1. Mental Health Conditions-Part-I
 Presentation made to Baker College
 January 29, 2013
 9:30-12:00
 Stuart S Segal, Ph.D.
 Director of the Office of Services for Students
with Disabilities
 University of Michigan
 (734)- 764-7485
 sssegal@umich.edu

2. Anxiety Disorders Among College
Students
 Anxiety disorders are extremely common
on college campuses
 40 million Americans suffer from anxiety
disorders and 75% experience first
episode of anxiety before age 22
 Evidence based treatments are available
and effective
 Treatment frequently includes Cognitive
Behavioral Therapy and medication

3. Anxiety Disorders Among College
Students
 GAD
 Achievement worries, critical thinking, unrealistic
expectations
 Social Anxiety Disorder

Avoidance of group social events/ parties, difficulty
public speaking, test anxiety
 Panic Disorder
 Fear of being stuck in class or with roommate and
having panic
 OCD – presentations are not specific to setting
 Trichotillomania
 Studies show may occur in 1-3% of college populations

4. Types of Anxiety Disorders
continued
 Phobias
 Acute Traumatic Stress Disorder
 Post Traumatic Stress Disorder
 Adjustment Reaction with mixed Anxiety
and Depression

5. Cognitive Behavioral Therapy for
Anxiety Disorders
 Short-term, evidence based treatment
 Based on the idea that thoughts and behaviors
affect the way we feel
 Often includes Exposure therapy
 Studies show CBT and medication are more
effective together than either are separately

6. General Goals in CBT treatment
of Anxiety Disorders
 Understand the function of anxiety, triggers
of anxiety and safety behaviors (anxiety
fuel)
 Focus on seeing anxiety as uncomfortable
rather than dangerous
 Not just thinking positive – what is the
evidence for a fear? Realistic or not?
 Gather evidence through experience
 Learning to accept a lack of control / safety
for a better quality of life

7. What’s “Normal” Anxiety? When
does it become a “real” problem?
 Anxiety is a normal and necessary
response
 Key issues for when you need help for
anxiety:
 Is anxiety interfering with your life? Are you
avoiding things or having to endure with
dread?
 Is anxiety happening too often? (you judge)
 Is your anxiety more severe than the actual
danger/risk present?

8. Social Anxiety Disorder
 Fear/avoidance of social situations
 Feared situations avoided or endured
with intense anxiety or distress
 Fear recognized as excessive or
unreasonable
 Fear/avoidance interferes with work,
social, school, family activities
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC,
American Psychiatric Association, 1994.

9. Social Anxiety Disorder
Common Fears
 Participating in small groups
 Eating, drinking, writing in public
 Talking to authority figures
 Performing or giving a talk
 Attending social events
 Meeting strangers or dating
 Using public bathroom
 Being center of attention/ being observed by others

10. Social Anxiety Disorder
 Test Anxiety

Often caused by fears of judgment by others,
fear of failure and other negative beliefs
 Classified and treated as a social anxiety
issue

CBT focus is on restructuring negative
thoughts around test performance and using
practice to desensitize anxiety response
 Treatment may include improvement of study
skills in addition to cognitive behavioral
therapy treatment

11. CBT for Social Anxiety
 Exposure :

Gradual confrontation of progressively more challenging
social encounters
 Prolonged sessions (60-90 minutes)
 Frequent sessions (daily is best)
 End session only when anxiety improves
 Common cognitive distortions
 Magnification - “It would be horrible if I didn’t know what to say”
 All or Nothing Thinking - “Why did I say that… I made a complete fool
of myself”
 Mind Reading - “He looked away, he must think I am weird”
 Fortune Telling - “Why bother to talk to her, she will just reject me like
all the others”
 Social Skills Training

12. Diagnostic Criteria For
Obsessive-Compulsive Disorder
Obsessions:
(1) recurrent or persistent thoughts, impulses, or images are experienced
as intrusive or inappropriate and cause distress
(2) not simply excessive worries about real-life problems
(3) person attempts to ignore or suppress thoughts or neutralize them with
another thought or action
(4) person recognizes that obsessions are product of his/her mind, not
imposed from without
Compulsions:
(1) repetitive behaviors or mental acts performed in response to an
obsession or according to certain rules
(2) designed to neutralize or prevent discomfort or some dreaded event or
situation
The obsessions and compulsions cause marked distress, are
time-consuming, or significantly interfere with normal routine,
usual social activities or relationships with others
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994.

