Head to Toe: TOOLS! to Use with Students on the Autism Spectrum

1. Head to Toe: TOOLS! to Use with Students on the Autism Spectrum Heather Knox, LISW sociallearningabq@yahoo.com www.sociallearningabq.webs.com

3. Going to A Training • Sometimes I go to a training. • I can learn new things. • I can get a break from being at my school.

4. Going to a Training • Sometimes I learn new ideas. • But sometimes I hear ideas I already know. • I might be frustrated. • I might wonder why I am here..

5. Going to a Training • When this happens, I can try to think about new ways to help other people understand important ideas. • Or I can chill out and think about the cute guy/girl I saw at the grocery store yesterday. • When more people understand ideas that can help my students, everyone feels better!

6. What is Autism? • A Neuro developmental SPECTRUM disorder – everyone is affected differently

7. Some Statistics for Autism Spectrum Disorders (ASD’s) Increase in incidence in population CDC 1/100 1/70 for boys. Increase large in last 10 years. More than can be accounted for by increase in knowledge or diagnostic capability. Cause? Unknown. Suspected to be a combination of genetics & an environmental trigger. Family hx of Bipolar Disorder, Depression, Anxiety –increased chances of having a child with an ASD.

9. Diagnostic Criteria for 299.00 Autistic Disorder I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C) (A) qualitative impairment in social interaction, as manifested by at least two of the following: • 1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction2. failure to develop peer relationships appropriate to developmental level • 3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) 4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

10. Diagnostic Criteria 299.00 continued • (B) qualitative impairments in communication as manifested by at least one of the following: • 1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others3. stereotyped and repetitive use of language or idiosyncratic language4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

11. Diagnostic Criteria 299.00 continued • (C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following: • 1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus2. apparently inflexible adherence to specific, nonfunctional routines or rituals3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)4. persistent preoccupation with parts of objects • (II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (A) social interaction(B) language as used in social communication(C) symbolic or imaginative play

12. Diagnostic Criteria 299.80 Aspergers Syndrome • (I) Qualitative impairment in social interaction, as manifested by at least two of the following: (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction(B) failure to develop peer relationships appropriate to developmental level(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)(D) lack of social or emotional reciprocity • (II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus(B) apparently inflexible adherence to specific, nonfunctional routines or rituals(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)(D) persistent preoccupation with parts of objects

13. 299.80 Asperger’s Continued • (III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

14. PDD-NOS • Characterized by some, not all of the characteristics of Autism

15. What’s Different? • Neurotypical kids can usually by age 4 or 5: • Guess your emotions by your face or the situation • Name their own emotions • Self soothe with 1 or 2 simple strategies • Know what you are thinking/ Track what you know. • Converse with you on a topic of shared interest • Mindblindness

16. How are kids affected? • Three primary areas: - Sensory Challenges - Social & Communication Impairment – Lack of friends, difficulty relating with adults and kids, difficulty communicating needs, questions, concerns - Restricted patterns of interest- a high schooler who wants only to talk about Pokemon.

17. Sensory Challenges: • The signals don’t come together! • Too loud, too bright, too fast, too tight– hyper or hypo sensitive • The mall at holiday time. • Challenges with normal bump & touch of a school setting. Or normal “background” noise. • Auditory processing • They work to hold it together, then melt down

18. How it might present.. • A student who is very bright, converses well with adults, but not with peers. • A student who “melts down” periodically, for unusual reasons, or no visible reason. • A “quirky” kid who excels academically, but will only work alone. • A child who invades the space of peers, but becomes quite agitated when touched or bumped. • A kid who looks “spoiled” and will tantrum or refuse to do certain work (like writing.)

19. Challenges • Dealing with loud noises (fire drill!) • Dealing with changes in routine • Asking for help • Negotiating with peers or others (what else is for lunch?) • Lack of understanding of situations due to • Lack of understanding of perspective of others “Mindblindness.” • Focusing on the details, can’t see the big picture

20. Additional Challenges: Who are you anyway? • Differences in part of brain that governs facial recognition • Identifying emotions on other’s faces • Reading nonverbal social cues • “J” 1:00-2:34

21. Frequently Co-occurring • Auditory processing challenges—You’re talking too much! • Language formation challenges, written or oral. --Inability to ask for help, even to formulate the question • “J”

22. Tools for Assessments • Checklists: • Observation • Talk to peers • Double Interview

23. Treatment Challenges • Most of us are “Neurotypical” • You don’t always know what you KNOW! • Its hard to see what these kids don’t know, and hard to tell what piece to teach them!

