Autocuidado da criança com espectro autista por meio das Social Stories / Self-care of a child with autism spectrum by means of Social Stories

Objetivos: Aplicar o processo de enfermagem da teoria do autocuidado, de Dorothea Orem, e utilizar a Social Stories como ferramenta de aprendizagem aliada à teoria do autocuidado pela criança com Transtorno do Espectro Autista. Métodos: Estudo qualitativo, descritivo, caso único de uma criança com Síndrome de Asperger. Realizado no domicílio, fundamentado na teoria de Dorothea Orem, com utilização da Social Stories. Coleta de dados feita por meio de entrevistas semiestruturadas, anamnese e intervenções de enfermagem. Resultados: Realizaram-se três intervenções semanais para o estímulo ao autocuidado e avaliações com a mãe acerca da evolução da criança. Constatou-se a evolução da criança do sistema parcialmente compensatório para o sistema de apoio-educação, devido ao aumento da capacidade de autocuidado no banho, na escovação dos dentes e na higienização após as eliminações intestinais. Conclusão: A associação da teoria de Orem com a Social Stories apresentou-se como uma estratégia efetiva no estímulo ao autocuidado pela criança.

A Group-Administered social Skills Training for 8- to 12- Year-Old, high-Functioning Children With Autism Spectrum Disorders: An Evaluation of its Effectiveness in a Naturalistic Outpatient Treatment Setting.

A social skills training (SST) for high-functioning children with autism spectrum disorders (ASD) was evaluated in an outpatient setting using a combined between- and within-subject design in which SST and a waiting list condition were compared. According to parents and teachers, the SST produced greater improvement of social skills than the waiting list, and these effects were maintained at 3 months follow-up. No between-group effects were found for loneliness, although in general scores on this outcome measure decreased from pre- to follow-up. The effects of SST were unaffected by social anxiety, ADHD symptoms, Theory of Mind, or desire for social interaction. Altogether, SST seems an effective intervention for high-functioning children with ASD that can be applied in daily clinical practice.

Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder.

The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high functioning individuals with ASD (HFA), and 23 typically developing (TD) peers. HFA children displayed higher ratings than their peers on all BAP traits. OO were indistinguishable from TD, with the exception of greater extraversion (e.g., increased talkativeness), a potential tendency to be less emotionally stable, and pragmatic language deficits such as getting sidetracked in conversation. Overall, OO individuals are not showing BAP characteristics, but may be subject to other mild ADHD-like characteristics.

Entrenamiento para la mejora de disfunciones atencionales en niños y adolescentes con Síndrome de Asperger a través de estimulación cognitiva directa / Training to improve attentional dysfunction in children and adolescents with Asperger Syndrome through direct cognitive stimulation

Esta investigación analiza la capacidad de generalización del aprendizaje en niños y adolescentes con Síndrome de Asperger a aspectos cognitivos atencionales con demandas diferentes a las ejercitadas mediante la utilización de un programa de estimulación cognitiva directa. La muestra estuvo constituida por 15 casos con Síndrome de Asperger entre 7 y 15 años (M = 12; DT = 2.7) con dificultades atencionales, medidas a través de instrumentos de orientación psicométrica, a los que se aplicó un programa de entrenamiento en atención dos horas semanales durante seis meses consecutivos. Los resultados del análisis pretest-postest mostraron diferencias estadísticamente significativas en todos los subsistemas atencionales. En atención selectiva las diferencias son de magnitud moderada en las variables relacionadas con la velocidad de procesamiento, en mantenida el tiempo de reacción disminuyó considerablemente (magnitud de la diferencia moderada) y aumentaron los aciertos disminuyendo los errores (ambos con una magnitud de diferencia grande). En atención alternante se observó un mayor número de aciertos, y en dividida se obtuvieron mayores niveles de respuestas totales (los dos de magnitud moderada). Se concluye que el rendimiento atencional en los casos analizados mejora tras la aplicación de un programa de entrenamiento cognitivo específico siendo capaces de generalizar el aprendizaje a medidas psicométricas

This research analyzes the generalization ability of learning in children and adolescents with Asperger Syndrome to attentional cognitive aspects with different demands on exercised through the use of a direct cognitive stimulation program. The sample consisted of 15 cases with Asperger between 7 and 15 years (M = 12, SD = 2.7) with attentional difficulties, measured by psychometric orientation instruments, to which an attention training program was implemented to two hours per week for six consecutive months. The results of the pretest-posttest analysis showed statistically significant differences in all attentional subsystems. Selective attention differences are moderate in variables related to processing speed, in sustained attention the reaction time significantly decreased (moderate magnitude of the difference) and increased the successes reducing errors (both with a large magnitude difference) . In alternating attention, a greater number of successes were observed and in split attention higher levels of total responses (both moderate magnitude) were obtained. It is concluded that the attentional performance in the cases analyzed improvement after applying a cognitive training program specifically being able to generalize learning psychometric measures

[Well Educated Unemployed--On Education, Employment and Comorbidities in Adults with High-Functioning Autism Spectrum Disorders in Germany]. / Überdurchschnittlich ausgebildete Arbeitslose--Bildung, Beschäftigungsverhältnisse und Komorbiditäten bei Erwachsenen mit hochfunktionalem Autismus in Deutschland.

