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

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Depression in Teens with Asperger’s & High-Functioning Autism

Adolescents suffer from depression more often than any number of grown-ups who live their entire lives with it. Moms and dads are generally dismissive of their child’s low moods, because they think that ALL teenagers are simply moody, hormonal, or tired and cranky. This dismissive attitude generally results in teenagers being even more depressed, because they think their mother or father doesn’t care. Take that in combination with adolescents with High-Functioning Autism (HFA) or Asperger’s (AS) who have very little impulse control as it is, and you have a horrible combination.

Depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenage son or daughter thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders like depression can occur at any time in life, symptoms are significantly more pronounced in adolescents than grown-ups. To make matters worse, the HFA/AS teen’s depressive symptoms are usually more pronounced than that of a “typical” teen.

Issues such as peer pressure, peer rejection, bullying, academic expectations and changing bodies can bring a lot of ups and downs for HFA and AS adolescents. But for some of these young people, the lows are more than just temporary feelings — they're a symptom of depression. Adolescent depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most HFA and AS adolescents, depression symptoms ease with treatment (e.g., medication and psychological counseling).

Adolescent depression signs and symptoms include changes in your HFA/AS adolescent's emotions and behavior, such as the examples below. Be alert for emotional and behavioral changes, such as:
  • Agitation or restlessness (e.g., pacing, hand-wringing or an inability to sit still)
  • Changes in appetite (e.g., decreased appetite and weight loss, or increased cravings for food and weight gain)
  • Disruptive or risky behavior
  • Extreme sensitivity to rejection or failure, and the need for excessive reassurance
  • Feelings of sadness, which can include crying spells for no apparent reason
  • Feelings of worthlessness, guilt, fixation on past failures or exaggerated self-blame or self-criticism
  • Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
  • Frequent thoughts of death, dying or suicide
  • Insomnia or sleeping too much
  • Irritability, frustration or feelings of anger, even over small matters
  • Loss of interest in, or conflict with, family and friends
  • Loss of interest or pleasure in normal activities
  • Neglected appearance (e.g., mismatched clothes and unkempt hair)
  • Ongoing sense that life and the future are grim and bleak
  • Poor school performance or frequent absences from school
  • Self-harm (e.g., cutting, burning, or excessive piercing or tattooing)
  • Slowed thinking, speaking or body movements
  • Tiredness and loss of energy
  • Trouble thinking, concentrating, making decisions and remembering things
  • Use of alcohol or drugs

It can be difficult to tell the difference between (a) ups and downs that are just part of being a young person and (b) full-blown depression. Talk with your teenage son or daughter. Try to determine whether your youngster seems capable of managing challenging feelings, or if life seems overwhelming. If depression symptoms continue or begin to interfere in your HFA/AS adolescent's life, talk to a physician or a mental health professional trained to work with these teens. Your adolescent's family physician is a good place to start. Your adolescent's school may recommend someone as well.

If you suspect your “special needs” son or daughter is depressed, make a physician's appointment as soon as you can. Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed adolescents may be at risk of suicide, even if signs and symptoms don't appear to be severe.  If you're an adolescent and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your physician or school nurse. Share your concerns with a mother or father, a close friend, your pastor, a teacher or someone else you trust.

If your teenage son or daughter is having suicidal thoughts, get help right away. Take all talk of suicide seriously. Here are some steps you can take:
  • Seek help from your physician, a mental health provider or other health care professional.
  • Reach out to family members, friends or spiritual leaders for support as you seek treatment for your HFA/AS adolescent.
  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor or encourage your HFA/AS adolescent to do so.

If you think your teenage son or daughter is in immediate danger of self-harm or attempting suicide, make sure someone stays with her or him. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your HFA/AS adolescent to the nearest hospital emergency department.

It's not known exactly what causes depression. A variety of factors may be involved. These include:
  • Learned patterns of negative thinking. Adolescent depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.
  • Inherited traits. Depression is more common in individuals whose biological (blood) relatives also have the condition.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
  • Early childhood trauma. Traumatic events during childhood (e.g., physical or emotional abuse, loss of a mother or father, etc.) may cause changes in the brain that make a teenager more susceptible to depression.
  • Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms.

Many factors increase the risk of developing or triggering adolescent depression, including:
  • Abusing alcohol, nicotine or other drugs
  • Being a female (depression occurs more often in females than in males)
  • Being bullied or rejected by peers
  • Being gay, lesbian, bisexual or transgender (becoming socially isolated or experiencing bullying may increase the risk of depression)
  • Having a chronic medical illness (e.g., cancer, diabetes or asthma)
  • Having been the victim or witness of violence (e.g., physical or sexual abuse)
  • Having certain personality traits (e.g., low self-esteem or being overly dependent, self-critical or pessimistic)
  • Having few friends or other personal relationships
  • Having issues that negatively impact self-esteem (e.g., obesity, peer problems, long-term bullying or academic problems)
  • Having other conditions (e.g., anxiety disorder, anorexia or bulimia, attention-deficit/hyperactivity disorder or learning disabilities)

Family history and issues with family or others may also increase your HFA/AS adolescent's risk of depression:
  • Having a dysfunctional family and conflict
  • Having a family member who committed suicide
  • Having a mother or father, grandparent or other biological (blood) relative with autism, depression, bipolar disorder or alcoholism
  • Having experienced recent stressful life events (e.g., parental divorce, parental military service or the death of a loved one)

Untreated depression can result in emotional, behavioral and health problems that affect every area of your HFA/AS adolescent's life. Complications related to adolescent depression can include:
  • Academic problems
  • Alcohol and drug abuse
  • Family conflicts and relationship difficulties
  • Involvement with the juvenile justice system
  • Low self-esteem
  • Social isolation
  • Suicide

You may choose to start by contacting your HFA/AS adolescent's family physician. In some cases, you may be referred directly to a mental health professional, such as a psychiatrist or psychologist.

To the extent possible, involve your teenage son or daughter in preparing for the appointment. Then make a list of:
  • Questions that you and your HFA/AS adolescent want to ask the physician
  • Key personal information, including any major stresses or recent life changes your HFA/AS adolescent has experienced
  • Any symptoms your adolescent has had, including any that may seem unrelated to the reason you scheduled the appointment
  • All medications, vitamins, herbal remedies or supplements that your HFA/AS adolescent is taking

Basic questions to ask the physician include:
  • Are there any possible side effects with the medications you're recommending?
  • Are there any printed materials that we can take home?
  • Are there any restrictions that my adolescent needs to follow?
  • How will we monitor progress and effectiveness of the treatment?
  • Is depression the most likely cause of my youngster's symptoms?
  • Is there a generic alternative to the medicine you're prescribing?
  • My adolescent has these other health conditions. Could they be linked to depression?
  • Should my adolescent see a psychiatrist or other mental health provider?
  • What are other possible causes for my youngster's symptoms or condition?
  • What are the alternatives to the primary approach that you're suggesting?
  • What kinds of tests will my youngster need?
  • What treatment is likely to work best?
  • What websites do you recommend?
  • Will making changes in diet, exercise or other areas help ease depression?

To make the most of the time allotted, make sure your HFA/AS son or daughter is ready to answer questions from the physician, for example:
  • Are you using any mood-altering substances, such as alcohol, marijuana or street drugs?
  • Do you ever have suicidal thoughts when you're feeling down?
  • Do you generally always feel down, or does your mood change?
  • Do you have a history of significant weight gain or loss?
  • Do you have any biological (blood) relatives — such as a mother or father or grandparent — with depression or another mood disorder?
  • Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
  • How long have you felt depressed?
  • How much do you sleep at night? Does the amount change over time?
  • How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
  • What is your diet like?
  • What other mental or physical health conditions do you have?
  • What, if anything, appears to worsen your symptoms?
  • What, if anything, seems to improve your symptoms?
  • When did family members or friends first notice your symptoms of depression?

When adolescent depression is suspected, the physician will generally do these exams and tests:
  • Lab tests. For example, your HFA/AS adolescent's physician may do a blood test called a complete blood count, or test your teen’s thyroid to make sure it's functioning properly.
  • Physical exam. The physician may do a physical exam and ask in-depth questions about your HFA/AS adolescent's health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem.
  • Psychological evaluation. This evaluation will include a discussion with your son or daughter about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.

