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AS Presentation Ahead07

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Workshop presentation on working with college students with Aspergers syndrome

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AS Presentation Ahead07

  1. 1. Asperger Syndrome Unraveled: Applied Strategies for Successful Integration into Campus Life Presented by: Louise Bedrossian, Ed.S, LPC and Rodney Pennamon, M.Ed. Georgia State University © Louise E. Bedrossian and Rodney E. Pennamon, 2007. All rights reserved. May not be reproduced without permission.
  2. 2. What is Asperger Syndrome? <ul><li>Named for a Viennese psychiatrist, Hans Asperger </li></ul><ul><li>Published a paper in 1944 describing a pattern of behaviors and abilities primarily in boys. </li></ul><ul><li>Leo Kanner, an Austrian psychiatrist in his 1943 paper, also focusing on children noted the three basic characteristics that today are recognized as defining autism . </li></ul><ul><li>These include social difficulties, communication problems and repetitive and restricted activities . </li></ul>
  3. 3. What is Asperger Syndrome? <ul><li>In 1981 Lorna Wing, a British autism expert , published a paper bringing to the forefront the work of Hans Asperger and Leo Kanner . </li></ul><ul><li>In the work of Wing and Gould they refer to these characteristics described by Kanner as the” triad of impairments.” </li></ul><ul><li>1990’s diagnostic criteria for AS were included in the DSM-IV and the ICD10. The following impairments were listed: social interaction, social communication, social imagination and absence of general delay in language development </li></ul>
  4. 4. What is Asperger Syndrome? <ul><li>The DSM-IV-TR lists the following characteristics as indicative of impairment in social interaction for AS, specifying that at least two must be present: </li></ul><ul><li>Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction </li></ul><ul><li>Failure to develop peer relationships appropriate to developmental level </li></ul><ul><li>A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) </li></ul>
  5. 5. What is Asperger Syndrome? <ul><li>Lack of social or emotional reciprocity </li></ul><ul><li>Other associated features may include motor clumsiness and awkward movements, as well as inattention </li></ul><ul><li>BUT </li></ul><ul><li>What do these students really look like when they are standing in front of us? </li></ul><ul><li>Can we recognize the student who is likely to have such a disorder? </li></ul>
  6. 6. What is Asperger Syndrome? <ul><li>HAVE YOU MET THIS STUDENT? </li></ul><ul><li>Often does not understand non-verbal/social cues </li></ul><ul><li>Avoids eye contact </li></ul><ul><li>Flat affect </li></ul><ul><li>Poor reciprocal conversational skill </li></ul><ul><li>Prosody is unusual </li></ul><ul><li>Sensory sensitivity/sensory integration problems </li></ul><ul><li>Unusual awkward gait … </li></ul>
  7. 7. What is Asperger Syndrome? <ul><li>People who are “loners” </li></ul><ul><li>Concrete thinking </li></ul><ul><li>Verbose on focused issues </li></ul><ul><li>Central coherence difficulties </li></ul>
  8. 8. Inside the Asperger Mind <ul><li>People with AS perceive the world differently. </li></ul><ul><li>Temple Grandin : “an anthropologist on Mars.” “…thinking in pictures;” “Words are like a second language to me.” “…sensory based language put into memory” </li></ul><ul><li>Bob Morris :AS “…see things with six degrees of freedom;” “…getting into a machine and swimming in it.” </li></ul><ul><li>Therese Joliffe : “…on a planet with alien creatures” </li></ul>
  9. 9. What it Looks Like from the Outside <ul><li>Theory of Mind: Inability to understand others’ plans, thoughts and points of view </li></ul><ul><li>Communication: Problems with language pragmatics, voice inflection & modulation (receptive & expressive) </li></ul><ul><li>Literal Thinking: Do not grasp abstract language or idiomatic expressions. </li></ul><ul><li>Unexpected Change: difficulty making sense of changes & adjusting. Order and predictability highly preferred. </li></ul>
  10. 10. What it Looks Like from the Outside <ul><li>Sensory Sensitivity: </li></ul><ul><ul><li>Often respond with more slowly and with greater sensitivity to sensory stimuli; </li></ul></ul><ul><ul><li>Difficult for the individual with AS to absorb and process these constant changes </li></ul></ul><ul><li>Preoccupation with a Subject: </li></ul><ul><ul><li>May focus on it to the exclusion of other activities; </li></ul></ul><ul><ul><li>Often unaware of others losing interest in their discussion of this passion </li></ul></ul>
