How to Conduct an Assessment for Aspergers

How does a diagnostician or clinician conduct an assessment for Aspergers?

Autism Spectrum Disorders are very complex, yet their features can be very subtle; they are not always obvious on the surface. As a result, an Aspergers (high-functioning autism) assessment will take more time than most other assessments. Below are the methods that clinicians who are new to the field of Aspergers can use as a guide. These are also the methods that moms and dads should look for to make sure they are getting a good assessment for their Aspergers child.

An assessment should be conducted by a doctor, psychologist, or psychiatrist who has expertise in Autism Spectrum Disorders (ASD). This is important because most degree programs may only give passing information about Aspergers. A clinician may have a lot of experience in evaluating and may know the DSM criteria for Aspergers – but knowing the criteria on paper is not the same as having the background to really know all of the subtle features to look for. If you are a clinician and do not have the background experience with Aspergers yet, consult with a clinician who does. If you are a mother or father getting an Aspergers assessment done, ask about the background experience of the clinician.

Assess each of the core areas of difficulty along with the more subtle characteristics. Aspergers involves qualitative difficulties in language, social interactions, and more stereotyped and repetitive behaviors and interests; however, there cannot be a real delay in language – but it does often involve difficulties in how language is being used.

It is not enough to question parents about language delays or social interactions or interests. A good assessment will look at how behaviors are being exhibited. Even if the Aspergers child is social, the clinician needs to look at whether he/she can take other people's perspective:

• Does he have imaginative play?
• Does he demonstrate sensory preferences that interfere with required or socially desires activities?
• Does he approach others and initiate interactions?
• Can he talk about someone else' preferred topic?
• Can he switch tasks when redirected fairly easily?
• Can he listen as well as talk?

These are just some of the more subtle behaviors that need to be observed in Aspergers kids who may be higher functioning. This goes beyond just asking, "Does your son or daughter socialize?"

Use observation in a variety of settings as the core of the assessment. Behaviors can be exhibited for more than one reason. For example, escape, reactions to sensory processing difficulties, attention seeking, and seeking rewards can all be the basis for behaviors. A question on a form reveals that a behavior is being exhibited, but does not reveal why or exactly what the behavior looks like. The only way to know the "why" of many behaviors is to observe in natural settings and to spend time with the Aspergers youngster.

It is not enough to simply observe the Aspergers child in a clinical setting. If clinicians take the child to an unfamiliar location and put her in a room with grown-ups that she has never seen before and then ask the parent to leave the room, you will not get a good picture of how this child interacts with others. If it is not possible to observe the child in a natural setting, then ask the parents if they can videotape their child during various activities.

It is critical to observe the child – close up – in a small playgroup. Observing play and social interactions may look good from a distance; however, when the clinician can (a) hear everything that is being said, (b) follow the child’s eyes, (c) see how he responds to interruptions and so forth, then the clinician can really assess the details of those interactions and begin to interpret them as possibly on the spectrum or not. The clinician can also tell if the child’s play is “parallel play” or if it is really “cooperative play.” Observations not only support the diagnosis, but they are essential in order to give individualized, rather than generic, recommendations.

Clinicians should pair observations with interviews, ratings scales and direct assessment. One rating scale alone should not be the actual assessment. However, rating scales should be given to support observations. If the results do match what is being observed, then check to make sure that the rating scales were completed correctly and ask the rater for examples of what was being rated high in the scales. For example, a behavior could be rated as being "frequently" observed. If it is occurring about 2 times per day, it may seem frequent, but according to the key on some scales, "frequent" is defined as 6 or more times in a 6 hour period. Thus, 2 times per day should be rated as "sometimes" observed. Also, make sure that the scoring follows the key, and get information about what the behavior looks like as well as examples of when and how it occurs. Many of the rating scales (e.g., Gilliam scales, CARS) have a high validity rating, and they are usually fairly correct; however, they are not always correct and cannot be used to make a diagnosis because the reported behaviors could be due to different causes.

