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Developments from Minds

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BSc Hons(S&H) MRCSLT MSPA. Stephen Underwood. Clinical Psychologist. MPsych(Clin) MAPS ... BPsych (Hons) PhD. Dr Isabelle Henault. Sexologist. MPsych(Clin) PhD ... – PowerPoint PPT presentation

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Title: Developments from Minds


1
Developments from Minds Hearts A specialist
clinic for autism and Aspergers syndrome
  • Presenters
  • Michelle Garnett
  • Keely Harper-Hill,
  • Tony Attwood
  • ARMS Global Autism Conference,
  • Oct 2006

2
M I N D S H E A R T S
  • Michelle Garnett
  • Clinic Director
  • MPsych(Clin) MAPS MCCP
  •  
  • Professor Tony Attwood
  • Senior Consultant
  • MSc PhD AFBPsS MAPS MCCP
  •  
  • Julie Fox
  • Psychologist
  • MPsych(Public Health) AMAPS
  •  
  • Winnie Yu Pow Lau
  • Psychologist
  • MPsych(Ed) PGradDip(ChFamPsych) MAPS
  • Keely Harper-Hill
  • Speech Pathologist
  • BSc Hons(SH) MRCSLT MSPA
  • Stephen Underwood
  • Clinical Psychologist
  • MPsych(Clin) MAPS
  • Dr Heather Ward
  • Educational Psychologist
  • BPsych (Hons) PhD
  • Dr Isabelle Henault
  • Sexologist
  • MPsych(Clin) PhD

3
M I N D S H E A R T S
  • Diagnostic assessments and problem-solving

4
M I N D S H E A R T S
  • Therapy all ages
  • Cognitive Behaviour Therapy
  • Family Therapy
  • Couples Therapy
  • Sex Therapy

5
M I N D S H E A R T S
  • Group Therapy
  • Friendship
  • Affection
  • Becoming a Man
  • Becoming a Woman
  • Sex Education

6
M I N D S H E A R T S
  • Intellectual, educational and behavioral
    assessments

7
M I N D S H E A R T S
  • Workshops and seminars

8
M I N D S H E A R T S
  • EXPLORING
  • AFFECTION
  • A GROUP PROGRAM CONDUCTED BY PROFESSOR TONY
    ATTWOOD AND MICHELLE GARNETT
  • MARCH 2006

9
M I N D S H E A R T S
  • EXPLORING
  • FRIENDSHIP
  • A GROUP PROGRAM CONDUCTED BY WINNIE LAU AND
    JULIE FOX
  • Sep-Oct, 2006

10
Hans Asperger - 1930s
Vienna University Childrens Clinic
11
What is needed?
  • Reliable, valid caregiver questionnaire to assist
    in diagnosis
  • Designed to specifically measure AS
  • Distinguish between AS and autism but not autism
    and HFA
  • Adequate sample size
  • Confirmatory diagnostic testing
  • Use of a Likert scale

12
ASASR What do we measure to measure Aspergers
Syndrome?
  • 8 dimensions
  • Social ability
  • Emotional ability
  • Language profile
  • Special interests
  • early development and severity
  • Motor skills
  • Cognitive skills
  • Routines
  • Sensory Issues

13
Diagnostic Process
  • 2 experts (TA 30 years experience MG 13
    years)
  • Diagnostic interview semi-structured, with
    parents and child (1-2 hrs), plus
  • Observations of child in Clinic
  • Review of previous reports
  • Telephone interview with class or learning
    support teacher (as necessary)

14
Diagnostic Definitions
  • Aspergers syndrome Ehlers Gillbergs (1993)
  • Autism DSM-IV-TR (APA, 2000)/ICD-10 (WHO, 1993)

15
Questionnaire Administration
  • Parent/caregiver ratings
  • Recruitment through databases of 2 clinics
    specialising in PDD
  • Information package sent to each parent
  • Questionnaires administered via a secure website

16
People involved
  • Aspergers Syndrome (N 265)
  • Autism (n96)
  • Neither diagnosis (n80)

17
  • The following questionnaire is designed to
    identify behaviours and abilities indicative of
    Aspergers Syndrome in children who are aged
    between 6 and 12 years. Each question or
    statement has a rating scale from 1 to 5.
    Rate each item using the scale to indicate the
    frequency with which the child you are rating
    shows the behaviour described. The scale is shown
    below.
  • While completing the questionnaire please compare
    the child you are rating with typically
    developing children you know who are the same age
    and sex as him or her.

18
Other measures
  • ASSQ (Ehlers et al., 1999) check for construct
    validity
  • Checks for divergent validity
  • Spence Questionnaires (Spence, 1995)
  • Social Competence Questionnaire
  • Social Skills Questionnaire
  • Strengths and Difficulties Questionnaire
    (Goodman, 1997)

19
What does the ASAS- R measure?
  • Factor analysis resulted in a solution
    significant at the plt.0001 level
  • 6 factors
  • Difficulty understanding emotion (Emotional
    ability)
  • Fact-oriented (Special interests)
  • Sensory Issues
  • Perspective-taking (Social ability)
  • Adherence to routines (Routines)
  • Pragmatic language problems (Language profile)

20
ASAS-R
  • 50 items
  • Explained 49.6 of the total variance between the
    3 groups

21
  • Dimensions of AS deemed to be important but not
    represented in new questionnaire
  • Motor skills
  • Cognitive skills

22
Reliability of the ASAS-R
  • Internal consistency was high for each subscale
    (alpha range .72-.93)
  • Test-retest reliability (r.92)

23
Validity of the ASAS-R
  • ASAS-R and ASSQ (r.53, plt.0001)
  • ASAS-R and SCQ (r-.06, p.39)
  • ASAS-R and SSQ (r.05 p.52)
  • ASAS-R and SDQ (r.39, plt.01)

24
How well does the ASAS-R discriminate between AS
and autism?
  • Overall percentage of accurate prediction was
    76.2
  • AS predicted at 95.4
  • Autism predicted at 47
  • Neither predicted at 0

25
Conclusions
  • The ASAS-R
  • is a reliable and valid measure of AS
  • Over-estimates Aspergers syndrome
  • Cannot discriminate between autism and AS
  • Usefulness
  • To identify people who may be on the autism
    spectrum (high accuracy for AS and high false
    positive rate)

26
Conclusions
  • results lend more evidence to the notion that
    autism and AS have considerable overlap
  • Results suggest that if AS and autism are not
    distinguished at assessment by developmental
    history, intellectual level, or severity of
    symptoms, other characteristics do not
    distinguish them

27
The Art of Conversation
  • Environmental strategies
  • Visual strategies
  • Video strategies

28
Environmental strategies
  • Used by communication partners
  • Part of a process

29
  • Minimise the amount of information to process
  • Slow it down
  • Pause

30
  • Make the process explicit
  • meeting of two minds
  • Ask questions make comments
  • Make explicit links
  • Temptations

31
Tools for talking together
  • Joint attention turn-taking listening
  • Recognition of talking/not talking
  • Recognition of looking at me/not looking at me
  • Question forms
  • Mental state vocabulary e.g. think, know, guess
  • Metalinguistic vocabulary ask say question
    topic.
  • Link these two e.g. you ask when you dont know.

32
Knowing does not equal doing!!!
  • Practice, practice, practice
  • Tasks that encourage particular skills
  • Make the specific skills explicit use visuals
    and structure to do this e.g. the turn-taking
    object the topic box
  • Make it asd specific - remember that thinking
    style dictates communication style.

33
Making it dynamic
  • Show the topic when do we move outside the
    topic zone?
  • Show how what we say is related to the
    preceding utterance or to the topic
  • Help the person make the link with the topic (say
    something) and then the person (ask a question)
  • Contingency trees
  • Learn to write fast
  • Colour code

34
Video strategies
  • Powerful caution
  • Desensitise
  • Intransient tool for reflection and discussion
    (of all involved!)
  • Objective measure of improvement
  • Allows us to return to the footage

35
  • Self-monitoring/ monitoring of others make the
    behaviours straightforward and measurable.
  • Link with visual strategies.

36
Exploring Affection
37
The Understanding and Expression of Affection
  • Ability to read the signals when someone expects
    affection.
  • Ability to express the appropriate level of
    affection.

38
The Understanding and Expression of Affection
  • Affection to repair someones feelings.
  • An immature expression of affection.
  • A limited vocabulary of expression that may not
    include subtle or age appropriate expressions.
  • Sometimes needing frequent expressions of
    affection for reassurance.

39
  • We feel and show affection but not often enough,
    and at the wrong intensity

40
Edgar Schneider
  • At one point my mother, exasperated at me, said,
    You know what the trouble is? You dont know how
    to love! You need tp learn how to love! I was
    taken aback totally. I hadnt the faintest notion
    what she meant. I still dont.

41
The Aspergers Perspective
  • Why are typical people so obsessed with
    expressing reciprocal love and affection?
  • A hug can be an uncomfortable, constricting
    squeeze.
  • Dont cry because someone will squeeze you.
  • Not comforted by affection to the degree that
    neurotypicals expect.

42
The Aspergers Perspective
  • Enjoy a very brief and low intensity expression
    of affection.
  • Confused or overwhelmed with greater levels of
    expression.

43
The Aspergers Perspective
  • Compassion for someones physical suffering
    (broken wrist) and a practical expression of love
    and affection.
  • Comfortable with expressing affection for an
    animal.

44
Aspergers Perspective
  • Intense dislike of public praise that includes
    words and gestures of affection.
  • The capacity for affection, a cup versus a bucket.

45
Chris Slater Walker
  • Limited tolerance of sentimental behaviour.
  • I detest sentimentality, which I think is a
    wilful display of empty emotion over matters of
    no consequence, and it really should be avoided
    because it devalues the true expression of
    feeling.

