Best Treatment Options for Aspergers and HFA

"What are some of the better treatment options for children on the autism spectrum?"

While there is no cure for Aspergers or High Functioning Autism (HFA), treating it early with proper school-based programs and medical care can (a) greatly reduce symptoms and (b) increase your youngster's ability to grow and learn new skills.

Early Intervention—

Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young kids with Aspergers and HFA. There is no single best treatment for all kids, but the American Academy of Pediatrics recently noted common features of effective early intervention programs. These include:

1. Encouraging activities that include typically developing kids, as long as such activities help meet a specific learning goal
2. Guiding the youngster in adapting learned skills to new situations and settings and maintaining learned skills
3. Having small classes to allow each youngster to have one-on-one time with the therapist or teacher and small group learning activities
4. Having special training for moms and dads and family
5. Measuring and recording each youngster's progress and adjusting the intervention program as needed
6. Providing a high degree of structure, routine, and visual cues, such as posted activity schedules and clearly defined boundaries, to reduce distractions
7. Providing focused and challenging learning activities at the proper developmental level for the youngster for at least 25 hours per week and 12 months per year
8. Starting as soon as a youngster has been diagnosed with Aspergers
9. Using a curriculum that focuses on:

• Cognitive skills, such as pretend play or seeing someone else's point of view- Language and communication
• Research-based methods to reduce challenging behaviors, such as aggression and tantrums
• Self-help and daily living skills, such as dressing and grooming
• Social skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it)
• Typical school-readiness skills, such as letter recognition and counting

One type of a widely accepted treatment is Applied Behavior Analysis (ABA). The goals of ABA are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of similar interventions that aim to help children with Aspergers and HFA reach their full potential. ABA-based interventions include:

• Pivotal Response Training: Aims at identifying pivotal skills, such as initiation and self-management that affect a broad range of behavioral responses. This intervention incorporates parent and family education aimed at providing skills that enable the youngster to function in inclusive settings.
• Verbal Behavior: Focuses on teaching language using a sequenced curriculum that guides kids from simple verbal behaviors (echoing) to more functional communication skills through techniques such as errorless teaching and prompting.

Other types of early interventions include:

• TEACCH (Treatment and Education of Autistic and related Communication handicapped Kids): Emphasizes adapting the youngster's physical environment and using visual cues (e.g., having classroom materials clearly marked and located so that students can access them independently). Using individualized plans for each student, TEACCH builds on the youngster's strengths and emerging skills.
• Interpersonal Synchrony: Targets social development and imitation skills, and focuses on teaching kids how to establish and maintain engagement with others.
• Developmental, Individual Difference, Relationship-based (DIR) / Floortime Model: Aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the youngster. One particular example is the Early Start Denver Model, which fosters improvements in communication, thinking, language, and other social skills and seeks to reduce atypical behaviors. Using developmental and relationship-based approaches, this therapy can be delivered in natural settings such as the home or pre-school.

For kids younger than age 3, these interventions usually take place at home or in a childcare center. Because moms and dads are a youngster's earliest educators, more programs are beginning to train moms and dads to continue the therapy at home.

Children on the autism spectrum may benefit from some type of social skills training program. While these programs need more research, they generally seek to increase and improve skills necessary for creating positive social interactions and avoiding negative responses. For example, Children’s Friendship Training focuses on improving kid's conversation and interaction skills and teaches them how to make friends, be a good sport, and respond appropriately to teasing.

Working With Schools—

Start by speaking with your youngster's teacher, school counselor, or the school's student support team to begin an evaluation. Each state has a Parent Training and Information Center and a Protection and Advocacy Agency that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. The evaluation will look at all areas related to your youngster's abilities and needs.

Once your youngster has been evaluated, he has several options, depending on the specific needs. If your youngster needs special education services and is eligible under the Individuals with Disabilities Education Act (IDEA), the school district (or the government agency administering the program) must develop an individualized education plan, or IEP specifically for your youngster within 30 days.

IDEA provides free screenings and early intervention services to kids from birth to age 3. IDEA also provides special education and related services from ages 3 to 21. Information is available from the U.S. Department of Education.

If your youngster is not eligible for special education services (not all kids on the spectrum are eligible) he can still get free public education suited to his or her needs, which is available to all public-school kids with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the type or severity of the disability.

