Emotions. Managing the Emotional Rollercoaster of Asperger Syndrome. happiness surprise. fear sadness disgust anger

Managing the Emotional Rollercoaster of Asperger Syndrome Timothy P. Kowalski, M.A.,C.C.C. Professional Communication Services, Inc. 1401-A Edgewater ...
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Managing the Emotional Rollercoaster of Asperger Syndrome Timothy P. Kowalski, M.A.,C.C.C. Professional Communication Services, Inc. 1401-A Edgewater Dr. • Orlando, FL 32804 www.socialpragmatics.com

Emotions

happiness surprise fear sadness disgust anger

600

42 Emotions are a function of the central nervous system

the brain has 100 billion nerve cells

Each nerve cell is connected to about 10,000 other nerve cells making the potential connections about 1000 trillion

Limbic System Responsible for showing, recognizing, controlling the body’s reaction to emotions

Do you get scared?

fear triggers immediate reactions

Emotions & Memory are Linked When remembering an emotional event, you recall not only what happened, but also how you felt – an emotional memory Both can be triggered by something you heard, saw or even smelt Scientists think that you store early emotional memories, even if you cannot remember what actually happened. These memories may still affect you as adults.

Why do we use emotions?

fear triggers escape happiness produces relaxation

Extreme Emotions Extreme emotions can lead to problems sadness can become depression anger can become aggression pleasure can become addiction fear can lead to anxiety phobia panic attacks

Phineas Gage

Why do we look at people?

to see if we recognize them judge gender and age determine their mood

Can you identify: happy surprised fearful sad disgusted angry

But, do people with AS have the same ability to recognize facial expressions as NTs?

Diagnostic criteria recognize the presence of a clinically significant difficulty with understanding, expressing, and regulating emotions.

DSM

a lack of social or emotional reciprocity

Gillberg

inappropriate social and emotional behavior

Szatmari

difficulty sensing feelings of others impossible to read emotions through facial expression of the child

Comorbidity Exists 65% of adolescents with AS have an affective or mood disorder “For teenagers with Asperger’s syndrome, an additional mood disorder is the rule rather than the exception.” Atwood, T., (2007). The Complete Guide to Asperger's Syndrome.

Philadelphia: Jessica Kingsley Publishers (p. 129).

Most common comorbid disorders anxiety disorder

Ghaziuddin, M. Wieder-Mikhail, W. and Ghaziuddin, N. (1998).

Comorbidity of Asperger Syndrome: a preliminary report. Journal of Intellectual Disability Research. 42: 279-283;Gillot, A. , Furniss, F. and Walter, A. (2001). Anxiety in high-functioning children with autism. Autism. 5: 277-286; Green, J., Gilchrest, A., Burton, D. and Cox, A. (2000). Social and psychiatric functioning adolescents with Asperger Syndrome compared with conduct disorder. Journal of Autism and Developmental Disorders. 30: 279-293; Kim, J. Szatmari, P., Bryson, S., Streiner, D. and Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger Suyndrome. Autism. 4: 117-132; Konstantareas, M. (2005) Anxiety and depression in children and adolescents with Asperger syndrome In K. Stoddart (ed) Children, Yourth and Adults with Asperger Syndrome: Integrating Multiple Perspectives. London: Jessica Kingsley Publishers; Russell, E. and Sofronoff, K. (2004). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry. 39: 633-638; Tantam, D. (2000). Psychological disorder in adolescents and adults with Asperger disorder. Autism. 4: 47-62; Tonge, B. Brereton, A., Gray, K, and Einfeld, S. (1999). Behavioral and emotional disturbance in high-functioning autism and Asperger Syndrome. Autism. 3: 117-130;

obsessive compulsive disorder (OCD) post-traumatic stress disorder (PTSD) depression paranoia

Increased risk for:

bipolar

DeLong, G. and Dwyer, J. (1988). Correlation of family history with specific autistic

subgroups: Asperger's syndrome and bipolar affective disease. Journal of Autism and Developmental Disorders. 18: 593-600; Frazier, J. Doyle, R., Chiu, S., and Coyle, J. (2002). Treating a child with Asperger's disorder and comorbid bipolar disorder. American Journal of Psychiatry. 159: 13-21.

anger management

Comorbid anxiety anxiety increases attempts at reducing the stress levels AS reduces flexibility and increases tunnel vision antisocial and noncompliant behavior often seen as controlling but it is an attempt at avoiding stress producing situations

may increase reliance on restricted narrow range of interest

reclusive behavior often used as an avoidance technique assures mistake will not be made since no attempt is made may self-medicate using alcohol or marijuana long-standing anxiety can escalate to mood congruent disorder thinking becomes psychotic and needs psychiatric intervention

Common Anxiety Disorders Obsessive Compulsive Disorder (OCD) characterized by intrusive thoughts that the individual does not want to think about restricted narrow range of interest often misdiagnosed as OCD 25% have true OCD

Russell, A., Mataix Cols, D., Anson, M. and Murphy, D. (2005). Obsessions and

compulsions in Asperger syndrome and high functioning autism. British Journal of Psychiatry. 186:525-528.

