Antioch i'12rev

Counseling Individuals with
Asperger’s
Who Changes?

Goals of Class
• Review therapeutic techniques
• (more importantly) raise critical issues regarding
use of these techniques
• Who decides? Who changes?
• Social vs. Individual Change

Today’s Agenda
• Who are you? Why are you here?
• Neurodiversity as the new multiculturalism?
• AS/HFA Described
• Behavioral and Cognitive Approaches
• Language
• Peer Mentoring
• Sex and Dating

Big Points
• A few good ideas about how to help
• Pathologize vs. Normalize (Consequences)
• Reciprocal Benefits (Does AS help Typicals?)
• Hear the point of view of persons with A.S.
(News from WrongPlanet) http://www.wrongplanet.net/article432.html

• Contribute our Ideas both locally and globally on
Asperger’s
• Neuroplasticity

Politics of Autism
• Cure Autism Now PSA
http://www.youtube.com/watch?v=j_cJp714jXQ
• E.g. Response to Cure Autism Now
http://www.youtube.com/watch?v=JFmi1o0JEaM&

• Comparing Autism Speaks to Women Speaks
http://www.dailykos.com/story/2007/05/19/336513/-An-Au

Politics of Autism
• Leave us alone
• Diagnose and treat! (Autism speaks) http://bit.ly/UMeVrS
• Aspergian Culture http://www.aspergianpride.com/
• Asperger’s as a advantage
http://autism-culture.com/parents/dont-mourn-for-us/
(“I urge parentsto make radical changes in their
perceptions of what autism means”)
• Eliminate Asperger’s?
http://www.npr.org/templates/story/story.php?storyId=

More Politics
• Does Neurodiversity precede Biodiversity?
http://www.youtube.com/watch?v=4wc8dYYxmos

• *A new kind of multiculturalism? (from the
Pumpkin Festival)
http://www.youtube.com/watch?v=NZS_1MogtQk

Local and Global Ideas
• Consider blogging
• Tweeting (Behavior Babe); ABA Chat
• Mainstream Literature vs. Tribe of Interested
Counselors, Educators, Parents
• Post-Modern Point: Your ideas just as important

Personal Advantages of blogs
• Blogs as Personal Lab Notebooks (ethnography,
Anthropology & half-baked ideas)
• Writing helps you think
• Blogs have impact
• Blogs as Resume

Autism, AS, Blog Impact
• Kathleen Seidel http://www.neurodiversity.com
• Kachina 17 yr. old with Autism
http://kla.typepad.com
• Andy Sylvia Keene State College Student and
politician with AS
https://secure.actblue.com/page/andrewsylvia
• Jenn Macintosh
http://www.cerebralpalsychatgirl.blogspot.com/
& on video: http://bit.ly/uvMBUd

Antioch ASD Student Blogs
• Hanako Jones
http://hanashimonaka.blogspot.com/2009/11/
introductions.html

Gina Colby’s Blog!
• http://ginacolby.blogspot.com/

Creating Online Communities/using
tech
• Virtual vs. Real Conferencing (Accomodating
social deficits?) http://blip.tv/file/88852
• *Kinect http://vimeo.com/27257317
• *Recent 60 minutes on Autism Apps
http://www.youtube.com/watch?v=F_8b7PgnNQQ

Asperger’s/HFA
• Who are these kids?
• Who are these adults?

DSM 5 Proposed Criteria ASD
1) social interaction and communication (e.g.,
maintaining eye-to-eye gaze, ability to sustain a
conversation and peer-relations) and 2) the
presence of repetitive behaviors and fixated
interests and behaviors. Additionally, in
recognition of the neurodevelopmental nature of
the disorder, the criteria require that symptoms
begin in early childhood.

DSM IV Diagnostic Criteria for
Asperger's
• (I) impairment in social interaction, as manifested by at
least two of the following:

(A)marked impairments in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression, body
posture, and gestures to regulate social interaction

(B) failure to develop peer relationships appropriate to
developmental level

(C) a lack of spontaneous seeking to share enjoyment,
interest or achievements with other people, (e.g.. by a lack
of showing, bringing, or pointing out objects of interest to
other people

(D) lack of social or emotional reciprocity

DSM (cont.)
• (II) Restricted repetitive & stereotyped patterns
of behavior, interests and activities; by at least
one of the following:
(A) preoccupation with one or more stereotyped
and restricted patterns of interest that is
abnormal either in intensity or focus
(B) inflexible adherence to specific, nonfunctional
routines or rituals
(C) stereotyped and repetitive motor mannerisms
(e.g. hand or finger flapping or twisting, or
complex whole-body movements)
(D) persistent preoccupation with parts of objects

