Nicola Martin and Luke Beardon

0114 225 5534 [email protected]

Brief

Understanding AS Succesful Inclusion Working with people who have AS Care Planning Resources

Areas to cover

 Issues /Implications  communication /social interaction /flexibility  Mental health  Relationships  Sustance misuse  Support /coping strategies  Diagnostic tools  Care planning  Resources

My response

 These areas are significantly inter related and can not be artificially separated  The voices of people with AS have to permiate the day.

Please read The Aspect Report

 Beardon L ,Edmonds G (2007) The Aspect report. A national report on the needs of adults with Asperger syndrome. www.shu.ac.uk/theautismcentre 

My aim is to help you to empathise with people who have AS-emphasising individuality and changes over time /context

The Autism Centre

 Staff have expertise in a range of areas including education, criminal justice, family issues, across the age range, and engage in teaching, consyultancy and research.

 The Social Model of Disability informs the work of the centre. If you want to find out more you could take a distance learning module www.shu.ac.uk/theautismcentre

0114 225 5534

Task

 Remember something which made you feel really anxious ,deeply humiliated or excluded. Think about it for a minute  Concentrate on the physical feelings  How receptive are you to work, study, socialising etc when you feel like this?

 People with AS experience depression and anxiety often, at least in part, as a result of environmental factors /other people

Inclusion

'People with AS are like salt water fish that are forced to live in fresh water. We are fine if you just put us into the right environment. When the person with AS and the environment match, the problems go away and we even thrive. When we don't we seem disabled'.

Baron -Cohen S (03) The Essential Difference. Penguin.

Task-definitions

inclusion mental well being

relationship coping

AS and Anxiety

 High levels of anxiety – as norm  Increased anxiety states for specific reasons  Global levels of high anxiety due to environmental factors  Possible as high as 90% of individuals have a recognisable anxiety disorder

Secondary Psychiatric Disorders

 Not a primary mental illness  Result of environmental factors and AS  High level in people with AS compared to peer groups  Better support should lead to a better prognosis and reduction in secondary conditions

Specific Reasons for Anxiety

 As a result of specific neurological differences in AS:   learning processes communication   social interaction Theory of Mind   Executive Functioning emotional recognition  Sensory processing   Central Coherence obsessions or in depth interests (which differ from OCD)

Learning Processes

Direct learning vs Indirect learning Examples of indirect learning / development:  Theory of Mind  Social skills  Social cues  Non verbal communication

Factors which can be negatives

 Resistance to Change  Environmental factors  Trust  Sense of self/diagnosis  Physical

Hypothesis - resistance to change

Individuals with AS have significantly lower ‘stability rates’ in their day to day lives than the neurotypical

This may lead, in part, to an explanation of ‘resistance to change’

Stability

Dependent on:       Communication Understanding other people Social awareness Predictability Fulfilled expectations Shared sensory environment

Neurotypical 24 Hour Period Autism and Resistance to Change

2 Unstable Stable 1

OBSESSIONS -SPECIAL INTERESTS

 Can be ''socially inappropriate''?!

 Need boundaries  Can be used as coping mechanisms   Obsessions /in depth interests, may be misinterpreted Task-consider the plus side of having an in depth interest

SELF-ESTEEM

    Must be taken very seriously Impacts directly on self-control and behaviour Culture of poor self-esteem in AS Individuals need to know what to do just as much as what not to do

Trust

◈ Possibly an unquestioning level of trust ◈ Possibly extremely distrustful ◈ NTs are renowned for lying ◈ Not being given the opportunity to trust can be highly anxiety inducing

Verbal Communication

◈ Literal interpretation ◈ Metaphor / sarcasm / irony ◈ Pedantic ◈ Echolalia ◈ Delayed processing ◈ Meaning transferability ◈ Expressive vs receptive skills

Non Verbal Communication

◈ Prosody ◈ Facial expression ◈ Body posture ◈ Inference ◈ Contextual information

Social Skills

◈ Recognising the ‘unwritten rules’ ◈ Assessing situations ◈ Reacting appropriately to social circumstance ◈ Adapting social skills to the situation

Social Cues

◈ Conversational turn taking ◈ Following the leads of others ◈ Understanding ‘friendships’ ◈ Group settings ◈ Sharing ◈ Participating in game scenarios

Traditional Model of Autism

   'Triad of Impairments' Wing and Gould 1979 Identified 3 areas of difference:    communication social understanding 'imagination'

Task-1.Is there an argument for describing 'the triad of difference'?

2.Think of positive and negative words associated with AS-and 3.Think about the language you use

Issues

 Deficit based  'Imagination' is inaccurate  Highly subjective  But useful as a guide in terms of areas of developmental difference

 

Theory of Mind

Understanding and recognising emotional states (self and others) Mentalising abilities  Difficulty in understanding that other people may see things from a different point of view      Inflexibility in the application of both the written and unwritten rules that govern behaviour Empathy Trust Appearance of rudeness Lack of pretend play

Mindreading allows us to:

 Explain Actions  Predict Actions  Recognise and utilise deception  Pretend and imagine  Experience empathy  Share information and co-operate

          

Executive Functioning

Planning Impulse control Sequencing Scripting Managing time and space Connecting events Flexibility Understanding 'what happens next' Turn taking Queuing Difficulty with understanding abstract concepts and cause and consequence

Central Coherence

 Identifying the pattern or underlying rules  Attention to detail  Knowing what is relevant and redundant  Recognising the 'big picture'

Behaviour

 Identify behaviour in isolation  Decide: elimination or not?

 Decide: adapt/modify  environment  behaviour    intensity duration frequency  Review

Bullying

 Individuals with AS are highly vulnerable:  don't 'fit in'  will not necessarily follow traditional social convention (fashion, etc.)  problems with adhering to social rules within society (classroom, playtime, employment, social arenas, etc.)  communication problems  poor TOM

EDUCATION

    PROBLEMS INCLUDE  Cognition can hide core defects Peer group Lack of understanding from staff Transference of problems (home to school/work/service and vice-versa) Academia takes preference over social and emotional development. Can lead to...

      Isolation Poor self-esteem Poor motivation Depression Unrealised potential Perfectionism

WHY GET A DIAGNOSIS OF ASPERGER SYNDROME ?

OPENS OPPORTUNITIES -

provided post diagnostic support is available

 To understand one’s self  To understand behaviour  To develop appropriate support mechanisms  To widen scope of services  Provides better chances for the future

diagnosis is a process not an event

PROBLEMS WITH DIAGNOSTIC PROCEDURE

  GENERAL  Inconsistency of diagnostic criteria (specifically language delay) Lack of awareness among some clinicians Poor clarity of referral routes CLINICAL  Behaviours within clinical settings may not provide an accurate profile  Echopraxic behaviours may be construed as pretend play  Many other difficulties can manifest similar behaviours (e.g. abuse and trauma)

ETHICAL CONSIDERATIONS

      Do not impose societal values on the person with AS There’s nothing wrong with having AS There is much to learn from people with AS Never assume anything when working with someone with AS Not acknowledging AS can be discriminatory Difference does not equate to negativity