Rule out other disorders that have similar characteristics. Many behaviors can be associated with more than one diagnosis. The trick is to look at what the underlying causes of the behaviors are – and what is maintaining the behaviors. With an Aspergers diagnosis, it is crucial to put all of the information together to get the big picture because Aspergers is a spectrum disorder (i.e., a spectrum of behaviors across three major areas of difficulty). If the clinician only looks at behaviors on the surface, then multiple diagnoses will be given for the same behaviors – or the child will get a misdiagnosis. If, for example, a child receives the diagnoses of ADHD, Bipolar, Autism, and ODD all at the same time, it’s likely that the clinician “cut some corners” and conducted a poor assessment. It is definitely possible to have a dual diagnosis that is accurate, but a good assessment will differentiate between diagnoses.

The Aspergers Comprehensive Handbook

The Benefits of "Therapy Pets" for Kids on the Autism Spectrum

Pets and kids with Asperger's or High-Functioning Autism (HFA) can be a great combination and give these children an opportunity to relate to another living being. Children with behavioral and social issues can be difficult to work with, and most of them have trouble trusting others. Dogs, cats, elephants, lizards, rabbits and horses can successfully be used in animal therapy (called Animal Assisted Therapy).

Animal Assisted Therapy provides an experience with an animal that is non-judgmental, gives affection unconditionally, and provides opportunities for physical and emotional therapy. This includes therapy for strengthening muscles through horseback riding, low-impact swimming with dolphins, and a boost of confidence with service dogs and companion dogs. These pets promote confidence and self-esteem while motivating children on the autism spectrum to interact and get stronger.

There are many cases in which kids with Asperger's and HFA have close relationship with special pets (e.g., dogs, cats, rabbits, etc.). The violent tendencies of "special needs" kids disappear while they play with the pet. Having a pet often promotes a healthy personality in kids, including trusting, respecting, contributing, self-confidence, commitment and responsibility. It also can teach these kids problem-solving skills, decision-making skills, language and social skills.

A meta-analysis found that animal-assisted therapy is associated with improving medical difficulties, behavioral problems, and emotional problems in kids on the spectrum. They also report the following improvements in:

• Attention skills (i.e., paying attention, staying on task)
• Leisure/recreation skills
• Reducing anxiety
• Reducing loneliness
• Self-esteem
• Verbal interactions between group members

The research into Animal Assisted Therapy is relatively new, and professionals believe more research is needed. However, there's a general consensus that “therapy pets” aid in the treatment of kids with Asperger's and HFA. As with other types of animal assisted therapy, the introduction of the animal seems to calm and soothe these kids. Often, they begin making eye contact with the animal first, then with people. Therapy usually results in these kids becoming more open – first with the pets, and then with people.

Moms and dads often bring a pet into the family to teach their child a sense of responsibility, or perhaps to provide him/her with a playmate. But these kids often learn something more fundamental about themselves and the world: how to empathize with others, how to understand subtle feelings, and how to look at the world from a vastly different perspective. The youngster learns how the world and living things are interconnected.

On the emotional level, pets can teach autistic kids many things, including:

• Communication: The kids learn the subtle cues their pets give them to indicate their feelings. They can later apply this lesson to human interaction because they are more attuned to watching for body posture.
• Confidence: The kids go through life under constant evaluation. They are rated by their behavior, grades and athletic performance. This is especially true of middle school students. Pets have no such expectations; they're delighted that the youngster is with them. Pets give kids the sense of unconditional acceptance. No judging or rating is involved.
• Empathy: The kids often become curious about the emotions their pets feel. This curiosity will extend itself to others. Animals offer an avenue for kids to explore their curiosity. For a youngster, curiosity can lead to hope and to greater engagement with the world around them.
• Nurturing skills: If properly supervised by adults, a youngster learns how to take care of another living being, and take pleasure in keeping the pet healthy and happy.
• Resilience to change: The kids who undergo traumatic experiences often cope better when they have a pet to confide in. Loneliness is very dangerous to kids. Having an animal companion can make them feel a part of something.

One study explored the relationship between pets and Asperger's kids. Specifically, the study, conducted by a child psychologist in New Mexico, looked at the effect dog ownership had on 10- to 12-year-olds. The researcher was surprised at the difference in empathy and self-esteem between pre-adolescents who owned a dog and those who did not. This research supported the growing body of evidence that shows dog ownership has statistically significant impact on self-esteem and sensitivity toward others. A pet has no such measures of success or failure; acceptance is total, which provides a sense of self worth.

