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Children on the Autism Spectrum: The "Outcast” Subtype

"My son (high functioning autistic) tries to make friends, but seems to not have the social skills to do it. He really wants to relate to his peer group, but is usually shunned by the kids he tries to bond with. How can I help?"

The "Outcast”

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



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

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

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

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

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

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

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

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

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

4. These young people are rarely able to master the subtleties of humor. They're better off trying to be nice, rather than funny.

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

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





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

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

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

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

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

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

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



COMMENTS:

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

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

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

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



==> www.AdultAspergersChat.com
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The Elimination of the Asperger’s Diagnosis

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

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



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

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

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

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

D. Symptoms collectively limit and hinder everyday functioning.

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

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

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

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

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

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

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

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


Comments:

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