Slide 1

Report
Asperger Syndrome 101
"SOLVING THE PUZZLE OF
AUTISM: PRACTICAL
STRATEGIES FOR SUCCESS"
June 2012
San Angelo, Texas
DSM-IV Classification
Pervasive Developmental Disorders
Pervasive Developmental Disorders
Autism
PDD-NOS
(not otherwise
specified)
Asperger’s
Syndrome
There is a wide range in severity of symptoms
from profound disability (Autism) to milder
forms (Asperger’s Syndrome)
Rett’s
Syndrome
Childhood
Disintegrative
Disorder
History of Asperger Syndrome
• Neurobiological
disorder affecting the
systems of both brain
and body
• First described in 1944
by Hans Asperger
• Officially recognized in
the Diagnostic and
Statistical Manual of
Mental Disorders
(DSM-IV) in 1994
Prevalence
of
ASD
• 1 in 88* children in
the U.S.
• Male to Female
ratio 4:1
• More prevalent in
pediatric
population than:
– Cancer
– Diabetes
– Down Syndrome
* Centers for Disease Control
and Prevention (CDC); 2012
?
Cause of Asperger Syndrome
• Genetic influences
(dozens of genes linked
to ASD)
• Possible Environmental
Factors
• Vaccines reactions
(Thimerosal?)
• Biological Factors
– abnormal tissue in gut
– food allergies
– inflamed tissue in the
brain
Autism does NOT result from:
•Poor parenting
•Differences in culture or language
Asperger’s Syndrome: DSM-IV
Diagnostic Criteria (2000)
• A. Qualitative impairment in social interaction.
• B. Restricted repetitive and stereotyped patterns of behavior, interests,
and activities.
• C. The disturbance causes clinically significant impairment in social,
occupational or other important areas of functioning.
• D. There is no clinically significant delay in language (e.g., single words by
age 2 years, communicative phrases used by age 3 years).
• E. There is no clinically significant delay in cognitive development, self
help skills, adaptive behavior (other than social), and curiosity about the
environment in childhood.
• F. Criteria are not met for another specific Pervasive Developmental
Disorder or Schizophrenia.
DSM-IV Criteria
• Briefly summarized:
– Impairment in social interaction
– Restricted, repetitive and stereotyped patterns of
behavior, interests and activities
– Clinical impairment in social, occupational, or other
important areas of functioning
– No significant language delay
– No significant cognitive delay
Disagreement with DSM-IV
Some professionals in the field, disagree
with current DSM-IV criteria for Asperger
Syndrome
Social
Differences
• Identical social and repetitive behavior
criteria as Autism
• Indication of no communication
differences in Asperger Syndrome
Agree that Asperger Syndrome is a “triad”
of symptoms
Social differences considered to be the
defining characteristic
Communication
Differences
Repetitive
Behaviors
Features of
Asperger Syndrome
Challenges with
Reciprocal Social Interaction
Reciprocal Social Interaction
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Lack of skills to establish friendships
Difficulty initiating or maintaining conversations
Difficulty joining in an activity
Is naïve and easily taken advantage of or bullied
Difficulty discerning appropriateness of topic
Personal space violations
Minimal, intense or unnatural eye-contact
Inappropriate affective expression or response
Lack of appropriate body language
Inability to read body language and facial expressions
Lacks tact or appears rude
Passivity / Aggressiveness
Lack of awareness or disinterest in popular fads and trends
Difficulty in perspective taking (theory of mind deficits)
Features of
Asperger Syndrome
Challenges with
Use of Language
Use of Language (Pragmatics)
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Repeats certain words or sounds repeatedly, “well, actually”
Interprets words or conversations literally
Difficulty with the rules of conversation
Doesn’t initiate or respond to social greetings
Difficulty using gestures and facial expressions appropriate to the situation
Talks incessantly or minimal talking (selectively mute)
Advanced vocabulary
Makes seemingly irrelevant comments
Difficulty talking about others’ interests
Speaks in an overly formal way; often sounds like a “little professor”
Unnatural rhythm or rate of speech (sing song voice or unusual tone)
Reduced ability to communicate and comprehend verbal language when
frustrated or anxious
• Expressive skills may mask significant receptive issues – especially socially
mediated information
Features of
