Autism around the World Symposium

Dubai 6-8 May 2010

Asperger Syndrome workshop

Maggi Rigg

Linda Simmons

2

• The Cambian Group – introduction video• Introduction to Asperger syndrome• Educational Issues• Break• Behaviour support strategies• Friendship, Siblings, enhancing family life• Break• Nicholas - living with Asperger syndrome• Therapeutic interventions• All Cats have Asperger syndrome! • Questions

Content

3

Cambian video

4

Introduction to Asperger Syndrome

5

A little bit of history….1943

• Lack of affective/ emotional contact with other people.

• Intensive insistence on sameness.

• Muteness or marked abnormality of speech.

• Fascination with manipulating objects.

• High levels of visuo-spatial skills or rote memory in contrast to learning difficulties in other areas.

• An attractive, alert intelligence appearance.

• Condition present from birth or within the first 30 months of life.

Leo Kanner

6

• Inappropriate social approaches to others.

• Intense interest in particular subjects such as railway timetables.

• Good grammar and vocabulary but used for monologues, not two way conversation.

• Poor motor co-ordination.

• Level of ability average but often with specific learning difficulties in one or two subjects.

• A marked lack of common sense.

• Condition not obvious until 3 years or until children started school.

A little bit of history…1944

Hans Asperger

7

A little bit of history…1950 - 1960

• “Refrigerator mothers”

Bruno Bettleheim

8

A little bit of history…1980

• Children with autism exhibit, to a greater or lesser degree, a TRIAD OF IMPAIRMENTS which is the defining characteristic of Autism:

• Language impairment across all areas of communication (speech, intonation, gesture, facial expression and other body language).

• Rigidity and inflexibility of thought process (resistance to change, obsessional and ritualistic behaviour)

• Difficulties with social empathy, rejection of normal body contact, inappropriate eye contact.

Lorna Wing

9

Overview to Asperger SyndromeGillberg 1991

• Social impairment – extreme egocentricity

• Narrow interest• Compulsive need for routines &

interests• Speech & language peculiarities• Non verbal communication problems• Motor clumsiness

10

The triad of impairments…

Communication

difficulties

Imagination

difficulties

Social Interaction difficulties

11

Or is it a square of impairments…?

Communication

difficulties

Social Interaction

difficulties

Imagination difficulties

Sensory Integration difficulties

12

Factors Affecting Clinical Picture

• Age• Gender• Overall level of ability• Associated features• Personality and temperament• Environment• Education

13

Possible Associated Conditions

• ADD/ADHD• Dyslexia• Dyspraxia• Tourettes Syndrome• OCD• Anxiety• Depression

14

Challenges

• Accepting mistakes• Taking advice• Making & keeping friends• Managing anger & frustration• Explaining thoughts & knowing

others thoughts and feelings• Avoid bullying & teasing• Written work• Demonstrating affection to family

members

15

Qualities & Strengths

• Determined• Distinct sense of humour• Attention to detail• Seek truth, knowledge & perfection• Different sensory experiences• May seek & enjoy solitude• Exceptional memory• Special skills & interests• Creative V co-operative• Original in problem solving

16

How it is for usFACTS BELIEFS FEELINGS BEHAVIOURS

I have A.S.

It is a lifelong condition

It makes me different from other people

I go to a residential

special school

I must be stupid

I am tainted

I am a dis-appointment to

my family

Nobody will ever like me

There’s no point in living

No one understands me

I am superior to other people

Incomprehension

Anger

Panic

‘Mania’

Sadness

Helplessness

Denial

Acceptance

Non compliance

Tantrums

Aggression

Passive resistance

Change of identity

Seeking a ‘cure’

Make the best of it

Self harm

Suicide

Active Compensation

17

EDUCATIONAL ISSUES FOR THE STUDENT WITH

ASPERGER SYNDROME

Sharing Effective Practices

18

Aspergers Syndrome

Triad of Impairment:

• Communication

• Imagination

• Socialisation

Language Difficulties

Rigidity & Inflexibility

Poor timing/Lack of empathy

Relationship issues

19

Other Features Often Present

• Sensory stimuli• Movement and posture• Attention/Level of Activity• Eating/Drinking/Sleeping issues• Mood• Behaviour

20

Common Classroom Issues

• Language – receptive/expressive• Change• Motivation• Sensory issues• Predicting Outcomes• Distractions• Planning/following instructions

21

Detached curiosity!

