ASPERGER'S SYNDROME (AS)

BEHAVIORAL DEFINITION

The autism spectrum extends from “classic autism” — which lies at the lower end of the spectrum — through ASPERGER'S SYNDROME, which is characterized as being at the mildest and highest functioning end of the spectrum — or Pervasive Developmental Disorder — Continuum

“The major source of stress in life for the person with Asperger's Syndrome is social contact, and increased stress generally leads to anxiety disorders and depression”
Attwood, T. Asperger's Syndrome: A Guide for Parents and Professionals, 1998, p. 148.

AS represents a neurologically-based disorder of development

AS reflects deviations or abnormalities in four aspects of development:

(1) Social relatedness and social skills

(2) The use of language for purposes of communication

(3) Certain behavioral and stylistic characteristics such as repetitive or persevering features

(4) Limited, but intense, range of interests

These dysfunctional features can range from mild to severe

“The Epidemiology of Asperger Syndrome: A Total Population Study" by Ehlers and Gillberg (www.asperger.org 2001), it is estimated that the prevalence of Asperger is 2.6 per 1,000 individuals. With the population of the U.S. currently estimated at 275 million (July 2000), this would mean an estimated 715,000 people are affected by Asperger's syndrome in the U.S. alone”
Stewart, K. (2002). Helping a Child with Nonverbal Learning Disorder or Asperger's Syndrome, p. 148

AS is characterized by:

• high cognitive abilities - or, at least, “normal” IQ level
• extending into the very superior range of cognitive ability
• normal language function when compared to other autistic disorders
• difficulties with pragmatic, or social language
• a better prognosis than other Autism spectrum disorders

“Individuals with autism also have gifts. The gifts of autism occur as a result of the strong visual abilities, attention to minute details, unusual interests, and amazing memory. Other common traits, such as honesty, naivetè, gentleness, compliance, and perfectionism, are exceedingly refreshing and unexpected in this increasingly cynical world”
Janzen, J. E. (1999). Autism: Facts and strategies for Parents, p. 151.

“Nurses are in a position to identify children with Asperger's early. After identification, the necessary referrals, treatment options, support, and follow-up are essential for these children. Nurses need more knowledge about this disorder and need to be proactive in defining their role to help children with the disorder in the schools and the community.”
Marshall, M.C. Asperger's syndrome: Implications for nursing practice. Issues in Mental Health Nursing, 2002; 23(6), p. 605.

Diagnostic Criteria from DSM-IV-TR (2000)

American Psychiatric Association, Washington, D.C.
www.psych.org
(Diagnostic and Statistical Manual of Mental Disorders)

Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) Lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereo-typed and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrase used by age 3 years)

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

“While there is no cure for Asperger's, experts agree that the earlier a child is properly diagnosed and receives individualized assistance, the better the chance that he can lead a quality life”
Parade Magazine, February 2, 2003; pp. 4-5

“People with Asperger's Syndrome may have unusual qualities to their language skills that superficially resemble the speech and thought disorder associated with schizophrenia…this can be confusing to the clinician who is not aware of this aspect of Asperger's Syndrome”
Attwood, T. (1998). Asperger's Syndrome: A Guide for Parents and Professionals, p. 149.

AS: CLINICAL FEATURES

One of the primary features of Asperger's syndrome is their passion for favorite topics or special interests

Some of these areas include:
- math
- science
- reading
- history
- geography
- social studies
- metereology
- astronomy
- extraterrestrials
- weather
- music
- machines or machinery
- trains
- dinosaurs
- maps
- space travel

Socialization deficits

• Different from "typical" Autism
• Described as being "in OUR world, but, ON THEIR OWN terms"
• Preoccupied with own agenda
• Seldom interested in other's interests/concerns
• By school age express desire to fit in socially
• Highly frustrated by their social awkwardness/alienation
• Lack effective interaction skills — not desire
• Difficulties making social connections
• Unable to “read” others' needs and perspectives
• Unable to appropriately respond to social cues
• Frequently described as “odd” or selfish
• Naïve and lack common sense
• Lack understanding of human relations and rules of social convention
• Are inflexible and incapable of coping with change
• Easily stressed and emotionally vulnerable

