Transcript Autism Spectrum Disorders

The Needs of College Students with
Autism Spectrum Disorders
Steve Altabet, Ph.D.
Clinic Director
Tacoma Satellite Clinic
Goals
Diagnosing Autism Spectrum Disorders
Challenges and Strengths
Educational Strategies
Coping Strategies
Resources
What is Autism?
Autism is considered a spectrum disorder in which
the individual exhibits “severe and pervasive
impairments” in communication, social
interaction, and/or presence of stereotyped
behavior, interests, or activities.
Diagnostic and Statistical Manual, 4th Ed, TR (DSM-IV-TR; 2000)
Highly
Impacted
High
Functioning
ASD Core Deficits
Communication
Social
Restricted/
Repetitive
Autism Spectrum Disorders
(Pervasive Developmental Disorders – DSM-IV)
Autism (Autistic Disorder)
Asperger’s Syndrome (Asperger’s Disorder)
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
DSM – IV Criterion
 Social Interaction
 Impairment in multiple nonverbal behaviors such
as eye contact, facial expression, body language,
and gestures.
 Failure to develop developmentally appropriate
peer relationships.
 Lack of spontaneous seeking to share enjoyment,
interests, or achievements with others.
 Lack of social or emotional reciprocity.
DSM – IV Criterion
 Communication
 Delayed or total lack of spoken language without
compensating nonverbal communication strategies
(e.g. pointing, gestures, or mime).
 Inability to initiate or sustain a conversation for
those with adequate speech.
 Odd or repetitive use of language.
 Lack of developmentally appropriate pretend play
or social play.
DSM – IV Criterion
 Restricted, Repetitive, and Stereotyped Behavior
 Patterns of interest that are either excessive, overly
odd, or overly narrow.
 Inflexible adherence to specific nonfunctional
routines and rituals.
 Odd and repetitive hand, finger, or complex whole
body movements.
 Preoccupations with parts of objects.
DSM – IV Criterion
 Other Criterion
 Causes clinically significant impairment in
academic, occupational, social, or other
important areas.
 Age of onset prior to 3 years with regard to
social interaction, social communication, or
play skills.
DSM – IV Criterion
 For Autistic Disorder – Must have at least one impairment in all
three categories and at least 6 impairments total.
 For Asperger’s Disorder – Must have at least two impairments in the
social interaction category and one impairment in the
restricted/repetitive behavior category. Must also have
appropriately developed language, cognitive abilities, and self help
skills.
 For PDD-NOS - Must have impairment in Social Interaction and
either Communication or Restricted/Repetitive behavior
DSM – V Criterion
 Major Changes from DSM-IV
 Instead of three diagnostic categories (Autistic Disorder,
Asperger’s Disorder, and PDD-NOS) there will now just be
one diagnosis (Autism Spectrum Disorder).
 The three existing domains (Social Interaction,
Communication, and Restricted/Repetitive Behavior) will be
combined into two (Social Communication &
Restricted/Repetitive Behavior).
 Specifiers will be made for level of support needed and
other contributing factors.
 Sensory Sensitivity is now part of the criterion.
DSM – V Criterion
 Reasons for the changes
 Clinicians & researchers unable to distinguish between High
Functioning Autism, Asperger’s Disorder, and PDD-NOS.
 Social and communication functioning interrelated.
 Language and intellectual delays not related to ASD.
 Criteria for PDD-NOS too vague.
 Service providers, governing agencies, and insurance
companies designated level of support based solely on
diagnosis (not on functional ability).
DSM – V Criterion
 Social Communication
 Deficits in Social-emotional Reciprocity.
 Deficits in nonverbal communication used for
social interaction.
 Deficits in developing and maintaining
developmentally appropriate relationships.
 All three areas must be met for ASD diagnosis.
DSM – V Criterion
 Restricted Repetitive Behavior
 Stereotyped or repetitive speech, motor movements, or
use of objects.
 Excessive adherence to routines, ritualized verbal or
nonverbal behavior patterns, or excessive resistance to
change.
 Highly restricted, fixated interests that are abnormal in
intensity and focus.
 Hypo or hyper-reactivity to sensory input or unusual
interest in sensory aspects of environment.
 Must have at least 2 of 4 areas for ASD.
DSM – V Criterion
 Levels of Support Needed (Severity)
 Requires very substantial support
 Requires substantial support
 Requiring support
 Subclinical symptoms
 Normal variation
DSM – V Criterion
 Specifiers and Modifiers
 Possible specifiers of etiology include medical
conditions such as Rett Syndrome, Fragile X
Syndrome, or Mitochondrial Disease.
 Possible modifiers (important other factors) may
include language or learning disorders, intellectual
disability, seizures, motor tics, or Irritable Bowel
Syndrome
DSM – V Criterion
 Early History also specified
 Age of onset
 Pattern of onset – Include any delays in
development, regression, or loss of
previously acquired skills.
DSM – V Criterion
 Social Communication Disorder
 Impairment in pragmatic communication
 Difficulty in the social use of verbal and nonverbal
communication in naturalistic contexts.
 Functional development of social relationships and
communicative comprehension negatively
affected.
 Cannot be explained by low abilities in use of word
structure, grammar, or general cognitive ability.
DSM – V Criterion
 Implications?
 Greater accuracy in diagnosing
 Early studies indicate no change in overall rate of diagnosis,
there was a change in the distribution of people being
diagnosed.
 A clearer understanding of the level of support needed
(more individualized).
 Social Communication Disorder to be classified as a
communication disorder (may not receive as much support)
 People diagnosed with Asperger’s Disorder feel like they are
losing their identity.
Challenges
 Communication
Cognitive
 Productivity
Social
 Emotional
Navigational
Communication Challenges
 Initiating and maintaining conversation
 Asking for assistance or clarification
 Literal interpretation of language
 Overly direct/blunt
 Expressing feelings/needs
Cognitive Challenges
 Flexibility:
 Rigid or concrete problem-solving strategies
 Tendency to get “stuck” on topics or ways of doing
things
 Perfectionism
 Desire for control
 Difficulty with transitions
 Preference for known procedures & established
routines
More Cognitive Challenges
Executive Functioning
 Organization & Planning:
 Challenges with organizing self, materials,
experiences
 Difficulty choosing & prioritizing
 Delays in completing work on time, turning in
assignments
Productivity Challenges
 Problem-Solving
 Difficulty seeing “whole picture” or main ideas
 Difficulty understanding individual steps
 Challenges related to integrating information,
drawing inferences
 Difficulty learning from experiences,
generalizing to new situations
More Productivity Challenges
 Attending
 Difficulty shifting attention to new tasks
 Overly focused on narrow details
 Self-Monitoring
 Off-task behavior
 Verbal impulsivity
 Difficulty modifying behavior to demands of
environment
Social Challenges
Theory of Mind:
 Predicting others’ behavior
 Reading others’ intentions & motives
 Explaining one’s own behavior
 Noticing, understanding emotions
 Motivation to please others
 Conversational & social reciprocity
 Sharing of attention with others
 Understanding “pretend”
 Asking for help
 Understanding personal boundaries
Emotional Challenges
 Regulating Emotion (Overly Sensitive)
 Coping Skills (Outside World Does Not
Always Accommodate)
 Anxiety
 Depression
Navigational
 Difficulty breaking down larger concepts.
 Difficulty with organizing and planning.
 Difficulty with sequencing.
 True for thoughts/speech as well as actions.
 Getting stuck leads to inaction, withdrawal, or frustration.
Other Issues Affecting Success
 Motivational issues – What’s the point?
 Sensory Issues
 Increased interest in opposite sex/dating but lack
skills to be successful (could distract or overwhelm)
 Depression and anxiety increase with awareness of
social difference/lack of success.
 Anxiety surrounding new experiences (e.g. separation
from home, lack of predictable routines, increased
responsibility)
Strengths
 Visual-spatial skills and/or verbal skills
 Excellent knowledge & passion related to interests
(e.g., computer)
 Good attention to areas of interest
 Good rote memory, memory for facts
 Original way of thinking
 Strong moral code, sense of justice
 Honesty, loyalty
 Recognizing order, following rules
 Independence
 Exceptional talents
Educational Strategies
 Visual Supports
 Technology
 Task Analysis
 Small class size, low social demand
 Match course work with interests
More Educational Strategies
 Scheduled help sessions
 Develop organization system/assignment calendar
 Develop study routines – specific study times + strategies
 Develop rationale/motivation for completing work
 Study groups? (May need facilitator).
Coping Strategies
 Regularly scheduled stress relieving activities
 Activity or club related to interest
 Physical Exercise
 Relaxation Exercises
Counseling – Individual or Group
More effective – Structured, Skill Based approaches like
Cognitive Behavior Therapy, Biofeedback, or Social Skills
Less effective – Insight oriented therapies
Support Groups
Schedules and clear expectations
Resources
 Assessment/Treatment Centers for Adults
 UW Autism Center – Seattle and Tacoma
Can also assist with:
Finding local resources (877) 408-UWAC
Training/consultation for college counselors
 The Center for Lifespan Development – Federal Way
April Walter, Psy.D.
Resources
 Support Groups
 FEAT of Washington – Seattle & South Sound
 South Sound Autism Partnership
 TACA – South Sound (Traditional and Alternative therapies)
 The Hub – young adult group through PAVE – Tacoma
 Exceptional Families Network – Pierce County
 Autism Society of Washington – Olympia
 South Sound Parent to Parent – Thurston County
 T.A.C.I.D. – Runs multiple support groups including Living
with Asperger’s (206) 935-2479.
Resources – Information
 Autism Speaks
 www.autismspeaks.org
 NIH Autism Fact Sheet
 www.ninds.nih.gov/disorders/autism/detail_autism.htm
 CDC Autism Information Center
 www.cdc.gov/ncbddd/autism/
 Autism Guidebook For Washington State
http://www.doh.wa.gov/cfh/mch/Autism/guidebook.htm
Other Websites
 http://www.autism-society.org
 http://www.autismsocietyofwa.org
 http://www.futurehorizons-autism.com/
 http://www.seattleaspergers.org
 http://www.aspergersnw.org
 http://www.udel.edu/bkirby/asperger/
 http://www.thegraycenter.org
 http://www.teacch.com
 http://www.usevisualstrategies.com