Converge Autism Summit 2023

For the next 2 days, I’m attending the Converge Autism Summit 2023 at the Greenville Convention Center in Greenville, SC. 

“The Converge Autism Conference is geared towards industry professionals but is also open to parents and caregivers from around the nation as a chance to meet and discuss educational, therapeutic, social, and psychological topics related to Autism Spectrum Disorder.” 

I have attended this for several years and I believe that I’ve learned a lot of valuable information there. This summit is great for professionals and families. There are breakout sessions for practitioners, educators, and families. 

I hope next week to share some of the information that I’ve learned from this conference. 

If you have never attended, please consider attending this in the future. 

Autism and Context blindness

Here are my notes from one of the sessions at the Converge Autism Summit. This presentation was: Autism and the predictive mind Context blindness 2.0 by Peter Vermeulen (founder of “Autism in Context,” where autism is understood in context).

Autism friendliness:

• An autism-friendly approach starts from an understanding of autism from within!
• Knowledge of “autistic thinking” is the key to success in education and treatment!
• Copernican revelation in brain science

Default idea about the brain:

• Input > processing > Output
• Perception > cognition (thinking and memory) > Output (motor system)

What’s wrong with our current ideas about the brain?:

• Information processing is not linear
• Sense making is not just integrating all the details of the sensory input
• There isn’t enough time to calculate and make that puzzle!
• Processing all the sensory input (computing) is not very helpful for survival!

So, the brain does not compute, It guesses,
And it can make smart guesses because it uses context,
This is known as: the predictive mind

So, it does NOT work like this: Stimulus > processing >meaning

It works like this: Stimulus > checking prediction > prediction

The brain does not process stimuli, only what is different from the stimuli it predicted.

Living in a relative world:

• Nothing has an absolute meaning! Everything depends on context.
• Therefore, our brain became an expert in using context for making quick and smart guesses

HIPPEA: High, Inflexible Precision of Prediction Errors in Autism

Autism may be related to problems with making predictions sensitive to the wider context.

Autism and the predictive mind: context:

• In ASD, the dysfunction of prediction based on context may impair the ability to adapt quickly to an ever-changing socio‐emotional world.
• Autism may be related to problems with making predictions sensitive to the wider context.”
• Comparably, reduced global processing in autism may reflect a reduced role for top‐down predictions in integrating sensory features into a more broadly coherent or context‐sensitive percept.

Autism as context blindness 2.0:
Reduced ability to use the context unconsciously and spontaneously to generate predictions about the world and process prediction errors.

Context and emotion recognition:

• Relation facial expression – emotion is not fixed.
• We never see facial expressions out of context.
• Context is more important than the face!
• But people with autism rely on the face, not the context

So, we thought emotion recognition went like this: Reading emotions FROM faces

But it actually goes like this: Reading emotions INTO faces

So we should teach people with autism to PREDICT emotions, using context, not faces:

• Link emotions to context.
• Action perception is not simply a reflection of what happens, but a projection of what will happen next.

Contextual variations are often seen as central or as fixed rules: e.g. having a dessert when going to a restaurant

Context and social competence:

• The biggest problem in ASD is not social skills (knowing what and how to do)
• The biggest problem in ASD is knowing where and when to do it and where and when not

Social competence requires contextual sensitivity

Understanding language and communication:
old model - Input (meaning, coding, symbols) > processing (decoding) > output (meaning)

Understanding language and communication:
new model - stimulus < > prediction error < > prediction

Context and predicting language and communication:

• The brain makes quick guesses about what someone is going to say or show, based on context
• Understanding language = predicting language

Context and communication:

• Nothing has an absolute meaning, remember?
• So, whatever we use to communicate such as words, gestures, pictures, or objects, their meaning is never fixed, but depending on the context

Context:

• Does not only help us to predict and recognize communication.
• It also helps us to avoid all the confusion of the ever-changing meanings of what people say or show us.

