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What is the Autism Spectrum?

Val Zore

Autism is a neurodevelopmental condition which affects the brain’s growth and development. It is a lifelong condition, with symptom that appear in early childhood.

What can autism look like for someone:
-Challenges with communication and interacting with others
-Repetitive and different behaviours, moving their bodies in different ways
-Strong interest in one topic or subject
-Unusual reactions to what they see, hear, smell, touch or taste
-Preference for routines and dislike change
-Autism can affects the way that individuals interact with others and how they experience the world around them.
Every Individual on the Autism Spectrum is Different

‘If you’ve met one person on the autism spectrum, you’ve met one person on the spectrum.’
Prof Stephen Shore

No two people on the autism spectrum are alike. All people on the autism spectrum are different and will experience autism in different ways.

Secondary Conditions and Difficulties Associated with Autism

Some people on the autism spectrum may have other conditions as well, such as:
-speech and language difficulties
-intellectual disability
-sleep problems
-attention problems
-epilepsy
-anxiety and depression
-difficulties with fine and gross motor skills

There are other conditions that are associated with autism, including Fragile X Syndrome, Tuberous Sclerosis and other genetic disorders.

Understanding the Autism Spectrum

Autism can cause individuals challenges in understanding how to relate to other people and to their environment.

There is no physical marker for autism, so individuals on the autism spectrum look no different to anyone else. Parents sometimes report that others might think that their children are badly behaved and that they lack parenting skills, based on different behaviours, however this can be very unhelpful for a family.

Adults on the autism spectrum may struggle with social situations and ‘small talk’, thus appear rude or say things that others would not say. However, as social interaction is fluid and constantly changing, people on the autism spectrum may have challenges in keeping up with the verbal and non-verbal messages that are begin communicated.

Autism Spectrum Facts
-Autism affects around 1 in every 100-110 people.
-Autism is diagnosed in around four times as many males as females.
-Autism is a lifelong condition and there is no cure.
-Unemployment rates for individuals on the autism spectrum are around 65% compared with only about 6% for the whole population.
-Individuals on the autism spectrum are over-represented in the homeless population and in the justice system.
-On the positive side, early intervention can have tremendous results in helping those affected to live to their full potential.
-For older individuals, timely and meaningful support, advice and information can also be critical to quality of life outcomes.

Common Names for the Autism Spectrum

The term “Autism Spectrum Disorder” includes Autism/Autistic Disorder, Asperger’s Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS). These specific terms are often required for funding purposes.

Other terms you might hear are “high functioning autism”, “classic autism”, “Kanner Autism” or “atypical autism”.

Note: the latter terms are not thought to be very useful for diagnosis and treatment, and most diagnosticians tend to use the term Autism Spectrum Disorder to describe the varied presentation of individuals on the autism spectrum.

What are the Causes?

There is no known cause of autism. Much research is being done to try to find out more. At this point it is believed to result from changes to the development and growth of the brain, which may be caused by a combination of factors, including environmental and genetic ones.

There is an increased chance of having another child on the autism spectrum if there already is a child in the family who has a diagnosis, but no specific genes have yet been proven to cause autism.

Autism is not caused by parenting or social circumstances.

Autism is not caused by vaccination or other medical treatment.

Source:http://www.amaze.org.au

Working with individuals on the Autism Spectrum

GPs and the Autism Spectrum

The general practitioner is usually the first port of call for an individual or a parent/carer the is concerned about the development of their child.

GPs need to have a good understanding of the autism spectrum (including Autistic Disorder and Asperger’s Syndrome), what common traits to look for and what the next steps are.

Find out more about the Autism Spectrum

As general awareness of the autism spectrum improves, the medical community is better able to recognise the signs, and diagnosis in pre-school children is increasing, with improved early intervention therapies providing a high level of assistance.

However, there are still individuals who do not receive a diagnosis until they are at school, at high school, or later in life. This is often the case where characteristics are less severe, where speech is not delayed or in girls and women, where the autism spectrum is not as likely to be the suspected.

Funding is provided through DSS, DOHA and DEEWR and support is available to children who have a DSM-IV diagnosis of Autistic Disorder, Asperger’s Disorder or, Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) or a DSM-5 diagnosis of Autism Spectrum Disorder (ASD).

Maternal and Child Health Nurses, Practice Nurses & School Nurses

As with GPs, nurses are well placed to notice developmental and behavioural differences in children, especially those who have the time to observe children regularly, as is the case in schools, local practices and child health centres.

It is therefore important to have a good understanding of the autism spectrum and to be able to identify characteristics that may signal the presence of it, and to refer parents to their GP or to a paediatrician for further assistance.

Occupational Therapists

Individuals on the autism spectrum often require the assistance of an occupational therapist (OT), depending on the issues they experience.

The Autism Spectrum is such that individuals may have advanced skills in one area, but very limited skills in another. It is not unusual for an individual, for example, to be able to play a musical instrument, but not to be able to put their shoes on and there are many other similar examples of skills developing at very different rates.

As with all learned skills, it is possible for individuals on the spectrum to learn and make advances, with the right supports.

Occupational therapists assist individuals on the autism spectrum with the following:
-Sensory processing – helping individuals with their sensory and motor skills such as spatial awareness, body awareness and motor planning
-Fine motor skills – such as using scissors, pre-handwriting skills
-Gross motor skills – to improve strength, balance and coordination in physical activities
-Self care skills – such as dressing
-Social skills – play skills and interacting with peers

In addition, OTs may assist with visual perception, cognition, equipment advice and prescription, life skills and recreational advice.

To provide the best possible assistance to individuals on the autism spectrum, we recommend that OTs attend training and read more about the condition.

Speech Pathologists

A major characteristic of the autism spectrum is difficulty with communication.

Some individuals on the autism spectrum are non-verbal whilst others have good verbal skills but difficulties with the social aspects of language, or have good language but lack understanding and their ability to communicate is impaired. Some are able to use alternative communication methods and have good communication skills but struggle with speech.

Another common characteristic of the autism spectrum is difficulty with social skills and this is can be closely allied with speech and communication difficulties.

While some individuals do not learn to speak, there are many stories of individuals making tremendous progress in this area with the right supports and therapies. Often, techniques such as signing and other communication methods, assist with speech development.

A speech pathologist is part of the multi-disciplinary team that makes a diagnosis of autism.

Speech pathologists work with individuals on the autism spectrum in the following areas:
-Receptive language – how the individual understands information given verbally or in written form
-Expressive language – how individuals express their needs and wants, thoughts and feelings. This can involve using picture symbols, signs, gestures or communication devices.
-Articulation – how the individual makes the sounds that make up words
-Social skills – understanding the unwritten social rules of conversation
-Cognitive skills – problem solving, making predictions and making inferences

Speech pathologists also assist with stuttering, eating and drinking, saliva control, voice and phonological awareness (such as rhyming skills).

To provide the best possible assistance to individuals on the autism spectrum, we recommend that speech pathologists attend specific autism training and read more about the condition.

Psychologists

Psychologists assist in two main areas with individuals on the autism spectrum:
-Diagnosis and assessment
-Treatment and intervention

Diagnosis and Assessment

Psychologists are part of the multi-disciplinary team that provides the assessment and diagnosis of autism. They will be involved in assessing the individual’s overall level of mental/cognitive development, in assessing the individual’s patterns of strengths and weaknesses, observing behaviour and social interaction, and in interviewing family members about the development and behaviour of the individual.

