ASD Outline for Final PDF

Study Outline for ASD FINAL 1\. **ASD Early Signs/Characteristics (Chapter 1 and PowerPoint)** - **Prevalence Rate:** - ASD prevalence is 1 in 36 children (CDC, 2023). - **Ratio of Males to Females:** - ASD is approximately 4.2 times more common in males. - **Diagnosis Rates...

Study Outline for ASD FINAL 1\. **ASD Early Signs/Characteristics (Chapter 1 and PowerPoint)** - **Prevalence Rate:** - ASD prevalence is 1 in 36 children (CDC, 2023). - **Ratio of Males to Females:** - ASD is approximately 4.2 times more common in males. - **Diagnosis Rates in Different Cultures:** - Rates vary due to cultural awareness, stigma, and access to healthcare services. - More diagnoses among non-Hispanic white children than non-Hispanic black children, and Hispanic children - **Diagnosis in Females:** - Females are often diagnosed later because they may present with subtler symptoms and may \"camouflage\" behaviors. - **DSM-V Criteria:** - Two Core Domains: 1. Social communication and interaction deficits. 2. Restricted, repetitive behaviors and interests. Diagnosis of austim must specify with/without language impairment or with/without intellectual disability - **Severity Levels:** - Level 1: Requires support, may have language but needs help with social interactions. - Level 2: Requires substantial support, more social interactions. - Level 3: Requires very substantial support, nonverbal - **Autism as a Culture:** - Acknowledge the strengths and unique characteristics of autistic individuals. - **Early Signs of Autism:** - Limited eye contact, delayed speech/language development, limited use of gestures, and preference for routines. - **Autistic Characteristics Viewed as Strengths:** - Detailed focus, strong memory skills, analytical thinking, and deep interest in specific topics. 2\. **Early Identification/Screening (Chapter 2, Journal Articles, & PowerPoint)** - **Difference Between Screening and Diagnosing:** - *Screening:* Quick, preliminary identification using tools like the M-CHAT. - *Diagnosis:* Comprehensive evaluation using standardized tools (e.g., ADOS-2) conducted by a multidisciplinary team. - **Screening Guidelines:** - Routine screenings are recommended from the CDC at 9, 18, and 24-30 months. - **Gold Standard ASD Assessment:** - ADOS-2 (Autism Diagnostic Observation Schedule): Direct assessment of communication, social interaction, play and restricted/repetitive behaviors. - 40-60 minutes to administer - Age range: 12mon- adult - **M-CHAT Process: Screener** - Screening tool for children aged 16-30 months. - Involves a parent-completed questionnaire and a follow-up interview. - **M-CHAT Risk Levels:** - *Low Risk: *Score of 0-2. - *Medium Risk:* Score of 3-7; requires follow-up. - *High Risk:* Score of 8-20; immediate referral for diagnostic evaluation. - **Social Communication Questionnaire (SCQ):** - Used for children 4 years and older to assess social communication behaviors. 1. Lifetime- 40questions focuses on entire development 2. Current-40 questions focuses on last 3 months - **Comprehensive Assessment Components:** - Review of medical history, direct observations, developmental and behavioral evaluations, parental interviews. - **Interdisciplinary Diagnostic Team:** - Includes pediatricians, psychologists, speech-language pathologists, and occupational therapists. - **Medical Diagnosis vs. Educational Diagnosis:** - Medical Diagnosis: Conducted by healthcare professionals for access to medical services. - Educational Diagnosis: Conducted within the school system to determine support needs. - **Talking with Families About ASD:** - Use supportive language, highlight strengths, discuss findings, and provide resources. - **PCP Role in Diagnosing/Barriers:** - Early screening and referrals; barriers include time, training, and access to specialists. - **Genetic Component of ASD:** - ASD has a complex genetic basis with high heritability and various genetic variations contributing to its presentation. 