Asperger Syndrome
Restricted Interests, Insistence on
Sameness, and Difficulty with Change
Restricted Interests, Insistence on Sameness,
Resistance to Change
• Has intense interest in a specific topic
• Resists change; difficulty with unexpected events or
changes between activities
• Seems unmotivated by typical rewards for age
• Difficulty stopping a task before it is completed
• Asks repetitive questions
• Appears ‘stubborn’ or ‘oppositional’
• Fixates on rules and moral rights
Features of
Asperger Syndrome
Motor Functioning
and
Motor Planning
Motor Functioning / Planning
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Balance difficulties
Poor coordination
Resists or refuses handwriting tasks
Dysgraphia (inability to write legibly)
Delayed timing, imitating and execution of movements
Accident prone
Difficulty with snaps, buttons, fasteners
Walks with an awkward or unusual gait
Unusual body postures and/or facial expressions
Difficulty starting or completing actions (may rely on prompting by others)
Difficulty with athletic activities including riding a bike, catching a ball
Often display hypotonia (general muscle weakness)
Features of
Asperger Syndrome
Differences in
Cognitive Processing
Cognitive Differences
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Poor problem solving skills
Difficulty with planning and organizing (materials, projects)
Difficulty applying learned skills in new settings (generalization)
Attention problems
Impulsive
Very logical learners
Rigidity in thinking and routine
Difficulty perceiving danger
Difficulty processing multimodal information simultaneously
Difficulty retrieving experiential memories
Difficulty generalizing knowledge to application
Difficulty discerning between fiction and reality
Difficulty discerning between relevant and irrelevant information
Displays weakness in reading comprehension despite strong word recognition ability
Very literal understanding of concepts
Poor self-reflection; Difficulty understanding the connection between behavior and
consequences
Cognitive Processing
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Theory of Mind (ToM)
Perspective taking
Making social judgements
Lack of skills creates easy targets for bullies
Poor inferencing and predicting skills (reading
comprehension)
• Written expression may be affected by fine motor issues
• fMRI studies clearly show some with AS that process info
using different parts of the brain
• Yale studies showing individuals with AS focused on
different parts of dramatic video
Features of
Asperger Syndrome
Sensory Differences
Some surveys indicate up to 90% of parents
reports children with ASD have sensory issues
Sensory Differences
• May be hypo (under) or hyper (over)
• responsive to:
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Touch – tactile defensiveness
Sounds or frequencies – auditory defensiveness
Light
Pain
Smells
Textures or tastes of foods.
• May be emerging evidence of Sensory Processing
Disorder in DSM-V
Features of
Asperger Syndrome
Emotional Vulnerability
Emotional Vulnerability
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Low frustration tolerance
Negative self-talk
Difficulty tolerating mistakes
Self-injury
Appears sad, depressed or anxious
Makes suicidal comments or gestures
Has difficulty managing stress and/or anxiety
Worries obsessively
Features of
Asperger Syndrome
The Gifts of Asperger Syndrome
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Honest
Determined
An Expert
Notices sounds others do
not hear
Kind
Forthright (speak their
mind)
Enjoy solitude (important
for emotional restoration)
Perfectionist
Reliable, loyal friend
Good at art (or other
creative outlets)
Observant of details
others do not see
Exceptional at
remembering things other
people have forgotten
Humorous in a unique way
Advanced knowledge in
mathematics
Liked by adults
The Gifts
Neurological Differences
Research is now showing us that people with Asperger Syndrome use their
brains in unusual ways: they memorize alphabet characters in a part of the
brain that ordinarily processes shapes. They tend to use the visual centers
in the back of the brain for tasks usually handled by the prefrontal cortex.
They often look at the mouth instead of the eyes of someone who is
speaking – missing the social context so important to interpretation and
understanding of the message being sent.
