Exceptional Children Chapter 7

Rett Syndrome (DSM-IV)

(1) apparently normal prenatal and perinatal development; (2) apparently normal psychomotor development through the first 5 months after birth; (3) normal head circumference at birth; B. Onset of all of the following after the period of normal development: (1) deceleration of head growth between ages 5 and 48 months; (2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing); (3) loss of social engagement early in the course (although often social interaction develops later); (4) appearance of poorly coordinated gait or trunk movements; (5) severely impaired expressive and receptive language development with severe psychomotor retardation;

prevelance

1. 1 in 110, 0.6% to 1%; 2. 4 to 5 time more boys than girls; 3. fastest growing disability category in special education;

communication and Language Deficits

A common characteristic of children with autism is the concrete or literal processing of verbal information. They understand straightforward cause-and-effect relationships and questions that have a definite answer more easily than they do abstract concepts, idiomatic expressions, or humor. mutism; echolalia;

pica

A form of self-injurious behavior in which the person ingests nonnutritive substances {e.g., dirt, rocks, sticks, plastic, string, feces); exhibited by some people with moderate and severe mental retardation.

autistic disorder (DSM-IV)

A pervasive developmental disorder marked by three defining features with onset before age 3: (a) impairment of social interaction(e.g., lack of social or emotional reciprocity and affect); (b) impairment of communication(e.g., delay or total absence of spoken language); (c) restricted, repetitive, and stereotypic patterns of behavior, interests, and activities(e.g., stereotypic or repetitive speech or motor behavior, excessive adherence to routines, preoccupation with unusual objects).

double-blind, placebo-controlled

A procedure used to control for expectancy effects by subjects and bias by researchers in studies evaluating the effects of a treatment or intervention. Some subjects receive the actual treatment being tested; others receive a placebo (fake) designed to appear like the actual treatment; subjects do not know whether they are receiving the real treatment or a placebo (they are "blind"); the researchers do not know which subjects received the treatment (making it a "doubleblind" experiment).

joint attention

A social communication skill in which two people interact with their shared environment in the same of reference. Joint attention is evident when a child looks where someone else is looking or turns head or eyes in the direction someone is pointing. when two people use gestures and gaze to share, follow or direct other's attention to interesting objects or events. Lack of joint attention is one of the reasons children with autism have difficulty learning by observing others.

characteristic of autism spectrum disorder

ASD is characterized by impaired social skills, language impairments, deficits in intellectual functioning, ritualistic and repetitive behavior patterns, and uneven development of skill acquisition. 1. Impaired Social Interaction(joint attention); 2. communication and Language Deficits(1/2 mute, echolalia, ); 3. Repetitive, Ritualistic, and Unusual Behavior Patterns; 4. Insistence on Sameness and Perseveration; 5. unusual Responsiveness to Sensory stimuli; 6. Intellectual functioning; 7. Problem Behavior; 8. Asperger Syndrome; 9. Positive Attributes and Strengths of Students with ASD

How to discriminate innovative interventions for autism that hold promise for effectiveness from those based on exaggerated claims, fads, ideology, and pseudoscience?

By staying abreast of developments in autism treatment research from credible sources: 1. American Academy of Pediatric; 2. The National Development Center on Autism Spectrum Disorders ((http:/ /autismpdc.fpg.unc.edu); 3. The Association for Science in Autism Treatment (http:/ fwww.asatonline.org); 4. Interactive Autism Network (http://www.iancommunity.org)

behavioral literature

applied behavior analysis, behavioral psychology, positive behavioral supports

splinter skills

areas of relatively superior performance that are unexpected compared to other domains of functioning

facilitated communication (FC)

facilitated communication (FC): A type of augmentative communication in which a "facilitator" provides assistance to someone in typing or pointing to vocabulary symbols; typically involves an alphanumeric keyboard on which the user types out a message one letter at a time. To date, research designed to validate FC has repeatedly demonstrated either facilitator influence {correct or meaningful language is produced only when the facilitator "knows" what should be communicated) or no unexpected language competence compared to the participants' measured IQ on a standard language assessment. FC is an unproven method

established treatments

joint attention intervention, modeling, naturalistic teaching strategies, peer training package, pivotal response treatment, self-management Approximately 2/3 of the Established Treatments were developed exclusively from the behavioral literature (e.g., applied behavior analysis,behavioral psychology, and positive behavioral supports). Of the remaining 1/3, 75% represent treatments for which research support comes predominantly from the behavioral literature.

