Young people with Aspergers are often misdiagnosed and underserved in the U.S. The difficulty in understanding and acknowledging Aspergers by the medical, psychological, and psychiatric community can lead to misdiagnosis and even failure to provide the services needed for these children. Thus, it is critical that parents who suspect their child may have Aspergers or High-Functioning Autism educate themselves about the early signs associated with this disorder and begin the intervention process early.
Moms and dads frequently begin to suspect that there is something wrong before the age of two. Many kids who are diagnosed at a very young age with Attention Deficit Disorder (ADD) may in fact have Aspergers.
Aspergers is not a disease; rather, it is a developmental neurobiological difference in brain functions and is characterized by the following:
- stereotyped and restricted patterns of behavior, activities, and interests
- qualitative impairment in social interaction
- no significant delay in cognitive development
- no general delay in language
In addition, intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis. Symptoms of Aspergers are usually recognized during the first three years of childhood; however, it is often not recognized until kids are of school age.
1. Parents may notice a lack of eye contact or social smiles, or they may observe too much eye contact and an appearance of the youngster viewing children as interesting to observe, but not necessarily interact with or seek recognition from. These kids may not have an interest in sharing toys and interests, and tend to be viewed as "lost in their own little world" at times. They may have a greater interest in sensory and physical play with others (e.g., tickling, hugging, piggy back, chasing, video games, fantasy play, repetitive watching of movies, reading books to the exclusion of social interaction, etc.).
2. Aspergers impacts normal development of the brain in the areas of social interaction and communication skills. The disorder makes it hard for children to communicate with others and relate to the social world. In some cases, aggressive and/or self-injurious behavior may be present; however, internal behaviors such as withdrawal, depression, anxiety, eating disorders, and social isolation may be just as prevalent.
Communication may not appear to be delayed, but comprehension and social language requiring give and take may be lacking. Also, an unusual tone or quality, rote or repetitive speech may present. Blurting out, excessively asking the same question over and over, echoing or mimicking, large vocabulary, or difficulty listening to another and understanding another perspective can be apparent. Some children with Aspergers demonstrate extreme abilities in remembering facts, numbers, phone numbers, maps, words, birth dates, or other factual information. They may appear very rigid in their point of view, and unable to accept or understand another's perspective. They may appear to never be able to "let it go," or tend towards appearing argumentative or "splitting hairs." A conversation can lead to tantrums, emotional meltdowns, or withdrawal with seemingly little provocation.
3. Children with Aspergers may exhibit repeated body movements (e.g., hand flapping, rocking), unusual responses to children or attachments to objects and resistance to changes in routines. They may also experience sensitivities in any or all of the five senses.
4. Children with Aspergers tend to rely heavily on rigid internal rules and struggle with the unwritten social rules of social interaction. Failure often accompanies Aspergers kids like a close companion. As a result, they may need much reassurance during stressful periods.
5. Empathy can be defined in numerous ways, and non-verbal communication (e.g., posture, gestures, eye contact, facial expression, tone, etc.), are clues in revealing our emotions, attitude, personality, relationships. This helps guide the interpretation of how another feels leading to an empathetic awareness or understanding of others. This empathetic understanding can be hindered in a child with Aspergers.
Given that characteristics of Aspergers may include a complete lack of the sense of fear or danger, too little or too much eye contact, which can appear as overly aggressive, threatening, or seductive, combined with a hindrance in the ability to judge another person's feelings or intentions accurately, females with Aspergers may be at increased threat for assault, abuse, violence, or worse. Many girls on the spectrum provide stories of being singled-out or picked on mercilessly due to their odd behaviors or just not fitting in and are literally disabled when it came to surviving the more sophisticated social complexity of adolescent society.
6. Kids with Aspergers have difficulty understanding subtle cues. Misunderstandings, literal interpretation, and/or sensory over stimulation can lead to overreactions, irritability, low frustration tolerance, tantrums, aggressiveness, appearing to have an explosive temperament, self stimulation, anxiety, depression, or self injury. Kids with Aspergers develop a tendency of distrust towards others due to social failures and negative social experiences over time, which can lead to self-isolation and social phobia. This behavioral reaction can be viewed as "rude" by others, and often children on the spectrum struggle to understand why they are not liked or frequently feel rejected.
