Tag Archives: Medical

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Transitioning to Adulthood with Aspergers

Individuals diagnosed with Aspergers or another autism spectrum disorder (ASD) may be presented with many challenges throughout their lives—especially during the transitional periods. As the individuals age and learn to use different skills in various environments, families, educators, medical professionals and the individuals themselves begin to anticipate the transition to adolescence and, eventually, to adulthood. Given the differences in abilities and behaviors that many individuals with Aspergers or HFA experience, it can often be overwhelming to plan for tomorrow much less several years later.

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Among the many skills that an individual must learn to successfully transition to adolescence and adulthood, daily living skills are often neglected.

Examples of daily living skills are bathing, grooming, preparing meals, managing finances, using public transportation, etc. These daily skills are necessary for independent functioning in the home and within the community.

A recent study discovered that individuals with ASD improved in daily living skills during adolescence and the early twenties. These skills plateaued around late twenties and began to decline in the early thirties—this shows the importance of honing these skills earlier in life instead of waiting until later.

Some positive findings were that inclusive schooling had a positive influence on adult outcomes. The study also found, “that vocational independence predicts improvements in autism symptoms and significant improvements in behavioral problems.” Daily living skills could also be increased by engaging in some type of work activity.

It is encouraging that daily living skills can continue to be gained at later points in development as other skills plateau. The authors suggest that more research is needed to develop behavioral and pharmacological interventions for older individuals on the autism spectrum.

While individuals with Aspergers or HFA may have challenges with the daily living skills necessary for transitional periods, it is important for their independence and quality of life to begin this journey at an early age to ensure success.

by Lupe Castañeda, M.S., BCBA

Have you thought about or experienced the transitional periods in your or your child’s life?

How did you cope with these experiences? 

Sources:

Smith L.E, Maenner, M.J. & Seltzer, M. (2012). Developmental Trajectories in Adolescents and Adults with Autism: The Case of Daily Living Skills. Journal of American Academy of Child and Adolescent Psychiatry.  51(6): 622–631.

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Aspergers is Not the Same as ODD (Oppositional Defiant Disorder)!

People with Asperger’s usually collect labels like ADHD, anxiety disorders, or bipolar disorder before they’re diagnosed with AS. The label that annoys me is Oppositional Defiant Disorder. Is there a difference between people whose Asperger’s-related behavior is misunderstood and ODD? I find that ODD is sometimes simply a description of behavior without a cause.

Insurers ask for diagnoses based on ICD 10, the “handbook” of diagnoses. One of the official ICD 10 descriptions of AS is that it’s a “neuropsychiatric disorder whose major manifestations is an inability to interact socially; other features include poor verbal and motor skills, single mindedness, and social withdrawal.”

ICD 10 describes ODD as a behavior disorder and a psychopathological disorder. It’s described as a “recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures.”  The criteria include “frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with requests or rules of adults, deliberately annoying others, blaming others for own mistakes, and being easily annoyed, angry or resentful.”

ICD 10 is right in my experience in describing those with Asperger’s Syndrome as “single minded.” This is a real strength when doing tasks, following rules and being honest. However, single mindedness can also include inflexibility or even severe rigidity in sticking to a point of view.

When an inflexible demand is made of an inflexible person, you have rigidity meeting rigidity. That’s not going to work. For people with AS, what’s being perceived as oppositional, hostile or rule breaking is actually more about having a fixed way of viewing the world.

Especially when rules or demands seem illogical or unfair, those with AS can dig in and stand their ground. Many with AS and NLD also have concrete or literal thinking, which adds to the mix of misunderstanding and “rule breaking.”

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DIR/Floortime Method for Social-Emotional Growth of Children with ASD

Although our emphasis is often focused on early intervention, it is important to consider various types of interventions that can grow with the child with Aspergers or HFA as they grow into adolescence, another area of huge potential growth. One approach that has demonstrated clinical impact is DIR/Floortime. This method is a relationship-based, developmental framework that is geared toward supporting foundational social-emotional capacities.

The DIR Model, or Floortime, aims to support higher level thinking abilities of multicausal and reflective thinking by building foundational stability in self-regulation and co-regulation with another. DIR/Floortime incorporates techniques and strategies geared toward promotion of more stable and more flexible emotional regulation in the child or adolescent.

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What Are School Accommodations and Modifications for Students with Asperger’s?

Some students with disabilities require accommodations or modifications to their educational program in order to participate in the general curriculum and be successful in school. Each child with autism or Asperger’s Syndrome is different and has their own unique needs. Parents will meet with school personnel in an ARD/IEP meeting to determine what accommodations and modifications should be implemented to best assist their child. It is imperative that parents and educators understand the difference between the two.

