Diverse Learners CoP Programming for Children with Asperger’s Syndrome

1. Diverse Learners CoPProgramming for Children with Asperger’s Syndrome Guest: Dot Lucci, M.Ed., C.A.G.S. Director of Consultation and Training Massachusetts General Hospital/ YouthCare Facilitator: Donna Lupatkin Date: December 3, 2007

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3. Welcome Introduction Characteristics Of Asperger’s Syndrome Theory of Mind Sensory Integration Executive Functioning Behavior Central CoherenceTheory Emotion Regulation Learning Style School wide programming V Bulletin Future Meetings and Assembly Agenda

4. Dot has 30 years experience working with individuals with Autism Spectrum Disorder. She is trained as a School Psychologist with additional training in neuropsychology. Dot is a national consultant and speaker and has published numerous journal articles and a book chapter in the Exceptional Brain. Currently she is Director of Consultation and Training at Boston’s Massachusetts General Hospital/YouthCare, on the Board of Directors of the Asperger’s Association of New England and an adjunct professor at Lesley University and Antioch College. Meet Dot

5. 1 in 150 children are being born with an ASD ASD - No 2 kids are alike 4:1 males/females - ASD 30 - 70% of ASD population are mentally retarded May be nonverbal May have co-morbid conditions ASD knows no boundaries (SES, ethnicity etc.) Life Long Disability No Known Cause No Known Cure Medications treat symptoms not ASD A disorder that affects the brain but is not just brain-based Pervasive Developmental Disorder (DSM-IV)(AKA: Autism Spectrum Disorders- ASD)

6. 1:1 male/female ratio Average to above average in IQ Life Long Disability No Known Cause No Known Cure Medications treat symptoms not AS AS appeared in DSM-IV in 1994 A disorder that affects the brain but is not just brain-based May have co-morbid conditions AS knows no boundaries (SES, ethnicity etc.) Pervasive Developmental Disorder (DSM-IV) (Autism Spectrum Disorders)Asperger’s Syndrome (AS)

7. Difficulties with Communication Superficial communication appears well developed strong vocabulary & grammar but literalness, concrete interpretation, poor abstraction, higher level language deficits… Difficulties with Behavior Rigid, concrete, routine bound, sensory issues, self-stims & odd behaviors, poor adaptation to novelty… Difficulties with Socialization & Play Impairment in using and reading non-verbal & verbal behaviors (gestures, affect, body language, intonation…) Impairment in higher level play skills Characteristics of Children with AS

8. Lack ‘Theory of Mind’, intuitive road map Exhibits Sensory Integration issues Poor Executive Functioning skills (planning, inhibiting, self-regulating, organization, productivity, …) Maladaptive Behavior = Communication Lack Central Coherence - Doesn’t “see the forest through the trees” Poor Anxiety and Emotional Regulation Average - Above Average IQ doesn’t always translate into daily social and academic functioning Characteristics of Children with AS

9. How these characteristics manifest in every child is different. No Two Students with AS are alike Describe Some of your Students Do These Characteristics Sound Familiar?

10. ToM - the ability to appreciate that other people have different mental states: intentions, needs, desires, beliefs that may be different that your own ToM - the understanding that other people have thoughts & feelings and that these people can reflect on their thoughts/feelings and can reflect on others people’s thoughts/feelings and change their thinking and behavior ToM - involves: joint attention, representation, transitioning, inferring, categorizing, abstraction, pretending, etc. Theory Of Mind (ToM)

11. Theory Of Mind

12. SENSORY INTEGRATION is… There are 7 senses - 5 + 2, proprioception & vestibular the ability of our senses to work together and interconnect with other systems in the brain the ability to use information gathered from our senses to organize our behavior and interact successfully with the world the ability to filter out unimportant sensory information and organize ourselves for performing meaningful activity Sensory Integration

