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Children and Youth with Asperger's Syndrome and Higher-Functioning Autism: Strategies for Achieving Positive Outcomes

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Title: Children and Youth with Asperger's Syndrome and Higher-Functioning Autism: Strategies for Achieving Positive Outcomes


1
Children and Youth with Asperger's Syndrome
and Higher-Functioning Autism Strategies for
Achieving Positive Outcomes
  • 2010 Beyond the Diagnosis Autism Across the
    Lifespan Conference
  • Richard L. Simpson
  • University of Kansas
  • October 15, 2010

2
Autism Spectrum Disorders (ASD) The Facts and
the Caveats Related to Asperger Syndrome and
Higher-Functioning Autism
  • ASD is a complex developmental disability that
    typically occurs early in life (usually by year
    3).
  • ASD is a neurological disorder there is no known
    psychogenic etiology for autism.
  • Exact prevalence is unknown, however current
    estimates are approximately 1 per 100.
  • Fastest-growing developmental disability more
    common than Downs syndrome, juvenile diabetes,
    and childhood cancer (CDC, 2008).
  • Approximately a 1,148 growth rate.
  • 1 to 1.5 million Americans live with an autism
    spectrum disorder.
  • 10 - 17 annual growth.
  • 60 billion annual cost in 10 years the annual
    cost is estimated to be 200-400 billion
  • Approximately 4-5 times more common in boys than
    girls there are no racial, ethnic, or social
    boundaries.
  • Family income, lifestyle and educational levels
    do not affect the chance of ASD occurrence.

3
Primary Characteristics of Individuals with
Autism Spectrum Disorders
  • Social Interaction Deficits
  • Speech/
    Behavior
  • Language Deficits
    Problems

4
ASD Classification and Diagnostic Systems
  • Diagnostic and Statistical Manual of Mental
    Disorders-1V (DSM-1V-TR)
  • Individuals with Disabilities Education
    Improvement Act (IDEIA)

5
Diagnostic and Statistical Manual of Mental
Disorders-1V Classification System
  • Pervasive Developmental Disorders
  • 1. Autistic Disorder
  • 2. Childhood Disintegrative Disorder
  • 3. Retts Disorder
  • 4. Pervasive Developmental Disorder--Not
    Otherwise Specified
  • 5. Asperger Disorder

6
DSM-1V Diagnostic Criteria Asperger Syndrome
  • Qualitative impairment in social interaction
  • Significant impairment in use of nonverbal
    behavior, such as social interaction gestures,
    facial expression, eye-eye-contact, and body
    postures
  • Inability to form and maintain developmentally
    appropriate relationships with peers
  • Failure to spontaneously seek out others for
    interactions, such as by sharing interests,
    achievements, and so forth
  • Difficulty with social or emotional reciprocity
  • B. Repetitive and restricted stereotyped patterns
    of behavior, activities, and interests
  • Significant preoccupation with one or more
    stereotyped and restricted interests
  • Significant manifestation of nonfunctional
    routines or inflexible adherence to rituals
  • Repetitive and stereotyped motor movements
  • Significant and persistent preoccupation with
    parts of objects
  • C. Clinically significant social, occupational,
    or other functioning impairment
  • D. Absence of a clinically significant general
    language delay
  • E. Absence of a clinically significant delay in
    cognitive development of age-appropriate adaptive
    behavior (other than social interaction) and
    self-help skills

7
Projected Amendments to DSMV
  • There will likely be one diagnosis Autism
    Spectrum Disorder (ASD)
  • There will likely be two primary diagnostic
    domains
  • Social-communication problems and fixated
    interests and repetitive behaviors, including
    stereotyped language
  • There will likely be dimensional ratings of
    domains, likely on a 5 point scale from most
    severe to mild/normal variations
  • There will likely be categories for ASD with
    intellectual disability, ASD with specific
    genetic syndromes, and so forth.
  • There will likely be additional attention given
    comorbid psychiatric diagnosis
  • There will likely be diagnostic information with
    a focus on looking at ASD as a constellation of
    attributes with a clear effect on function, range
    of etiologies, and a spectrum that presents from
    severe to mild disabilities

8
Salient Elements of Asperger Disorder
  • Social
  • Social withdrawal
  • Unskilled initiations and responses
  • Socially stiff, awkward, emotionally blunted,
    self-centered, unable to understand social cues,
    inflexible, lacking in empathy and understanding
  • Emotionally vulnerable and easily stressed
  • Easy targets for teasing and bullying
  • Speech/Language
  • Good speaking fluency
  • Poor pragmatics
  • Poor non-verbal skills

