Understanding Asperger's Disorder


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Understanding Asperger's Disorder

  1. 1. A Neuropsychological Perspective Wednesday, April 15, 2009 Gorham Campus, University of Southern Maine Presented by: Bernice Conklin-Powers, Psy.D.
  2. 2. What is Asperger’s Syndrome? Asperger’s Syndrome is a pervasive developmental disorder characterized by the following diagnostic features or symptoms (DSM- IV Criteria):  Marked impairment in social interaction  Marked impairment in non-verbal behavior  Failure to develop peer relationships  Lack of spontaneous seeking to share interests with others  Lack of social or emotional reciprocity  Restricted, repetitive and stereotyped patterns of behavior, interests, and activities  Encompasses preoccupations with stereotyped or restricted interests  Inflexible adherence to routines or rituals  Stereotyped and repetitive motor movements  Persistent preoccupation with parts of objects
  3. 3. However…  Each individual with Asperger’s Syndrome (AD) has a unique cognitive, emotional, social, and behavioral profile.  “One size fits all” solutions do not pertain when it comes to working with individuals with Asperger’s Syndrome.  There is no “magic bullet” or “quick fix” when it comes to managing challenges in your relationship with an individual with Asperger’s Syndrome (although maintaining an attitude of openness and curiosity helps!)
  4. 4. Facts About Asperger’s Syndrome  Prevalence rates vary by study (@2.5/10,000)  It is a disorder that is more common in boys than girls (ratio rates vary by study (4:1 to 8:1).  Asperger’s Syndrome is caused by a variety of genetic and biological factors.  Common neuropsychological profiles (weak pragmatic language, poor memory, poor motor coordination, weak executive functioning, etc.)  Distinguished from other forms of autism by relatively intact overall IQ and verbal skills.  Frequent co-morbid diagnoses include ADHD and specific learning disabilities (particularly dysgraphia).
  5. 5. Cognitive Features of Asperger’s Syndrome  Cognitive perseveration – particularly regarding preferred topics  Cognitive inflexibility or rigidity  Poor processing of information communicated non-verbally (humor, sarcasm, innuendo, etc.)  Challenges with abstract language – can be overly concrete and literal  Poor executive functioning (organization, planning, etc.)  Difficulty with main points or global concepts (perceiving the “forest from the trees”)  Poorly developed “theory of mind” resulting in difficulty observing the situation from the perspective of another individual.
  6. 6. Recognizing the Cognitive Features  Difficulty perceiving the perspective, feelings or needs of others in conversations or interpersonal exchanges.  Rigidity and inflexibility in thinking and/or communication (increases under stress)  May have difficulty getting the “gist” of a conversation.  Difficulty managing time and meeting deadlines  Difficulty completing homework or other academic demands  Difficulty with study skills (developing a study plan, monitoring progress, revising as needed)  Can be overly perfectionistic and inflexible in their approach to tasks  Difficulty with written expression, particularly long-range and/or complex writing assignments  Difficulty with sustained attention, easily distracted
  7. 7. Managing the Cognitive Features  Use clear & specific in your language (avoid humor, sarcasm, idioms, metaphors, etc)  Individuals with Asperger’s Syndrome benefit from clear communication and structure. Be clear and specific in your language and in your expectations.  Check, don’t assume comprehension  Use concrete examples to elucidate abstract points  Break multi-step tasks or communications down into smaller parts or segments  Provide a visual (and refer to it) whenever possible when communicating important information  Provide individualized academic accommodations. Menu of suggestions for academic accommodations will be provided in a handout.
  8. 8. Behavioral Features of Asperger’s Syndrome  Repetitive or stereotyped behaviors  Adherence to routines and rituals, particularly calming and stress reduction rituals  Difficulty with transitions or (unexpected) changes  Poor self-monitoring  Poor verbal inhibition  Restless  Difficulty with emotional regulation, particularly if anxious or over-stimulated
  9. 9. Recognizing the Behavioral Features  Idiosyncratic gestures or behaviors such as hand flapping  “Calming rituals” such as pacing or rocking  Bringing “comfort items” to class  Interrupting lectures with questions  Monopolizing class discussions  Continuing to talk after being asked to stop  Correcting or arguing with instructor or classmates  Strong reactions to small sensory events (noises, lights, etc.)  May have difficulty regrouping after becoming frustrated or upset  Strong preference for routine
  10. 10. Managing the Behavioral Features  Include explicit and specific directions up front (syllabus, residential life info, etc., regarding behavioral norms and expectations  Be consistent in enforcing behavioral norms and expectations.  Provide an “exit” during classes or activities for the student to take a break and regroup if needed.  If behavioral issues arise, address them privately. Be clear and specific. Keep it simple. Summarize at the end and check comprehension. Provide a written summary or follow-up.  If additional intervention is required use consultation as appropriate to the situation.
