Understanding Autism Spectrum Disorder: A Parent's Guide

Understanding Autism Spectrum Disorder
A handbook designed with parents in mind
Italy???
Italy???
Im often asked to describe the experience of raising a child with a disability to try and help people who have not shared that unique experience to understand it, to imagine how it would feel. Its like this. When youre going to have a baby, its like youre planning a fabulous vacation trip to Italy. You buy a bunch of guidebooks and make your wonderful plans. The Coliseum. Michelangelos David. The Gondolas in Venice. You may learn some handy phrases in Italian. Its all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says Welcome to Holland! Holland?!?!?!?!?! you say. What do you mean Holland?? Im supposed to be in Italy. All my life Ive dreamed of going to Italy. But theres been a change in the flight plan. Theyve landed in Holland, and there youll stay. The important thing is that they havent taken you to a horrible, disgusting, filthy place full of pestilence, famine and disease. Its just a different place. So you must go out and buy a new guidebook. And you must learn a whole new language. And you will meet a whole group of people you never would have met. Its just a different place. Its slower paced than Italy, less flashy than Italy. But after youve been there for a while and you catch your breath, you look around and you begin to notice that Holland has windmills. Holland has tulips. Holland even has Rembrandts. But everyone else you know is busy coming to and from Italy. Theyre bragging about what a wonderful time they had there and for the rest of your life you will say, Yes, that is what I had planned. And the pain of that will never, ever, ever go away because the loss of that dream is a very significant loss. But if you spend your life mourning the fact that you didnt get to Italy, you will never be free to enjoy the very special, the very lovely things about Holland.
Washington State School for the Deaf
Table of Contents
5. 7. 8. 10. The Stages of Normal Grief and the Family What Is Autism Spectrum Disorder? Characteristics of Autism Spectrum Disorder Your Family & Autism Spectrum Disorder Siblings Interacting with the Community Working with Professionals Educational Programming/Treatment Options IDEA and Your Childs IEP Other Related Resources About the MMR Vaccine & Autism Spectrum Disorder Fact Sheets Re: Echolalia, Savants, Social Stories Recommended Books for Parents & Families Helpful Websites for Information About Autism Spectrum Disorder
14. 16. 38. 40.
Autism is not the end of the world just the beginning of a new one Just open your eyes--and see. -Sally Meyers
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The Stages of Normal Grief and the Family

No two children are identical, so having a label like autism spectrum disorder, cerebral palsy, cognitive impairment, or epilepsy does not mean your child will be like every other child with the same condition. No two families are the same, and so what applies to one family may not make sense for the next. Also, as families grow and age, their needs change. For each family, there will be a unique set of attitudes, beliefs, behaviors, and situations underlying their approach to raising a child with a disability. You should be aware that all parents go through the stages of grieving. It is perfectly normal to go through these stages, not just once, but many times. Although you love your child, you will grieve that this is not the child you dreamed of. Shock, Denial, Disbelief These feelings are natures way of protecting you from the reality of the news that your child has a disability. Perhaps you think he or she is going through a passing stage, maybe the doctor made a mistake in the diagnosis, or perhaps the test results were mixed up anything that means your child doesnt have a disability. This tends to be a short-lived stage. Guilt/Regret Most parents wonder if they did something wrong to cause this to happen. The most frequently heard statements start with If only I had. . . All of these thoughts, which you may or may not share with others, question whether you could have changed the situation. Remember that we cannot change the past, but we do have control over much of the future. Anger, Hate, Blame, Terror, Rage, and Jealousy These are explosive emotions that you may feel. Although it is not logical, it is easy to blame others in this stage. These feelings are usually in reaction to the underlying feelings of pain, helplessness, fear, and hurt. All of these feelings are perfectly normal and must be expressed, not repressed. Expressing the feelings by talking them out is the key. Repressed explosive emotions lead to feelings of chronic low self-esteem, depression, guilt, and physical complaints. Having these feelings for an extended period of time may indicate the need to be seen by a trained therapist. 5
Loss, Emptiness, Sadness, Depression When you imagined your life, chances are that you never dreamed about having a child with any problems. Yes, your child is alive, but he or she is not the child you dreamed of. Part of the grieving process is to mourn the loss of that child that you expected to have. Your sadness may be responded to by those around you with It could be worse scenarios. Allow yourself to be sad! You have every right to feel loss, emptiness, and sadness. Generally periods of sadness will be greater at certain times than others. If feelings become overwhelming, it may be classified as clinical depression. Symptoms such as sleep disturbance, appetite disturbance, decreased energy, withdrawal, guilt, dependency, lack of concentration, and a sense of losing control warrant a therapist or doctors attention.
Pain becomes bearable when we are able to trust that it wont last forever, not when we pretend that it doesnt exist. -Alla Bozarth-Campbell
Acceptance As parents of a child with special needs, you may be relieved to know that you will come to terms with the fact that your child has certain limitations. You may even feel, in looking back, that the challenge has made you stronger as a person and has strengthened your family.
It is important to note that you will go through these stages more than once, in any order, and with varying degrees of intensity. Birthdays, holidays, and special events may all trigger the cycle of grieving. Remember that communication is the key. You may not be able to cure your child, but you can make a positive difference in his or her life.
What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a lifelong developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain, ASD impacts the normal development of the brain in the areas of social interaction and communication skills. Children and adults with autism spectrum disorder typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. People with ASD range from extremely capable to significantly impaired, causing it to be known as a spectrum disorder. Autism spectrum disorder is the most common of the Pervasive Developmental Disorders, affecting an estimated 1 in 166 births (Centers for Disease Control and Prevention, 2003). This means that as many as 1.5 million Americans today are believed to have some form of autism spectrum disorder. And that number is on the rise. Based on statistics from the U.S. Department of Education and other governmental agencies, autism spectrum disorder is growing at a rate of 10-17 percent per year. At these rates, the Autism Society of America estimates that the prevalence of ASD could reach 4 million Americans in the next decade. The overall incidence of autism spectrum disorder is consistent around the globe, but is four times more prevalent in boys than girls. Autism knows no racial, ethnic, or social boundaries, and family income, lifestyle, and educational levels do not affect the chance of autism's occurrence. 7
Characteristics of Autism
While understanding of autism spectrum disorder has grown tremendously since it was first described by Dr. Leo Kanner in 1943, most of the public, including many professionals in the medical, educational, and vocational fields, are still unaware of how ASD affects people and how they can effectively work with individuals with ASD. Contrary to popular understanding, many children and adults with ASD may make eye contact, show affection, smile and laugh, and demonstrate a variety of other emotions, although in varying degrees. Like other children, they respond to their environment in both positive and negative ways. Autism is a spectrum disorder. The symptoms and characteristics can present themselves in a wide variety of combinations, from mild to severe. Although ASD is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Whatever the severity, children with ASD can learn and function productively and show gains with appropriate education and treatment.
Every child with ASD is unique, however, there are some common characteristics. No two people with autism spectrum disorder experience the world or behave in the same way, despite sharing these characteristics: Insistence on sameness; resistance to change Difficulty in expressing needs; uses gestures or pointing instead of words Repeating words or phrases in place of normal, responsive language Laughing, crying, showing distress for reasons not apparent to others Prefers to be alone; aloof manner Challenging behaviors such as frequent tantrums, aggression, self-injury or severe withdrawal May not want to cuddle or be cuddled Little or no eye contact Unresponsive to normal teaching methods 8
Uneven skill development or splinter skills; some skills are normal or superior for their age while others show significant delay Poorly developed social skills and unusual play with toys Certain behaviors exhibited to stimulate the senses, such as spinning objects, switching a light on and off, repeatedly opening and closing doors, selftalk/repeating phrases over and over, or humming loudly Inappropriate attachments to objects No real fear of danger Apparent over-sensitivity or under-sensitivity to pain Noticeable physical over-activity or extreme under-activity Uneven gross/fine motor skills Not responsive to verbal cues; acts as if deaf although hearing tests in normal range
Taken from: www.autism-society.org
Your Family & Autism Spectrum Disorder

