Parent Management Training [PMT] for Parents of Aspergers Children

Parent management training (PMT) is an adjunct to treatment that involves educating and coaching moms and dads to change their Aspergers child’s problem behaviors using principles of learning theory and behavior modification.

Purpose—

The aim of PARENT MANAGEMENT TRAINING is to decrease or eliminate an Aspergers child’s disruptive or inappropriate behaviors at home or school and to replace problematic ways of acting with positive interactions with peers, moms and dads and such authority figures as teachers. In order to accomplish this goal, PARENT MANAGEMENT TRAINING focuses on enhancing parenting skills. The PARENT MANAGEMENT TRAINING therapist coaches parents in applying such strategies as rewarding positive behavior, and responding to negative behavior by removing rewards or enforcing undesirable consequences (punishments).

Although PARENT MANAGEMENT TRAINING focuses on specific targeted behaviors rather than on the youngster's diagnosis as such, it has come to be associated with the treatment of certain disorders. PARENT MANAGEMENT TRAINING is used in treating oppositional defiant disorder , conduct disorder , intermittent explosive disorder (age-inappropriate tantrums), and attention deficit disorder with hyperactivity (attention-deficit/hyperactivity disorder ). Such antisocial behaviors as fire-setting and truancy can also be addressed through PARENT MANAGEMENT TRAINING.

Description—

In PARENT MANAGEMENT TRAINING, the therapist conducts initial teaching sessions with the parent(s), giving a short summary of foundational concepts in behavior modification; demonstrating interventions for the moms and dads; and coaching parents in carrying out the techniques of PARENT MANAGEMENT TRAINING. Early meetings with the therapist focus on training in the principles of behavior modification, response-contingent learning, and ways to apply the techniques. Moms and dads are instructed to define the behavior(s) to be changed concretely and specifically. In addition, they learn how to observe and identify relevant behavior and situational factors, and how to chart or otherwise record the youngster's behavior.

Defining, observing and recording behavior are essential to the success of this method, because when such behaviors as fighting or tantrums are highlighted in concrete, specific ways, techniques of reinforcement and punishment can be put to use. Progress or its absence is easier to identify when the description of the behavior is defined with enough clarity to be measurable, and when responses to the PARENT MANAGEMENT TRAINING interventions are tracked on a chart. After the Aspergers child’s parents grasp the basic interventions as well as when and how to apply them, the techniques that the moms and dads practiced with the therapist can be carried out at home.

Learning theory, which is the conceptual foundation of PARENT MANAGEMENT TRAINING, deals with the ways in which organisms learn to respond to their environment and the factors that affect the frequency of a specific behavior. The core of learning theory is the notion that actions increase or decrease in frequency in response to the consequences that occur immediately after the action. Research in parent-child interactions in families with disruptive, difficult or defiant kids shows that parental responses are unintentionally reinforcing the unwanted behavior. PARENT MANAGEMENT TRAINING trains moms and dads to become more careful in their reactions to a youngster's behavior.

The parents learn to be more discerning: to provide attention, praise and increased affection in reaction to the Aspergers child’s behaving in desired ways; and to withdraw attention, to suspend displays of affection, or to withdraw privileges in instances of less desirable behavior.

The most critical element of PARENT MANAGEMENT TRAINING is offering positive reinforcement for socially appropriate (or at least non-deviant) behaviors. An additional component involves responding to any undesired behaviors by removing rewards or applying punishment. These two types of response to the youngster must be carried out with great consistency. Consistent responding is important because erratic responses to unwanted behavior can actually cause the behavior to increase in frequency. For instance, if a youngster consistently throws tantrums in stores, hoping to be given something to end the tantrum, inconsistent parent responses can worsen the situation. If a parent is occasionally determined not to give in, but provides a candy bar or a toy to end the tantrum on other occasions, the youngster learns either to have more tantrums, or to have more dramatic tantrums. The rise in the number or intensity of tantrums occurs because the youngster is trying to increase the number of opportunities to obtain that infrequent parental reward for the behavior.

