ELOUERA ASSOCIATION (Inc)
AUTISM SPECTRUM DISORDER
INTRODUCTION
Autism
is a life long disorder that generally effects a child from birth.
It is thought to be a neurological disorder of the brain and central
nervous system. There is no cure for autism and at best we can provide
intensive training to help the individual live in a very confusing world.
Autism
effects about 15 people in every 10,000 and of these 4 out of 5 will be boys.
While girls rarely get Autism when they do it is generally more severe.
Autism
is world wide and it effects all cultures.
No single grouping other than gender occurs and Autism has been found
even in the most isolated cultures.
The
degree a person is effected with Autism varies from mild to severe but all
people with Autism are effected in many of the same ways.
These are:-
Difficulty with Social Skills
Poor Communication skills if any
Limited focus on interests but obsess ional over a few.
Behaviour problems from being withdrawn to aggressive behaviour and self harm.
Inability to cope with change
Lack of playing skills
A preference for repetitive tasks
Autistic children have no imagination
A dislike for being cuddled
Focusing on a point not the whole picture
Asperser’s Syndrome is a form of autism with the main difference being that at three years of age they had verbal communications. This however does not mean they communicate the same as other people as they tend to repeat rote and are very robotic in speech. They have the ability to talk but not an equal ability in the use of language.
Over 75% of people with Autism also have an intellectual disability however in all cases no matter how severe the intellectual disability is the Autism will be their primary disability as it has the greatest impact on the persons quality of life.
Many people with Autism have an exceptional skill such as the ability to memorise Postal codes and town names or even days of the week to any nominated date. The unfortunate thing is often they are masters of useless information.
30 years ago there was a strong belief that Autism was caused by uncaring mothers and this is why even today you will find many parents defending the way they have cared for their child particularly the older generation that had to endure this criticism.
People with Autism have very literal and because of this you need to be careful of using double meanings or slang. An example of this is you would tell a person with Autism to go and wait for a bus at the bus stop then get on it. Telling them go catch the bus you may well find them in the middle of the road attempting to do just that. Remember the scene in Rainman where Raymond stops in the middle of a cross walk because the little green man turned red. I have seen people with Autism do exactly that.
ELOUERA ASSOCIATION (Inc)
THEORY OF MIND
CHARACTERISTIC
An individual with autism has no concept of individual thought and what they know you do also, they have great difficulty in understanding that other peoples thoughts or ideas are different to their own. Often you will hear a person with autism say to someone "didn't you know that ...your dumb". If you watch Star Trek a person with Autism sea’s the world as the Borg do there is only one collective mind, their own.
People
with Autism have no understanding of the emotional needs of other people and
that is why they can watch a mother cry out for a hug and just walk away.
MANAGEMENT
Never
view rudeness or that when the individual with autism ridicules another as being
a behaviour problem as such as it is not intentional. Disciplining is detrimental as they have no idea that they
have done anything wrong nor can they link the consequence to the action.
People
with Autism can be cuddly or learn to hug but it is generally a learnt behaviour
or when they want the hug. Watch
the kids being hugged its like a rag doll in many cases.
We
need to teach the skills of
Reading and understanding other peoples behaviours
That certain actions will result in a reaction from others and why
Learnt responses to certain
situations (Hello Michael is responded with Hello .... back to the person)
ELOUERA ASSOCIATION (Inc)
LIMITED RANGE OF INTERESTS
CHARACTERISTIC
People
with Autism have far fewer interests or activities they undertake but those
undertaken may be very repetitive. This
can be a very simple repetitive movement or
habit such as self tapping or smelling items.
Activities may be performed in a very elaborate routine that never
changes and any change causes extreme stress.
They may become collectors of a particular item or object and this can
become an obsession, sometimes these collections are of bizarre objects.
When
talking there will tend to be a pet subject that is repeated over and over but
normally with great knowledge of the subject, I met one individual that knew
more about Lazar technology than a friend of mine who is NASA's head Lazar
technicians in the Australasian and Middle East region.
This
interest may be focussed on a cartoon character, sports hero or trains it is a
very individual thing. This need
for a limited but absorbing interest is to allow the individual with Autism to
screen out the overload of information they receive.
It is a way of making order out of the chaos in their lives and is very
soothing and pleasurable to them while to us may be very annoying and anti
social.
Repetitive
movements generally are an indicator of stress, take notice of the environment
and what has happened, is happening or about to happen and take notes of this.
Over time you will see a pattern emerge that enables you to better manage
the stress thus reducing the action. There
is no point in addressing the action itself just the cause.
The
practice of repetitive movement will never be eliminated and in some cases it
may well be included in the persons schedule as free time where they can tick
hum or tap to their hearts content for 10 minutes.
Favourite
subjects can be built into the days schedule and used as a way of motivating the
individual, eg do this work well and we will talk trains for ten minutes or
social stories with a central theme around their subject.
