ASD: THE INVISIBLE DISABILITY AN OVERVIEW OF THE LEARNER WHERE ARE WE IN IMPROVING THE QUALITY OF LIFE OF THOSE WITH ASD?

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1 AN OVERVIEW OF THE LEARNER WITH ASPERGER SYNDROME: A SNAPSHOT OF LEARNER CHARACTERISTICS Brenda Smith Myles WHERE ARE WE IN IMPROVING THE QUALITY OF LIFE OF THOSE WITH ASD? Independent living Employment Friendships and other relationships Community participation What is the focus in school, as a whole? 2 ASD: THE INVISIBLE DISABILITY You could teach a child with ASD the theory of relativity once and he d get it. But you d have to to tell him the rules for lining up for recess 500 times. 3 1

2 PREVALENCE 1 in 91* 1 in 110** 4 or 5:1 male to female ratio * (2009) Health Resources and Services Administration, Health and Human Resources ** (2009) Centers for Disease Control PREVALENCE STARTING POINTS A growing body of research suggests that autism can be accurately diagnosed by 2 years old American A i Academy of Pediatrics i guidelines oppose a wait and see approach. Let s Just Wait and See Bishop, S.L., Luyster, R., Richler, J., & Lord, C. (2008). Diagnostic Assessment. In K. Chawarska, A. Klin, & F.R. Volkmar (Eds.), Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment (pp ). New York, NY: Guilford Press. Johnson, C.P., Myers, S.M., Council on Children with Disabilities (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5)

3 HANS ASPERGER (1944) I will describe a particularly interesting and highly recognisable type of child. The children all have in common a fundamental disturbance which manifests itself in their physical appearance, expressive functions, and, indeed, their whole behavior. 7 CHARACTERISTICS Cognitive Differences Social/Communication Restricted Patterns of Behavior, Interests, and Activities Sensory Differences Motor Differences Emotional Vulnerability Known Medical or other Biological Factors COGNITIVE DIFFERENCES 3

4 INTELLIGENCE Average IQ No verbal/performance split 22% have IQs in the superior or very superior range Low comprehension scores may reflect poor social judgment, failure to take responsibility, immaturity, concrete thinking IQ DIVERSITY OF INDIVIDUALS WITH AN ASD MATURITY Children with AS are generally considered to have the social maturity of someone 1/3 to 2/3 of their age. 4

5 THEORY OF MIND Difficulty in Predicting Reading intentions Understanding emotions Explaining own behavior Perspective or reference Reading and reacting to others interests Understanding social interactions 13 After lunch today, I had trouble concentrating because this kid kept tapping his pencil. I told him to stop but he just looked at me and kept tapping. He continued to tap his pencil even after the teacher told him to stop. When I couldn t stand the noise another second, I grabbed his pencil and broke it. It isn t fair that I m the one in trouble now. This is Asperger Syndrome. CENTRAL COHERENCE Idiosyncratic focus Preference for the known Difficulty in choosing and prioritizing Difficulty seeing connections Lack of compliance 15 5

6 A GREAT EXAMPLE OF CENTRAL COHERENCE Reason No. 4 Why Guys Don t Write Advice Columns Submitted by E.T. Thompson Reader s Digest, 3/08, p. 182 DEAR ABIE, The other day I set off for work, leaving my husband in the house watching the TV. I hadn t gone more than a mile when my engine conked out and the car shuddered to a halt. I walked back home, only to find my husband making love to our neighbor. He was let go from his job six months ago, and he says he has been feeling increasingly depressed and worthless. DEAR ABIE (CONT) I love him very much, but I don t know if I can trust him anymore. What should I do? Sincerely, Frustrated 6

7 DEAR FRUSTRATED, A car stalling can be caused by a variety of faults with the engine. Check that there is no debris in the fuel line. If it s clear, check the jubliee clips holding the vacuum pipes onto the inlet manifold. Or it could be that the fuel pump itself is faulty, causing low delivery pressure to the carburetor float chamber. I hope this helps. CENTRAL COHERENCE When learning this information, what is important? If you have good central coherence, you will memorize the names that match to the parts. If you do not, you memorize the words in order. Or memorize the colors. 20 FOCUS ON THE WRONG THING AND YOU MISS THE BIG PICTURE Boys vs. girls 21 7

