Autism around the World
Symposium
Dubai 6-8 May 2010
Asperger Syndrome workshop
Maggi Rigg
Linda Simmons
Content
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The Cambian Group – introduction video
Introduction to Asperger syndrome
Educational Issues
Break
Behaviour support strategies
Friendship, Siblings, enhancing family life
Break
Nicholas - living with Asperger syndrome
Therapeutic interventions
All Cats have Asperger syndrome!
Questions
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Cambian video
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Introduction to Asperger
Syndrome
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A little bit of history….1943
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Lack of affective/ emotional contact with other people.
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Intensive insistence on sameness.
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Muteness or marked abnormality of speech.
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Fascination with manipulating objects.
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High levels of visuo-spatial skills or rote memory in contrast to
learning difficulties in other areas.
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An attractive, alert intelligence appearance.
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Condition present from birth or within the first 30 months of life.
Leo Kanner
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A little bit of history…1944
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Inappropriate social approaches to others.
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Intense interest in particular subjects such as railway
timetables.
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Good grammar and vocabulary but used for
monologues, not two way conversation.
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Poor motor co-ordination.
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Level of ability average but often with specific
learning difficulties in one or two subjects.
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A marked lack of common sense.
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Condition not obvious until 3 years or until children
started school.
Hans Asperger
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A little bit of history…1950 - 1960
• “Refrigerator mothers”
Bruno Bettleheim
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A little bit of history…1980
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Children with autism exhibit, to a greater or
lesser degree, a TRIAD OF
IMPAIRMENTS which is the defining
characteristic of Autism:
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Language impairment across all areas of
communication (speech, intonation,
gesture, facial expression and other body
language).
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Rigidity and inflexibility of thought process
(resistance to change, obsessional and
ritualistic behaviour)
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Difficulties with social empathy, rejection of
normal body contact, inappropriate eye
contact.
Lorna Wing
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Overview to Asperger Syndrome
Gillberg 1991
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Social impairment – extreme egocentricity
Narrow interest
Compulsive need for routines & interests
Speech & language peculiarities
Non verbal communication problems
Motor clumsiness
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The triad of impairments…
Communication
difficulties
Imagination
difficulties
Social Interaction
difficulties
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Or is it a square of impairments…?
Communication
Social Interaction
difficulties
difficulties
Imagination
difficulties
Sensory
Integration
difficulties
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Factors Affecting Clinical Picture
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Age
Gender
Overall level of ability
Associated features
Personality and temperament
Environment
Education
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Possible Associated Conditions
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ADD/ADHD
Dyslexia
Dyspraxia
Tourettes Syndrome
OCD
Anxiety
Depression
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Challenges
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Accepting mistakes
Taking advice
Making & keeping friends
Managing anger & frustration
Explaining thoughts & knowing others
thoughts and feelings
• Avoid bullying & teasing
• Written work
• Demonstrating affection to family
members
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Qualities & Strengths
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Determined
Distinct sense of humour
Attention to detail
Seek truth, knowledge & perfection
Different sensory experiences
May seek & enjoy solitude
Exceptional memory
Special skills & interests
Creative V co-operative
Original in problem solving
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How it is for us
FACTS
BELIEFS
FEELINGS
BEHAVIOURS
I have A.S.
I must be stupid
Incomprehension
Non compliance
It is a lifelong
condition
I am tainted
Anger
I am a disappointment to
my family
Panic
It makes me
different from
other people
I go to a
residential
special school
Nobody will ever
like me
There’s no point
in living
No one
understands me
I am superior to
other people
Tantrums
Aggression
Passive resistance
‘Mania’
Change of identity
Sadness
Seeking a ‘cure’
Helplessness
Make the best of it
Denial
Acceptance
Self harm
Suicide
Active
Compensation
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EDUCATIONAL ISSUES FOR
THE STUDENT WITH
ASPERGER SYNDROME
Sharing Effective Practices
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Aspergers Syndrome
Triad of Impairment:
Language Difficulties
• Communication
Rigidity & Inflexibility
• Imagination
Poor timing/
Lack of empathy
• Socialisation
Relationship issues
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Other Features Often Present
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Sensory stimuli
Movement and posture
Attention/Level of Activity
Eating/Drinking/Sleeping issues
Mood
Behaviour
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Common Classroom Issues
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Language – receptive/expressive
Change
Motivation
Sensory issues
Predicting Outcomes
Distractions
Planning/following instructions
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Detached curiosity!
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Suggested Strategies to Manage Difficulties
Language:
• Say what you mean, mean what you say!