Modification of an interest is possible such as if an individual had a love of flicking things you could play tiddlie winks as a way of teaching colours and counting discs flicked into a circle.
ELOUERA ASSOCIATION (Inc)
NEED FOR ROUTINE AND SAMENESS
CHARACTERISTIC
People
with autism become very rigid in their routines, layout of rooms or work
stations and the way they travel from A to B.
They are far more tuned into their environment and surrounds than we are
and remember detail we would not even notice
As
a result of this other peoples behaviour and ways of doing things appear to the
person with autism to be chaotic and very unpredictable.
We have no patterns in our lives and will do things different each time
we do them even if we think we do them the same.
In
Rainman you saw Raymond get upset because he only got 4 fish sticks and he
always gets 8, Tom Cruises character then cut them in half and he was happy
because again he had 8.
I
had a worker that was very capable and drove their own car to work,
they moved to a new home closer to work but were arriving late each day.
What they were doing was driving to their old house first and following
the established rout to work. The
same worker also returned home one day and phoned work in an agitated state.
Road works had closed the end of his road and a detour had been clearly
marked around the works, this change in his routine was devastating.
The
layout of rooms is often a major consideration and changes can cause stress,
A bin might be put back on the left of a desk not the right or the
magazines are not all in a neat pile. One
of my employees in Perth was upset because I had left his workstation in total
disorder but to me it was exactly the same.
The difference was in the box I had placed a letter opener against the
edge where he used to place it diagonally across the box, I turned his adding
machine off at the machine where he turned it off at the power point.
Change
in routine needs to be planned well ahead, they need to be informed something
will be different to day and what it will be.
Where possible give them choices and involve them in the planning of the
change.
In
regard to items in a room these need to be ladled.
Why well if you move a desk they will not recognise it as theirs because
it is not where their desk goes. The
label is needed to visually convince them it is their desk. If
you want to change the class room do it bit by bit over time and involve them in
the moving of things.
Do
practice runs of a new way of travelling somewhere giving them things on the way
to look for.
The
TEACCH Method is particularly good for this as there is a wall chart to let them
know what is to happen next in their routine.
ELOUERA ASSOCIATION (Inc)
DIFFICULTY INTERPRETING TRANSIENT
INFORMATION
CHARACTERISTIC
This
is the ability to undertake tasks that require sequential processing of obscure
information. Things such as a wave
meaning come here or look out where the item to look out for is not defined.
As
a result of not being able to do this a person with autism can not understand
the complexities of play hence their inability to join into a game of football.
This inability to understand the whole picture or a message we take for
granted is why they appear to get confused or do something entirely different to
the intent of a message.
On
the other hand a person with autism excels at tasks involving rote learning,
tables for example in maths. They
also learn well from visual stimulation as this involves less processing of
information for the brain (We however when told I will show you, often respond
with just tell me).
Because of the superior ability in interpreting visual information they normally are good at sorting, recognising shapes and jigsaws etc. It should however be noted that these abilities will still only be relative to the persons intellectual ability.
MANAGEMENT
Unfortunately
the ability of a person with autism often translates into the ability to learn
useless information.
Always
use visual information to support verbal instructions given and don't stop this
practice once a task is learnt just make the visual support over time more
subtle. An example of this is in
school an individual will use a wall mounted chart that organises themselves and
as an adult they may use an organiser type of diary compulsively.
Keep
all verbal instructions to single item exact sentences.
Don't pad out sentences, a person with autism wont be upset if you don't
say please its meaningless anyway.
Never give a string of commands to save time you will end up repeating it again anyway.
ELOUERA ASSOCIATION (Inc)
DIFFICULTY IN GENERALIZING AND RELATING SITUATIONS
CHARACTERISTIC
People
with autism do not generally integrate or generalise information and as a result
have difficulty transferring skills learnt in one situation to another.
In
a general class situation they may miss the whole point of the lesson and focus
on one insignificant fact or example given.
What
does this mean, you can take a person with autism to swim to a competent level
at the local swimming pool. The
become confident and proficient but when taken to a lake nearly drown failing to
swim at all. This is because they
have learnt they can swim in a pool but can't transfer the relevance or skills
to a lake as the environment has changed.
This
will help you understand the reason skills are often forgotten, it may well be
the environment has changed not that the person has forgotten the skills.
Teach
skills in the settings they will be used or in as close to the setting as
possible. A good example of this is
shopping lists and money use should be taught in a real shop or simulated shop.
When
teaching Road rules the individual should initially be taught with toy cars then
taken out on the road (as a passenger) and shown this occurring in real time.
Once
a skill is mastered practice it in different settings with different teachers or
aids to get an understanding the skill can be transitioned to numerous
locations. Remember though each
time you may need to start with the basic skills training again.
With
social skills training organise real life situations and environments for
practicing skills so they learn the relevance.
The may never understand this fully but will use them in rote.
If respite care is organised or a school camp is taken the house parents may need to be made aware of the fact basic life skills like toileting, cleaning and grooming as well as cooking skills may need to be taught or prompted.
