Do you know anyone with an autism spectrum disorder? Have you been diagnosed? Is there someone in your family, your school, or in your community with autism that you find difficult to understand? The behaviors of someone on the autism spectrum are driven by a difference in their brain and the way their body responds to stimuli. Forming and maintaining relationships may require some additional understanding and consideration.

What is Autism?
Autism spectrum disorder is complex brain-based (neuro-developmental) disorder that has an impact on communication, social skills development and behavior.  Some people who have autism may “blend right in” at school, but are overcoming challenges to do so.  Other people with autism don’t have verbal communication and appear to be profoundly disabled.  Asperger’s Syndrome is considered a disorder in the autism spectrum, but some adults with Asperger’s Syndrome argue that is a separate diagnosis.  You may also hear people talk about a pervasive developmental disorder, or PDD.  The PDD label is sometimes used to describe characteristics similar to those in a child with autism, when the child is too young to really meet the criteria.  Like ASD, PDD is characterized by:

• Trouble understanding language, or using it appropriately (understanding humor, for example)
• Trouble connecting with or relating to people (knowing how far away to stand when talking to a friend)
• Using common objects in an atypical way (spinning the wheels on a toy instead of pretending to drive it)
• Difficulty accepting changes in a plan (taking a different route to the store, or a movie being sold out)
• Repetitive behaviors (rocking or hand-flapping)
• Hesitancy to be held or cuddle others.

Who has Autism?
Autism can affect people of any race or social group.  Some statistics quote that is occurs four times more often in boys than in girls.  Autism Speaks, one non-profit organization that works with families and individuals with autism, cites autism impacts 1 in 110 children, and 1 in 70 boys, in the United States. This is an increase of 600 percent from 20 years ago.  While it seems that this disorder is diagnosed so much more often, the Center for Disease Control notes that while there is a dramatic increase the case diagnosed in recent years, there are also now better screening tools, more awareness about early warning signs of autism spectrum disorders, and a recognized benefit in labeling the disorder for children who need to access services that could help their development at an early age.  Better data is now kept on behavior, and families are more open to discussing behavioral challenges with physicians, and teachers than they were in the past.  While autism is not something that can be cured, managing the behaviors associated with the disorder, and teaching things like social skills in a specific way help those with autism to be more included in activities of daily life.

How is it diagnosed?
Since autism a neuro-developmental disorder, there is no blood test that can be used for diagnosis. Characteristics may start to appear in babies as young as 6 months.  By age two or three, the signs may be more apparent, as children start to reach milestones that indicate typical development.   Children are screened initially during well-visits by their primary care physicians, at 9 months, 18 months, and about 24 months, but if there are warning signs, or risk factors such or a family history of autism, a more aggressive approach may be used to screen, such as sending the child to a developmental pediatrician, or a screening by educators, speech therapists and occupational therapists, to collect more information.

The benefit of diagnosing autism early is that children can have access to services, such as speech therapy and occupational therapy, when they are younger, and it is not as difficult to make progress.

How do people with autism learn? 
Young children have more neuroplasticity, meaning that the brain can change the way it works, with more ease than adults whose brains have been operating the same way for years.  It was thought that people’s brains were one way or another, and some people were “smart” and others were not.   What research has shown is that the brain sends messages to different regions, which receive those messages (stimuli) and respond to them, by telling the body to move, speak, stop, or perform another action.  Some areas of the brain are more receptive that others in different people.

Scientists can look at how a brain responds to stimuli using a tool called a PET scan.  When an area of the brain is stimulated, or working hard, it burns glucose.  This appears red, in color, on the scan.  By examining which parts of the brain are working harder an item is examined, like looking at a smiling face, it helps researchers to understand that certain areas of the brain are receiving the messages, and others are not.  Children with autism learn by both utilizing the parts of the brain that work well, and trying to stimulate the parts of the brain that do not respond as well to stimuli. A young brain is more adept at “re-routing” these messages to the appropriate areas on of the brain.

A child with autism may see a smiling face, and instead of the area of the brain that processes emotions being stimulated, because of the happy smile, the part of the brain that recognized objects (that can differentiate a fork from a spoon) is stimulated.  Therefore, a person with autism may need to be taught that happy people have smiling faces, so that smiling person must be happy, as a logical fact.  Other children see a smiling face, smile back, and feel happy, so the feeling is the stimulus.  It isn’t that children with autism don’t have feelings, or can’t learn, they just learn differently.

Some approaches to learning:
There are several characteristics of autism that are addressed by specialists in educational settings, and each child is unique, so a team of people who know and care about the child would create a list of goals, depending on what the student needs to work on, and what their strengths are.  Often, these goals are in the areas of communication, behavior, and social skills.  One child may have the goal to use a toy for the purpose for which it was intended, such as playing with pots and pans to pretend to cook dinner, for example. Another student may have a goal to initiate play with a friend by asking a question, as another example. Since there is a spectrum in autism, meaning people are working on different kinds of skills, there is no one approach that works for all students.

