The Learning Clinic
DMHASDMHASChild & FamilyAgency
A Scholar in Residence
Workshop
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Nurturing the Healthy Nurturing the Healthy Development of Development of
Young People with Young People with Aspergers SyndromeAspergers Syndrome
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The Learning Clinic Brooklyn, Connecticut
Presented by:
Raymond W. DuCharme, Ph.D.Kathleen A. McGrady, Psy. D.,
ABDA
Hilton Garden Inn, Glastonbury, CT
April 04, 2006
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Transition Needs and Services
and
Transfer of Rights Statement
Presented by:
Founder and Executive Director, The Learning Clinic
Dr. Raymond DuCharme
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1990 - Congress Introduces Provision into
IDEA• Public agencies required to provide
students with disabilities aged 16 and older with appropriate instruction in community experiences, development of employment, and other post-school objectives
• When appropriate, also provide instruction in independent living skills and functional vocational evaluations
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1997 - Congress introduces new requirements in the IDEA further expanding transition
services• All LEA’s required to include statement of
Transition Services in child’s IEP
• The purpose: “focus attention on how the child’s education program can be planned to afford a successful transition to his or her goals for life after secondary school”
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President’s Commission on Special Education analyzed
outcome of 12 years of Transition Services
Results: (Compared to nondisabled peers)
• Students with disabilities are unemployed and under-employed when they leave school
• Too many students with disabilities leave school without earning any type of diploma
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Results: (Compared to nondisabled peers)(continued)
• Students with disabilities attend postsecondary programs at rates lower than their nondisabled peers
• Adults with disabilities are much less likely to be employed than adults without disabilities
• Unemployment rates for working-age adults with disabilities have hovered at the 70% level for at least the past 12 years
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• Conclusion: The Commission determined that statistics reflected failures in the 1997 Transition Services Structure and recommended the IDEA Transition Requirements be amended.
• Action: Congress made several changes to the Transition Requirements in response to those concerns.
• Result: The new definition of Transition Services has been amended to reflect the reauthorization's emphasis on achievement.
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• Transition Services: The term ”Transition Services” is now defined to mean a coordinated set of activities for a child with a disability that:
• Is designed within a results-oriented process focused on improving the academic and functional achievement of the child with a disability to facilitate his or her move from school to post-school activities, including postsecondary education, vocational education, integrated employment.
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• Transition Services (continued)
• Is based on the individual child’s needs, taking into account his or her strengths, preferences and interests.
• Includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives and, when appropriate, acquisition of daily living skills and functional vocational evaluation.
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• New Changes: In addition, the law modifies the age at which student begin to receive Transition Services. Under the new law, the first IEP that will be in effect when a child is 16 years old must contain:
• Appropriate measurable postsecondary goals based on age-appropriate transition assessments related to training, education, employment, and, when appropriate, independent living skills.
• A description of Transition Services, including courses of study, needed to assist the child in reaching those goals.
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• Changes to the Existing Law:
• Under the old IDEA, IEP’s for children aged 14-16 needed to include a statement regarding the child’s Transition Services.
• This was intended to focus on coursework to effectively prepare children to receive Transition Services at age 16.
• IEP’s developed for children aged 16 or older were required to include a description of needed Transition Services.
• The new law eliminates the requirement for children aged 14-16.
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• Changes to the Existing Law: (continued)
• Now, children with disabilities must be provided Transition Services starting in the school year that they turn 16.
• Should a participating agency fail to provide the Transition Services, the LEA must reconvene the IEP team to identify alternative strategies to meet the Transition Objectives for the child set out in the program.
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• Continued Provisions of the Prior Law:
• As under the prior law, if a child with a disability is convicted as an adult under state law and incarcerated in an adult prison, the child’s IEP need not contain a statement of Transition Services if that child will “age out” of special education prior to release from prison.
• The IDEA also retains the requirement regarding transfer of IDEA rights from parents to child when the child reaches the age of majority.
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• Continued Provisions of the Prior Law:
• At least one year before a child reaches the age of majority under state law, the IEP must include a statement the child has been informed of the rights under the IDEA that will transfer to the child on reaching the age of majority.
