Autism Spectrum Disorders Network News

January 15th, 2010 Issue 20

Autism: Trying to Make Sense of It!

Inside this issue: Typing the word “Autism” into any popular internet search engine results in approximately seventeen million hits. Clearly, there is no shortage of information on the topic of autism. However, things become more complex when we notice contradictory arguments on almost every topic related to autism. Communication Corner 2 This article aims to identify the central factors leading to disparity amongst autism findings.

Behaviour Strategies 2 Is autism an epidemic? Teacher Tip 2 Current research places the autism prevalence rate in the United States at 1 out of every 150 live births (Pediatrics, 2009, p 1395-1403), compared to rates of 1 out of 1000 in 1990. There are two competing Read All About it! 3 hypotheses to explain this increase. Dr. Grinker (2007), an anthropologist, argues that the rise in inci- dence is not an autism epidemic, but rather can be attributed to better diagnostic tools, increased aware- Psychology Tip 3 ness among medical professionals and families, as well as the adoption of social and financial policies helping people with autism. However, other scientists assert that better diagnostic tools account for Try This! 3 only a small fraction of the dramatic increase in numbers; the rest is due to a true rise in the incidence of autism due to environmental factors. In summary, then, the debate regarding whether autism is an Hot Off The Press 4 epidemic rests on the percentage that various researchers attribute to the broadening of the definition and increased knowledge in the area of autism versus the percentage attributed as due to a true increase WWW 4 in the number of people who have autism.

Coming Soon 4 What is the most effective treatment for autism? Student Corner Applied Behaviour Analysis is often touted as being the only scientifically proven method to treat au- tism. Other families indicate that interventions such as medication, the gluten-free, casein-free (GFCF) diet, Relationship Developmental Intervention (RDI), not to mention Sensory Integration have had a positive impact on their children with autism. There is no accurate response as to which treatment is ASD Team Members: the most effective because it is so difficult to perform quality research in this area (Research Autism,

● Patricia Assouad 2009). For one, many children who have autism are involved in more than one therapy at a time. Sec- ASD Consultant ondly, placebos have shown measurably positive impacts on many children who have autism. In addi- tion, in terms of some specific therapies, the theory on the ideal intervention techniques differs greatly ● Dr. Andrew Bennett from the standard of care that is actually observed in practice. It appears as if more than one interven- Psychologist/Coordinator tion can play a positive role in helping a child who has autism and that there exists a question of good-

● Katie Cohene ness of fit that needs to be individually examined for each child. ASD Consultant Why are individuals with autism fighting against the very organizations that are representing them? ● Joëlle Hadaya Many individuals who have autism have accepted their diagnosis as part of their identity. These indi- Occupational Therapist viduals would like to be accepted for who they are. Most autism advocacy groups, however, focus on just the opposite. Their goal is to promote research that is focused on finding a cure for autism or on ● Jovette Francoeur Consultant for Special Needs / interventions designed to make children “less autistic.” Michelle Dawson, a researcher who has autism, Co-Coordinator explains that in order to get services, many activists are inaccurately and negatively portraying a bleak outcome for individuals who have autism and do not receive ABA. Everyone agrees that there is a huge ● Christina Kyriakidou need for autism services. But the important need for services is not an excuse to associate a diagnosis of ASD Consultant autism with fear and despair. As Michelle Dawson says in an interview for the Ottawa Citizen (2007), ● Jade Lawsane “Accurate information is always good for autistic people. It might not be good for advocates, it might ASD Consultant not be good for researchers, it might not be good for funding bodies, but it is always good for autistic people." ● Helene Packman Speech and Language Jade Lawsane Pathologist References: Ottawa Citizen, Autism. December 1, 2007.; Dawson, M. (2004). The Misbehaviour of Behaviourists. http://www.sentex.net/~nexus23/naa_03.html; Grinker, R. R. (2007). Unstrange Minds. Basic Books: Massa- chussets.; Kogan, M.D. , Blumberg, S.J., Schieve, L.A., Boyle, C.A., Perrin, J.M., Gandhour, R.M. & al. (2009). Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007. Pedi- atrics, 124, 1395-1403.; www.researchautism.net (2009).

