Getting AHEAD with Students with Autism Spectrum Disorder

1. Getting AHEAD with Students with Autism Spectrum Disorder Utah AHEAD Conference University of Utah May 21, 2010

2. Presenters • Michael Brooks Accessibility Center Brigham Young University • Edward Martinelli Accessibility Services Utah Valley University • Julie Preece Academic Support Brigham Young University • Ronald Chapman Student Life Brigham Young University • Norman Roberts Campus Life Brigham Young University J

3. Before we begin…What is your perspective? • What has been your experience working with students with autism spectrum disorders? • What are your concerns when working with students with these disorders? J

4. Presentation Overview • Presentation purpose—Setting Limits • Disability Law and Autism Spectrum Disorders • Looking at the numbers • Cases, discussions, and recommendations: • Autism Spectrum Disorders • Autism • Asperger’s Disorder • Nonverbal Learning Disorders • Concluding comments J

5. Presentation Purpose—Setting Limits • Enhance awareness of best advisement practices; not prepare psychological service providers. • Autism spectrum disorders are complex; a thorough review of all disorders is beyond the scope of one workshop. • Disorders may vary in their signs and symptoms from person-to-person. • Recognition, Reconnaissance, Respect, and Referral (4R’s) help a majority of students experiencing psychological concerns. J

6. Autism Spectrum Disorders & the Law • Any condition can be a qualifying condition as long as it is a physical or mental impairment that substantially limits a major life activity • Substantially limits is to be considered liberally • ADA Amendments Act has provided a non-exhaustive list of major life activities, including: • Communicating & • Concentrating Two problems seen in PDDs M

7. A Few Numbers Psychological Disorders among Higher Education Students N

8. College Students and Mental Health National College Health Assessment American College Health Association Fall 2009 N=34,208 N

9. Proportion of College Students Reporting Following Conditions: ADD 5.1% Chronic Illness 4.1% Psychiatric Condition 3.7% Learning Disability 3.5% Partially Sighted/Blind 1.7% Deaf/Hard of Hearing 1.6% Mobility/Dexterity Disability 1.0% Speech or Language Disorder 0.9% Other Disability 2.1% N

10. Proportion of College Students Reporting Following Conditions: ADD 5.1% Chronic Illness 4.1% Psychiatric Condition 3.7% Learning Disability 3.5% Partially Sighted/Blind 1.7% Deaf/Hard of Hearing 1.6% Mobility/Dexterity Disability 1.0% Speech or Language Disorder 0.9% Other Disability 2.1% N

11. Within the last 12 months, diagnosed or treated by professional for : Anxiety 9.4% ADD/HD 3.4% Bipolar 1.3% Depression 9.2% OCD 2.1% Panic attacks 4.6% Phobia 1.0% Schizophrenia 0.4% N

12. Autism Spectrum:The Numbers? • Prevalence varies quite widely from study to study due to “divergent diagnostic criteria” • Tends to be about: • 2 per 10,000 for Asperger’s disorder • 10 per 10,000 for Autism • Male-to-female ratio is estimated to be 4:1 E

13. Autism Spectrum Disorders The Ripple from the 1990s E

14. What is Autism Spectrum Disorder? • Life-long developmental disability. • Symptoms usually apparent within the first 36 months of life. • However, for high-functioning individuals, symptoms may not be apparent until later in life. • Syndrome, i.e., a condition defined by the existence of a collection of characteristics.  Susan J. Moreno, MAAP Services for the Autism Spectrum http://www.aspergersyndrome.org/Articles/What-is-autism-.aspx E

15. The Psychology Student Video 1 Student with High Functioning Autism E

17. Comments & Observations E

18. Autism Spectrum Disorders:Characteristics • Range of difficulties in verbal/nonverbal communication: • not speaking at all • unable to interpret body language • Unable to participate comfortably in two-way conversation • Rigidity in thought processes, including difficulty with: • learning abstract concepts • generalizing information • tolerating changes in routines and/or environments • Difficulty with reciprocal social interaction. • appearing to want social isolation • experiencing social awkwardness in attaining and maintaining ongoing relationships Susan J. Moreno, MAAP Services for the Autism Spectrum http://www.aspergersyndrome.org/Articles/What-is-autism-.aspx E

19. Autism Disorder (DSM-IV) A. A total of 6 (or more) items from (1), (2), & (3), with at least two from (1), and one each from (2) & (3): (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) 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 (b) failure to develop peer relationships appropriate to developmental level (c) 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) (d) lack of social or emotional reciprocity E

20. Autism Disorder (DMS-IV) (2) qualitative impairments in communication as manifested by at least one of the following: (a) 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) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level E

21. Autism Disorder (DMS-IV) (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) apparently inflexible adherence to specific, nonfunctional routines or rituals (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements) (d) persistent preoccupation with parts of objects E

22. Autism Disorder (DSM-IV) B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: • social interaction, • language as used in social communication, or • symbolic or imaginative play. C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder. E

23. Autism Spectrum Disorders (DSM-V) Must Meet criteria 1, 2, &3: 1. Clinically significant, persistent deficits in social communication and interactions 2. Restricted, repetitive patterns of behavior, interests, and activities 3. Symptoms must be present in early childhood E

24. Autism Spectrum Disorders (DSM-V) Must Meet criteria 1, 2, &3: 1. Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following: a. Marked deficits in nonverbal and verbal communication used for social interaction: b. Lack of social reciprocity; c. Failure to develop and maintain peer relationships appropriate to developmental level E

25. Autism Spectrum Disorders (DSM-V) Must Meet criteria 1, 2, &3: 2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following: a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors b. Excessive adherence to routines and ritualized patterns of behavior c. Restricted, fixated interests 3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) E

