VCU Autism Center



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This lecture was produced for the VCU-ACE Foundations of ASD Course. The transcript is intended for use by participants in the online course. Please do not disseminate this material without the permission of VCU-ACE staff.

Autism across the Lifespan

Slide 1

My name is Dawn Hendricks. I am the Director of Training for the VCU Autism Center for Excellence. In this presentation, I will be presenting Autism across the Lifespan.

Slide 2: Autism across the Lifespan

• Look at how autism spectrum disorders including Asperger’s Syndrome present across the lifespan.

• We will consider how these diagnoses present in five key areas including:

o Cognitive and intellectual ability,

o Social interaction,

o Communication,

o Patterns of Behavior,

o Challenging Behaviors.

• Everyone develops differently.

• Think about how the person will change across different stages of his life.

We are going to take a look at how autism spectrum disorders including Asperger’s Syndrome and Pervasive Developmental Disorder present across the lifespan. We will consider how these diagnoses present in five key areas including cognitive and intellectual ability, social interaction, communication, patterns of behavior, and also problem behaviors. I will outline key clinical features during early childhood, elementary school, adolescence, and adulthood.

Please keep in mind that the content of this presentation are generalizations and are not firm or absolute. Everyone develops differently and this is certainly the case for those with ASD. The summaries provided in this presentation represent what we know about the disorder as presented in research.

As I go through each section, think about how the person will change across different stages of his life. As you look across the lifespan and changes in behavior, there are always questions regarding level of intervention provided and how changes may occur through maturation or through intervention efforts. At the end of this presentation, these questions will be discussed as we highlight supports and interventions that are required of a person with ASD during various periods of his or her life.

Finally, at the end, I will present a few case studies for you to consider and work though which describe a person according to age and diagnosis.

Slide 3: Diagnosis

• The age of diagnosis will vary from person to person.

• There is no biological marker of autism. The diagnosis is based on behavioral observation and parental report information.

• Despite advancements in assessment and understanding the disorder, many may not receive a diagnosis during this optimal age of 18-36 months.

• For Asperger’s Syndrome, the current diagnosis often happens around elementary school when children are with their same age peers and there are significant signs of social skill deficits.

• The age of diagnosis may impact the characteristics due to the provision of supports and services.

The age of diagnosis of ASD will vary from person to person. With new and improved diagnostic instruments and increased knowledge about the disorder, our ability to diagnoses individuals on the spectrum has gradually declined from the age span of 5 to 7 in the 90’s, to between 18 months and 3 years of age. At this time, there is no biological marker of autism; therefore, the diagnosis is based on behavioral observation and parental report information.

Despite advancements in assessment and understanding the disorder, many may not receive a diagnosis during this optimal age of 18-36 months. There are many reasons for this. Pediatricians and doctors need to be better educated on ASD and need to provide more screening of infants and toddlers during critical developmental periods. Some children may receive an inaccurate diagnosis. Additionally, the DSM diagnostic criteria for autism were not developed for young children, and some criteria, such as problems with conversational language, are not appropriate for infants and toddlers. As a result, definitive diagnoses of autism are often not made until children are over three years of age.

That said, even before a formal diagnosis is obtained, a pattern of social and communicative impairments may be observable within the first 2 years of life. For Asperger’s Syndrome, the current diagnosis often happens around elementary school when children are with their same age peers and there are significant signs of social skill deficits. While there are many reasons why the age of diagnosis may occur later in life, I want to stress. This is not optimal. The earlier the diagnosis, the sooner supports and services can begin.

As we go through the remainder of this presentation and look at these characteristics of ASD through the lifespan, keep in mind that the age of diagnosis may impact these characteristics due to the provision of supports and services. Individuals will receive a diagnosis at different points in their lives.

In the upcoming slides, you will see tables. The tables will provide the stages in a person’s life and describe characteristics that may be present. For each area discussed, we will look at the presentation in those with autism and those on the other end of the spectrum considered to have Asperger’s Syndrome.

