Diverse Learners CoPProgramming for Children with Asperger’s

Syndrome

Guest: Dot Lucci, M.Ed., C.A.G.S.Director of Consultation and Training

Massachusetts General Hospital/ YouthCare

Facilitator: Donna LupatkinDate: December 3, 2007

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Agenda• Welcome• Introduction• Characteristics Of Asperger’s Syndrome• Theory of Mind• Sensory Integration• Executive Functioning• Behavior• Central CoherenceTheory• Emotion Regulation• Learning Style• School wide programming• V Bulletin• Future Meetings and Assembly

Meet Dot

Dot has 30 years experience working with individuals with Autism Spectrum Disorder. She is trained as a School Psychologist with additional training in neuropsychology. Dot is a national consultant and speaker and has published numerous journal articles and a book chapter in the Exceptional Brain. Currently she is Director of Consultation and Training at Boston’s Massachusetts General Hospital/YouthCare, on the Board of Directors of the Asperger’s Association of New England and an adjunct professor at Lesley University and Antioch College.

Pervasive Developmental Disorder (DSM-IV)

(AKA: Autism Spectrum Disorders- ASD)

• 1 in 150 children are being born with an ASD• ASD - No 2 kids are alike • 4:1 males/females - ASD • 30 - 70% of ASD population are mentally retarded• May be nonverbal • May have co-morbid conditions • ASD knows no boundaries (SES, ethnicity etc.)• Life Long Disability• No Known Cause No Known Cure• Medications treat symptoms not ASD• A disorder that affects the brain but is not just brain-based

Pervasive Developmental Disorder (DSM-IV) (Autism Spectrum Disorders)Asperger’s Syndrome (AS)

• 1:1 male/female ratio • Average to above average in IQ • Life Long Disability• No Known Cause No Known Cure• Medications treat symptoms not AS• AS appeared in DSM-IV in 1994• A disorder that affects the brain but is not just brain-

based• May have co-morbid conditions • AS knows no boundaries (SES, ethnicity etc.)

Characteristics of Children with AS

• Difficulties with Communication– Superficial communication appears well developed strong

vocabulary & grammar but literalness, concrete interpretation, poor abstraction, higher level language deficits…

• Difficulties with Behavior – Rigid, concrete, routine bound, sensory issues, self-stims & odd

behaviors, poor adaptation to novelty…

• Difficulties with Socialization & Play– Impairment in using and reading non-verbal & verbal behaviors

(gestures, affect, body language, intonation…)– Impairment in higher level play skills

Characteristics of Children with AS

• Lack ‘Theory of Mind’, intuitive road map• Exhibits Sensory Integration issues• Poor Executive Functioning skills (planning, inhibiting,

self-regulating, organization, productivity, …)• Maladaptive Behavior = Communication• Lack Central Coherence - Doesn’t “see the forest through

the trees”• Poor Anxiety and Emotional Regulation• Average - Above Average IQ doesn’t always translate

into daily social and academic functioning

Do These Characteristics Sound Familiar?

• How these characteristics manifest in every child is different.

• No Two Students with AS are alike

• Describe Some of your Students

Theory Of Mind (ToM)

• ToM - the ability to appreciate that other people have different mental states: intentions, needs, desires, beliefs that may be different that your own

• ToM - the understanding that other people have thoughts & feelings and that these people can reflect on their thoughts/feelings and can reflect on others people’s thoughts/feelings and change their thinking and behavior

• ToM - involves: joint attention, representation, transitioning, inferring, categorizing, abstraction, pretending, etc.

Theory Of Mind

Sensory Integration

SENSORY INTEGRATION is…• There are 7 senses - 5 + 2, proprioception &

vestibular• the ability of our senses to work together and

interconnect with other systems in the brain• the ability to use information gathered from our

senses to organize our behavior and interact successfully with the world

• the ability to filter out unimportant sensory information and organize ourselves for performing meaningful activity

Sensory Integration in Children with AS

• Children with AS often have differences in the way they receive, filter, modulate, and integrate sensory information from their environments.

