HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

Education and Counseling for Individuals Affected by Autism Spectrum Disorders

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Aspergers: Quick Reference for Clinicians

Aspergers is a form of pervasive developmental disorder characterized by persistent impairment in social interactions, repetitive behavior patterns, and restricted interests. Unlike autistic disorder, no significant aberrations or delays occur in language development or cognitive development. Aspergers is generally evident in kids older than 3 years and occurs more often in boys.

Kids with this disorder often exhibit a limited capacity for spontaneous social interactions, a failure to develop friendships, and a limited number of intense and highly focused interests. Although some individuals with Aspergers may have certain communication problems, including poor nonverbal communication and pedantic speech, many have good cognitive and verbal skills. Although individuals with Aspergers have fewer memories, the experiences of remembering are qualitatively similar in people with Aspergers compared with healthy control subjects. Physical symptoms may include early childhood motor delays, clumsiness, fine motor difficulty, gait anomalies, and odd movements.

People with Aspergers have normal or even superior intelligence and may make great intellectual contributions while demonstrating social insensitivity or even apparent indifference toward loved ones. Published case reports of people with Aspergers suggest an association with the capacity to accomplish cutting-edge research in computer science, mathematics, and physics. Although the deficits manifested by those with Aspergers are often debilitating, many people experience positive outcomes, especially those who excel in areas not dependent on social interaction.

People with Aspergers have exhibited outstanding skills in mathematics, music, and computer sciences. Many are highly creative, and many prominent individuals demonstrate traits suggesting Aspergers.

Although normal language and cognitive development differentiate Aspergers from other developmental disorders, the severe social impairment associated with this condition overlaps with disorders such as high-functioning autism (HFA).

Key features of the deficit manifested in individuals with Aspergers pertain to their inability to understand the thoughts of other people and themselves. A typical youngster can recognize the thoughts of other children and himself and hypothesize how other people are likely to respond to life occurrences. The lack of this comprehension in an individual with Aspergers is termed a deficiency in the formation of a theory of the mind.

Frequency—

• Likely, many individuals with Aspergers are undiagnosed in North America. Many individuals with Aspergers are probably members of the general population without awareness of their diagnosis. Family and friends probably accommodate the signs of Aspergers as idiosyncrasies of the individual.

• Because of the divergent diagnostic criteria used in the United States and Canada, estimates of Aspergers frequency widely vary. Various studies indicate rates ranging from 1 case in 250-10,000 kids. Additional epidemiologic studies are needed, using widely accepted criteria and a screening instrument that targets these criteria.

Mortality/Morbidity—

People with Aspergers appear to have normal life spans; however, they seem to endure an increased prevalence of comorbid psychiatric maladies (e.g., depression, mood disorders, obsessive-compulsive disorder, Tourette disorder).

Race—

Aspergers has no racial tendency.

Sex—

The estimated male-to-female ratio is approximately 4:1.

Age—

Aspergers is commonly diagnosed in the early school years and less frequently during early childhood or even adulthood.

Clinical—

Developmental history:

• Include a thorough evaluation of social behaviors, language, interests, routines, physical coordination, and sensory sensitivity, starting from birth.

• Interview mothers/fathers about prenatal history and maternal health factors that may have affected the pregnancy.

Social problems:

• An affected youngster may not display affection to mothers/fathers or other family members. A lack of bonding and warmth with mothers/fathers and other guardians may seem apparent, typically resulting from the youngster's lack of social skills.

• Kids with Aspergers may have difficulties with peer relations and may be rejected by other kids. Depression and loneliness may occur in adolescents with Aspergers.

• People with Aspergers may have particular difficulty in dating and marriage. Boys and men with Aspergers may decide to marry suddenly without the dating and courtship that typically precede a union. They may also be unaware that friendship often precedes courtship and engagement. People with Aspergers may want to marry despite the lack of awareness of the many social interactions that usually lead up to matrimony.

• Outside the realm of immediate family members, the affected youngster may exhibit inappropriate attempts to initiate social interaction and to make friends. Within the immediate family, the youngster is often loving and affectionate.

• Individuals with Aspergers are vulnerable to depression, even suicide, after a perceived rejection in a social situation such as dating and marriage. Clinicians must be aware of the risk of depression and institute prompt interventions when major depression occurs.

• Individuals with Aspergers may benefit from counseling and social skills training. Attwood (1998) provides exercises for mothers/fathers to use to foster social skills in their kids. These activities can be modified for the needs of adults with Aspergers. Psychotherapy is often helpful for people to recognize their deficits in social skills.

• Separations from mothers/fathers because of work and divorce may be particularly stressful for these kids. Changing homes, communities, and neighborhoods may also exacerbate symptoms.

• Socially inappropriate behavior and failure to understand social cues may be reported.

• The youngster may not understand why individuals become upset when he or she breaks social rules.

Communication abnormalities:

• Body language or nonverbal communication may be awkward and inappropriate.
• Facial expressions may be absent or inappropriate.
• Pragmatic errors are commonly produced by kids with Aspergers in response to questions. Kids with Aspergers often produce irrelevant responses.
• Use of gestures is frequently limited.

Speech and hearing:

• Affected kids demonstrate several abnormalities in speech and language, including pedantic speech and oddities in pitch, intonation, prosody, and rhythm.

