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DMHAS. Syndro. erg. The. Learning. Syndrom. Clinic. AspergerS. Asp. erge. ome. er. Syndro. erg. The. Learning. Syndrom. Clinic. AspergerS. Asp. Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive Development Delay. erge.

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slide2

Syndro

erg

The

Learning

Syndrom

Clinic

AspergerS

Asp

erge

ome

er

slide3

Syndro

erg

The

Learning

Syndrom

Clinic

AspergerS

Asp

Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive Development Delay

erge

ome

er

slide4

Child & FamilyandDMHAS

Agency

A Scholar in Residence Workshop

Hilton Garden Inn, Glastonbury, CT

September 17, 2004

Presented by:

Raymond W. DuCharme, Ph.D.

Kathleen A. McGrady, Psy. D., ABDA

Pamela Ruff, Transition School Faculty

The Learning Clinic

The Learning Clinic

slide5

Introduction

What is a pervasive developmental delay? Is a diagnostic description of Pervasive Development Delay not otherwise specified, helpful to the individual, his family and those responsible to provide treatment?

The purpose of a diagnosis are to precisely describe a condition in need of treatment, and to determine from the described symptoms a preferred regimen of treatment. Further, the diagnosis should predict that if a treatment is provided then a forecast may be made of a prognosis.

pervasive development disorder
Pervasive Development Disorder

Category of Diagnosis that includes Autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy.

The Learning Clinic

asperger syndrome criteria
Asperger Syndrome Criteria

The Learning Clinic

slide8

Differential Diagnosis Pervasive Developmental Disorders

The Learning Clinic, Inc.

slide9

DSM-IV - ICD Diagnostic Criteria

Precise differential diagnosis of pervasive developmental delays evident in the symptom profile of an individual currently remain problematic. And the consequent ramifications are also evident.

  • Unclear diagnostic criteria result in error and misdiagnosis.
  • Misdiagnosis causes error in the selection of type and duration of treatment.
  • Treatment misapplications yield poor prognosis and little evidence of efficacy
slide10

DSM-IV - ICD Diagnostic Criteria

/ Continued

Gillberg’s six criteria (Elhers and Gillberg 1993) comprise social impairments, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems and motor clumsiness. Gillberg includes Szatmari’s (1989) criteria and Tantam’s (1988) five criteria. The ICD-10 and DSM-IV note an absence of any clinical delay in language and cognitive development in the first 3 years of life. The DSM-IV adds no delay in the development of self-help skills, adaptive behavior, and curiosity about the environment.

asperger syndrome criteria1
Asperger Syndrome Criteria

Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis.

The Learning Clinic

other developmental issues
Other Developmental Issues
  • Deviation from normal development
  • Do not “Outgrow” Developmental Deficits
  • Stress Impairs Performance
  • Co-Morbid Diagnosis Impairs Overall Functioning

The Learning Clinic

slide13

Medications

Cognitive Functioning

The Learning Clinic

slide14

Age / Time

Psychological Symptoms

The Learning Clinic

slide15

Grade

Clinical Symptoms and Learning Disabilities

The Learning Clinic

asperger syndrome pervasive developmental delay
C O G N I T I O N

Memory

Higher Order Process Analysis,

Synthesis, and Evaluation

Organization

Flexibility

Asperger SyndromePervasive Developmental Delay

The Learning Clinic

slide17

Asperger SyndromePervasive Developmental Delas

  • C O G N I T I O N
  • Wide Band of Knowledge
  • Problem Solving
  • Verbal-Performance IQ
  • Attention Shift
  • Rule and Governing Behavior

The Learning Clinic

asperger syndrome pervasive developmental delay1
Asperger SyndromePervasive Developmental Delay

L A N G U A G E

  • Pragmatics
  • Syntax
  • Meaning: Connotative

Denotative

The Learning Clinic

slide19

Asperger SyndromePervasive Developmental Delay

  • L A N G U A G E
  • Processing Speed
  • Expression
  • Duration

The Learning Clinic

asperger syndrome pervasive developmental delay2
Asperger SyndromePervasive Developmental Delay

S P E E C H

  • Prosody
  • Pedantic
  • Elocution
  • Volume

The Learning Clinic

asperger syndrome pervasive developmental delay3
Asperger SyndromePervasive Developmental Delay

M O T O R

  • Fine Control
  • Gross Control
  • Coordination
  • Regulation

The Learning Clinic

asperger syndrome pervasive developmental delay4
Asperger SyndromePervasive Developmental Delay

S E N S O R Y P R E C E P T I O N

  • Visual Integration
  • Kinesthetic
  • Tactile Accuity
  • Gestalt
  • Integration of other Senses

The Learning Clinic

asperger syndrome pervasive developmental delay5
Asperger SyndromePervasive Developmental Delay