Slide 4: Cognitive and Intellectual Ability - Autism

|Age Stage |Autism Presentation ------------------------------------------------------( |

|Early Childhood (18months – 4 |Delayed achievement of developmental milestones or missed developmental milestones may be present. |

|years) | |

|Elementary School (5-10 years) |Intellectual disabilities may be present. |

| |Cognitive abilities can range from severely impaired to gifted. |

| |Splinter skills may develop. |

| |Challenges may be present in most content areas. |

| |Difficulties with executive functioning (e.g. organizing, planning) may be present. |

|Adolescence (11-18 years) |Challenges in content areas persist with modest improvement. |

| |Difficulties with executive functioning persist with modest improvement. |

|Adulthood |Executive functioning deficits may result in supports for employment. |

| |Executive functioning deficits may result in supports for living within the community. |

In the upcoming slides, you will see tables. Each table will provide the stages in a person’s life and describe characteristics that may be present. For each area discussed, we will look at the presentation in those with autism and those on the other end of the spectrum considered to have Asperger’s Syndrome. Let’s first look at cognitive and intellectual ability. Remember from a previous presentation, cognitive ability can be a difference between an individual with autism and Asperger’s Syndrome. The co-occurrence of cognitive impairment in a portion of individuals with autism is a possibility.

Let’s look at the trajectory with those with autism. In early childhood, many children with autism will look differently cognitively than those with Asperger’s Syndrome. The most marked characteristic that separates an autism diagnosis from Asperger’s Syndrome in early childhood is the delayed or missed achievement of developmental milestones.

When children with autism reach elementary school and are compared to their same age peers, you will see the disparities in cognitive abilities arise. Children with autism may have challenges completing tasks related to executive functioning including planning, organizing, and completing a task. Children may develop splinter skills. In other words, the child may be very strong in one content area, while struggle in another. Joshua, a third grader, is very good at math and receives math instruction in the 3rd grade general education classroom, but struggles in reading and requires intensive instruction in this area. Many with autism will require individualized support in all content areas.

Once into adolescence and adulthood, cognitive and intellectual abilities remain stable as you can see by this chart. However, in adulthood, the differences in cognitive ability, especially those related to executive functioning may present challenges in employment and living in the community. Since all people can work and can live in the community, supports may be required to build skills and ensure success in these areas. The table has more information than what was provided during the narration of this slide and outlines the Cognitive / Intellectual characteristics that may be present for a person with autism during early childhood, elementary school, adolescence, and adulthood.

Slide 5: Cognitive and Intellectual Ability - Asperger's Syndrome

|Age Stage |Asperger’s Syndrome Presentation ---------------------------( |

|Early Childhood |Has average or above average cognitive abilities. |

|(18 months – 4 years) |Meets or exceeds developmental milestones. |

|Elementary School |Has average to above average cognitive abilities. |

|(5-10 years) |Cognitive abilities can range from mildly affected to gifted. |

| |Challenges may be present in math and reading comprehension as well as abstract concepts. |

| |May have difficulties with executive functioning (e.g. organizing, planning). |

|Adolescence |Challenges in content areas persist with improvement. |

|(11-18 years) |Difficulties with executive functioning persist with modest improvement. |

|Adulthood |Executive functioning deficits may result in supports for employment. |

| |Executive functioning deficits may result in supports for living within the community. |

Now, let’s talk about the trajectory of a person with Asperger’s Syndrome. Those with Asperger’s Syndrome are often reported to hit developmental milestones on time and sometimes before expected. This will continue through development. The abilities of the person will vary. Cognitive abilities can range from mildly affected to gifted. Braxton has been in a gifted program at school since 3rd grade and is about to graduate with an advanced diploma. The person can be quite adept in all content areas or may have challenges in specific areas such as math and reading comprehension or abstract concepts. As with individuals with autism, a person with Asperger’s Syndrome may have tremendous difficulty with tasks related to executive functioning even through adulthood. I know an adult, 50 year old woman with a Ph.D. who still struggles with going to the grocery store. This requires a tremendous amount of planning and organizing so she has a person to help her do this task.

Please review the table above. The table outlines the Cognitive / Intellectual characteristics that may be present for a person with Asperger’s Syndrome during early childhood, elementary school, adolescence, and adulthood.

Slide 6: IQ

• Research is demonstrating that the IQ of an individual with ASD may not stay stable over time.

• It may change as the person moves from childhood to adolescence and into adulthood.

• This may be related to proper assessment of an individual.

• Research is demonstrating that the person’s IQ may increase slightly over time.

• Specifically, the performance or nonverbal IQ may increase.

