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-=====Introduction====
-This web page explores Autism Spectrum Disorders (ASD) from a cultural perspective, addressing the role culture may play in its diagnosis and treatment.  Incidence rates, as well as diagnosis and treatment practices in Oregon, the United States and other countries are identified.  Multicultural views of ASD, such as family impact and the social and political identity of ASD (including changing views of Asperger's Syndrome in relation to its diagnosis in the DSM-5), are also addressed.
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+=====Introduction====
+This web page explores Autism Spectrum Disorders (ASD) from a cultural perspective, addressing the role culture may play in its diagnosis and treatment.  Incidence rates, as well as diagnosis and evidence-based treatment practices in other countries are identified.  Multicultural views of ASD, such as family impact and the social and political identity of ASD, are also addressed.  Please note that the information provided on this page is in regards to the specific diagnosis of autism (i.e., not high functioning autism or Asperger's syndrome) unless noted.
+For general information regarding the treatment and identification of ASD in the USA, please see the [[Autism Spectrum Disorders in the USA]] page.
+=====Empirical Multicultural Research =====
-====Assessment and Diagnosis====
-===Definition===
-Autism Spectrum Disorder (ASD) is a group of complex neurological disorders, resulting in impairments across linguistic, cognitive, and social domains ((Wetherby, A.M., & Prutting, C.A. (1984). Profiles of communicative and cognitive-social abilities in autistic children. Journal of Speech and Hearing Research, 27, 364-377.)).  ASD represents a spectrum of disorders, ranging from autism, Asperger’s syndrome, Rett’s disorder and childhood disintegrative disorder, to Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS). As this is a spectrum disorder, the profiles of individuals with ASD are somewhat heterogeneous.  For example, individuals diagnosed with autism present with qualitative impairments in social interaction and communication, as well as restricted, repetitive or stereotyped behaviors, interests, or activities ((American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C: American Psychiatric Association.)).  In contrast, individuals with Asperger's Syndrome generally do not exhibit significant deficits in language or cognition, but demonstrate social interaction challenges and restricted interests or behaviors ((American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C: American Psychiatric Association.)).
-===Diagnosis===
-Currently, Autism is diagnosed through a series of observations, checklists, and standardized assessments.  These various assessments are performed by a collaborating team of professionals, which can include psychologists, psychiatrists, developmental pediatricians, speech language pathologists, and other allied health professionals.  Together the professionals compile the results of their formal and informal measures to determine if the child meets the criteria as specified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
-==Diagnostic Criteria for 299.00 Autistic Disorder==
-A total of at least six items from (1), (2), and (3), with one each from (2) and (3)((American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C: American Psychiatric Association.)):
-  - Qualitative impairment in social interaction, as manifested by at least two of the following:
-    * Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
-    * Failure to develop peer relationships appropriate to developmental level.
-    * A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest).
-    * Lack of social or emotional reciprocity.
-  - Qualitative impairments in communication as manifested by at least one of the following:
-    * Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
-    * In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
-    * Stereotyped and repetitive use of language or idiosyncratic language.
-    * Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
-  - Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
-    * Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
-    * Apparently inflexible adherence to specific, nonfunctional routines or rituals.
-    * Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements).
-    * Persistent preoccupation with parts of objects.
-Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years; (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
-The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
-===Proposed Revisions for the DSM-5===
-Presently, the DSM-IV is being revised and is expected to be released to the public in May, 2013.  Among many other changes, the new edition (the DSM-5) will be revised so that Autism Spectrum Disorder includes autistic disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified, and Asperger's disorder.  By including Asperger's disorder under the diagnosis of Autism Spectrum Disorder, the DSM-5 hopes to provide a better representation of the current knowledge gained from research surrounding ASD.
-==Diagnostic Criteria for 299.00 Autism Spectrum Disorder==
-Must meet criteria 1, 2, and 3 ((http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#)):
-  - Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following:
-    * Marked deficits in nonverbal and verbal communication used for social interaction;
-    * Lack of social reciprocity;
-    * Failure to develop and maintain peer relationships appropriate to developmental level.
