Asperger’s Syndrome or “I’m just a weird kid.”

1. Asperger’s Syndromeor “I’m just a weird kid.” Barbara Stanton, PhD, LPCC

2. “We are convinced, then, that autistic people have their place in the organism of the social community. They fulfill their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers.” Dr. Hans Asperger (1944)

3. Autism vs. Asperger’s • Many similarities • Social difficulties • Communication differences • Theory of mind • Aspies are very verbal • Average to superior IQ • Asperger’s, High Functioning Autism, PDD-NOS, Non-verbal Learning Disability

4. “These children often show a surprising sensitivity to the personality of the teacher. However difficult they are even under optimal conditions, they can be guided and taught, but only by those who give them true understanding and genuine affection, people who show kindness towards them, and, yes, humor.” Hans Asperger, 1944

5. History and Statistics • Dr. Leo Kanner: 1943 • Dr. Hans Asperger: 1944 • Dr. Lorna Wing: 1981 • Dr. Tony Attwood: 1980s • Asperger’s added to DSM in 1994 • No quantitative studies to date, most is qualitative/anecdotal information

6. Over last ten years individuals identified with Autism Spectrum Disorders have gone from 1 in 5000 to 1 in 88 (2012) • 4:1 males to females • Often misdiagnosed • Under diagnosed in females • The difference between boys and girls

7. Diagnostic Criteria DSM IV TR: Impairments in communication Social interactions Repetitive/stereotypic behaviors

8. DSM V Potential changes may restrict the upper end of the spectrum. We will wait and see….

11. Co-morbid Conditionsor Misdiagnoses • Obsessive Compulsive Disorder • Anxiety Disorders • Mood Disorders • Bipolar Disorder • Conduct Disorders/ODD • Depression • ADD/ADHD • Schizophrenia (may be characteristic of ASD)

12. Brain Differences • Neurological • Cellular differences in the limbic system and the cerebellum (emotions/thought) • Differences in the amygdala (emotions/impulsivity) • Functioning of the frontal lobe impaired (executive functioning) • Chemical pathways • Differences in myelin • Mirror neurons

15. It is neurobiological…it is not their fault, they cannot help it and it will last a lifetime.

16. Causes • Nobody knows • Theories include: Genetics (inherited) Unfavorable obstetric condition Infections in pregnancy and infancy Early immunizations Foods may produce a toxic reaction that kills brain cells opening a path to ASD (gluten) Environmental toxins

17. Why professionals may miss the identification Lack of knowledge Trouble differentiating characteristics (i.e parallel play vs. interactive) Gender differences Want child to be typical Preconceived ideas (not like other ASD children) Parents have been training Don’t ask the right questions

18. Influence of medication on behavior/thought • Influence of RTC or other placements

19. Assessment General assessment by someone familiar with autism spectrum disorders Neuropsychological assessment Occupational Therapy assessment Speech/language assessment (primarily for social language)

20. Challenges They may appear: To not pay attention To not follow the rules To not understand you To not care what’s happening around them To be clueless To over react To be rude, manipulative, aggressive

21. They are: Autistic Be calm, unemotional, thoughtful, and respectful.

22. CHARACTERISTICS OF ASPERGER’S SYNDROME

24. Spectrum within the Spectrum • The characteristics will vary in degree within each individual with Asperger’s Syndrome. For example, some are more gifted in the arts while some have their gifts in technology. Some will have aggressive meltdowns while others will withdraw passively. Some will be very physically uncoordinated while some will be skilled athletes.

25. Who should change? • Asperger’s may be a form of human genius that will save the world (Attwood, Baron-Cohen). • The pleasures vs. the pain of Asperger’s. • Honor neurodiversity.

26. The Controversy • Should there be a cure? Dr. Simon Baron-Cohen (Cambridge University) invites us to question what is “normal”. He sees Asperger’s not as an impairment but as a natural variant of humans. Without people with AS we would not have the same world or the same chance for change.

27. The illusion of competency

29. The Key: Executive Skills Working memory and recall (hold facts in memory while manipulating information, accessing facts in long term memory, trouble following instructions, trouble summarizing, can impact sense of past events, sense of time, sense of self awareness, sense of the future) Activation, arousal, and effort (getting started on a task, paying attention to things of varying interest, finishing work, sustained attention)

30. Internalizing language (direct future actions, control behavior by self talk) Taking an issue apart, analyzing the pieces, reconstructing and organizing and sequencing events Time management Controlling emotions (emotional dysregulation, frustration tolerance, thinking before acting or speaking)

31. Mental Flexibility: Shifting sets(moving one thought to another) or make transitions to other places or activities; rigid or stuck thinking Metacognition: Seeing the big picture from smaller parts Adaptive behavior: ability to change from one behavior to another to achieve success in the situation

32. Theory of Mind • The ability to recognize and understand beliefs, thoughts, desires and intentions of other people is impaired. They are unable to predict what people will do next as they are unable to “read” the cues. Cannot “put themselves in someone else’s shoes”.