Tips for parenting your child with autism spectrum disorder
Pay attention to your childs environment and routine:

Keep the environment predictable and familiar, and prepare your child for changes. Provide structure and routine. Pay attention to sensory input from the environment such as noise, temperature, smells, lots of people around, etc.
When you talk to your child:

Be logical, organized, clear, concise and concrete. Avoid jargon, double meanings, sarcasm, nicknames, and teasing. Explain abstract concepts in concrete terms. Dont talk about your child in front of him/her, unless you include them in the conversation.
To help your child improve their behavior:

Help your child learn to communicate using gestures, sign language, picture boards, communication devices, and/or speech. Work on communication early, and be consistent to help your child improve. Better communication will help relieve frustration and may lead to better behavior. Teach your child to make choices. Be consistent in rewarding positive behavior. Replace an unwanted behavior with a favorite activity. In other words, use distraction. Choose rewards you know your child will like.
All children need love and compassion.

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Recommendations for Siblings of Children with ASD

Siblings of children with autism spectrum disorder have their own unique issues that they are forced to deal with and yet are often overlooked. For example, they frequently have more responsibilities for the care of their sibling with ASD than those whose siblings develop normally. Siblings of children with autism spectrum disorder also commonly face social situations in which they must describe to peers why their sibling is different, handle temper tantrums or noncompliance of their sibling, and attend treatment programs and services that they may or may not feel comfortable participating in. They experience a wide range of emotions as a result of having a sibling with ASD such as shame, guilt, frustration, anger, happiness, or being proud. Siblings of children with autism spectrum disorder typically feel neglected at times and uninformed about why their sibling is different.
To help siblings of children with ASD, researchers have made a number of recommendations. First, parents and professionals should provide the siblings with age appropriate information regarding autism spectrum disorder and the specific strengths and difficulties their brother or sister may have. Secondly, the siblings should be provided with opportunities to meet other siblings of children with special needs and to discuss feelings and experiences. Doing so will help to increase a sense of belongingness and reduce the misconception that no one else understands what s/he may be going through. A third recommendation is to encourage and establish good communication within the family. Open discussions should occur frequently. Parents should also ensure that they spend special, one-on-one time with each sibling to learn more about each childs experiences and to create a secure bond with each child. Finally, it may be helpful for parents and professionals to involve the siblings in the future plans of the child with ASD. Involvement in the current treatments, goals, and future plans may help to reduce siblings uncertainty and worry and to create a sense of importance within the family. 11
Parents should also consider the siblings needs when choosing treatment programs and services for their child with autism spectrum disorder. Parents should ask the following questions when exploring options: 1) Are siblings included in the services definition of family, 2) Does the service reach out to the siblings specifically and how, 3) Does the service educate the staff about sibling issues, and 4) Does the service offer programs specifically designed for the siblings? Programs for siblings of children with ASD should be motivating and ensure that they are active participants in the activities. The programs should also focus on team-building and provide times for open discussions. Descriptions of autism spectrum disorder and the implications on the family should be readily available as well. The programs should offer diverse experiences and topics for the siblings.
WEBSITE RESOURCES:
www.seattlechildrens.org www.kidstogether.org www.angelfire.com/bc/autism/index.html
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Interacting With the Community
As a parent of a child with autism spectrum disorder you will find that you may have to deal with some negativity regarding your childs behavior. This can come from total strangers or even from friends and extended family members. People may try and give you advice or question your parenting skills. It is helpful to be prepared for these situations and think about how you may respond. Unfortunately, there are no easy answers. There are some strategies that parents can use when people are being negative. One of the most powerful ways to deal with negativity is to educate. Tell people the truth. Make sure people at church, work, etc. know your son or daughter has ASD. Autism spectrum disorder has received a lot of media attention in the past few years so most people are at least aware of what is involved. If a stranger gives you a dirty look or scolds you for your childs behavior when he/she has an outburst in a public place, have a statement ready. Something like My son has autism spectrum disorder. He has trouble with communication and social situations because he doesnt always understand what is expected of him or cant tell us what he needs. should be sufficient. You may find that the more educated people are about your childs needs, the more helpful they may be. If you cant change peoples minds, often just avoiding them is perfectly healthy and, in some cases, easy to do. Of course, there are some cases such as relatives where this is harder. Try to seek out a support network that really supports the relationship with your child. Dont let anyone alienate you from your child. Finally, recognize the positive aspects of your child and share them with others. There may be a long list of things your child cant do, but try and make a list of the things he/she can do.
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Working with Professionals

In addition to your childs teachers, the following professionals may be included in your childs treatment/educational program.
Developmental pediatrician - Treats health problems of children with developmental delays or handicaps. Child psychiatrist - A medical doctor who may be involved in the initial diagnosis; can prescribe medication and provide help in behavior, emotional adjustment and social relationships School psychologist - Specializes in understanding the nature and impact of developmental disabilities including autism spectrum disorders. May perform psychological and assessment tests and may help with behavior modification and social skills training. Occupational therapist - Focuses on practical, self-help skills that will aid in daily living such as dressing, eating; may work on sensory integration, coordination of movement, and fine motor skills. Physical therapist - Helps to improve the use of bones, muscles, joints, and nerves to develop muscle strength, coordination and motor skills. Speech/Language therapist - Involved in the improvement of communication skills including speech and language. Social Worker - May provide counseling services or act as case manager helping to arrange services.
It is important that parents and professionals work together for the child's benefit. While professionals will use their experience and training to make recommendations about your child's treatment options, you have unique knowledge about his/her needs and abilities.
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Once a treatment program is in place, communication between parents and professionals is essential to monitor the child's progress. Here are some guidelines for working with professionals:
Be informed. Learn as much as you can about your child's disability so you can be an active participant in determining care. If you don't understand terms used by professionals, ask for clarification. Be prepared. Be prepared for meetings with doctors, therapists, and school personnel. Write down your questions and concerns, and then note the answers. Be organized. Many parents find it useful to keep a notebook detailing their child's diagnosis and treatment as well as meetings with professionals. Communicate. It's important to ensure open communication - both good and bad. If you don't agree with a professional's recommendation, for example, say specifically why you don't.
Taken from www.autism-society.org
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Educational Programming
Educating children with autism spectrum disorder is a challenge for both parents and teachers. These children are individuals first and foremost with unique strengths and weaknesses. Some may be of average to above average intelligence, while others may be below average. Academic goals need to be tailored to that individual's intellectual ability and functioning level. Educational programming for students with autism spectrum disorder often addresses a wide range of skill development including academics, communication and language skills, social skills, self-help skills, behavioral issues, and play/leisure skills. Parents and professionals need to work together. Teachers should have some understanding of the child's behavior and communications skills at home, and parents should let teachers know about their expectations as well as what techniques work at home. Open communication between school staff and parents can lead to better evaluation of a student's progress. Just as school goals such as calculating the money needed to purchase groceries can be reinforced at home, parent goals for outside of school, such as the development of leisure activities, can be re-enforced at school. Cooperation between parents and professionals can lead to increased success for the individual with ASD.
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Treatment Options
While there is no cure for autism spectrum disorder, there are treatment and educational approaches that may reduce some of the challenges associated with the disability. Intervention may help to lessen disruptive behaviors, and education can teach self-help skills that allow for greater independence. But just as there is no one symptom or behavior that identifies autistic children, there is no single treatment. Most professionals agree that individuals with autism respond well to highlystructured, specialized education programs, designed to meet the individual's needs. Based on the major characteristics associated with autism spectrum disorder, there are areas that are important to look at when creating a plan: social skill development, communication, behavior, increased independence, and sensory integration. Programs sometimes include several treatment components coordinated to assist a person with autism. For example, one individual's program may consist of speech therapy, social skill development and the use of medication, all within a structured behavior program. Another child's may include social skill development, sensory integration and dietary changes.
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When looking at treatment approaches, it is important to remember that many treatments are made up of an eclectic mix of ingredients. It is helpful to note the common features in many effective interventions, across many different disciplines. These include: Using environmental accommodations which slow down interactions, setting a consistent pattern paced to the persons unique rhythms Eliminating unnecessary stimuli and distractions which may overwhelm and confuse Following the childs lead by building on his/her own enthusiasms and interests Utilizing typical home and community settings, and the friendship and support of typically developing peers
Please keep in mind that the descriptions of treatment approaches provided here are for informational purposes only. They are meant to give you an overview of an approach. The following pages give an overview of some of the treatment approaches available such as: Floor Time Discrete Trial (DT) TEACCH PECS
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Educational/Treatment Options
Floor Time
What is Floor Time? Floor Time is a technique from the DIR model (Developmental, Individualdifference, Relationship-based) designed to help a child elaborate and expand on interactions with others through gestures, words, and pretend play. It is a way of relating to the child. Floor Time was designed to strengthen individuals cognitive, emotional, social, and physical development. Emphasis is placed on facilitating two-way communication, expressing feelings, and developing logical thought. Dr. Stanley Greenspan, a Clinical Professor of Psychiatry, Behavioral Science and Pediatrics at George Washington University Medical School, established Floor Time as an interactive play strategy to teach children with developmental difficulties. The technique is based on the assumption that the childs actions are purposeful and it is the caregivers role to follow the childs lead during interactions to foster communication and development. DIR DIR is a theoretical approach of addressing a childs developmental challenges. It takes a developmental perspective and focuses on individual differences. In the DIR model, the childs difficulties are examined through relationship and affect issues. For example, the childs abilities to stay engaged in play, express pleasure, and problem solve with others would be examined. Floor Time is the cornerstone of the DIR model. Goals of Floor Time Objectives of Floor Time include helping the child to: become more alert take more initiative become more flexible tolerate frustration sequence and plan longer actions mediate the process of finding solutions communicate gesturally and verbally take pleasure in learning
Characteristics It is suggested that individuals working with children through Floor Time use a calm voice, speaking slowly with gentle looks. They should also be non-intrusive and supportive in listening. Additional characteristics of this program include: no specific direct skill teaching incorporate activities into daily life child-centered follow childs lead in play and interactions can incorporate toys and materials into activities to facilitate interactions uses symbolic play and items For More Information Please visit the following website: http://www.coping.org
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Discrete Trial (DT)

