Insistence on sameness is a core feature of autism spectrum disorders, characterized by compulsive adherence to routine, and stereotyped, repetitive behaviors. This makes it hard for children on the autism spectrum to adjust to the ever-changing demands of their environment. Their preference for sameness is typically accompanied by significant distress when a preferred activity is interrupted, resulting in serious behavioral management problems.
It is possible that the brain systems responsible for changing from repetitive behaviors to more flexible ones are impaired in children on the spectrum. On the other hand, these children may not recognize or respond to external cues or rewards intended to promote changes in behavior. Understanding the brain systems involved in changing behavior and their dysfunction will ultimately help guide treatment for this understudied – yet disabling aspect – of autism spectrum disorders.
Young people with Asperger’s (AS) and High-Functioning Autism (HFA) are easily overwhelmed by minimal change, are highly sensitive to environmental stressors, and sometimes engage in rituals. They are anxious and tend to worry obsessively when they do not know what to expect. Stress, fatigue and sensory overload easily throw them off balance.
Programming suggestions for teachers:
1. Provide a predictable and safe environment for the AS or HFA student.
2. Offer consistent daily routine. The “special needs” youngster must understand each day's routine and know what to expect in order to be able to concentrate on the task at hand.
3. Minimize transitions as much as possible.
4. Avoid surprises. Prepare the youngster thoroughly and in advance for special activities, altered schedules, or any other change in routine, regardless of how minimal.
5. Allay fears of the unknown by exposing the youngster to the new activity, teacher, class, school, camp and so forth beforehand, and as soon as possible after he or she is informed of the change, to prevent obsessive worrying.
For instance, when the AS or HFA youngster must change schools, he or she should meet the new teacher, tour the new school and be apprised of his or her routine in advance of actual attendance. School assignments from the old school might be provided the first few days so that the routine is familiar to the youngster in the new environment. The receiving teacher might find out the youngster's special areas of interest and have related books or activities available on the youngster's first day.
Cognitive Restructuring enables teens with Asperger’s (AS) and High-Functioning Autism (HFA) to correct distorted conceptualizations and dysfunctional beliefs. The process involves challenging their current thinking with logical evidence and ensuring the rationalization and cognitive control of their emotions.
The first stage of Cognitive Restructuring is to establish the evidence for a particular belief. Teens with AS and HFA often make false assumptions of their circumstances and the intentions of others. They have a tendency to make a literal interpretation, and a casual comment may be taken out of context or may be taken to the extreme.
For instance, a 14-year-old male with AS was once told his “voice was breaking.” He became extremely anxious that his voice was becoming faulty and decided to consciously alter the pitch of his voice to repair it. The result was an artificial falsetto voice that was atypical of a male teenager. Another example of literal interpretation involves a 16-year-old female with AS who overheard a conversation at school that implied that “a girl must be slim to be popular.” She then achieved a dramatic weight loss in an attempt to be accepted by her classmates.
All teens are vulnerable to distorted conceptualizations, but teens with AS and HFA are less able to put things in perspective, seek clarification, and consider alternative explanations or responses. Parents and teachers can encourage these “special needs” teens to be more flexible in their thinking and to seek clarification, using questions or comments such as “Are you joking?” or “I'm confused about what you just said.” Such comments also can be used when misinterpreting someone's intentions such as, “Did you do that deliberately?” and to rescue the situation after they have made an inappropriate response with a comment such as, “I'm sorry I offended you,” or “Oh, what should I have done instead?”
To explain a new perspective or to correct errors or assumptions, “comic strip conversations” can help AS and HFA teens determine the thoughts, beliefs, knowledge, and intentions of the participants in a given situation. This technique involves drawing an event or sequence of events in storyboard form with stick figures to represent each participant, and speech and thought bubbles to represent their words and thoughts. The parent (or teacher) and the teen use an assortment of colored pens, with each color representing an emotion. As they write in the speech or thought bubbles, the teen's choice of color indicates his perception of the emotion conveyed or intended. This can clarify his interpretation of events and the rationale for his thoughts and response. This technique can help the teen identify and correct any misperception and determine how alternative responses might affect the participants' thoughts and feelings.
Paranoia—
One common effect of misinterpretation is the development of paranoia. Knowledge of impaired “Theory of Mind” skills in the cognitive profile of teens with AS and HFA suggests a simple explanation. The teen can have difficulty distinguishing between accidental or deliberate intent. “Typical” teens will know from the context, body language, and character of the peer involved that the intent was not to cause distress or injury. However, young people with AS and HFA can focus primarily on the act and the consequences (e.g., “He hit me and it hurt, so it was deliberate”), whereas “typical” teens would consider the circumstances (e.g., “He was running, tripped, and accidentally knocked my arm”). “Special needs” teens may need to be trained in checking the evidence before responding and developing more accurate “mind reading” skills.