13. OCD Symptom Clusters
Washers/Cleaners Harmers/Checkers
Common
OCD
Symptom
Clusters
Hoarders Sinners/Doubters
Orderers/Arrangers

14. Obsessive-Compulsive
Personality Disorder
 A pervasive pattern of preoccupation with orderliness,
perfectionism, and mental and interpersonal control, at
the expense of flexibility, openness, and efficiency,
beginning by early adulthood and present in a variety of
contexts, as indicated by 4 or more of the following:
 Is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the major
point of the activity is lost
 Shows perfectionism that interferes with task completion
 Is excessively devoted to work and productivity to the
exclusion of leisure activities and friendships

15. Obsessive-Compulsive Personality
Disorder (cont.)
 Is over conscientious , scrupulous, and inflexible about
matters of morality, ethics, or values
 Is unable to discard worn-out or worthless objects
even when they have no sentimental value
 Is reluctant to delegate tasks or to work with others
unless they submit to exactly his or her way of doing
things
 Adopts a miserly spending style toward both self and
others; money is viewed as something to be hoarded
for future catastrophes
 Shows rigidity and stubbornness

16. OCD vs. OCPD
 OCD involves ego-dystonic thoughts and
urges to neutralize

The person realizes the symptoms are
senseless

Symptoms are distressing and anxiety-
evoking
 OCPD involves ego-syntonic behavior
 Symptoms are consistent with person’s world
view
 Often associated with rigidity, inflexibility, and
anger

17. Behavioral Treatment of Obsessive
Compulsive Disorder
 Exposure and Response Prevention
Therapy - 70 % Effective
 Requires Substantial Effort
 Durable Treatment
 Effective For Both Obsessions and
Compulsions

18. Exposure and Response
Prevention for OCD
 Exposure Therapy
 Graded Hierarchy
 Continuous Exposure is Best
 Watch for patients Attempts at Avoidance of
Exercises
 Response Prevention
 Rapid over very gradual
 Make rituals inconvenient to do
 Enlist family as a response prevention team
 Do not compromise on time… make the exposure
exercise less difficult

19. Diagnostic Criteria for GAD
 Excessive anxiety and worry, for more days than
not for ≥6 months, about many subjects
 Worry is difficult to control
 Anxiety, worry, physical symptoms impair social,
occupational, and other functioning
 Associated with ≥3 of the following
 restlessness/keyed-up
 easily fatigued
 difficulty concentrating
 irritability

muscle tension
 sleep disturbances
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC:
American Psychiatric Association; 1994.

20. Generalized Anxiety Disorder
 Worries, negative thoughts, or predictions
that are future oriented
 Many worries around many topics with
significant difficulty managing anxiety
triggered by worry
 What if I don’t pass this class? I’ll never
catch up. I’m not working hard enough. I
should have known that answer. Failing
would be terrible.

21. Symptom Overlap in GAD
and Depression
Depression GAD
• Agitation
• Depressed Mood • Dysphoria
• Sleep • Worry
• Interest
• Fatigue • Anxiety
• Appetite
• Concentration • Tension
• Esteem
• Suicidality • Restlessness
• Irritability
Roy-Byrne et al. J Clin Psychiatry. 1997;58(suppl 3):34.

22. CBT for GAD
 Focus is on 3 areas:

Lifestyle change: creating balance of work &
leisure, exercise, sleep hygiene, etc.
 Relaxation Training : to address physical
symptoms of anxiety such as muscle tension

Cognitive Restructuring: Try to identify
cognitive distortions in negative thinking,
understand a situation in a realistic way, and
develop a more balanced life perspective

23. Diagnostic Criteria For Panic Attack
A discreet period of intense fear or discomfort, in which four or
more of the following symptoms developed abruptly and reached
a peak within 10 minutes:
• Palpitations, pounding heart • Dizziness
• Sweating • Chills or hot flushes
• Trembling or shaking • Feelings of unreality
• Shortness of breath or • Fear of losing control or
smothering going crazy
• Choking feeling • Fear of dying
• Chest pain or discomfort • Paresthesias (tingling /
• Abdominal distress numbness)
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed.
Washington, DC, American Psychiatric Association, 1994.

