Autism spectrum disorders
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Autism Spectrum Disorders. Demystifying Autism. Dr. Barbara Luskin September 2014. Who is the Autism Society of Minnesota?. Our mission : as an agency of families, educators, care givers and professionals, we are committed to supporting individuals with ASD and their families

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Autism spectrum disorders

Autism Spectrum Disorders

Demystifying Autism

Dr. Barbara Luskin

September 2014


Who is the autism society of minnesota

Who is the Autism Society of Minnesota?

Our mission: as an agency of families, educators, care givers and professionals, we are committed to supporting individuals with ASD and their families

Our vision: to realize its mission through education, support, collaboration and advocacy.

Established in 1971 as the local presence of the autism community in MN we have provided over 40 years of services and programs that have enhanced the lives of individuals with ASD


Speaker bio

Speaker Bio

  • Dr. Barbara Luskin, PhD, LP is a licensed psychologist who has worked with people with autism in various capacities for over 20 years. She earned her PhD from the University of Chicago in Human Development. For the past 11 years Dr. Luskin has provided mental health services at the Autism Society of Minnesota (AuSM). Much of her practice involves the diagnosis of and therapy for adults with ASD . She facilitates a support group for high functioning adults with ASD and provides training and education to families and service providers.


Where have you been

Where Have You Been ?

  • At least 1 in 88 children are diagnosed with an ASD. Perhaps as many as one in 54 males.

  • 30 years ago 4 in 10,00 were diagnosed

  • There is no solid evidence of a dramatic growth in actual occurrence of ASD

  • DSM-IV dramatically changed the criteria


Labeled

Labeled?

  • Personality Disorders (schizoaffective, avoident, schizoid, narcissistic, borderline )

  • MR

  • ADHD

  • ODD

  • Weird, Lazy, Eccentric


Understanding the labels dsm iv

Understanding the Labels-DSM IV

  • Pervasive developmental disorders (PDD) 299

    299.00 autism

    299.80 Asperger syndrome

    299.80 Rett syndrome

    299.10 childhood disintegrative disorder

    299.80 pervasive developmental disorder not otherwise specified (PDD-NOS


Understanding the labels dsm 5

Understanding the Labels DSM 5

  • Autism Spectrum Disorder

  • Social Communication Disorder

  • Specified Neurodevelopmental Disorder

  • Unspecified Neurodevelopmental Disorder


Autism spectrum disorders

  • Autism is a developmental disability that is now diagnosed based on two areas of disorder (as opposed to simply delay). These areas are defined by the American psychiatric association in the DSM-5 as:

  • 1. Qualitative impairment in social interaction and communication.

  • 2. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.


  • Pattern of development

    Pattern of Development

    120

    100

    80

    60

    autism

    Typical development

    Developmental delay

    Motor IQ lang.comp lang.expr social memory


    Autism spectrum disorders

    • Disorder implies that someone does things in a different way rather than doing them in a simpler, slower, or delayed way

  • It may also mean that someone has “splinter” skills. He/she may have some more sophisticated skills without being able to perform more basic activities that usually precede those skills


  • Examples of disorder

    Examples of Disorder

    • Unable to have a conversation but able to remember with great accuracy details of a routine after two or three times

    • Doing Calculus but not understanding basic budgeting

    • Having a college level vocabulary but not knowing how to greet others

    • Having PhD in computer science but being unable to complete a job application


    Autism spectrum disorders

    Asperger vs Autism

    • With the publication of DSM 5 Asperger syndrome is no longer an official diagnosis. In the past it was distniguished from autism in different ways by different professionals. Two main criteria were:

    • IQ above 70

    • Fluent speech


    Qualitative impairment in social interaction

    Qualitative Impairment in Social Interaction


    Use of nonverbal behavior

    Use of Nonverbal Behavior

    • They think you are shifty …”

    • “My boss said I was the calmest one in the dept…..”

    • “How was I supposed to know you were mad?”

    • “What’s the point of waving goodbye?”

    • “I can’t figure out how to join a conversation”

    • “I learned to look at people in high school…”


    Problems in relationships

    Problems in Relationships

    • “ All my friends are people I play music with”

    • “My wife arranges all our social life”

    • “I have always been bullied”

    • “ My coworkers blame everything on me”


    Failure to develop peer relationships

    Failure to Develop Peer Relationships.

    • “I had friends in high school but we’ve lost touch”

    • “People irritate me…”

    • “I really don’t know what friendships mean”

    • “I have two good friends, we see each other once a year.”