Controversies in Diagnosis: Should
Asperger’s Disappear?
• Will The AS diagnosis disappear from NY Times
• Simon Baron-Cohen’s plea to save AS diagnosis

Changing DSM Criteria Graphic
• http://www.nytimes.com/interactive/2012/01/20/u

Changing Autism Criteria: Volkmar
Comments
• http://www.nytimes.com/2012/01/20/health/resear

What’s the difference?
Under the current criteria, a person can qualify for
the diagnosis by exhibiting 6 or more of 12
behaviors; under the proposed definition, the
person would have to exhibit 3 deficits in social
interaction and communication and at least 2
repetitive behaviors, a much narrower menu.

Comments from GRASP
• http://welkowitz.typepad.com/aspergers_conversati

Arguments for DSM Change
For:
1.ASD reflects continuum
Against:
1.Don’t know yet if AS is distinct from Autism
genetically/biologically
2.Parents/Families have organized around AS
label

Challenge Question
• Your thoughts on changes in diagnostic criteria.
• Do changes simply serve the needs of
psychiatry?

Billy The Kid

• Video clips

If I could say it in words
• http://www.youtube.com/watch?v=NhzgNMTcioM&

Galen Clip I: Breaking down by
symptoms http://bit.ly/bdfwjv
• Halting speech- odd patterning of pauses
• Vocal Intensity- a bit loud…but little variability
(prosody)
• Content- no problem with saying he’s working
on social skills, “etiquette”
• Rocking-
• Closing-doesn’t say anything

Galen Clip II: break down
• Halting speech
• Odd content
• Some odd attempts at prosody (we’re working on
that)
• Clipped responses: “Food Court, Candy store,
arcade”
• Closing-walks out of my room

Galen’s Deficits: Comments
• 1. Blink- People make fast judgements (so much
of our story is about OTHER PEOPLE)…15-30
secs…people rely on intuition…but their
intuition is sometimes right and sometimes
wrong
BIG Point: We need to coach both the person with
AS and their conversational partners.
• Good social skills are a strong predictor of
success (e.g., children on playground: questions
vs. statements.

Perspectives
• Doubling a penny
• Power of 10
http://www.youtube.com/watch?v=0fKBhvDjuy0

• Bill Gates & Malaria http://bit.ly/TKomXu

Levels of Intervention

Therapist Intervenes

Person with AS/HFA Community Family

Know Your Role!
• hub of the wheel for information (a good case mgr)
• consultant on all aspects of a program:
educational, ancillary services/ot/pt/adaptive
p.e./medical/recreational
• Advocate: Promote ASSETS vs. DEFICITS (e.g.,
Galen at work---works hard…not good at down
time…I play up the “good at work” part);
Educational Opportunities!
• Family Therapist- Support, problem solving,
consultant, more support
• Contributors to larger discussion about AS/HFA
through blogging, community talks, conferences

Therapy Orientations: CBT vs.
Traditional Orientations
• Rogerian Methods: Unconditional Regard;
Reflection; Transparent Self (helps AS know
they are understood).
• Insight oriented approach limited but ASers had
difficult early childhoods which need to be put in
perspective; Use the “time tunnel” technique:
“What was this like when you were younger?”
Billy: Now I understand that many problems
were due to AS

Therapy Orientations (cont)
• Behavioral theory/techniques- Both
typical and non-typical individuals benefit
from “setting goals” and “building new
repertoires of skills” in pragmatic ways.
(e.g., building dating skills involve step-by-step
increases in social activites…asking someone
out for coffee  asking 2 people out for coffee
 asking one of them out to a movie 
gradually increasing intimate behaviors…etc.

Therapy Orientations (cont)
• Cognitive theory- focusing on the details of
positive or negative thoughts, pursuing ideas
that interfere with progress (e.g., “I can’t do
that” or “That’s not me to say things like that.”)

Orientations Summary
• Cognitive-thinking
• Behavioral-behavior
• Rogerian-affect/feelings
• Psychodynamic-unconcious

Challenge Question
• What is your orientation or style in counseling
individuals with ASD?

Direct vs. Indirect Treatments
• In therapy with AS we do both
• E.g., social communication:
▫ Direct speech training (speechmatch)
▫ Social skills training
▫ Social networking via mentoring
▫ Scripts and Social Stories

Parameters of Speech
• Vocal intensity (Volume)
• Lengths of pauses
• Lengths of switching pauses
• Lengths of vocalizations
• Pitch
• Rhythm

Matching Speech Patterns
• Vocal Congruence
• Visual Display
• Talking like others do
• Empathy, warmth, understanding (Rogers!)

