Autism vs. High Functioning Autism...2018/02/10 · Asperger's disorder. School Psychology Review,...
Transcript of Autism vs. High Functioning Autism...2018/02/10 · Asperger's disorder. School Psychology Review,...
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Research-Supported Treatment for High Functioning Autism
(a.k.a., Asperger's Syndrome)
Symposium on the Child and FamilyAlexander Khislavsky, Ph.D., L.C.P.
University of California MercedSaturday, February 10, 2018
Autism vs. High Functioning Autism
A Spectrum Developmental Disorder
Characterized by significantly atypical …..
Impaired social communication & interactions
Restricted / repetitive behavior, interests, & activities
Presents in early periods of development (formerly < 3)
Autism vs. High Functioning Autism
High Functioning Autism (HFA)
Formerly Known as Asperger's Syndrome:
Dramatic social deficits & restricted interests
With intact language skills
With preserved cognitive ability
Once Seen as Distinct Diagnosis:
Was in DSM-IV-TR, not in DSM-V, still in ICD-10
Was a PDD along with Autism
Now a part of broader Autism Spectrum (ASD)
Autism vs. High Functioning Autism
Distinctions b/w Autism & HFA
Problems w/ social interactions, odd behavior, and communication not like those in autism
Often precocious language development
Onset / recognized after age 3 years
Intense, highly circumscribed interests
Want & interested in social engagement
Often co-occurring motor difficulty
Autism vs. High Functioning Autism
Neuropsychological Findings
Children with HFA Show: Weak VMI, visual-spatial perception, & visual / working memory
Weak gross and fine motor skills (clumsy)
Limited All-Encompassing Interests:
Many accumulated facts
But interfering with general learning
But non-reciprocal or socially facilitating
Autism vs. High Functioning Autism
Neuropsychological Findings
Children with HFA Show:
Verbal skills stronger than non-verbal
Language intact but verbose & one-sided
Strong semantic / factual memory
Socially interested w/ limited social perception
Executive Weakness: Disrupts social judgments and decision making
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Treatment Needsof
High Functioning Autism (HFA)
Treatment Needs for HFA
Not the Typical Autism for Treatment
HFA Strength & Needs Differ:Have historically been less-eligible for services
Too bright, verbal, academically successful
Need Targeted Intervention: For managing novel and socially demanding situations
High-structure / routine-rich
Academically driven setting
Treatment Needs for HFA
Not the Typical Autism for Treatment
HFA Needs Unique Treatment Strategies: Not exactly like / different from NVLD, ED, or SED
Not like the focus on verbal skills w/ autism
Not like placements for conduct problems
Not like tactics for academic LDs
W/ option for help w/ comorbid internalizing probs
Treatment Needs for HFA
Not the Typical Autism for Treatment
To Maximize Adaptation & Performance:In unstructured social situations
With groups same-aged peers
To reduce disruptive behaviors
In novel quickly-adjusting situations
Employing combination of educational, behavioral, group / individual therapies
General Treatment Strategies for
High Functioning Autism (HFA)
General Treatment Strategies for HFA
Thoughtful & Consistent
Individualized, based on empirical assessment
Targeting Varied Degrees Of:Concreteness / rigidity
Paucity of insight
Social awkwardness
Communicative one-sidedness
Practical & commonsense clinical judgment
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General Treatment Strategies for HFA
Thoughtful & Consistent
Problem-Solving with Behavioral Routines:
Taught in explicit / maybe rote fashion
Using part-to-whole, via verbal instruction
Rehearsed & verbalized
Especially for recurring, troublesome situations
Also how to identify novel problems & resort to pre-planned, well-rehearsed steps as solution
General Treatment Strategies for HFA
Thoughtful & Consistent
Build Social Awareness & Perspective Taking:
Identify relevant / essential aspects of situations
Show discrepancies in self / other perspectives
Make others perspective explicit
Encourage Self-Evaluation:
Knowing what others do & do not know
Normalize frustration, anxiety & negative emotion
General Treatment Strategies for HFA
Thoughtful & Consistent
Address Neuropsychological Weaknesses:Fine- and visual-motor coordination
Visual-spatial attention & perception
Visual memory & problem-solving
Executive
Helping integration of visual & auditory info in social situations
Social & Communication Therapies
forHigh Functioning
Autism (HFA)
Social & Communication Therapy for HFA
Enhance Communication & Social Skill
Raise Competence: In baseline levels of social intuition & comprehension of societal normsW/out discounting personal choice
W/out stifling uniqueness & individuality
To Function Effectively: In specific social roles Conversation partners
Potential friends or companions
Employable professionals
Social & Communication Therapy for HFA
Pragmatic Language
Structured Social Skills Intervention: BehavioralExpand vocabulary of emotions
Playing cooperative games
Social problem solving
More Availability of Pre-packaged Programs:
Look for empirically supported
See Reynow & Volkmar (2010)
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Social & Communication Therapy for HFA
Pragmatic Language
Social Stories TM: From school-based research
Easily adapted to SPED classroom
Focus on child’s actual experiences
Social Perception Skills Training:
For adolescents & adults
Teach social skills valued by employers
Minskoff & DeMoss (1994)
Social & Communication Therapy for HFA
Teach Rules / Norms for Social Behavior
Pragmatic Language Awareness: Conventions and rules of conversation
Choosing topics (avoiding the circumscribed)
Shifting topics (lists of other-preferred topics)
Knowing what unfamiliar listeners know
Reading Social Cues: Figuring out listener’s perspective, keeping up reciprocity, etc.
