Asperger Syndrome

1. Asperger Syndrome Asperger Syndrome Rethinking the Glass House Rule

2. Complexity Perhaps student profiles and behaviors are becoming more complex… The Real Question… What is your professional and ethical responsibility?

3. Understanding Asperger - Research Break in the brain Cannot figure it out Cognitive ability does not = social skill development Not holding back on social skills Activity: Conversation without looking at the person’s eyes

4. Aspergers Aspergers – Seeking guidance from someone who probably knows what to do is usually not a first or even a second thought. The student with Aspergers might be sitting next to someone who could obviously help but appears blinkered and determined to solve the problem by himself. Atwood, 2007

5. Fat lady in the grocery store Student with Aspergers remarks in his usual tone of voice and volume, “That lady is fat and needs to go on a diet” The child’s opinion is that she should be grateful for the observation and advice, the likelihood that his mother will be embarrassed or the woman would be offended at such a rude comment is not part of the thinking process. Atwood, 2007

6. “People expect cognition and social functioning to be equally developed. When kids with Asperger’s Syndrome experience difficulty they [public] wrongly assume it is deliberate misconduct.”(A. Klin and F. Volkmar, 1997) Public Assumptions

7. Making Associations – Right or Wrong

8. Create rigid rule structures to make order in ambiguity Playing with toys for young children and the child molester “NO LEFT TURNS!” Men go to bars and women are maids “Jocks”, “People that don’t make good decisions” and “friends” Pass four red cars and it’s a good day Blue gel pen = good assignment Grocery Store Scenario Exchanging Christmas presents

9. Eric Courchesnewww.autismsandiego.com Brain Research Dr. Eric Courchesne explains the underlying brain biology of autism

10. Progression of Etiological Theories BRAIN research . . . Looking at brain differences

11. Cerebellum • Balance & coordination • Modulating sensory input • Integrating motor & sensory information • Smaller or sudden overgrowth that decreases

12. Purkinje Neurons “Inability to rapidly or accurately shift attention”

13. Limbic System

14. Neuron Pruning

15. Brain Cells Columbia University Medical Center: Meds to restore normal pruning in mouse model (Neuron)

16. Amygdala-Brain’s Fear Center November 22, 2006: Study (Davidson, Univ. of Wisconsin) confirms reduced size of amygdala in most socially withdrawn individuals with ASD. Starts hyperactive and enlarged Shrinks over time (toxic adaptation) which correlates with length of eye contact and general fear of, withdrawal from, people.

17. Amygdala, Cont. Small amygdala: significantly slower in identification of happy, angry, sad facial expressions. Spent least amount of time looking at eyes relative to other facial regions. Smallest amygdala: 40% longer to recognize emotional expressions. Largest amygdala: looked at eyes 4 times longer than smaller amydgalae.

18. Cerebrum (Cerebral Cortex) Executive Functions examples: • Reasoning • Planning • Problem solving • Judgment • Organization

19. Synaptogenesis

20. Corpus Collosum

21. Neurons Mirror Neurons: A study by UCLA neuroscientists (Dapretto et al) featuring functional MRI suggests that mirror neurons help people understand the intentions of others – a key component to social interaction. Faulty? Not cued into them? Cell-Adhesion Molecules: Help brain cells connect (Hakonarson, 2009, Center for Applied Genomics at Children’s Hospital of Philadelphia)

22. Brain Studies Resting-state brain studies are important because that is when patterns emerge spontaneously, allowing us to see how various brain areas naturally connect and synchronize their activity Nature Neuroscience, Hahamy et al

23. Environment Interactions • From a young age, the average, typical person's brain networks get molded by…shared experiences that could make synchronization patterns more similar to each other • It is possible that in ASD, as interactions with the environment are disrupted, each one develops a more uniquely individualistic brain organization pattern

24. Journal Article

25. Conclusions: • EEG has identified ASP group as within the ASD population…therefore, there is justification to consider ASP as broadly belonging within Autism Spectrum Disorders • Also evidence that ASP can be physiologically distinguished from ASD subjects… “distinct entity within the higher functioning tail of the autism distribution curve.”

26. Yawning Study Current results suggest that contagious yawning is impaired in ASD, which may relate to their impairment in empathy. It supports the claim that contagious yawning is based on the capacity for empathy. Senju, et al, 2007

27. Trust Think about the different relationships that you have… Talk at your table: • What conditions or variables create trust within your relationships? • What conditions or variables create distrust?

28. Typical Development of Trust

29. Simple View of How We Build Trust:requires one or both… Shared Understanding • Shared understanding of the person, place, feeling, sensation, event or thing • Ex: Brain surgeon– element of trust because of position they hold & understanding that comes with that position Interactions • Interactions with each other that are recurring, intimate, positive, low-risk In absence of shared understanding, interaction is the way to go!

