Autism Spectrum Disorders

1. Autism Spectrum Disorders Demystifying Autism Dr. Barbara Luskin September 2014

2. Who is the Autism Society of Minnesota? Our mission: as an agency of families, educators, care givers and professionals, we are committed to supporting individuals with ASD and their families Our vision: to realize its mission through education, support, collaboration and advocacy. Established in 1971 as the local presence of the autism community in MN we have provided over 40 years of services and programs that have enhanced the lives of individuals with ASD

3. Speaker Bio • Dr. Barbara Luskin, PhD, LP is a licensed psychologist who has worked with people with autism in various capacities for over 20 years. She earned her PhD from the University of Chicago in Human Development. For the past 11 years Dr. Luskin has provided mental health services at the Autism Society of Minnesota (AuSM). Much of her practice involves the diagnosis of and therapy for adults with ASD . She facilitates a support group for high functioning adults with ASD and provides training and education to families and service providers.

4. Where Have You Been ? • At least 1 in 88 children are diagnosed with an ASD. Perhaps as many as one in 54 males. • 30 years ago 4 in 10,00 were diagnosed • There is no solid evidence of a dramatic growth in actual occurrence of ASD • DSM-IV dramatically changed the criteria

5. Labeled? • Personality Disorders (schizoaffective, avoident, schizoid, narcissistic, borderline ) • MR • ADHD • ODD • Weird, Lazy, Eccentric

6. Understanding the Labels-DSM IV • Pervasive developmental disorders (PDD) 299 299.00 autism 299.80 Asperger syndrome 299.80 Rett syndrome 299.10 childhood disintegrative disorder 299.80 pervasive developmental disorder not otherwise specified (PDD-NOS

7. Understanding the Labels DSM 5 • Autism Spectrum Disorder • Social Communication Disorder • Specified Neurodevelopmental Disorder • Unspecified Neurodevelopmental Disorder

8. Autism is a developmental disability that is now diagnosed based on two areas of disorder (as opposed to simply delay). These areas are defined by the American psychiatric association in the DSM-5 as: • 1. Qualitative impairment in social interaction and communication. • 2. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.

9. Pattern of Development 120 100 80 60 autism Typical development Developmental delay Motor IQ lang.comp lang.expr social memory

10. Disorder implies that someone does things in a different way rather than doing them in a simpler, slower, or delayed way • It may also mean that someone has “splinter” skills. He/she may have some more sophisticated skills without being able to perform more basic activities that usually precede those skills

11. Examples of Disorder • Unable to have a conversation but able to remember with great accuracy details of a routine after two or three times • Doing Calculus but not understanding basic budgeting • Having a college level vocabulary but not knowing how to greet others • Having PhD in computer science but being unable to complete a job application

12. Asperger vs Autism • With the publication of DSM 5 Asperger syndrome is no longer an official diagnosis. In the past it was distniguished from autism in different ways by different professionals. Two main criteria were: • IQ above 70 • Fluent speech

13. Qualitative Impairment in Social Interaction

14. Use of Nonverbal Behavior • They think you are shifty …” • “My boss said I was the calmest one in the dept…..” • “How was I supposed to know you were mad?” • “What’s the point of waving goodbye?” • “I can’t figure out how to join a conversation” • “I learned to look at people in high school…”

15. Problems in Relationships • “ All my friends are people I play music with” • “My wife arranges all our social life” • “I have always been bullied” • “ My coworkers blame everything on me”

16. Failure to Develop Peer Relationships. • “I had friends in high school but we’ve lost touch” • “People irritate me…” • “I really don’t know what friendships mean” • “I have two good friends, we see each other once a year.” • “I have had hundreds of first dates”

17. Lack of sharing of emotions • “I don’t really think about sharing my achievements” • “I’d like to share but don’t know how to bring it up” • “No one cares about what I am interested in …” • “I know I am supposed to say ‘congratulations’ but don’t feel anything.”

18. Lack of reciprocity • “She doesn’t want to talk to me anymore…” • “Why should I say good morning when it isn’t one?” • “It took me years to realize that other people weren’t robots.” • “I don’t get going to an event just because my girlfriend wants to go.”

19. Qualitative Impairments in Communication

20. Problems in Speech • “By the time I get my words organized the conversation has gone on” • “When I am upset I can’t talk”

21. Problems with Conversation • “I hate small talk” • “People tell me I talk too much/too little” • “Mostly I just sit in a corner and listen” • “Things are better since e-mail” • People always change the topic before I am finished”

22. “People say don’t interrupt, but they keep interrupting me..” • “I’d rather just talk about what I am interested in..” • “I have to make other people understand me..”

