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Domains of Autism

Restricted Patterns

Domain:  Restricted Patterns of Behavior, Interests and Activities

Restricted patterns of behavior, interests, and activities serve a purpose for persons on the autism spectrum.

1. Restricted patterns of behavior, interests, and activities serve a purpose for persons on the autism spectrum.  **When displaying such behaviors or activities, the individual with autism is not purposefully misbehaving, but exhibiting some anxiety, or trying to communicate. 

  • Strategies:
    • Define a time, place and duration for the behavior
    • Use the interest as a reward for completing tasks
    • Help make the connection from an interest to a job
    • Find an environment (group, club) where the interest is valued and explored. This will provide social practice. 

2. Tantrums:  Unfortunately for individuals with autism and their families, ‘tantrums’ and destructive behaviors are common, especially among children.  This is very important in autism, as it is unlikely that any behavior which causes difficulties for families and professionals is intended maliciously or vindictively. There is virtually always some other, unidentified, cause which provokes challenging behavior. It is worth noting that in most cases (although not all) individuals do not enjoy ‘being challenging’.  It is important to remember that ‘tantrums’ and similar behaviors are not rejections. They are not emotional blackmail or warfare aimed at those close to the individual. They are the natural reactions to various stimuli. Natural if you have autism that is. Disruption of routine or structure is only one trigger of such behavior.

  • Strategies:
    • Understand there may be underlying issues
    • Recognize if the behavior is serving as a way of communicating
    • Teach replacement skills through direct instruction
    • Set up structure and routine supported by visuals
    • Decide if the behavior is harmful or not and then ask “to whom”
    • Use interests as rewards

Sensory

Many people on the autism spectrum have difficulty managing their sensory input. They may over- or under-react to visual, tactile, and aural input – sometimes to the point where they are unable to participate in typical life activities. 

Strategies:

  • Visual Ideas -Tape visuals to a student’s desk.
  • Auditory Ideas -Use social stories about what might happen or sounds that can be heard in the room.
  • Tactile Ideas -Provide easy access to small hand fidgets.
  • Taste and Smells Ideas -When rewarding student with food or cooking time, use food they already like. Have a scented lamp, candle, lotions, liquid soap, scented markers or stickers available to smell to calm student.
  • Vestibular Ideas-Create heavy work activities (e.g. take down chairs in computer lab, take garbage out at lunch, and/or take a pile of encyclopedias to library).
  • Proprioceptive Ideas -Engage student in up and down movements (i.e. jumping rope, bouncing a ball, trampoline) to wake up student.

Heavy Work and Motion related activities that involve pulling, pushing, and pressure are calming to students while motion incorporated into these activities can be alerting.

Ideas: chair or wall push ups, wear a heavy backpack, carry a box of books, wash tables/desks, erase the board, push/stack chairs, open doors for others, sharpen pencils with manual pencil sharpeners, make deliveries to the office, fidget toys, stress balls, cutting cardboard/heavy paper, bounce on a therapy ball/mini-trampoline, jumping jacks, sit in a rocking chair while reading, do head/shoulder/neck rolls while sitting, stretch breaks, have the student push his/her feet into a thera-band placed around the legs of the chair, wiggle seat, and/or deep breathing. 

Links*:

This article says it is geared for K-6, but has several strategies to use at any grade level:

This site has a lot of classroom ideas!

   Sensory Processing Disorder 

Motor

Children with autism often have problems developing motor skills, such as running, throwing a ball or even learning how to write. Kids who have difficulty with motor skills might have trouble with what we think are simple things like brushing their teeth, buttoning, snapping or starting a zipper – things that are so basic to being independent, but would cause other problems at school. They would need to have an aide or someone helping them, and that would set them off as different from the other kids.

Some kids are not socially aware enough that it bothers them, but others are aware, and they feel bad about themselves.They may have low self-esteem, so even if they have delays only in the motor skills, there is a lot of impact on their well being into adulthood. 

