DMHAS

1. DMHAS

2. Syndro erg The Learning Syndrom Clinic AspergerS Asp erge ome er

3. Syndro erg The Learning Syndrom Clinic AspergerS Asp Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive Development Delay erge ome er

4. Child & FamilyandDMHAS Agency A Scholar in Residence Workshop Hilton Garden Inn, Glastonbury, CT September 17, 2004 Presented by: Raymond W. DuCharme, Ph.D. Kathleen A. McGrady, Psy. D., ABDA Pamela Ruff, Transition School Faculty The Learning Clinic The Learning Clinic

5. Introduction What is a pervasive developmental delay? Is a diagnostic description of Pervasive Development Delay not otherwise specified, helpful to the individual, his family and those responsible to provide treatment? The purpose of a diagnosis are to precisely describe a condition in need of treatment, and to determine from the described symptoms a preferred regimen of treatment. Further, the diagnosis should predict that if a treatment is provided then a forecast may be made of a prognosis.

6. Pervasive Development Disorder Category of Diagnosis that includes Autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy. The Learning Clinic

7. Asperger Syndrome Criteria The Learning Clinic

8. Differential Diagnosis Pervasive Developmental Disorders The Learning Clinic, Inc.

9. DSM-IV - ICD Diagnostic Criteria Precise differential diagnosis of pervasive developmental delays evident in the symptom profile of an individual currently remain problematic. And the consequent ramifications are also evident. • Unclear diagnostic criteria result in error and misdiagnosis. • Misdiagnosis causes error in the selection of type and duration of treatment. • Treatment misapplications yield poor prognosis and little evidence of efficacy

10. DSM-IV - ICD Diagnostic Criteria / Continued Gillberg’s six criteria (Elhers and Gillberg 1993) comprise social impairments, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems and motor clumsiness. Gillberg includes Szatmari’s (1989) criteria and Tantam’s (1988) five criteria. The ICD-10 and DSM-IV note an absence of any clinical delay in language and cognitive development in the first 3 years of life. The DSM-IV adds no delay in the development of self-help skills, adaptive behavior, and curiosity about the environment.

11. Asperger Syndrome Criteria Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis. The Learning Clinic

12. Other Developmental Issues • Deviation from normal development • Do not “Outgrow” Developmental Deficits • Stress Impairs Performance • Co-Morbid Diagnosis Impairs Overall Functioning The Learning Clinic

13. Medications Cognitive Functioning The Learning Clinic

14. Age / Time Psychological Symptoms The Learning Clinic

15. Grade Clinical Symptoms and Learning Disabilities The Learning Clinic

16. C O G N I T I O N Memory Higher Order Process Analysis, Synthesis, and Evaluation Organization Flexibility Asperger SyndromePervasive Developmental Delay The Learning Clinic

17. Asperger SyndromePervasive Developmental Delas • C O G N I T I O N • Wide Band of Knowledge • Problem Solving • Verbal-Performance IQ • Attention Shift • Rule and Governing Behavior The Learning Clinic

18. Asperger SyndromePervasive Developmental Delay L A N G U A G E • Pragmatics • Syntax • Meaning: Connotative Denotative The Learning Clinic

19. Asperger SyndromePervasive Developmental Delay • L A N G U A G E • Processing Speed • Expression • Duration The Learning Clinic

20. Asperger SyndromePervasive Developmental Delay S P E E C H • Prosody • Pedantic • Elocution • Volume The Learning Clinic

21. Asperger SyndromePervasive Developmental Delay M O T O R • Fine Control • Gross Control • Coordination • Regulation The Learning Clinic

22. Asperger SyndromePervasive Developmental Delay S E N S O R Y P R E C E P T I O N • Visual Integration • Kinesthetic • Tactile Accuity • Gestalt • Integration of other Senses The Learning Clinic

23. Asperger SyndromePervasive Developmental Delay S O C I A L • Cue Identification • Responsive to others • Isolate • Rude • Aggressive The Learning Clinic

24. Asperger SyndromePervasive Developmental Delay • S O C I A L • Boundary Acceptance • Maintain Social Roles (e.g., student, son, daughter, friend) • Self-Regulate The Learning Clinic

25. Developmental Tasks of Adolescence: Ages 12 - 18 • Achieving new and more mature relations with age-mates of both sexes • Achieving a masculine or feminine social role • Accepting one’s physique and using the body effectively • Achieving emotional independence of parents and other adults The Learning Clinic

26. Developmental Tasks of Adolescence: Ages 12 - 18 / Continued • Preparing for marriage and family life • Preparing for an economic career • Acquiring a set of values and an ethical system as a guide to behavior; developing an ideology • Desiring and achieving socially responsible behavior The Learning Clinic

27. Developmental Tasks of Early Adulthood • Selecting a mate • Achieving a masculine or feminine social role • Learning to live with a marriage partner • Starting a family • Rearing children • Managing a home The Learning Clinic

28. Education: Asperger Student Classroom Behavior • 1. Attending Behavior • Discern Task Expectations • Focus Attention on Relevant Stimuli • Shift Attention to Relevant Stimuli • Ignore Irrelevant Material • Perform Multi-Task Operations The Learning Clinic