3\. **Understanding & Assessing Communication (Journal Articles & PowerPoint)** - **Language and Theory of Mind:** - Individuals with ASD often struggle with Theory of Mind (understanding others\' thoughts and feelings), impacting social communication. - **Typical Language Development:** - Involves progression from babbling to single words, phrases, and complex sentences. - 6 months- generate own responses, demonstrates joint engagement, nonverbal gesures to indicate an object of interst. - 1^st^ Birthday- awareness of others, shared world, differences exist. - 12-15 months- value others, social exchange, respond to simple questions. - 24-36 months- by the ends of 3^rd^ year, child has mastered basics of language, understand multiple meaning/labels, context, intonation, inflection, and follower directions. - **Developmental Differences in ASD:** - Pragmatic language is often delayed; challenges include understanding social cues, expressive/respective language, and nonverbal communication. - Sensory Processing Issues: - Hypersensitivity- oversensitive to stimuli - Hyposensitivity- undersensitive to stimuli (sensory seeking) - Joint Attention- difficulties with initating/responding to joint attention activities (Refers objects over people) - Play- limited exploratory play, difficulties with symbolic play. (Prefers solitary play) - Theory of Mind- Difficulties with recognizing emotions and taking others perpectives. - Language- simple sentences, errors in tense markers, understanding context, phonological processing (blending syllables), figurative language, and turn-taking - **Echolalia, Perseverative Speech, Excessive Questioning:** - *Echolalia*: Repeating words or phrases; can be immediate or delayed. - *Perseverative Speech:* Repetitive utterances that may not have communicative intent. - *Excessive Questioning*: May result from difficulty in processing responses or seeking reassurance. - **Comprehensive Assessment of Language:** - Formal Tools: PPVT (Peabody Picture Vocabulary Test), CELF (Clinical Evaluation of Language Fundamentals), OWLS (Oral and Written Language Scales). - **Informal Assessment of Language:** - Observations in natural settings to evaluate the child\'s use of language and communication strategies. - **Stages of Natural Language Acquisition (NLA):** - Developed by Marge Blanc; describes how gestalt language processors (GLPs) move from using echolalia to spontaneous, flexible language. - **Gestalt vs. Analytical Processing:** - Gestalt Processing: Learning language in large chunks (\"scripts\"). - Analytical Processing: Breaking down language into smaller units, like individual words and morphemes. - **Figure 1 (Luyster et al., 2022):** - Illustrates stages and patterns in social communication development in children with ASD. - **Non-Generative Language:** Fixed phrases with no context adaptation; often seen in echolalic speech. - Immediate Echolalia- Repetition of words or phrases immediately or almost immediately after they have been heard. - Delay Echolalia- Repetition of words or phrases after some time has passed since the original utterance. This delay can vary in length. - Self Repetition- refers to the repetition of words, phrases, or questions originally produced by the speaker themselves. - **Transitional Language:** Some flexibility and modification of familiar phrases; indicates emerging language skills. - Mitagated Echolalia- Type of speech repetition where the original words or phrases are slightly altered or modified. - Gestalt Processing- Learning language in large chunks - **Generative Language:** Ability to create new sentences and express original thoughts, showcasing advanced language proficiency. - Pedantic Language- Style of communication that\'s overly formal, inappropriate for the situation, or uses too many academic words. - Idiosyncractic Language- These are new or unique words created by individuals that are not found in standard language use - Neologisms- Creation of new words or phrases that are not found in the conventional lexicon. - Idiosuncratic Phrasing- These are unique or unconventional combinations of words or expressions that deviate from standard usage. They may involve novel or creative uses of known words or phrases, but they often diverge from conventional meanings or structures, sometimes resulting in expressions that are difficult for others to interpret. - Strategies can focus on moving from non-generative to transitional and ultimately to generative forms by encouraging flexible use of language, introducing new vocabulary, and fostering opportunities for creative expression. 4\. **Interventions to Support Communication (Chapters 3, 4, 10 & PowerPoint)** - **Who Can EMT Be Used With:** - Effective for children in the early stages of language learning, particularly those using single words or early word combinations. (MLU= 3.0 or less) - **Theoretical Basis for EMT:** - Combines principles from behavioral theory, social interactionist theory, and developmental approaches. - Behavioral Theory- reinforcement theory uses strategies like modeling, imitation, abd prompting to increase frequency, and complexity of the child's language. - Social Interactionist Theory- language develops through social interactions by scaffolding and modeling language at and slight above child's developmental