Planning responses ahead of time to predefined target behaviors by rewarding desired actions and by withdrawing rewards or applying punishment for undesirable behavior is a fundamental principle of PARENT MANAGEMENT TRAINING. Consistent consequences, which are contingent on (in response to) the youngster's behavior, result in behavior change. Moms and dads practice therapeutic ways of responding to their Aspergers child’s behavior in the PARENT MANAGEMENT TRAINING sessions with the therapist.

Through PARENT MANAGEMENT TRAINING, parents learn that positive rewards for appropriate behaviors can be offered in a variety of ways. Giving praise, providing extra attention, earning points toward obtaining a reward desired by the youngster, earning stickers or other small indicators of positive behavior, earning additional privileges, hugging (and other affectionate gestures) are all forms of reward. The technical term for the rewarding of desired behavior is positive reinforcement. Positive reinforcement refers to consequences that cause the desired target behavior to increase.

PARENT MANAGEMENT TRAINING instructs moms and dads to cancel rewards or give punishments when the Aspergers child behaves in undesirable ways. The removal of rewards usually entails time away from the circumstances and situations in which the youngster can do desired activities or receive attention. The concept of a "time out" is based on this notion of removal of rewards. Time out from rewards customarily means that the youngster is removed from people and stimulation for a certain period of time; it can also include deprivation of privileges.

Punishment in PARENT MANAGEMENT TRAINING is not necessarily what parents typically refer to as punishment; it most emphatically is not the use of physical punishment. A punishment in PARENT MANAGEMENT TRAINING involves a response to the youngster's negative behavior by exposing the Aspergers child to something he or she regards as unpleasant. Examples of punishments might include having to redo the correct behavior so many times that it becomes annoying; verbal reproaches; or the military standby—"drop and give me fifty"—having to do pushups or sit-ups or laps around a playing field to the point of discomfort.

The least challenging problems, which have the greatest likelihood of successful change, are tackled first, in hope of giving the family a "success experience." The success experience is a positive reinforcement for the family, increasing the likelihood that they will continue using PARENT MANAGEMENT TRAINING in efforts to bring about change. In addition, lower-level behavioral problems provide opportunities for moms and dads to become skilled in intervening and to learn consistency in their responses. After the parents have practiced using the skills learned in PARENT MANAGEMENT TRAINING on the less important problems, more severe issues can be tackled.

In addition to face-to-face sessions with the parents, some PARENT MANAGEMENT TRAINING therapists make frequent telephone calls to the moms and dads between sessions. The purposes of the calls are to remind moms and dads to continue to be consistent in applying the techniques; to answer questions about the work at home; and to praise the parents' attempts to correct the youngster's behavior. In addition, ongoing support in sessions and on the telephone helps parents feel less isolated and thus more likely to continue trying to use learning principles in managing their youngster. Troubleshooting any problems that arise regarding the application of the behavioral techniques is handled over the telephone and in the office sessions.

An additional aspect of learning theory is that rewarding subunits of the ultimately desired behavior can lead to developing more complex new actions. The subunits are finally linked together by changing the ways in which the rewards are given. This process is called "chaining." Sometimes, if the youngster shows no elements of the desired response, then the desired behavior is demonstrated for the Aspergers child and subsequent "near hits" or approximations are rewarded. To refine "close but not quite" into the targeted response, rewards are given in a slightly "pickier" manner. Rewarding successive approximations of the desired behavior is also called "shaping."

Risks—

The best way to learn to alter parental responses to Aspergers child behaviors is with the support and assistance of a behavioral health professional (psychologist, psychiatrist, clinical social worker). As noted earlier, moms and dads often inadvertently reinforce the problem behaviors, and it is difficult for a parent to see objectively the ways in which he or she is unintentionally supporting the defiant or difficult behavior. Furthermore, inappropriate application of such behavioral techniques as those used in PARENT MANAGEMENT TRAINING can actually make the problem situation worse. Families should seek therapists with valid credentials, skills, training and experience in PARENT MANAGEMENT TRAINING.

Normal results—

Typically, the parents should notice a decrease in the unwanted behaviors after they implement the techniques learned in PARENT MANAGEMENT TRAINING at home. Of the various therapies used to treat childhood disorders, PARENT MANAGEMENT TRAINING is among those most frequently researched. PARENT MANAGEMENT TRAINING has shown effectiveness in changing Aspergers kid's behavior in very well-designed and rigorous studies. PARENT MANAGEMENT TRAINING has a greater effect on behavior than many other treatments, including family therapy or play therapy.

