Getting Educational Services Getting Educational Services Right for Children & Young Right for Children & Young

People with ASDPeople with ASD

Prof Rita Jordan PhDProf Rita Jordan PhDEmeritus professor in Autism StudiesEmeritus professor in Autism Studies

University of Birmingham, UKUniversity of Birmingham, UK

NAS Surrey Conference: 01/10/2011NAS Surrey Conference: 01/10/2011

Diagnostic ChangesDiagnostic Changes

• AS (Asperger syndrome) currently part of ASD, which is AS (Asperger syndrome) currently part of ASD, which is part of PDDpart of PDD

• in DSM-V (2012)in DSM-V (2012)– PDD = ASDPDD = ASD– no subcategories (AS & PDD-NOS gone)no subcategories (AS & PDD-NOS gone)– triad for a category replaced with 2 dimensions: triad for a category replaced with 2 dimensions:

social/communication; flexibilitysocial/communication; flexibility– sensory dimension recognisedsensory dimension recognised

• social/ service consequences for ASsocial/ service consequences for AS

What will diagnosis mean?What will diagnosis mean?

• broad category (ASD) then individual profilebroad category (ASD) then individual profile• needs-led services?needs-led services?• distinction between ASC & ASD?distinction between ASC & ASD?• recognition of wide vulnerability (1/38?)recognition of wide vulnerability (1/38?)• individualisation of education & servicesindividualisation of education & services• ‘‘ASD of Asperger type?’ASD of Asperger type?’

SEN arise from:SEN arise from:

• difficulties related to the condition, difficulties related to the condition,

• strengths and compensationsstrengths and compensations

• interests and motivation interests and motivation

• characteristics of the situation characteristics of the situation

issues of entitlement and access but also a issues of entitlement and access but also a therapeutic environmenttherapeutic environment

Learning StyleLearning Style

• visual rather than verbalvisual rather than verbal• memorymemory

– cuedcued– roterote

• ‘‘social’ a dimension of difficultysocial’ a dimension of difficulty• emotions and cognitionemotions and cognition

– use interests for engagementuse interests for engagement

• repetition & consolidationrepetition & consolidation• explicit strategies for problem solvingexplicit strategies for problem solving

Individual factors: SociabilityIndividual factors: Sociability

• Wing’s classificationWing’s classification– withdrawn/ solitary -> passive/ responds -> ‘active but odd’ -> withdrawn/ solitary -> passive/ responds -> ‘active but odd’ ->

eccentric & sensitiveeccentric & sensitive

• varies with conditions & with teachingvaries with conditions & with teaching

• level suggests optimum form of approachlevel suggests optimum form of approach– withdrawn - 1:1 directive & desensitisationwithdrawn - 1:1 directive & desensitisation

– passive - interest & structured play experiencepassive - interest & structured play experience

– active but odd - social rules & experience (context)active but odd - social rules & experience (context)

– eccentric - social skills in context e.g. buddyeccentric - social skills in context e.g. buddy

Teaching Play & Making Teaching Play & Making FriendsFriends

• essence of play is:essence of play is:– spontaneityspontaneity– emotional engagementemotional engagement

• need informed choice about ‘friends’need informed choice about ‘friends’– fear of loss of controlfear of loss of control– no experienceno experience

• 2 strands to play teaching2 strands to play teaching– cognitivecognitive

• sensori-motor -> relational -> functional -> symbolicsensori-motor -> relational -> functional -> symbolic

– socialsocial• alongside -> imitative-> ‘join in’ -> co-operate - collaboratealongside -> imitative-> ‘join in’ -> co-operate - collaborate

• Legotherapy & SHEDSLegotherapy & SHEDS– structures interaction structures interaction – enables social role learning & cooperationenables social role learning & cooperation

Teaching Social UnderstandingTeaching Social Understanding

• cognitive aspects of early interactioncognitive aspects of early interaction• Social StoriesSocial Stories• Comic Book ConversationsComic Book Conversations• SULPSULP• LegotherapyLegotherapy• SEAL? SEAL? • PfCPfC• explicit labels explicit labels What did she say? What did she mean?What did she say? What did she mean?

StrengthsStrengths

• sustained attention to interestssustained attention to interests• no social distractionsno social distractions• usually visual informationusually visual information• careful attention to detailcareful attention to detail• no social heirarchy - no deceit - get job doneno social heirarchy - no deceit - get job done• accurate detailed memoriesaccurate detailed memories• ‘‘fresh’ idiosyncratic art - visual/ poetry/ musicfresh’ idiosyncratic art - visual/ poetry/ music• ICTICT• vulnerability brings out the best in others (often!)vulnerability brings out the best in others (often!)

