#2241- Computer Assisted Improvement of Social and Executive Functioning in Asperger’s Disorder

ASA's 37th National Conference on Autism Spectrum Disorders (July 13-15, 2006)

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Thursday, July 13, 2006: 11:00 AM-12:15 PM
Narragansett Ballroom A
#2241- Computer Assisted Improvement of Social and Executive Functioning in Asperger’s Disorder

Audio Recorded Presentation
Klim and Volkmar have said: “There is a need to teach social and communication skills, explicitly, at all times, as an integral part of the [Asperger] program and as its major priority”. Our presentation reports the findings of an NIMH study that addressed this challenge. It describes how TEACCH principles were expanded for higher functioning Autistic students and integrated into academics, social skills training and executive functioning. Teens and young adults used handheld computers to assist functioning in multiple settings.
Presenters:	Ronald Calvanio, AB, MA, PhD, Harvard Medical School, Instructor - Dr. Calvanio has been working in the areas of neuropsychology and executive functioning throughout his career. He has been actively involved in development of novel technology-based treatments for more than 15 years. Dr. Calvanio has been working with individuals with autism spectrum disorders for two and a half years, has presented posters at scientific meetings based on his autism work, and was one of the authors of an autism-related STTR grant proposal that was funded by the National Institute of Mental Health. He has been an invited speaker at several rehabilitation conferences, presenting on executive functioning and innovative rehabilitation techniques. Gary Mesibov, AB, MA, PhD, University of North Carolina at Chapel Hill, Director, Division TEACCH, Professor of Psychology - Dr. Mesibov has been one of the primary developers of the TEACCH approach to the treatment of persons on the autism spectrum. He is the author of an extensive list of books and scientific papers on treatment of people with ASD. TEACCH has been at the leading edge in developing visual support systems that empower individuals with ASD to function more independently. As Director of Division TEACCH, Dr. Mesibov has accumulated extensive experience with providing services to people with ASD and has helped develop TEACCH-based programs around the world. He has run training courses in UK, France, Japan, and Scotland. Clare O'Callaghan, RN, CD, EdD, South End Community Health Center, Clinical Director, Children's Mental Health Program and Training Director - Dr. Clare O’Callaghan is a clinical neuropsychologist and clinical psychiatric nurse specialist. She is the Clinical Director of the Children’s Mental Health Program at the South End Health Center and Training Director of the mental health services. She is in private practice evaluating children and adults, specializing in autism, ADHD, and learning disorders. She also does psychopharmacologic evaluations and treatment of children and adults. Clare has been on the board of the League School of Greater Boston (a school for children on the autism spectrum) for more than 10 years. She is the current president of the Massachusetts Neuropsychological Society.