level. - Developmental Theory- uses developmental milestones to guide intervation goals - Naturalistic Developmental Intervetion- intergrates skills into natural interactions by embedding learning targets into everyday interactions - **The 6 Stages of EMT:** - *Environmental Arrangement*: Organizing the environment to encourage communication. - *Responsive Interaction*: Following the child's lead, using modeling, and providing feedback. - *Language Modeling:* Using language at or slightly above the child\'s level. - *Language Expansion:* Adding information to the child's utterances to enhance complexity. - *Time Delay:* Introducing pauses to prompt communication without direct questioning. - *Prompts:* Using least-to-most support strategies (e.g., questions, cues). **5. Understanding Play, Social/Emotional (Chapters 7, 9, 11 & PowerPoints)** - **6 Levels of DIR (Developmental, Individual-Difference, Relationship-Based):** 1. Shared Attention and Regulation- the ability to focus and regulate attention together w/ others. 2. Engagement and Relating- developing reciprocal interactions and relationships. 3. Two-Way Intentional Communication- using communication intentionally/engaging in two-way exchanges. 4. Complex Problem Solving- tackling complex tasks and problem solving. 5. Creative Representations- symbolic thinking/creativity. 6. Representational differentiation and emotional thinking- understanding and differentiating emotions and thoughts. - **Elements of Individual Processing Profile:** 1. Sensory Modulation- includes hyporeactivity and hyperreactivity in each sensory modality. 2. Sensory Processing- how the child responds to and intergrates sensory information. 3. Motor Planning and Sequencing- ability to plan and sequence motor actions/thoughts. 4. Sensory-Affective Processing- capacity to process and react to affect/emotions - **Goals of DIR:** 1. The DIR model aims to support children in reaching their full potential in a comprehensive abd individualized manner by tailering strategies to help children progress through their FEDLs and improve their individual processing based on their sensory and motor needs. 2. Facilitate development at and above the child's FEDLs within context of the child's individual processing profile. - **Functional Outcomes of DIR:** 1. Improved social-emotional engagement, communication, and flexible thinking through interdisciplinary understanding of child's development. - **Practical Requirements of DIR:** 1. Multidisciplinary collaboration and parent involvement. 2. Should consider- number of professionals needed, hours of intervention, parent commitment, sessions are 6-8 20-minute sessions thoughout the day, can be facilitated by parent, certification in DIR is ideal. - **DIR Assessment Process:** 1. Observation-based assessment focusing on functional emotional developmental levels. - **DIR Type and Prognosis for Treatment:** 1. Categorizing engagement types to guide individualized interventions. - **DIR Data Collection:** 1. Use of Functional Emotional Assessment Scale (FEAS) for tracking progress. - **JASPER Model:** 1. **Acronym:** Joint Attention, Symbolic Play, Engagement, Regulation. 2. **Goal:** Enhance social communication and play skills. 3. **Target Population**: Children up to age 9, particularly those who are minimally verbal. 4. **Theoretical Basis**: Draws on social-interactionist and behavioral theories. 5. **Functional Outcomes**: Improved joint attention, play diversity, and engagement. 6. **Target Areas**: Joint attention, symbolic play, and emotional regulation. 7. **Practical Requirements**: 30-60 minute sessions, 2-4 times a week. 8. **JASPER Strategies**: Includes imitation, modeling, and expanding play routines. - **Early Social Interaction (ESI) Key Components:** 1. Early Social Interaction (ESI) is a parent-implemented intervention aimed at improving developmental outcomes for toddlers at risk for or diagnosed with Autism Spectrum Disorder (ASD). It focuses on enhancing social communication skills through daily routines and interactions. - **Key Componets:** 1. ***Parent Implemented:*** - Parents are actively involved in evaluating, planning, and implementing interventions. 2. ***Natural Environments:*** - Interventions occur in typical environments such as the home or childcare settings to create meaningful learning experiences. 3. ***Family-Centered Framework:*** - The model is tailored to the family's needs and routines, ensuring active parental involvement and engagement. 