Transcript Asperger's Syndrome or What a Weird Kid!

Asperger’s Syndrome
or
“I’m just a weird kid.”
Barbara Stanton, PhD, LPCC
“We are convinced, then, that autistic people
have their place in the organism of the social
community. They fulfill their role well, perhaps
better than anyone else could, and we are
talking of people who as children had the
greatest difficulties and caused untold worries to
their care-givers.”
Dr. Hans Asperger (1944)
Autism vs. Asperger’s
Many similarities

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
Social difficulties
Communication differences
Theory of mind
Aspies are very verbal
Average to superior IQ
Asperger’s, High Functioning Autism,
PDD-NOS, Non-verbal Learning Disability
“These children often show a surprising
sensitivity to the personality of the teacher.
However difficult they are even under
optimal conditions, they can be guided and
taught, but only by those who give them
true understanding and genuine affection,
people who show kindness towards them,
and, yes, humor.”
Hans Asperger, 1944
History and Statistics
Dr. Leo Kanner: 1943
Dr. Hans Asperger: 1944
Dr. Lorna Wing: 1981
Dr. Tony Attwood: 1980s
Asperger’s added to DSM in 1994
No quantitative studies to date, most is
qualitative/anecdotal information
Over last ten years individuals identified
with Autism Spectrum Disorders have
gone from 1 in 5000 to 1 in 88 (2012)
4:1 males to females
Often misdiagnosed
Under diagnosed in females

The difference between boys and girls
Diagnostic Criteria
DSM IV TR:
Impairments in communication
Social interactions
Repetitive/stereotypic behaviors
DSM V
Potential changes may restrict the upper
end of the spectrum.
We will wait and see….
Co-morbid Conditions
or Misdiagnoses
Obsessive Compulsive Disorder
Anxiety Disorders
Mood Disorders
Bipolar Disorder
Conduct Disorders/ODD
Depression
ADD/ADHD
Schizophrenia
(may be characteristic of ASD)
Brain Differences
Neurological
Cellular differences in the limbic system and the
cerebellum (emotions/thought)
Differences in the amygdala
(emotions/impulsivity)
Functioning of the frontal lobe impaired
(executive functioning)
Chemical pathways
Differences in myelin
Mirror neurons
It is neurobiological…it is not their fault,
they cannot help it and it will last a lifetime.
Causes
Nobody knows
Theories include:
Genetics (inherited)
Unfavorable obstetric condition
Infections in pregnancy and infancy
Early immunizations
Foods may produce a toxic reaction that kills
brain cells opening a path to ASD (gluten)
Environmental toxins
Why professionals may miss the
identification
Lack of knowledge
Trouble differentiating characteristics (i.e
parallel play vs. interactive)
Gender differences
Want child to be typical
Preconceived ideas (not like other ASD
children)
Parents have been training
Don’t ask the right questions
Influence of medication on
behavior/thought
Influence of RTC or other placements
Assessment
General assessment by someone familiar
with autism spectrum disorders
Neuropsychological assessment
Occupational Therapy assessment
Speech/language assessment (primarily
for social language)
Challenges
They may appear:
To not pay attention
To not follow the rules
To not understand you
To not care what’s happening around them
To be clueless
To over react
To be rude, manipulative, aggressive
They are:
Autistic
Be calm, unemotional, thoughtful, and
respectful.
CHARACTERISTICS OF
ASPERGER’S SYNDROME
Spectrum within the Spectrum
The characteristics will vary in degree
within each individual with Asperger’s
Syndrome. For example, some are more
gifted in the arts while some have their
gifts in technology. Some will have
aggressive meltdowns while others will
withdraw passively. Some will be very
physically uncoordinated while some will
be skilled athletes.
Who should change?
Asperger’s may be a form of human
genius that will save the world (Attwood,
Baron-Cohen).
The pleasures vs. the pain of Asperger’s.
Honor neurodiversity.
The Controversy
Should there be a cure?
Dr. Simon Baron-Cohen (Cambridge
University) invites us to question what is
“normal”. He sees Asperger’s not as an
impairment but as a natural variant of
humans. Without people with AS we
would not have the same world or the
same chance for change.