Teaching Conversational
Reciprocity

Using Audacity
• Free download: http://audacity.sourceforge.net/
• Audacity Clip
http://www.youtube.com/watch?v=k88peetnAp8

• Speechmatch Pilot
http://www.youtube.com/watch?v=TAYOhi7uxqM

• Demonstrate Audacity

D. Githmark & L. Welkowitz, Mensa Rsch.
Journal, Fall, ‘09

iPad App Demo
• Volume, Rhythm, Pitch, Overall % Match
• Neuroplasticity
• Tuning in

Current iPad Study at KSC
• 10 subject with Autism
• 20 hours training
• Experimenters work in teams
• Pre/post conversation recordings

What an iPad speechmatch trial
looks like…
• http://www.youtube.com/watch?v=JLW9MWT8fzg

Preliminary Findings
• Happy, Sad vs. Unpleasant/Pleasant Surprise
• Volume vs. Pitch vs. Rhythm
• Child studies (coming up)
• Generalization to real life
• Component of social skills program (awareness
of talk)

iPad Collaboration with MuseAmi, Inc.
• Demo iPad APP
• Preliminary Results:
• fMri Studies at Dartmouth Medical Center with
Karen Jennings, Ph.D. (KSC) & Laura Flashman,
Ph.D. (Dartmouth):
Plan A: Resting fMri with Autism
Plan B: Pre-Post fMri with Speechmatch training

Speechmatch as therapy and as
outcome measure
• Does Speechmatch improve Prosody?
• Does Speechmatch measure changes in Prosody?

Point Light Pilot
• Screencast on PointLight
• Pilot study- biomotions lab

KSC student Katey Wichland
Catalogs Observations
Male:
• Arms swing outward while they walk. Elbows pointing away from the body, and wrists pointing towards the hips.
• Broader shoulders
• Torso makes the shape of a goblet where the shoulders curve inward towards the hips.
• Hips are narrow
• Men’s hips don’t swing with each step like a woman’s does, causing men to use more force in the calves and knees when walking.
• When trying to picture a man walk, think of a male gorilla and how the shoulders are hunched over, father from the body.
• When nervous, shoulders will move up towards the ears. The more relaxed, the further the shoulders are from the ears.
• Pace is quickened when stressed. Pace slows when relaxed. Longer swing in the arms when relaxed.
• When happy, males tend to have a bounce when they walk, radiating from each footstep.
• When sad, pace is slowed, shoulders are hunched, and the arms do not swing as wide.
• Larger men tend to move slower, elbows are further from the body, and more pressure is put on the knees when walking. Lighter men tend to walk
a little faster and have more bounce in their step.

Wichland Observations Cont.
• When trying to picture a man walk, think of a male gorilla and
how the shoulders are hunched over, father from the body.
• When nervous, shoulders will move up towards the ears. The
more relaxed, the further the shoulders are from the ears.
• Pace is quickened when stressed. Pace slows when relaxed.
Longer swing in the arms when relaxed.
• When happy, males tend to have a bounce when they walk,
radiating from each footstep.
• When sad, pace is slowed, shoulders are hunched, and the
arms do not swing as wide.
• Larger men tend to move slower, elbows are further from the
body, and more pressure is put on the knees when walking.
Lighter men tend to walk a little faster and have more bounce
in their step.

Wichland Observations Cont.
• When sad, pace is slowed, shoulders are
hunched, and the arms do not swing as wide.
• Larger men tend to move slower, elbows are
further from the body, and more pressure is put
on the knees when walking. Lighter men tend to
walk a little faster and have more bounce in their
step.

Observations by KSC student with
diagnosed A.S.
Male:
• Arms wider, legs closer
Male Heavy:
• Slower, less movement from side to side
Male Light:
• Arms closer to the body, walks a lot faster
Male Nervous:
• Faster movement, elbows way up, hands in front
of body, “ready to defend himself”, looks nervous
in the general gate and how he holds himself

Katie Wichland Catalogs observations
of AS student
• Point_Light_Research.doc

Challenge Question
• How important is speech style to you in getting
along with others? Do certain styles turn you
off?

iPad Apps for Autism
• More on iPads and ASD:
http://www.youtube.com/watch?v=F_8b7PgnNQQ
(60 minutes broadcast) Comment: But no data!

Need to UNPLUG
• YELP (with apologies to Allen Ginsburg)
http://www.youtube.com/watch?v=UowVsL3dXjM

Social Communication II: Errorless
Modeling
• Conversation with prompts
• Conversation without Prompts
http://welkowitz.typepad.com/aspergers_conversations/2006/02/errorle

• Behavioral Test (BAT)
http://www.youtube.com/watch?v=fBj-QGxdGTI

Social Communication III: Scripts
Initial Contact Script
Instructions: This is a suggested script for the
student’s initial contact with a potential site
supervisor. Feel free to use all our part of this
script as a guide for this initial conversation.