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For many students with Asperger’s Syndrome, accommodations will be needed to access the curriculum and remain in the least restrictive environment. Accommodations (the HOW) can be made for any student. Students do not need to have a 504 plan or an IEP.

Accommodations do not alter what the student is expected to learn but rather make learning accessible to the student.

They allow the student to demonstrate what they know without being impeded by their disability. Students are required to complete the same assignment or test as other students, but with a change in the timing, formatting, setting, scheduling, response and/or presentation. They do not alter in any way what the assignment or test measures.

(http://www.texasprojectfirst.org/ModificationAccommodation.html)

Accommodations can be referred to as good teaching practices. Here are some common accommodations made for students with Asperger’s, high functioning autism, and other related disabilities.

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How to Use Visual Supports for Social Skills Training

Many school students carrying the diagnosis of Asperger’s Syndrome exhibit challenges in the area of social interactions and social skills. These social difficulties are worrisome for parents and family members who look for supports to address these challenges. Struggles in the school setting often center on their child’s inability to “fit in” with other students or an inability to grasp social expectations from their teachers and peers. Additionally, their child’s feelings of high anxiety and stress can make the learning environment challenging for them and the people around.

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Over time, I’ve listened to concerns from parents and teachers regarding a student’s lack of understanding when it comes to social situations in the classroom environment. This often leads to isolation and the need for behavior support.

There is information in the literature that suggests both adult and peer mediated techniques to teach and build social skills in children with autism.

Strategies that are directed by an adult include reinforcement of shaped social skills. This is a technique where the child is reinforced when they demonstrate closer and closer approximations of a desired behavior. Peer mediated strategies incorporate the use of proximity, prompts with reinforcement, and teaching peer initiation. The literature also supports using social scripts to capitalize on visual learning methods (Krantz and McClannahan 1993).

In my experience, I’ve observed how visual supports can be very beneficial in producing non-transient messages for the student to follow and use during social situations. When paired with direct instruction using ABA techniques like shaping and reinforcement, social skills training can be accomplished.

When you set out to develop visual supports, first perform an internet search to get some ideas.

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Cognitive Behavioral Therapy for Individuals with Aspergers

Anxiety-related symptoms are frequent concerns in children, adolescents and adults with Aspergers and HFA, which may be treatable with Cognitive Behavioral Therapy.

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Anxiety is commonly found in high functioning individuals on the spectrum in particular because they have an increased awareness of their own social difficulties. This cognitive awareness may intensify their anxiety toward social interaction and promote isolation.

Recent numbers found that 11-84% of children on the autism spectrum experience impairing anxiety, while only 4.7% of all children aged 3-17 years have experienced anxiety.

Cognitive Behavioral Therapy (CBT) is a type of psychotherapeutic treatment that helps individuals recognize how thoughts and feelings influence behavior and cope with these challenges.

CBT is used to treat a wide range of issues, in addition to anxiety, including:

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What is ABA Therapy?

Applied Behavioral Analysis

So, what exactly is ABA, or Applied Behavioral Analysis?

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ABA is an intervention therapy that specifically addresses behavior. ABA is one of the proven best practice therapies for children on the autism spectrum, including Aspergers. Thousands of research articles have documented the effectiveness of ABA in individuals with autism across behaviors, settings, and specialists. The behaviors that ABA seeks to address could relate to academics, communication, challenging behaviors, and other daily living skills.

ABA, as a field, seeks to understand and improve human behavior—the goal of many disciplines. What sets ABA apart from other fields is the approach and process. Professionals trained in ABA—or behavior analysts—break down each component of interactions to understand this behavior.

In ABA, behaviors are analyzed by looking at antecedents, behaviors, and consequences. These are known as the ABCs of ABA.

  • A = Antecedents (what happened before the behavior)
  • B = Behavior (the behavior targeted for intervention)
  • C = Consequence (what happened after the behavior)

For example, a child sees a box full of cookies on the table that his mother just took out of the pantry (antecedent). He asks her, “Mom, can I have a cookie please” (behavior). His mother tells him that he must eat his omelet before he can have a cookie (consequence).

Behavior analysts believe that adaptive and maladaptive behaviors are learned, and can be changed.

Basic principles of ABA state that when behavior is followed by something pleasant, it will occur more often in the future. In the same way, when a behavior is followed by something unpleasant, it will occur less often in the future. Behavior analysts utilize these principals of behavior to understand and improve human behavior.

Here is a general process for developing interventions utilizing ABA:

  1. Select the target behavior that is socially significant, observable, and measurable
  2. Clearly and specifically define this behavior
  3. Utilize principles of ABA to develop interventions
  4. Collect data in a way that demonstrates the changes in the target behavior are due to the intervention implemented and determine the impact of the intervention
  5. Make educational/therapeutic decisions based on the data.

It is key that an ABA intervention be effective. Meaning, the changes produced in the behavior are significant enough to make a difference in the person’s life outside of the context in which the intervention was implemented.