Context and communication:
What is difficult for people with ASD, is to find out what something (a word, a sentence, a gesture, a picture, etc.) means in this context.

Old Strategies for hyperreactivity:

• Taking away stimulus
• Reducing stimulus
• Controlling stimulus
• Stress coping

Instead, Tackle the prediction errors:

• Changing prediction
• Giving control
• Changing stimulus
• Stress Coping

We need to ‘feed’ the brain so it can update its models and reduce the prediction errors
(prediction errors = stress / unpleasant)

Pushing the context button clarifies the world and makes it predictable, certain, uncomplicated, unambiguous, and a safe place to be.

Contextualizing the concept of free time:

• How much time do I have?
• Do I want to do it with someone?
• Where can I do the activity?

Pushing the context button helps to ‘predict’ an uncertain world with all its ever-changing meanings.

Contextualized teaching;

• Do not use decontextualized materials
• Do not teach ‘skills’ but start from contexts 
• Link behaviors always to contexts

Teaching: traditional approach - generic skills

Contextualized teaching: Does not start from skills but from contexts

Contextualized teaching -  Teaching and clarifying context:

• What can happen in that context?
• What can you do in that context?
• What can you say in that context?
• Contextualized scripts

Autism: Dispelling Myths

Here are my notes from one of the sessions at the 

Converge Autism Summit. This presentation was: Autism: Dispelling Myths by Dr. Matthew Fisher (Adolescent Psychiatrist at Springbrook Autism Behavioral).

Research GI Flora (Gut Bacteria):

• November 2021 Australia
• 99 Patients with ASD
• 51 Siblings
• 97 Unrelated Children (Picky Eaters)
• Stool samples showed no differences in gut flora between ASD and Picky Eaters

Waiting for the Diagnosis: 

• Prior to Pandemic wait times ~12 months
• “Post” Pandemic wait times ~18+ months
• Waiting for a formal diagnosis potentially misses critical developmental stages and windows for improved interventions
• Get referrals for Occupational Therapy, Speech Therapy, and Possibly Dietary

Occupational Therapy:

• Improve Fine Motor Skills
• Regulate Sensory Needs
• Assist in Education
• ADLs (Activities of Daily Living)
• Social Interactions and Participation
• Special Note: OT is not intended to find you a job!!!

Dispelling the myths of OT:
Contrary to popular belief:

• Not every child needs a weighted vest Not every child has sensory issues
• Not every child needs OT
• OT is not Physical Therapy

Speech Therapy:
Speech and Language Pathologists: 

• Improve Verbal Communication
• Improve Nonverbal Communication
• Feeding and Swallowing Concerns

Dispelling the myths of ST:

Speech and Language Pathologists:

• Improve Verbal Communication
• Improve Nonverbal Communication
• Feeding and Swallowing Concerns

Direct Contact is Overrated:

• Direct eye contact can be overwhelming and sensory averse
• Best to have them face you so show that they are listening

Communication and ASD:

• Many believe that teaching augmentative communication (sign language, picture boards, etc.) will decrease the likelihood of speaking
• Alternative Augmentative Communication (AAC) facilitates the development of speech

Overly focused on a single goal/skill:

• Too much focus is often given to mastering a single communication goal
• Best to cycle through functional communication, social skills, and language skills to expose them to a variety of skills needed for daily functioning

Fixation on a single mode of communication:

• Signs, picture communication, rudimentary gestures, and verbal communication should ALL be targeted.
• A Total Communication approach expands skills faster than a single focused approach

Picky Eaters:

• Some children may be picky eaters however, others may overeat as they crave sensory input.
• Some children may appear picky but have sensory aversions (texture, tastes, smells)

Other Explanations for Picky Eaters:

• Perhaps your child just doesn’t like certain foods. . .and that’s OK!!!
• Maybe it’s genetic (ie: Broccoli)

Early Childhood Intervention Programs:
BabyNet

Making the Diagnosis:

• Formal Diagnosis should come from a Medical Doctor
• Child and Adolescent Psychiatrist or Developmental & Behavioral Pediatrics. . .if you can find them
• Many states “require” CARS or ADOS assessment to meet requirements for services

CARS vs. ADOS:

• CARS: Childhood Autism Rating Scale
• Questionnaire answered by someone familiar with the patient (parent, teacher, daycare worker)
• ADOS: Autism Diagnostic Observation Scale
• Structured and detailed assessment that involves tasks of varying complexity

CARS:

• A Questionnaire designed to identify those who might have developmental delays and/or ASD traits
• The form is filled out by someone familiar with the child so results can be quite subjective
• Results can vary widely

ADOS:

• Modules based on functioning level
• You must be specifically trained in ADOS and have the proper assessment kit
• The scores are based entirely on the results of the test
• Testing can take an extended amount of time

IQ Testing:

• Intelligence Quotient
• Often a “cut off” for services
• Typical cut off score is 70
• Highly dependent on the administrator of the test ◦ Requires active engagement by the child
• You can always “fake” a low score
• Unreliable Indicator

IQ vs. Functional Skills:

• IQ provides a number to qualify for services
• Adaptive Functioning – Actual Abilities
• Tests may include: 
• Vineland (VABS)
• Woodcock-Johnson

ID vs. ASD

• Intellectual Disability: The diagnosis formerly known as Mental Retardation (MR)
• Borderline Intellectual Functioning: IQ 70-85
• Ranges: Mild, Moderate, Severe
• Mild: IQ 50-69
• Moderate: IQ 35-49
• Severe: IQ 20-34
• Independent from ASD

Observation is the best assessment!

The Academic Diagnosis of ASD:

• A medical/clinical diagnosis does not necessarily entitle a child to additional school resources or services
• An academic diagnosis does not mean that the child will meet clinical criteria for the diagnosis.

What’s Up With Nonverbal ASD:

• Nonverbal vs Minimally Verbal vs Echolalia
• Do they use other forms of communication??? 
• Sign Language
• Communication Boards
• Typing

Receptive vs Expressive Communication Can they follow commands?

• Can they follow multi-step commands?
• Indicator/Marker for overall progress if still nonverbal by 4 years of age

No Cause for Behaviors:
Just because you aren’t aware of a cause doesn’t mean there isn’t an actual cause!!! (antecedent)

Don’t Forget Medical Diagnosis:

• Children with ASD often struggle to communicate discomfort, pain, or to indicate the presence of medical conditions
• Even verbal patients often fail to recognize or convey information regarding physical symptoms

Children with ASD:

• 25% lifetime chance of Seizure Activity
• 25% with some form of Gastrointestinal Problems
• Diarrhea (runny stools the most common) Constipation
• Esophageal Reflux (GERD)
• Eosinophilic Esophagitis (EoE)

Special Diets:

• Gluten Free
• Casein Free
• Soy Free
• You’re already dealing with picky eaters
• Do they have a medical diagnosis or allergy? Often more trouble than it works Starting an unnecessary battle

Fish Oils:

• Fish Oil has been found to have mild mood stabilizing properties 
• Natural Sources yield broader health benefits than Supplements (change diets if possible)

They’ll Never Be Able To:

• Hold a Job. . .
• Live Alone. . .
• Function Independently. . .
• Complete Neurologic Maturity reached at 25 years old (18 isn’t remotely an adult brain)
• Meanwhile in Ancient Rome. . .

Neural Wiring and Dendritic Pruning

Dendritic Pruning streamlines neural firing and functioning


Undiagnosed ASD:

• Reactive Attachment Disorder (RAD) Abuse/Neglect/Trauma
• Emerging Psychosis
• ADHD & Anxiety

What happened to Aspergers?