Wallis, Claudia – Time Magazine. May 15, 2006. “Inside the Autistic
Mind”
Neurological
Differences
• Frontal Lobes
– home to
higher
reasoning
– greatly
enlarged
due to
excess white
matter
(brain’s
connector
cables)
• Impaired
higher
reasoning
influences
student’s
ability to easily
learn abstract
concepts.
Neurological
Differences
• Corpus Collosum
– Undersized
– Links left and right
hemispheres of the
brain
– Activity across
diverse regions of
brain is poorly
coordinated
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• Left to Right brain
connectivity is
slowed
• Effects many areas
of learning –
creative writing for
example
Activity: Left – Right Brain Test
Neurological
Differences
• Hippocampus
– about 10% larger than normal
– vital to memory
– possibility is that this
structure becomes enlarged
because autistic children rely
on memory to interpret
situations that most people
process elsewhere.
• Tendency to hyperfocus on
detail and miss the big
picture
• Rote memory is a strength
(making connections
between new material is
not)
• Learn in “scripts” or
routines – will often
respond in ways that have
been witnessed in movies /
tv even if situation is
somewhat different
• Cerebellum
– overloaded with white
matter
– Fine tunes motor
activity, balance, body
movements,
coordination and the
muscles used in
speaking
– May also play a
significant role in the
ability to shift attention
from one stimulus to
another
• May be “clumsy” or
uncoordinated
• Difficulty anticipating
events / action of
others in context
• Miss information due
to slow attention shift
Neurological
Differences
Neurological
Differences
• Distribution of white matter
– the nerve fibers that link
diverse parts of the brain is
abnormal.
• Local areas tend to be overconnected with more limited
connectivity between more
distant areas of the brain.
Right and left hemispheres of
the brain are also poorly
connected.
– As if there are too many
competing local phone services
but no long distance. Students
with ASD have difficulty
bringing different cognitive
functions together in an
integrated way
• Thought processes often
result in unexpected answers
or ideas – typically connect
to a previous experience /
learned or memorized
response to an event
• Processing is often delayed
Moving from knowledge to intervention
Identification and implementation of appropriate
supports and strategies across all environments,
activities and persons is crucial to aiding students
in achieving success
Moving from Knowledge to Action
• How do we know what
• interventions to put in place?
Areas of Instructional Need –
Other Than Grade Level Academic
• Instructional Needs (to address features)
• Social Skills
– Link to reading comprehension skill development
– Direct Instruction
• Emotional Vulnerability
• Organization
• Adaptive
– Motor planning
– Self-help
Social & Pragmatic Language
Skills
“Normal children acquire the necessary social habits
without being consciously aware of them, they learn
instinctively. It is these instinctive relations that are
disturbed in autistic children. Social adaptation has to
proceed via the intellect”
– Hans Asperger
Why are Social Skills Important?
• Value society places on social ability
• Good social skills promote acceptance of students by
peers
• Build lifelong social and emotional growth
• Improved social competence reduces problem behaviors
• Can be successful without high cognition, but impaired
social skills will hurt in the long run
Social and Pragmatic Language
Skills to Teach
• Initiation of play –early, tween, teen, adult
• Conversational Skills
• Reading emotions / non-verbal cues (self and
others)
• Flexibility
• Self-regulation / anxiety management
Social / Emotional Needs
Directed, specific, cognitive-based, instruction in play,
social thinking and friendship is essential
Social Thinking
Video modeling
Drama / Role Playing
Social Stories / Comic Strip Conversations /
Power Cards
Rating Scales
Cognitive Behavior Therapy
Emotional Toolbox
Social and Pragmatic Language
• Social Narratives
– Social Stories™
– Social Articles
– Power Cards
Social and Pragmatic Language
Instructional Practices and Curricula
Integrated Play Groups – (Wolfberg)
Think Social (Winner)
- Cognitive Behavioral Therapy
Bellini’s Building Friendships
The Hidden Curriculum
PLAY (Ric Solomon)
Skill Streaming
Emotional Vulnerability
• “Autistic children are often tormented and rejected by their
classmates simply because they are different and stand out
from the crowd. Thus, in the playground or on the way to
school one can often see the autistic child at the center of a
jeering horde of little urchins. The child himself may be
hitting out in a blind fury or crying helplessly. In either case
he is defenseless”
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- Hans Asperger
Teasing & Bullying
• Use a team approach and include the target, school
administration, teachers, parents, psychologist, other children
and the child engaging in bullying
• Provide staff training
• Ensure justice is equitable based on motivation, knowledge
and facts
• Use positive peer pressure
• Teach target skills to handle bullies
– Don’t be alone
– Assertive and honest response
– Self-protection courses
KEY
to Solving Behavior Problems…
You must find
the real
antecedent!!!!!