-  - Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following:
-    * Stereotyped motor or verbal behaviors, or unusual sensory behaviors
-    * Excessive adherence to routines and ritualized patterns of behavior
-    * Restricted, fixated interests.
-  - Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
-For more information regarding these changes and their rationale go to [[http://www.dsm5.org/research/pages/autismandotherpervasivedevelopmentaldisordersconference%28february3-5,2008%29.aspx|American Psychiatric Association - DSM-5 Development]]
-==Changing Views of Asperger Syndrome==
-The following is paraphrased from an article on the proposed changes regarding Asperger syndrome and autism spectrum disorders in the DSM-5.  The article was published in the New York Times on November 9th, 2009 by Simon Baron-Cohen, a leading researcher on ASD.
-After reviewing the history of the Diagnostic and Statistical Manual of Mental Disorders, Baron-Cohen reminds us that psychiatric diagnoses are not set in stone- they are “manmade.”  He makes the point that “psychiatry is not at the stage of other branches of medicine, where a diagnostic category depends on a known biological mechanism….psychiatry does not yet have any diagnostic blood tests with which to reveal a biological mechanism.”  Considering this, the boundaries of certain “mental disorders,” in this case, Asperger syndrome, are not yet definitive.
-Baron-Cohen cites the following consequences for removing Asperger syndrome from it’s own diagnostic category.  First, will individuals with Asperger’s and their families have to go back to clinics to get their diagnoses changed?  Second, science hasn’t had a chance yet to determine if there is a biological difference between Asperger syndrome and classic autism.  Baron-Cohen and his colleagues have, in fact, recently identified 14 genes associated with Asperger syndrome.
-According to Baron-Cohen, “there may be important differences between subgroups [of the autism spectrum] that the psychiatric association should not blur too hastily.”
-[[http://www.nytimes.com/2009/11/10/opinion/10baron-cohen.html?_r=1&ref=opinion|Click HERE to read the full article]]
-**Opinions from the online Asperger's community related to the proposed diagnostic changes in the DSM-5**
-   *Schools may lump students together inappropriately in special needs classrooms.
-   *People will make unrealistic assumptions based on a diagnosis of “Autism” vs. “Asperger syndrome”
-   *It might be more difficult to find a job with the label “Austim” vs. “Asperger syndrome”
-   *"It is simply a fact that everything I did professionally for the last 16+ years of my life would have been impossible if I had ever identified myself or been diagnosed as "Autistic"."
-   *It will be easier to receive disability benefits with the diagnosis of “Autism” instead of “Asperger syndrome”
-   * “In some ways, a label of "autistic" might get us better services but then again, it would likely work against getting employment, housing, and general recognition within society.”
-   * "I don't think anyone will understand what we are if they generalize."
-   *Calling it “mild autism” will give the wrong impression of the challenges people with Asperger’s have.
-   *"I'm personally very happy to be included in the general autism spectrum, but also would like to keep calling myself an aspie if I so wish."
-   *"Just because the title "Asperger's Syndrome" is being eliminated or lumped in with another diagnosis in "the book", that doesn't mean that Asperger's is going away, any more than it means we are going away."
-The comments and opinoins listed above were taken from the following websites:
-[[http://www.aspiesforfreedom.com|Aspies For Freedom Blog]]
-[[http://www.wrongplanet.net|WrongPlanet.net]]: An online resource and community for Autism and Asperger’s.
-===Eligibility for Oregon Special Education Services===
-According to the Oregon Department of Education (ODE), a child has an educational diagnosis of Autism when his/her developmental disability is characterized by verbal, nonverbal, and social impairments that adversely affect his/her //educational performance//.  The sensory characteristics, repetitive behaviors, and rigid thought patterns that are necessary for a medical diagnosis are not required for an educational diagnosis in Oregon.((http://www.ode.state.or.us/search/page/?id=299))
-For more information regarding the eligibility process in Oregon go to [[http://www.ode.state.or.us/search/page/?id=299|Oregon Department of Education - Autism Spectrum Disorder]]
-===General Tools to Assist in Diagnosis===
-  * Childhood Autism Rating Scale (CARS)
-  * Autism Diagnostic Checklist Form E-2
-  * Checklist for Autism in Toddlers (CHAT)
-  * Modified Checklist for Autism in Toddlers (M-CHAT)
-  * Pervasive Developmental Screening Test - 2
-  * Autism Diagnostic Observation Scale (ADOS)
-  * Autism Diagnostic Interview - Revised (ADI-R)
-  * Test of Nonverbal Intelligence - Third edition (TONI-3)
-  * Autism Spectrum Quotient (AQ)
---------------
-====Incidence / Prevalence====
-===United States===
-The Autism and Developmental Disabilities Monitoring Network (ADDM) aims to estimate the prevalence of ASDs within the [[united_states|USA]].
