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

happinesssurprisefearsadnessdisgustanger

600

42

the brain has 100 billion nerve cells

Emotions are a function of the

central nervous system

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 memoryBoth 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 EmotionsExtreme emotions can lead to problems

sadness can become depressionanger can become aggressionpleasure can become addictionfear can lead to

anxietyphobiapanic attacks

Phineas Gage

Why do we look at people?

to see if we recognize themjudge gender and agedetermine 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 othersimpossible 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)depressionparanoia

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 anxietyanxiety increases attempts at reducing the stress levels

AS reduces flexibility and increases tunnel visionantisocial 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 marijuanalong-standing anxiety can escalate to mood congruent disorder

thinking becomes psychotic and needs psychiatric intervention

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.

teasingbullyingmaking a mistake

Common Anxiety Disorders

Post-traumatic stress disorder (PTSD)attempt at avoiding incident or memory of such

fear of bullyingfear of harm from a bully

these thoughts are difficult to block outschool refusal

selective mutisma severe form of anxietyoften impacts girls more than boysanxiety increases the behaviors of:

agitation (fight)avoidance (flight)inability to participate (freeze)

social anxiety disorderoften a function of the fear of making a mistakesocial confusion often leads to social ineffectiveness

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

depression often a function of reactive-depression

poor self-esteemmental exhaustion feelings of lonelinessbeing tormentedbeing teasedbeing bulliedpessimistic view on lifeperfectionist outlook

rapid, intense anger often triggered by trivial eventsemotional regulation often disrupted

on a continuum they function 1-2-9-10often can’t think of alternate strategies to resolve situation

but can in another environment

Anger

property destruction often an attempt at removing unwanted feelingslimited language of emotions

not typical of NT peersaggression may function as a means of achieving solitude

preemptive in nature

be aware of externalized-agitated depression where one blames others for faultschildhood 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 reasoningempathetic difficultyimpaired conversational skillsatypical learning stylesensory processing deficits

...which predispose them to:

stressanxietyfrustrationemotional exhaustion

Why?

Theory of Mind DeficitsExecutive Function Deficits

Theory of Mind

significant difficulty understanding the thoughts, feelings and emotions of otherswhy?

prosopagnosiaalexythymia

ProsopagnosiaBarton, 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 facemay not realize one expression has multiple meanings

AlexythymiaBerthoz, 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 otherslimited 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.

disinhibitedimpulsive

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 peerscontinues to escalate but can’t recognize the escalation until it is too lateexplosion 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 situationsreduced coping skillsnegative impact on job skills

AS coping strategies

social regressionfear reactionsomatic complaints (hypchondriasis)paranoid thoughts &/or feelingsdepressionclowning to hide inefficienciespoor self imagepassive aggression to elicit angerimpulsivity

Factors Limiting the Ability to Recognize Emotional States

excessive concrete reasoningoveruse of literal interpretationlimited analytic skillslimited flexibilitylimited perspective takingfocusing on one aspect and not the whole

Reading the Many Moods of an Aspie

Happy Depressed

Suicidal Ecstatic

Irritated

Bored

EQ impacts

personal competencesocial competence

Personal Competence

3 levels:self-awarenessself-regulationself-motivation

self-awareness

3 sublevels:emotional awareness

recognizing one’s emotions and their effects

self-assessmentknowing one’s strengths and limits

self-confidencesureness about one’s capabilities

AS impact on emotional awareness

can’t recognize and explain their emotionscan’t associate feelings with their behaviorcan’t realize their feelings impact their performance

AS impact on self-assessment

not aware of their own strengths and limitsexperiential learning is difficultnot open to new ideas or suggestionscan’t show a sense of humor/perspective about themselves

AS impact on self confidence

limited self confidenceespecially 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/impulsestrustworthiness

honesty and integrityconscientiousness

responsibility for one’s own actionsadaptability

flexible and open to new ideas

AS impact on self-control

can’t manage impulsive feelingscan’t manage distressing emotionsfalls apart in stressful situationsincreased pressure creates:

distractibilityirrational behavior

AS impact on trustworthiness

not prone to admit their own mistakesreliability can be impacted by central coherenceopinionated

AS impact on conscientiousness

chaos often a result from:multiple demandsrapid changeshifting priorities

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

AS impact on adaptability

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

limited flexibility impacts problem solving skillsnot open to new ideascan’t determine best option from a wide variety of sources

self-motivation

4 sublevels:achievement drive

the need to meet or exceed a given standardcommitment

embracing the goals of the groupinitiative

the ability to act on opportunitiesoptimism

being able to continue a goal despite setbacks

AS impact on achievement

may not have a strong desire to excellimited 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 expectationslimited ability to mobilize otherspoor leadership qualities

