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

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The Telltale Signs of High-Functioning Autism: A Comprehensive Checklist

Below you will find the majority of symptoms associated with High-Functioning Autism (HFA), also referred to as Asperger’s. The HFA child will not usually have all of these traits.

We will look at the following categories: sensory sensitivities, cognitive issues, motor clumsiness, narrow range of interests, insistence on set routines, impairments in language, and difficulty with reciprocal social interactions.

Sensory Sensitivity Checklist—

1. Difficulty in visual areas:
  • Avoids eye contact
  • Displays discomfort/anxiety when looking at certain pictures (e.g., the child feels as if the visual experience is closing in on him)
  • Engages in intense staring
  • Stands too close to objects or people

2. Difficulty in auditory areas:
  • Covers ears when certain sounds are made
  • Displays an inability to focus when surrounded by multiple sounds (e.g., shopping mall, airport, party)
  • Displays extreme fear when unexpected noises occur
  • Fearful of the sounds particular objects make (e.g., vacuum, blender)
  • Purposely withdraws to avoid noises

3. Difficulty in olfactory areas:
  • Can recognize smells before others
  • Displays a strong olfactory memory
  • Finds some smells so overpowering or unpleasant that he becomes nauseated
  • Needs to smell foods before eating them
  • Needs to smell materials before using them

4. Difficulty in tactile areas:
  • Complains of a small amount of wetness (e.g., from the water fountain, a small spill)
  • Complains of clothing feeling like sandpaper
  • Displays anxiety when touched unexpectedly
  • Does not respond to temperature appropriately
  • Difficulty accepting new clothing (including for change of seasons)
  • Difficulty using particular materials (e.g., glue, paint, clay)
  • Difficulty when touched by others, even lightly (especially shoulders and head)
  • Difficulty with clothing seams or tags
  • Overreacts to pain
  • Under-reacts to pain

5. Difficulty in gustatory areas:
  • Can’t allow foods to touch each other on the plate
  • Displays unusual chewing and swallowing behaviors
  • Easily activated gag/vomit reflex
  • Rigidity issues tied in with limited food preferences (e.g., this is the food he always has, it is always this brand, and it is always prepared and presented in this way)
  • Makes limited food choices
  • Must eat each individual food in its entirety before the next
  • Needs to touch foods before eating them
  • Will only tolerate foods of a particular texture or color

6. Engages in self-stimulatory behaviors (e.g., rocking, hand movements, facial grimaces)

7. Is oversensitive to environmental stimulation (e.g., changes in light, sound, smell, location of objects)

8. Is under-sensitive to environmental stimulation (e.g., changes in light, sound, smell, location of objects)

Cognitive Issues Checklist—

1. Mind-blindness:
  • Displays a lack of empathy for others and their emotions (e.g., takes another person’s belongings)
  • Displays difficulty with inferential thinking and problem solving (e.g., completing a multi-step task that is novel)
  • Impaired reading comprehension; word recognition is more advanced (e.g., difficulty understanding characters in stories, why they do or do not do something)
  • Is unaware he can say something that will hurt someone's feelings or that an apology would make the person "feel better" (e.g., tells another person their story is boring)
  • Is unaware that others have intentions or viewpoints different from his own; when engaging in off-topic conversation, does not realize the listener is having great difficulty following the conversation
  • Is unaware that others have thoughts, beliefs, and desires that influence their behavior
  • Prefers factual reading materials rather than fiction
  • Views the world in black and white (e.g., admits to breaking a rule even when there is no chance of getting caught)

2. Lack of cognitive flexibility

A. Distractable and has difficulty sustaining attention:
  • Engages in competing behaviors (e.g., vocalizations, noises, plays with an object, sits incorrectly, looks in wrong direction)
  • Difficulty when novel material is presented without visual support
  • Difficulty with direction following
  • Difficulty with organizational skills (e.g., What do I need to do, and how do I go about implementing it?)
  • Difficulty with sequencing (e.g., What is the order used to complete a particular task?)
  • Difficulty with task completion
  • Difficulty with task initiation

B. Poor impulse control, displays difficulty monitoring own behavior, and is not aware of the consequences of his behavior:
  • Displays a strong need for perfection, wants to complete activities/assignments perfectly (e.g., his standards are very high and noncompliance may stem from avoidance of a task he feels he can't complete perfectly)
  • Displays rigidity in thoughts and actions
  • Engages in repetitive/stereotypical behaviors
  • Difficulty incorporating new information with previously acquired information (i.e., information processing, concept formation, analyzing/ synthesizing information), is unable to generalize learning from one situation to another, may behave quite differently in different settings and with different individuals
  • Difficulty with transitions
  • Shows a strong desire to control the environment

