the learning clinic. the learning clinic the learning clinic the learning clinic a sperger s yndrome...

The Learning Clinic

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Presented by:

Raymond W. DuCharme, Ph. D.

Kathleen A. McGrady, Psy. D.

CT CollegeCT CollegeJanuary 16, 2004January 16, 2004

The Learning Clinic

Pervasive Development Disorder

Category of Diagnosis that includes Autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy.

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The Learning Clinic

Asperger Syndrome CriteriaDSM-IV ICD-10

Qualitative impairment in social interaction X XRestricted repetitive and stereotyped patterns of behavior, interests, and activities

No general language delay X XNo delay in cognitive development X XNormal general intelligence (most) XMarkedly clumsy (common) XNo delay in development of: age appropriate self-help skills adaptive behavior (excluding social interaction) curiosity about environment

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Asperger Syndrome Criteria

Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis.

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Other Developmental Issues

Deviation from normal development

Do not “Outgrow” Developmental Deficits

Stress Impairs Performance

Co-Morbid Diagnosis Impairs Overall Functioning

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Cognitive Functioning

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Psychological Symptoms

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Clinical Symptoms and Learning Disabilities

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Asperger SyndromePervasive Developmental

DelayC O G N I T I O N

Memory

Higher Order Process Analysis, Synthesis, and Evaluation

Organization

Flexibility

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DelayC O G N I T I O N

Wide Band of Knowledge

Problem Solving

Verbal-Performance IQ

Attention Shift

Rule - Governed Behavior

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L A N G U A G E

Pragmatics

Syntax

Meaning: Connotative Denotative

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L A N G U A G E

Processing Speed

Expression

Duration

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S P E E C H

Prosody

Pedantic

Elocution

Volume

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M O T O R

Fine Control

Gross Control

Coordination

Regulation

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DelayS E N S O R Y P R E C E P T I O N

Visual Integration

Kinesthetic

Tactile Accuity

Gestalt

Integration of other Senses

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Delay S O C I A L

Cue Identification

Responsive to others

Isolate

Aggressive

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Delay S O C I A L

Boundary Acceptance

Maintain Social Roles(e.g., student, son, daughter, friend)

Self - Regulate

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The Learning Clinic

Priorities of the Asperger Student

1. Independence How to find and use resources

and self-advocate

2. Work Experience Paid employment and volunteer

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3A. Shared Living versus Living Alone

Advantages and disadvantages of each

3B. Resources

How to find resources, e.g., doctors,therapists, etc.

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4A. Social Activities

How to find resources for fun activities?

How to make friends and find others with common interests?

How to deal with the tendency to isolate?

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4B. Medication

How do you know when you need medication?

Who do you go to for help?

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5. College Experience

What it takes to be successful in college

6. Problem-Solving

How to partner with others to solve problems

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6. Problem-Solving / Continued

Expressing issues openly

Independent problem-solving versus teaming

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How Can We Assess Readiness for Independence?

The Learning Clinic Pragmatic Skills Survey

The Learning Clinic Transition & Independent Living Skills Assessment

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Which Asperger Symptoms Compete with Independence?

Degree of Anosognosia

Over time, symptoms become egosyntonic

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What Does a Transition Program Include?

Independent Living

1. Housing

Housing Acquisition & Leases

Home Management

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Independent Living

2. Nutrition

Meal Planning & Preparation

Dining

Clean-up & Food Storage

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Independent Living

3. Money Management

Budgeting & Taxes

Banking & Credit

Consuming

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Independent Living

4. Transportation

Type of Transportation & Costs

Independent Travel

Obtaining Driver’s License

Vehicle Maintenance

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Independent Living

5. Leisure

Exercise Routine

Community Activities

Personal Hobbies

Community Groups

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Independent Living

6. Legal Awareness

Responsibilities of Adulthood

Contracts

Constitutional Rights

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Independent Living

6. Legal Awareness / Continued

Misdemeanor versus Felony

Resources for Legal Obligations

Sexual Harassment

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Independent Living

7. Health

First Aid

Self-Administer Prescription Medications

Personal Hygiene

Stress-Control Strategies

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Independent Living

8. Time Management

Realistic Goals

Time of Day Most / Least Productive

Priorities - Establish and Organize

Appointment Book or Calendar

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Independent Living

8. Time Management / Continued

Step - Wise “Bite Size” Goals

Self - Reward

Identify Basic Needs

Schedule Time to Meet Basic Needs

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Independent Living

9. Personal Safety at Home

Smoke Alarm - Check Operation Monthly

Fire Drill Procedures & Fire Extinguisher

Post Emergency Numbers

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Independent Living

9. Personal Safety at Home / Continued

Basic First Aid

First Aid Supplies

Hazardous Materials

Lock Doors in the Home

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Independent Living

10. Personal Safety in the Community

Walking in the Community at Night

Public Transportation

Dating

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Independent Living

11. Personal Safety during Dating Relationships Sexual Abstinence Social Gender Boundaries STD’s Methods of Contraception “Safe” Sex Practice