4. **Naturalistic Developmental Behavioral Interventions (NDBIs):** - ESI integrates principles from Applied Behavior Analysis (ABA) with developmentally appropriate strategies, including: - Natural Reinforcement: Using naturally occurring rewards to encourage positive behavior. - Modeling and Prompting: Adults demonstrate desired behaviors and guide the child through verbal or gestural cues. - Fading Procedures: Gradually reducing prompts to encourage the child's independence. - **Goals of ESI** - *Enhancing Social-Communication Skills*: Improving interaction and emotional regulation in toddlers with ASD. - *Embedding Learning Opportunities:* Teaching through everyday routines to promote skill generalization. - *Parent Empowerment:* Supporting parents in developing skills to facilitate their child\'s development. +-----------------------------------------------------------------------+ | **Feature/Aspect** **EMT (Enhanced Milieu Teaching)** | | **DIR (Developmental, Individual-Difference, Relations | | hip-Based)** **JASPER (Joint Attention, Symbolic Play, Engagement, | | Regulation)** **ESI (Early Social Interaction)** | | ------------------------------ ------------------------------------ | | -------------- ------------------------------------------------------ | | -------------- ------------------------------------------------------ | | --------------- ----------------------------------------------------- | | --------- | | **Theoretical Basis** Behavioral, Social Interactionist, D | | evelopmental Developmental, Individual Differences, Relationship-Ba | | sed Social Interactionist, Behavioral | | ABA principles with developmental strategies | | **Target Population** Children in early language stages | | Children with varied developmental needs | | Children up to age 9, particularly minimally verbal | | Toddlers at risk or diagnosed with ASD | | **Key Goals** Increase frequency and complexity of | | language Support full potential through individualized strategi | | es Enhance social communication and play skills | | Improve social communication skills and emotional reg | | ulation | | **Intervention Environment** Naturalistic settings (everyday inte | | ractions) Tailored to individual needs within context | | Structured play environments | | Home and childcare settings | | **Parental Involvement** Encouraged but not primary focus | | Central to the intervention | | Involvement varies; parents may participate in session | | s Actively involved in evaluation and implementation | | **Assessment Methods** Ongoing observation and feedback | | Functional Emotional Assessment Scale (FEAS) | | Observation-based assessment | | Parent and professional evaluation | | **Session Structure** Flexible, 6-8 sessions of about 20 m | | inutes Individualized based on child's needs | | 30-60 minute sessions, 2-4 times a week | | Typically structured sessions focusing on routines | | **Focus Areas** Language modeling, responsive intera | | ction Emotional development, sensory processing, motor plann | | ing Joint attention, symbolic play, emotional regulation | | Natural reinforcement and modeling | | **Outcomes** Improved language use and complexity | | Enhanced social-emotional engagement, communication | | Improved joint attention, play diversity, engagement | | Enhanced social skills, learning through routines | +-----------------------------------------------------------------------+ **6.** **Interventions to Support Play/Sensory and Motor Considerations (Chapter 16 & PowerPoints)** - **Sensory/Motor Considerations:** - Address sensory modulation and processing issues to support daily engagement. - **Play Defined:** - An intrinsically motivated, spontaneous activity that supports various areas of development. - **Development Areas Needed for Play:** - Cognitive (problem-solving), motor (coordination), social/emotional (turn-taking), language (vocabulary). - **Benefits of Play:** - Enhances cognitive, social, motor, and language skills. - **Motor, Language, Cognitive Stages of Play:** - Ranges from sensory-motor play to fine motor activities. - **Social Stages of Play:** - Solitary, onlooker, parallel, associative, and collaborative play. - **Pretend Play Links to Language:** - Supports symbolic thinking and flexible language use. - **Common Play Problems in ASD:** - Difficulties with symbolic play, repetitive behaviors, and social engagement. - **Social Stories Areas to Target:** - Address specific social skills, routines, behaviors, and emotional regulation. - **Different Sentence Types in Social Stories:** - Descriptive, perspective, directive, and affirmative sentences. - **Social Story Guidelines:** - Use positive language tailored to the child's level. - **Modification of Social Stories:** - Adjust content for individual needs and ensure it is neurodiverse-affirming. **Sensory/Motor