BACKGROUND: Based on clinical experience there is a discrepancy between the educational records and vocational performance in patients with high functioning autism spectrum disorder (ASD). METHOD: In order to assess psychosocial and vocational specificities of adult ASD patients we analyzed the demographic and hospital data of consecutively diagnosed patients employing descriptive statistics. RESULTS: We were able to include 255 patients into our sample who were consecutively diagnosed between October 2009 and October 2011. The gender ratio was 162:93 in favor of male patients. The educational records of our patient sample was comparatively good [50 % highest level of German schooling system (allgemeine Hochschulreife), 39 % university degree], however, the vocational records were poor with 58 % of our patients being unemployed. The psychiatric comorbidity was high, 57 % of the patients suffered from depression. CONCLUSION: There is a high need for special support programs for adult high functioning ASD patients focusing on adaptive vocational skills to avoid unemployment and secondary psychiatric problems.

Applying the ICF to identify requirements for students with Asperger syndrome in higher education.

UNLABELLED: Higher education requires more than academic skills and everyday student-life can be stressful. Students with Asperger syndrome (AS) may need support to manage their education due to difficulties in social functioning. OBJECTIVE: As preparation for the development of a structured tool to guide student and coordinator dialogues at Swedish universities, this study aimed to identify ICF categories that reflect requirements in everyday student-life for students with AS. METHODS: Using descriptive qualitative approach, information in documents reflecting the perspectives of university students, international classifications, user/health organisations and education authorities were linked to ICF codes. RESULTS: In total, 114 ICF categories were identified, most of which related to learning, tasks and demands, communication and interactions. CONCLUSION: Students with AS need varying accommodations to be successful in higher education. In the future, ICF-based code sets, including demands on student roles, can be used as checklists to describe functioning and needs for support.

Group training in interpersonal problem-solving skills for workplace adaptation of adolescents and adults with Asperger syndrome: a preliminary study.

Adults with Asperger syndrome show persistent difficulties in social situations which psychosocial treatments may address. Despite the multiple studies focusing on social skills interventions, only some have focused specifically on problem-solving skills and have not targeted workplace adaptation training in the adult population. This study describes preliminary data from a group format manual-based intervention, the Interpersonal Problem-Solving for Workplace Adaptation Programme, aimed at improving the cognitive and metacognitive process of social problem-solving skills focusing on typical social situations in the workplace based on mediation as the main strategy. A total of 50 adults with Asperger syndrome received the programme and were compared with a control group of typical development. The feasibility and effectiveness of the treatment were explored. Participants were assessed at pre-treatment and post-treatment on a task of social problem-solving skills and two secondary measures of socialisation and work profile using self- and caregiver-report. Using a variety of methods, the results showed that scores were significantly higher at post-treatment in the social problem-solving task and socialisation skills based on reports by parents. Differences in comparison to the control group had decreased after treatment. The treatment was acceptable to families and subject adherence was high. The Interpersonal Problem-Solving for Workplace Adaptation Programme appears to be a feasible training programme.

The effects of awareness training on tics in a young boy with Tourette syndrome, Asperger syndrome, and attention deficit hyperactivity disorder.

Previous research has shown habit reversal training (HRT) to be effective in reducing tics. In some studies, tics have been reduced by implementing only a few components of HRT. The current study investigated the first step, awareness training, for treating tics in a young boy with Asperger syndrome, Tourette syndrome, and attention deficit hyperactivity disorder. The results showed a reduction in all tics.

Students with disabilities in higher education - perceptions of support needs and received support: a pilot study.

Students with disabilities in higher education frequently need support to succeed in their studies. Perceived problems in managing studies and everyday life may be the same for students with different disabilities, although the reasons for support may vary between them. In this pilot study, a questionnaire aimed to survey everyday functioning in students with disabilities was tested. Thirty-four students with Asperger syndrome, motor disabilities or deafness/hearing impairments were asked 55 close-ended and open-ended questions on participation restrictions and available support programmes. One aim of this study was to test the usefulness of the questionnaire, and another aim was to identify students' perceptions of their everyday student life and the support they are offered, with a special focus on comparing perceptions of needs and support between students with Asperger syndrome and other student groups. The results indicate the need to plan recruitment of participants carefully and that the questionnaire was useful. The descriptive analyses indicated that the groups primarily reported the same difficulties; however, the open-ended comments indicated that the reasons for the problems vary between the groups. It indicates that Likert-type responses to questions concerning perceived difficulties need to be supplemented by open-ended questions on the perceived reasons to problems.

