# Presentation: 160681

## Asperger's Syndrome

**Supporting Students on the Spectrum**

## Presenters

- Dr. Vicki Boyd
- 	Center Mental Health Consultant
- 	Humanitas
- Debbie Jones
- 	Disability Specialist
- 	Humanitas

## What is the spectrum?

- Autism is one of five disorders coming under the umbrella of Pervasive Developmental Disorders (PDD), a category of neurological disorders characterized by "severe and pervasive impairment in several areas of development,” including social interaction and communications skills.
- The five disorders under PDD are
- Autistic Disorder
- Asperger's Disorder
- Childhood Disintegrative Disorder (CDD)
- Rett's Disorder
- PDD-Not Otherwise Specified (PDD-NOS)

## What is the spectrum?

- Hans Asperger, a Viennese pediatrician, was the first individual to identify a cluster of clinical characteristics in a group of children that is now recognized as Asperger’s disorder or syndrome.

## Diagnostic Criteria

- According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), an individual who has received a diagnosis of Asperger’s Syndrome generally has the following features:
- Impairments in social interaction which may include:
- impairments in the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
- failure to develop age-appropriate peer relationships
- a lack of spontaneous interest in sharing experiences with others
- lack of social or emotional reciprocity

## Diagnostic Criteria

- Restricted repetitive and stereotyped patterns of behavior, interests and activities which might include one or more of the following:
- preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- inflexible adherence to specific, nonfunctional routines or rituals
- stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting), or preoccupation with parts of objects
- There is no clinically significant delay in either general cognitive function, self-help/adaptive skills, interest in the environment or overall language development.

## Dr. Temple Grandin

**Notes:**
She is known world wide for her work on the design of livestock handling facilities. In North America half the cattle are handled in systems she has designed. 
Dr. Grandin didn't talk until she was three and a half years old, communicating her frustration instead by screaming, peeping and humming. In 1950, she was labeled "autistic," and her parents were told she should be institutionalized. She tells her story of "groping her way from the far side of darkness" in her book Emergence: Labeled Autistic, a book which stunned the world because, until its publication, most professionals and parents assumed being diagnosed "autistic" was virtually a death sentence to achievement or productivity in life.Even though she was considered "weird" in her young school years, she eventually found a mentor, who recognized her interests and abilities, which she later expanded into becoming a successful livestock handling equipment designer, one of very few in the world. She has designed the facilities in which half the cattle are handled in the United States, consulting for firms such as Burger King, McDonald's, Swift and others.She presently works as an Associate Professor at Colorado State University but also speaks around the world on both autism and cattle handling. 

## True or False

- All individuals with Asperger’s Syndrome have the same manifestations of their disability and the same needs?
- False

## True or False

- Individuals with Asperger’s Syndrome can have meaningful jobs and live independently.
- True

## True or False

- Many individuals with this syndrome desire to have friendships.
- True

## True or False

- Individuals with Asperger’s Syndrome do not make eye contact.
- True and False (some do and some do not)

## Accommodation Considerations

- Individuals with the same diagnosis may and often do have needs that are unique to them; the same disability may manifest itself in different ways in different people.

## Accommodations -Social Interaction

- Provide a place for down time and/or time to be alone each day.
- Provide a peer buddy for support.
- Educate other students about Asperger’s Syndrome.
- Provide opportunities for the student to provide assistance or tutoring to someone else, perhaps in his/her particular area(s) of interest.

## Accommodations -Communication

- Use concrete, clear, short statements in providing instruction and direction to the student.  Use of idioms or sarcasm may inadvertently positively reinforce inappropriate behavior.  For example,  a sarcastic “Oh that was great!” may be taken literally.
- Allow extra time for the student to process the question and provide a response.  Often if interrupted, the student will have to start his thought process all over again.

## Accommodations -Comprehension

- Break down directions into simple steps.
- Using visual cues to assist in providing directions or when demonstrating new skills.
- Slow speech down when providing directions or delivery material content.
- When presenting multi-step directions, pause between instructions and check for comprehension.
- Incorporate visual cues and graphics organizers with written expression tasks.
- Provide visual picture strips to help the student remember what to do and in what order.

## Accommodations -Transitions

- Provide visual or electronic organizers for daily routine.  Review each day’s activities and if using a visual organizer, have student highlight any changes in routine.
- Provide structured routines wherever possible.
- Provide advance notice before a change in activity or use extra verbal and/or visual cues if needed to aide successful transition.
- Provide direct instruction on how to make a transition.

## Accommodations -Organizational Skills

- May require explicit, direct instruction in use of study and organizational skills.
- Use graphic organizers to brainstorm and organize outlines for writing.
- Use an electronic organizer to manage schedule, appointments, reminders.
- Use checklists to keep up with materials (in career technical training, especially).
- Use more structured routines and schedules.

## Accommodations -Attention/Distractibility

- Allow the student to have brief periods of movement to refocus attention.
- Keep desk or work area organized and clutter free.

## Accommodations -Handwriting

- Allow the use of computers or as appropriate, voice dictation software in place of hand written work.
- Provide copies of notes.