Treatment and Intervention

Psychologists are able to provide a range of treatments to improve:

-Behaviour strategies – working with individuals and/or their parents, carers, teachers, to encourage appropriate behaviours and reduce or eliminate inappropriate behaviours
-Social skills – working with individuals and/or parents/family members to encourage social skills
-Help with anxiety and mood – working with individuals and/or parents/family members to help with relaxation and mood improvement
-Planning and monitoring – developing a plan that other therapists, teachers and family members implement with the individual
-Support – assistance for other family members including parents and siblings to cope with the demands that living with an individual on the autism spectrum places on the whole family

To provide the best possible assistance to individuals on the autism spectrum, we recommend that psychologist attend training and read more about the condition.

Psychiatrists

A psychiatrist assesses an individual’s physical and mental health and development and looks for any medical conditions that may be associated with the autism spectrum.

The psychiatrist may order further tests, such as blood tests, to help diagnose certain conditions. Psychiatrists will also ask the individual or their family members questions about their development and the family history to help them to make a diagnosis of autism.

Psychiatrists may also diagnose mental illnesses such as depression or anxiety, which individuals on the autism spectrum may also display. It is important that psychiatrists making a diagnosis have a good understanding of the autism spectrum and other developmental conditions.

After the diagnosis Psychiatrists will continue to monitor their patients’ progress and development. They may make referrals to other professionals, such as psychologists or speech pathologists.

In some case Psychiatrists may prescribe medications for their patients. There are no medications to treat autism, but medications may help with associated problems, such as anxiety, depression, inattention and sleep problems.

Paediatricians

Paediatricians who specialise in the Autism Spectrum are part of the multi-disciplinary team that makes a diagnosis of autism in children and adolescents up to 17 years old.

Paediatricians assess children’s health and development and look for any medical conditions that may be associated with the autism spectrum. They may order further tests, such as blood tests, to help diagnose these conditions. Paediatricians will also ask parents questions about their children’s development and the family history, to help them to make the diagnosis.

It is important that paediatricians making a diagnosis have a good understanding of the autism spectrum and other neurodevelopmental conditions.

After the diagnosis paediatricians will continue to monitor their patients’ progress and development. They may make referrals to other professionals, such as psychologists or speech pathologists. In some case they may prescribe medications for their patients.

There are no medications to treat autism, but medications may help with associated problems, such as anxiety, depression, inattention and sleep problems.

Neurologists

The Autism Spectrum is a neurodevelopmental condition and it may be the case that individuals with certain characteristics of the autism spectrum are referred to neurologists for assistance.

Neurologists may also be asked to conduct tests such as EEGs and MRIs on individuals with the autism spectrum to assess for the presence of any underlying or associated brain abnormalities or to make a differential diagnosis between the autism spectrum and other conditions that may have similar symptoms.

While there are no specific neurological tests for the autism spectrum, neurological conditions such as epilepsy can be present in individuals on the autism spectrum. Neurologists need to be aware of the characteristics of individuals on the autism spectrum that may make it more difficult for them to cope with or cooperate with neurological testing.

Dentists

One of the characteristics often present in individuals on the autism spectrum is a difference in their responses to sensory stimuli – individuals may be hyper-sensitive or hypo-sensitive. This can make a visit to the dentist a lot more of an issue than it is for the general population.

If you are notified that your patient is on the autism spectrum, you can familiarise yourself with the condition so that you know how to help them. You may not be notified that your patient is on the autism spectrum, or you may be told that they have sensory issues. It is a good idea to find out as much about the specific sensory issues as you can from the patient or their parents/carers.

Schools and Education

The Autism Spectrum is very broad: some children attend mainstream schools, others attend specialist development schools, whilst others attend a mixture of both.

It would be unusual for any school not to have students on the autism spectrum present.

Therefore, the better prepared the school is, the better the experience for students on the autism spectrum, their teachers and other students.

Individuals on the autism spectrum have certain needs, which require understanding. Teachers, school nurses, welfare staff and education support staff are well placed to notice developmental and behavioural differences in students. Whilst parents are only familiar with their own child or children, you will have experience of many children, and differences may be more obvious to you.

