practical interventions for children with high functioning autism and asperger s syndrome l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome PowerPoint Presentation
Download Presentation
Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome

Loading in 2 Seconds...

play fullscreen
1 / 48

Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome - PowerPoint PPT Presentation


  • 541 Views
  • Uploaded on

Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome. Lauren Kenworthy, Ph.D. and Laura Anthony, Ph.D. Wednesday, January 30 th , 2008 CASD Outreach Night. Center for Autism Spectrum Disorders Faculty and Staff.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome' - Albert_Lan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
practical interventions for children with high functioning autism and asperger s syndrome

Practical Interventions for Children with High Functioning Autism and Asperger’s Syndrome

Lauren Kenworthy, Ph.D. and Laura Anthony, Ph.D.Wednesday, January 30th, 2008

CASD Outreach Night

slide2

Center for Autism Spectrum Disorders Faculty and Staff

Lauren Kenworthy, Ph.D. Peter Daniolos, M.D

Director Medical Director

Pediatric Neuropsychologist Child and Adolescent Psychiatrist

Laura Anthony, Ph.D. Kathleen Atmore, Psy.D.

Clinical Child Psychologist Developmental Neuropsychologist

Cheryl Anselmo, M.A., CCC-SLP Angela Bollich, Ph.D., SLP

Speech and Language Pathologist Pediatric Neuropsychologist

Joette James, Ph.D. Christine Amerasinghe/Katea Selby

Pediatric Neuropsychologist Clinical Operations Representative

Katie Jankowski/Jenni Sokoloff BenYerys, PhD/Rafael Oliveras, PsyD

Research Assistant Post Doctoral Fellows

slide3
Autism does not have one cause or cure…

The triad of impairments in autism can be fractionated and should be studied separately (Happe, Ronald & Plomin, 2006)

  • Single explanations of autism have not been successful at explaining social deficits and rigid/repetitive behavior
  • Autistic like behavioral traits in typical children (twin study 7-9 year olds) show only modest to low correlations (Ronald et al, 2006)
  • Autism is a heterogeneous disorder
slide4

Solution to the riddle:

  • Teach by doing
  • Teach process (make implicit explicit)
  • Go step by step
  • Provide hard copy
teach by doing harder than you think
Teach by Doing: Harder Than You Think
  • Intervene in everyday activities with everyday people in the contextof a real problem
  • Explicitly decode reasons for change
  • Positive verbal labels
teach by doing harder than you think6
Teach by Doing: Harder Than You Think
  • Model behavior
  • Begin from an “external support” position, slowly encouraging internalization of routines
  • Teach until automatic
teach by doing with not for
Teach by Doing: “With, Not For”
  • Collaborate with child
  • Give child opportunity to solve problem
  • Elaborate responses
  • Reward effort
  • Hold child responsible for outcome
  • Make all interventions positive
goal plan do review
Goal-Plan-Do-Review
  • GOAL: WHAT DO I WANT TO ACCOMPLISH?
  • PLAN: HOW AM I GOING TO ACCOMPLISH MY GOAL?
  • MATERIALS/ EQUIPMENTSTEPS/ASSIGNMENTS
  • 1. 1.
  • 2. 2.
  • PREDICTION: HOW WELL WILL I DO?
      • Self rating 1 2 3 4 5 6 7 8 9 10
      • Other Rating 1 2 3 4 5 6 7 8 9 10
  • DO
  • PROBLEMSSOLUTIONS
  • 1. 1.
  • 2. 2.
  • 3. 3.
  • REVIEW: HOW DID I DO?
      • Self rating 1 2 3 4 5 6 7 8 9 10
      • Other Rating 1 2 3 4 5 6 7 8 9 10
  • WHAT WORKED?WHAT DIDN'T WORK
  • 1. 1.
  • 2. 2.
  • WHAT WILL I TRY NEXT TIME?
incentives for change
Incentives for Change
  • Motivation “Let’s work on your Harry Potter stuff”
  • Collaboration child and teacher or parent work together
  • Rewards individually identified based on each child’s interests, child will help develop the reward system
  • Positive Behavior Supports (PBS)including praise and concrete progress tracking (graphs, etc; Horner et al, 2002)
mutual misunderstanding
MUTUAL MISUNDERSTANDING