C. Inflexible thinking, not learning from past mistakes (note: this is why consequences often appear ineffective)

D. Can only focus on one way to solve a problem, though this solution may be ineffective:
  • Continues to engage in an ineffective behavior rather than thinking of alternatives
  • Does not ask a peer or adult for needed materials
  • Does not ask for help with a problem
  • Is able to name all the presidents, but not sure what a president does
  • Is unable to focus on group goals when he is a member of the group

3. Impaired imaginative play:
  • Attempts to control all aspects of the play activity; any attempts by others to vary the play are met with firm resistance
  • Engages in play that, although it may seem imaginary in nature, is often a retelling of a favorite movie/TV show/book (note: this maintains rigidity in thoughts, language, and actions)
  • Focuses on special interests such that he dominates play and activity choices
  • Follows a predetermined script in play
  • Uses limited play themes and/or toys
  • Uses toys in an unusual manner

4. Visual learning strength

A. Benefits from schedules, signs, cue cards:
  • Uses visual information as a “backup” (e.g., I have something to look at when I forget), especially when new information is presented
  • Uses visual information as a prompt
  • Uses visual information to help focus attention (e.g., I know what to look at)
  • Uses visual information to make concepts more concrete
  • Uses visual information to provide external organization and structure, replacing the child’s lack of internal structure (e.g., I know how it is done, I know the sequence)

B. Has specific strengths in cognitive areas:
  • Displays average or above average intellectual ability
  • Displays average or above average receptive and expressive language skills
  • Displays high moral standard (e.g., does not know how to lie)
  • Displays strong letter recognition skills
  • Displays strong number recognition skills
  • Displays strong oral reading skills, though expression and comprehension are limited
  • Displays strong spelling skills
  • Displays strong word recognition skills
  • Excellent rote memory
  • Has an extensive fund of factual information

Motor Clumsiness Checklist—

A. Difficulties with gross motor skills
  1. An awkward gait when walking or running
  2. Difficulty coordinating different extremities, motor planning (shoe tying, bike riding)
  3. Difficulty when throwing or catching a ball (appears afraid of the ball)
  4. Difficulty with motor imitation skills
  5. Difficulty with rhythm copying
  6. Difficulty with skipping
  7. Poor balance

B. Difficulties with fine motor skills
  1. Has an unusual pencil/pen grasp
  2. Difficulty applying sufficient pressure when writing, drawing, or coloring
  3. Difficulty with handwriting/cutting/coloring skills
  4. Difficulty with independently seeing sequential steps to complete finished product
  5. Frustration if writing samples are not perfectly identical to the presented model
  6. Rushes through fine motor tasks

Narrow Range of Interests/Insistence on Set Routines Checklist—

A. Rules are very important as the world is seen as black or white
  1. Has a set routine for how activities are to be done
  2. Difficulty with any changes in the established routine
  3. Has rules for most activities, which must be followed (this can be extended to all involved)
  4. Takes perfectionism to an extreme — one wrong answer is not tolerable, and the child must do things perfectly

B. Few interests, but those present are unusual and treated as obsessions
  1. Has developed narrow and specific interests; the interests tend to be atypical (note: this gives a feeling of competence and order; involvement with the area of special interest becomes all-consuming)
  2. Patterns, routines, and rituals are evident and interfere with daily functioning (note: this is driven by the child’s anxiety; the world is confusing for her; she is unsure what to do and how to do it; if she can impose structure, she begins to have a feeling of control)
  3. Displays rigid behavior:
  • Arranges toys/objects/furniture in a specific way
  • Can't extend the allotted time for an activity; activities must start and end at the times specified
  • Carries a specific object
  • Colors with so much pressure the crayons break (e.g., in order to cover all the white)
  • Erases over and over to make the letters just right
  • Feels need to complete projects in one sitting, has difficulty with projects completed over time
  • Narrow clothing preferences
  • Narrow food preferences
  • Has unusual fears
  • Insists on the parent driving a specific route
  • Is unable to accept environmental changes (e.g., must always go to the same restaurant, same vacation spot)
  • Is unable to change the way she has been taught to complete a task
  • Needs to be first in line, first selected, etc.
  • Only sits in one specific chair or one specific location
  • Plays games or completes activities in a repetitive manner or makes own rules for them
  • Selects play choices/interests not commonly shared by others (e.g., electricity, weather, advanced computer skills, scores of various sporting events) but not interested in the actual play (note: this could also be true for music, movies, and books)