8 GET THE FACTS AND DRAW THE WRONG CONCLUSIONS 22 CENTRAL COHERENCE 23 Attribution Attribution refers to how individuals attribute success and failure Students with AS generally attribute failure and success to external causes Negative attributions are related to depression levels 24 8

9 PROBLEM SOLVING One way of viewing a problem Stuck thinking Sees facts instead of a whole Problems with cause and effect Does not see problems as having more than one option Problem solving is often literal 25 MATHEMATICS Expand? Is there more than one meaning? 26 MATHEMATICS What does Find the x really mean? 27 9

10 SCIENCE 28 MOM, I M HOME! No car in the garage! Koeber, Buoy, McHenry, & students,

11 PSEUDO-LOGIC Is extremely logical, but the logic is very unique based on that student s perspective Spencer and his exams 31 EXECUTIVE FUNCTION Difficulty in Perceiving emotions Imitating others Planning Starting and stopping Organizing (time, self, space) 32 SOCIAL/COMMUNICATIO N 11

12 LANGUAGE AND SOCIAL CHALLENGES Nonverbal communication Verbal communication Initiating and maintaining social interactions Literalness Perspective taking Hidden curriculum Cause/effect relationships 34 LANGUAGE AND SOCIAL CHALLENGES Cause/effect relationships Difficulty conveying own thoughts May not use social niceties FIRST LANGUAGE IS USUALLY VISUAL 35 LANGUAGE AND SOCIAL CHALLENGES You need to change your behavior management system. Can I wear hooks? I have a fish in my knee. I m going to knock your block off! (you weasel-ly wabbit) 12

13 Language and Social Challenges I saw Mary at the arcade. What did she have to say? LANGUAGE AND SOCIAL CHALLENGES FAIR AND SQUARE! LANGUAGE AND SOCIAL CHALLENGES UNFAIR AND CIRCLE! 13

14 SOUND MORE COMPETENT THAN THEY ARE Expressive language is most often more advanced than receptive language. Expressive language in children with AS, however, DOES NOT EQUAL comprehension. Many children with ASD will say something without knowing what it means. SOUND MORE COMPETENT THAN THEY ARE How do you know when a baby is ready to be born? SOUND MORE COMPETENT THAN THEY ARE How do you know when a baby is ready to be born? When his head is in the birth canal and his head is facing Virginia. 14

15 SOUND MORE COMPETENT THAN THEY ARE What do you need to know for your Bar Mitzvah? SOUND MORE COMPETENT THAN THEY ARE What do you need to know for your Bar Mitzvah? I need to know about the Israelites and the genitals. DO NOT UNDERSTAND THE SEEMINGLY OBVIOUS Expectations Assumptions Unstated social rules, mores, guidelines This is often called the Hidden Curriculum 45 15

16 BRAIN ACTIVATION IN RESPONSE TO FACES REVEALS THAT INDIVIDUALS WITH ASD USE AREAS THAT TYPICALLY PROCESS OBJECTS Courchesne & Pierce, 2005 FILTERING What is in the head comes out of the mouth -- sometimes with disastrous effects 47 RESTRICTED PATTERNS OF BEHAVIOR, INTERESTS, AND ACTIVITIES 16

17 SPECIAL INTERESTS AND OBSESSIONS Narrow interests Not permanent Often appear uncontrollable Role of the interest: interest; fun; security, comfort; relaxation; stress reduction 49 MY PERSONAL FAVORITE SPECIAL INTEREST 50 SENSORY 17