    • “I have had hundreds of first dates”


    Lack of sharing of emotions

    Lack of sharing of emotions

    • “I don’t really think about sharing my achievements”

    • “I’d like to share but don’t know how to bring it up”

    • “No one cares about what I am interested in …”

    • “I know I am supposed to say ‘congratulations’ but don’t feel anything.”


    Lack of reciprocity

    Lack of reciprocity

    • “She doesn’t want to talk to me anymore…”

    • “Why should I say good morning when it isn’t one?”

    • “It took me years to realize that other people weren’t robots.”

    • “I don’t get going to an event just because my girlfriend wants to go.”


    Qualitative impairments in communication

    Qualitative Impairments in Communication


    Problems in speech

    Problems in Speech

    • “By the time I get my words organized the conversation has gone on”

    • “When I am upset I can’t talk”


    Problems with conversation

    Problems with Conversation

    • “I hate small talk”

    • “People tell me I talk too much/too little”

    • “Mostly I just sit in a corner and listen”

    • “Things are better since e-mail”

    • People always change the topic before I am finished”


    Autism spectrum disorders

    • “People say don’t interrupt, but they keep interrupting me..”

    • “I’d rather just talk about what I am interested in..”

    • “I have to make other people understand me..”


    Problems in communication

    Problems in communication

    • Basically…”

    • “People tell me I am always too loud..”

    • “People take things the wrong way…”

    • “ I don’t know how to talk informally..”

    • “ I hate poetry…”

      • “I can only say what I have heard”

      • “I can say things better than I can understand them

  • “People should just say what they mean”


  • Difficulty with imagination

    Difficulty with Imagination

    • “Why plan, I don’t know what will happen…”

    • “Its really hard to play with my kids…”

    • “I have a hard time predicting how people will react…”

    • “ I am a terrible liar”

    • “I hate planning activities, I can never think of what to do…”

    • “I never understood why other kids wanted to pretend”


    Restricted repetitive and stereotyped patterns of behavior interests and activities

    Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities


    Unusual focus

    Unusual Focus

    • “How many have spend ½ hour watching the pattern Windows makes ….”

    • “I have been working for years on a dictionary of ancient Summarian…”

    • I’m not interested in gardening so why should I listen to her talk about it?”


    Narrow focus

    Narrow focus

    • “most people are boring”

    • “most of my friends are from the weather chat room”

    • “I just wish my boss would tell me why she wants me to do it.”


    Preference for routine

    Preference for Routine

    • All change is bad..”

    • “Once I have found a good way to do something there is no reason to change..”

    • “Why try a new cereal, I like the old one..”

    • “My world is very chaotic, routines help reduce the chaos..”

    • “ I make it a point to remind people that the employee handbook says…”


    Stereotyped motor mannerisms

    Stereotyped motor mannerisms

    • “I have to do something with my hands”

    • “flapping my hands helps me calm down but I know people think I am crazy…”

    • “I get so mad I start biting myself”

    • “lights really bother me”

    • “I can’t stand the smell of certain foods”

    • “I love the feel of soft flannel”

    • “ I was never good at sports”


    Detail focus

    Detail Focus

    • “I start to do something but get focused on one detail and get distracted..”

    • “I see all the details but not the pattern..”

    • “I can’t recognize faces

    • “All the details are important…”


    Autism spectrum disorders

    • “I save every piece of paper because I can’t figure out which ones I might need”

    • “I can remember every bus route in the cities but I can’t remember my appointments.”

    • “My apartment is a mess…I can’t get it organized.”


    Problems summarizing and generalizing

    Problems Summarizing and Generalizing

    • “ My proposal to the county for using my funds for a new computer system was 20 pages long and they didn’t even read it.”

    • “He tells us more than we ever wanted to know about…”

    • “The job application never gives me enough room to answer the question.”


    Sensory and motor differences

    Sensory and Motor Differences

    • “I have to have something in my hands..”

    • “Flapping my hands helps me calm down but I know people think I am crazy…”

    • “I get so mad I start biting myself…”

    • “Lights really bother me..”

    • “I can’t stand to smell certain foods..”

    • “I love the feel of soft flannel..”


    Ideas for accomodations and supports

    Ideas for accomodations and supports


    Visual supports a picture is worth 1 000 words

    Visual Supports: A Picture is Worth 1,000 Words

    • Schedules

    • Calendars

    • Visual Directions/Models

    • Summary notes from sessions

    • Offer written communication in meetings


    Adjust communication

    Adjust Communication

    • Communicating on different wave lengths

      • Logical AM vs. Emotional FM

  • One thing at a time

    • Differences in information processing

  • Write it down

  • Speech may be better than understanding-clarify

  • Be concrete and specific-avoid non-literal speech and leading questions

  • Don’t rely on nonverbal communication


  • Social stories

    Social Stories

    • Describe upcoming events

    • Describe routine situations

    • Explain other’s emotions

    • Explain expected behavior

    • These can be as complex and detailed as the verbal level of the individual ranging from quite simple to quite complex


    A social story

    A Social Story

    • Jon goes home from work on the bus. Jon lives on 65th street

    • Usually the bus drives on Walnut and then turns on 65th.

