Adults with Autism Spectrum Disorder: Identifying Support Needs and Initiating Effective Strategies Part One Chris Filler Program Director Lifespan Transitions Center chris_filler@ocali.org Evant January 6, 2014 12:30PM – 4:00 PM A Hopeful Agenda Registration 12:30 – 1:00 Welcome, Introductions, Who Is Here? 1:00 – 1:10 CHARACTERISTICS of ASD 1:10 – 2:00 Quick Review, Introduce a Tool, Try it! STRATEGY IDEAS 2:00 – 3:00 Focus on Communication and Sensory CREATING PLANS with SART 3:00 – 4:00 How to organize supports and strategies We will take a short break somewhere midway through the afternoon. However, if you need to get up at another time, please quietly feel free to take care of your own needs. Expectations • The expectations of community living, learning, and working are changing. • ALL people with developmental disabilities are expected to be provided real opportunities to be part of their communities • This means we must prepare community environments, build on individual strengths and interests, and provide customized and effective supports. • For individuals with ASD, this can take special planning and skill. DSM-V 1. Persistent social-communication impairment 2. Restricted and repetitive patterns of behavior Can be Complicated by Co-Occurring Disorders in some people http://www.cdc.gov/ncbddd/autism/data.html ASD is a Spectrum Disorder • Characteristics • Challenges and Strengths • Potential Opportunities and Barriers Social Sensory Communication Emotional Regulation Cognitive Differences Restricted Patterns of Behavior/Interests Restricted Behavior and Interests: Can be the foundation for success! Displays rituals/nonfuncti onal routines Strong need for routine or sameness Strong need for closure Difficulty handling transition or change Eccentric or intense interests Asks repetitive questions Unconventional motivation Spectrum of Social Profile: Preferences and Challenges Difficulty Understanding Nonverbal communication (Body Language and Facial Expressions) Difficulty Understanding Social Communication Difficulty participating, waiting Difficulty Maintaining Personal Space Differences in Eye Contact Lacks Tact/Appears Rude Difficulty Making Friends Emotional Regulation: Indicators of Challenge Difficulty tolerating mistakes Appears anxious, easily stressed Appears depressed/sad Exhibits meltdowns Easily frustrated Demonstrates unusual fear response May demonstrate self-injurious behaviors Cognitive Differences: Challenges Can Hide Strengths Strong word recognitionpoor comprehension Poor problem solving Has excellent memory for details Has attention problems Poor organizational skills Difficulty generalizing skills Extensive knowledge in narrow area of interest Difficulty understanding the connection between behavior and resulting consequences Communication Qualities Can Amplify Communicating Partner Mismatch Difficulty with rules of conversation Difficulty expressing thoughts or feelings Difficulty asking for help Immediate or delayed echolalia Little or not speech Interprets words or conversations literally Difficulty with humor/sarcasm Difficulty starting, joining, and/or ending a conversation Sensory Preferences and Needs: Potential Barriers May Arise Avoids Seeks Makes noise such as humming or singing frequently Seeks activities that provide touch/pressure Responds in unusual manner to temperature Responds in unusual manner to sound Avoids activities that provide Avoids touch/pressure activities that provide movement Seeks activities that provide movement “In My Language” View this video on youtube: www.youtube.com/watch?v=JnylM1hI2jc Meet Larry Bissonnette www.youtube.com/watch?v=ku5rYjgbbPg More of Larry Documentary “ Wretches and Jabberers” (www.wretchesandjabberers.org) http://channel.nationalgeographic.com/channel/taboo/videos/autistic-artist/ The Point… Even if WE are unsuccessful in tapping into a person’s communication system, abilities, and thoughts… ..never assume they do not exist. Our responsibility is to keep trying! Support Begins with Understanding • Learn to understand what you observe (or hear) about a person with ASD through the ‘lens’ of the features of autism. Support Begins with Understanding • View the person as competent, skilled, and full of potential while also facing the barriers that ASD may create. Creating)the)Right)Fit:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Name:) Creating the “Right Fit”: Identifying Strengths and Needs Communica2on) Concerns:)What!aspects!will!need! intervenAon!and!support?!! Posi2ve)Aspects:)How!is!this!area!a! strength?! Social)Competency) Concerns:)What!aspects!will!need! intervenAon!and!support?!! Posi2ve)Aspects:)How!is!this!area!a! strength?! Sensory) Sensory)Observa2ons) Communica2on) Social)Competency) Observa2ons) Posi2ve)Aspects:)How!is!this!area!a! strength?! Social)Competency) )Communica2on)Observa2ons) Sensory) Developing!a!Person2Centered,!Strengths–Based!Profile!