Reasons for challenging Reasons for challenging behaviour in ASDbehaviour in ASD

• biologybiology– epilepsyepilepsy– perception/ sensory disturbanceperception/ sensory disturbance– sensory ‘deprivation’sensory ‘deprivation’– reactions to painreactions to pain

• lack of communication skillslack of communication skills• lack of self-awarenesslack of self-awareness• adaptation to the environmentadaptation to the environment

Background FactorsBackground Factors

• DietDiet– peptide theorypeptide theory– effects of dietseffects of diets

• SleepSleep– chronic deprivationchronic deprivation– melatoninmelatonin

• ExerciseExercise– daily aerobicdaily aerobic

Teaching to cope with stressTeaching to cope with stress

• teaching relaxation and ‘escape’teaching relaxation and ‘escape’– careful not to rewardcareful not to reward– observation of ‘build up’observation of ‘build up’– teach alternativeteach alternative– general strategies - relaxation, aerobic exercise, general strategies - relaxation, aerobic exercise,

cognitive behavioural therapycognitive behavioural therapy

• coping with paniccoping with panic– automatic responseautomatic response

Functional AnalysisFunctional Analysis

• SettingsSettings– ‘‘last straw’ not always ‘trigger’last straw’ not always ‘trigger’– whole child (inc. skills) & whole school approach whole child (inc. skills) & whole school approach – parent collaborationparent collaboration

• BehaviourBehaviour– accurateaccurate– frequencyfrequency– durationduration– intensityintensity

• ResultsResults

Teaching ConsequencesTeaching Consequences

• less able - single trackless able - single track• more able -more able -

– railway - no turnsrailway - no turns

– 2 clear termini with no 2 clear termini with no connectionsconnections

– choice point choice point emphasisedemphasised

Moment of choiceMoment of choice

Problem Problem Taught alternativeTaught alternative

Basic Guide to Anxiety Basic Guide to Anxiety ReductionReduction

• relaxationrelaxation– general - sensory/ meditation/ yoga/ deep pressuregeneral - sensory/ meditation/ yoga/ deep pressure– specific - fold arms, close eyes, chant or humspecific - fold arms, close eyes, chant or hum

• exerciseexercise– aerobic/ contingent & non-contingentaerobic/ contingent & non-contingent

• dietdiet– GI index low / low stimulants/ sugar & additivesGI index low / low stimulants/ sugar & additives

• talking with otherstalking with others– drawing? music drawing? music

Atypical Reactions in ASDAtypical Reactions in ASD

• misinterpret ‘bumps’ as intentionalmisinterpret ‘bumps’ as intentional• may accept as inevitable (Gerland, 1997)may accept as inevitable (Gerland, 1997)• may react inappropriately to pain/ insultsmay react inappropriately to pain/ insults• may not be able to report or use inappropriate may not be able to report or use inappropriate

language or not give context or timelanguage or not give context or time• cannot think when anxious & react emotionally - cannot think when anxious & react emotionally -

forgetting trained responseforgetting trained response

Teaching to CopeTeaching to Cope• pre-empt:pre-empt:

– stress - prosthetics & exercisestress - prosthetics & exercise– anger - alternativeanger - alternative– frustration - communicationfrustration - communication– panic - posture / drillpanic - posture / drill

• train for ‘escape’train for ‘escape’• teach relaxationteach relaxation• teach social understandingteach social understanding

– Social Stories/ video life/ soapsSocial Stories/ video life/ soaps

Train for sensory ‘panic’Train for sensory ‘panic’

• need for trained need for trained response for ‘panic’ response for ‘panic’ situations &situations &

buddy or visual cuebuddy or visual cue

to remind.to remind.

• note use of prime note use of prime numbers!numbers!

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Buddy schemesBuddy schemes• useful for useful for

transitions &transitions &

as modelas model

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Use of LSAUse of LSA

• care from a distancecare from a distance

• checking not creating checking not creating ‘learned helplessness’‘learned helplessness’

• available to othersavailable to others

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Teaching adaptationsTeaching adaptations

• visual instructionsvisual instructions• lists for meaninglists for meaning• allow time for allow time for

interestsinterests• work then playwork then play

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Managing DemocracyManaging Democracy

• no tact or no tact or

sensitivitysensitivity• no intentional no intentional

rudenessrudeness• give alternativegive alternative• mark for future mark for future

teachingteaching

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Curriculum IssuesCurriculum Issues

• individual - no subject exclusionsindividual - no subject exclusions• foreign language teaching a good model for social foreign language teaching a good model for social

& linguistic understanding& linguistic understanding• use interests where feasible or ‘work then play’use interests where feasible or ‘work then play’• aspects of some subjects a problem - teach aspects of some subjects a problem - teach

specifically or by-passspecifically or by-pass

ConclusionConclusion

• no ‘autism’ curriculum or single approachno ‘autism’ curriculum or single approach• needs to fit:needs to fit:

– individualindividual– familyfamily– practitionerpractitioner– contextcontext– current goalscurrent goals– prognosisprognosis