Autism spectrum

Neurodivergence is an umbrella term that describes people whose brains function differently from what is considered "neurotypical."
Besides autism, other forms of neurodivergence include:

ADHD (Attention-Deficit/Hyperactivity Disorder): Differences in attention, impulse control, and energy levels.
Dyslexia: Differences in reading, spelling, and language processing.
Dyscalculia: Differences in understanding and working with numbers.
Dyspraxia (Developmental Coordination Disorder): Differences in motor skills and coordination.
Tourette Syndrome: A condition involving involuntary movements or vocalizations (tics).
Intellectual Disabilities: Significant limitations in intellectual functioning and adaptive behavior.:

• Neurodivergent means "thinking or experiencing the world differently."

• Neurotypical means "thinking in a way that society sees as standard or expected."

*NOT EVERY PERSON WITH AUTISM HAS DISORDER

DISORDER -> WHEN IT HAS NEGATIVE AND CONSTANT IMPACT ON EVERYDAY LIFE AND DAILY FUNCTIONING

Autism Spectrum Disorder diagnosis requires (ABCD): 

• Persistent deficits in social communication and social interaction across multiple contexts (A autistic communication)

Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

Deficits in nonverbal communicative behaviors used for social interaction (poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language or deficits in understanding and use of gestures, lack of facial expressions and nonverbal communication)

Deficits in developing, maintaining, and understanding relationships (difficulties adjusting behavior to suit various social contexts, difficulties in sharing imaginative play or in making friends, absence of interest in peers)

• Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following (B behaviours)

STIMMING-Stereotyped or repetitive motor movements, use of objects, or speech ( simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases)

SAME-Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day)

SPECIFIC INTERESTS-Highly restricted, fixated interests that are abnormal in intensity or focus (strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest)

SENSORIC NEEDS-Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)

• Childhood

-How did person behaved as a child, in school...

• Degree of functioning 

-If it is not interfering with everyday life then it is not a disorder

• Can it be Explained by intelectual deficit or other conditions?

Women, in particular, are less likely to receive a diagnosis. This is partly because diagnostic tests were standardized primarily on male populations. Additionally, traits such as special interests and emotional reactions in women are often misinterpreted as typical female behavior rather than indicators of autism.

People on the autism spectrum without additional disabilities often go unnoticed. 

AUTISM

- deficits come cause environment is not adjusted for neurodivergent people

-communication between autistic group is equaly succesful as neurotypical group in task of "broken telephone" game 

-> different ways of communication

AFFECTIVE EMPATHY PRESENT-they feel emotions of others, sometimes too much- not understanding WHY? (Cognitive empathy)

ATTENTION-no social bias; -looking at geometrical shapes and people / not focusing first on human interactions 

People with ASD have more neural networks

-usually number of neural connection drop and the ones that stay are more "specialized" 

-in autism there is a lot more localized connections (for example neuron connections for auditory stimulii) -> thats why hypersensitivity is more often

3 important neural NETWORKS:

1. default mode- when brain is resting

2. salience network- when something gets our attention

3. central executive network- when we need to react

STIMMING- way of coping with overwhelming situations- allow it in safe ways

SAME-make ways to know whats going to happen next- visual schedules, being told in advance -> giving time to prepare, less anxiety

INTERESTS- explore them -> good motivator, great for planning therapy and education

SENSORY- 

• Hypersensitivity to different things

-> accommodate environment

Examples:

 tactil sensitivity- look into clothes w same material percentage as the ones they usually wear

 light sensitivity- glasses, dimmer lights...

take into consideration- HARDER TIME WITH:

• Proprioception

 knowing/feeling the position of your body/limbs in space 

• Interocetion

 understanding messages from own body -hunger,temperature

Early childhood

-drop in social interest -> deprivation in social exiriences ->problems in social learning and cognitive development

->less visual exploring

EARLY INTERVENTION

- goal is to get the child interested more in social enviroment and to motivate him to explore it

18 months- first noticable signs

2-6 months drop in eye contact

-not using mimics and gestures

-not using words

-no interest for surrounding

• ALSO ASK:

How does kid play? (repeating vs symbolic games)

How much eye contact kid makes?

Does kid react to name?  Check hearing!

