DMHAS Child & Family Agency A Scholar in Residence Workshop

The Learning Clinic

DMHASDMHASChild & FamilyAgency

A Scholar in Residence

Workshop

The Learning Clinic

Nurturing the Healthy Nurturing the Healthy Development of Development of

Young People with Young People with Aspergers SyndromeAspergers Syndrome

The Learning Clinic

The Learning Clinic Brooklyn, Connecticut

Presented by:

Raymond W. DuCharme, Ph.D.Kathleen A. McGrady, Psy. D.,

ABDA

Hilton Garden Inn, Glastonbury, CT

April 04, 2006

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Transition Needs and Services

and

Transfer of Rights Statement

Presented by:

Founder and Executive Director, The Learning Clinic

Dr. Raymond DuCharme

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1990 - Congress Introduces Provision into

IDEA• Public agencies required to provide

students with disabilities aged 16 and older with appropriate instruction in community experiences, development of employment, and other post-school objectives

• When appropriate, also provide instruction in independent living skills and functional vocational evaluations

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1997 - Congress introduces new requirements in the IDEA further expanding transition

services• All LEA’s required to include statement of

Transition Services in child’s IEP

• The purpose: “focus attention on how the child’s education program can be planned to afford a successful transition to his or her goals for life after secondary school”

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President’s Commission on Special Education analyzed

outcome of 12 years of Transition Services

Results: (Compared to nondisabled peers)

• Students with disabilities are unemployed and under-employed when they leave school

• Too many students with disabilities leave school without earning any type of diploma

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Results: (Compared to nondisabled peers)(continued)

• Students with disabilities attend postsecondary programs at rates lower than their nondisabled peers

• Adults with disabilities are much less likely to be employed than adults without disabilities

• Unemployment rates for working-age adults with disabilities have hovered at the 70% level for at least the past 12 years

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• Conclusion: The Commission determined that statistics reflected failures in the 1997 Transition Services Structure and recommended the IDEA Transition Requirements be amended.

• Action: Congress made several changes to the Transition Requirements in response to those concerns.

• Result: The new definition of Transition Services has been amended to reflect the reauthorization's emphasis on achievement.

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• Transition Services: The term ”Transition Services” is now defined to mean a coordinated set of activities for a child with a disability that:

• Is designed within a results-oriented process focused on improving the academic and functional achievement of the child with a disability to facilitate his or her move from school to post-school activities, including postsecondary education, vocational education, integrated employment.

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• Transition Services (continued)

• Is based on the individual child’s needs, taking into account his or her strengths, preferences and interests.

• Includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives and, when appropriate, acquisition of daily living skills and functional vocational evaluation.

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• New Changes: In addition, the law modifies the age at which student begin to receive Transition Services. Under the new law, the first IEP that will be in effect when a child is 16 years old must contain:

• Appropriate measurable postsecondary goals based on age-appropriate transition assessments related to training, education, employment, and, when appropriate, independent living skills.

• A description of Transition Services, including courses of study, needed to assist the child in reaching those goals.

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• Changes to the Existing Law:

• Under the old IDEA, IEP’s for children aged 14-16 needed to include a statement regarding the child’s Transition Services.

• This was intended to focus on coursework to effectively prepare children to receive Transition Services at age 16.

• IEP’s developed for children aged 16 or older were required to include a description of needed Transition Services.

• The new law eliminates the requirement for children aged 14-16.

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• Changes to the Existing Law: (continued)

• Now, children with disabilities must be provided Transition Services starting in the school year that they turn 16.

• Should a participating agency fail to provide the Transition Services, the LEA must reconvene the IEP team to identify alternative strategies to meet the Transition Objectives for the child set out in the program.

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• Continued Provisions of the Prior Law:

• As under the prior law, if a child with a disability is convicted as an adult under state law and incarcerated in an adult prison, the child’s IEP need not contain a statement of Transition Services if that child will “age out” of special education prior to release from prison.

• The IDEA also retains the requirement regarding transfer of IDEA rights from parents to child when the child reaches the age of majority.

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• Continued Provisions of the Prior Law:

• At least one year before a child reaches the age of majority under state law, the IEP must include a statement the child has been informed of the rights under the IDEA that will transfer to the child on reaching the age of majority.

• These rights include all rights accorded to a parent of a disabled child when the child is a minor. The purpose of the statement is to clarify who holds those rights when the child reaches adult age.

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TheLearningClinic

Transition ProgramTransition Program

A Model for StudentA Model for Student

based Independencebased IndependenceTransition to Community-Transition to Community-

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Pervasive Development Disorder

Category of Diagnosis that includes Autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy.

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Who is theWho is the AspergerAsperger Individual?Individual?