• Check for understanding
• Avoid use of metaphors
• Give student time to process
• Use name first to get attention
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Suggested Strategies to Manage Difficulties
cont’d:
Change
• Give early warnings
• Positive and clear instructions
• Visual/auditory cues. Timers, timetables
• Support transitions – mentor (staff or peer)
• Walk through timetable
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Suggested Strategies to Manage Difficulties
cont’d:
Coping
• Remembering instructions
• Following the instructions
• Asking for help
• Sequencing and completing work
• What to do next
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Suggested Strategies to Manage Difficulties
cont’d:
Motivation
• Sufficient and varied work
• Achievable tasks
• Clear beginnings and endings
• Reward achievement – use future
conditional
• Creative rewards
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Suggested Strategies to Manage Difficulties
cont’d
Environment
• Predictable – as far as possible
• Tutor time/pastoral support
• Safe place/safe person
• Low distraction/low noise
• Identify stress triggers
• Open exit policy
• Seating plan – to reduce potential trouble
spots
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Suggested Strategies to Manage Difficulties
cont’d
Boredom
• Differentiation by effort and outcome
• Clear expectations and rules
• Creative use of special interests –
special interest box
• MIST focus – Maths, IT, Science, Tech
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LIKELY FAVOURITE ACTIVITIES
Home
Sciences and
Management
Maths
Cooking
Technology:
Workshop
Activities
Music and Art
(if needs led)
Fitness PE
General
Knowledge
Activities not
always Age
Appropriate
Computers
Video
Tests and
Memory Skills
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LESS LIKELY FAVOURITE
ACTIVITIES
English
Any Written
Work
Geography
(map and route
finding work)
Sharing
History
(inability to
think back in
time
PSE Work
(but it is vital)
Drama
Role play can
be good)
Team Games
Group Work
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CONCLUSION – Do you have what it takes to
help an ASD individual?
Can you?
• Understand the disorder
• Work in a lone desert
• Protect the student’s self-esteem
• Give directions slowly, clearly and repeat
• Motivate and encourage
• Make adaptations
• Differentiate
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CONCLUSION – Do you have what it takes to
help an ASD individual?
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Are you?
Attracted by the differences
Beyond manipulation
Exciting and stimulating in teaching style
Clear and consistent
Firm yet kind
Open and positive minded
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Break
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Behaviour Support Strategies for
Young People with Asperger
Syndrome
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Stress Model of Crisis
Outburst
Escalation
Trigger
Recover
y
Baseline
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Communication
Listener
Filters
Filters
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Filters
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Language
Past Experience
Tone of voice
Body Language
Environment
Special Educational needs i.e. ASD/
ADHD
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Self Awareness
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Body Language
Tone of Voice
Language used
Facial Expression
Eye contact
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Self Awareness
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Be aware of your own emotions
Be aware of your own expectations
Be aware of your own thoughts
Role Model
Listening Skills
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Strategies for speaker at
Baseline/Trigger/Escalation
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Traffic lights
Social Stories
Mood O’Meters
Reward charts
Check environment
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Strategies for speaker at
baseline/Trigger/Escalation
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Listen
Direct
Prompt
Teach
Time away
Appropriate use of humour
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Strategies for speaker at
baseline/Trigger/Escalation
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Be descriptive
Use Name first
Give time to process
Inform of positive/negative consequences
Provide predictable/ consistent rules &
routines
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Strategies for Speaker at Outburst
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SAFETY – remove stress/target or objects
Engage or withdraw?
Few clear words
Avoid touch
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Strategies for Speaker at Outburst
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Don’t try to reason
Direct to 1 or 2 choices
Be visual
Give a way out
Listen
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Strategies for Speaker to help young person improve
coping skills
• Wait until calm but when s/he will
remember
• Don’t ignore but explore behaviour
• Listen
• Find strategy for feeling not behaviour
• Plan (led by person guided by speaker)
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Strategies for Speaker to help young
person improve coping skills
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Role play
Planned exposure to stress
Time to process
Natural consequences for positive and
negative behaviours
• Be aware of learning style
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Strategies for the Adult Listener
• Goal = get person to off load
• Think about goal of your questionsvent/get specific info?
• Don’t put up road blocks/argue/problem
solve
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Strategies for the Adult Listener
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Silences
Reflection & Summaries
Check your & their understanding
Encouragements i.e. “ah huh”
Identify feelings
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Conclusion
Final words of wisdom
• We may never alter the behaviour so may
have to move the goal posts
• Remember the 3 r’s – rules, routine,
repetition
• You could get your answer by asking the
student direct!
