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What Is Asperger Syndrome?

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What Is Asperger Syndrome? 

Imagine…

You had just landed on another planet and you did not know the inhabitants, their language, their customs, how they interacted or how you should behave in their presence.




Trying to find your way in a crowd, in a foreign country with only jumbled signposts to follow, and directions, which you can only partially understand.

Not being able to talk, use your hands, use facial expressions or gestures to communicate

Hearing 10 TVs all at once and not being able to ‘tune in’ to any of them.

… For a person with Asperger Syndrome ordinary situations can feel just like this.

Pervasive Development Disorder (PDD) is a developmental disability and has an overall prevalence of one in 300 children. Of the individuals with PDD, or Autism Spectrum Disorder as it is otherwise known, approximately 10-15% have average or above average intelligence (including some whose IQs measure in the superior range). This subgroup is classified as having Asperger’s Syndrome. The organically based problems that define PDD are not reversible.

Diagnostic Criteria for 299.80 Asperger's Disorder – DSM-IV

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

1. marked impairments 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 stereotyped 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 phrases 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 social interaction), and curiosity about the environment in childhood

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

KEY CHARACTERISTICS

Social Interaction

The criteria for AS and autism are identical in terms of social deficits. However, in AS there are generally fewer symptoms, as well as a distinct presentation. Individuals with AS are aware of other people and desire friendship. They are often (involuntarily) socially isolated because their approaches tend to be inappropriate and peculiar. Although the AS individual may be able to correctly describe other people's intentions, emotions, and conventions, they are unable to execute this knowledge in a spontaneous and useful manner. The lack of spontaneous adaptation is associated with an over-reliance on formalistic rules of behaviour. Autistic individuals are more apt to be withdrawn and may seem disinterested in relating to others whereas those with AS are often quite eager to relate to others but lack the requisite skills to do so.

Communication

Although severe deficits in communication would lead to a diagnosis of autism instead of AS, several unique qualitative aspects of communication in AS have been identified. First, speech is often marked by poor prosody. Inflection and intonation typically are not as rigid and monotone as in autism. A restricted range of intonation patterns may result in utterances in which tone of voice is inconsistent or unrelated to content and communicative intent. Second, speech may also seem tangential and circumstantial. Although this may sometimes be a manifestation of a thought disorder, among AS children it is more often a reflection of their egocentric conversational approach and failure to censor output, which accompanies internal thoughts. This may be evident in monologues on the topic of consuming interest (e.g., geography, railway schedules), failure to integrate what the listener can be expected to know in terms of background information; difficulty implementing the rules of conservation, such as turn-taking and topic transitioning. A third characteristic of communication among individuals with AS is verbosity. The individual with AS may launch into monologues on their favorite topic with complete disregard of the listener's interest, nonverbal signals, or background information.

Restricted Range of Interests, Activities, or Behaviours

In autism, one of the most frequently observed and most pronounced symptoms is an intense preoccupation with restricted patterns of interest. In AS, this is much less commonly reported, with the exception of a preoccupation with an unusual topic about which the AS individual amasses considerable factual knowledge. Given deficits in pragmatics of social interaction, the AS individual will readily share this information, at great length and in considerable detail. The area of special interest may dominate the social interactions and activities of the AS individual (and often their families, as well). The specific subject area may change every two years or so (Klin & Volkmar, 1995).

Motor Deficits

Gross and fine motor problems are often seen in association with AS but are not part of the required criteria for diagnosis. Motor milestones may be delayed, but more typically, there are delays in the acquisition of more complex motor skills such as riding a bike, catching a ball, and climbing. AS individuals often display odd gait, poor manipulative skills, and deficits in visual-motor coordination. In autism, gross motor skills are often a relative strength.

FUNDAMENTAL FEATURES OF AUTISM

The diagnostic features of PDD are useful in distinguishing it from other disabilities but are relatively imprecise for the purpose of conceptualizing how an individual with PDD understands the world, acts upon his understanding, and learns. Following are the fundamental features of PDD that interact to produce the behaviours, which comprise the “culture” of this disorder.

