Learning, Living, and Workingwith Asperger’s Syndrome

Virginia Autism Council

Date

Training Development

Virginia Autism Council

http://www.autismtrainingva.org/

The Council believes individuals with ASD should fully participate in every

aspect of society.

Goals for Training

1. Promote an understanding of Asperger’s

Syndrome across the life span

2. Introduce evidenced-based supports and

strategies

Opening Activity

• Choose a name for your table based on a positive characteristic of AS

• Write the name you selected on one side of the name tent

• Draw a picture that represents that characteristic on the other side

• Explain your name to the whole group

VideoUnderstanding Classmates with Asperger’s Syndrome

http://www.youtube.com/watch?v=0mQDF6R_cHk&feature=related

Autism Spectrum DisordersDSM-V, 2012

Share a triad of impairments affecting: • Social interaction• Communication • Restricted , repetitive behaviors, interests

or activities

Continuum of Autism-Related Disorders

What Is Asperger’s Syndrome? • A pervasive developmental disorder• Diagnostic criteria: DSM-IV-TR, 2000

– Qualitative impairments in social interaction

– Restricted, repetitive, and stereotypic behaviors

– No clinically significant delays in:• Language skills• Cognitive skills• Adaptive behavior

Attwood’s View of AS

• “Little Professors”

• Alternative priorities and perceptions

• Frank Sinatra syndrome: “My Way”

• “One track mind, but last to know they are on the wrong track”

Grandin’s Advice

Teachers and parents must step out of their perspective, which is “inherently socially-conscious and emotionally-driven,” and learn to interpret the world around them from the autism perspective if they are going to understand why those on the autism spectrum act the way they do. Otherwise they will teach from their perspective and will not “get” it.

Unwritten Rules of Social Relationships» Grandin & Barron, 2005, p. 269

Characteristics

• Socialization

• Communication

• Behavioral

• Cognitive

• Sensory

Socialization

Difficulties:

• Relating to peers

• Using body language

• Using social niceties

• Expressing emotion

• Choosing appropriate models

Socialization

May:

• Intentionally elicit any type of social

interaction

• Repeat strategies perceived as effective

• Make poor social choices

• Be teased or coerced

VideoGirls with Asperger’s

http://www.youtube.com/watch?v=qs5L2R2lZAU&feature=related

Social/Conversation Activity

•Was the conversation comfortable?

•What was the most challenging?

•What did you learn from the

experience?

Communication

• Stilted and repetitive speech

• Flat and emotionless voice

• Difficulty modulating voice

• Cumbersome monologues

Communication

• Perseverate on topics

• “Parrot” what’s been heard, but not always understand

• Fail to ask for clarification

• Have problems repairing conversations

• Make literal interpretations

Behavior• Restricted, repetitive & stereotyped patterns

of behavior, interests and activities:

• Intense preoccupation

• Inflexible

• Unusual motor mannerisms

Behavior

Emotional vulnerability“... rarely seem relaxed and are easily

overwhelmed when things are not as their rigid views dictate”

~ Williams, 2001, p. 291

“Difficult Moments”

• May also be called:– Meltdowns– Disintegrative rage– Neurological storm– Worse than terrible, no good, very bad day

• Not goal directed

What’s Behind the Behavior?

• Very low frustration tolerance

• Limited capacity for flexibility and adaptability

• Tendency to think in black and white

• Difficulty thinking through ways of resolving frustrating situations

What Else Impacts Behavior?

• Social skills deficits

• Language processing deficits

• Frequent co-existing conditions e.g.

mood disorders and anxiety

• Sensory experiences

The Three Rs• Rumbling

• Rage

• Recovery

~ Myles & Southwick, 2005

Rumbling Stage

• Beginnings usually subtle

• May withdraw

• May show physical signs

• May make verbal complaints

• May get into power struggle

Rumbling Strategies

• Antiseptic bouncing

• Proximity control

• Signal interference

• Touch control

• Defusing tension through humor

• Support from routine

Rumbling Strategies

• Interest boosting

• Redirecting

• Home base

• Acknowledge student’s difficulties

• Just walk and don’t talk

Rage Stage

• Out of control

• Acts disinhibited, impulsively, emotionally

• May be explosive

• May include internalizing behavior

• Episode WILL run its course!