-In 2002, the ADDM presented the following research:
-  * 2,685 8 year-old children with autism((www.cdc.gov/ncbddd/autism/.../AutismCommunityReport.pdf))
-  * Average prevalence of ASD is 1 in 150 children((www.cdc.gov/ncbddd/autism/.../AutismCommunityReport.pdf))
-==Oregon==
-Every year the Individuals with Disabilities Education Act (IDEA) requires that each state submit information regarding childhood disabilities to the U.S. Department of Education.  In November 2004, fightingautism.org analyzed and published this information in order to gain a better insight regarding the prevalence of autism in the United States.
-This analysis indicated that in 2003:
-  * 4,389 children received a diagnosis of autism in Oregon((http://www.fightingautism.org/idea/, 2004))
-  * 1 out of 120 children in Oregon's public schools has an educational diagnosis of autism((http://www.fightingautism.org/idea/, 2004))
-  * Between 1992 and 2003, the annual average growth of autism has been 22% ((http://www.fightingautism.org/idea/, 2004))
-To read more about the prevalence of autism in Oregon and the rest of the United States go to [[http://fightingautism.org/idea/autism-prevalence-report.php|Prevalence Reports]]
-//**Portland Public Schools**//
-As of October 2009, there were a total of 46,785 students enrolled in the Portland Public School District.((http://www.pps.k12.or.us/about-us/index.htm))  Of the entire Portland Public School population 14%, or approximately 6550, receive special education services.((http://www.pps.k12.or.us/about-us/index.htm))  According to the Preliminary Enrollment Studies for October 2009, there is no data about the number of children receiving autism services in 2009.  However, in 2002 - the last year in which data was provided - there were 631 children receiving treatment for ASDs.((http://www.mis.pps.k12.or.us/.docs/pg/10309))
-For general information about the Portland Public School District go to [[http://www.pps.k12.or.us/|Portland Public Schools]]
-For additional information regarding enrollment data in the Portland Public School District go to [[http://www.mis.pps.k12.or.us/.docs/pg/10309|PPS - Enrollment Reports]]
---------------
-====Evidence-Based Treatment Approaches====
-The 2001 National Research Council suggest the following principles as priorities when working with children with ASD: early intervention (by age 3); intensive instruction (25 or more hours per week) starting at 24 months of age; repeated, planned teaching opportunities; systematic developmentally appropriate instruction; family inclusion; ongoing assessment; and instruction in settings with typical peers ((National Research Council. (2001). Educating children with autism. Washington DC: National Academy Press.)).
-===Applied Behavior Analysis (ABA)===
-The most effective comprehensive approaches to teaching children with ASD incorporate principles based in Applied Behavior Analysis (ABA).  ABA identifies behaviors that should be extinguished, behaviors that should be taught and reinforced, reinforcers, and reinforcement schedules.  It includes a functional analysis of behavior which aims to identify an antecedent or environmental trigger to a behavior, while describing the behavior and the consequence of the behavior (positive or negative).  Interventions that have produced significant, lasting results have been rooted in principles of ABA. ((Foxx, R. (2008). Applied behavior analysis treatment of autism: The state of the art. Child and Adolescent Psychiatric Clinics of North America, 17(4), 821-834.)) [[http://www.centerforautism.com/getting_started/aba.asp|Click HERE for a more in-depth look at ABA]]
-===Early Intervention Programs===
-Several common early intervention and naturalistic behavioral programs that incorporate the principles listed above are currently being implemented for young children with ASD in the US.  Some of these include: Learning Experiences And Alternative Programs for Preschoolers and Parents (LEAP), Floortime, Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and the Early Start Denver Model (ESDM).