Considerations** - **Sensory Modulation and Processing**: It's vital to create an environment that accommodates different sensory needs. This might involve using sensory tools (like fidgets or weighted blankets) or structuring play areas to minimize overwhelming stimuli. **Play Defined** - **Intrinsically Motivated and Spontaneous**: Play is not just fun; it's a natural way for children to explore their environment and express themselves, leading to significant developmental gains. **Development Areas Needed for Play** - **Cognitive**: Problem-solving during play helps children learn to navigate challenges. - **Motor**: Coordination improves through physical activities, enhancing fine and gross motor skills. - **Social/Emotional**: Engaging in turn-taking and sharing fosters empathy and emotional regulation. - **Language**: Expanding vocabulary through dialogue and storytelling during play. **Benefits of Play** - **Holistic Development**: Regular play enhances cognitive, social, motor, and language skills, laying the foundation for future learning and interactions. **Motor, Language, Cognitive Stages of Play** - **Developmental Progression**: Children move from sensory-motor play (using their senses and bodies) to more complex fine motor activities, reflecting their growing abilities. **Social Stages of Play** - **Types of Play**: - **Solitary**: Playing alone, often seen in younger children. - **Onlooker**: Watching others play without joining in. - **Parallel**: Playing alongside peers without interaction. - **Associative**: Interacting with peers while playing the same game. - **Collaborative**: Working together towards a shared goal. **Pretend Play Links to Language** - **Symbolic Thinking**: Pretend play encourages children to use symbols, enhancing their understanding of language and promoting flexible thinking. **Common Play Problems in ASD** - **Challenges**: Children with ASD may struggle with engaging in symbolic play, exhibit repetitive behaviors, and find social interactions daunting, which can hinder their play experiences. **Social Stories Areas to Target** - **Specific Skills**: Tailoring social stories to address particular skills, routines, and emotional responses can help children navigate social situations more effectively. **Types of Sentences in Social Stories** 1. **Descriptive Sentences** - **Purpose: These sentences provide factual information about the situation, setting, or behavior.** - **Example: \"At the playground, there are many children playing on the swings.\"** 2. **Perspective Sentences** - **Purpose: These sentences explain how others might feel or think in a given situation. This helps children understand different viewpoints and emotions.** - **Example: \"Some children might feel happy when they play with their friends.\"** 3. **Directive Sentences** - **Purpose: These sentences offer guidance on what to do or how to behave in specific situations. They often include strategies or steps to follow.** - **Example: \"When I want to join a game, I can ask, \'Can I play too?\'\"** 4. **Affirmative Sentences** - **Purpose: These sentences reinforce positive behaviors and outcomes, helping to build confidence and self-esteem.** - **Example: \"I can make friends when I share my toys.\"** Visual Support Strategies Learning Differences: - TOM- Ability to understand others thoughts/feelings - Executive Functioning- planning, organizing, self-analysis - Central Coherence- focus on the tiny details but doesn't understand the whole picture ICEBERG MODEL- Top(all of the behaviors exhibited), Bottom (why the behavior is occurring) TEACH model focuses on the why of the behavior Autism as a culture: Everyone uses a form of visual supports. \*Keep the visual schedule just adapt Visual Supports: 1. Characteristics 2. Theories 3. Learning Style 4. Strengths/Deficits 5. Environment 6. Motivation 7. Sensory Profile Types of Structure - Physical Organization: The way we set up and organize the child's physical environment. (what, where, how is the physical area) - Provides environmental organization. - Clear physical and visual boundaries (understand where each area begins/ends) - Minimizes visual and auditory distractions. - Specific areas based on curriculum. - Daily Schedules: A visual cue which indicates what activities and when - An organizational system for time - Concrete method used to tell which activities will make up the day and in what order - Schedules are for big chunks of time. - Consider level of functioning, flexibility, length, routine for checking schedule, interest, visual cue, sequence, who manages. - Work Systems: Systematic way for individual