Autism vs. High Functioning Autism - University of California, Merced

Research-Supported Treatment for High Functioning Autism

(a.k.a., Asperger's Syndrome)

Symposium on the Child and Family Alexander Khislavsky, Ph.D., L.C.P.

University of California Merced Saturday, February 10, 2018

Autism vs. High Functioning Autism

A Spectrum Developmental Disorder

Characterized by significantly atypical .....

Impaired social communication & interactions Restricted / repetitive behavior,

interests, & activities Presents in early periods of

development (formerly < 3)

Autism vs. High Functioning Autism

High Functioning Autism (HFA)

Formerly Known as Asperger's Syndrome:

Dramatic social deficits & restricted interests With intact language skills With preserved cognitive ability

Once Seen as Distinct Diagnosis:

Was in DSM-IV-TR, not in DSM-V, still in ICD-10 Was a PDD along with Autism Now a part of broader Autism Spectrum (ASD)

Autism vs. High Functioning Autism

Distinctions b/w Autism & HFA

Problems w/ social interactions, odd behavior, and communication not like those in autism

Often precocious language development Onset / recognized after age 3 years Intense, highly circumscribed interests Want & interested in social engagement Often co-occurring motor difficulty

Autism vs. High Functioning Autism

Neuropsychological Findings

Children with HFA Show: Weak VMI, visualspatial perception, & visual / working memory

Weak gross and fine motor skills (clumsy)

Limited All-Encompassing Interests:

Many accumulated facts But interfering with general learning But non-reciprocal or socially facilitating

Autism vs. High Functioning Autism Neuropsychological Findings Children with HFA Show:

Verbal skills stronger than non-verbal Language intact but verbose & one-sided Strong semantic / factual memory Socially interested w/ limited social perception

Executive Weakness: Disrupts social judgments and decision making

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Treatment Needs of

High Functioning Autism (HFA)

Treatment Needs for HFA

Not the Typical Autism for Treatment

HFA Strength & Needs Differ:

Have historically been less-eligible for services Too bright, verbal, academically successful

Need Targeted Intervention: For managing novel and socially demanding situations

High-structure / routine-rich Academically driven setting

Treatment Needs for HFA

Not the Typical Autism for Treatment

HFA Needs Unique Treatment Strategies: Not exactly like / different from NVLD, ED, or SED

Not like the focus on verbal skills w/ autism

Not like placements for conduct problems

Not like tactics for academic LDs W/ option for help w/ comorbid internalizing probs

Treatment Needs for HFA

Not the Typical Autism for Treatment

To Maximize Adaptation & Performance:

In unstructured social situations With groups same-aged peers To reduce disruptive behaviors In novel quickly-adjusting situations

Employing combination of educational, behavioral, group / individual therapies

General Treatment Strategies for

High Functioning Autism (HFA)

General Treatment Strategies for HFA Thoughtful & Consistent Individualized, based on empirical assessment Targeting Varied Degrees Of:

Concreteness / rigidity Paucity of insight Social awkwardness Communicative one-sidedness

Practical & commonsense clinical judgment

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General Treatment Strategies for HFA

Thoughtful & Consistent Problem-Solving with Behavioral Routines:

Taught in explicit / maybe rote fashion Using part-to-whole, via verbal instruction Rehearsed & verbalized

Especially for recurring, troublesome situations

Also how to identify novel problems & resort to pre-planned, well-rehearsed steps as solution

General Treatment Strategies for HFA

Thoughtful & Consistent

Build Social Awareness & Perspective Taking:

Identify relevant / essential aspects of situations Show discrepancies in self / other perspectives Make others perspective explicit

Encourage Self-Evaluation:

Knowing what others do & do not know Normalize frustration, anxiety & negative emotion

General Treatment Strategies for HFA

Thoughtful & Consistent

Address Neuropsychological Weaknesses:

Fine- and visual-motor coordination Visual-spatial attention & perception Visual memory & problem-solving Executive

Helping integration of visual & auditory info in social situations

Social & Communication Therapies for

High Functioning Autism (HFA)

Social & Communication Therapy for HFA

Enhance Communication & Social Skill

Raise Competence: In baseline levels of social intuition & comprehension of societal norms

W/out discounting personal choice W/out stifling uniqueness & individuality

To Function Effectively: In specific social roles

Conversation partners Potential friends or companions Employable professionals

Social & Communication Therapy for HFA

Pragmatic Language

Structured Social Skills Intervention: Behavioral

Expand vocabulary of emotions Playing cooperative games Social problem solving

More Availability of Pre-packaged Programs:

Look for empirically supported See Reynow & Volkmar (2010)

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Social & Communication Therapy for HFA

Pragmatic Language

Social Stories TM: From school-based research

Easily adapted to SPED classroom Focus on child's actual experiences

Social Perception Skills Training:

For adolescents & adults Teach social skills valued by employers Minskoff & DeMoss (1994)

Social & Communication Therapy for HFA

Teach Rules / Norms for Social Behavior Pragmatic Language Awareness: Conventions

and rules of conversation Choosing topics (avoiding the circumscribed) Shifting topics (lists of other-preferred topics) Knowing what unfamiliar listeners know

Reading Social Cues: Figuring out listener's perspective, keeping up reciprocity, etc.