9
Salient Elements of Asperger Disorder(continued)
  • Cognitive/Academic
  • Generally average intellectual abilities
  • Obsessive, narrowly defined interests
  • Concrete/literal thinking style
  • Rigidity and inflexible demeanor
  • Poor problem solving skills
  • Poor organization
  • Difficulty in discerning relevant stimuli
  • Sensory
  • Hypo-and hyper-sensitivity to stimuli
  • Poor auditory processing, including sound
    sensitivity
  • Physical/Motor
  • Fine and gross motor challenges

10
Salient Elements of Asperger Disorder (continued)
  • Behavioral
  • Based on the Behavior Assessment Scale for
    Children (BASC)
  • Significant difference between the perceptions of
    parents and teachers on Externalizing Problems
    and Adaptive Skills Index parents ratings were
    Clinically Significant
  • Depression and Atypicality were areas of concern
  • Students self-perceptions were within the
    average range
  • Students may be able to control behaviors at
    school more so than at home

11
Co-Morbidity and Asperger Disorder and High
Functioning Autism
  • ADD/ADHD
  • Obsessive Compulsive Disorders
  • Mood disorders and Depression
  • Anxiety disorders
  • Explosive disorders
  • Cognitive and learning challenges

12
AS and HFAD Characteristics Affecting School
Performance
  • Distraction/Inattention
  • Difficulty comprehending abstract concepts vs.
    concrete information
  • Tunnel Vision narrowly focused and fixated
    unique interests
  • Rote Memory
  • Visual vs. Auditory Processing
  • Problem Solving Difficulties
  • Motor Skill difficulties
  • Motivation problems
  • Difficulty distinguishing relevant and irrelevant
    information

13
Suggestions for Improving School Performance
  • Students with AS/HFAD often require direct
    problem-solving skill instruction to effectively
    use and retain information
  • Often need more time to complete written work
  • Often need abstract concept comprehension
    assistance
  • Provide problem-solving support
  • Provide schedules and supports for time
    management
  • Individualize and modify assignments and grading
  • Provide supports for small group work
  • Provide supports for writing, homework and exams
  • Provide stress breaks and stress reduction plans

14
Recommendations for Improving School Performance
  • Incorporate students interests within curriculum
  • Provide sufficient wait time
  • Reward quality rather than quantity
  • Offer alternatives to paper/pencil tasks
  • Provide reasoning for tasks and task objectives
  • Check frequently for understanding
  • Carefully consider homework assignments
  • Provide notes/outlines or note taking assistance
  • Monitor learners affect and emotions
  • Use graphic organizers
  • Provide guided practice and No Fail Practice

15
Foundational Supports for Learners with AS and
HFAD
  • Consistent schedules, routines and predictability
  • Home-base programs
  • Safe harbor programs
  • Visual supports
  • Classroom transition supports
  • Competent buddy pairing
  • Protection from teasing/bullying
  • Structured teaching, task organization and clear
    behavior and task requirements
  • Systematic performance monitoring

16
Visual Supports for Learners with AS and Higher
Functioning ASD
  • Task Organizers
  • Turn Taking Cards
  • Waiting Symbols
  • Choice Making
  • Rules and Alternate Behaviors
  • Consequence Maps
  • Calming Supports
  • Transition Supports
  • Activity Completion Signals
  • Introducing Change
  • First, Then Cards
  • Video modeling

17
Additional Instructional Supports for Learners
with AS and HFAD
  • Priming
  • Assignment Modifications
  • Length modifications, study guides, models for
    assignments, alternatives to paper-and pencil
    tasks, and so forth
  • Graphic Organizers
  • Outlines
  • Task Cards
  • Supports for Preparing for Changes in Routine
  • Early or Late Release
  • Homework Assignment Notebooks and Homework
    Modifications
  • Timelines
  • Travel Cards
  • Instructional Modeling and No-Fail Practice

18
Novel and Promising (albeit Largely Unproven) ASD
Intervention Strategies
  • Consequence maps
  • Power cards
  • Cartooning

19
Consequence Maps
  • Consequence maps or Contingency Maps are graphic
    representations of a behavior and its
    consequences. Consequence maps identify two (or
    more) tracks. One track depicts a present (and
    typically undesirable) behavioral response and an
    alternate (and more socially desirable) behavior
    along with the consequences connected to the
    options. Teachers and other educational
    personnel use the maps to assist students
    understand and make decisions about their
    behavior and to become more involved in the
    process of understanding the choices available to
    them and the consequences associated with their
    actions.

20
Power Cards
  • The Power Card strategy connects an appropriate
    or desired behavior or social skill to an
    individuals area of special interest.
  • Power Cards involve scenarios wherein a childs
    special interest, a hero, or a model connected to
    a special interest models a solution to a problem
    similar to the one experienced by the child.

21
Cartooning
  • Cartooning uses cartoon-like illustrations to
    describe and interpret social situations and
    problems and to create a forum for social
    problem solving and choice making.
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