Now you know a little bit about the basics of ABA as a field. Do you think this process would apply to your child?

By Berenice de la Cruz, Director of Training and Research at Autism Community Network

Sources

Baer, D. M., Wolf, M. M., & Risley, T R.(1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-98.

Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied Behavior Analysis. Prentice-Hall: New Jersey.

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Seeking Help For Depression with Aspergers: The Specifics

If you have: lost interest in your usual activities; trouble sleeping, wake up early or sleep all the time; a change in appetite (more or less); withdrawn from people with a down mood (for Aspies it might be sad, irritable or a sense of hopelessness – whatever negative mood or thoughts you recognize), you have what we call major depression.

Depression, Aspergers, Help, Resources

For this, you probably need professional help. Things are not hopeless but being depressed is like looking through dark glasses. While people with Asperger’s are prone to depression because of challenging life experiences, clinical depression is not part of Asperger’s Syndrome and usually responds to treatment. For those struggling with lower level depression, you might still consider therapy to look at ways to make life changes and feel better.

Professional Help

For finding professional help and other resources, Autismsource.org is a gold mine of resources including lists of local therapists in your area.

Online directories:

Psychologists, social workers, psychiatrists, advanced practice registered nurses (APRN), and other specialties all can provide therapy. Individuals should be licensed providers in their states. You can find this information by looking at their websites.

Only psychiatrists, other MDs (medical doctors), and APRNs can provide medication. Medication has been demonstrated to be effective in treating depression. Often a combination of medication and therapy are most useful. The form of therapy most recommended is CBT (cognitive behavioral therapy). MBCT (mindfulness-based cognitive therapy) has been shown to be effective for depression although there isn’t research on it with people on the spectrum. Most therapists specializing in working with those with ASD know how to modify traditional CBT to best work with those on the spectrum.

It can be very challenging, certainly in parts of the US, to find therapists who take insurance.

The prevailing cost of therapy varies widely across the country. Some therapists (usually psychologists) offer sliding scale fees or have some lower fee slots, so it’s worth calling and asking. Clinics generally take insurance but you want to be sure that the therapist is familiar with ASD. The first thing you should do is call the number for patient or customer service on your insurance card and ask for a list of providers (psychologists/psychiatrists/social workers) in your area. This way you can know all the providers near you who are in network with your insurance plan before you call around clinics. In network providers have more affordable rates than out of network providers. It is important to inform yourself about your insurance plan and coverage before you begin the search.

Also, check providers with Medicaid if you have it. Any MD or APRN will know about treating depression with medication. Some therapists who accept Medicaid might be experienced with ASD even if they’re not on a directory for ASD.

Self Care Strategies

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ABA and Aspergers: The Three Step Plan You Can Use

The main use of ABA for individuals on the autism spectrum is to decrease challenging behaviors and increase appropriate skills.

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Here are the three steps for utilizing ABA to decrease challenging behaviors and increase appropriate skills:

Step 1: Assessment

The first step in decreasing problem behavior is to conduct a functional behavior assessment, which determines the function of challenging behavior.

Appropriate skills including academic, language, and daily living skills are assessed in a similar way. The founding father of ABA, B.F. Skinner, wrote the book Verbal Behavior in 1957. In the book, language is analyzed based on the function. Assessments like the Verbal Behavior-Milestones and Assessment Program (VB-MAPP; Sundberg, 2008) are utilized to assess the persons’ language skills, as well as other appropriate skills like academic and daily living skills.

Other assessments utilized in ABA are the Assessment of Basic Language and Learning Skills-Revised (ABBLS-R; Partington, 2006) and the Assessment of Functional Living Skills (AFLS; Partington & Mueller, 2013).

Step 2: Developing a Plan and Treatment Goals

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Components of a Behavior Intervention Plan

The complexities of High-Functioning Autism or Aspergers Syndrome may present themselves in behaviors that may be either excessive for specific situations or lacking.

Strategies developed to target such behaviors are often included in packages known as behavior intervention plans (BIP), behavior support plans (BSP), behavior management plans (BMP), positive behavior support plans (PBSP), and several others.

The primary purpose of a behavior plan is to outline and describe strategies that prevent problem behaviors, teach new behaviors that replace problematic behaviors and attempt to remove consequences that maintain or strengthen undesirable behaviors. The plans are usually developed for use in school settings, home and community settings, and sometimes employment settings.

The primary components of a plan are:

1.  Identifying Information

The basics behind the behavior intervention plan, including the individual’s information, the stakeholders, time introduced and the settings in which the plan is to be implemented.

2.  Description of Behaviors

This operational definition should be a specific description of the behaviors targeted for reduction or increase. They should be both observable and measurable.

3.  Replacement Behaviors