Autism & Asperger’s Syndrome

1. Autism & Asperger’s Syndrome Conference Summary: Susan Hines and Ashley Hart

2. Carol Kranowitz Summarywww.out-of-sync-child.com • Sensory Processing Disorder- Atypical reactions in the Central Nervous System to ordinary sensory experiences causing… Atypical responses in work, play, and relationships

3. The “Biggies” Hallmarks of SPD: • Avoiding ordinary touch and movement • Seeking excessive touch and movement • Difficulty making one’s body cooperate (coordination)

4. Sensory Modulation Disorder:Sensory Over-Responsivity (SOR) • “Sensory avoider” • Fearful and cautious, or • Negative and defiant • Quick, intense “fight or flight” response to harmless sensations • Most emotionally laden • Aka: Defensiveness

5. Sensory Modulation Disorder:Sensory Under-Responsivity (SUR) • “Sensory disregarder”: inattentive, self-absorbed, disengaged • Slow, sluggish responses to ordinary sensations; lost; loose and floppy • Intense sensory input needed to get in gear; may bite self or inflict pain on others

6. Sensory Modulation Disorder:Sensory Seeking/Craving (SS) • “Sensory craver” or “bumper and crasher” • Constant search for more, more, more! • Sensory input helpful to reduce impulsive, dare-devilish behavior and tendency to get into trouble

7. Sensory Discrimination Disorder(SDD) • “Sensory jumbler” • Difficulty in differentiation among and between stimuli (often visual and auditory) • Difficulty evaluating external or internal sensations to produce adaptive responses • May or may not coexist with SMD

8. Sensory-Based Motor Disorder:Postural Disorder • “Sensory Slumper” • Difficulty with: • Movement • Stabilizing body while moving or resting • Bilateral coordination, balance, and crossing the midline • May involve fatigue, slumping, overflow, and associated movements

9. Sensory-Based Motor Disorder:Dyspraxia • “Sensory Fumbler” • Difficulty with fine motor, gross-motor, oral-motor output • Clumsy, inflexible, inactive behavior • Preference for familiar rather than novel

10. Anxiety Asperger Syndrome Autism Bipolar disorder Down Syndrome Dyslexia Fragile X Fetal Alcohol Syndrome Obsessive compulsive disorder Oppositional defiant disorder Pervasive Developmental Delay Prader-Willi Syndrome Selective mutism Possible Co-Existing Disorders

11. Visual Problems Associated with SPD • Difficulty with visual-spatial processing (ability to interpret and respond to what the eyes see) • 90% visual problems never diagnosed • 25% all school-age students and 70% juvenile delinquents have undiagnosed visual dysfunction • Problems: visual discrimination, attention and memory

12. Attention-Deficit Hyperactivity Disorder (ADHD) Learning Disabilities (LD) SPD + ADHD + LD ADHD ADHD SPD LD SPD LD

13. Symptom Inattention Hyperactivity Impulsivity Alternative Diagnoses: ADHD SPD Visual problems Speech and language problems Anxiety Nutritional deficits Allergies Not enough recess! Normal child under 7! Sensory… or ???

14. Kids with SPD often: Are clumsy Prefer same-old, same old Can inhibit impulsive behavior Tend not to habituate to sensations Kids with ADHD often: Are agile; “sprinters” Love novelty and diversity Cannot inhibit impulsive behavior Do habituate SPD vs. ADHD

15. Jed Baker, PhDwww.socialskillstrainingproject.com Autism Spectrum Disorders • Social Difficulties • Initiating and Reciprocating • Language Difficulties • Semantic and/or Pragmatic • Repetitive Behaviors/ desire for sameness Associated issues: • Learning Issues • Motor Issues • Sensory issues: Tactile or noise sensitivity • ADHD, OCD, Tourettes

16. Difficulties Associated with Challenging Behavior • Difficulty with abstract thinking and perspective-taking • Misbehavior is often unintentional! Teach perspective more than discipline. • Inflexibility: Limited problem solving • Learning facts is more enjoyable than socializing. • Preparation and expanded problem solving avoids meltdowns • Low frustration Tolerance: Difficulty with Thinking-Feeling Connection • Concept of Emotional Hijacking • Prevent rage and distract when in rage

17. Behavior Management • Step 1: Relationship Issues • Feeling competent: 80/20 rule • Avoid power struggles: problem solve together • Step 2: Crisis Management • Distract, soothe, or ignore when logic is gone • Make a plan for next time • Step 3: Repeat Behavior Problems • Explore why it happens: Interview, observe, and keep an ABC journal (Before, During, After) • Develop a good prevention plan

18. Typical Triggers • Biological issues: hunger, tiredness, illness • Sensory issues: noise, light, touch, over-stimulation, boredom • Lack of structure • Challenging or new work, feared situations • Having to wait, not get what one wants, disappointments • Threats to self-esteem: losing, mistakes, criticism • Unmet wishes for attention: ignored, want others to laugh

19. Temple Grandin“A good teacher is gently insistent.” • Attention shifting slowness occurs with many disorders • Takes longer to shift back and forth between two different things • “All my thinking uses specific examples to create concepts.” • “It is bottom up thinking and not top down thinking.” • “I learned ALL concepts using specific examples.” • Fear is the main emotion in Autism.