• Sometimes children’s behavior will be better understood by thinking about their sensory differences or anxiety level.

• Children may be over- and/or under-sensitive to sensory input.

Executive Function in Children with AS

• Children with AS often have deficits in Executive Functioning . For example, they may:– Not manage time effectively– Get stuck on one topic or a detail– Be inflexible– Act impulsively– Not plan well– Be disorganized– Not know what to attend to– Not use previously learned knowledge

Behavior May Not Be What It Appears To Be

• Behavior = Communication (requests, feelings, negations, comments, self, sensory)

• Behaviors can appear willful, weird/odd, rude, manipulative, annoying etc….

• Behaviors are usually connected to the environment, a child’s internal state/emotions, the environment, sensory input, developmental level, attention…

• AS is a neurological disorders -- it’s easier to change what’s external to the child than to change the child

Central Coherence Theory & AS

(Frith, 1989)Individuals with AS• have deficits in “getting the Big Picture” - not

understanding how the parts relate to the whole. • have difficulty conceptualizing & integrating information• tend not to relate information to a larger pattern of

behavior and thought.

Anxiety and Emotional Regulation in Children with AS

Children with AS have difficulty with:• Understanding & using a wide range of emotions• Regulating emotions• Linking behavior to emotions• High rate of anxiety is a result of their wiring• Responding appropriately to emotionally

charged situations

Anxiety and Emotional Regulation in Children with AS

Children with AS:• Often misinterpret the environment, and this can

increase anxiety• Lose IQ points when anxious (we all do) leading

to decreased coping & problem solving abilities• Challenges with anxiety are often misinterpreted

as behavioral – THINK ABOUT ANXIETY FIRST

Anxiety and Emotional Regulation in Children with AS

Common stressors for children with AS:• Being told “no,” reprimanded, criticized• Being around other disruptive people• Leaving a preferred activity• Having to engage in a less preferred activity• Change in the environment or routine• Having to wait for preferred events• Having a change in directions or a new task• Fears

Typical Learning Styles of Children with AS

• Verbal-Linguistic or Concrete-Sequential• Likes: order, predictability, facts/details, exact directions• Difficulties: incomplete or unorganized environments/

tasks, open-ended questions/tasks (no right/wrong, favorite..), waiting, dealing with opposing view, acting without specific instructions

• Learns Best: Structured & quiet environment/ tasks, predictable routines, clear directions/consequences, opportunities to apply learning in practical & meaningful ways

• Things Makes Sense: step by step approach, here/now, a schedule to follow, visuals coupled with verbals, immediate feedback/guided practice

CHIME IN - Applying What We’ve Learned

• What are the behaviors that you see that challenge you or your staff?

• Do you recognize how Sensory Integration, ToM, Central Coherence or Executive Function deficits interfere with social and academic learning?

• How have you dealt with them?

So What Do You Do With All That Theory? -

Programming for the Student with AS

• Consider All the Referenced Areas– ToM– Sensory Integration– Executive Functioning– Behavior = Communication– Central Coherence– Anxiety & Emotional Regulation– Learning Style– And then some

Guiding Principle

Consistency, Structure, and Predictability provide Simplicity and Stability which enable the child with AS to Anticipate Activities thus increasing his Independence and Self-Esteem and Quality of Life

Consider the Human Environment

External - What Non-verbal Communication (affect, gestures, body language,

proximity, nuances…) Verbal Communication (prosody,tone, volume, rate, type,

humor…)

External - Who Type (1-1, dyad, small group…) Adults, peers, familiar/unfamiliar….

