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  1. What is autism spectrum disorder (ASD)?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interactions and social communication and by restricted, repetitive patterns of behavior. (NAC)

  1. Are there any known causes for ASD?

Although one specific cause of ASD is not known, current research links ASD to biological or neurological differences in the brain. ASD is believed to have a genetic basis, although no single gene has been directly linked to the disorder. Researchers are using advanced brain- imaging technology to examine factors that may contribute to the development of ASD. MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) scans can show abnormalities in the structure of the brain, with significant cellular differences in the cerebellum. (NAC)

  1. How common is ASD?

The number of diagnosed cases of ASD and related disorders has dramatically increased over the past decade. The most recent studies (CDC, 2014) report that ASD occurs in approximately one in every 68 births. ASD is one of the most common serious developmental disabilities, and is almost five times more likely to occur in boys than in girls. (NAC)

  1. What are some possible “red flags” for ASD?

Autism spectrum disorder typically appears during the early years of life. Early assessment and intervention are crucial to a child’s long-term success. We encourage you to talk to your pediatrician about concerns. (NAC)

Early warning signs include:

  • no social smiling by 6 months
  • no one-word communications by 16 months
  • no two-word phrases by 24 months
  • no babbling, pointing, or meaningful gestures by 12 months
  • poor eye contact
  • not showing items or sharing interests
  • unusual attachment to one particular toy or object
  • not responding to sounds, voices, or name
  • loss of skills at any time

Signs of ASD in older children might include difficulty making friends, appearing awkward in social interactions, having difficulty understanding others’ social cues and emotions, and having trouble with conversations around topics that are not of interest to them. These symptoms may be present for other reasons, such as dealing with the complex social world of adolescence. However, the presence of these symptoms may suggest the need for further evaluation.

  1. Is medical diagnosis of ASD necessary for an individual to qualify for special education services at school?

In the education setting, children with ASD receive services under the educational classification of “Autism”. School teams can and should conduct educational evaluations for ASD if the student is demonstrating some of the characteristics associated with a diagnosis of ASD. The education team must have members who are familiar with ASD. The team cannot make a diagnosis, but they can identify the student as eligible for special education services under the category of “Autism”. For Louisiana schools, eligibility guidelines are outlined in Bulletin 1508, which may be found at http://bese.louisiana.gov/documents-resources/policies-bulletins

  1. What is the treatment for ASD?

There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better. (NINDS)

  1. What is an evidence-based practice (EBP)?

Many interventions exist for students with ASD. Yet, scientific research has found only some of these interventions to be effective. The interventions that research has shown to be effective are called evidence-based practices (EBPs). One reason for using EBPs is because, by law, teaching practices must be based on evidence of effectiveness. (NPDC) For a list of EBPs, see the National Professional Development Center on Autism Spectrum Disorder. (link to http://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrum-disorder .

  1. Why could ASD be associated with aggressive and challenging behaviors?

Since behavior is often a form of communication, many individuals with ASD (as well as those without ASD) voice their wants, needs, or concerns through challenging behaviors, rather than words. Whenever challenging behavior occurs, it is important to consider its purpose, or what is most often called its function. Although some behavior is biologically driven, much behavior is learned over time and through experiences, and shaped by what happens before and after the behavior takes place. Common functions of behavior include: social attention, escape/avoidance, seeking access to tangibles/activities, and sensory stimulation (Autism Speaks). To identify the function of a behavior, a Functional Behavior Assessment (FBA) should be conducted.  For more information about FBAs, see http://afirm.fpg.unc.edu/node/783

  1. Can medication help individuals with ASD?

No medications can cure ASD, but sometimes medication id prescribed to treat specific symptoms associated with ASD. These symptoms may include anxiety, depression, aggression, and compulsions. It is important to work with health care professionals with experience in treating individuals with ASD as their reactions to drugs may differ from the general population.

  1. How does ASD affect communication?

Individuals with ASD often are self-absorbed and seem to exist in a private world where they are unable to successfully communicate and interact with others. They may have difficulty developing language skills and understanding what others say to them. They also may have difficulty with nonverbal communication, such as gestures, eye contact, and facial expression.

