Asperger Syndrome 101

1. Asperger Syndrome 101 "SOLVING THE PUZZLE OF AUTISM: PRACTICAL STRATEGIES FOR SUCCESS" June 2012 San Angelo, Texas

2. DSM-IV ClassificationPervasive Developmental Disorders Pervasive Developmental Disorders PDD-NOS (not otherwise specified) Asperger’s Syndrome Autism Rett’s Syndrome Childhood Disintegrative Disorder There is a wide range in severity of symptoms from profound disability (Autism) to milder forms (Asperger’s Syndrome)

3. History of Asperger Syndrome • Neurobiological disorder affecting the systems of both brain and body • First described in 1944 by Hans Asperger • Officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994

4. Prevalence ofASD • 1 in 88* children in the U.S. • Male to Female ratio 4:1 • More prevalent in pediatric population than: • Cancer • Diabetes • Down Syndrome * Centers for Disease Control and Prevention (CDC); 2012

5. Cause of Asperger Syndrome? • Genetic influences (dozens of genes linked to ASD) • Possible Environmental Factors • Vaccines reactions (Thimerosal?) • Biological Factors • abnormal tissue in gut • food allergies • inflamed tissue in the brain • Autism does NOT result from: • Poor parenting • Differences in culture or language

6. Asperger’s Syndrome: DSM-IVDiagnostic Criteria (2000) • A. Qualitative impairment in social interaction. • B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities. • C. The disturbance causes clinically significant impairment in social, occupational or other important areas of functioning. • D. There is no clinically significant delay in language (e.g., single words by age 2 years, communicative phrases used by age 3 years). • E. There is no clinically significant delay in cognitive development, self help skills, adaptive behavior (other than social), and curiosity about the environment in childhood. • F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

7. DSM-IV Criteria • Briefly summarized: • Impairment in social interaction • Restricted, repetitive and stereotyped patterns of behavior, interests and activities • Clinical impairment in social, occupational, or other important areas of functioning • No significant language delay • No significant cognitive delay

8. Social Differences Communication Differences Repetitive Behaviors Disagreement with DSM-IV • Some professionals in the field, disagree with current DSM-IV criteria for Asperger Syndrome • Identical social and repetitive behavior criteria as Autism • Indication of no communication differences in Asperger Syndrome • Agree that Asperger Syndrome is a “triad” of symptoms • Social differences considered to be the defining characteristic

9. Features of Asperger Syndrome Challenges with Reciprocal Social Interaction

10. Reciprocal Social Interaction • Lack of skills to establish friendships • Difficulty initiating or maintaining conversations • Difficulty joining in an activity • Is naïve and easily taken advantage of or bullied • Difficulty discerning appropriateness of topic • Personal space violations • Minimal, intense or unnatural eye-contact • Inappropriate affective expression or response • Lack of appropriate body language • Inability to read body language and facial expressions • Lacks tact or appears rude • Passivity / Aggressiveness • Lack of awareness or disinterest in popular fads and trends • Difficulty in perspective taking (theory of mind deficits)

11. Features of Asperger Syndrome Challenges with Use of Language

12. Use of Language (Pragmatics) • Repeats certain words or sounds repeatedly, “well, actually” • Interprets words or conversations literally • Difficulty with the rules of conversation • Doesn’t initiate or respond to social greetings • Difficulty using gestures and facial expressions appropriate to the situation • Talks incessantly or minimal talking (selectively mute) • Advanced vocabulary • Makes seemingly irrelevant comments • Difficulty talking about others’ interests • Speaks in an overly formal way; often sounds like a “little professor” • Unnatural rhythm or rate of speech (sing song voice or unusual tone) • Reduced ability to communicate and comprehend verbal language when frustrated or anxious • Expressive skills may mask significant receptive issues – especially socially mediated information

13. Features of Asperger Syndrome Restricted Interests, Insistence on Sameness, and Difficulty with Change

14. Restricted Interests, Insistence on Sameness, Resistance to Change • Has intense interest in a specific topic • Resists change; difficulty with unexpected events or changes between activities • Seems unmotivated by typical rewards for age • Difficulty stopping a task before it is completed • Asks repetitive questions • Appears ‘stubborn’ or ‘oppositional’ • Fixates on rules and moral rights