What is a Discrete Trial? A discrete trial is a form of applied behavioral analysis which represents an isolated opportunity for a student to make a single behavioral response to instruction. The purpose of discrete trial is to utilize a behavioral sequence to maximize learning. ABA
4. Between-Trial Interval (the time between the consequence and the next instruction). Characteristics
Applied Behavioral Analysis (ABA) is a systematic approach that involves reinforcing desired behaviors and discouraging undesired behaviors by ignoring or redirecting them. ABA breaks down a task into its specific skills and teaches each part in a highly structured manner. An ABA behavioral program is a comprehensive intervention, carried out in every setting. Discrete Trial teaching is a component of ABA and takes a set of skills and teaches them separately using a consistent manner with no other environmental distractions. The skills that are taught in discrete trial drills must be practiced and generalized in natural settings. Components Antecedent (the instruction). Make the instruction clear and concise. Say the entire instruction without interruption and do not repeat. 2. Behavioral Responses (the students action in response to the instruction). Determine what the expected specific response is before you give the instruction. Responses are measured as correct, incorrect, and no response. 3. Consequence (what occurs following the childs response). The consequence will depend upon the individuals response. Follow correct responses with a reward and incorrect responses with an instructional No. 1.
Most experts agree for a successful program, a minimum of 20 to 40 hours a week across environments is needed. It is important for every member of a team to be consistent in techniques The time between trials should be 3 to 5 seconds Each trial should have a clear beginning and end Reinforcing consequences must occur immediately after the response Always identify the exact response requested Avoid unintentional help during all trials
Tips on Using Prompts

All prompts must be faded over time before the response is considered mastered Simplify the instruction by removing all unnecessary information Always use the least intrusive prompt Exaggerate the relevant component of the instruction
The Lovaas Method In the 1980s, Ivar Lovaas demonstrated a successful use of discrete trial training with individuals with autism within a specific early intensive behavioral program. This program is often referred to as the Lovaas Method. Although that it is based on principles of ABA, it is not the same as applied behavioral analysis. To learn more about the Lovaas Method, visit the following websites http://www.lovaas.com; http://www.autismweb.com http://www.ctfeat.org
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TEACCH
What is TEACCH? The Treatment and Education of Autistic and related Communication handicapped CHildren (TEACCH) is a division of the Department of Psychiatry of the School of Medicine at the University of North Carolina at Chapel Hill. Eric Schopler, Co-Director and Founder of TEACCH and Robert Reichler developed TEACCH from an earlier project. Gary B. Mesibov is the current Director of Division TEACCH. TEACCH is dedicated to improving the understanding and services available for all children and adults with autism spectrum disorder and related communication disorders. Who is TEACCH for?
Characteristics of Structured Teaching
The TEACCH program was developed primarily for students with various disorders. These include infantile autism, childhood psychosis, childhood schizophrenia, developmental disabilities, severe emotional disturbances, aphasia with behavior disturbances, and pervasive developmental disorders. Services
TEACCH provides diagnostic evaluations, individualized curriculum, social skills training, vocational training, and parent counseling and training. The structured classroom teaching approach is one frequently replicated component of TEACCH. This structured teaching approach involves setting up the classroom so that students know where to be, what to do, and how to do it all as independently as possible.
Emphasis is placed on developing individual plans to help people with autism and their families to live together more effectively by reducing or replacing autism-related behaviors that interfere with independence and quality of life The physical layout of the classroom is arranged in a way that avoids distractions Materials are clearly marked and arranged Individual needs of students are considered when planning the physical structure in the classroom as well as the instructional lessons Schedules are a must! Individuals with autism typically have difficulties with sequential memory and organization of time. Class and individual schedules help to overcome such difficulties. Prompts and reinforcements are used in an organized, systematic matter to build success Directions are given both verbally and with alternative forms such as written, PECS, or gestures. The focus of teaching is on strengths while remediating difficulties Takes a broad-based ecological approach by examining diverse areas and components of the individuals life Most effective when applied across age groups and agencies Individuals with autism are prepared to live and work more effectively at home, at school, and in the community
For More Information Please visit one of the following websites: http://www.autism-resources.com http://www.teacch.com
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PECS
What is PECS? PECS stands for the Picture Exchange Communication System. It is a unique augmentative alternative communication system to permit children with autism spectrum disorder and other communication deficits to initiate communication with others. PECS was developed in 1989 by Andrew Bondy and Lori Frost. It was first used at the Delaware Autistic Program in the United States. The primary purpose of PECS is to focus on the initiation component of communication to enhance individuals independence and use of successful, initiated communication. Who is PECS for? PECS has been successful with individuals who have a wide array of communicative, cognitive, and/or physical difficulties. The individual can use PECS with educators, resident care providers, families, friends, and others with ease. Characteristics

