Documentary about Asperger's Syndrome

Aspergers and Impairment in Communication

Inappropriate Questions/Comments—

The uttering of inappropriate comments or questions can be a serious problem. Sometimes the remarks are inappropriate to the setting. Sometimes the comments are sexually inappropriate. In any case, the remarks or questions do not take into account the impact on the other individual involved. For example, Conner was attending a funeral. Oblivious to the impact his question would have on the grieving friends and relatives, he wondered out loud about the process of bodies decomposing. In another example, Mike found himself attracted to a young woman and proceeded to stare at her. When she asked him what he wanted, he told her in sexually explicit details what he was staring at and the specific nature of his interest.

Lack of Symbolic Play—

For most kids, play is a crucial area of communication and development. Kids with Aspergers Syndrome generally display problems with imaginative or symbolic play. In autism, there is sometimes a lack of symbolic play. Some autistic kids do play imaginatively for brief periods of time, but unlike their typically developing peers, they usually cannot sustain and elaborate on the play. There may be rather elaborate imaginative play, especially in females with Aspergers. According to Tony Attwood, "Females with Aspergers Syndrome can create imaginary friends and elaborate doll play which superficially resembles the play of other females but there can be several qualitative differences. They often lack reciprocity in their natural social play and can be too controlling when playing with their peers... While the special interest in collecting and playing with dolls can be assumed to be an age appropriate activity and not indicative of psychopathology, the dominance and intensity of the interest is unusual. Playing with and talking to imaginary friends and dolls can also continue into the teenage years when the individual would have been expected to mature beyond such play."

Some clinicians consider play of paramount importance to the development of the youngster. Stanley Greenspan, M.D. has developed a treatment technique which he terms “Floor Time.” In this approach Greenspan utilizes play to “open and close circles of communication”. For example, when one individual makes a communicative overture, the expectation is that the other individual will respond to this overture in a reciprocal way. He believes play is critical not only for the development of social interaction, but also for the development of logical, flexible and creative thinking.

Literal Thinking—

In addition to problems with imaginative play, individuals with Aspergers Syndrome have a tendency to think in a literal way. Moms & dads and teachers are sometimes astonished to learn how a youngster with Aspergers Syndrome has misunderstood a commonly used term or expression. Idioms are particularly problematic. Individuals with Aspergers Syndrome often have great difficulty with metaphors and with information that is implied but not stated directly. On occasion, the youngster’s misperception becomes apparent, as in the following examples.

Edward was told by the staff in his group home that wake-up on weekends was 10:00 a.m. Staff were surprised to see that he was lying in bed awake for hours on week-end mornings. When asked about it, he replied that he was not allowed to get out of bed until 10:00, rather than understanding that he could stay in bed as late as 10:00 if he chose to do so.

Similarly, the same youngster was told by his parent to put on his winter jacket. He found two winter jackets hanging on the banister, but told his mother he did not know which one was his. To her surprise, he said he could not tell which one to wear because they both had a name-tag with his name on it. In fact, he had been wearing one of the jackets all winter; he had outgrown the other one, but his mother had failed to remove his name from inside.

"Theory of Mind"—

In addition to the problems in communication mentioned above, individuals with Aspergers Syndrome may have trouble with a concept referred to as "theory of mind". Briefly, this notion, first described by Simon Baron-Cohen, refers to difficulty in perspective taking. An example of this difficulty is that individuals with Aspergers may assume other people have the same knowledge as they do, even when there is no basis for this assumption.

For example, Nicholas was very interested in movies, frequently talking about the latest movies he had seen. He would discuss the content of movies with anyone who would listen, not recognizing that they could not possibly know what he was referring to, since they had not seen the movie under discussion.

A related matter is the inability many with Aspergers Syndrome have to recognize how other people are perceiving them. This difficulty contributes to a lack of shame or embarrassment about their behavior.