Rage Stage

May include:

• Screaming

• Biting

• Hitting

• Kicking

• Destroying property

• Self-injury

Rage Strategies

• Be proactive; not reactive: have a plan • Help individual gain control and preserve

his/her dignity• Emphasize safety of others in the vicinity• Ensure the safety of the individual• Do not take individual’s behavior

personally

Recovery Stage

• May not be ready to learn

• Do not make excessive demands

• Consider student “fragile”

Recovery Strategies

• Help student become part of class

routine

• Support with structure

• Direct to highly motivating task easily

accomplished

Lightening Share

• Quickly share successful strategy addressing one of the Three R’s

• Stand when each person at your table has had one turn

VideoSensory ExperiencesIntricate Minds II: Understanding

Elementary School Classmates With Asperger Syndrome (2006)

www.coultervideo.com

Core DeficitsCognitive Style

• Central Coherence

• Theory of Mind

• Executive Functioning

Central Coherence

http://www.youtube.com/watch?v=Ahg6qcgoay4Video

• Difficulty seeing the “big picture”• Good at piecemeal processing• Black and white thinking• May hold on to false beliefs• Preference for routines • Reliance on learned information• Experience life as a series of “freeze frames”

Central Coherence

Theory of Mind

The ability to:

• Attribute thoughts and feelings to others

• Understand that others have perspectives which are unique and different from our own

Theory of Mind

Difficulty in…

• Predicting

• Reading intentions

• Understanding emotions

• Explaining own behavior

• Understanding that their behavior impacts others

Individual may…

• Appear to be self-focused

• Have difficulty with group dynamics/team activities

• Have difficulty knowing when to withhold information

Executive Function

Ability to integrate:

• Planning

• Organization

• Goal selection

• Flexibility

• Self Regulation

• Inhibition

Video Executive Function

The Stroop Effect

http://www.youtube.com/watch?v=Tpge6c3Ic4g&feature=related

• Difficulty getting started, prioritizing, setting goals, sequencing steps of task

• Poor sense of passage of time• Overly focused on precision• Difficulty inhibiting/regulating emotions• Unable to filter info and just react

Executive Function

VideoUnderstanding Asperger’s Syndrome:

A College Professor's GuidePeter Gerhardt

http://www.youtube.com/watch?v=233-3jtEZck

College: Questions to Consider

• Ready to leave home• Roommate or single room• Part-time study or full time study• Type of college

– Community or junior– Large university or smaller university– Online university

»Freedman, 2010

Skills for Success in College

• Being ‘smart’ not enough• Instruction on daily living skills and

independence needed»Freedman, 2010, p. 45

Self-Determination

A set of skills that result in an individual’s being the ‘causal agent’ in his or her life.

»Wehmeyer, Gragoudas & Shogren, 2006 in Wehman, Smith & Schall, 2009, p. 55

College Skill Sets

• Self monitoring• Self-advocacy• Personal management• Organization• Time management• Self-regulation• Socially appropriate

ActivityWhat is needed for successful

college life?

AS Presentation in Adults

• Eccentric• Loyal• Usually found a niche for self where he/she

can fit in • Have capacity for empathy: receive and

express it differently• May have insight to develop strengths and

minimize differences

Employment

Adults with AS reported obstacles in maintaining employment were:• Poor social communication between

employee and employer or coworkers• Social skills deficits• Sensory issues

Grandin & Duffy, 2004

Job Searching Advice

• Do what you do best• Develop your talents whatever they are• Get to know your community• Develop a plan• Create a portfolio• Be prepared to enter job market through

back door, side door, any door but front»Grandin & Duffy, 2004

What I Learned

• Write one thing you learned about AS on your puzzle piece

• Trade information with one person at a time as you walk around the room

• Keep trading until the music stops

http://www.youtube.com/watch?v=mc1H0aVqn20

Lunch Break

Strategies

Classroom and the Workplace

Communication

Social Skills

Classroom and Workplace Strategies

• Organization

• Clarity

• Routines

Organization

• Visual supports– Schedules

– Calendars

– Checklists

– Graphic organizers

– Lists/task sequences

• Work systems

Which Do You Prefer?