The U.S. Department of Education's Office for Civil Rights enforces Section 504 in programs and activities that receive Federal education funds. More information on Section 504 is available on the Department of Education website.

During middle and high school years, your youngster's educators will begin to discuss practical issues such as work, living away from a parent or caregiver's home, and hobbies. These lessons should include gaining work experience, using public transportation, and learning skills that will be important in community living.

Medications—

Some medications can help reduce symptoms that cause problems for your youngster in school or at home. Many other medications may be prescribed off-label, meaning they have not been approved by the U.S. Food and Drug Administration (FDA) for a certain use or for certain people. Physicians may prescribe medications off-label if they have been approved to treat other disorders that have similar symptoms to Aspergers, or if they have been effective in treating adults or older kids with Aspergers and HFA. Physicians prescribe medications off-label to try to help the youngest patients, but more research is needed to be sure that these medicines are safe and effective for kids and teens with the disorder.

At this time, the only medications approved by the FDA to treat aspects of ASDs are the antipsychotics risperidone (Risperdal) and aripripazole (Abilify). These medications can help reduce irritability—meaning aggression, self-harming acts, or temper tantrums—in kids ages 5 to 16 who have the disorder.

Some medications that may be prescribed off-label for kids on the spectrum include the following:

• Stimulant medications, such as methylphenidate (Ritalin), are safe and effective in treating people with attention deficit hyperactivity disorder (ADHD). Methylphenidate has been shown to effectively treat hyperactivity in kids with Aspergers and HFA as well. But not as many kids with the disorder respond to treatment, and those who do have shown more side effects than kids with ADHD and not ASDs.
• Antipsychotic medications are more commonly used to treat serious mental illnesses such as schizophrenia. These medicines may help reduce aggression and other serious behavioral problems in kids, including kids with Aspergers and HFA. They may also help reduce repetitive behaviors, hyperactivity, and attention problems.
• Antidepressant medications, such as fluoxetine (Prozac) or sertraline (Zoloft), are usually prescribed to treat depression and anxiety but are sometimes prescribed to reduce repetitive behaviors. Some antidepressants may also help control aggression and anxiety in kids on the autism spectrum. However, researchers still are not sure if these medications are useful; a recent study suggested that the antidepressant citalopram (Celexa) was no more effective than a placebo (sugar pill) at reducing repetitive behaviors in these young people.

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

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

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How Aspergers is Diagnosed

"We have a son who we believe may have asperger syndrome and we were wondering how this disorder is diagnosed."

An Aspergers diagnosis is often a two-stage process. The first stage involves general developmental screening during the child’s checkups with a doctor or an early childhood health care provider. Kids who show some developmental problems are referred for additional evaluation. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties. At this stage, a youngster may be diagnosed as having some form of autism. Kids with an autism spectrum disorder can usually be reliably diagnosed by age 2, though research suggests that some screening tests can be helpful at 18 months or even younger.

Many individuals (e.g., family doctors, teachers, and moms/dads) may minimize signs of Aspergers at first, believing that kids will "catch up" with their friends. While you may be concerned about labeling your young youngster with Aspergers, the earlier the disorder is diagnosed, the sooner specific interventions may begin. Early intervention can reduce or prevent the more severe problems associated with Aspergers. Early intervention may also improve your youngster's IQ, language, and everyday functional skills (also called adaptive behavior).

Screening—

Your child’s checkup should include a developmental screening test, with specific Autism Spectrum Disorder (ASD) screening at 18 and 24 months. Screening for ASD is not the same as diagnosing ASD. Screening instruments are used as a first step to tell the doctor whether a youngster needs more testing. If your youngster's doctor does not routinely screen your youngster for ASD, ask that it be done.

For moms and dads, your own experiences and concerns about your youngster's development will be very important in the screening process. Keep your own notes about your youngster's development and look through family videos, photos, and baby albums to help you remember when you first noticed each behavior and when he/she reached certain developmental milestones.

Types of ASD Screening Instruments—

Sometimes the doctor will ask moms/dads questions about their youngster's symptoms to screen for Aspergers or some other form of Autism. Other screening instruments combine information from parents with the doctor's own observations of the youngster. Examples of screening instruments for toddlers and preschoolers include:

• Checklist of Autism in Toddlers (CHAT)

• Communication and Symbolic Behavior Scales (CSBS).

