Navigating the Ups and Downs of Asperger Syndrome

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Navigating the Ups and Downs of Asperger Syndrome

• Gena Barnhill Ph.D.
• Lynchburg College
• barnhill_at_lynchburg.edu

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Asperger Disorder DSM-IV-TR Criteria

• Impairment in social interaction
• Restricted repetitive and stereotyped patterns of
  behavior, interests, and activities
• Clinical impairment in social, occupational, or
  other important areas of functioning
• No significant language delay
• No significant cognitive delay

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Attwoods Definition of AS

• Pursuit of knowledge, truth, and perfection
• Alternative priorities and perceptions (Truth is
  more important than feelings)
• Talents (3 Ms) and vulnerabilities
• Frank Sinatra syndrome My Way
• One track mind, but last to know they are on the
  wrong track

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AS Difficulties Relating to Others

• Difficulty in peer relationships
• Difficulty with body language
• Do not use social niceties
• Difficulty expressing emotion
• Model others

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AS Difficulties Relating to Others

• May intentionally elicit any type of social
  interaction
• Repeat strategies perceived as effective
• Make poor social choices
• Often teased or coerced

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AS Speech and Language

• Often begin speaking at a normal age
• Good grammar and vocabulary
• Speech stilted and repetitive
• Voice is flat and emotionless
• Cumbersome monologues are frequent
• Have difficulty modulating voice

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AS Speech and Language

• Conversations revolve around eccentric topics-
  perseveration
• Comprehension is impaired
• Interpretation is literal
• Difficulty with communicative relevance

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AS Cognitive Issues

• General intelligence within normal limits
• Wide range of abilities
• Unevenness in areas of ability
• May perform below expectations for IQ
• Limited social cognition
• Defective Theory of Mind
• Poor Executive Function
• Poor Central Coherence Theory

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Theory of Mind

• The ability to attribute thoughts and feelings to
  others and to understand that others have
  perspectives which are unique and different from
  our own

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Theory of Mind

• Difficulty in
• predicting
• reading intentions
• understanding emotions
• explaining own behavior
• understanding that behavior impacts others

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Executive Function

• A wide range of abilities including planning,
  organization, goal-selection, flexibility,
  self-regulation, and inhibition.
• Similar to the responsibilities of a CEO

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Central Coherence Theory

• Tendency to draw together diverse information to
  construct higher-level meaning in context.
• Ability to get the gist by looking for a few
  relevant, socially important cues.
• Tends to be weak in persons with ASD. Therefore,
  they are relatively good at piecemeal processing,
  but weak at recognition of global meaning.
• Those with ASD experience life as a series of
  freeze frames and are good at seeing parts or
  details instead of wholes.

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Behavioral Characteristics

• Restricted range of interests
• Insistence on sameness
• Poor concentration
• Emotional vulnerability
• ... rarely seem relaxed and are easily
  overwhelmed when things are not as their rigid
  views dictate
• Williams, 2002, p. 291

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Sensory Issues

• Common Outer Sensory Reactions
• Sight fluorescent lights
• Sounds birds singing
• Taste avoid strong tastes
• Smell perfume
• Touch light touch
• Inner sensory reactions
• Vestibular sense of balance
• Proprioceptive body position, clumsy movement
• Adapted from Shore, 2003

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• In order to understand how to meet the needs of
  the student with AS, it is necessary to view the
  world from their individual perspectives (p.
  xiv)
• Students with AS inhabit a topsy turvy world,
  given that the willful and volitional appearance
  of their behavior leads to misunderstanding of
  their motivations (p. 63)
• Twachtman-Cullen, 2000

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• We need to realize that students with Asperger
  Syndrome do not try to be malicious, obnoxious,
  or difficult. When they act out, they are
  generally upset, anxious, or confused but unable
  to communicate it.
• Perhaps it is the manner in which the world
  responds to a childs inflexibility-explosiveness
  that makes all the difference. (Greene, 2001)

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Social Skills

• The development of social skills for all children
  is one of the most important outcomes of
  schooling according to Gresham and Elliot (1993).
• It is considered the missing piece in efforts to
  reach various goals associated with improving
  schools.

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Social Skills

• Social skills are considered the most malleable
  of the components of social competence.