• Kids often exhibit auditory discrimination and distortion, particularly when the youngster encounters 2 or more individuals speaking simultaneously.

• People with Aspergers may vocalize their thoughts without censoring. Personal remarks inappropriate to most social environments may be uttered routinely.

• People with Aspergers often exhibit practical speech problems, including an inability to use language in social contexts, a lack of sensitivity about interrupting others, and irrelevant commentary.

• Miscomprehension of language nuance (e.g., literal interpretations of figures of speech) is common.

• Some people with Aspergers may display selective mutism, speaking not at all to most individuals and excessively to specific individuals. Some may choose to talk only to individuals they like. Thus, speech may reflect idiosyncratic interests and preferences of the individual.

• Speech may be unusually formal or used in idiosyncratic ways that others do not understand.

• The amount of speech may also widely vary and reflect the individual's current emotional state more than the communication requirements of the social setting. Some people may be verbose and others taciturn. Furthermore, the same individual may demonstrate excesses and paucity of speech intermittently.

• The form of language chosen may include metaphors that are meaningful only to the speaker. The message meant by the speaker may not be understood by those who hear it, or the message may be meaningful only to a few individuals who understand the private language of the speaker.

Activities:

Kids exhibit peculiar and narrow interests, excluding other activities. These interests may be so important that the kids do not develop typical relationships with their family, school, and community.

Sensory sensitivity:

• Kids may be particularly sensitive to the texture of foods.
• Kids may exhibit synesthesia, including a sensory response to an environmental stimulus in a different sensory modality.
• Kids may show sensitivity to sound, touch, taste, sight, smell, pain, and temperature. For example, a youngster may demonstrate either extreme or diminished sensitivity to pain.

Physical findings:

• Affected kids may exhibit anomalies of locomotion, balance, manual dexterity, handwriting, rapid movements, rhythm, and imitation of movements.
• Clumsiness is common.
• Children exhibit impaired ball-playing skills.
• Lax joints are often observed (e.g., an immature or unusual grasp for handwriting and other fine hand movements).

Prognosis—

• Children with Aspergers may be taught specific social guidelines, but the underlying social impairment is believed to be lifelong.
• People with Aspergers tend to have a better prognosis when they have supportive families who are knowledgeable about Aspergers.
• Comorbid psychiatric disorders, when present, significantly affect the client's prognosis.

Social Behaviors in School Settings—

• Auditory integration training helps some kids with social interactions.

• Because changes in schools, classrooms, and teachers may exacerbate symptoms, attempt to minimize alterations to the client's schedule and educational environment.

• Kids can learn to watch other kids for social cues and for behaviors to imitate.

• Kids may benefit from a full-time, trained, 1-on-1 teacher aide to shadow them in the classroom and to coach appropriate behavior.

• Kids, adolescents, and adults with Aspergers typically benefit from a weekly, therapist-guided, social skills group with peers.

• Teachers can explain appropriate means of seeking help when the youngster demonstrates problematic social behaviors in the classroom. Videotapes may facilitate self-monitoring of adherence to classroom rules.

• Teachers can model socially appropriate behavior and encourage cooperative games in the classroom.

• Teachers have many opportunities to help kids develop appropriate social behaviors.

• Teachers may help kids in challenging social situations by supervising breaks between classes and lunchroom and playground activities.

• Teachers may identify suitable friends for kids and encourage prospective friendships.

Interaction with Other Kids—

• Kids may benefit from an organized club, chaperoned by adult leaders who provide advance preparation and a discussion forum.
• Mothers/fathers can help kids learn appropriate play by modeling and rehearsing such skills as flexibility, cooperation, and sharing.
• Mothers/fathers should encourage an affected youngster to invite a friend to their home.

Communication and Language Strategies—

• Because interpretation of metaphors and figures of speech is often difficult, caregivers should explain these language subtleties when they arise.

• Caregivers, through modeling, can teach affected kids how to interpret the conversational cues of others to reply, to interrupt, or to change topics.

• Kids can be taught to memorize phrases for specific purposes (e.g., to open conversations).

• Kids can be taught to refrain from vocalizing every thought.

• Kids can learn to seek clarification by asking individuals to rephrase confusing expressions. Encourage kids to ask that confusing instructions be repeated, simplified, clarified, and written down.

• Encourage kids, when appropriate, to admit that they do not know an answer.

• Role-playing may help a youngster learn to understand the perspectives and thoughts of other individuals. Encourage the youngster to stop and think how another person will feel before the youngster acts and speaks.

• Some kids with Aspergers may have good visual thinking abilities; they may be encouraged to visualize using diagrams and visual analogues.

• When communicating a series of instructions to a youngster with this disorder, pause between each separate statement.

Career Counseling and Orientation—

• People may need special help to prepare for job interviews and to maintain an appropriate demeanor in a work environment.

• Career choices using technology, especially the Internet, are often particularly suitable for individuals with Aspergers. Computer science, engineering, and natural sciences are common career choices for people with this disorder. Other special interests may be developed into careers.

• Career choice is crucial for persons with Aspergers because social impairment limits their success in many occupations.

The Aspergers Comprehensive Handbook

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