Lack of concept of meaning

Individuals with PDD do not draw relationships between ideas or events. For them the world consists of series of unrelated experiences and demands while the underlying themes, concepts, reasons or principles are typically unclear to them.

Excessive focus on details, with limited ability

Individuals with PDD are usually very good at observing minute details, particularly visual details. Those with Asperger’s Syndrome may focus on cognitive details, such as call letters of radio stations, area codes or capitals of countries.

Distractibility

It is frequently difficult for students with PDD to pay attention to what their teacher wants because they are focusing on sensations, which to them are more interesting or important. Their focus often switches rapidly. Distractions may be visual, auditory or internal. People with Autism Spectrum Disorders have great difficulty putting in priority the importance of external stimulation or thoughts.

Concrete Thinking

Regardless of cognitive level, individuals with PDD have relatively greater difficulty with symbolic or abstract language concepts than with straightforward facts and descriptions. In the culture of autism, words mean one thing; they do not have additional connotations.

Difficulty with combining or integrating ideas

It is easier for people with PDD to understand individual facts or concepts than to put concepts together, or to integrate them with related information, particularly when the concepts appear to be somewhat contradictory.

Difficulty with organization and sequencing

Organization requires the integration of several elements to achieve a predetermined end. Organizational skills are difficult for people with PDD because they require the ability to focus on both the immediate task and the desired outcome at the same time. It is not unusual for a person with PDD to perform a series of acts in illogical, counter-productive order and seem not to notice. They may master the individual steps in a complex process, but not understand the relationships between the steps, or the meaning of the steps with regard to the final outcome.

Difficulty with generalization

People with PDD often learn skills or behaviours in one situation but have great difficulty generalizing these to a different situation. They might learn the literal wording of a rule but not understand its underlying purpose, and so have trouble applying it in different situations.

Strong impulses

Individuals with PDD are often extraordinarily persistent in seeking out the things they desire, whether these are favourite objects, experiences or sensations such as touching something, performing a complex ritual, or repeating an established behavioural pattern.

Excessive anxiety

Many people with PDD are prone to high levels of anxiety; they are frequently upset or on the verge of becoming upset. Some anxiety is probably attributable to biological factors. Anxiety can result from confrontations with an environment that is unpredictable and overwhelming. Because of cognitive deficits, people with PDD often have difficulty understanding what is expected of them and what is happening around them. Anxiety and agitation are understandable reactions to this constant uncertainty.

Sensory / perceptual abnormalities

Sensory processing systems of people with PDD are unusual. They often have unusual food preferences. They may spend their time watching their fingers flick or rubbing different textures. They may appear deaf when they have perfect hearing acuity or hear sounds that others don’t. People with PDD show us that their differences begin at the level of processing some or all the sensations that impinge on their body every waking minute.

PRINCIPLES FOR TEACHING INDIVIDUALS WITH PDD

Strengths and Interests



All students have strengths and interests that can be made more functional for them. While we cannot change Autism or Asperger’s Syndrome, we can use it as a context to help the student acquire the skills required by our culture.

Assistance Understanding Meaning

We can never assume that our students understand why we ask them to do certain things, how the skills and behaviours we teach them are related, or even what, specifically, we are requesting. Even the most intelligent students with PDD are frequently confused or uncertain about expectations and customs in our culture. Students have a constant need for an empathetic, helpful guide to our confusing and difficult to interpret environment.

Noncompliance resulting from lack of understanding

Most of the behaviour that students display is due to their cognitive difficulty in understanding what is expected of them. Students with PDD are not deliberately defiant or provocative. It is most likely that the student does not understand the words that have been used, the facial expression and body language of the speaker, or the social expectations of the situation. The student might be driven by strong impulses to act regardless of rules and consequences, or might be agitated and overwhelmed by sensory stimulation in the room. The rules might be too abstract or too vague.

SUGGESTIONS FOR THE CLASSROOM

Impairment in Social Interaction

Protect the child from bullying and teasing

Attempt to educate peers about the child with AS when social ineptness is sever by describing his or her social problems as a true disability. Praise classmates when they treat him or her with compassion. Try to promote empathy and tolerance in the other students.