to receive and understand information - Clarifies the meaning of finished and the expectations - Specific activities within a task (step by step) - Every system should answer: what work, how much, how do I know I am finished, what's next - Designed left to right, matching, written - Daily schedules are different than a work system, [not a choice board] - Visually structured tasks: Allows the person to combine and organize a series of steps to obtain a desired outcome. - We all need visual support Understanding Stress & Behavior in ASD Understanding Behavior: - Behavior is communication. - Behavior is an attempt on the part of the brain to keep itself stimulated or in equilibrium. - Behavior is a logical response to the environment where the behavior was initially learned. - \*If you don't create meaning the child will and not in a fun way. - Optimal level of stress is needed for learning to be able to learn and attain information. - Too little- we drift, and sensory system is not engaged. - Too much- sensory system shuts down and nothing is registered. - Low registration: Does not recognize or process all of the incoming sensory information and does not compensate by trying to gain more sensory input to meet and does not compensate by trying to gain more sensory input to meet needs. They may seem uninterested, and inattentive to surrounding needs. - Sensation Seeking: Does not recognize or process all incoming sensory information, but contrary to low registration, actively tries to gain sensory input to meet needs. May be hyperactive, touch others to often or engage in unsafe activities. - Sensory Sensitive: Feels overwhelmed by sensory information, but does not actively try to avoid the overstimulation, instead they may display frustration. May be\ overstimulated by noise or other sensory information. - Sensory Avoiding: Feels overwhelmed by sensory information and will actively avoid stimulation. May run away from loud, busy environments, cover ears, etc. A screenshot of a computer Description automatically generated **Chain of Behavior:** Intense/severe behavior usually starts small - Fatigue, irritation, confusion, frowning, restlessness - Individuals with ASD have little control over their behaviors - Depend on others to identify their feelings and needs **Situations Associated with Behaviors: (Cause)** - Situations involving people - Inability to ignore, modulate, or organize sensory information - Demands are too difficult, non-preferred activities, work too long, feel rushed, & not knowing when tasks will be finished - Interruptions and changes (schedules, rules, routines, activities, physical structure, travel routes) - Lack of information (not understanding what is to happen now, when event will occur, how to do the work, when to start, when it will be done, what will happen next) Behaviors on Top (measurable, specific, observable)  Theories/Sensory on Bottom (TOM, Executive function, central coherence, DSM-5) Functional Communication Training: 1. Assess the function of the behavior. (before, behavior, after) - Antecedents and consequences - **Use two or more functional assessment techniques to determine what variables are maintaining the problem behavior** 2. Select the communication modality - AAC, verbal, sign language, etc - **Identify how you want the individual to communicate with others** 3. Create teaching situation - Arrange the environment to create opportunities for communication - Teach the skill where it will be used - **Identify situations in the environment that are triggers for problem behavior and use these as the settings for teaching the alternative reponses** 4. Prompt communication - Introduce prompts (prompting hierarchy) - Prompt self advocacy "I need help" "I don't like it" "I need a break" - **Prompt the alternative communication in the setting where you want it to occur. Use the least intrusive prompt necessary.** 5. Fade prompts - Full physical prompt -- partial prompt -- gestural prompts -- verbal prompts - **Quickly fade prompts, ensuring that no problem behaviors occur during training.** 6. Teach new communicative responses - Introduce new forms of communication while reintroducing demands/settings - **When possible, teach a variety of alternative communication responses that can serve the same function** 7. Modify the environment (changes with life) - Environmental/curriculum changes - **When appropriate, implement changes in the environment, such as improving student task match in school** Table 8.1 outlines several typical functions of challenging behavior: 1. **Tangible**: Behaviors aimed at obtaining desired items or activities (e.g., toys, food). 