To be diagnosed with depression, your teenage son or daughter must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Symptoms can be based on your HFA/AS adolescent's feelings or on the observations of someone else. For a diagnosis of major depression, the following symptoms must occur most of the day, nearly every day, during at least a two-week period, and be a change or worsening in the adolescent's usual attitude and behavior.

Your adolescent must have at least one of the following:
  • Diminished interest or feeling no pleasure in any or most activities
  • Depressed mood, such as feeling sad, empty or tearful (in adolescence, depressed mood can appear as constant irritability)

Your adolescent must also have four or more of the following:
  • Fatigue or loss of energy
  • Feelings of worthlessness, or excessive or inappropriate guilt
  • Insomnia or increased desire to sleep
  • Recurrent thoughts of death or suicide, making a suicide plan or a suicide attempt
  • Restlessness or slowed behavior that can be observed by others
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in adolescence, failure to gain weight as expected can be a sign of depression)
  • Trouble making decisions, thinking or concentrating

To be considered major depression:
  • Symptoms are not caused by grieving (e.g., temporary sadness after the loss of a loved one)
  • Symptoms are not due to the direct effects of something else (e.g., drug abuse, taking a medication or having a medical condition such as hypothyroidism)
  • Symptoms aren't due to a mixed episode, which is mania along with depression that sometimes occurs as a symptom of bipolar disorder
  • Symptoms must be severe enough to cause noticeable problems in day-to-day activities (e.g., school, social activities or relationships with others)

Other types of major depression include:
  • Psychotic depression. This is severe depression accompanied by psychotic symptoms, such as delusions or hallucinations.
  • Dysthymia. Dysthymia is a less severe, but more long-term form of depression. While it's usually not disabling, dysthymia can prevent your teenage son or daughter from functioning normally in a daily routine and from living life to the fullest.
  • Atypical depression. In this type of depression, key signs and symptoms include increased hunger, weight gain, sleeping a lot, feeling that your arms and legs are heavy, and difficulty maintaining relationships.

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so that your HFA/AS adolescent gets appropriate treatment. Your physician or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:
  • Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect feelings, thoughts and behavior.
  • Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression.
  • Cyclothymia. Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
  • Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder such as depression.
  • Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.

Many types of treatment are available. In some cases, a primary care physician can prescribe medications that relieve depression symptoms. However, many adolescents need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychotherapy is very effective for most HFA/AS adolescents with depression.

If your teenage son or daughter has severe depression or is in danger of self-harm, she or he may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Antidepressants and increased suicide risk— Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, kids, teens and young people under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, individuals in these age groups must be closely monitored by parents and health care providers.  If your son or daughter has suicidal thoughts while taking an antidepressant, immediately contact your physician or get emergency help.  For most HFA/AS adolescents, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.

Antidepressants and pregnancy— If your teenage daughter is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing youngster. If your daughter becomes pregnant, make certain she talks to her physician about antidepressant medications and managing depression during pregnancy.

Finding the right medication— Everyone's different, so finding the right medication or dose for your HFA/AS son or daughter may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts.  If your adolescent has bothersome side effects, she or he shouldn't stop taking an antidepressant without talking to the physician first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression. Encourage your adolescent not to give up. If antidepressant treatment doesn't seem to be working, your adolescent's physician may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available.

Hospitalization and other treatment programs— In some HFA and AS adolescents, depression is so severe that a hospital stay is needed, especially if your son or daughter is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your adolescent calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control.

Managing medications— Carefully monitor your HFA/AS adolescent's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for adolescents with depression, your adolescent's physician may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your son or daughter does not have a large amount of pills available at once.

Medications— Because studies on the effects of antidepressants in HFA and AS adolescents are limited, physicians rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for adolescent depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with grown-ups, other medications may be prescribed at the physician's discretion (off label), depending on your HFA/AS adolescent's needs. Talk with your adolescent's physician and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication.

Psychotherapy— Psychotherapy is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members, or in a group.  Through these regular sessions, your teenage son or daughter can:
  • explore relationships and experiences
  • find better ways to cope and solve problems
  • learn how to identify and make changes in unhealthy behaviors or thoughts
  • learn about the causes of depression
  • set realistic goals

Psychotherapy can help your son or daughter regain a sense of happiness and control, and help ease depression symptoms like hopelessness and anger. It may also help your HFA/AS adolescent adjust to a crisis or other current difficulty.

You are your adolescent's best advocate to help her or him succeed. Here are some steps you and your “special needs” child can take that may help:
  • Encourage communication with your HFA/AS adolescent. Talk to your son or daughter about the changes you're observing and emphasize your unconditional support. Create an environment where your youngster can share concerns while you listen.
  • Help the HFA/AS adolescent avoid alcohol and other drugs. Your son or daughter may feel like alcohol or drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat.
  • Learn about depression. Education can empower your teenage son or daughter and motivate her or him to stick to a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression and understand that it's a treatable condition.
  • Make sure your HFA/AS adolescent adopts healthy habits. Even light physical activity can help reduce depression symptoms. Sleeping well is important for all adolescents, especially those with depression. If your teenage son or daughter is having trouble sleeping, ask the physician for advice.
  • Pay attention to warning signs. Work with your HFA/AS adolescent's physician or therapist to learn what might trigger depression symptoms. Make a plan so that you and your child know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
  • Stick to the treatment plan. Make sure your HFA/AS son or daughter attends appointments, even if he or she doesn't feel like going. Even if your adolescent is feeling well, make sure he or she continues to take medications as prescribed. If your child stops taking medications, depression symptoms may come back. Quitting suddenly may cause withdrawal-like symptoms.

Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for professional care. But some mind-body therapies may help.

Complementary and alternative medicine practitioners believe the mind and body must be in harmony to stay healthy. Examples of mind-body techniques that may be helpful for depression include:
  • Acupuncture
  • Guided imagery
  • Massage therapy
  • Meditation
  • Music or art therapy
  • Relaxation techniques
  • Spirituality
  • Yoga or tai chi

Relying solely on these therapies is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy.

Showing interest and the desire to understand your HFA/AS adolescent's feelings lets her or him know you care. You may not understand why your adolescent feels hopeless or why she or he has a sense of loss or failure. Listen to your “special needs” child without judging and try to put yourself in his or her position. Help build your child’s self-esteem by recognizing small successes and offering praise about his or her competence.

Encourage your HFA/AS adolescent to:
  • Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your son or daughter to talk to a family member or other trusted adult whenever needed.
  • Connect with other adolescents who struggle with depression. Talking with other adolescents facing similar challenges can help your son or daughter cope. So can learning skills to manage life's challenges. Local support groups for depression are available in many communities. And support groups for depression are offered online (but check them out to make sure they're credible and trustworthy sites).
  • Encourage your HFA/AS adolescent to keep a private journal. Journaling may help improve mood by allowing your child to express and work through pain, anger, fear or other emotions.
  • Have realistic expectations. Many adolescents judge themselves when they aren't able to live up to unrealistic standards (e.g., academically, in athletics, in appearance, etc.). Let your teenage son or daughter know that it's OK not to be perfect.
  • Make and keep healthy friendships. Positive relationships can help boost your HFA/AS adolescent's confidence and stay connected with others. Encourage her or him to avoid relationships with peers whose attitudes or behaviors could make depression worse.
  • Simplify life. Encourage your son or daughter to carefully choose obligations and commitments, and set reasonable goals. Let your child know that it's OK to do less when she or he feels down.
  • Stay active. Participation in sports, school activities or a job can help keep your teenage son or daughter focused on positive things, rather than negative feelings or behaviors.
  • Stay healthy. Do your part to make sure your child eats regular, healthy meals, gets regular exercise and gets plenty of sleep.
  • Structure time. Help your child plan activities by making lists or using a planner to stay organized.

There's no sure way to prevent depression. However, these strategies may help. Encourage your HFA/AS adolescent to:
  • Boost low self-esteem by recognizing small steps toward getting better.
  • Get treatment at the earliest sign of a problem to help prevent depression from worsening.
  • Maintain ongoing treatment, if recommended, even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.
  • Reach out for friendship and social support, especially in times of crisis.
  • Take steps to control stress, for example, not committing to too many obligations at once.

