Educating Students With Aspergers Syndrome AS

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Educating Students With Aspergers Syndrome (AS)

• Douglas W. Walker, PhD
• Clinical Director
• Mercy Family Center
• New Orleans, Louisiana
• USA

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Characteristics of Asperger Syndrome

• History
• Definitions
• Diagnostic Criteria
• Differential Diagnosis Within PDD
• (AS vs. HFA)

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History

• Originally recognized by Austrian doctor Hans
  Asperger in 1944
• Discovered near time of Leo Kanners ID of Early
  Infantile Autism
• Asperger patients all had speech, so early on
  term was used to label autistic persons who had
  speech

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History

• Gerhard Bosch was first author to use the term
  Asperger Syndrome. Between 1951 and 1962, Bosch
  worked as a psychiatrist at Frankfurt University.
  In 1962, he published a monograph detailing five
  case histories of individuals with PDD that was
  translated to English eight years later.

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History

• English psychiatrist, Lorna Wing, popularized the
  term "Asperger Syndrome" in a 1981 publication
• Wing L (1981). Asperger syndrome A
• clinical account. Psychological Medicine,
• 11(1) pp. 11529

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History

• Lorna Wing is credited with widely popularizing
  the term "Asperger syndrome" in the
  English-speaking medical community in her 1981
  publication of a series of case studies of
  children. Wing also placed AS on the autism
  spectrum, although Asperger was uncomfortable
  characterizing his patients on the continuum of
  autistic spectrum disorders.

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History

• 1994 was the first year Asperger Syndrome
  appeared in the DSM manual

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Journal of Autism and Developmental Disorders

• Review of 2008 Volumes to Identify Key Terms for
  Articles
• Provide vocabulary and understanding to build
  concepts

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Key Terms Definitions

• High Functioning Autism
• DSM-IV
• Evidence Based Practice
• Prosody
• Pragmatics

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Key Terms Definitions

• Shared / Joint Attention
• Theory of Mind

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High Functioning Autism

• High functioning autism is not an official
  diagnostic term, though it may be used as such.
• It tends to describe people who have many or all
  of the symptoms of autism with a confirmed
  history atypical language development.

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High Functioning Autism

• Tend to have average or above average
  intelligence
• Language also is more developed
• Age of onset in HFA is argued to be younger than
  children diagnosed with Asperger

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DSM-IV

• The Diagnostic and Statistical Manual of Mental
  Disorders (DSM) is a handbook for mental health
  professionals that lists different categories of
  mental disorders and the criteria for diagnosing
  them, according to the publishing organization
  the American Psychiatric Association.

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DSM-IV

• It is used in the US and in varying degrees
  around the world, by clinicians, researchers,
  psychiatric drug regulation agencies, health
  insurance companies, pharmaceutical companies and
  policy makers.

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DSM-IV

• There have been five revisions since it was first
  published in 1952, gradually including more
  disorders. The last major revision was the DSM-IV
  published in 1994, although a "text revision" was
  produced in 2000. The DSM-V is currently in
  consultation, planning and preparation, due for
  publication in May 2012.

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Spectrum vs. Multi-Dimensional
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Spectrum vs. Multi-Dimensional
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Spectrum vs. Multi-Dimensional
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Spectrum vs. Multi-Dimensional
IQ
Depressed
AS
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Surly
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Spectrum vs. Multi-Dimensional
IQ
ADHD
AS
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Squirrel-ly
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Prosody

• The rhythmic and intonational aspect of language

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Prosody

• I dont hate you.
• Changing meaning prosody

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Pragmatics

• Rules for social language

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Pragmatics involve three major communication
skills

• Using language
• Changing language
• Following rules

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Pragmatics Using language for different purposes

• Greeting (e.g., hello, goodbye)
• Informing (e.g., I'm going to get a cookie)
• Demanding (e.g., Give me a cookie)
• Promising (e.g., I'm going to get you a cookie)
• Requesting (e.g., I would like a cookie, please)

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Pragmatics Changing language according to the
needs of a listener or situation

• Talking differently to a baby than to an adult
• Giving background information to an unfamiliar
  listener
• Speaking differently in a classroom than on a
  playground

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Pragmatics Following rules of conversation or
storytelling

• Taking turns in conversation
• Introducing topics of conversation
• Staying on topic
• Rephrasing when misunderstood
• How to use verbal and nonverbal signals
• How close to stand to someone when speaking
• How to use facial expressions and eye contact