  11. 11. Commonly Co-Morbid Disorders and Initial Diagnoses <ul><li>Depression -Affects about one in fifteen people with AS </li></ul><ul><li>Anxiety -Affects 84.1 percent of children with PDD and continues into adulthood </li></ul><ul><li>Obsessive-compulsive disorder- Third commonly occurring mental health problem among those with Asperger syndrome; </li></ul><ul><ul><li>8% of children with AS, and continues to adulthood </li></ul></ul><ul><li>Eating disorders- Focus on rules and perfectionism with misunderstanding of usage may contribute to incidence </li></ul>
  12. 12. Accommodations and Strategies <ul><li>Common Functional Limitations </li></ul><ul><li>Sensory sensitivity </li></ul><ul><li>Difficulties in understanding social interactions </li></ul><ul><li>Problems with both expressive and receptive communication </li></ul><ul><li>Slower processing of auditory information </li></ul><ul><li>Difficulties with comprehending cognitive information, including very literal interpretations, and difficulties with understanding main or overriding concepts. </li></ul><ul><li>Tendency to become fixated on details </li></ul><ul><li>Inflexible thinking tendencies and patterns </li></ul><ul><li>Inefficient ability to regulate emotions </li></ul><ul><li>Trouble with organizational tasks </li></ul><ul><li>Poor motor coordination </li></ul>
  13. 13. Accommodations and Strategies <ul><li>Testing Accommodations: </li></ul><ul><li>Extended testing time </li></ul><ul><li>Testing in a distraction-reduced environment </li></ul><ul><li>Use of a computer with word processing software, especially for essay tests and those that require extensive writing. </li></ul><ul><li>Use of organizational software such as Inspiration for writing and organizing ideas </li></ul><ul><li>Use of noise reducing devices such as white noise machines, head phones and earplugs </li></ul>
  14. 14. Accommodations and Strategies <ul><li>Classroom Accommodations: </li></ul><ul><li>Use of audio recorders </li></ul><ul><li>Use of a volunteer note-taker </li></ul><ul><li>Access to PowerPoint presentations or instructors’ notes (preferably in advance, if available) </li></ul><ul><li>Priority registration </li></ul><ul><li>Behavioral contracts/guidance (not code of conduct issues) </li></ul><ul><li>Priority seating (if needed) </li></ul>
  15. 15. Accommodations and Strategies <ul><li>Other Accommodations: </li></ul><ul><li>Single/private dormitory room </li></ul><ul><li>Assistance of dormitory personnel in case of an emergency situation, should a student become immobilized or unusually agitated and unable to respond, evacuate, etc. </li></ul>
  16. 16. Accommodations and Strategies <ul><li>Common Strategies : </li></ul><ul><li>A list of activities and specific limited choices </li></ul><ul><li>Clear instructions (i.e. routines, calming down) </li></ul><ul><li>Behavioral rules </li></ul><ul><li>Written guidelines </li></ul><ul><li>Task checklists </li></ul><ul><li>Task instruction cards (i.e. what you will need, don’ts, steps) </li></ul><ul><li>Reminders </li></ul><ul><li>Interpersonal communication advice (i.e. what to say, how to ask for help) </li></ul><ul><li>Explanations and key elements of common social situations </li></ul><ul><li>Organizational methods (i.e. schedules, wall calendars, notebooks)- </li></ul><ul><li>A Resource notebook (i.e. financial, housing, leisure options, “who to call if…”) </li></ul><ul><li>Advance training and job preparation (i.e. internships, part-time? employment) </li></ul>
  17. 17. Accommodations and Strategies <ul><li>Common Strategies (Continued): </li></ul><ul><li>Explanations and key elements of common social situations </li></ul><ul><li>Organizational methods (i.e. schedules, wall calendars, notebooks)- </li></ul><ul><li>A Resource notebook (i.e. financial, housing, leisure options, “who to call if…”) </li></ul><ul><li>Advance training and job preparation (i.e. internships, part-time? employment) </li></ul><ul><li>Develop a Student Success Plan… </li></ul><ul><li>(Sample template available in upcoming publication: </li></ul><ul><li>College Students with Asperger Syndrome: Practical Strategies for Academic and Social Success , LRP Publications) </li></ul>
  18. 18. Successful Internships <ul><li>Previous general work experience helps prepare </li></ul><ul><li>Explore the workplace environment beforehand for stimuli that are noxious to the student </li></ul><ul><li>Clear job description, list of duties and expectations in advance is critical </li></ul><ul><li>Determine needed modifications and accommodations </li></ul><ul><li>Institution-sponsored worksites offer opportunity for educating employer about AS, and other interventions </li></ul><ul><li>Student must be “otherwise qualified” and meet all technical standards </li></ul>