NOTICE- regression in skills, parental concern- as they can tell/feel when something is off

• TESTS TO USE:

M-chat questionnaire -intrest in other kids; showing things with index finger while also making eye contact; showing things they do; reaction to name; following direction person they talk to is looking at

ADI-R guestures-descriptive,comercial (bye wave,kiss blowing), instrumental, moving hands while talking

ADOS II- observation that confirms diagnostics; moduls depend on age and speech

SENSORY

Filtering less information -> person can get overwhelmed easier

MELTDOWN

- "break"

-can include agression, shouting, selfharm and repeating behaviours

-sometimes "shutdown" can occur (Not able to talk or even move)

 When overwhelmed even small frustrations can lead to meltdowns

Kids can understand very fast that meltdowns are socialy unnaceptable 

-> that can lead to isolation, mutism, social stress, shutdown

-We can try to notice signs of frustration and getting agitated and try to REACT  (7S *explained more detailed later)

ROUTINE

Routines bring back energy to autistic people

EDUCATION

-learning about autism

-good to read books written by autistic authors

THERAPY

-speech therapist, occupational therapist and psychologist

How to save energy and confidence in self?

Before using therapy with medication first ask: GOAL? WHY? -side effects, what to do CONCENTRATION? how much, test absorbtion as it can vary greatly

BEFORE GIVING NEUROLEPTICS ALWAYS MAKE SURE BEHAVIOR IS NOT CAUSED BY SOMETHING SOMATIC OR SENSORY!

EVEN THEN DO NOT GIVE THEM TOO LONG - Use the time to work on communication therapies

NEVER GIVE 2 NEUROLEPTICS- NEVER MORE EFFECTIVE THEN 1 !!!

NEURODIFFERENCES

Look into other possible conditions

OTHER DISESES/CONDITIONS

-if new behaviours accure check omatic problems first

CONSTIPATION

TOOTHACHE - possible head hitting, excessive ear touching

PARASITES

-less diverse microbiome

EILEPSY- 4x more common

-all night EKG to be sure

-often in nightime

-regression can indicate possibility of epilepsy

CIRCADIAN RYTHM

-melatonin is synthesizing less

-sleep hygiene- ritual,rutine,room temperture..

EHLERS-DANLOS SINDROME

-hyperfelxibility of joints - can cause pain so pay attention if the sindrom is present-  problems with collagen 

HOW TO REACT SAFELY:  7-S

SAFETY

-make sure person is safe, remove sensory stimulation (loud sounds, bright lights...)

-dont ask questions/tell them to stop -> only more pressure and sensory stimuli

SOURCE

-find source- are you hungry? thirsty? tired? (Because of difficulties with interoception, sometimes signals are misinterpreted or bodily needs go unnoticed)

SPEAKING TONE

-soft, quite, gentle 

-or just being silent

SURROUNDINGS

-make surrounding quite, remove others to make space

-prepare others (kids in class) to the understand what is going on, how to quietly give space, how to be inclusive and not judge, have safe space for person to isolate from others

SECURE RYTHM/RUTINE

-give enough time

-make rutines they do available

-keep rythm in your work as teacher/assistant

SENSITIZATION 

-normalise expirience, explain difference between meltdown and tantrum

SPECIAL THINGS

-make favourite things, toys, music, routine available 

First people that are in longer contact with child

• NOTICING

-early signs-> evaluation -> early intervention

some signs: no imitation, isolating when noise is high,selective eating, social skills

• CONNECTING

-if teacher makes connection and invests time in beginning child will be more relaxed

-teacher = pleasant expirience;internal motivator

-following what kid likes and using it in work

• SPACE

-physical structure: clear zones-work, play, rest (by functions), zones should have clear borders

-visual structure: daily schedule with pictures/pictograms (if needed); shelves,zones and shelves have labels; tasks shown step by step

-individual work: everyone has their corner/table; tasks are adjusted to development; clear instructions- what,how,when,what after

• PREDICTIBLENESS

pyctograms or small objects if pyctograms are to apstract still -small shoe for going outside, small ball for playing

-visual timers- easier transition between activities, being able to see how time passes 

• NEEDS

-unstructured activities- free aproach, child chooses what to do
-halfstructured activities - verbal instruction, child chooses how
-structured activities -model/photo- need to reproduce whats shown

• OVERWHELMINGNESS 

Problems with-proprioception, balance, introception

• PRAISE

-MOTIVATION -NOT wish to please grownups but something that is caused by appropriate motivation enhancers

-give attention to kid when it is calm (even if we finally want to catch a break at that moment of peace)- strenghtens motivation to keep calm more often

Structure and predictability but other challenges

• NOTICING

SOCIAL RELATIONSHIPS--adjusting to groups, understanding rules, isolation, bullying

COMMUNICATION- Literal speech, prefer clear instructions, not understanding irony, jokes and not clear directions

RIGIDY AND ROUTINE- they want to try by themselves- less trust in authority, insisting on same routines, hard time with changes in classroom

INTRESTS - narrow, specific

SCHOOL DIFFICULTIES- attention and executive functions Autism/hyperfocus/internal distractors - ADHD/hypofocus/external distractions

*around age 7-12 - drop in neural connections

• STRUCTURE

Executive functions = ower over time and sace- planning, imaginating, flexibility, mental representation

Frontal cortex- interaction of different areas-in autism they are not working together  

• PREDICTIBLENESS OF ACTIVITIES

 Being able to see how time is passing - visual timers

Have clear way to announce beginning and ending of activity/task

Help in understanding apstract concepts

Show and help with switching roles- while playing or talking, giving examples

-> when possible; goal is not to overwhelm

• ROUTINES

Start day/class in similar way

Predictibleness helps with focus and lowers stress

Visual structure - INTRO-WORK-PAUSE-CONCLUSION

Ending ritual- what I learned/what was hard -> sense of control

• NEURODIFFERENCES

Autism- 5% ADHD   ADHD-80% autism

I CANT ----> I WILL NOT -----> I DONT CARE

ADHD----> Oppositional Defiant Disorder (ODD) ---> Conduct Disorder

1. Child wants to do it but cant/doesnt know how, hard time with attention +, selfcontrol and organizing

-> Gets criticized 

2. Child doesnt want to do it, fight for autonomy, testing boundaries, giving resistance when feeling frustraited

3.  Child knows and can do sth, but doesnt care, breaking rules without guilt 

• PERCEPTION

look out for signs of getting overwhelmed

teach strategies to kids of how to defend themselves- how to leave stressful situations, make tools possible and available (earplugs, sunglasses...)

METHODS IN DIRECT WORK

Preschool/disabilities

Physical leading and gesticulating

School

Verbal - short and simple instructions

Visual- using photographs, pyctograms 

Imitation - showing examples

Enviromental - preparing surroundings to lead to desired behaviour - preparing different work/play materials in space and adjusting it

HOW TO MAKE SCHOOL MORE MANAGEABLE?

-Predictable schedule – daily plan on the board, visual schedule

-Breaking tasks into smaller steps – step-by-step instructions

-Social stories – texts or comic-style stories that explain behavior rules

-Flexible accommodations – a calm space for breaks, extended time for writing tests

CHALLENGING BEHAVIOURS

-Screaming,shouting,aggresion, self agression, refusal

4 MAIN FUNCTIONS:

GETTING SOMETHING -I WANT

ESCAPING OR AVOIDING- I DO NOT WANT THIS

ATTENTION- LOOK AND ACKNOWLEDGE ME

SELFSTIMULATION- I AM TRYING TO CALM DOWN/STIMULATE MYSELF

Working with people on autism spectrum and intelectual disabilities

1. Communication:

• Be clear and concrete. Avoid vague instructions. Say exactly what you mean.

• Use visual supports. Pictures, written lists, schedules, or charts- depending on level of understanding of each individual.

• Give extra processing time. After you ask a question or give a direction, pause and wait. Don’t rush to fill the silence.

2. Build Trust and Rapport:

• Be patient and consistent. Relationships might take time to build, but consistency helps them feel safe.

• Respect their individuality. Everyone is different — interests, communication styles, sensory needs — so get to know them personally.

• They often need to adjust to others so try to find a way to get into their world.

3. Set Realistic Expectations:

• Break tasks into steps. Small, manageable chunks feel less overwhelming.

• If task is too hard or there is not enough attention dont just end the task. Adjust it to be easier and try to accomplish it.

• Celebrate small wins -positive reinforcement builds confidence and motivation.

4. Sensory Awareness:

• Be mindful of sensory sensitivities (bright lights, loud noises, certain textures — if you notice signs of discomfort, adjust the environment if possible)

5. Support Self-Advocacy:

• Encourage independence -let them make choices when possible and appropriate

• Teach self-advocacy skills- expressing their needs, wants, and boundaries

6. Emotional Regulation:

• Teach coping strategies- deep breathing, taking breaks, or using calming tools (like fidgets) can help 

• Stay calm yourself -your tone and body language really matter, especially if they’re upset

• Allow healthy way and safe space to let unpleasant emotions out

7. Social Skills and Life Skills:

• Practice real-world scenarios. Role-play conversations, real life interactions like grocery shopping.

• Be supportive, not controlling. Guide them, but allow them to problem-solve too.

8. Work Collaboratively:

• Partner with families and other support staff- sharing information leads to better support

• Ask them! Young adults often know what works best for them — involve them in decisions about their support