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Friendships, Siblings
& Enhancing Family Life
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Strategies for Social Understanding &
Friendship
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Teach turn taking
Play pretend games with your child
Watch a video of children playing
Help develop a sense of humour
Teach what not to say
Teach playground ‘slang’
Use role play to practice
Ask school for like minded child – share
interests
• Friendship diary
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Siblings
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Recognise sources of stress
Embarrassment
Jealousy
Frustration – not able to engage
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Siblings continued
• Concern re: parents stress & grief
• Target for aggressive behaviour
• Trying to compensate for AS siblings
‘deficits’
• Concern re: their role in future care giving
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Strategies for Sibling Issues
• Explain AS – early & often
• Teach siblings simple skills to enable
positive interactions
• Give siblings own special time
• Not everything as a family
• Ensure safety of personal belongings –
lock on door, special box, visual aid on
door
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Strategies for Siblings,
continued
• Stress expectations to adult siblings re:
future role
• Share plans for care arrangements
• Reduce isolation – sibling support groups
• Online resources – US Sibchat
• Most cope well – love, grace & humour
beyond their years
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Surviving Celebrations/Family
Occasions
• Look at the world of ‘celebrations’ through
their eyes – fasting, prayers etc…
• Create a schedule
• Consider sensory overload
• Presents – reduce surprises – leave
unwrapped
• Have a celebration free zone – DVD,
computer
• Liaise with school – timetable changes
• Use photos for visits by friends & family
• Father Christmas – prepare for man in a red
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Surviving Homework
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A major source of stress & anxiety
Create distraction free area
Create a homework timetable
Ask school to differentiate by effort &
outcome
Consider use of scribe
Ask teacher to highlight key aspects
Fatigue overwhelming – ask for max 30
mins
Use ICT where possible
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Adolescence & Growing Up
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Early years – teach:
Acceptable physical contact
Gender grouping
Modesty
Anatomy
Hygiene, health
Self help skills
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Adolescence & Growing up
continued
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Growth & development
Respect of privacy
Public V Private
Differentiate friends, family, acquaintances
& strangers
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Some Rules!!!
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If you can teach the skill teach it
If you can’t teach the skill adapt it
If you can’t adapt it find a way around it
If you can’t find a way around it teach the
neurotypical to cope
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Break
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Nicholas Hedges video
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Therapeutic Interventions
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Autism and Therapeutic
Support
Speech
and
Speech and
Language
Language
Therapy
Therapy
Communication
Communication
difficulties
difficulties
Social
Social
Interaction
Interaction
difficulties
difficulties
Imagination
Imagination
difficulties
difficulties
Psychology
Challenging
Challenging
behaviour
behaviour
Sensory
Sensory
Integration
Integration
Difficulties
Difficulties Occupational
Motor,
perceptual
and
Motor,
perceptual
Therapy
play skills
and play skills
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Professional Support
• Clinical Psychology
• Occupational Therapy
• Speech and Language Therapy
• Holistic therapies
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What do Psychologists do?
• Assess cognitive abilities: memory,
attention, reasoning.
• Analyse behaviours.
• Formulate areas of strengths and
difficulties.
• Provide Behaviour Support Strategies
to reduce frequency and intensity of
challenging behaviour.
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How do they do this?
• Visual work
• Role play
• Gathering & scrutinizing evidence
• Emotional listening
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What do SaLT’s do?
• Assess communication
strengths and needs
• Advise
• Individualised programmes
• Train staff/parent own
communication style
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How do they do this?
• 1:1 sessions
• Individualised target objectives
• Social use of language programme
• What do you say/what do you mean?
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Visual strategies to support understanding, teach new skills and
manage change
Social Stories
When I get into the minibus, it’s important to fasten my seatbelt.
My seatbelt keeps me safe.
It’s good to keep my seatbelt fastened just right.
This keeps me safe.
When I get into the minibus, I will try to get the seatbelt, find the
handle and push it into the holder. When I hear a CLICK sound,
I know my seatbelt is fastened. I know I am safe.
I am safe in my seatbelt that is why I try to always wear a
seatbelt.
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Visual strategies to support understanding,
teach new skills and manage change
Mind maps
Who will be
there?
What do I do
after the
meeting?
Where will it be?
Discussing
IEP targets.
What do I do
at the meeting?
When will it
happen?
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Visual strategies to support understanding,
teach new skills and manage change
Visual conversations
Everyone is
talking at once –
voices in unison
(e.g. choir)
Interrupt – when
someone is still
talking
Listen
Thoughts
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What do OTs do?
• Assess motor, perceptual,
sensory and play skills.
• Focus particularly on the
impact of sensory
processing difficulties and
on building calming and
alerting activities into
routines to support
emotional regulation.
• Provide advice, including
sensory strategies and how
to adapt tasks and
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How do they do this?
• Sensory diets
• Functional programmes
• FMS/GMS – using handwriting, cutlery
adaptations
• Core concept programmes for posture,
spatial and body awareness and
proprioception
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Sensory Strategies
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Alternative Therapies
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Psychotherapy
Art therapy
Drama therapy
Music therapy
Holistic therapy
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What does ‘Therapeutic Environment’
mean?
• Enhanced communication.
• Controlled sensory environment.
• Predictability of day and routines.
• Positive behaviour management.
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Overall outcome
A multidisciplinary team including
Psychologists, Occupational Therapists
and Speech and Language Therapists can
provide the appropriate therapy support to
reduce the frequency of challenging
behaviours and enhance the quality of life
for an individual with Asperger syndrome
and their family.
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Contact details
Websites
www.cambiangroup.com
www.oaasis.co.uk
Telephone
+44 (0)20 8 735 6150
Emails
maggi.rigg@cambiangroup.com
linda.simmons@cambiangroup.com
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