C. Failure to follow rules and routines results in behavioral difficulties, which can include:
  1. Anxiety
  2. Emotional responses out of proportion to the situation, emotional responses that are more intense and tend to be negative (e.g., glass half-empty)
  3. Inability to prevent or lessen extreme behavioral reactions, inability to use coping or calming techniques
  4. Increase in perseverative/obsessive/rigid/ritualistic behaviors or preoccupation with area of special interest, engaging in nonsense talk
  5. Non-compliant behaviors
  6. Tantrums/meltdowns (e.g., crying, aggression, property destruction, screaming)

Impairments in Language Checklist—

A. Impairment in the pragmatic use of language
  1. Uses conversation to convey facts and information about special interests, rather than to convey thoughts, emotions, or feelings
  2. Uses language scripts or verbal rituals in conversation, often described as “nonsense talk” by others (scripts may be made up or taken from movies/books/TV). At times, the scripts are subtle and may be difficult to detect
  3. Difficulty initiating, maintaining, and ending conversations with others:
  • Does not inquire about others when conversing
  • Does not make conversations reciprocal (i.e., has great difficulty with the back-and-forth aspect), attempts to control the language exchange, may leave a conversation before it is concluded
  • Focuses conversations on one narrow topic, with too many details given, or moves from one seemingly unrelated topic to the next
  • Knows how to make a greeting, but has no idea how to continue the conversation; the next comment may be one that is totally irrelevant
  • Once a discussion begins, it is as if there is no “stop” button; must complete a predetermined dialogue

4. Unsure how to ask for help, make requests, or make comments:
  • Engages in obsessive questioning or talking in one area, lacks interest in the topics of others
  • Fails to inquire regarding others
  • Difficulty maintaining the conversation topic
  • Interrupts others
  • Makes comments that may embarrass others

B. Impairment in the semantic use of language
  1. Displays difficulty understanding not only individual words, but conversations
  2. Displays difficulty with problem solving
  3. Displays difficulty analyzing and synthesizing information presented:
  • Creates jokes that make no sense
  • Creates own words, using them with great pleasure in social situations
  • Does not ask for the meaning of an unknown word
  • Has a large vocabulary consisting mainly of nouns and verbs
  • Difficulty discriminating between fact and fantasy
  • Interprets known words on a literal level (i.e., concrete thinking)
  • Is unable to make or understand jokes/teasing
  • Uses words in a peculiar manner

C. Impairment in prosody
  1. Rarely varies the pitch, stress, rhythm, or melody of his speech. Does not realize this can convey meaning
  2. Has a voice pattern that is often described as robotic or as the “little professor”; in children, the rhythm of speech is more adult-like than child-like
  3. Displays difficulty with volume control (i.e., too loud or too soft)
  4. Uses the voice of a movie or cartoon character conversationally and is unaware that this is inappropriate
  5. Difficulty understanding the meaning conveyed by others when they vary their pitch, rhythm, or tone

D. Impairment in the processing of language
  1. When processing language (which requires multiple channels working together), has difficulty regulating just one channel, difficulty discriminating between relevant and irrelevant information
  2. Has difficulty shifting from one channel to another; processing is slow and easily interrupted by any environmental stimulation (i.e., seen as difficulty with topic maintenance). This will appear as distractibility or inattentiveness. (Note: When looking at focusing issues, it is very difficult to determine the motivator. It could be attributed to one or a few of the following reasons: lack of interest, fantasy involvement, anxiety, or processing difficulty.)
  3. Displays a delay when answering questions
  4. Displays difficulty sustaining attention and is easily distracted (e.g., one might be discussing plants and the HFA child will ask a question about another country; something said may have triggered this connection or the individual may still be in an earlier conversation)
  5. Displays difficulty as language moves from a literal to a more abstract level (generalization difficulties found in the HFA population are, in part, due to these processing difficulties)