and templates for data and progress reporting (Pyramid Educational Consultants) Examples Picture Boards, Cue Cards, Photos, and other materials to help an individual to do such things as: request a preferred food indicate a desired recreational activity visualize the steps for a daily schedule or task Steps to Use 1. Teach student to exchange a picture of a desired item with a teacher who immediately honors the request. 2. Teach symbol discrimination. 3. Teach sentence building. 4. Teach student to comment and answer direct questions using symbols. *Note: The initial design of PECS does not involve verbal prompts. Initially, verbal prompts are not used in an attempt to build immediate initiation and to avoid prompt dependency. However, in some cases, the use of PECS has been modified for individual needs. For More Information Please visit the following website: http://www.pecs.com
Does not require complex or expensive materials Used in a variety of settings Especially useful when appropriately combined with elements of behavior analysis A 6-phase training manual is available which provides examples, helpful hints,
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Complementary Approaches
While early educational intervention is key to improving the lives of individuals with autism spectrum disorder, some parents and professionals believe that other treatment approaches may play an important role in improving communication skills and reducing behavioral symptoms associated with autism. Examples of complementary approaches include: Music Therapy Auditory Integration Therapy Sensory Integration Peer Mediation Incidental Teaching Visual Strategies Social Stories Inclusion Diets (Further information on these complementary approaches follow this page.)
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Auditory Integration Therapy/Training (AIT)

AIT was developed in 1960 by Guy Bernard in France and it was introduced to the United States in 1991 by Annabel Stehl. AIT is sound therapy designed to improve the bodys reaction to excessive sensory input within the brain by exercising, strengthening, or enhancing the middle ears acoustic reflex muscle. The idea behind AIT is to cause flexion and extensions of the middle ear muscles with repeated sound. The successive sounds ideally would improve the bodys ability to interpret sound and thus decrease pain for individuals whose perception of sound was painful or blocked. Individuals with autism spectrum disorder who are oversensitive to sound or who tune out sound may benefit from auditory integration therapy. AIT consists of an initial consultation followed by the completion of an audiogram. The person then attends 20 one-half hour sessions of sound therapy and completes the process with a follow-up appointment with the trainer. Supporters of AIT propose that auditory integration therapy offers the following possible treatment benefits: reduction of echolalia, enhanced attention span, increase in appropriate social behavior, decreased hypersensitivity to sounds, and reduction in self-stimulation, aggression, and self abuse. However, some organizations such as the American Academy of Pediatrics advocate for the use of caution when considering AIT as a treatment of autism due to the lack of clinical data to support its use. AIT devices do not have FDA approval for treating autism spectrum disorder. Thus, potential consumers must individually examine the possible benefits and risks of this treatment before implementing it. RESOURCES: WEBSITES: www.oakdaleservices.com www.thedaviscenter.com www.aap.org www.autism.org ARTICLES: American Academy of Pediatrics, Committee on Children with Disabilities (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102 (2), 431-433. Tharpe, A. (1999). Auditory integration training: The magical mystery cure. Language, Speech, and Hearing Services in Schools, 30 (4), 378-382.
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Music Therapy
What is Music Therapy? Music Therapy uses music to tap into an individual's interests to try to enhance his/her quality of life. Activities include singing, moving to music, playing any type of instrument, listening to various types of music, and others. Music therapy is individualized and tailored to meet the unique needs of the individual. It can be used with anyone, including individuals with autism spectrum disorder, physical handicaps, developmental delays, or mental illnesses regardless of age. Thus, due to the diverse needs and abilities of participants, programs vary greatly. Music Therapy began during World War I in the United States Veterans Administration Hospitals as an intervention to help veterans relieve pain. Soon after, music therapy spread throughout the nation and world. Today, the American Music Association conducts research about various music therapy techniques and provides training for music therapists. Goals of Music Therapy The ultimate goal of music therapy is to develop skills that will help the individual to develop and grow personally. Targeted areas may include: Enhancing social skills (i.e., turn-taking, routines) Increasing motivation for academic tasks Strengthening motor skills Improving attention span and listening skills Decreasing inappropriate behaviors Managing or reducing stress Enhancing communication skills Music Therapy can help to create a relationship between the student and therapist. It can also teach social skills that can be generalized to nonmusical settings. Participants may also benefit by strengthening the use of their lips, tongue, jaws, and teeth with instruments. Music therapy can facilitate communication by encouraging speech and vocalization. The rhythmic characteristics of the music can replace stereotypical behaviors. Movement to the music can help to improve coordination and body awareness as well. Music Therapy and Education Under IDEA, Music Therapy is considered a related service for students with special needs. The students' goals for Music Therapy must be documented in his/her Individualized Education Plan (IEP). Music therapy uses techniques and activities to facilitate the student's involvement in his/her least restrictive environment. When using music therapy as part of an IEP, consider the following suggestions: Incorporate music programs and activities with all students in a regular classroom setting Use predictable pauses in the music as a "teaching moment" to take advantage of the student's heightened attention Use lyrics that a student can model Use visually interesting instruments Do not use consistent background music throughout all lessons because students will learn to tune the music out; thus, use music with discretion Add movements such as clapping and tapping to the music. Exaggerate them and other behaviors to encourage imitation Sing slowly and repeat what is said Use different types of music Use language that is cognitively and developmentally appropriate for the student For further information, please visit one of the following websites: www.mtabc.com www.namt.com
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Sensory Integration Therapy

What is Sensory Integration Therapy? Sensory Integration techniques are designed to reduce overall arousal while generating attention and awareness. The techniques include such things as pressuretouch, muscle squeeze, and brushing body parts with a soft scrub brush. It is based on the theory that individuals have a dysfunctional sensory system in that one or more senses are either under-reactive or over-reactive to stimulation. This dysfunction is neurological whereby stimulation is not correctly interpreted by the brain causing problems in development, information processing, and behavior. Advocates of sensory integration therapy believe that sensory problems are contributing factors for self-stimulating behaviors often exhibited by individuals with autism such as rocking, spinning, and hand-flapping. Goals of Treatment 1. To offer the person sensory information which helps the central nervous system become organized 2. To help the person stop, manage, or change incoming stimulation 3. To help the person learn to respond to sensory stimuli in more efficient and organized ways Components of the Sensory System Senses. Includes sight, smell, tactile (touch), auditory (hearing), vestibular (sense of where we are in space), and proprioception (sensations from muscles, joints, and tendons). Receptors. Nerve endings in skin that receive sensory information. There are 3 types for touch: one responds to light touch, the second to discriminate touch, and the third receives information about heat, cold, pain, etc. Tactile System. Includes the nerves under the skins surface that send information to the brain regarding light touch, pain, temperature, and pressure. A dysfunction in the tactile system can result in being tactile defensive or extremely sensitive to light touch. Vestibular System. Includes structures in the inner ear that detect movement and changes in head position. A dysfunction in the vestibular system can result in overstimulation in which the person seems to be very clumsy. The person may have trouble learning to crawl, walk, or climb. A dysfunction can also result in understimulation in which the person desires intense sensory behaviors such as body whirling, jumping, or spinning. Proprioceptive System. Includes muscles, joints, and tendons that provide information regarding body position and the ability to plan motor movements. A dysfunction in the proprioceptive system can result in clumsiness, an unusual body posture, minimal crawling as a young child, difficulty performing tasks requiring sequential movements, and others.
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Sensory Integration Therapy, continued

