MHMR T ARRANT S UPPORTING I NDIVIDUALS WITH A UTISM S PECTRUM D ISORDER AND I NTELLECTUAL D ISABILITY Monica Durham, PsyD Michael J. Parker, PhD MFP Webinar June 8, 2016

O VERVIEW The incidence of Autism Spectrum Disorder in children has grown to 1 in 50 by 2013 (CDC) “Spectrum” captures the great variability among how characteristics manifest among individuals. Characteristics include advantages and not simply impairments Interventions for individuals with ASD carries special considerations

ASD & ID Autism Spectrum Disorder (ASD) is classified in the DSM-5 as a Neurodevelopmental Disorder. Characterized by: Social Communication & Social Interaction deficits Restricted patterns of Behavior, Interests or Activities May or may not be accompanied by intellectual impairment.

ASD DSM-5 C RITERIA A. Persistent deficits in social communication & social interaction across multiple contexts 1. deficits in social-emotional reciprocity, ranging, for example from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions & non-verbal communication. 3. deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers

ASD DSM-5 C RITERIA B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history 1. stereotyped or repetitive motor movements, use of objects, or speech (e.g. simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases) 2. insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests) 4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

ASD & ID 8 Advantages of ASD Weigle, Hill & Millot Center for START Services Focus Unique global insights Internal motivation Attention to detail 3-dimensional thinking Cutting through the smoke screen Logical decision making

ASD & ID Autism Spectrum Disorder “versus” Intellectual Disability Intellectual Disability and Mental Health: A Training Manual in Dual Diagnosis (McGilvery & Sweetland, NADD)  Influences of intellectual functioning  Perceptions of the world.

ASD & ID Issues to consider Diagnostic Overshadowing Things that are not ASD or ID Rule-out’s

ASD & ID Trauma Regression Presentation in people who are nonverbal (Acting out – communicating through behavior)

ASD & ID People with ASD will need help with Identifying and Labeling feelings in self and others o Physical awareness of emotions Somatic Complaints o Feelings in the body & what they mean

ASD & ID What’s important when setting TX goals Set expectations based on abilities Don’t set expectations based on projections Verbal skills Empathic awareness Are stereotypy behaviors really an issue? Realistic goals

ASD & ID Best matched therapies Based on interests, verbal abilities, TX goals Social Stories Art therapy Play therapy Empathy training?

ASD & ID Generalization: Efficacy & Effectiveness of Therapies

ASD & ID Obsessions, Compulsions, and Perseveration

ASD & ID Questions & Responses

ASD & ID Monica Durham, PsyD Michael J. Parker, PhD