Transcript PowerPoint Presentation - Toolbox for Transition: Autism

Autism Spectrum Disorders:
Foundations for Understanding
and Service Provision in PostSecondary Education
Lisa King, M.Ed.
Jane Thierfeld Brown Ed.D. (in absentia)
Lorraine Wolf Ph.D. (in absentia)
[email protected]
612-730-1806
March 25, 2010
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Is this your student?……….
They:
• can’t read the entire chapter because it’s “irrelevant”
• score 35 on the ACT’s
• make poor choices: can’t get off the internet long
enough to study
• are fluent in four languages (self-taught)
• can’t turn in the paper because it’s not perfect
• could have written the textbook
• don’t learn from mistakes: take 20 credits each
semester then crash
• find the cure for the common cold
• can’t “repair” or change course after acquiring new
info
• can’t remember to refill or take their meds
• have 150 IQ’s
• get lost on campus on daily basis
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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The Modal AS Student
 Male
 Logical
 Spatially aware
 Honest
 Detail Oriented
 Eye contact issues
 Thorough
 Independent Thinker
 Clumsy
 Efficient
Wolf, Thierfeld Brown, King, Bork, 2008
Focused
Lonely or sad
Appears rigid
Disorganized
Sensory aversive
Bright, especially
in areas of interest
Doesn’t see
others point of view
Uses odd phrases
or gestures
CollegeAutismSpectrum.com
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Autism Spectrum Disorders
Umbrella
of Autism Spectrum Disorders is a disability
category of neurological disorders characterized by “severe
and pervasive” impairment in several areas of development.
Significant Impairments in 3 core behavioral features or
indicators…
1.Social interaction
2.Communication
3.Restricted repetitive and stereotyped patterns of
behavior
Wide
range of severity in behavioral and learning profiles
The
borders: Autistic Disorder, Asperger's Disorder,
Childhood Disintegrative Disorder (CDD), Rett's Disorder,
PDD-Not Otherwise Specified (PDD-NOS), others…
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Aspergers Syndrome
 Normal to (way) above average IQ
 Mildest end of spectrum
 Best prognosis
 No language delay (clinical criteria)
 Shadow syndromes range into normal
 Einstein, Mozart, Gates?
Wolf, Thierfeld Brown, King, Bork, 2008
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Autism Goes to College
 Increasing numbers on campus
 Not like other college students with disabilities
 Accommodations typically needed in social and
executive areas vs academic
 Support needed in the extra-academic campus
experience
 Environment presents barriers
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Statistics
Incidence: The number of children in Minnesota diagnosed
with Autism Spectrum Disorders increased 1,291% from
1993 to 2003- Department of Education, 2003
One in 100 is diagnosed with an Autism spectrum or related
disorder-Center for Disease Control, July 2009
Popular press (Wired, Time magazines, Amazing Race, etc.)
DSM IV - Asperger’s Syndrome added as new diagnosis in
1994.
Programs/Services: Gersch Academy, College Living
Experience, MN Life College, Marshall University, etc.
Strategic Education for Asperger’s Students -Thierfeld
Brown and Wolf, 2005
University of Minnesota, UCONN, Storres Campus
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Incidence or Prevalence?
Why should we pay attention?
Unique gifts and potential for societal impact
Potential to drain time, energy, resources of
institution
Low incidence high maintenance
Paradigm shift: environment is the barrier
Ready or not, here they come!
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Why Can’t He Get it Together?
 Imagine if you processed pieces of the
environment in the order they came in and could
not organize these bits?
 Imagine if you screened out many of the bits
because they confused or overwhelmed you?
 What if you could not rely on consistency in your
sensory environment?
 Imagine if you could not fathom how other people
do it any differently?
 What if everyone is expecting or demanding that
you comply with things you don’t understand?
Wolf, Thierfeld Brown, King, Bork, 2008
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What’s it like to think like AS?
Distractible
Unable to “know” what other’s want from me
Concrete – black and white
Highly knowledgeable about certain topics
Excellent memory for things that were said,
seen, heard, from a long time ago – many of
wouldn’t
Remember (pros and cons)
I show little to no care or interest in interest
areas of my friends and family
Problems generalizing across settings
Rule-bound
From Leppicello, Mitch. LICSW
2006
Wolf, Thierfeld
Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Growing up with AS
Many negative experiences: trauma - big “T”
and little “t”
 Bullied, teased, ridiculed by peers, siblings, by
adults: often coaches and teachers
General sense and feeling of being lost and
confused for sometimes decades of their life.
Misdiagnosed and mistreated from mental health
to education; many professionals
For most young adults on the autism spectrum,
depression and anxiety are daily facts of life.
Robin McLeod and Mitch Leppicello for U of M, 2005
Wolf, Thierfeld Brown, King, Bork, 2008
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Co-Morbid Conditions
Remember, depression and anxiety are
daily facts of life.
There are no meds for AS,only help to
manage other symptoms
Behaviors that resemble symptoms of
depression and anxiety may be functioning
as sensory regulation strategies
McLeod, Robin for U of M 2005
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Oops,
Wrong Planet
Syndrome
Being autistic means that when the
person entered this world, no one gave
him (or her) “the orientation manual for
extraterrestrials!”
Wolf, Thierfeld Brown, King, Bork, 2008
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Neurotypical Disorder (NTD)
Is a neurobiological disorder characterized by
preoccupation with social concerns, delusions
of superiority, and obsession with conformity.
Impairment in independent social interaction





delusional “awareness” of others’ feelings
abnormally seeks comfort from others when distressed
imitates others mindlessly (waves bye-bye)
obsessive rigidity regarding social conformity
phobic avoidance of being different
From: http://isnt.autistics.org/
Wolf, Thierfeld Brown, King, Bork, 2008
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Major Skills Expected from ALL
Beginning College Students
Classroom Preparation:
Study habits/ test taking skills
Self advocate
Organized
Social Skills: Interact according to social norms
Deal with criticism, peer pressure
Use telephone and email effectively
Independent Living Skills:
Locate help when needed
Use leisure time effective
Carry out basic tasks: laundry
Budgeting, managing money
Adapted from
Technology
for Transition:
College
Planning State
Wolf, Thierfeld
Brown, King, Bork, 2008
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Theories of cognitive challenge for AS
 Executive functioning (The
Conductor in the orchestra)
Frontal lobe functions:
–
–
–
–
–
–
–
–
Emotional-Regulation
Inhibition of Impulsive Responding
Planning & Organization
Goal Directed Behavior
Attention
Problem Solving
Working Memory
Shifting Set
 Theory of Mind
 Central Coherence
“Can he PASS the course?
He could have written
the textbook!
But…it doesn’t matter if he can’t get
to class!”
Quote from physics professor, U of M
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Gaining Admission is
NOT
the issue……………
It’s completing a degree !
Wolf, Thierfeld Brown, King, Bork, 2008
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Typical path of new students with AS:
Special Ed is all done
No more disability
I want to be like everyone else
STRESS
I am overwhelmed
What’s wrong with me
Depression, isolation
CRASH
Cleaning up “the mess”
Lost time, money, resources
maybe irreparable damage…
Then hopefully…….
Maybe I do need support
Wolf, Thierfeld Brown, King Bork, 2008
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Domains affected:
Social
Communication (Language)
Behavior

Other Associated Features:
Motor clumsiness
Perceptual difficulties (visual)
Sensory sensitivities
Organizational and planning deficits
Depression/anxiety
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Areas of Impact Overlap
Cognitive/Language
Social
Behavioral
Adapted from Bishop, 2001
When you have met one person
with Aspergers……
You have met one person with
AS.
Stephen Shore
Assume that you know very little about the
person’s experience. You cannot guess
what their experience is based on your
experiences of similar situations.
