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Aspergers: Diagnosis and Clinical Features

The diagnosis of Aspergers requires the demonstration of qualitative impairments in social interaction and restricted patterns of interest, criteria which are identical to autism. In contrast to autism, there are no criteria in the cluster of language and communication symptoms, and onset criteria differ in that there should be no clinically significant delay in language acquisition, cognitive and self-help skills. Those symptoms result in significant impairment in social and occupational functioning. In some contrast to the social presentation in autism, children with Aspergers find themselves socially isolated, but are not usually withdrawn in the presence of others.

Typically, they approach others but in an inappropriate or eccentric fashion. For example, they may engage the interlocutor, usually an adult, in one-sided conversation characterized by long-winded, pedantic speech, about a favorite and often unusual and narrow topic. They may express interest in friendships and in meeting people, but their wishes are invariably thwarted by their awkward approaches and insensitivity to the other person's feelings, intentions, and non-literal and implied communications (e.g., signs of boredom, haste to leave, and need for privacy).

Chronically frustrated by their repeated failures to engage others and form friendships, some children with Aspergers develop symptoms of an anxiety or mood disorder that may require treatment, including medication.

They also may react inappropriately to, or fail to interpret the valence of the context of the affective interaction, often conveying a sense of insensitivity, formality, or disregard to the other person's emotional expressions.

They may be able to describe correctly, in a cognitive and often formalistic fashion, other people's emotions, expected intentions and social conventions; yet, they are unable to act upon this knowledge in an intuitive and spontaneous fashion, thus losing the tempo of the interaction.

Their poor intuition and lack of spontaneous adaptation are accompanied by marked reliance on formalistic rules of behavior and rigid social conventions. This presentation is largely responsible for the impression of social naiveté and behavioral rigidity that is so forcefully conveyed by those with Aspergers.

Although significant abnormalities of speech are not typical of children with Aspergers, there are at least three aspects of communication patterns that are of clinical interest:

1. The communication style of children with Aspergers is often characterized by marked verbosity. The youngster may talk incessantly, usually about a favorite subject, often in complete disregard to whether the listener might be interested, engaged, or attempting to interject a comment, or change the subject of conversation. Despite such long-winded monologues, the child may never come to a point or conclusion. Attempts by the interlocutor to elaborate on issues of content or logic, or to shift the interchange to related topics, are often unsuccessful.

2. Speech may often be tangential and circumstantial, conveying a sense of looseness of associations and incoherence. Even though in a very small number of cases this symptom may be an indicator of a possible thought disorder, the lack of contingency in speech is a result of the one-sided, egocentric conversational style (e.g., unrelenting monologues about the names, codes, and attributes of innumerable TV stations in the country), failure to provide the background for comments and to clearly demarcate changes in topic, and failure to suppress the vocal output accompanying internal thoughts.

3. Speech may be marked by poor prosody, although inflection and intonation may not be as rigid and monotonic as in autism. They often exhibit a constricted range of intonation patterns that is used with little regard to the communicative functioning of the utterance (e.g., assertions of fact, humorous remarks). Rate of speech may be unusual (e.g., too fast) or may lack in fluency (e.g., jerky speech), and there is often poor modulation of volume (e.g., voice is too loud despite physical proximity to the conversational partner). The latter feature may be particularly noticeable in the context of a lack of adjustment to the given social setting (e.g., in a library, in a noisy crowd).

Young people with Aspergers typically amass a large amount of factual information about a topic in a very intense fashion. The actual topic may change from time to time, but often dominates the content of social interchange. Frequently the entire family may be immersed in the subject for long periods of time. This behavior is peculiar in the sense that oftentimes extraordinary amounts of factual information are learned about very circumscribed topics (e.g., snakes, names of stars, TV guides, deep fat fryers, weather information, personal information on members of congress) without a genuine understanding of the broader phenomena involved. This symptom may not always be easily recognized in childhood since strong interests in certain topics, such as dinosaurs or fashionable fictional characters, are so ubiquitous. However, in both younger and older kids typically the special interests become more unusual and narrowly focused.

Children with Aspergers may have a history of delayed acquisition of motor skills such as pedaling a bike, catching a ball, opening jars, and climbing outdoor play equipment. They are often visibly awkward and poorly coordinated and may exhibited stilted or bouncy gait patterns and odd posture. Neuropsychologically, there is often a pattern of relative strengths in auditory and verbal skills and rote learning, and significant deficits in visual-motor and visual-perceptual skills and conceptual learning. Many people exhibit high levels of activity in early childhood, and, as noted, may develop anxiety and depression in adolescence and young adulthood.

My Aspergers Child: Preventing Meltdowns

Asperger Syndrome: Epidemiology

Given the lack of consensual definitions of diagnosis until recently, it is not surprising that the prevalence of Aspergers is unknown, although a rate of 2 to 4 in 10,000 has been reported.

There is little doubt that the condition is more prevalent in boys than girls, with a reported ratio of 9 to 1.

In the past few years, there have been a proliferation of parent support groups organized around the concept of Aspergers, and there are indications that this diagnosis is being given by clinicians much more frequently than even just a few years ago; there are also indications that Aspergers is currently functioning as a residual diagnosis given to normal-intelligence young people with a degree of social disabilities who do not fulfill criteria for autism, overlapping in this way, with the DSM-IV term PDD-NOS.

Possibly the most common usage of the term Aspergers is as synonymous or a replacement to autism in children with normative or superior IQs. This pattern has diluted the concept and reduced its clinical utility. Empirical validation of specific diagnostic criteria is badly needed, although this will have to await reports of rigorous studies employing standard diagnostic procedures, and “validators” truly independent of the diagnostic definition such as neuropsychological, neurobiological and genetic data.

The History Behind "Aspergers"

Aspergers  is characterized by impairments in social interaction and restricted interests and behaviors as seen in autism, but its early developmental course is marked by a lack of any clinically significant delay in spoken or receptive language, cognitive development, self-help skills, and curiosity about the environment. All-absorbing and intense circumscribed interests and one-sided verbosity as well motor clumsiness are typical of the condition, but are not required for diagnosis.

In 1944, Hans Asperger, an Austrian pediatrician with interest in special education, described four kids who had difficulty integrating socially into groups. Unaware of Kanner's description of early infantile autism published just the year before, Asperger called the condition he described "autistic psychopathy", indicating a stable personality disorder marked by social isolation.

Despite preserved intellectual skills, the kids showed marked paucity of nonverbal communication involving both gestures and affective tone of voice, poor empathy and a tendency to intellectualize emotions, an inclination to engage in long winded, one-sided, and sometimes incoherent speech, rather formalistic speech (he called them "little professors"), all-absorbing interests involving unusual topics which dominated their conversation, and motoric clumsiness. Unlike Kanner's patients, these kids were not as withdrawn or aloof; they also developed, sometimes precociously, highly grammatical speech, and could not in fact be diagnosed in the first years of life.