13. Children with AS often have differences in the way they receive, filter, modulate, and integrate sensory information from their environments. Sometimes children’s behavior will be better understood by thinking about their sensory differences or anxiety level. Children may be over- and/or under-sensitive to sensory input. Sensory Integration in Children with AS

14. Children with AS often have deficits in Executive Functioning . For example, they may: Not manage time effectively Get stuck on one topic or a detail Be inflexible Act impulsively Not plan well Be disorganized Not know what to attend to Not use previously learned knowledge Executive Function in Children with AS

15. Behavior = Communication (requests, feelings, negations, comments, self, sensory) Behaviors can appear willful, weird/odd, rude, manipulative, annoying etc…. Behaviors are usually connected to the environment, a child’s internal state/emotions, the environment, sensory input, developmental level, attention… AS is a neurological disorders -- it’s easier to change what’s external to the child than to change the child Behavior May Not Be What It Appears To Be

16. Individuals with AS have deficits in “getting the Big Picture” - not understanding how the parts relate to the whole. have difficulty conceptualizing & integrating information tend not to relate information to a larger pattern of behavior and thought. Central Coherence Theory & AS (Frith, 1989)

17. Children with AS have difficulty with: Understanding & using a wide range of emotions Regulating emotions Linking behavior to emotions High rate of anxiety is a result of their wiring Responding appropriately to emotionally charged situations Anxiety and Emotional Regulation in Children with AS

18. Children with AS: Often misinterpret the environment, and this can increase anxiety Lose IQ points when anxious (we all do) leading to decreased coping & problem solving abilities Challenges with anxiety are often misinterpreted as behavioral – THINK ABOUT ANXIETY FIRST Anxiety and Emotional Regulation in Children with AS

19. Common stressors for children with AS: Being told “no,” reprimanded, criticized Being around other disruptive people Leaving a preferred activity Having to engage in a less preferred activity Change in the environment or routine Having to wait for preferred events Having a change in directions or a new task Fears Anxiety and Emotional Regulation in Children with AS

20. Verbal-Linguistic or Concrete-Sequential Likes: order, predictability, facts/details, exact directions Difficulties: incomplete or unorganized environments/ tasks, open-ended questions/tasks (no right/wrong, favorite..), waiting, dealing with opposing view, acting without specific instructions Learns Best: Structured & quiet environment/ tasks, predictable routines, clear directions/consequences, opportunities to apply learning in practical & meaningful ways Things Makes Sense: step by step approach, here/now, a schedule to follow, visuals coupled with verbals, immediate feedback/guided practice Typical Learning Styles of Children with AS

21. CHIME IN - Applying What We’ve Learned • What are the behaviors that you see that challenge you or your staff? • Do you recognize how Sensory Integration, ToM, Central Coherence or Executive Function deficits interfere with social and academic learning? • How have you dealt with them?

22. Consider All the Referenced Areas ToM Sensory Integration Executive Functioning Behavior = Communication Central Coherence Anxiety & Emotional Regulation Learning Style And then some So What Do You Do With All That Theory? - Programming for the Student with AS

23. Consistency, Structure, and Predictability provide Simplicity and Stability which enable the child with AS to Anticipate Activities thus increasing his Independence and Self-Esteemand Quality of Life Guiding Principle

24. External - What Non-verbal Communication (affect, gestures, body language, proximity, nuances…) Verbal Communication (prosody,tone, volume, rate, type, humor…) External - Who Type (1-1, dyad, small group…) Adults, peers, familiar/unfamiliar…. Internal - Who (Student characteristics/temperament…) Physical Health (hunger, thirst, hormones, emotions, sleep…) Consider the Human Environment

25. Environment (inside/outside, place) Seating Options & Room Arrangement Sensory Influences (color, visuals, smells, lighting, manipulatives, temperature, air quality, music/sounds Animals & Plants Seasons & Weather Tasks & Curriculum Consider the Non-Human Environment

