In the last version of the Diagnostic and Statistical Manual (DSM V) the separate conditions of Autism and Asperger’s syndrome were put together as one: Autistic Spectrum Disorder. To most parents, teachers and practitioners this seemed perverse since the non-verbal child who will never be able to attend a main stream school would now have the same diagnosis as the clever child whose unawareness of social conventions made him/her seem like a “little professor”. Asperger’s Syndrome was initially recognised as a developmental disorder, and was included in the diagnostic criteria of DSM IV, an internationally recognised list of mental and learning difficulties. It was defined as the mildest and highest functioning end of the spectrum of Autistic Disorder. Despite the abolishing of Asperger’s Syndrome as a separate category, the books written on Asperger’s Syndrome remain just as relevant, despite any difference in diagnosis. One of the best, “Asperger’s Syndrome” by Tony Attwood (JKPb.) lists the symptoms as:
• Qualitative impairment of social interaction
• Restricted, repetitive, and stereotyped patterns of behaviour, activities and interests
• Social impairment with extreme subjectivity
• Limited interests and preoccupations
• Repetitive routines and rituals
• Speech and language peculiarities
• Non-verbal communication problems
• Motor clumsiness
There is a genetic vulnerability to the anxiety that underlies the impairment of social skills and the obsessiveness that can propel the “little professor” to academic, if not social success. Parents of the affected child will often have echoes of the near obsessive attention to detail that allows them to succeed, especially in careers involving, science, maths, computing and I.T., even though they are not autistic themselves. The journey to Autism in their children has had many theories, from abnormal eye movements and neurochemistry that truncates neural connections to inadequate methylation and vulnerability to toxic build-up of pollution and damaging chemicals such as mercury, pesticides, organophosphates that the autistic system cannot deal with normally. This would include the “leaky gut” idea that also suggests that diet can help.
Whatever the cause there are many scientific breakthroughs that only that dogged concentration on detail have allowed. Mendel for example, who with his continual planting and crossbreeding of green, yellow, wrinkly, smooth, short and tall pea plants, discovered the laws of inheritance, now known as genes. Not to mention Newton with his discovery of the laws of motion that still form the basis of today’s physics. These men and many other great scientists are recorded to have had the classic signs of Autism.
But to get a child with this background onto a successful path involves a great deal of effort and understanding on the part of parents and teachers. Both have to understand the sensory overload an Asperger’s child experiences. (From this point the information refers to a child who fulfils the old definition – i.e. normal I.Q., age-appropriate literacy and numeracy but as noted above, weighed down with anxiety, disliking change, fearful of social interaction and tendency to obsessional interests) But even children with Asperger’s syndrome differ a great deal in these traits, from the simply slightly anxious and awkward introvert to the total obsessive energy of the child only happy when they are pursuing their particular interest shut away in their bedroom for hours on end.
Awkwardness is easy. It seems odd to some that people who cannot communicate with others (after all we are a social species) have survived and even increased, some surveys quote up to 1 in 100 people diagnosed with Autism. However, Ty Tashiro in his book on awkwardness makes the point that these are the people who don’t waste time partying and are better at devising algorithms or developing cyber security protocols. Obsessiveness seems to breed sharp focus and a localised processing that acts as an attentional spotlight as well as an admirable persistence, probably due to the underlying neurochemistry. Tashiro’s studies found that University students doing well in computer science and Maths were the socially less fluent. They will probably not be diagnosed with Asperger’s syndrome, just thought a bit socially inept.
Social blindness is harder. Many Asperger’s syndrome people are unaware of social cues (turn-taking in conversation, politeness etc.) and the unwritten rules of social interaction. Their anxiety makes them avoid eye contact that non-Asperger people use to understand the feelings and motivations of others. Their disinterest in others and their feelings comes across as egocentric. Their dislike of sensory overload – loud noises, bright lights, and large busy crowds are an assault on their nervous systems and seem odd to the more socially adventurous. Other symptoms such as extreme or obsessional thinking and behaviour and lack of “common-sense” seem eccentric to their peers as does the bias towards their emphasis on self rather than the give and take characteristic of normal social interaction
For school this means the necessity to understand the anxiety that lies behind the child’s reluctance to interact socially, especially in groups. Typically the Asperger’s diagnosed child is unable to generalise easily and adapt to new and variable situations and learning and note-taking and written work is never consistent with the child’s understanding. Teachers will be concerned over how difficult the Asperger’s pupil finds it to maintain attention on information and conversation in which they are not interested. Organisational ability is weak because it involves an overall progressing and integration of details. There are some general principles in managing such children at school.
• Classroom routines should be kept as consistent, structured and predictable, though they must be clear and explicit teaching should try to connect to the particular interests of the child, i.e. bring in examples of their pet interest when teaching general subjects.
• Use visual material, schedules, charts, lists, pictures
• Keep teaching as concrete as possible, avoiding figurative speech, idioms and simplify abstract concepts and language, they may need some help with meta-cognition – generalising knowledge and generating concepts
• Try to find a mature child who might “look out” for the Asperger’s diagnosed child in social groups
• Designate a named teacher to whom the child can go for help when they feel overwhelmed by social interaction
• Keep classes and groups they are going to join as small as possible or least in a less crowded part of the classroom.
