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DMHAS. The Learning Clinic The Learning Clinic Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive.

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Presentation on theme: "DMHAS. The Learning Clinic The Learning Clinic Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive."— Presentation transcript:

1 DMHAS

2 The Learning Clinic

3 The Learning Clinic Treatment and Prevention of Dysfunctional Behavior in Adolescents Diagnosed within the Category of Pervasive Development Delay

4 The Learning Clinic Presented by: Raymond W. DuCharme, Ph.D. Kathleen A. McGrady, Psy. D., ABDA Pamela Ruff, Transition School Faculty September 17, 2004 Child & Family and DMHAS Agency A Scholar in Residence Workshop Hilton Garden Inn, Glastonbury, CT

5 Introduction What is a pervasive developmental delay? Is a diagnostic description of Pervasive Development Delay not otherwise specified, helpful to the individual, his family and those responsible to provide treatment? The purpose of a diagnosis are to precisely describe a condition in need of treatment, and to determine from the described symptoms a preferred regimen of treatment. Further, the diagnosis should predict that if a treatment is provided then a forecast may be made of a prognosis.

6 The Learning Clinic Pervasive Development Disorder Category of Diagnosis that includes Autism, Retts Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy.

7 The Learning Clinic Asperger Syndrome Criteria DSM-IVICD-10 Qualitative impairment in social interaction XX Restricted repetitive and stereotyped patterns of behavior, interests, and activities XX No general language delay XX No delay in cognitive development XX Normal general intelligence (most) X Markedly clumsy (common) X No delay in development of: age appropriate self-help skills adaptive behavior (excluding social interaction) curiosity about environment X

8 Differential Diagnosis Pervasive Developmental Disorders DiagnosisOnset of Symptoms GenderSocial Skills Head Circumference Language Skills Cognitive Functioning Motor Skills Autism Prior to age 3 years. Symptoms in infancy are subtle Males (8 times greater than females) Social skill deficits Delay, or lack of development 75% have mental retardation Repetitive and Stereotyped Retts Disorder Five months normal development; diagnosed between 5-48 months FemalesLoss of social interaction early; may develop later Decelerates between 5-48 months Expressive and receptive language problems Severe to profound retardation Hand- Wringing gait and truck coordination problems Childhood Disintegrati ve Disorder Two years normal development; diagnosed before age 10 Males – more common Loss of social skills (after age 2 years) Expressive or receptive (after age 2 years) Severe mental retardation (usually) Loss of motor skills after age 2 years Asperger Syndrome Recognition and diagnosis later (e.g., school age, between ages 7-11 years) Males (8 times greater than females) Social skill deficits No general delay in language; but pragmatic language deficits. Theory of Mind- Subvocal Speech Normal IQ Verbal Performance Deviation Motor delays and clumsiness Absence of research PDD, NOS Does no meet criteria for any of the above, but has some of the behaviors The Learning Clinic, Inc.

9 DSM-IV - ICD Diagnostic Criteria Unclear diagnostic criteria result in error and misdiagnosis. Misdiagnosis causes error in the selection of type and duration of treatment. Treatment misapplications yield poor prognosis and little evidence of efficacy Precise differential diagnosis of pervasive developmental delays evident in the symptom profile of an individual currently remain problematic. And the consequent ramifications are also evident.

10 DSM-IV - ICD Diagnostic Criteria Gillbergs six criteria (Elhers and Gillberg 1993) comprise social impairments, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems and motor clumsiness. Gillberg includes Szatmaris (1989) criteria and Tantams (1988) five criteria. The ICD-10 and DSM-IV note an absence of any clinical delay in language and cognitive development in the first 3 years of life. The DSM-IV adds no delay in the development of self-help skills, adaptive behavior, and curiosity about the environment. / Continued

11 The Learning Clinic Asperger Syndrome Criteria Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis.

12 The Learning Clinic Other Developmental Issues Deviation from normal development Do not Outgrow Developmental Deficits Stress Impairs Performance Co-Morbid Diagnosis Impairs Overall Functioning

13 The Learning Clinic Cognitive Functioning Medications

14 The Learning Clinic Psychological Symptoms Age / Time

15 The Learning Clinic Clinical Symptoms and Learning Disabilities Grade

16 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay C O G N I T I O N Memory Higher Order Process Analysis, Synthesis, and Evaluation Organization Flexibility