Student: Hello, my name is
_________________. I am a student in the
Department of Psychology at Keene State
College and I’m calling to speak with you about
the possibility of doing a practicum/internship
at your agency.

Pros and Cons of Scripts
• Helpful in inserting new behaviors in social
repertoires
• Creates “sameness” to conversations (not
natural)
• Are overused or used inappropriately

Social Communication: Children
• poor social reciprocity
- games for increasing back and forth in
conversation:
▫ collaborative story telling
▫ using a magic stick (exchange during floor
shifts)
▫ eye contact as punctuation (fun to do!)
▫ Skillstreaming-

Skillstreaming: Having a
Conversation
1. The Greeting
2. small talk
3. big point
4. closing
5. Autopsy

Reading Faces

• watch videos (stop and chat)
• practice making faces in the office
• Brattleboro face project (KLA)
• Ekman Faces

More on Decoding others’ emotions
• Use Cartoons!
• Bubbles over characters to infer thoughts and
feelings

Empirically Validated approaches
to empathy
• http://www.parentingscience.com/teaching-empathy

Other Social Conversation
Interventions
• CBT for SP
• ID difficult social situations
• ID neg cognitions
• Challenge neg cognitions and develop coping
responses
• Design exposure/role play
• Set Goal
• Begin Role-play
• Monitor anxiety at 1 min intervals
• End Role-play
• Review Goal
• Cognitive Autopsy

Challenge Question
• Is there a continuum of ability in decoding
emotion in speech and language?
• What common understandings of “how to
decode” can we offer others?

Anthropology
• Ethnography
• Student Center to study college student
greetings
• Playgrounds for younger children

Anthropology II:
We study them
• Education is Key (British Video Clip)

Constructional Approach
• Current Accomplishments
• Weekly Goals
• Program Notes

Constructional Approach (cont)
• Antidote to Pathological Approach
• What’s wrong vs. What needs to be added
• How will you be different
• How will others see you as different
• (for little kids)…people come from outer space,
what changes in you will they report?

Managing Emotional Problems:
Anger
• Using Visual Guides (e.g., scaling anger)
• Novaco: Cognitive, physiological, behavioral
• 2 Big Cognitive errors
• I’m going to kill Jeremy (interpreting anger)
• Self-monitoring

CBT
• Depression: Cognitive Therapy
• Depression: Frequency of Pleasant Activities
• Self-Reinforcement

More of Today’s Agenda
• Newtown and AS
• Your work
• Trends in Neuroscience
• Special Interests
• Peer mentoring
• Co-morbidity deconstructed
• Sexuality
• Turnaround

Asperger’s and Newtown
• From the NY Times:
http://www.nytimes.com/2012/12/15/nyregion/adam-lanza-an-enigma-who-is-now-identif

Response
• MJ Carley Adult Asperger’s Group
• Asperger’s Conversations
http://welkowitz.typepad.com/aspergers_conversations/2012/12/aspergers-mentioned-in-n

Always concerned with distinguishing
subjective vs. Objective Reality
• Ben-X
http://welkowitz.typepad.com/aspergers_conversations/2009/06/benx-fantasy-v

From Hilde’s paper
• I loved the tone ’I don’t care about who and what
you are. Please, come up with constructive ideas,
and I’ll listen to you. After due consideration, I’ll
put your idea into practice in my own
environment.’
• Blogging is a form of thinking aloud and having
a good conversation that doesn’t require spewing
out reams of paper with very wordy messages.

Jillian’s reflection on Doidge
• While this child did not have the intensive CI
therapy discussed in this book chapter, she did
have a lot of demanding therapies that required
her to work a lot with her weak left side. Without
the interventions and working to make her left
side of her body stronger and teach her brain to
make changes, she definitely would not be where
she is today.

Sharon Shirley-Bailey
“Understanding (and truly embracing) the concept
of neurodiversity was inspiring to me. I feel this
way because of the work that I do with
emotionally disturbed deaf adolescents and
children. Not only because of that, but because
my parents were deaf so I had to endure both
surprise and ignorance from the general
population about deafness.”
-From Shirley’s paper

Carolyn Sprague
“Because of the many advantages of a
constructional approach, I’ve begun to think
about how I could apply it to building my
thirteen year old son’s conversation skills.”
-Carolyn

Tammy Massengill
“. What a brain buzz! I thought that I returned to
higher education to learn what I was missing,
forgot that I am an inventor, also. Thanks Dr. W
for breaking me out of my shell and causing me
to participate in the Big Picture, once again.”
-Tammy

Important Trends
• Mirror Neurons: Positive Support
http://news.sciencemag.org/sciencenow/2005/12/0

• Mirror Neurons/Autism conflicting evidence
http://news.sciencemag.org/sciencenow/2010/05/a
• Unanswered question: Do mirror neuron deficits
explain empathy deficits?