“A failure to understand how a child’s typical behaviors reflect this disability can result in misperceptions such as viewing the child as noncompliant, willfully stubborn, or unmotivated, rather than confused, involved in repetitive routines, or focusing on less relevant aspects of the situation.” (Kunce & Mesibov, 1998)

misunderstanding failure to help
Misunderstanding/Failure to Help
  • What exactly is the problem?
  • What is causing the problem?
    • Physical, Cognitive, Self Regulatory, Emotional, Behavioral
  • Vary conditions to test hypothesis
  • Team collaboration
  • On-going process
placement decisions
Placement Decisions
  • Minimum requirements
    • Staff with ASD expertise and team approach
    • Safe address
    • Specialized pull-out: social/executive support
  • Best Practice
    • Social/Executive support integrated
    • Small class size
  • Consider
    • Windows of Opportunity
    • Overload Effects
overload
Overload
  • Structure, structure, structure
  • Preview transitions, post schedules, stick to routines
  • Limit the number of adults/peers who work with child
  • Give breaks from people
  • Avoid, decode or at least predict large group or unstructured events
  • Assign specific jobs or tasks
misses big picture
Misses “Big Picture”
  • Safe Address
  • Teach to strength: explicit short rules, recipes, checklists and routines
  • Predict decline in abilities as size/structure of group increases
  • Put new information in familiar context
inflexibility
Inflexibility
  • Use prediction, routine and repetition to support behavior
    • Make schedule clear and public
    • Forewarn of any changes in schedule
    • Give 2 minute warnings of time to change
    • Make changes from one task to the next, or one topic to the next, clear and explicit
inflexibility16
Inflexibility
  • Assess understanding of situation, devise Social Story
  • Flexibility training
  • Script (“This is not part of the plan, is there a new plan?”)
learnet problem solving system and resource website
LEARNet Problem-Solving System and Resource Website
  • Self-Regulation/Executive Function Issues
    • Problem Solving
    • Self-Monitoring and Self-Evaluating
    • Flexibility Versus Rigidity In Thinking and Behavior
    • Impulsiveness / Disinhibition
    • Inconsistency in Performance
    • Self-Regulation / Executive Function Routines After TBI
    • Transition Routines
    • Initiation
    • Cognitive Egocentrism / Theory of Mind
learnet problem solving system and resource website18
LEARNet Problem-Solving System and Resource Website
  • Advance Organizers
  • Attention
  • Organization
  • Retrieval and Retrieval Problems
  • Approaches to Teaching: Traditional Training vs. Apprenticeship
  • Word Retrieval and Word Retrieval Problems
  • Memory and Memory Problems
  • Slow Information Processing
  • Transfer of Training / Generalization
  • Reading Comprehension
  • Concrete vs. Abstract Thinking
  • Written Composition

Authors: Mark Ylvisaker, Ph.D., Mary Hibbard, Ph.D., Timothy Feeney, Ph.D.

The Brain Injury Association of New York State (2006)http://www.bianys.org/learnet

poor self monitoring
Poor Self-monitoring
  • Videos
  • Review situations with safe address
  • Metacognitive narrative
  • Slow interactions down
  • Build in explicit, routine checking procedures
  • Make predictions
just do what i say
Just Do What I Say!
  • Written rules, recipes, routines, checklists
  • Tapes
  • Hand held computers
  • Notebooks
  • Dry Erase boards
  • Talk out loud (Winsler, 2006)
  • Memorize it, make it automatic
just sit there
Just Sit There!
  • Activity breaks
  • Increase structure in environment to set limits for inhibition problems
  • Make behavior and work expectations clear and explicit; review with student
  • Post rules in view; point to them when child breaks rule
  • Teach response delay techniques (counting to ten before acting)
  • Positive behavior management plans
slide22

