10.12.11

Strategies for Parents and Teachers: Summary of Mark Hutten's Lecture

The autism spectrum extends from “classic autism” (which lies at the lower end of the spectrum) through to Aspergers (which is characterized as being at the mildest and highest functioning end of the spectrum).

Aspergers reflects deviations or abnormalities in four aspects of development:

1. Certain behavioral and stylistic characteristics such as repetitive or persevering features
2. Limited, but intense, range of interests
3. Social relatedness and social skills
4. The use of language for purposes of communication

These dysfunctional features can range from mild to severe.

Aspergers is characterized by:

• a better prognosis than other Autism spectrum disorders
• difficulties with pragmatic, or social language
• extending into the very superior range of cognitive ability
• high cognitive abilities - or, at least, “normal” IQ level
• normal language function when compared to other autistic disorders

Diagnostic Criteria from DSM—

Aspergers:

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
  1. 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 to other people)
  2. failure to develop peer relationships appropriate to developmental level
  3. lack of social or emotional reciprocity
  4. 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. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
  1. apparently inflexible adherence to specific, nonfunctional routines or rituals
  2. encompassing preoccupation with one or more stereo-typed and restricted patterns of interest that is abnormal either in intensity or focus
  3. persistent preoccupation with parts of objects
  4. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrase used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

CLINICAL FEATURES—

One of the primary features of Aspergers is the child’s passion for favorite topics or special interests. Some of these areas include:

• astronomy
• dinosaurs
• extraterrestrials
• geography
• history
• machines or machinery
• maps
• math
• meteorology
• music
• reading
• science
• social studies
• space travel
• trains
• weather

Socialization deficits:

• Are inflexible and incapable of coping with change
• By school age express desire to fit in socially
• Described as being "in OUR world, but, ON THEIR OWN terms"
• Different from "typical" Autism
• Difficulties making social connections
• Easily stressed and emotionally vulnerable
• Frequently described as “odd” or selfish
• Highly frustrated by their social awkwardness/alienation
• Lack effective interaction skills — not desire
• Lack understanding of human relations and rules of social convention
• Naïve and lack common sense
• Preoccupied with own agenda
• Seldom interested in other's interests/concerns
• Unable to “read” others' needs and perspectives
• Unable to appropriately respond to social cues

Use of Language:

• Concrete language rather than abstract
• Difficulty understanding humor
• Early years: repetitive phrases or language or stock phrases from memorized material
• Excessively formal or pedantic language
• Hyper-verbal (highly developed vocabularies)
• Laugh at “wrong time” with jokes or interactions
• Many have good sense of humor
• Misused or not used cultural slang or social idioms
• Problems with taking turns in conversations
• Prosody (speech volume, intonation, inflection, rate) is frequently deficient or unusual
• Rote skills are strong
• Typically revert to favorite topic area
• Usually like word games and puns
• Weak pragmatic-conversational-skills
• Some have normal or early language development while others have speech delays, then rapidly catch up, making diagnosis between Aspergers, autism, and speech disorders difficult

TEACHING STRESS REDUCTION SKILLS—

Aspergers kids are:

• are often anxious and worrisome
• easily overwhelmed
• highly sensitive
• often engage in rituals

Practical Suggestions:

• consistent routines
• let them know what to expect
• minimize fears of unknown
• minimize transitions
• prepare them for altered plans, schedules or changes
• provide predictable, safe environments

Examples:

• Introduce to teacher, therapist or para-professional before work begins
• Take tour of building child will be working or learning in
• Learn about child's favorite topics or special interests

Aspergers kids typically display impaired social interaction…


Practical Suggestions:

• Create cooperative learning situations
• Educate peers
• Praise classmates when supportive
• Promote empathy and tolerance
• Shield them from bullying and teasing

Examples:

• Encourage participation in conversations
• Insensitive or inappropriate comments from Aspergers child are usually innocent
• Model two-way interactions
• Rehearse proper response repertoires
• Teach and support proper reaction to social cues
• Teach WHAT to say, WHEN, and HOW to say it
• Teach/model correct emotional responding
• Teaching WHY & WHAT response is appropriate is necessary
• Use Aspergers youngster’s strengths in exchange for liabilities to foster acceptance

COMMUNICATION AND GESTURES—

Six steps for understanding challenging communications…

1. Try to figure out what your youngster is communicating with the challenging behavior:

• “I can't remember what I'm supposed to do”
• “I'm mad…scared…confused”
• “This is too difficult for me”

2. Consider how you can adapt the situation:

• Child overwhelmed or over-stimulated? Try reducing amount of time in situation, or avoiding it in future.
• Child expressing confusion? Consider how to make the situation easier to understand; make it more concrete, routine, or predictable.