15. Features of Asperger Syndrome Motor Functioning and Motor Planning

16. Motor Functioning / Planning • Balance difficulties • Poor coordination • Resists or refuses handwriting tasks • Dysgraphia (inability to write legibly) • Delayed timing, imitating and execution of movements • Accident prone • Difficulty with snaps, buttons, fasteners • Walks with an awkward or unusual gait • Unusual body postures and/or facial expressions • Difficulty starting or completing actions (may rely on prompting by others) • Difficulty with athletic activities including riding a bike, catching a ball • Often display hypotonia (general muscle weakness)

17. Features of Asperger Syndrome Differences in Cognitive Processing

18. Cognitive Differences • Poor problem solving skills • Difficulty with planning and organizing (materials, projects) • Difficulty applying learned skills in new settings (generalization) • Attention problems • Impulsive • Very logical learners • Rigidity in thinking and routine • Difficulty perceiving danger • Difficulty processing multimodal information simultaneously • Difficulty retrieving experiential memories • Difficulty generalizing knowledge to application • Difficulty discerning between fiction and reality • Difficulty discerning between relevant and irrelevant information • Displays weakness in reading comprehension despite strong word recognition ability • Very literal understanding of concepts • Poor self-reflection; Difficulty understanding the connection between behavior and consequences

19. Cognitive Processing • Theory of Mind (ToM) • Perspective taking • Making social judgements • Lack of skills creates easy targets for bullies • Poor inferencing and predicting skills (reading comprehension) • Written expression may be affected by fine motor issues • fMRI studies clearly show some with AS that process info using different parts of the brain • Yale studies showing individuals with AS focused on different parts of dramatic video

20. Features of Asperger Syndrome Sensory Differences Some surveys indicate up to 90% of parents reports children with ASD have sensory issues

21. Sensory Differences • May be hypo (under) or hyper (over) • responsive to: • Touch – tactile defensiveness • Sounds or frequencies – auditory defensiveness • Light • Pain • Smells • Textures or tastes of foods. • May be emerging evidence of Sensory Processing Disorder in DSM-V

22. Features of Asperger Syndrome Emotional Vulnerability

23. Emotional Vulnerability • Low frustration tolerance • Negative self-talk • Difficulty tolerating mistakes • Self-injury • Appears sad, depressed or anxious • Makes suicidal comments or gestures • Has difficulty managing stress and/or anxiety • Worries obsessively

24. Features of Asperger Syndrome The Gifts of Asperger Syndrome

25. The Gifts • Honest • Determined • An Expert • Notices sounds others do not hear • Kind • Forthright (speak their mind) • Enjoy solitude (important for emotional restoration) • Perfectionist • Reliable, loyal friend • Good at art (or other creative outlets) • Observant of details others do not see • Exceptional at remembering things other people have forgotten • Humorous in a unique way • Advanced knowledge in mathematics • Liked by adults

26. Neurological Differences Research is now showing us that people with Asperger Syndrome use their brains in unusual ways: they memorize alphabet characters in a part of the brain that ordinarily processes shapes. They tend to use the visual centers in the back of the brain for tasks usually handled by the prefrontal cortex. They often look at the mouth instead of the eyes of someone who is speaking – missing the social context so important to interpretation and understanding of the message being sent. Wallis, Claudia – Time Magazine. May 15, 2006. “Inside the Autistic Mind”

27. Neurological Differences • Frontal Lobes • home to higher reasoning • greatly enlarged due to excess white matter (brain’s connector cables) • Impaired higher reasoning influences student’s ability to easily learn abstract concepts.

28. Neurological Differences • Corpus Collosum • Undersized • Links left and right hemispheres of the brain • Activity across diverse regions of brain is poorly coordinated • Left to Right brain connectivity is slowed • Effects many areas of learning – creative writing for example

29. Activity: Left – Right Brain Test

30. Neurological Differences • Hippocampus • about 10% larger than normal • vital to memory • possibility is that this structure becomes enlarged because autistic children rely on memory to interpret situations that most people process elsewhere. • Tendency to hyperfocus on detail and miss the big picture • Rote memory is a strength (making connections between new material is not) • Learn in “scripts” or routines – will often respond in ways that have been witnessed in movies / tv even if situation is somewhat different

31. Neurological Differences • Cerebellum • overloaded with white matter • Fine tunes motor activity, balance, body movements, coordination and the muscles used in speaking • May also play a significant role in the ability to shift attention from one stimulus to another • May be “clumsy” or uncoordinated • Difficulty anticipating events / action of others in context • Miss information due to slow attention shift