Not every individual with ASD will have a language problem. An individual’s ability to communicate will vary, depending upon his or her intellectual and social development. Some may be unable to speak, while others may have rich vocabularies and be able to talk about specific subjects in great detail. Most individuals on the spectrum have little or no problem pronouncing words. The majority, however, have difficulty using language effectively, especially for social purposed. Many have problems with the mean and rhythm of words and sentences. They may also be unable to understand body language and the nuances of vocal tones. (NIDCD)

  1. Do vaccines cause autism spectrum disorder (ASD)?

Many studies that have looked at whether there is a relationship between vaccines and autism spectrum disorder (ASD). To date, the studies continue to show that vaccines are not associated with ASD. (CDC)

  1. Would my child/student with ASD benefit from being in an inclusion setting at school?

YES! Inclusion is about offering the same activities to everyone, while providing support and services to accommodate people’s differences. One of the most obvious advantages of inclusion is the fact that students with disabilities can be integrated socially with their peers. Students with disabilities can also benefit academically in an inclusion setting. (Autism Speaks)

  1. What is Peer-Mediated Instruction and Intervention (PMII)? How can it help my child/student that is diagnosed with ASD?

Peer-mediated instruction is used to teach typically developing peers ways to interact with and help learners with ASD acquire new social skills by increasing social opportunities within natural environments. With PMII, peers are systematically taught ways of engaging learners with ASD in social interactions in both teacher-directed and learner-initiated activities (English et al., 1997; Odom et al., 1999; Strain & Odom, 1986). (NDPC ASD)

  1. Why are visual supports important for children/students with ASD?

The main features of ASD are challenges in interacting socially, using language, and having limited interests or repetitive behaviors. Visual supports help in all three areas.  First, children with ASD may not understand social cues as they interact with others in daily activities. Visual supports can help teach social skills and help children with ASD use them on their own in social situations. Second, children with ASD often find it difficult to understand and follow spoken instructions. Visuals can help parents communicate what they expect. This decreases frustration and may help decrease problem behaviors that result from difficulty communicating. Finally, some children with ASD are anxious or act out when their routines change or they are in unfamiliar situations. Visuals can help them understand what to expect and will happen next and also reduce anxiety. (Autism Speaks)

  1. What can I do if my child/student has difficulty with transitions throughout the day?

Children with ASD may better handle transitions when they can predict what will happen next. This can be accomplished through the use of schedules. Schedules can be used anywhere — at home, in classrooms, during doctors’ visits, or on community outings. Schedules can be used for any activity — including leisure, social interaction, self-care, and housekeeping tasks. It is important for children and adolescents to possess prerequisite skills of picture identification (when using pictures) or reading (when using words/phrases) when considering use of schedules. (NAC)

  1. How can I help my child/student cope with challenging social situations?

Story-based interventions are a simple way to teach individuals with autism spectrum disorder (ASD) to manage challenging situations in a wide variety of settings. When using a story-based intervention, use written descriptions for:

• The target behavior 

• The situations in which the behavior should occur 

• The likely outcome of performing the behavior. This often includes a description of another person’s perspective. Although the information included in the story will vary based on your child’s cognitive and developmental level, some typical features include: 

  • Information about the “who/what/when/where/why” of the target behavior 
  • Being written from an “I” or “some people” perspective with the goal of increasing perspective-taking skills 
  • Discussion or comprehension questions to make certain the child understands the main points 
  • Pictures to enhance comprehension of the skills

Story-based interventions are often used with individuals who have acquired reading and comprehension skills, but may also be used with individuals with strong listening comprehension skills. (NAC)

  1. What is priming and when should I use it?

Priming is an intervention that helps prepare students for an upcoming activity or event with which they normally have difficulty. Priming can occur at home or in the classroom and is most effective if it is built into the child’s routine.

Does your child/student experience:

- Difficulty adapting to new learning situations?

- Difficulty with transitions?

- Avoidance behaviors when presented with materials or tasks?

- Difficulty interacting with adults and peers?

Priming is an effective strategy for increasing success with a variety of tasks such as comprehending new material, interacting with others and reducing behavioral problems due to anxiety caused by environmental changes. (NASDN)

  1. What are accommodations and modifications? Who is eligible?

Accommodations are changes to HOW students access instruction and demonstrate what they have learned. They can enable students with a disability to take the same kinds of tests and courses as nondisabled students and graduate with a standard diploma.

Modifications involve significant changes to WHAT the students are expected to learn and demonstrate in school. Modifications made in the elementary school may impact the type of diploma a student ultimately earns. When modifications are made to the curriculum in elementary school, a student may be unprepared to pursue the courses in middle school or high school that could lead to a standard diploma. Therefore, in elementary school, it is very important not to make modifications and lower expectations unless absolutely necessary.