23. Problems in communication • Basically…” • “People tell me I am always too loud..” • “People take things the wrong way…” • “ I don’t know how to talk informally..” • “ I hate poetry…” • “I can only say what I have heard” • “I can say things better than I can understand them • “People should just say what they mean”

24. Difficulty with Imagination • “Why plan, I don’t know what will happen…” • “Its really hard to play with my kids…” • “I have a hard time predicting how people will react…” • “ I am a terrible liar” • “I hate planning activities, I can never think of what to do…” • “I never understood why other kids wanted to pretend”

25. Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

26. Unusual Focus • “How many have spend ½ hour watching the pattern Windows makes ….” • “I have been working for years on a dictionary of ancient Summarian…” • I’m not interested in gardening so why should I listen to her talk about it?”

27. Narrow focus • “most people are boring” • “most of my friends are from the weather chat room” • “I just wish my boss would tell me why she wants me to do it.”

28. Preference for Routine • All change is bad..” • “Once I have found a good way to do something there is no reason to change..” • “Why try a new cereal, I like the old one..” • “My world is very chaotic, routines help reduce the chaos..” • “ I make it a point to remind people that the employee handbook says…”

29. Stereotyped motor mannerisms • “I have to do something with my hands” • “flapping my hands helps me calm down but I know people think I am crazy…” • “I get so mad I start biting myself” • “lights really bother me” • “I can’t stand the smell of certain foods” • “I love the feel of soft flannel” • “ I was never good at sports”

30. Detail Focus • “I start to do something but get focused on one detail and get distracted..” • “I see all the details but not the pattern..” • “I can’t recognize faces • “All the details are important…”

31. “I save every piece of paper because I can’t figure out which ones I might need” • “I can remember every bus route in the cities but I can’t remember my appointments.” • “My apartment is a mess…I can’t get it organized.”

32. Problems Summarizing and Generalizing • “ My proposal to the county for using my funds for a new computer system was 20 pages long and they didn’t even read it.” • “He tells us more than we ever wanted to know about…” • “The job application never gives me enough room to answer the question.”

33. Sensory and Motor Differences • “I have to have something in my hands..” • “Flapping my hands helps me calm down but I know people think I am crazy…” • “I get so mad I start biting myself…” • “Lights really bother me..” • “I can’t stand to smell certain foods..” • “I love the feel of soft flannel..”

34. Ideas for accomodations and supports

35. Visual Supports: A Picture is Worth 1,000 Words • Schedules • Calendars • Visual Directions/Models • Summary notes from sessions • Offer written communication in meetings

36. Adjust Communication • Communicating on different wave lengths • Logical AM vs. Emotional FM • One thing at a time • Differences in information processing • Write it down • Speech may be better than understanding-clarify • Be concrete and specific-avoid non-literal speech and leading questions • Don’t rely on nonverbal communication

37. Social Stories • Describe upcoming events • Describe routine situations • Explain other’s emotions • Explain expected behavior • These can be as complex and detailed as the verbal level of the individual ranging from quite simple to quite complex

38. A Social Story • Jon goes home from work on the bus. Jon lives on 65th street • Usually the bus drives on Walnut and then turns on 65th. • Today there is construction on Walnut street • The bus cannot turn on Walnut street • The bus will drive on Oak street instead • Jon will get off at the

39. Use Cartoons and Social Mapping to: • Analyze problems • Differentiate thoughts from words • Explain relationships

40. Social Map

41. Comic Strip Conversatoin

42. Video Self Monitoring • Video showing a person doing a skill that they want to increase • One or two minutes long • Use digital editing to create image of new behavior • Successful across a range of functioning

43. Executive Functioning • Saying “ok” doesn’t mean I know what to do • Make suggestions very concrete • Break down goals into very small steps • Help schedule when tasks will be done

44. Time Management: People with autism have a different sense of time • Teach scheduling • Help client explore alarms, timers, etc that may work

45. Focus • People with autism are good at sustained focus but not shifting attention: • Avoid jobs that require a lot of multitasking • Keep your own sessions focused- one thing at a time

46. Sensory Accomodations The client may need: • Lower lighting • Reduce noise • Allow sensory activities • Allow plenty of opportunity for movement You may need to teach him/her to self advocate

47. Self Defeating Behavior • He’s just trying to annoy me!” • “She is so noncompliant!” • “Ignore him—he just wants attention!” • “She just wants her own way!” • “He just doesn’t care about anyone”

48. Challenging Behavior: Ways ASD Effects Behavior • Inflexible thinking • Problems with Theory Of Mind • Thinking may not be logical • Little “thinking” happens when stressed • Low tolerance for frustration • “Rigid” and concrete thinking • Little attention to the reactions of others

49. Strong need for “routine” or “sameness’ • May be unmotivated by “customary” rewards • Difficulty with transitions or change • Strong need for closure or “task completion” • Difficulty in communicating • Poor problem solving skills • Poor organizational skills • Sensory Issues

50. Every Behavior Has a Function Try to understand why a person uses an inappropriate behavior • How is he feeling • What triggers the behavior • Who is this person: skills, temperament, interest • What results from the behavior