I want to make a note regarding IQ. Research is demonstrating that the IQ of an individual with ASD may not stay stable over time but may change as the person moves from childhood to adolescence and adulthood. This of course, may be due to being able to properly assess an individual. Many IQ tests require some command of language so it stands to reason that a person with autism may not perform well on a test of this nature and may have a different score when tested at an older age when there are new skills. However, research is demonstrating that the person’s IQ may increase slightly over time. Specifically, the performance or what is also known as the nonverbal IQ may increase. This involves tasks requiring visual-spatial perception such as puzzles, mazes, or motor skills.

Slide 7: Social Ability - Autism

|Age Stage |Autism Presentation ------------------------------------------------------( |

|Early Childhood |Has limited reciprocation with family. |

|(18months – 4 |Shows little interest in social activities. |

|years) |May prefer being alone /ignore or avoid other children. |

| |May have little interest in being held. |

| |Has difficulty with emotional regulation / angers easily. |

| |Has limited or repetitive play skills. |

|Elementary School |Social deficits persist with modest improvement over time. |

|(5-10 years) |Emotional regulation challenges continue with modest improvement. |

| |May desire social interactions but unable to facilitate. |

| |Play skills improve but are predominantly isolated and repetitive. |

| |Attempts to interact with others are one-sided. |

| |Social skill deficits can result in misunderstandings and problem behavior. |

Next, let’s take a look at social skills. Lack of social interaction is often one of the first things parents report as missing in their child who is later diagnosed with autism. They will often talk about how their child is hard to soothe, doesn’t look at them, doesn’t have the social smile as an infant, or doesn’t socially reference a common object, or doesn’t follow their point or as we call lack of joint attention.

For the person with autism, the early years are marked by impairment in social interaction related to interactions, demonstrating affection, and reciprocity. This means playing or communicating in a back and forth nature. The young child may also prefer to play alone. Play skills are generally marked by repetitive, non-creative activities. During these years, this child may also have tremendous difficulties with emotional regulation and may be very easy to anger and difficult to calm.

As the child goes through the elementary school years, social skills improve modestly. During this time, the child may desire to interact and play with peers but not have the skills to do so. Play may be very isolated. Ty spends recess walking the perimeter of the playground while his peers are playing kick ball.

It is important to note, that social skill deficits can result in misunderstandings or problem behavior. Lack of social skills and not understanding social rules is often a cause of problem behavior. The table outlines the Social characteristics that may be present for a person with Autism during early childhood and elementary school.

Slide 8: Social Ability - Autism

|Age Stage |Autism Presentation ------------------------------------------------------( |

|Adolescence (11-18 |Social deficits persist with modest improvement over time. |

|years) |Leisure skills improve but continue to be predominantly isolated and repetitive. |

| |Odd social behavior can result in seclusion. |

| |Social skill deficits can result in misunderstandings and problem behavior. |

|Adulthood |Social interaction occurs primarily with family. |

| |Social skill deficits can result in misunderstandings and problem behavior. |

| |Social skill deficits can result in need for supports for employment. |

During adolescence we may see continued improvement. However, often times odd behavior and poor social functioning can lead to isolation. In adulthood, social interactions outside of the home may be limited. With employment and recreational activities, this can be increased. The table outlines the Social characteristics that may be present for a person with Autism during adolescence and adulthood.

Slide 9: Social Ability - Asperger's Syndrome

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Early Childhood |May prefer being alone /ignore or avoid other children. |

|(18months – 4 |Difficulty with emotional regulation / angers easily. |

|years) |Demonstrates repetitive play skills.. |

| |May dominate interactions with peers |

| |May be physical towards peers. |

|Elementary School |Social deficits persist with modest improvement over time. |

|(5-10 years) |Social abilities can range from severely impaired to mildly impaired. |

| |Interested in friends, but does not approach others appropriately. |

| |Has difficulty making and keeping friend. |

| |Doesn’t understand meaning of friendship. |

| |May not respect authority. |

| |Has difficulty understanding social rules (e.g. turn taking, waiting, personal space). |

| |Social skill deficits can result in misunderstandings and problem behavior. |

Asperger’s Syndrome is an interesting diagnosis, often a person does not receive their diagnosis until elementary school, or even into adolescence or adulthood. However, there may be characteristics present in the early childhood years. These include having atypical peer interactions. This may include preferring to be alone or dominating an interaction and being physical. Patterns of play may be different than peers as the person with Asperger’s may demonstrate repetition in the play or themes of play. Like the child with autism, this child will likely show challenges with emotional regulation.