18 SENSORY AND BRAIN FUNCTION THE SENSORY SYSTEMS (IT ALL STARTS HERE) VISUAL A light like this might look like this! 18

19 TACTILE Expresses distress during grooming Bathing Combing hair Getting hair cut Toothbrushing Is sensitive to particular food textures/temperatures, fabrics 55 TACTILE (CONT) Has difficulty standing in line or close to others Expresses discomfort at dental work Has H rigid id rituals in personal hygiene 56 VESTIBULAR (MOVEMENT) Seeks sedentary play options Poor endurance/tires easily Dislikes activities where head is upside down Rocks unconsciously during activities Becomes overly excited after a movement activity 57 19

20 PROPRIOCEPTION (BODY POSITION) Seems to have weak muscles Tires easily especially when standing or hold a particular position Has a weak grasp Seeks opportunities to fall without regard for personal safety 58 AUDITORY Is distracted or has trouble functioning in noise Responds negatively to loud or unexpected noise Appears not to hear what you say 59 VISUAL Looks away from tasks to notice all actions Has a hard time finding objects in competing backgrounds Avoids eye contact Expresses discomfort at bright lights 60 20

21 TASTE & SMELL Avoids certain tastes/smells Routinely smells objects Shows preference for certain tastes From Dunn, 1999; Dunn, Myles, & Orr, 2002; Rinner, CHILDREN WITH AS HAVE MORE DIFFICULTIES WITH MODULATION - KNOWING HOW TO RECOGNIZE AND CHANGE BEHAVIOR 62 AND EMOTIONAL REACTIVITY RECOGNIZING AND CHANGING EMOTIONAL STATES -- WHEN COMPARED TO THEIR COUNTERPARTS WITH AUTISM 63 21

22 MODULATION PROBLEMS Tactile Defensive about others touching Gags easily Doesn t notice when others brush or touch against Vestibular Holds onto walls or banisters Craves movements Tires easily May hug too hard May not know how much pressure to use to open a door 64 MODULATION PROBLEMS Proprioceptive Less fluidity of movements Locks joints to stabilize Poor endurance Tires easily Props to support self Visual Watches everyone in the room Doesn t notice when people come into the room Trouble locating times in a drawer, on desk, on paper 65 MODULATION PROBLEMS Auditory Overreacts to unexpected sounds Easily distracted Holds hands over ears Cries about sounds Seems oblivious in an active environment Makes sounds constantly 66 22

23 EMOTIONAL REACTIVITY Displays emotional outbursts when unsuccessful Is stubborn or uncooperative Often gets stuck in a situation Is overly sensitive Reacts overtly when sensory systems needs are not met 67 THE SOCIAL EMOTIONAL COMPONENT: THE AREA OF GREATEST CONCERN Empirically based 68 THE SOCIAL EMOTIONAL COMPONENT Has difficulty making friends Has trouble growing up Has definite fears Seems anxious Has inefficient ways of doing things Has poor frustration tolerance Has difficulty tolerating changes 69 23

24 SENSORY ISSUES THAT IMPACT BEHAVIOR Light Smells People Noise Hunger Boredom Frustration Temperature Illness Movement Emotions Touch Task Demands Anxiety Fouse & Wheeler, COMMON SIGNS OF OVERSTIMULATION Screams Muscle tension Turns lights off Climbs Decreases attention Covers ears, eyes Attempts to hide Inflexibility Fouse & Wheeler, 1998 Repetitive noises/phrases Panic reactions Repeated noncompliance Aggression Withdrawal Tries to run away Self-stimulation 71 MOTOR 24

25 MOTOR SKILLS Fine motor Gross motor Visual motor Motor planning Martin, 2008 JUDY ENDOW (2010) I think the fluidity of access to various places in my brain is dependent upon neurological movement between places. I'm no scientist, but have always been able to "see" this inside of me. Sometimes my speaking is hindered, other times my thinking, and sometimes my physical movement. The hardest is when thinking is not working smoothly. 25