Difficulty with Reciprocal Social Interactions Checklist—

A. Inability and/or a lack of desire to interact with peers
  1. Displays an inability to interact because she does not know how to interact. She wants to interact with others, but does not know what to do:
  • Compromises interactions by rigidity, inability to shift attention or “go with the flow,” being rule bound, needs to control the play/activity (play may “look” imaginative but is most likely repetitive — e.g., action figures are always used in the same way, songs are played in the same order, Lego pieces are always put together in the same way)
  • Displays a limited awareness of current fashion, slang, topics, activities, and accessories (does not seem interested in what peers view as popular or the most current craze, unless it happens to match a special interest)
  • Displays a limited awareness of the emotions of others and/or how to respond to them (does not ask for help from others, does not know how to respond when help is given, does not know how to respond to compliments, does not realize the importance of apologizing, does not realize something she says or does can hurt the feelings of another, does not differentiate internal thoughts from external thoughts, does not respond to the emotions another is displaying)
  • Displays narrow play and activity choices (best observed during unstructured play/leisure activities: look for rigidity/patterns/repetitive choices, inability to accept novelty)
  • Engages in unusual behaviors or activities (selects play or activity choices of a younger child, seems unaware of the unwritten social rules among peers, acts like an imaginary character, uses an unusual voice — any behaviors that call attention to the child or are viewed as unusual by peers)
  • Initiates play interaction by taking a toy or starting to engage in an ongoing activity without gaining verbal agreement from the other players, will ignore a negative response from others when asking to join in, will abruptly leave a play interaction
  • Is unable to select activities that are of interest to others (unaware or unconcerned that others do not share the same interest or level of interest, unable to compromise)
  • Lacks an understanding of game playing — unable to share, unable to follow the rules of turn taking, unable to follow game-playing rules (even those that may appear quite obvious), is rigid in game playing (may want to control the game or those playing and/or create her own set of rules), always needs to be first, unable to make appropriate comments while playing, and has difficulty with winning/losing
  • Lacks conversational language for a social purpose, does not know what to say — this could be no conversation, monopolizing the conversation, lack of ability to initiate conversation, obsessive conversation in one area, conversation not on topic or conversation that is not of interest to others
  • Lacks the ability to understand, attend to, maintain, or repair a conversational flow or exchange — this causes miscommunication and inappropriate responses (unable to use the back-and-forth aspect of communication)
  • Observes or stays on the periphery of a group rather than joining in

2. Prefers structured over non-structured activities

3. Displays a lack of desire to interact:
  • Does not care about her inability to interact with others because she has no interest in doing so. She prefers solitary activities and does not have the need to interact with others, or she is socially indifferent and can take it or leave it with regard to interacting with others
  • Is rule bound/rigid and spends all free time completely consumed by areas of special interest. Her activities are so rule bound, it would be almost impossible for a peer to join in correctly. When asked about preferred friends, the child is unable to name any or names those who are really not friends (family members, teachers)
  • Sits apart from others, avoids situations where involvement with others is expected (playgrounds, birthday parties, being outside in general), and selects activities that are best completed alone (e.g., computer games, Game Boy, books, viewing TV/videos, collecting, keeping lists)

B. Lack of appreciation of social cues
  1. Lacks awareness if someone appears bored, upset, angry, scared, and so forth. Therefore, she does not comment in a socially appropriate manner or respond by modifying the interaction
  2. Lacks awareness of the facial expressions and body language of others, so these conversational cues are missed. He is also unable to use gestures or facial expressions to convey meaning when conversing. You will see fleeting, averted, or a lack of eye contact. He will fail to gain another person's attention before conversing with her. He may stand too far away from or too close to the person he is conversing with. His body posture may appear unusual
  3. When questioned regarding what could be learned from another person's facial expression, says, “Nothing.” Faces do not provide him with information. Unable to read these “messages,” he is unable to respond to them
  4. Has difficulty with feelings of empathy for others. Interactions with others remain on one level, with one message:
  • Fails to assist someone with an obvious need for help (not holding a door for someone carrying many items or assisting someone who falls or drops their belongings)
  • Ignores an individual’s appearance of sadness, anger, boredom, etc.
  • Talks on and on about a special interest while unaware that the other person is no longer paying attention, talks to someone who is obviously engaged in another activity, talks to someone who isn’t even there

C. Socially and emotionally inappropriate behaviors
  1. Laughs at something that is sad, asks questions that are too personal
  2. Makes rude comments (tells someone they are fat, bald, old, have yellow teeth)
  3. Engages in self-stimulatory or odd behaviors (rocking, tics, finger posturing, eye blinking, noises — humming/clicking/talking to self)
  4. Is unaware of unspoken or “hidden” rules — may “tell” on peers, breaking the “code of silence” that exists. He will then be unaware why others are angry with him
  5. Responds with anger when he feels others are not following the rules, will discipline others or reprimand them for their actions (acts like the teacher or parent with peers)
  6. Touches, hugs, or kisses others without realizing that it is inappropriate

D. Limited or abnormal use of nonverbal communication
  1. Averts eye contact, or keeps it fleeting or limited
  2. Stares intensely at people or objects
  3. Does not observe personal space (is too close or too far)
  4. Does not use gestures/body language when communicating
  5. Uses gestures/body language, but in an unusual manner
  6. Does not appear to comprehend the gestures/body language of others
  7. Uses facial expressions that do not match the emotion being expressed
  8. Lacks facial expressions when communicating
  9. Does not appear to comprehend the facial expressions of others
  10. Displays abnormal gestures/facial expressions/body posture when communicating:
  • Confronts another person without changing her face or voice
  • Does not turn to face the person she is talking to
  • Has tics or facial grimaces
  • Looks to the left or right of the person she is talking to
  • Smiles when someone shares sad news
  • Stands too close or too far away from another person

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