S O C I A L

  • Cue Identification
  • Responsive to others
  • Isolate
  • Rude
  • Aggressive

The Learning Clinic

slide24

Asperger SyndromePervasive Developmental Delay

  • S O C I A L
  • Boundary Acceptance
  • Maintain Social Roles

(e.g., student, son, daughter, friend)

  • Self-Regulate

The Learning Clinic

slide25

Developmental Tasks of Adolescence: Ages 12 - 18

  • Achieving new and more mature relations with age-mates of both sexes
  • Achieving a masculine or feminine social role
  • Accepting one’s physique and using the body effectively
  • Achieving emotional independence of parents and other adults

The Learning Clinic

slide26

Developmental Tasks of Adolescence: Ages 12 - 18

/ Continued

  • Preparing for marriage and family life
  • Preparing for an economic career
  • Acquiring a set of values and an ethical system as a guide to behavior; developing an ideology
  • Desiring and achieving socially responsible behavior

The Learning Clinic

slide27

Developmental Tasks of Early Adulthood

  • Selecting a mate
  • Achieving a masculine or feminine social role
  • Learning to live with a marriage partner
  • Starting a family
  • Rearing children
  • Managing a home

The Learning Clinic

slide28

Education: Asperger Student Classroom Behavior

  • 1. Attending Behavior
    • Discern Task Expectations
    • Focus Attention on Relevant Stimuli
    • Shift Attention to Relevant Stimuli
    • Ignore Irrelevant Material
    • Perform Multi-Task Operations

The Learning Clinic

slide29

Education: Asperger Student Classroom Behavior

  • 2. Responding Behavior
    • Verbal Skills
    • Pragmatic Language Skills
    • Writing Ability
    • Executive Function Ability
    • Perseverance
    • STM for Denotative Items

The Learning Clinic

slide30

Education: Asperger Student Classroom Behavior

  • 3. Reinforcement Behavior
    • Provide Contingent Positive Social Reinforcement
    • Assert Negative Reinforcement in an Appropriate Way
    • Receive Positive Reinforcement
    • Ability to Respond to Positive Reinforcement

The Learning Clinic

slide31

Education: Asperger Student Classroom Behavior

  • 4. Initiating Behavior
    • Self - Initiate Classroom Routines
    • Use CAI Prompts
    • Start Task According to Direction

The Learning Clinic

slide32

Education: Asperger Student Classroom Behavior

  • 5. Comply / Demonstrate Rule - Governed Behavior
    • Accept Correction from Instructor
    • Accept Correction in Public Setting
    • Self - Correct Assignments to Pre - determined Standards

The Learning Clinic

slide33

Education: Asperger Student Classroom Behavior

  • Completing Behavior
    • Perform Tasks to Standards
    • Return Completed Product to

Supervisor

The Learning Clinic

slide34

Education: Asperger Student Classroom Behavior

  • 7. Transitioning Behavior
    • Initiate Independent Steps between Tasks
    • Use Prompts / Cues to Signal Move

from One Task to Another

The Learning Clinic

slide35

Education: Asperger Student Classroom Behavior

  • 8. Cooperating Behavior
    • Taking Turns
    • Waiting
    • Avoid Arguing
    • Sharing
    • Making Requests Before Acting

The Learning Clinic

slide36

Education: Asperger Student Classroom Behavior

  • 9. Adapting Behavior
    • Adjust to Different Routines in Different Classrooms
    • Adjust to Alteration in Routine
    • Follow New Routine Required by a Situation

The Learning Clinic

slide37

Education: Asperger Student Classroom Behavior

10. Cooperate with Medication

  • Administration
  • Complete Homework
  • Attend School
    • Discern Task Expectations
    • Focus Attention on Relevant Stimuli
    • Shift Attention on Relevant Stimuli
    • Ignore Irrelevant Material
    • Perform Multi-Task Operations

The Learning Clinic

slide38

Competing Clinical Behaviors

  • Perseveration
  • Obsessive Thought
  • Rigid Cognitive Style
  • Inability to Shift from “Personal View”

to Data - Based Decision

The Learning Clinic

slide39

Competing Clinical Behaviors

/ Continued

  • Confabulation
  • Affirming False Information
  • “Stealing”
  • Sexually Inappropriate Actions and Statements

The Learning Clinic

slide40

Competing Clinical Behaviors

/ Continued

  • Violation of Boundaries
  • Cognitive Disorientation and

Distortion

The Learning Clinic

slide41

Optimal Classroom Behaviors

  • Closed Classroom
  • Applied Task - Oriented Setting
  • Standards are Limited, Precise and Based on Asperger Student’s Level of Ability to Self - Regulate
  • Class Size Under 10 - Over 3