26 JUDY ENDOW (2010) When that happens, I have to line up one thought at a time, like train cars. I like it much better when my thoughts do not have to be methodically lined up, but are more fluid with colors coming in and out and swirling into unique and beautiful patterns. (My thoughts are in pictures and sometimes moving colors). EMOTIONAL VULNERABILITY BEHAVIOR Anxiety and stress Depression Distractibility and inattention Tantrums, rage, meltdowns, and shutdowns Internalized Externalized Rigidity and lack of flexibility 26

27 SELF-REGULATION Individuals with ASD may have challenges in recognizing and changing their own emotional states Tantrums, rage, and meltdowns are not on purpose often the only way they know to express their emotions Cannot discern minor from major concerns Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009) Outsmarting Explosive Behavior, Endow,

28 The ECLIPSE Model by Sherry A. Moyer 82 Modulation Chart Situation My Response More Positive Response Bumped in Call the person a bad Ignore it or say hallway at school name excuse me. by a friend Hit bare toe on a Slam the door and yell Rub my foot, get ice, door frame ask Mom for help Missed school Cry, throw books on the Wake up earlier, bus, late for ground, blame Mom watch clock closely in school the morning Ask a girl on a Become depressed, Try to understand her date and she think you are stupid, get reason, hide in room turns you down angry at the girl all weekend Get fired from Scream at the boss, Understand what first job hate yourself, give up happened, improve trying to work work habits, find another job SENSE OF SOCIAL JUSTICE The good guys always win. Rules are meant to be followed. You can t bring food into the theater! 28

29 TOP 10 SITUATIONS THAT TRIGGER INSISTENCE ON SAMENESS 1. Annoying behavior 2. Activity interrupted 3. Losing a game 4. Object breaks 5. Event cancelled 6. Event delayed 7. Materials run out 8. Item misplaced 9. Sequence changed 10. Momentary separation Green, Sigafoos, Pituch, Itchon, O Reilly, & Lancioni (2006). Assessing Behavioral Flexibility in Individuals with Developmental Disabilities. Focus on Autism and Other Developmental Disabilities, 21(4) PARENT REPORTS While schools report that the student is doing fine during the day (no behavioral outbursts, attending to task, appropriate social skills, good transitions), the parents reports that the student falls apart at home (uncontrollable tantrums, verbal outbursts, aggressions against siblings) BIOLOGICAL OR MEDICAL FACTORS 29

30 SOME BIOLOGICAL FACTORS Seizures Ear infections Gastrointestinal Diarrhea Constipation Abdominal pain SOME COMORBID CONDITIONS Attention Deficit Hyperactive Disorder Oppositional Defiant Disorder Depression ess o (including major depression) Obsessive Compulsive Disorder Tourette Syndrome Selective Mutism Bipolar Disorder 89 ASSESSMENT 30

31 WHAT PRECIPITATES AN EVALUATION REQUEST? Depending on age of the individual: Disorganization Depression Perfectionism Inattention ti Home schooling Multiple diagnoses 2+ suspicious ADHD, OCD, ODD, Bipolar Disorder WHAT PRECIPITATES AN EVALUATION REQUEST? Social interaction problems Lack of understanding of the environment/hidden curriculum Cluelessness Overactivity Stress/anxiety Fears Sensory challenges Problems with regulation EVALUATION MEASURES Autism Diagnostic Interview (ADI) Lord et al. Autism Diagnostic Observation Schedule (ADOS) Lord et al. Gilliam Asperger Diagnostic Scale Gilliam Australian Scale for Asperger s Syndrome Attwood 31

32 EVALUATION MEASURES The Autism-Spectrum Quotient Baron-Cohen et al. Autism Spectrum Screening Questionnaire Ehlers et al. Asperger Syndrome Diagnostic Scale Myles et al. ASDS Ages 5 to items rated observed/nonobserved Language 9 items Social 13 items Maladaptive 11 items Cognitive 10 items Sensorimotor 7 items ASQ ASQ > < 69 Very likely Likely Possibly Unlikely Very unlikely 32