Furthermore, the results— improved child behavior and reduction or elimination of undesirable behavior— are sustained over the long term. When a group of kids whose families had used PARENT MANAGEMENT TRAINING were examined one to fourteen years later, they had maintained higher rates of positive behavior and lower levels of problem behavior.

Son has difficulty picking up on social cues...

"Our 10-year-old son is diagnosed with high functioning autism. He is bright and inquisitive, but has great difficulty picking up on social cues and understanding many aspects of friendship. We struggle to coach him in these areas ...our explanations often don’t make sense to him. Any suggestions?"

Click here for the answer...

Aspergers Children and Disruptive Behavior

Aspergers and high-functioning autistic kids with disruptive behavior need a higher level of supervision than other "typical" kids of the same age. However, supervision does not always have to be by the parent. In fact, because defiant behavior is often directed primarily at parents and teachers, parents may find that alternative caregivers, such as competent babysitters or aides, are able to develop good relationships with the youngster that provide social learning for the youngster and valuable respite for moms and dads.

Find ways to maintain a positive relationship with your Aspergers youngster. Pay attention to his good qualities and find joy in the moments of closeness. We naturally avoid people who cause us anxiety and are angered when they hurt us. But, we love our kids and that drives us forward to seek healing for them and for us. You need an outlet for your own feelings, so seek out support to help you cope. Many moms and dads also find that they need support to maintain a healthy, supportive marriage in difficult situations.

Get a plan and stick with it. Learn all you can about how to effectively manage your Aspergers youngster's behavior. Find what works for you, and then use those strategies in a consistent and structured way. Routines and clear expectations for behavior benefit all kids. They are vital to the healthy development of the disruptive youngster.

Respite and parent support are important because moms and dads need to be in control of their own emotions during difficult episodes with the Aspergers youngster. These kids enjoy making you mad, and they are good at it. Moms and dads need to maintain an emotionally neutral stance when giving instructions or consequences to the disruptive youngster. This skill doesn't come naturally and must be practiced and perfected over time. If moms and dads don't learn to control their own emotions when disciplining the youngster, the result is often violence and escalation of the disorder.

In working with disruptive Aspergers kids, I like to keep in mind the model I learned from Assertiveness Training. When a youngster has a need or desire to communicate, he may present it in one of three ways:

1. Unassertive (passive) communication - I lose, you win.

2. Aggressive communication - I win, you lose.

3. Assertive communication - I win, you win.

It may seem odd that the best thing to do to help disruptive Aspergers kids is the same thing you do to help shy kids, teach assertiveness! Of course you are coming at it from a different angle. The first step in changing the pattern of disruptive behavior in your youngster is to develop a sense of empathy. Observe and discuss with your youngster the emotions of others to help him understand how people feel when they are treated badly. TV and books are useful tools for teaching your youngster to recognize the feelings of others. Treat your youngster with empathy and respect, and he will learn to treat others in the same way.

An ideal opportunity to teach your Aspergers youngster how to handle angry feelings is when you and your spouse have an argument. Your youngster can learn principles of listening well, remaining calm, cooling off, and negotiating a solution by your example. Do you and your spouse often lose control emotionally? Name-calling, hateful words, and, of course, physical aggression by parents are directly modeled by disruptive kids.

Harsh physical punishment and abuse also lead to an aggressive pattern of externalizing painful emotions. Aggression in Aspergers kids is related to Oppositional Defiant and Conduct Disorders. These disorders set the stage for many long years of delinquency, substance abuse, poor relationships, and maladaptation in young adulthood. The destructive cycle is only stopped by learning self-control, a lesson best learned in childhood.

Aspergers kids need to understand the difference between right and wrong. A healthy sense of guilt when they do wrong is a good thing. Feeling "shame" rather than "guilt", however, is associated with disruptive behavior. What is the difference between shame and guilt, and why is it important? Probably because guilt is focused more on the transgression than the self, guilt seems to motivate restitution, confession, and apologizing rather than avoidance. Now you know why experts say condemn the behavior, not the youngster. It's a delicate balance for moms and dads, but an important one. In the same vein, parents should be realistic in their praise of the youngster. As kids reach the elementary years, they need to have an accurate perception of their abilities and relationships. Some interesting current research suggests that kids who have an unrealistically positive perception of themselves are more disruptive.