AS impact on optimism

not good when frustratedoperate on fear of failure rather than hope of successsee setbacks as personal failure rather than opportunity for change

Social Competence

2 levels:social-awarenesssocial 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 orientationanticipating, recognizing, and meeting needs of others

developing othersrecognize what others need to enhance their abilities

leveraging diversityembracing multiculturalism

political awarenessrecognizing a group’s emotional current and power relationships

AS impact on empathy

fail to attend to emotional cues60-90% is non-semantic

don’t listen welldon’t express sensitivity using socially expected means

language of emotions

AS impact on service orientation

fail to recognize others needsmay not offer assistancefail to recognize other’s perspective

AS impact on developing others

don’t acknowledge achievements of othersmentoring qualities overshadowed by perspective deficits

AS impact on leveraging diversity

lack of tact may be perceived as bigotedfail to recognize and consider cultural differences of othersmay be perceived as intolerant

AS impact on political awareness

fail to read emotional currentsfail to recognize social networksfail to recognize the factors that shape actions of othersfail to see how external events shape internal environment

social skills

8 sublevels:influence

being an effective persuadercommunication

able to express oneself clearly and effectivelyleadership

able to inspire and guide individuals and groups

changeinitiate change

conflict managementnegotiate and resolve differences

building bondsnurturing appropriate relations

collaborationworking with others for shared goals

team capabilitiescreating group dynamics to achieve collective goals

AS impact on influence

poor use of persuasionfail to appeal to listener’s needspoor consensus builders

AS impact on communication

fail to recognize and act on emotional cues when communicatingavoid difficult situationspoor listening skillsfail to be open minded

especially to bad/unpleasant information

AS impact on leadership

attempts at arousing enthusiasm may be seen as lecturingdo not perform well in leadership positionsoften seen as dictatorial

AS impact on change catalyst

don’t like changeargue to argue not to produce improvement

AS impact on conflict management

don’t handle difficult people welldon’t initiate methods to deescalate disagreementsfail to establish open dialoguefixate on their needs/issues

AS impact on building bonds

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

AS impact on collaboration and

cooperation

often hyperfocus on details and not on relationshipsnot good at collaboratingfail to identify collaborating opportunities

AS impact on team capabilities

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

AS intervention must stress EQ

social skill training does not make one socially savvythe how is not as important as the whysimply knowing how to do something doesn’t mean knowing when or where to use itbeing 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 daygen. 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

EBDASDTBIOHI

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 behaviorincreasing reinforcement for appropriate student behaviordata driven for proper design and monitoring

What Do I Do?

Know the Risk Factors

high school concerns5.9% of students reported having carried a weapon (knife, gun, or club) on school property7.8% reported being threatened or injured with a weapon on school property12.4% reported having been in a fight on school property22.3% of students were offered, sold, or given an illegal drug on school property32% of students reported being bullied

ESE Students have

Unique Set of Triggers

sensorynoise

fire alarmloud PA systemcafeteriaassembly

visualobserving inappropriate behavior in others

touchhallwayPEcafeteriaassembly

change to routinesubstitute teacherassemblyfire drillfield trip

timelinesssooner the better to reduce escalation

appropriatenessinappropriate strategies are often used

measure the responsefrequently knee-jerk overboard reactions are used

“Fear Factor”injury of self or student during altercationfear of being suedfear school won’t support actions taken

Educators’ Response

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 assistant2nd grade principal’s lunch woes

Rumbling-Rage-RecoveryAlbert, 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 Stageintervene without escalation by using:

antiseptic bouncingproximity controlsignal interferencesupport from routineredirectinghome baseacknowledge student’s difficultieswalk without talkself-calming strategies

Rage Stage

complete lack of self-controlexcessive and explosive impulsivityfocus on protecting child, others and propertyavoid redirectionseek assistancebe extremely careful regarding use of restraint

Recovery Stage

typical behaviors expressed:apologeticamnesicsullenwithdrawndeny inappropriate behavior occurred

don’t force admittanceonly serves to escalate behavior

allow to sleepredirect using easy tasksfocus on relaxation techniquesdo not refer to the previous rage behavior

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

What’s Necessary?

happinesssurprisefearsadnessdisgustanger

Which of the

6are you experiencing right now?

Some helpful booksand yes they’re all written by me!

Pract ical Strategies for Assessment and

Treatment

Social-Pragmatic Successfor Asperger Syndrome and Other Related Disorders

Timothy P. Kowalski

Practical Strategies for

Assessment and Treatment

Are you In The Zone?

Timothy P. KowalskiIllustrated by Laura S. Kowalski

Asperger Syndromeexpla

ined

Illustrated  by  Laura  S.  Kowalski

Timothy  P.  Kowalski

Thank you for coming.