24. Panic Disorder
Recurrent, unexpected panic attacks followed by more
than 1 month of persistent concern about another
panic attack, worry about possible implications or
consequences of panic attacks, or significant
behavioral change related to attacks
May Occur with or without Agoraphobia
* Agoraphobia is an intense fear of being alone in a
place where help might not be available or escape
might be difficult
Many times is exacerbated or onset during substance
use (alcohol, marijuana, hallucinogens)

25. CBT for Panic
 Exposure to external panic cues

Places where previously experienced panic or other avoidance cues
 Exposure to internal panic cues

Panic patients avoid activities that create feelings similar to panic

Create exercise to produce panic sensations
 Cognitive Therapy for panic fears
 Collect information to dispute distorted thoughts in panic by using:
-BEHAVIORAL TESTS: Experience panic attacks without intervention to
see if catastrophe takes place
-AWFUL TESTS : Pretend to experience catastrophe and test whether it is
really so awful, terrible
-Patient’s previous experiences with panic
-Information about symptoms

26. Impulse Control Disorders
 Trichotillomania – compulsive pulling of
hair

Pulling often occurs from scalp, eyelashes
and/or eyebrows
 Compulsive Skin Picking
 While both are common problems, access
to evidence based treatment is limited
 Both are treated with habit reversal
therapy and medication

27. CBT for Impulse Control Disorders
 Focus is on using Habit Reversal Therapy
to reduce the intensity of the urges
 Learn coping skills to use during high risk
situations – very behavioral
 Gain an understanding of this as a
neurobiological problem
 Engage in cognitive restructuring around
negative self-talk related to pulling
behaviors

28. Economic Burden of Anxiety Disorders
Total Costs = $42.3 Billion Per Year
Total Mortality
Workplace Costs
(3%)
Pharmaceutical Costs
Costs (10%)
(2%)
Direct
Nonpsychiatric
Total Direct Medical Treatment
Psychiatric Costs
Treatment (54%)
Costs
(31%)
Greenberg et al. J Clin Psychiatry. 1999;60:427.

29. Post-Tramatic Stress Disorder-
PTSD
An Anxiety Disorder.
3-6% of adults in the United
States.
Twice as common in women as
in men.
Rates as high as 58% in heavy
combat
1-14% non combat
Torture/POW 50-75%
Natural Disaster victims 4-16%

30. DSM-IV diagnostic criteria for
PTSD
Exposure to a traumatic event in which
the person
Experienced, witnessed, or was
confronted by death or serious injury
to self or others
AND
Responded with intense fear,
helplessness,
or horror
Features
Appear in 3 clusters: re-experiencing,
avoidance/numbing, hyperarousal
Last for > 1 month
Cause clinically significant distress or
impairment in functioning

31. DSM-IV Diagnostic Criteria of PTSD- Re-
experiencing
 Persistent Re-experiencing of > 1 of the
following:
 Recurrent Distressing Recollection of the
Event
 Recurrent Distressing Dreams of the Event
 Acting or Feeling that Event was reocurring
 Psychological Distress of Cues Resembling
Event
 Physiological Reactivity to Cues Resembling
Event

32. DSM-IV Diagnostic Criteria for PTSD-
Avoidance and Numbing
 Avoidance of Stimuli & Numbing of General
Responsiveness indicated by >3 of the
following:
 Avoid Thoughts, Feelings or Conversations
related to trauma
 Avoid Activities, Places or People Related to
Trauma
 Inability to Recall Parts of the Trauma
 Decreased Interests in Activities
 Estrangement from Others
 Restricted Range of Affect
 Sense of Foreshortened Future

33. Summary of Symptoms of PTSD
Spontaneous re-experiencing of
the trauma
Startle responses
Irritability
Depression and Guilt
Phobias
Multiple physical complaints
Numbing
Impaired concentration and
memory
Disturbed sleep and distressing
dreams

34. Depression is complex!
• Genetics
▫ Often runs in families
• Medical Condition
▫ Injury (stroke, brain injuries)
▫ Illness (heart attacks, diabetes)
• Neurotransmitters (brain chemicals)
▫ Abnormal levels or not functioning as they should
▫ Drug abuse
• Stress and environment
▫ Abuse
▫ Trauma

35. Depression?
Depression (major
depression (“little d”) of

A temporary feeling depressivelow mood or

Constant disorder)
sadness anhedonia (lack of
 “Normal” pleasure)
 Other symptoms
present
 A common and
potentially destructive
illness

36. Historical Names for
Diagnosis:
Nostalgia
Fright Neurosis
Combat/War Neurosis
Shell Shock
Survivor Syndrome
Operational Fatigue
Compensation Neurosis

37. Brain function changes in
depression
http://www.mayoclinic.com/health/medical/IM00356
A PET scan can compare brain activity during periods of depression (left) with normal brain
activity (right). An increase of blue and green colors, along with decreased white and yellow
areas, shows decreased brain activity due to depression.