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Social & Communication Therapy for HFA
Teach Rules / Norms for Social Behavior
Visual Strategies for Improving Communication:
Improves understanding of task-demands, imposed by social settings
Hogdon (1995, 1996)
Read Non-Verbal Cues: Setting demands
Body proximity, position & posture
Emotional expression (body, face, voice)
Social & Communication Therapy for HFA
Teach Rules / Norms for Social Behavior
Teach Self-Monitoring During Conversation: Social skills training groups
Topic boxes
Comic strip conversation (Gray, 1995)
To Monitor & Know What it Means When:People use eye contact or gaze
Use verbal inflection / tonal changes
Use facial / hand gestures
Social & Communication Therapy for HFA
Teach Rules / Norms for Social Behavior
Teach About Non-Literal Communication: Irony, teasing, sarcasm, figures of speech, humor
Via Explicit Verbal Teaching & Practice:Concrete situations
Rehearsed in therapeutic setting
Mirror, recorded speech, video
Mediated Peer Interactions
&High Functioning
Autism (HFA)
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Mediated Peer Interactions & HFA
Paul (2003)
Most Effective Social Skills Training: Happens in company of typically developing peers
Provide a little training
Provide a some incentives
Helps Skills Generalize: Mainstream exposurePeer mentors
Peer skills group members
Peer part-time buddies
Defining Autism & Asperger’s
Kamps et al. (1992)
Peers As Support Networks: Secondary school
Short sessions during school
Structured scripts & scenarios
Reading, lunch, game time, etc.
Prompt & Praise: Typical students reinforce child w/ HFA for specific / targeted interactions
Create ‘Safe Room’: For self-timeout
Academic Curriculumfor
High Functioning Autism (HFA)
Academic Curriculum for HFA
Benefit from Modifications
Long-Term Focus: On goals that maximize vocational potential & quality of life
Cultivate circumscribed interests that boost prospects for employment
Flex Credit-System Requirements: Tangential classes often lead to ↓ motivation & failureTaylor to HFA student’s interests
Academic Curriculum for HFA
Classroom Setting
Ideal Program: Small class, offers individual attention, small group work
W/ individual communication specialist
W/ individual OT specialist
Structured, supervised activities w/ peers
Focused on real-life skills
W/ in-school counselor as ‘safe address’
Academic Curriculum for HFA
Type of School Supports
Both Specialized & Inclusive Experiences:
In self-contained & mainstream classes
Combo works as long as individualized
Depending on what district has available
Bibliography
BibliographyAmbery, F. Z., Russell, A. J., Perry, K., Morris, R., & Murphy, D. G.
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students with Asperger syndrome and high-functioning autism. In E. Schopler & G.B. Mesibov (Eds.), Asperger syndrome or high-functioning autism? Current issues in autism (pp. 167-198). New York: Plenum Press.
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Bibliography
Hodgdon, L. (1996). Visual strategies for improving communication: Vol 1 Practical supports for school children for school and home. Troy, MI, Quick Roberts.
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Bibliography
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Bibliography
Morris, R.G., Rowe, A., Fox, N., Feigenbaum, J., Miotto, E., & Howlin, P. (1999). Spatial working memory in Asperger's syndrome and in patients with focal frontal and temporal lobe lesions. Brain & Cognition, 41(1), 9-26.
Moyes, R. (2003). Incorporating social goals in the classroom: A guide for teachers and parents of children with high functioning autism and Asperger syndrome. British journal of Educational Psychology, 73(1), 138-139.
Mrug, S., & Hodgens, J. (2008). Behavioral summer treatment program improves social and behavioral functioning of four children with Asperger's disorder. Clinical Case Studies, 7(3), 171-190.
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Bibliography
Szatmari, P., Bryson, S.E., Streiner, D.L., Wilson, F., Archer, L., & Ryerse, C. (2000). Two-year outcome of preschool children with autism or Asperger's syndrome. American journal of Psychiatry, 157(12), 1980-1987.
Tager-Flusberg, H., Joseph, R. M., & Folstein, S. (2001). Current directions in research on autism. Mental Retardation and Developmental Disabilities Research Reviews, 7(1), 21-29.
Tiger, J.H., Fisher, W.W., & Bouxsein, K.J. (2009). Therapist- and self-monitored DRO contingencies as a treatment for the self-injurious skin picking of a young man with Asperger syndrome. Journal of Applied Behavior Analysis, 42(2), 315-319.
Whitby, P.J., & Mancil, G. (2009). Academic achievement profiles in children with high functioning autism, Asperger syndrome: A review of the literature. Education &Training in Developmental Disabilities, 44(4), 551-560.
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BibliographyOnline Resources
PUBLICILY AVAILABLE ACTIVITIES
https://www.staples.com/super-duper-say-and-do-positive-pragmatic-game-boards-fun-sheets-resource-book/product_307868
SOCIAL STORY SAMPLES:
https://carolgraysocialstories.com/social-stories/social-story-sampler/
COMIC STRIP CONVERSATIONS:
http://www.qe2cp.westminster.sch.uk/attachments/download.asp?file=266&type=pdf
VISUAL LEARNING
www.amazon.com/Visual-Strategies-Improving-Communication-Practicalebook/dp/B01BN2SS7U/ref=tmm_kin_swatch_0?_encoding=U
TF8&qid=&sr=