46
Parents or Partners Perspective
  • Rare use of gestures and words of affection
    lamented by a parent or partner.
  • Not being soothed or comforted by gestures and
    words of affection.
  • Too intense an adoration or crush on someone
    who has expressed an act of kindness.

47
The Exploring Affection Program
  • For children (10 to 13 years old) who have
  • Immaturity in the understanding or expression of
    affection.
  • Anxiety or become agitated in family situations
    when affection is expected or expressed.

48
Aims of the Program
  • Affection education to de-mystify affection.
  • To understand why people need and enjoy
    affection.
  • Explain and encourage appropriate expressions of
    affection.
  • Explain to parents the perspective of the child
    with Aspergers syndrome.

49
Program
  • 4 sessions, each session was for one hour with
    the children, then 30 minutes with their parents.
  • Practical and entertaining activities.
  • Social Stories.
  • Projects.

50
Session 1
  • Ten activities or experiences you enjoy.
  • Write the number from 0 to 100 for how much you
    like each one.
  • Each activity written on a Post It and placed
    on a thermometer to measure the degree of
    enjoyment.

51
Session 1
  • Ten people you like and how much you like that
    person (pets).
  • Each persons name written on a Post It and
    placed on a thermometer to measure the degree
    of liking or loving.
  • Explanation of the dimension from like to love.

52
Session 1
  • How do those people express their feelings that
    they like or love you?
  • Reasons why we express our feelings of liking or
    loving someone.
  • The things that are nice and not so nice about
    being liked or loved.
  • Social Story

53
How liking or loving someone can affect your
feelings, thoughts and abilities
  • When someone likes or loves you, there can be a
    change to the way you feel, think and what you
    can do.
  • The feelings you can have when someone likes or
    loves you are feelings of being happy, excited,
    comfortable and warm. These are really nice
    feelings that can make you feel good.
  • Your thinking can be better when someone likes or
    loves you. You can think you are Okay, likeable,
    and that life is good.

54
  • When someone likes or loves you, you are able to
    relax, talk to the person, and express your
    feelings.
  • There are some not so nice things about being
    liked or loved.
  • The person could worry about you and you could
    worry about them. They could disappear from your
    life and you would feel sad and miss them. They
    could be annoying sometimes.
  • But if you like someone or love someone, they can
    play with you, talk to you, say nice things about
    you, buy things for you, protect you and help
    you.
  • Life is easier and happier when people like and
    love each other.

55
Project
  • Collect pictues or drawings of people your age
    expressing that they like or love someone.
  • Discover with your family, situations where they
    would expect you to express that you like or love
    them, but that you find difficult.

56
Session 2
  • Placing the pictures collected for the project on
    the like to love thermometer.
  • What can you say or do to show that you like
    someone?
  • For each suggestion, how much liking does this
    show from 1-50.

57
Session 2
  • What can you say or do to show that you love
    someone?
  • For each suggestion, how much love does this show
    from 51-100.

58
Session 2
  • When do we show affection and how much?
  • Getting the balance right.
  • Game of matching the type of affection for each
    person.
  • List of people (from strangers to a parent) and
    types of affection (from a smile to a kiss)

59
Project
  • The situations at home that someone expects an
    expression of affection that the child finds
    difficult to express.
  • Think of one situation.
  • What was that situation?

60
Project
  • Think of some of the expressions discussed today
    that you could use in that situation.
  • Have a go at expressing affection.

61
Session 3
  • Review the project, when, what type of affection,
    what did the person say or do, how did you feel?

62
Session 3
  • When do we use affection?
  • Game of matching a list of situations with
    different types of affection.

63
Session 3
  • How can you tell if someone needs affection?
  • How can you tell if you have given too much
    affection?
  • How can you tell if you have given not enough
    affection?

64
Project
  • A log book for the child and a parent that
    provides a record of when the child expressed
    affection and some examples of the type of
    affection.

65
Person completing the log book of
affection Please place a ? in the box when you
have expressed each type of affection. See if you
can express each type of affection at least twice
a day.
66
Session 4
  • Why do we give affection?
  • What would happen if nobody showed you that they
    liked or loved you?
  • How would you feel, what would you say, what
    would you do?
  • What would happen if you stopped showing your
    friends that you liked them?
  • How would your friend feel etc.

67
Session 4
  • If you did not get enough affection, how could
    you make yourself feel better?
  • Review of the program, what have you learned?
  • What can you do in the future?
  • Certificate of achievement.

68
Temple Grandin
  • My brain scan shows that some emotional circuits
    between the frontal cortex and the amygdala just
    arent hooked up- circuits that affect my
    emotions and are tied to my ability to feel love.
    I experience the emotion of love, but its not
    the same way that most neurotypical people do.
    Does this mean my love is less valuable than what
    other people feel?
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