The illusion of competency
The Key: Executive Skills
Working memory and recall (hold facts in
memory while manipulating information,
accessing facts in long term memory, trouble
following instructions, trouble summarizing, can
impact sense of past events, sense of time,
sense of self awareness, sense of the future)
Activation, arousal, and effort (getting started
on a task, paying attention to things of varying
interest, finishing work, sustained attention)
Internalizing language (direct future actions,
control behavior by self talk)
Taking an issue apart, analyzing the pieces,
reconstructing and organizing and
sequencing events
Time management
Controlling emotions (emotional dysregulation,
frustration tolerance, thinking before acting or
speaking)
Mental Flexibility: Shifting sets (moving one
thought to another) or make transitions to other
places or activities; rigid or stuck thinking
Metacognition: Seeing the big picture from
smaller parts
Adaptive behavior: ability to change from one
behavior to another to achieve success in the
situation
Theory of Mind
The ability to recognize and understand
beliefs, thoughts, desires and intentions of
other people is impaired. They are unable
to predict what people will do next as they
are unable to “read” the cues. Cannot “put
themselves in someone else’s shoes”.
LANGUAGE
Stiff, pedantic conversation (“little
professors”) may sound
scripted/superficial
Intonation and inflection seems odd
Preoccupation with a special interest that
they will talk about endlessly
Problems with social use of language
(literal interpretations), no reciprocity
Inability to interpret and express nonverbal
language (facial expressions)
Difficulty understanding rules for social
engagement, games. Misconstrues
other’s agenda’s, priorities, and
preferences. The “hidden” curriculum
(Brenda Smith-Myles)
May interrupt, dominate, minimally
participate, have trouble shifting topics,
problems initiating and termination
conversation.
Insensitive to non-verbal cues of others.
Apparent lack of common sense.
Joint attention limited.
Can’t self advocate.
Can’t explain what’s wrong or what they
are feeling.
“Smart ass” responses, blunt
“Revealers of the truth” (Attwood)
http://www.youtube.com/wa
tch?v=ibCck2iDOqA
DMV
EMOTIONAL ISSUES
Lack of shared enjoyment
(mind-blindness)
May seem apathetic or not empathetic,
they can’t see things from another’s
perspective. Social cognition
Negativistic world view
Difficulty with peer relationships
Good connection with adults
Emotional lability and anxiety
Low tolerance for frustration, refusals
Anxious, anxious, anxious, depression
Transitions difficult
They understand from their world view.
May have tantrums/rages or withdraw
Can’t distinguish other people’s emotions
May seem aloof and indifferent
Are naïve or gullible
Good sense of humor
Social and emotional maturity delays
Extremes in emotions
Take all or no responsibility
Attribution Theory
When we do something well we will
believe that it is because of something we
did (worked hard…) but an AS child will
think they got lucky if they did something
well. If they do poorly, they will blame the
teacher (she doesn’t like me) or their
parent (unfair). Therefore they put in no
effort because they have no control over
the outcome.
EXECUTIVE FUNCTIONING
High intelligence, articulate
Rigid, concrete thinking
Unique world view…rules must fit
Things must be fair
Organizational problems
Abilities to learn certain subjects
Talents with arts or foreign language
Poor short term memory, excellent long term
memory
Can’t generalize situations
Difficulty with comprehension
Dysgraphia (handwriting difficult)
Difficulties with transitions
Strong sense of what is fair
Different academic profile (excel in some
subjects, fail in others) Homework is misery.
Processing takes longer
Thinking all the time…they can’t stop.
Can’t make choices.
Difficulty with new tasks (perfection or
anxiety).
May be able to listen and remember better
when involved in another activity.

Usually multi-tasking is difficult.
A neuropsychological assessment will be
useful to identify their needs and learning
style.
BEHAVIOR
Behavior is communication. Learn to
translate.
BEHAVIORAL ISSUES
Sensory integration problems (touch,
sound, taste, sight) If affected they will
freak out and may be fascinated by it
Stimulation…flapping, hopping, fidgeting,
sucking, chewing, rocking, twirling
Motor clumsiness, fall, difficulty with
balance, unusual gait (toe walkers)
Inappropriate or no eye contact (functional
eye contact) Don’t know the message
they are sending or receiving, nonfunctional.
No understanding of danger/risky behaviors
Appears to be obsessive compulsive:
perseveration (unable to shift sets)
Non-compliant and oppositional
Tantrums and rages, explosive, quick
meltdowns (sometimes over nonfunctional
details of their environment) or withdrawal
High pain tolerance
Can’t mimic
No sense of personal space
Adolescence X10 (seizures with puberty)
May have bad or unusual hygiene.
Rigidly adhered routines.
Collecting “treasures”
Typical rewards and consequences do not work.
There is a reason for EVERY behavior. It may
take us a while to figure it out.
Every person is different.
Adaptive Behavior
Typically, IQ will correlate to adaptive behavior.
For example, someone with an IQ of 65 would
have adaptive skills at 65. Children with AS do
not meet that profile. If they have an above
average IQ (110) they will have an adaptive
skills score of 65. Therefore we have to teach
adaptive behaviors.
