Asperger Syndrome 101

Asperger Syndrome 101

"SOLVING THE PUZZLE OF AUTISM: PRACTICAL

STRATEGIES FOR SUCCESS"

June 2012San Angelo, Texas

DSM-IV ClassificationPervasive Developmental Disorders

Pervasive Developmental Disorders

AutismAsperger’s Syndrome

PDD-NOS(not otherwise

specified)

Rett’s Syndrome

ChildhoodDisintegrative

Disorder

There is a wide range in severity of symptoms from profound disability (Autism) to milder forms (Asperger’s Syndrome)

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

Prevalence of

ASD • 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

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

brainAutism does NOT result from:•Poor parenting •Differences in culture or language

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.

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

Disagreement with DSM-IVSome 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

Communication Differences

Social Differences

Repetitive Behaviors

Features of Asperger Syndrome

Challenges with Reciprocal Social Interaction

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)


Challenges with Use of Language

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


Restricted Interests, Insistence on Sameness, and Difficulty with Change

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


Motor Functioning and

Motor Planning

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)


Differences in Cognitive Processing

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

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


Sensory DifferencesSome surveys indicate up to 90% of parents

reports children with ASD have sensory issues

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


Emotional Vulnerability

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


The Gifts of Asperger Syndrome

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

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”


• 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.


• 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

Activity: Left – Right Brain Test


• 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


• 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


• 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

Moving from knowledge to intervention

• How do we know what• interventions to put in place?

Moving from Knowledge to Action

Identification and implementation of appropriate supports and strategies across all environments, activities and persons is crucial to aiding students in achieving success

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

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

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

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

Social / Emotional NeedsDirected, specific, cognitive-based, instruction in play, social thinking and friendship is essential

Social ThinkingVideo modelingDrama / Role PlayingSocial Stories / Comic Strip Conversations / Power CardsRating Scales Cognitive Behavior TherapyEmotional Toolbox


• Social Narratives– Social Stories™– Social Articles– Power Cards


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

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

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

KEY to Solving Behavior Problems…

You must findthe real

antecedent!!!!!

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 misbehavesDenying a student request before hearing

it outFocusing on what the student does wrong,

(look for antecedents)

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

Finding the Antecedent• What was going on just before the incident? -

(antecedent)

• Include info such as: • Time• Activity the student participating in• Environmental factors

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).

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

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

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)

Behavior

• All behavior communicates

Anxiety

And

Frustration

Receptive and Expressive Language (ability to communicate)

Behavior

A few key points to remember…

Teaching must occur before learning can occur

Showing a student a visual – is not teaching

Have a crisis plan for anticipated behaviors – but realize that crisis management is a short-term solution and does not equal long-term behavior change

Support StrategiesRestricted Interests

• “Don’t treat the special interest as a toxin to be purged, but as a trait to be managed”

• Jennifer McIlwee Myers in • an email to Tony Attwood

Support StrategiesRestricted Interests

Limit time with interest (‘special time’)

Work “with” the interest rather than against

Support interests that could become long-term employment

Use to facilitate friendships/peer interaction

Support StrategiesCognitive

• Difficulties in this area may include transitions, impulsivity, inflexibility and distractibility.

• STRATEGIES:– Transition strategies: visual supports– Attention to task strategies: may be maintain by selecting activities to

task; positive reinforcements, frequent breaks– Self monitoring strategies: behavior sheet, social stories, schedule

boards, etc.– Planning and organizing strategies: agenda/planner for recording

assignments, Franklin Homework Whiz, and mind mapping software.

Support StrategiesMotor

• Physical Supports• Frequent Breaks • Assistive Technology

RESOURCES

• OASIS• OAR• Social Thinking• National Professional Development Center on

Autism• Texas Autism Resource Guide for Effective

Teaching• Brenda Smith Myles, Tony Attwood, Michelle

Garcia Winner,

Documents

Asperger Syndrome 101