17 The Learning Clinic Asperger Syndrome Pervasive Developmental Delas C O G N I T I O N Wide Band of Knowledge Problem Solving Verbal-Performance IQ Attention Shift Rule and Governing Behavior

18 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay L A N G U A G E Pragmatics Syntax Meaning: Connotative Denotative

19 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay L A N G U A G E Processing Speed Expression Duration

20 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay S P E E C H Prosody Pedantic Elocution Volume

21 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay M O T O R Fine Control Gross Control Coordination Regulation

22 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay S E N S O R Y P R E C E P T I O N Visual Integration Kinesthetic Tactile Accuity Gestalt Integration of other Senses

23 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay S O C I A L Cue Identification Responsive to others Isolate Rude Aggressive

24 The Learning Clinic Asperger Syndrome Pervasive Developmental Delay S O C I A L Boundary Acceptance Maintain Social Roles (e.g., student, son, daughter, friend) Self-Regulate

25 The Learning Clinic Developmental Tasks of Adolescence: Ages Achieving new and more mature relations with age-mates of both sexes Achieving a masculine or feminine social role Accepting ones physique and using the body effectively Achieving emotional independence of parents and other adults

26 The Learning Clinic Developmental Tasks of Adolescence: Ages Preparing for marriage and family life Preparing for an economic career Acquiring a set of values and an ethical system as a guide to behavior; developing an ideology Desiring and achieving socially responsible behavior / Continued

27 The Learning Clinic Developmental Tasks of Early Adulthood Selecting a mate Achieving a masculine or feminine social role Learning to live with a marriage partner Starting a family Rearing children Managing a home

28 The Learning Clinic Education: Asperger Student Classroom Behavior 1. Attending Behavior Discern Task Expectations Focus Attention on Relevant Stimuli Shift Attention to Relevant Stimuli Ignore Irrelevant Material Perform Multi-Task Operations

29 The Learning Clinic Education: Asperger Student Classroom Behavior 2. Responding Behavior Verbal Skills Pragmatic Language Skills Writing Ability Executive Function Ability Perseverance STM for Denotative Items

30 The Learning Clinic Education: Asperger Student Classroom Behavior 3. Reinforcement Behavior Provide Contingent Positive Social Reinforcement Assert Negative Reinforcement in an Appropriate Way Receive Positive Reinforcement Ability to Respond to Positive Reinforcement

31 The Learning Clinic Education: Asperger Student Classroom Behavior 4. Initiating Behavior Self - Initiate Classroom Routines Use CAI Prompts Start Task According to Direction

32 The Learning Clinic Education: Asperger Student Classroom Behavior 5. Comply / Demonstrate Rule - Governed Behavior Accept Correction from Instructor Accept Correction in Public Setting Self - Correct Assignments to Pre - determined Standards

33 The Learning Clinic Education: Asperger Student Classroom Behavior 6.Completing Behavior Perform Tasks to Standards Return Completed Product to Supervisor

34 The Learning Clinic Education: Asperger Student Classroom Behavior 7. Transitioning Behavior Initiate Independent Steps between Tasks Use Prompts / Cues to Signal Move from One Task to Another

35 The Learning Clinic Education: Asperger Student Classroom Behavior 8. Cooperating Behavior Taking Turns Waiting Avoid Arguing Sharing Making Requests Before Acting

36 The Learning Clinic Education: Asperger Student Classroom Behavior 9. Adapting Behavior Adjust to Different Routines in Different Classrooms Adjust to Alteration in Routine Follow New Routine Required by a Situation

37 The Learning Clinic Education: Asperger Student Classroom Behavior 10. Cooperate with Medication Administration 11. Complete Homework 12. Attend School Discern Task Expectations Focus Attention on Relevant Stimuli Shift Attention on Relevant Stimuli Ignore Irrelevant Material Perform Multi-Task Operations

38 The Learning Clinic Competing Clinical Behaviors Perseveration Obsessive Thought Rigid Cognitive Style Inability to Shift from Personal View to Data - Based Decision

39 The Learning Clinic Competing Clinical Behaviors Confabulation Affirming False Information Stealing Sexually Inappropriate Actions and Statements / Continued

40 The Learning Clinic Competing Clinical Behaviors Violation of Boundaries Cognitive Disorientation and Distortion / Continued