20% of AS children have an above average IQ
but their social maturity is 1/3 to 2/3 of
chronological age.
http://www.youtube.com/watch?v=p49epME
JE0E&feature=related
sensory overload
Sensory Issues
Sensory problems impact:
Reading
Writing
Math
Spelling
Problem solving
Creativity
Behavior
Mastery of
environment
Independent skills
Independent work
habits
Socialization
Creativity
Relationships
Emotions
Behavior
Mastery of
environment
Sensory Issues
Sound (auditory)
Taste (gustatory)
Smell (olfactory)
Touch (tactile)
Movement (vestibular)
Sight (visual)
Muscle input/joints (proprioceptive)
Sensory seeking/sensory avoiding
Incorporate sensory activities into the full
day not just a pull out activity
Do NOT use holds unless absolutely
necessary.
If a child can’t read, we teach
If a child can’t tie their shoes, we teach
If a child can’t ride a bike, we teach
If a child can’t behave appropriately, we
punish…
The Hidden Curriculum
These are the social rules that no one has
been directly taught but everyone knows
them. Violations of these rules can make
you a social outcast or can even be illegal.
If you are saying “I shouldn’t have to tell
you”, “It’s so obvious” or “Everybody
knows…” it is a hidden curriculum.
Brenda Smith Myles
Bullies
Children with AS are vulnerable. They may not
always see the threat.
Little (2002) surveyed 400 parents of children
with ASD and found that 94% of the children had
been bullied. When compared to the general
population they are 4X more likely to be bullied,
twice as likely to be hit or kicked by peers.
We must have ZERO tolerance of bullying
behaviors. We must monitor the situations
carefully.
Types of Bullying
Physical bullying
Verbal bullying: teasing, language, gestures,
non-verbal communication
Social bullying: isolation, manipulation
Educational (Systems) bullying: when adults
who are charged with assisting children use
sarcasm, control, humiliation, or are overly
punitive
90% report being bullied 1X per week. 75%
report it gets worse when the teacher is told.
Heinrichs (2003) Perfect Targets
“You tell me, and I forget; you
teach me, and I remember;
you involve me, and I learn.”
Ben Franklin
Learn the
Nurtured Heart Parenting Approach
By Howard Glasser
Offending Behaviors
Appearance of a lack of empathy (Theory
of Mind)
Lack of awareness of social rules; socially
naive
Can’t understand potential outcome of
behavior
Impulsivity
Desire to connect with others can lead to
misinterpretation of relationships
Difficulty judging age/maturity of others
Obsessions/compulsions
Stuck behaviors
Central coherence: excessive
preoccupation without understanding
consequences…maladaptive fantasies
Look for general cluelessness to behaviors
and consequences
Over-represented in sex offender
programs
Knowing is different than implementation.
ASD child and abuse
May display behaviors/symptoms similar
to neurotypical children or may not
Lack of emotion attached to event
Doesn’t understand inappropriateness of
behaviors
Exposure to pornography can shape future
behaviors
Obsessive thoughts
Interviewing Techniques
Interviewing will be difficult due to the
language and information processing
problems. Learning how to talk with
people on the spectrum will strengthen
your case. Inappropriate interviewing may
damage your understanding.
Remember the “illusion of competency”.
Do not use open-ended questions. Speak
using concrete simple sentences.
Do not put together multiple ideas.
Do not use words with double meanings or
idioms.
Do not expect or force them to make eye
contact.
Use visual aids.
Let them do a calming activity while
interviewing.
Do not interfere with stimming behavior.
They may answer in a way they think you
expect them to. They want to please.
Do not be sarcastic or threatening.
Do not make promises you cannot keep.
Do not attempt to confuse or trick them.
If you ask, “Do you understand” they will
likely say “yes” even when they don’t.
They may not know that they don’t
understand. Check it out by using
different language. (Watch for echolalia or
scripting.)
They will not tell you they don’t
understand.
Give them enough time to process the
question. Their first response may me “I
don’t know” or “I don’t care”. This will be a
way to get time.
They may answer just to get you to go
away.
Empathize and show respect to them in
order to get respect back.
Include a parent or trusted adult in
questioning. Especially someone who
speaks “aspie”.
Do not look for “typical” emotions.
Use their special interest.
Give them a chance to de-escalate on
their own…distractions are not rewarding
bad behavior.
Repeat or re-phrase questions.
Appeal to the intellect and logic.
Watch for sensory concerns.