22

Suggested Strategies to Manage Difficulties

Language:• Say what you mean, mean what you

say!• Check for understanding• Avoid use of metaphors• Give student time to process• Use name first to get attention

23

Suggested Strategies to Manage Difficulties cont’d:

Change• Give early warnings• Positive and clear instructions• Visual/auditory cues. Timers,

timetables• Support transitions – mentor (staff or

peer)• Walk through timetable

24

Suggested Strategies to Manage Difficulties cont’d:

Coping• Remembering instructions• Following the instructions• Asking for help• Sequencing and completing work• What to do next

25

26

Motivation• Sufficient and varied work• Achievable tasks• Clear beginnings and endings• Reward achievement – use future

conditional• Creative rewards

Suggested Strategies to Manage Difficulties cont’d:

27

Environment • Predictable – as far as possible• Tutor time/pastoral support• Safe place/safe person• Low distraction/low noise• Identify stress triggers• Open exit policy• Seating plan – to reduce potential trouble

spots

Suggested Strategies to Manage Difficulties cont’d

28

Suggested Strategies to Manage Difficulties cont’d

Boredom

• Differentiation by effort and outcome

• Clear expectations and rules• Creative use of special interests –

special interest box• MIST focus – Maths, IT, Science,

Tech

29

LIKELY FAVOURITE ACTIVITIES

Sciences and Maths

Home Managemen

t Cooking

Technology: Workshop Activities

Computers Video

Music and Art

(if needs led)

Fitness PE

Tests and Memory

Skills

General Knowledge

Activities not always

Age Appropriate

30

LESS LIKELY FAVOURITE ACTIVITIES

EnglishAny Written

Work

Geography (map and

route finding work)

Sharing

History (inability to

think back in time

PSE Work (but it is vital)

Drama Role play

can be good)

Team Games

Group Work

31

CONCLUSION – Do you have what it takes to help an ASD individual?

Can you?• Understand the disorder• Work in a lone desert• Protect the student’s self-esteem• Give directions slowly, clearly and repeat• Motivate and encourage• Make adaptations• Differentiate

32

CONCLUSION – Do you have what it takes to help an ASD individual?

• Are you?• Attracted by the differences• Beyond manipulation• Exciting and stimulating in teaching

style• Clear and consistent• Firm yet kind• Open and positive minded

33

Break

34

Behaviour Support Strategies for Young People with Asperger

Syndrome

35

Stress Model of Crisis

Baseline

RecoveryTrigger

Escalation

Outburst

36

Communication

Filters

Listener

Filters

37

• Language• Past Experience • Tone of voice• Body Language• Environment• Special Educational needs i.e. ASD/

ADHD

Filters

38

Self Awareness

• Body Language• Tone of Voice• Language used• Facial Expression • Eye contact

39

Self Awareness

• Be aware of your own emotions• Be aware of your own expectations• Be aware of your own thoughts• Role Model• Listening Skills

40

Strategies for speaker at Baseline/Trigger/Escalation

• Traffic lights• Social Stories• Mood O’Meters• Reward charts• Check environment

41

Strategies for speaker at baseline/Trigger/Escalation

• Listen• Direct• Prompt• Teach • Time away • Appropriate use of humour

42

Strategies for speaker at baseline/Trigger/Escalation

• Be descriptive• Use Name first• Give time to process• Inform of positive/negative

consequences • Provide predictable/ consistent rules

& routines

43

Strategies for Speaker at Outburst

• SAFETY – remove stress/target or objects

• Engage or withdraw?• Few clear words• Avoid touch

44

Strategies for Speaker at Outburst

• Don’t try to reason • Direct to 1 or 2 choices• Be visual• Give a way out• Listen

45

Strategies for Speaker to help young person improve coping skills

• Wait until calm but when s/he will remember

• Don’t ignore but explore behaviour• Listen• Find strategy for feeling not

behaviour• Plan (led by person guided by

speaker)

46

Strategies for Speaker to help young person improve coping skills

• Role play• Planned exposure to stress• Time to process• Natural consequences for positive

and negative behaviours • Be aware of learning style

47

Strategies for the Adult Listener

• Goal = get person to off load• Think about goal of your questions-

vent/get specific info? • Don’t put up road

blocks/argue/problem solve

48

Strategies for the Adult Listener

• Silences• Reflection & Summaries• Check your & their understanding• Encouragements i.e. “ah huh”• Identify feelings

49

Conclusion

Final words of wisdom

• We may never alter the behaviour so may have to move the goal posts

• Remember the 3 r’s – rules, routine, repetition

• You could get your answer by asking the student direct!

50

Friendships, Siblings & Enhancing Family Life

51

• Teach turn taking• Play pretend games with your child• Watch a video of children playing• Help develop a sense of humour• Teach what not to say• Teach playground ‘slang’• Use role play to practice• Ask school for like minded child – share

interests• Friendship diary

Strategies for Social Understanding & Friendship

52

Siblings

• Recognise sources of stress• Embarrassment• Jealousy• Frustration – not able to engage

53

Siblings continued

• Concern re: parents stress & grief• Target for aggressive behaviour• Trying to compensate for AS siblings

‘deficits’• Concern re: their role in future care

giving

54

Strategies for Sibling Issues

• Explain AS – early & often• Teach siblings simple skills to enable

positive interactions• Give siblings own special time• Not everything as a family• Ensure safety of personal belongings