Gross motor difficulties in children may be related to: 

  • proprioception problems (lack of awareness of body in space)
  • lack of motivation to participate
  • avoidance because of the social nature of many of the skills
  • limited strength or muscle endurance
  • lack of confidence or a fear of moving equipment
  • difficulty problem solving to develop skills

 Strategies: 

  • Break up seated tasks with movement/engage in physical activity before a seated activity
  • Have heavy objects/materials for the child to carry
  • Marching-high kneeling, sitting in place
  • Balance activities-walk on a line, backwards, stand still with eyes shut

 Some methods that therapists use when promoting motor development in children diagnosed with autism are: 

  • Teaching remedial exercises that are designed to encourage improvement with letter formation, appropriate spacing between words, and a functional pencil grasp.
  • Providing adaptations for writing as the child gets older, such as keyboarding options on a portable word processing device.
  • Working on basic fine motor skills by having the child lace on lacing cards, stack blocks, assemble nuts and bolts and string beads.
  • Address strength issues in the hands and fingers by having the child search for beads hidden in putty, squeezing and placing clothespins on the edge of a box or jar, squeezing on exercise balls and using the thumb and index finger to pop the bubbles on plastic bubble wrap.
  • Offering hands-on assistance when practicing tasks such as buttoning, holding utensils, and tying laces, and then fading that assistance as the child gains mastery of the skills.
  • Providing children with ample opportunity to work on physical coordination and balance through supervised use of playground equipment, such as climbing up steps and ladders, walking on balance beams and navigating jungle gyms.
  • Increasing arm and leg coordination with activities such as swimming and moving to music.
  • Developing hand-eye coordination by practicing athletic skills such as catching, throwing, or kicking balls.
  • Working on crab walks, hopping like a frog, and wheelbarrow walking with the child.
  • Having the child jump over a rope stretched out with several curves (like a snake). Instruct the child not to touch the rope or loose balance while jumping.

Links*: 

Biological

Medical and Biological 

A number of medical and behavioral issues frequently occur with autism spectrum disorder (ASD).  These may include anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), gastrointestinal (GI) problems, seizures, sleep disturbances and epilepsy. 

Children with autism or other developmental disorders have higher than expected rates of an even broader range of medical conditions. Specifically, these children are: 

  • 1.8 times more likely than children without developmental disabilities to have asthma

  • 1.6 times more likely to have eczema or skin allergies,

  • 1.8 times more likely to have food allergies,

  • 2.2 times more likely to have chronic severe headaches, and

  • 3.5 times more likely to have chronic diarrhea or colitis (inflammation of the colon)

Strategies:

  • It is very important to communicate with the families about what is happening in the classroom because the chances of the issue (behavior, work production, etc.) being medical or biological are high. 
  • Fitness, sleep, and nutrition can make big differences and significantly improve the lives of children with autism 

Links*:

FACT-BASED AUTISM INFORMATION: Biological Developmental Domain

This domain includes the physical growth, change, stability and diversity of the structures and functions of the human body and brain.

What are the different degrees or kinds of Autism?

While the level of this pervasive developmental condition ranges from mild to moderate to severe, Autism can represent very serious challenges for the individual with Autism, their family, and those in the community (teachers, etc). This is because Autism alters a person's learning and reasoning processes at a physical level in ways that create a very different perception of our outer environment, experience of our inner realities, and perspective of our human interactions as social beings and groups. Children and adults with Autism and related disorders most often show combinations of different levels of more or less severe, moderate, or mild degrees of their sensory, communication and social features. Any one person with Autism may have any or all of these three levels across these three features. By its very nature Autism represents both a diverse spectrum of individuals and a splintering of development within each individual. This is why understanding any one individual's true profile of Autism requires sharing of family and professionals observations over time and across settings.

A few people with Autism may show high or savant level skills in one or more of these sensory abilities. This is why in the early twentieth century people with severe Autism, but intact high splinter skills such as rote memory skills, music, math and art were labeled as Idiot Savants. While savant skills are impressive in children with Autism, maximizing or even maintaining such extreme splinter skills may come at the long term cost of some critical neurological forms of imbalances in developing other important knowledge, skills or abilities people with Autism can learn to live more typically and independently. While it is an individual judgment call (AND an emerging issue of social empowerment for self advocacy by the group of adults with Autism for their member group of children with AUTISM) savant skills probably should NOT be over-focused on in the hope of fostering exceptional giftedness, or other areas of development and independent functioning may seriously suffer.

What has the history of biologically-based research of this neurological condition revealed?