-     *LEAP targets social interactions with the use of applied behavioral analysis techniques in an inclusion classroom with parent participation.  ((Strain, P.S., & Cordisco, L.K. (1994). LEAP preschool. In S.L. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders (pp. 573-586). Washington, DC: American Psychological Association.)) [[http://www.txautism.net/docs/Guide/Interventions/LEAP.pdf|Click HERE for an introduction to the LEAP model]]
-     *Floortime is an approach that emphasizes the importance of building relationships in a child-directed play model.  ((Greenspan, S.I., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emotional growth. Reading, MA: Addison-Wesley.)) [[http://www.icdl.com/dirFloortime/overview/index.shtml|Click HERE for an overview of the Floortime model]]
-     *TEACCH follows a developmental framework with increased structure and task-analyzed goals, building off of children's strengths while focusing on lifelong continuum of services through community and families.  ((Mesibov, G.B. (1996). Division TEACCH: A collaborative model program for service delivery, training and research for people with autism and related communication handicaps. In M.C. Roberts (Ed.), Model programs in child and family mental health (pp. 215-230). Hillsdale, NJ: Lawrence Erlbaum.)) [[http://www.teacch.com/|Click HERE for more information on TEACCH]]
-     *ESDM utilizes applied behavior analysis and relationship-based approaches with toddlers, beginning at 12 months of age and has resulted in improvements in IQ, adaptive behavior and diagnostic status after 2 years of intervention.  ((Smith, M., Rogers, S., & Dawson, G. (2008). The Early Start Denver Model: A comprehensive early intervention approach for toddlers with autism. In J.S. Handleman & S.L. Harris (Eds), Preschool education programs for children with autism (pp. 65-101). Austin, TX: Pro-Ed Corporation, Inc.)) [[http://www.ucdmc.ucdavis.edu/edsl/esdm/|Click HERE for more information on the ESDM]]
-===Approaches for children with ASD who are nonverbal===
-Two common language interventions for children with ASD who are nonverbal that are currently being implemented in the US are Pivotal Response Training (PRT) and Enhanced Milieu Teaching (EMT).
-     *PRT focuses on learning across the child’s environment, through the use of pivotal areas, that is, areas that, when targeted, lead to change in other, untargeted areas.  Pivotal areas include response to multiple cues, motivation, self-management, and self-initiations.  PRT highlights the effectiveness of motivational procedures (i.e. requiring that the child produce a vocalization in order to receive a desired item) for acquiring verbal language in noverbal children with autism.  ((Koegel, L.K., Koegel, R.L., Harrower, J.K., & Carter, C.M. (1999). Pivotal response intervention I: Overview of approach. The Journal of the Association for Persons with Severe Handicaps, 24, 174-185.)) ((Koegel, R.L., Sze, K.M., Mossman, A., Koegel, L.K., Brookman-Frazee, L. (2006). First words: Getting verbal communication started. In R. L. Koegel & L.K. Koegel (Eds.), Pivotal response treatments for autism (pp. 141-159). Baltimore, Maryland: Paul H. Brookes Publishing Co.))  [[http://www.autismspeaks.org/treatment/prt.php|Click HERE for an introduction to PRT]]
-     *EMT utilizes responsive engagement in which children are engaged in activities that interest them while the adult embeds prompting into the play interaction.  EMT has been effective in increasing early communication abilities in children with ASD, both when implemented through parent-training and when implemented by trained therapists. ((Hancock, T.B., & Kaiser, A.P. (2002). The effects of trainer-implemented enhanced milieu teaching on the social communication of children with autism. Topics in Early Childhood Special Education, 22, 39-54.)) ((Kaiser, A.P., Hancock, T.B., & Nietfeld, J.P. (2000). The effects of parent-implemented enhanced milieu teaching on the social communication of children who have autism. Early Education and Development, 11, 423-446.)) [[http://depts.washington.edu/isei/iyc/kaiser_16_1.pdf|Click HERE to access an article on the effectiveness of teaching parents to implement family-centered interventions.]]