AS individuals’ thought patterns differ from NTs McDougle, C. Kresch, L., Goodman, W. and Naylor, S. (1995). A case controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive compulsive disorder. American Journal of Psychiatry. 152: 772-777.

teasing bullying making a mistake

Post-traumatic stress disorder (PTSD) attempt at avoiding incident or memory of such fear of bullying fear of harm from a bully these thoughts are difficult to block out

school refusal

selective mutism a severe form of anxiety often impacts girls more than boys anxiety increases the behaviors of: agitation (fight) avoidance (flight) inability to participate (freeze)

social anxiety disorder often a function of the fear of making a mistake social confusion often leads to social ineffectiveness

Depression Common in AS

Clarke, D., Baxter, M., Perry, D., and Prasher, V. (1999).

Affective and psycholtic disorders in adults with autism: seven case reports. Autism. 3:149-164; Gillot, A. , Furniss, F. and Walter, A. (2001). Anxiety in high-functioning children with autism. Autism. 5: 277-286; Green, J., Gilchrest, A., Burton, D. and Cox, A. (2000). Social and psychiatric functioning adolescents with Asperger Syndrome compared with conduct disorder. Journal of Autism and Developmental Disorders. 30: 2; Kim, J. Szatmari, P., Bryson, S., Streiner, D. and Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger Suyndrome. Autism. 4: 117-132; Konstantareas, M. (2005) Anxiety and depression in children and adolescents with Asperger syndrome In K. Stoddart (ed) Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives. London: Jessica Kingsley Publishers.

may be as high as 1 in 3 children and adults

Ghaziuddin, M. Wieder-Mikhail, W. and Ghaziuddin, N. (1998). Comorbidity of Asperger

Syndrome: a preliminary report. Journal of Intellectual Disability Research. 42: 279-283; Kim, J. Szatmari, P., Bryson, S., Streiner, D. and Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger Syndrome. Autism. 4: 117-132; Tantam, D. (1988). Asperger's syndrome. Journal of Child Psychology and Psychiatry. 29: 245-253; Wing, L. (1981). Asperger's Syndrome: a clinical account. Psychological medicine. 11: 115-130.

depression often a function of reactive-depression poor self-esteem mental exhaustion feelings of loneliness being tormented being teased being bullied pessimistic view on life perfectionist outlook

Anger rapid, intense anger often triggered by trivial events emotional regulation often disrupted on a continuum they function 1-2-9-10

often can’t think of alternate strategies to resolve situation but can in another environment

property destruction often an attempt at removing unwanted feelings limited language of emotions not typical of NT peers

aggression may function as a means of achieving solitude preemptive in nature

be aware of externalized-agitated depression where one blames others for faults childhood depression and mania associated with bipolar disorder are often manifested as anger

So why is this a concern?

Challenges are a function of: reduced social reasoning empathetic difficulty impaired conversational skills atypical learning style sensory processing deficits

...which predispose them to:

stress anxiety frustration emotional exhaustion

Why?

Theory of Mind Deficits Executive Function Deficits

Theory of Mind significant difficulty understanding the thoughts, feelings and emotions of others why? prosopagnosia alexythymia

Prosopagnosia Barton, J., et al. (2004) Are patients with social developmental disorders prosopagnosic? Perceptual heterogeneity in the Asperger and socio-emotional processing disorders. Brain. 127: 1706-1716; Duchaine, B, Nieminen-von Wendt, T., New, J. and Kulomaki, T. (2003). Disocciations of visual recognition in a genetic prosopanosic: evidence for separate developmental processes. Neurocase. 9:380-389; Kracke, I. (1994). Developmental prosopagnosia in Asperger syndrome: presentation and discussion of an individual case. Developmental Medicine and Child Neurology. 36: 873-876.Nieminen-von Wendt, T. (2004). On the origins and diagnosis of Asperger syndrome: a clinical neuroimaging and genetic study. Academic dissertation., Medical Faculty. University of Helsinki. Njiokikrjien, C, et al. (2001) Disordered recognition of facial identity and emotions in three Asperger type autists. European Journal of Child and Adolescent Psychiatry. 10: 79-90.