Pets also teach these young people about the importance of taking care of themselves. For instance, one therapist says she teaches kids why it is important to take care of a pet, brush his teeth and keep him clean. When they understand the importance, the therapist turns the focus on the kids themselves. If brushing a dog's teeth is important for his health, then naturally it is important for the youngster's well being.

This doesn't necessarily mean that all kids with the disorder are ready for pet ownership. Moms and dads should first make sure their youngster desires a pet before rushing out to get one. Together, they should decide what type of pet is best. Moreover, don't assume your youngster will take care of the pet. The ultimate responsibility usually falls on the parent, not the kid, to make sure the pet is healthy.

As most of us with pets realize, pets can be a source of comfort and happiness. It is no surprise that they can also have therapeutic and healing benefits. The playful nature of pets seems to help bring kids with Asperger's and HFA out of isolation.  


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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Aspergers and Leaky Gut Syndrome (LGS)

Leaky Gut Syndrome (LGS) is a gastrointestinal disorder that affects the lining of the digestive tract. Some researchers believe that this digestive problem is a contributing factor to Aspergers (high functioning autism). The digestive tract lining becomes irritated and permeable. As a result, undigested food particles (particularly proteins) and toxins end up leaking into the blood stream. This leakiness can lead to disturbances in neurological brain function.

Part of the problems inherent in LGS is that the body is naturally designed to fight off foreign entities. The food particles and toxins cause the body to put the immune system into overdrive, which is suspect for causing autoimmune disorders. Specific symptoms indicate that there might be a problem with a permeable intestinal tract. They include:

• aggressive behavior and mood swings
• anxiety, confusion, and nervousness
• asthma
• bed-wetting
• bloating and constipation
• chronic pain
• diarrhea and gas
• discomfort in the abdominal area
• disorientation and memory problems
• fatigue
• indigestion and heartburn
• poor immunity
• recurrent infections
• shortness of breath
• skin rashes

Aspergers kids who suffer with LGS are bound to suffer frequent bouts of allergies or common illnesses as protein substances and other “hard-to-break-down” molecules filter through their intestinal tracts into the intestines, causing the body to misinterpret them as a harmful substance (such as a virus) and go into an anti-body production overdrive to combat these.

Other complications arising from LGS are caused when the child’s body starts to cause an auto-immune disease. As a result, (a) the body begins to attack itself, and (b) bacteria (that should only be found in the intestinal tract) gets transported to bloodstream, which causes infections and weakens the liver besides resulting in increased toxicity elsewhere in the body.

To avoid these problems associated with LGS, it is advisable for parents with Aspergers children to raise their awareness of this disorder. This includes avoiding intake of a diet that is high in carbohydrates, alcohol and caffeine content, and drugs such as ibuprofen and antacids – all of which work to reduce the impermeable nature of the intestinal walls that is a measure of disease control. Also, since the digestive system of Aspergers kids is very sensitive, medical advice strongly recommends going on a gluten and casein free diet – and avoiding spicy food.

There's a variety of supplements for LGS. The process of choosing the right ones for a specific case can be time consuming, but the results can be quite dramatic! While a diet composed of a combination of vitamins and minerals can be ideal, it might be better to take a gradual approach to introducing these elements into Aspergers children’s diet.

1. Shark liver oil often tops the lists of supplements that can be used to treat LGS.

2. Vitamins and minerals that can be used in the treatment of LGS include:

• beta carotene
• co-enzyme Q10
• digestive enzymes
• glutamine
• methyl sulfonyl Mmethane (MSM)
• selenium
• vitamins A, C, and E

3. Other dietary supplements include:

• aloe vera juice
• barley grass powder
• bovine colostrums
• garlic
• Kolorex Intenstical Care capsules
• lactobacilus
• lactoferrin
• olive leaf extract
• virgin coconut oil

Frequently track your youngster’s progress, and make sure to use a systematic approach for introducing different elements. After you've selected the best supplements for LGS, the results can be well worth the effort. Consult your child’s doctor before beginning any program.

Part of answering the questions about LGS revolves around finding out how the condition affects the brain. Research is a continuing process, which we hope will provide more answers in the near future.

The Aspergers Comprehensive Handbook

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