Effects of Sensory System Dysfunctions A dysfunction in the sensory system can appear in many ways. The following are a few common results: Expressing frustration, aggression, or withdrawal as a result of difficulty adjusting to new situations Constantly moving or easily fatigued Impulsivity and/or easily distracted Tips to Help Students Who Are Oversensitive to Various Stimuli Input
Provide graph paper to help organize math problems and lined paper for writing assignments Reduce visual and auditory distractions Approach the child from the front to provide the child with a clue that a possible verbal interaction and/or light touch may be upcoming Position the students desk so that the child has a good view of where everyone is and where they are going Avoid crowded places and situations
Tips to Help Students Who Are Sensory Seekers Never discipline a sensory seeker by removing recess privileges or gym class because you may intensify the random movements, fidgeting, and outbursts Provide opportunities for extra movement (i.e., erasing the chalkboard, passing out papers, etc) Suggest 5 minutes of swinging or climbing during recess before returning back to class Use a rocking chair or bean bag for periodic rewards _______________________________ *Adapted from the Sensory Integration Resource Center: www.sinetwork.org August 2001 For more information please visit one of the following websites: http://www.autism-resources.com http://www.autism.org http://www.sinetwork.org
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Incidental Teaching
What is Incidental Teaching? Incidental teaching is providing structured learning opportunities in the natural environment by using the child's interests and natural motivation. Incidental teaching was developed to increase language and social responding by maximizing the power of reinforcement and encouraging generalization (Hart & Risley, 1968, 1974). As with more traditional teacher-directed instruction, incidental teaching is planned to be used to implement an instructional curriculum and related goals for a student with autism or related needs. However, unique to incidental teaching is the focus on childdirected teaching, in other words, following the child's lead regarding interests with in naturally occurring daily activities. This is particularly useful with children with autism spectrum disorder who often initially tend to exhibit difficulty maintaining interest in teacher or parent lead activities. Most parents and teachers are very accustomed to teaching children many different skills throughout the day in the natural environment. For example, parents may point to pictures in a book and ask the child to label the pictures. Teachers ask children to make requests and choices in the classroom. These are all teaching opportunities. Incidental teaching involves being planful in using "teachable moments" that are initiated by the child. Almost any situation throughout the day can be made into a "teachable moment." Daily routines that can be used for teaching include: meals, dressing, playtime, car trips, watching television or listening to music, and functional or academic tasks. How is it done? Since incidental teaching is planned, key instructional goals should be identified. These will assist the teacher or caregiver in determining key activities and teachable moments on which to focus. Once these types of opportunities have been determined, there are four levels of prompts that a teacher or caregiver can utilize: Level l: This prompt involves instituting a 30 second delay when a child displays an interest in a specific object or material. This delay is designed to encourage a verbal initiation for the object or material. Level 2: After 30 seconds, if the child has not verbally requested the item, then you prompt the appropriate verbalization (i.e., "What do you want?") Level 3: If the child does not respond to level 2 prompt, then provide a more specific prompt while showing the desired object (i.e.," What is this?"). Level 4: At this level, the most intense, the child is prompted to imitate the correct response as modeled by the caregiver (i.e., "car"). It is important to use the least intense level of prompt possible to encourage the response. In addition, once the child responds appropriately, it is important to confirm the child's response by reacting to the request, giving praise, expanding a phrase (this is the natural consequence or reinforcer). Also, data should be collected as appropriate to assess present levels and ongoing progress and necessary adjustments. Once initial levels of responses are achieved, the promoting hierarchy can be used to gain more elaborate responses (i.e., "red car"). Tips for Using Give yourself and the child time. It is hard to attend to child initiations if you are always in a rush. The best time to use incidental teaching to develop language and social skills is when the child wants something such as food, an activity, a toy, attention or help. In this case, it is important to give the desired item/interaction as soon as a communicative attempt is made by the child.
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'
Peer Mediation
What is the Peer Mediation? In peer mediated social interaction interventions, normally developing children are selected and trained to improve social interaction of children with autism spectrum disorder. The peers can work one-on-one with a student with autism spectrum disorder or within small groups. The social activities and interactions occur in natural settings such as a during a group project in a classroom. Peer mediation was initially used with withdrawn preschool children. It has more recently been successfully used with students with autism spectrum disorder and other disabilities. Peer mediated interactions are important because simply having access to socially active peers or social environments does not guarantee that interactions will occur between the student with ASD and his or her peers. Inclusion alone is often unsuccessful for three main reasons. First, disruptive behavior does not decrease until the student with ASD learns to initiate social interactions on his or her own. Secondly, many children with autism are unable to attend to relevant social cues and need direct instruction and prompts to do so.
Peers can be better at fulfilling this need as they are more natural role models and may be better accepted than adults. Finally, children with ASD rarely initiate social interactions and have a tendency to end or greatly reduce interactions due to a lack of responsiveness and other behaviors such as inappropriate play, noncompliance, use of little language, and stereotypical habits. Peer mediated interventions serve to more purposefully and systematically promote successful social interactions between children with ASD and their non-disabled peers. Pros and Cons Advantages of peer mediation include: Use of natural social interaction environments Use of typical social interaction behaviors of socially competent peers to ensure appropriate modeling and teaching Ease and time efficiency Increased levels of initiations and responses from the student with autism and his or her peers that have lasting effects Disadvantages of peer mediation are: Prompts are sometimes necessary Not enough evidence of generalization and maintenance of interactions 29
Peer Mediation, continued

Typical Steps of Interaction 1. Peer establishes eye contact (e.g., say students name, touch shoulder, etc.) 2. Peer establishes a joint focus of attention (e.g. look at same toy) 3. Peer describes his or her own play and that of others 4. Peer prompts requests (e.g., Do you want the car? Say yes.) 5. Peer acknowledges all forms of communication 6. Student responds to speech of others by imitating 7. Peer expands and restates comments 8. Peer and student request clarification as needed 9. Peer redirects play activity as needed Tips on Using

Encourage brief interaction initially and gradually expand Initially focus on activity rather than on interaction to allow children to become familiar with one another Emphasize similarities among all students Teach peers how to obtain answers (e.g., using communication choice boards) Teach socially competent peers to interact with student with autism and incorporate untrained peers into the activity Use dyads or triads Emphasize turn-taking behaviors
*Adapted from Simpson et. al (1997). Social Skills for Students with Autism-2nd Edition For More Information Please visit one of the following websites: http://www.circleofinclusion.org http://www.peer.ca
Teach peers to acknowledge and discuss the behaviors of student with autism to help increase awareness and understanding
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Visual Strategies
What are Visual Strategies? Visual strategies are ways to improve the communication process by using supports that can be seen. Four common types of visual supports are: 1. Natural Environmental Cues Examples include: signs, logos, menus, and the location of people 2. Body Language Examples include: eye contact, facial expressions, touching, and body stance 3. Traditional Tools to Provide Information and Organization Examples include: calendars, planners, maps, telephone books, and to-do-lists 4. Specifically Designed Tools to Meet Specific Needs An Example is a visual schedule of the morning routine at school Who are Visual Strategies for? Benefits of Visual Strategies Visual Strategies have been successful with individuals who have a wide array of communication skills and abilities. Verbal and non-verbal individuals of various disabilities can use visual strategies to varying degrees. Individuals can use visual strategies with educators, resident care providers, families, friends, and others in the community with ease.

