Autism around the World Symposium
Dubai 6-8 May 2010
Asperger Syndrome workshop
Maggi Rigg
Linda Simmons
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• 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
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Cambian video
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Introduction to Asperger Syndrome
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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
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• 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
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A little bit of history…1950 - 1960
• “Refrigerator mothers”
Bruno Bettleheim
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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
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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
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The triad of impairments…
Communication
difficulties
Imagination
difficulties
Social Interaction difficulties
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Or is it a square of impairments…?
Communication
difficulties
Social Interaction
difficulties
Imagination difficulties
Sensory Integration difficulties
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Factors Affecting Clinical Picture
• Age• Gender• Overall level of ability• Associated features• Personality and temperament• Environment• Education
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Possible Associated Conditions
• ADD/ADHD• Dyslexia• Dyspraxia• Tourettes Syndrome• OCD• Anxiety• Depression
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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
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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
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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
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EDUCATIONAL ISSUES FOR THE STUDENT WITH
ASPERGER SYNDROME
Sharing Effective Practices
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Aspergers Syndrome
Triad of Impairment:
• Communication
• Imagination
• Socialisation
Language Difficulties
Rigidity & Inflexibility
Poor timing/Lack of empathy
Relationship issues
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Other Features Often Present
• Sensory stimuli• Movement and posture• Attention/Level of Activity• Eating/Drinking/Sleeping issues• Mood• Behaviour
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Common Classroom Issues
• Language – receptive/expressive• Change• Motivation• Sensory issues• Predicting Outcomes• Distractions• Planning/following instructions
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Detached curiosity!
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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
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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
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Suggested Strategies to Manage Difficulties cont’d:
Coping• Remembering instructions• Following the instructions• Asking for help• Sequencing and completing work• What to do next
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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:
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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
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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
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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
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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
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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
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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
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Break
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Behaviour Support Strategies for Young People with Asperger
Syndrome
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Stress Model of Crisis
Baseline
RecoveryTrigger
Escalation
Outburst
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Communication
Filters
Listener
Filters
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• Language• Past Experience • Tone of voice• Body Language• Environment• Special Educational needs i.e. ASD/
ADHD
Filters
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Self Awareness
• Body Language• Tone of Voice• Language used• Facial Expression • Eye contact
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Self Awareness
• Be aware of your own emotions• Be aware of your own expectations• Be aware of your own thoughts• Role Model• Listening Skills
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Strategies for speaker at Baseline/Trigger/Escalation
• Traffic lights• Social Stories• Mood O’Meters• Reward charts• Check environment
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Strategies for speaker at baseline/Trigger/Escalation
• Listen• Direct• Prompt• Teach • Time away • Appropriate use of humour
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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
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Strategies for Speaker at Outburst
• SAFETY – remove stress/target or objects
• Engage or withdraw?• Few clear words• Avoid touch
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Strategies for Speaker at Outburst
• Don’t try to reason • Direct to 1 or 2 choices• Be visual• Give a way out• Listen
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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)
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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
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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
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Strategies for the Adult Listener
• Silences• Reflection & Summaries• Check your & their understanding• Encouragements i.e. “ah huh”• Identify feelings
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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!
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Friendships, Siblings & Enhancing Family Life
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• 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
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Siblings
• Recognise sources of stress• Embarrassment• Jealousy• Frustration – not able to engage
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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
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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
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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
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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
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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
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Adolescence & Growing Up
• Early years – teach:• Acceptable physical contact• Gender grouping• Modesty• Anatomy• Hygiene, health• Self help skills
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• Growth & development• Respect of privacy• Public V Private• Differentiate friends, family,
acquaintances & strangers
Adolescence & Growing up continued
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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
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Break
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Nicholas Hedges video
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Therapeutic Interventions
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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
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Professional Support
• Clinical Psychology
• Occupational Therapy
• Speech and Language Therapy
• Holistic therapies
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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.
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How do they do this?
• Visual work
• Role play
• Gathering & scrutinizing evidence
• Emotional listening
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• Assess communication strengths and needs
• Advise
• Individualised programmes
• Train staff/parent own communication style
What do SaLT’s do?
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How do they do this?
• 1:1 sessions
• Individualised target objectives
• Social use of language programme
• What do you say/what do you mean?
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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
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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
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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
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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.
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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
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Sensory Strategies
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Alternative Therapies
• Psychotherapy• Art therapy• Drama therapy• Music therapy• Holistic therapy
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What does ‘Therapeutic Environment’ mean?
• Enhanced communication.
• Controlled sensory environment.
• Predictability of day and routines.
• Positive behaviour management.
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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.
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Contact details
Websiteswww.cambiangroup.comwww.oaasis.co.uk
Telephone +44 (0)20 8 735 6150
[email protected]@cambiangroup.com