38. Types of depression:
 Adjustment disorder
 Depression NOS (depression)
 Dysthymic disorder
 Major depressive disorder
 Bipolar disorder (cycles of depression and
mania)- Will be dealt with in Part II of this
discussion

39. What are the symptoms
and signs of clinical
depression?
 Prolonged sadness, crying spells
 Loss of pleasure, social withdrawal, loss of motivation,
decreased energy, pessimism
 Unexplained pains, fears, apprehension
 Significant changes in appetite, sleep and other physical
functions (e.g., dry mouth, constipation, loss of taste)
 Irritability, anger, excessive worry, anxiety, guilt
 Inability to concentrate or make decisions
 Recurring thoughts of death or suicide
 Monthly or seasonal cycling is common
 Excessive consumption of alcohol or other chemical
substances to seek relief

These worsen rather than help clinical depression

40. Reasons for Depression
1.
2. Early
Widesprea
Symptom
d
Onset
Prevalence
8. Brain Tissue 3.
Underdiagnosis
Degenerative
and
Changes Undertreatment
Depression
’s 4. Genetic
7. Stigma and BURDEN: Vulnerability
Poor Stress-
REASONS
Adherence genetic
interactions
5.Recurrences
6. Little ,
Recurrence Increased
Prevention Cycles,
Severity

41. Depression is underdiagnosed
and undertreated at all ages
5%
5%
No diagnosis / No treatment
10%
Diagnosis, but no treatment
50%
Diagnosis, inaccurate
treatment (BZD)
30%
Diagnosis, proper treatment
but inadequate dose,
duration or discontinuation
Successfully treated

42. Symptoms of Major Depression
 S - Sleep changes (too
much or too little)
 I - loss of Interests
 G - excessive Guilt
 E - lack of Energy
 C - loss of Concentration
 A - change in Appetite
 P - Psychomotor
(movement) slowing or
agitation
 S - Suicidal thoughts

43. Depression affects many!
 1-2% prepubertal children

Both sexes equally affected
 3-8% teenagers
 3:1 female to male ratio

Lifetime prevalence ~20% by end of
adolescence
 CDC (2007): Suicide is the
third leading
cause of death people aged 15-24 years

44. Treating Depression

45. Types of Depression Treatment
1. Psychotherapy (“talk therapy”)
2. Antidepressant medication (selective
serotonin reuptake inhibitors or SSRI)
• Other (sleep, exercise and nutrition)
interventions may be helpful
• The best treatment is combination
(medication and psychotherapy)

46. Prefrontal
Cortex
Raphe Nuclei
(5-HT source)
Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.

47. Heightened Risk of Suicide
 Feeling of hopelessness and
desperation
 Extreme anxiety, agitation or enraged
behavior
 Severe insomnia
 Increased alcohol/drug use

48. Warning Signs of Suicide
 Suicidal Thought/Expressions
 Obsession with death
 Decreased interest in friends
 Dramatic change in personality or
appearance
 Irrational, bizarre behavior
 Overwhelming sense of guilt, shame or
rejection
 Changes in eating or sleeping patterns
 Changes in school performance
 Worsening symptoms of depression

49. Overview:
Asperger Disorder,
High Functioning Autism, and Nonverbal
Learning Disabilities:
Diagnostic, and Post Secondary
Educational Considerations

50. Terms:
 ASD: Autism Spectrum Disorder
 AS: Asperger’s Syndrome
 HFA: High Functioning Autism
 NLD: Nonverbal Learning Disability
 DSM: Diagnostic & Statistical Manual of
Mental Disorders 4th edition

51. First Described
 Kanner 1943
 Asperger 1944
 Bettleheim1967
 Asperger diagnosis in DSM-IV 1994

52. Kanner (1943)
 First to describe parents of children with
autism as emotionally distant.
 Also stated that there was a considerable
biological component which impacted the
development of relationships.