Representation Systems A representation system is the way in which objects and activities are depicted in a visual form. They are the symbols that are used to convey information. Examples of a representation include written words, line drawings, photographs, and signs. Components of Good Visual Tools

Purposefulcreated to help remediate a clearly defined, specific need Plannedcreated with who, what, where, when, and how, decided prior to using Contain a combination of representations Words + Pictures = best strategy Simple, but clear Individualized Creative Highly motivating to use
Facilitates intentional communication Increases the individuals attention Easy to use and requires little training Inexpensive Individualized Can foster word recognition Highly motivating to use Can quickly learn sequences to complete a task or routine Increases independenceuses visual supports rather than being dependent on caregiver Can complete complex tasks by referring to the visually depicted steps of the tasks
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Visual Strategies, continued

Purposes of Visual Strategies There are four broad goals of using a visual strategy: 1. To Provide Information To Create & Use a Visual Schedule

2. To Give Directions Such as using gestures, physical prompting, visual tools, or pointing to convey instructions 3. To Organize the Environment Such as labeling objects and places things belong or creating lists of things to remember 4. To Use Visual Bridges that
encourage a connection between environments
Such as using a calendar or schedule
Divide the time (i.e., day) into sections Give each section a name Pick a representation system Select the format Make a plan to implement Set goals for use Fade out or change the representation system as need Generalize the skills learned to other settings
For example, a student may have an on-going log to share between home and school. In the log, the student could circle the pictured events that were done that day or complete the following sentence with a word or picture Today, I _________ at school.
*Adapted from: Hodgdon, L. (1995). Visual Strategies for Improving Communication. Volume 1: Practical Supports for School and Home. Troy, MI: Quirk Roberts Publishing. For More Information Please visit the following website: www.usevisualstrategies.com
Typical Visual Strategies Include

What activities will happen What activities will not happen Sequence of events to complete a task or routine Changes in a routine When to stop an activity and start another
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Visual Strategies Suggestions for Visual Organization

Use color-coding for: Organizing material by area Organizing materials for each child (e.g., Jasons chair always has a red tape stripe, his cubby is marked with red tape, and/or he sits on the red tape) Designating areas of the room (e.g., self-help is yellow or leisure is purple) Use pictures for: Designating each childs place Destinations Daily schedules Delineating activities to perform in each area of the classroom Reminding students of desired behavior Designating personal belongings Designating where things belong Designating tasks and activities Use lists for: Reminding what things to take home or bring to school Reminding what to buy at the store or in the cafeteria Reminding what things to take on community outings Reminding what jobs to do Reminding what tasks need to be done Use tape (e.g., wide electricians tape) or paint for: Designating transition paths (e.g., painted footsteps) Designating line-up areas Creating a personal space area for each student (e.g., taped square around desk, taped square around where students are to sit) Use dividers for: Designating transition paths Visually masking seductive stimuli (e.g., children playing outside) Providing obstacles for running away
Adapted from: Scheuermann, B., & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA: Wadsworth.
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Social Stories
What is a social story? A social story is a short story that describes to an individual the relevant social cues and commonly desired responses in a specific situation. It explains what happens and why the situation occurs. A social story is designed to prepare an individual for an uncertain event, to share information, or to provide him/her with a thoughtout plan and guide. The social story should be based on the individuals specific needs that relate to a particular concern. Social stories can help individuals to cope with numerous things such as new situations, transactions, academic tasks, and any situation that may cause anxiety or be unclear. Carol Gray, consultant to students with Autism Spectrum Disorders, developed the social stories program. Individuals from preschool through adulthood can use social stories. She offers extensive and detailed information in her many Social Stories publications. Goals of Social Stories Based on identified needs, a social story may: Be part of a behavior, social skills, or communication program

Translate a goal into understandable steps Facilitate social interactions Include the individual in more activities within social settings by facilitating independence and related skills
Using a Social Story 1) Select a behavior that would increase a positive social interaction for the individual and break it down into sequential steps 2) Define the target behavior concisely 3) Collect data about the target behavior before, during and after using a social story as an intervention. 4) Help the individual to generalize the story across situations through different activities and experiences 5) Gradually fade out the use of the story Components of Social Stories Social stories are comprised of four types of sentences: Descriptive Sentences: Describe where a situation occurs, who is involved, what the individuals are doing, and why. They are used to describe a social setting or to provide sequential steps for completing an activity. 34
Perspective Sentences: Describe the responses and actions the person should ideally make in a given situation. The desired behavior is defined in positive terms. These sentences often begin with I can try to . . . or I will work on . . . Control Sentences: Describe strategies the individual will use to remember social story information. This step may be eliminated for individuals with very limited skills or those with stimulus over-selectivity. Characteristics of Effective Social Stories

Suggestions for writing a social story

Focus on the purpose of the story Name the people and characters involved in the story Describe the setting State what happens in the order that events occur Provide the reason(s) why things happen Provide the responses required in the situation Use a simple format with 1-3 sentences per page Add visuals to the story such as photographs and drawings to help illustrate the desired behaviors.
Written in first person Describe a present or future social situation Use vocabulary, illustrations, and print size that are appropriate for the individual Read with the individual several times; desired behaviors modeled ahead of time Avoid terms like always and never Maintain a proportion of 2 to 5 descriptive sentences for every directive sentence in a story, regardless of its length.
For Additional Information Please visit the following website: www.thegraycenter.org
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Inclusion
What is Inclusive Education? Inclusion recognizes every individuals right to be treated equally and to receive the same services and opportunities as everyone else. Inclusive learning environments ensure that everyone feels a sense of belonging, is accepted, receives needed supports, and is encouraged by peers and school personnel in the course of having educational needs fulfilled. Students are educated in the general education classrooms with their peers to the greatest extent possible. Not all students study the exact same curriculum. Instead, they learn together and have adjustments in the curriculum to meet individual needs. Characteristics of Inclusive Educational Models

students needs. Students success is achieved when both individual and group goals are met. (Source: Walter-Thomas, et al., 2000) Tips on Developing Inclusive Environments for Students with Autism Spectrum Disorder
The general education classrooms are modified to meet individual needs Collaborative teams share leadership responsibility Students and teachers learn from each other and solve problems together Instruction is aimed to match the needs of students at all levels of achievement Grade-level placement and individual curricular content are independent of each other Instruction is active, creative, and collaborative among members of the classroom Activities are designed to include all students though participation levels may vary The classroom teachers, special educators, related service staff, and families share ownership for educating all students Students are evaluated by individually appropriate standards The system of education is considered successful when it strives to meet each
Utilize and advocate for better assessment of students with ASD to provide detailed information regarding strengths, difficulties, and support services needed for functional and academic skills Develop an unique profile of the student that encompasses strengths, needs, as well as communication and learning styles Be aware of the impact of the environment and events which may effect the student and accommodations to minimize such effects (e.g., visual cues for transitions) Provide a full array of supports to include such things as computer assisted technology, tutors, speech/language therapy, behavior intervention plans, and class work accommodations Provide the student with the choice to participate in all activities of the school and support such choices Develop and implement an educational program that goes beyond compliance models Promote acceptance and diversity within activities and curriculum Encourage all students to value the contributions of all their peers BE FLEXIBLE
For More Information Please visit one of the following websites: http://www.inclusion.com http://www.autcom.org http://www.disabilityresources.org http://www.ideallives.com
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Gluten-free/Casein-free Diets
What is a Gluten and/or Casein-free Diet? Gluten is a protein found in wheat, barely, oats and rye. Casein is a protein found in dairy products such as milk. Thus, the child would not eat wheat or wheat-based products such as cereals and bread if on a gluten-free diet. The child would not eat dairy products such as yogurt, milk, cheese, ice cream, or anything prepared with dairy products if on a casein-free diet. Diets and Autism Spectrum Disorder Some research has found elevated urinary excretions of gluten and casein in children with ASD. It appears that there may be a deficiency in the enzymes that break down these proteins in some children with autism spectrum disorder. Thus, the proteins are incompletely digested and can cause other reactions within the body such as an opiod reaction. This opiod reaction goes directly into the bloodstream and can cause behaviors similar to those associated with morphine use. The areas of the brain that are most affected include those involved in learning and speech. It is hypothesized that if casein and gluten are removed from the diet of an individual with autism spectrum disorder, then improvements in communication, behavior, and socialization may occur. Testing and Side-Effects Children can have their urine tested to determine the levels of existing proteins. Sometimes the test can give false results. Thus, trying the diet is often the best way to find out if there is sensitivity to casein and/or gluten. If there is not an elevated level of casein or gluten, then the gluten-casein free diet would probably not have any effect. However, for those individuals with elevated protein levels, the diet may cause side-effects such as withdrawal symptoms which include hyperactivity, insomnia, aggressiveness, and refusal to eat. These symptoms may occur when the proteins are removed from the diet due to their possible morphine-like reactions in the body. The symptoms usually disappear over time. Diet users and their families can expect long periods of time before seeing any results reportedly, it can take up to one year. Research Findings There have not been consistent researchbased findings to support or disprove the use of a gluten and/or casein-free diet as a treatment option for the difficulties many individuals with autism spectrum disorder experience. Support for the gluten and/or casein free diet comes from family testimonials. A small percentage of parents of children with ASD have reported improved eye contact, decreased aggressive tendencies, and improved communication and socialization. However, results vary greatly and the diet is not a guarantee. Implications for Educators It is important for educators to follow the guidelines of the diet for their students who are on a gluten/casein-free diet. It may also be helpful for educators to document behavioral data during classroom activities to provide valuable information for the student, parents, and physicians to use when evaluating the effectiveness of the diet. However, it is still unclear the degree to which the diet impacts the individuals behaviors and life. For Further Information Please visit one of the following websites: www.serenaid.com www.members.aol.com/lisas156/gfpak.htm www.autisminfo.com
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Alternative Treatments
As you search for more information about autism spectrum disorder, you may hear about new or alternative treatments that people are talking about. Before starting your child on one of these treatments, be sure to talk about it with your childs doctor. If you are curious about the research behind a special treatment you can do a search at the internet site Quackwatch.org. Many treatments that are marketed to parents of children with autism spectrum disorder are very expensive, may harm your child, and are not based on sound research. Beware of treatments that promise a miracle cure for ASD. Do not let alternative or complementary treatments infringe in any way on intensive, interactive treatment programs as described in the treatment section above. When evaluating treatment approaches you should: Be suspicious of any treatment that makes claims using words like amazing breakthrough, miraculous, cure, or recovery. Be suspicious of professionals who publicize and promote their method or program as if it were a product. Beware of parent support groups dedicated to the promotion of a particular miraculous method.
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IDEA & Your Childs IEP

