Q: What types of school-based services should I be considering for my older grade school through high school aged child or student?

 

A: Each student with AS/HFA or a related disorder is a unique individual and needs to be provided with a program that addresses that his or her particular set of strengths and weaknesses. However, there are certain features that, by definition, all individuals with AS/HFA have to varying degrees. These include poor social skills, compromised pragmatic language (the use of language in a socially appropriate and fluid way), problems with developing and maintaining friendships, restricted and intense interests in certain subjects or activities, and stereotyped, repetitive routines. In addition, many of these students also suffer from poor attention and focusing skills, sensory hypersensivity, weak motor and coordination skills, learning disabilities, poor organizational ability, and compromised abstract thinking skills. Therefore, in designing school or home-based programs for these students, each of these factors must be assessed for the individual student, and addressed as needed. For more information on designing a comprehensive curriculum for school-aged, high functioning students, click here. This will take you to a copy of my article on this subject published in the Summer/Fall, 2001 issue of the FEAT newsletter.

 

Q: Do you have any recommendations for a good book to read to get an overview of Asperger's Syndrome and high functioning autism?

 

A: There are several good books out there for people who are just beginning to learn about these diagnoses. My favorite for those who want a straight-forward, easy to read, but very informative text is Tony Attwood's Asperger's Syndrome: A Guide for Parents and Professionals. Jessica Kingsley, 1998. For those who want to delve into an extensive review of recent research in this area, I recommend Asperger Syndrome by Klin, Volkmar, and Sparrow (Guilford Press, 2000). For more information on books and other sources of information, click on the Resources section of this website.

 

Q: I work with children who are autistic as well as children who have Asperger's. I'm trying to work with children at school, because social situations, as you know, are difficult. But what I find interesting is that the children don't seem to know what to talk about- such as they have a topic, but don't know how to carry on a conversation. Do you have some suggestions or thoughts about this? They understand emotions, and a lot of the things that you go over in your book, but I'm very stuck on this issue lately of not knowing how to teach them what to talk about, besides scripting conversations for them, which is not how older children, adolescents, speak.

 

A: You are not alone—even when students with AS/HFA are given a topic they may not know where to go with it. Start with the Basic Conversational Responses program in Navigating the Social World, (p. 64) to help them with single conversational exchanges. It may take weeks to months to get trough this program depending on the skill level of your students. Work on each step separately, about 5-15 mins. per session. Once they have mastered this have them start the Initiating Conversations program (p. 94). Interviewing other people in order to prepare personal file cards for them will give your students great practice in asking “getting to know you” type questions. Make sure that you do the physical writing on the index card so that your students can focus on the conversation. Show them how the interview process looks by first demonstrating an interview between you and an aide. Then have your students interview a friendly partner with whom they are already acquainted. (Later on they can practice interviewing people they do not yet know.) Have them start with the facts side of the card and stick with factual information until that side is completed before moving on to the interests side of the card. If you need to prompt, give indirect prompts using words such as “What could you ask him about his school, (family, birthdate, interests, etc.)?” Give your students LOTS of time to come up with their own questions and responses. Many of them process verbal information and generate questions and responses very slowly and a common mistake that the rest of us make is to jump in and “rescue” them while they are still working out what they are going to say. This can be very disheartening to the student and make them hesitant to continue trying. Finally, make sure that your social skills sessions are done in a relaxed and fun environment. For example, my office is furnished with a sofa, easy chairs, a coffee table, and a comfortable area rug for sitting on the floor with my younger students. We have snacks and drinks during group sessions to put the students at ease. Remember that food is one of the best ice breakers at parties and meetings, and this is also true for groups of students working on social skills.

 

Q: I attended the Future Horizons workshop you presented at…. I was very impressed and influenced by your presentation and have taken pieces from that and put them to work already. Thank you for that. I work primarily with a 3rd grader…who has ASD and Cerbral Palsy. He is fairly high-functioning, meaning that he is verbal and in the average range academically in his mainstream classroom (although his reading level is low). He has some behavior problems, as well as rigid and perseverative behaviors that are typical of people with Autism. One great thing about(him) is that he has an intrinsic desire to be social with adults and peers, but he doesn’t always know how to interact appropriately. I have learned some things from that conference that will hopefully teach him the skills he needs to build and maintain the relationships he wants so much to have. The reason I am writing to you today is regarding your stress management program with respect to (the student). I shared your slides with (his) clinical team and we would like to implement something to help him better deal with stressors. (He) has a hard time accepting “no” from peers or changes in his “rigid plan” that are not preferable. He struggles with social reciprocity and gets upset if he doesn’t always get his way. His anxiety level rises when he is rushed or overstimulated as well. I agreed to contact you in hopes of some words of wisdom regarding (this student) and a stress management program...