Discipline for Defiant Aspergers Teens

Asperger's Subtype: The "Outcast”

The "Outcast”

There are 3 basic subtypes in children and teens with Asperger's (AS) and High-Functioning Autism (HFA):
  1. The Actor: This child desires inter-personal relationships with others and has learned enough social skills over time to pass as a "neurotypical" (i.e., he or she can "act" like someone who is not on the spectrum).
  2. The Loner: This child does NOT desire inter-personal relationships (except with a very safe/close family member or friend) and could care less about "fitting-in" with "the group."
  3. The Outcast: This child desires inter-personal relationships with others, but has difficulty finding and maintaining friendships due to a lack of social skills. He or she really wants to "fit-in," but usually gets ostracized from "the group" due to "odd" behavior.

In this post, we will look at the "Outcast"…

No youngster with AS or HFA deserves to be ostracized from his or her peer group. But, many AS and HFA kids regularly act in ways that make it hard for other “typical” children to accept them. Helping AS and HFA kids to recognize and change negative, self-defeating behaviors can make it less likely that they will be ostracized. Although negative behaviors often lead to peer-rejection, the reverse is also sometimes true: Being ostracized can bring out the worst in AS/HFA children, which leads to even more ridicule and rejection.

To find – and keep – a friend, a youngster needs to avoid or resolve any disagreements, behave in ways that the other youngster enjoys, and communicate about likes and dislikes. There are many ways this can go wrong for an AS or HFA child. For example, yelling at or hitting the other youngster, snatching toys away, refusing to share, ignoring or walking away, bossing the other youngster around, etc. All of these interfere with shared fun and lead to the AS/HFA child being ridiculed and rejected. 

Here is how parents can help their peer-rejected AS/HFA youngster to “fit-in”:

1. Compliments are an easy way to win a friend. Brainstorm with your youngster some ways to compliment peers (e.g., “Your shirt is cool!” for a youngster wearing a new outfit; “Nice shot!” for a kid playing basketball; “I like the way you drew the mountain!” about a classmate’s artwork, etc.).

2. Fan the flames of a budding friendship by helping your youngster arrange a one-on-one, activity-based play date. Plan ahead by talking with your youngster about how to be a good host (e.g., good hosts stay with the guest rather than playing with someone else or wandering away and leaving the guest alone; good hosts make sure that their guest has a good time; good hosts go along with what the guest wants and try not to argue, etc.). If your youngster has special digital gadgets, games or toys too precious to share, put those items away before the guest arrives.

When the guest arrives, your youngster can start out by offering several choices of activities (e.g., watch a movie, ride bike, pop some popcorn, play basketball, play a video game, go bowling, bake cookies, etc.). If the shared activity is fun, the other youngster will associate your youngster with fun, which moves them toward friendship. (Note: Keep an ear out for conflicts that aren’t quickly settled. If your youngster seems to be getting angry, pull him aside quietly and, while out of earshot of the guest, help him figure out how to move forward.)

3. Kids with AS and HFA are often oblivious to others' reactions, which can lead them to persist in doing unwanted and inappropriate behaviors. For example, they may continue rambling on and on about a favorite topic long after their friends have lost interest, or they may repeatedly tap a peer on the shoulder to get his attention long after they've been asked to stop. This can be aggravating for peers.

Help your youngster learn to recognize “social stop signs” (e.g., when the other child looks away, walks away, says “Stop it” …and so on). See if your youngster can make a list of “social stop signs.” Also, help her come up with a plan for stopping (e.g., asking, "What would you like to do instead?" or physically moving farther away).

4. Kids with AS and HFA are rarely able to master the subtleties of humor. They're better off trying to be nice, rather than funny.

Help your youngster brainstorm possible “ways to be nice” to try at school (e.g., sharing a lunch treat, saving someone a seat, lending a pencil to a peer, helping a peer carry something, etc.). Writing down “ways to be nice,” or reporting them at dinnertime or bedtime, can also help your youngster feel good about himself.

5. Kids with AS and HFA often have a hard time coping with losing. They may argue, cheat, shove, or have a meltdown if things don't go their way. This ruins the fun for everyone else.

If your youngster struggles in this area, you may want to build-up his tolerance for losing at home. Start with cooperative games or "beat your own record" contests, and then work toward brief and then longer competitive games. Point out that both winning and losing are temporary. Explain to your youngster that he can't always win the game, but he can always "win the entertainment" by enjoying the company of friends.

6. Kids with AS and HFA often have difficulty greeting a potential friend. If another youngster says “Hi!” to them, they tend to look away and say nothing, or just mumble in response. This happens because they feel uncomfortable. But, the non-verbal message that they’re sending to the other youngster is “Stay away, I don’t want to be your friend.”

Help your youngster use role play to practice greeting peers. Explain that a friendly greeting involves speaking loudly enough to be heard, smiling, saying the other person’s name, making eye contact, and so on. After you’ve practiced, help your youngster figure out some peers to practice on in real life.

7. Kids with AS and HFA sometimes think that they need to impress their friends in order to keep them. This rarely works! Rather than trying to impress their friends (which implies, "I'm better than you!"), they need to find some common ground. Children make – and keep – friends by doing things together. Kids are more attracted to other kids that they perceive as similar to themselves.

Help your youngster discover a few things that she has in common with her friends (e.g., invite a potential friend to a fun outing, observe or ask questions to identify shared interests with peers, sign-up for an after-school activity, etc.). Ask your youngster, “How can you figure out what you have in common with someone?” Answers could include observing the other youngster, asking questions, or doing things together to create shared experiences. 

Finding common ground doesn’t mean that your youngster has to be a clone of everyone else. It also doesn't mean that your youngster can never become friends with someone who has a different background or different interests. It simply means recognizing that friendships start with common interests. To make friends, kids need to develop or discover those “me too” areas.

No boy or girl deserves to be ostracized from “the group.” It hurts and causes emotional damage – sometimes for a lifetime. This is why it is so terribly important that parents help their child recognize and change “relationship-destroying” behaviors as soon as possible – preferably before he or she enters elementary school.

Teaching Social Skills and Emotion Management


COMMENTS:

*  Anonymous said... This is so my son, fits into neither the NT crowd nor the crowd of the kids with ASD we also meet with.
*  Anonymous said... So true
*  Anonymous said... But for those who don't want to mix that has to be OK too right?
*  Anonymous said... This is so timely! My son just had a major meltdown after a birthday party yesterday. He feels so rejected and "weird." Thanks for sharing.
*  Anonymous said... This is my biggest fear because my son does want to fit in and have friends, any tips to make it easier for him are so greatly appreciated.
•    Anonymous said… And he now reverts to formally polite as a default coping mechanism in social situations
•    Anonymous said… Good read
•    Anonymous said… I worry about that too. My son is very sociable and tries so hard to make friends but, is more often than not the outlast which forces him to be a loner. Breaks my heart.
•    Anonymous said… mine has been in all three, outcast at secondary school, reverts to loner when it gets too tough but can maintain a facade as an actor for periods.
•    Anonymous said… My daughter is/has been all three types... now at 22 she's more the actor, She was the outcast/bullied at school which led to her being a loner, and kidding herself that she preferred it that way. Broke my heart that she was never invited to birthday parties that plainly everyone else had attended. Now she's an assistant librarian, and she 'acts' sociable with the customers at the public library, but it is exhausting for her. If I remind her about manners etc, she will actually say 'it's ok, I can fake it'. She's finding ways to cope.
•    Anonymous said… My girl is the actor. She adapts so well that it's hard to tell when it's real or acting.
•    Anonymous said… My son #3 :(
•    Anonymous said… My son (15) is the same. Started out as the outcast, moved to loner and is now trying to fit in as actor
•    Anonymous said… My son is definitely a loner & I can't see that ever changing... He has no interest in social relationships & that troubles me as I won't be here forever  😢
•    Anonymous said… My son is the actor who eventually becomes the outcast when he acts weird/unexpectedly around potential friends. He just can't handle socializing in a group, but one on one he's good. Once that bad first impression is made, no one wants to try to get to know him better.  😢


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Asperger's Subtypes: The "Actor" - The "Outcast" - The "Loner"

There are 3 basic subtypes in people with Asperger's and High-Functioning Autism:
  1. The Actor: This individual desires inter-personal relationships with others and has learned enough social skills over time to pass as a "neurotypical" (i.e., he or she can "act" like someone who is not on the autism spectrum).
  2. The Outcast: This individual desires inter-personal relationships with others, but has difficulty finding and maintaining friendships due to a lack of social skills. This person really wants to "fit-in," but usually gets ostracized from "the group" due to his or her "odd" behavior.
  3. The Loner: This individual does NOT desire inter-personal relationships (except with a very safe/close family member or friend) and could care less about "fitting-in" with "the group."