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Social and Emotional Competence

• the ability to understand, manage, and express
  social and emotional aspects of ones life in
  ways that enable the successful management of
  life tasks such as learning, forming
  relationships, solving everyday problems, and
  adapting to the complex demands of growth and
  development (Elias et al., 1997)

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Social Skills

• All environments are social.
• Compensation for social skills deficits is
  impossible
• If student learned incidentally, s/he would have
  learned it from parents and teachers
• Students need direct instruction
• Lavoie 1994

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Social Skills Interventions

• Teaching the Hidden Curriculum
• Social Skills Training Groups
• Social Stories
• Social Scripts
• Power Cards
• Comic Strip Conversations

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Hidden Curriculum

• The culture that makes your school different than
  others
• Unwritten, unspoken rules of school
• Skills must be taught directly
• Special educators need to communicate with
  support staff to discover hidden curriculum

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Components of the Hidden Curriculum

• Physical plant of the school
• Social environment
• administrative structure of school
• extra-curricular activities
• who the cool kids are
• School schedule

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Addressing the Hidden Curriculum

• Teachers expectations
• Teacher-pleasing behaviors
• Teachers likes
• Students to interact with and avoid
• Safe and unsafe places in school
• What the cool kids do and dont do

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Teacher Pleasing Behaviors

• Be on time
• Eye contact with teachers
• Participate in class
• Use teachers name
• Submit work on time
• Use requested formats
• Request explanations
• Avoid crossing out
• Lavoie, 1994

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Positive Student Traits

• Smiling and laughing
• Greeting others
• Extending invitations
• Conversing
• Giving compliments
• Good appearance
• Sharing
• Lavoie, 1994

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6 Hidden Curriculum Skills

• Listening
• Following directions
• Staying on task
• How to get help
• Ability to get started
• Finish task on time
• Lavoie, 1994

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Temple Grandins SocialRule System

• Really bad things
• Courtesy rules
• Illegal but not bad
• Sins of the system (SOS)
• You will be fired from work if you commit an SOS
  no matter how good your work is. The social
  knowledge required is very complex.

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Social Skills Training Groups

• Conduct a social skills deficit analysis
• Define target behaviors
• Begin structured lessons
• Model appropriate behavior
• Provide multiple opportunities to practice
• Give feedback
• Work toward maintenance and generalization of
  skills.

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Social Skills Deficit Analysis

• What is the specific deficit?
• Is it a performance deficit or an actual skill
  deficit?
• Does the child have the necessary language and
  comprehension skills?
• Does the child have the necessary motor skills?
• Will others reinforce?

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Social Skills Curriculum

• Classroom survival skills
• Playground survival skills
• Friendship making skills
• Skill alternatives to aggression
• Skills for dealing with stress

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Friendships

• Typical children join a group by
• 1. Watching
• 2. Listening
• 3. Moving close
• 4. Easing in
• Running next to or acting like others is not
  typically a good group entry skill.
• It is important to abandon favorite activities
  temporarily when easing into a group. Adapted
  from Kenneth Rubins The Friendship Factor

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Howard Knoff, Ph.D. 1994
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Teach Pragmatics of Language

• requesting
• criticizing
• asking
• discussing options
• expressing complex thoughts, feelings, and
  emotions

• speculating
• negotiating
• deceiving
• understanding others

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Communication Instruction

• Teach
• Multiple meaning words
• Idioms
• Literal interpretations
• Jokes
• Do not assume understanding just because the
  child parrots what he or she has heard.

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Nonverbal Communication Skills

• Pace of speech
• Interpersonal distance and touch
• Gestures and postures
• Facial expressions
• Paralanguage
• Clothing and grooming

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SENSE

• Space
• Eye Contact
• Nodding
• Statements of Encouragement
• Expressions
• McAfee, 2002

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Social StoryTM

• Describes a social situation from the
  individuals perspective in a story format.
• Provides relevant social cues, perspectives, and
  common responses.
• Serves as a visual cue.
• Is personalized and often motivating.
• Targets one behavior for improvement
• From Carol Gray

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Purposes of a Social StoryTM

• Teaches routines and changes in routines
• Increases understanding of expected behaviors
• Shares others perspectives
• Corrects responses in a nonthreatening manner
• Translates student goals into understandable
  steps
• Describes social situations
• Personalizes social skills programs
• Goal has NEVER been to change behavior.

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Social Story Sentences

• Descriptive Truthful, opinion and
  assumption-free statement of fact, contains
  answers to wh questions
• Perspective Refers to or describes persons
  internal state, knowledge/thoughts, feelings,
  beliefs, opinion, motivation, or physical
  condition/health
• Directive Identifies a suggested response or
  choice of responses (I will try)
• Affirmative Stresses important point, states a
  rule, or reassures (This is a safe thing to do.)

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Identify the Descriptive Sentences

• 1. My name is ___________________.
• 2. I am attending a workshop.
• 3. The instructor is standing at the front of the
  room.
• 4. My friends are taking this course for graduate
  credit.
• 5. The speaker is very interesting.
• 6. Usually, I buy lunch at school.