7. Kids with Aspergers may become extremely upset if their routine or ritual is changed in any way, and can become agitated if someone touches their things, moves furniture or toys around, or even takes a different driving route to or from school. They may be very rigid and insist on doing things the same way every time, or demonstrate an extreme aversion or experience tantrums during transitions. Stereotypical movements (e.g., spinning, flapping, lining things up, toe walking, body rocking, grimaces, twirling, pacing, racing around, noisemaking, leg bouncing, clearing of the throat, chair rocking) may be more significant or frequent during periods of change or transitions. An extreme perfectionism or "having to finish" what they have started to the point of meltdowns may be evident especially during unexpected or unwanted transitions.
8. Kids with Aspergers may display a very narrow or an unusual range of interests, with elaborate or unusual play-based behaviors. They may act-out elaborate rituals, which appear to be creative play, but are actually scripted activities without the variation or creativity of imaginary play. They may demonstrate fixations on things (e.g., Pokémon, television shows, computer games, numbers, trains, cars, etc.), and tend toward lining things up, organizing by color, or even repeating lines verbatim.
9. Kids with Aspergers may exhibit and excessive desire or intense aversion to sensory input. They may appear hyperactive, and pursue movement to an excessive degree, or they can appear unresponsive or ‘flat’ if overwhelmed hypersensitive to sensory input and movement. Some may have an unusual or extreme response to sounds and cover their ears in response to vacuum cleaners, hair dryers, crying babies, sirens or other loud or unexpected noise. Some may be extremely affected by smells, tastes, textures, heat, or commotions. They may have problems falling asleep, or staying asleep. Kids who are overly reactive to crowds and commotion may appear uncomfortable or avoidant of cafeterias, malls, gymnasiums, parties, family gatherings, or even theaters. In reaction, they may feel hot, get a stomach or headache or tantrum, or resist going to such places.
10. Kids with Aspergers may interact very well with grown-ups, but struggle with appropriately initiating peer interaction or maintaining interest. Sometimes, kids with Aspergers do not notice if a playmate loses interest, or even wanders away. The unwritten social rules seem to be confusing, and interpreting social comments, facial expressions, tone of voice, or body language can be similar to trying to interpret a foreign language. A general lack of fear may be evident, and kids with Aspergers may talk openly with strangers, hug strangers, invade other's personal space, bump into peers in lines, touch or climb on others inappropriately, or have excessive or a complete lack of separation anxiety from moms and dads.
11. Motor clumsiness or fine motor difficulties may be present, and intuitive physics may be higher than intuitive psycho-social abilities. An Aspergers youngster may be able to dismantle and recreate elaborate Lego designs, set a clock, reprogram a VCR, match shapes, or display, artistic or musical talents.
12. Social isolation, a limitation in reciprocation or give and take interactions, tending to be self-absorbed or aloof, a lack of social discrimination, and/or difficulties with social skills are also common in Aspergers children and teens. Social isolation may look like the youngster is withdrawn, avoiding contact or interaction with children, family, or peers, and a preference towards playing alone or with "things" rather than playmates. Kids with Aspergers may appear to play next to – but not with – others, and establishing friendships with “give and take” interactions may be lacking.
For a professional to meet only briefly in a single setting is not enough to paint a complete portrait of an Aspergers child's needs and abilities. Often, a child with Aspergers can appear to have the behaviors of a mentally handicapped, behaviorally disordered, or hearing impaired person. The behaviors noted are sometimes dismissed as immaturity, odd, or shy.
Early identification and intervention are considered key to positive outcomes for kids on the spectrum. In order to reach all Aspergers children, school psychologists, mental health professionals, physicians, and moms and dads should work together to become better informed regarding research, assessment tools, and diagnostic criteria, as well as the best proactive interventions to increase social skills, personal communication, behavior, and peer interaction for Aspergers children.