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Independent Living

12. Personal Presentation

Appropriate Clothing for Different Settings

Clothing: Needs versus Wants

Budgeting and Shopping for Clothes

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Independent Living

12. Personal Presentation / Continued

Cleaning Different Types of Clothing

Female: Appropriate Use of Make-up / Hair Care

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Independent Living

12. Personal Presentation / Continued

Male: Proper Grooming / Hair & Shaving

Body Language: Personal versusProfessional

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Community Resources

Access Community Health Resources

Completion of Medical Forms

911 / Local Emergency Numbers

Health Insurance & Its Use

Community Services: Library, Legal Aid, Adult Education, Leisure

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Community Service / Volunteer Opportunities

Community Service Opportunities

Value of Volunteering

Ten Hours / Month - Minimum per Quarter

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Vocational Readiness, Training &Post-Secondary Education

Career PlanningAreas of InterestAptitudeTraining

Career PlanAction Plan

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Employment Importance of Paid Employment

Job Shadowing, Internship, Volunteer Work

Search for Employment

Resumé

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Employment / Continued Job Applications

Job Interview

Computer Skills for the Workplace

Wage Deductions

Maintaining Employment

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Employment / Continued Changing Jobs

Termination of Employment

Job Safety Gear

Work Procedures

Maintaining Employment

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Employment / Continued Workman’s Compensation

Procedures

Sexual Harassment in the Workplace

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Post Secondary Education Career Track and Opportunities for

Employment

Education and Training Needed for Chosen Career

Colleges & Technical Schools with Available Programs

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Post Secondary Education / Continued Cost & Ways to Pay for Tuition

Financial Aid Paperwork

Scholarships

Complete College Applications

Analyze Acceptance & Available Money

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Post Secondary Education / Continued Borrowing Money for College Training

Plan Timeline & What Will Be Needed for School

Support Service for Post-Secondary Education

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What Does a Transition Program Include? Healthy Relationships

Quality of Healthy Relationships

Personality Traits (Self & Others) Necessary for Healthy Relationships

Emotional & Mental Well-being Within a Relationship

Boundaries & Intimacy

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Healthy Relationships / Continued Relationship “Games”

Abusive Dangerous Relationships

How to Choose Healthy Partners for Relationships

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Education: Asperger Student Classroom Behavior

1. Attending Behavior

Discern Task Expectations

Focus Attention on Relevant Stimuli

Shift Attention to Relevant Stimuli

Ignore Irrelevant Material

Perform Multi-Task Operations

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2. Responding Behavior

Verbal Skills Pragmatic Language Skills Writing Ability Executive Function Ability Perseverance STM for Denotative Items

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3. Reinforcement Behavior

Provide Contingent Positive Social Reinforcement

Assert Negative Reinforcement in an Appropriate Way

Receive Positive Reinforcement Ability to Respond to Positive

Reinforcement

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4. Initiating Behavior

Self - Initiate Classroom Routines

Use CAI Prompts

Start Task According to Direction

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5. Comply / Demonstrate Rule - Governed Behavior

Accept Correction from Instructor

Accept Correction in Public Setting

Self - Correct Assignments to Pre - determined Standards

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6. Completing Behavior

Perform Tasks to Standards

Return Completed Product to Supervisor

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7. Transitioning Behavior

Initiate Independent Steps between Tasks

Use Prompts / Cues to Signal Move from One Task to Another

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8. Cooperating Behavior

Taking Turns

Waiting

Avoid Arguing

Sharing

Making Requests Before Acting

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9. Adapting Behavior

Adjust to Different Routines in Different Classrooms

Adjust to Alteration in Routine

Follow New Routine Required by a Situation

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10. Cooperate with Medication Administration

11. Complete Homework

12. Attend School

Discern Task Expectations

Focus Attention on Relevant Stimuli

Shift Attention on Relevant Stimuli

Ignore Irrelevant Material

Perform Multi-Task Operations

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Competing Clinical Behaviors

Perseveration

Obsessive Thought

Rigid Cognitive Style

Inability to Shift from “Personal View” to Data - Based Decision

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Confabulation

Affirming False Information

“Stealing”

Sexually Inappropriate Actions and Statements

/ Continued

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Violation of Boundaries

Cognitive Disorientation and Distortion

/ Continued

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Optimal Classroom Behaviors

Closed Classroom Applied Task - Oriented Setting

Standards are Limited, Precise and Based on Asperger Student’s Level of Ability to Self - Regulate

Class Size Under 10 - Over 3

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Cues and Prompts are Provided

a. Daily Plan / Organizerb. Assigned Work Stationc. CAI Task Presentation

Clear System of Discipline Consistently Applied Setting Wide

/ Continued

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Classroom Mix Controlled

Interpersonal Style of Teacher: Direct, Non-Judgmental, Organized

Task Analysis Reflects:

a. Backward Chaining b. Performance Standardsc. Over - Learning Options

/ Continued

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Control Risk

Minimize Transitions

/ Continued

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What Is on the Horizon for Asperger Students?

Early Diagnosis

Pediatric Training

Teacher Training

Psycho - Education Treatment

Cognitive Behavioral Therapy

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Technology

Distant Coaching (remote video monitoring)

Computer Checklists and Prompting

Computer Assisted Instruction (CAI)

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Technology / Continued

Kurtzweil 3000

Dragon Naturally Speaking

The Learning ClinicLCLCT

CCLCLCT

CCTTTLCTLC

TheLearningClinic

. . . because every child can succeed!

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