Beruflich Dokumente
Kultur Dokumente
with Autism Spectrum Disorder
kristisakai@Hotmail.com
I’d like to thank
L.B.C.C. & The Corvallis Clinic
• Parenting Education My mom!
– Cyrel Gable – Toni Kayner
– Jerri Wolfe Co‐author
– Dee Dee – Joe Steiner
Strombeck
• Family Connections
– Pam Dunn
• Education/Child Studies
– Susan Knapp
Prevalence of ASD
1 in 110 Although improved
ascertainment
4 X boys than girls accounts for some of
• From 1994‐2005 the the prevalence
number of children ages increase in the [study
sites] a true increase
5‐21 receiving services in the risk for children
increased from 22, 664 to develop ASD
to 193, 637 symptoms cannot be
• Cost $35 Billion per year ruled out
Center for Disease Control and Catherine Rice, Ph.D. National Center
Prevention www.cdc.gov for Birth Defects and Development
Disabilities 2009
What IS Autism Spectrum Disorder?
ASD Definition IDEA 2004
"Autism means a developmental disability significantly affecting
verbal and nonverbal communication and social interaction,
generally evident before age three, that adversely affects a
child's educational performance.
• Speak their language!
Sensory: hyper or hypo sensitive
• Taste
• Dinnertime and the living
ain’t easy
• Touch/Tactile
• I’m not putting that on!
• Audio
• That hurts my ears!
• Vestibular
• Balance
• Proprioception
• Body awareness
• Smell
• Mall perfume meltdown
Social and Emotional
• Individuals with autism
have difficulty picking
up social cues, facial
expressions, body
language
• KU Study
• Your look said, “I don’t like
you.”
• No, it was a look that said,
“I have a migraine.”
Emotions
Difficulty understanding • What am I feeling?
own emotional state • Look for clues:
– Facial expression
– Body language
– Actions
– “You look sad.” You have
tears coming out of your
eyes
Note: Anger is often the
“reaction”, not the true
underlying emotion
Importance of providing choice
• Practicing decision
making skills
• Consequences
• Implement choice ‐‐
but limit options
• Don’t overwhelm with
TOO MANY choices
• Respect the choices
they make—especially if
you gave them the
option to choose in the
first place
• Keeping in mind the greater good for the
individual and helping him find his place in the
world.
Within Social Context
• Individual supports are
taught with the
eventual intent of self‐
management
• Balanced as much as
possible with the needs
of others
• They must be in balance
with the rights of others
Behavior tells us a story…
• I can’t express my • I’m not aware of
needs verbally how others
• I feel anxious perceive me
• I am coping the • I don’t understand!
best I can • You don’t
• This relaxes me understand me, I
(stress reliever i.e. give up!
hand flapping,
twirling)
Prudent Flexibility
• What is the goal?
• Is a current meltdown worth the cost of the
long‐term goal?
• Risk assessment
• Pick your battles
• Is the intervention you’re using escalating or
de‐escalating the behavior?
Self‐Management Tools
• Priming
• Predicting
• Count‐down
• Wrap‐up
• Reward
Priming:
This is what we expect will happen
• What is going to
• Explanation happen?
• Schedule • What typically
• Visual Aide happens?
• Reward • Be brief yet
thorough
Priming: Explanation
• Get the child’s attention
But, do not force eye • Be brief yet thorough
contact • Get verbal confirmation
• Tell the child what is • Show no panic or fear!
going to happen
Priming: Schedule
• Use a timeline and Stick
to it
• No last minute changes
• Consider this step as a
trust‐builder
• Write it down or create
a visual
Priming: Visual Aids
• Oh great! One more thing I have to do!
