Warrnambool Handouts

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Warrnambool Handouts
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The Diagnostic Assessment
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5 Coherent and Reliable Dimensions of Aspergers
Syndrome

• Perspective taking
• Understanding and expressing emotions
• Fact orientation
• Sensory sensitivity
• Rigidity in thinking

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Making Friends

• Strategies to improve social understanding and
  friendship skills

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Assessment of Social Interaction Skills and
Social Reasoning

• The nature of these children is revealed most
  clearly in their behaviour towards other people.
  Indeed, their behaviour in the social group is
  the clearest sign of their disorder and the
  source of conflicts from earliest childhood.
  Hans Asperger.

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Solitude

• The diagnostic criteria dissolve in solitude.
• Solitude is an effective emotional restorative.
• Preference for learning in solitude.

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Stages in Friendship

• 1. Physical world.
• 2. Wanting to have friends.
• 3. Functional friends.
• 4.Loneliness.
• 5. Partner.

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A Tree Growing in a Forest Clearing
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Social Impairment

• Maturity in friendship skills.
• Limited vocabulary for characterization.
• Limited response to peer pressure.
• Conspicuous preference for solitude.
• Unaware of the codes of social conduct.

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Social Impairment

• See a room full of toys to play with not friends
  to play with.
• Limited ability with team skills.
• Dimension
• Cooperation------------------------------Control

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Social Impairment

• Limited range of facial expression and body
  language.
• Difficulty reading the facial expressions and
  body language of others(11).
• Limited ability to conceptualize the thoughts and
  feelings of others.
• Empathy. (mother characterization and being
  sad.).

12
Eye Contact

• Social punctuation.
• Read a face.
• Look away to think.
• Overwhelmed by facial expressions.

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Ability to Attribute Social Meaning

• Noticing objects and facts rather than thoughts,
  feelings and intentions.

LDA Language Cards Emotions
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LDA Language Cards Emotions
Descriptions of pictures and events may not
include thoughts and feelings.
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Friendship and Social Play Skills With Peers

• The duration of solitary play.
• Enforcement of social rules.
• Anxiety in new social situations.

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The Value of Friendship

• Learn alternative perspectives and solutions.
• Facilitates appropriate conflict resolution.

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Team Work Skills for Employment
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Basis of Adult Personal Relationships.
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The Value of Friendship

• Antidote to depression.
• Avoid bullying.

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Four Stages in the Development of Friendship
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0 3 years Pre Friendship Stage

• Curiosity,parallel play and imitation.
• Hide their favorite toys from visitors.
• Conflict resolved with physical force.

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Level 1 3-6 Years
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Level 1 Approximately 3 to 6 Years

• Recognition of sharing and turn taking.
• Friend has toys the child wants to play with.
• One way assistance (he helps me).
• Proximity.

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Level 1 Approximately 3 to 6 Years

• Why is .. your friend?
• He sits next to me.
• Momentary friends.
• Conflict resolved by force and a referee.

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An Adult Acting As a Friend

• Observe the natural play of the childs peers,
  learn the games and rules.
• Learn child speak.
• Turn taking.
• Ask for help.

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An Adult Acting As a Friend

• What else could it be?
• Video replay of social play scenes at school.
• Pause button.

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Level 2 6-9 Years
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Level 2 Approximately 6 to 9 Years

• Reciprocity and being fair.
• Mutual assistance.
• Like the same activities.

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Level 2 Approximately 6 to 9 Years

• Why is . your friend?
• She comes to my party and I go to hers.
• Conflict Who started it not how it finished.
• Offender needs to retract the action (an eye for
  an eye).

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Level 2

• Role play activities, rehearsal, feedback and
  rewards.
• Social engineering (modelling and protection).
• Resources.

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Books on Friendship (www.tonyattwood.com.au)
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Theory Of Mind Skills
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Level 3 9-13 Years
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Level 3 Approximately 9 to 13 Years

• Aware of others opinion of them and how their
  words and actions affect the feelings of
  others.(white lie).
• Need for companionship rather than functional
  play.
• Cooperation more than competition.
• Share thoughts rather than toys.

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Level 3 Approximately 9 to 13 Years

• Personality characteristics, audacious, humor.
• Helps in times of emotional distress.
• Help the child feel good about themselves
  (compliments).
• Greater selectivity and durability.