2. **Sensory**: Behaviors providing sensory feedback (e.g., twirling, making noises) that can be triggered by overstimulation or being left alone. 3. **Attention**: Behaviors designed to gain social attention from others (e.g., praise, interaction). 4. **Escape**: Behaviors that remove undesired requests or activities (e.g., avoiding chores). **Response match:** Matching communicative behavior to the function of the challenging behavior **Response success:** To be successful, use of a conventional behavior as an alternative to a challenging behavior must be followed by a reinforcer that serves the same function as that served by the challenging behavior **Response efficiency** Response acceptability - Whether or not the response is acceptable to other people  - If new communication response is seen as unacceptable in community, then others wont respond appropriately and the desired consequences will not be obtained - Also known as cultural consideration **Response recognizability:** Whether or not the taught response can be recognized by others to effectively replace the challenging behavior - Ziggurat Model: A Functional Approach to Autism Planning - ppt video online download CH.14 SCERTS: - SCERTS is comprehensive educational approach for young children and older individuals with ASD - Grounded in developmental theory - Three main domains: social communication (SC) emotional regulation (ER) and transactional support (TS) - Designed to support individuals across lifespan - The developmental age range of teh model spans from 8m-12 years Target populations - Intended for educational and intervention settings for ASD but due to developmental nature, the SCERTS model can be used to assess an scaffold any individual with social communication and emotional regulation concerns - There are three partner stages in model that reflect the developmental sophistication of communicative abilities and give us information about the individual as a learner 1. 2. 3. **Domains and components of SCERTS model** +-----------------------------------+-----------------------------------+ | **Social communication** | **Joint attention- the why of | | | communication** | | | | | | **Symbol use\-- the how of | | | communication** | +===================================+===================================+ | **Emotional regulation** | **Mutual regulation\-- capacity | | | to maintain well regulated state | | | with assistance of another | | | person** | | | | | | **Self regulation\-- capacity to | | | maintain active engagement | | | without assistance** | +-----------------------------------+-----------------------------------+ | **Transactional support** | **Interpersonal support\-- | | | adjustments in interactive style | | | made by partners** | | | | | | **Learning support\-- | | | modifications to activity and | | | physical environment made by | | | partners** | +-----------------------------------+-----------------------------------+ Strength Based Goals Traditional Goals- (have a time/place) - Focus on the deficit model - Neurotypical standards - Tend to focus on independent skills (mastery) w/ no support - Does not include autistic perspective Strength Goals- - Supports/strategies (not independent) - Autonomy- I need break, I need help stop - Self-advocacy- Requesting help, identifying boundaries, communicating needs/wants/choices - Pragmatics- neurotypical communication vs. autistic communication Writing Neurodiverse goals (similar to writing traditional with a few tweaks) - Personalized to the individual- useful to the client - Empowerment vs. normalizing - Inclusive and collaborative - Flexible and adaptable Neurodiverse Movement - Acknowledges brain differences are natural (nothing about us, without us) \*Provide each person their own supports based on their needs to be successful  Masking - Camouflaging- to blend in and appear non-autistic, ASD mask w/out knowing - Masking can cause mental health (exhausting, prohibits development of true identity) - Neurotypical choose when to mask Mental Health - Suicide in the 2^nd^ leading cause of death for autistic individuals - Autistic people make up 1% of the 11% of suicides Comic strip conversations and video modeling Relationship Development Intervention w/ Young Children (RDI) - Program for developing relationship skills with autistic children - Used with children as young as 2 through adulthood Younger Children 2-9 targets - Social referencing - Regulating behavior - Conversational reciprocity - Synchronized actions Comic Strip Conversations: Carol Gray (follow step by step if stated by Carol Gray) - Conversations between 2 or more people which incorporates the use