53. Asperger (1944)
 Impairment in nonverbal communication.
 Verbose, one-sided communication style.
 Lack of friends despite interest in others.
 All-absorbing, circumscribed interests.
 Intellectualization of affect.
 Motoric clumsiness.
 Normal intelligence.

54. Bettelheim (1967)
Wrote, “The Empty Fortress”
Autistic symptoms represented a defensive
reaction against cold and detached mothers
e.g., one patient’s obsession with weather could
be understood by dissecting the word into
we/eat/her – concerned that her mother and later,
others, would devour her
Promoted a policy of “parentectomy”
After his suicide in 1990, it was discovered that his
credential were fraudulent and the “successes” did
not have autism in the first place.

55. DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
Asperger’s Disorder first appeared in the
fourth edition in 1994.

56. DSM-IV
Qualitative Impairment in Social
Interaction
At least two of the following:
(a) Marked impairment in this use of multiple non verbal
behaviors to regulate social interactions (e.g., eye-to-eye gaze, facial
expression, body pressure, and gestures).
(b) Failure to develop developmentally appropriate peer relationships.
(c) A lack of spontaneous seeking to share enjoyment, interests,
or achievements (e.g. pointing, joint attention)
(d)A lack of social or emotional reciprocity.

57. COMMENT
Qualitative Impairment in Social Interaction
 Often desire friendship but are isolated because
their approaches to gain entry to social situations is
ineffective.
 Often can recite social rules but have a lot of
difficulty with generalization and application.

58. Deficits in Social Interaction
Often desire friendship but are isolated
because their approaches to gain entry to
social situations is ineffective
Often can recite social rules but have a lot
of difficulty with generalization and
application.

59. COMMENT:
Qualitative Impairment in Social Interaction
May reflect the tendency to focus on facts and finding relevance in
what most others would find irrelevant.
 ME: Sorry I kept you waiting – I just spilled coffee all
over my leg.
 JACOB: What kind of coffee?
 ME: Columbian Decafe.
 JACOB: Oh.

60. DSM-IV
Deficits in Communication
At least one of the following:
(a) Delay in, or lack of, development of spoken language (not
accompanied by attempts to compensate through alternative
modes of communication).
(b) In individuals with adequate speech, marked impairments in
the ability to initiate or sustain a conversation with others.
(c) Stereotyped and repetitive use of language or idiosyncratic
language.
(d) Lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level.

61. COMMENT:
Deficits in Communication
 Good formal language skills but poor
pragmatics
 Tangential & Circumstantial Speech
►Monologues
►Verbosity
►Failure to provide listener with context necessary for understanding
 Unusual prosody
►Restricted range of intonation patterns
►Volume, modulation, etc. that is not well orchestrated with
communicative intent

62. Too Much Honesty

63. DSM-IV
Restricted Range of Interests, Activities, or
Behaviors
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

64. COMMENT:
Restricted Range of Interests, Activities, or
Behaviors
Preoccupation with parts over wholes has
broader implications – ASD individuals
tend to miss perceiving and
communicating context.

65. Restricted Range of Activities or Behaviors –
DSM-IV
encompassing preoccupation with one or
more stereotyped and restricted patterns
of interest that is abnormal either in
intensity or focus
apparently inflexible adherence to
specific, nonfunctional routines or rituals
stereotyped and repetitive motor
mannerisms, e.g., hand or finger flapping
or twisting, or complex whole-body

66. Circumscribed Interests
 All-absorbing
 Unusual topics
 Amasses facts
 MUST interfere with learning and social
adaptation

67. Motor Characteristics
 Often clumsy
 Poor motor planning
 Delayed acquisition of self-help skills
 Problems with climbing, team sports,
catching
 Graph motor deficits
 Odd gait
 Proximity problems

68. Asperger’s has been used to describe:
 High Functioning Autism (HFA) without
cognitive impairment
 Pervasive Developmental Disorder-Not
Otherwise Specified (PDD-NOS) aka
Atypical Autism
 Shyness, social anxiety (shades of
normalcy)
 Distinct disorder
 In DSM-V all of these will become-Autism
Spectrum Disorder (ASD)