## Accommodations -Auditory Processing

- Give the student ample time to process what has been said.
- Give the student advance notice of questions you might call on him/her to answer in class.
- Present oral information in smaller chunks and provide written copy of notes or information.

## Accommodations -Sensory Processing

- Allow student to go to a quiet place if there is a lot of chaos and noise heightening sensory responses (i.e., distractibility, agitation, stimming, etc.).
- Provide earplugs or noise-cancelling headsets for managing transitions between classes, during lunch, or for use in other noisy environments.

## Accommodations -Test Taking

- Allow use of computer for writing.
- Allow extra time for test taking.
- Provide quiet, low distraction, test environment.

## Behavioral Considerations

- Individuals with Asperger’s Syndrome can interpret rules literally and can be rigid about following them in a particular way.
- Teach the student cause/effect relationships for better understanding of center and rule requirements.
- Preferably write the rules down for them and review together.
- Have them explain what the rules mean to them.  Clarify as needed.
- Provide anger skill management training (if appropriate and warranted).

## Behavioral Considerations

- Avoid escalating power struggles as these individuals may not understand the situation or pick up on the anger until it is too late.  They may become more rigid and stubborn if confronted in a forceful and rigid method.
- If the student is becoming more rigid, stubborn, or resistant to direction.  Step back and give the individual time to cool down.
- Remain calm.

## Behavioral Considerations

- Take preventative action to avoid these situations whenever possible.
- Use humor to diffuse tension.
- Offer two choices as options (if possible).
- Redirect through diversion of attention to something else.
- Again, allow time for the individual to regroup and regain level of calmness.

## Strategies

- Teach student to know his/her preferred learning styles and what works best for them as individuals. [Temple Grandin, a scientist and author who also has autism, talks about “thinking in pictures”. She says that words are like a second language to her. She actually translates both spoken and written words into full color movies, complete with sound that runs like a VCR tape in her head].
- Provide clear concrete expectations and rules for behavior.

## Strategies

- Conduct role playing to teach the use of pragmatic language and social cues (i.e., when is it ok to interrupt, taking turns speaking).
- If the student engages in perseverative questioning that interferes with classroom instruction, you can try instructing the student to write the question down and that you will discuss it with him later in the class period.  Incorporate a private visual signal that lets the student know that you will talk with him or her later but not now.

## Strategies

- Check for understanding; the student could just be parroting what he or she has heard.
- Maintain a calm speaking voice when addressing or instructing this student.
- Provide sensitivity training (disability awareness) to all staff and students, as appropriate.

## Asperger’s Syndrome and Employment DVD

- Nick Dubin, who is diagnosed with Asperger's Syndrome, discusses his own experiences at work and highlights challenges common to many individuals diagnosed with High Functioning Autism or Asperger's Syndrome .
- The DVD also includes interviews with Nick's former employers who assess his strengths and weaknesses, as well as commentary from Gail Hawkins (author of the book, How to Find Work that Works for People with Asperger's Syndrome) who relates Nick's experiences to those she sees in her work with people with AS.

## Study 

- Meeting the Vocational Support Needs of Individuals with Asperger’s Syndrome and Other Autism Spectrum Disabilities
- Eve Müller, University of California at Berkeley and San Francisco State University Department of Special Education
- Adriana Schuler, San Francisco State University Department of Special Education
- Barbara A. Burton, University of California at Berkeley and San Francisco State University Department of Special Education
- Gregory B. Yates, ASD Peer Liaison, AUTASTICS

## Positive and Negative Experiences

- Four major themes emerged in response to questions relating to positive and negative experiences within the workplace:
- diverse vocational interests
- patterns of unemployment and underemployment
- work as a generally negative experience, and
- exceptions to the rule – i.e., the isolated positive experience

## Obstacles to Successful Employment

- Study found four major themes:
- mastering the job application process
- acclimating to new job routines
- communication
- navigating social interactions with supervisors and co-workers

## Career Technical Support Recommendations

- Grouped into five major themes:
- job matching
- individualized ASD-specific job supports
- communication supports
- autism awareness training
- attitudinal supports

## Resources

- Books
- Look Me in the Eyes, John Elder Robison
- Right Address...Wrong Planet, Gena P. Barnhill
- Ten Things Your Student with Autism Wishes You Knew, Ellen Notbohm
- Thinking in Pictures, Expanded Edition: My Life with Autism, Temple Grandin
-  The Unwritten Rules of Social Relationships: Decoding Social Mysteries Through the Unique Perspectives of Autism, Temple Grandin
-  The Out of Sync Child, Carol Kranowitz (Sensory Processing Disorder)

## Resources	

- Dr. Vicki Boyd, Regional Mental Health Consultant
- 	Humanitas
- 	vdelboyd@aol.com
- Dr. Andrew Berger, Regional Mental Health Consultant
- 	Humanitas
- 	headoc@aol.com
- Sylvia Domagalski, Regional Disability Consultant
- 	Humanitas
- 	sjdnurse@aol.com