In elementary school, it is really during this time that differences begin to present themselves. It is in the elementary class that often we first see stark differences in the social functioning as this child may have tremendous difficulty following the school rules and understanding social norms such as when you can touch someone, when you can touch something that is not yours, how close you stand to a person, topics that are appropriate to talk about, how to wait, among others. This is a child who is often in trouble for not respecting authority and challenging the teacher.

During elementary school making friends may be difficult. The person with Asperger’s may desire to have friends and attempt to interact, but do so inappropriately. For some, even understanding what a friend is and what it means is problematic. The table outlines the Social characteristics that may be present for a person with Asperger’s Syndrome during early childhood and elementary school.

Slide 10: Social Ability - Asperger's Syndrome

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Adolescence (11-18 |Social deficits persist with modest improvement over time. |

|years) |May have difficulty making friends / interacting with peers. |

| |May be isolated. |

| |May not date. |

| |Odd social behavior may result in seclusion or bullying. |

| |Social skill deficits can result in misunderstandings and problem behavior. |

|Adulthood |Leisure skills may be isolated. |

| |May not marry. |

| |Social skill deficits can result in misunderstandings and problem behavior. |

| |Social skill deficits can result in need for supports for employment. |

| |Social skill deficits can result in need for support group. |

During adolescence, children with Asperger’s Syndrome become more anxious about fitting in with others and their odd social behavior often makes others less likely to engage with them on an interpersonal level. In adulthood, a lack of social skills often results in isolation or misunderstandings by others. As you can imagine this could lead to difficulties holding a job or having relationships with others.

Often these adults will gravitate to a job or profession that relates to their own areas of special interest such as a computer programmer for those who have a keen ability for computers, sometimes becoming very proficient. They are most successful in a job that requires less face-to-face social interaction. Some with Asperger’s are able to successfully complete college and graduate school. Nonetheless, in most cases they will continue to demonstrate differences in social interactions. They can be challenged by the social and emotional demands of marriage, although many do marry and have families. Their rigidity and eccentric perspective on things can make interactions difficult, both in and out of the family. The table outlines the Social characteristics that may be present for a person with Asperger’s Syndrome during adolescence and adulthood.

Slide 11: Communication - Autism

|Age Stage |Autism Presentation ------------------------------------------------------( |

|Early Childhood (18months|May be nonverbal. |

|– 4 years) |For child who is verbal, communication is one sided. |

| |Receptive and expressive language milestones not met. |

| |May have challenges using and understanding nonverbal communication. |

| |Communication deficits may result in problem behavior. |

|Elementary School (5-10 |Communication delays persist with modest improvement over time. |

|years) |Challenges may occur in learning to expand language/ develop vocabulary. |

| |May have challenges following directions. |

| |Challenges using and understanding nonverbal communication may occur. |

| |Pronoun reversal may be present. |

| |Communication deficits may result in problem behavior. |

|Adolescence (11-18 years)|Communication delays persist with modest improvement over time. |

| |Challenges learning to expand language/ develop vocabulary may occur. |

| |Challenges using and understanding nonverbal communication may be noticed. |

| |Communication deficits may result in problem behavior. |

|Adulthood |Communication ability impacts psychosocial functioning and quality of life. |

| |Communication deficits may result in problem behavior. |

During this slide, we will talk about communication. Many children with autism do not meet receptive and expressive language milestones. Some children may not develop expressive language until well after their third birthday while others may not develop verbal language at all. For those who are verbal, the amount of communication and content may be very limited. Additionally, they will lack the non-verbal communicative skills that develop in early childhood such as the use of gestures or joint attention.

In elementary school, language improves moderately for most. Research on this topic is showing that speech in individuals with autism, including the classic signs of autism such as pronoun reversal improves the most. Nonverbal communication improves the least. Those with autism will likely to continue demonstrating challenges acquiring and using language, developing vocabulary and communicating effectively, especially without targeted intervention.

It certainly makes sense, but those with autism who have better communication skills in adulthood have better psychosocial outcomes. Communication is empowering and helps foster control for the person with autism. Please review the table above. The table outlines the Communication characteristics that may be present for a person with Autism during early childhood, elementary school, adolescence, and adulthood.