The Learning Clinic

slide42

Optimal Classroom Behaviors

/ Continued

  • Cues and Prompts are Provided
    • Daily Plan / Organizer
    • Assigned Work Station
    • CAI Task Presentation
  • Clear System of Discipline Consistently Applied Setting Wide

The Learning Clinic

slide43

Optimal Classroom Behaviors

/ Continued

  • Classroom Mix Controlled
  • Interpersonal Style of Teacher:

Direct, Non-Judgmental, Organized

  • Task Analysis Reflects:
    • Backward Chaining
    • Performance Standards
    • Over - Learning Options

The Learning Clinic

slide44

Optimal Classroom Behaviors

/ Continued

  • Control Risk
  • Minimize Transitions

The Learning Clinic

slide45

Writing a News Story

Associated Press

Hurricane Ivan Blasts Alabama, Kills 12

GULF SHORES, Ala. (AP) - Hurricane Ivan slammed into the Gulf Coast early Thursday with 130 mph wind, launching tornadoes, washing out a major bridge and hurling metal signs through the night. At least 12 U.S. deaths were blamed on the storm, but officials said the toll and the damage could have been even worse. Up to 15 inches of rain were expected as the storm moved inland. It weakened by late morning, but remained a Category 1 hurricane with wind of 75 mph eight hours after its 3 a.m. landfall.

The Learning Clinic

slide46

Writing a News Story

Directions: Writing a News Story

Write a news story using what you consider the most relevant facts listed by numbered sentences.

First - read all the sentences and answer the question “What is the main point of the numbered sentences that are related

Second - arrange the sentences into a one paragraph news story

Third - be sure your first sentences is the main theme of the news story.

Fourth - place other sentences in order of story organization

Fifth - be prepared to explain why the sentences you did not use did not belong in the story

Sixth – read your story aloud and make any changes

Seventh – compare your story with one written by another student

The Learning Clinic

slide47

Writing a News Story

  • Relevant and Irrelevant Information
  • Colorado experienced a severe winter storm today
  • Denver, Colorado international airport is located on a high mountain plateau
  • Low visibility and storms make a landing dangerous at the Colorado airport
  • A plane crashes in an attempt to land at Denver Colorado
  • Rescue efforts were started within minutes of the crash
  • Pilot training on simulators is important
  • Many people fear flying
  • The number of survivors in today's plane crash in Colorado is unknown
  • Colorado has many large ranches
  • People travel to Denver, Colorado by cars more than other types of transportation

The Learning Clinic

slide48

Syndro

erg

Syndrom

AspergerS

Asp

What are the Prioritiesof the Asperger Syndrome Student?

erge

ome

er

The Learning Clinic

The Learning Clinic

slide49

Priorities of the Asperger Student

Living Alone

The Learning Clinic

slide50

Priorities of the Asperger Student

Living Alone

The Learning Clinic

slide51

How Can We Assess Readiness for Independence?

  • The Learning Clinic Pragmatic Skills Survey
  • The Learning Clinic Transition & Independent Living Skills Assessment

The Learning Clinic

slide52

Social Skills Training

Effective Social Skills Training should

include the following components:

  • Comprehensive and Integrated approach
  • Incorporate Changes in Development Tasks/Challenges

The Learning Clinic

slide53

Social Skills Training

Comprehensive & Integrated:

  • Multiple Settings
  • Clinical Therapy Groups
      • Hands-on
      • Role-plays
      • Video Feedback
  • Classroom
  • Home/Residential House

The Learning Clinic

slide54

Social Skills Training

Comprehensive & Integrated:

  • Self-Regulation
      • Self-Restraint
      • Point/Level System
  • Extended School Day
      • Social Skills Goal
  • Community
  • Young Apprenticeship – Work Setting
      • Job Shadowing

/ Continued

The Learning Clinic

slide55

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

Social Skill requirements change as the

Child goes through different

developmental stages

  • Social Skills learned at earlier developmental stage do not always generalize to challenges at next developmental stage

The Learning Clinic

slide56

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Mastery of skill at one developmental level does no ensure generalization to social challenges at next developmental level

/ Continued

The Learning Clinic

slide57

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Social challenges change
      • Childhood to Adolescence:
        • Childhood
          • casual friendships based on “unconditional acceptance
          • generally concrete communication
          • parallel interactions

/ Continued

The Learning Clinic

slide58

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Social challenges change
      • Childhood to Adolescence:
        • Adolescence
          • competition for social acceptance based on “popularity”
          • need to “read” nonverbal communication

/ Continued

The Learning Clinic

slide59

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Childhood to Adolescence:
    • Adolescence
      • must interpret increasingly abstract and complex communication
      • interactions include reciprocity and ability to “intuit” the feelings and thoughts of others

/ Continued

The Learning Clinic

slide60

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Adolescence to Young Adulthood
    • Adolescence
      • Parents are caretakers
    • Young Adulthood
      • Independent Living:

employment

driving

college

integration into community

accessing community services

/ Continued

The Learning Clinic

slide61

Social Skills Training

Social Skills and Developmental

Tasks/Challenges

  • Adolescence to Young Adulthood
    • Young Adulthood
      • Independent Living:

self-advocacy

finances

legal rights/responsibilities

health needs

maintaining an apartment

grocery shopping and meal preparation

/ Continued

The Learning Clinic

which asperger symptoms compete with independence
Which Asperger Symptoms Compete with Independence?

