Transcript New Challenges in the Classroom: Asperger Syndrome and

New Challenges in the Classroom:
Asperger and Tourette Syndromes
AASSA Conference
Buenos Aires, 2007
Juani Pinzás, Ph.D.
Lucrecia Rodríguez, MA.
Colegio F. D. Roosevelt
Lima, Peru
Why Asperger Syndrome?
Why Tourette Syndrome?



Increased cases in the
classrooms
Increased presence
nationwide
Recent research:
 Medical
 Psychological
 Educational

Teachers’ concerns

Parental expectations

Counselors’ Role
Our task today:



Share updated
information on theory
about both syndromes
Provide specific
guidelines and tips for
counselors and teachers
Suggest ways of
supporting parents
Outline of Presentation
Asperger Syndrome







Definition
Diagnosis
Characteristics
Development
 Cognition
 Language
 Motor
 Social
Treatment
Recommendations for
Counselors
Recommendations for Teachers
Tourette Syndrome








Definition
Diagnosis
Facts
Types of tics
 Motor
 Vocal
Impact on School Performance
Treatment
Recommendations for
Counselors
Recommendations for Teachers
Asperger Syndrome (AS)
What is it?
“Asperger Syndrome (AS) is a neurobiological
disorder named after a Viennese physician, Hans
Asperger, who described a pattern of behaviors in
several young children, mainly boys, who had
normal intelligence and language development, but
who also exhibited autistic-like behaviors and
marked deficiencies in social and communication
skills.”
(Barbara L. Kirby, 2006)
Diagnosis of Asperger Syndrome

Asperger syndrome can be very difficult to diagnose. Children
with Asperger syndrome function well in most aspects of life,
so it may be easy to perceive them as just being "different.“

Researchers and mental health experts are still investigating
the causes of autism and Asperger syndrome .

Asperger syndrome should be diagnosed by a clinical
psychologist and/or child psychiatrist.

Diagnoses can be best done in Kindergarten or 1st grade.

Teachers cannot make a medical diagnoses like this one. The
whole school should avoid labeling students with Asperger
syndrome.
Comorbidity
Depression or
Bipolar disorder
Asperger
Syndrome
Asperger syndrome can be accompanied by depression or
bi-polar disorder.
Identified Asperger Syndrome students may
exhibit a variety of the following
characteristics:

marked deficiencies in social skills

preoccupation with a particular subject of interest

obsessive routines

difficulties with transitions or changes

preference for sameness

great difficulty reading nonverbal cues (body language)

difficulty determining proper body space

over sensitivity to sounds, tastes, smells, and sights
Cognitive Development



By definition, those with Asperger syndrome have a
normal IQ and many individuals exhibit exceptional skill
or talent in a specific area.
Because of their high degree of functionality those with
Asperger syndrome are often viewed as eccentric or odd
and can easily become victims of teasing and bullying.
Asperger syndrome ranges from mild to severe.
Language Development




no significant delay in the development of language
milestones
despite normal language development, deficits in
pragmatics and prosody
extraordinarily rich vocabulary, sometimes sounding like
"little professors"
extremely literal, difficulty using language in a social
contexts
Language Development (Cont.)

high amount of verbal output,

good verbal learning

adequate to advanced level of word recognition,
Language Development
(Cont.) **

speech tends to be formal, robotic or repetitive

no figurative use of language, symbolic representation,
nuances or double meanings

linguistic sophistications such as jokes and idioms are
hard to grasp.

language development is quite literal, therefore reading
other people's intentions are areas where language
problems occur.
Social Development




inadequate social
perception

minimal social interactions
no empathy

weak social pragmatics
problems reading
nonverbal cues, such as
facial expressions or
body language

lack of "common sense"

obsessive routines
inappropriate affect
Motor Development and Other




motor delay

motor dyspraxia
(reflected in a tendency
to be clumsy)

problems in visual motor
integration skills

problems in visual
spacial orientation

problems in spatial
memory
usually have a deficit in
nonverbal skills
may have problems with
attention span
may have problems with
organization

As far as we know, there seems to be no cure for the
disorder - children with Asperger syndrome will become
adults with Asperger syndrome .

But adults with Asperger's may lead full, happy, and
productive lives.

The likelihood of achieving this is enhanced with
appropriate education, support, and resources.