• “Former” Diagnosis that encompassed higher functioning ASD with no speech delays
• Normal IQ range
• No higher risk of medical diagnoses
• Blame DSM-V

Closing Thoughts/Tips/Tricks:

• Schedules
• Logs
• Maps
• Pattern Recognition
• Prescriptions

Autism and Happiness: From Neurodiversity to Neuroharmony

Here are my notes from one of the sessions at the Converge Autism Summit. This presentation was: Autism and Happiness: From Neurodiversity to Neuroharmony by Peter Vermeulen (founder of “Autism in Context,” where autism is understood in context).

Outcome of autism in adulthood:

• Outcome is highly variable
• Diagnosis is generally stable, although autism symptoms and adaptive skills often improve
• Outcome in integration and independence: +50% not good or even poor

What are the criteria?

• Employment
• relationships/friends
• Health
• Cognitive functioning
• Living situations
• Autism symptoms

Shortcoming of outcome studies: Objective criteria don’t say much about quality of life.

Measuring outcome in autism - objective criteria (societal norms) plus subjective criteria (wellbeing)

And when we focus on well‐being:

• then it is from a negative side: focus on the lack of well‐being: Co‐morbidity
• Mental health issues: anxiety, depression
• All kinds of measurements and questionnaires have been developed to measure negative feelings in autistic people

Happiness - pleasant life vs. meaningful life

Pleasant life:

• Positive feelings
• Joy - pleasure
• Absence of pain
• Safety
• Activities you like

Meaningful life:

• Contentment
• Purpose in life
• Personal growth
• Serving others
• Life satisfaction

Focus on (emotional) wellbeing, but:

• Avoid forcing a person with ASD into neurotypical concepts of happiness
• Avoid forcing a person with ASD into stereotyped ideas about autism
• So, ask people and do a well‐being assessment – Find out what makes people feel good
• – Assessment of interests

Assessment of Sensory Preferences - don’t make assumptions.

Talent scouting: The success stories in autism like Temple Grandin, show that focusing on strengths and interests leads to a more happy and successful life with autism

Quality of Life (QoL) - no link between IQ and Severity

This is how many think it works:
Less autistic → more well being
This it works like this:
More well being → less autistic

Happier people are more successful in life.

Why focus on happiness and wellbeing?

Because happy autistic people will have better outcomes in:

• Employment
• relationships/friends
• Health
• Cognitive functioning
• Living situations
• Autism symptoms

H.A.P.P.Y - Happiness in Autism Personal Project for Young people

www.petervermeulen.be

Working in a System - Why Can’t We Get It Right

Here are my notes from one of the sessions at the Converge Autism Summit. This presentation was: Working in a System - Why Can’t We Get It Right by Dr. Brandon Clark (Director of Autism Clinical Services at Springbrook Autism Behavioral Health in Travelers Rest, South Carolina).

Dyadic vs. Systems Theory

Dyadic: 

• 2 party relationships
• Traditional ABA 
• Focuses on the individual 

Systems Thinking:

• Overall organization and process for execution
• All the factors that contribute to successful outcomes

Weaknesses of Dyadic:

• narrow focus
• undesired effects on the environment
• behavior change may not last
• How to identify? Lack of progress or behavior not generalizing

Levers of Change:

• Behavior - What we want and how to do
• Process - How we are supposed to do
• Organizational Levers - Why we do

Weaknesses of Systems Approach: 

• Too much emphasis on process and not on the human component
• We must learn the art of interaction 

Healthy systems integrate both approaches. 

Behavior change is not sustainable without identifying and addressing barriers. 

Barriers to Implementation - there are 31 of them. 

• Top 3 barriers are managing problem behaviors, remembering to implement, and competing responsibilities. 
• Other barriers are school culture, conflicting beliefs, administrative support, and structure and time. 

Change Resistance:

• Education: The less education an individual has obtained, the less likely a person is to accept change.
• Age: The older someone is, the less likely the person is to accept change.
• Tenure: The longer someone has been employed, the less likely the person is to accept change.
• Role conflict: When expectations of a job are incompatible with a person’s skill set, or willingness to assert additional effort, the person is less likely to accept change. 