    • Today there is construction on Walnut street

    • The bus cannot turn on Walnut street

    • The bus will drive on Oak street instead

    • Jon will get off at the


    Use cartoons and social mapping to

    Use Cartoons and Social Mapping to:

    • Analyze problems

    • Differentiate thoughts from words

    • Explain relationships


    Social map

    Social Map


    Comic strip conversatoin

    Comic Strip Conversatoin


    Video self monitoring

    Video Self Monitoring

    • Video showing a person doing a skill that they want to increase

    • One or two minutes long

    • Use digital editing to create image of new behavior

    • Successful across a range of functioning


    Executive functioning

    Executive Functioning

    • Saying “ok” doesn’t mean I know what to do

      • Make suggestions very concrete

      • Break down goals into very small steps

      • Help schedule when tasks will be done


    Time management people with autism have a different sense of time

    Time Management: People with autism have a different sense of time

    • Teach scheduling

    • Help client explore alarms, timers, etc that may work


    Focus

    Focus

    • People with autism are good at sustained focus but not shifting attention:

      • Avoid jobs that require a lot of multitasking

      • Keep your own sessions focused- one thing at a time


    Sensory accomodations

    Sensory Accomodations

    The client may need:

    • Lower lighting

    • Reduce noise

    • Allow sensory activities

    • Allow plenty of opportunity for movement

      You may need to teach him/her to self advocate


    Self defeating behavior

    Self Defeating Behavior

    • He’s just trying to annoy me!”

    • “She is so noncompliant!”

    • “Ignore him—he just wants attention!”

    • “She just wants her own way!”

    • “He just doesn’t care about anyone”


    Challenging behavior ways asd effects behavior

    Challenging Behavior: Ways ASD Effects Behavior

    • Inflexible thinking

    • Problems with Theory Of Mind

    • Thinking may not be logical

    • Little “thinking” happens when stressed

    • Low tolerance for frustration

    • “Rigid” and concrete thinking

    • Little attention to the reactions of others


    Autism spectrum disorders

    • Strong need for “routine” or “sameness’

    • May be unmotivated by “customary” rewards

    • Difficulty with transitions or change

    • Strong need for closure or “task completion”

    • Difficulty in communicating

    • Poor problem solving skills

    • Poor organizational skills

    • Sensory Issues


    Every behavior has a function

    Every Behavior Has a Function

    Try to understand why a person uses an inappropriate behavior

    • How is he feeling

    • What triggers the behavior

    • Who is this person: skills, temperament, interest

    • What results from the behavior


    Primary reasons for inappropriate behavior in job seekers

    Primary reasons for inappropriate behavior in job seekers

    • Motivation- Is it what the client wants or is it what he thinks he is “supposed to do”

    • Lack of social awareness- not realizing the impact of an action on others

    • Lack of skill- not knowing what else to do

    • Mental Health issues- often overwhelming anxiety


    Offer an alternative

    Offer an alternative

    • Once the reason for inappropriate behavior is identified it is most effective to provide (through suggestion or teaching) a more appropriate alternative.


    Rules rules rules

    Rules, Rules, Rules

    You may need to explain to your client the hierarchy of rules and when they can be broken:

    Laws: Sexual Harassment, Theft

    Major Rules

    Explicit: All phone calls must be logged

    Implicit: Always greet the boss politely

    Minor Rules:

    Explicit: Request items using form C

    Implicit: Fill the water pitcher if you empty it


    Disclosure and self advocacy

    Disclosure and Self Advocacy

    If a disability related behavior cannot be changed and will be misinterpreted disclosure is vital.

    • Diagnosis vs. behavior description- “ I have autism” or “I just can’t get hints- please tell me what you want and need.”

    • Who needs to know?

    • What are reasonable accommodations.

    • Pride not arrogance


    How to get in trouble

    How to get in trouble

    • Always say exactly what you think

    • Have no clue what the difference between an attractive aquaintance and a girlfriend is

    • Ignore all hints


    Autism spectrum disorders

    • “Insist on explaining to the “officer” why you are right”

    • “Insist on obedience to the rules and “fairness at all times.”

    • “Don’t let anything interfere with an important routine.”


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