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Language Laginappe
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Additional Language Issues in Asperger Syndrome

• Nonverbal aspects of language
• Pedantic speech The Little Professor
• Literal / Concrete interpretations

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Nonverbal Aspects of Language

• Facial expression
• Voice tone
• Volume
• Gesture

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Pedantic Speech

• Little professor
• Formality
• Need to convey information vs. chat
• Need to be correct, precision

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Being Concrete
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Pregnant witch cartoon
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Other Social Issues

• Impaired perspective-taking
• Difficulty reading cues and being read
• Reciprocity
• Idiosyncrasies
• Trouble with unwritten rules
• Trouble being a member of a team

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Eye contact Why??

• Punctuation
• Reading facial cues
• Why NOT??
• Stimulus overload
• Attention issues

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Sensory Sensitivity

• Sound
• Touch, texture
• Taste
• Vision
• Undersensitivity

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Shared / Joint Attention

• Types
• Responding and Initiating Share / Joint Attention

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Shared / Joint Attention

• Responding Childs ability to follow an adults
  attentional directive (Seibert, Hogan, Mundy,
  1982)
• Initiating Childs use of eye contact, affect,
  gesture, vocalization or symbolic communication
  to spontaneously share positive affect or
  interest about a referent (Mundy Stella, 2000)

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Shared / Joint Attention

• Measurement of Joint Attention via Autism
  Diagnostic Observation Schedule (ADOS)

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Theory of Mind

• Individuals with ASDs fail to impute mental
  states to themselves and others and that this
  deficit is expressed as a failure to take others
  mental states into account

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Theory of Mind

• Theory of mind is also the main way in which we
  make sense of or predict another persons behavior

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Theory of Mind Exercise
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Theory of Mind Exercise

• Dad and Son Make a Cake

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Theory of Mind Exercise

• Dad and Son Place Cake on Counter

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Theory of Mind Exercise

• Son Goes Outside to Play

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Theory of Mind Exercise

• Dad Places Cake in Refrigerator

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Theory of Mind Exercise

• Son Comes in From Playing Outside

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Theory of Mind Exercise

• Where Does The Son Look For The Cake?

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Theory of Mind Exercise

• Where Does The Son Look For The Cake?

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Theory of Mind Exercise

• Child with TOM Will See it From Sons Perspective
  and Say Counter

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Theory of Mind Exercise

• Child with without TOM Will Be Unable to See it
  From Sons Perspective and Say Refrigerator

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Theory of Mind Exercise

• Because Thats Where It Is

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TREATMENT

• Securing services
• Learning
• Adaptive Functioning
• Maladaptive Behaviors
• Social and Communication Skills
• Vocational Training
• Pharmacotherapy

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AGGRESSION

• Resistance to Change / Anxiety about the
  Unexpected
• Sensory sensitivity
• Communication Impairment
• Frustration Intolerance
• Coping Deficit
• Mood Regulation Impairment

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Philosophy of Structured Teaching

• Based on strengths and weaknesses
• Minimize behavioral and educational problems by
  creating a meaningful environment
• Improve functioning proactively
• Focus on independence

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Schedules

• What happens when
• Visual clarity
• Tailor to students developmental level
• Attention span
• Alternate desirable with less desirable

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Social Interventions

• Teach concrete skills
• Make rules explicit
• Address problems with perspective-taking
• Provide a time and place to feel accepted
• Anxiety reduction

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Social Stories

• Developed by Carol Gray
• To correct misreading of social situations
• To generalize social skills
• To help with changes
• To manage behavior

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Social Stories

• There are TWO valid social perspectives
• Person with Autism
• Writer

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Social Stories

• Write at individuals reading level
• Write in first person
• Write in positive terms, emphasizing desired
  behaviors

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Social scripts

• That looks like fun. Can I have a turn?
• Excuse me for interrupting, but
• Give me just a minute to think about that.
• Oops! Theres been a change in schedule.
• I like to talk about the weather. Do you?