Discarding the possibility of a psychogenic origin, Asperger highlighted the familial nature of the condition, and even hypothesized that the personality traits were primarily male transmitted. Aspergers work, originally published in German, became widely known to the English speaking world only in 1981, when Lorna Wing published a series of cases showing similar symptoms. Her codification of the syndrome, however, blurred somewhat the differences between Kanner's and Aspergers descriptions, as she included a small number of girls and mildly mentally retarded kids, as well as some kids who had presented with some language delays in their first years of life. Since then, several studies have attempted to validate AS as distinct from autism without mental retardation, although comparability of findings has been difficult due to the lack of consensual diagnostic criteria for the condition.3

Aspergers was not accorded official recognition before the publication of ICD-10 and DSM-IV, although it was first reported in the German literature in 1944. Aspergers work was known primarily in German speaking countries, and it was only in the 1970's that the first comparisons with Kanner's work were made, primarily by Dutch researchers such as Van Krevelen, who were familiar with both English and German literatures. The initial attempts at comparing the two conditions were difficult because of major differences in the patients described – Kanner's patients were both younger and more cognitively impaired. Also, Aspergers conceptualization was influenced by accounts of schizophrenia and personality disorders, whereas Kanner had been influenced by the work of Arnold Gesell and his developmental approach.

Attempts at codifying Aspergers prose into a categorical definition for the condition were made by several influential researchers in Europe and North America, but no consensual definition emerged until the advent of ICD-10. And given the reduced empirical validation of the ICD-10 and DSM-IV criteria, the definition of the condition is likely to change as new and more rigorous studies emerge in the near future.

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Aspergers Children and Social Skills Interventions

In this post, we will look at the ingredients that are critical to making “social skills interventions” successful for kids with Aspergers. Here you will find basic principles for teaching social skills that capitalize on the strengths of such kids, while specifically addressing their deficits:

Make the abstract concrete—

Relative to some academic skills, teaching social competence involves abstract skills and concepts. Because kids with Aspergers tend to be concrete and literal, the abstract nature of these interpersonal skills such as kindness, reciprocity, friendships, thoughts, and feelings makes them especially difficult to master. A first critical step is to define the abstract social skill or problem in clear and concrete terms. The behavior must be explicitly operationalized and the youngster taught to identify it and differentiate it from other behaviors (Is this a friend or not a friend? Is this a quiet or a loud voice? Were you being teased or not? Are you following directions or not?). Kids learning eye contact may respond better to the more concrete “point your eyes” than to “make eye contact” or even “look at me.” Personal space can be defined concretely as “an arm away” or “a ruler away” instead of “too close.” “If-then” rules can be taught when the social behaviors involved are predictable and consistent. For example, “If someone says ‘thank you,’ then you say ‘you're welcome’.” Short menus of behavior options can be presented for particular social situations for kids to choose among (e.g., three things you can do to deal with teasing).

Visually-based instruction is another example of a way to make the abstract concrete. Many kids with Aspergers, even those who are high functioning and who have considerable verbal skill, demonstrate a visual preference or learn best with visually cued instruction. Incorporating visual cues, prompts, and props to augment verbal instruction can make abstract social skills more tangible and easily understood. Pictures can be used to define concepts or clarify definitions. Examples of intermediate and finished products can be used to demonstrate steps in activities or projects. Written lists can be used to summarize discussion topics. Voice volume or affect intensity can be depicted visually, in a thermometer-like format. In the PROGRESS Curriculum, a large “Z” made of cardboard is used to depict the back-and-forth of a conversation. Similarly, kids are taught to look at the eyes of others using a cardboard arrow. They are instructed to hold the arrow on the side of their face, next to their right eye, and point it at the eyes of the person to whom they are speaking. This aligns their face and eyes in the correct direction. Once this skill has been practiced using this concrete visual cue, use of the arrow is faded. When a youngster needs a reminder to look in someone's eyes, the arrow can be held up unobtrusively as a cue. Such visual prompts can then be faded and the skill can be practiced in more natural contexts.

Structure and predictability—

In most group therapy, including social skills training, topics and session content change from week to week. One way to ease the anxiety that this may cause, while also facilitating transitions between activities and increasing comprehension, is to provide structure, predictability, and routines. Specifically, maintaining a consistent opening, lesson, and closing format, regardless of session topic, can be helpful, as can predictable group rituals, such as weekly songs or joke time. For example, younger kids might always begin with a singing routine that welcomes each participant by name. Older kids and adolescents might start each session with a routine in which each member recounts a positive and a difficult event from the previous week. The greeting might always be followed by an instructional activity. Although the content, focus, and technique would change from week to week, the sequence of this instruction always following the group greeting would provide some measure of predictability. Group instruction might always be followed by a snack, with accompanying conversation on an identified topic of interest or joke telling. A closing routine should always signal the end of the session. This routine could include a review of the session's topic, a song, a story, a quiz, or a goodbye to each participant. The essential ingredient is the predictability of the routine, not its specific content.

Visual cues, such as picture schedules and written lists, also can clarify the sequence of events during group and prepare members for upcoming transitions, new activities, or unexpected changes. The session schedule used in the PROGRESS Curriculum resembles a traffic light with picture-word icons depicting each activity. The icons in the upper-most green circle of the traffic light begin the session, those in the yellow circle occur during the middle of the session, and those in the bottom red circle close the group. As an activity is completed, the icon is removed from the traffic light.

Engaged transitions—

Another way to ease the anxiety and behavior difficulties often associated with transitions is to focus participants' attention on a concrete task that naturally leads them from one activity to the next. For example, when transitioning from the structured group activity to the snack period, kids might work in pairs to put away materials and prepare the room for the snack. This focuses them on a specific task, as opposed to the change of activity. The PROGRESS Curriculum transitions kids from the opening group circle to the structured skill development activity in a novel way. The transition is facilitated by an activity called “Pick-and-Pass,” which uses a large container decorated with question marks that contains objects, pictures, or words that are used in the subsequent activity. Each youngster removes an item from the can and passes it to the next youngster as the rest of the group chants “Pick and pass” while clapping. This is usually met with great excitement as the kids select an item or wait for the can to be passed, easing the transition between activities.

Scaffolded language support—

There is a complex interplay between social skills, cognitive function, and language. Kids with Aspergers have not only social challenges, but also communication and cognitive challenges. It is therefore vitally important to consider the cognitive and language abilities of the kids participating in social skills intervention and to adapt the intervention as needed. Social skills curricula can be designed to meet the needs of kids with Aspergers at a variety of ages, developmental levels, and language abilities. One way to do this is to group kids by general language ability, so that those who need extra structure, support, and language scaffolding are treated together. Then activities can be adapted to the amount and level of language support and structure required by the participants. For kids who do not have fluent language, directions and activities need to be visually clear, concrete, and hands-on. Language models or scripts can be provided so that group members need little or no spontaneous language to participate. Conversely, activities for kids with fluent expressive language (e.g., those with Asperger syndrome or high functioning autism) would require greater independence in generating spontaneous language. Fewer concrete supports would be needed and activities enabling them to practice social skills in more natural social interactions would be more appropriate.

The following example demonstrates how an activity from the PROGRESS Curriculum has been modified for kids at two different language ability levels. In the friendship unit, one session is devoted to learning more about other people. One activity uses a board game format, in which the cards that advance players around the board require them to ask other group members personal questions. For kids with more fluent language, a card might read “Find out three things (name) likes to do.” For kids with greater language difficulties, a comparable card would use words and picture icons to read “(name), what is your favorite color?” If the peer cannot respond verbally, pictures of different colors are available so he or she can point. Thus, fewer expressive language skills are required. Questions are more specific, address concrete attributes, and avoid abstract concepts. Responses are more circumscribed and less open-ended in this format. Yet the goal of finding out about others is fulfilled, just as for kids with more verbal fluency.

