autism spectrum disorders

Autism Society of Minnesota

Autism Spectrum Disorders

Dr. Barbara LuskinSeptember 2014

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Demystifying Autism

Autism Society of MinnesotaAutism Society of Minnesota

Who is the Autism Society of Minnesota?

Our mission: as an agency of families, educators, care givers and professionals, we are committed to supporting individuals with ASD and their families

Our vision: to realize its mission through education, support, collaboration and advocacy.

Established in 1971 as the local presence of the autism community in MN we have provided over 40 years of services and programs that have enhanced the lives of individuals with ASD

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Speaker BioDr. Barbara Luskin, PhD, LP is a licensed

psychologist who has worked with people with autism in various capacities for over 20 years. She earned her PhD from the University of Chicago in Human Development. For the past 11 years Dr. Luskin has provided mental health services at the Autism Society of Minnesota (AuSM). Much of her practice involves the diagnosis of and therapy for adults with ASD . She facilitates a support group for high functioning adults with ASD and provides training and education to families and service providers.

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Where Have You Been ?At least 1 in 88 children are diagnosed with an

ASD. Perhaps as many as one in 54 males.30 years ago 4 in 10,00 were diagnosedThere is no solid evidence of a dramatic growth

in actual occurrence of ASDDSM-IV dramatically changed the criteria

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Labeled? Personality Disorders (schizoaffective,

avoident, schizoid, narcissistic, borderline ) MR ADHD ODD Weird, Lazy, Eccentric

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Understanding the Labels-DSM IVPervasive developmental disorders (PDD) 299

299.00 autism299.80 Asperger syndrome299.80 Rett syndrome299.10 childhood disintegrative disorder299.80 pervasive developmental disorder not otherwise specified (PDD-NOS

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Understanding the Labels DSM 5Autism Spectrum DisorderSocial Communication DisorderSpecified Neurodevelopmental DisorderUnspecified Neurodevelopmental Disorder

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Autism is a developmental disability that is now diagnosed based on two areas of disorder (as opposed to simply delay). These areas are defined by the American psychiatric association in the DSM-5 as:

1. Qualitative impairment in social interaction and communication.

2. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.

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Pattern of Development

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autism

Typical development

Developmental delay

Motor IQ lang.comp lang.expr social memory

120

100

80

60


Disorder implies that someone does things in a different way rather than doing them in a simpler, slower, or delayed way

It may also mean that someone has “splinter” skills. He/she may have some more sophisticated skills without being able to perform more basic activities that usually precede those skills

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Examples of Disorder Unable to have a conversation but able to remember with

great accuracy details of a routine after two or three times

Doing Calculus but not understanding basic budgeting

Having a college level vocabulary but not knowing how to greet others

Having PhD in computer science but being unable to complete a job application

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Autism Society of Minnesota

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Asperger vs Autism

•With the publication of DSM 5 Asperger syndrome is no

longer an official diagnosis. In the past it was distniguished from autism in different ways

by different professionals. Two main criteria were:

•IQ above 70•Fluent speech


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Qualitative Impairment in Social Interaction


Use of Nonverbal BehaviorThey think you are shifty …”“My boss said I was the calmest one in the

dept…..”“How was I supposed to know you were mad?”“What’s the point of waving goodbye?”“I can’t figure out how to join a conversation”“I learned to look at people in high school…”

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Problems in Relationships“ All my friends are people I play music with”“My wife arranges all our social life”“I have always been bullied”“ My coworkers blame everything on me”

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Failure to Develop Peer Relationships.“I had friends in high school but we’ve lost

touch”“People irritate me…”“I really don’t know what friendships mean”“I have two good friends, we see each other

once a year.”“I have had hundreds of first dates”

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Lack of sharing of emotions“I don’t really think about sharing my

achievements”“I’d like to share but don’t know how to bring it

up”“No one cares about what I am interested in

…”“I know I am supposed to say ‘congratulations’

but don’t feel anything.”

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Lack of reciprocity“She doesn’t want to talk to me anymore…”

“Why should I say good morning when it isn’t one?”

“It took me years to realize that other people weren’t robots.”

“I don’t get going to an event just because my girlfriend wants to go.”

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Qualitative Impairments in Communication

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Problems in Speech

“By the time I get my words organized the conversation has gone on”

“When I am upset I can’t talk”

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Problems with Conversation“I hate small talk”“People tell me I talk too much/too little”

“Mostly I just sit in a corner and listen”

“Things are better since e-mail”People always change the topic before I am finished”

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“People say don’t interrupt, but they keep interrupting me..”

“I’d rather just talk about what I am interested in..”

“I have to make other people understand me..”

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Problems in communicationBasically…”“People tell me I am always too loud..”“People take things the wrong way…”“ I don’t know how to talk informally..”“ I hate poetry…”“I can only say what I have heard”“I can say things better than I can

understand them“People should just say what they mean”

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Difficulty with Imagination“Why plan, I don’t know what will happen…”“Its really hard to play with my kids…”“I have a hard time predicting how people will

react…”“ I am a terrible liar”“I hate planning activities, I can never think of

what to do…”“I never understood why other kids wanted to

pretend”

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Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

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Unusual Focus“How many have spend ½ hour

watching the pattern Windows makes ….”

“I have been working for years on a dictionary of ancient Summarian…”

I’m not interested in gardening so why should I listen to her talk about it?”

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Narrow focus“most people are boring”

“most of my friends are from the weather chat room”

“I just wish my boss would tell me why she wants me to do it.”

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Preference for RoutineAll change is bad..”“Once I have found a good way to do

something there is no reason to change..”

