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Enhancing Social Skills for High Functioning Children with Autism Attending School

Enhancing Social Skills for High Functioning Children with Autism Attending School . Naoufel Gaddour MD Child Psychiatrist, University of Monastir Tunisia naoufel.gaddour@rns.tn. Autism: important variation in intensity. Severe picture, with neurological morbidity

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Enhancing Social Skills for High Functioning Children with Autism Attending School

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  1. Enhancing Social Skills for High Functioning Children with Autism Attending School Naoufel Gaddour MD Child Psychiatrist, University of Monastir Tunisia naoufel.gaddour@rns.tn

  2. Autism: important variation in intensity Severe picture, with neurological morbidity Moderate picture, with language and intelligence impairments Mild forms, with more or less developed language and normal intelligence

  3. Age of first referral (Monastir)475 recorded cases 2003-2011 7 yrs 3 yrs

  4. High functionning autism + • Children who improve dramatically after early intervention  NEW CHALLENGES

  5. Settings to take care of children with ASD in Tunisia • Tunisia had a poor school inclusion policy until 2004 • For children with special needs, special education centres are preferred and except for autism, they represent a widespread network. • Many children with autism attend centres for mental handicap, but usually without autism focused intervention (work on self-help, leisure, academic and professional skills…) and most of them usually carry other problems (mental retardation, epilepsy..)

  6. Autism: no specific answer • Parents of children with « pure » autism often would not put their children in centres for mental handicap • Once the preschool years are over (Kindergarten often accept autistic children), they worry. • Many have complicated time frames with individual sessions with multiple professionals (special educator, speech therapist, psychomotrician…) and pay a lot of money in « side » activities: animal assisted therapy, swimming pool…

  7. Tunisian Programme of School Inclusion for Children with Special Needs

  8. Law for the Promotion andProtection of Persons with Disability (August 2005) "Is guaranteed to all persons with disability the right to appropriate education and professional training, in priority in the mainstream system , in order to ensure equal opportunity and protectionagainst all forms of discrimination "

  9. Practical Aspects • Some schools are inclusive (special managements) • Children with mild disabilities are accepted after decision of a regional committee of professionals (health, education, social affairs, NGO’s…) • Teacher receives training • 1 child with disability = - 5 students per class • 2 hours of individual work per week • IEP with other professionals

  10. Current picture • From year to year, a higher number of children with ASD are acceptec in inclusive schools • After a first period of distrust and fear: school teachers are often more enthusiastic

  11. According to ourexperience, inclusion has more chances to succeed if • Asperger’s syndrome • High Functionning Autism • No disruptive behaviour • Existence of expressive language

  12. CHALLENGES • Related to learning and cognitive functioning • Related to communication and socialization impairments

  13. Challenges related to learning and cognitive functioning

  14. Organizationalskills • Often intuitive approach to solve problems • Difficulties to guess and follow tacit instructions • Confusion of different steps • impulsivity

  15. Generalization of learnedskills • Poor creativity • Important difficulties if exam different from lesson • Problem of contextualized learning

  16. Autistic intelligence • Sensory rather than deductive • Visual memory (+++), • Learning made through sensory approach (e.g. Hyperlexia) Daniel Tammet Dawson, Mottron 2001

  17. Theory of mind impaired: • Problems in representing mental states • Important problems in producing texts (التعبير الكتابي) • Difficulties in understanding mentalized stories (e.g. the fox and the crow)

  18. Example (Yahya: 4th grade) • Subject: You visited a friend who was sick. Describe what you felt • Answer: I visited my friend Aymen. He did not come to school because he was sick. I bought him flowers and candy.

  19. Excess of systematization • Student attracted by « mechanical » learning: systematic research for repetetive patterns, order, rituals • Cumulative rather than hypothetic-deductive learning (e.g. how to learn arithmetics) • Major problem: rigidity

  20. Poor central coherence • distractibility and failure if stimulus is presented in two or more differnent sensory dimensions at once.

  21. Challenges Related to communication and socialization impairments

  22. Balance between academic andpsycho-social Our experience: often, the variousstakeholders are fascinated by theacademic achievement and neglectsocial aspects Examples:

  23. Anxieties: Dhaker, 8 years • Excellent marks • But no friends • Massive and strange phobias and anxieties (Orthopedic problem suspected because he refused to walkfor a week without explanations after floor tiles were changed)

  24. Theory of mind again • Inability to imagine invented situations • Difficulties to understand irony, guilt, regret, shame • Problems with figured speech and metaphors

  25. Socially naive kids • Hamma: lost in town. When asked why he said « teacher said you can go », « she did not say go home !» • Many children with ASD stick to Classic Arabic when they speak to others • Can’t share other students’s interests

  26. Narrative skills • Often poor ability to report on what happened at school • Difficulties in putting different scenes in a continuous story

  27. Hyperactivity • Very often present during first years • Not really ADHD, but difficulties to adjust to school schedule + selective attention problems • Many children with ASD take anti-ADHD medications

  28. Bullying • Long term physical or psychological violence perpetrated by one or more perpetrators (bully) against a victim (bullied) in a domination relationship • The goal is to hurt others • Physical, verbal (nicknames, insults)psychic (harassment, exclusion ..) Juvonen, 2001 • 40% of children with ASD (NAS, UK)

  29. Enhancing Social Skills for children with attending schools

  30. Initiative • Joint project between child and adolescent psychiatry unit and NGO running a special education centre for autism • 7 children of first and second grades (3 were regular) • Therapists: child psychiatrists, psychologists, educators

  31. The session • One hour per week (Saturday) • Circular table • Session begins with greetings and announcing who is present and who is absent • Activities are proposed  a visual schedule is proposed

  32. The rest of presentation will be interactive around actions that will be described in pictures or videos

  33. Major activities • Role play • Social games • Puppet play • Collaborative problem solving • Narration • Emotions recognition (faces) and expression • Humor

  34. Proposals for actions to do at school setting • Visual strategies • Structured learning, space, time • Avoid tacit instructions • Use academic learning for social targets (sharing experiences, competition…) • Begin with individual learning  generalization to group situation • Reduce quantity of language and distracting stimuli • anti-bullying strategies

  35. Example of Think-Feel-Say-Do

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