Teachers, parents and counselors are key.
Outline - Tourette Syndrome








Definition
Diagnosis
Facts
Types of tics
 Motor
 Vocal
Impact on School Performance
Treatment
Recommendations for Counselors
Recommendations for Teachers
Tourette Syndrome (TS)
What is it?
“Tourette Syndrome (TS) is a neurological
disorder characterized by repetitive,
stereotyped, involuntary movements and
vocalizations called tics. The disorder is
named for Dr. Georges Gilles de la Tourette, a
French neurologist.”
(National Institute of Neurological Disorders,
2006)
Diagnosis of Tourette Syndrome (TS)




Neurologists make the diagnosis after verifying that the
patient has had both motor and vocal tics for at least 1 year.
Clinical psychologists or child psychiatrists should complement
the diagnosis with a complete psycho-educational battery and
a good family and child history.
For families and physicians unfamiliar with Tourette syndrome,
mild and even moderate tic symptoms may be considered part
of a developmental phase or the result of another
condition. (*)
Many patients are self-diagnosed after they, their parents,
other relatives, or friends read or hear about Tourette
Syndrome from others.
Some Facts About Tourette Syndrome

The early symptoms of Tourette syndrome are almost
always noticed first in childhood, with the average onset
between the ages of 7 and 10 years.

Tourette syndrome occurs in people from all ethnic
groups.

Males are affected about three to four times more
often than females (3:1 or 4:1).

Their cognitive development is normal. People with
Tourette syndrome have average or high average
intelligence.
Comorbidity

Some individuals with Tourette syndrome
experience additional neurobehavioral
problems such as:



Attention Deficit Hyperactivity Disorder
(ADHD) or
Obsessive-Compulsive Disorder (OCD) or
Behavior Disorder
Comorbidity
Attention Deficit
Hyperactivity Disorder
ObsessiveCompulsive
Disorder
Tourette
Syndrome
Behavior
Disorder

Although the cause of Tourette syndrome is unknown,
current research points to certain brain regions, the
circuits that interconnect these regions, and the
neurotransmitters (dopamine, serotonin, and
norepinephrine) responsible for communication among
nerve cells.




A significant percentage of all children will experience one, or
even a few tics at some point in their development.
For most children, a tic will emerge without any warning or
explanation, remain a few weeks, and then disappear slowly. For
some children the tic does not disappear, but continues its
development as either a chronic tic or a Tourette condition.
A tic is defined as a brief, repetitive, purposeless, involuntary
movement or sound.
Tics that produce movement are called "motor tics," while tics
that produce sound are called "vocal tics" or "phonic tics."




Tics may often be characterized by whether they are "simple"
or "complex."
A simple tic involves one muscle group or one simple sound.
A complex tic involves a coordinated movement produced by a
number of muscle groups.
Motor tics generally precede the development of vocal tics and
simple tics often precede complex tics.


Studies suggest that Tourette syndrome is an inherited
disorder.
Although there is no cure for Tourette syndrome , the
condition in many individuals improves in the late teens and
early 20s.

As a result, some may actually become symptom-free or no
longer need medication for tic suppression.

Individuals with Tourette syndrome have a normal life
expectancy. Tourette syndrome does not impair intelligence.
Examples of Simple Motor Tics









Eye Blinking
Eye Rolling
Nose Twitching
Lip-licking
Shoulder Shrugs
Head Jerks
Brushing or Tossing Hair Out of Eyes
Mouth Opening
Arm Extending
Examples of Complex Motor Tics










Pulling at Clothes
Touching People
Touching Objects
Smelling Fingers
Smelling Objects
Jumping or Skipping
Flapping Arms
Tensing Muscle Groups
Twirling Hair
Sequences or patterns combining different simple and
complex motor tics
Examples of Simple Vocal Tics







Throat Clearing
Grunting
Yelling or Screaming
Sniffing
Coughing
Humming
Whistling
Examples of Complex Vocal Tics


Unusual changes in volume of voice
Coprolalia: obscenities or socially taboo phrases
Note: This list is not all-inclusive
**



Tics often worsen with excitement or anxiety and
lessen during calm, focused activities.
Certain physical experiences can trigger or increase tics,
for example tight collars may trigger neck tics, or
hearing another person sniff or throat-clear may trigger
similar sounds.
Tics come and go over time, varying in type, frequency,
location, and severity. The first symptoms usually
occur in the head and neck area and may progress to
include muscles of the trunk and extremities.
**