can’t read the face of others may focus only on individual components of the face may not realize one expression has multiple meanings

Alexythymia Berthoz, S. and Hill, E (2005). The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. European Psychiatry. 20: 291-298; Nieminen-von Wendt, T. (2004). On teh origins and diagnosis of Asperger syndrome: a clinical neuroimaging and genetic study. Academic dissertation., Medical Faculty. University of Helsinki; Rastam, M., Gillberg, C., Gillberg, I. and Johansson, M. (1997). Alexithymia in anorexia nervosa: a controlled study using the 20-item Toronto Alexithymia Scale. Acta Psychiatrica Scandinavica. 95: 385-388; Tani, P. et al (2004). Asperger syndrome, alexityhmia and sleep. Neuropsychobiology. 49: 64-70.

the inability to identify and describe feeling states can’t read emotions in others limited vocabulary to describe these states especially with subtle states

Executive Functions typical characteristics associated with AS:

Eisenmajer, R. et al. (1995). Comparison of clinical symptoms in autism and

Asperger's disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 35: 1523-1531; Nyden, A., Gillberg, C., Hjelmquist, E., and Heiman, M. (1999). Executive function/attention deficits in boys with Asperger syndrome, attention disorder and reading/writing disorder. Autism: 3: 213-228; Ozonoff, S., South, M. and Miller, J. (2000) DSM0IV defined Asperger syndrome: cognitive behavioral and early history differentiation from high-functioning autism. Autism. 4: 29-46; Pennington, B. and Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry Annual Research Review. 38: 51-87.

disinhibited impulsive

It’s the amygdala!

research has determined structural and functional abnormalities exist

Adolphs, R., Sears, L. and Piven, J. (2001).

Abnormal processing of social information from faces in autism. Journal of Cognitive Neuroscience. 13: 232-240; Baron-Cohen, S., et al. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or High-Functioning Autism. Journal of Autism and Developmental Disorders. 29; 407-418l; Critchley, H., et al. (2000). The functional neuroanatomy of social behavior. Brain. 123: 2203-2212; Fine, C., Lumsden, J. and Blair, R. (2001) Dissociation between theory of mind and executive functions in a patient with early left amaygdala damage. Brain Journal of Neurology. 124: 287-298;

in AS it may not function properly individual can’t receive information as effectively as NT peers continues to escalate but can’t recognize the escalation until it is too late explosion happens “out of the blue”

Emotional Intelligence

What is EQ?

the ability to perceive, identify, and manage emotions on a personal and social level

How does AS impact EQ?

reduced ability to adapt to new situations reduced coping skills negative impact on job skills

AS coping strategies social regression fear reaction somatic complaints (hypchondriasis) paranoid thoughts &/or feelings depression clowning to hide inefficiencies poor self image passive aggression to elicit anger impulsivity

Factors Limiting the Ability to Recognize Emotional States excessive concrete reasoning overuse of literal interpretation limited analytic skills limited flexibility limited perspective taking focusing on one aspect and not the whole

Reading the Many Moods of an Aspie

Happy

Depressed

Irritated

Suicidal

Ecstatic

Bored

EQ impacts

personal competence social competence

Personal Competence

3 levels: self-awareness self-regulation self-motivation

self-awareness 3 sublevels: emotional awareness recognizing one’s emotions and their effects self-assessment knowing one’s strengths and limits self-confidence sureness about one’s capabilities

AS impact on emotional awareness

can’t recognize and explain their emotions can’t associate feelings with their behavior can’t realize their feelings impact their performance

AS impact on self-assessment

not aware of their own strengths and limits experiential learning is difficult not open to new ideas or suggestions can’t show a sense of humor/ perspective about themselves

AS impact on self confidence

limited self confidence especially in new situations

overly opinionated may reach the point of being obsessive

often based on personal views and not grounded in sound decisions Grice’s maxim of “quality”

self-regulation 4 sublevels: self-control ability to manage disruptive emotions/impulses trustworthiness honesty and integrity conscientiousness responsibility for one’s own actions adaptability flexible and open to new ideas

AS impact on self-control

can’t manage impulsive feelings can’t manage distressing emotions falls apart in stressful situations increased pressure creates: distractibility irrational behavior

AS impact on trustworthiness

not prone to admit their own mistakes reliability can be impacted by central coherence opinionated