Learning Objectives: Major Objective: To learn how TEACCH principles of Autism management/instruction can be expanded for: HFA/AS students, social skills training, teens and young adults, and handheld computer assisted functioning. Supportive Objectives: 1. To review TEACCH principles in brief including: visual presentation and directing attention, paired associate learning, the integration of environmental systems, schedule systems, and work systems. 2. To learn how expansions and additions to TEACCH principles support the main objective. The additions include: the information content of social exchanges, the components of social utterance (in a classroom setting), the teaching and measurement of component fulfillment, and the use of goal setting, graphical feedback and a Portable Visual Guidance System (PVGS). 3. To become familiar with the components of a PVGS: making behavior checks on a handheld computer, the variety of visual guidance on a handheld computer, and the applications of visual guidance to social and executive functioning. 4. To learn what kinds and levels of social skill improvement and executive skill improvement can be achieved with a PVGS: improvement in classroom social exchange, improvement in one-on-one social exchanges, and improvement in executive functioning. This skill improvement is achieved in matters of personal responsibility, in matters of independent learning and in performance of a technical skill (desktop publishing). 5. Questions and Answers. Content: We report the outcome of an NIMH funded study to improve the social skills and executive functioning of Asperger and Higher Functioning Autistic (AS/HFA) students in an academic environment. The study employed visually based TEAACH principles of instruction that have been extended for use by Asperger Syndrome/High Functioning Autistic persons and adapted for use on a handheld computer. The handheld computer was transformed into a Portable Visual Guidance System (PVGS) using SymTrend e-diary software. The PVGS supports student self-monitoring of behavior and feelings in three activity domains: 1) social activity (cooperation, peer interaction, self-expression, and self-control), 2) personal executive activity (e.g., scheduling and completing: assignments, grooming, housekeeping, purchasing), and 3) independent school/work project activity (e.g., desktop publishing). The study addresses, and we will report, our findings regarding four questions. 1) The Prosthetics Question: Can a PVGS enhance the functioning of AS/HFA persons? 2) The Challenge Question: Can a PVGS meet the more complex, varied, trans-situational needs of AS/HFA persons? 3) The Comparative Advantage Question: Can a PVGS be as effective as, or more effective than, standard direct coaching followed by distant supervision? 4) The Benefit Question: Does a PVGS yield at most a prosthetic benefit (real-time assistance to perform the task at hand), or does it also produce a specific knowledge benefit (ability to perform the task without the PVGS prosthesis), or even more importantly a “learning to learn” benefit (i.e., the acquisition of a behavioral rule that permits generalization form the current situation to new situations)? The aim of the grant was to build a PVGS prototype and to evaluate its efficacy vis-à-vis our four study questions. The PVGS has several important and/or innovative features: It consists of a sequence of handheld computer screens (task guide) designed to support task performance. The task guides are written using commercially available electronic diary software (SymTrend, Inc.) and are used on the most inexpensive of handheld computers (Palm, Zire 21). The task guides can be used prior to the commencement of a task to establish task set. They can be used to prompt the start of task performance, to step the user through task steps, and to undertake problem solving during task execution. In addition, task guides can be used to evaluate task products at task completion. The task guides can be customized to personal functional requirements in terms of screen contents, number of screens, and branching for conditions (e.g., if you are running out of time, click here and follow priorities). The task guides can be used to support social exchanges in specific contexts (e.g., classroom participation or one-on-one exchanges), to support meeting personal responsibilities (e.g., morning routine, daily schedule), and to support independent technical job task functioning (e.g., desktop publishing). Use of task guides can be initiated by the user or through scheduled signaling (beeping or vibrating). Task guides can be used for data collection as well as task guidance. The data collected can be sent to a website where it is automatically charted. This charting can be used to check individual progress, in counseling, to offer feedback and to make changes in the task guides. These data can also be used as progress material to be inserted in periodic IEP reports. Task guide contents can be authored to suit educational goals and to coordinate specific academic contents. At this point of the study completion, we can report that students can use a PVGS to monitor their feelings and behavior in a classroom setting. A large majority of students like using the PVGS. Students actively used the computers to attempt to improve functioning, and have been successful in doing so. Improvements occurred in the management of personal executive activity and social pragmatics in a classroom setting and in one-to-one dynamics. At this time, the study is still in progress and additional findings will be reported at presentation. Advances to the Field of Autism The research to be reported: 1) Addresses the important challenge to advance Asperger education made by clinical and scientific leaders Klim and Volkmer: “There is a need to teach social and communication skills, explicitly, at all times, as an integral part of the [Asperger] program and as its major priority”. 2) Extends TEACCH educational principles for HFA/AS students, for social skills training, for teens and young adults, and for handheld computer assisted functioning. 3) Introduces the use of computer and web technology into Asperger education with the centrality that Klim and Volkmer's challenge requires. This research introduces a new approach to teaching HFA/AS individuals that incorporates three features epitomizing best practices: 1) Customization: A PVGS allows for more personalized support when teachers and parents are not available. 2) Generalization: A PVGS reduces the problem of generalization from the teaching setting to the applied setting by supporting learning at a distance in an applied setting. 3) Data Collection: PVGS can be used for data collection, for feedback, IEP reporting and research purposes.

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