Bridging the Social Gap & Connecting Cultures: Asperger’s

1. Bridging the Social Gap & Connecting Cultures: Asperger’s Lisa Hoang, LMHC Rose Augustine, MA Pasadena Villa Network of Services

2. The “Stuff” People Say... Right Click Here to Open the Hyperlink to the Video: Stupid SH*T that people say to Aspies

3. Cultural Awareness Preparing for Discovery

4. Cultural Awareness • Purpose • Cultural Awareness is the foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs and perceptions. Why do we do things in that way? How do we see the world? Why do we react in that particular way? (Stephanie Quappe &GiovanneCantatore, 2005) • Cultural awareness becomes central when we have to interact with people from other cultures. Aspergers – Innate Culture

5. Multicultural Approach • Culture: "any group of people who identify or associate with one another on the basis of some common purpose, need, or similarity of background" (Axelson, 1999) • Multiculture: Distinct group uniqueness and concepts that facilitate attention to individual differences (Gladding, 2009) • Asperger's Syndrome is unique and diverse in symptom presentations and prognosis. Each person with AS has unique strengths, deficits, and needs.

6. Cultural Awareness • Increasing cultural awareness means to see both the positive and negative aspects of cultural differences – celebrating discovery • Degrees of Awareness • My Way is the only way • I know their way, but my way is better • My way and Their way • Our Way (shared meaning – participatory) “Labels are for soup cans”

7. Let’s Travel …. Right Click Here to Open the Hyperlink to the Video: Asperger's High - Coming This Fall on the CW!

8. Discover Differences • Asperger Syndrome (AS) is considered a pervasive developmental disorder at the higher functioning end of the autism spectrum. • It is characterized by sustained impairment in: • Social interaction and • limited interests • stereotyped and repetitive behavior (Stiefel, Shields, Swain, & Innes , 2008) • In contrast to autism, there are no obvious delays in language or cognitive development, or in age appropriate self-help skills and adaptive behaviors though there are subtle impairments. • More common in males then females • Officially recognized in 1994 in the DSM-IV (Elkis-Abuhoff, 2004)

9. Discover Differences

10. Neurotypicals are BetterFALSE Right Click Here to Open the Hyperlink to the Video: ADAM - Theatrical Trailer

11. Aspergers and Neurotypicals: Social DifferencesMen are from Mars Women are from Venus Cat People 41% Dog people 74% Pack animal Look for and reciprocate affection During stress/moments of fear dogs protect & approach Dogs can learn from punishment Easy to train • Loner – More likely to be solitary • Affection typically displayed on cats terms • During stress/moments of fear cats tend to hide/isolate • Cats wont learn from punishment – they will avoid the source (discover wants). • Arduous to train

12. Common Traits & Characteristics • socially awkward and clumsy • naive and gullible • unaware of others' feelings • unable to carry on conversation • easily upset by changes • literal in speech and understanding • sensitive to loud sounds, lights, odors • fixated on one subject or object • physically awkward in sports • very accurate memory for details • trouble understanding things they have heard or read • inappropriate body language & expression • repetitive and irrelevant comments • unusually loud, high or monotonous voice • rock, fidget or pace while concentrating

13. Central Coherence • Ability to focus on both details as well as wholes • Challenges with Central Coherence suggests that a person with Aspergers struggles with information processing leading to limitations with understanding the “big picture” and getting stuck on details. • Weak central coherence leads to an inability to bring together various details from perception to make a meaningful whole AKA Gestalt

14. Central Coherence • Heightened focus on details rather than wholes • Sensory struggles (hypersensitive sensory perception) • Reading comprehension • Theory of Mind • Executive Functioning • The inability to hold information in mind in order to use it later (poor working memory)

15. Assess current skills & needs in order to develop intervention plan • Keep structural timetable • Consistent is key – limits possible confusion or distress • Keep instructions simple & clear (resume style) • Be aware of possible distractions • Start simple/easy and work up Central Coherence Tips

16. Let’s Experience Group I Group II

17. Group I

18. Group II

19. Theory of Mind • Challenges with Theory of Mind suggests that a person with Aspergers has an arduous time gaining insight to the thoughts, feelings, and beliefs that are distinctive to others AKA perspective. • An inability to recognize that other people have thought's, feelings and intentions that are different to one’s own and an inability to intuitively guess what these might be