24. Strengths • Visual Mind • Detail oriented • Rule followers • Seeing a different picture

25. Temple Grandin First 7 min or so of : http://www.ted.com/talks/temple_grandin_the_world_needs_all_kinds_of_minds.html

26. What’s our treatment method?

27. What doesn’t work • Basically, everything I was ever taught clinically • Insight oriented therapy • Role Play • Peer Modeling • Standard Non-Directive Play Therapy (supported play CAN work, with some careful thought.)

28. THE BIG THING MAKE IT AS VISUAL AS YOU CAN!

29. Treatment Needs to Be: • Concrete • Visual • Explicit • Repetition Repetition Repetition • Research Based • Structured • Supported

30. Tools that DO work: A whirlwind tour • Social Stories • Social Thinking/ I LAUGH model including Superflex and You are a Social Detective • Sixth Sense Curriculum • Video Social Stories: My school day, etc. • The Incredible 5 Point Scale • Comic Strip Conversations • Socially Curious and Curiously Social • 10 unwritten Rules of Social Relationships. • Videotaping –used carefully

31. Could you have had a successful conversation without thinking about the other person? What information were you “tracking?” Can you be taught to do something without understanding WHY? “Social Thinking ® ” vs. Social Skills

32. “Social Thinking is….” • Thinking about others • and how they think about YOU • A model developed by Michelle Garcia Winner, MA-CC SLP • www.socialthinking.com

33. The I-Laugh Model • I = Initiation of communication or action • L = Listening with eyes and brain • A = Abstract and Inferential • U = Understanding Perspective • G = Gestalt Perspective Getting the “big picture.” • H = Humor

34. Key Lessons: • Expected & Unexpected Behavior • How we Make Impressions • Social Behavioral Map • Making “Smart Guesses”

35. Behavior for a Conference • Expected • Unexpected

36. Making Impressions Parts of an Impression—Begin with a visual, CLAY, etc • How You Look • What You Say (just your words) • What You Do

37. How your message gets across • Is it the WORDS? • Or the WAY?

38. Parts of an Impression • How you look… • A. Hygiene • B. Clothes you wear, hairstyle • What you Say… • A. Just the words you use

39. Parts of an Impression, continued • What you do… • A. Body language & gestures • B. Facial expression • C. Tone of voice • D. Proximity • E. Loudness, pitch of voice, etc.

40. Social Behavioral Map

42. Social Stories* Slides courtesy of Marci Laurel, MA-CC-SLP • Social stories were developed by Carol Gray and are used to help students understand expected behaviors in situations that are challenging for them. • The goal of the story is to increase understanding, provide comfort and offer some appropriate responses. • Social stories can reduce problem behaviors, increase social awareness and/or teach new skills.

43. Social Stories • Language is based on the student’s ability to comprehend both vocabulary and abstract ideas. • The story is reviewed regularly in preparation for, but not during, the challenging event. • Cartoons and social scripts can also be used.

44. Describe the Situation • Address the “wh” questions: where does the situation take place, who is involved, what they are doing and why they may be doing it. • Helps the student recognize the situation when it happens… “Sometimes our class sits on the carpet. We sit on the carpet to listen to stories and for group lessons.” “The teacher wants the students to be quiet and still.”

45. Provide the Perspective of Others Give an idea about what might be in the minds of others in the story or provide details about the emotions and thoughts of others. “My friends are trying hard to listen so they can enjoy the story or learn from the teacher. It can be hard for them to listen if someone is moving all around.”

46. Student Perspective Describe one or two of the student’s possible feelings or responses. “It is hard for me to sit still. When the teacher tells me to sit still I might feel mad.”

47. Give Ideas About What to Do Suggest desired (expected) responses designed to be supportive to the specific student. “When I want to jump around while the teacher is reading, I can do floor push ups, push and pull with my hands or walk to the back of the group.”

48. Happy Ending • It can be helpful to create a happy ending that makes sense to an individual student. • Linking the ending to the beginning can bring the whole story full circle! “My friends will be happy when I can remember to use my ideas to be still during carpet time!”

49. I Can Be a SUPER FRIEND! Created by Lisa Grant & Rochelle Lentini 2002

50. I like talking and playing with my friends at school.