Use of Language

• Rote skills are strong
• Prosody-speech volume, intonation, inflection, rate-
is frequently deficient or unusual
• Excessively formal or pedantic language
• Misused or not used cultural slang or social idioms
• Concrete language rather than abstract
• Weak pragmatic-conversational-skills
• Problems with taking turns in conversations
• Typically revert to favorite topic area
• Difficulty understanding humor
• Laugh at “wrong time” with jokes or interactions
• Many have good sense of humor
• Usually like word games and puns
• Hyper-verbal (highly developed vocabularies)
• Early years: repetitive phrases or language or stock phrases from memorized material
• Some have normal or early language development
others have speech delays, then rapidly catch up, making diagnosis between AS, autism, and speech disorders difficult

TEACHING STRESS REDUCTION SKILLS

AS children are:

- easily overwhelmed
- highly sensitive
- often engage in rituals
- are often anxious and worrisome

Practical Suggestions:

- provide predictable, safe environments
- minimize transitions
- consistent routines
- let them know what to expect
- prepare them for altered plans, schedules or changes
- minimize fears of unknown

Examples:
Introduce to teacher, therapist or para-professional before work begins.

Take tour of building child will be working
or learning in.

Learn about child's favorite topics or special interests

Adapted from: Williams, K. (1995). Understanding the student with Asperger's Syndrome: Guidelines for Teachers. Focus on Autistic Behavior, Vol. 10, #2.

AS children typically display impaired Social Interaction

Practical Suggestions:

- Shield them from bullying and teasing
- Educate peers
- Praise classmates when supportive
- Promote empathy and tolerance
- Create cooperative learning situations

Examples: Use AS child's strengths in exchange for liabilities to foster acceptance

- Teach and support proper reaction to social cues
- Rehearse proper response repertoires
- Teach WHAT to say, WHEN, and HOW to say it
- Model two-way interactions
- Teach/model correct emotional responding
- Insensitive or inappropriate comments from
   AS are usually innocent
- Teaching WHY & WHAT response is
   appropriate is necessary
- Encourage participation in conversations

Adapted from: Williams, K. (1995). Understanding the student with Asperger's Syndrome: Guidelines for Teachers. Focus on Autistic Behavior, Vol. 10, #2.

COMMUNICATION AND GESTURES
Six steps for understanding challenging communications:

(1) Try to figure out what your child is communicating with the challenging behavior.

- “This is too difficult for me”

- “I can't remember what I'm supposed to do”

- “I'm mad…scared…confused”

(2) Consider how you can adapt the situation

- Child expressing confusion? -> consider how to make the situation easier to understand. Make it more concrete, routine, or predictable
- Child overwhelmed or overstimulated? Try reducing amount of time in situation, or avoiding it in future.

(3) If the message must be communicated, come up with alternate way in which your child can communicate his or her needs or wishes more appropriately

- Help your child develop appropriate ways of conveying requests/needs. If screaming when confused by a task, teach child to raise hand, ring a bell, or say: “I need help with this…this is too hard”

(4) Practice the “new way” of communicating

- model more appropriate phrase or nonverbal signals
- have child practice the “new phrase” or behavior
- during the situation, remind (prompt) child to use new phrase or behavior

(5) Reward your child for using the strategy by showing that it gets his or her needs met.

- if your child requests help assist her immediately
- if asks to leave situation, provide her with immediate break
- if needs attention, stop what you're doing and provide some time/interest

(6) Be sure that the challenging behavior is no longer effective in getting your child's needs met.

- ignore problem behaviors
- provide prompt for the “new, appropriate one
- if child screams to avoid situation, prompt her to use an appropriate phrase. Do NOT allow her to leave the situation while she is screaming.

Ozonoff, S., Dawson, G., & McPartland, J. (2002). A parent's guide to asperger syndrome and high-functioning autism: How to meet the challenges and help your child thrive. New York, NY: The Gilford Press.pp. 132-140.