2 types of visual support

Picture activity schedules; social stories;

3 standing out characteristics of autistic disorder

The combination of 1. behavioral deficits (e.g., inability to relate to others, lack of functional language); 2. behavioral excesses (e.g., self-stimulation, bizarre and challenging behaviors); 3.unusual responses to or interest in sensory aspects of their environment; makes children with autism stand out as strikingly different from most children.

Promote Generalization and Maintenance of Skills

Unless children demonstrate skills across a variety of situations and maintain them over time, they will have limited ability to participate meaningfully in inclusive environments. • target skills that be useful in each child's life. Skills a child needs in many situations and those typically enjoyed by same-age children are likely to generalized and maintained because they are frequently practiced and produce naturally reinforcing outcomes. • use instructional prompt judiciously, and fade them rapidly. To keep children from depending on adult assistance and direction, use the least directive and intrusive prompt that ensures successful skill performance. Fade the prompt as quickly as possible without disrupting performance. • Distribute learning trials naturally. Capitalize on teaching opportunities that occur within natural school routines and activities. • Use common materials for instructions. Teach with materials frequently found in preschools, child-care settings, and the homes of young children. Arrange for children to practice with these materials across many settings in the classroom .

Visual supports

Visual supports encompass a wide variety of interventions that involve visual cues and prompts that help students perform skills with greater independence and accuracy

Teach and Provide Opportunities for Independence

While interdependence is appropriate and normal in human relationships, we expect children to become increasingly independent as they grow. • Give children choices whenever possible, and teach choice making when necessary. • Picture schedules can help some children learn to follow the sequence and duration of daily activities. • Because it is easy to overlook nonverbal children, give them frequent chances to respond to teacher initiations. • Maintain high expectations for all children. Celebrate small victories, and immediately "up the ante," and all the while believing that the child has the ability to reach the next objective.

Teach Communication and Social Competence

Without communication and social interactions among children, an inclusive program may provide little more than parallel instruction. • Provide systematic instruction in imitation skills. Imitation is critical to learning from and relating to others. Embed imitation training throughout the day in small groups, opening circle, gym, and outdoor play. • Plan opportunities for students with disabilities to interact directly with typically developing peers. For example, at opening circle, begin with a desirable toy such as a jar of bubbles and then help all children share the toy directly with other children instead of passing the toy from child to teacher to child.

Picture activity schedules

a series of images, photos, icons, video clips depicting activities a child can perform, present in sequence - can help students independently select and carry out a sequence of activities in the classroom. picture activity schedules to increase their independence in selecting and carrying out a sequence of activities in the classroom, Video modeling

idiopathic autism

the etiology, the cause, is unknown

mutism

unwillingness or refusal to speak, arising from psychological causes such as depression or trauma.

echolalia

verbatim repetitions of what people around them have said and noncontextual speech phrases without any apparent communicative purpose

overselective

the tendency to focus on a minute feature of an object or a person rather than the whole.

who can diagnostic autism

developmental pediatrician, a psychologist, a psychiatrist, neurologist

Asperger's disorder (DSM-IV)

1. At the mild end of the autism spectrum; 2. The most distinctive feature of Asperger syndrome is impairment in social areas, particularly an inability to understand how to interact socially; 3. Deficits in the use of nonverbal behaviors related to social interaction such as eye gaze, facial expression, gestures, body posture, and judging personal space; 4. do not have general language delay; 5. most have average or above-average intelligence. A developmental disorder characterized by normal cognitive and language development with impairments in all social areas, repetitive and stereotypic behaviors, preoccupation with atypical activities or items, pedantic speech patterns, and motor clumsiness. 1. normal cognitive and language development 2*. impairments in all social areas; 3. repetitive and stereotypic behaviors; 4. preoccupation with atypical activities or items; 5. pedantic speech patterns; 6. motor clumsiness

