New Challenges in the Classroom: Asperger and Tourette Syndromes AASSA Conference Buenos Aires, 2007

1. New Challenges in the Classroom: Asperger and Tourette SyndromesAASSA ConferenceBuenos Aires, 2007 Juani Pinzás, Ph.D. Lucrecia Rodríguez, MA. Colegio F. D. Roosevelt Lima, Peru

2. Increased cases in the classrooms Increased presence nationwide Recent research: Medical Psychological Educational Teachers’ concerns Parental expectations Counselors’ Role Why Asperger Syndrome?Why Tourette Syndrome?

3. Our task today: • Share updated information on theory about both syndromes • Provide specific guidelines and tips for counselors and teachers • Suggest ways of supporting parents

4. Asperger Syndrome Definition Diagnosis Characteristics Development Cognition Language Motor Social Treatment Recommendations for Counselors Recommendations for Teachers Tourette Syndrome Definition Diagnosis Facts Types of tics Motor Vocal Impact on School Performance Treatment Recommendations for Counselors Recommendations for Teachers Outline of Presentation

5. Asperger Syndrome (AS) What is it? “Asperger Syndrome (AS) is a neurobiological disorder named after a Viennese physician, Hans Asperger, who described a pattern of behaviors in several young children, mainly boys, who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills.” (Barbara L. Kirby, 2006)

6. Diagnosis of Asperger Syndrome • Asperger syndrome can be very difficult to diagnose. Children with Asperger syndrome function well in most aspects of life, so it may be easy to perceive them as just being "different.“ • Researchers and mental health experts are still investigating the causes of autism and Asperger syndrome . • Asperger syndrome should be diagnosed by a clinical psychologist and/or child psychiatrist. • Diagnoses can be best done in Kindergarten or 1st grade. • Teachers cannot make a medical diagnoses like this one. The whole school should avoid labeling students with Asperger syndrome.

7. Comorbidity Asperger syndrome can be accompanied by depression or bi-polar disorder.

8. Identified Asperger Syndrome students may exhibit a variety of the following characteristics: • marked deficiencies in social skills • preoccupation with a particular subject of interest • obsessive routines • difficulties with transitions or changes • preference for sameness • great difficulty reading nonverbal cues (body language) • difficulty determining proper body space • over sensitivity to sounds, tastes, smells, and sights

9. Cognitive Development • By definition, those with Asperger syndrome have a normal IQ and many individuals exhibit exceptional skill or talent in a specific area. • Because of their high degree of functionality those with Asperger syndrome are often viewed as eccentric or odd and can easily become victims of teasing and bullying. • Asperger syndrome ranges from mild to severe.

10. Language Development • no significant delay in the development of language milestones • despite normal language development, deficits in pragmatics and prosody • extraordinarily rich vocabulary, sometimes sounding like "little professors" • extremely literal, difficulty using language in a social contexts

11. Language Development (Cont.) • high amount of verbal output, • good verbal learning • adequate to advanced level of word recognition,

12. Language Development(Cont.) ** • speech tends to be formal, robotic or repetitive • no figurative use of language, symbolic representation, nuances or double meanings • linguistic sophistications such as jokes and idioms are hard to grasp. • language development is quite literal, therefore reading other people's intentions are areas where language problems occur.

13. inadequate socialperception no empathy problems reading nonverbal cues, such as facialexpressions or body language inappropriate affect minimal social interactions weak social pragmatics lack of "common sense" obsessiveroutines Social Development

14. motor delay motor dyspraxia (reflected in a tendency to be clumsy) problems in visual motor integration skills problems in visual spacial orientation problems in spatial memory usually have a deficit in nonverbal skills may have problems with attention span may have problems with organization Motor Development and Other

15. As far as we know, there seems to be no cure for the disorder - children with Asperger syndrome will become adults with Asperger syndrome . • But adults with Asperger's may lead full,happy,and productive lives. • The likelihood of achieving this is enhanced with appropriate education, support, and resources. • Teachers, parents and counselors are key.

16. Outline - Tourette Syndrome • Definition • Diagnosis • Facts • Types of tics • Motor • Vocal • Impact on School Performance • Treatment • Recommendations for Counselors • Recommendations for Teachers

17. Tourette Syndrome (TS) What is it? “Tourette Syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, a French neurologist.” (National Institute of Neurological Disorders, 2006)

18. Diagnosis of Tourette Syndrome (TS) • Neurologists make the diagnosis after verifying that the patient has had bothmotor and vocal tics for at least 1 year.  • Clinical psychologists or child psychiatrists should complement the diagnosis with a complete psycho-educational battery and a good family and child history. • For families and physicians unfamiliar with Tourette syndrome, mild and even moderate tic symptoms may be considered part of a developmental phase or the result of another condition.  (*)  • Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about Tourette Syndrome from others. 

19. Some Facts About Tourette Syndrome • The early symptoms of Tourette syndrome are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. • Tourette syndrome occurs in people from all ethnic groups. • Males are affected about three to four times more often than females (3:1 or 4:1). • Their cognitive development is normal. People with Tourette syndrome have average or high average intelligence.

20. Comorbidity Some individuals with Tourette syndrome experience additional neurobehavioral problems such as: Attention Deficit Hyperactivity Disorder (ADHD) or Obsessive-Compulsive Disorder (OCD) or Behavior Disorder

21. Comorbidity

22. Although the cause of Tourette syndrome is unknown, current research points to certain brain regions, the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells.

23. A significant percentage of all children will experience one, or even a few tics at some point in their development. • For most children, a tic will emerge without any warning or explanation, remain a few weeks, and then disappear slowly. For some children the tic does not disappear, but continues its development as either a chronic tic or a Tourette condition. • A tic is defined as a brief, repetitive, purposeless, involuntary movement or sound. • Tics that produce movement are called "motor tics," while tics that produce sound are called "vocal tics" or "phonic tics."