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Communication Corner: The Social Thinking Curriculum Students with High Functioning Autism or Asperger’s have a Step Two: You think about why that person is near you. Is that per- social cognitive learning disability. Students with average to above son just sharing space? (In an elevator) Do they need to get by you? average I.Q.’s on standardized tests can still have significantly im- (In a grocery store to reach an item on the shelf) Do they want to talk paired social skills. Many of the programs developed to teach social or ask a question? Do they want to harm you in any way? These are skills have limited success with students with Autism because things that we need to think about to keep safe and to predict what although they teach responses in social situations, they do not explic- might happen next. itly teach the cognitive underpinnings that are so critical to successful Step Three: You wonder what the person is thinking about you. social interactions. Michelle Garcia Winner (1997) has coined the Step Four: You monitor your behaviour so the person you are with term social thinking and has developed the social thinking treatment will think about you the way you want them to think about you. Neu- approach. This approach focuses on the cognitive processes that rotypical people are constantly regulating their behaviour to make occur during a social interaction that are “hard wired” into the sure that people have “normal” thoughts about them most of the brains of neurotypical individuals. Students with social thinking time. deficits need to be taught these skills through direct teaching. One of the critical skills that needs to be taught is perspective These four steps occur before we speak. We are participating socially taking. Winner developed the “Four Steps of Perspective Taking”². even when we are not talking. Most go through these four steps automatically without paying much For more information refer to: Winner, M. (2007). Thinking About You nd attention to the process and we do so within a few seconds. Thinking About Me, 2 Edition. San Jose: Think Social Publishing, Inc.

Step One: When someone enters into your space you immediately Helene Packman, Speech-Language Pathologist have a little thought about them and they have a little thought about you. ²http://www.socialthinking.com/articles/the-four-steps-of-perspective- taking.html Teacher Tip Competencies such as communicating effectively and working collaboratively can be challenging for students with ASD regardless of their age and level of functioning. One way to help students develop these competencies in the inclusive classroom is to focus on one social skill each week. The skill is illustrated & posted in the classroom, it is announced at the beginning of the week and examples are shared about what the social skill looks like, sounds like and feels like. Ideally, students would have the opportunity to role play or view videos of the social skills & practice it during the week. It is important to acknowledge & praise positive examples. Some of the themes for the social skill of the week could be: cooperation, sharing, participation, being a friend, helping others, being patient, following directions, taking turns, remaining on task, accepting differences, listening, etc. Have fun! Behaviour Strategies: Using the SOCCSS In 2004, Brenda Smith Myles and her colleagues described the sequence. Ask the student “What do you think would happen if SOCCSS activity (Situation-Options-Consequences-Choices- (option)?” Strategies-Simulation) in their book “The Hidden Curriculum”. 4. Choices: Student prioritizes the list of options and conse- The SOCCS sheet is intended for use with higher functioning quences by number or a yes/no response. The student must students with autism in order to help them develop an under- choose the most appropriate option that they are more likely to standing of social situations and problem-solving techniques. It should be filled out with the student immediately after they have do in a future similar situation. made a social error. It is important to remember that if the stu- 5. Strategies: Student develops a plan, which includes fixing the dent is agitated or reacting following an incident, give them a few current situation, so that they know how to proceed the next time minutes to calm down and regroup. The SOCCSS should really they are in such a situation. be done when the student is mentally available to receive the in- formation. 6. Simulation: Student practices their plan in a variety of ways e.g. talking, drawing, writing, role-playing, etc.

Fill out the sheet using the following six steps: 1. Situation: Students identify the who, what, where, when, To borrow a copy of “The Hidden Curriculum” or the SOCCSS and why of the incident. please ask your Consultant for Autism. 2. Options: Student brainstorms different options that could be chosen in such a situation. Reference: Myles, B., et al. (2004). The Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations. Autism 3. Consequences: For each option, the student identifies a con- Asperger Publishing Company: Shawnee Mission, KS. Issue 20 Page 3

Read All About It! If you are a busy teacher, integration aide or technician working for the first time with a child who has autism, a helpful resource is the book, “Ten Things Every Child with Autism Wishes you Knew,” by Ellen Notbohm (2005). This short, easy-to-read book very simply describes the sensory processing challenges, speech and language deficits, social interaction difficulties and self-esteem issues of students who have autism and offers practical strategies for addressing these core features. It can serve as a basic guide to understanding and facilitating learning for students who have autism.

To borrow this book or any other item in the ASD Resource library, please consult your Autism Consultant.

Psychology Tip The Diagnostic and Statistical Manual of Mental Disorders (DSM) Fourth Edition is the psychiatric manual that is used to diagnose psychological disorders. The DSM-IV is currently undergoing revisions for the fifth edition that may have implications for the way in which Autism Spectrum Disorders (ASD) are defined and diagnosed. The workgroup is considering reducing the three applicable diag- noses (Autism, Asperger Syndrome and PDD-NOS) to a single diagnosis of ASD, which would encompass the full continuum of im- pairments observed among individuals in the autism spectrum. Experts are on the fence as to whether the movement away from sepa- rate diagnoses represents a valid reflection of clinical reality and what the implications may be for diagnosis and services. For a discus- sion on the impact that these changes may have on the autism community, please see the recent article in the New York Times (http:// www.nytimes.com/2009/11/03/health/03asperger.html) .