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Asperger Syndrome Criteria

DSM-IV ICD-10

Qualitative impairment in social interaction X X

Restricted repetitive and stereotyped patterns of behavior, interests, and activities

X X

No general language delay X X

No delay in cognitive development X X

Normal general intelligence (most) X

Markedly clumsy (common) X

No delay in development of: age appropriate self-help skills adaptive behavior (excluding social interaction)

curiosity about environment

X

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Asperger Syndrome Criteria

Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis.

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Other Developmental Issues

Deviation from normal development

Do not “Outgrow” Developmental Deficits

Stress Impairs Performance

Co-Morbid Diagnosis Impairs Overall Functioning

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Cognitive Functioning

Med

icati

on

s

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Psychological Symptoms

Ag

e /

Tim

e

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Clinical Symptoms and Learning Disabilities

Gra

de

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Asperger SyndromePervasive Developmental

DelayC O G N I T I O N

Memory

Higher Order Process Analysis, Synthesis, and Evaluation

Organization

Flexibility

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DelayC O G N I T I O N

Narrow Band of Knowledge

Problem Solving Deficit Verbal-Performance IQ

Attention Shift Problem: Too Short or Too Long

Limited Perspective / Restricted Point of View

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L A N G U A G E

Pragmatics

Syntax

Meaning: Connotative Denotative


Delay

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L A N G U A G E

Processing Speed

Expression

Duration


Delay

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S P E E C H

Prosody

Pedantic

Elocution

Volume


Delay

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Delay M O T O R

Fine Control

Gross Control

Coordination

Regulation

Proprioceptive Feedback

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S E N S O R Y P R E C E P T I O N

Visual Integration

Kinesthetic Sense

Tactile Accuity

Gestalt

Integration of other Senses


Delay

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S O C I A L

Cue Identification

Responsive to others

(Isolate) Social Interaction Initiative

Rude / Insensitive to Social Conventions

Aggressive: Verbally & Physically


Delay

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S O C I A L

Boundary Acceptance

Maintain Social Roles(e.g., student, son, daughter, friend)

Self-Regulate with and without Stressor


Delay

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Competing Clinical Behaviors

Perseveration

Obsessive Thought

Rigid Cognitive Style

Inability to Shift from “Personal View” to Data - Based Decision

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Confabulation

Affirming False Information

“Stealing”

Sexually Inappropriate Actions and Statements

Pornography Interests

/ Continued

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Violation of Boundaries

Cognitive Disorientation and Distortion

/ Continued

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Suicide Ideation Data

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Suicide Ideation Data Seasonal Frequency

10

8

6

4

2

0

January – December 2005

Winter (10)

Spring (7)

Summer (4)

Fall (3)

Suicide Ideation Data: Jan-Dec 2005

Total No. of Students Observed:

66

Total No. of Students with S.I.s:

16 (Males - 9) (Females - 7)

% of Students with S.I.s:

24%

Dec-Feb

Mar-May

Jun-Aug

Sep-Nov

Total Number of S.I.s Jan - Dec 2005 = 24

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Suicide Ideation Data Number of Repeat Incidents by

Season

10

8

6

4

2

0


Winter (7)

Spring (5)

Summer (1)

Fall (2)

Suicide Ideation Data: Jan-Dec 2005

Total No. Students with Repeat S.I.s:

7 (7 of 16 = 44%)

Dec-Feb

Mar-May

Jun-Aug

Sep-Nov

Total Number of Repeat S.I.s Jan - Dec 2005 = 15

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Suicide Ideation Data Number of Incidents by Student Age

GroupJanuary – December 2005

7/8 (1) 1

10/11 (2) 3

11/12 (1) 3

12/13 (1) 1

13/14 (1) 1

14/15 (1) 2

15/16 (1) 1

16/17 (2) 4

17/18 (3) 3

18/19 (2) 3

20/21 (1) 2

Student Age Groups (Number of Students by Age Group)

Number of S.I.s by Age Group

No. of Students: 16 No. of Incidents: 24

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Suicide Ideation Data Number of Incidents by Gender


No. of Students: 16

GenderNo. of S.I.s

% of S.I.s

Males 15 63%

Females 9 38%

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Suicide Ideation Data Number/Percentage of Incidents by

DiagnosesJanuary – December 2005

Diagnoses

Bipolar 12 50%

Depression 3 12.5%

(Bipolar & Depression / Combined)

(15) (62.5%)

Asperger’s 4 16.7%

Schizophrenia 2 8.3%

ODD/Intermittent Exp DO 2 8.3%

ADHD Comb/GAD 1 4.2%

No. of S.I.s % of S.I.s

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Suicide Ideation Data Number of Ideations vs. Suicide

AttemptsJanuary – December 2005

Suicide Ideation:

16 Students

24 Ideations (16 Repeats)

Suicide Attempts:

16 Students

0 Attempts

Ideations: 24 Attempts: 0

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What are theWhat are the PrioritiesPriorities

of the of the AspergerAsperger Syndrome Syndrome

Student?Student?

