CADS – Module du Trouble du Spectre de l’Autisme CADS - Autism Spectrum Disorder Module

By: CADS Technical Committee2015-2016

Training plan

1) Definition2) Category3) Strength4) Weaknesses5) Interventions

1) Communication2) Security

Aim of the Training Plan

Be able to assess communication and intervention strategies,

Be able to prepare for a ski lesson using multiple strategy and plans,

Be able to organize multiple choices within each ski lesson.

…. with and without the uses of pictograms.

1- ASD: definition

Autism Spectrum Disorder (ASD), also referred as autism, is:

A Neurological Disorder that causes developmental disability...and

affects the way brain functions resulting in:

◦Communication difficulties◦Social interaction difficulties◦May also include unusual behaviour patterns,

activities and interests.

1. ASD : Definition

The term “spectrum” refers to a continuum of severity or developmental impairment.

1. ASD : Definition

The conditions cover a wide range in:

Number and kinds of symptoms,Severity: mild (1) to severe (3),Age of onset,Levels of functioning,Challenges with social interactions,

1. ASD : Dx

Includes:

A. Persistent deficits in social communication and social interaction across contexts;

B. Restricted, repetitive patterns of behaviour, interests, or activities;

C. Symptoms must be present in early childhood;

D. Symptoms together limit and impair everyday functioning;

2- Severity Code

The severity code is in line with amount of support needed:

1. Need for support;

2. Important need for support;

3. Very important need for support;

DSM-V

Causes / origins…

Amygdala Emotion Aggressive

behaviours

Temporal Lobe Language Social

perception

Prefrontal cortex Attention Planning Abstract

thinking Social

behaviour

Cerebellum Attention Motor:

Coordination Balance Speaking

Parts of the brain affected by ASD

Strengths exhibited 1/2

Non verbal reasoning skills,◦Chess.

Reading Skills,

Perceptual Motor skills,◦Baseball.

Computer interest and skills with computers,

Strengths exhibited 2/2

Exceptional memory,

Visual and Spatial abilities,

Music Skill,

Drawing skills,

Exceptional memory & Drawing skills

Stephen Wiltshire, incredibly drawing the entire London skyline from memory

Weaknesses Exhibited

Impaired Communication:

◦Idiosyncratic words or phrases, (“Yes Sir” )◦Choppy language,◦Repetitive language,◦Difficulty staying on-topic,◦Poor conversation skills,◦Abnormalities in pitch, stress, rate, rhythm and

intonation of speech.

Weaknesses Exhibited

Impaired Social Skills:

◦Lack of Awareness: Awkward social initiation, Little to no social initiation, One sided conversation, Struggling with perspective taking, Takes you literally, Little to no eye contact,

◦Abnormal Seeking of Comfort when Stressed,◦Impaired Imitation Skills,◦Abnormal Toy Play,◦Difficulties forming relationships,◦Perseveration.

Weaknesses Exhibited

Dependence on routine,◦But not all individual.

Abnormal responses to Sensory Stimulation,◦Hyper-hyporeactivity.◦Hyper-hyposensitivity.

Behaviour problems◦Tantrum◦Self injuries◦Property destruction, etc.

Weaknesses Exhibited

Difficulties in Sleeping,

Eating challenges / diet,

Gastrointestinal problems,

Motor skills problems,◦Balance, ◦Agility, ◦Limb speed, ◦Coordination (Eye-Foot).

Interacting with an individual with ASD

Talk less – listen & observe,

Use show and tell strategy,

Avoid the Yes/No question type,

Brake the task into achievable pieces,

Interacting with an individual with ASD

Give time to process,

Utilise repetition:◦Re-teach, repeat and practice.

Ensure your communication style matches your student’s ability.

Interacting with an individual with ASD

Support Strategies (AOT)

Like / dislike?

Anything I should avoid?

Is there one strategy I should be using?

Checklist?