Students who have been evaluated and found eligible for special education servcies are also eligible for accommodations and modifications. Professionals, family members, and the student work together on the IEP team to develop an individual educational plan (IEP). The IEP team looks at the student’s present level of performance and educational needs and decides what kinds of accommodations and modifications are needed. (FLDOE)

  1. How can I improve my child's/student's motivation at home or school?

The answer is reinforcement! Reinforcement increases the likelihood that a student will produce a certain behavior in the same way again. Reinforcement is typically thought of as providing a preferred item or activity to a child/student for behaving in ways that are productive and support their continued personal growth. This is a good way to keep the focus on students’ positive behaviors, with the added benefit of building rapport. Keep in mind students with ASD may not respond to typical reinforcers -  only the individual can define what his reinforcing to him/her.  If you're not sure what may be reinforcing, see the next question to learn about preference assessments. (CSESA)

  1. What are preference assessments and why should I conduct them?

Preference assessments are observations or trial-based evaluations that allow practitioners to determine a preference hierarchy. A preference hierarchy indicates which items are a child’s highly-preferred items, moderately-preferred items, and low-preferred items. Sometimes (but not always), the child’s most preferred items can be used to reinforce a child’s appropriate behaviors. For older children and typically developing children, it is often simple to determine potential reinforcers (i.e., items that will reinforce targeted behaviors). Often, you can just ask them what they like or want to work for! For younger children and children with disabilities, potential reinforcers are sometimes less obvious. Commonly assumed reinforcers—like tokens and social praise—might not be reinforcing for children with ASD and related disabilities. (Vanderbilt University)

    21. How does ASD affect communication?

Some children with ASD may not be able to communicate using speech or language, and some may have very limited speaking skills. Others may have rich vocabularies and be able to talk about specific subjects in great detail. Many have problems with the meaning and rhythm of words and sentences. They also may be unable to understand body language and the meanings of different vocal tones. Taken together, these difficulties affect the ability of children with ASD to interact with others, especially their typical age peers.

Some of the noted patterns of language use and behaviors that often occur in children with ASD might be:

Repetitive or rigid language. Some children with ASD may fluctuate voice tone; speaking in a high-pitched or sing-song voice or use robot-like speech. Often, children with ASD who can speak say things that are not related to the conversation they are having (e.g. a child may count from one to five repeatedly amid a conversation that is not related to numbers) or may use stock phrases to start a conversation or use language heard in a familiar movie, favorite TV show or video game. Echolalia occurs when a child continuously repeats words or phrases heard. Immediate echolalia is when the child repeats words someone has just said (e.g. the child responds to a question by repeating the question asked). Delayed echolalia occurs when the child repeats words heard at an earlier time. (e.g. when asking for a drink the child may say “Do you want something to drink?”)

Narrow interests and exceptional abilities. Some children may be able to deliver an in-depth monologue about a topic that holds their interest, but they may not be able to carry on a two-way conversation about the same topic. Others may have musical talents or an advanced ability to count and do math calculations. Approximately 10 percent of children with ASD show “savant” skills, or extremely high abilities in specific areas, such as memorization, calendar calculation, music, or math.

Uneven language development. Many children with ASD develop some speech and language skills, but not to a normal level of ability, and their progress is usually uneven. For example, they may develop a strong vocabulary in a particular area of interest very quickly. Many children have good memories for information just heard or seen. Some may be able to read words before age five, but may not comprehend what they have read. They often do not respond to the speech of others and may not respond to their own names. As a result, these children are sometimes mistakenly thought to have a hearing problem.

Poor nonverbal conversation skills. Children with ASD are often unable to use gestures—such as pointing to an object—to give meaning to their speech. They often avoid eye contact, which can make them seem rude, uninterested, or inattentive. Without meaningful gestures or other nonverbal skills to enhance their oral language skills, many children with ASD become frustrated in their attempts to make their feelings, thoughts, and needs known. They may act out their frustrations through vocal outbursts or other inappropriate behaviors. (NIDCD)

    22. What are some ways to support communication?

Every individual must have a form of communication. When children have noticeable speech delays,  parents and caregivers of the child should seek other ways to promote receptive and expressive language to occur. There are many different approaches, but the best treatment program begins early, during the preschool years, and is tailored to the child’s age and interests. Some children with ASD may never develop oral speech and language skills. For these children, the goal may be learning to communicate using gestures, such as sign language, or a symbol system in which pictures are used to convey thoughts. Symbol systems can range from picture boards or cards to sophisticated electronic devices that generate speech through the use of buttons to represent common items or actions. (NIDCD)

    23. My child/student is content to engage in solitary activities like her iPad.  Is there anything I can do to increase her interest in interacting with others?

iPad apps are visual and predictable - two things that make them appealing to individuals with ASD. Be careful not to interpret her intense interest in the iPad and possible social deficits as a lack of desire or an avoidance of social interaction. People can be noisy and unpredictable  - so sometimes the presence of others may be disconcerting or disturbing to individuals with ASD.  While communication skills are critical to eventual social competence, even individuals with significant receptive and expressive language challenges can still work on basic social skills, for example, observing and imitating the behaviors of others during routines. 

