Transcript Totally Social ASD Presentaiton 2.11

Making sure that we are on the same page!!
Totally Social ASD
Chris Rans, Ed. S., Autism Specialist
Rans Consulting and Advocacy LLC
[email protected]
810 923-5620
How Do Persons with
Autism Spectrum Disorder (ASD)
“See and Interpret”
the World Around Them!
ASD Strategies and Tools for Everyone!
Increase of ASD to
date!
• 1 in 55
– 1 in ????? (Boy born w/ HFA)
Intelligence
vs.
Social Cognition
“Oddities”!
70
40-50
Severely
Cognitively
Impaired
Cognitively
Impaired
At or below
grade-level
85115
Average to
Above
Average
Intelligence
At or above
grade-level
New DSM V
Autism Spectrum Disorders
ASD
w/ Restricted and Repetitive
Interests!
So……….You, Me and
Communication!
What is expressive communication?
Learning to observe and recognize social
communication skills in the NTD person!
What is Communication?
• A range of purposeful, intentional
behavior, either verbal or non-verbal,
evidenced by anticipation of an outcome,
which is used to exchange information w/in
a social context.
• ASD: A wide range of communication
behaviors, from non-verbal to extremely
verbal w/ varying degrees of
communication intent.
NTD Speech and
Language Develop:
• 3 Stages of Communication
Intentionality
– Prelocutionary (birth to 8 mon.)
– Illocutionary Stage (8 to 12mon.)
– Locutionary Stage (12 mon. +)
Illocutionary Stage…..8-12 mon.
• Intentional Communication
– Realizes that their acts have an affect on others
– Attempts to control/interact thru non-symbolic
means i.e. gestures or vocalizations
– Begins to use gestures/vocalizations to communicate
– Gestures used for a goal;
• Used to equate cognitive ability to dev. a plan to
achieve a goal
– Social skills
• Enjoys simple social games i.e. peek a boo or
patty cake
– Reciprocity/turn taking
Non-Verbal Social Communication by
12 mon.
• Coordinates non-verbal behavior by using their
eyes, face, body and hands together to interact
and regulate social interactions and
read/understand the non-verbal behavior of
others
– Ex. Follow eye gaze and point reference to look
where someone else is looking. Understanding
facial and vocal tones to denote happy, sad or
angry. (JA)
• Again: prior to talking, baby can participate in
reciprocal interactions using non-verbal social
communication
What is Joint Attention (JA)
( Schertz & Odom 2004)
• Coordinating attention to an event
or object w/ another individual,
sharing interest and social
engagement, and showing an
understanding that the partner is
sharing the same focus
– Note: mastery of JA is a reliable
predictor of language development
More JA………..
• The use of early gestures to
coordinate attention between
objects/events of another person
• Sharing experiences w/ others by
drawing their attention to objects or
events
• Following another person’s gaze or
point of reference
• The use of a gaze to shift another
person’s attention
JA’s Review:
• 2-3 mon.:
– Infant smiles in response to a parent smile
or voice
• 8 mon.:
– Baby is able to follow parents’ eye gaze
(e.g. look at dog)
• 10-12 mon.:
– Baby is able to follow a point reference and
then look back at the parent
• “Checking back” = critical component
• 12-16 mon.:
-Toddler initiates and draw’s parents’
attention to object of interest using
sounds, pointing, and looking back and forth
Review: NTD Language Development
by 3 yrs.
• Talks about past and future ideas
• Relates experiences so that they can be
followed w/ reason
• Able to reason out questions such as “what
must you do when sleepy, hungry or thirsty”.
• Uses pronouns I, you, me correctly
• Uses plurals and past tense
• 3-4 word utterances/sentences
• Plays make-believe
Current Theories & Research
• Genetic predisposition with
environmental triggers
So……what are these?
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Playful
Comforting
Irritated
Bored
Ashamed
Nervous
Indecisive
Suspicious
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Joking
Desire
Flustered
Convinced
Impatient
Irritated
Aghast
Reflective
Remember:
EYE MOVEMENTS!
Studies and Research!
Bits and Pieces of Info.
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Margaret Bauman
SC vs. Object
Who’s Afraid of ……
Box and Sticks (animation)
Monotone crying
Yawning! (Amygdala)
Dr. Simon baron-Cohen
– Research of the NTD “male” brain
– Systematic vs. Empathetic Thinkers
The DSM-V Definition of
Autism
(MI definition)
Differences in
Socialization
Differences
in Behavior
Differences in
Communication
“The low functioning child
with autism lives in a world
of his own, whereas the
higher functioning child
with autism lives in our
world but in his own way.”
Van Krevelen
Social Cognitive Challenges!