Mirror neurons
http://www.youtube.com/watch?
v=BOd3N20XNC4

Trends (cont): Oxytocin
• http://www.sciencedaily.com/releases/2010/02
/100216221350.htm
• Largest Study 13 subjects
• Looked more at upper face vs. lower face
• Discriminated types of games children were
playing

Did Disney rip off Welkowitz?
• Speechmatch:
http://www.youtube.com/watch?v=k88peetnAp8
• Wall-E
http://adisney.go.com/disneyvideos/animatedfi
lms/wall-e/games/sayit/

AS and Oppositional Behavior
• Behavior Chains
• Meeting Special Interests (Hunter Clip
http://www.youtube.com/watch?v=D1T-
zY1DXQk )
• Going With rather than against re: special
interests

Going with Special Interests
• e.g.2 Ben- The Cloud Room…Hey Now Now
• e.g. 3 Billy- sports statistics…
and began a blog about the LA Dodgers this
summer

Death Metal in Norway and Asperger
Academic Success
• http://www.npr.org/templates/story/story.php?
storyId=90126955
• Clip of Norwegian Black Metal Band
http://www.youtube.com/watch?
v=i4U33U_UyzQ (ability to view disturbing info
differently; objectively)

Perspective Taking
• Are neurotypicals MORE RIGID in thinking due
to cultural restraints?
• Are we more likely to “go with the majority” and
spurn unusual ideas?
• E.g., medical students and interest in
preventative medicine
• E.g., A.S. member of religious family declares his
atheism

Social Networking: Mentoring as
Intervention
• The Insider-Outsider Problem
• Challenging the notion that ALL INSIDERS are
enemies
• Challenging the notion that ALL INSIDER
activities are unethical
• Work to Move AS person to Insider status

Gaining Insider Status
• Quirky Groups (Drama, Band, Geography, Math)
• Quirky skills (magic; knife throwing)
http://bit.ly/gHXWEH
• Hit Your Connectors
• Ask Your Mavens to ID Connectors
• Peer Mentoring

Peer Mentoring
• Doug Flutie Jr. Grant
• Up to 12 peer mentors at KSC
• ID AS individuals (close connections to
Counseling and Disability office)
• Peer Mentors provide support, advice giving,
friendship
• Meet regularly; introduce to friends; Networks
Expand

Peer Mentoring: Social Network
Development
• Networks serve as buffers against stress
• Networks serve as buffers against depression
• Networks serve as important source of
information
• Networks serve as important source of activities

Peer Mentoring Issues
• Mentors meet regularly to discuss problems
• Confidentiality (Inner vs. Outer Circle)
• Relationship Boundaries
• Handling Difficult Problems
• Ethical Dilemmas

Reinforcing the Reinforcer
• Volunteers vs. Salaried Workers
• Use of Practicum or Independent Study
• Regular contact (fielding calls; dealing with
emergencies)

Peer Mentoring: Outcome
• Anecdotal Reports: Benefits are clear
• Quality of Life Increases
• Parent testimonials
• School Retention
• Interest in Program
• Service Learning (new!)
• Dana Githmark Clip
• Mike Hayes Clip

Peer Mentoring: Outcome II
• Seth Clip http://www.youtube.com/watch?
v=PRwCHp1on-E

AS and Comorbidity
• People like simple answers: With one
diagnosis we can “put people in a box” and we
feel better that we have a grasp on the problem
and ideas for
• Leads to Prescriptive Approach: Matching
Problem with Solution
• Topography vs. Function (Goldiamond)
• Makes Outcome Studies Manageable

OCD and Comorbidity
• Data from the National Anxiety Screening Day
Study:
Obsessive-Compulsive Disorder & Co-
Morbid Anxiety in A National Screening
Sample
Lawrence A. Welkowitz, Ph.D., Keene State
College; Elmer Streuning, Ph.D., Columbia
University; John Pittman, M.A., Columbia
University; Mary Guardino, Freedom From Fear,
Staten Island, NY

Request for More Details on Co-
Morbidity

AS and OCD
A B C
Antecedent Behavior Consequence

Tension UP Ritual Tension
DOWN

(exposed to Washes (Reinforces
Ritual) Contaminant)

AS and OCD: Eg. 2
A B C

Exposed Ritual Decreased
Tension
To oven

Tension UP Checks Oven Decreased

Tension/Anxiety

AS and OCD: Treatment
• Exposure with Response Prevention
• Extinction that leads to elimination of ritual
behaviors. This is good since:
If not stopped…AS/HFA individuals will fail to
resist OCD behaviors in public since they are less
tuned in to SOCIAL CONSEQUENCES.

