Getting AHEAD with Students with Autism Spectrum

Disorder

Utah AHEAD ConferenceUniversity of Utah

May 21, 2010

Michael BrooksAccessibility CenterBrigham Young University

Edward MartinelliAccessibility ServicesUtah Valley University

Julie PreeceAcademic SupportBrigham Young University

Ronald ChapmanStudent LifeBrigham Young University

Norman RobertsCampus LifeBrigham Young University

Presenters

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Before we begin…What is your perspective?

•What has been your experience working with students with autism spectrum disorders?

•What are your concerns when working with students with these disorders?

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Presentation Overview Presentation purpose—Setting Limits Disability Law and Autism Spectrum Disorders Looking at the numbers Cases, discussions, and recommendations:

Autism Spectrum Disorders Autism Asperger’s Disorder

Nonverbal Learning Disorders

Concluding comments

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Presentation Purpose—Setting Limits Enhance awareness of best advisement practices; not prepare

psychological service providers. Autism spectrum disorders are complex; a thorough review of all

disorders is beyond the scope of one workshop. Disorders may vary in their signs and symptoms from person-to-person.

Recognition, Reconnaissance, Respect, and Referral (4R’s) help a

majority of students experiencing psychological concerns.

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Autism Spectrum Disorders & the Law

Any condition can be a qualifying condition as long as it is a physical or mental impairment that substantially limits a major life activity

Substantially limits is to be considered liberally

ADA Amendments Act has provided a non-exhaustive list of major life activities, including:

Communicating &

Concentrating

Two problems seen in PDDsM

A Few NumbersPsychological Disorders among Higher Education Students

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College Students and Mental Health

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National College Health AssessmentAmerican College Health Association

Fall 2009

N=34,208

Proportion of College Students Reporting Following Conditions:

ADD 5.1%Chronic Illness 4.1%Psychiatric Condition 3.7%Learning Disability 3.5%Partially Sighted/Blind 1.7%Deaf/Hard of Hearing 1.6%Mobility/Dexterity Disability 1.0%Speech or Language Disorder 0.9%Other Disability 2.1%

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Proportion of College Students Reporting Following Conditions:

ADD 5.1%Chronic Illness 4.1%Psychiatric Condition 3.7%Learning Disability 3.5%Partially Sighted/Blind 1.7%Deaf/Hard of Hearing 1.6%Mobility/Dexterity Disability 1.0%Speech or Language Disorder 0.9%Other Disability 2.1%

N

Within the last 12 months, diagnosed or treated by professional for :

Anxiety 9.4%ADD/HD 3.4%Bipolar 1.3%Depression 9.2%OCD 2.1%Panic attacks 4.6%Phobia 1.0%Schizophrenia 0.4%

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Autism Spectrum:The Numbers?

Prevalence varies quite widely from study to study due to “divergent diagnostic criteria”

Tends to be about: 2 per 10,000 for Asperger’s disorder 10 per 10,000 for Autism

Male-to-female ratio is estimated to be 4:1

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Autism Spectrum Disorders

The Ripple from the 1990s

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Life-long developmental disability. Symptoms usually apparent within the

first 36 months of life. However, for high-functioning individuals,

symptoms may not be apparent until later in life.

Syndrome, i.e., a condition defined by the existence of a collection of characteristics. 

What is Autism Spectrum Disorder?

Susan J. Moreno, MAAP Services for the Autism Spectrumhttp://www.aspergersyndrome.org/Articles/What-is-autism-.aspx

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The Psychology Student

Video 1Student with High Functioning Autism

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Comments & Observations

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Range of difficulties in verbal/nonverbal communication:not speaking at all unable to interpret body language Unable to participate comfortably in two-way conversation

Rigidity in thought processes, including difficulty with:learning abstract conceptsgeneralizing informationtolerating changes in routines and/or environments

Difficulty with reciprocal social interaction. appearing to want social isolationexperiencing social awkwardness in attaining and

maintaining ongoing relationships

 

Autism Spectrum Disorders:Characteristics

Susan J. Moreno, MAAP Services for the Autism Spectrumhttp://www.aspergersyndrome.org/Articles/What-is-autism-.aspx

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A. A total of 6 (or more) items from (1), (2), & (3), with at least two from (1), and one each from (2) & (3):(1) qualitative impairment in social interaction, as manifested

by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

Autism Disorder (DSM-IV)

E

(2) qualitative impairments in communication as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c)stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Autism Disorder (DMS-IV)

E

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(a)encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b)apparently inflexible adherence to specific, nonfunctional routines or rituals

(c)stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)

(d)persistent preoccupation with parts of objects

Autism Disorder (DMS-IV)

E

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Autism Disorder (DSM-IV)

E

Must Meet criteria 1, 2, & 3:1. Clinically significant, persistent deficits in

social communication and interactions

2. Restricted, repetitive patterns of behavior, interests, and activities

3. Symptoms must be present in early childhood

Autism Spectrum Disorders (DSM-V)

E

Must Meet criteria 1, 2, & 3:1. Clinically significant, persistent deficits in social

communication and interactions, as manifest by all of the following:a. Marked deficits in nonverbal and verbal communication

used for social interaction:b. Lack of social reciprocity;c. Failure to develop and maintain peer relationships

appropriate to developmental level

Autism Spectrum Disorders (DSM-V)

E

Must Meet criteria 1, 2, & 3:2. Restricted, repetitive patterns of behavior,

interests, and activities, as manifested by at least TWO of the following: a. Stereotyped motor or verbal behaviors, or unusual

sensory behaviorsb. Excessive adherence to routines and ritualized patterns

of behaviorc. Restricted, fixated interests

3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

Autism Spectrum Disorders (DSM-V)