Another example of language scaffolding from the PROGRESS Curriculum comes from the conversation skills unit, in an activity that teaches contingent commenting. Kids with fluent language sit in a circle, spin a topic spinner that visually depicts several categories (e.g., food, animals, movies), and comment on the topic indicated. This same activity is redesigned for kids with limited language skills to provide significantly more language modeling, visual prompts, and concrete directions. Kids are given a card with a carrier phrase written on it, such as “I have a ___.” The group leader reads the words for the kids, if necessary. A tray of interesting objects is then placed in the middle of the circle. Each youngster selects an object and uses the carrier phrase to comment, “I have a (item from tray).”

The length and complexity of the opening and closing songs also can be adapted to the language abilities of the participants. For example, in the PROGRESS Curriculum, the opening song for kids with limited language use is (to the tune of Goodnight Ladies): “Hello (name), hello (name), hello (name), I'm glad you came to group.” This song is elaborated for kids who are functioning at a higher language level by including an extra verse tailored to preview the session's topic. For example, during a lesson on teasing, the opening song is (to the tune of Frere Jacques): “Hello (name), hello (name). How are you? How are you? Sometimes people tease me, I don't like it, how about you? How about you?”

Multiple and varied learning opportunities—

Although many kids with Aspergers demonstrate strengths in visual processing, there is still diversity in their interests, preferences, and learning styles. Some kids learn best while moving their bodies, others need to sit and focus to learn. Some kids learn well through reading, others are not yet literate. Some kids find music calming and facilitating, whereas others find it a distraction or even an irritant. Just as kids with typical development demonstrate multiple “intelligences”, so too do kids with Aspergers. Varying the learning opportunities, techniques, and approaches within and across sessions maximizes the likelihood that the particular learning styles or preferences of participants will be tapped. Different learning modalities include construction tasks, games, role plays, craft or cooking projects, gross motor activities, reading or writing tasks, drawing or art activities, and countless others. At different times, kids can practice working in dyads, small groups, and large groups.

As an example, the PROGRESS Curriculum's session focused on sharing starts by reading a story about sharing. The kids then transition into pairs by selecting objects from the Pick and Pass can that are part of a pair of toys (e.g., miniature baseball and miniature bat) and matching up with their partner. In these pairs, they then share a toy that encourages turn-taking. At snack, the kids pair up with the peer beside them and are given a single, large piece of cake. They must agree on how to decorate the cake together. Once completed, they share the piece of cake by cutting it in half. The group then plays a group game, “Musical Shares” (an analog of Musical Chairs). The kids walk around on mats while music is playing. Each time the music stops, they must find a mat to share with a new friend. In this way, sharing is practiced in a variety of different ways and through a variety of different activities.

“Other”-focused activities—

In positive social group environments, the members typically have a sense of community and friendship that develops over time, through repeated interactions. For kids with Aspergers, a feeling of “group belonging” is rarely achieved. The desire to attend to the interests of others, get to know others, and do things for others is often impaired. One way to facilitate the development of these skills is to ensure that all or most activities in the curriculum are “other”-focused. Nothing that can be done in a pair or group is ever done alone. Kids help others, rather than help themselves. For example, in art activities, kids can make something for a peer, rather than for themselves. They may be required to find out information about a peer, and then use that peer's favorite colors and preferences to develop a picture for him or her. During snack, kids can serve each other, rather than themselves. If they need more food, they must request it from another youngster rather than get it on their own. Through repeated, required social opportunities and practice, cooperation and partnership become the culture of the group, over time creating an environment of group camaraderie. Through this process, it is hoped that the participants come to recognize that social interaction can be rewarding and enjoyable.

Perspective taking and sharing the interests of others is also encouraged in the PROGRESS Curriculum through a weekly routine called “Special Spotlight.” During this part of the session, one youngster shares a topic of special interest with the group. Another youngster in the group is designated as the “spotlight partner.” His or her role is to learn about the “spotlight” youngster's interest and bring something to share or discuss related to that topic. This exercise serves to expand the partner's own repertoire of interests and knowledge, while also improving the ability to take another person's perspective. The other kids in the group are encouraged to make comments or ask questions about the spotlight topic. Assignments for the “special spotlight” and “spotlight partner” are made in advance so that the kids can prepare by bringing relevant items, developing a list or script, and so forth. Topics chosen by the kids have ranged from pets, dinosaurs, and video games to bus schedule collections, lectures on the solar system, and theme park brochures. Although the primary goal of the “spotlight” activity is to promote interest in others, it also serves as a way to focus or channel the circumscribed interests of group members into a specific part of the session, so that they do not distract from the rest of the group's activities.

Fostering self-awareness and self-esteem—

Most kids with Aspergers experience frequent social failure and rejection by peers. Because social encounters are seldom reinforcing, kids with Aspergers often avoid social interaction. Over time, they may develop negative attitudes about themselves and others. The poor self-esteem that may result makes it difficult to further attempt social interaction and thus, the cycle continues. Therefore, another essential ingredient of social skills interventions is fostering self-awareness, self-appreciation, and self-acceptance. It is only within a positive and nurturing environment that a straightforward examination of strengths and weaknesses can be achieved and the process of self-value initiated. Opportunities for self-awareness and self-acceptance can be incorporated throughout the curriculum. Positive attributes and strengths should be the focus whenever possible. Many kids with Aspergers are more used to a focus on their deficits and express surprise that Aspergers also involves much strength (e.g., memory, visualization, reading, rule-following, passion and conviction). To foster self-acceptance, group leaders can regularly comment on members' strengths. Kids can be taught the concept of complimenting and can be regularly required to compliment peers. In the University of Utah's adolescent group, participants give positive and constructive feedback to each other at the end of each session.

The adolescent group also includes a specific unit devoted to self-awareness. In one session, the game Bingo is adapted to focus on aspects of the Aspergers style and help individuals become more aware and accepting of their “quirks” or behaviors. The Bingo card lists strengths and weaknesses associated with the autism spectrum (e.g., “hard to point my eyes,” “like to flap my hands,” “know a lot about computers,” “good memory”). The group leader then reads these characteristics aloud one by one, with participants placing a marker on any trait they notice in themselves. Occasionally, several participants achieve “Bingo” (five characteristics in a row, column, or diagonal) at once. The teens are usually surprised and fascinated to find that they share behaviors with others. This activity can be especially helpful in the development of self-acceptance, as many comment that they have never met anyone else like themselves.

Select relevant goals—

Difficulty with social skills is not isolated to kids with Aspergers. Many kids exhibit difficulties with a variety of social skills for a variety of different reasons. As described at the beginning of this article, however, curricula developed to address general social impairments do not adequately tackle the social skills deficits specific to Aspergers. Thus, when selecting social goals for intervention, it is critical to prioritize and address the skill deficits that are most relevant and salient to Aspergers. For example, eye contact is probably a greater priority than manners or negotiation skills, given its centrality to social interaction (e.g., to monitor other people's reactions, to indicate interest or engagement). Related to this, it is important that all activities have an underlying social purpose. In our experience, it is a great deal easier to design fun activities than it is to design fun activities that target specific and relevant goals.