Autism (IDEA)

1. Autism means a developmental disability affecting verbal and nonverbal communication and social interaction; 2. generally evident before age 3; 3. adversely affect the child's educational performance. 4. engagement in repetitive activities or stereotyped movement; 5. resistance to environment change or change in daily routines; 6. unusual responses to sensory experience;

pervasive developmental disorder not otherwise specified (PDD-NOS) (DSM-IV)

1. Children who meet some but not all of the criteria for autistic disorder are often diagnosed as having PDD-NOS; 2. have significant impairments in socialization with difficulties in communication or restricted interest.

EDUCATIONAL APPROACHES

1. Critical Importance of Early Intensive Behavioral Intervention(EIBI), Lovaas' research; 2. Applied Behavior Analysis (ABA); 3.Visual supports ;

other skills needed in GE classroom

1. Display near-zero levels of problem behavior (16); 2. Participate and learn in group lessons (16); 3. Complete assigned tasks independently (or with minimal teacher assistance) (15); 4. Interact with peers appropriately (13); 5. Comply with classroom rules/follow the teacher's directions (12); 5. Get the teacher's attention/assistance appropriately (11)

5 strategies of effective instructions for children with ASD in GE classroom

1. Teach Communication and Social Competence; 2. Use instructional strategies that maintain the Class's Natural Flow; 3. Teach and Provide Opportunities for Independence; 4. Build a Classroom Community That includes All Children; 5. Promote Generalization and Maintenance of Skills

Resource and Special Classrooms

1. The general education classroom is not the least restrictive environment for all students with ASD; 2. most student need receive a highly individualized program of intensive, specialized instruction focused on the social/ communication, self-control, and independence skills; 3. resource room is the settings they can receive intensive, specialized instruction focused on their individualized educational plan (IEP) goals and objectives; 4. goals of using resource room: high frequency instruction, transferring control stimuli to natural stimuli, generalizing the skills, monitoring (daily review) the performance.

Intellectual functioning

1. about 70% to 80% of individuals with autistic disorder also meet the diagnostic criteria for intellectual disabilities; About one-half of those individuals function in the severe or profound range of intellectual disabilities; 2. low-functioning autism and high-functioning autism to differentiate individuals with and without intellectual disabilities; 3. Uneven skill development; 4. 10% to 15% of children exhibit "splinter skills"; 5. 10% of people with autism have savant syndrome; 6. overselective; 7. Obsessive attention on a specific object or activity; 8. strong aptitude for rote memory for certain things;

4 techniques of effective instructional practice

1. choral responding and response cards (for participating in group instruction); 2. self-management (for completing assigned tasks and following rules and directions); 3. collaborative learning activities such as class wide peer tutoring (for interacting appropriately with classmates); 4. recruit teacher attention/assistance;

Asperger Syndrom

1. do not have the deficits in language and overall intellectual functioning; 2. are highly verbal and often have superior intelligence; 3. 90% have SIAs (special interest area) • Intense interest in a particular subject, often atypical things or parts of things (e.g., deep-fat fryers, ZIP codes, washing-machine motors) to the exclusion of everything else; • Clumsiness, difficulty with fine- and/ or gross-motor activities; • Inflexible adherence to routines; • Fascination with maps, globes, and routes; • Superior rote memory, tendency to amass many related facts; • Speech and language impairments in the areas of semantics, pragmatics, and prosody (volume, intonation, inflection, and rhythm); pedantic, odd speech patterns; formal style of speaking; • Difficulty understanding others' feelings; • Extensive vocabulary, reading commences at an early age (hyperlexia); • Perfectionist, frustrated when asked to submit work they believe is below standard;

factors of increasing number of autism disability

1. greater awareness of ASD, 2. changes in federal and state policy and law favoring better identification and reporting of autism, 3. improved screening and assessment procedures, 4. greater availability of services for the diagnostic category, 5. changes in the definition and diagnostic criteria to a spectrum of related disorders that includes children with milder forms of autism who would not have been identified in earlier years, 6. diagnosis shift (increase autism, decrease other disabilities); 7. an actual increase in the incidence of the disability