Age

Degree of Anosognosia

Over time, symptoms become egosyntonic

The Learning Clinic

slide63

Treatment and Non-treatment Students Skill Assessment T5

Housing Acquisitions & LeasesHome ManagementMeal Planning & PreparationDining Clean Up & Food Storage Budgeting & TaxesBanking & Credit Consuming Transportation Leisure Legal Awareness Health Time Management Maintain Personal Safety in HouseMaintain Personal Safety in Community Safety During Dating Relationships Personal PresentationCommunity ResourcesCommunity Service Career Planning EmploymentPost-Secondary EducationParticipation in Therapy Sessions

Time Line for Data Collection 2004-05

Sep Oct Nov Dec Jan Feb Mar

0

Skills Showing Significant Improvement by Treatment vs. Non-Treatment Students

Time - 5

The Learning Clinic

slide64

Transition Program Independent Living Skills - Areas of Significant Progress

Housing Acquisitions & Leases Meal Planning & Preparation Dining Clean Up & Food Storage Consuming Transportation Legal Awareness Health Time Management Maintain Personal Safety in House Maintain Personal Safety In Community Safety During Dating Relationships Community Resources Community Service Career Planning Employment Post-Secondary Education Healthy Relationships

22%

Home Management Budgeting & Taxes Banking & Credit Leisure Personal Presentation

% of Skills (5 of 23) Significantly Increased from T1 – T4

The Learning Clinic

slide65

Transition Program Independent Living Skills - Areas of Significant Progress

Housing Acquisitions & Leases Budgeting & Taxes Banking & Credit Consuming Transportation Leisure Legal Awareness Time Management Maintain Personal Safety in Home Maintain Personal Safety in Community Safety During Dating Relationships Community Resources Community Services Career Planning Employment Post Secondary Education Health Post-Secondary Education Healthy Relationships

70% Significant Improvement

Home Management Leisure Personal Presentation Time Management

% of Skills (16 of 23) Significantly Increased T5 at 7 Months

The Learning Clinic

slide66

T1 Comparison:

Student Self-Assessment vs. Teacher Assessment Comparison

Skills Students Self-assessed higher

than Teachers Assessed

52%

Home Management Dining Clean UP & Food Storage

Nutrition Banking & Credit

Transportation

LegalAwareness

Health Time Management Safety During Dating Relationships

Personal Safety

Independent Living

Career Planning Employment Post-Secondary Education

22%

% of Skills (12 of 23) Students rated themselves significantly higher than Teachers at T1

The Learning Clinic

slide67

T5 Comparison:

Student Self-Assessment vs. Teacher Assessment Comparison

Skills Students Self-assessed higher

than Teachers Assessed

39%

22%

Clean UP & Food Storage

Leisure Health

Time Management

Safety During Dating Relationships

Personal Presentation

Career Planning Employment Healthy Relationships

% of Skills (9 of 23) Students rated themselves significantly higher than Teachers at T5

The Learning Clinic

slide68

What Is on the Horizon for Asperger Students?

  • Early Diagnosis
      • Pediatric Training
      • Teacher Training

Psycho - Education Treatment

Cognitive Behavioral Therapy

The Learning Clinic

slide69

What Is on the Horizon for Asperger Students?

  • Technology
      • Distance Coaching (remote

video monitoring)

      • Computer Checklists and Prompting
      • Computer Assisted Instruction (CAI)

The Learning Clinic

slide70

What Is on the Horizon for Asperger Students?

  • Technology / Continued
      • Kurtzweil
      • Dragon Naturally Speaking

The Learning Clinic

slide71

TLC

LCTLCTLC

The

TLCTLC

Learning

Clinic

LCTLCTLC

TLCTLCT

End

TLC

TLCTL

. . . because every child can succeed!

slide72

TLC

LCTLCTLC

TLCTLC

To view this Presentation - or other TLC Presentations, visit The Learning Clinic web site:

www.thelearningclinic.org

Then click to the - Conferences and Presentationspage.

LCTLCTLC

TLCTLCT

TLCTL

TLC