OCALI
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Where we see the impact:
Academic Matters
Being overwhelmed
Use of the syllabus
Time management issues
Multi-tasking issues
Group work
Initiation issues
The paradox of deadlines
Homework
Taking notes
Perspective taking
Tutoring and issues associated with it
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Writing Specific Issues
Essay questions
English courses and courses requiring
papers
Writing papers vs. writing “the obvious”
Peer editing
Writing per assignment vs. a novel
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Where we see the impact:
Behaviors
Interruptions or calling out
Correcting instructor
Out of seat
Sensory integration
Mannerisms or noises
Classmate attitudes or reactions
Meltdowns or outbursts
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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College personnel will likely face:
Behavior issues: odd, offensive, awkward
Social issues: complaints related to interacting
with others
Emotional issues: anger outbursts, meltdowns
Learning issues: not wanting to do homework,
misunderstood assignments
DS and staffs role: reassure faculty
Wolf, Thierfeld Brown, King, Bork, 2008
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An Intellectual Map
Most Behaviors serve a purpose
Find the commonalities in the triggers
Target the behavior
Develop:
accommodation plan
scripts to cope
rules to manage behavior
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Where we see the impact:
Extra Curricular
Housing and residential life
Social and interpersonal
Navigating the environment
Clubs, joining and involvement
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Navigating social interactions
Reading facial expressions
Understanding tone of voice
Teasing versus sarcasm
Understanding casual chit-chat
Ending conversations
Round peg in a square hole
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Research Findings
Social competence is associated with
acceptance by peers, positive self concept and
successful employment
Social skill impairments are most critical for
high functioning students
Once students leave school “situations
requiring social competence tend to far
outnumber those requiring academic skill”
(Canney & Byrne, 2006)
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ASD and Second Life
Texas researchers believe that
people who have Asperger's
Syndrome may have found a
new therapy in an unlikely
place: the online virtual world
Second Life. As a treatment,
professionals take patients
through a series of exercises, in
groups and individually,
designed to help them learn
social skills. In the center's new
therapy, patients may have a
job interview with a "boss"
character or learn to ask
another avatar out on a date.
http://abcnews.go.com/Technology/OnCall/Story?id=4133184&page=1
STRESS
Typical Stressors at College
• The seat you usually sit in is taken when you get to class.
• You have to look for a different parking spot every day.
• They are out of the foods you eat when you get to the dining
hall.
• The professor has left a note on the classroom door
explaining that class will be held in an alternative building
today.
• You are called upon in class to discuss a reading with a
student next to you.
• The class you are taking is a summer school class but your
college calendar only shows the dates for fall and spring
semester.
• The bookstore does not have the book you need when you
arrive to purchase it.
• Your C.A. tells you there have been complaints about your
hygiene.
Stress & Higher Education
Increase academic demand
Away from home in new environment
Sleep & eating changes
Identity crises
Changed family dynamic
Financial burdens
Social changes
New people, ideas, expectations
Alcohol & drugs
Sexual identity
Prepare for postgraduate life, career uncertain
copyright Wolf, Thierfeld Brown,
2009
Wolf, Thierfeld Brown, King, Bork, 2008 Bork
CollegeAutismSpectrum.com
Adapted from NIMH 1997
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NEW + Change = STRESS!!!
Lack
of clarity
Being
misunderstood
Social
situations
Confusion/chaos
Unstructured
Having
time
to rush
Change/novelty
Having
things not go the
way you wanted
Wolf, Thierfeld Brown, King, Bork, 2008
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The Incredible 5 Point Scale
Social narrative that teaches a student
about :
• How to manage Stress
• Determine appropriate social
Behaviors
** See A 5 is Against the Law
Author: Kari Dunn Buron
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Kari Dunn Buron’s books
Sensory Integration Dysfunction
Lights
Music
General dorm or noise
Fire alarms
Touch
Behaviors/causes/misinterpretation
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Sensory
Area
Calming
Activities
Alerting Activities
Tactile
Wear soft clothing like sweat
pants.
Squeeze resistive putty
Wear ankle weights or
weighted vest
Handle fidget items
Hold something cold
Wash face with cool cloth
Light touch to the palm of the hand
Proprioceptive
Push heavy object
Push a heavy cart
Carry boxes
Vacuum the floor
Deliver office mail, papers.
