Understanding & caring for individuals on the Autism

Spectrum

Prof Rita Jordan PhD OBEEmeritus Professor in Autism Studies

University of Birmingham, UK

Kilronan School, Feb. 20, 2012

Current Diagnosis• ICD:10 & DSM:IV - based on underlying ‘triad’ of

difficulties:– social & emotional understanding– communication– flexibility in thinking & behaviour

• ASD part of PDD– autistic disorder (classical autism)– Asperger syndrome– atypical autism/ PDD-NOS

• DSM V coming (2012?)– future of Asperger syndrome?– some excluded from help?

Sensory Issues

• evidence that at extremes• both over- and under-responsive to different senses• ‘over-responsive’: sensory avoiding; ‘under-responsive’:

sensory seeking• shield from sensitivities and/or desensitise• attach meaning to perception - reduce ‘bombardment’ of

meaningless stimulation• aware of variability - use proximal blocks• give environmental control to individual if possible• reduce overall stress • teach to monitor and manage levels of arousal

A Developmental Disorder

– compensation – secondary 'handicaps'– transactional process

Psychological Functioning in ASD

• perception/ sensation– ‘chicken & egg’

– no socially meaningful patterns

– idiosyncratic

– ‘backgrounding’ difficult

• attention– mono attention

– joint attention & monitoring

– social signals

Psychological Functioning in ASD (2)

• sense of self– intersubjectivity fails to develop– ‘experiencing self’ & consciousness

• socialisation– social brain dysfunctional– sensory cues dominate

• memory– paradoxical - rote vs meaningful– slow & accurate - not reconstructed– needs cues

Psychological Functioning in ASD (3)

• concept development– abstract as verb not adjective - fuzzy concepts

• feelings & emotions– understanding then symbols– external cueing of own feelings

• flexibility & self control– comes from understanding– plan do reflect sequences & consequences

• communication– language & communication separate– all aspects– pragmatics

Wendy Lawson: Teenage Years

negative view: – began to recognise that I was different

• beginnings of despair

– started to form over attachments• obsessive behaviours increased

– sent off to the Guides and Youth Group • obsessed about earning badges, but couldn’t form friendships• age 17yrs. first attempt at suicide

beginning of history with the mental health system

But things can get better

• Kanner (1973):– follow up of 96 adults– significant improvement often in mid-late teens

as individuals more aware of their problems & motivated to address them

– special interests important in providing work & occupation and in fostering social contacts

Working Towards Adult Life

• work (meaningful occupation)• enjoyable leisure • accommodation (changing needs?)• ‘friends’ - informed choice• intimate relationships? sex?• contact with relatives ‘belonging’• holidays - varied experiences• income of one’s own• independent & self-advocacy skills

Teaching Consequences

• less able - single track• more able -

– railway - no turns

– 2 clear termini with no connections

– choice point emphasised

Moment of choiceMoment of choice

Problem Problem Taught alternativeTaught alternative

Preparation in Teens to avoid challenges

• provide sustainable forms of structure– moving towards mental structure but some still needed

• reduce stress and keep occupied• daily aerobic exercise • build optimism for problem solving through CBT &

realistic valuing• structure social engagement with peers e.g. Legotherapy• ‘Circles of Intimacy’ not rigid social rules

Dealing with Loss & Disappointment

• loss of a person– replace the function & place in the life of the

teen– connect ‘happy memory’ pictures with future

plans

• loss of a goal– start early in teaching alternative routes to a

goal– teach disappointment in supportive settings

Fostering ‘Realistic Optimism’

• use ‘ecological curriculum’ approach to life and social skills– accurate appraisal of self– see plan for future coping

• help them notice good things that happen• teach ‘mindfulness’ & avoid

– too much worry over future– too much anger & distress over past