Interacting with an individual with ASD

Communication & behaviour tips:

First – then;◦Motivation

Countdown Strips;◦Shows how many more are needed◦Help stretch the First-then

Interacting with an individual with ASD

Communication & behaviour tips:

Token Boards;◦Motivation◦Positive feedback

Interacting with an individual with ASD

Communication & behaviour tips:

Timers;Good in transition between activities

Interacting with an individual with ASD

Communication & behaviour tips:

CHOICE 

Play with snow ball

 

Built a Snowman

 Go Snowboarding

Choice can be : verbal, written or pictures in a choice board

Interacting with an individual with ASD

Communication & behaviour tips:

Visual Scheduler…

◦Decrease anticipation -stress -anxiety

◦Help the individualunderstand what is going to happen today.

Interacting with an individual with ASD

Behaviour Support Tools:

Wait Cards;◦Make waiting more concrete◦Hold the card

Interacting with an individual with ASD

Behaviour Support Tools:

Visual support for teaching safety;◦How to wear equipment safely… example

Cognitive and Intellectual Disability

By: CADS Technical Committee2015-2016

Presentation for CI

DefinitionDown SyndromeFragile X SyndromeASDSeverity CodesBrain InjuryCommon difficulties

Definition

Defining cognitive disability/impairment (CI) is not easy, and definitions of cognitive disability are usually very broad.

Individuals with CI also present:◦difficulties in various types of mental tasks. ◦diminished cognitive and adaptive

development. ◦may require assistance in daily activities.

Down Syndrome

Known and called Trisomy 21 ◦Extra chromosome on the 21st pair (t21)

Refers to a type of cognitive delay in general intellectual functioning that may include deficits in :

◦adaptive behaviour, ◦motor coordination, ◦muscle tone,◦cardiac, digestive, vision and hearing

impairments.

Down Syndrome

Individual with Down Syndrome shows:

Loose joints ◦Hyperlaxia

Low muscle tone◦Muscular hypotonic

Atlanto-axial/occipital instability◦Two first cervical bone

Effect on learning style

Fragile X Syndrome

Fragile X is the second leading genetic cause of intellectual disabilities:

◦Most common cause in men,

◦Generally large in stature but with poor muscle tone,

Fragile X Syndrome

Behaviour features:

◦Reluctance to make eye contact,

◦Engage in odd stereotyped movements,

◦Hyperactivities,

◦Tremors,

◦Poor motor coordination,

◦Social and communication skills are not well developed.

Fragile X Syndrome

Similar behavioural symptoms are characteristic of ASD.

Three Subtypes of Fragile X (only two will be presented here)

◦1- Cognitive deficits more severe and share with ASD. Social avoidance Repetitive movement Severe delays in developing speech and language

◦2- affect motor skills (balance), present tremor and memory deficits.

Severity Code

Category Efficacy in 3 domain* Description

Mild 85

Can achieve academic success Mostly self-sufficient Need assistance with life decisions, finances,

nutrition, shopping and transportation

Moderate 10

Adequate communication but complexity is limited

Social cues and social judgment regularly need support.

Self care can be achieve (support may be required)

Can be employed with some support.

Severe 3-4 Communication skills are basics Self-care require daily assistance

Profound 1-2 Usually 24-h care and support is needed Presence of co-occuring limitations (sensory or

physical

*1-Conceptual, 2-Social, 3-Daily activities

Learning Disabilities

Genetic/neurobiological factors/injury that alters the brain functioning process relate to learning.

Its refer to a number of disorder that may affect:

◦Acquisition,◦Organisation,◦Retention,◦Understanding or use of verbal or nonverbal

information.

Brain Injury

Damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease. 

Could be from but not restricted to:

◦Stroke, ◦Illness, ◦Traumatic Brain Injury (TBI), ◦Brain tumors, and ◦Meningitis.

Brain Injury

Impacts of Brain Injury could be observed in:◦Motor capacity (66%)

Agility, coordination, limp speed, reaction time Focal paralysis of on or few muscles

◦Sensory capacity (28%) Balance, and vision (61%)

◦Cognitive (93%) Learning, memory(79%)

◦Psychological (79%) Anxiety (61%), frustration-control of (68%)

Brain Injury

Lesions to the main line of the motor system may result in an enhancement of some features (positive features or exaggerated response) or a reduction (negative features). Positive features or exaggerated

response can include:◦Hyperreflexia and hyper-tonus (abnormal resistance

to passive movement).

Negative features can include: ◦Loss of strength, Loss of dexterity, Fatigability.