Asperger’s and Impairment in Social Interaction

1. Difficulty Using Non-Verbal Behaviors in Social Interaction—

There are several broad categories of difficulties falling under the general heading of impairment in social interaction. First of all, people with Aspergers Syndrome have difficulty using non-verbal behaviors in social interaction.

Eye contact may be impaired, meaning that the youngster may not look at others upon greeting or during conversations and may not respond when others try to catch his/her eye.

It is easy to see why others might inaccurately perceive the youngster to be rude or not paying attention.

Social smiling may be impaired. In this case, people with Aspergers Syndrome may not smile back at someone smiling at them, may not smile during greeting or may not smile in response to something someone else said.

Facial expressions used to communicate may be odd. Sometimes the expressions are limited or flat, sometimes they are inappropriate and at other times are exaggerated.

Again, it is easy to see why others might misread what the youngster with Aspergers Syndrome is thinking or feeling. For example, Jake, a rather sweet and kind youngster, broke out into laughter when his brother injured himself. Clearly, his response was inappropriate to the situation and would not be expected from a youngster his age. Similarly, Joe, upon learning that a family friend would be arriving for a visit, let out an excited cry, as if this were the most wonderful and extraordinary event that could possibly happen.

Body postures regulating social interaction may be affected. A very common example of this difficulty is that those with Aspergers Syndrome may not know how to judge social distance and may stand too close.

2. Difficulty Forming Peer Relationships—

The second category of difficulties falling under the heading of impairment in social interaction is difficulty forming peer relationships.

Some kids with Aspergers Syndrome seem to lack interest in others and may prefer solitary activities. Marty, age 6, was very skilled at building with blocks and Legos. However, when another youngster would approach to try to join his play, he would become extremely angry, not wanting his play to be disturbed.

Inappropriate overtures towards others or inappropriate responses to the approaches of other people are common occurrences. Jim, age 5, was fascinated with his next-door neighbor, George, a toddler of 18 months. Unfortunately, his way of showing his interest in George was hitting him over the head. Another youngster with Aspergers Syndrome, Benny, was somewhat more sophisticated in his technique: his way of showing his interest was throwing his arms around another youngster in a bear hug.

Difficulty forming friendships is a common fact of life for kids with Aspergers Syndrome. Interestingly, what these kids mean by friendship may be decidedly different from what their typically developing peers mean. For example, Nicholas repeatedly referred to another youngster in his school, Tom, as his best friend, although no one had observed the two boys talking or playing together. When asked what makes them friends, Nicholas replied that Tom said hello to him.

Impairment in group play with peers is another common difficulty. Unfortunately, most of the team sports so common to school-age kids are terribly difficult for kids with Aspergers Syndrome. Their troubles with social interaction and peer relationships make organized group sports a real challenge. Oftentimes, sports in which individual achievement is stressed (e.g., track, archery, fishing) are more successful.

3. Difficulty in Sharing Enjoyment—

The third area of impairment in this section is difficulty sharing enjoyment. Young kids with Aspergers Syndrome are less likely than their typical peers to share objects, such as food or toys, with others. People with Aspergers Syndrome are not as likely to show other people items in which they are interested. Lastly, they generally make more limited efforts to share feelings of enjoyment with others.

4. Lack of Social or Emotional Reciprocity—

The fourth kind of social interaction impairment is a lack of social or emotional reciprocity. This area includes such difficulties as inappropriate or limited responses to the approaches of others, as well as limited offers of comfort shown towards others.

For example, Max enjoyed going to the supermarket with his mother. He liked to help prepare the shopping list, easily located the items on the shelves, loved to sample the free food often available, and calculated the correct change while in the check-out line. However, when the cashier spoke to him and tried to make small talk, he generally did not look at her, did not answer her questions, and sometimes made a remark completely off the topic, but one that was of interest to him.

Similarly, Ben was walking outside with his mother on a cold winter day, when his mother slipped and fell on the ice. Ben clearly was aware something was not quite right, as he immediately began to scream. What he did not do was ask his mother if she were okay, and offer to help her, as a typical youngster his age probably would have done.