IDEA
To understand your child's rights in America's public schools, it helps to start with one of the primary laws governing the education of children with disabilities: the Individuals with Disabilities Education Act (P.L. 101-476). IDEA is a federal law that guarantees a free and appropriate public education for every child with a disability. This means that if you enroll your child in public school, his education should be at no cost to you (free), and it should be appropriate for his age, ability and developmental level. IDEA is an amended version of the Education for All Handicapped Children Act (P.L. 94-142), passed in 1975. In 1997, IDEA was reauthorized (P.L. 105-17), further defining children's rights to educational services and strengthening the role of parents in the educational planning process for their children.
Appropriate vs. Ideal

Given the rights your child has to educational services, you must keep in mind that IDEA establishes the minimum requirements schools must provide. For states to receive federal funds, they must meet the eligibility funding criteria of IDEA. States may exceed the requirements and provide more services. They cannot, however, provide less or have state regulations or practices that contradict the guidelines of IDEA. The federal regulations do not require states to provide an "ideal" educational program or a program the parents may feel is "best." The state must provide an appropriate educational program, one that meets the needs of the individual student. The appropriate education for a child with disabilities may not always be the "best" or "ideal" program.
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The Individualized Education Plan (IEP)

The Individualized Education Plan (IEP) serves as an outline for a child's education. As the name implies, the educational program should be tailored to the individual student to provide educational benefit. The key word is individual. A program that is appropriate for one child with autism may be inappropriate for another. The IEP is the cornerstone for the education of a child with a disability. The IEP is a written statement of a child's educational program that identifies the services a child needs so that he or she may grow and learn during the school year. It is a legal document that outlines:

the childs present levels of educational performance, the child's special education plan by defining goals for the school year, services needed to help the child meet those goals, a method of evaluating the student's progress.
Parents are entitled to participate in the IEP meeting as equal participants with suggestions and opinions regarding their child's education. They may bring a list of suggested goals and objectives, as well as additional information that may be pertinent, to the IEP meeting.
After The IEP Is Completed