The PROGRESS Curriculum addresses five broad topic units that the authors believe are particularly relevant to Aspergers: basic interactional skills, conversational skills, play and friendship skills, emotion-processing skills, and social problem-solving skills. The Interaction Basics unit teaches the nonverbal behaviors that are important to social interaction, such as appropriate eye contact, social distance, voice volume, and facial expression. The second unit, Conversation Skills, covers basic elements of how to start, maintain, and end a conversation. The more subtle aspects of conversations, like taking turns in conversation, joining a conversation already underway, making comments, asking questions of others, using nonverbal indicators to express interest, and choosing appropriate topics, are included. The third unit teaches basic friendship and relationship skills. The concept of friendship and the important qualities of being a good friend are discussed, listed, and practiced. This unit also includes greeting others and responding to greetings, joining groups, sharing and taking turns, compromising, and following group rules. Next comes a unit on understanding thoughts and feelings of self and other people. The curriculum begins by increasing emotion recognition and vocabulary skills, as many kids with Aspergers are not familiar with emotional terms beyond the basics. Perspective taking and empathy training are included in this unit, requiring the kids to act out situations in which different people think different things or have different underlying motives. The final unit addresses social problem solving, such as what to do when a youngster is teased, feels left out, or is told “No.” The focus is on the development of practical solutions, coping mechanisms, and self-control for these difficult interpersonal situations.

It is important to make clear to the participants how and why the goals selected are relevant for them. For most people, whether they have Aspergers or not, learning is facilitated when the necessity of the learning or its application is made clear. Teaching the relevance of the social skill is believed to facilitate improved skill awareness and use in natural, daily settings for kids with Aspergers. One way to do this is to use Social Stories to introduce new social skills. Social Stories are written, sometimes illustrated, vignettes that present social information. Although they provide some specific guidance about what to do or say in a social situation, they also highlight social cues, peoples' motives or expectations, and other information that the person with Aspergers may not have appreciated. Thus, Social Stories can provide a rationale for why the youngster or kids should do or say what we tell them they should do or say. In addition, regular reminders regarding the importance of the skill being practiced should be regularly infused within group activities. For example, if a youngster is not making eye contact when requesting an item from a peer, he or she might be reminded, “Point your eyes and body so your friend knows you are talking to him.”

In addition to choosing group goals that are relevant to Aspergers, individualized goals can be identified for each group member. Each youngster should be aware of his or her personal target goal and should be reinforced for meeting it throughout the session. Individual goals may be consistent across weeks, or vary from session to session, depending on the needs of the youngster. A variety of different systems can be used, including reinforcement charts posted on the wall, individual goal or point cards, or cups in which the goal is affixed and tokens are placed. Reinforcement schedules can be individualized as needed to best promote skill acquisition and maintenance. For new or emerging skills, kids might be reinforced the moment the skill is displayed spontaneously. Once the skill is established, maintenance can be promoted by reinforcing after longer time periods or at the end of an activity or session.

Sequential and progressive programming—

Skills taught in isolation or without adequate practice and repetition most likely result in poor skill mastery and limited generalization and use. It is essential that the skills and behaviors addressed across the curriculum have relevance to each other and build on each other. As more complex, higher-order skills are learned, basic skills learned early on must continually be practiced. This not only promotes skill maintenance, but also integrates the individual skills into a larger, more fluid, social competence. Complex behaviors must be broken down into specific skills that are taught sequentially and then integrated.

This goal is achieved in the PROGRESS Curriculum in the following manner. Each topic unit consists of five sessions. In the first week of the curriculum, the new unit topic and set of skills are introduced, defined, or described (Introduction Phase). In the second and third weeks (Skill Development Phase), specific individual skills or situations are addressed and practiced. In the fourth week (Integration Phase), skills practiced individually in the previous 3 weeks are integrated and practiced. In the last week (Generalization Phase), the group meets out in the community to practice specific skills, socialize, and participate in natural age-appropriate activities with invited peers and friends. For example, the first session of the conversation unit describes the importance of conversation and outlines the three distinct skills that follow: starting, maintaining, and ending a conversation. Then one skill, such as greeting, is introduced. The following week, another skill is taught (e.g., making a comment) while the first skill (greeting) continues to be practiced and reinforced. In the next week, yet another skill is added (e.g., asking a question), as the previous two skills continue to be practiced and reinforced. In the fourth week, all three of the previously isolated skills are integrated (e.g., greet a peer: “Hi, Mike!”, make a comment: “I like your picture”, then ask a question: “How did you do it?”). In the final week, the skills are practiced in less structured and more typical environments during a community outing; for example, the group gathers at a local restaurant and practices conversation skills while eating pizza.

A similar sequential and progressive plan should exist across the curriculum units. Skills learned in the first unit should be relevant to and practiced in the subsequent units. For example, eye contact is first introduced as an isolated skill in Unit One, Basic Interactional Skills. In Unit Two, Conversation Skills, group members are regularly reminded to point their eyes at their peers as they learn to greet, make comments, and ask questions. In Unit Three, Play and Friendship, the kids, as needed, are encouraged to make eye contact and use appropriate greetings as they learn to share and take turns with others, and so forth.

Programmed generalization and ongoing practice—

Skill mastery and generalization require significant practice and repetition in a variety of settings. As described earlier, providing multiple and varied learning opportunities promotes generalization, as does practice of skills in more naturalistic settings through community outings. Another way to promote generalization is to practice skills with a variety of different people. Unfamiliar adults or peers can be invited to group parties or to snack so that kids have the opportunity to practice their new skills with others.

When group social skill intervention is provided in a clinic setting, transfer of skills to the home or school also can be enhanced through “generalization activities” (akin to homework). A written handout can be provided to moms and dads, teachers, or others, briefly describing the week's target skill and describing a specific activity that practices this skill outside of the group. For example, to generalize conversation skills, moms and dads might be prompted to ask their youngster to tell them three things that happened at school each day, using visual prompts (e.g., photographs or relevant objects) or multiple-choice lists as necessary. Or kids might call another group member on the phone to practice back-and-forth conversation, using a list of prearranged topics or a script as necessary. Generalization may be further enhanced through a concurrent parent training group that apprises moms and dads of the skills their kids are learning and provides ideas on how to practice the skills or implement specific techniques at home or in the neighborhood.