What are some of the things to consider when addressing social skills?

  • Consider beginning by utilizing a social skills checklist to assess where your child/student is and what skills come next.  Check out the Autism Social Skills Profile 2 by Scott Bellini or Jed Baker’s Assessment for Social Skills Training: Social Skills Menu Once you identify skills that your child/student needs to learn, scaffold skills in appropriate developmental sequence, provide evidence-based supports (e.g., visual supports, video modeling, peer mediated instruction and intervention), opportunities for practice, and direct teaching.
  • Be aware that free play, recess, and other unstructured times can be the most difficult times for children with ASD.  You may need to teach skills in more structured settings in the beginning then generalize them to more complex settings.
  • Recognize that a student with ASD may have anxiety before, during, and after social situations.  This may result in avoidance or inappropriate behaviors. Building competence and confidence is essential to reducing this anxiety. You will likely have to provide additional reinforcement to build these skills. 

For more strategies, visit Autism Speaks.

     24.  I’ve tried a visual schedule to help my student/child with transitions, but he/she is still exhibiting challenging behaviors. Any other strategies/supports I can try?

Whether at home, school, or in the workplace, transitions naturally occur frequently and require individuals to stop an activity, shift their attention, and refocus on something else.  Transitions may also involve physically moving from one location to another. Individuals with autism spectrum disorder (ASD) may have greater difficulty in shifting attention from one task to another or in changes of routine. This may be due to a greater need for predictability (Flannery & Horner,1994), challenges in understanding what activity is coming next (Mesibov, Shea, & Schopler, 2005), or difficulty when a pattern of behavior is disrupted. A number of supports to assist individuals with ASD during transitions have been designed both to prepare individuals before the transition will occur and to support the individual during the transition. (Indiana Resource Center for Autism, IRCA)

Here are some strategies you can try to support transitions for your child or student.

  • Priming is exposure to information or activities that an individual is likely to find difficult. For example, you can prime (prepare) your student/child for an upcoming change by telling them the change is about to occur or use visual supports to help them understand when the change will happen.
  • Visual supports/cues can help facilitate transitions and provide understanding and predictability. It is always a good idea to have a visual schedule to help the individual see the sequence of the day.  Another helpful visual could be a “stop light visual” to help the individual understand when he/she is supposed to engage in the activity (green), when the activity is about to end (yellow), and when the activity has ended (red). You can also use a cue card to signal that the transition is about to occur to prepare the individual. The cue card could be a picture of a clock, the next activity, or a check schedule icon.
  • Sometimes carrying a familiar object through each transition can add to a sense of predictability and comfort during the transition. The individual can either keep the object throughout the day, or get the object after they have completed an activity to move with them to the next activity. 
  • It may be helpful for individuals with ASD to “see” how much time remains in an activity before they will be expected to transition.  Visual timers help make the abstract concept of time visual and therefore more concrete.
  • A “finished” box can be placed in a designated location where individuals place items that they are finished with when it is time to transition.
  • It will also be helpful to create a “finish later” folder to help individuals understand that there will be a designated time later in the schedule to complete unfinished work.  This often helps them move on even when they have not completed an assigned task.
  • For more strategies, visit https://www.iidc.indiana.edu/pages/Transition-Time-Helping-Individuals-on-the-Autism-Spectrum-Move-Successfully-from-One-Activity-to-Another

     25. I’m concerned that my student/child may be getting bullied at school. What are some steps I can take to address the situation?  

Unfortunately, children with ASD are especially vulnerable to bullying. A 2012 study by the Interactive Autism Network found that a total of 63% of 1,167 children with ASD, ages 6 to 15, had been bullied at some point in their lives. Because individuals with ASD may not realize that they are being bullied or may be unable to communicate what is happening at school or in the community, the first step is to get the conversation started so they understand what bullying means and why it is not okay. You may have to break down bullying in simple terms or use different visual supports for the individual to recognize the signs of bullying.  Here are some steps outlined by Autism Speaks:

1. Start the Conversation

Teach your child or your student to know the difference between appropriate and inappropriate treatment from classmates. Make sure your child feels comfortable telling you when he or she feels bullying may be happening. Encourage him or her to talk to you about his or her feelings at school. Be supportive.

