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.