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Securing and Implementing Services
• Authorities who decide on entitlement to services
  in schools are usually unaware of the extent and
  significance of the disabilities in AS.
• Proficient verbal skills, overall IQ usually
  within the normal or above normal range, and a
  solitary life style often mask outstanding
  deficiencies observed primarily in novel or
  otherwise socially demanding situations, thus
  decreasing the perception of the very salient
  needs for supportive intervention.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Students with AS are sometimes characterized as
  exhibiting "Social-Emotional Maladjustment"
  (SEM), a general educational label that is often
  associated with conduct problems and willful
  maladaptive behaviors.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• These individuals are often placed in educational
  settings for individuals with conduct disorders,
  thus allowing for possibly the worse mismatch
  possible, namely of individuals with a very naive
  understanding of social situations in a mix with
  those who can and do manipulate social situations
  to their advantage without the benefit of
  self-restraint.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Although individuals with AS often present with
  maladaptive and disruptive behaviors in social
  settings, these are often a result of their
  narrow and overly concrete understanding of
  social phenomena, and the resultant overwhelming
  puzzlement they experience when required to meet
  the demands of interpersonal life.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Monkey in the middle

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• The social problems exhibited by individuals with
  AS should be addressed in the context of a
  thoughtful and comprehensive intervention needed
  to address their social disability - as a
  curriculum need, rather than punishable, willful
  behaviors deserving suspensions or other
  reprimands that in fact mean very little to them,
  and only exacerbate their already poor
  self-esteem.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services
Which Basket Do I Place These Behaviors?
What is this about?
Oppositional
Confused Frightened
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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Situations that maximize the significance of the
  disability include unstructured social situations
  (particularly with same age peers), and novel
  situations requiring intuitive or quickadjusting
  social problem-solving skills.

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General Guidelines for Treatment and Intervention
in Schools Securing and Implementing Services

• Detailed interviews with parents and
  professionals knowledgeable of the child in
  naturalistic settings (such as home, school,
  outpatient social skills group, organized sport).
• Observations in cafeteria, recess, gym class

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• Relatively small setting with ample opportunity
  for individual attention, individualized
  approach, and small work groups

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• The availability of a communication specialist
  with a special interest in pragmatics and social
  skills training

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• Opportunities for social interaction and
  facilitation of social relationships in fairly
  structured and supervised activities

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• A concern for the acquisition of real-life skills
  in addition to the academic goals, making use of
  creative initiatives and making full use of the
  individual's interests and talents

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• Example
• Given the fact that individuals with AS often
  excel in certain activities, social situations
  may be constructed so as to allow him or her the
  opportunity to take the leadership in the
  activity, explaining, demonstrating, or teaching
  others how to improve in the particular activity.

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• Example
• Such situations are ideal to help the individual
  with AS (a) take the perspective of others, (b)
  follow conversation and social interaction rules,
  and (c) follow coherent and less one-sided
  goal-directed behaviors and approaches.
  Additionally, by taking the leadership in an
  activity, the individual's self-esteem is likely
  to be enhanced, and his/her (usually
  disadvantageous) position vis--vis peers is for
  once reversed

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General Guidelines for Treatment and Intervention
in Schools
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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• A willingness to adapt the curriculum content and
  requirements in order to flexibly provide
  opportunities for success,

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General Guidelines for Treatment and Intervention
in Schools General Intervention Setting

• The availability of a sensitive mental health
  provider (s) who can focus on the individual's
  emotional well being, and who could serve as a
  coordinator of services, monitoring progress,
  serving as a resource to other staff members, and
  providing effective and supportive liaison with
  the family.

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Dos and Donts in the classroom

• Dos

• Donts

• Preferential seating
• Assignments provided in writing/to parents
• Ask the child specifically for assignments to be
  handed in
• Physical cues/prompts
• Tapping on desk or shoulder, depending on the
  child, is helpful.

• Assignments written on the board to be copied
• Repeating their name is often futile
• Giving the teacher look is pointless.
• Verbal prompts/cues

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Dos and Donts

• Donts

• Dos

• Consistency and routine, as much as is possible
• Alert parents and student ahead of time to any
  changes in schedules, substitutes, moving of
  furniture, etc.
• Be aware of environmental stimuli.
• Protect from overt and covert bullyingcats, bugs

• Fluorescent lights, white noise, scents, screen
  savers, etc.
• Expect them to toughen up and be able to handle
  bullies
• Use slang, idioms, metaphors, and/or similes

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Be Structured yet Flexible

• Mr. Smith is a math teacher who always has the
  day's homework assignment written on the board.
  He provides a written/email copy to Sams
  parents. He gives clear instructions and due
  dates for each section of a project. He has a
  quiz every Wednesday and a test every Friday.
• While Mr. Smith provides structure, he
  understands that Sam (who has AS) has a problem
  wanting to talk at great length whenever he
  answers a question. Mr. Smith is willing to work
  with Sam on signals just the two of them know
  that help Sam realize it's time to stop talking
  and give someone else a turn.