Although the symptoms of Tourette syndrome are
involuntary, some people can sometimes suppress or
manage their tics in an effort to minimize their impact
on functioning.
Tics vary in frequency. Decreased frequency occurs in
the morning and it increases in the afternoon and
evening.
Although Tourette syndrome can be a chronic condition
with symptoms lasting a lifetime, most people with the
condition experience their worst symptoms in their
early teens, with improvement occurring in the late
teens and continuing into adulthood.
Treatment



Because tic symptoms do not often cause impairment,
the majority of people with Tourette syndrome require
no medication for tic suppression. However, effective
medications are available for those students whose
symptoms interfere with functioning.
Psychotherapy may also be helpful. Although
psychological problems do not cause Tourette syndrome ,
such problems may result from Tourette syndrome .
Psychotherapy can help the person with Tourette
syndrome better cope with the disorder and deal with
the secondary social and emotional problems that
sometimes occur.
The Impact of Tics on
School Performance



Tics can impact learning and performance in different
ways.
The most commonly reported problems are that eye tics
and head/neck tics directly interfere with reading and
can be very frustrating for the student.
Eye, head/neck, and arm tics also directly interfere with
handwritten work for a number of students with tics.

Tics can distract students from concentrating as they
become aware of the need to tic.

Severe or frequent tics can cause pain, frustration, and
irritability.

Vocal tics can lead the student to withdraw from class
discussions or make them embarrassed to read aloud.

Tics can lead to peer teasing or fear of peer rejection.
General Tips for Teachers




Work around the tics.
Keep the focus on learning.
Be flexible.
Keep a positive outlook as you remind yourself
and the student that however bad a tic seems,
this too shall pass.
Strategies for Teachers and Counselors
Asperger Syndrome
Tourette Syndrome
(see attached handout)
Sources

http://www.childdevelopmentinfo.com/disorders/asperger.shtml

http://www.udel.edu/bkirby/asperger/aswhatisit.html

http://www.hyperlexia.org/aha_winter9697.html

http://www.kidshealth.org/parent/medical/brain/asperger.html

http://www.ninds.nih.gov/disorders/tourette/detail_tourette.ht
m#56583231

http://www.tsa-usa.org/news/headlines.html
Books Used on Asperger Syndrome







1001 Great Ideas for Teaching and Raising Children with Autism
Spectrum Disorders by Veronica Zysk
Preparing for Life: The Complete Guide for Transitioning to
Adulthood for Those with Autism and Asperger's Syndrome by Jed
Baker
Autism? Asperger's? ADHD? ADD? by Diane Drake Burns
Asperger's: What Does It Mean to Me? by Catherine Faherty
Understanding Asperger's Syndrome: Fast Facts--A Guide for
Teachers and Educators to Address the Needs of the Student by
Emily L Burrows
Navigating the Social World: A Curriculum for Individuals with
Asperger's Syndrome, High Functioning Autism and Related
Disorders by Jeanette McAfee
Asperger's and Self-Esteem: Insight and Hope through Famous
Role Models by Norm Ledgin, Temple Grandin, and Marsha M. Ledgin
Books Used on Tourette Syndrome










Tourette's Syndrome: Finding Answers and Getting Help
(Patient-Centered Guides) by Mitzi Waltz
Living with Tourette Syndrome by Elaine Fantle, Shimberg
Tourette Syndrome: The Facts by Mary Robertson
Search for the Tourette Syndrome and Human Behavior Genes by
David E. Comings
Coping With Tourette Syndrome and Tic Disorders (Coping) by
Barbara Moe
A Mind of Its Own: Tourette's Syndrome: a Story and a
Guide by Ruth Dowling Bruun
Children With Tourette Syndrome: A Parent's Guide (Special
Needs Collection) by Tracy Haerle
Hi, I'm Adam: A Child's Book About Tourette Syndrome by Adam
Buehrens
Tourette Syndrome by Donald J. Cohen
I Can't Stop!: A Story About Tourette Syndrome by Holly L.
Niner and Meryl Treatner
Contact Us
Juani Pinzás, Ph. D.
Educational Psychologist
Counselor Early Childhood/Gr. 1
[email protected]
Lucrecia Rodríguez, MA
Educational Psychologist
Counselor Gr. 2-5
[email protected]