Autism can make the world a very confusing place and an individual on the autism spectrum may experience high levels of anxiety. If they are unable to express this, it may manifest as a ‘meltdown’ or inability to cope with the situation.

Strategies for Students on the Autism Spectrum

Many of the typical strategies that assist students on the autism spectrum work very well with all students.

For example, a student on the autism spectrum may have difficulty choosing from multiple activities: instead, if they are offered just two choices, the decision can be easier to make. This same strategy works equally well with all students, especially young children.

Routine and Interruptions

Children on the autism spectrum like order and routine and find it very difficult when their day is disrupted or changed without notice.

For example, if an emergency teacher takes their class, they may find this extremely upsetting. Whilst for other students, this might be an enjoyable change, for a student on the autism spectrum, it can lead to high anxiety levels and stress.

This can be helped greatly by warning the students that there will be a different teacher, giving as much time as possible for them to take this in. Once again, this is something that not only helps the individual on the autism spectrum, but helps all students.

Preference for Visual Learning

As with the general population, the majority of students on the autism spectrum have a preference for visual learning: comprehension of visual information is understood better than verbal (auditory) information.

Visual timetables and visual representations of classroom rules are often a great help for students on the autism spectrum, and once again, help many other students as well.

Supporting the student

Education support staff may be employed to assist individuals on the autism spectrum: however, there is often little training provided.

Autism is a spectrum condition that differs from individual to individual, so it is important to understand the diad of impairments and sensory sensitivities that individuals on the autism spectrum are likely to experience.

We strongly recommend that you find out as much as you can about the student you are working with, from the child’s parents as a start. The parents know their child better than anyone and can tell you about their specific support needs. We also recommend that you undertake training and read as much as you can about the condition.

Source:http://www.amaze.org.au

What is Childhood Apraxia of Speech?

Val Zore

Childhood Apraxia of Speech (or CAS as we refer to it as), is a type of speech disorder that occurs in children, although it is rather uncommon. It is different than other speech disorders because it is neurologically-based, meaning it has to do with problems with the nervous system. Though it is important to keep in mind that this is not a problem that can be seen by a neurologist on a scan. Childhood Apraxia of Speech cannot be diagnosed by typical neurological scans. It is more of a hidden disorder.

How Is Apraxia Different from Other Speech Sound Problems?

Most children with speech problems either have trouble physically making the sounds (like an /r/ distortion or a lisp on the /s/ sound) or they have trouble with entire groups of sounds, like replacing all long sounds like /f/ and /s/ with short sounds like /p/ and /t/. Children with CAS have a different type of speech problem. Children with CAS know what they want to say but when their brains send the message to the motor-planning part of the brain (the part of the brain that tells your muscles to move), the signal gets all mixed up and doesn’t make it to the mouth correctly. There’s a problem with the wiring!

Let’s think of it in terms of your car. Imagine you’re driving down the road and you realize that you need to turn left. You know that you need to turn on your left blinker so you tell your car to turn on the blinker (by pushing that little stick down). But, for some reason, the wiring in your car is all mixed up so instead of your blinker turning on, your clock starts flashing instead (true story: I had a car that did that once). You planned for the car to do one thing (turn on the blinker) but it did something else instead (flashed the clock). So you try again. This time, when you hit the blinker your headlights turn off. WHAT?? Every time you turn on your blinker, something different happens.

Can you imagine how frustrating that would be? That’s how these kiddos feel because they know they want their mouths to say something but every time they try it comes out differently. Sometimes it’s absolutely correct and clear as day, but then when they try to say that exact same thing again, they can’t do it.

That means children with CAS have trouble with the precision and consistency of speech movements even though the muscles and reflexes in their mouths are working just fine. (Think about our car analogy again: there’s nothing wrong with the light bulb in the blinker, it’s the wiring that’s the problem). However, young children with CAS are also lacking in the knowledge of how to move their mouths to create the different sounds because they have never been able to do it consistently before.