  19. 19. Coping with the Unexpected, Changes and the Adverse <ul><li>More disturbing for a longer period to those with AS </li></ul><ul><li>Students need a plan for coping with unexpected changes such as: </li></ul><ul><ul><li>The test does not arrive at the alternate testing location </li></ul></ul><ul><ul><li>The expected professor is not teaching the course </li></ul></ul><ul><ul><li>The student’s car breaks down on the way to campus for class </li></ul></ul><ul><ul><li>There is suddenly a new roommate </li></ul></ul><ul><ul><li>Road construction closes the usual route to school or work </li></ul></ul><ul><ul><li>There is a new disability service provider </li></ul></ul>
  20. 20. Coping with the Unexpected, Changes and the Adverse <ul><li>Students need a plan for coping with noxious stimuli or sensory overload such as : </li></ul><ul><ul><li>Visual : Florescent lighting, crowds, heavy traffic, flashing lights/signs </li></ul></ul><ul><ul><li>Auditory: Fast-paced speech, certain music, construction noise or emergency vehicle sirens </li></ul></ul><ul><ul><li>Smells/Tastes: food odors, chemicals in labs, fragrances,, toothpaste, cleaning product or pesticide odors, smoke, city air pollution </li></ul></ul><ul><ul><li>Tactile: Food textures, clothing, touching objects, solutions or other substances, being touched </li></ul></ul>
  21. 21. Coping with the Unexpected, Changes and the Adverse <ul><li>Calming Routines </li></ul><ul><li>Rocking, Spinning, Pacing </li></ul><ul><li>Rubbing skin or clothing </li></ul><ul><li>Sitting in a warm bath, or hot tub, especially one with circulating water </li></ul><ul><li>Eating/chewing a favorite food, or just eating in general </li></ul><ul><li>Watching something peaceful or monotonous (fireplace, fish tank, etc.) </li></ul><ul><li>Listening to favorite music </li></ul><ul><li>Students should be helped to develop a Disability Management Plan… </li></ul><ul><li>(Detailed discussion in: College Students with Asperger Syndrome: Practical Strategies for Academic and Social Success , LRP Publications) </li></ul>
  22. 22. Coping with the Unexpected, Changes and the Adverse <ul><li>Finding Sanctuary in Times of Stress </li></ul><ul><li>Ending a conversation that is unpleasant or beginning to escalate into aggression </li></ul><ul><li>Learning and practicing deep breathing techniques </li></ul><ul><li>Learning and practicing deep muscle relaxation </li></ul><ul><li>Using mental imagery that is calming </li></ul><ul><li>Repeating affirmations or a favorite line or phrase from music or literature </li></ul><ul><li>Getting to a predetermined private place, such as the student’s room or disability services office, where other calming and satisfying behaviors can be performed </li></ul><ul><li>Creating a calming daily routine on which to focus during unavoidable stressful situations that are routine   </li></ul>
  23. 23. Communication and Social Interaction <ul><li>Problems with communication and social interaction </li></ul><ul><li>Marked impairment in the use of multiple nonverbal behaviors </li></ul><ul><li>Failure to develop appropriate peer relationships </li></ul><ul><li>A lack of spontaneous seeking to share </li></ul><ul><li>Lack of social or emotional reciprocity </li></ul><ul><li>Difficulty with Theory of Mind </li></ul><ul><li>YET… </li></ul><ul><li>75 to over 90 percent of communication is non-verbal </li></ul><ul><li>Some say these skills can be taught </li></ul>
  24. 24. Communication and Social Interaction <ul><li>Building Social Skills and Connections </li></ul><ul><li>Social Rules- concrete examples that demonstrate “rules </li></ul><ul><ul><li>Build a bank of rules and discuss transferability to other situations </li></ul></ul><ul><li>Social Stories -describe a social situation in a systematic fashion </li></ul><ul><ul><li>Descriptive - describe a situation or event </li></ul></ul><ul><ul><li>Directive - describes how the reader should act in a situation </li></ul></ul><ul><li>Learning to read and non-verbal language though training programs such as those in books by Baron-Cohen (Mind Reading) & Ekman (Emotions Revealed) </li></ul>
  25. 25. Communication and Social Interaction <ul><li>Finding a Social Group </li></ul><ul><li>Radio </li></ul><ul><li>Film and video </li></ul><ul><li>Robots </li></ul><ul><li>Computer gaming </li></ul><ul><li>Fantasy </li></ul><ul><li>Pets and animals </li></ul><ul><li>Computer generated or other music </li></ul><ul><li>Trains or other mechanical interests </li></ul><ul><li>Other computer applications </li></ul><ul><li>Alternative for Social Interaction Practice: </li></ul><ul><li>SecondLife.com </li></ul>