Exercise
Pick up trash in hall ways
Vestibular
Rock in a rocking chair
Gustatory
Chew, suck on a pen top,
necklace, hard candy.
Suck liquids through a
straw.
Drink warm liquids
Eat crunchy foods-pretzels, ice, carrots, celery,
apple.
Eat chewy food-licorice, taffy, gum.
Keep water bottle with cold water on desk
Olfactory
Write with a scented pen or
marker.
Smell potpourri, scented
candle.
Use scented lotion or soap
Spray a citrus room deodorizer
Auditory
Listen to quiet music with
slow, even beat.
Listen to soft singing or
humming.
Work in a quiet environment
Use headphones to block
noise.
Prepare in advance for loud, strange noises
(startle).
Listen to music with varied pitch, loudness
or uneven beat.
Speak in animated high and low voice.
Visual
Work in dim light or with no
lights.
Work at distraction free desk.
Work in natural light.
Work in bright light.
Use colored paper.
Use highlighter.
Adapted from Simple Strategies That Work! p. 18-19.
www.asperger.net
Behavior
Cause
Head on desk
(mis)Interpretation
Sensory overload
Rude, sleeping
Mimics or recites back Time to process
Not taking speaker
seriously
Great expressive skills Compensates for
receptive skills
Overestimation of
functioning
Odd speaking habits
Pragmatic Language
deficits
Inappropriate
May not respond to
facial expressions,
tone
Difficulty with
non-verbals
Leads to miscues in
assignments
Does not recognize
you
Limited facial
recognition
Aloof, rude
May not shift topic on
cue
Does not
Self-absorbed,
automatically catch on uninterested
HYPER or HYPO
Too Much or too Little?
Sensory issue/ possible strategies
Think in terms of “replacing” rather than
“extinguishing”for inappropriate behaviors
Examples: Chewing gum vs. constant nose-blowing
Carpet swatch under desk vs. picking at skin
Doodling on paper vs. head down during
lecture
Sprig of rosemary vs. smelling armpit
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Advice for Support Staff:
Lose the counselor hat “how do you feel?”
Develop rapport first: find the “hook”
Use visuals: maps, write things down
Use formulas: “if….then…..”
Dry humor, wit
Remember: PTSD ( hx of little “t’s” through life)
Consider mentors
Use “rules”
Wolf, Thierfeld Brown, King Bork, 2008
CollegeAutismSpectrum.com
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Working with the family
 Like father, like son
Great memory for all that’s gone wrong (hx of
little “t’s”)
Unreasonable requests
To parents, “services” = “program”
Helicopter…?
Time on front end = insurance
Write things down
Clarify roles
Have agendas for meetings
Use same strategies you use for student
Wolf, Thierfeld Brown, King Bork, 2008
CollegeAutismSpectrum.com
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Transition issues:
The newness of your campus
Size and Culture
Navigating campus
Unfamiliar terms: “Registrar’s Office and
Bursar’s Office
Campus expectations: students managing their
own business as adults
Schedules different from what the students are
accustomed to having
Syllabus: importance and use of to manage
one’s time
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The importance of
building Trust
Get into the world of student : Find the
hook!
Increase awareness of strengths before
addressing deficits
Link skills to the students goals
Use of assigned readings: AquaMarine
Blue #5
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Generate options for dealing with
stressful situations (emphasize options
and effective)
Encourage a willingness to ask for help
(“The smartest people ask for help”)
Increase the skill of identifying who can
be helpful in different situations
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Tools for the student
 Provide student with DS “handbook”
 Maps
 Contact info: profs, T.A.s, DS, health




center, writing center, etc.
Campus spending account
Grade tracking forms
Calendar (time management)
Organization training
Ann Palmer, parent of AS, TEAACH
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Advice for Support Staff:
Lose the counselor hat “how do you
feel?”
Develop rapport first: find the “hook”
Use visuals: maps, write things down
Use formulas: “if….then…..”
