DO-WATCH-LISTEN-SAY

Kathleen Quill, L. Lynn Stansberry Brusnahan

• Publisher: Brookes Publishing
• Year: 2017
• ISBN:
  9781681252322
• Edition: 2
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

Trusted for more than 15 years, the groundbreaking DO-WATCH-LISTEN-SAY has revolutionized social and communication intervention for children of all ages with autism spectrum disorder. Now a new edition is here, reimagined and expanded for the next generation of children and support teams.

Whether you're a professional already or in training to be one, this is the resource you need to address complex social and communication challenges for children with autism from ages 3 to 18. In one comprehensive volume, you'll have everything you need to conduct effective assessment, set goals and objectives for the child, plan interventions that work, ensure generalization of skills, and monitor progress. Immediately useful new additions—including a more extensive assessment tool and a system to monitor skill development—make this a cornerstone resource for every professional working with children and youth with autism.

WHAT'S NEW

• Expanded and revised assessment and intervention planning tool, with an emphasis on tracking generalization of new skills
• The very latest evidence-based practices and intervention approaches for enhancing social and communication skills
• 29 new printable activity sheets with ideas for fun and motivating activities to teach social, communication, and community skills
• A look at how ritualistic behaviors affect learning and development (one of the most underexplored areas of autism)
• Guidance on prioritizing goals and objectives, linking them to assessment, and designing interventions.
• New chapter on progress monitoring that includes a full data collection toolkit for tracking the generalization of social and communication skills
• Updated vignettes and extended case stories illustrating social and communication challenges characteristic of autism

PRACTICAL MATERIALS: Assessment tool; activities to build play, group skills, and communication; more than a dozen forms to help monitor progress toward skill mastery and generalization.

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CHAPTER 1

Understanding the Complexity of Autism

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LEARNING GOALS:

1. Acquire a historical overview and learn the contemporary implications of autism spectrum disorder and how our understanding of autism has evolved.

• Provide a timeline of the history of autism spectrum disorder that includes seminal researchers and their contributions.

• Describe how theoretical perspectives can guide intervention (e.g., how the “refrigerator mother” mindset led to institutionalization).

• Recognize how society has moved philosophically from providing interventions through an exclusion model to the more contemporary model of inclusion.

• Report the possible etiology (i.e., cause) of autism spectrum disorder.

• Discuss the prevalence of individuals identified with autism spectrum disorder.

2. Understand the process of identifying and diagnosing autism spectrum disorder.

• Define autism spectrum disorder.

• Describe the key feature areas used in the medical criteria for diagnosing autism spectrum disorder.

• Explain how education needs must be identified to qualify for special education services.

• Compare the similarities and differences between a medical diagnosis and meeting criteria for special education services under the educational category of autism spectrum disorder.

• Identify the common types of comorbidity that can accompany autism spectrum disorder.

3. Identify the social, communication, and behavioral characteristics typically associated with autism spectrum disorder.

• Describe the cognitive features associated with autism with regard to attention, information processing, and social cognition challenges.

• Understand satisfactory working theoretical explanations for the core features of autism, specifically theory of executive dysfunction, weak central coherence, and mindblindness.

4. Articulate the complexity of autism spectrum disorder.

Autism is a lifelong disorder characterized by challenges in the areas of social interaction and communication along with restricted, repetitive behavior, interests, or actions (American Psychiatric Association [APA], 2013). This edition will describe the complexity of typical social and communication development and articulate the challenges that individuals with autism spectrum disorder (ASD) experience in these areas. In this edition, individuals with autism are referred to using a variety of terms (e.g., child, youth, student, learner). The characteristics and strategies highlighted in this edition may be applicable for individuals with autism across the lifespan regardless of age. This first chapter lays the foundation for understanding ASD, providing a historical and contemporary overview, identification and diagnosis criteria, and some of the major satisfactory working theories and cognitive explanations related to ASD.

HISTORICAL OVERVIEW AND CONTEMPORARY IMPLICATIONS OF AUTISM

This section includes a brief historical overview and discussion of etiology, prognosis, and prevalence of ASD. Philosophical views on the disorder have an impact on intervention practices, so it is important to understand how our perceptions, theories, and understanding of autism have evolved over time. Through the years, society has moved philosophically from an exclusion model to the more contemporary model of inclusion.

Historical Overview of Autism

Autism is derived from the Greek word autos, meaning self. Autism was not recognized as a distinct disability until the mid-20th century. In 1943, Leo Kanner, a psychiatrist at Johns Hopkins University, described the challenges inherent in 11 of his patients. In this seminal study, Kanner noted that his patients shared similar characteristics but their pattern of challenges appeared different from other conditions. Dr. Kanner considered social withdrawal to be one of the primary features and labeled the disorder early infantile autism. Kanner referred to the “autistic aloneness” in his patients as the inability to relate to people and situations. Kanner also noted an obsessive insistence on sameness and included this trait in his descriptions of autism. The current definition of autism and the diagnostic criteria remain consistent with many of the characteristics first described by Kanner.

Around the same time, Hans Asperger (1944), a pediatrician at Vienna University Hospital, identified patients with characteristics that included an absence of empathy for others, one-sided conversations, and intense interests; his patients also demonstrated marked social challenges. Asperger’s patients possessed average to above-average intellectual (cognitive) skills with no significant delays in language development. Asperger used the term “autistic psychopathy” when referring to these patients. Through the 1960s, the medical community thought of autism as a form of psychosis linked to “childhood schizophrenia” and excluded individuals from society through institutionalization.