Slide 12: Communication - Asperger’s Syndrome

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Early Childhood (18months –|May meet language milestones early. |

|4 years) |Language present by 2 years of age. |

| |May be very verbal and use vocabulary beyond age expectations. |

| |Speaks at length about a specific topic or item. |

| |Challenges using and understanding nonverbal communication (e.g. facial expressions, body language) may occur. |

|Elementary School (5-10 |Language continues to develop. |

|years) |May speak in monotone or lack voice inflection. |

| |Deficits are present in the social components of communication (e.g. turn taking). |

| |Difficulty with conversations may be present. |

| |Talks “at” a person / not “to” the person. |

| |May prefer to talk to adults versus peers. |

| |May have difficulty with figurative language. |

| |Speaks at length about a specific topic or item. |

| |May have difficulty reading and using nonverbal communication effectively. |

Children with Asperger’s Syndrome may meet receptive and expressive language milestones on time or even early. Vocabulary may be advanced. Parents often report that they don’t know where he heard a certain vocabulary word or how he learned to recite the Gettysburg Address!

For children with Asperger’s Syndrome they have language, however the way it is used is often rigid, monotone and does not have the support of the non-verbal communication skills for it to be used successfully in a conversation. Conversations are a challenge and are one-sided. I have worked with many children and teens with Asperger’s Syndrome that will start a conversation without giving any background information. The listener has no idea why the person is talking about NASCAR. If you give him non-verbal cues of disinterest in the topic, he continues on without missing a beat. Often, communication focuses on a specific topic of interest and the person may appear to be a walking encyclopedia on the topic!

Please review the table above. The table outlines the Communication characteristics that may be present for a person with Asperger’s during early childhood and elementary school.

Slide 13: Communication - Asperger’s Syndrome

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Adolescence (11-18 |Deficits in the social components of communication persist with modest improvement persist. |

|years) |Deficits in nonverbal communication persist with modest improvement. |

| |Difficulty with conversations persists with modest improvement. |

| |Speaks at length about a specific topic or item. |

| |Communication is one sided. |

|Adulthood |Communication deficits can result in misunderstandings and problem behavior. |

| |Communication deficits regarding the social components of communication can result in need for supports for employment. |

| |Communication deficits can result in need for support group |

Adolescence may be a very difficult time for individuals with Asperger’s. Deficits in nonverbal communication and challenges with conversational skills may impact his or her ability to fit in with peers and to understand the social nuances of adolescence. Their lack of appropriate and/or successful communication skills may lead to misunderstandings by others. The person may appear to be rude or abrasive by those who do not understand the nature of the disability. This may continue into adulthood without appropriate supports. The table outlines the Communication characteristics that may be present for a person with Asperger’s during adolescence and adulthood.

Slide 14: Restricted and Repetitive Patterns of Behavior - Autism

|Age Stage |Autism Presentation ------------------------------------------------------( |

|Early Childhood (18months –|Motor stereotypies are present (e.g. hand flapping). |

|4 years) |Demonstrates unusual postures. |

| |May use objects and toys inappropriately. |

| |May have attachment to unusual objects. |

| |May be unresponsive to sounds. |

| |May have difficulty with transition or changes in routine. |

|Elementary School (5-10 |Presence of behaviors persists with modest abatement over time. |

|years) | |

|Adolescence (11-18 years) |Presence of behaviors persists with modest abatement over time. |

|Adulthood |Presence of behaviors may result in need for supports for employment. |

Next, we will talk about restricted and repetitive patterns of behavior. The difference between children with autism versus Asperger’s is that children with autism usually have more pronounced stereotypies such as hand flapping, rocking, finger flicking, spinning, etc. These behaviors are often difficult to redirect and may replace appropriate forms of play. Children with autism may demonstrate any array of behaviors. For those who have restricted interests, this usually involves attachment to an object, and the child may collect items or carry around specific objects, such as a hair brush or favorite truck. In the realm of behavior, you may also see difficulties in changes in routines or transitions in the young child with autism.

These behaviors tend to continue during elementary school, and may actually become more extreme or exacerbated during the early years of elementary school. There tends to be a number of changes during this time and involve multiple transitions each day. This may not bode well for the child so it may be a challenging period. What we may also see is that stereotypies such as hand flapping may increase initially due to environmental issues or events that may provoke anxiety. There is good news I want to share. Research in this area is demonstrating that repetitive and restricted patterns of behavior do abate. Unusual preoccupations and complex mannerisms may lessen over time. Additionally, the qualitative nature of the behaviors does change over time and may lessen. What we may find is for the person with autism, as he or she develops more skills, these behaviors may reduce. However, during times of stress or change, they may be more apparent.