Generalization of behaviors learned in a social skills group to the “real world” may be greater when the group is offered in a natural social setting, such as a school. At the least, the same training model and format described in this article can be implemented in a school, rather than a clinic. Additional methods will likely be necessary to generalize such training to more natural school settings, however, if the training is conducted in a segregated setting (e.g., a separate room, with special education personnel). Written handouts describing the youngster's target skills and individual goals can be provided to the classroom teacher or other school staff. The handout might identify natural opportunities throughout the school day when staff can prompt students to use their skills with peers (e.g., during a small group classroom activity, at lunch). A description of how to best prompt the youngster can be included. It is ideal if classroom teachers or other relevant school staff have the opportunity to observe the social skills group to learn and use the same prompting techniques and teaching strategies. Generalization also might be enhanced by including the social skills group leader in the Individualized Education Plan meeting so that social skills goals can be included in the youngster's overall educational goals and objectives. The benefits of offering social skills intervention and generalization within the school setting include teaching skills in the environment in which they will be used, creating positive social communities with peers who interact daily, and having regular contact among staff members who can promote skill use in natural settings.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Aspergers Tantrums, Rage, and Meltdowns


My eldest boy J___ who is now 5-years-old was diagnosed with Aspergers last July. We did 6 months of intense therapy with a child psychologist and a speech therapist before we moved over to Ghana. J___ has settled in well. He has adjusted to school very well and the teachers who are also expats from England are also dealing with him extremely well.

My current issue is his anger. At the moment if the situations are not done exactly his way he has a meltdown. Symptoms are: Extreme ear piercing screaming, intense crying, to falling down on the floor saying he is going to die. I have tried to tell him to breathe but his meltdown is so intense that his body just can't listen to words. I then have asked him to go to his room to calm down. He sometimes (very rarely) throws things across the room, but does not physically hurt anyone. As I have two younger boys (ages 1 and 3) I still need to be aware of their safety. I then managed to put J___ in his room with the help of a nanny. He throws all blankets off the bed (which doesn't bother me) and then hides under them. Today I waited 10 minutes then went upstairs to talk to him, but he then started again with the extreme crying and screaming at me. It took him over an hour to calm down fully. The situation arose as the nanny and I were helping him to make muffins and the nanny put a spoonful of the mixture into the muffin tin.

I am requesting your help on ways to calm him down in a manner that is acceptable. He is getting too old to be put in the "thinking corner/naughty corner" and I am a petite person so I'm not going to physically put him there. I am finding his resistance at the moment is a lot with me and his father.

I have structures in place by visual laminated pictures of how the morning is run and the structure before bed. This works fine, but like I said when things aren't done exactly his way, he can have an outburst in a flash. Please give me some strategies on how I can better manage these meltdowns.

FYI - he was diagnosed on the border on the CARS model. I have found a qualified speech therapist who is from England which we go to once a week (but as it is summer break we don't go back to August) to assist with his pragmatic language.


Problems related to stress and anxiety are common in kids with Aspergers (high-functioning autism). In fact, this combination has been shown to be one of the most frequently observed comorbid symptoms in these children. They are often triggered by or result directly from environmental stressors, such as:
  • a sense of loss of control
  • an inherent emotional vulnerability
  • difficulty in predicting outcomes
  • having to face challenging social situations with inadequate social awareness
  • misperception of social events
  • rigidity in moral judgment that results from a concrete sense of social justice violations.
  • social problem-solving skills
  • social understanding

The stress experienced by kids with Aspergers may manifest as withdrawal, reliance on obsessions related to circumscribed interests or unhelpful rumination of thoughts, inattention, and hyperactivity, although it may also trigger aggressive or oppositional defiant behavior, often captured by therapists as tantrums, rage, and “meltdowns”.

Educators, therapists, and moms/dads often report that kids with Aspergers exhibit a sudden onset of aggressive or oppositional behavior. This escalating sequence is similar to what has been described in kids with Aspergers, and seems to follow a three-stage cycle as described below. Although non-Aspergers kids may recognize and react to the potential for behavioral outbursts early in the cycle, many kids and teenagers with Aspergers often endure the entire cycle, unaware that they are under stress (i.e., kids with Aspergers do not perceive themselves as having problems of conduct, aggression, hyperactivity, withdrawal, etc.).

Because of the combination of innate stress and anxiety and the difficulty of kids with Aspergers to understand how they feel, it is important that those who work and live with them understand the cycle of tantrums, rage, and meltdowns, and the interventions that can be used to promote self-calming, self-management, and self-awareness as a means of preventing or decreasing the severity of behavior problems.


The Cycle of Meltdowns

Meltdowns typically occur in three stages that can be of variable length. These stages are (1) the “acting-in” stage, (2) the “acting-out” stage, and (3) the recuperation stage.

The “Acting-In” Stage

The “acting-in” stage is the initial stage of a tantrum, rage, or meltdown. During this stage, kids and teenagers with Aspergers exhibit specific behavior changes that may not seem to be related directly to a meltdown. The behaviors may seem minor. That is, kids with Aspergers may clear their throats, lower their voices, tense their muscles, tap their foot, grimace, or otherwise indicate general discontent. Furthermore, somatic complaints also may occur during the “acting-in” stage. Kids also may engage in behaviors that are more obvious, including emotionally or physically withdrawing, or verbally or physically affecting someone else. For example, the youngster may challenge the classroom structure or authority by attempting to engage in a power struggle.

During this stage, it is imperative that a mother/father or educator intervene without becoming part of a struggle. The following interventions can be effective in stopping the cycle of tantrums, rage, and meltdowns – and they are invaluable in that they can help the youngster regain control with minimal adult support:

1. Intervention #1 involves displaying a chart or visual schedule of expectations and events, which can provide security to kids and teenagers with Aspergers who typically need predictability. This technique also can be used as advance preparation for a change in routine. Informing kids of schedule changes can prevent anxiety and reduce the likelihood of tantrums, rage, and meltdowns (e.g., the youngster who is signaling frustration by tapping his foot may be directed to his schedule to make him aware that after he completes two more problems he gets to work on a topic of special interest with a peer). While running errands, moms and dads can use support from routine by alerting the youngster in the “acting-in” stage that their next stop will be at a store the youngster enjoys.

2. Intervention #2 involves helping the youngster to focus on something other than the task or activity that seems to be upsetting. One type of redirection that often works well when the source of the behavior is a lack of understanding is telling the youngster that he can “cartoon” the situation to figure out what to do. Sometimes cartooning can be postponed briefly. At other times, the youngster may need to cartoon immediately.

3. Intervention #3 involves making the Aspergers child’s school environment as stress-free as possible by providing him/her with a “home-base.”. A home-base is a place in the school where the child can “escape.” The home-base should be quiet with few visual or activity distractions, and activities should be selected carefully to ensure that they are calming rather than alerting. In school, resource rooms or counselors' offices can serve as a home-base. The structure of the room supersedes its location. At home, the home-base may be the youngster's room or an isolated area in the house. Regardless of its location, however, it is essential that the home-base is viewed as a positive environment. Home-base is not “timeout” or an escape from classroom tasks or chores. The youngster takes class work to home-base, and at home, chores are completed after a brief respite in the home-base. Home-base may be used at times other than during the “acting-in” stage (e.g., at the beginning of the day, a home base can serve to preview the day's schedule, introduce changes in the typical routine, and ensure that the youngster's materials are organized or prime for specific subjects). At other times, home-base can be used to help the youngster gain control after a meltdown.

4. Intervention #4 involves paying attention to cues from the Aspergers child. When the youngster with Aspergers begins to exhibit a precursor behavior (e.g., throat clearing, pacing), the educator uses a nonverbal signal to let the youngster know that she is aware of the situation (e.g., the educator can place herself in a position where eye contact with the youngster can be achieved, or an agreed-upon “secret” signal, such as tapping on a desk, may be used to alert the youngster that he is under stress). A “signal” may be followed by a stress relief strategy (e.g., squeezing a stress ball). In the home or community, moms and dads may develop a signal (i.e., a slight hand movement) that the mother/father uses with their youngster is in the “acting-in” stage.