Common Mistakes in
Managing Behavior
Thinking that a student can learn when under
extreme stress and anxiety
Thinking that the behavior is on “purpose” or
under the student’s control
Raising voice when a student misbehaves
Denying a student request before hearing it
out
Focusing on what the student does wrong,
(look for antecedents)
Mistakes Cont.
Talking about the student as if he/she is not
there
Disagreeing with another professional about
discipline in front of the student
Repeating instructions too often rather than
checking to see whether the student
understood, or had time to process
Focusing on too many behaviors with the
student
Finding the Antecedent
• What was going on just before the incident? (antecedent)
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Include info such as:
Time
Activity the student participating in
Environmental factors
Finding the Antecedent – cont.
• Formulate a hypothesis for the behavior?
• Put on your detective hat and really think…
• Remember the Autism perspective (consider
the difference in thinking).
Behavior
• Remember that behavior serves a purpose for
the individual and that our job is to figure out
that purpose
– Sensory Defensiveness / Dysregulation
– Misinterpretation of the environment
– Misinterpretation of teacher expectations
– Social misunderstandings with peers
Behavior
• Conditions likely to increase unwanted
behaviors
– Anxiety / biological issues
– Schedule / staff changes
– Medication change
– Irregular sleep patterns
– Illness / pending illness
– Skill deficits
– Lack of communication system
Behavior
• Teaching an alternative response (alternative
behavior) should be an integral part of the behavior
response plan
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Focus on self-control / not outside (adult) control
Self-monitoring / self-awareness
Choice making
Relaxation training
Communication
Social Skills
• If we are only rewarding / punishing behavior then
we are not teaching what is wanted (appropriate
behavior)
Behavior
• All behavior communicates
Anxiety
And
Frustration
Receptive and
Expressive Language
(ability to communicate)
Behavior
A few key points to remember…
Teaching must occur before learning can occur
Showing a student a visual – is not teaching
Have a crisis plan for anticipated behaviors – but
realize that crisis management is a short-term
solution and does not equal long-term behavior
change
Support Strategies
Restricted Interests
• “Don’t treat the special interest as a toxin to
be purged, but as a trait to be managed”
• Jennifer McIlwee Myers in
• an email to Tony Attwood
Support Strategies
Restricted Interests
Limit time with interest (‘special time’)
Work “with” the interest rather than against
Support interests that could become long-term
employment
Use to facilitate friendships/peer interaction
Support Strategies
Cognitive
• Difficulties in this area may include transitions, impulsivity,
inflexibility and distractibility.
• STRATEGIES:
– Transition strategies: visual supports
– Attention to task strategies: may be maintain by selecting activities to
task; positive reinforcements, frequent breaks
– Self monitoring strategies: behavior sheet, social stories, schedule
boards, etc.
– Planning and organizing strategies: agenda/planner for recording
assignments, Franklin Homework Whiz, and mind mapping software.
Support Strategies
Motor
• Physical Supports
• Frequent Breaks
• Assistive Technology
RESOURCES
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OASIS
OAR
Social Thinking
National Professional Development Center on
Autism
• Texas Autism Resource Guide for Effective
Teaching
• Brenda Smith Myles, Tony Attwood, Michelle
Garcia Winner,

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