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Social & Communication Therapy for HFA

Teach Rules / Norms for Social Behavior

Visual Strategies for Improving Communication:

Improves understanding of taskdemands, imposed by social settings

Hogdon (1995, 1996)

Read Non-Verbal Cues:

Setting demands Body proximity, position & posture Emotional expression (body, face, voice)

Social & Communication Therapy for HFA

Teach Rules / Norms for Social Behavior

Teach Self-Monitoring During Conversation:

Social skills training groups Topic boxes Comic strip conversation (Gray, 1995)

To Monitor & Know What it Means When:

People use eye contact or gaze Use verbal inflection / tonal changes Use facial / hand gestures

Social & Communication Therapy for HFA

Teach Rules / Norms for Social Behavior

Teach About Non-Literal Communication: Irony, teasing, sarcasm, figures of speech, humor

Via Explicit Verbal Teaching & Practice:

Concrete situations Rehearsed in therapeutic setting Mirror, recorded speech, video

Mediated Peer Interactions &

High Functioning Autism (HFA)

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Mediated Peer Interactions & HFA

Paul (2003)

Most Effective Social Skills Training: Happens in company of typically developing peers

Provide a little training Provide a some incentives

Helps Skills Generalize: Mainstream exposure

Peer mentors Peer skills group members Peer part-time buddies

Defining Autism & Asperger's

Kamps et al. (1992)

Peers As Support Networks: Secondary school

Short sessions during school Structured scripts & scenarios Reading, lunch, game time, etc.

Prompt & Praise: Typical students reinforce child w/ HFA for specific / targeted interactions

Create `Safe Room': For self-timeout

Academic Curriculum for

High Functioning Autism (HFA)

Academic Curriculum for HFA

Benefit from Modifications

Long-Term Focus: On goals that maximize vocational potential & quality of life

Cultivate circumscribed interests that boost prospects for employment

Flex Credit-System Requirements: Tangential classes often lead to motivation & failure

Taylor to HFA student's interests

Academic Curriculum for HFA

Classroom Setting

Ideal Program: Small class, offers individual attention, small group work

W/ individual communication specialist W/ individual OT specialist Structured, supervised activities w/ peers Focused on real-life skills W/ in-school counselor as `safe address'

Academic Curriculum for HFA

Type of School Supports

Both Specialized & Inclusive Experiences:

In self-contained & mainstream classes Combo works as

long as individualized Depending on what

district has available

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Bibliography

Bibliography

Ambery, F. Z., Russell, A. J., Perry, K., Morris, R., & Murphy, D. G. (2006). Neuropsychological functioning in adults with Asperger syndrome. Autism, 10(6), 551-564

Atwood, T. (2003). Frameworks for behavioral intervention. Child and Adolescent Psychiatric Clinics of North America, 12, 65-86.

Castorina, L. L., & Negri, L. M. (2011). The inclusion of siblings in social skills training groups for boys with Asperger syndrome. Journal of Autism and Developmental Disorders, 41(1), 73-81.

Gillberg, I. C., & Gillberg, C. (1989). Asperger syndrome-some epidemiological considerations: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines, 30(4), 631-638.

Gray, C. A. (1995). Teaching children with autism to "read" social situations. In K. A. Quill (Ed.), Teaching children with autism: Strategies to enhance communication and socialization (pp. 219-242). New York: Delmar.

Paul, R., (2003) Enhancing social communication in high functioning individuals with autistic spectrum disorders. Child & Adolescent Psychiatric Clinics of North America, 12, 87-106

Bibliography

Gray, C.A. (1998). Social Stories and comic strip conversations with students with Asperger syndrome and high-functioning autism. In E. Schopler & G.B. Mesibov (Eds.), Asperger syndrome or high-functioning autism? Current issues in autism (pp. 167-198). New York: Plenum Press.

Gray, C.A., Dutkiexicz, M., Fleck, C., Moore, L., Cain, S.L., Lindrup, A., eta!. J (1993). The Social Story book. Jenison, MI: Jenison Public Schools.

Gray, C.A., & Garand, J. (1993). Social Stories: Improving responses of students with autism with accurate social information. Focus on Autistic Behavior, 8, 1-10.

Graetz, J. (2009). Effective academic instruction for students with high functioning autism or Asperger's syndrome. In V. Spencer & C. Simpson (Eds.), Teaching children with autism in the general classroom: Strategies for effective inclusion and instruction in the general education classroom (pp. 45-74). Waco, TX: Prufrock Press.

Hanley-Hochdorfer, K.P., Bray, M.A., Kehle, T.J., & Elinoff, M.J. (2010). Social Stories to increase verbal initiation in children with autism and Asperger's disorder. School Psychology Review, 39(3), 484-492.

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