20. Theory of Mind • Mind Blindness – difficulty conceptualizing and appreciating the thoughts and feelings of others • Being able to relate to and understand the behaviors of others (distinguishing whether someone's actions are intentional or accidental). • Mind Blindness leads to Social Struggle • Poor communication skills • Difficulty with: • Providing adequate information • Commenting on conversation • Organizing thoughts • Inability to take another’s perspective, predict outcomes and decipher intentions • Difficulty generalizing tasks to everyday situations

21. Teach using visuals • Learn Check-ins • Educate purpose of Small talk & Practice (smart talk) • Role Playing • Feedback from peers • Repetition, Repetition, Repetition Theory of Mind Tips

22. Theory of Mind Social Need Perspective

23. Executive Functioning • Challenges in Executive Functioning suggests that the cognitive process makes it difficult to execute some practical living functions. • Some examples: • Organizing • Planning • Sequencing • Getting tasks and/or activities started (initiating) • Completing • Changes/Transitions • Focus • Emotional Control

24. Executive Functioning • The way people monitor and control their thoughts and actions (Carlson & Moses, 2001). • Impairment or deficits in the higher-order processes that enable us to plan, sequence, initiate and sustain our Bx towards some goal, incorporating feedback and making adjustments along the way. • Involves working memory, planning, cognitive flexibility and inhibitory control (language development).

25. Visuals (i.e. lists, charts) • Memory Techniques • Technology • Clear, Short & Sweet • Routine/Repetition • Sleep Executive Functioning Tips

26. Awarness Perception Perspective Theory of Mind – Struggles with Mind Blindness Weak Central Coherence – Struggle with details vs whole (lost/confused/left behind) Executive Functioning – Struggle with organization, prioritizing • He/She doesn’t care – has No Empathy • He/She doesn’t care – they never listen or pay attention • He/She doesn’t care - lazy, and careless

27. Awareness Right Click Here to Open the Hyperlink to the Video: Neurotypical documentary trailer

28. Social Integration Model • Social Integration Model is rooted in the belief that it is the responsibility of healthcare providers to prepare clients for life outside of Tx - designed to assist individuals in reaching the highest level of individual functioning possible. • Emotional and psychological support are foundational. Focus on facilities is less important than how individuals act, behave and function outside of contained four walls. What really matters is how individuals function in the real world – that is the premise of the Social Integration Model. • Social Integration Model immerses individuals into real life activities within the community. • Recreational, social, cultural and life skills activities within the community with healthcare professionals form the core treatment interventions in the Social Integration Model

29. Social Integration Model How Does It Work

30. Benefits of Social Integration • Reduces being marginalized – Exposure for individuals exposure for the community (Demystify) • Practicing coping skills in the moment with support from healthcare providers with immediate feedback. • Social involvement with therapeutic support promotes effective participation in family, occupational, community and societal life.

31. Real Life – Real Time – RelevantSocial Integration Model for Aspergers • The adaptation of the social integration model is to help normalize behaviors. The philosophical goal is to assist individuals with Aspergers to achieve maximum social functioning so that they integrate into their families and society at large and can thus enjoy those benefits of belonging and participating. • Social and Life Skills development - through modeling, active training, exposure, experience, practice, repetition, etc. • Kinesthetic

32. Social Integration Model • Delivery of therapeutic services in the natural environment is embedded in the DNA of the Social Integration Model. • Every activity must be looked at as an opportunityto provide therapeutic services that increase social functioning. • learning to eat with proper manners at the table • maintaining an organized personal space • developing habits that establish proper ADLs • learning to behave in proper fashion in public places such as stores & restaurants • learning conflict resolution in public settings • establishing an ability to function in high stimulus environments (i.e. theme parks & other recreational activities) • developing healthy eating habits • developing healthy exercise regimens

33. Social Integration Model

34. Colors of Development • Hunter • Sage

35. Felt different • Emotionally Reactive • Poor sense of self • Direct and Blunt • Loves animals • Unable to follow-through with goals • Kicked out of multiple schools • Unable to complete college • Unable to go to a restaurant with family Hunter– His Story “The basement couch is my future!”

36. Hunter Colors of Development • Feels connected • Lengthened the fuse • Loves animals - Career • Follow through with goals • Can go out to eat with family

37. Poor perception of self • Obsessive/Irrational thoughts • Strong imagination • High IQ • Gifted in languages • Unable to pass class • Multiple medical leaves • Struggled with making friends Sage Her Story “I belong in a special farm for special people who get fake jobs to help them feel that they have purpose.”