5. Intervention #5 involves removing a youngster, in a non-punitive fashion, from the environment in which he is experiencing difficulty. At school, the youngster may be sent on an errand. At home, the youngster may be asked to retrieve an object for a mother/father. During this time the youngster has an opportunity to regain a sense of calm. When he returns, the problem has typically diminished in magnitude and the grown-up is on hand for support, if needed.

6. Intervention #6 is a strategy where the educator moves near the youngster who is engaged in the target behavior. Moms/dads and teachers move near the Aspergers youngster. Often something as simple as standing next to the youngster is calming. This can easily be accomplished without interrupting an ongoing activity (e.g., the educator who circulates through the classroom during a lesson).

7. Intervention #7 is a technique in which the mother/father or educator merely walks with the youngster without talking. Silence on the part of the grown-up is important, because a youngster with Aspergers in the “acting-in” stage will likely react emotionally to any adult statement, misinterpreting it or rephrasing it beyond recognition. On this walk the youngster can say whatever he wishes without fear of discipline or reprimand. In the meantime, the grown-up should be calm, show as little reaction as possible, and never be confrontational.

8. Intervention #8 is a technique that is effective when the youngster is in the midst of the “acting-in” stage because of a difficult task, and the mother/father or educator thinks that the youngster can complete the activity with support. The mother/father or educator offers a brief acknowledgement that supports the verbalizations of the youngster and helps him complete his task. For instance, when working on a math problem the youngster begins to say, “This is too hard.” Knowing the youngster can complete the problem, the educator refocuses the youngster's attention by saying, “Yes, the problem is difficult. Let's start with number one.” This brief direction and support may prevent the youngster from moving past the “acting-in” stage.

When selecting an intervention during the “acting-in” stage, it is important to know the youngster, as the wrong technique can escalate rather than deescalate a behavior problem. Further, although interventions at this stage do not require extensive time, it is advisable that grown-ups understand the events that precipitate the target behaviors so that they can (1) be ready to intervene early, or (2) teach kids and teenagers strategies to maintain behavior control during these times. Interventions at this stage are merely calming. They do not teach kids to recognize their own frustration or provide a means of handling it. Techniques to accomplish these goals are discussed later.

The “Acting-Out” Stage

If behavior is not diffused during the “acting-in” stage, the youngster or adolescent may move to the “acting-out” stage. At this point, the youngster is dis-inhibited and acts impulsively, emotionally, and sometimes explosively. These behaviors may be externalized (i.e., screaming, biting, hitting, kicking, destroying property, or self-injury) or internalized (i.e., withdrawal). Meltdowns are not purposeful, and once the “acting-out” stage begins, most often it must run its course.

During this stage, emphasis should be placed on youngster, peer, and adult safety, and protection of school, home, or personal property. The best way to cope with a tantrum, rage, or meltdown is to get the youngster to home base. As mentioned, this room is not viewed as a reward or disciplinary room, but is seen as a place where the youngster can regain self-control.

Of importance here is helping the individual with Aspergers regain control and preserve dignity. To that end, grown-ups should have developed plans for (1) obtaining assistance from educators, such as a crisis educator or principal, (2) removing other kids from the area, or (3) providing therapeutic restraint, if necessary. 

The Recuperation Stage

Following a meltdown, the youngster with Aspergers has contrite feelings and often cannot fully remember what occurred during the “acting-out” stage. Some may become sullen, withdraw, or deny that inappropriate behavior occurred; others are so physically exhausted that they need to sleep.

It is imperative that interventions are implemented at a time when the youngster can accept them and in a manner the youngster can understand and accept. Otherwise, the intervention may simply resume the cycle in a more accelerated pattern, leading more quickly to the “acting-out” stage. During the recuperation stage, kids often are not ready to learn. Thus, it is important that grown-ups work with them to help them once again become a part of the routine. This is often best accomplished by directing the youth to a highly motivating task that can be easily accomplished, such as activity related to a special interest.

Preventing Tantrums, Rage, and Meltdowns

Kids and teenagers with Aspergers generally do not want to engage in meltdowns. Rather, the “acting-out” cycle is the only way they know of expressing stress, coping with problems, and a host of other emotions to which they see no other solution. Most want to learn methods to manage their behavior, including calming themselves in the face of problems and increasing self-awareness of their emotions. The best intervention for tantrums, rage, and meltdowns is prevention. Prevention occurs best as a multifaceted approach consisting of instruction in (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.

Increasing Social Understanding and Problem Solving

Enhancement of social understanding includes providing direct assistance. Although instructional strategies are beneficial, it is almost impossible to teach all the social skills that are needed in day-to-day life. Instead, these skills often are taught in an interpretive manner after the youngster has engaged in an unsuccessful or otherwise problematic encounter. Interpretation skills are used in recognition that, no matter how well developed the skills of a person with Aspergers , situations will arise that he or she does not understand. As a result, someone in the person's environment must serve as a social management interpreter.

The following interpretative strategies can help turn seemingly random actions into meaningful interactions for kids with Aspergers:

1. Analyzing a social skills problem is a good interpretative strategy. Following a social error, the youngster who committed the error works with an adult to (1) identify the error, (2) determine who was harmed by the error, (3) decide how to correct the error, and (4) develop a plan to prevent the error from occurring again. A social skills analysis is not “punishment.” Rather, it is a supportive and constructive problem-solving strategy. The analyzing process is particularly effective in enabling the youngster to see the cause/effect relationship between her social behavior and the reactions of others in her environment. The success of the strategy lies in its structure of practice, immediate feedback, and positive reinforcement. Every grown-up with whom the youngster with Aspergers has regular contact, such as moms and dads, educators, and therapists, should know how to do social skills analysis fostering skill acquisition and generalization. Originally designed to be verbally based, the strategy has been modified to include a visual format to enhance child learning.

2. Visual symbols such as “cartooning” have been found to enhance the processing abilities of persons in the autism spectrum, to enhance their understanding of the environment, and to reduce tantrums, rage, and meltdowns. One type of visual support is cartooning. Used as a generic term, this technique has been implemented by speech and language pathologists for many years to enhance understanding in their clients. Cartoon figures play an integral role in several intervention techniques: pragmaticism, mind-reading, and comic strip conversations. Cartooning techniques, such as comic strip conversations, allow the youngster to analyze and understand the range of messages and meanings that are a natural part of conversation and play. Many kids with Aspergers are confused and upset by teasing or sarcasm. The speech and thought bubble as well as choice of colors can illustrate the hidden messages.


Although many kids and teenagers with Aspergers exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the youngster is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.

Kids with Aspergers experiencing stress may react by having a tantrum, rage, or meltdown. Behaviors do not occur in isolation or randomly; they are associated most often with a reason or cause. The youngster who engages in an inappropriate behavior is attempting to communicate. Before selecting an intervention to be used during the “acting-out” cycle or to prevent the cycle from occurring, it is important to understand the function or role the target behavior plays.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


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Anxiety and Sleep Problems


My 11 yr old daughter was diagnosed with Asperger's just about a year ago. She is very very high functioning, well we though until about 6 months ago, when her anxiety took over and she had a mental and physical breakdown. Her anxiety continues to plague her, although, she is better than she was.