Issues in treating co-morbid OCD
• May need “coach” to increase motivation
• need to make social consequences of “odd”
public behaviors clear
• Reassure pt by discussing difference between
OCD and Psychosis

AS and ADHD
• Lots of overlap…but also lots of differential dx
errors due to similar “topography” of behavior:
• e.g. impulsiveness- As pts may “seem”
impulsive because they are less likely to respond
to social cues/consequences
• inattention- may be due to lack of interest
rather than inability to focus…or lack of eye
contact may be due to sensory aversion.
• Hyperactivity- may be linked to not
understanding the “social demands” in a
particular situation.

What to do about Disorganization?
• Systems that child can relate to…
• Spread sheets, graphs of progress, digital sticky
notes, digital checklists, Power School
• Key is RULE GOVERNED BEHAVIOR (math
papers go in math folder, etc)
• Algorithms for writing e.g., “Main Idea”
http://www.youtube.com/watch?feature=player_embedded&v=vwKa1mWU98Y#!
• (start at min. 2:00 above)
• But what is main idea?

Inattention?
• AS students must have relevant motivation (e.g.,
letting student do Holocaust Essay using
cartoons; letting student do math using baseball
statistics)
• Hint: Go “with” rather than “against” special
motivators

AS & Depression
• due to chronic outsider status
• Pts get worse as their AS improves…recognize
their social failings; desire insider status but realize
how tough it is…may even miss their “splendid
isolation.”
• lack of social reinforcement (just think of how
much reinforcement a typical person receives
throughout the day)…
• lack of social networks which serve as a
BUFFER against stress and anxiety
• bullying and teasing (Seligman’s Learned
Helplessness…dogs unable to escape shock)
• assaults on self-esteem- low rates of praise

Treatment Issues: Depression
• Cognitive Therapy helpful
• Lewinshon’s Freq. of Pleasant Events
• Low Rates of Behavior
• Physical Activity
• Help shift AS/HFA individuals from “outsider”
to “insider” status (e.g., mentoring, circle of
friends, teaching them special skills that other
like…such as magic or knife throwing)

Treatment of Depression cont.
• Err on the side of “reinforcing gains” rather than
“focusing on deficits”…heap lots of positives on kids
and adults
• encourage friends, spouses, teachers to focus on
positives and ignore minor negative behaviors (e.g.,
“catch me when I’m good”)
• Provide “outs” for kids to escape aversive
environments (e.g., escape from crowded hallways
where kids get shoved against lockers or bullied)
• SSRI’s or MAOI’s for socially avoidant individuals
with high interpersonal sensitivity

Validation
• Validation Clip

Clinical Exercise: Break in to Pods
• Pick any problem or disorder that you have seen
(or heard of) that co-occurred with Autism or
Asperger’s. How did the two mix? What ideas
do you have for therapy?

Depression and Bullying at College
Level
• E.g.s. of college level bullying (dorms, gym,
class)
• Team Approach (counseling staff, profs,
residential life staff)
• Identify Save Havens
• High Status Mentors as “Protectors” and
“Promoters”
• Teaching Assertive Behavior

AS and psychotic disorders
• “Hallucinations”/”Delusions” may be due to
chronic outsider status rather than
schizophrenia (Attwood)
• Relentless CBT to treat irrational ideas (e.g.,
“The FBI told me to ignore what my parent’s
say”; “My father is out to get me”)

CBT for Irrational Thoughts
• Are you sure your father is out to get you?
• Have you ever felt this way before and it turned
out that he was not out to get you?
• When did the FBI contact you?
• What were the names of the FBI agents?
• “Is this a highly irrational idea you are
experiencing…or is it grounded in reality?”
• Dogged Pursual leads to “revised cognition”

Schizophrenia Symptoms vs. AS
▫ Delusions vs. radical thinking (recent story by
professor about her brother)
▫ Paranoid thinking- due to chronic attacks by
NT’s?
▫ Hallucinations vs. “Visions” or highly valued
ideas
▫ negative symptoms: anhedonia, alogia (lack of
initiating speech, action, pleasure). Are these
due to lack of social connection or does it have
“an organic feel”??