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Level 3 Approximately 9 to 13 Years

• Gender split. (Boy and girl activities).
• Trust, loyalty and keeping promises.
• Why is .. your friend?
• I can trust her with my secrets.
• Conflict resolved by discussion that can
  strengthen the relationship.
• Conflicts forgiven.

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Books on Friendship
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Level 4 Adolescent to Adult
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Level 4 Adolescence to Adult

• Peer group acceptance more important than the
  opinion of parents.
• Greater depth and breadth of self disclosure.
• Desire to be understood by friends.
• Friends character compatible with their own.

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• Clubs.
• Buddy system.
• Team work program.
• Drama classes.

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Finding a friend

• Matching individuals with similar interests.
• Local and pen pal registries.
• Adult support groups.
• Hobby and interest groups.
• Work. (Academia, computers, artistic communities).

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Managing Challenging Behaviour in Children with
Autism
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Autism, High Functioning Autism and Aspergers
syndrome
Typical development
Aspergers syndrome
High Functioning Autism
Classic Autism
Early childhood
Adolescence
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Repetitive Behaviour
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1 Communication

• The mannerisms have a message
• Communication of thoughts and emotions

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• When behaviour is the only means of communication
• Thoughts such as I cant cope or I need help
• Feelings such as jumping for joy or in a flap
• Foreign phrase dictionary

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Strategies

• Acquire an alternative means of communication
  using actions, gestures, vocalizations and speech
• Use the behaviour as an early warning system of
  agitation
• Thermometer

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2 Exploration Through Sensation

• The persons developmental level in exploratory
  play
• Exploring the world through taste, touch, aroma,
  sound, colour and perspective
• Prior stage to constructive and imaginative play

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Exploration Through Sensation

• Introduce a wide range of sensory experiences
• Sensory integration therapy
• Can be used as a reward
• If the action is dangerous or socially
  inappropriate, find an acceptable substitute

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3To Block Sensory Overload.

• Acute auditory sensitivity to specific sounds
  (Hyperacusis)
• Sudden or sharp noises, ( dog barking,
  coughing, click of a pen top)
• Small electric motors or a specific pitch

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Temple Grandin

• Sudden loud noises hurt my ears like a
  dentists drill hitting a nerve. High pitched
  continuous noises such as hair dryers and other
  small motors are annoying. All the behaviour
  modification in the world is not going to stop an
  autistic child from screaming when a noise hurts
  his ears.

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Suggestions to Reduce Auditory Sensitivity

• Identify and avoid the sound
• Barrier such as ear plugs
• Camouflage the perception of the sound with music
  - iPod
• Social Story

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Tactile Defensiveness

• Acute sensitivity to specific tactile experiences
• Sensitivity to touch and texture on particular
  parts of the body (scalp, upper arms, palms of
  hands and soles of feet)

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Temple Grandin

• I pulled away when people tried to hug me,
  because being touched sent an overwhelming tidal
  wave of stimulation through my body.
• Church was a nightmare because the petticoats
  and other Sunday clothes itched and scratched.
  Many behaviour problems in church could have been
  avoided by a few simple clothing modifications.

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Stephen Shore

• Haircuts were always a major event. They hurt!
  To try to calm me, my parents would say that hair
  is dead and has no feeling. It was impossible for
  me to communicate that the pulling on the scalp
  was causing the discomfort.

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Tactile Defensiveness

• Gestures of affection perceived as too intense a
  sensation
• Aversion to certain fabrics
• Strategies deep pressure, sensory integration
  therapy

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Sensitivity to the Taste and Texture of Food

• Sensitivity to fibrous texture and multiple
  flavours
• Sensitivity to particular aromas
• Problems at meal times that are not due to having
  to sit still, talk, socialize or try
  unanticipated food

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Sean Barron

• I was supersensitive to the texture of food and
  I had to touch everything with my fingers to see
  how it felt before I could put it in my mouth. I
  really hated it when food had things mixed with
  it. I could never put any of it into my mouth. I
  knew if I did I would get violently sick.