Try This! Individuals with autism have a difficult time interpreting social situations. We can increase understanding of social situations and teach socially appropriate responses to higher functioning students using comic strip conversations developed by Carol Gray (1994). Comic Strip Conversations are a visual way to represent social interactions and conversations between two or more characters. A comic strip format is used to depict a conversation that took place and what the people in the conversation may have been thinking by using speech and thought bubbles. This technique can be used:

 To convey important information

 For problem-solving and conflict resolution

 To learn social skills

 To follow simple classroom rules

 To communicate perspectives, feelings and ideas A comic strip conversation should describe the event that caused the problem, label the feelings and thoughts of everyone involved and, finally, provide a solution to the problem and ideas on how to avoid it in the future. The more involved the student is in creating the comic strip, the more helpful it will be to him/her in future situations. Other fun ideas:  Use the student’s favorite character to enhance effectiveness (e.g. Spiderman or Sponge Bob)  Use colour to code the conversation. Example: RED– bad ideas/teasing/anger; GREEN–good ideas/happiness; BLACK–facts.  Allow your student to record conversations into a notebook which they can refer to at different times to recall key concepts.

References: Gray, C. (1996) Comic Strip Conversations. Arlington, TX: Future Horizons; http://www.thegraycenter.org/store/index.cfm? fuseaction=product.display&product_id=41 Autism Spectrum Disorder Team Page 4 Autism Spectrum Disorders Network News

Our team is comprised of many professionals with a variety of specializations. Designated as a Centre of Excellence within the province, our mandate is to assist LBPSB schools in the implementation of best practices for the inclusion of students with an ASD and to serve as a resource to the other English school boards in Quebec. Our team provides assistance to students and families and works to support educational personnel in augmenting their capacity to meet a Lester B. Pearson School Board wide range of needs in the classroom. We do this through direct intervention, 1925 Brookdale Avenue coaching, consulting, professional development, and the sharing of materials. Dorval, Quebec Phone: 514-422-3000 Fax: 514-422-3014 We’re on the web! E-mail: [email protected] http://www2.lbpsb.qc.ca/eng/asdn/index.asp Hot Off the Press! WWW: Social Skills Parents, educators and clinicians all work hard on a daily basis to im- http://www.cccoe.net/social/skillslist.htm provides a wide range of prove the lives of individuals who have autism using an array of strategies lessons on social skills for home, school and on the job. The step by and intervention techniques. But in the article, “The Primacy of Trust,” step student rubric is a good tool to use as a guide, memory aide or Prizant and Carley (Autism Spectrum Quarterly, Winter 2009) assert the script for teaching social skills to students. importance of gaining the trust of persons who have autism. They indi- cate that “the person with ASD will change most certainly after trust has The ICAN (Interactive Collaborative Autism Network) site offers been earned.” Having good intentions, working hard and learning about on-line instructional modules on autism spectrum disorders (ASD). autism does not automatically equate to gaining the trust of individuals Each module consists of an introduction, lecture, quiz, frequently who have autism. This article outlines 8 steps such as acknowledging asked questions (FAQs), glossary, and resources. It also contains a communicative attempts and celebrating successes that educators can forum that allows users to communicate with other ICAN users. adopt to facilitate the development of trust. Please visit their module on social interventions by following the To read this article or any of the Autism Quarterly Journals, please consult link: http://www.autismnetwork.org/modules/social/soccss/ the ASD Resource Library through your Autism Consultant. lecture01.html Coming Soon! The ASD team is proud to announce its second Parent, Professional & Student Seminar with Jack Strulovitch & Vicki Tagalakis, on February 2nd 2010 for Social Skills Groups for Adolescents with Autistic Spectrum Disorder at 1925 Brookdale Ave, Dorval (7:00—9:00 pm). Check out our website for more information. Student Corner We recently asked LBPSB students to create and submit a logo for the title “Fitting In: Social Skills Training”. Here are some of the entries (more to follow in the next issue) :

Dylan Tina William Grade: 8 Grade: 11 Grade: 3 Age: 14 Age: 17 Age: 9

“5 Hands” by Leo “The Eternal Smile” Grade: 11 By Patrick Age: 16 Grade: 9 Age: 15

Thank you to the students from John Rennie High School for preparing this newsletter for distribution.