At home and in general the Asperger diagnosed child needs to become more aware of the non-verbal aspects of social interaction. It is this that allows perception of others motivations, which is the basis of empathy and co-operation. An over emphasis on words at the expense of body-language and emotional tone of speech leads to a literality, which is perceived as lack of social sensitivity.
It is important to maintain exemplar conversations at home, with co-operative turn taking observed, continuance of the topic, elaborated conversational “repair” mechanisms observed, scrupulous attention to another’s topic and so on. “Mood Management” by Carol Langelier, Sage publications, is a cognitive-behavioural skills-building programme (book) for adolescents which older students could benefit. They must then be able to apply these psychological concepts to others and realise that others act in an orderly predictable way and that their own actions can affect that. For teachers “Social Standards at School” by Judi & Tom Kinney, pbld by Attainment Company gives self-monitoring skills checklists for inclusion in IEP’s.
Games involving the detection of emotional states from facial expression, body language and tone of voice will help. See the LDA catalogue (0800 783 8648) for “Social Sequences”, “Photo Emotions” games and “Photo adjectives” – that will encourage a more expressive, less literal language. A more complex programme for adolescents “Mind Reading; the interactive guide to emotions” a programme on a set of DVD’s from Jessica Kingsley Pblrs.
Home based ideas are to point out occasions when people demonstrate emotion or emotional conflicts i.e. a person who really wants to say no, agreeing. Parents can ask the child to comment on people the family come into contact with after they have demonstrated some emotion. Discussing the symbolic associations of colour and how they might represent emotional state widens emotional perception. For teachers and parents ”Nurturing Emotional Literacy” by Peter Sharp and “Non-verbal Reasoning” by Alan Blackmore also published by Jessica Kingsley gives good ideas and exercises for developing and becoming aware of emotions. If possible a valuable exercise would be videotaping the child in social interaction and showing this to them, pointing out how others perceive this and how it can be changed. Role-plays of potentially frightening situations (asking another child to stop etc.) at home can alleviate anxiety; the more a frightening situation is discussed, practised and alternatives generated the less fearfully anticipated it will be. If this doesn’t happen the child can develop an armour against his anxiety by assuming they are always right and will avoid conflict by not discussing the situation. The other possible downside is the vulnerability to internet addiction. Many parents feel that long hours on gaming changes the Asperger child’s personality and behaviour and leads them to become manipulative and deceptive. In fact, Video game addiction is becoming recognised as an impulse control disorder, or an Internet Addiction Disorder, similar to other psychological addictions and affecting over 1% of the population. Treatment ranges from total removal to limitation of time spent on the games at the same time as a replacement of some interest to the child to help make up the void, See http://kidsfitnessfirst.org/?study=internet-addiction-or-excessive-internet-use for some help.
Most children with mild Asperger’s syndrome manage life quite successfully, especially if they are able to be educated to a normal level, which involves the above special arrangements. The major deficit in Asperger’s syndrome is not understanding social rules (which are unwritten) and these then have to be taught, just as other children need to be taught literacy. A normally intelligent child is quite able to learn these even though they may not have an intuitive understanding of them. Thus there will always be an element of over-rationalisation to their emotional interactions, since they will be acting on learnt cortical knowledge rather than feeling “heart” knowledge.
Learning to put together cause and affect means the Asperger-diagnosed child or adult can learn and understand the higher order social concepts – that co-operation benefits all, that people have feelings that dictate their actions, etc. even if they don’t accept this emotionally. Learning to understand the perspective of others is taught by modelling and role play in social groups. Then the child can “join up” their disparate (at the moment) knowledge and come to a better understanding of social interaction. The area of most concern for young children is the necessity for more and more appropriate social interaction as they move through education. This is the area most out of their control. In later life they will be able to control the level and degree of social interaction they can tolerate. But as they move up through senior school and Higher Education these pupils will be at their period of highest vulnerability, more social interaction will be forced on them which may be frightening to them. Thus preparation is essential – familiarizing the pupil with the syllabus, other students and teachers and so on.
The National Autistic Society puts out much useful information and the OAASIS group has a free mailing group for assistance, support and information. Schafer@ sprynet.com will put you on a free website detailing all the latest world-wide research in Autism and Asperger’s syndrome.
Many parents find nutritional supplements helpful, and this is addressed in the Nutrition section of this website.
Academic Book List:
Many books and articles by Simon Baron-Cohen of Cambridge Autism Research
Parents and teachers:
The Complete Guide to Asperger’s Syndrome – Tony Attwood JKPress
Parenting a child with Asperger’s Syndrome; 200 tips and strategies by Brenda Boyd
Asperger’s Syndrome – what teachers need to know by Matt Winter
The Oasis Guide to Asperger’s syndrome; advice, support, insight and inspiration by Patriciza Boyd, Barbara Kirby and Simon Baron-Cohen
Asperger’s syndrome: your child, a parents Guide by M. Powers & J. Poland
Create a reward plan for your child with Asperger’s syndrome by John Smith
Asperger’s syndrome: practical strategies for the classroom; a teachers guide by Leicester City Council and Education dept
Asperger’s syndrome: a practical guide for teachers; resources and materials by Val Cumine et al
Social Skills training for children and adolescents with Asperger’s syndrome and social communication difficulties by Jed E Baker
Social Skills training for children and adolescents with Asperger’s syndrome; a step by step guide (JKP resource material) by Kim Kiker Painter
All of these are available from amazon.co.uk or Jessica Kingsley Press.co.uk