Warning Signs during 1 to 1.5 years old

1. lack of pointing or gestures, 2. infrequent or poor-quality imitation of the caregiver's facial expression, 3. no single words by 16 months, 4. lack of smiling, 5. not responding to name being called, 6. lack of joint attention, 7. loss of previously acquired language or social skills. 8. engage in repetitive and stereotyped patterns of specific behaviors; 9. showing obsessive interest in certain objects, activities, or parts of objects. usually have a typical development during the 1st year, then between 12 and 15 months of age: 1. showing an oversensitivity to certain sounds or touch; 2. no longer seemed to understand even simple words or gestures; 3. became increasingly withdrawn, aimless, and perseverative;

Causes

1. no medical and physiological marker; 2. 95% are idiopathic autism; 3. no evidence on parenting factor; 4. biomedical: neuropathology, genetic inheritance, environmental toxins that invade the central nerve system; 5. clear biological origin for autism in the form of abnormal brain development, structure, neurochemistry; 6. Autism clearly has a genetic component; having one child with autism greatly increases the chances of having another child with autism. A recent study found that parents who have a child with autism have a 19% chance overall (26% for males and 9% for females) of having a second child who will also be affected. These findings are considerably higher than the level of risk of 3% to 8% reported in previous sibling recurrence studies; 7. complex inheritance. This means that multiple genetic factors are likely to be involved;

Identification and assessment

1. no medical test is available for ASD; 2. Determining whether a child has an ASD is based on professional assessment of behavioral characteristics per the DSM; 3. usually, parents will notice something wrong around 15 month; 4. can be reliably diagnosed at 18 month; 5. many are diagnosed until 5 or older; 6. Asperger is diagnosed (average) at 5.5 years old; 7. Early diagnosis is highly correlated with dramatically better outcomes; Screening: a). CHICKLIST FOR AUTISM IN TODDLERS (CHAT); b). MODIFIED CHECKLIST FOR AUTISM IN TODDLERS (M-CHAT); c). SOCIAL COMMUNICATION QUESTIONNAIRE (SCQ); d). AUTISM SPECTRUM SCREENING QUESTIONNAIRE (ASSQ) (high functioning, Asperger..); Diagnosis: a). CHILDHOOD AUTISM RATING SCALE(CARS); b). AUTISM DIAGNOSTIC INTERVIEW REVISED (ADI-R) AND AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS); c). ASPERGER SYNDROME DIAGNOSTIC SCALE (ASDS);

GE classroom

1. peer-mediation intervention is an evidence-based practice for children with ASD; 2. doing well in first grade have a much greater chance of continued success in school than do those who struggle in the first grade; 3. Early intervention is very helpful; 4. Teacher implements evidence-based practice for preventing challenging behavior and replacing it with adaptive responses; 5. Intervention practice apply to entire class, increase the chances for teacher to use it;

2 domains of autism manifested in:

1. persistent deficits in social communication and social interaction; 2. restricted, repetitive patterns of behaviors, interests or activities

Behavior problems

1. property destruction, aggression toward others(biting, scratching, and kicking.), and even self-injury; 2. sleep problems (delayed onset of sleep, brief sleep duration and night walk); 3. Food and eating problem (narrow food preference, refuse to eat, choke, gag, and spit out food); 4. pica

childhood disintegrative disorder (DSM-IV)

1. shares behavioral characteristics with autistic disorder; 2. the condition does not begin until after age 2 and sometimes not until the child has reached age 10; 3. Medical complications are common; 4. the prognosis for significant improvement is usually very poor.