Etiology and Medical History Since autism was first identified, our understanding of the disorder has grown, and the medical community continues to conduct research on the etiology (i.e., cause). Historically, there have been a number of theories regarding the etiology of autism. Throughout the 1950s and 1960s, autism was attributed to an absence of adequate environmental support. In his book An Empty Fortress (1967), psychologist Bruno Bettelheim advanced this emotional deprivation theory and wrote about the cold and rejecting upper-middle-class parents who were unable to psychologically bond with their children. This psychogenic (i.e., of mental origin) theory placed blame for autism specifically on the mother of the child, who was referred to as a “refrigerator mother” (Pollak, 1997). It was speculated that the parents’ withholding of affection or negative feelings toward their child caused the child to retreat into autism. During this period, medical professionals recommended children be removed from their homes and institutionalized, along with the parents receiving psychoanalysis.

In 1964, Bernard Rimland, a psychologist and parent of a son with autism, presented the first solid argument to refute the blame on the parent–child bond and published Infantile Autism and Its Implications for a Neural Theory of Behavior, stressing the plausibility of a biological causation. To advocate for education and end institutionalization, Dr. Rimland joined together with parents of children with autism across the country and founded the Autism Society of America (formerly the National Society for Autistic Children). Since 1965, this grassroots organization has grown into a leading source of information and support to improve the lives of all affected by autism.

In 1980, the APA defined infantile autism as a cluster of pervasive development disorders (PDDs) and declared it a separate category from childhood schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). In a 1987 revision, infantile autism was changed to autistic disorder. In 1994, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) added the category of PDDs with five subtypes, which included autistic disorder, Asperger’s disorder, PDDs-not otherwise specified (PDD-NOS), Rett disorder, and childhood disintegrative disorder. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) consolidated the previous subtypes under the broader heading autism spectrum disorder, which replaced the term PDDs. In this text, the terms autism spectrum disorder, ASD, and autism will be used interchangeably.

Currently, autism is considered a neurodevelopmental disorder. The term neuro is used because research has revealed that specific structures of the brain do not function as expected in individuals with autism, and developmental is used because children with autism do not meet typical milestones in some areas of skill development. Some professionals believe that to treat autism, we need to intervene with whole-body strategies and not just focus on the brain (Herbert, 2012).

The puzzle of autism continues as researchers seek to uncover the etiology of the disorder. Considering the complexity of the disorder and how characteristics and severity vary, autism may not result from a single root cause (Happé, Ronald, & Plomin, 2006). Rather, there could be many causal factors eventually implicated. Research is ongoing to identify the underlying (e.g., genetic, environmental, neurological) explanations for autism.

Medical conditions such as fragile X syndrome may explain the autism characteristics in a small percentage of individuals (Hagerman, Rivera, & Hagerman, 2008). Sibling and twin research has demonstrated risk for autism in additional family members, leading researchers to seek answers about genetic factors that may play a role in causation for some with autism (Tick, Bolton, Happé, Rutter, & Rijsdijk, 2016). Genes by themselves probably cannot explain the complex etiology of ASD, and it is unlikely that a single gene that causes autism will be found. It is more likely that researchers may identify several susceptible (vulnerable) genes contributing to autism characteristics (Rapin, 2008).

The high incidence of seizures in individuals with autism (Boutros, Lajiness-O’Neill, Zillgitt, Richard, & Bowyer, 2015) has steered some researchers to explore an organic framework for autism. There has been speculation about environmental factors playing a role in the disorder, with research linking autism to prenatal influences (e.g., maternal infection during pregnancy), birth complications (e.g., oxygen deprivation), and toxic chemicals (e.g., lead) (Landrigan, Lambertini, & Birnbaum, 2012). Much debate also has occurred about an association between autism and vaccinations. To date, research finds no evidence of a causal association between the two (Institute of Medicine, 2011; Taylor, Swerdfeger, & Eslick, 2014).

Regardless of etiology, scientists have discovered differences in the brain’s structures, functioning, and development in individuals with ASD (Stoner et al., 2014). It appears there are early differences in the way the brain grows and develops in the prenatal period, and increased head size has been found in some children with ASD. Differences have also been noted in specific areas of the brain (e.g., cerebral cortex, basal ganglia, amygdala, hippocampus, corpus callosum, cerebellum, brainstem), with multiple regions likely involved (Minshew, Scherf, Behrmann, & Humpreys, 2011). Research continues, and organizations like Autism Speaks raise money to fund research into the causes of the disorder.

Educational History With the 1990 revision of the Individuals with Disabilities Education Act (IDEA), autism was identified as a discrete disability category eligible for special education services. With the federal mandate for free and appropriate public education (FAPE), students with autism are required to be educated in the least restrictive environment (LRE), which includes the general education classrooms as part of the continuum of placement and service options available. The history of educational practice for learners with autism has been characterized by controversy regarding different approaches grounded in divergent philosophies.

Examples of these conflicting approaches include behavioral interventions grounded in applied behavior analysis (ABA) versus relationship-based approaches grounded in developmental psychology. Psychology professor Ole Ivar Lovaas was a pioneer in behaviorism in the field of autism. In the beginning, Lovaas applied the experimental behavior analysis developed by Skinner to individuals with disabilities who experienced self-injurious behaviors (Lovaas, Freitag, Gold, & Kassorla, 1965). Later, Lovaas (1987) refocused his behavior modification efforts, providing intensive discrete trial training to children with autism in their homes. As another approach, Stanley Greenspan developed a developmental relationship-based model (i.e., Floortime) for children with a variety of developmental delays, including autism (Greenspan & Wieder, 2006). Rather than actively attempting to shape or direct a child’s behavior, the Floortime approach is more child-directed and involves engaging the child naturally in his or her world. There has been considerable debate over these two approaches. On one side of the debate, “those who believe that Floortime is the better way still paint ABA as consisting of rote and repetitious drills that stifle the child’s spirit. On the other side, critics of Floortime see...