Autism litigation: outcomes for 2010, trends in decision making and changes in diagnostic criteria.

The diagnosis of autism spectrum disorder has systematically risen since Kanner's description in 1943 and Asperger's definition in 1944. An increase in numbers has met with an increase in litigation regarding autism spectrum disorder (ASD) and the Individuals with Disabilities Education Improvement Act (IDEIA). Outcomes that first favored parents (2002-2004) have moved to outcomes favoring school districts. The authors update the reader on case outcomes for 2010 and discuss how pending changes in legislation and diagnostic criteria may impact navigation through the education system as individuals seek a free appropriate public education (FAPE) and placement in the least restrictive environment (LRE).

Job support by occupational therapists for people with developmental disabilities: two case studies.

The present report uses two cases to provide an overview of employment support by occupational therapists for people with developmental disabilities and investigates the roles occupational therapists should play and the support they should give. Case A was a man in his 30s with Asperger disorder who used a trial employment program and received on-the-job training, leading to regular employment. Case B was a man in his 40s with intellectual disability who used outreach supported employment and achieved financial stability through sheltered employment. These two cases suggest that occupational therapists can help people with developmental disabilities acquire stable employment by accelerating their adaptation to the workplace through the following steps: assessing the occupational performance of the individual and the work environment; understanding the characteristics of the job by experiencing the job first-hand; and adjusting or improving the work environment to match the capabilities of the individual.

Experiences of handwriting and using a computerized ATD in school: adolescents with Asperger's syndrome.

Adolescents with Asperger's syndrome (AS), often have handwriting difficulties that affect their academic performance. The purpose of this descriptive multiple-case mixed-method study was to highlight how adolescents with AS experience writing in the school setting when writing by hand and when using a computerized Assistive Technology Device (ATD), for writing. A qualitative content analysis approach was used, including interviews with five adolescents, their parents, and their teachers. This was complemented by asking the adolescents to rate their perceived performance and satisfaction of writing with and without the ATD. All adolescents described handwriting difficulties, but a reduced ability to express oneself in writing was also common. Initiating and completing writing tasks was often so demanding that it caused resistance to the activity. Several advantages when using the ATD were described by the participants and the self-ratings showed higher scores for performance of and satisfaction with writing when the ATD was used. The results show that teachers' encouragement seemed to be important for the initiation and continuation of use of the ATD.

An evaluation of the EQUIP treatment programme with men who have intellectual or other developmental disabilities.

BACKGROUND: The Equipping Youth to Help One Another Programme (EQUIP) was designed for young offenders to address a developmental delay in moral reasoning, distorted cognitions and social skills. METHODS: The present authors undertook a single case series study and piloted an adapted version of the EQUIP programme with three men with intellectual disabilities and four men with a diagnosis of Asperger Syndrome, all of whom were detained in a medium-secure forensic unit for people with intellectual disabilities. Treatment was delivered over a 12-week period, and participants took part in four-one-hour sessions per week. RESULTS: The results suggested that treatment was successful at increasing moral reasoning ability, reducing distorted cognitions and improving ability to choose effective solutions to problems. However, treatment did not have a significant effect upon anger. CONCLUSIONS: The EQUIP programme is a promising treatment, but further research is needed to investigate its effectiveness with men with intellectual or other developmental disabilities.

Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial.

Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders (ASD). Mindfulness-based therapy (MBT) has been found effective in reducing anxiety and depression symptoms, however research in autism is limited. Therefore, we examined the effects of a modified MBT protocol (MBT-AS) in high-functioning adults with ASD. 42 participants were randomized into a 9-week MBT-AS training or a wait-list control group. Results showed a significant reduction in depression, anxiety and rumination in the intervention group, as opposed to the control group. Furthermore, positive affect increased in the intervention group, but not in the control group. Concluding, the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS.

Learning of idiomatic language expressions in a group intervention for children with autism.

In typical development, children learn an extensive range of idioms and other figurative (non-literal) language expressions during childhood and adolescence. However, many children with autism fall far behind in their idiom comprehension and production and never fully reach adult levels. The current study measured the effectiveness of a group idiom intervention for ten children, aged 7 to 12 years, with autism spectrum disorders. This intervention was conducted by a community-based social skills program. The children were initially very low in idiom understanding, but were able to learn and remember the meaning of idiomatic phrases that they were taught during the 2-week-long intervention. The children showed greater increases at a delayed post-test for idioms trained in the intervention than idioms that were untrained controls. Implications for future educational possibilities are discussed.

Becoming a member of the work force: perceptions of adults with Asperger Syndrome.