Without practice, the mouth doesn’t know what to do which is further complicated by the fact that the wiring is crossed. Therefore, it’s very important for these kiddos to get excellent feedback on how to move their mouths to say the sounds and whether or not they are saying it correctly. This feedback helps the brain figure out which paths to strengthen (for the wiring) and where to put the articulators (lips, tongue, etc.).

What Causes Childhood Apraxia of Speech?

Childhood Apraxia of Speech can be caused by a number of different causes or by seemingly nothing at all! Some CAS cases have been attributed to brain damage, such as a traumatic head injury or a near drowning. Other CAS cases have been linked to a “complex neurobehavioral disorders”, which is a fancy way to describe changes in behavior that come from a problem with the brain. These include attention deficit disorder and autism spectrum disorders. And then again, many cases of CAS have no known cause.

The problem with CAS is that no one has really been able to nail down a definite description of the disorder. Research on the topic is still rather limited so there is no formal definition of the disorder or even diaganostic criteria. That is to say that no one has been able to agree on a set of symptoms that say “Yes, this child definitely has childhood apraxia of speech”. For that reason, diagnosis of this disorder can be very tricky and two professionals may disagree on if a child does or does not have the disorder. Plus, many therapists feel ill-equipped to diagnose and treat CAS due to this confusion.

The 3 Criteria for Childhood Apraxia of Speech

That being said, there are three criteria which are gaining some consensus among investigators at the time that I am writing this (Summer of 2015). Hopefully there will be more definite criteria in the future, but the most commonly-accepted features currently are:

1.Inconsistent errors on consonants and vowels in repeated productions of syllables or words (meaning that if the child says the same word many times, it may sound differently each time)

2.Lengthened and disrupted coarticulatory transitions between sounds and syllables (meaning that the child’s speech sounds choppy or disconnected due to trouble transitioning between sounds or between words in older children)

3.Inappropriate prosody, especially in the realization of lexical or phrasal stress (meaning that the rhythm, intonation, and stress of speech may sound off, the child may sound robotic, have incorrect phrasing, or stress the wrong words or syllables)

Keep in mind that since this is not an official definition, no one is saying that a child MUST have all three of these to qualify for the diagnosis and there are definitely more symptoms and features that may be present aside from these. Also, a single child may show these symptoms more or less depending on the difficulty of the task that he/she is doing as well as how stressful the situation is.

Possible Other Characteristics of Childhood Apraxia of Speech:

In addition to the three features mentioned above, there is a less commonly-agreed on set of characteristics that have been reported in some children with CAS. These characteristics are not always there and children without CAS can also have them, but the presence of many items from this list may point to CAS being the more likely diagnosis.

-Reduced vowel inventory
-Vowel errors
-Increased errors in longer or more complex syllable and word shapes (especially omissions, particularly in word-initial position)
-Groping
-Unusual errors that “defy process analysis,”
-Persistent or frequent regression (e.g., loss of words or sounds that were previously mastered)
-Differences in performance of automatic (overlearned) versus volitional (spontaneous or elicited) activities, with volitional activities more affected
-Errors in the ordering of sounds (migration and metathesis), syllables, morphemes, or even words

How is Childhood Apraxia of Speech Diagnosed?

A childhood apraxia of speech diagnosis should be given cautiously. There is still much unknown about this disorder and diagnosis can be very tricky. This condition is very rare and many children are being given this diagnosis when they really just have a severe phonological or articulation disorder. A certified speech-language pathologist is capable of making a CAS diagnosis but you want to make sure that they have special training and experience with this population.

What are the Treatments for Childhood Apraxia of Speech?

Children with CAS benefit immensely from speech therapy from a certified speech-language pathologist. The following video will give you a brief overview of what we would include in therapy for a child with CAS.

What are the Treatments for Childhood Apraxia of Speech?
Children with CAS benefit immensely from speech therapy from a certified speech-language pathologist. The above video will give you a brief overview of what we would include in therapy for a child with CAS.

