ASD

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ASD Asperger's Syndrome Emotion management,
Theory of Mind and Social skills

• Isabelle Henault, PhD
• in collaboration with Tony Attwood, PhD

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Prevalence RatesTony Attwood (2006)

• 1/250 has AS (Gillberg 2002).
• In USA 1/150 on ASD (2007).
• Perhaps 50 receive a diagnosis.
• 4-5 boys for 1 girl. Clinic 11
• Percentage detection rates are increasing.
• Average age of diagnosis is 11 years (Howlin and
  Asgharian 1999).

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ASD profile

• Social skills free of social rules
• Communication abilities verbal and non verbal
• Theory of Mind different ways of thinking?
• Emotions detecting, reading, expressing
• Sensory issues

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1. Social Impairment

• Less maturity in friendship skills.
• Limited vocabulary for characterization.
• Limited response to peer pressure.
• Conspicuous preference for solitude.
• Unaware of the codes of social conduct.
• Limited ability with team skills.

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2. Eye Contact

• Social punctuation.
• Read a face.
• Construct a reply without interruption.
• Stimulus overload.

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Reading the mind in the eyes test.
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Ability to Attribute Social Meaning

• Noticing objects and facts rather than thoughts,
  feelings and intentions.

LDA Language Cards Emotions
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• The nature of these children is revealed most
  clearly in their behavior towards other people.
  Indeed, their behavior in the social group is the
  clearest sign of their disorder and the source
  of conflicts from earliest childhood.
• Hans Asperger

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LDA Language Cards Emotions
Descriptions of pictures and events may not
include thoughts and feelings.
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3. Friendship and Social Play Skills With Peers

• Other children consider the child is not fun to
  play with.
• Can be intrusive and irritating to peers
  (socially clumsy).
• May be on the periphery of play in the
  playground.
• Does not play in conventional ways.
• Play less likely to be of interest to peers.

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Friendship and Social Play Skills With Peers

• The duration of solitary play.
• Passivity in social play.
• Enforcement of social rules.
• Competence and anxiety in new social situations.

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Teased, Bullied and Mocked
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Social Reasoning

• Lack awareness of social codes and conventions.
• Poor understanding of personal space.
• Allegiance to truth rather than peers.
• Honesty and lateness in learning to lie (white
  lie).
• Imaginary friends.
• Sense of social justice.

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4. Empathy and the Communication of Emotions

• Difficulty reading the facial expressions, body
  language and tone of voice of others.

Immaturity or difficulty with the facial
expression of emotions (make a face).
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Empathy and the Communication of Emotions

• Facial expression may not reflect the inner mood.
  
• People tell me to smile even though I feel great
  inside
• How am I suppose to know how I feel ? 
• Range of responses to the distress of another
  person may be limited or unusual.

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5. Communication of Emotions

• Not an absence of empathy, but an immaturity and
  confusion regarding empathy.
• Can soak up emotions as a sponge.
• Immaturity of emotional expressions (anger and
  affection).
• Limited range of vocabulary.
• Intensity of emotional response (black white
  0 to 10).

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Communication of Emotions

• Difficulty showing compassion and remorse.
• Unusual response to affection.
• Intellectualizing of emotions.
• Impaired ability to manage emotions.

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Profile of Abilities in Girls

• Pattern can be a less severe expression.
• Coping and camouflaging mechanisms of hiding
  and mimicking roles
• Tendency to disappear in a crowd.
• Doll play to replay and understand social
  situations.
• Peer support (not bitchy).
• Single friend who provides guidance and security.

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Profile of Abilities in Girls

• Become slaves to other girls.
• Observe and try to understand before they make
  the first step.
• Reading fiction helps learn about inner thoughts,
  feelings and relationships.

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Profile of Abilities in Girls

• Less disruptive and so less likely to be noticed.
• Learn that if you are good, you are left alone.
• Faster rate of learning social skills than boys
  with AS.
• Special interests more likely to be unusual in
  terms of the intensity rather than the focus.
• Imaginary friends.

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Encouraging Friendship Skills

• Assess which skills are observed or absent.
• Assess the quality and range of expression.
• Observation schedule (www.tonyattwood.com.au -
  Paper on friendship).