32. Neurological Differences • Distribution of white matter – the nerve fibers that link diverse parts of the brain is abnormal. • Local areas tend to be over-connected with more limited connectivity between more distant areas of the brain. Right and left hemispheres of the brain are also poorly connected. • As if there are too many competing local phone services but no long distance. Students with ASD have difficulty bringing different cognitive functions together in an integrated way • Thought processes often result in unexpected answers or ideas – typically connect to a previous experience / learned or memorized response to an event • Processing is often delayed

33. Moving from knowledge to intervention • How do we know what • interventions to put in place? Identification and implementation of appropriate supports and strategies across all environments, activities and persons is crucial to aiding students in achieving success Moving from Knowledge to Action

34. Areas of Instructional Need – Other Than Grade Level Academic • Instructional Needs (to address features) • Social Skills • Link to reading comprehension skill development • Direct Instruction • Emotional Vulnerability • Organization • Adaptive • Motor planning • Self-help

35. Social & Pragmatic Language Skills “Normal children acquire the necessary social habits without being consciously aware of them, they learn instinctively. It is these instinctive relations that are disturbed in autistic children. Social adaptation has to proceed via the intellect” – Hans Asperger

36. Why are Social Skills Important? • Value society places on social ability • Good social skills promote acceptance of students by peers • Build lifelong social and emotional growth • Improved social competence reduces problem behaviors • Can be successful without high cognition, but impaired social skills will hurt in the long run

37. Social and Pragmatic Language Skills to Teach • Initiation of play –early, tween, teen, adult • Conversational Skills • Reading emotions / non-verbal cues (self and others) • Flexibility • Self-regulation / anxiety management

38. Social / Emotional Needs Directed, specific, cognitive-based, instruction in play, social thinking and friendship is essential Social Thinking Video modeling Drama / Role Playing Social Stories / Comic Strip Conversations / Power Cards Rating Scales Cognitive Behavior Therapy Emotional Toolbox

39. Social and Pragmatic Language • Social Narratives • Social Stories™ • Social Articles • Power Cards

40. Social and Pragmatic Language Instructional Practices and Curricula Integrated Play Groups – (Wolfberg) Think Social (Winner) - Cognitive Behavioral Therapy Bellini’s Building Friendships The Hidden Curriculum PLAY (Ric Solomon) Skill Streaming

41. Emotional Vulnerability • “Autistic children are often tormented and rejected by their classmates simply because they are different and stand out from the crowd. Thus, in the playground or on the way to school one can often see the autistic child at the center of a jeering horde of little urchins. The child himself may be hitting out in a blind fury or crying helplessly. In either case he is defenseless” • - Hans Asperger

42. Teasing & Bullying • Use a team approach and include the target, school administration, teachers, parents, psychologist, other children and the child engaging in bullying • Provide staff training • Ensure justice is equitable based on motivation, knowledge and facts • Use positive peer pressure • Teach target skills to handle bullies • Don’t be alone • Assertive and honest response • Self-protection courses

43. KEY to Solving Behavior Problems… You must find the real antecedent!!!!!

44. Common Mistakes inManaging Behavior Thinking that a student can learn when under extreme stress and anxiety Thinking that the behavior is on “purpose” or under the student’s control Raising voice when a student misbehaves Denying a student request before hearing it out Focusing on what the student does wrong, (look for antecedents)

45. Mistakes Cont. Talking about the student as if he/she is not there Disagreeing with another professional about discipline in front of the student Repeating instructions too often rather than checking to see whether the student understood, or had time to process Focusing on too many behaviors with the student

46. Finding the Antecedent • What was going on just before the incident? -(antecedent) • Include info such as: • Time • Activity the student participating in • Environmental factors

47. Finding the Antecedent – cont. • Formulate a hypothesis for the behavior? • Put on your detective hat and really think… • Remember the Autism perspective (consider the difference in thinking).

48. Behavior • Remember that behavior serves a purpose for the individual and that our job is to figure out that purpose • Sensory Defensiveness / Dysregulation • Misinterpretation of the environment • Misinterpretation of teacher expectations • Social misunderstandings with peers

49. Behavior • Conditions likely to increase unwanted behaviors • Anxiety / biological issues • Schedule / staff changes • Medication change • Irregular sleep patterns • Illness / pending illness • Skill deficits • Lack of communication system

50. Behavior • Teaching an alternative response (alternative behavior) should be an integral part of the behavior response plan • Focus on self-control / not outside (adult) control • Self-monitoring / self-awareness • Choice making • Relaxation training • Communication • Social Skills • If we are only rewarding / punishing behavior then we are not teaching what is wanted (appropriate behavior)