3. If the message must be communicated, come up with alternate way in which your youngster can communicate his or her needs or wishes more appropriately:

• Help your youngster develop appropriate ways of conveying requests/needs. If screaming when confused by a task, teach youngster to raise hand, ring a bell, or say: “I need help with this…this is too hard.”

4. Practice the “new way” of communicating:

• during the situation, remind (prompt) youngster to use new phrase or behavior
• have youngster practice the “new phrase” or behavior
• model more appropriate phrase or nonverbal signals

5. Reward your child for using the strategy by showing that it gets his or her needs met:

• if asks to leave situation, provide her with immediate break
• if needs attention, stop what you're doing and provide some time/interest
• if your youngster requests help assist her immediately

6. Be sure that the challenging behavior is no longer effective in getting your youngster’s needs met:

• ignore problem behaviors
• provide prompt for the “new, appropriate one
• if youngster screams to avoid situation, prompt him to use an appropriate phrase; don’t allow him to leave the situation while he is screaming

==> The Aspergers Comprehensive Handbook

9.12.11

How To Have A Stress-Free Christmas

Christmas is often filled with stress. There is a lot of pressure to make Christmas perfect and fun, and to enjoy yourself while you're doing it. This is a tall order in any situation, but when you add to that the stress of having a child with special needs for whom you also want the holidays to be perfect and fun – it can often become more overwhelming than ever. 

Here are 10 tips to help you have a stress-free Christmas with your Aspergers or high-functioning autistic child:

1. Kids on the autism spectrum will always do better when they are not over-stimulated by the many sights, sounds, smells, and unpredictable events of the outside world. You can create an experience in your home that you normally would go out for. For example, instead of going to an evening parade with a festival of lights, you can put Christmas lights all around your house, turn off all the lights, and play Christmas music at a gentle volume. You may be concerned about depriving your youngster of a fun holiday experience, but keep in mind that when your youngster can’t digest the experience, he’s not having the fun experience you want. That’s why, if you can create a digestible version of the experience at home, your youngster can take in and enjoy the experience. By doing this, you are actually giving him more, not less.

2. Focus on a few things you know are important to make sure you have prepared around this time. Of course, some things may need modification so that it is possible to enjoy them with your youngster. For example, if there is a danger of them hurting themselves on fragile decorations, you may have to put them higher up and out of reach, or get new ones that are not so fragile. Some special foods may not be served. These modifications often bring some disappointment, but if the goal is a nice family holiday, it's important and we can adjust.

3. Holiday decorations inside the house – including bright and blinking lights, wreaths, trees, candles and stacks of presents – could be areas of concern. Parents know best what their Aspergers youngster enjoys and at what point things may become overwhelming. However, parents should not expect higher tolerance simply because it is the holiday season.

4. Holiday shopping with an Aspergers youngster may present its own set of challenges, especially when the stores are crowded and noisy. Make a list that identifies the items you’re shopping for, and do not roam the stores trying to decide what to buy. Keeping the trip short and being organized will help minimize the potential for your youngster to become overwhelmed and have a “meltdown” in the middle of a store.

5. If you are visiting family with your child, send them an email ahead of time to explain what they can do to make the visit comfortable for you and your Aspie. Explain why a group of talkative family members asking your child a bunch of questions might be problematic, or tell everyone the answer your youngster likes to hear when he asks over and over, “How fast does your car go?” Also, designate in advance a calm room or space where he can go to decompress once he begins to be overwhelmed by all of the commotion and sensory input that comprise most celebrations. Every so often, take the youngster to this room and spend some time alone with him.


6. Make the demands on yourself realistic and don't try to do so much that you feel only frustration. Make realistic lists and work on things one at a time. Looking at a whole month of this holiday season is less overwhelming if you take it in small pieces. You may also have to lower your expectations of what you can really do, but at least what you do will be less stressful and make the holidays special.

7. Most parents dread their Aspergers children behaving in a challenging way. We worry about it, we look for it, and we try to stop it as soon as it happens. Ironically, this puts all the focus on what you DON’T want from your youngster. If you don’t want him to hit, for example, focusing on getting him ‘not to hit’ actually creates more hitting. Instead celebrate your child every time he does something well. If your kid sometimes hits, cheer wildly every time he is gentle.