In this video, we will look at the "Loner":



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The Elimination of the Asperger’s Diagnosis

There is a lot of confusion regarding the new Diagnostic and Statistical Manual of Mental Disorder’s (DSM-5) revision to exclude Asperger’s. Hopefully this post will clarify some things…

Taking into account the most up-to-date research, diagnostic criteria in the DSM are revised periodically by a team of professionals. Here are a few of the main changes in the DSM-5 that specifically apply to autism spectrum disorders:
  • Sensory behaviors are included in the criteria for the first time (under restricted, repetitive patterns of behaviors descriptors).
  • The terms used in the DSM-4 are autistic disorder, Asperger’s disorder, childhood disintegrative disorder and PDD-NOS (pervasive developmental disorder not otherwise specified). In the DSM-5, when people go for a diagnosis, instead of receiving a diagnosis of one of these disorders, they will be given a diagnosis of “autism spectrum disorder.”
  • The emphasis during diagnosis has changed from giving a name to the disorder to identifying all the needs someone has and how these affect his or her life.
  • The triad of impairments has been reduced to two main areas: (1) social communication and interaction; (2) restricted, repetitive patterns of behavior, interests, or activities.
  • Also, there are “dimensional elements,” which should give an indication of how much a person’s disorder affects him or her. This should help to identify how much support the individual needs.

The DSM-5 has eliminated Asperger’s as a separate diagnosis and weaves it into Autism Spectrum Disorders with severity measures within the broader diagnosis. In this revision, the individual must meet the criteria in sections A, B, C and D below to receive a diagnosis of Autism Spectrum Disorder:

A. Deficits in social communication and interaction not caused by general developmental delays (the individual must have all 3 of the following areas of symptoms present):
  1. Deficits in social-emotional reciprocity; failure to have a back and forth conversation
  2. Deficits in nonverbal communication (e.g., abnormal eye contact and body language) or difficulty using and understanding nonverbal communication, and lack of facial expressions or gestures
  3. Deficits in creating and maintaining relationships appropriate to developmental level – apart from relationships with parents (this may include trouble adjusting behavior to suit different social contexts, difficulties with imaginative play and making friends, and a lack of interest in others)

B. Demonstration of restricted and repetitive patterns of behavior, interest or activities (the individual must present two of the following):
  1. Repetitive speech, repetitive motor movements or repetitive use of objects (e.g., echolalia, idiosyncratic phrases)
  2. Adherence to routines, ritualized patterns of verbal or nonverbal behavior, or strong resistance to change (e.g., insists on eating the same food, repetitive questioning, or great distress at small changes) 
  3. Fixated interests that are abnormally intense or focus (e.g., strong attachment to unusual objects, restricted interests)
  4. Over or under reactivity to sensory input or abnormal interest in sensory aspects of environment (e.g., indifference to pain, heat or cold, negative response to certain sounds or textures, extreme smelling or touching or objects, fascination with lights or spinning objects)

C. Symptoms must be present in early childhood (although they may not become apparent until social demand exceeds limited capacity).

D. Symptoms collectively limit and hinder everyday functioning.

If your child currently has a diagnosis of Asperger’s – this will not change. In the DSM-5, people will get a diagnosis of “autism spectrum disorder” rather than any of the current DSM diagnostic terms.  The term “Asperger’s” may still be used colloquially by diagnosticians (e.g., for a diagnosis of autism spectrum disorder with similarities to Asperger’s). Also, many people identify closely with the term Asperger’s and may continue to use it in everyday language.

Overall, the changes to the diagnostic criteria are helpful. They are clearer and simpler than the previous DSM criteria. Including sensory behaviors in the criteria is very practical, because many young people with autism have sensory issues which affect them on a day-to-day basis. The emphasis on identifying the full range of difficulties that the person has during the diagnosis process is also convenient.

The DSM criteria are medically-based, and a diagnosis is given when “symptoms together limit and impair everyday functioning.” The criteria create the foundation for diagnostic tools, for example:
  • ADI (Autism Diagnostic Interview)
  • ADOS (Autism Diagnostic Observation Schedule
  • DISCO (Diagnostic Interview for Social and Communication Disorders)

These and other schedules are used to collect information in order to diagnose whether someone is on the autism spectrum or not. Therefore the criteria form the basis for the diagnosis, but the diagnostician’s judgment is very important.

The DSM-5 is an American publication. Most diagnoses in the UK are based on the International Classification of Diseases (ICD), published by the World Health organization. The current ICD (ICD-10) is virtually the same as DSM. The next version of the International Classification of Diseases (ICD-11) is due to be published in 2015. The authors of the ICD will consider the changes made to DSM-5, but their descriptions are often slightly different. Currently, there are no plans to change the label of Asperger’s during the next revision.

Diagnoses using the DSM criteria should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. If a person gets a diagnosis of an autism spectrum disorder, it is likely to mean that he or she would benefit from support or services. However, the diagnosis is not directly linked to whether someone is eligible for support and services. Decisions over support and services are generally made by social service agencies and education professionals (often based in the local authority). The DSM-5 introduces levels of severity into the diagnostic process, to indicate how much support a person who receives a diagnosis may need. 

It is possible that fewer people – particularly at the higher-functioning end of the autism spectrum – will be diagnosed as having autism spectrum disorder in the DSM-5. However, the DSM team believes that this is not the case. Diagnoses should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. Diagnoses will be given where symptoms cause impairment to everyday functioning. Many individuals with Asperger’s and high-functioning autism may continue to meet the proposed diagnostic criteria for autism spectrum disorder.

The removal of Aspergers Syndrome from the Diagnostic and Statistical Manual of Mental Disorders has been controversial, because it is commonly used by health insurers, researchers, state agencies, schools, and people with the disorder.  Many parents – and professionals – are concerned that eliminating the Asperger’s diagnosis will prevent mildly affected children from being evaluated for Autism, which may result in the ineligibility of much needed services.


Comments:

•    Anonymous said... I am in Liverpool uk, and I often find it really hard to get professionals to take his needs seriously, he can often seem very typical and many people tell me that there is nothing to be concerned about. It's not until they spend some time with him that they can see more of what's going on and how he finds little things so difficult.
•    Anonymous said... I found an autism "center" in monroe. Gonna try as and get info from them. My heart just breaks for parents and the autistic children who are in the dark about autism. Thanks to you, Stephanie  and Patrick, for making me see how awesome these kids are. I hope to at least be able to help the patients we have learn more.
•    Anonymous said... I found it hard having teachers and school psychologists get to have the final say (without going to due process, that is) on whether my son needed certain interventions. The people who deal with Asperger's and HFA every day can make suggestions, but the school doesn't have to follow them...never mind that they have seen fewer total aspie students than our medical providers, and studied asperger's less (or not at all...I met a special ed teacher once who found out my son had Asperger's and asked me to explain it to her). We need a new model of educational intervention.
•    Anonymous said... I have to say, I'm glad they have changed the diagnosis to ASD, I was so sick of people saying to me, "its only aspergers, or it's just aspergers" so I was kind of relieved when we got the diagnosis letter and it said ASD.
•    Anonymous said... I'm in BC and, while my guy has Aspergers, the diagnosis states ASD. It's hard with Aspergers isn't it, at first glance many seem neurotypical and hard to have their special needs taken seriously. I'm worried my guy will lose funding as seems so high functioning but a deeper look show his needs r actually quite high.
•    Anonymous said... Our local council in Cornwall UK are using DSM4
•    Anonymous said... sadly, many with Aspergers will no longer meet the criteria for Autism based on the changes. Boo.
•    Anonymous said... This scares me but knew it was coming.
•    Anonymous said... What is the difference if you dont mind me asking between asd and Aspergers
 

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Assisting the Peer-Rejected Aspergers Student: Tips for Teachers

Playing and conversing with classmates is a daily routine for school-aged kids. But children with Aspergers (AS) and High Functioning Autism (HFA) are often isolated and rejected by their peers. Their problems making and keeping a “buddy” are exacerbated by their poor social skills.