Dry humor, wit
Remember: PTSD ( hx of little “t’s”
through life)
Wolf, Thierfeld Brown, King Bork, 2008
CollegeAutismSpectrum.com
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An Intellectual Map
Most Behaviors serve a purpose
Find the commonalities in the
triggers
Target the behavior
Develop:
accommodation plan
scripts to cope
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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Developing Scripts
Learning to be a good advocate
Teaching negotiating strategies
Working with others for problem
solving
Employment on campus?
Working with peers
Members of the opposite sex
Getting started in organizations
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SCRIPTS for solving problems
Classroom Problems
THE SITUATION OR ISSUE:
My lab partner does not show up
and I have to do the lab alone.
STEP ONE:
Identify problem
Anxiety and distraction due to
unexpected change in routine.
STEP TWO:
Dete rmine Solutions
1. Ask to leave class for a few
minutes to calm down
2. Use relaxation techniques
3. Talk to TA or professor to
determine options
4. Join another group
STEP THREE:
Who can help
1. Myself / Self-help
2. Professor or TA
College Autism Spectrum 3/09
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In theory…
• Academic difficulties in AS directly
related to deficits in integration,
executive dysfunction, and selfregulation
• If we understand why, we can figure
out when and how to best
accommodate
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Support for Student
Help make the unfamiliar more familiar
Pictures
Maps
Repeated visits
Familiar routines in new places
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Clear Behavioral Requirements
 Behavioral standards & expectations must be
explicit
 Student & family need to understand because
this is different from high school
 Standards are not subject to accommodation
 Make sure student understands the rules and
the consequences for breaking them
 Written communication!
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Good Night!
Do 5-10 minutes of cleaning (start in
bathroom)
Lock doors
Take medication
Fill pill case. If you need refill, put in palm
pilot
Put socks in washer
Hang clothes if dryer is full
Check Palm for tomorrow's schedule
Brush teeth
Do you need to use the bathroom?
Put glasses on the bathroom counter
Go to bed! Zzzzz....
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Importance of Structure
Organization:
have a clear beginning and end
Predictability, Structure, and Routine can
never be under-estimated
Visual Supports are helpful, regardless of
how many times one is verbally given the
message or asked a question
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Learning to use a Schedule
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Clocks or Timers
can help with
waiting ….if events
occur at a
predictable time
Resource Notebook
 Financial information: spending account, bank
account numbers, bank location and phone
number, etc.
 Employer information: rules, breaks
information
 Important contacts: job coach, instructors,
mentor, etc.
 Social options- list of free time activities, club
and organization information, info on
upcoming social events
 Medical info: doctor’s contacts, meds, dosage
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Developing Scripts
 Learning to be a good advocate
 Teaching negotiating strategies
 Working with faculty for problem
solving
 Employment on campus?
 Working with peers
 Members of the opposite sex
 Getting started in organizations
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Policies and Procedures
 Know and use the student conduct code
 Create rules sheet
 Create social/ res life reminders
 BE SPECIFIC and concrete
 Scripts: Fire Drills, lock downs
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When working with students with AS, remember:
Consistency, Structure and Predictability
Honor who they are; prioritize challenges based
on impact on life/job or course
Use special interests or fascinations whenever
possible; find their “hook”
Visuals remain constant, words do not
What’s obvious to you is not to AS, explain
Adapted from Dorothy Lucci, MGH/YouthCare, 05.
Wolf, Thierfeld Brown, King, Bork, 2008
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When working with students with AS, remember:
If you have met one person with AS, you have
met one person with AS
Be clear and direct in communication: say what
you mean; mean what you say
Provide big picture and details: why are we
doing what we are doing
Don’t assume what’s in your head is in theirs:
check it out
Adapted from Dorothy Lucci, MGH/YouthCare, 05.
Wolf, Thierfeld Brown, King, Bork, 2008
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Questions and Comments
Thank you for coming.
Lisa King, M.Ed.
Higher Education and Autism Spectrum
Disorders, Inc.
612-730-1806
[email protected]
www.CollegewAutismSpectrum.com
Wolf, Thierfeld Brown, King, Bork, 2008
CollegeAutismSpectrum.com
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