• These rights include all rights accorded to a parent of a disabled child when the child is a minor. The purpose of the statement is to clarify who holds those rights when the child reaches adult age.
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TheLearningClinic
Transition ProgramTransition Program
A Model for StudentA Model for Student
based Independencebased IndependenceTransition to Community-Transition to Community-
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Pervasive Development Disorder
Category of Diagnosis that includes Autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDD NOS. Historically, other diagnostic labels in this category have included Childhood Schizophrenia and Autistic Psychopathy.
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Who is theWho is the AspergerAsperger Individual?Individual?
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Asperger Syndrome Criteria
DSM-IV ICD-10
Qualitative impairment in social interaction X X
Restricted repetitive and stereotyped patterns of behavior, interests, and activities
X X
No general language delay X X
No delay in cognitive development X X
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
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Asperger Syndrome Criteria
Pragmatic language skill deficits not part of DSM-IV or ICD-10 criteria but should be included for differential diagnosis.
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Other Developmental Issues
Deviation from normal development
Do not “Outgrow” Developmental Deficits
Stress Impairs Performance
Co-Morbid Diagnosis Impairs Overall Functioning
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Cognitive Functioning
Med
icati
on
s
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Psychological Symptoms
Ag
e /
Tim
e
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Clinical Symptoms and Learning Disabilities
Gra
de
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Asperger SyndromePervasive Developmental
DelayC O G N I T I O N
Memory
Higher Order Process Analysis, Synthesis, and Evaluation
Organization
Flexibility
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Asperger SyndromePervasive Developmental
DelayC O G N I T I O N
Narrow Band of Knowledge
Problem Solving Deficit Verbal-Performance IQ
Attention Shift Problem: Too Short or Too Long
Limited Perspective / Restricted Point of View
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L A N G U A G E
Pragmatics
Syntax
Meaning: Connotative Denotative
Asperger SyndromePervasive Developmental
Delay
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L A N G U A G E
Processing Speed
Expression
Duration
Asperger SyndromePervasive Developmental
Delay
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S P E E C H
Prosody
Pedantic
Elocution
Volume
Asperger SyndromePervasive Developmental
Delay
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Asperger SyndromePervasive Developmental
Delay M O T O R
Fine Control
Gross Control
Coordination
Regulation
Proprioceptive Feedback
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S E N S O R Y P R E C E P T I O N
Visual Integration
Kinesthetic Sense
Tactile Accuity
Gestalt
Integration of other Senses
Asperger SyndromePervasive Developmental
Delay
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S O C I A L
Cue Identification
Responsive to others
(Isolate) Social Interaction Initiative
Rude / Insensitive to Social Conventions
Aggressive: Verbally & Physically
Asperger SyndromePervasive Developmental
Delay
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S O C I A L
Boundary Acceptance
Maintain Social Roles(e.g., student, son, daughter, friend)
Self-Regulate with and without Stressor
Asperger SyndromePervasive Developmental
Delay
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Competing Clinical Behaviors
Perseveration
Obsessive Thought
Rigid Cognitive Style
Inability to Shift from “Personal View” to Data - Based Decision
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Competing Clinical Behaviors
Confabulation
Affirming False Information
“Stealing”
Sexually Inappropriate Actions and Statements
Pornography Interests
/ Continued
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Competing Clinical Behaviors
Violation of Boundaries
Cognitive Disorientation and Distortion
/ Continued
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Suicide Ideation Data
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Suicide Ideation Data Seasonal Frequency
10
8
6
4
2
0
January – December 2005
Winter (10)
Spring (7)
Summer (4)
Fall (3)
Suicide Ideation Data: Jan-Dec 2005
Total No. of Students Observed:
66
Total No. of Students with S.I.s:
16 (Males - 9) (Females - 7)
% of Students with S.I.s:
24%
Dec-Feb
Mar-May
Jun-Aug
Sep-Nov
Total Number of S.I.s Jan - Dec 2005 = 24