2. Develop a Plan

Your child's IEP is a great resource you can use to combat bullying. You can work with your team to map out precautions to put in place to prevent bullying, as well as procedures to stop it if it does happen. The IEP should include mechanisms to keep your child safe based on his or her unique abilities and challenges.

3. Teach Tolerance

It is of utmost important for educators and administrators to teach tolerance in schools. The environment at school sets the tone for how potential bullies behave and how safe students who may be bullied feel. Develop lesson plans to teach students about the importance of tolerance and the effects bullying can have on individuals. Bring in speakers so students can learn more about celebrating differences like disabilities.

4. Increase Awareness and Acceptance

One good way to increase awareness and acceptance at school and in the community is by educating the students and staff members. Though some parents may not feel comfortable doing so, others have found that teaching classmates about their child's disability has helped prevent bullying, as well as made their child feel more accepted by his or her peers. It can help to work with your child's school on this as well. 

5. Speak Up

Whether you are a parent and you know your child is bullying, a teacher who sees that bullying is happening at school or a student who feels that you are being bullied, the first thing you should do is speak up! Let school administrators know about what is happening and tell them that bullying is a violation of the individual's rights, as well as his or her IEP. If the school isn't doing enough to stop the bullying and prevent it from happening again, you can reach out to an advocacy organization for assistance.

 

     26. What is the best way to teach my child/student a new skill?

The best way to approach teaching a new skill is to first determine what the components of that skill are. So for example, what are the components of brushing teeth or tying a shoe? You analyze the skill to determine the individual steps involved.  This is called task analysis.  Task analysis allows an individual to work on the task one part at a time instead of trying to master the whole task at once (Szidon & Franzone 2009). Task analysis has been identified as an evidence based practice for individuals on the autism spectrum but can be useful for all learners and is frequently used to teach self-help and other adaptive skills.

Here are the steps for implementing task analysis as a teaching strategy.

  • Determine what you want to teach or the target skill – for example brushing teeth, turning on the iPad and opening an app, or even asking a peer to play)
  • Determine if there are any pre-requisite skills the student may need to be able to learn the target skill.  For example, for tooth brushing the individual would have to be able to grasp and hold an object for several minutes.  If you determine there are pre-requisite skills the individual does not yet have then you either need to teach them or provide an accommodation.  For grasping the toothbrush, you might utilize an adapted toothbrush that wraps around the hand and does not require gripping.
  • Next you break the skill into steps or components.  Sometimes it helps to perform the skill yourself and record each step or observe someone else completing the task.
  • Determine how you will teach the task.  Are you going to teach the first step first (forward chaining) or the last step first (backwards chaining), what kind and how much prompting will the  student need to be successful,  what other evidence-based strategies will you use to support learning (e.g., visual supports, reinforcement, peer modeling, video modeling)  and what data you will keep to monitor progress. This YouTube video illustrating task analysis and chaining may be helpful to you.
  • Once the individual has become independent with one step of the task, you move on to the next step until all steps can be completed independently.
  • Work on generalizing skills to different settings, using different materials and with different instructors. 

For more information on implementing a task analysis go to the National Professional Development Center on Autism Spectrum Disorder.

References:

Autism Speaks – www.autismspeaks.org

Centers for Disease Control and Prevention (CDC) - www.cdc.gov/ncbddd/autism/index.html

Center on Secondary Education for Students with Autism Spectrum Disorder (CSESA) - http://csesa.fpg.unc.edu/

Florida Department of Education (FLDOE) - http://www.fldoe.org/

Indiana Resource Center for Autism (IRCA) - https://www.iidc.indiana.edu/pages/irca

National Autism Center (NAC) - www.nationalautismcenter.org/

National Institute of Neurological Disorders and Stroke (NINDS) – www.ninds.nih.gov

National Institute on Deafness and Other Communication Disorders (NIDCD)- www.nidcd.nih.gov/

National Professional Development Center on Autism Spectrum Disorder (NPDC) http://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrum-disorder

Nebraska Autism Spectrum Disorders Network (NASDN) - http://www.unl.edu/asdnetwork/

Vanderbilt University - http://vkc.mc.vanderbilt.edu/ebip/

 

 

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