30. Trust-building Interactions • Recurring: You need predictability and familiarity in order to make a judgement of trustworthiness • Intimate: Interaction is personal and uniquely tailored to a specific person • Positive: You come out of the interaction in a better state than when you entered. If you try something and it ends up in a negative result, trust was diminished, rather than built • Low-risk: In order to interact with something that you have low trust in, the interaction needs to be fairly low-risk (Adapted from Asperger Experts)

31. Jonah’s Take on Trust Asking Jonah (middle school student with AS) whether there was anyone in school that he could trust: “Not a chance!” he said. When asked what it would take for him to make a new friend he could trust: “A year of knowing someone, and at least four visits at my house and the other person’s house.” (Prizant, Uniquely Human)

32. Misunderstandings and Trust • Many people with AS routinely experience misunderstanding (e.g., actions of others, social nuances) • Their own behavior is regularly misunderstood by peers, educators, strangers, and even those close to them • The more often these misunderstandings occurs, the less the person with AS trusts people and the more likely he will shut down and disconnect (“Why should I try?”) (Prizant, Uniquely Human)

33. Teacher Student Interactions Brodie was told is he completed the seven assignments in the class he would pass the class. Brodie did complete the assignments and the teacher would not pass him because the assignments were late. He is now refusing to do any work. Teacher explained he should have been working all along and not save all the assignments until the end.

34. Rules are Important Kayla as no idea when she will and will not be able to go to recess. If she doesn’t get her work done, then she is not allowed to go to recess unless the teacher is busy doing something else and then she can go to recess. It is not always about getting her work done…sometimes it’s about it took her too long to get ready. Kayla has no idea what the rules are around recess because they are inconsistent based on the staff need not the student need.

35. Our Responsibility with Trust • It is essential for those of us in the lives of people with AS to make the extra effort to build trusting relationships • Rather than demanding or pressuring the person with autism to change, we must change first! • When we change, the person with autism changes too! • We have to create the recurring, intimate, positive, low-risk interactions (Prizant, Uniquely Human)

36. Christmas Dance Recital • Long 2 hour recital • “This isn’t even a Christmas song!” • “What is the criteria for it to be a Christmas song?” • Has the word “Christmas” in it • Has “winter words” • Of course, if there are jingle bells • Kept track of how many met criteria for rest of recital on program

37. Susan • Wolves • Four Core Classes – Each Teacher Created a Wolf Activity • Bulletin Board • Question on Computer • Wilderness Magazine • Nothing • Pool

38. Trust-building Strategies • Celebrate and focus on success (Can’t build trust when someone points out all the mistakes) • Be dependable, reliable, and clear • Acknowledge the person’s emotional state (allows us to alleviate rather than exacerbate stress – “formating” the agitation) • Practice shared control to build self-determination (i.e., choices, a voice in planning schedules, activities, significant events)

39. Repair vs anticipation strategies • Need both! • Teaching anticipation strategies cognitively – “Social Thinking” • Still going to make social mistakes, so have to have judgement-free repair strategies that move the student forward • Brandon & the tie/shredder • Isaac on the playground • NOT punitive responses

40. Your Turn • As a team, work to develop one trust building strategy for your target student • When prompted, find someone from another team and share strategies with each other • Back at your team, talk about strategies that you heard from other teams • Adjust your plan based on knowledge gained

41. Cognitive development typically ranges from average to very superior IQ. Difficulties may include: Difficulty shifting attention Difficulty processing two cognitive tasks simultaneously Generalizing information Retrieving information on demand Developing problem-specific solutions Difficulty with sense of time Cognitive Differences

42. Problem- Specific Solutions J.Janzen, Understanding the Nature of Autism

43. Problem- Specific Solutions J.Janzen, Understanding the Nature of Autism

44. Things to think about • One guy vs. “thousands/billions” • Neurons • Inefficient, slow retrieval • Misfilings • Shredder • Can’t “forget” any information • Can’t differentiate between important & non-important information • Microphone • Isn’t used much (visual stronger than auditory) • Uses the big computer screen • Memory storage—no sound • Power Cords • Brain Bacteria • Interferes with storage of information • Different Levels of Storage • Daydreaming (processing?)

45. Cognitive Inflexibility • Difficulty with change • Insistence on sameness • Rule-governed • Routines/rituals • Concrete thinking • Difficulty letting go of thought and ideas • Over-focus on details (weak central coherence)

46. Cognitive Strengths • Processing whole chunks of information quickly • Good rote memory • Good long-term memory • Process visual information meaningfully • Understand and use context-free information and rules

47. Learning Characteristics of ASD Uneven skill development Tends to resist change in learning environment Difficulty generalizing skills/information Difficulty with abstract concepts Relies on cues and learned routines May tend to function more reliably with consistency and structure within activities and environments

48. Learning Characteristics of ASD Organizational issues Focus on unimportant information Difficulties processing multiple sensory input under certain conditions Difficulty seeing the “big picture” Over-selectivity Good long-term and rote memory Prefers sequences and routines May demonstrate desirable persistence with a task if motivated Tendency toward literalness – difficulty with multiple meaning words

49. How do you navigate cultural expectations? • Taarof (Iranian Politeness) • How would you handle the picture problem? • What about the ice issue? • Would you know what to do?

50. Developmental Trajectories