD, but both are separate

conditions. The symptoms can be confused and be interlinked but experts are clear that the apparent similarities will

separate out as the child gets older. Symptoms of ADHD include:

• Inattention • Impulsivity • Hyperactivity

28% of children with autism also have ADHD

Dyspraxia

• Dyspraxia: affects the way that the brain processes information, which results in messages not being properly or fully transmitted; it affects people's motor co-ordination, and the ability to organise or to plan.

Unknown prevalence rates, but very common in Aspergers

Learning Disability

Learning disabilities can affect all aspects of someone's life, from studying in school, to learning how to make a meal. People with

autism can have different degrees of learning disability. It is thought 75% of people with

autism have associated learning disabilities.

Epilepsy

Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures due to abnormal or excessive neuronal activity in the brain. It is usually controlled, but not cured, with medication. There is a heightened risk of development at puberty.

It is thought around 25% of children with autism have epilepsy.

Tourettes

• Is characterised by the presence of multiple motor (physical) tics and at least one vocal tic which vary during the lifetime and tend to wax and wane depending on lifestyle and health

28% of children with an ASD are thought to also have Tourettes

Psychological theories

• There are 3 main theories relating to ASD which have been scientifically accepted and well researched

• Theory of Mind• Central Coherence• Executive Dysfunction

Theory of Mind

• The ability to comprehend others thought processes or that they even have a thought process at all. Also known as Mind blindness.

(Baron-Cohen, Leslie & Frith, 1985)

How might a ToM deficit affect a person?

• Predicting others’ behaviour• Understanding others and own emotions• Knowing that behaviour affects self and others• Understanding social interactions• Accounting for what others think and know• Interpreting mental state from facial expression• Interpreting intentions in response to biological motion

Example

Central coherence

• Awareness of context, seeing the bigger picture. A preference for detail rather than global processing.

(Happe’, 1996)

How might a local central coherence affect a person?

• Seeing connections• Preference for the known• Idiosyncratic focus of attention• Lack of generalising skills• Face recognition• Inattentive to new tasks

Example

Which orange circle is bigger?

Executive Dysfunction

• Assumes a form of frontal lobe pathology leading to perseverance or inability in shifting attention which results in observed desire for sameness and routines

(Ozonoff, Rogers, Farnham & Pennington, 1993)

Executive Function allows:

• Goal directed behaviour• Problem solving in a planned way• Flexibility in thought and behaviour• Self monitoring• Impulse control• Interpretation and regulation of emotions

Examples of dysfunction

Make, Plan & Carry Out

Strengths

• Great memory, recall fine detail• Poor ability to lie or deceive• Polite and rule conscious• Refreshingly frank view of the world• Encyclopaedic knowledge of subjects of a

special interest• Attention to detail/perfectionist

Quick tips• Limit choice – free choice can cause anxiety• Make language explicit• Ensure you have the persons attention• Highlight key information• Check you have been understood• Warn about changes in routine• Specific praise• Don’t be subtle• Don’t take offence• Avoid confrontation• Back up changes required in behaviour with visuals

Rory’s Story

Different types of intervention

• Parent Mediated Interventions• Communication Interventions• Social Communication & Interaction Interventions• Behavioural/Psychological Interventions• Biomedical/Nutritional Interventions• Pharmacological Interventions

Scottish Intercollegiate Guidelines Network - 98

Biomedical/Nutritional

• Casein/Gluten free diets

• Vitamin B6 & Magnesium

• Omega 3 & 6 fatty acids

Research findings: www.nas.org.uk/nas/jsp/polopoly.jsp?

d=1385&a=3368

Behaviour

Remember...

• All behaviour is a communication

• What is the child trying to communicate?

• Challenges are often a result of the child's anxiety and not a desire to be naughty

McDonnell (1995) lists 9 common causes of Challenging Behaviour

• Being unable to communicate a need

• Being confused• Being in pain• Medication change• Inactivity • The need for contact

recognition from another person

• Changes in routine• Environmental effects/Sensory differences• Delusional thoughts+• Sexuality• Bereavement

Triad of Impairments

Communication

Imagination Social awareness and interaction

Sensory sensitivity

ABC Charts & STAR charts

• Antecedent

• Behaviour

• Consequence

• Setting

• Triggers

• Action

• Results

Life after school

• Anecdotal evidence of independence with support

• Supported living

• Supported employment

• Further/Higher education

Resources

• Partners in Play (PIP) 01698-230130 Youth clubs/advocacy

• Sleep Scotland www.sleepscotland.org• Sibling support www.actionforchildren.org.uk• Carer Support Workers PRT 01236-755550• Legal advice at Govan Law Centre

www.govanlc.blogspot.com • Autism alert cards

www.glasgow.gov.uk/en/Residents/Care_Support/GettingaService/AutismAlertCard.htm

Resources cont.

• Online support sites and forums – www.wasp.uk.com www.wrongplanet.net

• Visual planners – www.autiplan.com• Social work locality offices• Education advice – www.enquire.org.uk

www.isea.org.uk www.northlanarkshire.gov.uk/index.aspx?articleid=15956

Resources cont.

• North Lanarkshire Supported Employment http://www.northlanarkshire.gov.uk/index.aspx?articleid=5124 01698-274500

• SOLWAY Supported Employment 01698-276206

• REMPLOY http://www.remploy.co.uk/ • Respite: www.kensingtonfoundation.com

www.phewrespite.org