Aspergers kids do model aggressive behavior from TV, movies, and games. This has been demonstrated convincingly in the research. If your youngster has a problem with disruptive behavior, you should definitely limit or eliminate his viewing of this type of programming now.

My Aspergers Child: Help for Parents with Disruptive Aspergers Children & Teens

Aspergers Students: Tips for Teachers

Students with Aspergers (high functioning autism) are unique, and they can affect the learning environment in both positive and negative ways. In the classroom, the Aspergers child can present a challenge for the most experienced teacher. These children can also contribute a lot to the classroom because they can be extremely creative and see things and execute various tasks in different ways. Teachers can learn a lot when they have a child with Aspergers in their class, but the teacher may experience some very challenging days too. Here are some tips for teachers to consider:

Every child with Aspergers is different.

As a teacher you want to take the information you have acquired and apply it, but every Aspergers child is different, so it's difficult to take knowledge you have gained from one experience, and apply it to a situation with another child with Aspergers. Remember that each child with Aspergers is unique, and strategies that have worked with other students in the past may not work effectively with the Aspergers child because they perceive the world in a unique way, and they sometimes react to their environment in unpredictable ways.

Avoid demanding the student with Aspergers maintain eye contact with you.

Eye contact is a form of communication in American culture; we assume a person is giving us their attention if they look at us. The Aspergers child experiences difficulty with eye contact; it is extremely hard for them to focus their eyes on a person for any extended period of time. Limited eye contact is a part of the disability. Don't demand an Asperger child look you in the eye as you are talking to them--this is extremely difficult for them to do.

Aspergers students frequently are visual learners.

Despite difficulties with eye contact, many Aspergers children are visual learners. Much of the information presented in classrooms is oral, and often children with Aspergers may have difficulty with processing language. Often they cannot take in oral language quickly, and presenting information visually may be more helpful. Many Aspergers children are "hands-on" learners.

Aspergers students and "showing work".

Many teachers require children to "show their work"; in other words, illustrate how they got the answer to a problem."Showing work" is a demand that usually accompanies math homework. This may not be the best strategy with the Aspergers child, and may in fact lead to a big disagreement with the child.

Since many Aspergers children are visual learners, they picture how to solve the problem in their heads. To make them write out how they got the answer seems quite illogical to them. Why would you waste your time writing out something you can see in your head? The requirement of "showing work" simply does not make any sense to them, and it may not be worth the time it would take to convince them to do the requirement anyway.

If the student with Aspergers is staring off into space or doodling, don't assume they're not listening.

Remember the Aspergers child may experience difficulty with communication, especially nonverbal communication. What appears to the teacher to be behavior illustrating a lack of attention on the part of the child may not be that at all. In fact, the Aspergers child who is doodling or staring off may actually be trying to focus him or herself through the act of doodling or staring. The child is unaware that nonverbally s/he is communicating to the teacher that "I'm not listening, or I'm bored." Doodling or staring may actually help the child with Aspergers focus more on what the teacher is presenting. You might simply ask the child a question to check if he or she is listening.

Students with Aspergers may experience difficulties with focusing as well as lack of focus.

Focus involves attention. Sometimes Aspergers children focus all their attention on a particular object or subject; therefore, they fail to focus on what information the instructor is presenting. All their energy is directed toward a particular subject or object. Why? Because that object or subject is not overwhelming to them and they understand it.

To overcome this problem, the teacher can try to establish some connection between the object or subject of interest and the area of study. For example, if a child is fascinated with skateboarding, the child could learn reading and writing skills through researching a famous skateboarder and writing a report. Math skills could be taught by looking at the statistics involving competitive skateboarders. The possibilities for instruction are endless, but it will take some time and creative planning on the part of the teacher.

Sensory issues affect learning for the student with Aspergers.