The sensitive educator should realize that kids go to school for a living. School is their job, their livelihood, and their identity. Thus, the crucial role that teachers play in the youngster's social development and self-concept should not be under-estimated. Even if a youngster is enjoying “academic success,” her attitude about school will be determined by the degree of “social success” she experiences.

There is much that the educator can do to promote social development in the Aspergers child. Kids tend to fall into four basic social categories in the school environment:
  1. Children who, although not openly rejected, are ignored by peers and are uninvolved in the social aspects of school.
  2. Children who have successfully established positive relationships within a variety of social settings.
  3. Children who “fit-in” with a peer-group based on common interests, but seldom move beyond that group.
  4. Children who are consistently rejected, bullied and harassed by peers.

Many children with AS and HFA find themselves in the rejected/bullied subgroup. Their reputations as being rather “odd” plague them over the years. It is important for the educator to assist the Aspergers youngster’s peers in changing their view of this boy or girl.

Discipline is a rather ineffective method of correcting bullying or rejecting behavior. For example, if the teacher disciplines Michael for insulting Ronnie, she only increases Michael's resentment of Ronnie. But, the teacher can increase Michael’s level of acceptance in several ways. Here’s how:

1. Assign the Aspergers youngster to work in pairs with a “socially skilled” youngster who will be accepting and supportive. Cooperative activities can be especially effective in the effort to include the rejected youngster in class. These activities enable the youngster to use her academic strengths while simultaneously developing her social skills.

2. Assign the rejected youngster to a leadership position in class wherein his peers become dependent on him (e.g., line leader). This can serve to increase his status and acceptance. However, understand that this may be an unfamiliar role for the Aspergers student, and he may require some guidance from the teacher in order to ensure success.

3. Attempt to determine specific interests, hobbies or strengths of the rejected youngster. This can be accomplished through discussions, interviews or surveys. Once the teacher has identified the youngster's strengths, celebrate it in a very public manner. For example, if the child has a particular interest in Indian wood carvings, find a ‘read-aloud’ adventure story in which an Indian plays an important role in the plot. Encourage the youngster to bring a couple of his Indian wood carvings to class and show how they were made. By playing the expert role, a rejected youngster can greatly increase his status.

4. Board and card games can be used to foster social development in class. These activities require children to utilize a variety of social skills (e.g., voice modulation, taking turns, sportsmanship, dealing with competition, etc.). These activities can also be used to promote academic skills. Since games are often motivating for children, this activity can be used as positive reinforcement.

5. Educators at the high school level must be particularly aware of the teen that is being rejected by peers. During the teenage years, it is very important that the Aspergers youngster be accepted by his peers. The rejection suffered by teens with social skill deficits often places them at risk for emotional problems.

6. The child with social skill deficits invariably experiences rejection in any activity that requires children to select classmates for teams or groups. This selection process generally finds the rejected youngster in the awkward position of being the "last one picked." Avoid these humiliating situations by pre-selecting the teams or drawing names from a hat.

7. The educator can assist the Aspergers youngster by making him aware of the traits that are widely-accepted and admired by his peers (e.g., when a particular child converses, extends invitations, gives compliments, greets others, laughs, shares, smiles, tells jokes, etc.).

8. The educator needs to recognize the critical role that the youngster's mom and dad – and even siblings – can play in the development of social competency. Ask the youngster’s mother or father to visit school for a conference to discuss the child’s social status and needs. School and home must work in concert to ensure that target skills are reinforced and monitored. Social goals should be listed and prioritized. Focus on a small set of social skills (e.g., making eye contact, sharing, and taking turns) rather than trying to deal simultaneously with the entire inventory of social skills.

9. The educator should demonstrate acceptance of - and affection for - the rejected youngster. This conveys the constant message that this youngster is worthy of attention. The educator can use her status as a leader to increase the status of the Aspergers youngster.

10. The socially incompetent youngster often experiences isolation and rejection in his neighborhood, on the school bus, and in peer-group activities. The educator can provide this child with a learning environment wherein he can feel comfortable, accepted and welcome. Coming to school every day can become a helpless event for some Aspergers kids – unless they succeed at what they do. Educators are shields against that helplessness. 

Teaching Social Skills and Emotion Management

Obsessive-Compulsive Disorder in Aspergers Children

There are many conditions associated with Aspergers and High-Functioning Autism. In this video, we look specifically at obsessive-compulsive disorder, and its treatment:

Identifying the Underlying Causes of “Difficult Behavior” in Asperger’s Kids

In order to identify the underlying causes of difficult behaviors in children with Asperger’s (AS) and High-Functioning Autism (HFA), a Functional Behavioral Assessment (FBA) must be performed. An FBA is an approach that incorporates a variety of techniques to diagnose the causes and to identify likely interventions intended to address difficult behaviors.

An FBA looks beyond the actual problem behavior, and instead, focuses on identifying biological, social, affective, and environmental factors that initiate, sustain, or end the problem behavior in question. The FBA is important because it leads the researcher beyond the "symptom" (i.e., the behavior) to the child's underlying motivation to escape, avoid, or get something (i.e., the cause of the behavior). Behavior intervention plans stemming from the knowledge of why a child misbehaves are extremely useful in addressing a wide range of issues.

The “functions” of behavior are not usually considered inappropriate. Rather, it is the behavior itself that is judged appropriate or inappropriate. For example, getting good grades and engaging in problematic behavior may serve the same function (e.g., to get attention), but the behaviors that lead to good grades are judged to be more appropriate than those that make up acting-out behavior. As an example, if the IEP team determines through an FBA that a child is seeking attention by misbehaving, they can develop a plan to teach the child more appropriate ways to gain attention, thus fulfilling the child's need for attention with an alternative behavior that serves the same function as the inappropriate behavior. By incorporating an FBA into the IEP process, team members can develop a plan that teaches “replacement behaviors” that serve the same function as the difficult behavior.

Before an FBA can be implemented, it is necessary to identify the behavior that is causing problems, and to define that behavior in concrete terms that are easy to communicate and simple to measure and record. If descriptions of behaviors are vague (e.g., child has a “bad attitude”), it is difficult to determine appropriate interventions. It will be necessary to observe the child's behavior in different settings and during different types of activities, and to conduct interviews with parents and teachers in order to identify the specific traits of the behavior. Once the difficult behavior has been defined concretely, the IEP team can begin to devise a plan for conducting an FBA to determine the functions of the behavior.

Since difficult behavior stems from a variety of causes, it is best to examine the behavior from as many different angles as possible. The IEP team should assess what the "pay-off" for engaging in problem behavior is, or what the child escapes/avoids/gets by engaging in the problem behavior. This assessment will enable the team to identify workable techniques for developing and conducting an FBA and developing behavior interventions. When carrying out these tasks, the IEP team should find answers to a few critical questions. Addressing these questions will assist the team in determining the necessary components of the assessment plan, and will lead to more effective behavior intervention plans. Questions to ask include the following:
  • Are there any settings where the problem behavior does not occur?
  • Does the child find any value in engaging in appropriate behavior?
  • Does the child have the skills necessary to perform expected behaviors?
  • Does the child realize that he is engaging in unacceptable behavior, or has that behavior simply become a "habit"? 
  • Does the child understand the behavioral expectations for the situation? 
  • In what settings is the problem behavior observed? 
  • Is it possible that the child is uncertain about the appropriateness of the behavior?
  • Is it within the child's power to control the behavior, or does she need support? 
  • Is the behavior problem associated with certain social or environmental conditions? 
  • Is the child attempting to avoid a demanding task?
  • Is there a more acceptable behavior that might replace this behavior? 
  • Is there evidence to suggest that the child does not know how to perform the skill – and therefore can’t? 
  • What activities or interactions take place just prior to the behavior? 
  • What current rules, routines, or expectations does the child consider irrelevant?
  • What usually happens immediately after the behavior? 
  • Who is present when the behavior occurs?