AS impact on conscientiousness chaos often a result from: multiple demands rapid change shifting priorities

rigid and not prone to adapt when necessary ToM impacts ability to see see events in multiple perspectives

AS impact on adaptability

limited ability to generate new ideas Bloom’s cognitive process: “Create”

limited flexibility impacts problem solving skills not open to new ideas can’t determine best option from a wide variety of sources

self-motivation 4 sublevels: achievement drive the need to meet or exceed a given standard commitment embracing the goals of the group initiative the ability to act on opportunities optimism being able to continue a goal despite setbacks

AS impact on achievement

may not have a strong desire to excel limited risk taking fail to learn how to improve performance

AS impact on commitment

can’t sacrifice own desires for the good of the group

AS impact on initiative

may have difficulty going beyond minimal expectations limited ability to mobilize others poor leadership qualities

AS impact on optimism

not good when frustrated operate on fear of failure rather than hope of success see setbacks as personal failure rather than opportunity for change

Social Competence

2 levels: social-awareness social skills

social-awareness

5 sublevels: empathy recognizing others feelings and perspective and taking an active interest in their concerns (Theory of Mind)

And then Mr. Spock used his mind meld...

service orientation anticipating, recognizing, and meeting needs of others developing others recognize what others need to enhance their abilities leveraging diversity embracing multiculturalism political awareness recognizing a group’s emotional current and power relationships

AS impact on empathy

fail to attend to emotional cues 60-90% is non-semantic

don’t listen well don’t express sensitivity using socially expected means language of emotions

AS impact on service orientation

fail to recognize others needs may not offer assistance fail to recognize other’s perspective

AS impact on developing others

don’t acknowledge achievements of others mentoring qualities overshadowed by perspective deficits

AS impact on leveraging diversity

lack of tact may be perceived as bigoted fail to recognize and consider cultural differences of others may be perceived as intolerant

AS impact on political awareness

fail to read emotional currents fail to recognize social networks fail to recognize the factors that shape actions of others fail to see how external events shape internal environment

social skills 8 sublevels: influence being an effective persuader communication able to express oneself clearly and effectively leadership able to inspire and guide individuals and groups

change initiate change conflict management negotiate and resolve differences building bonds nurturing appropriate relations collaboration working with others for shared goals team capabilities creating group dynamics to achieve collective goals

AS impact on influence

poor use of persuasion fail to appeal to listener’s needs poor consensus builders

AS impact on communication

fail to recognize and act on emotional cues when communicating avoid difficult situations poor listening skills fail to be open minded especially to bad/unpleasant information

AS impact on leadership

attempts at arousing enthusiasm may be seen as lecturing do not perform well in leadership positions often seen as dictatorial

AS impact on change catalyst

don’t like change argue to argue not to produce improvement

AS impact on conflict management

don’t handle difficult people well don’t initiate methods to deescalate disagreements fail to establish open dialogue fixate on their needs/issues

AS impact on building bonds

poor at friend making and friend keeping may be perceived as stalking often alienate colleagues

AS impact on collaboration and cooperation

often hyperfocus on details and not on relationships not good at collaborating fail to identify collaborating opportunities

AS impact on team capabilities

often not perceived as being helpful, respectful, and cooperative large group dynamics create excess stress

AS intervention must stress EQ social skill training does not make one socially savvy the how is not as important as the why simply knowing how to do something doesn’t mean knowing when or where to use it being aware of one’s EQ is critical

So what do we do?

Better teacher training 96% of students with disabilities are included at least some of the day in general education U.S. Department of Education, Office of Special

Education and Rehabilitative Services. (2004). 26th Annual report to Congress on the implementation of the Individuals with Disabilities Education Act.

37.5% spend most of the day

gen. ed. teachers often feel ill prepared to meet needs of students with disabilities Cook, B. (2002). Inclusive attitude, strengths, and

weaknesses of pre-service general educators enrolled in a curriculum infusion teacher preparation program. Teacher Education and Special Education. 25: 262-277; Kamens, M., Loprete, S. and Slostad, F. (2003). Inclusive classrooms: What practicing teachers want to know. Action in Teacher Education. 25: 20-26; U.S. Department of Education (2002). 24th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act.

Challenging Behaviors are Increasing students identified with behavioral issues are increasing EBD ASD TBI OHI

staff lack effective training in prevention and management of student conflict often don’t respond appropriately Couvillon, M. et al. (2010)., A review of crisis intervention training programs for schools. Teaching Exceptional Children. 42: 6-17.

