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