38. SageColors of Development • Acceptance (public mistakes) • Positive self-talk • Strong imagination • Tutoring – both ways • In college (library) • Friends – study dates "Being happy doesn't mean that everything is perfect, it means that you've decided to look beyond the imperfections"

39. Another View • Cultural Awareness • Social Differences • DSM / Clinical Education • Social Integration Model • Examples of individual development • Now ….. • Back to Purpose

40. A Different Perspective …Celebrate Differences • Qualitative advantage in social interaction, as manifested by a majority of the following: • peer relationships characterized by absolute loyalty and impeccable dependability • free of sexist, "age-ist", or culturalist biases; ability to regard others at "face value“ • speaking one’s mind irrespective of social context or adherence to personal beliefs • ability to pursue personal theory or perspective despite conflicting evidence • seeking an audience or friends capable of: enthusiasm for unique interests and topics; • consideration of details; spending time discussing a topic that may not be of primary interest • listening without continual judgment or assumption • interested primarily in significant contributions to conversation; preferring to avoid ‘ritualistic small talk’ or socially trivial statements and superficial conversation. • seeking sincere, positive, genuine friends with an unassuming sense of humor

41. A Different Perspective …Celebrate Differences • Cognitive skills characterized by at least four of the following: • strong preference for detail over gestalt • original, often unique perspective in problem solving • exceptional memory and/or recall of details often forgotten or disregarded by others, for example: names, dates, schedules, routines • avid perseverance in gathering and cataloguing information on a topic of interest • persistence of thought • encyclopedic or ‘CD ROM’ knowledge of one or more topics • knowledge of routines and a focused desire to maintain order and accuracy • clarity of values/decision making unaltered by political or financial factors

42. A Different Perspective …Celebrate Differences • Additional possible features: • acute sensitivity to specific sensory experiences and stimuli, • for example: hearing, touch, vision, and/or smell • strength in individual sports and games, particularly those involving endurance or visual accuracy, including rowing, swimming, bowling, chess • “social unsung hero” with trusting optimism: frequent victim of social weaknesses of others, while steadfast in the belief of the possibility of genuine friendship • increased probability over general population of attending university after high school • often take care of others outside the range of typical development

43. Enrich Yourself • Become Culturally Aware • Educate and Share with others (key stakeholders) • Self Explore (who needs Tx – video game ex) • Practice (Our Way)

44. Enrich Yourself The Ode to the Autistic Man by Scott Lentine Try to understand the challenges that I faceI would like to be accepted as a human in all placesWhere I will end up in life I don’t knowBut I hope to be successful wherever I goI would like to expand my social skills in lifeMaking new friends would be very nice Stand proud for the autistic manFor he will find a new fanI hope to overcome the odds I face todayIncreased acceptance will lead me to a brighter day By the age of 20, I will have made tremendous stridesI know in the future, life will continue to be an interesting rideI have made new friends by the yearI will be given tremendous respect by my family and peersI hope to get noted for bringing the issue of autism to the common manSo that autistic people can be accepted in this great land Stand proud for the autistic manFor he will find a new fanI hope to overcome the odds I face todayIncreased acceptance will lead me to a brighter day

45. Bridging the Gap & Connecting Cultures “Strangers in a new culture see only what they know” – Unknown Become Aware …. Discover

46. Resources • Organizations • Advancing Futures for Adults with Autism • Center for Autism and Related Disabilities • Autism Speaks • CARD • AANE • Websites • www.aane.org • www.tonyattwood.com • www.pasadenavilla.com • www.autisminternetmodules.org • www.autismvotes.org • www.centerforautism.com • Books • The Complete Guide to Asperger's Syndrome by Tony Attwood • Asperger's Syndrome: A Guide for Parents and Professionals by Tony Attwood • A Self-Determined Future with Asperger's Syndrome: Solution Focused Approaches by E. Veronica Bliss and Genevieve Edmonds • Look Me in the Eye: My Life with Aspergers by John E. Robison

47. References • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.  • Attwood, Tony. "The Discovery of ." Morning News. 11.3 (1999): n. page. Web. • Garcia, Winner. "Three Core Deficits of Aspergers Syndrome." www.sacramentooasis.com. Sacramento Aspergers Syndrome Information and Support. Web • Attwood, Tony. "What is Asperger's Syndrome?."WWW.tonyattwood.com. Tony Attwood, n.d. Web. • Pasadena, . "Social Integration Model."WWW.pasadenavilla.com. Appleton Creative , n.d. Web. • Quappe, Stephenie. "What is Cultural Awareness, anyway? How do I build it?." Adler, Organizational Behavior. (1991): n. page. Web. 21 Mar. 2013. <www.culturosity.com>.