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Additional Strategies

• Friendship diary.
• Figure play and fiction.
• An anthropologist in the classroom.
• Training their peers.
• Policy and Services.
• Team person with ASD-AS, peer friends, class
  assistant, class teacher, consultant.

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Explanation Rather Than Correction

• Create an explanation.
• I need to look away to help me to concentrate on
  my answer to your question.
• I am the sort of person who..

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Cognitive Behaviour Therapy

• 1. Assessment of the nature and degree of mood
  disorder.
• Two thirds of adolescents with Aspergers
  syndrome have a secondary mood disorder.
• Self report scales.
• Mood diary.
• Triggers.

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Cognitive Behaviour Therapy Assessment

• Social situations.
• Sensitivity to social errors.
• Change.(circumstances, routines, caregivers, job
  expectations, and special interest).
• Unfamiliar situations.
• Unconventional signals of distress (giggling,
  singing, humming).

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Affective Education

• A project on a specific emotion.
• Start with happiness or pleasure.
• Create a scrap book that illustrates the emotion.
• Diary with new experiences.
• Compare and contrast other childrens scrap books.

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Examples of activities-Happiness

• My strengths and talents. (happiness from the
  special interest).
• How much do you like..?(1-10).
• What could your mother say to make you feel
  happy? ( Feeling rated from1-10).

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Anxiety

• Waves or tides.
• Mood diary to determine the cycle.
• Panic response to a particular situation.
• Sensory perception.
• Retreat into solitude and the special interest.

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Anxiety

• Rigid thought processes.
• Pedantic speech a sign of anxiety.
• Increased sensory sensitivity.
• Tyrannical in controlling their environment.
• May be a family history of anxiety disorders.

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Comic Strip Conversation

• Carol Grays Comic Strip Conversation
• Step 1 draw yourself
• Step 2 thought bubble/emotion
• Step 3 speech bubble-explanation
• See Mind Reading software for example
• Thinking about how I feel and expressing myself,
  use my words instead of behavior-reaction

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Emotions Thermometer
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CAT-KIT

• Naming emotions
• Category of emotions
• Day schedule
• Thermometer

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CBT
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Sensory Tools

• Sounds. Ear plugs, headphones.
• Light. Irlen Lenses, hat, sun glasses.
• Aroma. Essential oil, products.
• Tactile. Clothing.

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A Balance

• Stress
• Socializing.
• Sensory experiences.
• Change and uncertainty

• Strategies
• Relaxation
• Physical activities
• Solitude
• Special interest

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• Different tools at different points on the
  thermometer.
• Relaxation tools at low stress levels, physical
  tools at high stress levels.
• Reassess the intensity of my emotion/number on
  the thermometer

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Theory of Mind

• Different ways of thinking
• Reading other peoples emotions
• ToM Scenarios
• Judge Judys books
• Mind Reading software (Baron-Cohen Cambridge
  University)

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Non-verbal language

•  How to Start a Conversation and Make friends 
• Don Gabor

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www.jkp.com
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Inappropriate behaviors

• Sensory issues hypersensitivity, hyposensitivity
  of tactile sense
• Social attention
• Misunderstanding the environment
• Deficit in expression (needs, verbal emotional)
• Lack of stimulation or activities
• Positive reinforcement giving attention

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Inappropriate behaviors

• Overwhelming demands
• Organic factors (25 serious health problems) no
  complains
• Psychologic/psychiatric condition dual diagnosis
• Depression, anxiety
• ADD-ADHD
• Phobia, OCD, etc.
• Drug abuse psychotic symptoms

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CBT for adults

• Mind over Mood Greenberger, D.(1995)
  www.guilford.com
• Anxiety, depression, anger
• Describe situations, mood, intensity
• Thought, situation, emotion
• Questions does some of your activities have an
  impact on your mood, do you see a pattern in your
  emotions, etc.

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Results

• Understanding and accepting ASD-AS
• Using qualities
• Team work collaboration
• Success at school-school visits
• Emotions under control
• Decreasing inappropriate behaviors frustrations
• Social inclusion