3 or 4 most important skills needed by a student with ASD for success in the regular classroom

1. transitioning from one activity to another without fuss, 2. being able to retain large amounts of auditory information, 3 dealing with thin schedules of adult attention and reinforcement, 4. self-care skills such as toileting and eating.

unusual Responsiveness to Sensory stimuli

70% to 80% of individuals with autism exhibit abnormal reactions to sensory, hypersensitivity, hyposensitivity, combination, highly variable across settings and situation, from day to day, or moment to moment

behavior trap

An interrelated set of contingencies of reinforcement that can be especially powerful, producing substantial and long-lasting behavior changes. Effective behavior traps include four essential features: (a) They are "baited" with virtually irresistible reinforcers that " lure" the student to the trap; (b) only a low-effort response already in the student's repertoire is necessary to enter the trap; (c) once inside the trap, the student is motivated by interrelated contingencies of reinforcement to acquire, extend, and maintain targeted academic and/or social skills; (d) they can remain effective for a long time because students show few, if any, satiation effects

Build a Classroom Community That lncludes All Children

Classrooms should be learning communities where everyone makes a valuable contribution and has something to learn. • Use activities that will engage children with a large range of abilities. Plan open-ended activities that use preferred materials, support many responses, and address strengths of children with disabilities. • Allow every child to have a tum and play a role. For example, every child, including children with autism can take a tum being in charge of handling out materials. This puts the children with disabilities on an equal footing with others in the group and requires them to be communicative partners with peers.

Placement

During the 2008-09 school year, 1. 36% general education classrooms, 2. 18% served in resource room programs, 3. 36% separate classes, 4. 10% special schools or residential facilities

Critical Importance of Early Intensive Behavioral Intervention

Early intensive behavioral intervention (EIBI) has helped some children with ASD learn communication, language, an social skills so that they have been able to succeed in GE classroom. Lovaas' work: 1. discovered and validated at least some of the factors that can be controlled to help children with autism achieve normal functioning in a general education classroom; 2. spur wide-ranging interest and research funding; 3. the successful outcomes provided a legitimate basis for hope and encouragement for parents and teachers desperate to learn how to help children with autism.

savant syndrome

Extraordinary ability or knowledge in a particular area (e.g., memorization, mathematical calculations, drawing, music) while functioning at the intellectually disabled level in all other areas

Autism Spectrum Disorder (DSM-IV, Diagnostic and Statistical Manual of Mental Disorder)

Group of 5 related developmental disorders that share common core deficits or difficulties in social relationships, communication, and ritualistic behaviors; differentiated from one another primarily by the age of onset and severity of various symptoms; includes 1. autistic disorder, 2. Asperger syndrome, 3. Rett syndrome, 4. childhood disintegrative disorder, 5. pervasive developmental disorder not otherwise specified (PDD-NOS) Autism spectrum disorder (ASD) is a group of related neurodevelopmental disorders of childhood marked by persistent deficits in social communication and interaction, and by restricted, repetitive patterns of behavior and interests.

Use instructional strategies that maintain the Class's Natural Flow

Instead of isolating children with disabilities to provide individualized instruction, teach within the context of developmentally appropriate activities and routines. • Use naturalistic teaching procedures. Instruction should involve activities that are interesting to students, take advantage of child-initiated interactions, and use naturally occurring consequences. • Use different cues and prompts to ensure that each child receives adequate support. Provide only what help is required so the children do not become dependent on teacher assistance.

Positive Attributes and Strengths of Students with ASD

Some people with autism spectrum disorders have described positive aspects of their disability, such as sensitivity to detail and intense interest in topics which can be assets to functioning in some environment.