Hallucinations as Reinforced Behavior
• Burns, et al Hallucinations controlled by
contingencies and mishearing of ambient noise
http://www.ncbi.nlm.nih.gov/pmc/articles/PM
C2741969/
• Layng, Andronis practical contingencies control
hallucinations
http://www.ncbi.nlm.nih.gov/pmc/articles/PM
C2741750/ (e.g., seeing electricity in winter)

Concrete to Abstract Leap: AS vs.
Schizophrenia
• Both groups can not decipher “sayings” or
metaphors:
“A rolling stone gathers no moss”
“A stitch in time saves nine”
“Don’t put the cart before the horse”
“I was pouring on the coals on the highway
this morning”
“That’s icing on the cake”

Egs. Of Psychotic-Like Behavior
• e.g. 2 KLA (age 18) “The Easter Bunny will visit my
home and scare me)…solved by explaining that the
easter bunny is “not real.”
(different from psychotic delusions…can’t explain
them away!)
• e.g. 3 Jacob (age 10) and 9/11: The end of MLB!!
Me: No, MLB will continue. School staff feared an
anxiety/trauma response to 9/11…simply due to
misperception (i.e., not a delusion)
• Comment: If reality testing is grossly impaired and
doesn’t respond to CBT, then co-morbid psychotic
disorder is possibility and anti-psychotic meds
should be considered.

AS and Humour
• Can only understand very obvious humour: e.g.,
Monty Python
• Counseling Tip: Make communications clear
(surface vs. deep structure of language)

AS and Social Phobia
• SP: Hallmark feature is “Fear of Negative
Evaluation”
AS: Often immune to Negative Evaluation
• SP: Social skills can be intact
AS: Poor Social Skills
• SP: Over focusing on social cues and events…
e.g., notices people frowning, rolling eyes, etc
AS: Doesn’t look at faces; don’t understand
faces

Social Phobia vs. AS
• Many ASers call themselves “shy” but are they
really?
• Misinterpret social inadequacy for social
anxiety?
• Become anxious as a result of poor social
abilities?

Treatment for Social Phobia
• SP: focus on certain cognitive errors:
▫ Mind reading
▫ Fortune telling error
▫ overgeneralization

AS and social problems
• AS: Focus on constructing social behaviors:
▫ Constructional Approach
▫ Exposure to social activities
▫ Basic friendship skills
▫ Some CBT around misconceptions of other
peoples’ intentions

AS and Oppositional Behavior
• e.g., 1. Colin Age 10 refusing to do math that he
feels is “insulting” “repetitive” “too easy”
• e.g., 2 Hunter age 11 with “genius IQ”, slipping
on homework compliance
• e.g. 3 Seth (age 20) taking “Gen Ed” classes that
are “too easy.”]
• e.g. 3 Annika’s classmate with obsessive interest
in spiders

Prevent ODD with Accomodation
• Must LISTEN and MAKE ARRANGEMENTS for
more challenging educational experiences…But
schools not geared this way!
• Having kids take advanced courses…
• Make rules clear (rule governed behavior)

Going with Special Interests
• e.g.2 Room…Hey Now Now
• e.g. 3 Billy- sports statistics…
and began a blog about the LA Dodgers this
summer

Very ODD: When all else fails
• Contingency management
• The List
• The Hook (Contingent access to special
interests/activities)
• Computer Addiction

AS and PTSD
• Effects of Pervasive Bullying and Teasing
• Model for Understanding PTSD:
▫ Classical Conditioning (Associated Stimuli such as
kids, classes, teachers Anxiety)
▫ Operant Conditioning (Escape is reinforced)
▫ Stimulus Generalization (high school college)
▫ Subjective Meaning of trauma stimuli (AS kid told
that high school kids will follow to college)

PTSD Treatment: CBT and
Exposure to trauma stimuli
• Challenge notions that “all kids are dangerous”
• gradual exposure to non-dangerous kids and
school situations
• Safe and secure environments
• on-going monitoring

AS/HFA and Dichotomous Thinking
• e.g., Collegues complaint about her brother rejecting
Church (“Religon is the source of All hatred and
violence”)
• e.g. G.’s absolute thinking “My father hates me
because he won’t take me to a mall this weekend…
and he must be punished”
• e.g., “Joe Lieberman is a Nazi”
• e.g., Andy: “Republicans deserve to die”
• e.g., Patrick Henry: “Give me Liberty, or Give me
Death”
• e.g., Luke Skywalker “We must risk our lives to fight
Darth Vader and all Evil”

Treating AS plus PTSD
• Obsessive nature of AS probably makes
treatment more difficult
• But argument can be made for effective
treatment