Attribution Retraining—
Cognitive restructuring also includes a process known as “attribution retraining.” The AS or HFA teen may blame others exclusively and not consider her own contribution, or she can excessively blame herself for events. One aspect of AS and HFA is a tendency for some teens to adopt an attitude of arrogance or omnipotence where the perceived focus of control is external (“I have no control; rather, outside circumstances control me.”). Specific individuals are held responsible and become the target for retribution or punishment. These teens have considerable difficulty accepting that they themselves have contributed to the event.
The opposite can occur when the AS or HFA teen has extremely low self-esteem and feels personally responsible, which results in feelings of anxiety and guilt. There also can be a strong sense of what is right and wrong and conspicuous reaction if others violate the social “rules.” The young person may be notorious as the class “policeman,” dispensing justice – but not realizing what is within her authority. Attribution retraining involves establishing the reality of the situation, the various participants' contributions to an incident, and determining how the teen can change her perception and response.
Emotional Repair—
Cognitive restructuring also includes activities that are designed to improve the AS or HFA teen’s range of emotional repair mechanisms (i.e., an emotional toolbox to “fix the feeling”). These teens know that a toolbox usually includes a variety of tools to repair a machine, and discussion and activities can be used to identify different types of “tools” for specific problems associated with emotions.
One type of emotional repair tool can be represented by a hammer, which signifies physical “tools” (e.g., going for a walk or run, bouncing on a trampoline, crushing empty cans for recycling, etc.). The intention is to repair emotions constructively by a safe physical act that increases the heart rate. One AS teenager explained how a game of basketball “takes the fight out of me.” A paintbrush can be used to represent relaxation tools that lower the heart rate (e.g., drawing, reading, listening to calming music, etc.). A two-handle saw can be used to represent social activities or people who can help repair feelings. This can include communication with someone who is known to be empathic and able to oust negative feelings. This can be by spoken conversation or typed communication, enabling the teen to gain a new perspective on the problem and providing some practical advice.
A picture of a manual can be used to represent “thinking tools” that are designed to improve cognitive processes. This includes phrases that encourage reflection before reaction. Scott, a 17-year-old teenager with AS, developed his “antidote to poisonous thoughts.” The procedure is to provide a comment that counteracts negative thoughts, for instance, “I can't cope” (negative or poisonous thought), “but I can do this with help” (positive thought or antidote). The teen also is taught that becoming emotional can inhibit his intellectual abilities in a particular situation that requires good problem-solving skills. When frustrated, the AS or HFA teen needs to become “calm” and less rigid in his thinking to solve the problem, especially if the solution requires social cognition.
Humor and imagination can be used as thinking tools. Young people with AS and HFA are not immune to the benefits of laughter. They can enjoy jokes typical of their developmental level, and can be remarkably creative with puns and jokes.
Parents and teachers can have a discussion of inappropriate tools (e.g., one would not use a hammer to fix a computer) to explain how some actions (e.g., violence, thoughts of suicide, etc.) are not appropriate emotional repair mechanisms. For instance, one AS teen would slap himself to stop negative thoughts and feelings. Another tool that could be inappropriate is to retreat into a fantasy world (e.g., imagining one is a superhero), or to plan retaliation. The occasional escape into fantasy literature and games can be an effective tool, but it is a concern when this becomes the exclusive coping mechanism. The border between fantasy and reality may be unclear, and the thinking may become delusional. Also of concern is when fantasies of retaliation to teasing and bullying are expressed in drawings, writing, and threats. Although this is a conventional means of emotional expression, there is a concern that the expression is misinterpreted as an intention to carry out the fantasy, or may be a precursor to retaliation using weapons.
Unusual tools should be discussed as well. For instance, one adolescent female with AS explained that, “Crying doesn't work for me, so I get angry.” So in this case, tears were rare as a response to her feeling sad, with a more common response to sadness being anger. As a result, her reactions to sadness were often misinterpreted by others. Another tool that seems to be unusual is that of being quick at resolving grief and serious tragedies. This characteristic can be of concern to the AS or HFA teen's parents, who expect the classic signs of prolonged and intense grieving. They may view their teen as uncaring, yet the rapid recovery is simply a feature of AS and HFA.
Social Tools—
Examples of social tools would be the (a) inclusion of talking to pets (sometimes in preference to talking to peers), and (b) positive effects on mood derived from helping someone. These techniques can be effective for teenagers with AS and HFA who also need to be needed and can improve their mood by being of practical assistance. The concept of a toolbox can be extremely helpful in enabling the teen not only to repair her own feelings, but also to repair the feelings of others. The teen can benefit from learning what tools to use to help her friends and family – and which tools others use – so that she can borrow tools to add to her own emotional repair kit.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
