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Nicola Martin and Luke Beardon0114 225 5534
n.martin@lse.ac.uk
BriefUnderstanding ASSuccesful InclusionWorking with people who have ASCare PlanningResources
Areas to coverIssues /Implications communication /social interaction /flexibilityMental health RelationshipsSustance misuseSupport /coping strategiesDiagnostic toolsCare planningResources
My responseThese areas are significantly inter related
and can not be artificially separatedThe voices of people with AS have to
permiate the day. Please read The Aspect Report
Beardon L ,Edmonds G (2007) The Aspect report. A national report on the needs of adults with Asperger syndrome. www.shu.ac.uk/theautismcentre My aim is to help you to empathise with people who have AS-
emphasising individuality and changes over time /context
The Autism Centre Staff have expertise in a range of areas
including education, criminal justice, family issues, across the age range, and engage in teaching, consyultancy and research.
The Social Model of Disability informs the work of the centre. If you want to find out more you could take a distance learning module www.shu.ac.uk/theautismcentre
0114 225 5534
TaskRemember something which made you
feel really anxious ,deeply humiliated or excluded. Think about it for a minute
Concentrate on the physical feelingsHow receptive are you to work, study,
socialising etc when you feel like this?People with AS experience depression and
anxiety often, at least in part, as a result of environmental factors /other people
Inclusion'People with AS are like salt water fish that
are forced to live in fresh water. We are fine if you just put us into the right environment. When the person with AS and the environment match, the problems go away and we even thrive. When we don't we seem disabled'.
Baron -Cohen S (03) The Essential Difference. Penguin.
Task-definitionsinclusion mental well being
relationship coping
AS and AnxietyHigh levels of anxiety – as normIncreased anxiety states for specific reasonsGlobal levels of high anxiety due to
environmental factorsPossible as high as 90% of individuals have a
recognisable anxiety disorder
Secondary Psychiatric DisordersNot a primary mental illnessResult of environmental factors and ASHigh level in people with AS compared to
peer groupsBetter support should lead to a better
prognosis and reduction in secondary conditions
Specific Reasons for AnxietyAs a result of specific neurological
differences in AS:learning processescommunicationsocial interactionTheory of MindExecutive Functioningemotional recognitionSensory processingCentral Coherenceobsessions or in depth interests (which differ from
OCD)
Direct learning vs Indirect learning
Examples of indirect learning / development:
Theory of Mind
Social skills
Social cues
Non verbal communication
Learning ProcessesLearning Processes
Factors which can be negatives
Resistance to ChangeEnvironmental factorsTrustSense of self/diagnosisPhysical
Hypothesis - resistance to change
Individuals with AS have Individuals with AS have significantly lower ‘stability rates’ in significantly lower ‘stability rates’ in
their day to day lives than the their day to day lives than the neurotypicalneurotypical
This may lead, in part, to an explanation of
‘resistance to change’
Dependent on:
Communication
Understanding other people
Social awareness
Predictability
Fulfilled expectations
Shared sensory environment
StabilityStability
Autism and Resistance to Change
1
2
Neurotypical 24 Hour Period
Stable
Unstable
OBSESSIONS -SPECIAL OBSESSIONS -SPECIAL INTERESTSINTERESTS
Can be ''socially inappropriate''?!
