Notes related to Autism Spectrum Disorder Powerpoint presentation Slide 1: Understanding patterns of challenging behaviour in young people with autism spectrum conditions Title slide Slide 2: Personal reasons for studying the challenging behaviour of Autism Spectrum (ASD) Although I have not had very much experience with Autism Spectrum Disorder it is a subject which I have found interesting and wide ranging. I have read a great deal about ASD and have found that the literature is constantly changing with new practices for helping those with ASD to be part of society. Society is much more diverse and so it is essential to include everyone where possible and so understanding and studying ASD will be personally useful for my future career. Slide 3: Introduction: Facts to indicate the importance of understanding Autism Spectrum Disorder (ASD) In order to learn more about ASD it is important to understand ASD through its statistics and facts: Autism Spectrum Disorder (ASD) affects millions of individuals globally with about 1 % of the world population having some form of ASD (CDC, 2014). It affects men, women and children. Both genders can be affected but it is more prevalent in boys than girls. There is not always the support and guidance which is needed to assist them to live within society (Frith, 2003). This has present and future implications both personal and social. There are around 700,000 people on the autism spectrum in the UK which is more than 1 in 100 (National Autistic Society, 2017). It is the diversity of ASD which makes it so important to understand as although there are certain common characteristics, there are still individual aspects such as learning disabilities, mental health issues, considering the world as being overwhelming, anxiety in unfamiliar situations, eye contact, sensitivity to sounds, smells, tastes, touch etc and so these differences mean that the support needed is very diverse for each individual (National Autistic Society, 2017). As those with ASD do not appear to have a physical difficulty it is harder to initially diagnose ASD and it can be confused with other related elements such as ADHD. The lack of early diagnosis affects how practitioners can help those with ASD. Understanding the diversity of ASD will help suffers to relate to other people and take part in family life, at school and within society. Diagnosis can be as early as 18 months old but it often takes longer due to the complexity of the different behaviours shown by the individual. Slide 4: Definitions of Autism Spectrum Disorder The definitions of ASD vary and it is considered likely that people with autism may present with patterns of behaviour that challenge others. It can be argued that the patterns of behaviour relate directly to the underlying differences that define autism. Autism is a “pervasive developmental disorder” which prevalence has been miscalculated in the past, due to confusion over the diagnosis of the disorder providing unclear boundaries between cognitive disorders and mental health problems (Sousa et al, 2011; Waterhouse, 2016). There is a common set of behaviours, represented as a single diagnostic category – ASD with ‘individuals with a well established DSM-IV diagnosis of autistic disorder, Asperger’s disorder or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.” Smitha (2015) states that ‘autism is a multifaceted neuro-behavioural disorder that includes impairments in social communication and developmental language and communication skills joint with unbending, recurring behaviours’ Slide 5: A discussion of concepts relating to challenging behaviour and autism Individuals with ASD exhibit challenging behaviour such as repetitive behaviour, body rocking, hyperactivity, short attention span, impulsivity, aggressiveness, self-injurious behaviour and temper tantrums. This can feel frightening or even threatening to others. The concepts are that ASD suffers have challenging behaviour related to their lack of communication, social interaction and imagination (Behavioural Neurotherapy Clinic ,2015; Chan, 2004; Hewitt, 2003). There can be obsessive behaviour with attachments to objects or even parts of objects such as toys, figurines or model cars or more unusual objects like milk bottle tops, stones or shoes. These obsessions help to provide a structure, order and predictability in their lives to cope with the uncertainty with makes them anxious. It also makes them relax and feel happier with life in general and allows others to open an avenue of conversation (National Autistic Society, 2017). This also covers the 3 main areas of social interaction, communication and imagination which those with ASD find difficult. Slide 6: Reality for those with ASD Although I have limited experience of individuals with ASD I have read individual accounts which show the difficulties with they face: ‘Reality to an autistic person is a confusing, interacting mass of events, people, places, sounds and sights... Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life. Trying to keep everything the same reduces some of the terrible fear’ (Jolliffe, 1992 in Howlin, 2004, p.137) Slide 7: The impact of challenging behaviour on others For those who are involved with anyone with ASD their behaviour can be challenging including parents, teachers, other students in the school and other people they come into contact with. NICE (2013) states that ‘behaviour that challenges usually has a significant impact on individuals themselves, on their parents and carers and those who work with them’. For families there is the lifelong challenge of behavioural issues from a child with autism. They feel loneliness, have a lack of friends, and few social activities and there is not as much support as there should be. Siblings of an autistic child can also feel isolated as they may feel that all the attention is on the autistic child and not on them. In schools if there is an inclusion policy then the other students in the class may also feel that there is an interference of their own learning and for the autistic child, if there is little support then there will be less academic learning as well as an acquisition of behaviours which are socially acceptable. Slide 8; Example of a behaviour which is challenging: shouting Shouting can be interpreted in a variety of ways including shouting a warning, to attract someone’s attention, in anger, in excitement. Therefore it is often the situational context in which the challenging behaviour – shouting – is observed. If it is in excitement it might be at a sporting event or a pop concert and may be considered as appropriate by some or threatening by others. I would consider a warning shout as unexpected but helpful as well as to attract my attention but a shout may sound angry which is much more frightening. Those with ASD may shout but not understand the effect it is having on others. Understanding if the shouting is part of the behaviour of an individual with ASD is essential Slide 9: Relevant policy /guidance that addresses challenging behaviour The UK government published new guidance in 2015 for addressing ASD which states that there should be autism awareness training for all NHS staff and specialist autism training for key staff, such as GPs and community care assessors as well as the development of diagnosis and assessment for adults with autism. Early diagnosis is essential (NICE, 2013) so that there is recognition, referral and a diagnosis and the work to change ASD challenging behaviour can begin. In the education system inclusion is recommended into mainstream schooling. Slide 10: Steps that may be taken to address the behaviour within policy guidelines. It is difficult for anyone to deal with the challenging behaviour of individuals, both adult and children with autism. Recommendations are to always remain calm where possible and to keep a diary of anything which can trigger a behavioural issue so that a pattern emerges. Reinforcing Programmes use a stimulus which follows a desired response, that increases the likelihood of those responses happening again. They are considered to be effective if there is an increase in the desirable behaviour (Ayers, 2004) Using positive language and being consistent is essential as well as preserving certain routines which make the individual feel more comfortable. Behavioural techniques can include changing the layout of a room to encourage alternative more appropriate behaviours. Augmentative and alternative communication can include Picture Exchange Communication System, sign language and voice output communication aids to help with communication Assistive and augmentative technology can use computer apps and visual schedules to help to give information about desired behaviour Medical interventions can use certain drugs for associated physical ailments Psychotherapeutic interventions can use as cognitive behavioural therapy or mindfulness training to help with anxiety Sensory therapies can help to calm challenging behaviours Slide 11: Conclusions: future career and lessons learned from approaches to ASD ASD is a complex issue for both those who suffer from it and those who come into contact with those directly affected. ASD is diverse and so the support needed is also diverse and this would have an impact on any personal future career path related to ASD support. Lessons learned have been immense including: The different elements of ASD The various challenging behaviours of ASD sufferers including repetition and obsession The various techniques used to change the challenging behaviour Slide 12: References: Ayers, H. (2000) Sensory Assessment for Children and Youth with Autism Spectrum Disorders Rinner Assessment for Effective Intervention.2002; 27: pp.37-46 Behavioural Neuropathy Clinical all Right Reserved (2015) Definition of Autism Spectrum Disorder [online] http://www.autism.net.au/Autism_Definition.htm CDC (2014) online https://www.cdc.gov/ncbddd/autism/data.html Diagnostic & Statistical Manual (DSM)“ 1V Autism online http://www.autreat.com/dsm4-autism.html Frith, U. (2003) Autism, explaining the enigma 2nd ed Oxford: Blackwell Hewitt, S. 2003) Specialist Support Approaches to Autism Spectrum Dirsorder Students in Mainstream London: Jessica Kingsley Howlin, P. (2004). Outcomes in autism spectrum disorders. In Volkmar, F.R.; Paul, R; Klin, A; & Cohen, D.J., (Eds.), Handbook Of Autism And Pervasiv Howlin, P. (2005) Autism and Asperger syndrome, 2nd ed. United States of America: Routledge;. National Autistic Society online http://www.autism.org.uk/about/behaviour/obsessions-repetitive-routines.aspx Smitha, B. (2015) Autism Spectrum Disorders Health Centre. UK: WebMD Sousa, I.; Holt, R.; Pagnamenta, A. and Monaco, M. (2011) Unravelling the Genetics of Autism Spectrum Disorders. In: Roth I, Rezaie P, editors. Researching the Autism Spectrum. Cambridge: Cambridge University Press; 2011. pp.53–111. Sousa D, (2001) Educating Children with Autism USA: Thousand Oakes California Waterhouse S (2000) A Positive Approach to Autism London: Jessica Kingsley Waterhouse, L.; London, E. and Gillberg, C. (2016) ASD Validity Journal of Autism and Development Disorder, Vol 3 Issue 4 pp.302-329