Sleeping is a huge issue for her, always has been since she was 18 months old. The hard thing is, is that no calming techniques seem to help or better yet, she is not willing to even try some. Not to mention the fact that nothing is consistent, yet it’s all consistent. That something is always the matter, here or there. She is very smart, very stubborn, and very very pre pubescent. She was always quirky, and pretentious, but this anxiety is very difficult to maintain daily life without know what she can handle and what she can’t. No rhythm or reason. She is on anti anxiety meds, only at night... but sometimes do the opposite. They make her cranky and anxious, frustrated and sometimes they knock her right out. But nothing.... keeps her sleeping. We need to re visit the Neurologist and see if there is something other than anxiety causing such issues. But, for right now, life is different every day and night. It’s getting harder on me, because we have to tip toe around the house at night, to try not to wake her or she cries until I lay with her or she makes me stay on the couch until she falls asleep there. So, I am wiped out too. It’s to the point where I need to take a mild sedative to fall asleep because I am always in anticipation of her waking up.

This is her first year of Middle school was a complete disaster. Beyond disaster. So, for this coming year, I am going to look into alternative education methods that fit her strengths and giftings. So, that is it in a short nut shell. I could type for days, on details of our life with an Aspie, but this is what I feel to share so far. Thanks for listening.


Re: Anxiety—

While most people associate anxiety with an emotional response to stress, a major factor in stress and anxiety is the physical response to external stimulus. The stress response in the brain sends signals to the body to prepare us to handle a perceived danger or threat, and this induces a physical state of tension that can add to the emotional reaction to problem situations. As the body stores tension over time, a state of chronic anxiety can occur. Proper diet and regular exercise can help alleviate the physical tension associated with stress and help lower anxiety levels.

Eating a balanced diet consisting of whole grains, fruits, vegetables, and lean meats can help strengthen the body’s resistance to stress. These foods contain nutrients that are essential for healthy body function. Combining complex carbohydrates available from whole grains such as whole wheat bread or whole oats with protein helps to keep blood sugar levels steady, avoiding the stress of the sugar crashing cycle that can add to physical stress. Drinking plenty of water helps, too, as dehydration is just added stress to the body.

Avoiding stimulants such as caffeine also helps to reduce stress. Stimulants put the body in a constant state of heightened agitation and can facilitate a kind of false stress response when no stress is present. Refined sugar also creates stress as the body feels a rush of energy and then a crash in blood sugar. Processed foods should be avoided in favor of whole foods as they don’t contain the nutrients needed for strengthening the body’s ability to handle stress.

Exercise also helps to alleviate stress and anxiety. It does this in several ways. Engaging in physical activity increases the flow of oxygen through the body and stimulates the nervous system, and this can help to release the tension held in the body and induce a relaxed state of calm, making it easier to deal with stressful situations when they arise. Hormones such as endorphins are released during exercise, and these hormones help to alleviate pain and create a mental state of well-being. Exercise also helps to create a more positive self-image, provides a distraction from worries, and facilitates a sense of motivation and positive direction.

It doesn’t have to be overwhelming or exhausting to provide benefits against anxiety. Just 10 minutes of moderate exercise a day can create a more positive outlook. Choose an activity that you enjoy. Try becoming a member of a group to provide the added benefit of social interaction and fun. To see benefit, make sure to move at least 3 to 4 times a week, and remember to start small and build slowly based on your level of fitness. Overdoing it too soon can cause problems and make it hard to keep up the routine.

Adopting a more physically healthy lifestyle based on balance is the key to a healthy emotional outlook and reduction in problems such as anxiety. Wellness can be looked at as a lifestyle choice, and making good decisions about diet and exercise is one way to improve the quality of life.

Re: Sleep problems—

Here are some suggestions:

• Accept some awakenings. The experts stress that nighttime awakenings are perfectly normal -- much more normal, in fact, than the elusive solid eight hours people think they should be getting. Most people will roll over and go back to sleep, but those with insomnia become conditioned to feel anxious when they awake during the night. You need to accept that you will arouse some, so reassure yourself in the middle of the night that nothing catastrophic will happen if you are awake for a while.

• Acupuncture may help reduce her anxiety and induce deeper sleep.

• Cognitive behavioral therapy is often used in cases like this, and the experts agree that it could help. CBT aims to stop the behaviors that are perpetuating the insomnia. Typically, a therapist will work with a patient for four to eight weeks -- in sessions that last from 30 minutes to two hours -- to assess, diagnose, and treat the underlying problem, such as relationship worries. The therapist will teach the patient things like progressive-relaxation techniques and point out actions that are getting in the way of deep sleep, such as rehashing conversations that occurred earlier in the day.

• Distract her brain by trying a relaxation technique, like focusing on her breathing.

• Keep the glaring electric clock off the bedside table. Clock watching will only increase your anxiety about being awake.

• Make an appointment at a sleep clinic, which can be a smart step for people with a long history of sleep issues. Most often this involves office visits (which will not necessarily be overnight observations), during which the patient will undergo a physical examination and work with a doctor to assess and diagnose the cause of the sleep problems.

• Modulate her exposure to light, which could reset her internal clock gradually. Too much light at night will push her clock even later, so the key is to keep the lights dim the closer she gets to bedtime. Also maximize her light exposure first thing in the morning. If she can go outside in bright sunlight for some exercise, that would provide a double whammy of wakefulness.

• Pay even more attention to her evening routine and her sleep environment. Good sleep habits don't necessarily solve sleep problems, but they do create a foundation for improved sleep. Good habits include things such as keeping the bedroom cool and dark, using a fan or a white-noise machine to create a blanket of sound, and using the bed exclusively as a place for sleeping -- and not for watching television, for example.

• Take 0.3 milligram of an over-the-counter melatonin supplement about 20 minutes before bedtime since the production of melatonin (a naturally produced hormone that helps regulate circadian rhythms) drops off as we age.

• Try wearing earplugs.

• Use caution regarding over-the-counter sleep medications, since they contain some type of antihistamine, which can stay in the body for a long time. It takes about 18 hours for your body to clear out 50 percent of the active drug. For most of your waking hours, it will still be in your system, making you drowsy.

• Work on keeping her sleep environment quieter, such as using an air conditioner or a fan, as well as blackout shades to block street light.

Some parents enforce a strict bedtime and a regular bedtime routine as a way of calming their child for sleep. Another good trick is to use flannel sheets and to experiment with pajama fabrics until you find one that your child tolerates. Enclosing the child in a sleeping bag or under a bed tent can help. So does playing "white noise" in the background.

Your pediatrician may prescribe sleeping pills such as Sonata, Ambien, Desyrel or Serzone.

