1 "I KNOW we're not supposed to use this word, but"I KNOW we're not supposed to use this word, but... IS MY KID'S BEHAVIOR NORMAL?" Presented by : Dave Sylvestro + Gail Gaiser

2 Sorry but….. Just because your child has a disability, you don’t get to miss all the stages of development…... Fun stages and Difficult Stages are going to happen…..

3 Consternation-Causing Behaviors in Teens with CTA (Chronological Teen Ager-itis)1. Lying • fear of the consequences for their behavior • fear that you will be upset or withdraw love if they tell you the truth. • take the easy way out — it’s a way to not have to take responsibility. 2. Arguing. • a means to assert independence • seeking parental approval for their way of viewing the world (however skewed that might be!) 3. Defiance. • a means to demonstrate strength • making their own decisions is a sign that they don’t need parental guidance and authority

4 Consternation-Causing Behaviors in Teens with CTS (Chronological Teenager-itis Syndrome)4. The “awkward” phase. • Not “acting out”; rather “acting in” • Self-consciousness, crises of confidence, social isolation • Unpredictable mood 5. Abandoning commitments. • Activity choices change (based more on friends than facility) • Willingness to invest time and energy in an activity wanes • *Important to teach kids the value of commitment by setting reasonable expectations BEFORE starting the activity 6. Withdrawal. • Teens often engage / communicate with family less • Kids begin to emulate their peer groups mannerisms, tastes, and values rather than their family’s • *Important to articulate and reinforce FAMILY values on an ongoing basis rather than preaching and lecturing in crisis

5 Consternation-Causing Behaviors in Teens with CTS (Chronological Teenager-itis Syndrome)7. Attitude. • Eye-rolling, deep exasperated sighs, know-it-all tone, etc. • Inconsiderate of others (except friends…) • Tantrums • Increased distance between them and their lame-o family 8. Impulsivity. • Ready. FIRE. Aim. • Acting without thinking through outcomes • Engage in high risk behaviors • choices often don’t reflect a rational reasoning process • Prefrontal cortex on vacation…

6 • Fatigue, hormonal distraction, compelling agenda of independence Consternation-Causing Behaviors in Teens with CTS (Chronological Teenager-itis Syndrome) 9.    Academic problems. • School performance can TEMPORARILY assume a lower rung on the priority ladder • Fatigue, hormonal distraction, compelling agenda of independence • *Important to reinforce performance/consequence connection & set realistic grade expectations 10.    Curfew violations. • Yet another assertion of independence and power • Time with friends trumps punctuality • *Important to maintain curfews to model the value of punctuality and responsibility

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8 Asperger’s Syndrome as defined by DSM IVThe following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV] (I) Qualitative impairment in social interaction, as manifested by at least two of the following: (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction (B) failure to develop peer relationships appropriate to developmental level (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people) (D) lack of social or emotional reciprocity (II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following: (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (B) apparently inflexible adherence to specific, nonfunctional routines or rituals (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) (D) persistent preoccupation with parts of objects (III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning. (IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years) (V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood. (VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia." American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

9 Social Communication Disorder as defined by DSM VDiagnostic Criteria A.      Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: 1.       Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context. 2.       Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language. 3.       Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction. 4.       Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation). B.      The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. C.      The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). D.      The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.  https://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

10 Learning DisabilitiesA learning disability is a neurological condition that interferes with an individual’s ability to store, process, or produce information. Learning disabilities can affect one’s ability to read, write, speak, spell, compute math, reason and also affect an individual’s attention, memory, coordination, social skills and emotional maturity. https://ldaamerica.org/support/new-to-ld/#defining

11 ADD/ADHD Attention Deficit Hyperactivity Disorder is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5 percent of children have attention deficit hyperactivity disorder (ADHD), or approximately 2 million children in the United States. This means that in a classroom of 24 to 30 children, it is likely that at least one will have ADHD. ADHD is not considered to be a learning disability. It can be determined to be a disability under the Individuals with Disabilities Education Act (IDEA), making a student eligible to receive special education services. However, ADHD falls under the category “Other Health Impaired” and not under “Specific Learning Disabilities.” Many children with ADHD – approximately 20 to 30 percent – also have a specific learning disability. The principle characteristics of ADHD are inattention, hyperactivity, and impulsivity. There are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive/impulsive type (that does not show significant inattention); The predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms). Other disorders that sometimes accompany ADHD are Tourette Syndrome (affecting a very small proportion of people with ADHD); oppositional defiant disorder (affecting as many as one-third to one-half of all children with ADHD); conduct disorder (about 20 to 40% of ADHD children); anxiety and depression; and bipolar disorder. *National Institute of Mental Health, 2003

12 Comorbid Conditions- autismDISORDERS COMMONLY ASSOCIATED WITH AUTISM AND ASPERGER'S Research indicates people on the autism spectrum may be far more likely to have the associated conditions. People with Aspergers syndrome symptoms may also be diagnosed with: • Gastrointestinal disorders • Sensory problems • Seizures and epilepsy • Intellectual disability • Fragile X syndrome • ADHD • Bipolar disorder • Obsessive compulsive disorder • Tourette syndrome • General anxiety disorder • Tuberous sclerosis • Clinical depression • Visual problems.

13 Comorbid conditions- LDRelated Neurologically-Based Disorders Cortically-Based Disorders- such as epilepsy Learning Disabilities Language Disabilities Motor Coordination Disorder Organization/Executive Function Disorders Attention-Deficit/Hyperactivity Disorder Regulatory Disorders Anxiety Disorders Depression Anger Control Problems Obsessive-Compulsive Disorder Tic Disorders Bipolar Disorder https://ldaamerica.org/what-you-should-know-about-related-disorders-of-learning-disability/

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15 Differences in behavioral issues in students with ASD-how does it manifest behaviorally?May overreact to seemingly benign situations with no overt antecedent Sensory issues – can be overwhelming- hypo or hypersensitivity Issues with physical space- too close, too far

16 Differences in social interaction- in students with ASD-how does it manifest socially ?Intrinsic motivation for social interaction Must make social skills a conscious act Modeling – if they learned from just modeling then they would have learned by now from family and peers Difficulty with perspective taking and vocal tone Self stimulatory behaviors

17 Differences in academic performance in students with ASD-How does it manifest academically?Difficulty with figurative language Generalization of skills Perspective taking Discrimination of relevant vs. irrelevant information- note taking, essay writing, presentations

18 Meta cognitive and meta linguistic differences- how do they manifest in students with ASD?Difficulty talking or writing about speaking or writing Executive function issues- time management, planning, organization of materials/content Lack of synthesis leads to lack of generalization or total overgeneralization and rigidity

19 Difference in behavioral approaches for students with ASDSocial rules are not “naturally” learned Rules need to be specific and concrete Consistency, consistency, consistency Beware of routinized and rigid behavior patterns Difficulty with transitions and unstructured times “time out” is a reward

20 Difference in social skills training approaches with ASD studentsDiscussion of need for interaction – purpose and benefits Social rules need to be made conscious Body language, vocal tone, phrasing and facial expressions must be addressed Acceptance of rule changes- particularly around food Practice opportunities are key to generalization

21 Differences in academic approaches with ASD studentsTEACCH ABA Floor time Sensory issues and their academic impact Social issues and their academic impact

22 References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. https://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria https://ldaamerica.org *National Institute of Mental Health, 2003

23 Resources