As mentioned previously, for individuals who have intense interests, using these interests towards employment may result in increased motivation and success. The example given above is for the person who is interested in computers becoming a technology person. Another example is Abdul. He loves cars and has a job washing cars at a car lot.

Please review the table above. The table outlines the Restricted and Repetitive Behaviors that may be present for a person with Autism during early childhood, elementary school, adolescence, and adulthood.

Slide 15: Restricted and Repetitive Patterns of Behavior - Asperger's Syndrome

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Early Childhood (18months – 4 years) |Exhibits an unusual intense, circumscribed interest. |

| |Mild motor stereotypies may be present (e.g. rocking). |

| |Attachment to unusual objects may be present. |

| |Difficulty with transition or change in routine may occur. |

|Elementary School (5-10 years) |Presence of behaviors persists. |

|Adolescence (11-18 years) |Presence of behaviors persists. |

| |Interests may change. |

| |Focus on interests may result in isolation or bullying. |

|Adulthood |Presence of behaviors may result in need for supports for employment. |

Children with Asperger’s may demonstrate milder forms of stereotypies such as rocking or head rubbing or biting fingernails. Often, the person has very specific interests, such as perseveration with electrical outlets and electricity, or truck makes and models.

In elementary school the intense interest likely persists and may intensify. The stress of school coupled with a mass audience of peers may result in the child talking incessantly about the topic.

In adolescence the patterns of behavior are fairly similar; however you may see new prescribed interests pop up or different stereotypies. One boy that I worked with who has Asperger’s Syndrome from the time he was 5 until 14, had evolving interests. As a young boy he loved numbers, and would write down numbers in sequence or math problems. As he got older, he started listening to music and would write down CD tracks to albums with their corresponding length—by memory. Now he writes down the scores that he and his friends get while playing Mario Kart and keeps track of who is winning and by how much.

Learning how to regulate the focus and discussion regarding topics of interest is often required in adulthood.

Please review the table above. The table outlines the Restricted and Repetitive Behaviors that may be present for a person with Asperger’s Syndrome during early childhood, elementary school, adolescence, and adulthood.

Slide 16: Challenging Behavior

|Age Stage |Autism Presentation |Asperger’s Syndrome Presentation |

|Early Childhood |Significant problem behavior may result in crying, |Problem behavior may result in yelling, noncompliance, |

|(18months – 4 |aggression or self-injury. |crying. |

|years) | | |

| |Diverse responses to sensory stimulation may occur. |Diverse responses to sensory stimulation may occur. |

|Elementary School |Problem behavior may persist or may lessen in frequency or|Problem behavior may persist or may lessen in frequency or |

|(5-10 years) |severity |severity. |

| | | |

| |Diverse responses to sensory stimulation |Diverse responses to sensory stimulation |

|Adolescence (11-18 |Significant problem behavior may increase in puberty. |Problem behavior may increase in puberty. |

|years) | | |

| |Diverse responses to sensory stimulation may occur. |Behaviors related to anxiety or depression may develop. |

| | | |

| | |May have diverse responses to sensory stimulation. |

|Adulthood |Presence of behaviors may result in need for supports for |Presence of behaviors may result in need for supports for |

| |employment, |employment. |

| | | |

| |Presence of behaviors may result in need for supports for | |

| |living in the community. | |

Challenging behavior is not a defining characteristic of autism spectrum disorders, but I wanted to touch on this topic. Both children with autism and Asperger’s may experience problem behavior throughout their lives; however, the behavior exhibited may look different. For those with autism, it may include more aggression or self-injury. For the person with Asperger’s it may be more in the form of noncompliance or yelling. With the proper intervention and with a focus on developing skills in communication and social skills, there should be a significant reduction and possibly elimination of problem behavior.

We may see a shift in problem behavior as children move into adolescence. Several changes occur including rapid biological growth, puberty, and an increase in the likelihood of comorbid diagnoses as we discussed previously. Children with autism and Asperger’s may experience an increase in problem behavior as they go through puberty. Changes to their body may be confusing and/or concerning for them at this time. Additionally, biological changes that happen to a person’s body during puberty can cause increased depressed mood or defiance. This is true for neurotypical adolescents as well. The teen with Asperger’s Syndrome often realizes his social differences from his peer and may also experience symptoms of depression and anxiety.