33 LANGUAGE SUBSCALE Speaks like an adult in an academic or bookish manner and/or overly uses correct grammar Talks excessively about favorite topics that hold limited interest for others Uses words of phrases repetitively Does not understand subtle jokes Interprets conversations literally cont LANGUAGE SUBSCALE Has peculiar voice characteristics Acts as though he understands more than he does Frequently asks inappropriate questions Experiences difficulty in beginning and continuing a conversation cont SOCIAL SUBSCALE Uses few gestures Avoids or limits eye contact Has difficulty in relating to others that cannot be explained by shyness, attention, or lack of experience Exhibits few or inappropriate facial expressions Shows little or no interest in other children cont 33

34 SOCIAL SUBSCALE Prefers to be in the company of adults more than peers Has few or no friends in spite of desire to have them Has little or no ability to make or keep friends Does not respect others personal space cont SOCIAL SUBSCALE Displays limited interest in what other people say or what others find interesting Has difficulty understanding the feelings of others Does not understand or use rules governing social behavior Has difficult understanding social cues cont MALADAPTIVE SUBSCALE Does not change behavior to match environment Engages in inappropriate behavior related to special interest Displays antisocial behavior Exhibits a strong reaction to a change in routine cont 34

35 MALADAPTIVE SUBSCALE Frequently becomes anxious or panics when unscheduled events occur Appears depressed or has suicidal tendencies Engages in repeated, obsessive, and/or ritualistic behavior Displays behaviors that are immature and are similar to those of a much younger child cont MALADAPTIVE SUBSCALE Frequently loses temper or has tantrums Frequently feels overwhelmed or bewildered, especially in crowds or demanding situations Attempts to impose narrow interests, routines, or structures on others cont COGNITIVE SUBSCALE Display superior ability in restrict area of interest while having average to aboveaverage skills in other areas Displays an extreme or obsessive interest in a narrow subject Functions best when engaged in familiar and repeated tasks Has an excellent rote memory cont 35

36 COGNITIVE SUBSCALE Learns best when pictures or written words are present Has average to above average intelligence Appears to be aware that he or she is different from others Is oversensitive to criticism Lacks organizational skills Lacks common sense cont SENSORIMOTOR SUBSCALE Display an unusual reaction to loud, unpredictable noise Frequently stiffens, flinches, or pulls away when hugged Overreacts to smells that are hardly recognizable to those around him or her Prefers to wear clothes made of only certain fabrics cont SENSORIMOTOR SUBSCALE Has a restricted diet consisting of the same foods cooked and presented in the same way Exhibits difficulties with handwriting or other tasks that require fine motor skills Appears clumsy or is uncoordinated 36

37 ASDS SCORES Raw score Percentile ranks Derived standard scores (mean 10; standard deviation 3) ASQ (mean 100; standard deviation 15) Non AS (mean 74; standard deviation 20) RELIABILITY Internal consistency reliability.83 Test-retest reliability.87 Interrater reliability.93 PREDICTED GROUP MEMBERSHIP Correctly predicted group membership with 85% accuracy 37

38 INTERVIEW PARENTS/CAREGIVERS ASK THE PARENT ABOUT Sensory issues Friendships Does he always want to be the leader? How does he get along with peers? If, he has friends what do they do together? Does he boss or interact? Organization Long and short-term memory Anxiety/stress Problems related to change or unanticipated events Self-calming Gonzalez/Myles ASK THE PARENT ABOUT Academic strengths and weaknesses Handwriting Life skills/adaptive behaviors Taking showers, brushing teeth, combing hair Answering the phone Making change Ordering at restaurants 38

39 ASK THE PARENT ABOUT Areas of interest Naivety/cluelessness Problem solving What does he do if he can t find something? What if the bus left him at the wrong stop? Sharing Friendliness (appropriateness/inappropriateness) Special interests BELIEVE THE PARENTS Imitation of gestures, facial expressions Use of language To share feelings, experiences To communicate needs To discuss special interests BELIEVE THE PARENTS Ask: How was the child as a baby (easy to please, required nonstop attention, etc )? How did he play as a toddler? Did he want you to play with him all of the time? Did he always want to play alone? What happened if you tried to change his play activities? Was the play creative? How easy was she to calm? Or settle down after being startled? 39