  26. 26. Organizational Skills and Asperger Syndrome <ul><li>Because of neurodevelopmental deficits, planning, organization, initiation and execution of goals are lacking for the student with Asperger syndrome. </li></ul><ul><li>The student with AS might be clueless on how to begin a task, such as writing a paper, that requires multiple steps. </li></ul><ul><li>Another common problem is committing to do too much, which can lead to unnecessary stress. </li></ul>
  27. 27. Organizational Skills and Asperger Syndrome <ul><li>Overall role for the provider and goal for the student should be development of self-management skills. </li></ul><ul><li>Developing methods for the student to self-reinforce positive behavior, as well as to understand the purpose or reason for the behavior or task, increases probability of success for the student with AS. </li></ul>
  28. 28. Organizational Skills and Asperger Syndrome <ul><li>Identifying the problem is the first step, followed by implementing useful techniques that the student can utilize long after they have left the college campus. </li></ul><ul><li>The disability service provider may wish to spend time exploring the problems the student is having and develop effective solutions. </li></ul>
  29. 29. Organizational Skills and Asperger Syndrome <ul><li>Schedules </li></ul><ul><li>Calendars </li></ul><ul><li>Action steps </li></ul><ul><li>To Do/Task Lists </li></ul><ul><li>Visual Reminders </li></ul><ul><li>Setting manageable goals </li></ul><ul><li>Time table </li></ul><ul><li>Resources </li></ul>
  30. 30. Service Providers and Students with Asperger Syndrome <ul><li>Student needs are complex and multifaceted </li></ul><ul><li>Preparing in advance will save time, effort and problems for service provider </li></ul><ul><li>Student and support system personnel must take much responsibility </li></ul><ul><li>Students’ use of a self-prepared Resource Book can be effective strategy </li></ul><ul><li>Use of other campus resources is efficient and aids student success, retention, and graduation rates </li></ul>
  31. 31. Asperger Syndrome Unraveled: Applied Strategies for Successful Integration into Campus Life <ul><li>References </li></ul><ul><li>Baron-Cohen, S., Mind Reading (2003), Jessica Kingsley Press, London and New York. </li></ul><ul><li>Baron-Cohen, S., DVD-ROM, Mind Reading: An Interactive Guide to Emotions, (2003) Jessica Kingsley, Ltd., London </li></ul><ul><li>Ekman, P., Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotions Life, (2003) Time Books, New York </li></ul><ul><li>Grandin, T., Thinking in Pictures, Doubleday, New York, 1995 and, Vintage Books, New York, 2006 </li></ul>
  32. 32. Asperger Syndrome Unraveled: Applied Strategies for Successful Integration into Campus Life <ul><li>References (Cont.) </li></ul><ul><li>Gross, T., Temple Grandin: A Key to Animal Behavior, on Fresh Air , National Public Radio , on the web at </li></ul><ul><li>http://wwwnpr.org/templates/story/story/php?storyId=4278538&sc=emaf , January 11, 2005 </li></ul><ul><li>Joliffe, T., Lansdown, R. and Robinson T. (1992) Autism: A Personal Account. National autistic Society, London </li></ul><ul><li>Sacks, O., Neurologist’s notebook: An anthropologist on Mars, New Yorker, and December 27, 1993 </li></ul>
  33. 33. Asperger Syndrome Unraveled: Applied Strategies for Successful Integration into Campus Life <ul><li>General Resources </li></ul><ul><li>The Complete Guide to Asperger’s Syndrome by Tony Attwood (2006) </li></ul><ul><li>Succeeding in College with Asperger Syndrome by John Harpur, Maria Lawlor, and Michael Fitzgerald (2004) </li></ul><ul><li>The Unwritten Rules of Social Relationships by Temple Grandin and Sean Barron (2005) </li></ul><ul><li>Pretending to be Normal: Living with Asperger’s Syndrome by Liane Holliday Willey and Tony Attwood (1999) </li></ul>
  34. 34. Asperger Syndrome Unraveled: Applied Strategies for Successful Integration into Campus Life <ul><li>Websites </li></ul><ul><li>Autism Society of America- www.autism-society.org </li></ul><ul><li>Autism Speaks- www.autismspeaks.org </li></ul><ul><li>HEATH Resource Center- www.heath.gwu.edu </li></ul><ul><li>National Autism Association- www.nationalautismassociation.org </li></ul><ul><li>National autism Society, (UK) Glossary of Terms-www.nas.org.uk/nas/jsp/polopoly.isp?d=666 </li></ul><ul><li> OASIS (Online Asperger Syndrome Information and Support)- www.udel.edu/bkirby/asperger </li></ul><ul><li>University Students with Autism and Asperger Syndrome- www.cns.dircon.co.uk/index.html </li></ul>

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