8. Since the holidays are a time for the whole family to enjoy together, it’s important to make siblings aware of how stressful this season can be for their brother or sister with Aspergers. Take the time to remind your other kids of their sibling’s sensory issues, communication difficulties, low frustration tolerance and likes and dislikes. Moms and dads can then share the family’s strategy for avoiding potential issues and discuss what they will do if their best efforts are unsuccessful.

9. So often, we get caught up in the trappings of the holidays – the tree, the presents, the outings that have to go exactly as planned. It’s okay to arrange fun things, but remember that these are only trimmings. They aren’t the gift, they’re just the wrapping. The gift is your special youngster. The gift is sharing hope and sweetness with loved ones. Instead of using the Christmas season as a “planning fest,” use it to see the beauty in your Aspergers kid’s uniqueness. Use it to celebrate what he can do, and use it to feel and encourage compassion for his very different way of experiencing the world.

10. We often put pressure on ourselves to make the holidays perfect, which is unrealistic. In the end, the most important thing to remember is that the holidays are a time to cherish one another and the joy of being together. Whether it’s scaling back or starting new traditions, celebrate in a way that makes the most sense for your family and is something that you, your Aspergers youngster, and the entire family will all enjoy.

==> My Aspergers Child: Preventing Meltdowns and Tantrums

Creating an Individualized Education Program (IEP) for Students with Asperger’s Syndrome and High Functioning Autism

Children with delayed skills or other disabilities might be eligible for special services that provide individualized education programs in public schools, free of charge to families. Understanding how to access these services can help moms and dads to be effective advocates for their Aspergers and high-functioning autistic children.

The passage of the updated version of the Individuals with Disabilities Education Act (IDEA 2004) made mothers/fathers of children with special needs even more crucial members of their youngster's education team. Moms and dads can now work with teachers to develop a plan — the individualized education program (IEP) — to help children succeed in school. The IEP describes the goals the team sets for a youngster during the school year, as well as any special support needed to help achieve them.

A youngster who has difficulty learning and functioning and has been identified as a special needs child is the perfect candidate for an IEP. Children struggling in school may qualify for support services, allowing them to be taught in a special way, for reasons such as:
  • attention deficit hyperactivity disorder (ADHD)
  • autism spectrum disorders
  • cognitive challenges
  • developmental delay
  • emotional disorders
  • hearing impairment
  • learning disabilities
  • speech or language impairment
  • visual impairment 

How Services Are Delivered—
    In most cases, the services and goals outlined in an IEP can be provided in a standard school environment. This can be done in the regular classroom (e.g., a reading teacher helping a small group of kids who need extra assistance while the other children in the class work on reading with the regular teacher) or in a special resource room in the regular school. The resource room can serve a group of children with similar needs who are brought together for help. However, children who need intense intervention may be taught in a special school environment. These classes have fewer children per teacher, allowing for more individualized attention.

    In addition, the teacher usually has specific training in helping children with special educational needs. The kids spend most of their day in a special classroom and join the regular classes for nonacademic activities (like music and gym) or in academic activities in which they don't need extra help.

    Because the goal of IDEA is to ensure that each youngster is educated in the least restrictive environment possible, effort is made to help children stay in a regular classroom. However, when needs are best met in a special class, then children might be placed in one.

    Referral and Evaluation—

    The referral process generally begins when a teacher, mother or father, or doctor is concerned that a youngster may be having trouble in the classroom, and the teacher notifies the school counselor or psychologist. The first step is to gather specific data regarding the child's progress or academic problems. This may be done through:
    • conference with moms and dads
    • conference with the child
    • analysis of the child's performance (e.g., attention, behavior, work completion, tests, class work, homework, etc.)
    • observation of the child

    This information helps school personnel determine the next step. At this point, strategies specific to the child could be used to help the youngster become more successful in school. If this doesn't work, the youngster would be tested for a specific learning disability or other impairment to help determine qualification for special services.

    It's important to note, though, that the presence of a disability doesn't automatically guarantee a youngster will receive services. To be eligible, the disability must affect functioning at school.

    To determine eligibility, a multidisciplinary team of professionals will evaluate the youngster based on their observations; the youngster's performance on standardized tests; and daily work such as tests, quizzes, class work, and homework.