41 The Learning Clinic Optimal Classroom Behaviors Closed Classroom Applied Task - Oriented Setting Standards are Limited, Precise and Based on Asperger Students Level of Ability to Self - Regulate Class Size Under 10 - Over 3

42 The Learning Clinic Optimal Classroom Behaviors Cues and Prompts are Provided a.Daily Plan / Organizer b.Assigned Work Station c.CAI Task Presentation Clear System of Discipline Consistently Applied Setting Wide / Continued

43 The Learning Clinic Optimal Classroom Behaviors Classroom Mix Controlled Interpersonal Style of Teacher: Direct, Non-Judgmental, Organized Task Analysis Reflects: a.Backward Chaining b.Performance Standards c.Over - Learning Options / Continued

44 The Learning Clinic Optimal Classroom Behaviors Control Risk Minimize Transitions / Continued

45 The Learning Clinic Writing a News Story Associated Press Hurricane Ivan Blasts Alabama, Kills 12 GULF SHORES, Ala. (AP) - Hurricane Ivan slammed into the Gulf Coast early Thursday with 130 mph wind, launching tornadoes, washing out a major bridge and hurling metal signs through the night. At least 12 U.S. deaths were blamed on the storm, but officials said the toll and the damage could have been even worse. Up to 15 inches of rain were expected as the storm moved inland. It weakened by late morning, but remained a Category 1 hurricane with wind of 75 mph eight hours after its 3 a.m. landfall.

46 The Learning Clinic Writing a News Story Directions: Writing a News Story Write a news story using what you consider the most relevant facts listed by numbered sentences. First - read all the sentences and answer the question What is the main point of the numbered sentences that are related Second - arrange the sentences into a one paragraph news story Third - be sure your first sentences is the main theme of the news story. Fourth - place other sentences in order of story organization Fifth - be prepared to explain why the sentences you did not use did not belong in the story Sixth – read your story aloud and make any changes Seventh – compare your story with one written by another student

47 The Learning Clinic Writing a News Story Relevant and Irrelevant Information 1.Colorado experienced a severe winter storm today 2.Denver, Colorado international airport is located on a high mountain plateau 3.Low visibility and storms make a landing dangerous at the Colorado airport 4.A plane crashes in an attempt to land at Denver Colorado 5.Rescue efforts were started within minutes of the crash 6.Pilot training on simulators is important 7.Many people fear flying 8.The number of survivors in today's plane crash in Colorado is unknown 9.Colorado has many large ranches 10.People travel to Denver, Colorado by cars more than other types of transportation

48 The Learning Clinic What are the Priorities of the Asperger Syndrome Student? The Learning Clinic

49 RankDecember /04 Group RankSeptember /05 Group 1. Independence 1. Independence Work Experience 2. Work Experience 2. Social Activities 3. a. Shared Living vs. b. Resources 3. a. Problem-Solving b. Resources Living Alone Priorities of the Asperger Student

50 The Learning Clinic RankDecember /04 Group RankSeptember /05 Group 4. a. Social Activities b. Medication 4. College Experience 5. College Experience 5. Shared Living vs. Living Alone 6. Problem-Solving 6. Living Alone Priorities of the Asperger Student

51 The Learning Clinic How Can We Assess Readiness for Independence? The Learning Clinic Pragmatic Skills Survey The Learning Clinic Transition & Independent Living Skills Assessment

52 The Learning Clinic Social Skills Training Effective Social Skills Training should include the following components: Comprehensive and Integrated approach Incorporate Changes in Development Tasks/Challenges

53 The Learning Clinic Social Skills Training Comprehensive & Integrated: Multiple Settings Clinical Therapy Groups Hands-on Role-plays Video Feedback Classroom Home/Residential House

54 The Learning Clinic Social Skills Training Comprehensive & Integrated: Self-Regulation Self-Restraint Point/Level System Extended School Day Social Skills Goal Community Young Apprenticeship – Work Setting Job Shadowing / Continued

55 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Social Skill requirements change as the Child goes through different developmental stages Social Skills learned at earlier developmental stage do not always generalize to challenges at next developmental stage

56 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Mastery of skill at one developmental level does no ensure generalization to social challenges at next developmental level / Continued

57 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Social challenges change Childhood to Adolescence: Childhood casual friendships based on unconditional acceptance generally concrete communication parallel interactions / Continued