-===Portland Public Schools===
-Portland Public Schools rely primarily on trained speech-language pathologists to administer intervention services to children with Autism Spectrum Disorders.  The clinician will choose an appropriate intervention method based on the child's areas of strength and need.  However, when a clinician has difficulty establishing or administering an appropriate intervention plan, he/she has access to the trained Autism specialists of the Columbia Regional Program.  Columbia Regional assists faculty by providing training to general education teachers, assisting in the evaluation process, developing appropriate materials for the classroom/intervention, and presenting on current research.
-For more information about Columbia Regional go to [[http://www.crporegon.org/home|Columbia Regional]]
-For more information about ASD resources outside of Multnomah County go to [[http://www.ode.state.or.us/groups/supportstaff/specializedservices/oregonmap/regional/map.doc|Oregon Department of Education]]
-=====Multicultural Issues =====
@@ Line 474: / Line 252: @@
-====Multicultural view of ASD====
+====Multicultural Viewpoint of ASD====
 ===Family Impact===
@@ Line 524: / Line 303: @@
+===== Implications for the SLP =====
@@ Line 540: / Line 320: @@
-===== Resources =====
-[[http://www.autism-india.org/worldorgs.html|Autism Information Abroad]]
-[[http://www.autismspeaks.org/|Autism Speaks]]
-[[http://www.cdc.gov/|Centers for Disease Control and Prevention]]
+==== Multicultural Issues with Autism ====
+**"Students with multicultural backgrounds and autism are challenged on at least four dimensions:  communication, social skills, behavioral repertoires, and culture.  The professional literature continues to address the first three; it is imperative to now consider the third:  multicultural issues [//sic//]."  ((Dyches, T. T., Wilder, L. K., Sudweeks, R. R., Obiakor, F. E., & Algozzine, B.  (2004). Multicultural Issues in Autism. //Journal of Autism and Developmental Disorders, 34//, 211-222.))**
+As demonstrated in earlier sections, the empirical research available describes how children with autism from other cultures are identified and treated according to the western viewpoint.  In other words, the DSM-III or DSM-IV was the primary diagnostic tool used and the treatments implemented were based on the empirical research available.  However, research neglects to demonstrate how certain cultures may not view autism and its development in the same manner as professionals from the mainstream western culture.((Dyches, T. T., Wilder, L. K., Sudweeks, R. R., Obiakor, F. E., & Algozzine, B.  (2004). Multicultural Issues in Autism. //Journal of Autism and Developmental Disorders, 34//, 211-222.))  That is to say, autism may not be considered a severe neurological disability, which will negatively impact and burden the family and its resources.  Therefore, professionals who work with children from multicultural backgrounds must reflect on this potential cultural difference and provide services in conjunction with the parent's cultural beliefs.
+Unfortunately, race and culture have not been emphasized (or even addressed) in the autism literature.  With the majority of research participants being of Anglo descent, the cross-cultural adaptation of these identification and treatment methods can lead to the over/under-diagnosis of autism in minorities.((Dyches, T. T., Wilder, L. K., Sudweeks, R. R., Obiakor, F. E., & Algozzine, B.  (2004). Multicultural Issues in Autism. //Journal of Autism and Developmental Disorders, 34//, 211-222.))  If it is true that autism is equally prevalent in all cultures, races, and social classes ((Autism Society of America.  (2000).  What is autism?  Advocate:  The newsletter of the Autism Society of America, //33//, 3.)), the IDEA should theoretically report equal identification across all multicultural groups.  However, this was not the case according to the IDEA's 1997 data, where students who were Asian/Pacific Islander were identified more often as having autism than any other disability.  This was in contrast to students who were American Indian/Hispanic and were identified less often as having autism than other disabilities.
+These differences in identification lead to questions that the SLP must keep in mind when working with families who may have a child with autism:
+  * Are the characteristics autism or unrecognized cultural differences?
+  * Does the person's culture make him/her more apt to seek out/reject services?
+  * Does autism have a stigma in that culture?  Or is it an honor?
+  * Would families prefer another diagnostic label over autism?  Or would they prefer no label?
+  * Are certain behaviors of autism not problematic to other cultures?  More problematic?