Changes in the size and thickness of the Cerebral Cortex. This is the big sheet of brain tissue that folds up to create the rib-like appearance of the brain. In people with retardation it is usually smaller in area dimension, while in some people with Autism it may be measurable bigger than normal. But the thickness and quality of the sheet may be thinner and atypical in its structure. The “association areas” where incoming messages from the senses are combined into meaningful impressions and interpreted in communication and social terms and responded to with outgoing motor behaviors are located across the cerebral cortex. This would account for the impairment of early learning and life span, executive and higher reasoning functions, as well as narrower high splinter skills common to some people with Autism. Very recent research confirms that some infants with Autism may have sudden periods of atypically large head size. This is an important finding that may someday reveal causes of the onset of Autism.

Changes in the neural fibers of the Corpus Callosum: This is the network of specialized nerve fiber that connects the hemispheres. These were seen as normal in early autopsies, yet later microscopic cellular scans showed atypical higher numbers of fibers than typical brains, but with poorer quality of the connecting cells. This could correlate to the difficulty in rapid automatic processing of information and integration of various mental functions in the brain seen in some people with Autism.

Changes in the functional activity of the Front Lobes: This area of the brain is very important but less understood in how it functions in typical people. It controls goal planning, following complex and reversable directions and task completion and what we see as emotional control and personality. It is atypically active/less active in people with Autism and ADD/HD. Yet this lower activity that may contribute to hyporesponsiveness to the environment can actually produce agitation and experiences of stress.

Changes in the functional activity of the Temporal Lobes: This area of the brain effects motivation as well as hearing, recognizing faces and smell, which include several are core symptoms of Autism such as auditory processing and poor recognition of faces, and facial expressions of emotional feelings and nonverbal social communications.

Changes in the structure of functional activity of the Limbic System: This is a ring of structures around the brain stem that effect sensory processing, reticular formation (which is the alert and arouse control of higher brain functions), and learning and emotional behavior. In typical people it has fewer longer loser type cells. However, people with Autism has shown to have more shorter tighter packed cell groups This would explain why people with Autism report being overwhelmed by input and their internal experience of thinking and feeling, even while the majority of their brains and response indicate a hypo arousal response pattern.

Changes in the structures and functional activities of the Thalamus: which controls processing of sensory input--except smell, the Hypothalamus, which produces and regulates motivation and emotion, and the Hippocampus and Amygdala which helps manage Information processing and integration in ways that effects behavior. All of these are shown to be involved in Autism.

Cognitive

Cognitive abilities may range from delayed, typical or gifted intelligenceSome cognitive differences for students on the spectrum may include:

  • weakness in abstract thinking
  • difficulty knowing what to pay attention to
  • generalizing a skill
  • Executive Dysfunction: difficulty in developing structure
    • knowing how to plan and organize
    • accepting change and adjusting plans
    • setting up materials for work
    • multiple step assignments
  • Weak Central Coherence: difficulty seeing the whole or being able to understand the big picture from pieces (i.e. listing facts about a war but not understanding how it changed the country)

STRATEGIES:

Visual Supports

  • picture directions of steps to follow can help with organization
  • graphic organizers to help students make connections to the big picture
  • visual schedules

Structured Work Settings: defined area that has visual reminders, personal space and organization

Clearly defined expectations:

  • teaching roles and routines
  • stating objectives and how we will accomplish them
  • explain steps, model them and practice

Analyze what you are asking students to do:

  • is the skill too hard?
  • has the skill been taught?
  • do you have the necessary supports?

Priming

  • preparing student for daily activity
  • reviewing schedule of changes, assignments and activities

It is important to capitalize on cognitive strengths that students with ASD present, such as intense interests and strong rote memory.  At the same time weakness in executive functioning (working memory, inhibition, planning, flexibility, task initiation, and self regulation), weak central coherence (integrating information into the whole), unevenness of skills, and difficulty with abstract concepts create difficulties in academic settings.  Academic demands must be adjusted in order to minimize the impact of these and other possible deficits.

Attention Deficit Tips:

  • Provide frequent reinforcement
  • Break larger projects into smaller, more manageable parts to facilitate work completion
  • Increase the pace of instruction and vary instructional methods
  • Reduce distraction by designating a quiet place to work
  • Allow for movement in the classroom and provide fidgets, snacks, or drinks of water

Central Coherence Deficit Tips:

  • Graphic organizers or spatial learning strategies such as webbing and mapping (this will make abstract material more concrete)
  • Word Banks “limits the forest” so that the student does have to think of and rule out all possibilities
  • Color coding uses the strength in visual processing to organize subjects or concepts
  • Highlighted materials aid in learner in recognizing key concepts among other details

Communication

A FEW Characteristics:

  • Verbal rituals and conversation rituals include:
    • Using same behavior to gain attention
    • Repeating the last word
    • Saying the same phrase or sentence repeatedly
    • Talking about the same topic repeatedly
  • In conversations, students on the spectrum struggle with considering the following:
    • Who is talking
    • What is said
    • How it is said
    • How the words related to what is happening, and
    • How the words relate to what we know
  • More likely to communicate for needs instead of pleasure
  • High language does not mean high communication
  • Students on the spectrum make associations between what they hear and what they see in the environment.
  • Ranges from a total lack of speech to developing language
  • Lack of non-verbal communication
  • Impaired ability to initiate and maintain interaction
  • Struggle to understand HOW to communicate
  • Lack joint attention
  • Poor generalization, very literal 

Tips and Strategies

  • WAIT TIME NEEDS TO BE CONSISTENT AND EXTENDED
  • Consistent and concise vocabulary among all conversation partners
  • Types of Augmentative and Alternative Communication (AAC) include:
  • Pictures, Big Mac Talkers, Dynavox, Ipads
  • STUDENTS MUST HAVE A WAY TO COMMUNICATE
  • Key ring flash card for visuals with conversation starters
  • Consistent and concise vocabulary among all partners
  • SCHEDULES
  • VISUALS
  • TAKE HOME JOURNALS

Social

LACK OF EMPATHY

According to Simon Baron-Cohen, many children with autism appear to lack a “theory of mind,” which is the ability to see things from another person’s perspective. This is a behavior cited as being exclusive to human beings above the age of five. Typical five-year-olds can usually develop insights into other people’s knowledge, feelings, and intentions based on social cues such as gestures and facial expressions. An individual with autism may lack these interpretation skills, leaving them unable to predict or understand other people’s actions or intentions. 

AUTISM, FRIENDSHIPS AND AFFECTION

Children with autism often experience social alienation during their school-age years. As a response to this, or perhaps because their social surroundings simply do not “fit” them, many report inventing imaginary friends, worlds, or scenarios. Making friends in real life and maintaining those friendships often proves to be difficult for those with autism. 

Children with Autism often seem to prefer being alone and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they seldom seek comfort from others or respond to parents’ displays of anger or affection in a typical way. Research has suggested that although children with Autism are attached to their parents, their expression of this attachment may be unusual and difficult to interpret.

TIP:

Be aware of the “Hidden Curriculum.” This is a set of unwritten rules that no one has been directly taught, but everyone knows. Violations of these can make an individual a social outcast.

For example:

  • A student getting bumped in the hall way may not understand that it was an accident, they should be taught to keep walking or say “excuse me.”
  • Don’t assume that students with ASD understand sarcasm, jokes, or figurative language. Often, these are things that need directly taught.
  • Making comments about another’s looks, smell, behavior could be inappropriate (even if it is true). Students need to be directly taught to keep some comments to themselves.

Social Skills

(The challenge of relating to others in an acceptable manner)

 A deficit in social skills can manifest in many ways. Some you may notice in your classroom are:

  • lack of reciprocity, or the give-and-take of conversation,
  • inability to initiate conversation,
  • lack of spontaneous sharing of interests and enjoyment,
  • inability to take the perspective of others,
  • lack of appropriate social pragmatics (i.e., proximity to others, body language, vocal tone, interruptions, and responses to facial and other physical gestures),
  • inability to understand humor, sarcasm and innuendo,
  • monologues on the individuals’ specific interests.
Strategies:
  • social stories
  • role-playing
  • video modeling
  • labeling and recognition of emotions in self and others

Links*:

Emotional

Children diagnosed with Autism Spectrum Disorders often have difficulty recognizing their own emotional states and the emotional states of others around them.

Because students with ASD often lack strategies to deal with emotions, the reactions to what happens to them often does not match their displayed emotion state.  Students with ASD display varied emotional vulnerability, often reporting feelings of stress, have difficulty tolerating mistakes and have low thresholds for frustration. Even though the emotional domain of autism is one of the most outward expressions of communication, with outbursts and classroom disruptions, little research has been done in this area.  Generally, we know that more time is needed to help students with ASD learn to identify, understand, and regulate their own emotions.

Strategy: Social Stories

What is a Social Story?

Carol Gray first defined social stories in 1991.  She states that a Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories developed should affirm something that an individual does well. Although the goal of a Story should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses.

Links*:

 

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