20. Signs of Visual Processing Problems • Finger flicking near eyes • Tilts head • Hates escalators • Hates fluorescent lights • Difficulty catching a ball • Eye exams may be normal

21. Interventions for Visual Processing Problems • Incandescent lamp by desk • Block fluorescent lights with a hat • Laptop computer • Gray, tan, or pastel paper • Irlen lenses or pale colored glasses • Balancing games-sit on ball • Prism glasses-Developmental Optometrist

22. Severe Sensory Problems • Background noise problems • Mono channel • Body boundary problems • Often an auditory thinker • Best book: How Can I Talk If My Lips Don’t Move: Inside My Autistic Mind by Tito Rajarshi Mukhopadhyay

23. What Have Scientists Learned? • Sensory problems are real • Immature lower brain area • Abnormal circuits between different brain regions • Sensory problems are variable • Many word based tasks are processed in visual areas of the brain • Frontal cortex is used less because it has missing circuits

24. Develop Talents in the Individual’s Specialist Brain • Photo Realistic Visual Thinking- poor at algebra • Pattern Thinker Music and Math- poor in reading • Verbal Facts Language Translation-poor at drawing • Auditory Thinker-visual perception fragmented **There can be mixtures of these thinking types

25. Sensory and Neurological Problems That May Need Accommodations • Screams when the fire alarm rings • Cannot tolerate scratchy clothes • Poor handwriting • Tantrums or hyperactive under fluorescent lights • Difficulty multitasking • Difficulty with long verbal directions

26. Dr. Tony Attwood:Making Friends and Managing Feelings Autistic Personality: • Impairments in verbal and non-verbal communication • Empathy not as mature as one would expect • Difficulties with social integration and making friends. • Tendency to be teased by peers. • Egocentric preoccupation with a specific topic of interest. • The need for more assistance with self-help skills and organizational abilities than on would expect. • Motor clumsiness. • Hypersensitivity to some sensory experiences. • Tendency for some children to develop conduct problems • Much more common in boys than girls. 3:1

27. Asperger’s Syndrome in Females • Coping and camouflaging mechanisms of “hiding” and “mimicking” • Tendency to “disappear” in a crowd • Single friend who provides guidance and security • Observe and try to understand before they make the first step. • Apologize and appease • Less disruptive and so less likely to be noticed • Learn that if you are good, you are left alone • Faster rate of learning social skills than boys with AS • Imaginary friends • Tom Boy- not interested in fashion • Male brain (mathematics and engineering) • May only come to the attention of clinicians when there is a secondary mood disorder.

28. 4 Reactions to Being Different: • Depression and isolation • Increased social withdrawal • Reduced motivation and energy • Risk of self-harm and impulsive or planned suicide attempts • Imagination • Imaginary friends • Inhabiting an imaginary world • Arrogance • Invariably someone else’s faulty • Ruminate over past injustices • Argumentative: use accurate recall of what whas said or done to prove the point • Deal with exclusion and estrangement by acting superior • Tend to attribute malicious intent to accidental or friendly acts • Imitation • Becoming an expert mimic (successful strategy that is popular with peers) • Learning how to act in social situations

29. Honest (to a fault) Determined An expert Notice sounds others do not hear Kind Speak their mind Enjoy solitude Perfectionist Reliable friend Making friends Managing feelings Taking advice Handwriting Knowing what someone is thinking Being teased Showing as much affection as others expect Qualities and Difficulties

30. Amygdala • 2 deep within the brain that connects to the frontal lobe • Part of limbic system-responsible for fight or flight. • Scans for danger • In a person with ADS it is 10-15% larger than it should be (sees danger when there isn’t any) • Less white matter connecting to frontal lobe to cool it down.

31. Emotions • Anxiety: • Very good at worrying • Pessimist • OCD (25% of adults with AS) • Controlling and oppositional • Fear of making a mistake • PTSD from being teased or bullied • Depression • Occurs in 1 in 3 adolescents and adults • Low self-esteem due to being rejected and ridiculed by peers • Painful awareness of being different • Anger • 2 out of 3 people with AS have a problem with anger management • Sadness and anger expressed as anger