24. Tics may often be characterized by whether they are "simple" or "complex." • A simple tic involves one muscle group or one simple sound. • A complex tic involves a coordinated movement produced by a number of muscle groups. • Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. 

25. Studies suggest that Tourette syndrome is an inherited disorder. • Although there is no cure for Tourette syndrome , the condition in many individuals improves in the late teens and early 20s. • As a result, some may actually become symptom-free or no longer need medication for tic suppression. • Individuals with Tourette syndrome have a normal life expectancy. Tourette syndrome does not impair intelligence.

26. Examples of Simple Motor Tics • Eye Blinking • Eye Rolling • Nose Twitching • Lip-licking • Shoulder Shrugs • Head Jerks • Brushing or Tossing Hair Out of Eyes • Mouth Opening • Arm Extending

27. Examples of Complex Motor Tics • Pulling at Clothes • Touching People • Touching Objects • Smelling Fingers • Smelling Objects • Jumping or Skipping • Flapping Arms • Tensing Muscle Groups • Twirling Hair • Sequences or patterns combining different simple and complex motor tics

28. Examples of Simple Vocal Tics • Throat Clearing • Grunting • Yelling or Screaming • Sniffing • Coughing • Humming • Whistling

29. Examples of Complex Vocal Tics • Unusual changes in volume of voice • Coprolalia: obscenities or socially taboo phrases Note: This list is not all-inclusive

30. ** • Tics often worsen with excitement or anxiety and lessen during calm, focused activities. • Certain physical experiences can trigger or increase tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. • Tics come and go over time, varying in type, frequency, location, and severity.  The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities.

31. ** • Although the symptoms of Tourette syndrome are involuntary, some people can sometimes suppress or manage their tics in an effort to minimize their impact on functioning. • Tics vary in frequency. Decreased frequency occurs in the morning and it increases in the afternoon and evening. • Although Tourette syndrome can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

32. Treatment • Because tic symptoms do not often cause impairment, the majority of people with Tourette syndrome require no medication for tic suppression. However, effective medications are available for those students whose symptoms interfere with functioning. • Psychotherapy may also be helpful. Although psychological problems do not cause Tourette syndrome , such problems may result from Tourette syndrome . • Psychotherapy can help the person with Tourette syndrome better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur.

33. The Impact of Tics on School Performance • Tics can impact learning and performance in different ways. • The most commonly reported problems are that eye tics and head/neck tics directly interfere with reading and can be very frustrating for the student. • Eye, head/neck, and arm tics also directly interfere with handwritten work for a number of students with tics.

34. Tics can distract students from concentrating as they become aware of the need to tic. • Severe or frequent tics can cause pain, frustration, and irritability. • Vocal tics can lead the student to withdraw from class discussions or make them embarrassed to readaloud. • Tics can lead to peer teasing or fear of peer rejection.

35. General Tips for Teachers • Work around the tics. • Keep the focus on learning. • Be flexible. • Keep a positive outlook as you remind yourself and the student that however bad a tic seems, this too shall pass.

36. Strategies for Teachers and CounselorsAsperger SyndromeTourette Syndrome(see attached handout)

37. Sources • http://www.childdevelopmentinfo.com/disorders/asperger.shtml • http://www.udel.edu/bkirby/asperger/aswhatisit.html • http://www.hyperlexia.org/aha_winter9697.html • http://www.kidshealth.org/parent/medical/brain/asperger.html • http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm#56583231 • http://www.tsa-usa.org/news/headlines.html

38. Books Used on Asperger Syndrome • 1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders by Veronica Zysk • Preparing for Life: The Complete Guide for Transitioning to Adulthood for Those with Autism and Asperger's Syndrome by Jed Baker • Autism? Asperger's? ADHD? ADD? by Diane Drake Burns • Asperger's: What Does It Mean to Me? by Catherine Faherty • Understanding Asperger's Syndrome: Fast Facts--A Guide for Teachers and Educators to Address the Needs of the Student by Emily L Burrows • Navigating the Social World: A Curriculum for Individuals with Asperger's Syndrome, High Functioning Autism and Related Disorders by Jeanette McAfee • Asperger's and Self-Esteem: Insight and Hope through Famous Role Models by Norm Ledgin, Temple Grandin, and Marsha M. Ledgin

39. Books Used on Tourette Syndrome • Tourette's Syndrome: Finding Answers and Getting Help (Patient-Centered Guides) by Mitzi Waltz • Living with Tourette Syndrome by Elaine Fantle, Shimberg • Tourette Syndrome: The Facts by Mary Robertson • Search for the Tourette Syndrome and Human Behavior Genes by David E. Comings • Coping With Tourette Syndrome and Tic Disorders (Coping) by Barbara Moe • A Mind of Its Own: Tourette's Syndrome: a Story and a Guide by Ruth Dowling Bruun • Children With Tourette Syndrome: A Parent's Guide (Special Needs Collection) by Tracy Haerle • Hi, I'm Adam: A Child's Book About Tourette Syndrome by Adam Buehrens • Tourette Syndrome by Donald J. Cohen • I Can't Stop!: A Story About Tourette Syndrome by Holly L. Niner and Meryl Treatner

40. Contact Us Juani Pinzás, Ph. D. Educational Psychologist Counselor Early Childhood/Gr. 1 jpinzas@amersol.edu.pe Lucrecia Rodríguez, MA Educational Psychologist Counselor Gr. 2-5 lrodrigu@amersol.edu.pe

41. Thank You!