Homework Schedule• Math

___ Read pages 3-5

___ Answer questions 1-5 on page 5

• Social Studies___ Read pages 10-12

___ Answer questions 1-5 on page 12

• Music___ Practice the recorder for 10 minutes

Work Schedule8:00 Bus to work

8:45 Arrive at work, put personal things away, prepare work for the day

9:00 Start work

10:30 Ten minute break, restroom, snack

10:45 Continue Work

12:00 Lunch

12:30 Continue Work

Assignment Checklist

____ Get out pencil and paper

____ Put name on paper

____ Read directions

____ Start on GO; End on STOP

____ Raise hand when finished

To Do List

Clean My Room___ Hang up clothes___ Pick up and put away books___ Store videos and DVDs___ Return dishes to kitchen___ Make bed___ Vacuum floor

Clarity

• Rules and routines

• Concrete, simplified language

• Structured tasks

• Clear feedback

Arrival Routine

ActivityWhat Is Needed for Success

in School?

• Pragmatics

• Prosocial

• Conversation

http://youtu.be/PxP2l2WISo8

Communication Strategies

Pragmatic Communication Goals

• Understanding non-verbal communication

• Understanding abstract language

• Selecting appropriate topics

• Making topic shifts (bridges)

• Giving background information

• Monitoring voice patterns

• Scripting

• Videotaping

• Cue cards and rule books

• Pantomiming; drama; role-playing

• Games

• Literature: character study

• Social stories

Pragmatic Communication Strategies

http://www.youtube.com/watch?v=k0xgjUhEG3U

The Friendship Algorithm

Not able to say the socially “nice” thing due

to:

• Difficulty using words with social meaning

• Ability to use verbal concrete language, but

may not say “thanks” or give compliments

Adapted from AutismPro

Prosocial Communication

Conversation

• Often talks about well-loved and learned

topics using scripts

• Does not talk about the interests of others in

creative and empathetic ways

ConversationTalking Back and Forth with Others

Adapted from AutismPro

• Provide conversation starters

• Use timer to show amount of time to talk

• Use object to indicate turn

• Teach listening

• Teach how to change topics

• Teach how to end a conversation

Strategies to Promote Conversation

Choosing Topics of Conversation

Depends Safe

Topics

Taboo

Topics

1_____________2_____________3_____________4_____________5_____________

1_____________2_____________3_____________4_____________5_____________

1_____________2_____________3_____________4_____________5_____________

Pattern: Conversation Scripts

Example: Conversation Scripts

• Rule-based focus

• Perspective-based focus

• Feelings-based focus

Social Skills Strategies

Rule-Based Focus

• Rule development

• Social skills picture stories

• Problem solving

10 Unwritten Rules for Social Relationships

1. Rules are not absolute. They are situation-based and people based.

2. Not everything is equally important in the grand scheme of things.

3. Everyone makes mistakes. It does not have to ruin your day.

4. Honesty is different than diplomacy.5. Being polite is appropriate in any

situation.» Grandin & Barron, 2005, p. 119

10 Unwritten Rules for Social Relationships

6. Not everyone who is nice to me is my friend.

7. People act differently in public than they do in private.

8. Know when you are turning people off.9. “Fitting in” is often tied to looking and

sounding like you fit in.10.People are responsible for their own

behaviors. » Grandin & Barron, 2005, p. 119

What’s OK and NOT OKFor Attention

What’s OK and NOT OKFor ____________

OK NOT OK

Social Skills Picture Stories

• Use photographs to clarify desired and

undesired behaviors

• Role play the skill

• Provide corrective feedback

• Generalize skill across settingsBaker, 2001

Standing too close Standing just right

Social Skills Picture Stories

Problem Solving

• Understand cause and

effect

• Accept personal

responsibilities

• Recognize need for help

• Ask questions

What I said or did….Pushing classmate inline at water fountain

Can lead to….Going to the end of the line

Can lead to….Keeping my place in line

What I could say or do….Waiting in line patiently at the water fountain

Can lead to….Getting water later

Can lead to….Getting water faster

Problem-Solving

Perspective-Based Focus

• Social narratives– Social Story™ / Social Article™– Social script– Power card– Comic strip

• Use of literature

• Video modeling

Social NarrativesUses:

• After a social "error" has occurred

• Prior to a transition or new experience

• As an intervention to reduce existing

recurring behaviors

Social Narratives

• Social Story™– Individualized stories describing a social

situation, often from the individual with ASD's perspective

• Social Article™– Similar; written for adults

Carol Gray, www.thegraycenter.org

Social Script:– Provides language needed for specific

situations– Reduces stress of social interactions– Can provide entire exchange or just part– Caution: can cause person to sound too

rehearsed

Social Narratives

Social Script ExampleOrdering at Wendy’s

When I go to Wendy's I like to order a SingleTM with cheese and nothing else on it. When the person taking the order at Wendy's says: "Can I help you?" I say: "I want a SingleTM with cheese only on it. No onion, no tomato, no lettuce and no mayonnaise." They usually say "SingleTM, cheese only?" And I say: "Yes, please.“ The person taking my order usually says: "Do you want fries?" And I say, "Yes, please, medium fries and a medium Sprite to drink.“ The person behind the counter then asks me if that will be all, and I say: "Yes, thank you.“ I give the person my money and they give me my change. I take one step to the side at the counter so the person behind me can give their order while I wait for my order to be put on the counter.

http://autismpdc.fpg.unc.edu/

Social Narratives

Power Card:

1. The Short Story

• Introduces person to hero

• Hero is given same problem as person with

ASD

Gagnon, 2001

Social Narratives

Power Card:

2. The Power Card with illustration

• Part 1 is related to hero

• Part 2 is solution to problem

• Part 3 is related to person’s particular situation

Gagnon, 2001

Superman would like you to consider these three facts about going to the bathroom:

Gagnon, 2001, p. 44

Power Card Example

1.When you are at home, just go when you need to go. 2.When you are at school, tell your teacher that you need to go to the bathroom. Try and go every time there is a scheduled break, even if you don’t feel you need to.3.If you are away from home, tell an adult you are with that you need to use the bathroom and have them show you where it is located. Superman is proud of young men who can take care of their own bathroom needs.

Power Card

_________would like you to consider these three facts.

1.

2.

3.

_______ is …

Social NarrativesComic Strip Activity

http://www.makebeliefscomix.com/

Use of Literature

• Character study

• Understanding motive

• Example: Little Red Riding Hood

– Kind vs. mean

– Motive of Little Red Riding Hood vs. wolf

Video Modeling• Video of a correct social behavior in a

realistic context

• Individual watches video

• Individual is given time to imitate/reenact the skill in a natural setting

• Individual repeats watching the video if doesn’t demonstrate skill

Example web site

http://www.modelmekids.com/autism-video-samples.html

Feelings-Based Focus

• Identify feelings

• Feelings thermometer

What makes me feel____?