Framework for Intervention:

• Organizational level- Funds available, materials, space and equipment, organizational health. External level- District community, government, federal policies, etc. 
• Intervention level- Complexity, time, materials, number of people and resources needed. The more complex it is, the worse the integrity.
• Implementer level- Implementer competency, professional development, competing responsibilities for other tasks/students. 

Strategies to Address: 

• Modify intervention
• Modify timing
• Re-teaching expectations/intervention
• Problem-Most strategies are simply aimed at re-teaching expectations. This doesn’t solve the problem in a non-supportive environment. 

5 Emerging Themes:

• Establishing supportive culture
• Admin leadership and support
• Attending to structure and use of time
• Providing ongoing support for professional development
• Facilitating family and student involvement 

Feedback = Task Engagement: (Variable  leads to Outcome)

• Task significance  leads to Higher task dedication
• Task autonomy leads to Higher task dedication
• Frequent feedback leads to Higher task dedication
• Perception of tasks as unnecessary leads to Job burnout
• Employees prone to burnout leads to Less likely to use critical thinking skills used for problem-solving
• Staff not aligned with company mission leads to Job burnout/failure to thrive 

6 Boxes:

Expectations and Feedback: Information about what to do and produce, how to do it

• Align expectations with consequences. ASK if people know what to do!
• Provide Feedback

Tools & Resources: The environmental and human resources needed to do a job.
Supportive physical space and ergonomics, sufficient time to do the job

Consequences and Incentives: Formal and informal, tangible or intangible results of behavior that increase or decrease its likelihood of occurrence.

Skills and Knowledge: Specific capabilities or expertise that the individual must use to perform a job. “Never assume that training is the solution. Training without a foundation in the “first three boxes” will probably not work or be cost-effective” 

Selection and Assignment: Having the right people for specific jobs, based on their social skills, personality, willingness to learn, etc.

Motives and Preferences: What types of incentives, work, and other job factors people prefer.

• Check to see if the person is inherently interested in the work.
• The success of a behavior plan is mostly dependent on someone’s willpower. And that load is much lighter when shared by many people.

Converge Autism Summit 2022

Last week I attended the Converge Autism Summit in Greenville, SC. It was a wonderful conference and I highly recommend going to it. I can’t wait until next year to learn some more.

Here are the sessions I attended:

• Working in a system - Why can’t we get it right by Dr. Brandon Clark.
• Autism and Happiness: From Neurodiversity to Neuroharmony by Peter Vermeulen. He was an extremely entertaining and knowledgeable speaker.
• Life Animated by Ron Suskind. He is a famous journalist whose son was diagnosed with autism. He shares about his family’s journey through this experience.
• Autism: Dispelling Myths by Dr. Matthew Fisher
• Context Blindness, Absolute Thinking in a Relative World by Peter Vermeulen. I would love to hear him in other sessions!
• You Can’t Make Me: Proactive Strategies for Positive Behavioral Change by Jim Ball
• The Use of Video Modeling for Learners with Autism by Jim Ball
• Techniques to Assist Children in Crisis by Dr. Brandon Clark, Peter Vermeulen, Dr. William Killion, and Dr. Matthew Fisher.
• The Way I See It: A Personal Look at Autism and Aspergers by Temple Grandin

I will be writing up my notes and sharing the information that I learned so please check back next week to see what I learned.

Converge Autism Conference 2017 Day 1

For pictures, click here.

Last week I attended a two day conference on autism hosted by Springbrook Behavioral Health. This was their first annual conference and it was a big hit! There was quality sessions by qualified speakers and the conference was well attended! I was so glad I went and I look forward to attending this next year. I hope after you read about the sessions that I attended and things that I learned, you will think about attending this conference next year if you live in the area. The facility where it took place was very comfortable easily accessible.