ELOUERA ASSOCIATION (Inc)
PLAY IS REPEDATIVE AND ISOLATED
CHARACTERISTIC
Children
with autism do not undertake imaginative play or play at all.
They are normally the FLK running around the fence or straight through
someone else’s game. If they do
play it is normally a learnt routine with little deviation from the same game
played the day before.
The
process of play is very abstract there are no rules or guidelines to follow and
to a person with autism nothing to focus on to give meaning.
Because they don't relate from situation to situation a toy car will
generally be turned over and the wheels are spun rather than driving it around
the floor.
Another
reason people with autism tend to stick to the fence in a play ground is that in
open spaces they get scared, they have no boundaries and are not sure where they
should be or where they should go. This
is why they will run over ovals or more dangerously roads.
Play
skills need to be taught. It is not
that a child with autism does not want to play they just don't know how.
Games they can learn are the ones with repetitive actions such as
skipping rope and the games where a rhyme may be sung.
The
child will need to learn about an object before they can learn the game
associated with it. Once they know
the function of the toys they then need to learn the social rules of the game
such as taking turns and sharing.
It
may appear this contradicts the statement the child can't play but realistically
it is more of a chore than enjoyment as the rules they learn and putting this
into practice in the totally disorganised environment of a playground are very
stressful for people with autism.
Most
schools find that allowing free time on a computer game or listening to music is
far more relaxing to the child with autism than being in the playground.
Remember
that trying to get a person with autism to play football or any team sport is
virtually an impossibility, just think of the number of un written rules in
these games and the fact they are played in an
environment with no clear boundaries. And
after you just get them involved you tell them now kick the other way.
ELOUERA ASSOCIATION (Inc)
SENSORY SENSATIVITIES
CHARACTERISTIC
A
person with autism may be hyper sensitive or even have fluctuating levels of
sensitivities.
Touch
- Frequently they are sensitive to touch, they find clothing very uncomfortable
and absolutely hate labels in clothing. They
will find shoes very restrictive and mostly prefer to wear non or to wear shoes
to big and loose.
They
may over react to your touch or the touch of others and go out of their way to
avoid others. I had a girl on a
recreation tour once go mental every time we were in a crowd because people
bumping her lightly was seen to her as if everyone was hitting her.
The
feeling of food in the mouth and swallowing it as well as the extremes in
temperature and spices for example are heightened.
This will explain why most people with autism are very limited in the
choices of foods they will eat.
Sound
- You will see people with autism react to sounds and flinch when they hear
them. This could be the school bell
or even a toilet flushing. To them
it is like finger nails on a blackboard to us.
Most often they have a sound overload as I will demonstrate on the day.
Light
sensitivities - Their eyes tend to be light sensitive or pick up the flickering
of fluorescent lights. Most will
prefer a lower light and in setting up work stations you will need to consider
this.
Smell
- the since of smell can be heightened and they can react around areas with
odour like toilets, factories or food stalls.
There
are desensitising programs that have limited success however the inclusion of a
preferred object in these situations may help more by distracting their
attention. This may be using a
walkman to mask sounds or holding a favoured object in situations that cause
fear or discomfort.
Clothing
needs to be well considered when being purchased and remove the labels.
Be aware that changes in seasons will lead to discomfort such as summer
with loose shorts and tee shirt to winter with long pants and jumpers.
Where
lights can not be dimmed or where activities occur outdoors use sun glasses to
reduce sensitivities to light.
From
a young age expose children to an assortment of smells to teach them that smells
are a part of their ever changing environment.
Remember
- We filter out these things and have the ability to focus on relevant noises or
sounds. A person with autism smells
hears feel and tastes the environment all at
the same volume. To us it would be
like having clothing made of Hessian bags, a TV Radio and rock concert happening
at the same time during a lecture and bright lights being shone in our eyes.
Then we come along in this mess and say lets go horse riding, think about
it.
ELOUERA ASSOCIATION (Inc)
INAPROPRIATE FACIAL
EXPRESSIONS OR EMOTIONS
CHARACTERISTIC
People
with autism have all the same facial expressions and emotional capacities as we
do they just use them all at different times.
They do not understand the social implications of a smile or a frown and
get confused when there is a need for emotional displays.
I
had a guy called Peter come up to me one day when I visited his group home.
He was very excited and greeted me with a huge smile and hand shake
saying guess what guess what Sue *** is leaving.
I
knew Peter loved sue and related to her very well and so I said and does this
make you sad. He burst into a laugh
and said yes.
Clearly
Peter was upset and was emotional but he used all the wrong emotions to display
this.
When
inappropriate facial expressions are used make them self aware of this, show
them your face then theirs in a mirror and how they should react in a situation.
Use
visual cards with faces to reflect the different moods,
a smiling face :-) for Happy and a sad face :-( for sad.
The
use of visually stimulating social stories and the practicing of faces for
different situations all helps.
Role playing is very useful.
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