Applied Behavior Analysis

The science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change. ABA provides a scientific approach to designing, conducting, and evaluating instruction based on empirically verified principles describing functional relationships between events in the environment and behavior change. ABA uses behavioral principles such as positive reinforcement to teach children skills in a planned, systematic manner. Children receive repeated opportunities to practice and use their new skills across the day, settings, people, and situations.

weak central coherence

The tendency to attend to individual details rather than integrate them into a gestalt or "big picture'' is a key element of a neuropsychological theory in autism

Impaired Social Interaction

difficulty perceiving the emotional states of others; expressing emotions; forming attachment and relationship; young, lack of joint attention;

benefit to use social stories

before events or activities, provide social stories will: 1. decrease the child's anxiety; 2. improve the child's behavior; 3. help child understand the event from other's perspective.

social stories

explain social situation and concepts, and the expected behaviors of people involved, in a format of understandable to a child with ASD. teachers and parents can use social stories to 1. describe a situation and expected behaviors, 2. explain simple steps to achieve the certain goals or outcomes, 3. teach new routines and anticipated actions. social stories could not currently be considered an evidence-based practice. Sufficient positive outcomes have been attained with social story interventions to date, however, and the method should be considered a promising practice. Social stories may be most effective when part of multicomponent intervention that includes other elements such as response prompts, feedback, reinforcement, and self-recording of desired behavior. An intervention for teaching social skills that uses individualized stories usually constructed with one sentence per page accompanied by photographs or simple line drawings depicting a social situation from the viewpoint of the student. Often used with children with autism spectrum disorders to decrease anxiety about the situation, help the child learn relevant social cues and the expected behaviors, explain how to behave to achieve desired outcomes from the situation and help understand the event from the perspective of others.

Insistence on Sameness and Perseveration

no changes in place and routine, talk incessantly, ask a same question over and over again

discrete trial training (DTT)

one-on-one sessions during which a routinized sequence of contrived learning trials is presented as teacher and child sit at a table. An instructional format involving a series of three-part trials: (a) an antecedent stimulus (e.g., flashcard with "2 + 2 = ?"), (b) student response (e.g., "four"), (c) feedback (reinforcement for a correct response; ignoring or correcting an incorrect response; and providing a response prompt or ignoring nonresponses). Each sequence of antecedent stimulus, child response, and consequence (or feedback) is a trial. DTT is the method of Socratic dialogue; DTT is not ABA, ABA can be done without DTT.

Repetitive, Ritualistic, and Unusual Behavior Patterns

rocking their bodies when in a sitting position, twirling around, flapping their hands at the wrists, flicking their fingers, sniffing at the air, humming a set of three or four notes over and over again, gazing at his cupped hands, staring at the light, spinning an object, clicking the ballpoint pen, etc...

stereotype

stereotype, a pattern of persistent and repetitive behaviors.

4 types of sentences to write social stories

written at the student's level of comprehension, usually written in 4 types of sentences from the perspective of student: 1. Descriptive sentences (identify the contextual variables of the target situation. Example: I can't interrupt when other is having a conversation or busy with something); 2. Perspective sentences (describe the reactions and feelings of others about the situation. Example: Interrupting makes people angry because you stop them from talking and they may forgot what they were talking about); 3. Directive sentences (describe the desired behavior with respect to a specific social cue or situation. Example: If it's extremely important, I can tap person on the shoulder and say excuse me, otherwise I must be patient and wait until they are finished); 4. Affirmative sentences (express shared belief or reference a rule or law about the situation to reassure the individual. Example: Everyone deserves to talk without being interrupted)

strategies for teaching autism derived from ABA

• Strategies for shifting control over a student's responses from contrived stimuli used in training to naturally occurring stimuli in the student's environment. • Alternative forms of communication such as the Picture Exchange Communication System (PECS) . • Teaching practices for spoken and written language based on a functional analysis of verbal behavior • Peer tutoring interventions for building academic and social relationships , • Strategies to increase active student responding during group instruction, • Self-management tactics, • Methods of errorless discrimination learning, • Functional assessment of challenging behavior, • Functional communication training, • Naturalistic strategies for teaching language and social skills .

Unproven treatment fads for children with autism thrive

• when the available treatments are not producing cures for the majority of those treated; • when the underlying cause of a disorder is unknown or mysterious; • because hope and need are far stronger motivators than reason or skepticism; • when we lean too much on the authority, fame, or niceness of those promoting the fads; • because often, neither parents nor the professionals they consult understand what constitutes credible evidence.