40 O C OBSERVATION OF CHILD PROFESSIONALS SHOULD NOT TRUST THEIR INSTINCTS IN A ONE-ON-ONE SETTING, AN OFFICE OR OTHER STRUCTURED SITUATION! PROFESSIONALS SHOULD NOT TRUST THEIR INSTINCTS In a one-on-one setting In an office In a structured visit 40

41 DO NOT TRUST YOUR INSTINCTS Children and youth with Asperger Syndrome often appear to have little difficulties/challenges when talking with adults. In interviews, adults tend to focus on (a) intelligent conversation, (b) above average vocabulary, (c) interesting topic of discussion, and (d) adult-manner. Affect and eye contact may appear normal. IN THE OFFICE, FOLLOW THIS PROTOCOL Language Let him talk. Is he too formal? Can you follow what he is saying or is sequence and presumed knowledge difficult? Does he follow your conversational lead? Does he understand subtle jokes? Ask what he can tell about you from personal effects in your office. Ketty Gonzalez IN THE OFFICE, FOLLOW THIS PROTOCOL Language Does he speak too loudly or too low? Does he understand proximity? Does he understand what you are saying or does he ask you to repeat it again? Ketty Gonzalez 41

42 IN THE OFFICE How hard did you have to work to establish rapport? Did he seem overly anxious? Does he change topics voluntarily? If he becomes excited does he (a) act like a much younger child or (b) have trouble calming down? cont YOUR BEST BET OBSERVE ON THE PLAYGROUND OR OTHER NATURAL ENVIRONMENT AND COMPARE WITH A SAME AGE, SAME GENDER PEER IN SCHOOL In class, compare with others (same age, same gender peer) Interactions with others On/off task behavior Odd or silly behaviors Help needed by peers and teacher Ease in transition between classes/activities Lunch, recess, PE behaviors 42

43 THINK ABOUT ASSESSMENT IN ANOTHER WAY!!! Barry Grossman and Ruth Aspy texasautism.com UNDERLYING CHARACTERISTICS CHECKLIST Barry Grossman and Ruth Aspy texasautism.com SOCIAL Has difficulty recognizing the feelings and thoughts of others (Mindblindness) Uses poor eye-contact Has difficulty maintaining personal space, physically intrudes on others Lacks tact or appears rude Has difficulty making or keeping friends 43

44 SOCIAL Has difficulty joining an activity Is naïve or easily taken advantage of Tends to be less involved in group activities than most same age individuals Has difficulty understanding others nonverbal communication Has limited understanding of own emotions SOCIAL Has difficulty understanding jokes Other RESTRICTED BEHAVIORS/INTERESTS Expresses strong need for routine or sameness Expresses desire for repetition Has eccentric or intense preoccupation/ absorption in own unique interests t Asks repetitive questions Seems to be unmotivated by customary rewards 44

45 RESTRICTED BEHAVIORS/INTERESTS Displays repetitive movements or paces Has problems handling transition and change Has strong need for closure or difficulty stopping a task before it is completed Other COMMUNICATION Has difficulty with rules of conversation (e.g., interrupts others, asking questions) Has difficulty starting, joining, and/or ending a conversation Has difficulty asking for help Makes irrelevant comments Has difficulty expressing thoughts and feelings COMMUNICATION Speaks in an overly formal way Gives false impression of understanding more than actually does Talks incessantly Uses an advanced vocabulary Speech sounds unusual (mechanical, sing-song, etc.) Has difficulty following instructions 45

46 COMMUNICATION Has difficulty with multiple meanings such as idioms or humor Has difficulty talking about others interests Other SENSORY DIFFERENCES Displays significant differences in response to sounds such as sudden unexpected noises, high-pitched continuous sounds, or complex/multiple noises Displays significant differences in response to pain (overreacts, or seems unaware of an illness or injury) SENSORY DIFFERENCES Displays significant differences in response to taste (e.g., resists certain textures, flavors, brands, etc.) Displays significant differences in response to light or color (e.g., focuses on shiny items, shadows, reflections, shows preference or strong dislike for certain colors) 46