– Developing a routine
– You can use basics again and again
– Once a routine is established, you may find you no longer need
detailed visuals
– Even adults use visual reminders: calendar, datebook, palm pilot,
grocery list
But we don’t use visual aides
in the “real world”
(yeah we do actually)
• Schedules • Mapquest
• Calendars • GPS
• Grocery list • Email
• To do list • Blackberry
• Syllabus • Palm pilot
• Powerpoint • TV Schedule
• Google
Rewards: Why And How They
Work
• Children respond to
extrinsic motivation
• They respond to positive
reinforcement, especially
when using a special
interest
• It creates a more self‐
motivated atmosphere
• It creates a cooperative
environment
• RESEARCH BASED
INTERVENTION
Predicting: Think Ahead
• Examine all variables
• What has happened in
the past
• With the child, think of
possible alternatives …
just in case
Countdown
• Time needed varies by
activity and location
• Be prepared
• Do not use seconds
• Don’t say “just a
minute” unless you
mean 60 seconds
Rewards: Why And How They
Work
• It teaches valuable
lessons that may help
your child to realize the
benefits of other types
of compensation
• It creates a habit that
often leads to
increasingly greater
motivation
Rewards
• Balance difficult or • Computer or
distasteful activities electronic games
with rewards: Candy
‐No meltdowns = ?? • Collectable cards
‐Penny rewards • Activity with an adult
‐Stop at Video Store
‐Stop for ice cream
Wrap‐Up
• Present the facts
– Not a time for
scolding or making
judgments
– A play‐by‐play listing
of what occurred
• Make sure the child is
calm before you wrap‐
up
Tools
• Priming: This is what we
expect will happen
• Predicting: This MIGHT
happen
• Count‐down: This is how
long until it begins or
ends
• Wrap‐up: How’d we do?
• Reward! What do I get
out of it?
But she won’t do it!
Challenges Common solutions
• Bathing, – Use The Tools
showering, – Incorporate special
brushing their interest: Spiderman,
teeth Hello Kitty
– Again: visual aides
• Going to school
– Reward/reinforcer
– Use of language: “After
your bath, THEN we will
watch the DVD”
Visual Strategies
• Many ways to use this
as a tool
• Allows processing
time
• Allows for review
• It’s the schedule
telling him, not you
Do2learn.com
Importance of providing choice
• Learning decision making
• Consequences
• Implement choice ‐‐
but limit options
• Don’t overwhelm with
TOO MANY choices
• Respect the choices they
make—especially if you
gave them the option to
choose in the first place
Importance of implementing Choice
• Give opportunities for
two positive choices,
instead of a yes or no
answer
• Be clear about
expectations, then
provide the individual the
opportunity to live with
the consequences of his
actions.
– Small bumps
“AFTER you finish your
homework you can go
to the movie.”
Sometimes living with
consequences=meltdowns
Note on NON‐Negotiables
• Some things are “have • Safety
to’s”, but it’s a matter • The law
of managing them • School
• Medical
care/medication
• Dental care
• Hygiene
Hygiene is a NON‐negotiable
Non‐negotiable Negotiable
• Showers • Hair length or color
• Hair cleanliness • Style of clothing within
• Brushing teeth and “norm”, remember it’s
dental care normal for teenagers to
express individuality
Managing medications
• To school: one week • Tell ‘em why they
plus an extra day are taking it
• Use pill organizers
• Won’t gag it down?
• Dangerous to skip
– Can it be ground up?
– Is there an alternative?
– Check to see if it can
be “compounded”
Meltdowns
It Is Not On Purpose
• It feels horrible to the
child
• It has to do with
– Poor modulation
– Poor impulse control
– Inflexibility
– Sensory overload
Antecedent…
• Understand the
characteristics of ASD
• Know the child through
behavior assessment
• We don’t always figure it
out
• In a pinch, use your best
educated guess
Difficult Moments; Myles and Southwick
2004
Rumbling
• Fidgeting • Tears
• Swearing • Tensing Muscles
• Making noises • Name calling
• Ripping paper • Increasing or
• Refusing to cooperate decreasing voice
• Rapid movements volume
• Verbal threats
Difficult Moments; Myles and Southwick 2004
Adult Behaviors During Rumbling
• Remain calm • Prevent power struggle
• Use a quiet voice • Re‐evaluate student
• Take deep breaths goals
• Be flexible
Difficult Moments; Myles and Southwick 2004
Rumbling
• Intervene EARLY
• Right intervention for
one is wrong for
another.
• When in doubt, less is
more.