Interviews with the child may be useful in identifying how he perceived the situation and what caused him to act in the way he did. Questionnaires, motivational scales, and checklists can also be used to structure indirect assessments of behavior. For example:

1. Hypothesis statement— Drawing on information that emerges from the analysis, school staff can establish a “working hypothesis” regarding the function of the behaviors in question. This hypothesis predicts the general conditions under which the behavior is most - and least - likely to occur, as well as the likely consequences that serve to maintain it.

2. Direct assessment— Direct assessment involves observing and recording situational factors surrounding a difficult behavior (e.g., antecedent and consequent events). A member of the IEP team may observe the behavior in the setting that it is likely to occur, and record data using an Antecedent- Behavior- Consequence (ABC) approach.

3. Data analysis— Once the IEP team is satisfied that enough data have been collected, they should compare and analyze the data. This analysis will help the team to determine whether or not there are any patterns associated with the behavior. If patterns can’t be determined, the team should revise the FBA to identify other methods for assessing behavior.

After collecting data on a child's behavior, and after developing a hypothesis of the function of that behavior, the IEP team should develop the child's behavior intervention plan. It is helpful to use the data collected during the FBA to develop the plan and to determine the discrepancy between the youngster's actual and expected behavior.

Intervention plans emphasizing the skills that AS and HFA children need in order to behave in a more appropriate manner will be more effective than plans that simply serve to control behavior. Interventions based upon “control” often fail to generalize (i.e., fail to continue to be used for long periods of time, in many settings, and in a variety of situations). Control measures usually only serve to suppress behavior, resulting in the youngster meeting unaddressed needs in alternative, inappropriate ways.

It is good practice for IEP teams to include two evaluation procedures in an intervention plan:
  • one designed to measure changes in behavior
  • one designed to monitor the accuracy with which the plan is implemented

In addition, IEP teams must determine a timeline for implementation and reassessment, and specify the degree of behavior change consistent with the goal of the overall intervention.

To be meaningful, plans need to be reviewed at least annually and revised as needed. However, the plan may be reviewed and re-evaluated whenever any member of the youngster's IEP team feels that a review is necessary. Circumstances that may warrant a review include the following:
  • It is clear that the original behavior intervention plan is not bringing about positive changes in the child's behavior.
  • The situation has changed, and the behavioral interventions no longer address the current needs of the child.
  • The youngster has reached his behavioral goals and objectives, and new goals and objectives need to be established.
  • The IEP team makes a change in placement.

If done correctly, the net result of an FBA is that school personnel are better able to provide an educational environment that addresses the special learning needs of the AS/HFA child.

CLICK HERE for an example of a completed Functional Behavioral Assessment (FBA) form…

CLICK HERE for a blank FBA and Behavior Intervention Plan (BIP) form…

Aspergers Children and Problems with Perfectionism

“I'd like to ask you about a very big problem for our Aspergers son - his perfectionism! Can you give me some advice on what to do about this issue, because I believe it is a major contributing factor to his never-ending anxiety, especially when doing his homework?”

Although it may be hard to completely change an Aspergers youngster’s perfectionist nature, there are many things that parents can do to help their child find a better balance and not be so hard on himself. Please consider these suggestions:

1. The pressure to be perfect may stem from school (or other areas where perfectionism is exhibited) being the only place from where your son derives self-worth. Try to expand your son’s notion of his identity by finding activities for him to participate in that do not involve scoring or competition (i.e., activities that simply exist to feel good and have fun).

2. Regularly remind your son to “keep it simple” and “make it fun.”

3. Make sure that you are not deriving your own sense of worth only from your son’s accomplishments.

4. Look for books and movies that provide role models of real people or characters who succeeded after a long line of failures.

5. Let your son make mistakes. Offer minor assistance and support if asked, but let him turn in work that is truly his own so he can get comfortable with constructive feedback. Allowing kids to do their own work and make mistakes not only can decrease a sense of pressure on them to always present a perfect front to the outside world, but also gives them the confidence that they can succeed on their own without the parent’s help.

6. Address faulty or unhealthy logic in your son’s thinking. Perfectionists tend to think in terms of “all-or-nothing” (e.g., “If I don’t get 100% on this quiz, then I’m dumb!”).

7. Keep the focus on the importance of learning new material or a new skill, rather than being the best. When your son brings home a perfect test score, you can say something like, “You worked really hard to learn that tough material,” instead of, “Excellent work – another 100%!”

8. If your son is spending too much time on homework, set a time limit so that he has to stop working and relax a bit. Explain the situation to his teacher and ask for help with what you are trying to teach your son.

9. Have a mantra in your house, for example, “Everyone makes mistakes. The important thing is to have fun learning and enjoy the process.” You may also want to consider finding a different word to use instead of “mistake” (e.g., everyone has “challenges” …or, everyone has to make a “detour” now and then).

10. Find activities for your son where he will not be the best. Help him learn how to handle being in such a circumstance. Do not let him stop the activity because it is too difficult or uncomfortable.

11. Do not discount your son’s school anxiety with statements like, “There’s no need to worry, I know you’ll get 100% on that test – you always do!” Even though your intentions are of the best, your son may interpret statements like that as adding more pressure to maintain his status. Instead, tell him that what matters most is putting forth enough effort to learn the subject matter, regardless of what the grade is.

12. Be careful about over-scheduling, and make sure that your son has time “scheduled” to just relax.

13. Be a good role model yourself by not holding yourself to perfectionist standards and showing your son how you handle mistakes. Point out what you did and how you learned from it.

14. Even though the pressure to be perfect often seems to come from the youngster himself, evaluate the messages that you are giving to your son. Even if you tell him that high grades or first-place trophies do not matter to you, if he hears you bragging about such honors all the time, he may feel a lot of trepidation about continuing to bring them home. Your son needs to understand that your love is unconditional, and not based on how well he does in school. Point out other ways in which he makes you proud (e.g., when he helps you around the house, when he is kind to others, etc.).

15. Lastly, have plenty of patience with your son. Don’t pressure him to relax and be “less than perfect.” It takes a lot of practice to overcome perfectionism!

Teaching Social Skills and Emotion Management


COMMENTS:

Anonymous said… I have come to except that its a packaged deal and is part of the OCD that hangs them up, allow for more time so he can make the corrections he needs to feel good about his work remember he sees flaws where your eyes see nothing but perfection.

Anonymous said… I'm loving this group. It's so helpful! Thanks...

Anonymous said… In fact, it is such that he will avoid doing his homework as much as possible, then the following morning when it is due, he is having a fit "because he needs to get it done....NOW!"

Anonymous said… It may not be a bad thing. I believe I suffered with some of the attributes of asperger when young - still do, getting obsessed with things being one of them. But that allows me to study and learn most trades, I have several degrees including a PhD and I earn a good salary, the only hindrance is saying a development project is finished and ready to go to market which we manage with certain constraining rules. I would be happy if my boys managed a good education that could earn them a decent salary, I don't see why they shouldn't achieve this and I will do everything in my power to make that happen. So I don't feel Perfectionism and the Obsessive nature is a bad factor of Asperger, the tantrums when over whelmed are the nasty attributes. As for the anxiety, I look at what I've managed before and make sure the next time it's better, I make that my satisfaction, which controls the anxiety, Back to what we were told a few days ago, to engineer their lives to succeed even if it's in little steps so taking any failure out of the equation.

Anonymous said… my aspie just wants to get credit for it, but doesn't actually want to do the work on it.

Anonymous said… My daughter is that way, too. Homework we can manage because it's too easy for her (first grade), but at school, she will meltdown if the teacher wants to display the classes work and she sees hers as not perfect enough, even though it's miles better then her classmates.

Anonymous said… tell him everyone messes up and does things wrong everyday. Maybe give him examples in writing and pictures. Tell him its okay and it everything doesn't have to be perfect.

Anonymous said… What I find is that if one part came out wrong, then the whole thing is messed up and sometimes it will get destroyed. The CF/GF diet has helped immensely.