+----------------
+====Sharing an understanding of the problem with the family====
+**“The meaning parents attach to their children’s symptoms and their associated beliefs about the symptoms’ causes, prognosis, and most appropriate course of care can be described within the context of culture"** ((Mandell, D.S. & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11, 110-115.))
+In order to provide the best treatment possible to your client and his/her family, it is important to come to a shared understanding of the diagnosis of autism as well as the impact that the disorder may have both on the child's experience in school and at home.  The following questions have been suggested to aid in this process.
+^^          Questions for Understanding Parents’ Beliefs about Autism ((Levy, Mandell, Merhar, Ittenbach, & Pinto-Martin, 2003 as cited in Mandell, D.S. & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11, 110-115.))        ^
+| 1. What did you call your child’s problem before it was diagnosed?    |
+| 2. What do you think caused it?    |
+| 3. Why do you think it started when it did?    |
+| 4. What do you think autism does?  How does it work?    |
+| 5. How severe is it?  Will it have a short or long course?    |
+| 6. What are the chief problems your child’s autism has caused?    |
+| 7. What do you fear most about it?    |
+| 8. What kind of treatment do you think your child should receive?  What do you expect from this treatment?    |
+===Behavioral characteristics of autism that should be considered with cultural sensitivity===
+As professionals we must foster a cultural awareness of each client that will lead to appropriate diagnosis and treatment for families who deem it appropriate. The following behavioral and linguistic characteristics should be kept in mind as you work together with a family, consult a cultural broker or consult other pages on this website to ensure the most effective identification and treatment methods for your client with autism.  Many of these characteristics may be interpreted differently across varying cultural contexts, so they may not be considered deviant in some cultures in the same way that they are in Western cultures.  It is important to be aware of the role these characteristics play in the specific culture you are interested in, especially as you work to reach a shared understanding of autism with the family.
+It is suggested that SLPs find out the cultural values of the following to determine if differences observed in a child are cultural or indicators of disorder:
+**Social Interaction**
+  *Use of eye contact
+  *Use of facial expression
+  *Use of body postures and gestures
+  *Significance of peer relationships
+  *Values of empathy or social or emotional reciprocity
+  *Importance of physical touch/ attachment styles
+**Communication**
+  *Role of communication, especially social communication
+  *Roles of communication partners (what type of communication is appropriate between child and child, child and adult, child and different family members)
+  *Importance and use of requesting and commenting
+  *Need for explicit and literal explanation of rules/abstract language
+  *Uses of spoken language and expected milestones
+  *Importance of make-believe play
+  *Significance of/use of repeated words or phrases and personal out-loud reflection (e.g. thinking out-loud)
+  *Use and importance of prosody (i.e. intonation or high vs. low pitch) and suprasegmentals (e.g. voice volume)
+**Restricted, repetitive and stereotyped behavior**
+  * Eating the same food (what type of variability is typical in the child's diet)
+  * Keeping to a rigid schedule/ adherence to routines
+  * Wearing the same clothes
+  * Preferred toys or activities
+  * High or intense interest in technology and/or the way things work.
+  * Importance of memorizing dates/maps/other info (consider importance of this in oral cultures)
+===== Resources =====
+[[http://www.autism-india.org/worldorgs.html|Autism Information Abroad]]
 [[http://www.autismeurope.org/|Autism Europe]]
 [[http://globalautismproject.org|Global Autism Project]]:  An organization with the mission: "bridging the global gap in the resources and understanding of autism."  Currently partnered with centers in [[ghana|Ghana]] and [[india|India]].
-[[http://www.autism-society.org|Autism Society of America]]
 [[http://www.autism.com/|Autism Research Institute]]:  Includes information especially on the biomedical approach to treating autism and the "Defeat Autism Now!" project.
@@ Line 563: / Line 451: @@
 [[http://www.autreat.com/|Autism Network International]]: An international self-help and advocacy organization for individuals with autism.
-[[http://www.wrongplanet.net/|Wrong Planet.net]]: An online resource and community for individuals with autism and Asperger's.
@@ Line 576: / Line 462: @@
-~~DISCUSSION:on~~
+~~DISCUSSION:off~~