  11. 11. Emotional Features of Asperger’s Syndrome  Variable motivation is high for preferred tasks, low for non-preferred tasks.  At higher risk for symptoms of anxiety and/or depression  Vulnerable to becoming emotionally overwhelmed under stress or when faced with change  May appear to others to lack empathy for others or lack emotional reciprocity  May have difficulty communicating feelings in a way that is clear to others (verbal communication may conflict with non-verbal communication)  Poor emotional monitoring and regulation  Stress or emotional distress often results in behavioral symptoms (increased perseveration, rigidity, etc.)
  12. 12. Recognizing the Emotional Features  May become upset or emotional if routines or schedule is changed or interrupted unexpectedly  May become excessively stressed by typical academic demands such as quizzes, presentations, group work, etc.  May be particularly emotionally sensitive to common learning events such as making a mistake, getting corrective feedback (even if it is done supportively)  Can be impatient and easily frustrated if they misunderstand or are misunderstood  May have difficulty containing or regrouping once upset  May engage in repetitive calming behaviors or rituals when stressed or upset (rocking, pacing, etc)
  13. 13. Managing the Emotional Features  Understanding and planning for emotional needs will minimize behavioral expressions of distress.  If an individual with Asperger’s Syndrome is distressed, communicate deliberately (allow processing time) and clearly. Focus on a short, basic message.  Avoid engaging in debates or arguments. Simply repeat concise, clear direction. Do not add additional language (additional processing demands).  If the individual continues to be perseverative, or argumentative, end the conversation in a firm but supportive manner. Once an individual with Asperger’s is “stuck” continuing to discuss or debate may be counterproductive (and may produce increased distress and agitation).
  14. 14. Social Features of Asperger’s Syndrome  Inability to process non-verbal social information  Difficulty reading the non-verbal feedback of others and adjusting behavior accordingly  Poor understanding of social rules or norms of behavior  Poor flexibility in social skill repertoire  Difficulty understanding social “cause and effect”  Lack of social reciprocity (turn-taking, reciprocal social greetings, etc.)  Difficult seeing another person’s perspective  Difficulty forming age appropriate peer relationships  A tendency to be easily slighted or annoyed in social exchanges
  15. 15. Identifying the Social Features  Unusual non-verbal behavior, such as reduced eye contact  Difficulty with the social demands of small group work (choosing group members, negotiating differences of opinion, social give and take, etc.)  May violate unspoken social norms, such as intruding into the personal space of others  Difficulty monitoring and regulating volume of voice  May present as arrogant or rude to others due to poor processing of social information  May have difficulty asking for help or accommodations  May have difficulty responding to feedback or criticism  May have difficulty letting go of an issue and moving on in response to differences of opinion  May lack tact in social situations
  16. 16. Managing the Social Features  Try not to take aversive behaviors personally. Keep in mind that aversive behaviors are often the result of processing challenges and skill deficits.  Avoid responding to arguments or debates.  Be mindful of the challenges that partner of group work might present.  Be mindful of calling on student and putting them “on the spot” unless they volunteer.  Practice flexibility with regard to effort and participation or other expectations of social participation.  Integrate expectations regarding social issues into syllabus or other written guides.  When addressing social concerns, do so privately.  If a student has a declared disability, meet with them early in the semester to develop rapport and establish and clarify expectations.  Individuals with Asperger’s may benefit from social algorithms or clear “if…then” statements of how to handle particular social situations.
  17. 17. Basic Steps to Address Issues or Concerns  Understanding the key neuropsychological features of the disorder and prevention are your best tools in avoiding problems from developing.  The best prevention strategies are introducing clear structure and expectations at the outset (especially in written form).  If issues arise, first speak with the student privately (see handout on tips for successful conferencing).  If concerns continue, contact the Office of Student Services to discuss a plan of action.