29. Education: Asperger Student Classroom Behavior • 2. Responding Behavior • Verbal Skills • Pragmatic Language Skills • Writing Ability • Executive Function Ability • Perseverance • STM for Denotative Items The Learning Clinic

30. Education: Asperger Student Classroom Behavior • 3. Reinforcement Behavior • Provide Contingent Positive Social Reinforcement • Assert Negative Reinforcement in an Appropriate Way • Receive Positive Reinforcement • Ability to Respond to Positive Reinforcement The Learning Clinic

31. Education: Asperger Student Classroom Behavior • 4. Initiating Behavior • Self - Initiate Classroom Routines • Use CAI Prompts • Start Task According to Direction The Learning Clinic

32. Education: Asperger Student Classroom Behavior • 5. Comply / Demonstrate Rule - Governed Behavior • Accept Correction from Instructor • Accept Correction in Public Setting • Self - Correct Assignments to Pre - determined Standards The Learning Clinic

33. Education: Asperger Student Classroom Behavior • Completing Behavior • Perform Tasks to Standards • Return Completed Product to Supervisor The Learning Clinic

34. Education: Asperger Student Classroom Behavior • 7. Transitioning Behavior • Initiate Independent Steps between Tasks • Use Prompts / Cues to Signal Move from One Task to Another The Learning Clinic

35. Education: Asperger Student Classroom Behavior • 8. Cooperating Behavior • Taking Turns • Waiting • Avoid Arguing • Sharing • Making Requests Before Acting The Learning Clinic

36. Education: Asperger Student Classroom Behavior • 9. Adapting Behavior • Adjust to Different Routines in Different Classrooms • Adjust to Alteration in Routine • Follow New Routine Required by a Situation The Learning Clinic

37. Education: Asperger Student Classroom Behavior 10. Cooperate with Medication • Administration • Complete Homework • Attend School • Discern Task Expectations • Focus Attention on Relevant Stimuli • Shift Attention on Relevant Stimuli • Ignore Irrelevant Material • Perform Multi-Task Operations The Learning Clinic

38. Competing Clinical Behaviors • Perseveration • Obsessive Thought • Rigid Cognitive Style • Inability to Shift from “Personal View” to Data - Based Decision The Learning Clinic

39. Competing Clinical Behaviors / Continued • Confabulation • Affirming False Information • “Stealing” • Sexually Inappropriate Actions and Statements The Learning Clinic

40. Competing Clinical Behaviors / Continued • Violation of Boundaries • Cognitive Disorientation and Distortion The Learning Clinic

41. Optimal Classroom Behaviors • Closed Classroom • Applied Task - Oriented Setting • Standards are Limited, Precise and Based on Asperger Student’s Level of Ability to Self - Regulate • Class Size Under 10 - Over 3 The Learning Clinic

42. Optimal Classroom Behaviors / Continued • Cues and Prompts are Provided • Daily Plan / Organizer • Assigned Work Station • CAI Task Presentation • Clear System of Discipline Consistently Applied Setting Wide The Learning Clinic

43. Optimal Classroom Behaviors / Continued • Classroom Mix Controlled • Interpersonal Style of Teacher: Direct, Non-Judgmental, Organized • Task Analysis Reflects: • Backward Chaining • Performance Standards • Over - Learning Options The Learning Clinic

44. Optimal Classroom Behaviors / Continued • Control Risk • Minimize Transitions The Learning Clinic

45. Writing a News Story Associated Press Hurricane Ivan Blasts Alabama, Kills 12 GULF SHORES, Ala. (AP) - Hurricane Ivan slammed into the Gulf Coast early Thursday with 130 mph wind, launching tornadoes, washing out a major bridge and hurling metal signs through the night. At least 12 U.S. deaths were blamed on the storm, but officials said the toll and the damage could have been even worse. Up to 15 inches of rain were expected as the storm moved inland. It weakened by late morning, but remained a Category 1 hurricane with wind of 75 mph eight hours after its 3 a.m. landfall. The Learning Clinic

46. Writing a News Story Directions: Writing a News Story Write a news story using what you consider the most relevant facts listed by numbered sentences. First - read all the sentences and answer the question “What is the main point of the numbered sentences that are related Second - arrange the sentences into a one paragraph news story Third - be sure your first sentences is the main theme of the news story. Fourth - place other sentences in order of story organization Fifth - be prepared to explain why the sentences you did not use did not belong in the story Sixth – read your story aloud and make any changes Seventh – compare your story with one written by another student The Learning Clinic

47. Writing a News Story • Relevant and Irrelevant Information • Colorado experienced a severe winter storm today • Denver, Colorado international airport is located on a high mountain plateau • Low visibility and storms make a landing dangerous at the Colorado airport • A plane crashes in an attempt to land at Denver Colorado • Rescue efforts were started within minutes of the crash • Pilot training on simulators is important • Many people fear flying • The number of survivors in today's plane crash in Colorado is unknown • Colorado has many large ranches • People travel to Denver, Colorado by cars more than other types of transportation The Learning Clinic

48. Syndro erg Syndrom AspergerS Asp What are the Prioritiesof the Asperger Syndrome Student? erge ome er The Learning Clinic The Learning Clinic

49. Priorities of the Asperger Student Living Alone The Learning Clinic

50. Priorities of the Asperger Student Living Alone The Learning Clinic