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Strategies for Sensitivity to Taste and Texture

• Check diet
• Avoid programs of starvation to encourage a wider
  range of foods
• Avoid programs of force feeding
• Accept the unusual diet at mealtimes
• Try new foods during programs of interesting
  sensory experiences
• Distraction, relaxation and rewards to encourage
  increased tolerance

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A World Of Terrifying Sensory Experiences

• Hyper-vigilant and shell shocked
• Need a coping or escape mechanism
• Self hypnosis, being mesmerized by a repetitive
  action or sensation

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Temple Grandin

• Intensely preoccupied with the movement of the
  spinning coin or lid, I saw nothing or heard
  nothing. People around me were transparent and no
  sound intruded on my fixation. It was as if I was
  deaf.

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4 Coping with change
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Therese Jolliffe

• Reality to an autistic person is a confusing,
  interacting mass of events, people, places,
  sounds and sights. There seems to be no clear
  boundaries, order or meaning to anything. A large
  part of my life is spent just trying to work out
  the pattern behind everything. Set routines,
  times particular routes and rituals all help to
  get order into an unbearably chaotic life.

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Donna Williams

• I loved to copy, create and order things. I
  loved our set of encyclopedias. They had letters
  and numbers on the side, and I was always
  checking to make sure they were in order or
  putting them that way. I was making order out of
  chaos.

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Sean Barron

• I loved repetition. Every time I turned on a
  light I knew what would happen. When I flipped
  the switch, the light went on. It gave me a
  wonderful feeling of security, because it was
  exactly the same each time.

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Weak Central Coherence

• Not recognizing the context (telescope)
• If the detail is changed, the whole picture
  changes
• Desperate to make order out of chaos

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• Repetitive behaviours and routines to achieve
  sameness and predictability
• Watching the same video again and again

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Pictures to see the sequence of activities
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Fascination with symmetry and order

• The fun came from setting up and arranging
  things. Maybe this desire to organise things
  rather than play with things is the reason I
  never had any great interest in my peers.

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Position

• For us, an object has colour, shape, density and
  position. Where it is in relation to other
  objects is part of the object. You can move it if
  you need to, but it goes somewhere specific and
  needs to be back there. Not to put it there is
  like changing its colour- it is out of balance
  and it will bother you until you put it back. If
  it is not in the right position, it is lost.
• Bess

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5 Manage Anxiety
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A Means of Reducing Anxiety

• A superstitious behaviour
• The Curious Incident of the Dog in the Nighttime
• Negatively reinforced
• Obsessive Compulsive Disorder
• To release emotional energy

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Strategies

• Stress management program
• Learn alternative means of relaxation
• Controlled access
• Medication
• Cognitive Behaviour Therapy

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ASAS-R Survey results for children and
adolescents More than typical children

• Talks about feeling anxious 37
• Talks about feeling sad more than typical
  children 33

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ASAS-R Survey results for children and adolescents

• Problems with anger management more than typical
  children 64
• When distressed seek solitude more than typical
  children 82
• When distressed prefer to avoid affection more
  than typical children 66
• Rapid mood changes more than typical children 58

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ASAS-R Survey results for children and adolescents

• Teased and bullied more than typical children
  71
• Has imaginary friends more than typical children
  18
• Unusual mannerisms 48
• Different accent to family or peers 28

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ASAS-R Survey results for children and adolescents

• Problems with handwriting 73
• Blinking and tics 20
• Motor clumsiness 50
• Problems with organizational and time management
  skills 81

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Repetitive Questions

• Social echolalia.
• To maintain the interaction.

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Repetitive Questions

• Predict what you are going to say next What
  colour is your car?
• Reassurance that you have not changed your mind

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6 Soothing and Pleasurable

• Soothing, as in a rocking chair or rocking to
  comfort someone
• Euphoria
• Tolerate an acceptable level

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7 A movement Disorder
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Tourettes DisorderMotor Tics

• Blinking
• Grimacing
• Nose twitching
• Lip pouting
• Shoulder shrugs
• Arm and head jerking

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Tourettes DisorderVocal Tics

• Grunting
• Barking
• Animal noises
• Coughing/sniffing
• Palilalia

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Tourettes Disorder Complex Motor or Behavioural
and Emotional Tics

• Touching the mouth area
• Clapping
• Face and head slapping
• Hopping
• Touching objects
• Licking objects
• Emotion tics (injury to others, crying)

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Self Injury

• Pain
• A means of communication and control
• Complex partial seizure
• Emotion tic
• Depression

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Summary

• Communication
• Exploratory play
• Sensory overload
• Cope with change
• Manage anxiety
• Pleasurable
• Movement disorder