Model calm behavior, breath slowly and
keep your distance
Interventions…
Evidence Based
The known…
social stories, video modeling
occupational/speech therapy
coaching/therapy
assistive technology
Maybe…
diet
medications
patterning (neurological exercises)
Scary and dangerous…
Neurofeedback
Son-Rise (emphasis on eye contact)
Packing (wrap child tightly for hour in
refrigerated wet sheets)
Cannabis (THC counteracts inhibitory
mechanisms)
Chelation therapy (detox from heavy
metals)
Cranioacral therapy (gentle pressure will
improve flow and balance of cerebrospinal
fluid)
Hyperbaric oxygen therapy (compensates
for decreased blood flow by increasing
oxygen)
Stem cell therapy (only in proposal stages)
The vaccination issue…
General Approaches
Approach in a quiet non-threatening manner.
Avoid sudden movements or speech. An
authoritative approach is likely to work against
you. Talking/shouting fast/loud will have the
same effect as speaking a foreign language.
Understand that touch, sound, lights may trigger
a meltdown/seizure. Try not to touch them. Let
them know what you want them to do and what
you are doing.
Talk to the person using calm unemotional
responses. Avoid engaging in arguments:
(Instead say…I know this doesn’t make sense to
you but I need to have you…). Be patient for
responses. You may need to ask several times.
Explain the obvious. Your authority is not
enough.
Instructions should be simple, direct and honest.
Don’t use sarcasm, innuendo, or slang. Use
literal language (i.e. don’t say hop in here, red
tape, up against the car…). Tell them only one
command at a time.
Seek all indicators to evaluate the situation as it
unfolds. Evaluate for injury…they have a high
tolerance for pain.
Maintain a safe distance until behaviors lessen
but remain alert to the possibility of outbursts or
impulsive acts. Do not corner the individual or
place them in an enclosed space unless they
request it. Do not stop stimming behavior.
.
Ask yourself, “Is this oppositional behavior or
the behavior of someone with autism?” What do
you need to understand? It doesn’t negate the
maladaptive activity but may be important in the
intervention.
Research indicates that children with
Asperger’s Syndrome should not be in
programs that include children with
behavioral or emotional problems.
Make Plan A; Plan B and an escape plan.
http://www.youtube.com/watch?v=k0xgjUhE
G3U
friendship
Historical People who Displayed ASD
Characteristics
Thomas Jefferson
Albert Einstein
Charles Darwin
Isaac Newton
Hans Christian Andersen
Wolfgang Mozart
George Orwell
Charles Richter
Emily Dickenson
Vincent Van Gogh
Andy Warhol
Karl Jung
Wasily Kandinsky
Henry Ford
Carl Jung
Mark Twain
Alexander Graham Bell
Franz Kafka
Famous People Identified with ASD
Characteristics
Dan Ackroyd (actor)
Darrell Hannah (actor)
Gary Numan (singer/composer)
Vernon Smith (Nobel Prize Economist)
Satoshi Tajiri (creator of Pokemon)
Bob Dylan (singer-songwriter)
Al Gore (politician, activist)
Crispin Glover (actor)
Bill Gates (businessman)
Garrison Keillor (writer, humorist)
Woody Allen (actor, writer, director)
Michael Palin (comedian)
Keenu Reeves (actor)
Fictional Characters with ASD
Characteristics
Calvin (of Calvin and Hobbes)
Dilbert
Napoleon Dynamite
Sheldon in The Big Bang Theory
Many Gary Larson characters
Mr. Spock (Star Trek)
Cliff Clavin (Cheers)
Chance the Gardener (Being There)
Sherlock Holmes
Brick (The Middle)
Look through the Asperger’s Lens
Red River Valley
Asperger Network
For more information:
www.rrvan.org
Interesting Books….
• The Complete Guide to Asperger’s
Syndrome (2007) Tony Atwood
Or if you buy more…
• Look Me In the Eye: My Life with
Aspergers (2007) John Robison
• Born on a Blue Day: Inside the
Extraordinary Mind of an Autistic Savant
(2006) James Tammet
• Anything by Temple Grandin
More Books….
The Explosive Child and Lost at School
Ross Greene
Executive Skills in Children and
Adolescents: A Practical Guide to
Assessment and Intervention (2010) Peg
Dawson EdD, Richard Guare Phd
The Nurtured Heart Parenting Approach
Howard Glasser
Anything by Temple Grandin
Acknowledgments
OASIS (Kirby and Bashe)
Dr. Tony Attwood
Dr. Brenda Smith Myles
Dr. Cathy Pratt
Kirby Lenz
Kari Dunn Buron
Dr. Simon Baron Cohen
Dr. Ami Klin
The “experts”, those with Asperger’s Syndrome
and their families
Dennis Debbaudt (law enforcement issues)