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70 Tips & Tricks for Educating Students with Aspergers/High-Functioning Autism

Research has identified classroom characteristics that promote success for children with Aspergers and High-Functioning Autism: individualized instruction, interesting curriculum, positive reinforcement, predictability, short working periods, small teacher-to-student ratio, and plenty of structure.

Research has also identified optimal teacher characteristics: consistency, firmness, frequent monitoring of the child’s work, humor, knowledge of behavior management strategies for students on the spectrum, patience, personal warmth, and positive academic expectations.

Based on this research, here are 70 quick and simple – yet highly effective – tips and tricks to use in teaching your students who are on the autism spectrum:

1. Allow the child to change seats and places as long as she or he stays on task.
2. Allow the child to chew gum to reduce anxiety if needed.
3. Allow the child to stand or walk with a clipboard (if possible) as long as she or he remains on task.
4. Allow the child to use learning aides, computers, and calculators (for different parts of the task).
5. Allow the student to manipulate an object, doodle, squeeze a ball, bend a pipe cleaner or paper clip, or handle another non-distracting item as long as she or he attends and is on task.
6. Assign a capable "study buddy" who can remind and assist the active or disorganized child.
7. Assign another child to be a "support buddy" who works with the distractible student, and provides one-to-one attention to assist in completing tasks.
8. Assign duties that require self-control (e.g., line leader, materials distributor, etc.). Prepare the student for the duty, encourage the student, and reinforce the student during and after that activity/task.
9. Assign the child to a seat that best allows him or her to observe you while avoiding distractions (e.g., away from doors, windows, pencil sharpeners, etc.).
10. Assign the test grade based on performance on different aspects of the assessment (i.e., organization, writing mechanics, penmanship, subject knowledge displayed, etc.).

11. Be sure you have the student's attention before you start.
12. Develop good rapport with the child. Aspergers students are more likely to respond to emotional connections than contingent consequences.
13. Devise interesting activities.
14. Eliminate excessive noise.
15. Eliminate excessive visual stimuli and clutter that might distract the student.
16. Employ study carrels or seat the child in the area of the class with the least distractions, and/or face the desk toward the wall. However, do not isolate the student for long periods of time because it may stigmatize the student. Allow the child to engage in group work too.
17. Encourage moms and dads to build physical activity into the student's out-of-school schedule.
18. Ensure that your style of presentation is enthusiastic and interesting.
19. Give a general overview first. Let the child know what will be learned and why it is important in life.
20. Give your attention to appropriate behaviors.

21. Have another child place carbon paper under the Aspergers student’s paper while writing down homework assignments. Give the carbon copy to the Aspergers child to take home.
22. Have the child progress through the following steps while learning: See it, say it, write it, and do it.
23. Have the child underline or highlight directions.
24. If social rewards/reinforcement is insufficient to bring about the desired behavior, pair social recognition with earned activities or tangible reinforcers.
25. If you get a lot of defiant behavior, review how often you say negative things and give commands to the student. Children who hear too many negatives and commands will shut off the teacher they come from. Get positive, encourage the student, and focus on progress, however small.
26. Ignore as much of the negative behavior as possible.
27. In a multi-part task, provide visual cues that are written on the child's desk or on the chalkboard for each part. The child then engages in that next step.
28. In cooperation with the child, create a "secret cue" (e.g., tugging on your ear lobe, clicking your tongue, saying an odd word such as "huckleberry") that reminds the student to attend.
29. Incorporate movement into lessons.

30. Involve the child's interests into assignments.
31. Keep directions and commentary short and to the point. Avoid "overloading" the child with too much verbiage.
32. Keep unstructured time to a minimum.
33. Make a tube that the child uses as a telescope, keeping you in view and blocking out other distractions.
34. Motivate the student by having him or her "race against the clock" to finish the task (or part of it).
35. Move nearer to the child when she or he becomes restless. Offer verbal encouragement or touch. When misbehavior occurs (or threatens to occur), move closer and soften your voice.
36. Place instructions on an audio tape that can be replayed by the child as needed.
37. Play soft background music without lyrics.
38. Present the assignment in parts (e.g., 5 math problems at a time). Give reinforcement for each completed part before giving the next segment of the task, or have the student mark off his or her progress on a chart.
39. Provide "do now" activities for other children while you focus the Aspergers child.

40. Provide a "squeeze ball" for the child to manipulate if he or she becomes frustrated.
41. Provide a bouncy inflatable seat cushion. The child may put his or her energy into squirming on it, but he or she will stay in the seat.
42. Provide a grown-up to whom the child reports at the beginning and end of the day to organize his or her work and assure assignments are in-hand.
43.  Provide a laptop computer to children who lose papers (but not books).
44. Provide a second set of textbooks for the forgetful child to use at home.
45. Provide a special "transition object" (e.g., puppet, small stuffed animal, etc.) that accompanies the child to other classrooms, providing a sense of consistency and support.
46. Provide an individualized written schedule to which the child can refer.
47. Provide extended time to finish.
48. Provide opportunities for physical movement (e.g., erasing the blackboard, running errands, distributing and collecting materials, etc.), and build physical activities into the daily schedule.
49. Provide some choice or variation in assignments to maintain the child's attention.

50. Reduce the length of assignments so that child does not lose interest.
51. Repeat and simplify the directions.
52. Seat the child next to appropriate models.
53. Set expectations for behavior BEFORE an activity or event.
54. Set up routines that prepare the student for upcoming transitions.
55. Teach memory techniques and study strategies.
56. To block out distractions on a page, create a "window" in a piece of card board that exposes only one or two lines of print.
57. To ensure understanding, have the child repeat the directions in his or her own words.
58. To gain the attention of younger “Aspies,” give directions through a puppet.
59. To increase reflection and concentration, have the child identify the correct answer AND cross out incorrect answers on multiple choice tests. Inform the child that there may be more than one correct answer.

60. Use a clock to remind the impatient student that the next activity must wait until a certain time.
61. Use alert cues to get the child's attention before giving directions.
62. Use color and highlighting to accentuate certain important words or phrases on worksheets.
63. Use concrete objects to assist in keeping the child's attention.
64. Use examples that capitalize on the child's interests.
65. Use game formats to teach and/or reinforce concepts and material.
66. Use more than one modality when giving directions. Supplement verbal instructions with visual ones.
67. Use oral testing if that format will keep the child's attention and better assess his or her knowledge.
68. Use pantomime to capture the attention of the child to give instructions.
69. Use performance testing. Have the child do something or make something.
70. Use progress charts and other visual records of behavior to encourage more appropriate behavior. Use colorful charts and cards to motivate the student and recognize effort.

Teaching Students with Aspergers and High-Functioning Autism

How to Create an Effective Behavioral Intervention Plan

In this post, we will look at how to create an effective behavioral intervention plan for students with Aspergers and High-Functioning Autism…

Once the IEP team (including the parents) has conducted a functional assessment, the information obtained from that assessment should be used to develop a behavioral intervention plan. The purpose of this intervention plan is to spell out what behaviors are being targeted for change – and how change will be handled.

Certain items in the behavioral intervention plan are required by the Individuals with Disabilities Education Act, while others are simply good information to have included:
  • description of how the Aspergers child’s behavior will be handled should it reach a crisis stage (called a “crisis plan”)
  • definition and description of the behavior being targeted
  • description of how the success of the interventions will be measured
  • description of previously tried interventions and how well they did - or didn’t - work in changing behavior
  • description of the behavior that will replace the inappropriate behavior (called the “replacement behavior”)
  • description of the interventions that will be used (e.g., who will be involved, specific procedures that will be followed, how data will be collected)
  • description of when and how information will be shared between the home and school
  • information about the child that could impact the intervention plan
  • list of the child’s strengths and abilities
  • measurable description of the behavior changes that all parties expect to see
  • schedule for when and how often the plan will be reviewed to determine its effectiveness
  • statement describing the function or purpose of the targeted behavior

When writing the behavioral intervention plan, make sure that everything is spelled out clearly and specifically so that the intervention plan can be used easily by all parties involved with the Aspergers child. In most circumstances, the intervention plan should be less than 4 pages in length. If it is longer than that, it may be too difficult for all parties to remember and follow.