The first keynote was by Dr. Killion on Autism and Applied Behavior Analysis. Dr. Killion is the author of The Functional Independence Skills Handbook (or FISH) Developmental Program.

1.     Autism was not clearly identified as a developmental disability until 1943.

2.     A person with autism demonstrates the ABCs:

·      Asocial behavior -  may not want cuddling, difficulty interacting with others, may prefer to be alone, may avoid eye contact. Asocial is not antisocial.

·      Behavior – burst of aggression, noncompliance, stereotypic behavior (don’t try to stop it because they need it to feel normal)

·      Communication  impairments

3.     Autism doesn’t occur randomly.

4.     Transition – give cues at least 5 min. before and then 1 min. before.

5.     Literal – be careful about using idioms (shrimp on the Barbie, cat out of the bag).

6.     Keep it visual.

7.     Keep a consistent schedule.

8.     Use Task analysis.

9.     When speaking:Keep sentences short.

10.  Don’t repeat until after 30 seconds.

11.  Use concrete words.

12.  Use gestures with your speech.

13.  Communicate – point to a picture if necessary or use sign language.

14.  Antecedent Control – changing things that may lead to problems.

15.  Affect – your impact on the environment and the environments impact on you.

16.  Learn a lot from giving a touch on the shoulder. Some with autism may find it offensive.

17.  All behavior has function!

18.  3 reasons for behavior: get something, avoid something, or sensory stability.

19.  Postive reinforcers – things the person likes

20.  Negative reinforcers – take away things the person likes; doesn’t last, temporary change

21.  Punishment – doesn’t work

22.  Schedules of reinforcement –

·      ratio (given per number of correct responses)

·      interval (given for periods of time where something does or does not happen)

·      fixed (given for an identified number of suceses)

·      variable (given in a random way for an average number of times) – most powerful

23.  Sometimes the moment has to pass before we can address it.

24.  Bribes vs. operant conditioning – insuring the act and not the reward is the motivator (reward after the appropriate behavior and not before)

25.  Threats – say what you mean and mean what you say.

26.  Choice vs. orders – most directives can have a negotiable part along with the non-negotiable.

27.  LEAF – listen, empathize, act, follow up

The second Keynote was by Jeffery Cohn on Finding Exceptional Abilities Not Disabilities.

1.     Many people on the Autism Spectrum have difficulty managing sensory input.    

2.     Auditory problems – may be due to improperly functioning stapedius , which is the middle ear muscle that contracts in response to loud noise. When it isn’t working, sounds may seem louder.

3.     How to help a child prior to being overloaded to avoid shutdown

·      Modulate room sounds and voice tones.

·      Create sensory space for calming and organizing thought.

·      Give time for response when asking questions.

·      Reduce white noise in room.

·      Use more visual prompts over verbal.

4.     Lights (blue and green on the walls to calm people.

5.     Squeeze ball under chin to help stress

During lunch (which was provided), there was a panel discussion and the audience was able to ask questions. I found this was very informative and educational.

After lunch, there were 2 breakout sessions and I chose Equine Assisted Psychotherapy (EAP): Both Behavioral and Mental Health Models by Melanie Watt.

1.     Hope Remains Ranch

2.     Horses can sense a person’s heartbeat.

3.     Horses have fight or flight so if someone is acting up, the horse will move away.

4.     They will be having an open house where you can demos and take a tour.

The last session of the day was by Dr. Janice Young on “Do You Know What I Know? An Insider’s Guide to Meeting the Needs of Students with Special Needs.”

1.     13 disability categories under IDEA

2.     Progress monitoring – MAPS, Woodcock Johnson, DIBELS, Easy CBM (www.easycbm.com)

3.     RTI

4.     IEPs

5.     Differentiated Instruction

6.     Instruction: Presentation (how is it being taught), Process (how students will learn), Product (how students will demonstrate what they learned).