26. Each Child is Unique - Know the Student with AS - treat respectfully, accept quirkiness Children with AS are Consistently Inconsistent - Breathe! They don’t get why we do what we do (ToM) - Always provide the Why Anxiety ---> fight/flight/fright --> Behavior Know that Behavior = Communication - it’s your job to figure out what it means Emotions are connected to learning & memory-> participation Look outside the child (Human & Non-Human Environment) to change the behavior Sensory Needs have to be addressed - create a sensory diet Be flexible and creative when discipline is needed Putting the Theory Into Practice

27. They don’t see the forest through the tress - teach the big picture Teach to their learning style, strengths & interests Use visual supports whenever possible Use specific AS teaching materials (social stories, comic strip conversations, Incredible 5 point scale, power cards) Use videotaping Use structures, graphic organizers, other tools to organize the academic & social world Teach audience control, Hidden Curriculum Teach self-awareness, self-management, self-advocacy, relaxation & emotional regulation/self-calming Putting the Theory Into Practice

28. It Takes A Village to educate students with AS - Create a Team (parents, staff, administrators, student (when applicable), outside therapists..) Building Atmosphere - Directly Teach social curriculum and create an Inclusive, Accepting Atmosphere among staff & students - Students with AS are Quirky Teacher Attitude - Consistent yet Flexible, a sense of Humor - able to laugh at self, ability to Think Outside the Box, Patient/Caring, Willing to ask for Help and know that you don’t know it all, Team Player, Organized School Wide Programming Considerations

29. Professional Development - Knowledge about AS and the related areas (ToM, SI, EF etc. ) is critical to success, Time & commitment for students and staff 3 Cs - Consultation, Communication, Collaboration, A willingness to seek outside consultation from an expert in the field, home-school communication system Staffing - Trained Special Education Staff (special educator, OT with SI knowledge, SLP, mental health professionals (SW, Psy.), paraprofessional/assistant Scheduling Considerations - leave early/arrive late, independent studies, classes to/not to take, length of classes, PE, Cafeteria, Assemblies, Unstructured/ Structured times of the day (hallways, recess, etc.) School WideProgramming Considerations

30. Administration - has to want these students, set the stage for their participation & create an atmosphere for inclusion & acceptance Other Considerations - discipline, grading, homework, modifications to instructional requirements & outcomes Materials/Supplies - Purchase materials specific to Students with AS to guide instruction, Create a reference library of published & teacher-made materials Space - may need additional space for OT/SI needs, behavioral needs, calming space School WideProgramming Considerations

31. Social-Emotional Considerations - School Wide emphasis on social/emotional guidelines, Safe person & safe place for the student with AS,Specific instruction in social-emotional skills & thinking, student-teacher relationship, friendships, play, emotional regulation, etc.) Assign a Case Manager - Students with AS and their parents are time consuming Access, Participation and Membership - Students with AS can thrive emotionally, socially and academically in supportive, caring, accepting environments with well trained staff and students School WideProgramming Considerations

32. Pick My Brain Now or Contact Me Later Dot Lucci, M.Ed., C.A.G.S. Director of Consultation Services Massachusetts General Hospital/YouthCare 47A River St. Suite A200 Wellesley, MA 02481 Ph. 781-489-6635 Fax 781-235-0285 Email Dlucci@Partners.org Question & Answer Period

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34. All of the calls will be on a Monday at 4:00 EST. January 14, 2008-Arlene Remz and colleagues from Gateways in Boston-Topic TBA February 11, 2008- Hidden Sparks professionals-Topic TBA March 10, 2008- Second Language Development-Teaching Hebrew to the Diverse Learner May 5, 2008-TBA June –date and topic TBA Future Conference Calls

35. We thank Hidden Sparks for their generous support of our CoP Stay tuned for information about the PEJE Assembly April 6-8, 2008 Looking forward to seeing everyone on January 14, 2008-Arlene Remz and colleagues from Gateways in Boston-Topic TBA”