OBJECTIVE: Research has shown that comparatively few adults with Asperger Syndrome (AS) participate in the competitive work force. The purpose of this study was to gain in-depth knowledge about contextual factors, which contribute to successful labor market participation in some adults with AS. PARTICIPANTS: This study was conducted by indepth-interviewing six adults with AS working in the competitive job market in Switzerland. METHODS: A developmental and hermeneutic narrative approach was used for data collection and analysis. Two in-depth narrative interviews were conducted with each participant. A narrative analysis according to the theories of Paul Ricoeur was performed. RESULTS: Results showed that participants received pre-vocational requisites during their childhood through parents and friends that provided a feeling of security in social contexts. For participants, a supportive school setting resulted in academic achievements. The narratives reveal participants' capacities for understanding and adapting to social norms. Participants' understanding of their own needs was essential to the successful labor market participation. However, disclosure is rare and social stigma is still present. CONCLUSIONS: This study showed that successful labor participation of adults with AS can be enhanced through adequate social support already in the early stages of an individual's lifetime.

La conciencia pragmática de adultos con síndrome de Asperger / The pragmatic awareness of adults with Asperger syndrome

La conciencia pragmática es un concepto complejo que se asocia a una ciencia cognitiva híbrida como es la psicolingüística. En este caso, se analiza el proceso relacionado con la percepción del propio sujeto sobre el uso lingüístico y la capacidad para referirlo. El primer paso fue elaborar un Cuestionario de Conciencia Pragmática (CCP), compuesto por 26 ítems, utilizando una escala Likert, al que contestaron 18 varones diagnosticados con síndrome de Asperger (SA) y 18 adultos con desarrollo típico (DT). El objetivo fue, por un lado, estudiar la dimensionalidad del CCP, aplicando un análisis factorial exploratorio (AFE) y, por otro, comparar las medias de las respuestas en cada uno de los ítems pragmáticos en función del grupo, por medio de la prueba U Mann-Whitney. Los resultados revelaron una estructura tridimensional para el CCP y las categorías se agruparon en torno a tres dimensiones pragmáticas: enunciativa, textual e interactiva. Los adultos con SA no mostraron, en general, diferencias significativas en los ítems referidos al área textual (mensaje, dominios léxico y gramatical). No ocurrió lo mismo en las áreas enunciativa e interactiva, donde exhibieron una conciencia pragmática deficitaria en relación con los adultos con DT. El presente trabajo constituye una primera aproximación al análisis del comportamiento comunicativo (verbal y no verbal) de adultos jóvenes con SA (AU)

Pragmatic awareness is a complex concept associated with a hybrid cognitive science such as psycholinguistics. In this case, the process related to the perception of one's own linguistic use and the capacity to report it, is analysed. The first step was to elaborate a Pragmatic Awareness Questionnaire (PAQ), composed of 26 items, using a Likert scale, which was answered by 18 male patients diagnosed with Asperger syndrome (AS), and 18 adults with typical development (TD). The objective was, on the one hand, to study the dimensionality of PAQ, applying an Exploratory Factor Analysis (EFA) and, on the other, to compare the average amongst the answers to each pragmatic item according to the group by performing a Mann-Whitney U test. The results revealed a three-factor structure for the PAQ and the categories were divided into three pragmatic dimensions: enunciative, textual and interactive. Adults with AS, in general, did not show significant differences in items related to textual area (message, lexical and grammatical domains). However, in enunciative and interactive areas they exhibited deficits with regard to TD adults. The present work represents a first approach to the analysis of communicative behaviour (verbal and non-verbal) of young adults with AS (AU)

Support to students with Asperger syndrome in higher education--the perspectives of three relatives and three coordinators.

An increasing number of students with disabilities attend institutes of higher education (HE). Among this group are persons with Asperger syndrome (AS). Persons with AS have a cognitive impairment that can interfere with their studies and the ability to describe their needs and ask for support. This study deals with an assessment of the support services for students with AS from the perspectives of the students' relatives and the students' service providers at the universities they attend. The aim of this study was to investigate (a) earlier experiences and events in relation to the transition of students with AS to higher education, according to the relatives' perceptions of how these experiences and events affect university studies; and (b) the perceptions of both the relatives of students with AS and the coordinators for students with disabilities with respect to the study environment and support for students with AS. The approach is a case study methodology involving relatives and university coordinators for three students with AS. The coordinators' way of working with students with disabilities is primarily based on the coordinators' own ideas. No specific organizational routines exist for students with AS. The results reveal that the needs of students with AS have to be made explicit and must be incorporated into the support system. Relatives lack information about the situation and opportunities to engage in collaboration. Universities must adapt the support system to the cognitive impairments experienced by AS students and the difficulties of their everyday lives. The relatives of students with AS may play the central role in supporting the students and in understanding their impairment.