Incentives for Change

Intervention Project Collaboration with Ivymount

Cognitive Instruction

Improved flexibility

in the classroom

Primary outcome

Better adaptive behavior

Increased Flexibility

Less missed instruction time

Guided Practice

Improved fluency and

flexibility on cognitive tests

Improved behavioral regulation and

metacognition at school and home

Generalization Training

Improved social skills

Improved flexibility at home

early intervention
Early Intervention
  • Teach pretend play and joint attention skills (Kasari, Freeman and Paparella, 2006)
  • Imitate your child
  • Speech and Language therapy
parent child interaction therapy eyeberg herschell
Parent-child Interaction Therapy (Eyeberg, Herschell)
  • Child Directed Interaction
    • Positive play therapy
    • Developmental approach
  • Parent Directed Interaction
    • Compliance training
    • Behavioral approach
applied behavioral analysis lovaas 1987
Applied Behavioral Analysis (Lovaas, 1987)
  • Intensive behavioral techniques (30-40 hours per week)
  • Targets basic language skills, behavior and academics
  • Research shows remarkable improvement in 50% of children
  • Most appropriate for early intervention in HFA, Asperger’s
active social coaching
ACTIVE Social Coaching

Deconstruct social situations (e.g., Solomon, Goodlin-Jones, Anders, 2004)

  • Process social situations out loud
  • Name your own feelings, what other person might be thinking, feeling
  • Stop action while watching videos and ask:
    • Why did he do that?
    • What will she do next?
    • What is she feeling?
    • What will happen if _____? (Gena et al, 2005)
active social coaching27
ACTIVE Social Coaching
  • Deconstruct social situations
    • Interpret facial expressions, gestures and body language out loud for your child
      • I can tell you are angry because_____
      • I could tell she didn’t have time to talk because _______
      • When I look at you this way, it means that _____
active social coaching28
ACTIVE Social Coaching
  • Social mentors
    • Good for older kids and teens
  • Social activities around special interests
  • Pragmatic language therapy
  • Drama (Asperger, 1944)
  • Social Stories, Comic Book Conversations, social skills workbooks, etc
    • i.e., write it down! (Theimann and Goldstein, 2004)
social stories carol gray
Social Stories (Carol Gray)

Riding the School Bus

Valerie Lowing

Some children ride to school on a bus.

Usually the bus will pick me up in the morning and bring me to school.

Some children like riding the bus. They think it is fun.

Usually the bus will pick me up from school at the end of the day and bring me back home.

Sometimes I will not ride the bus. Mom or dad will tell me when I will not ride the bus.

http://www.thegraycenter.org/

active social coaching30
ACTIVE Social Coaching
  • Social coaching in groups (e.g., RDI, McAfee)
    • Discrete skills
      • Eye contact, turn taking, listening
    • Pragmatic skills
      • Social scripts
      • “Opportunistic” skill building
      • Challenge tasks

(Gutstein, 2000; McAfee, 2002)