 

Brain Injury

Brain Stem System may lead to: ◦Dyscontrol of automatic behaviours, such as posture,

balance, locomotion and breathing.

 Motor Areas of the Cerebral Cortex may

cause: ◦Weakness - hyperreflexia - spasticity. ◦Organising, shaping and refining movement

difficulties.

 Cerebellum lesions may lead to:

◦Poor planning of movement,◦Poor regulation and timing of movement,◦Reduced smoothness and co-ordination of movement.

Brain Injury

Common difficulties:

Reduce Frustration tolerance,Self-Esteem,Social Skills,Hyperactive ,

◦Difficulties blocking out signals◦Prone to motor sickness

Hypoactive,◦Difficulties attending to signals

Tips to create a successful learning environment

Create positive relationship

Clear, simple and concise instructions

Give student time to process

Use the «Doer & Feeler» approach

Tips to create a successful learning environment

Maintain a positive attitude,

Give positive feedback,

Look for achievements, and be able to highlight it,

Exercises

For exercise #1a, #1b, #2a and #2b:

Use participant characteristic #1 for ASD

Use participant characteristic #2 and #3 for CI

ASD/CI Exercice #1a

Create an activity using Pictograms to perform any of the steps 1 to 4 (CADS Level 1) or steps 1 to 6 (CADS Level 2).

Be creative, Use suggested pictogram or Create your own, Time 15 min, AOT must include Checklist, Must include safety, Team up to 4.

Use the Marking grid to help candidate instructor building a successful ski lesson

ASD/CI Exercice #1b

Create an activity without Pictograms to perform any of the steps 1 to 4 (CADS Level 1) or steps 1 to 6 (CADS Level 2).

Be creative, Use other communication tools, Time 15 min, AOT must include Checklist, Must include safety, Team up to 4.

Use the Marking grid to help candidate instructor building a successful ski lesson

ASD/CI Exercice -2a

Create an activity using Pictograms to perform lift procedure

Be creative, Use suggested pictogram or Create your own, Time 15 min, AOT must include Checklist, Must include safety, Team up to 4.

Use the Marking grid to help candidate instructor building a successful ski lesson

ASD/CI Exercice #2b

Create an activity without Pictograms to perform lift procedure

Be creative, Use other communication tools, Time 15 min, AOT must include Checklist, Must include safety, Team up to 4.

Use the Marking grid to help candidate instructor building a successful ski lesson

ASD/CI Exercise - participant #1

13, Fille, 37kg Dx= Trouble du spectre de l’autisme (TSA) / TDAH, ScolioseRx= DexedrineSx= difficulté motrice et faible résistance/endurance (fatigue), Problème de posture, intolérance face à certaines textures d’aliment, mutisme sélectif (mais parle aux personnes connues)

___________________

13, Girl, 37kg Dx= Autism Spectrum Disorder (ASD) / ADHD, ScoliosisRx = DexedrineSx= Motor difficulties et little resistance/endurance (fatigue), Stance problem, dislike some food texture, do not speak to stranger (but do with known individual)

ASD/CI Exercise - participant #2

46, Femme, 85Kg,Dx= T21, glande tyroïdeRx= Syntroïde, (hypo)Sx= Sous-réactive (hyporéactive), difficultés motrices,

problème de prononciation (dysarthrie), anxiété sociale.__________________

46, woman, 85Kg, Dx= T21,down syndrome, Thyroid Rx= Syntroid (hypo)Sx= hyporeactive, motor difficulties, language difficulties (dysarthria), social anxiety.

ASD/CI Exercise - participant #3

18, homme, déficience intellectuelle léger, 65KgDx= Déficit d’attention, TDAH; déficit d’apprentissageRx= Pms methylphenidate, (4 fois par jour)Sx= Basse vision, dyspraxie, opération scoliose en mars 2008… mise en place d’une tige de métal. Problème de positionnement des pieds (ouverts) lors des déplacements

_______________________18, men, CI mild, 65KgDx= ADHD; learning disabilityRx= Pms methylphenidate, (4 times a day)Sx= low vision, dyspraxia, scoliosis surgery in march 2008… rods and screws. Foot (open) position when walking