More resources for parents of children and teens with Asperger's and High-Functioning Autism:

•    Anonymous said… How can anxiety be managed in hfa children please?
•    Anonymous said… I also recommend melatonin - completely natural (no script needed) and works very well for my daughter, who is now 16. For the anxiety, she started on Zoloft a year ago and it helps her keep it at a manageable level. That plus cognitive behavioural therapy has been a winning combo. My daughter has improved dramatically in the past year.
•    Anonymous said… I do not have any advise. I will pray for all of you as you journey this rocky road. My Grandson Tyler is an aspie. His Dad, my son, has just written a book, Love That Boy, that may help you not feel so alone.
•    Anonymous said… I hear and feel you. My soon to be 16 year old daughter began severe anxiety and depression right about that age. Sleep has always been an issue;however, we had done several things with her in her early years that have luckily carried over into her teen years that do help. Melatonin helped for a while, but I have found that meditation helps the most. What is happening is that she can't stop the multitude of thoughts that come into her head and leaves her body in a state of fight or flight. Spray a little lavender near her pillow (calming), have her soak in a hot bath before bed (you can add lavender essential oil to the bath too), if she will allow it - lay down next to her and take turns telling each other what silly things pop up in your head while falling asleep. This helps to keep the anxious thoughts at bay. If she is really wound up, try just holding her feet. It sounds strange, but there is a hugely calming effect that this has. On the bright side, my daughter has decided to not depend on anti-anxiety/depression meds anymore and is doing great! Every day is a new day, with new challenges and hopefully some victories as well. Stay strong. She will get through this.
•    Anonymous said… I'd like to know if anyone has successfully gone "back" to school and graduated after experiencing all of the above^^^^symptoms? And if so, what worked for you?
•    Anonymous said… I'm experiencing something simile with my 10 year old daughter who is going through the diagnosis process. It especially comforting to me to read these comment as Esmes symptoms are starting to present themselves more severely now. Never been good at sleep since day1, now she is starting to say she won't go to school on a daily basis, cries all the time, tremendous anger outbursts. It's mentally exhausting for her and us. It's helpful for us as parents knowing this is not exclusive to Esme as everyone knows, we are having to find out a lot of this info by ourselves as the diagnosis process is so slow
•    Anonymous said… Melatonin has worked wonders with our kids. We have also been subscribed Clonodine with success though I am not sure there is much of a difference between them.
•    Anonymous said… Melatonin to help her sleep could work. No sleep, even if she denies being tired, will make her very overtired and emotional and then it won't matter what you do. Sleep is #1
•    Anonymous said… My 7 year old daughter has epilepsy and we thought adhd, but now the neuro is saying he thinks it could be aspergers, we are screening her for it now.... she is a sweet girl but gets bad rage fits all the time and it's not the medicine, she had them before the medicine. If she does have this she is very high functioning, I just can't be sure. But school, sleep every day its a struggle with her when she is not happy. When she doesn't get her way watch out and I don't mean regular kid meltdowns, she doesnt seem to care about punishment or time outs or anything. Rewards barely work on her. I find myself pleading and begging her all the time to stop with the behavior. Once it is over, she is back to her normal self and exhausted. The neuro says it has nothing to do with her epileptic spike. We are going to take her to a psychiatrist soon as well. We recently got IEP for her because of her slow slow pace. She is smart, but can't always focus and can't always complete her work.
•    Anonymous said… My daughter has the same issues. Cannabis oil isn't legal in Oklahoma yet. I wish it was.
•    Anonymous said… My six year old son is the same way, except for instead of anxiety and depression, he experiences anxiety and aggression. He has been a horrible sleeper since day one. We have tried several different meds to help his behavior, different counsellors, sports, and nothing takes his aggression towards our family away. He's fine with everyone else. Ugh. It's a daily struggle I wouldn't wish on anyone.
•    Anonymous said… My son is 13 and had struggled and struggles with all the above! He has good times and bad times that seem to come in waves. I have found a few helpful things....Anxiety medication has really helped calm his Anxiety and that in turn helps his friendships, his OCD And calms his mind so his ticks are not as bad as normal. I also have a weighted blanket, and use Melatonin to help him sleep. If all else fails I lay beside him, just having me with him helps soothes! I've even had late night walks, swinging time on the swing set or having him run laps around the yard to calm him at night. Hope this has given a few ideas to those that are struggling like I am. Each day is a new day! Never know what version of your child your going to see...such a stressful thing! Love and patience above all!!
•    Anonymous said… Not for under 18 though
•    Anonymous said… Our 10 year old use to wake up 1-3 times a night for almost eight years. Melatonin and a weighted blanket has finally straightened out his sleeplessness.
•    Anonymous said… Please check into the safe and effective cbd cannabis oil treatment. It is a miracle waiting for her.
•    Anonymous said… Saphris works wonders for high functioning Aspergers..taken at night sleep for 10 hrs straight
•    Anonymous said… Sounds like my 10 year old boy, our challenges are really more about the anxiety bought about through his Aspy needs for structure, routine etc than the other Aspy challenges. We had not slept through the night for the years and had tried everything from weighted blankets, meditation, counselling, bed routines (multiple), and sleeping medications to little success. In December his Paedetritian put him on a half tablet of anti anxiety medication (Prozac) due to his anxiousness around school and unexpected activities associated with being the youngest of four, He is a different boy. Within a month he was sleeping through the night and he s now sleeping through the night and in his own bed. I am not sure if this will be your answer but stay hopeful and keep trying things. Something will work. Good luck and God bless
•    Anonymous said… This is our 16 year old daughter
•    Anonymous said… This post mirrors my now 18 yr old daughter, eventually had to pull her out of school and do virtual classes. Helped the anxiety tremendously. Last year we were introduced to essential oils and were given a blend to help support her anxiety and she loves it. I have a fb page Essential Oils For All Your Needs, not trying to market it here, but it's got a lot of information on safe oil use and different blends to read about. I wish we knew of these oils years earlier so there wouldn't have been so many years of suffering. Great advice on here-Good luck to your family!
•    Anonymous said… We experienced something similar with our 16 year old son. There is a program called getting your teen out of defence mode that we are finding very helpful. It's put out by a group called asperger experts.
•    Anonymous said… We had the same breakdowns but our little one is 5. The neurologist put her on resperidol and epival when she had her mental break down and it was a god send. We added prozac for her anxiety and she is doing wonderfully and now sleeps through the night.
•    Anonymous said… We use melatonin for sleep. I didn't have high hopes for it originally since a lot of other oils and natural sleep aides didn't work. To my surprise my usual night owl was asleep in under 15 min.
•    Anonymous said… my world. We have a 14 year old daughter. Her high functioning autism comes along with its friends anxiety and depression. The trio are making life so miserable. Getting her to go into a school building is a never ending battle. Academically, she is fine. Well ahead of her grade....she still struggles to go in. Everyday. She hates being there. We even switched from a public school to a private, autism aware, school--thinking that might help. Nope. Sleep has been a thorn in her side from day one. It's been a rough road for her (and I) for at least 6 years. Seems to only be getting worse through the teen years. Hugs back to you mom. I know it's not easy.
•    Anonymous said… What are some of the medications being used. I am thinking it's time for a change and want some ideas.

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

Social rejection has devastating effects in many areas of functioning. Because the ASD 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.

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How to Prevent Meltdowns in Children on the Spectrum

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 or HFA child is totally out-of-control. When it ends, both you and your 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.

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Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the 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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Older Teens and Young Adult Children with ASD 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 ASD 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."

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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...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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My Aspergers Child - Syndicated Content