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Priorities of the Asperger Student

1. Independence How to find and use resources

and self-advocate

2. Work Experience Paid employment and volunteer

work

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3A. Shared Living versus Living Alone

Advantages and disadvantages of each

3B. Resources

How to find resources, e.g., doctors,therapists, etc.

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4A. Social Activities

How to find resources for fun activities?

How to make friends and find others with common interests?

How to deal with the tendency to isolate?

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4B. Medication

How do you know when you need medication

Who do you go to for help

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5. College Experience

What it takes to be successful in college

6. Problem-Solving

How to partner with others to solve problems

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6. Problem-Solving / Continued

Expressing issues openly

Independent problem-solving versus teaming

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Which Asperger Symptoms Compete with

Independence?

Degree of Anosognosia

Ag

e

Over time, symptoms become egosyntonic

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How Do Students How Do Students Assess Assess

and Comment on and Comment on Their Their

Experience?Experience?

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How Can We Assess Readiness for

Independence?

The Learning Clinic Pragmatic Skills Survey

The Learning Clinic Transition & Independent Living Skills Assessment

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Independent Living Skills

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HousingHousing Acquisition &

Leases

Home Management

NutritionMeal Planning &

Preparation

Dining

Clean-up & Food Storage

Money Mgmnt. Budgeting & Taxes

Banking & Credit

Consuming

Transportation

Leisure

Legal

Health

Time Mgmnt.

Personal Safety Personal Safety - Home

Personal Safety - Community

Personal Safety - Relationships

Personal Presentation

Community Participation

Community Resources

Community Service

Vocational Readiness Career Planning

Employment

Post-Secondary Education

Healthy Relationships

Participation in Therapy


Significant Differences Between Treatment & Non-Treatment Groups in November 2005.

Treatment Group Scored Significantly Higher than Non-Treatment Group in 2 Categories:

• Housing Acquisition & Leases

• Vocational Readiness/Employment

• Money Mgmt/Consuming

• Personal PresentationIndependent Living Skills The Learning Clinic

Treatment Group vs. Non- Treatment

Group November, 2005

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Leases

Home Management


Preparation

Dining



Banking & Credit

Consuming

Transportation

Leisure

Legal

Health

Time Mgmnt.






Community Resources

Community Service


Employment





Significant Differences Between Treatment & Non-Treatment Groups from November 2005 to February 2006.

Treatment Group Scored Significantly Higher than Non-Treatment Group in 4 Categories:


• Money Mgmt/Banking & Credit

• Money Mgmt/Consuming

• Personal PresentationIndependent Living Skills The Learning Clinic

Treatment Group vs. Non- Treatment

Group Nov 2005 – Feb 2006

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Leases

Home Management


Preparation

Dining



Banking & Credit

Consuming

Transportation

Leisure

Legal

Health

Time Mgmnt.






Community Resources

Community Service


Employment





Significant Decrease in Skills for Treatment Group Only from November 2005 to February 2006

Treatment Group Scored Significantly Lower in these 3 Categories:

• Nutrition/Meal Planning & Prep.

• Nutrition/Clean-up & Storage

• Community Resources/ Community Services

Independent Living Skills The Learning Clinic

Treatment


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Leases

Home Management


Preparation

Dining



Banking & Credit

Consuming

Transportation

Leisure

Legal

Health

Time Mgmnt.






Community Resources

Community Service


Employment





Significant Decrease in Skills for Non-Treatment Group from November 2005 to February 2006

Non-Treatment Group Scored Significantly Lower in these 4 Categories:

• Housing/Home Management


• Nutrition/Dining

• Nutrition/Clean-up & Food StorageIndependent

Living Skills The Learning Clinic

Non-Treatment


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Areas in which Students showed Significant Progress from Nov 2005 – Feb 2006: (6 0f 24)


• Banking & Credit

• Consuming

• Personal Safety in Relationships

• Personal Presentation

• Community ServiceAreas in which Students Showed Significant Regression from Nov 2005 – Feb 2006: (3 of 24)


• Nutrition/Clean-up & Storage

• Community Resources/ Community Services

25%

12.5%

Percentage of Living Skills Significantly IMPROVED (25%) or REGRESSED (12.5%) from November 2005 to February 2006.

Treatment


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What Is on the Horizon for Asperger Students?

Early Diagnosis

Pediatric Training

Teacher Training

Psycho - Education Treatment

Cognitive Behavioral Therapy

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Technology

Distance Coaching (remote video monitoring)

Computer Checklists and Prompting

Computer Assisted Instruction (CAI)

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Technology / Continued

Kurtzweil

Dragon Naturally Speaking

The Learning ClinicLCLCT

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. . . because every child can succeed!

end

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DMHAS Child & Family Agency A Scholar in Residence Workshop