The most important thing to remember during this age-stage and into adulthood is making sure that the individual has a way to communicate how they are feeling. This can range from nonverbal use of a communication system, to conversations with a trusted adult, to journaling for those who have the ability to do so. The table outlines the possible challenging behaviors that may be present for a person with Autism and Asperger’s Syndrome during early childhood, elementary school, adolescence, and adulthood.

Slide 17: Autism Intervention

|Age Stage |Autism Intervention ------------------------------------------------------( |

|Early Childhood (18months – 4 |Early Intervention |

|years) |Targeted support for all areas of need |

| |Parent training |

|Elementary School (5-10 years) |School program providing an individualized education |

| |Targeted support for all areas of need |

| |Speech-language therapy |

| |Occupational therapy |

| |Physical therapy |

|Adolescence (11-18 years) |School program providing an individualized education |

| |Targeted support for all areas of need |

| |Speech-language therapy |

| |Occupational therapy |

| |Physical therapy |

| |Focus on independence and skills required in adulthood |

|Adulthood |Employment or postsecondary education |

| |Targeted support for employment |

| |Targeted support for residential needs |

I want to make a very important point. Individuals with autism can and will continue to learn and grow throughout their life. Abilities increase and skills develop over time. They will improve in regards to cognition, communication, social functioning and behavior. This is the case for all of us and is certainly the case for those with an autism spectrum disorder.

This slide outlines the components of intervention that are necessary for a person with autism.

As a young child, early intervention is critical. This is a time when the young child’s brain is developing and ensuring direct instruction that is targeted to the child is essential. Early intervention should address developmental, communication, socialization, play, self-help, and motor goals. According to a pivotal report published in 2001, The National Research Council recommended children with autism should receive intensive early intervention with several hours of direct service each week. Additionally, during this time, parents benefit from training by a professional as they learn to support and teach their young child with autism. This isn’t to say a parent can’t do this on his or her own, but support and training can help the parent with problem solving, brainstorming, learning support strategies and being more successful.

During elementary school, an individualized education is required. This continues through adolescence until the person graduates from high school. It is important for intervention and the child or adolescent’s education ensures there are services and supports to address all areas of need. This will vary from child to child. Most, if not all will benefit from speech-language therapy through the school years. After all, this is a disability related to communication and social impairment! Additionally, some may benefit from occupational therapy to address functioning related to using one’s hands effectively including hand writing, typing, and dressing as well as to address issues related to differences in sensory responding. Some may require physical therapy to address motor difficulties.

During the adolescent years, it will be important to ensure the focus is on preparing for the transition to adulthood and teaching the person skills needed for employment and living in the community. Individuals with autism may become employed, go on to postsecondary education, or may not engage in a productive activity once graduating. This transition is essential and must be prepared for.

Looking at all areas of functioning, we can see that as a person progresses through adolescence the shift of needs moves toward transition services and preparation for adulthood. Adults with autism vary in the supports that they require to be active members of the community and family. Adults with autism are capable of employment and can live in a variety of setting including Independent living, home with family, supervised group living. A nurturing environment at home, at school, and later in adulthood, helps persons with autism continue to learn and to develop throughout their lives.

Please review the table on this slide. The table outlines the possible Interventions that may be warranted for a person with Autism during early childhood, elementary school, adolescence, and adulthood.

Slide 18: Asperger’s Syndrome Intervention

|Age Stage |Asperger’s Syndrome Presentation---------------------------( |

|Early Childhood (18months – 4 |Diagnosis likely not made |

|years) |Early Intervention |

| |Parent training |

|Elementary School (5-10 years) |School program providing an individualized education |

| |Targeted support for all areas of need |

| |Speech-language therapy |

| |Occupational therapy |

| |Physical therapy |

|Adolescence (11-18 years) |School program providing an individualized education |

| |Targeted support for all areas of need |

| |Speech-language therapy |

| |Occupational therapy |

| |Physical therapy |

|Adulthood |Employment or postsecondary education |

| |Targeted support for employment |

For the child with Asperger’s, a diagnosis may not be made in the early childhood years. If so, intervention should begin in order to address concerns related primarily to social functioning and executive functioning.