• Mild CI to Superior Intelligence
– Difficulties may include:
• Difficulty shifting attention
• Difficulty shifting two cognitive tasks
simultaneously
• Generalizing information
• Retrieving information on demand
• Developing problem-specific solutions
• Difficulty w/sense of time
More…Differences in Socialization
• Marked impairment in the use of
nonverbal social communication to
regulate social interaction
– eye to eye gaze (more HFA)
– facial expression
– body posture
– gestures
• Failure to achieve developmentally
appropriate peer relationships
• Again, what is reciprocity?
– What is talking “at” vs. “with” ?
Yet….More Differences in
Socialization..
• Lack of spontaneous seeking to share
enjoyment, interest, or achievements with other
people
 Does not show, bring, or point to items of
interest (more HFA)
 What is talking “at” vs. with?
• Lack of social or emotional reciprocity
 Identifying and responding appropriately to
emotional states of other people (e.g., comfort
a crying person)
• Impaired perspective taking
 Viewing situations from another person’s
point of view and predicting other’s behavior
The last for now!
 Difficulties recognizing and responding
to subtle social nuances, cues, and
unspoken messages
 Responding to a person losing interest
 Identifying and responding to people’s tone
of voice, facial expressions, posture
 May seem egocentric and may not show
empathy in typical ways
 Often aware of their differences
(especially adolescents and young adults)
which can lead to low self-esteem
Restricted and Repetitive
Patterns of Behavior
• Encompassing preoccupation with one
or more stereotyped and restricted
patterns of interest, abnormal in
intensity or focus; for example:
 History, Computer Games, Gozilla
 Weather Systems, Animals
 Others
• Apparently inflexible adherence to
specific nonfunctional routines or
rituals
 Dressing rituals
 Distress at unexpected changes
Review: Overall Basic Components
to Social Communication!
Theory of Mind
Central Coherence
Executive Functioning
For YOU and ME!
• Autism could feel like being
forced to move and live in
Russia for the rest of your life
and never being “taught” the
Russian language, social
rules/hidden curriculum and
laws! You just learn to survive!
Theory of Mind
“Mind Reading”
• Knowing that you have a different
perspective than I do
• Predicting others’ behavior
• Inferring /referencing what is going
on around me
• “Reading” the intentions of others
• Understanding the motives of others
Note:……Females on the
Spectrum
• Females below grade level tend to be
more severe than males
• Females at or above grade level
– More Theory of Mind
• More into fantasy: unicorns, wolves, cats
– Reads about fantasy, Ex. medieval
– Usually love animals to include stuffed
• Thrive on details of certain animal
information
Central Coherence
• Not knowing what is important and what is not
important
• Not seeing the big picture, but fixating on
details
• Not maintaining a full range of interests
• Not “connecting” things around me
• Imposing one’s own perspective
(their way or the high way)
• Difficulty with new tasks
• Apparent lack of compliance or NOT
Executive Functioning
• Overall Planning and organization
• Inability to generalize skills from
previous experiences or settings
• Behavior often appears rigid and/or
repetitive
• Often narrowly focused on details of
items or topics of special interest
The “Real” Definition of
Autism:
Autism means that someone
is really smart in some
things but needs a lot of
help in other things.
Mrs. Fizell’s 2nd Grade class (1999)
from Barry Prizant
Soooooo………
Anxiety blossoms from:
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Too many words from adults
Changes in schedules, routines
New people, events, environments
Unfamiliar task demands
Immersion in social settings
Separation from “safe” people/place
Teasing and bullying
Then comes sensory overload!
In trying to relate:
• Autism could feel like being forced
to move and live in Russia for the
rest of your life and never being
“taught” the Russian language, social
rules/hidden curriculum and laws!
You just learn to survive!
Sooooooooo again……
Behavior is Communication!
Behavior is a Function!
• Persons w/ ASD:
• Do not have the emotional resources to
cope with the demands of things going
on around them
• Too many words!
• Can have reactions/temper outbursts in
response to stress/frustration/anxiety.
• Can become confused, disoriented or
scared
Strategies that work!
Who is Temple Grandin?
Gooooooooo Visual!
Looking to Develop the ……Ultimate
Goals for Persons w/ASD
• Functional independence
– What social communication skills do I need to
acquire and hold a job?
• Socially appropriate
– What social communication skills do I need in
order to acquire and maintain a
job/relationship?
• Academics/ and or Job Skills
– What social communication skills do I need to
acquire and/or keep a job?.
Remember, persons w/ “social
thinking” challenges” ……
•Are “visual learners” due to the
language and communication
processing challenges
•So…what and how do we teach………?
First Learn to
Recognize the……………….
Hidden Curriculum!
WHAT WE TAKE FOR GRANTED!
What is the “Hidden Curriculum”?
•Most students are taught the academics
– Say……………………. how to divide
•However, persons w/ASD need to be taught rules
and/or guidelines that are “assumed” by most people
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Men’s bathroom
Nose Picking
David /Kmart
Shut-up
Who to talk to on the internet
• Not recognizing when someone is being bullied!