of simple drawings - Concrete - Illustrates ongoing communication, while providing additional support to comprehend\ the quick exchange of information that occurs in a conversation. - Identify what people say and do, emphasize what people may be thinking - Illustrates social skills which are abstract and difficult for children with autism to understand - Helps identify beliefs/motivations (TOM) of others - Used to report a past event, describe present, or plan for future activities - Used 8 symbols and different colors to present conversation skills (colors identify emotions) - Colors are gradually introduced (1 at a time over several conversations) Green -- good ideas, happy friendly\ Red -- bad ideas, teasing anger, unfriendly\ Blue -- sad, uncomfortable\ Black -- facts, things we know\ Orange -- questions \*If client gets fixated on meaning of color then use any color for communication Video Modeling (can contribute to masking) - A behavioral technique that uses video recordings rather than live scenarios for child to observe, allowing the focus of attention to be concentrated on the tape. - Video recordings target behaviors in order to expand the child's capability to memorize, imitate, and generalize or adapt targeted behaviors. Different Models - Adult models - Peer models - Video self-modeling- autistic client, taking out unwanted behaviors - Point of view models- through the lens of the client - Mixed models Used to teach appropriate 1. Play skills 2. Social skills 3. Academic skills 4. Functional daily living skills 5. Communication WHY? - Visual learners - Highly interested, motivated, attentive to video - Imitate, practice, try in real world - Prepares for noisy, stimulating environments How? 1. Write a script to target specific skill 2. Film peer/adult performing task, in the typical environment where target skills occur 3. Film scripted social/play interaction 4. Edit video to only show target behavior/skill Autistic Women in the Workplace - Females have been found to be diagnosed 14-months later compared to males - Women long term self-medicate, substance abuse, incarcerate due to result of misdiagnosis and underdiagnosis Masking: - Masking is used to hide the behaviors that make an individual stand out - It is viewed as necessary for many autistic individuals due to fears and can be considered survival Employment: - Many autistic adults do not disclose their diagnosis to co-workers/employers because they did not want to be treated differently - Autistic individuals often work in positions below their qualifications and at lower pay rates Executive Function and Social Communication Supports for Autistic Adults in the Workplace 35% of autistic adults 18yr olds go to college/15% are employed after college Typical Areas of Support for Autistic Adults - Sustained Attention (focus on most interest) -Provide meaning for the task or the underlying processes or needs of the project. (break into chunks) Strategies: Eliminate distractions, sensory input, self-talk, mini breaks - Working Memory (Small amount of memory) -Taking notes while getting directions, prioritizing tasks, visual memory prompts Strategies: External (claendars, alarms, to do lists) Internal (planning ahead, memory aids, relaxation, taking notes) - Time Mangement (controlling your time) -Set reasonable productivity goals Strategies: (do, delegate, delete), Pomodoro (25min+5min break), time blocking, priorizing important tasks first, Use technology apps - Mental Flexibility (ability to adapt to changes) -When possible, provide lead-up time to any changes Strategies: thinking out loud, brain dump, validate emotions, help them put into perspective, look at another person's point of view - Emotional Regulation (ability to manage and respond to emotions) -Responding to emotions in a way that's effective Strategies: breathing, workplace set-up w/ sensory needs, mini breaks, with a mentor identify emotions/triggers/plan for appropriate responses - Context Awareness (customizing your responses or actions to your environment or system) -Utilizes a big-picture perspective Strategies: visual prompts of the mission/vision of an organization, understanding your role and others, starting meetings with reminders - Social Communication (TOM, Central Coherance, Exective Functioning) -Social Cognition: Understand the meaning of works beyond linteral or concrete meaning -Social Knowledge: How to respond in social situations and understand what is expected -Social Perspective: Ability to read social cues Strategies: Clear/Precise directions, time to process information, giving information in preferred way, allow camera off, have meeting details