Source:https://www.speechandlanguagekids.com/childhood-apraxia-speech-resource-page/

What is an Expressive Language Delay?

Val Zore

Expressive language delay (ELD) is a broad diagnosis that simply means that a child is having trouble using language in some way, shape, or form. Since this diagnosis is so broad, each child with this diagnosis looks very different. Some have difficulty putting words together to form sentences. Some have difficulty using the correct vocabulary and words. Others have difficulty sequencing information together into a logical manner. There are all types of different expressive language symptoms and each one is treated quite differently. This page will give you links to information that will help you with one of these areas.

What Help is Available for Children with Expressive Language Delays?

Language therapy from a certified speech-language pathologist can be crucial for children with expressive language delays. For whatever reason, these children are having trouble learning a particular part of language and they require additional assistance to pick that skill up.

However, there is no one-size-fits-all approach to expressive language delay therapy. Instead, the child’s specific problems within the category of “expressive language” are addressed. Each skill that the child is missing is taught explicitly. Instead of waiting to see if the child will learn that part of language on his own, the speech therapist jumps in and provides therapy to fix the problem.

Below are the different areas covered under “expressive language delay” and links to resources and activities that address that specific area.

Or, check out my e-book that contains lesson plans for a variety of expressive and receptive speech and language skills:

Late Talkers!!

A child who is late to begin talking may be described as having an expressive language delay. For the young child who isn’t speaking yet, he has no expressive language (unless he is using sign language or another alternative means) so therapy is focused on increasing his ability to use language to communicate. Here is more information on late talkers:

How to Jump Start Your Late Talker: 8-Week Program for Late Talkers

Sequencing

Many children with expressive language delays have trouble organizing their language so that what they say makes logical sense. They may have trouble sequencing past events when telling a story or putting steps to an activity in a logical order. This can make their conversation very difficult to follow. Here are some activities and resources that are great for teaching sequencing skills:

Using Descriptors

Children with expressive language delay (ELD) can have difficulty using descriptors correctly. Descriptors like adjectives and adverbs can add color to our language and help us make our point more clearly, and in a more interesting manner. Children with ELD may either leave these words out all together or use them incorrectly. Here are some resources and activities for teaching descriptors:

Grammar Skills

Many children with expressive language delay also have trouble with using correct grammar. They may omit grammatical markers or use them incorrectly. These are the smaller words and word parts that string together the larger words to make meaningful sentences. Without these words, the child’s speech may sound telegraphic or choppy. Teaching proper grammar is also a great way to increase sentence length for a child who speaks in very short sentences.

Pragmatics/Social Skills

A child may be described as having an expressive language delay if they have trouble with social skills, also known as pragmatics. These children may have difficulty knowing what language to use to interact appropriately with other children. Here are some resources on pragmatics and social skills:

Answering and Asking Questions

The ability to answer questions correctly requires quite a bit of language skills. First, the child has to understand what the question being asked means. Then, the child must process that question and formulate an answer. Finally, the child must speak that answer in a logical manner. Children with expressive language delay often have difficulty with this process. They may also have difficulty asking questions with correct word order and in a coherent manner. Here are some resources for those children:

Vocabulary

Children with expressive language delay may also struggle to learn new words and expand their vocabularies. These children may need extra help to learn words, remember words, and recall them when they need to use them. Here are some great resources on vocabulary:

Figurative Language

Children with language delays often have difficulty understanding and using figurative language such as idioms, similes, and metaphors. Click the link below to find out how to teach these to a child:

Making Inferences

Children with language delays often have difficulty making inferences about what’s going on around them or when they are reading. Click the link below to learn more about helping a child make inferences:

Selective Mutism
Selective mutism is when a child has the ability to speak and will speak in at least one setting (usually home) but refuses to speak in another setting (usually school and/or in public). Treatment for selective mutism is very different from treatment for other speech and language delays.

Source:https://www.speechandlanguagekids.com/expressive-language-delay-resource-page

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