• Modified Checklist for Autism in Toddlers (M-CHAT)

• Screening Tool for Autism in Two-Year-Olds (STAT)

• Social Communication Questionnaire (SCQ)

To screen for mild Autism in older kids, the doctor may rely on different screening instruments, such as:

• Australian Scale for Asperger's Syndrome (ASAS)

• Autism Spectrum Screening Questionnaire (ASSQ)

• Childhood Asperger Syndrome Test (CAST)

Comprehensive Diagnostic Evaluation—

The second stage of diagnosis must be thorough in order to find whether other conditions may be causing your youngster's symptoms. A team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals experienced in diagnosing Aspergers may do this evaluation. The evaluation may assess the youngster's cognitive level (i.e., thinking skills), language level, and adaptive behavior (i.e., age-appropriate skills needed to complete daily activities independently, for example eating, dressing, and toileting).

Because Aspergers is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include brain imaging and gene tests, along with in-depth memory, problem-solving, and language testing. Kids with any delayed development should also get a hearing test and be screened for lead poisoning as part of the comprehensive evaluation.

Any kid can lose his/her hearing (for various reasons), but common Aspergers symptoms (e.g., not turning to face a person calling their name) can make it seem that the youngster can’t hear – when in fact he/she can. If a youngster is not responding to speech, especially to his/her name, it's important for the doctor to test whether a youngster has hearing loss.

The evaluation process is a good time for moms and dads to ask questions and get advice from the whole evaluation team. The outcome of the evaluation will help plan for treatment and interventions to help your youngster. Be sure to ask who you can contact with follow-up questions.

Finding the Right Job: Help for Young Adults with Aspergers

If you’re an older teen or young adult with Aspergers or High Functioning Autism, be sure to find a job that makes use of your strengths.

"Aspies" tend to 1) have poor short-term memory, 2) have good long-term memory, and 3) be visual thinkers (although some are non-visual thinkers). Thus, in some (if not most) cases, a job that takes these three factors into consideration may be a good fit for Aspergers employees.

The “visual thinking” jobs listed below (a) put very little demand on fast processing of information in short-term memory and (b) utilize the visual thinking and long-term memory of the Aspie.

The “non-visual thinking” jobs listed below are for those who are good with numbers, facts and music. These jobs also put low demands on short-term memory and utilize an excellent long-term memory.

Good jobs for Aspies who are visual thinkers:

• Animal trainer or veterinary technician
• Automobile mechanic
• Building maintenance
• Building trades
• Commercial art
• Computer animation
• Computer programming
• Computer-troubleshooter and repair
• Drafting
• Equipment designing
• Factory maintenance
• Handcrafts of many different types such as wood carving, jewelry making, ceramics, etc.
• Laboratory technician
• Photography
• Small appliance and lawnmower repair
• Video game designer
• Web page design

Good jobs for Aspies who are non-visual thinkers:

• Accounting
• Bank Teller
• Clerk and filing jobs
• Computer programming
• Copy editor
• Engineering
• Inventory control
• Journalist
• Laboratory technician
• Library science
• Physicist or mathematician
• Statistician
• Taxi driver
• Telemarketing
• Tuning pianos and other musical instruments

Job Tips for Young Adults with Aspergers:

1. Aspies who are still in high school should be encouraged to take courses at a local college in drafting, computer programming or commercial art. This will help keep them motivated and serve as a refuge from bullying.

2. If you can’t afford a computer for your older teen to learn programming or computer aided drafting, used computers can often be obtained for free or at a very low cost when a business or an engineering company upgrades their equipment. Many people don’t realize that there are many usable older computers sitting in storerooms at schools, banks, factories and other businesses. It will not be the latest new thing, but it is more than adequate for a student to learn on.

3. Jobs should have a well-defined goal or endpoint.

4. Make a portfolio of your work.

5. Pick a college major in an area where you can get jobs. Computer science is a good choice because it is very likely that many of the best programmers have either Aspergers or some of its traits. Other good majors are accounting, engineering, library science, and art with an emphasis on commercial art and drafting.

6. Sell your work, not your personality.

7. The employer must recognize your social limitations.

8. You need to learn a few social survival skills, but you will make friends at work by sharing your shared interest with the other people who work in your specialty.

9. Young adults with Aspergers have to compensate for poor social skills by making themselves so good in a specialized field that people will be willing to "buy" their skill even though social skills are poor.

10. Be patient with yourself as you navigate the give-and-take of the social environment in the workplace.