34. LANGUAGE • Stiff, pedantic conversation (“little professors”) may sound scripted/superficial • Intonation and inflection seems odd • Preoccupation with a special interest that they will talk about endlessly • Problems with social use of language (literal interpretations), no reciprocity • Inability to interpret and express nonverbal language (facial expressions)

35. Difficulty understanding rules for social engagement, games. Misconstrues other’s agenda’s, priorities, and preferences. The “hidden” curriculum (Brenda Smith-Myles) • May interrupt, dominate, minimally participate, have trouble shifting topics, problems initiating and termination conversation. • Insensitive to non-verbal cues of others. • Apparent lack of common sense. • Joint attention limited.

36. Can’t self advocate. • Can’t explain what’s wrong or what they are feeling. • “Smart ass” responses, blunt “Revealers of the truth” (Attwood)

37. http://www.youtube.com/watch?v=ibCck2iDOqA DMV

38. EMOTIONAL ISSUES • Lack of shared enjoyment (mind-blindness) • May seem apathetic or not empathetic, they can’t see things from another’s perspective. Social cognition • Negativistic world view • Difficulty with peer relationships • Good connection with adults • Emotional lability and anxiety • Low tolerance for frustration, refusals • Anxious, anxious, anxious, depression

39. Transitions difficult • They understand from their world view. • May have tantrums/rages or withdraw • Can’t distinguish other people’s emotions • May seem aloof and indifferent • Are naïve or gullible • Good sense of humor • Social and emotional maturity delays • Extremes in emotions • Take all or no responsibility

40. Attribution Theory • When we do something well we will believe that it is because of something we did (worked hard…) but an AS child will think they got lucky if they did something well. If they do poorly, they will blame the teacher (she doesn’t like me) or their parent (unfair). Therefore they put in no effort because they have no control over the outcome.

41. EXECUTIVE FUNCTIONING • High intelligence, articulate • Rigid, concrete thinking • Unique world view…rules must fit • Things must be fair • Organizational problems • Abilities to learn certain subjects • Talents with arts or foreign language • Poor short term memory, excellent long term memory

42. Can’t generalize situations • Difficulty with comprehension • Dysgraphia (handwriting difficult) • Difficulties with transitions • Strong sense of what is fair • Different academic profile (excel in some subjects, fail in others) Homework is misery. • Processing takes longer • Thinking all the time…they can’t stop. • Can’t make choices.

43. Difficulty with new tasks (perfection or anxiety). • May be able to listen and remember better when involved in another activity. • Usually multi-tasking is difficult. A neuropsychological assessment will be useful to identify their needs and learning style.

44. BEHAVIOR • Behavior is communication. Learn to translate.

45. BEHAVIORAL ISSUES • Sensory integration problems (touch, sound, taste, sight) If affected they will freak out and may be fascinated by it • Stimulation…flapping, hopping, fidgeting, sucking, chewing, rocking, twirling • Motor clumsiness, fall, difficulty with balance, unusual gait (toe walkers) • Inappropriate or no eye contact (functional eye contact) Don’t know the message they are sending or receiving, non-functional.

46. No understanding of danger/risky behaviors • Appears to be obsessive compulsive: perseveration (unable to shift sets) • Non-compliant and oppositional • Tantrums and rages, explosive, quick meltdowns (sometimes over nonfunctional details of their environment) or withdrawal • High pain tolerance • Can’t mimic • No sense of personal space • Adolescence X10 (seizures with puberty)

47. May have bad or unusual hygiene. • Rigidly adhered routines. • Collecting “treasures” • Typical rewards and consequences do not work. • There is a reason for EVERY behavior. It may take us a while to figure it out. • Every person is different.

50. Adaptive Behavior • Typically, IQ will correlate to adaptive behavior. For example, someone with an IQ of 65 would have adaptive skills at 65. Children with AS do not meet that profile. If they have an above average IQ (110) they will have an adaptive skills score of 65. Therefore we have to teach adaptive behaviors. • 20% of AS children have an above average IQ but their social maturity is 1/3 to 2/3 of chronological age.