Internal - Who (Student characteristics/temperament…) Physical Health (hunger, thirst, hormones, emotions, sleep…)

Consider the Non-Human Environment

• Environment (inside/outside, place)• Seating Options & Room Arrangement• Sensory Influences (color, visuals, smells, lighting,

manipulatives, temperature, air quality, music/sounds• Animals & Plants• Seasons & Weather• Tasks & Curriculum

Putting the Theory Into Practice

• Each Child is Unique - Know the Student with AS - treat respectfully, accept quirkiness

• Children with AS are Consistently Inconsistent - Breathe!• They don’t get why we do what we do (ToM) - Always

provide the Why• Anxiety ---> fight/flight/fright --> Behavior• Know that Behavior = Communication - it’s your job to

figure out what it means• Emotions are connected to learning & memory->

participation• Look outside the child (Human & Non-Human Environment)

to change the behavior• Sensory Needs have to be addressed - create a sensory

diet• Be flexible and creative when discipline is needed

Putting the Theory Into Practice

• They don’t see the forest through the tress - teach the big picture

• Teach to their learning style, strengths & interests• Use visual supports whenever possible • Use specific AS teaching materials (social stories, comic

strip conversations, Incredible 5 point scale, power cards)• Use videotaping• Use structures, graphic organizers, other tools to

organize the academic & social world• Teach audience control, Hidden Curriculum• Teach self-awareness, self-management, self-advocacy,

relaxation & emotional regulation/self-calming

School Wide Programming Considerations

• It Takes A Village to educate students with AS - Create a Team (parents, staff, administrators, student (when applicable), outside therapists..)

• Building Atmosphere - Directly Teach social curriculum and create an Inclusive, Accepting Atmosphere among staff & students - Students with AS are Quirky

• Teacher Attitude - Consistent yet Flexible, a sense of Humor - able to laugh at self, ability to Think Outside the Box, Patient/Caring, Willing to ask for Help and know that you don’t know it all, Team Player, Organized

School WideProgramming Considerations

• Professional Development - Knowledge about AS and the related areas (ToM, SI, EF etc. ) is critical to success, Time & commitment for students and staff

• 3 Cs - Consultation, Communication, Collaboration, A willingness to seek outside consultation from an expert in the field, home-school communication system

• Staffing - Trained Special Education Staff (special educator, OT with SI knowledge, SLP, mental health professionals (SW, Psy.), paraprofessional/assistant

• Scheduling Considerations - leave early/arrive late, independent studies, classes to/not to take, length of classes, PE, Cafeteria, Assemblies, Unstructured/ Structured times of the day (hallways, recess, etc.)

School WideProgramming Considerations

• Administration - has to want these students, set the stage for their participation & create an atmosphere for inclusion & acceptance

• Other Considerations - discipline, grading, homework, modifications to instructional requirements & outcomes

• Materials/Supplies - Purchase materials specific to Students with AS to guide instruction, Create a reference library of published & teacher-made materials

• Space - may need additional space for OT/SI needs, behavioral needs, calming space

School WideProgramming Considerations

• Social-Emotional Considerations - School Wide emphasis on social/emotional guidelines, Safe person & safe place for the student with AS,Specific instruction in social-emotional skills & thinking, student-teacher relationship, friendships, play, emotional regulation, etc.)

• Assign a Case Manager - Students with AS and their parents are time consuming

• Access, Participation and Membership - Students with AS can thrive emotionally, socially and academically in supportive, caring, accepting environments with well trained staff and students

Question & Answer Period

Pick My Brain Now or Contact Me Later

Dot Lucci, M.Ed., C.A.G.S.Director of Consultation Services

Massachusetts General Hospital/YouthCare47A River St. Suite A200

Wellesley, MA 02481Ph. 781-489-6635Fax 781-235-0285

Email Dlucci@Partners.org

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Future Conference Calls

• All of the calls will be on a Monday at 4:00 EST.• January 14, 2008-Arlene Remz and colleagues

from Gateways in Boston-Topic TBA• February 11, 2008- Hidden Sparks

professionals-Topic TBA• March 10, 2008- Second Language

Development-Teaching Hebrew to the Diverse Learner

• May 5, 2008-TBA• June –date and topic TBA

We thank Hidden Sparksfor their generous support of our CoP

Stay tuned for information about the PEJE Assembly April 6-8, 2008

Looking forward to seeing everyone on January 14, 2008-Arlene Remz and colleagues from Gateways in Boston-Topic TBA”