Arguments for treating AS plus
PTSD
• Many AS kids have elements of PTSD (90% report
some form of bullying or assault…many report
sexual assault as well)
• Foa and colleagues rsch. (Annenberg Found.
Consensus Reports): CBT for PTSD in Kids
effective
• Recent studies by Sofronoff & Attwood: CBT
directed toward Anx. Disorders effective, espec.
With strong parental involvement!
• Anger MGT helpful because AS kids “lash out”
when confronted with trauma-related stimuli…
unable to manage emotional stimuli effectively
(Amygdala abnormalities?; executive functioning
deficits?)- See Attwood Program:

Clinical Exercise
• Think of a problem you have seen (or heard of)
in Autism/Asperger’s that might be helped if the
person with autism can “take a different
perspective”…think about things differently.
How would you go about encouraging a new way
of thinking?

Clinical Exercise
• Think of a problem that you have seen in
Autism/Asperger’s that might lend itself to
straightforward EXPOSURE therapy (ie., just
doing it).

Behavior Chain
Antecedent

Crisis

Key to Intervention
• Break chain as early as possible
• Break chain at weakest link

Behavior Chain II: Meltdown
Wakes up late
Favorite Clothes
Not available
Teased on Bus

Loses Homework

Given Instruction Misinterprets
To do “boring” Reprimand
MELTDOWN task

Meltdown Interventions
• Wakes up late • Scheduling control
• Favorite clothes not • Deal with sensory issues;
available use gradual exposure
• Teased on bus • Anti-bullying programs
• Loses homework • Organizational training
• Misinterprets reprimand • Be Clear; avoid sarcasm
• Instructions to do boring • Assess interest in task; go
task with special interests
• MELTDOWN • Stay calm; Contain child

Common Stressors
1. Going Against vs. Going With Special
Interests
2. Stimulus Overload
3. Using facial expressions as instructions
4. Physical Proximity
5. Olfactory stimulation

More Stressors…
6. Ambiguous social situations
7. Intense eye contact (“look at me”)
8. Disrupting pleasant activities
9. Strong criticism
10. Unpleasant Physical Activities

Clinical Exercise
• Pair off, select a behavior problem, do a
Behavior Chain Analysis

Stigma
• Negative “halo effect”
• Wahl (2002) concluded: Negative attitudes
toward persons with SMI evident by 3rd grade.
• Perceptions of Violence

Reducing Stigma
• Promote Contact (Racism literature: “contact
hypothesis”…contact effects strongest when the
individuals:
 meet as equals
 work cooperatively
 target person moderately disconfirms a
stereotype (someone who greatly disconfirms a
stereotyped is dismissed as “an exception”)

AS and Sexuality
• Disconnect between AS skills and complexity of
sexual activities
• Adolescence and hormonal change
• Lack of social influence leads to “what feels
good” versus “what is acceptable”
• Lack of information

Sexuality: Problems that Arise
• Inappropriate advances
• Stalking like behaviors
• Compulsive masturbation
• Gender identity problems
• Sensory difficulties (light touch vs. moderate
touch; soft music vs. loud)

Sexuality Interventions
• Education
• Problem solving
• Friendship
• Obtaining Consent at Every Level of Intimate
Advancement (Antioch Rules for Sexual Activity)
• Monitoring conversations

Monitoring Conversations/moods
Conversation Monitoring
What I Said What they said What I said

Monitoring Moods
Time Situation 0-10 Mood
Rating

Deep Survival
• Laurence Gonzales on Key Elements of Survival:
Link to AS?

Them vs. Us
• Extending these ideas to “typical” individuals
• Changing our own ways of thinking and Culture
to “fit the person with AS” versus “changing the
person with AS to fit the culture”

AS and Culture
• Dominant Culture Forces its views
• Perceived Racism
• How we treat AS individuals reflects the kind of
world we want to live in
• How we treat AS individuals reflects our own
feelings about our own “inner geek”

Other Counseling Issues
• Physical Activity
• Being clear
• Assessing Readiness (e.g., to hear about
diagnosis; to advance to next step in treatment)
• Teaching how to ask questions
• Using alternative methods of communication
• Meeting out of office

Challenge Question
• How do you feel about using non-traditional
counseling methods?

Case Study
• Present Your Cases
• How would you incorporate elements of today’s
class to these people’s lives?

Getting Funding
• Changemakers
• Doug Flutie Jr. Foundation
• N.I.H.
• Autism Speaks
• Ben and Jerry’s
• Local Developmental Services (MDS)

Turnaround
• Anything you would like to say?
• Questions?

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