Often Aspergers children are distracted by something in the environment that they simply cannot control. To them, the ticking of the clock can seem like the beating of a drum, the breeze from an open window can feel like a tremendous gust, the smell of food from the cafeteria can overpower them and make them feel sick, the bright sunshine pouring through the windows may be almost blinding to them.

This sensory overload the Aspergers child experiences may overwhelm them, so focusing can be difficult and frustration occurs. Frustration can then lead to disruptions from the child. To cope with frustration, the child might choose to repeatedly tap a pencil on a desk (or another disruptive behavior) in order to focus because s/he is experiencing sensory overload. What appears disruptive to the teacher and the rest of the class may actually be a way for the Aspergers child to cope with the sensory overload.

Obviously, a teacher does not want disruptions in the classroom. Take time to evaluate the classroom in terms of sensory stimulation, and how the environment affects the child with Aspergers. Perhaps some modifications can be made, or the child can be taught some coping skills that are not disruptive to classmates, like squeezing a squishy ball in their hand or some similar activity.

Don't assume the student with Aspergers is disrupting class or misbehaving to get attention.

More often than not, children with Aspergers react to their environment, and sometimes the reaction can be negative. Sometimes the child may be reacting to a sensory issue, and other times the child may be reacting to a feeling of fear. The Aspergers child feels fear because of a lack of control over his/her response to the environment or because of a lack of predictability. The child with Aspergers does best with clear structure and routine. A visual schedule can be helpful for the child.

Students with Aspergers experience difficulty with transitions.

Often a child with Aspergers gets "stuck" and has difficulty moving from one activity to another. They may need to be coached through the transition, and if a typical school day is loaded with lots of transitions, the child faces increased anxiety. Moving from one activity to another is not a challenge for most children, but for the child with Aspergers transitions can be monumental tasks.

Some possible strategies a teacher, paraprofessional, or parent can use: visual schedules, role-playing or preparing the child by discussing upcoming activities. Appropriate strategies are dependent on the age of the child and his/her abilities.

As a teacher, paraprofessional or parent of a child with Aspergers, it's important to recognize the child's gifts as well as limitations. Children with Aspergers present a challenge for the people who work with them, but these children also enrich our lives. So when you're feeling frazzled, take a deep breath and remember that tomorrow is another day. This child will grow up and make a contribution to our world in some way we can only imagine, and you can help this child.

==> 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

Aspergers Syndrome and Conduct Disorder

Although several studies have suggested an association between violent crime and Aspergers (high functioning autism), few have examined the underlying reasons. All kids display oppositional or aggressive behavior from time to time, especially when they are upset, tired, or hungry. Oppositional behavior, such as arguing, lying, and disobeying, is a normal part of development for kids and early teenagers. When this behavior is frequent or excessive, affects the youngster’s home or school life, or violates the rights of others, a conduct disorder may be present.

In this post, we will discuss the following:

What is conduct disorder?
What are the signs of conduct disorder?
How common is conduct disorder?
Who is at risk for conduct disorder?
What help is available for families?
What can parents do?
How to Identify Conduct Disorder
4 Crucial Mistakes in Dealing with Oppositional Behavior
The Best Way To Help Oppositional Children 

CLICK HERE for the full article...

Misdiagnosing ASD Level 1 [High-Functioning Autism]

"Is it possible for a child suspected of having HFA to be misdiagnosed as having a Personality Disorder?"

Personality disorders cannot be safely diagnosed prior to early adolescence. Still, though frequently found between the ages of 3 and 6, High-Functioning Autism [and Asperger's] is often misdiagnosed as a cluster B personality disorder, most often as the Narcissistic Personality Disorder (NPD).

1. The HFA Child

This child is self-centered and engrossed in a narrow range of interests and activities. Social and occupational interactions are severely hampered and conversational skills (the give and take of verbal intercourse) are primitive. The child's body language - eye to eye gaze, body posture, facial expressions - is constricted and artificial, akin to children with the Schizoid, Schizotypal, and Narcissistic Personality Disorders. Nonverbal cues are virtually absent and their interpretation in others lacking. Yet, HFA and personality pathologies have little in common.

