Transcript AdultswithAS

Nicola Martin and Luke Beardon
0114 225 5534
[email protected]
Brief
Understanding AS
Succesful Inclusion
Working with people who have AS
Care Planning
Resources
Areas to cover
 Issues /Implications
 communication /social interaction /flexibility
 Mental health
 Relationships
 Sustance misuse
 Support /coping strategies
 Diagnostic tools
 Care planning
 Resources
My response
 These areas are significantly inter related and can
not be artificially separated
 The voices of people with AS have to permiate the
day. Please read The Aspect Report
 Beardon L ,Edmonds G (2007) The Aspect report.
A national report on the needs of adults with
Asperger syndrome.
www.shu.ac.uk/theautismcentre
 My aim is to help you to empathise with people who have AS-emphasising
individuality and changes over time /context
The Autism Centre
 Staff have expertise in a range of areas including
education, criminal justice, family issues, across
the age range, and engage in teaching,
consyultancy and research.
 The Social Model of Disability informs the work of
the centre. If you want to find out more you could
take a distance learning module
www.shu.ac.uk/theautismcentre
0114 225 5534
Task
 Remember something which made you feel really
anxious ,deeply humiliated or excluded. Think
about it for a minute
 Concentrate on the physical feelings
 How receptive are you to work, study, socialising
etc when you feel like this?
 People with AS experience depression and anxiety
often, at least in part, as a result of environmental
factors /other people
Inclusion
'People with AS are like salt water fish that are forced
to live in fresh water. We are fine if you just put us
into the right environment. When the person with
AS and the environment match, the problems go
away and we even thrive. When we don't we seem
disabled'.
Baron -Cohen S (03) The Essential Difference. Penguin.
Task-definitions
inclusion
mental well being
relationship
coping
AS and Anxiety
 High levels of anxiety – as norm
 Increased anxiety states for specific reasons
 Global levels of high anxiety due to environmental
factors
 Possible as high as 90% of individuals have a
recognisable anxiety disorder
Secondary Psychiatric Disorders
 Not a primary mental illness
 Result of environmental factors and AS
 High level in people with AS compared to peer groups
 Better support should lead to a better prognosis and
reduction in secondary conditions
Specific Reasons for Anxiety
 As a result of specific neurological differences in
AS:
 learning processes
 communication
 social interaction
 Theory of Mind
 Executive Functioning
 emotional recognition
 Sensory processing
 Central Coherence
 obsessions or in depth interests (which differ from OCD)
Learning Processes
Direct learning vs Indirect learning
Examples of indirect learning /
development:
Theory of Mind
Social skills
Social cues
Non verbal communication
Factors which can be negatives
 Resistance to Change
 Environmental factors
 Trust
 Sense of self/diagnosis
 Physical
Hypothesis - resistance to change
Individuals with AS have
significantly lower ‘stability rates’ in
their day to day lives than the
neurotypical
This may lead, in part, to an explanation of
‘resistance to change’
Stability
Dependent on:

Communication

Understanding other people

Social awareness

Predictability

Fulfilled expectations

Shared sensory environment
Autism and Resistance to Change
Neurotypical
24 Hour Period
2
Unstable
Stable
1
OBSESSIONS -SPECIAL INTERESTS
 Can be ''socially inappropriate''?!
 Need boundaries
 Can be used as coping mechanisms
 Obsessions /in depth interests, may be
misinterpreted
 Task-consider the plus side of having an in
depth interest
SELF-ESTEEM
 Must be taken very seriously
 Impacts directly on self-control and behaviour
 Culture of poor self-esteem in AS
 Individuals need to know what to do just
as much as what not to do
Trust
◈Possibly an unquestioning level of trust
◈Possibly extremely distrustful
◈NTs are renowned for lying
◈Not being given the opportunity to
trust can be highly anxiety inducing
Verbal Communication
◈Literal interpretation
◈Metaphor / sarcasm / irony
◈Pedantic
◈Echolalia
◈Delayed processing
◈Meaning transferability
◈Expressive vs receptive skills
Non Verbal Communication
◈Prosody
◈Facial expression
◈Body posture
◈Inference
◈Contextual information
Social Skills
◈Recognising the ‘unwritten rules’
◈Assessing situations
◈Reacting appropriately to social
circumstance
◈Adapting social skills to the situation
Social Cues
◈Conversational turn taking
◈Following the leads of others
◈Understanding ‘friendships’
◈Group settings
◈Sharing
◈Participating in game scenarios
Traditional Model of Autism
 'Triad of Impairments'
 Wing and Gould 1979
 Identified 3 areas of difference:
 communication
 social understanding
 'imagination'
Task-1.Is there an argument for describing 'the triad of
difference'?
2.Think of positive and negative words associated with AS-and
3.Think about the language you use
Issues
 Deficit based
 'Imagination' is inaccurate
 Highly subjective
 But useful as a guide in terms of areas of
developmental difference
Theory of Mind
 Understanding and recognising emotional states (self and
others)
 Mentalising abilities
 Difficulty in understanding that other people may see things from a
different point of view
 Inflexibility in the application of both the written and unwritten rules
that govern behaviour
 Empathy
 Trust
 Appearance of rudeness
 Lack of pretend play
Mindreading allows us to:

Explain Actions
 Predict Actions
 Recognise and utilise deception
 Pretend and imagine
 Experience empathy
 Share information and co-operate
Executive Functioning
 Planning
 Impulse control
 Sequencing
 Scripting
 Managing time and space
 Connecting events
 Flexibility
 Understanding 'what happens next'
 Turn taking
 Queuing
 Difficulty with understanding abstract concepts and cause and consequence
Central Coherence
 Identifying the pattern or underlying rules
 Attention to detail
 Knowing what is relevant and redundant
 Recognising the 'big picture'
Behaviour
 Identify behaviour in isolation
 Decide: elimination or not?
 Decide: adapt/modify
 environment
 behaviour



intensity
duration
frequency
 Review
Bullying
 Individuals with AS are highly vulnerable:
 don't 'fit in'
 will not necessarily follow traditional social convention
(fashion, etc.)
 problems with adhering to social rules within society
(classroom, playtime, employment, social arenas, etc.)
 communication problems
 poor TOM
EDUCATION
PROBLEMS INCLUDE





Cognition can hide core defects
Peer group
Lack of understanding from staff
Transference of problems (home to school/work/service and
vice-versa)
Academia takes preference over social and emotional
development. Can lead to...

Isolation

Poor self-esteem

Poor motivation

Depression

Unrealised potential

Perfectionism
WHY GET A DIAGNOSIS OF ASPERGER SYNDROME?
OPENS OPPORTUNITIES provided post diagnostic support is available

To understand one’s self

To understand behaviour

To develop appropriate support mechanisms

To widen scope of services

Provides better chances for the future
diagnosis is a process not an event
PROBLEMS WITH DIAGNOSTIC PROCEDURE
GENERAL

Inconsistency of diagnostic criteria (specifically
language delay)

Lack of awareness among some clinicians

Poor clarity of referral routes
CLINICAL

Behaviours within clinical settings may not provide
an accurate profile

Echopraxic behaviours may be construed as pretend
play

Many other difficulties can manifest similar behaviours
(e.g. abuse and trauma)
ETHICAL CONSIDERATIONS
 Do not impose societal values on the person
with AS
 There’s nothing wrong with having AS
 There is much to learn from people with AS
 Never assume anything when working with
someone with AS
 Not acknowledging AS can be discriminatory
 Difference does not equate to negativity