– lock on door, special box, visual aid on door

55

Strategies for Siblings, continued

• Stress expectations to adult siblings re: future role

• Share plans for care arrangements• Reduce isolation – sibling support

groups• Online resources – US Sibchat• Most cope well – love, grace &

humour beyond their years

56

Surviving Celebrations/Family Occasions

• Look at the world of ‘celebrations’ through their eyes – fasting, prayers etc…

• Create a schedule• Consider sensory overload• Presents – reduce surprises – leave unwrapped• Have a celebration free zone – DVD, computer• Liaise with school – timetable changes• Use photos for visits by friends & family• Father Christmas – prepare for man in a red

suit

57

Surviving Homework

• A major source of stress & anxiety• Create distraction free area• Create a homework timetable• Ask school to differentiate by effort &

outcome• Consider use of scribe• Ask teacher to highlight key aspects• Fatigue overwhelming – ask for max

30 mins• Use ICT where possible

58

Adolescence & Growing Up

• Early years – teach:• Acceptable physical contact• Gender grouping• Modesty• Anatomy• Hygiene, health• Self help skills

59

• Growth & development• Respect of privacy• Public V Private• Differentiate friends, family,

acquaintances & strangers

Adolescence & Growing up continued

60

Some Rules!!!

• If you can teach the skill teach it• If you can’t teach the skill adapt it• If you can’t adapt it find a way

around it• If you can’t find a way around it

teach the neurotypical to cope

61

Break

62

Nicholas Hedges video

63

Therapeutic Interventions

64

Speech and Language Therapy

Autism and Therapeutic Support

Communication

difficulties

Social

Interaction

difficulties

Imagination difficulties

Challenging

behaviour

Sensory

Integration

Difficulties

Motor, perceptual and play skills

Speech and Language Therapy

Psychology

Occupational Therapy

Communication

difficulties

Social

Interaction

difficulties

Imagination difficulties

Challenging

behaviour

Sensory Integration

DifficultiesMotor, perceptual

and play skills

65

Professional Support

• Clinical Psychology

• Occupational Therapy

• Speech and Language Therapy

• Holistic therapies

66

What do Psychologists do?

• Assess cognitive abilities: memory, attention, reasoning.

• Analyse behaviours.

• Formulate areas of strengths and difficulties.

• Provide Behaviour Support Strategies to reduce frequency and intensity of challenging behaviour.

67

How do they do this?

• Visual work

• Role play

• Gathering & scrutinizing evidence

• Emotional listening

68

• Assess communication strengths and needs

• Advise

• Individualised programmes

• Train staff/parent own communication style

What do SaLT’s do?

69

How do they do this?

• 1:1 sessions

• Individualised target objectives

• Social use of language programme

• What do you say/what do you mean?

70

Visual strategies to support understanding, teach new skills and manage change

When I get into the minibus, it’s important to fasten my seatbelt. My seatbelt keeps me safe.

It’s good to keep my seatbelt fastened just right.This keeps me safe.

When I get into the minibus, I will try to get the seatbelt, find thehandle and push it into the holder. When I hear a CLICK sound, I know my seatbelt is fastened. I know I am safe.

I am safe in my seatbelt that is why I try to always wear a seatbelt.

Social Stories

71

What do I do after the meeting?

What do I do at the meeting?

When will it happen?

Where will it be?

Who will be there?

DiscussingIEP targets.

Visual strategies to support understanding,

teach new skills and manage changeMind maps

72

Visual conversations

Visual strategies to support understanding, teach new skills and manage change

Everyone is talking at once

– voices in unison (e.g.

choir)

Interrupt – when

someone is still talking

Listen Thoughts

73

What do OTs do?• Assess motor, perceptual,

sensory and play skills.

• Focus particularly on the impact of sensory processing difficulties and on building calming and alerting activities into routines to support emotional regulation.

• Provide advice, including sensory strategies and how to adapt tasks and environments.

74

How do they do this?

• Sensory diets• Functional programmes • FMS/GMS – using handwriting, cutlery

adaptations• Core concept programmes for

posture, spatial and body awareness and proprioception

75

Sensory Strategies

76

Alternative Therapies

• Psychotherapy• Art therapy• Drama therapy• Music therapy• Holistic therapy

77

What does ‘Therapeutic Environment’ mean?

• Enhanced communication.

• Controlled sensory environment.

• Predictability of day and routines.

• Positive behaviour management.

78

Overall outcome

A multidisciplinary team including Psychologists, Occupational Therapists and Speech and Language Therapists can provide the appropriate therapy support to reduce the frequency of challenging behaviours and enhance the quality of life for an individual with Asperger syndrome and their family.

79

Contact details

Websiteswww.cambiangroup.comwww.oaasis.co.uk

Telephone +44 (0)20 8 735 6150

Emailsmaggi.rigg@cambiangroup.comlinda.simmons@cambiangroup.com