family burden
Family Burden
  • Psychoeducation
  • Family navigators
  • “Similar to myself” support
  • Respite care
  • Encouraging movement towards advocacy and empowerment
behavioral intervention strategies
Behavioral Intervention Strategies
  • Aversives
    • “No,” Time Out
  • Differential reinforcement
    • Replacement
  • Extinction
    • Stop reinforcing (IGNORE)
  • Antecedent (cause) manipulation
behavioral intervention for ocd and phobias
Behavioral Intervention for OCD and Phobias
  • Obsessive/compulsive or phobic symptoms can be treated by Exposure and Response Prevention Therapy
    • Create a fear hierarchy
    • Client picks where to start
    • Expose client to feared stimulus
    • Prevent escape/avoidance/compulsion
    • Wait for anxiety to reduce
behavioral intervention for ocd and phobias34
Behavioral Intervention for OCD and Phobias
  • Must be done in the context of a trusting therapeutic relationship
  • Must be led by the child, and under child’s control
  • May take longer for those with ASD
anxiety
Anxiety
  • Relaxation training
    • Guided imagery
    • Special interests
    • Meditation
    • Adapted yoga
  • Cognitive Behavioral Therapy to help identify anxiety, accept it without being overwhelmed, and use cognitive strategies to reduce anxiety
compliance
Compliance
  • Reward when intrinsic motivation doesn’t work
  • Collaborate together on behavior plan
  • Integrate behavior plan in home and at school
  • Rewards and praise work better than loss of privileges or punishments
    • Magic ratio of 1:5
attention problems
Attention Problems
  • Environmental adaptations
  • Deep pressure
  • Attention training sessions (using behavioral methods)
  • Joint attention training in young children
meltdowns
Meltdowns
  • Prevention (warnings, preparation, practice)
  • Wait for the storm to pass
  • Do not “give in” once meltdown has started
  • Don’t talk
  • Provide safety and reassurance
  • It is not your fault, don’t take it personally
preparing now for adulthood
Preparing Now for Adulthood
  • Almost no research on long term outcomes
    • All information is on current adults using retrospective data
    • Adults with AS seem to continue to make progress in core symptoms
    • Best indicator of prognosis may be peer relationships
asperger s in adulthood
Asperger’s in Adulthood
  • Transition planning and training must start in middle school (elementary school if you consider daily living skills)
  • Work issues: interests vs. skills
  • College
    • Need for support
    • On-line vs. mainstream
foundational skills
Foundational Skills
  • Personal hygiene and professional dress
  • Time management skills
  • Professional demeanor (eye contact, handshaking skills, etiquette)
  • Limit lectures and talk of special interest
  • Increasing tolerance for boring tasks
  • Taking instruction
summary
Summary
  • Interventions need to be multi-disciplinary
  • ASDs are developmental disorders, so expect changes in skills and problems
    • Swiss cheese syndrome
resources
Resources
  • Autism Asperger’s: Solving the Relationship Puzzle by Steven Gutstein, PhD (Future Horizons)
  • Navigating the Social World by Jeanette McAfee, MD (Future Horizons)
  • Executive Skills in Children and Adolescents, Dawson and Guare (Guilford Press)
  • Cartoon Cut-Ups Teaching Figurative Language and Humor, Jean Hamersky (Thinking Publications)
resources44
Resources
  • College Internship Programs-Examples
  • The Brevard Center, Melbourne, FL, 1-866-603-1900
  • The Berskhire Center, Lee, Massachusetts (413) 243-2576 http://www.berkshirecenter.org
  • Foothill College Transition to Work Program Los Altos Hills, CA, (650) 949-7242http://www.foothill.edu/al/ttw.html
resources45
Resources
  • Meyer, R.G. (2001). Asperger Syndrome Workbook: An Employment Workbook for Adults with Asperger Syndrome. London & Philadelphia: Jessica Kingsley Publishers.
  • Smith, M.D., Becher, R.G. & Juhrs, P.D. (1995). A Guide to Successful Employment for Individuals with Autism. Baltimore: Paul H. Brookes Publishing Company.
resources46
Resources
  • Autism Society of America www.autism-society.org
  • Yale info.med.yale.edu/chldstdy/autism/welcome.html
  • TEACCH www.unc.edu/depts/teacch
  • National Information Center for Children and Youth with Disabilities www.nichcy.org
resources47
Resources
  • Future Horizons www.FutureHorizons-autism.com
  • National Academy Press (free version of Educating Children with Autism, 2001) www.nap.edu
  • OASIS http://aspergersyndrome.org/
resources48
Resources
  • Autism Speaks www.autismspeaks.org
  • Organization for Autism Research

http://www.researchautism.org/

  • www.NationalAutismAssociation.org

Direct grants to families

  • www.take2camp.org
  • www.dcchildrens.com (Click on Departments and Programs)