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Research-Supported Treatment for High Functioning Autism

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

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

University of California MercedSaturday, 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, visual-spatial 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 Needsof

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

forHigh Functioning

Autism (HFA)

Social & Communication Therapy for HFA

Enhance Communication & Social Skill

Raise Competence: In baseline levels of social intuition & comprehension of societal normsW/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: BehavioralExpand 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 task-demands, 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 exposurePeer 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 Curriculumfor

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 & failureTaylor 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

Bibliography

BibliographyAmbery, F. Z., Russell, A. J., Perry, K., Morris, R., & Murphy, D. G.

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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.

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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.

Bibliography

Hodgdon, L. (1996). Visual strategies for improving communication: Vol 1 Practical supports for school children for school and home. Troy, MI, Quick Roberts.

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Volkmar, F.R., & Wiesner, L.A. (2009). A practical guide to autism: What every parent, family member, & teacher needs to know. Hoboken, NJ: Wiley.

Bibliography

Koyama, T., Tachimori, H., Osada, H., Takeda, T., & Kurita, H. (2007). Cognitive and symptom profiles in Asperger's syndrome and high-functioning autism. Psychiatry and Clinical Neurosciences, 61(1), 99-104

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Bibliography

Morris, R.G., Rowe, A., Fox, N., Feigenbaum, J., Miotto, E., & Howlin, P. (1999). Spatial working memory in Asperger's syndrome and in patients with focal frontal and temporal lobe lesions. Brain & Cognition, 41(1), 9-26.

Moyes, R. (2003). Incorporating social goals in the classroom: A guide for teachers and parents of children with high functioning autism and Asperger syndrome. British journal of Educational Psychology, 73(1), 138-139.

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Bibliography

Szatmari, P., Bryson, S.E., Streiner, D.L., Wilson, F., Archer, L., & Ryerse, C. (2000). Two-year outcome of preschool children with autism or Asperger's syndrome. American journal of Psychiatry, 157(12), 1980-1987.

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Tiger, J.H., Fisher, W.W., & Bouxsein, K.J. (2009). Therapist- and self-monitored DRO contingencies as a treatment for the self-injurious skin picking of a young man with Asperger syndrome. Journal of Applied Behavior Analysis, 42(2), 315-319.

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BibliographyOnline Resources

PUBLICILY AVAILABLE ACTIVITIES

https://www.staples.com/super-duper-say-and-do-positive-pragmatic-game-boards-fun-sheets-resource-book/product_307868

SOCIAL STORY SAMPLES:

https://carolgraysocialstories.com/social-stories/social-story-sampler/

COMIC STRIP CONVERSATIONS:

http://www.qe2cp.westminster.sch.uk/attachments/download.asp?file=266&type=pdf

VISUAL LEARNING

www.amazon.com/Visual-Strategies-Improving-Communication-Practicalebook/dp/B01BN2SS7U/ref=tmm_kin_swatch_0?_encoding=U

TF8&qid=&sr=