2. Narcissistic Personality Disorder and HFA

Consider pathological narcissism. The narcissist switches between social agility and social impairment voluntarily. His social dysfunctioning is the outcome of conscious haughtiness and the reluctance to invest scarce mental energy in cultivating relationships with inferior and unworthy others. When confronted with potential Sources of Narcissistic Supply, however, the narcissist easily regains his social skills, his charm, and his gregariousness.

Many narcissists reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of Narcissistic Supply usually put an end to the narcissist's career and social liaisons.

The HFA child often wants to be accepted socially, to have friends, to marry, to be sexually active, and to sire offspring. He just doesn't have a clue how to go about it. His affect is limited. His initiative - for instance, to share his experiences with nearest and dearest or to engage in foreplay - is thwarted. His ability to divulge his emotions stilted. He is incapable or reciprocating and is largely unaware of the wishes, needs, and feelings of his interlocutors or counter-parties.

Inevitably, children with HFA are perceived by others to be cold, eccentric, insensitive, indifferent, repulsive, exploitative or emotionally-absent. To avoid the pain of rejection, they confine themselves to solitary activities - but, unlike the schizoid, not by choice. They limit their world to a single topic, hobby, or person and dive in with the greatest, all-consuming intensity, excluding all other matters and everyone else. It is a form of hurt-control and pain regulation.

Thus, while the narcissist avoids pain by excluding, devaluing, and discarding others - the HFA child achieves the same result by withdrawing and by passionately incorporating in his universe only one or two people and one or two subjects of interest. Both narcissists and children on the autism spectrum are prone to react with depression to perceived slights and injuries - but HFA children are far more at risk of self-harm and suicide.

3. The use of language

Children with most personality disorders are skilled communicators and manipulators of language. In some personality disorders (Antisocial, Narcissistic, Histrionic, Paranoid) the child’s linguistic skills far surpass the average. The narcissist, for instance, hones language as an instrument and uses it to obtain Narcissistic Supply or as a weapon to obliterate his "enemies" and discarded sources with. Cerebral narcissists actually derive Narcissistic Supply from the consummate use they make of their innate loquaciousness.

In contrast, the HFA child, though verbose at times (and taciturn on other occasions) has a far more limited range of tediously repetitive topics. Youngsters on the autism spectrum fail to observe conversational rules and etiquette (for instance, let others speak in turn).

The HFA child is unaware and, therefore, unable to decipher body language and external social and nonverbal cues and gestures. He is incapable of monitoring his own misbehavior. Psychopaths, narcissists, borderlines, schizotypals, histrionics, paranoids, and schizoids are similarly inconsiderate - but they control their behavior and are fully cognizant of reactions by others. They simply choose to ignore these data.

==> Click here for information on the specific traits of high-functioning autism, and the corresponding recommended parenting strategies...

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


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Best Comment:

My friend has been told his whole life that he has autism but meaning Aspergers, I learned that autistism is actually very different than Aspergers and autism revolves around not being able to learn meanwhile Aspergers is just a disorder meaning you cannot connect or feel with others. I realized I do not think my friend has Aspergers, he solializes perfectly with me, there are times he does not pick up social cues but he is still a very caring person and generally knows when something is wrong or right. I believe he has severe OCD, and anxiety because he gets so anxious he stutors and cannot talk and I think he had anger management as a child because he has every single sign in these disorders (not anger now... but still self harm when in upsetting situations in front of other people like he will bite himself and then say I bite myself when i'm upset, I know he does this for attention and it probably gets him attention at home, but when hes with me I don't pay attention to it so he doesn't do it really like he would at home, I think this was taught to him)I tried to tell him that he has OCD and he would not believe me but actually got offended, then later proceeded to tell me when he was getting diagnosed they had no idea if he had Aspergers or OCD, they actually had to decide upon it. His whole life he has been told everything he does is because of a disorder and that there isn't anything you can do and that basically that's just the way he is and I don't believe that to be true because he cares about others when he wants to. He only does what he does for attention because he did not get enough at home.

Antisocial Behavior in Aspergers Teens

Antisocial behavior is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility among others. As a consequence of these criteria the antisocial individual has the image of a cold, heartless, inhuman being. But do all antisocial individuals show a complete lack of normal emotional capacities and empathy? Like healthy people, many antisocial individuals love their parents and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, antisocial individuals do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behavior.