58 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Social challenges change Childhood to Adolescence: Adolescence competition for social acceptance based on popularity need to read nonverbal communication / Continued

59 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Childhood to Adolescence: Adolescence must interpret increasingly abstract and complex communication interactions include reciprocity and ability to intuit the feelings and thoughts of others / Continued

60 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Adolescence to Young Adulthood Adolescence Parents are caretakers Young Adulthood Independent Living: employment driving college integration into community accessing community services / Continued

61 The Learning Clinic Social Skills Training Social Skills and Developmental Tasks/Challenges Adolescence to Young Adulthood Young Adulthood Independent Living: self-advocacy finances legal rights/responsibilities health needs maintaining an apartment grocery shopping and meal preparation / Continued

62 The Learning Clinic Which Asperger Symptoms Compete with Independence? Degree of Anosognosia Age Over time, symptoms become egosyntonic

63 The Learning Clinic Time - 5 Treatment and Non-treatment Students Skill Assessment T5 Skills Showing Significant Improvement by Treatment vs. Non-Treatment Students T5 Sep Oct Nov Dec Jan Feb Mar Time Line for Data Collection Housing Acquisitions & Leases Home Management Meal Planning & Preparation Dining Clean Up & Food Storage Budgeting & Taxes Banking & Credit Consuming Transportation Leisure Legal Awareness Health Time Management Maintain Personal Safety in House Maintain Personal Safety in Community Safety During Dating Relationships Personal Presentation Community Resources Community Service Career Planning Employment Post-Secondary Education Participation in Therapy Sessions

64 The Learning Clinic Housing Acquisitions & Leases Meal Planning & Preparation Dining Clean Up & Food Storage Consuming Transportation Legal Awareness Health Time Management Maintain Personal Safety in House Maintain Personal Safety In Community Safety During Dating Relationships Community Resources Community Service Career Planning Employment Post-Secondary Education Healthy Relationships Home Management Budgeting & Taxes Banking & Credit Leisure Personal Presentation 22% Transition Program Independent Living Skills - Areas of Significant Progress % of Skills (5 of 23) Significantly Increased from T1 – T4

65 The Learning Clinic Housing Acquisitions & Leases Budgeting & Taxes Banking & Credit Consuming Transportation Leisure Legal Awareness Time Management Maintain Personal Safety in Home Maintain Personal Safety in Community Safety During Dating Relationships Community Resources Community Services Career Planning Employment Post Secondary Education Health Post-Secondary Education Healthy Relationships Home Management Leisure Personal Presentation Time Management 70% Significant Improvement Transition Program Independent Living Skills - Areas of Significant Progress % of Skills (16 of 23) Significantly Increased T5 at 7 Months

66 The Learning Clinic Home Management Dining Clean UP & Food Storage Nutrition Banking & Credit Transportation Legal Awareness Health Time Management Safety During Dating Relationships Personal Safety Independent Living Career Planning Employment Post-Secondary Education 22% T1 Comparison: Student Self-Assessment vs. Teacher Assessment Comparison % of Skills (12 of 23) Students rated themselves significantly higher than Teachers at T1 52% Skills Students Self-assessed higher than Teachers Assessed

67 The Learning Clinic Clean UP & Food Storage Leisure Health Time Management Safety During Dating Relationships Personal Presentation Career Planning Employment Healthy Relationships 22% T5 Comparison: Student Self-Assessment vs. Teacher Assessment Comparison % of Skills (9 of 23) Students rated themselves significantly higher than Teachers at T5 39% Skills Students Self-assessed higher than Teachers Assessed

68 The Learning Clinic What Is on the Horizon for Asperger Students? Early Diagnosis Pediatric Training Teacher Training Psycho - Education Treatment Cognitive Behavioral Therapy

69 The Learning Clinic What Is on the Horizon for Asperger Students? Technology Distance Coaching (remote video monitoring) Computer Checklists and Prompting Computer Assisted Instruction (CAI)

70 The Learning Clinic What Is on the Horizon for Asperger Students? Technology / Continued Kurtzweil Dragon Naturally Speaking

71 The Learning Clinic... because every child can succeed! End

72 To view this Presentation - or other TLC Presentations, visit The Learning Clinic web site: Then click to the - Conferences and Presentations page.


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