As the child ages, as with autism, we need to ensure there targeted support for any areas of need. It should go without saying, but a primary need for a child in elementary school, middle or high school will be speech language therapy. This service should provide support in the social components of communication, help the person learn and apply social rules, and to develop interpersonal skills. Additionally, this child may also need occupational therapy to address deficits in motor planning and sensory differences.

As the person enters adulthood, needs do not stop. The social challenges with getting and maintaining a job can be overwhelming for the person with Asperger’s Syndrome. Supports to help the person navigate the social world are often required.

Sometimes it is said that Asperger’s is a mild disability. I would like to caution you on prescribing to this idea. While it is different from autism, it is still a disability that creates challenges for the individual throughout the lifespan. Supports and services will likely be required and will be beneficial to help the person develop socially.

Please review the table above. The table outlines the possible Interventions that may be warranted for a person with Asperger’s Syndrome during early childhood, elementary school, adolescence, and adulthood.

Slide 19: Case study 1

• Johnny is a ___________ year old boy who has a diagnosis of______.

• Can you guess the approximate age or age range of this person as well as his diagnosis?

• Johnny is 3 and has an Autism diagnosis.

Let’s go over a case study. Johnny is a ___________ year old boy who has a diagnosis of ________. He has no expressive language at this time. He gets his needs met by pulling adults by their arm to the desired object although never looks at them for any amount of time. He does not respond to his name when called. If he does not get his needs met he will scream, and hit his head with his fist. When left on his own, he will often line up objects such as pens or spoons. When he falls down and hurts himself, he is not easily soothed by his mother. Johnny is not toilet trained nor can dress himself. When in school, he is in a self-contained class with other children with similar behaviors. He has a difficult time attending to tasks in a large group setting.

Can you guess the approximate age or age range of this person as well as his diagnosis? Johnny is 3 and has an Autism diagnosis

Slide 20: Case study 2

• Tony is ____ years old and has a diagnosis of ____________.

• Can you guess the approximate age or age range of this person as well as his diagnosis?

• Tony is 9 and has a diagnosis of Asperger’s Syndrome.

Here is a second case study. Tony is ____ years old and has a diagnosis of ____________. He is a typical little boy in many ways, enjoying cartoons and Batman, playing outside and especially playing computer games. Unlike many little boys, though, he has to watch the same cartoons at the same time every week. If he has to miss Batman for any reason, he's upset over it for days. He studies Batman, draws Batman, talks to others about Batman, and collects action figures, but rarely plays with them like most boys do. He simply likes to have them at hand. He plays outside, but only if there is no chance of him spotting a butterfly-even a picture of one terrifies him. Additionally, he cannot wear shorts, or even short sleeves, even in the warmest weather because it bothers him from a sensory perspective. He can hold witty, intelligent conversations with any adult, but children his age find him overly formal. He is at the top of his class academically, and reads on a 8th grade level , especially if it is on a topic of interest to him. In his general education class, they do a lot of collaborative projects. Tony struggles with these as he wants to tell everyone in the group what to do.

Can you guess the approximate age or age range of this person as well as his diagnosis? Tony is 9 and has a diagnosis of Asperger’s Syndrome

References

Bauer, S. (1995). Autism and the pervasive developmental disorders: Part 2. Pediatrics in Review, 16(5), 168.

Lord, C., & McGee, J. P. (2001). Educating children with autism. National Research Council. Washington, DC: National Academy Press.

Schall, C. M., & McDonough, J. T. (2010). Autism spectrum disorders in adolescence and early adulthood: Characteristics and issues. Journal of Vocational Rehabilitation, 32(2), 81-88.

Seltzer, M. M., Shattuck, P., Abbeduto, L., & Greenberg, J. S. (2004). Trajectory of development in adolescents and adults with autism. Mental Retardation and Developmental Disabilities Research Reviews, 10(4), 234-247.

Tager-Flusberg, H., Paul, R., & Lord, C. (2005). Language and communication in autism. In F. R. Volkmar, R. Paul, A. Klin & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders, vol. 1: Diagnosis, development, neurobiology, and behavior (3rd ed.). (pp. 335-364). New York, NY: John Wiley & Sons, Inc.

Tantam, D. (2003). The challenge of adolescents and adults with Asperger’s Syndrome. Child and Adolescent Psychiatric Clinics of North America, 12(1), 143-63, vii-viii.

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