•Reading body language, gestures, facial
expressions
HC in the…….Workplace
for You and Me!
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Can present major obstacles for a person on the spectrum
Adults are assumed to know certain things
Adults are assumed to learn the rules in a short period of time
Two organizational charts in every business
– The company manual/written document
– HC/The other is the “hidden chain of command” not written
in any book
Other HC:
– Business email for personal stuff
– Casual business dress
– When to introduce a new idea
– Who to avoid
– Customer is always right
– Disagreeing with your boss
– Asking for a raise
– Lunch
– Break
– Expressing anger
HC….in the Legal
System
Wow! What I did not know!
Helping people on the
spectrum……..”connect”
Let’s Go VISUAL To
Become Functionally Independent!
Manage, Establish and Learn
Routines!
• Routines need to be taught
• Duck Tape City!!!!!!!! For US!
• Never assume that a person w/ ASD
understand things that the neurotypical adult “gets” naturally
• What is knowing things vs. what is
knowing how to “connect” those things
Start w/:
“Social Communication” Time!
• For the person on the spectrum:
– What is recognizing and accepting their ASD?
– What is recognizing “what and who” are
helpers/social coaches?
– What is finding time to work on social
communication skills using visual strategies?
• Most of the lessons can be on the “go”
around the school, home and in the
community after the system has been
established
4W’s Plus How
(The only verbal visual!)
What is referencing, self, others and
situations around by using the 4 W’s
Plus How?
• Who
• What
• Where
• When
• How
• NEVER------------------ WHY!
Priming w/ the 4 W’s and
Visuals
• When planning “anything” staff need
to prime a person ahead of time
– Show them that activities can be
changed, cancelled or rescheduled
– Use the 4 W’s and or other visual
strategies
– When unavoidable situations occur.
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Be flexible
Recognize that change is stressful
Adapt expectations
Adapt language
Listen To Their Words
• Listen and probe
• Seek and offer clarification
– 4 W’s plus How
• Continue to break down the words to help
clarify more and more information on what
appears to be a challenge
Use Visual Strategies:
• SC Tool/Binders or an Ipad can house:
– Visual tools:
• 4 W’s plus How
– Sometimes use the computer to communicate
• Schedules
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– Mini-schedules
Social Stories
Power Cards
5 Point Scale
Comic Strips
Social Rules
Sensory Diet
Try and…..
Draw and/or write as you talk!
• Materials/being prepared
– Laminate marker board (big or
small)
• Provide flexibility
• Easy to erase
• Use of different colored
markers representing different
feelings
Schedules and Mini-schedules!
• Helps to predict what is next in the
details of a day
• Left to right
• Vertical
• How have you used schedules?
– Talk Time
Build in Sensory/Relaxation
Time throughout the day!
• Build into the daily schedule as a positive tool!
– Safe Place
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Quiet
Sensory
Relaxation Techniques
Reteach Time
Social Skill Development
– Time Away (Not Time Out!)
• 5 Point Scale
• Directed by a staff/parent
– Time with safe person
More ……..Visuals
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Video Modeling
Role Play
Scripting
Movie Time
Remember….Set a Calm,
Positive Tone
• If a person can not see out of
their world then comes------------Anxiety!
• Persons w/ASD can detect high
emotional content
– When a parent becomes agitated
about constant interruptions
– Tend to take on the emotional tone of
the person that is upset
– Can go into a full blown meltdown
– Soooooooooooooooooooooooooo
Be Generous With Praise
• Low self-esteem and limited self
confidence
• Afraid to take risks
– Soooooooooooooooooooooo find time to praise
throughout the day with very clear and specific
comments
• Ex. “ Good morning, Danny. I hope that
you slept well.”
• “I noticed you held the door open for Mr.
Hake when he had his hands full, Joey.
That was so thoughtful.”
• “You did well on your history test. Your
studying really helped you do well.”
THEN……..Developing Social
Communication Skills in the
Home and Jobsite!
– Establish a social communication plan
for home and on the job as a team
• Create a PBIS Plan as a team to establish
objectives
• Decide on a SC Curriculum to follow
• Involve peer support when possible
• Create a time for SC work time
When a behavior
occurs…..
• We need to:
– Recognize their lack of “disconnect”
• Play detective and “think how they think”!
• Provide a “teachable moment”
– When, Where and who
– Or communicate to appropriate staff/parents
Social Job Coaching is
#1………. even on the job site!
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Who
How
When
Where
NEVER WHY!!!!!!!!!!!!!!!!
– For a life time!
Review-Basic Needs for
Enhancing SC Skills!
• Structure and organization for learning SC
skills
• Develop trust in who is teaching the skills
• Life to be logical and predictable
• Information to be more visual than
auditory
• An awareness of sensory needs when
anxiety is high and on overload