Children and Youth with Asperger's Syndrome and Higher-Functioning Autism: Strategies for Achieving Positive Outcomes

2010 Beyond the Diagnosis: Autism Across the Lifespan Conference

Richard L. SimpsonUniversity of Kansas

October 15, 2010

Autism Spectrum Disorders (ASD): The Facts and the Caveats Related to Asperger Syndrome

and Higher-Functioning Autism ASD is a complex developmental disability that typically occurs early in

life (usually by year 3).ASD is a neurological disorder; there is no known psychogenic etiology

for autism. Exact prevalence is unknown, however current estimates are

approximately 1 per 100. Fastest-growing developmental disability; more common than Down’s syndrome, juvenile diabetes, and

childhood cancer (CDC, 2008). Approximately a 1,148% growth rate. 1 to 1.5 million Americans live with an autism spectrum disorder. 10 - 17 % annual growth. $60 billion annual cost; in 10 years the annual cost is estimated to be $200-400 billion

Approximately 4-5 times more common in boys than girls; there are no racial, ethnic, or social boundaries.

Family income, lifestyle and educational levels do not affect the chance of ASD occurrence.

Primary Characteristics of Individuals with Autism Spectrum Disorders

Social Interaction Deficits

Speech/ Behavior

Language Deficits Problems

ASD Classification and Diagnostic Systems

• Diagnostic and Statistical Manual of Mental Disorders-1V (DSM-1V-TR)

• Individuals with Disabilities Education Improvement Act (IDEIA)

Diagnostic and Statistical Manual of Mental Disorders-1V Classification System

Pervasive Developmental Disorders:

1. Autistic Disorder

2. Childhood Disintegrative Disorder

3. Rett’s Disorder

4. Pervasive Developmental Disorder--Not Otherwise Specified

5. Asperger Disorder

DSM-1V Diagnostic Criteria: Asperger Syndrome

Qualitative impairment in social interaction: Significant impairment in use of nonverbal behavior, such as social interaction gestures,

facial expression, eye-eye-contact, and body postures Inability to form and maintain developmentally appropriate relationships with peers Failure to spontaneously seek out others for interactions, such as by sharing interests,

achievements, and so forth Difficulty with social or emotional reciprocityB. Repetitive and restricted stereotyped patterns of behavior, activities, and interests: Significant preoccupation with one or more stereotyped and restricted interests Significant manifestation of nonfunctional routines or inflexible adherence to rituals Repetitive and stereotyped motor movements Significant and persistent preoccupation with parts of objectsC. Clinically significant social, occupational, or other functioning impairmentD. Absence of a clinically significant general language delayE. Absence of a clinically significant delay in cognitive development of age-appropriate

adaptive behavior (other than social interaction) and self-help skills

Projected Amendments to DSM:V

There will likely be one diagnosis: Autism Spectrum Disorder (ASD) There will likely be two primary diagnostic domains:

Social-communication problems and fixated interests and repetitive behaviors, including stereotyped language

There will likely be dimensional ratings of domains, likely on a 5 point scale from most severe to mild/normal variations

There will likely be categories for ASD with intellectual disability, ASD with specific genetic syndromes, and so forth.

There will likely be additional attention given comorbid psychiatric diagnosis

There will likely be diagnostic information with a focus on looking at ASD as a constellation of attributes with a clear effect on function, range of etiologies, and a spectrum that presents from severe to mild disabilities

Salient Elements of Asperger Disorder

Social Social withdrawal Unskilled initiations and responses Socially stiff, awkward, emotionally blunted, self-centered, unable to

understand social cues, inflexible, lacking in empathy and understanding

Emotionally vulnerable and easily stressed Easy targets for teasing and bullying

Speech/Language Good speaking fluency Poor pragmatics Poor non-verbal skills

Salient Elements of Asperger Disorder(continued)

Cognitive/Academic Generally average intellectual abilities Obsessive, narrowly defined interests Concrete/literal thinking style Rigidity and inflexible demeanor Poor problem solving skills Poor organization Difficulty in discerning relevant stimuli