47 SENSORY DIFFERENCES Displays significant differences in response to temperature Displays significant differences in response to smells Seeks activities that provide touch, pressure, or movement (e.g., swinging, hugging, pacing, hand flapping, etc.) SENSORY DIFFERENCES Avoids activities that provide touch, pressure, or movement (e.g., resists wearing certain types of clothing, strongly dislikes to be dirty, resists hugs, etc.) Other COGNITIVE DIFFERENCES Has narrow interests Displays poor problem-solving skills Has poor organizational skills Withdraws into complex inner worlds/ fantasizes a lot Is easily distracted by unrelated details has difficulty knowing what is relevant 47

48 COGNITIVE DIFFERENCES Displays weakness in reading comprehension with strong word recognition Knows many facts and details but has difficulty with abstract reasoning (weak central coherence) Has difficulty applying learned skills in new settings COGNITIVE DIFFERENCES Has academic skills deficits Has attention problems Displays very literal understanding Has difficulty understanding the connection between behavior and consequences Memory seems to be inconsistent (seems to forget previously learned information) Other MOTOR DIFFERENCES Has balance difficulties Strongly resists handwriting Has poor handwriting Motor coordination is poor (e.g., accident prone, difficulty using fasteners, etc) Writes slowly Has athletic skills deficits 48

49 MOTOR DIFFERENCES Displays an awkward gait Other EMOTIONALITY VULNERABILITY Is easily stressed worries obsessively Seems to be depressed or sad Exhibits rage reactions or meltdowns Has difficulty tolerating mistakes Has low frustration tolerance Has low self-esteem, makes negative comments about self EMOTIONALITY VULNERABILITY Has difficulty identifying, quantifying, expressing, and controlling emotions (e.g., can only recognize and express emotions in extremes) Has a limited understanding of own and others emotional responses Has difficulty managing stress and anxiety Other 49

50 FROM THE WONDERFUL BOOK The Ziggurat Model By Barry Grossman and Ruth Aspy DIAGNOSTIC SEQUENCE IN READING, MATHEMATICS, AND WRITTEN/ORAL LANGUAGE AREAS Brenda Smith Myles READING SAMPLE COMPONENTS Comprehension Phonics Sight words Listening capacity Sequencing Fluency Rate 50

51 READING -UPPER ELEMENTARY STUDENTS Informal reading inventory (silent and oral) Commercial Curriculum based Miscue analysis Listening capacity Cloze procedures Categorization At recognition and recall levels cont READING -UPPER ELEMENTARY STUDENTS Levels of comprehension Factual Inferential Main idea Predicting outcomes At recognition i and Drawing conclusions recall levels Fact vs fantasy Vocabulary Sequencing READING -LOWER ELEMENTARY STUDENTS Informal reading inventory (silent and oral) Curriculum based Commercial At recognition and Miscue analysis recall levels Listening capacity Phonics measures In isolation Within words 51

52 READING -LOWER ELEMENTARY STUDENTS Sight words Flashed Analysis Categorization Language Experience Reads own stories Reads own words on flash cards Comprehends story At recognition and recall levelsl READING -LOWER ELEMENTARY STUDENTS Levels of comprehension Factual -- Drawing conclusion Inferential -- Predicting Outcomes Main idea -- Fact vs fantasy Vocabulary -- Sequencing Sequencing of visual material and relating story At recognition and recall levels WHAT WE KNOW ABOUT READING AND STUDENTS WITH AS Very little! Comprehension during oral reading is higher than silent reading Word recognition is higher than comprehension Inferential responses were answered at a lower level than literal responses cont 52