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Suicide Ideation Data Number of Repeat Incidents by
Season
10
8
6
4
2
0
January – December 2005
Winter (7)
Spring (5)
Summer (1)
Fall (2)
Suicide Ideation Data: Jan-Dec 2005
Total No. Students with Repeat S.I.s:
7 (7 of 16 = 44%)
Dec-Feb
Mar-May
Jun-Aug
Sep-Nov
Total Number of Repeat S.I.s Jan - Dec 2005 = 15
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Suicide Ideation Data Number of Incidents by Student Age
GroupJanuary – December 2005
7/8 (1) 1
10/11 (2) 3
11/12 (1) 3
12/13 (1) 1
13/14 (1) 1
14/15 (1) 2
15/16 (1) 1
16/17 (2) 4
17/18 (3) 3
18/19 (2) 3
20/21 (1) 2
Student Age Groups (Number of Students by Age Group)
Number of S.I.s by Age Group
No. of Students: 16 No. of Incidents: 24
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Suicide Ideation Data Number of Incidents by Gender
January – December 2005
No. of Students: 16
GenderNo. of S.I.s
% of S.I.s
Males 15 63%
Females 9 38%
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Suicide Ideation Data Number/Percentage of Incidents by
DiagnosesJanuary – December 2005
Diagnoses
Bipolar 12 50%
Depression 3 12.5%
(Bipolar & Depression / Combined)
(15) (62.5%)
Asperger’s 4 16.7%
Schizophrenia 2 8.3%
ODD/Intermittent Exp DO 2 8.3%
ADHD Comb/GAD 1 4.2%
No. of S.I.s % of S.I.s
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Suicide Ideation Data Number of Ideations vs. Suicide
AttemptsJanuary – December 2005
Suicide Ideation:
16 Students
24 Ideations (16 Repeats)
Suicide Attempts:
16 Students
0 Attempts
Ideations: 24 Attempts: 0
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What are theWhat are the PrioritiesPriorities
of the of the AspergerAsperger Syndrome Syndrome
Student?Student?
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Priorities of the Asperger Student
1. Independence How to find and use resources
and self-advocate
2. Work Experience Paid employment and volunteer
work
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Priorities of the Asperger Student
3A. Shared Living versus Living Alone
Advantages and disadvantages of each
3B. Resources
How to find resources, e.g., doctors,therapists, etc.
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Priorities of the Asperger Student
4A. Social Activities
How to find resources for fun activities?
How to make friends and find others with common interests?
How to deal with the tendency to isolate?
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Priorities of the Asperger Student
4B. Medication
How do you know when you need medication
Who do you go to for help
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Priorities of the Asperger Student
5. College Experience
What it takes to be successful in college
6. Problem-Solving
How to partner with others to solve problems
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Priorities of the Asperger Student
6. Problem-Solving / Continued
Expressing issues openly
Independent problem-solving versus teaming
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Which Asperger Symptoms Compete with
Independence?
Degree of Anosognosia
Ag
e
Over time, symptoms become egosyntonic
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How Do Students How Do Students Assess Assess
and Comment on and Comment on Their Their
Experience?Experience?
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How Can We Assess Readiness for
Independence?
The Learning Clinic Pragmatic Skills Survey
The Learning Clinic Transition & Independent Living Skills Assessment
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Independent Living Skills
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HousingHousing Acquisition &
Leases
Home Management
NutritionMeal Planning &
Preparation
Dining
Clean-up & Food Storage
Money Mgmnt. Budgeting & Taxes
Banking & Credit
Consuming
Transportation
Leisure
Legal
Health
Time Mgmnt.
Personal Safety Personal Safety - Home
Personal Safety - Community
Personal Safety - Relationships
Personal Presentation
Community Participation
Community Resources
Community Service
Vocational Readiness Career Planning
Employment
Post-Secondary Education
Healthy Relationships
Participation in Therapy
Independent Living Skills
Significant Differences Between Treatment & Non-Treatment Groups in November 2005.
Treatment Group Scored Significantly Higher than Non-Treatment Group in 2 Categories:
• Housing Acquisition & Leases
• Vocational Readiness/Employment
• Money Mgmt/Consuming
• Personal PresentationIndependent Living Skills The Learning Clinic
Treatment Group vs. Non- Treatment
Group November, 2005
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HousingHousing Acquisition &
Leases
Home Management
NutritionMeal Planning &
Preparation
Dining
Clean-up & Food Storage
Money Mgmnt. Budgeting & Taxes
Banking & Credit
Consuming
Transportation
Leisure
Legal
Health
Time Mgmnt.