1st minute of crisis situation is crucial for prevention of escalation or injury prevention

Bickel, P. (2010). How long is a minute? The

importance of a measured plan of response to crisis situations. Teaching Exceptional Children. 18-22.

ineffective educational programming may exacerbate behavioral cycle

Long, N. (1996). The conflict cycle paradigm on how

troubled students get teachers out of control. In N. Long, W. Morse, and R. Newman (Eds.), Conflict in the classroom (5th Ed., pp 244-266). Austin, TX: Pro-Ed

teachers in inclusive classrooms often fail to receive adequate information on how to successfully include students with disabilities Snyder, L, Garriott, P. and Williams Alor, M. (2001).

Inclusion confusion: Putting the pieces together. Teacher Education and Special Education. 24: 198-207.

key predictor for teaching ability is teacher’s confidence to teach those who feel more confident are more likely to meet their students’ needs

Eggan, P. and Kauchak, D. (2006). Strategies and Models for Teachers: Teaching

Content and Thinking Skills. Boston: Pearson/Allyn & Bacon; Poulou, M. (2007). Student-teachers' concerns about teaching practice. European Journal of Teacher Education. 30: 91-110.

be aware that students with AS will hold it to together in school but collapse at home he doesn’t realize he is getting stressed (alexythymia) home is a safe environment for release

Prevention and De-escalation

Prevention & De-escalation better staff training designed to prevent behavior problems Ryan, J. Peterson, R., Tetreault, G. and Van der Hagen, E.

(2007). Reducing seclusion timeout and restraint procedures with at-risk youth. Journal of At-Risk Issues. 13: 7-12.

Positive Behavior Interventions and Supports (PBIS) evidence based practice focusing on: teaching students appropriate behavior increasing reinforcement for appropriate student behavior data driven for proper design and monitoring

What Do I Do?

Know the Risk Factors high school concerns 5.9% of students reported having carried a weapon (knife, gun, or club) on school property 7.8% reported being threatened or injured with a weapon on school property 12.4% reported having been in a fight on school property 22.3% of students were offered, sold, or given an illegal drug on school property 32% of students reported being bullied

ESE Students have Unique Set of Triggers sensory noise fire alarm loud PA system cafeteria assembly visual observing inappropriate behavior in others

touch hallway PE cafeteria assembly change to routine substitute teacher assembly fire drill field trip

Educators’ Response timeliness sooner the better to reduce escalation

appropriateness inappropriate strategies are often used

measure the response frequently knee-jerk overboard reactions are used

“Fear Factor” injury of self or student during altercation fear of being sued fear school won’t support actions taken

What are the needs? incorporate teachers in identifying their needs and how best to meet them but “Aspie-eyes” can impact appropriate identification of the problem Tonka-toy playground assistant 2nd grade principal’s lunch woes

Rumbling-Rage-Recovery Albert, L. (1989) A Teacher's Guide to Cooperative Discipline: How to Manage Your Classroom and Promote Self-Esteem. Circle Pines, MN: American Guidance Service; Beck, M. (1987) Understanding and managing the acting-out child. The Pointer. 29: 27-29.

Rumbling Stage intervene without escalation by using: antiseptic bouncing proximity control signal interference support from routine redirecting home base acknowledge student’s difficulties walk without talk self-calming strategies

Rage Stage complete lack of self-control excessive and explosive impulsivity focus on protecting child, others and property avoid redirection seek assistance be extremely careful regarding use of restraint

Recovery Stage typical behaviors expressed: apologetic amnesic sullen withdrawn deny inappropriate behavior occurred don’t force admittance only serves to escalate behavior

allow to sleep redirect using easy tasks focus on relaxation techniques do not refer to the previous rage behavior

What’s Necessary? Collaboration: “...improvements invariably involve the cooperation of many minds.” Alexander Graham Bell

Competence: “Real knowledge is to know the extent of one’s ignorance.” Confucius

Communication: “When ideas fail, words come in very handy.” Goethe

happiness

Which of the

6

surprise fear sadness disgust anger

are you experiencing right now?

Some helpful books and yes they’re all written by me!

Social-Pragmatic Success for Asperger Syndrome and Other Related Disorders

Practical Strategies for Assessment and Practical Strategies for Treatment

Assessment and Treatment

Timothy P. Kowalski

Are you In The Zone? %7MQTPI8IGLRMUYIXS,IPT7SQISRI[MXL7SGMEP(MJ½GYPXMIW

Timothy P. Kowalski Illustrated by Laura S. Kowalski

Timothy  P.  Kowalski

Asperger Syndrome ed expla

in

Illustrated  by  Laura  S.  Kowalski

Thank you for coming.

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