Many students with Asperger’s (AS) and High-Functioning Autism (HFA) are unable to generalize the skills that they learn. For instance, the teacher may inform the student how to respectfully address a teacher. Normally this skill would then be generalized to any adult in a position of authority. However, a student with AS or HFA is likely to only apply the skill to the individual initially used as the target of respect in the learning process. The student will probably not apply this behavior to a principal, dean, or police officer.
The inability to generalize can also pose a problem in classroom assignments. For example, giving the direction to open a math book to a certain page does not communicate to additionally begin solving the problems. Thus, teachers should verbally give all the steps necessary to complete an assignment rather than assuming the AS or HFA student will know what comes next.
There are additional techniques that have been used in assisting “special needs” students to learn to generalize. Modes of instruction such as "scope and sequence" can be useful in equipping these students with the skills that assist in social and academic learning as well as generalization. Scope and sequence training involves teaching the student about the basics prior to expecting the generalized rules to be learned. For example, it would be best to (1) teach the student that “the tone of a person's voice sends a message” BEFORE (2) teaching the student he should “use a tone that is respectful to others.” Due to the difficulty AS and HFA students have with generalization, failing to teach the basics will further enhance their inability to generalize.
The IDEA Act is clear in its declaration that students must be placed in the least restrictive environment possible in an effort to provide them with the best education possible. This can only be achieved by means of evaluation by teachers as to the effectiveness of their chosen teaching strategies and a willingness on the part of teachers to continue to learn new techniques of instruction. Every AS and HFA youngster needs to (a) be evaluated, (b) have a plan established addressing areas of weakness, and most importantly (c) have a teacher that believes in the student and expects her to reach appropriate grade level requirements.
It is important that the teacher understands what AS and HFA is – and how it hinders students. Without a clear understanding of this disorder, actions that are clearly a part of the syndrome can be confused with behavioral issues and dealt with inappropriately.
"My child (with HFA) does obsess about certain things, but how can I tell if he has full-blown obsessive compulsive disorder?"
Obsessive compulsive disorder (OCD) is described as a condition characterized by recurring, obsessive thoughts and compulsive actions. Obsessive thoughts are ideas, pictures of thoughts or impulses that repeatedly enter the mind, while compulsive actions and rituals are behaviors that are repeated over and over again.
The obsessions seen in kids with Asperger’s (AS) and High-Functioning Autism (HFA) differ from the youngster with obsessive compulsive disorder. The youngster with AS or HFA does not have the ability to put things into perspective. Although terminology implies that certain behaviors in AS and HFA are similar to those seen in obsessive compulsive disorder, these behaviors fail to meet the definition of either obsessions or compulsions.
They are not invasive, undesired or annoying, which is a prerequisite for a diagnosis of obsessive compulsive disorder. The reason for this is that children with severe autism are unable to contemplate or talk about their own mental states. However, obsessive compulsive disorder does appear to coincide with AS and HFA.
Szatmari et al (1989) studied a group of 24 kids. He discovered that 8% of the kids with AS and 10% of the kids with HFA were diagnosed with obsessive compulsive disorder. This compared to 5% of the control group of kids without autism, but with social problems. Thomsen el at (1994) found that in the kids he studied, obsessive compulsive disorder continued into adulthood.
AS and HFA kids with obsessive compulsive disorder:
become preoccupied with whether something could be harmful, dangerous, wrong, or dirty
experience a need for symmetry, order and precision
experience intrusive sounds or thoughts
feel like they must perform the task or dwell on the thought
feel strong urges to do certain things repeatedly (i.e., rituals or compulsions) in order to banish the scary thoughts or ward off something dreaded
have a difficult time explaining a reason for their rituals
have a fear of contamination
have a fear of illness or harm coming to oneself or relatives
have a strong belief in lucky and unlucky numbers
have an "overactive alarm system"
have upsetting or scary thoughts or images that pop into their minds that are hard to shake
may have preoccupation with body wastes
may have religious obsessions
may have sexual or aggressive thoughts
realize that they really don't have to repeat the behaviors, but the anxiety can be so great that they feel that repetition is "required" to neutralize uncomfortable emotions
try to relieve anxiety via the use of obsessions and compulsions
want to feel absolutely certain that something bad won't happen
worry about losing things, sometimes feeling the need to collect these items, even though the items may seem useless to others
worry about things not being "in order" or "just right"
Compulsions that are most common include:
cleaning rituals
counting rituals
grooming rituals
hoarding and collecting things of no apparent value
ordering or arranging objects
repeatedly checking homework
repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting, etc.)
rituals to prevent harming self or others
rituals to undo contact with a "contaminated" person or object
touching rituals
Moms and dads can look for the following possible signs of obsessive compulsive disorder in their AS or HFA child:
a continual fear that something terrible will happen to someone
a dramatic increase in laundry
a persistent fear of illness
a sudden drop in test grades
an exceptionally long amount of time spent getting ready for bed
constant checks of the health of family members
high, unexplained utility bills
holes erased through test papers and homework
raw, chapped hands from constant washing
reluctance to leave the house
requests for family members to repeat strange phrases or keep answering the same question
If your AS or HFA youngster shows signs of obsessive compulsive disorder, talk to your physician. In screening for obsessive compulsive disorder, the physician will ask your youngster about obsessions and compulsions in language that he or she will understand, for example:
Are there things you have to do before you go to bed?
Do things have to be "just so"?
Do you collect things that others might throw away (e.g., hair, fingernail clippings, dead batteries, etc.)?
Do you count to a certain number or do things a certain number of times?
Do you have to check things over and over again?
Do you have to wash your hands a lot?
Do you have worries, thoughts, images, feelings, or ideas that bother you?
Treatment—
The most successful treatments for AS and HFA children with obsessive compulsive disorder are cognitive-behavioral therapy (CBT) and medication. CBT helps these “special needs” children learn to change thoughts and feelings by first changing behavior. The therapy involves gradually exposing children to their fears, with the agreement that they will not perform rituals in order to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur.
Just talking about the rituals and fears have not been shown to help obsessive compulsive disorder, and may actually make it worse by reinforcing the fears and prompting extra rituals. Thus, for CBT to be successful, it must be combined with “response prevention,” in which the youngster's rituals or avoidance behaviors are blocked (e.g., a youngster who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly).
Many children can do well with CBT alone, while others will need therapy and medication. Selective serotonin reuptake inhibitors (SSRIs) often can reduce the impulse to perform rituals. Once a youngster is in treatment, it's important for moms and dads to participate, to learn more about obsessive compulsive disorder, and to modify expectations and be supportive.
AS and HFA kids with obsessive compulsive disorder get better at different rates, so parents should try to avoid any day-to-day comparisons and recognize and praise any small improvements. Also, try to keep family routines as normal as possible.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