Once the IEP is completed, ongoing communication between school and parents is essential to a child's success. The family and the school need to work together for the child to receive maximum benefit. The IEP is a working document that can change. It should represent a program flexible enough to respond to the changing needs and skills of the person with autism. The IEP team can meet to discuss changes or additions to a child's plan at any time. The child's parents or school representatives may request a meeting when either party feels the IEP needs to be adjusted to a child's current needs.
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Other Related Resources & Information
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Hyperlexia
Hyperlexia is the ability to decode written words at a higher level than expected given ones intellectual abilities. The term hyperlexia was coined in 1967 by the Silberbergs. However, Bonner was the first to document the descriptions of a child with hyperlexia in 1917. In 1943, Kanners study also documented children with autism spectrum disorder who had good reading abilities and memory for words. There are five common characteristics of hyperlexia. First, it occurs in the developmentally disabled population. Secondly, hyperlexia usually is expressed before the age of 5. A third characteristic is that people with hyperlexia typically teach themselves how to decode words. Reading is also ritualistic and compulsive. The final characteristic is that the ability to read words is at a much higher level than the persons intellectual abilities. Children with hyperlexia are usually first described as different. They typically do not show interest in toddler activities and have difficulty forming relationships with others. They initially focus on letters and then move on to the whole words. Children with hyperlexia may also have difficulties with conversational speech. Other common attributes associated with hyperlexia include: echolalia, pronoun reversals, idiosyncratic use of words or phrases, and delays in using single words. There is no known cause at this time for hyperlexia. To assess if hyperlexia is present, tests must focus on visual processes rather than on verbal ones. Intensive speech and language therapy and early intervention programs can help to develop language and comprehension skills. RESOURCES WEBSITE: www.hyperlexia.org ARTICLES: Aram, D. (1997). Hyperlexia: Reading without meaning in young children. Topics in Language Disorders, 17, 113. Cobrinik, L. (1974). Unusual reading ability in severely disturbed children. Journal of Autism and Childhood Schizophrenia, 4, 163-175. Kupperman, P., Bligh, S., & Barouski, K. (1997). What is hyperlexia? American Hyperlexia Association. Silberberg, N. & Silberberg, M. (1971). Hyperlexia: The other end of the continuum. The Journal of Special Education, 5, 233-241.
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Echolalia
Echolalia is repeating or echoing of a verbal utterance made by another person. 75% of individuals with autism spectrum disorder who are verbal demonstrate one or both forms of echolalia. One type is immediate echolalia in which the person says a word or phrase immediately after hearing it. It involves short-term memory. The other type is delayed echolalia in which the person says what was heard after a delay or lapse of time. For example, the person may repeat a line of a movie that s/he heard the day before. Many consider echolalia to be an encouraging sign in the language development of a person with autism. Echolalia is a normal part of acquiring language. Professionals should attempt to replace the echolalia with a way to fulfill its function rather than try to eliminate it. Overtime, echolalia can be overcome with methods that meet the echolalias function. For example, if the person repeats questions that are asked of him or her, then it may be appropriate to teach the person the phrase I dont know; if the function of the echolalia is to deal with uncertainty during conversations. Another possible method is the Cues-Pause-Point technique in which a pause, or break, is built into conversations to permit the person time to think of a response.
RESOURCES WEBSITES: http://groups.msn.com/TheAutis mHomePage/echolaliafacts.msnw www.iidc.indiana.edu BOOK: Wetherby, A. & Prizant, B. (2000). Autism Spectrum Disorders: A Transactional Developmental Perspective. Baltimore: Paul H. Brookes Publishing Co.
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Savants
Individuals with autism spectrum disorder who have savant skills are described as having an extraordinary, special ability despite their communication, social, and behavior difficulties. There are 3 types of savant abilities. Splinter skills involve memorization of a specific item or fact such as license plates or sports trivia. Talented savants are more specialized skills and abilities such as computing algebraic problems or playing a musical instrument well. Prodigious savants have extremely specialized skills that would be remarkable even if a person without a disability performed them. An example of a prodigious savant is computing square roots in ones head by the age of 8. To date, there is no generally accepted answer as to how these individuals can perform their skills and abilities. 3-10% of individuals with autism spectrum disorder demonstrate a type of savant abilities while only 1% of the non-autistic population (including people with mental impairments) does. It occurs in males more than females with a ratio of 6 to 1. Individuals with savant skills should be encouraged to develop their specialized ability to facilitate language acquisition, socialization with others, independence, and future employment opportunities. However, a balanced approach that includes such things as social skills training, counseling, other areas of interest, and speech therapy can help to encourage the savant skills yet not permit them to dominate the persons life. RESOURCES WEBSITES: http://www.wisconsinmedicalsociety.or g/savant/default.cfm
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Theory of Mind
To interact successfully with others, one must consider different viewpoints or theories of mind. Some individuals with autism spectrum disorder typically lack social skills causing them to withdraw from interactions with others or display inappropriate behaviors during social situations. As a result of such antisocial behavior, they are commonly labeled as self-centered or uncaring. Supporters of the notion Theory of Mind would argue otherwise. A theory of mind encompasses the ability to understand the thoughts, feelings, and emotions of others. Each person has unique plans, thoughts, and perspectives. Thus, individuals with autism may lack a theory of mind by perceiving that their own feelings are the same as others. Individuals with autism may also not understand social meaning, not show empathy, or not be able to take others perspectives which all would be indicative of a lack of theory of mind. Tasks have been developed to enhance individuals theory of mind. These tasks have been used as a treatment approach to help individuals overcome their difficulties with social situations by emphasizing perspective taking abilities. Theory of mind tasks include roleplaying, perspective taking scenarios and questions, and one-on-one conversations. These theory of mind tasks have a positive effect on pragmatic skills, or the use of language. However, research has not demonstrated if the individual clearly understands the concepts presented in the task or if the ability to understand or express appropriate feelings improves. RESOURCES WEBSITE: www.autism.org
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MMR Vaccine
The MMR vaccine is a single shot given to children around the age of 12 to 15 months to immunize them against measles, mumps, and rubella. Some believe that the MMR vaccine may be linked to autism due to the mercury previously within the immunization. Possible evidence to support this claim arose when the number of diagnosed autism spectrum disorder cases increased in the mid 1980s, which was about the same time the MMR vaccine was introduced and used as a single immunization shot. Some individuals also believe that the live, weakened measles virus in the vaccine attacks childrens intestines and prevents them from absorbing nutrients that are critical to brain development. However, the only data to support this idea was reported by Dr. Andrew Wakefields study which had a number of limitations such as a small sample size (only 12 children were studied). More recent research has examined the Wakefield study and found the results to be erroneous due to design flaws and possible influencing variables that were not controlled for. Current data has also shown that despite an increase in the number of diagnosed Autism Spectrum Disorder cases, no sudden increase occurred after the introduction of the MMR vaccine. CNN reported on April 23, 2001 that there has been no link between the MMR vaccine and autism spectrum disorder within the major population. There could be a link in a very small number of children, but this possible association has not yet been proven. Thus, based on current data, it appears that the MMR vaccine will not increase the risk of developing autism. Furthermore, a childs chance of being harmed by an infectious disease is far greater than any risk of being harmed by the vaccine. Current vaccines do not contain mercury. RESOURCES WEBSITES: www.909shot.com http://www.cdc.gov/nip/vacsafe/concer ns/autism/autism-mmr.htm ARTICLES: DeStefano, F. (1999). Negative association between MMR and autism. Vaccine Safety and Development Branch, June 12, p. 1-4. Fischman, J. (2001). Vaccine worries get shot down but parents still fret. Time, March, p. 61. Fombonne, E. (2001). Is there an epidemic of autism? American Academy of Pediatrics, 107, 411413. Wong, K. (1999). Is vaccination risky? U.S. News & World Report, August 30th, p. 59. 46
Recommended Books About Autism For Parents & Families

The Everything Parents Guide to Children with Autism
Author: Adelle Jameson Tilton This book is intended for people who are new to the diagnosis of autism spectrum disorder. It is designed to give coping tips and hints to parents, grandparents and other caregivers.
A Parents Guide to Autism

Author: Charles A. Hart The author gives a great guide to dealing with the problems that parents face when their child is diagnosed with autism spectrum disorder. Well written and easy to understand, this book is a great resource for any parent of a child with ASD.
Activity Schedules for Children with Autism

Author: Lynn McClannahan, Patricia J., Krantz, PhD This is a great resource for parents and teachers who want information on planning a workable routine for their child with autism spectrum disorder. Lots of activities are included in this book.
Autism in the Early Years: A Practical Guide

Author: Val Cumine, Gill Stevenson, Julia Leach If youre looking for information on early intervention techniques that parents can use, this is the book for you. It is easy to understand and practical guidelines for dealing with the younger child with autism spectrum disorder. 47
Autism and Play

Author: Jannik Beyer, Lone Gammeltoft It has been said that a childs work is play. Now parents of children on the autism spectrum can learn more about the play habits and activities of their children.
Children with Autism: A Parents Guide

Author: Michael D. Powers, Editor This book gives a good description of autism spectrum disorder and provides plenty of strategies for parents to use when coping with this condition.
The Effects of Autism on the Family

Author: Eric Schopler Learn more about family dynamics when a member of the family has autism spectrum disorder. This book gives some great insights into how the family is affected by autism spectrum disorders.
Breaking Barriers: A Fathers Story

Author: Bill Davis, Wendy Goldband Schunick Few books about autism have been written from a fathers perspective. In this book Bill Davis chronicles his fight to overcome the physical, emotional, public, educational, and therapeutic obstacles to his sons disorder.
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Compiled by the Huron Intermediate School District 2005 For additional copies, download at www.hisd.k12.mi.us, Special Services, Information about Disabilities, Autism Spectrum Disorder. 50

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Understanding Autism Spectrum Disorder

A handbook designed with parents in mind

14. 16. 38. 40.

The Stages of Normal Grief and the Family

What is Autism Spectrum Disorder?

Your Family & Autism Spectrum Disorder

Pay attention to your childs environment and routine:

When you talk to your child:

To help your child improve their behavior:

All children need love and compassion.

Recommendations for Siblings of Children with ASD

www.seattlechildrens.org www.kidstogether.org www.angelfire.com/bc/autism/index.html

Interacting With the Community

Working with Professionals

Taken from www.autism-society.org

Discrete Trial (DT)

Tips on Using Prompts

Characteristics of Structured Teaching

Auditory Integration Therapy/Training (AIT)

Sensory Integration Therapy

Sensory Integration Therapy, continued

Peer Mediation, continued

Visual Strategies, continued

Such as using a calendar or schedule

Typical Visual Strategies Include

Visual Strategies Suggestions for Visual Organization

Suggestions for writing a social story

For Additional Information Please visit the following website: www.thegraycenter.org

IDEA & Your Childs IEP

Appropriate vs. Ideal

Taken from www.autism-society.org

The Individualized Education Plan (IEP)

After The IEP Is Completed

Taken from www.autism-society.org

Other Related Resources & Information

Recommended Books About Autism For Parents & Families

A Parents Guide to Autism

Activity Schedules for Children with Autism

Autism in the Early Years: A Practical Guide

Autism and Play

Children with Autism: A Parents Guide

The Effects of Autism on the Family

Breaking Barriers: A Fathers Story

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