53 WHAT WE KNOW ABOUT READING AND STUDENTS WITH AS Generally read at least one year below grade level Move quickly from independent level to frustration level -- often within the same grade level MATHEMATICS SAMPLE COMPONENTS Readiness skills One to one correspondence Sets Numeral recognition Conservation Math language Computation MATHEMATICS SAMPLE COMPONENTS Math application Place value Properties Reasoning Estimation Generalization Fractions 53

54 MATHEMATICS SAMPLE COMPONENTS Graphing Problem solving Word problems Strategies Furniture and Clocks! MATHEMATICS -UPPER ELEMENTARY STUDENTS Overview of skills Number/notation Mathematical language Ordinality Geometric concepts Measurement Mathematical applications Word problems MATHEMATICS -LOWER ELEMENTARY STUDENTS Overview of skills (based on Piaget s levels of concrete, semi-concrete and abstract) Numeration Measurement Geometry Computation Fractions Conservation of sets Graphs 54

55 MATHEMATICS -LOWER ELEMENTARY STUDENTS Word problems Presented orally only Presented pictorially Math facts Flash Analysis Place value MATHEMATICS Survey measures Curriculum based measures Diagnostic/informal measures Clinical math interview Error pattern analysis Information math inventory WHAT WE KNOW ABOUT MATH AND STUDENTS WITH AS Very little! General difficulties with math Wide variance exists Tendency to have more problems with application than rote skills 55

56 WRITTEN/ORAL LANGUAGE SAMPLE COMPONENTS Grammar Spelling Handwriting Expressive language Receptive language WRITTEN/ORAL LANGUAGE SAMPLE COMPONENTS Handwriting Manuscript Cursive Physical aspects of writing (pencil grip, posture) Organization (margins, alignment) Handwriting is generally problematic! WRITTEN/ORAL LANGUAGE SAMPLE COMPONENTS Expressive language Semantics Pragmatics Syntax Receptive language Following directions Vocabulary 56

57 WRITTEN/ORAL LANGUAGE SEQUENCE FOR UPPER ELEMENTARY CHILDREN Oral language sample With brainstorming/without brainstorming With outlining/without outlining Written language sample With brainstorming/without brainstorming With outlining/without outlining Capitalization and punctuation in contrived sample WRITTEN/ORAL LANGUAGE SEQUENCE FOR UPPER ELEMENTARY CHILDREN Spelling of known words (look for organization) Rule based Predictable Unpredictable Words missed at recognition level Following multi-step directions Written Oral WRITTEN/ORAL LANGUAGE SEQUENCE FOR UPPER ELEMENTARY CHILDREN Idioms Synonyms Antonyms Categories Identifying category for a group of words Identifying words for particular categories Mathematics, reading, academic terms Near/far point copying 57

58 WRITTEN/ORAL LANGUAGE SEQUENCE FOR LOWER ELEMENTARY CHILDREN Oral language sample Language experience story Written language sample (one sentence from story or story creation) Writing alphabet (from memory and from model if reversals or other difficulties appear) Writing personal information WRITTEN/ORAL LANGUAGE SEQUENCE FOR LOWER ELEMENTARY CHILDREN Spelling of known words Words missed at recognition level Following multi-step directions Written Oral Idioms, synonyms, antonyms Academic subjects language Near and far point copying WHAT WE KNOW ABOUT WRITTEN LANGUAGE AND STUDENTS WITH AS Very little! Students with AS scored within the average range on the TOWL similar to neurotypical peers Spelling Capitalization Punctuation Word usage cont 58

59 WHAT WE KNOW ABOUT WRITTEN LANGUAGE AND STUDENTS WITH AS An informal analysis revealed differences in the number of Morphemes t-units Words Elaborations No differences in the number of sentences produced cont WHAT WE KNOW ABOUT WRITTEN LANGUAGE AND STUDENTS WITH AS Analysis of handwriting revealed differences from peers in Legible letters Legible words Alignment Spacing Letter formation Letter size POTENTIAL Individuals with ASD have limitless potential Their potential is limited by our ability to teach 59

60 THE POWER OF WORDS Judy Endow 60