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Identify the Perspective Sentences

• 1. I will enjoy listening to the instructor.
• 2. The teacher will like it if I am listening to
  her.
• 3. I usually have difficulty listening to
  lectures.
• 4. Many people like to go on vacations.
• 5. My friends like when I offer to help them with
  their work.
• 6. If I try really hard, I will be able to listen
  to the instructor.

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Identify the Directive Sentences

• 1. I will try to listen to the instructor when
  she speaks.
• 2. I will listen to the instructor and take
  notes.
• 3. If I need to leave the room, I have 2 choices
• I may raise my hand to ask permission
• I may wait until the next scheduled break time
• 4. I will sit in my seat on the bus.
• 5. I will try to sit still, listen, and pay
  attention to the teacher.

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Grays Basic Social Story Ratio
0 - 1 directive sentence
Basic Social Story Ratio
2 - 5 descriptive and/or perspective sentences
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Social Stories

• Use positive language and state desired responses
  positively.
• Are literally accurate and may mention possible
  changes in routine with terms such as usually and
  sometimes.
• Use concrete, easy to understand words enhanced
  by visual supports
• Often use a repetitive logical format.

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Social Story Guidelines

• Picture the goal Clear specific accurate picture
  of goal, or desired outcome.
• Tailor the text Usually write in 1st person
  answer wh questions write positive desired
  responses translate abstract concepts into
  visual, concrete terms consider students
  cognitive ability, attention span, reading and
  comprehension level, and interests.
• Teach with titles Title states goal title can
  also be stated as a question with answer in the
  social story.

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PE at North Elementary

• On most school days we have PE class
  (descriptive).
• Usually PE is outside (descriptive).
• Sometimes PE is inside (descriptive).
• Usually our PE teacher looks at the weather to
  decide if it will be an inside or an outside PE
  day (perspective).
• If PE is inside, I will try to remain calm
  (directive).
• On another day, PE will be outside (descriptive).

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Social Scripts

• Provide the student with scripted statements for
  specific settings or scenarios
• Examples
• Conversation starters
• Specific social responses
• Cues to change topics
• Cues to follow nonverbal cues

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Power Cards

• A visual aid that incorporates the childs
  special interest to teach appropriate social
  interactions
• Short scenario written in 1st person on a single
  sheet or booklet form
• Describes how childs hero solves a problem
• POWER CARD recaps how child can use same strategy
  to solve a similar problem
• Gagnon, 2001

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Jacob

• Jacob is a 10-year-old boy with Asperger
  Syndrome. He wants to have perfect papers and
  tests and will start crying at school if he
  thinks that he may not get 100 on a test. He
  also yells out that he might as well just give
  up. His parents and teachers have tried to tell
  him that it is okay if he does not get 100 and
  that he just needs to try to have confidence in
  his abilities. This has not helped reduce his
  episodes of crying. Jacob loves tennis and Andy
  Roddick is his hero.
• The following scenario and Power Card were
  introduced to Jacob in an attempt to help him
  relax when feels nervous.

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How Andre Agassi Handles His Nervousness

• Andy Roddick is one of the worlds best tennis
  players. He has won many major championships over
  the past years. He knows that it is important to
  work hard and try his best on and off the tennis
  court. However, there are times when he gets
  nervous, especially when he knows he has a test
  to take or a tennis match. That is when he
  sometimes feels like crying and giving up. He
  realizes that this would be inappropriate. He
  knows if he behaved that way, the coach would not
  allow him to play and he would not have a chance
  to win.

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• Andy wants everyone to know how important it is
  to handle nervousness appropriately. He began
  working on controlling his emotions when he was
  in elementary school and has advice for all boys
  who feel nervous.
• Next time you feel nervous, try doing the
  following 3 things that helped Andy

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• 1. Stop and take 3 deep breaths.
• 2. Say to yourself, Im ready. I prepared for
  the test. I can do this.
• 3. Say to yourself, If I dont dont get 100,
  its okay. There will be another chance to take a
  test soon.

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Comic Strip Conversations

• a conversation between 2 or more people which
  incorporates the use of simple drawings. These
  drawings serve to illustrate an ongoing
  communication, providing additional support to
  individuals who struggle to comprehend the quick
  exchange of information which occurs in a
  conversation.
• Gray, 1994, p.. 1

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Comic Strip Conversations

• Emphasize what people say, do, and think
• Use symbols and color to clarify communication
  improve comprehension.
• Keep symbols simple and representative (i.e..,
  use thought bubbles, show interrupting by having
  2 spoken word bubbles bump into each other).

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Other Social Strategies

• Educate peers about the students exceptionality
• Pair with a socially astute/compliant buddy
• Consider teacher and peer mentors
• Circle of Friends
• Attwood suggests Teamwork Group instead of
  Friendship Program