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• In other words, Mr. Smith provides the structure
  that Sam needs to understand the assignments, but
  he's also flexible enough to accommodate and help
  modify some of Sam's Asperger Syndrome-related
  behaviors to help him learn and to minimize class
  disruptions.

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Ideal Interventions

• Education of staff
• Sensitivity training of peers
• Peer buddy programs
• Sensory room
• Social Skills training at schoolin the
  classroom, in the cafeteria, on the playground.

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Social Skills Group
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Social Skills Group Weekly Progress
Note Introduction (What good things happened to
me this week)General Discussion. Topic
Activity Game Skills Demonstrated Today
Attention ltltPoor Fair Good
ExcellentgtgtEye Contact ltltPoor Fair Good
ExcellentgtgtControlling Body ltltPoor Fair
Good ExcellentgtgtNot Speaking Over Others
ltltPoor Fair Good ExcellentgtgtKeeping on
Subject ltltPoor Fair Good
ExcellentgtgtSaying kind things to others ltltPoor
Fair Good ExcellentgtgtMotivation ltltPoor
Fair Good ExcellentgtgtNotes
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What good things happened this week

• level of prompting depends on agesreally
  difficult for little onesespecially to pick one
  thing as time goes on, they will help each other
  (especially for holidays and special events at
  schools)

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General Discussion Topic

• Adjusted to age/maturity of group members
• Topics range from Bullies to Friends to Girls

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Activity

• Mystery bag
• Feelings ball
• Jenga with questions
• Jed Bakers Social Skills Training
• The Social Skills Game
• Acting exercises

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Game

• picking game
• picking game piece
• turn taking.
• rules of play
• dice on board,
• who goes first,
• clockwise after first,
• each person picks own card and moves own piece
• being a good winner/loser
• being able to have some social talk while playing
  gamenot just getting from start to finish

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Inform parents

• Discuss basic criteria that is met for
  PDD/Aspergers
• Explain hyper/hyposensitivity
• give concrete examples of traits and
  sensitivities and why they occur

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GIVE EXAMPLES

• does he need you to cut labels out of shirts?
• is he a picky eater?
• How is his eye contact?
• How does he do with board games?

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Bullying/Teasing

• May not seem like it to us
• Regular definitions may not apply
• They generally DO NOT TELL

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Ask them!

• Ask them if they understand
• Ask them about their topic of interest
• Ask them if they were excluded or chose to not
  join in
• BE CREATIVE
• BE CHILD SPECIFIC

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Questions/Discussion
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Resources

• Online Asperger Syndrome Information Support
  http//www.udel.edu/bkirby/asperger/
• http//www.asperger-institute.com
• Edwards,D. (2008). Providing Practical Support
  for People with Autism Spectrum Disorder.
  Philadelphia, PA Jessica Kingsley Publishers.
• Attwood, T. (1998). Aspergers Syndrome A guide
  for Parents and Professionals. Philadelphia, PA
  Jessica Kingsley Publishers.
• Baker, J. (2003). Social Skills Training for
  Children with Aspergers Syndrome and Social
  Communication Problems. Shawnee Mission, Kansas
  Autism Asperger Publishing Company

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Resources

• Autism Society of America. Phone (800) 3-AUTISM
• http//www.autismspeaks.org/index.php Autism
  Speaks website
• www.mercyfamilycenter.com
•  
• www.TonyAttwood.com
• Aspergers Syndrome and Autsm Spectrum Disorders
  and Related Conditions in Children and
  Adolescents John M. Ortiz,PhD, 2004

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Resources

• www.mercyfamilycenter.com
• www.teacch.com
• www.thegraycenter.org
• www.autism-society.org
• members.aol.com/room5/welcome.html
• www.aspergersyndrome.org

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Group/Individual Consultation
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Educating Students With Aspergers Syndrome (AS)

• Douglas W. Walker, PhD
• Clinical Director
• Mercy Family Center
• New Orleans, Louisiana
• USA

dwallacewalker_at_yahoo.com