Antisocial individuals can suffer emotional pain for a variety of reasons. Like anyone else, antisocial individuals have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Antisocial individuals are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most antisocial individuals are devoid of a stable social network or warm, close bonds.

The life histories of antisocial individuals are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods. They may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, inside antisocial individuals feel inferior to others and know they are stigmatized by their own behavior. Although some antisocial individuals are superficially adapted to their environment and are even popular, they feel they must carefully hide their true nature because it will not be accepted by others. This leaves antisocial individuals with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.

Antisocial individuals are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many antisocial individuals are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the justice system.

As antisocial individuals age they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.

Social isolation, loneliness and associated emotional pain in antisocial individuals may precede violent criminal acts. They believe that the whole world is against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. As antisocial serial killers Jeffrey Dahmer and Dennis Nilson expressed, violent psychopaths ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently their sadness and suffering increase, and their crimes become more and more bizarre.

Dahmer and Nilsen have stated that they killed simply for company. Both men had no friends and their only social contacts were occasional encounters in homosexual bars. Nilsen watched television and talked for hours with the dead bodies of his victims; Dahmer consumed parts of his victims' bodies in order to become one with them: he believed that in this way his victims lived further in his body.

For the rest of us it is unimaginable that these men were so lonely -- yet they describe their loneliness and social failures as unbearably painful. They each created their own sadistic universe to avenge their experiences of rejection, abuse, humiliation, neglect and emotional suffering.

Dahmer and Nilsen claimed that they did not enjoy the killing act itself. Dahmer tried to make zombies of his victims by injecting acid into their brains after he had numbed them with sleeping pills. He wanted complete control over his victims, but when that failed, he killed them. Nilsen felt much more comfortable with dead bodies than with living people -- the dead ones could not leave him. He wrote poems and spoke tender words to the dead bodies, using them as long as possible for company. In other violent antisocial individuals, a relationship has been found between the intensity of sadness and loneliness and the degree of violence, recklessness and impulsivity.

Violent antisocial individuals are at high risk for targeting their aggression toward themselves as much as toward others. A considerable number of antisocial individuals die a violent death a relatively short time after discharge from forensic psychiatric treatment due to their own behavior (for instance as a consequence of risky driving or involvement in dangerous situations). Antisocial individuals may feel that all life is worthless, including their own.

Treatment Developments—

In the last decade, neurobiological explanations have become available for many of the traits of antisocial behavior. For example, impulsivity, recklessness/irresponsibility, hostility and aggressiveness may be determined by abnormal levels of neurochemicals including monoamine oxidase (MAO), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), triiodothyronine (T3), free-thyroxine (T4), testosterone, cortisol, adrenocorticotropic hormone (ACTH), and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. Other features like sensation-seeking and an incapacity to learn from experiences might be linked to cortical underarousal. Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal grey matter volume. Many antisocial individuals can thus be considered, at least to some degree, victims of neurobiologically determined behavioral abnormalities that, in turn, create a fixed gulf between them and the rest of the world.

It may be possible to diminish traits like sensation-seeking, impulsivity, aggression and related emotional pain with the help of psychotherapeutic, psychopharmacological and/or neurofeedback treatment.

Long-term psychotherapeutic treatment (at least five years) seems effective in some categories of antisocial individuals, in so far as antisocial personality traits may diminish.

Psychotherapeutic treatment alone may be insufficient to improve symptoms. Psycho-pharmacological treatment methods may help normalize neurobiological functions and related behavior/personality traits. Lithium is impressive in treating antisocial, aggressive and assaultive behavior. Hollander (1999) found that mood stabilizers such as divalproex (Depakote), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors (MAOIs) and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients. To date there have been no controlled studies of the psychopharmacological treatment of other core features of antisocial behavior.

Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques.

Conclusions--

It is extremely important to recognize hidden suffering, loneliness and lack of self-esteem as risk factors for violent, criminal behavior in antisocial individuals. Studying the statements of violent criminal antisocial individuals sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacological, neurofeedback and combined psychotherapeutic research is needed to prevent and treat antisocial behavior.

My Aspergers Child: Help for Parents with Antisocial Children/Teens