 

A: The stress management program in Navigating the Social World (I talked about it at the conference) should be helpful for your student. After he has had ample practice using his chosen relaxation techniques while completing the tasks on his stress hierarchy, you can purposefully reproduce schedule changes or times when he does not get his way in your sessions with him. First, use cartooning to show visually how to, and how not to handle schedule changes and not getting one's way, using two cartoon characters to show how both people might think and feel in such a situation. Next, model the techniques you want your student to use. Then have him role play dealing with a schedule change, for example, paying attention to appropriate scripts and non-verbal cues. When he can do this comfortably in role plays, you can purposefully include within your sessions schedule changes (by not following the order of activities that you have listed on the board, for example) or situations in which he does not get his way (by having the group decide upon a group activity, but prompting your student aides ahead of time to choose a game that is not your student’s favorite, for example). Then prompt him to 1) use a relaxation technique if needed and 2)use the same approach he practiced during the role plays to handle the challenging situation.

 

Q: I am a resource and methods teacher in a high school in … and I 'm looking for some ideas and suggestions about a specific situation I have with a student who has recently developed an aversion to school. I would say he is almost classic autistic and essentially non-verbal. He has just turned 17 and this is his second year in our school. Up until a month ago he was attending school daily - he is here for half days only. He appeared to be making progress and as his mother confirmed he liked coming to school. (He is very likable and anyone who has worked with him T.A.s etc. have enjoyed working him too.) He went home twice in two weeks, sick to his stomach and when he returned he obviously was getting over a cold or bug. However, we now have a situation whereby he will come to school for about an hour and pretend to be sick. He'll yell "sick" and "home" and becoming agitated to the point of potentially hurting himself. This has happened twice and both times he has gone home with mom. He has not been back since the last episode (nearly three weeks ago). His father attempted to bring him to school one day for a "visit" but he refused to get out of the car and repeatedly said, "No school". The parents are very supportive but tend to be fairly passive and there are little demands on him at home. Dad says its his stress free zone. He goes out with a human resources counselor three times each week and sees a speech therapist once every week or two. The problem occurs only at school. As far as I can tell there are no major changes here. The last time he became upset was when he was asked to read a passage (which he is capable of doing). I am looking for some ideas and possible options before we meet with his parents next week. Any suggestions? Do you know of a similar case? Could this be depression? Should we look at a work placement? I feel the parents will be looking to the school for direction. Any help would be greatly appreciated.

 

A: Your student may be having problems at school that he cannot communicate effectively to the staff. If he is able to answer verbal questions, try asking him if there are any noises, smells, food tastes, or other specific sensory stimuli that bother him at school. Offer him specific examples. If he cannot process the verbal questions, try using pictures to illustrate the questions. Also, ask him about other issues such as fatigue, nausea, pain, undiagnosed learning differences, inability to focus, being teased or bothered by other students, or any other potential trouble areas. Alternately, there may be something positive at home that he doesn't want to miss. Again, try asking him about specific potential reinforcers at home using either verbal or picture questions. Also check with his parents to find out how he has been spending his days when not in school. Is he having fun at home, going on outings with loved ones, sleeping or playing video games for several hours, etc? This will help you to figure out what his motivation is for avoiding school. RE depression, yes, his desire to avoid school could be related to depression. It can be hard to diagnose depression in developmentally delayed individuals, but it is important to know if he is having problems with his moods. If the parents have any questions about this, they should take him to a child/adolescent psychiatrist who is familiar with patients with developmental delays. RE work placement, the school team can be a great help in preparing students for future work, and this should be addressed at school as early as age 11 or 12 years. If your school can arrange for a work-study program through which the student receives high school credits for working (usually under the supervision of both the on-site manager and a designated teacher on campus) this could be very helpful to your student in finding future work.

 

Q: (My son, Joseph) is ten years old and autistic. He received early intervention from the age of two and so is blessed to function extremely well in a typical classroom and is exceptionally social given his situation. However, he will not speak on the telephone to anyone, including my husband or me or his very best friends. Since he will enter middle school next fall, this is becoming more of a problem and I was wondering if you had any ideas for how we might begin to make him feel more comfortable using the telephone.

 

A: I would start with practicing just “answering” the telephone in role plays without actual telephones. Write down a script for him on a white board or large piece of paper and put it where he can see it in case he freezes and can’t remember what to say. Start with something simple, like “Hello” /(other person says “Hi, is Mrs. _____ there?”)/”Yes, just a moment, please.” Practice this for a few short sessions (3-4 minutes per day). When he has this down, add variations, such as having the other person say “Hi, this is John. Is Joseph there?”, and write down a script such as “This is Joseph. Hi John.”, etc. Stop the conversation after the initial greetings at first so that he can focus on one thing at a time. When he has this down, start practicing with a couple of real phones that are not hooked up. Give him lots of extra time to formulate his answers as he practices—he may need quite a bit of practice before he becomes more fluent at this, and remember that it may take from a few to multiple sessions of practice before he is ready to actually use a real phone in real time. After his practice sessions, let him celebrate his efforts with something fun like one of his favorite foods, or some time with one of his favorite games, etc.