Personal Safety Personal Safety - Home
Personal Safety - Community
Personal Safety - Relationships
Personal Presentation
Community Participation
Community Resources
Community Service
Vocational Readiness Career Planning
Employment
Post-Secondary Education
Healthy Relationships
Participation in Therapy
Independent Living Skills
Significant Differences Between Treatment & Non-Treatment Groups from November 2005 to February 2006.
Treatment Group Scored Significantly Higher than Non-Treatment Group in 4 Categories:
• Housing Acquisition & Leases
• Money Mgmt/Banking & Credit
• Money Mgmt/Consuming
• Personal PresentationIndependent Living Skills The Learning Clinic
Treatment Group vs. Non- Treatment
Group Nov 2005 – Feb 2006
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HousingHousing Acquisition &
Leases
Home Management
NutritionMeal Planning &
Preparation
Dining
Clean-up & Food Storage
Money Mgmnt. Budgeting & Taxes
Banking & Credit
Consuming
Transportation
Leisure
Legal
Health
Time Mgmnt.
Personal Safety Personal Safety - Home
Personal Safety - Community
Personal Safety - Relationships
Personal Presentation
Community Participation
Community Resources
Community Service
Vocational Readiness Career Planning
Employment
Post-Secondary Education
Healthy Relationships
Participation in Therapy
Independent Living Skills
Significant Decrease in Skills for Treatment Group Only from November 2005 to February 2006
Treatment Group Scored Significantly Lower in these 3 Categories:
• Nutrition/Meal Planning & Prep.
• Nutrition/Clean-up & Storage
• Community Resources/ Community Services
Independent Living Skills The Learning Clinic
Treatment
Group Nov 2005 – Feb 2006
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HousingHousing Acquisition &
Leases
Home Management
NutritionMeal Planning &
Preparation
Dining
Clean-up & Food Storage
Money Mgmnt. Budgeting & Taxes
Banking & Credit
Consuming
Transportation
Leisure
Legal
Health
Time Mgmnt.
Personal Safety Personal Safety - Home
Personal Safety - Community
Personal Safety - Relationships
Personal Presentation
Community Participation
Community Resources
Community Service
Vocational Readiness Career Planning
Employment
Post-Secondary Education
Healthy Relationships
Participation in Therapy
Independent Living Skills
Significant Decrease in Skills for Non-Treatment Group from November 2005 to February 2006
Non-Treatment Group Scored Significantly Lower in these 4 Categories:
• Housing/Home Management
• Nutrition/Meal Planning & Prep.
• Nutrition/Dining
• Nutrition/Clean-up & Food StorageIndependent
Living Skills The Learning Clinic
Non-Treatment
Group Nov 2005 – Feb 2006
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Independent Living Skills
Areas in which Students showed Significant Progress from Nov 2005 – Feb 2006: (6 0f 24)
• Housing Acquisition & Leases
• Banking & Credit
• Consuming
• Personal Safety in Relationships
• Personal Presentation
• Community ServiceAreas in which Students Showed Significant Regression from Nov 2005 – Feb 2006: (3 of 24)
• Nutrition/Meal Planning & Prep.
• Nutrition/Clean-up & Storage
• Community Resources/ Community Services
25%
12.5%
Percentage of Living Skills Significantly IMPROVED (25%) or REGRESSED (12.5%) from November 2005 to February 2006.
Treatment
Group Nov 2005 – Feb 2006
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What Is on the Horizon for Asperger Students?
Early Diagnosis
Pediatric Training
Teacher Training
Psycho - Education Treatment
Cognitive Behavioral Therapy
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What Is on the Horizon for Asperger Students?
Technology
Distance Coaching (remote video monitoring)
Computer Checklists and Prompting
Computer Assisted Instruction (CAI)
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What Is on the Horizon for Asperger Students?
Technology / Continued
Kurtzweil
Dragon Naturally Speaking
The Learning ClinicLCLCT
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. . . because every child can succeed!
end