• Remain CALM
Rumbling Stage Intervention
Strategies
• Anticeptic bouncing • Interest boosting
• Proximity control • Redirecting
• Touch control • Home base
• Defusing tension • Acknowledging
through humor difficulties
• Support from routine • Just walk and don’t talk
Difficult Moments; Myles and Southwick 2004
Home Base
• Home base safe place: transition easement
• Provide comforting structure
• Not punitive
• Place to calm
• To finish work in a quiet location
• Sensory activities
Difficult Moments; Myles and Southwick 2004
Typical Rage Stage Behaviors
• Explosive Acting impulsively
• Yelling Emotional
• Screaming Flailing
• Kicking Repeating phrases
• Self‐injurious Unintelligible
• Destroying property Internalizing behavior
• Biting
Difficult Moments; Myles and Southwick 2004
Rage Stage Interventions
• Protect the student • Be non‐confrontational
• Protect others • Follow a plan
• Protect the • Use few words
environment • Obtain assistance
• Don’t discipline • Be flexible—the child
• Remove the audience cannot
Difficult Moments; Myles and Southwick
2004
Recovery Stage Interventions
• Allow to sleep if necessary
• Support use of relaxation techniques
• Do not refer to the rage behavior
• Support with structure
• Plan structural intervention to prevent re‐
escalation
Difficult Moments; Myles and Southwick 2004
Recovery Stage Interventions
• Allow to sleep if necessary
• Support use of relaxation techniques
• Do not refer to the rage behavior
• Support with structure
• Plan structural intervention to prevent re‐
escalation
Difficult Moments; Myles and Southwick 2004
I Don’t Want to Talk about it!
Parents Guide to Asperger’s & Sexuality
This isn’t a curriculum
It’s a conversation
Kristi Sakai & Joe Steiner
Autism Asperger Publishing Company
asperger.net
Kristisakai@hotmail.com
What IS Sexuality?
• Biological
• Psychological
• Sociological: social roles & expectations
• Spiritual
• Affects personality development and
interpersonal relationships
• Gender Identification
• Encompasses behaviors
Importance of Sexuality Education
• By the age of 18 • Teens 16‐19 are 3 ½ times
– 1 in 3 girls will have been more likely to be victims of
sexually assaulted rape, attempted rape or
– And 1 in 5 boys sexual assault
• Statistically female victims
are more likely to be RE‐
victimized
– Acquaintance rape
– Domestic violence
www.siecus.org
Addressing issues related to sexuality
on the IEP
• ALL individuals need to have social‐sexual
issues addressed on the IEP
– Sexual health education
– Social skills
• Social communication IS the foundation for healthy
relationships
– School‐wide anti‐bullying training/atmosphere
• Bullying is victimization which can lead to exploitation
Behavioral Intervention
• Harmful to self or
others
• Impedes the learning
process
• Restricts access to the
community
• Safe
• Personal Choice
• Not safe
Assessment and Intervention
Data collected in order to
meet the INDIVIDUAL’S
needs
– My child doesn’t do that!
• Conducted by team that
includes staff, parents,
medical professional and
psychologist as well as the
individual him or herself
• Utmost respect toward the
individual
Assessment and Intervention
• Frequency, length, and
intensity
– How much is it
interfering with general
activities
– Is it merely perception
or fact? DATA
• Reaction of others
– Teaching appropriate
boundaries?
– Shaming? Harcopos, D. & Pederson, L. 1992 (in
Danish)
Assessment and Intervention
• Functional assessment
• What sexual behaviors
are displayed?
• Toward Whom?
– Him or herself
– Other people
– Objects
Harcopos, D. & Pederson, L. 1992 (in Danish)
Healthy Sexuality
• Expression of sexual • Satisfactory results
behavior is limited to
private, either alone or – Physically
with a partner – Emotionally
• Limited potential for • Not compulsive
harm
• Free of exploitation – Doesn’t interfere with
• Not self‐shaming or self‐ other activities
destructive
Adapted from Sexual Healing Journey; Wendy Maltz
1992
What about porn?
• Minors: against the law
• How realistic is it?
• Not healthy images
– video modeling…most
effective instruction tool
• Addiction
– Keep the computer in
common area
– Take laptop to adults
room at night
Informed consent
• No consistent Generally accepted:
definition by all – Proper educational
states programming
• Biological age vs. – Knowledge of
potential risks
mental age
– Capacity to
• Guardianship understand the
concept of choice
From Autism Spectrum Quarterly
Holmes, Isler, Bott, Markowitz, 2005
Establishing criteria for informed consent
Absolutely necessary!
1. Individual can demonstrate “no”
• Imbalance of power must be taken into consideration
2. Individual knows that having intercourse can
result in pregnancy
3. When given options the individual can make and
informed choice
4. Individual knows that intercourse/sexual activity
can result in an STD
From Autism Spectrum Quarterly
Holmes, Isler, Bott, Markowitz, 2005
Establishing criteria for informed consent (cont.)
5. Individual can differentiate between
appropriate and inappropriate times and
places to engage in intimate relations
6. Individual can differentiate between males
and females
7. Individual can recognize persons or
situations that might be a threat
8. Individual will stop a behavior if another
individual tells him or her “no”