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Date:!!!! Concerns:)What!aspects!will!need! intervenAon!and!support?!! Creating)the)Right)Fit:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Name:) Creating the “Right Fit”: Identifying Strengths and Needs Sensory)Observa2ons) Wants own space. Likes the movement of rocking chair and car. Sensitive to touch. Posi2ve)Aspects:)How!is!this!area!a! strength?! Opportunities do exist. Build on TV shows to establish more interaction. Use favorite programs (Nat Geo) as a way to connect. Posi2ve)Aspects:)How!is!this!area!a! strength?! Knows what helps him. Have some ‘tool’ already that work to help his sensitivities. Communica2on) Wants to communicate. Initiates! Can use his ability to initiate to introduce other means to communicate. Visual? Social)Competency) Pushes people away that get in his space. Calm times with others (watch TV, car rides) are the best. Relaxes. Posi2ve)Aspects:)How!is!this!area!a! strength?! Sensory) Social)Competency) Observa2ons) Social)Competency) Uses few words. Pays attention to the environment. Bangs on table to signal a need. Sensory) )Communica2on)Observa2ons) Communica2on) Developing!a!Person2Centered,!Strengths–Based!Profile!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Date:!!!! Concerns:)What!aspects!will!need! intervenAon!and!support?!! Not many concerns. Need to find motivating things that will encourage him to use a communication tool Concerns:)What!aspects!will!need! intervenAon!and!support?!! Others overreact when he pushes. Can escalate to selfabuse (hitting head). Need to create a proactive plan. Need to help communicate in another way. Concerns:)What!aspects!will!need! intervenAon!and!support?!! He can be so sensitive that he escalates before we can help. Need to find even more ways to help him meet those needs in the community. What Did You Learn Tell About Scott’s Right Fit? Scott wants to work in his local community a few hours a week. In the past he has tried to enter the world of work, only to find that he struggles again and again to be successful. You spend some time with Scott and his family to get to know him better so you can help make the “Right Fit”. One of the first things you notice is that Scott yawns quite a bit. His mom says he has days where he doesn’t sleep well. He may wake up at 3 AM and not go back to sleep. On those days he is tired and she says he can get cranky over little things. You also note that when you are start asking Scott question, he struggles to answer and changes the conversation to Game Shows…his favorite topic! When you change the subject back to your question, Scott seems to get nervous, anxious, and a few times Scott abruptly excuses himself. While he is out, his parents explain that when he feels himself getting anxious or nervous, he will try to find a way to take a break…to separate from the stress. They tell you that if the stress continues and he cannot manage it, or regulate… he might cry, scream or occasionally he has been known to throw items. That’s why he excuses himself for a brief time. Scott returns in 5-10 minutes and he is willing to try and engage in conversation again. In fact he seems to want to be with you and interact with you. Of course, he does continue to move it back to the game show theme. Even when you look at your watch and use some strategies to clue him in on your interests in other subjects, he seems not to be responding. You finally ask him directly if you could talk about something different, to which he agrees and tries to answer questions as best he can. Scott’s conversation seems to lag when his mom and dad are both talking with you. He visibly seems anxious as the three of you chat quickly and laugh about a funny story. In fact, Scott disengages with the conversation as soon as more than one person joins the conversation. He tries hard to be part of a group, but it clearly is difficult. In the middle of all this, you also notice that when a car outside blasts it’s horn to move some geese off the road, he jumps and puts his hands over his ears. You then ask Scott about what he does during the day…what he likes to do. He has a hard time giving you a cohesive answer until he picks up his calendar / schedule. He then gives you a detailed description of the events of his past week. Similarly, when you ask about what he likes, enjoys, etc… he is quiet. His father opens a photo album on the table and slips it across the table to Scott. At that point Scott begins telling you about liking the car shows he and his dad often attend, swimming, volunteering at the food bank to help organize and label the items and looking at the price of items in stores (because that helps him play “Price Is Right”. ) Scott moves easily and smoothly around the room. He gets up and down frequently and seems to favor sitting in the overstuffed chair with the pillows and high sides. He does sit on the couch briefly, but moves to the favored chair when you and his father joined him on the couch and sit on either side of him. Read About Scott. What Did You Learn About Scott’s ‘Right Fit?’ Scott’s “Right Fit”: Identifying Strengths and Needs