26. Asperger’s Disorder Continuing Along the Autism Spectrum J

27. Features of Asperger’s Disorder • Social interaction impairment • Repetitive or stereotyped behavior patterns • No significant general delay in language • No significant delay in cognitive or self-help skills   J

28. The Collision of Intellect Video 2 Asperger’s Disorder J

30. Observations & Comments J

31. Asperger’s Disorder, ala DSM-IV • Qualitative impairment in social interaction • Restricted repetitive and stereotyped patterns of behavior, interests, and activities • No significant general delay in language • No significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior • eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction • peer relationships • spontaneous seeking to share enjoyment, interest or achievements with other people • lack of social or emotional reciprocity • preoccupation with one or more restricted patterns of interest • apparently inflexible adherence to specific, nonfunctional routines or ritualsrepetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) • persistent preoccupation with parts of objects J

32. Daily Life Planning:Students with Asperger’s & High Functioning Autism • Meal plans • Laundry • Budgeting • Campus ID • Dorm rules • Fire drills • Communal bathrooms • Transportation • Campus maps • Security personnel • Finding restrooms • Using alarm clock • Mail • Library usage • Lecture halls • Dorm activities • Health services • Emergencies • Illness self-care • Physical exercise http://ezinearticles.com/?College-and-the-Autistic-Student&id=523157 J

33. Possible Accommodations • Private dorm room • 1-on-1 help with time management & budget • Note-taker • “Daily Life Coach” • Distraction-free testing • Modified presentation assignments • Preferential seating • On-line courses • Learning specialist support • Emotional support  • Tutoring • Proctors for reading and transcribing • Photocopies of class  materials J

34. Nonverbal Learning Disorder & Autism Spectrum Disorder Comparisons & Contrasts: Drawing Distinctions M

35. Nonverbal Learning Disorder (NVLD) • What is it? • AS and NVLD may describe the same “type” of disorder but at differing levels of severity—with AS describing more severe symptoms.  • Deficits are thought to be due to right cerebral hemisphere involvement “It may be that the diagnoses of Asperger syndrome (AS) and NLD simply “provide different perspectives on a heterogeneous, yet overlapping, group of individuals…” – Klin and Volkmar M

36. Is it a formal diagnosis? • No! • Not in the Diagnostic and Statistical Manual – Fourth Edition – Text Revision (DSM-IV-TR) • But, often referenced in neuropsychological evaluations • Disability resource coordinators need to consider whether to recognize it as a disorder worthy of accommodation. M

37. Diagnostic Criteria for NVLDWhat will you see in NVLD? • IQ tests: • Usually at least a 10-point difference between verbal and performance scores (with verbal higher). • Difference is often 40 points or higher. • Well developed: • Rote memory & auditory memory, • May have poor memory for essences, emotional experiences, and visual data. • Elaborated, but often odd, verbal expression (e.g., define “umbrella”) with strong vocabulary M

38. Diagnostic Criteria Continued • Reading ability: • generally excellent reading skills • with poor comprehension • Math skills: • Poor • May affect later understanding of science concepts • Poor visual-spatial organization skills • Distorted sense of time • Tactile: • perceptual and motor deficits, generally left side • physical awkwardness and poor coordination • Messy or laborious handwriting M

39. NVLD & Social Skills Probable Major Deficits of NVLD • Hyper-attention to detail • Missing ‘big picture’ • Concrete thinking • Literal thinking • Problems reading facial expressions, gestures, social cues, and tones of voice (low ‘social IQ’) • Difficulty using social feedback • Difficulty adjusting to new situations M

40. Social Skills & NVLD • Naïvete or lack of common sense • Rote reactions to situations • Dependence on language to gather information and anxiety relief - doesn’t always work (hearing “nice going” with dropped football pass – what does this mean?) • Problems developing and maintaining friendships, leading to : anxiety, depression, social withdrawal. M

41. Student’s History with NVLD • Strikes others as very intelligent • Strong early academic record: • Abstractions become important from 6th grade on • Grades plummet • Abstractions for sequencing in math, science & writing • Coordination skills for physical activities • Spend more time with adults: • Plays to verbal strengths • adults tolerate eccentricities • “Inattentive and hyperactive” early in life • Socially withdrawn and isolated later in life M

42. NVLD History • Problems seen in organization as each detail is taken one-at-a-time, not integrated. • Appears smart but unmotivated, which can be internalized secondary to adults’ feedback • display internalizing behaviors • nail biting, stomach aches, etc. • Later, when learning is lecture-based, problems with hearing and transcribing concurrently. M

43. NVLD & Accommodations • Outlines to provide the “forest” • Schedule of the day’s events (primary) • Meet with professor to discuss how the syllabus will play out (postsecondary) • Sequencing tips to break down complex tasks • Interactive discussion rather than lectures • Play to strengths in rote learning • Point out social rules and articulate events M

44. Case Study • Joey – active boy • Infant physical development: • Walked at 12 months • Could not drink from cup until 15 months • Age 4 • Teacher concerned with his fine motor skills • “Engaging” with “advanced expressive language” • Language “confusing and circuitous” • Age 7 • VIQ 136/PIQ 92 • Socially one-on-one “OK”, but not so in groups M

45. Conclusions Questions and Answers J

46. Contact Information • Michael Brooks: michael_brooks@byu.edu • Edward Martinelli: edward.martinelli@uvu.edu • Julie Preece: julie_preece@byu.edu • Ronald Chapman: ronald_chapman@byu.edu • Norman Roberts: norman.roberts@byu.edu