Need boundaries
Can be used as coping mechanisms
Obsessions /in depth interests, may be misinterpreted
Task-consider the plus side of having an in depth interest
SELF-ESTEEMSELF-ESTEEM
Must be taken very seriously
Impacts directly on self-control and behaviour
Culture of poor self-esteem in AS
Individuals need to know what to do just as much as what not to do
◈Possibly an unquestioning level of trust
◈Possibly extremely distrustful
◈NTs are renowned for lying
◈Not being given the opportunity to trust can be highly anxiety inducing
TrustTrust
◈Literal interpretation
◈Metaphor / sarcasm / irony
◈Pedantic
◈Echolalia
◈Delayed processing
◈Meaning transferability
◈Expressive vs receptive skills
Verbal CommunicationVerbal Communication
◈Prosody
◈Facial expression
◈Body posture
◈Inference
◈Contextual information
Non Verbal CommunicationNon Verbal Communication
◈Recognising the ‘unwritten rules’
◈Assessing situations
◈Reacting appropriately to social circumstance
◈Adapting social skills to the situation
Social SkillsSocial Skills
◈Conversational turn taking
◈Following the leads of others
◈Understanding ‘friendships’
◈Group settings
◈Sharing
◈Participating in game scenarios
Social CuesSocial Cues
Traditional Model of Autism'Triad of Impairments'Wing and Gould 1979Identified 3 areas of difference:
communicationsocial understanding'imagination'
Task-1.Is there an argument for describing 'the triad of difference'?
2.Think of positive and negative words associated with AS-and 3.Think about the language you use
IssuesDeficit based'Imagination' is inaccurateHighly subjectiveBut useful as a guide in terms of areas of
developmental difference
Theory of MindUnderstanding and recognising emotional states (self and
others)Mentalising abilitiesDifficulty in understanding that other people may see things from a
different point of view
Inflexibility in the application of both the written and unwritten rules that govern behaviour
EmpathyTrustAppearance of rudenessLack of pretend play
Mindreading allows us to:Explain Actions
Predict Actions
Recognise and utilise deception
Pretend and imagine
Experience empathy
Share information and co-operate
Executive Functioning Planning Impulse control Sequencing Scripting Managing time and space Connecting events Flexibility Understanding 'what happens next' Turn taking Queuing Difficulty with understanding abstract concepts and cause and consequence
Central CoherenceIdentifying the pattern or underlying rules
Attention to detail
Knowing what is relevant and redundant
Recognising the 'big picture'
BehaviourIdentify behaviour in isolationDecide: elimination or not?Decide: adapt/modify
environmentbehaviour
intensity duration frequency
Review
BullyingIndividuals with AS are highly vulnerable:
don't 'fit in'will not necessarily follow traditional social
convention (fashion, etc.)problems with adhering to social rules within
society (classroom, playtime, employment, social arenas, etc.)
communication problemspoor TOM
EDUCATIONEDUCATION
PROBLEMS INCLUDEPROBLEMS INCLUDE Cognition can hide core defects Peer group Lack of understanding from staff Transference of problems (home to school/work/service
and vice-versa) Academia takes preference over social and emotional
development. Can lead to... Isolation Poor self-esteem Poor motivation Depression Unrealised potential Perfectionism
WHY GET A DIAGNOSIS OF ASPERGER WHY GET A DIAGNOSIS OF ASPERGER
SYNDROMESYNDROME??
OPENS OPPORTUNITIES -OPENS OPPORTUNITIES -provided post diagnostic support is availableprovided post diagnostic support is available
To understand one’s self
To understand behaviour
To develop appropriate support mechanisms
To widen scope of services
Provides better chances for the future
diagnosis is a process not an event
PROBLEMS WITH DIAGNOSTIC PROBLEMS WITH DIAGNOSTIC PROCEDUREPROCEDURE
GENERALGENERAL
Inconsistency of diagnostic criteria (specifically language delay)
Lack of awareness among some clinicians
Poor clarity of referral routes
CLINICALCLINICAL
Behaviours within clinical settings may not providean accurate profile
Echopraxic behaviours may be construed as pretend play
Many other difficulties can manifest similar behaviours(e.g. abuse and trauma)
ETHICAL CONSIDERATIONSETHICAL CONSIDERATIONS
Do not impose societal values on the person with AS
There’s nothing wrong with having AS
There is much to learn from people with AS
Never assume anything when working with someone with AS
Not acknowledging AS can be discriminatory
Difference does not equate to negativity
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