69. Asperger’s v. HFA
ASPERGER’S HFA
Delays primarily in More severe language
nonverbal communication delays
and pragmatic language
Atypical attachment patterns
More typical attachment
patterns Earlier diagnosis
Diagnosis common after Less VIQ/PIQ discrepancy
age 7 Reduced social interest
Distinct VIQ/PIQ split Failure of basic
Area of special interest mechanisms of
predominant socialization
Social motivation for
relationships
Failure to understand
nonverbal communication

70. DSM-IV AS/Autism Distinction
 Significant delays across all areas
 There is no clinically significant delay in cognitive
development
or in the development of age-appropriate self-help
skills, adaptive behavior (other than social
interaction), and
curiosity about the environment in childhood.

71. Volkmar (2004)
DIFFERENTIAL DIAGNOSIS
FEATURE AS HFA
Social Skills Poor Very Poor
Motor Skills Clumsy Good
Circumscribed Usual Variable
Interests
Family History Usual Occasional
Age at >24 mos. <24 mos.
Diagnosis

72. Nonverbal Learning
Disabilities

73. Nonverbal Learning Disability
 A neuropsychological profile
 Not a DSM-IV diagnosis
 Overlaps with deficits associated with
AS/HFA

74. NLD Characteristics
 DEFICITS  STRENGTHS
Visual-spatial Language-based
organization thinking and
Nonverbal problem reasoning
solving Rote memory
Difficulty relating parts Expressive language
to wholes

75. The NLD Profile Results in:
Adapting to novel and complex situations
over reliance on rote behaviors in such
situations
Relative deficits in mechanical arithmetic
as compared to proficiencies in single
word reading
Poor pragmatics
Unusual prosody in speech
Poor social perception, social judgment,
and social interaction skills.

76. Other Overlapping Concepts…
 Semantic-Pragmatic Language Disorder
(from psycholinguistics)
 Hyperlexia
 Pathological Demand Avoidance

77. Important Things for Service Providers to
remember :
ASD and NLD individuals have trouble imposing
organization on the internal and external environment.
This underlies their rigid adherence to rules and their
difficulties in simultaneously processing stimuli from
multiple sources.
Negative behaviors emerge primarily when the student is
overwhelmed because the demands exceed their level
of competence.

78. Common Co morbid Conditions
AD/HD
Obsessive Compulsive Disorder
Depression
Anxiety
Dyspraxia
Learning Disabilities
◦ Written expression
◦ Math disability

79. Gender Issues
 Male to female ratio estimated at 4:1
 Some evidence that females are less
likely to develop autism, and when they
do, they are generally less impaired.
 Tendency to view symptoms in females as
psychologically based

80. Gender Issues-Continued
 Girls may be better at masking the
symptoms.
 The DSM-IV criteria are based on male
presentation of the disorder
 Tendency to view girls’ problems as
psychological or emotional in nature

81. Family Issues and Diagnosis of ASD

Strain on family time, energy, and
financial resources
 Frustrated by the confusion of special
education and medical terms and
procedures.
 Finding the “right” educational fit

82. ASD-Lack of Social
Reciprocity
 Social Co-Regulation
 Emotional Coordination
 Social Referencing
 Intersubjectivity
 Emotional Regulation

83. ASD-Stereotypic Movements/ Interests
 Hypersensitivity  Inconsistent physical
 Responses can and emotional
cause distraction modulation
 Strong preferences  Poor episodic
for certain types of memory
sensory input  Poor self regulation
 Inconsistent  Reduced identity
attentiveness development

84. Rigid Thinking
 Difficulty generalizing
 Misinterpretation of information
 Lack of symmetry between verbalizations
and actions
 Preference for static systems
 Black and white thinking

85. Education Issues-Questions for Families and
Transition Specialists to Consider
 How much structure does the student need and can the
school provide it?
 Is there someone in the SSD office with a specialty in
these conditions?
 How receptive are staff and faculty to students with this
condition?
 What is the philosophical outlook of the SSD office?
 Given the students documentation and severity of
disability what academic accommodations are available

86. Education Issues-Questions for Families and
Transition Specialist to Consider
 Is tutoring, academic coaching, psychotherapy
available at the school or in the community and
what is the cost?
 Are there support groups?
 Are there workshops or professionals who teach
study or social skills?
 Is there anyone to assist in academic advising,
financial aid?
 Can a student take a reduced load and still be
considered a full time student?