    Professionals on the Team—

    The professionals on the evaluation team can include:
    • physical therapist
    • psychologist
    • special educator
    • speech therapist
    • vision or hearing specialist
    • occupational therapist

    As a mother or father, you can decide whether to have your youngster assessed. If you choose to do so, you'll be asked to sign a permission form that will detail who is involved in the process and the types of tests they use. These tests might include measures of specific school skills, such as reading or math, as well as more general developmental skills, such as speech and language. Testing does not necessarily mean that a youngster will receive services.

    Once the team members complete their individual assessments, they develop a comprehensive evaluation report (CER) that compiles their findings, offers an educational classification, and outlines the skills and support the youngster will need.

    The moms and dads then have a chance to review the report before the IEP is developed. Some moms and dads will disagree with the report, and they will have the opportunity to work together with the school to come up with a plan that best meets the youngster's needs.

    IEP Development—


    The next step is an IEP meeting at which the team and moms and dads decide what will go into the plan. In addition to the evaluation team, a regular teacher should be present to offer suggestions about how the plan can help the youngster's progress in the standard education curriculum.

    At the meeting, the team will discuss your youngster's educational needs — as described in the CER — and come up with specific, measurable short-term and annual goals for each of those needs. If you attend this meeting, you can take an active role in developing the goals and determining which skills or areas will receive the most attention.

    The cover page of the IEP outlines the support services your youngster will receive and how often they will be provided (e.g., occupational therapy twice a week). Support services might include special education, speech therapy, occupational or physical therapy, counseling, audiology, medical services, nursing, vision or hearing therapy, and many others.

    If the team recommends several services, the amount of time they take in the youngster's school schedule can seem overwhelming. To ease that load, some services may be provided on a consultative basis. In these cases, the professional consults with the teacher to come up with strategies to help the youngster but doesn't offer any hands-on instruction. For instance, an occupational therapist may suggest accommodations for a youngster with fine-motor problems that affect handwriting, and the classroom teacher would incorporate these suggestions into the handwriting lessons taught to the entire class.

    Other services can be delivered right in the classroom, so the youngster's day isn't interrupted by therapy. The youngster who has difficulty with handwriting might work one on one with an occupational therapist while everyone else practices their handwriting skills. When deciding how and where services are offered, the youngster's comfort and dignity should be a top priority.

    The IEP should be reviewed annually to update the goals and make sure the levels of service meet your youngster's needs. However, IEPs can be changed at any time on an as-needed basis. If you think your youngster needs more, fewer, or different services, you can request a meeting and bring the team together to discuss your concerns.

    Parents’ Legal Rights—

    Specific timelines ensure that the development of an IEP moves from referral to providing services as quickly as possible. Be sure to ask about this timeframe and get a copy of your parents’ rights when your youngster is referred. These guidelines (sometimes called procedural safeguards) outline your rights as a mother or father to control what happens to your youngster during each step of the process.

    The parents’ rights also describe how you can proceed if you disagree with any part of the CER or the IEP — mediation and hearings both are options. You can get information about low-cost or free legal representation from the school district or, if your youngster is in Early Intervention (for children ages 3 to 5), through that program.

    Attorneys and paid advocates familiar with the IEP process will provide representation if you need it. You also may invite anyone who knows or works with your youngster whose input you feel would be helpful to join the IEP team. 

    Conclusion—

    Moms and dads have the right to choose where their children will be educated. This choice includes public or private elementary schools and secondary schools, including religious schools. It also includes charter schools and home schools.

    However, it is important to understand that the rights of kids with disabilities who are placed by their moms and dads in private elementary schools and secondary schools are not the same as those of children with disabilities who are enrolled in public schools or placed by public agencies in private schools when the public school is unable to provide a free appropriate public education (FAPE).

    Two major differences that moms and dads, educators, other school staff, private school representatives, and the children need to know about are:
    1. Not all children with disabilities placed by their moms and dads in private schools will receive services.
    2. Kids with disabilities who are placed by their moms and dads in private schools may not get the same services they would receive in a public school.

    The IEP process is complex, but it's also an effective way to address how your youngster learns and functions. If you have concerns, don't hesitate to ask questions about the evaluation findings or the goals recommended by the team. You know your youngster best and should play a central role in creating a learning plan tailored to his or her specific needs.


    More resources for parents of children and teens with Asperger's and High-Functioning Autism:

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