Diagnostic Assessment for Asperger’s Syndrome The Continuum of Autism
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Diagnostic Assessment for Asperger’s Syndrome The Continuum of Autism: From the work of Tony Atwood What is Asperger’s Syndrome?
Symptoms of Asperger’s Syndrome
Aloof Avoid interactions Mute Behavior the main means of communication Fascination with sensory experience Passive
Active but Odd Often initiates interactions of short duration Repetitive questions (social echolalia, script, alternative meaning, reassurance) Lack of social play with others Fascination with a specific topic or person. Six Pathways to a Diagnosis of Asperger’s Syndrome Diagnosis of autism in early childhood Significant natural progress between 4 and 6 years of age Effective early intervention programs Progression along the continuum of autism Recognition of Characteristics When First Enrolled at School No clear signs of autism in early childhood Teacher notices conspicuous features Avoids social play with peers Unaware of the codes of social conduct Unusual qualities in conversation and imaginative play Clumsiness when running, writing and catching Teacher completes a developmental checklist for Asperger’s syndrome (ASAS) Diagnosis of a Relative with Autism or Asperger’s Syndrome
Dual Diagnosis Attention deficit disorder Language disorder Cerebral palsy Tourette’s disorder Secondary Psychiatric Disorder Depression Anxiety disorder such as Obsessive Compulsive Disorder Anger management Schizophrenia Residual Asperger’s Syndrome in an Adult Self referral due to a relative having the diagnosis or information from the media Agency referral from psychiatric services, forensic psychology and employment agencies Diagnostic Assessment
Social Impairment Reciprocity (the balance between participants) Inclusion (welcome, cooperation and control) Pretending to be Normal “…the fun came from setting up and arranging things. Maybe this desire to organize things rather than play with things, is the reason I never had a great interest in my peers. They always wanted to use the things I had so carefully arranged. They would want to rearrange and redo. They did not let me control the environment.” Social Impairment Limited ability with team skills Limited range of facial expressions and body language Difficulty reading the facial expressions and body language of others Limited ability to conceptualize the thoughts and feelings of others Speech and Language Characteristics
Pragmatic Aspects The art of conversation Reciprocity Repairing a conversation Knowing when and how to interrupt Inappropriate comments Keeping on track Primarily interested in an exchange of information Appropriate topics Monologues or scripts Recognizing and accepting different points of view Literal interpretation Prosody or the Melody of Speech Lack of change of vocal tone and volume to indicate emotion and key words Lack of variation in pitch, stress and rhythm Accent not consistent with that of the local children Difficulty understanding the relevance of the change in tone, inflection or emphasis on certain words when listening to the speech of others Pedantic Speech Overly Formal Excessive technical details “Adult” quality, sophisticated grammar or phrases Must correct errors Precise intonation Unusual Qualities of Speech
Special Interests Dominate the person’s time and conversation Statistics, cataloguing and symmetry Idiosyncratic Motor Clumsiness
Cognition Problems with advanced Theory of Mind Skills Weak Central Coherence Impaired Executive Function Profile on an Intelligence Test Visualisers or verbalisers Enclopedic memory Solitary and idiosyncratic play Preference for routines Limited flexibility in thinking Originality in problem solving Sound sensitivity Tactile sensitivity Sensitivity to the taste or texture of food Stoic in response to pain or temperature Synaesthesia Relevant Information Family history of similar individuals Reports from teachers and therapists Medical investigations and medicine Developmental history Prior diagnosis Presence of a psychiatric disorder Observation at school and home Issues Relevant to the Diagnostic Assessment
Alternative Terms HFA and AS at the behavioral and treatment level, are more the same than different Lack of expertise, experience and confidence in the diagnosis of AS Developing Social Skills and Understanding Emotions
Social Play Observe and make notes of the social “play” of the child’s peers Note the “script” and “acts” Rehearse with an adult acting as a friend Turn taking and help “Rent a friend” as a “dress rehearsal” Social Sandwich Sharing experiences Strategies for Social Integration Inclusion with Ordinary Children Observation of appropriate social/emotional behavior Peer group who know how to modify their behavior to accommodate and support the child Knowledge of the Nature of Asperger’s Syndrome
Teach Theory of Mind Skills Photographs, text, drawings, games Metaphor Social Stories Comic Strip Conversations Encourage Friendship Skills Behavioral strategies of task analysis, shaping, prompting and rewards Cognitive strategies to learn the theory and script using Social Stories Four Levels in the Development of Friendship
Level 1: Approximately 3 to 6 Years Recognition of turn taking Egocentric conceptualization One way assistance Proximity and physical attributes Why is….your friend? “Because I like him” “He lives next door” Level 2: Approximately 6 to 9 Years
Level 3: Approximately 9 to 13 Years Aware of other’s opinion of them and how their words and actions affect the feelings of others Shared experiences and interests Greater selectivity and durability Gender split Trust, loyalty and keeping promises Level 4: Adolescence to Adult Peer group acceptance more important than the opinion of parents Greater depth and breadth of self disclosure Desire to be understood by friends Different types of friendships “He/She accepts me for who I am” “We think the same way about things” Characteristics Associated with Asperger’s Syndrome Motivation for friendship Immaturity Control the activity Describe what a friend should not do Negative experiences Checklist of Social Behaviors Used as an Index of Friendship Skills Entry Skills Recognizing when and how to join in The “welcome” provided for children who approach them Assistance When and how to provide assistance Seeking assistance from others Criticism Compliments Compliments at appropriate times Responding to a friend’s compliment Accepting Suggestions Incorporating the ideas of others in the activity Indicating agreement Reciprocity and Sharing An equitable distribution of conversation, direction and resources Checklist of Social Behaviors Used as an Index of Friendship Skills - Con’t Conflict Resolution Managing disagreement with compromise Accepting the opinions of others Not responding with aggression or immature resolution mechanisms Monitoring and Listening Regularly observing the other person to monitor their contribution and body language Their own body language indicating an interest in the other person Empathy Recognizing when appropriate comments and actions are required in response to the other person’s circumstances and positive and negative feelings Avoiding and Ending Appropriate behavior and comments to maintain solitude Appropriate behavior and comments to end the interaction Encouraging Friendship Skills Assess which skills are observed or absent Assess the quality and range of expression Use behavior and cognitive strategies to acquire and develop specific skills Task analysis, prompting, shaping and reward Reward all participants Teach the theory as well as the practices Social stories Additional Strategies
Characterization Skills Unusual in their perception and description of the personality characteristics of others and themselves Limited lexicon to describe the different types of character Immaturity and predominance of physical attributes One dimensional approach Difficulty reading a person’s character and adapting their behavior accordingly Teaching Characterization Skills The Mr. Men and Little Miss books Examples are Mr. Grumpy, Little Miss Chatterbox and Mr. Nosey Choosing an animal to represent someone’s personality Reading dictionary definitions of character and identifying someone who has those characteristics Identifying the description of their own character Social Skills Groups
The Understanding and Expression of Emotions A project on a specific emotion Create a scrap book that illustrates the emotion Compare and contrast other children’s scrap books Identify the facial elements that express the emotion A “thermometer” to measure the degree of intensity Place photographs and words at the appropriate point on the “thermometer” Point to the “degree” of expression in a particular situation The Understanding and Expression of Emotions – Con’t Appropriate tone of voice Drama games for appropriate body language Mirror and video recordings Story books Sentence completion exercises Alternate positive and negative emotions Imitation Identify individuals skilled in a specific ability Observe their actions and script Copy or mimic their style Speech and drama training Dostları ilə paylaş:
