06/04/2011. What do we know about AS?

Transcription

1 Identifying Strengths and Enhancing Resiliency in Children and Youth Dr. Adam McCrimmon, University of Calgary Current research supported by a grant from SSHRC. Past research supported by a grant from The Alberta Centre for Child, Family and Community Research (ACCFCR). Asperger s syndrome facts What is wrong with our current understanding and views of AS Research projects EF EI Resiliency What does it all mean? Where to go from here What do we know about AS? 1

2 Severe and pervasive impairment in social interactions Restricted, repetitive patterns of behaviour Perseverative tendencies No lag in early language development Intact cognitive abilities Clumsy Diminished humour Lack of empathy and understanding Lacking affect or normal affective responses Mental health difficulties If often viewed as mild autism 10:1 Male:Female ratio What do all of these have in common? Focus on deficits and on things that are done more poorly than typical Here s what I know There is a definite lack of research and findings on strengths that these individuals possess. Essentially, what kinds of things can individuals with Asperger s do well or better than typicals? 2

3 The focus of my work and the work of a colleague has been in this vein. Investigate areas that have been poorly or improperly identified as deficits to provide more specific information Focus on the strengths of these individuals Focus on promotion of resiliency Focus on Asperger s as opposed to Autism More specifically understand the skills and abilities of these individuals. This work has focused primarily on two domains thus far Executive functions (EF) and related cognitive abilities Emotional intelligence (EI) Understanding how EF and EI relate to resiliency in this population Resiliency is the ability to positively adapt in spite of the presence of risk factors or significant adversities How skills in these areas can be used to promote resiliency? 3

4 Defined as higher order cognitive abilities Mental operations enabling individuals to guide behaviour by reference to future goals. Allow for planning, flexible strategy employment, impulse control, and organized search. 4

5 Inhibitory Control Behavioural Initiation Inability to Sustain Behaviour Problems in Self-Monitoring Disorganization Planning Difficulties There are three primary problems with the current state of EF research and information. 1. Many researchers combine individuals with Asperger s and Autism into one group The conclusions from this approach are not really representative of individuals with Asperger s There is a well-documented difference in cognitive abilities between AS and other non-as Pervasive Developmental Disorders 2, 3. 5

6 2. Many researchers make groups of participants and compare performance. However, they don t ensure that people in each group should be in that group. Lack of diagnostic clarity Research on executive functions has primarily investigated performance on specific measures. Tasks of mental flexibility/set shifting (Tower of London/Hanoi, WCST, ID/ED task) have proven challenging for this population 1, 2, 5, 6. It is believed that individuals with Asperger s have a deficit in executive functions. However, performance on specific measures does not provide an appropriate context by which to understand EF in this population Challenges on one specific task does not fully explain the difficulties that individuals with AS experience Is there another framework that can better explain the social and behavioural difficulties? 6

7 Investigate the possibility of modalityspecific EF abilities in individuals with AS 66 participants (33 with AS and 33 age- and gender- matched controls). Age: M = / Gender: 78.8% male VIQ: M = / PIQ: M = / FSIQ: M = / No significant differences between groups on VIQ, PIA, or FSIQ 7

8 7 subtests from the DKEFS were administered (3 verbal, 4 nonverbal) Cluster analysis was used to derive subgroups of participants based upon performance on the EF tasks 1. Trail Making 4 (Nonverbal) Set shifting/mental flexibility 2. Verbal Fluency 3 (Verbal) Set shifting/mental flexibility 3. Design Fluency 3 (Nonverbal) Set shifting/mental flexibility 4. Color-Word Interference 4 (Nonverbal) Inhibition 5. Word Context (Verbal) Deductive reasoning/mental flexibility 6. Tower (Nonverbal) Planning/inhibition 7. Proverbs (Verbal) Verbal abstraction 8

9 D 4 3 B 5 1 E C 2 Alternate saying beverages and hockey teams. 9

10 RED BLUE GREEN BLUE RED BLUE GREEN BLUE RED RED BLUE RED BLUE GREEN BLUE RED GREEN BLUE RED GREEN BLUE A druxle makes a sound. What is a druxle? A druxle is held by the hands. A druxle has strings. A druxle is used in music. A druxle is used in rock music. 10

11 Common Proverbs Hit the nail on the head. One rotten apple spoils the barrel. All that glitters is not gold. Uncommon Proverbs Still waters run deep. Better untaught than ill taught. Good and quickly seldom meet. Individuals with AS performed as well as the control group on all verbal EF tasks In-tact ability to dynamically process and work with verbal information What does this mean? There is no overall EF deficit There are some aspects of EF that individuals with AS struggle with Visual EF tasks But there was a lot of variability in performance So even saying that there is a nonverbal deficit is incorrect 11

12 We ve all heard it individuals with AS have Social skills deficits Emotional unawareness Lack of understanding But how much of this is true? Two separate approaches Trait Ability 12

13 Views EI as a set of competencies Is measured by the BarOn EQ-i Has 5 components Intrapersonal Skills Interpersonal Skills Stress Management Adaptability General Mood Consists of a series of questions that the individual rates 1-5 Very seldom true of me Seldom true of me Sometimes true of me Often true of me Very often true of me I like being with people I am confident in my abilities I don t understand people I am impulsive 13

14 Inter-related set of abilities Recognizing meaning of emotion Recognizing relationship between emotions Reason based on this information Is an intelligence that benefits from and processes emotions Is measured by the MSCEIT Is based on a 4-branch model of EI Perceiving Emotions Understanding Emotions Using Emotions Managing Emotions Consists of 8 sections of questions 14

15 What mood(s) might be helpful when... You want to greet somebody new You go for a job interview Jimmy felt happy as he thought about his day. The more he thought about it, the more he felt... Paula had a long tiring day at work. Her boss was upset with her. How well would each of the following actions help her improve her mood? 15

16 How do you think individuals with AS performed? On the trait measure? On the ability measure? Overall, individuals with AS outperformed the typically-developing normative sample on three branches of the ability measure Using Emotions Understanding Emotions Perceiving Emotions And they were no different from the typical sample on Managing Emotions and the Total Score 16

17 However, they struggled more with the trait measure Interpersonal skills Intrapersonal skills Stress management General mood What aspects of functioning might be used to promote resiliency in this population? 17

18 This was assessed with the Resiliency Scales for Adolescents Has 3 primary domains Sense of Mastery - optimism, self-efficacy, and adaptability increases the likelihood that the individual will be able to cope with adverse circumstances Relatedness - Relationships with others and sense of relatedness serve as a buffer against stress 18

19 Emotional Reactivity - Vulnerability to stress or impact from adversity is related to the individual s pre-existing level of emotional reactivity Individuals with AS reported difficulties with Sense of Mastery and Relatedness Also Optimism, Adaptability, Sense of Trust, Comfort with Others, Sensitivity, and Impairment These results are likely not surprising. However, aspects of EI were strongly related to these outcomes. Aspects of the trait EI measure (competencies) was indicative of nearly all domains of resiliency The strongest being the overall score on the trait EI measure 19

20 What do we know about individuals with AS? They have an EF deficit Not really They have a deficit in emotional awareness Not really Those social skills programs are useful Up to a point Individuals with AS demonstrate intact verbal EF abilities These skills can be very well-developed in this population. This ability should be utilized in the classroom environment They will likely be better able to think fluidly when information is presented verbally 20

21 They outperformed typicals on the ability measure of EI The knowledge is there The answers to the emotion-based questions were correct, often more so than the typical population The focus of support has to be more on application of the knowledge Individuals have the knowledge, but indicated that they are not often successful in social interactions or in managing stress So, all those social skills groups/programs that teach this knowledge are effective, but largely an overkill. Trait EI was very strongly related to resiliency and should be the focus of interventions If individuals with AS develop the skills to use their knowledge effectively, it will improve their ability to cope with daily stressors and success with social interaction 21

22 Extend findings to other populations Younger individuals with AS developmental perspective of EF, EI, and resiliency Underway now talk to us about it!! ADHD individuals also struggle with EF and EI Also underway now members of the Strengths in ADHD Research Group are here as well!! HFA examine differences in verbal/nonverbal EF performance and trait/ability EI between AS and HFA I graciously thank all of our participants and their families as well as our community partners Autism Calgary Association The Sinneave Family Foundation Asperger Manitoba Inc. Kind acknowledgement to research team members: Dr. Janine Montgomery, Danielle Brady, Keoma Thorne, Jo-Anne Burt, Yvonne Hindes, & Candace Kosack 1. Ozonoff, S., Pennington, B., & Rogers, S. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology and Psychiatry 32(7), doi: /j tb00351.x 2. Ozonoff, S., Rogers, S., & Pennington, B. (1991). Asperger's Syndrome: Evidence of an empirical distinction from high-functioning autism. Journal of Child Psychology and Psychiatry 32(7), doi: /j tb00352.x 3. Ghaziuddin, M., & Mountain-Kimchi, K. (2004). Defining the intellectual profile of Asperger Syndrome: Comparison with highfunctioning autism. Journal of Autism and Developmental Disorders 34(3), doi: /b:jadd Mayes, S., Calhoun, S., & Crites, D. (2001). Does DSM-IV Asperger's Disorder exist? Journal of Abnormal Child Psychology 29(3), doi: /a: Manjiviona, J., & Prior, M. (1999). Neuropsychological profiles of children with Asperger s Syndrome and autism. Autism 3(4), doi: / Verte, S., Guerts, H., Roeyers, H., Ooosterlaan, J., & Sergeant, J. (2006). Executive functioning in children with an autism spectrum disorder: Can we differentiate within the spectrum? Journal of Autism and Developmental Disorders 36(3), doi: /s Kleinhans, N., Akshoomoff, N., & Delis, D. (2005). Executive functions in autism and Asperger's Disorder: Flexibility, fluency, and inhibition. Developmental Neuropsychology 27(3), doi: /s dn2703_5 8. Adachi, T., Hirabayashi, S., Shiota, M., Suzuki, S., Wakamiya, E., Kitayama, S., Kono, M., Maeoka, Y., & Koeda, T. (2006). Study of situational recognition of attention deficit/hyperactivity disorders, Asperger's disorder and high functioning autism with the Metaphor and Sarcasm Scenario Test (MSST). No To Hattatssu, 38(3), Adachi, T., Koeda, T., Hirabayashi, S., Maeoka, Y., Shiota, M., Wright, E., & Wada, A. (2004). The metaphor and sarcasm scenario test: a new instrument to help differentiate high functioning pervasive developmental disorder from attention deficit/hyperactivity disorder. Brain & Development, 26(5), doi: /s (03) Baron-Cohen, S. (1988). Social and pragmatic deficits in autism: Cognitive or affective? Journal of Autism and Developmental Disorders, 18(3), doi: /bf Tager-Flusberg, H. (2006). Defining language phenotypes in autism. Clinical Neuroscience Research, 6(3 4), doi: /j.cnr