Communication
However, since many students with autism are visual learners, teachers often find success using symbols with both text and pictures of items, such as pretzels, balls, or playground equipment to help students know what will have happen first, next and last.  The idea of using a visual schedule helps students know what to predict will happen, and in what order, so that they are less anxious.  These symbols are also often used to facilitate. If a student can’t ask for a snack, they may hand a card with a picture of a snack to their parent or a teacher, to make a request. This is known as a picture exchange communication (PEC) system.  Some students with autism don’t generalize well, meaning that they may learn to use a red toothbrush at home, but have difficulty using a different type or color of toothbrush on vacation or while away at camp.   Using a consistent set of images or symbols helps students to get “stuck” when they are learning because of a subtle difference pictures that could irritate them.  Using images to help facilitate communication is known as augmentative communication. Some students use special devices that speak when a particular button or key is pressed.  Recently, new iPad apps have been developed to use for augmentative communication as well.

Behavior
Behavioral goals are usually a part of the program for a student with autism, as well.  A strategy known as applied behavioral analysis uses rewards to motivate the student to perform a task.  Students with more complex goals may use charts or long term plans, such as working towards earning a toy or privilege at the end of the week, or they may require a more immediate reward for a small task, depending on the level at which they are functioning.  The idea is that the rewards will elicit a positive feeling that will be linked toward the behavior, and motivate the student to repeat this appropriate or desired behavior in the future.  Students with autism also may have unique behaviors that are tied to sensory needs, like a desire to spin, rock, or feel pressure against their skin.  Instead of meeting this need in a way that is harmful, like squeezing someone else’s arm, the need is met with therapeutic tools, like clothing that is heavier or worn closely to the skin. The student is rewarded for choosing a therapeutic approach.  Some call these tools a “sensory diet.”  An occupational therapist might help to create a customized plan to meet a child’s sensory needs.

Social Skills
The need to make friends and maintain relationships with peers seems to begin at infancy, but for a child with autism, it can be a greater challenge. Reading the cues that others send asking to start a friendship may be harder to interpret.  For example, if a student has a sensory issue and does not like to have people sitting close to them, a child who comes to join them at the lunch table may not be welcomed.  Subtle social cues like smiling, winking, standing too close or too far from someone may also be hard to understand for a student with autism.  Children with autism may become hyper-focused on an area of interest, such a baseball statistics or transportation, and may be reluctant to talk about topics of interest to their peers.  Goals around social skills may include turn taking in conversation, remembering to ask others if they want to share a story, or beginning and ending a conversation appropriately.  Learning the rules of what is socially appropriate may be a part of their program.  Complex use of language, such as sarcasm or slang, may be hard to interpret. Students who are neurologically typical may find the person on the autism spectrum to “selfish” before realizing that when they talk about their favorite topic, it is an effort to share this with them.  Students with autism may respond better to a direct statement, such as, “I would like to talk about something else now.  Let’s talk about movies,” instead of a more subtle response like, “Do you like to talk about movies, or anything?”   Teachers and parent may use a tool developed by Carol Gray, an autism specialist, called Social Stories.  Simple books are created that show the student what could happen in a new setting, how others might behave, and what they are expected to do or what they might say.  While the story may seem very simple to a typical child, knowing what to anticipate, and having a road map for how to respond can be very calming to a child on the autism spectrum. 

Introduction:
Have students read Autism Now from PBS NEWSHOUR online or on a printed copy.

Step 1: Ask the students to choose a task that is typical for a student in their grade, such as trying out for a team, asking someone to join you at the movies, or going on a field trip.  Create an 8-page social story for this situation.  You can draw the illustrations by hand, use simple images or symbols, or use clip art from a computer program like PowerPoint.  Each page (or PowerPoint slide) should have no more than 3 sentences.  The sentences should be declarative statements, and not include any language that can be misinterpreted, such as “cut me some slack,” or “I died of embarrassment,” since you are creating it for a student who is a very literal thinker.  Remember to include details about the place, the people, the social expectations, and any strategies or tools one could use if they are physically uncomfortable, like wearing earplugs during a fireworks display.

Step 2: Ask the student to chose a partner, and read the social story to the class while their partner “acts out” the tasks in the story.  Did the story truly prepare their partner for the sounds of the crowd at the indoor hockey game, or the heat and humidity associated with visiting a special monument in the spring?  Do the pictures in the social story accurately match what usually happens at that event or location?  (Hint: uniform colors might change if a team is home or away, and menu items at some restaurants change during lunch or dinner).

Step 3: Based on what the class has learned about autism, as a group, revise the social stories using feedback from others, and include additional pages or slides, as needed. 

Temple Grandin, an adult with autism who was able to teach the world a great deal about the disorder, said this about her childhood, “ I can remember the frustration of not being able to talk. I knew what I wanted to say, but I could not get the words out, so I would just scream.” When person with autism has what looks like a tantrum, it is called a meltdown. Having the ability to label feelings, communicate them, and make a plan to change something to make the feeling go away is a learned skill, and a challenging one for someone with autism. As homework, or as a related activity, create a choice board that can be used in your classroom or school. Use a folder or cardstock to create a simple board like the "I feel frustrated board", but substitute either a different feeling (sad, angry, hungry) and around the board, draw symbols to represent at least 12 things that can address that feeling. Just like on the model, have a space that reads “I want _____ please.” For example, if you write, “I feel sad,” some of the choices could be items or actions like tissues, privacy, or company. Use photos, drawings, or real items on your board, and share it with others for feedback. What would you add to your classmate’s board or your own? After testing it, which symbols did you use most often? How would you have to adapt it if the person using it was on a special diet, or needed assistance with toileting, for example?