Sensory Hypo-and hyper-sensitivity to stimuli Poor auditory processing, including sound sensitivity

Physical/Motor Fine and gross motor challenges

Salient Elements of Asperger Disorder (continued)

BehavioralBased on the Behavior Assessment Scale for Children (BASC) Significant difference between the perceptions of parents and teachers

on Externalizing Problems and Adaptive Skills Index: parents ratings were “Clinically Significant”

Depression and Atypicality were areas of concern Students’ self-perceptions were within the average range Students may be able to control behaviors at school more so than at

home

Co-Morbidity and Asperger Disorder and High Functioning Autism

ADD/ADHD

Obsessive Compulsive Disorders

Mood disorders and Depression

Anxiety disorders

Explosive disorders

Cognitive and learning challenges

AS and HFAD Characteristics Affecting School Performance

Distraction/Inattention Difficulty comprehending abstract concepts vs. concrete

information Tunnel Vision; narrowly focused and fixated unique

interests Rote Memory Visual vs. Auditory Processing Problem Solving Difficulties Motor Skill difficulties Motivation problems Difficulty distinguishing relevant and irrelevant

information

Suggestions for Improving School Performance

• Students with AS/HFAD often require direct problem-solving skill instruction to effectively use and retain information

• Often need more time to complete written work• Often need abstract concept comprehension assistance• Provide problem-solving support• Provide schedules and supports for time management• Individualize and modify assignments and grading• Provide supports for small group work• Provide supports for writing, homework and exams• Provide stress breaks and stress reduction plans

Recommendations for Improving School Performance

• Incorporate students’ interests within curriculum• Provide sufficient “wait time”• Reward quality rather than quantity• Offer alternatives to paper/pencil tasks• Provide reasoning for tasks and task objectives• Check frequently for understanding• Carefully consider homework assignments• Provide notes/outlines or note taking assistance• Monitor learners’ affect and emotions• Use graphic organizers• Provide guided practice and “No Fail” Practice

Foundational Supports for Learners with AS and HFAD

Consistent schedules, routines and predictability“Home-base” programs“Safe harbor” programsVisual supportsClassroom transition supportsCompetent buddy pairingProtection from teasing/bullyingStructured teaching, task organization and clear

behavior and task requirements Systematic performance monitoring

Visual Supports for Learners with AS and Higher Functioning ASD

Task Organizers Turn Taking Cards Waiting Symbols Choice Making Rules and Alternate Behaviors Consequence Maps Calming Supports Transition Supports Activity Completion Signals Introducing Change First, Then Cards Video modeling

Additional Instructional Supports for Learners with AS and HFAD • Priming • Assignment Modifications

Length modifications, study guides, models for assignments, alternatives to paper-and pencil tasks, and so forth

• Graphic Organizers• Outlines• Task Cards• Supports for Preparing for Changes in Routine • Early or Late Release • Homework Assignment Notebooks and Homework Modifications• Timelines • Travel Cards• Instructional Modeling and “No-Fail” Practice

Novel and Promising (albeit Largely Unproven) ASD Intervention Strategies

Consequence maps

Power cards

Cartooning

Consequence Maps

• Consequence maps or Contingency Maps are graphic representations of a behavior and its consequences. Consequence maps identify two (or more) tracks. One track depicts a present (and typically undesirable) behavioral response and an alternate (and more socially desirable) behavior along with the consequences connected to the options. Teachers and other educational personnel use the maps to assist students understand and make decisions about their behavior and to become more involved in the process of understanding the choices available to them and the consequences associated with their actions.

Power Cards

• The Power Card strategy connects an appropriate or desired behavior or social skill to an individual’s area of special interest.

• Power Cards involve scenarios wherein a child’s special interest, a hero, or a model connected to a special interest models a solution to a problem similar to the one experienced by the child.

Cartooning

• Cartooning uses “cartoon-like” illustrations to describe and interpret social situations and problems; and to create a forum for social problem solving and choice making.