E

Asperger’s DisorderContinuing Along the Autism Spectrum

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Social interaction impairment

Repetitive or stereotyped behavior patterns

No significant general delay in language

No significant delay in cognitive or self-help skills  

Features of Asperger’s Disorder

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The Collision of Intellect

Video 2Asperger’s Disorder

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Observations & Comments

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Qualitative impairment in social interaction

Restricted repetitive and stereotyped patterns of behavior, interests, and activities

No significant general delay in language

No significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior

 

Asperger’s Disorder, ala DSM-IV

eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction

peer relationships spontaneous seeking to share enjoyment,

interest or achievements with other people lack of social or emotional reciprocity

preoccupation with one or more restricted patterns of interest

apparently inflexible adherence to specific, nonfunctional routines or ritualsrepetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)

persistent preoccupation with parts of objects J

1. Meal plans2. Laundry3. Budgeting4. Campus ID5. Dorm rules6. Fire drills7. Communal

bathrooms8. Transportation9. Campus maps10. Security personnel

11. Finding restrooms12. Using alarm clock13. Mail14. Library usage15. Lecture halls16. Dorm activities17. Health services18. Emergencies19. Illness self-care20. Physical exercise

Daily Life Planning:Students with Asperger’s & High Functioning Autism

http://ezinearticles.com/?College-and-the-Autistic-Student&id=523157

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1. Private dorm room2. 1-on-1 help with time

management & budget

3. Note-taker4. “Daily Life Coach”5. Distraction-free testing6. Modified presentation

assignments7. Preferential seating

8. On-line courses9. Learning specialist

support10. Emotional support  11. Tutoring12. Proctors for reading

and transcribing13. Photocopies of class 

materials

Possible Accommodations

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Nonverbal Learning Disorder & Autism

Spectrum Disorder Comparisons & Contrasts: Drawing Distinctions

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Nonverbal Learning Disorder (NVLD)

What is it? AS and NVLD may describe the same “type” of

disorder but at differing levels of severity—with AS describing more severe symptoms. 

Deficits are thought to be due to right cerebral hemisphere involvement

“It may be that the diagnoses of Asperger syndrome (AS) and NLD simply “provide different perspectives on a heterogeneous, yet overlapping, group of individuals…”

– Klin and Volkmar

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Is it a formal diagnosis?

No!◦ Not in the Diagnostic and Statistical Manual –

Fourth Edition – Text Revision (DSM-IV-TR)

But, often referenced in neuropsychological evaluations

Disability resource coordinators need to consider whether to recognize it as a disorder worthy of accommodation.

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Diagnostic Criteria for NVLDWhat will you see in NVLD?

IQ tests: Usually at least a 10-point difference between

verbal and performance scores (with verbal higher). Difference is often 40 points or higher.

Well developed: Rote memory & auditory memory, May have poor memory for essences, emotional

experiences, and visual data.

Elaborated, but often odd, verbal expression (e.g., define “umbrella”) with strong vocabulary

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Diagnostic Criteria Continued Reading ability:

generally excellent reading skills with poor comprehension

Math skills: Poor May affect later understanding of science concepts

Poor visual-spatial organization skills

Distorted sense of time

Tactile: perceptual and motor deficits, generally left side physical awkwardness and poor coordination

Messy or laborious handwritingM

NVLD & Social SkillsProbable Major Deficits of NVLD

Hyper-attention to detail Missing ‘big picture’ Concrete thinking Literal thinking Problems reading facial expressions,

gestures, social cues, and tones of voice (low ‘social IQ’)

Difficulty using social feedback Difficulty adjusting to new situations

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Social Skills & NVLD Naïvete or lack of common sense Rote reactions to situations Dependence on language to gather

information and anxiety relief - doesn’t always work (hearing “nice going” with dropped football pass – what does this mean?)

Problems developing and maintaining friendships, leading to : anxiety, depression, social withdrawal.

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Student’s History with NVLD Strikes others as very intelligent Strong early academic record:

◦ Abstractions become important from 6th grade on◦ Grades plummet ◦ Abstractions for sequencing in math, science & writing◦ Coordination skills for physical activities

Spend more time with adults:◦ Plays to verbal strengths◦ adults tolerate eccentricities

“Inattentive and hyperactive” early in life Socially withdrawn and isolated later in

life M

NVLD History Problems seen in organization as each detail

is taken one-at-a-time, not integrated. Appears smart but unmotivated, which can be

internalized secondary to adults’ feedback display internalizing behaviors nail biting, stomach aches, etc.

Later, when learning is lecture-based, problems with hearing and transcribing concurrently.

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NVLD & Accommodations Outlines to provide the “forest” Schedule of the day’s events (primary) Meet with professor to discuss how the

syllabus will play out (postsecondary) Sequencing tips to break down complex

tasks Interactive discussion rather than lectures Play to strengths in rote learning Point out social rules and articulate events

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Case Study Joey – active boy Infant physical development:

Walked at 12 months Could not drink from cup until 15 months

Age 4 Teacher concerned with his fine motor skills “Engaging” with “advanced expressive language” Language “confusing and circuitous”

Age 7 VIQ 136/PIQ 92 Socially one-on-one “OK”, but not so in groups

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ConclusionsQuestions and Answers

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Michael Brooks: michael_brooks@byu.edu

Edward Martinelli: edward.martinelli@uvu.edu

Julie Preece: julie_preece@byu.edu

Ronald Chapman:ronald_chapman@byu.edu

Norman Roberts: norman.roberts@byu.edu

Contact Information