“Why try a new cereal, I like the old one..”

“My world is very chaotic, routines help reduce the chaos..”

“ I make it a point to remind people that the employee handbook says…”

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Stereotyped motor mannerisms“I have to do something with my hands”“flapping my hands helps me calm down but I

know people think I am crazy…”“I get so mad I start biting myself”“lights really bother me”“I can’t stand the smell of certain foods”“I love the feel of soft flannel”“ I was never good at sports”

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Detail Focus“I start to do something but get

focused on one detail and get distracted..”

“I see all the details but not the pattern..”

“I can’t recognize faces

“All the details are important…”

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“I save every piece of paper because I can’t figure out which ones I might need”

“I can remember every bus route in the cities but I can’t remember my appointments.”

“My apartment is a mess…I can’t get it organized.”

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Problems Summarizing and Generalizing“ My proposal to the county for using my funds

for a new computer system was 20 pages long and they didn’t even read it.”

“He tells us more than we ever wanted to know about…”

“The job application never gives me enough room to answer the question.”

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Sensory and Motor Differences“I have to have something in my

hands..”“Flapping my hands helps me calm

down but I know people think I am crazy…”

“I get so mad I start biting myself…”“Lights really bother me..”“I can’t stand to smell certain

foods..”“I love the feel of soft flannel..”

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Ideas for accomodations and supports

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Visual Supports: A Picture is Worth 1,000 Words

SchedulesCalendarsVisual Directions/ModelsSummary notes from sessionsOffer written communication in meetings

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Adjust Communication Communicating on different wave lengths

o Logical AM vs. Emotional FMOne thing at a time

o Differences in information processing Write it downSpeech may be better than understanding-

clarify Be concrete and specific-avoid non-literal speech and

leading questions Don’t rely on nonverbal communication

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Social StoriesDescribe upcoming eventsDescribe routine situationsExplain other’s emotionsExplain expected behavior

These can be as complex and detailed as the verbal level of the individual ranging from quite simple to quite complex

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A Social StoryJon goes home from work on the bus. Jon lives

on 65th streetUsually the bus drives on Walnut and then

turns on 65th.Today there is construction on Walnut streetThe bus cannot turn on Walnut streetThe bus will drive on Oak street insteadJon will get off at the

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Use Cartoons and Social Mapping to:Analyze problemsDifferentiate thoughts from wordsExplain relationships

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Social Map

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Comic Strip Conversatoin

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Video Self MonitoringVideo showing a person doing a skill that they

want to increaseOne or two minutes longUse digital editing to create image of new

behaviorSuccessful across a range of functioning

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Executive FunctioningSaying “ok” doesn’t mean I know

what to doMake suggestions very concreteBreak down goals into very small steps

Help schedule when tasks will be done

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Time Management: People with autism have a different sense of time

Teach scheduling

Help client explore alarms, timers, etc that may work

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FocusPeople with autism are good at

sustained focus but not shifting attention:

Avoid jobs that require a lot of multitasking

Keep your own sessions focused- one thing at a time

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Sensory AccomodationsThe client may need:Lower lightingReduce noiseAllow sensory activitiesAllow plenty of opportunity for movement

You may need to teach him/her to self advocate

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Self Defeating BehaviorHe’s just trying to annoy me!”

“She is so noncompliant!”

“Ignore him—he just wants attention!”

“She just wants her own way!”

“He just doesn’t care about anyone”

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Inflexible thinkingProblems with Theory Of MindThinking may not be logicalLittle “thinking” happens when stressedLow tolerance for frustration“Rigid” and concrete thinkingLittle attention to the reactions of others

Challenging Behavior: Ways ASD Effects Behavior


Strong need for “routine” or “sameness’May be unmotivated by “customary” rewardsDifficulty with transitions or changeStrong need for closure or “task completion”Difficulty in communicatingPoor problem solving skillsPoor organizational skillsSensory Issues

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Every Behavior Has a FunctionTry to understand why a person uses an

inappropriate behaviorHow is he feelingWhat triggers the behaviorWho is this person: skills, temperament,

interestWhat results from the behavior

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Primary reasons for inappropriate behavior in job seekersMotivation- Is it what the client wants or is it

what he thinks he is “supposed to do”Lack of social awareness- not realizing the

impact of an action on othersLack of skill- not knowing what else to doMental Health issues- often overwhelming

anxiety

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Offer an alternativeOnce the reason for inappropriate behavior is

identified it is most effective to provide (through suggestion or teaching) a more appropriate alternative.

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Rules, Rules, RulesYou may need to explain to your client the hierarchy

of rules and when they can be broken:Laws: Sexual Harassment, TheftMajor Rules

Explicit: All phone calls must be logged

Implicit: Always greet the boss politelyMinor Rules:

Explicit: Request items using form CImplicit: Fill the water pitcher if you

empty it

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Disclosure and Self Advocacy

If a disability related behavior cannot be changed and will be misinterpreted disclosure is vital.

Diagnosis vs. behavior description- “ I have autism” or “I just can’t get hints- please tell me what you want and need.”

Who needs to know?What are reasonable accommodations. Pride not arrogance

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How to get in troubleAlways say exactly what you think

Have no clue what the difference between an attractive aquaintance and a girlfriend is

Ignore all hints

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“Insist on explaining to the “officer” why you are right”

“Insist on obedience to the rules and “fairness at all times.”

“Don’t let anything interfere with an important routine.”

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autism spectrum disorders

Documents

autism community

autism spectrum disordersdr

labels dsm

years of services

publication of dsm

asperger syndrome299

areas of disorder

different professionals