Happy Sad Mad

Things that make me feel…

HAPPY SAD CALM ANGRY FRUSTATED WORRIED

5-Point Scales

Characteristics of a 5-point scale to teach social understanding:

• Rate a behavior from 1-5 from low to high

• Present support needed as go up the scale

• Can write a story to accompany the scale

Buron, 2003

My Feeling ThermometerLooks Like Number Name of Feeling

5 Furious

4 Angry

3 Upset

2 Worried

1 OK

My Feeling ThermometerNumber Feeling Looks like Feels like I can try to

5 Furious VolcanoDo 10 push

ups

4 Angry Boiling water

Run around the gym

3 UpsetMexican jumping

bean

Take a walk

2 Worried KnotTalk to

someone

1 OK Noodle Stay calm

Number Feeling Looks like Feels like I can try to

5

4

3

2

1

My Feeling Thermometer

The Discovery of Aspie Criteria

By Carol Gray and Tony Attwood, M.Sc., Ph.D., MAPS., AFBPsS

A qualitative advantage in social interaction, as

manifested by a majority of the following

characteristics:

Peer relationships characterized by absolute

loyalty and impeccable dependability

Free of sexist, "age-ist,“

or cultural biases; ability to regard others at

"face value"

Speaking one’s mind irrespective of social context

or adherence to personal beliefs

Ability to pursue personal theory or perspective despite

conflicting evidence

Seeking an audience or friends capable of:

• Enthusiasm for unique interests and topics;

• Consideration of details;

• Spending time discussing a topic that may not be of primary interest;

Listening without continual judgment or

assumption;

Interested primarily in significant contributions to conversation;

preferring to avoid "ritualistic small talk"

or socially trivial statements and superficial conversation

Seeking sincere, positive, genuine friends

with an unassuming sense of humor

Fluent in “Aspergerese“,

a social language characterized by at least three of the

following:

A determination to seek the truth

Conversation free of hidden meaning or agenda

Advanced vocabulary and interest in words

Fascination with word-based humor,

such as puns

Advanced use of pictorial metaphor

Cognitive skills characterized

by at least four of the following:

Strong preference for detail over gestalt

Original, often unique perspective in problem solving

Exceptional memory and/or recall of details often forgotten

or disregarded by others, for example: names, dates,

schedules, routines

Avid perseverance in gathering and cataloging

information on a topic of interest

Persistence of thought

Encyclopedic or "CD ROM" knowledge of one or more topics

Knowledge of routines and a focused desire

to maintain order and accuracy

Clarity of values/decision making unaltered by political or

financial factors

Additional possible features:

Acute sensitivity to specific sensory experiences and

stimuli, for example: hearing, touch, vision,

and/or smell

Strength in individual sports and games,

particularly those involving endurance or visual accuracy, including rowing, swimming,

bowling, chess

“Social unsung hero" with trusting optimism: frequent victim of social

weaknesses of others, while steadfast in the belief of the

possibility of genuine friendship

Increased probability over general population of attending university

after high school

Often take care of others outside the range of typical

development

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References CitedBaker, J. (2001). The social skills picture book:

Teaching play, emotion, and communication to children with autism. Arlington, TX: Future Horizons.

Buron, K. D. (2003). The incredible 5-point scale. Assisting individuals with autism spectrum disorders in understanding social interactions and controlling their emotional responses. Shawnee Mission, KS: Autism Asperger Publishing.

References Cited

Freedman, S. (2010). Developing college skills in students with autism and Asperger syndrome. London: Jessica Kingsley.

Gagnon, E. (2001) . Power cards: Using special interests to motivate children and youth with Asperger Syndrome and autism. Shawnee Mission, KS: Autism Asperger Publishing.

References Cited• Grandin, T., & Barron, S. (2005). Unwritten

rules of social relationships: Decoding social mysteries through the unique perspectives of autism. Arlington, TX: Future Horizons.

• Grandin, T., & Duffy, K. (2004). Careers for individuals with Asperger Syndrome and high-functioning autism. Shawnee, KS:

Autism Asperger Publishing.

References CitedGray, C. (2000). Writing social stories with

Carol Gray: Accompanying workbook to video. Arlington, TX: Future Horizons.

Myles, B. S., & Southwick, J. (2005). Asperger Syndrome and difficult moments: Practical solutions for tantrums, rage, and meltdowns. (2nd ed.). Shawnee Mission, KS: Autism Asperger Publishing.

References CitedWilliams, K. (2001). Understanding the

student with Asperger Syndrome: Guidelines for teachers. Intervention in School and Clinic, 35, 287-292.