The IEP team should make sure that the interventions included are ones that they have the resources and ability to implement consistently (e.g., if “time-outs” are included in the plan, but a time-out space is only available 2 days a week, then it will be more effective to choose a different intervention).

Once the IEP team agrees on the behavior intervention plan, all parties involved must agree to implement it consistently. If even one team member thinks that he or she is unable to support the plan, it needs to be revisited. Inconsistent application of any intervention may result in an increase in the targeted inappropriate behavior, or in the appearance of a new inappropriate behavior.

Sample Behavioral Intervention Plan:

Name: Michael Jones
Grade: 5
Age: 10
School: Big City Elementary School
Date Written: 2/4/13

Strengths of the child:
  • enjoys praise and positive, social reinforcement 
  • likes science and hands-on activities
  • usually responds well to educators
  • wants to be in the general education classes
  • usually wants to do the same work as his peers
  • works hard and participates most days

Individualized information about the child:
  • Biological factors, medication interactions, and anxiety can cause child to react to situations/directions differently on some days. Child will have productive days and not so productive days. 
  • has difficulty with tasks necessitating writing
  • often works and moves more slowly than peers
  • Some behaviors associated with Obsessive-Compulsive Disorder and Tourettes are apparent (e.g., tapping, noises/verbalizations, some scratching/ rubbing hands and face, repetitive movements). These behaviors are made worse when child is anxious.

Previously implemented interventions:
  • Time-outs, negative reinforcement, and positive reinforcement with tangibles were ineffective interventions. There was some success with a token economy using concrete reinforcers.

Problematic behaviors:

Behavior 1— Incomplete assignments

Baseline: averaging 5 incomplete assignments per week for last 5 weeks

Function of the behavior:
  • allows child to express/feel in control of a situation when he’s uncomfortable with something 
  • relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement behavior:
  • complete assignments in study period or at home 
  • ask for help (e.g., asking for assistance, modifications or breaks)

Interventions:
  • Modify assignments by reducing the number/length of responses required for each concept.  Where possible, reduce the amount of writing required. 
  • Grading: Teacher establishes a minimum for each assignment. If child does more than the minimum number of responses required, he gets credit/extra credit for each extra response that is correct (no penalty for incorrect responses). If child doesn’t complete the minimum, he is counted off for the missing responses.
  • Child will have a scheduled study period each day. If he has all assignments completed, he can participate in other activities.

Documentation:
  • number of incomplete/missing assignments in each class 
  • assignment grades

Amount of improvement expected:
  • no more than 2 incomplete assignments per week for 3 consecutive weeks

Behavior 2— Unable/unwilling to work in class

Baseline: 20% of assignments completed and 35% completed in class

Function of the Behavior:
  • allows child to express/feel in control of a situation when he’s uncomfortable with something 
  • relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement Behavior:
  • at least attempt each assignment 
  • verbalize frustration and/or need for modification

Intervention:
  • Child is given 1 prompt to start assignment. After that, refusal is ignored (any behavior disturbing others will be dealt with according to classroom rules and consequences and child earns a 0 on that assignment). 
  • Child receives 2 points for every assignment he attempts (e.g., does at least 1/4th of the assigned task) and 5 points for every completed assignment. Points can be spent before lunch and before child goes home on items/activities on his reinforcement menu (child must have input on what’s on the menu).
  • Child will be given the option of completing an assignment in the resource room for full credit.
  • Child will receive instruction/guidance in how to express needs from the school counselor. Child will earn 5 points for appropriately (according to the guidelines taught by the school counselor) expressing frustration and/or need for help/modifications.

Documentation:
  • record % of assignments attempted and % of assignments completed 
  • record frequency and duration of time in the resource room for this behavior

Amount of improvement expected:
  • at least 60% completed and 75% attempted in class for at least 3 of 4 weeks

Behavior 3— Using profanity around peers

Baseline: average of 8 incidents per week for last 5 weeks

Function of the behavior:
  • vent anger/frustration in a situation less threatening than with teachers/peers 
  • relieving feeling of anxiety due to Tourettes or Obsessive-Compulsive Disorder
  • attention-getting

Replacement behavior:
  • recognize anxiety or anger/frustration and get help to vent appropriately (e.g., cool down time, removing self from situation, talking with teachers/peers) 
  • get attention by interacting appropriately with peers

Intervention:
  • when child is verbally inappropriate, he is directed to remove himself to a different location and is not allowed to participate in the activity (e.g., recess) for 5 minutes 
  • provide opportunities for child to practice interacting appropriately with peers (e.g., reading with them)
  • praise for appropriate verbal interaction

Documentation:
  • record number of times child asks for help with anxiety or anger/frustration
  •  record number of times child is verbally inappropriate with peers

Amount of improvement expected:
  • no more than an average of 4 incidents per week for 3 consecutive weeks

Schedule for review:
  • documentation review at least each nine weeks when grade cards are distributed

Provisions for home coordination:
  • On Fridays, a note will be sent home with weekly grade for each class number of inappropriate verbalizations toward peers and number of times child requested resource room and/or cool down. 
  • Assignment notebook sent home daily. Assignments will be marked as attempted, completed or not attempted.

Crisis management plan:
  • If an injury or property damage occurs as a result of Michael’s behavior, a police report will be made and he will be suspended according to district policy. The IEP team will meet as soon as possible within 10 days to review the behavior intervention plan and make modifications where necessary. 
  • If Michael endangers himself or others while in isolation, physical restraint will be used by staff members trained in Mandt procedures.
  • If Michael is not able to demonstrate compliance within 30 minutes, or if he has had more than 3 timeouts, he will be seen by support staff as soon as possible.
  • If Michael endangers himself or others, he will be isolated from his peers and mother or her designee will be called. Michael will remain in isolation until it is determined that he is no longer in imminent danger of hurting himself or others. He will finish his school day in the resource room.
  • Michael will be given a cue that he can use with staff to indicate that he is getting upset and needs to cool down. Once he gives the cue, he can choose from the following options: (a) ask to see a support staff member, (b) go to the resource room, (c) walk in the hall or outside (a staff member will accompany child, but will not talk to child). 
  • If staff sees that Michael is becoming upset and is not using his cue for help, staff will say, “You’re getting upset. I need you to see a support staff member, or go to the resource room, or take a walk in the hall or outside with a staff member.” If Michael is unable to cool down, he will be directed to go to time-out where he will remain until he can demonstrate compliance. 

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the Aspergers child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Aspergers Children

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's child is totally out-of-control. When it ends, both you and the Asperger’s child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Aspergers Teens

Although Aspergers is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager with Aspergers are more difficult than they would be with an average teen. Complicated by defiant behavior, the Aspergers teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

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Aspergers Children “Block-Out” Their Emotions

Parenting children with Aspergers and HFA can be a daunting task. In layman’s terms, Aspergers is a developmental disability that affects the way children develop and understand the world around them, and is directly linked to their senses and sensory processing. This means they often use certain behaviors to block out their emotions or response to pain.

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Older Teens and Young Adult Children With Aspergers Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with Aspergers face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Living with an Aspergers Spouse/Partner

Research reveals that the divorce rate for people with Aspergers is around 80%. Why so high!? The answer may be found in how the symptoms of Aspergers affect intimate relationships. People with Aspergers often find it difficult to understand others and express themselves. They may seem to lose interest in people over time, appear aloof, and are often mistaken as self-centered, vain individuals.

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Online Parent Coaching for Parents of Asperger's Children

If you’re the parent of a child with Aspergers or High-Functioning Autism, you know it can be a struggle from time to time. Your child may be experiencing: obsessive routines; problems coping in social situations; intense tantrums and meltdowns; over-sensitivity to sounds, tastes, smells and sights; preoccupation with one subject of interest; and being overwhelmed by even the smallest of changes.

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Unraveling The Mystery Behind Asperger's and High-Functioning Autism

Parents, teachers, and the general public have a lot of misconceptions of Asperger's and High-Functioning Autism. Many myths abound, and the lack of knowledge is both disturbing and harmful to kids and teens who struggle with the disorder.

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Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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to read the full article...

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