Emphasize the proficient academic skills of the student with AS by creating cooperative learning situations which his or her reading skills, vocabulary, memory and so forth will be viewed as an asset by peers, thereby engendering acceptance.

Most individuals with AS want friends but simply do not know how to interact. They should be taught how to react to social cues and be given repertoires of responses to use in various social situations.

Since individuals with AS lack social instinct and intuition, they must learn social skills intellectually. When they have been unintentionally insulting, tactless or insensitive explain to them why the response was inappropriate and what response would have been correct.

“Buddy” the AS student with a sensitive nondisabled classmate who can look out for the AS student and attempt to include him or her in school activities.

Children with AS tend to be reclusive. Encourage active socialization and limit time spent in isolated pursuit of interests.

Remember that most individuals with autism or AS have difficulty reading facial expressions and interpreting “body language”.

Communication Difficulties

Use visual methods of communicating as much as possible. Use a daily visual schedule to communicate events of the day, and what order they will occur in. Put all important instructions in writing. If there are several instructions on a page, use a highlighter to emphasize the most important ones.

Communicate expectations through the organization of the environment. For example: work independently at your desk; work with the teacher at the teacher’s table; eat in the lunchroom; play games at the leisure center. Avoid interchanging the usage of different spaces to communicate what is expected in each location.

Individuals with AS have problems with abstract and conceptual thinking. Avoid asking vague questions such as, “Why did you do that?” Instead, state what was inappropriate and matter-of-factly inform the student of the desired response.

Be as concrete as possible in all your interactions with these students.

Use and interpret speech literally. Until you know the capabilities of the individual, you should avoid:

Idioms (save your breath, jump the gun, second thoughts)

Double meanings (most jokes)

Sarcasm

Nicknames or cute names (pal, buddy, wise guy)

Avoid verbal overload. Be clear. Use shorter sentences if you perceive that the student does not fully understand you. Although he or she probably has excellent hearing and may be paying attention, he or she may have difficulty understanding your main point and identifying important information.

Do not rely on individuals with autism or AS to relay important messages. Frequent and accurate communication between the teacher and parent is very important.

Restricted Range of Interests

Do not allow the child with AS to perservatively discuss or ask questions about isolated interests. Limit this behaviour by designating a specific time during the day when the child can talk about this.

Praise AS students for simple, expected social behaviour that is taken for granted in other children(e.g., allowing others to speak)

Keep clear firm expectations for the completion of classwork, while allowing opportunities to pursue their interests.



For particularly recalcitrant children, individualize assignments around their interest areas. Gradually introduce other topics into assignments.

Link student interests to the subject being studied. For example, during social studies unit, a child obsessed with trains might be assigned to research the modes of transportation used by people in that country.

Use the child’s fixation as a way to broaden his or her repertoire of interests. A child who is obsessed with animals might study the rain forest, as this is where many animals live. Study be extended to the local people who are forced to chop down the animals’ forest habitat in order to survive.

Insistence on Sameness

Prepare the student for transitions with a daily schedule

Provide a predictable and safe environment

Provide a predictable environment (do not play at a work table or work at a play table)

Avoid surprises; prepare the student in advance of special activities, or any other changes to the routine regardless of how minimal

Allay fears of the fears of the unknown by gradual exposure. (For instance, when the child with AS must change schools, he or she should meet the teacher in advance, tour the new school and be apprised of the routines in advance of actual attendance.)

Emotional Vulnerability

Prevent outburst by offering a high level of consistency. Prepare students for changes in daily routine, to lower stress. Individuals with AS frequently become fearful, angry and upset in the face of forced or unexpected changes.

Be calm, predictable and matter-of-fact in interactions with the child with AS, while clearly indicating compassion and patience. Hans Asperger, the psychiatrist for whom this syndrome is named, remarked that “the teacher who does not understand that it is necessary to teach children [with AS] seemingly obvious things will feel impatient and irritated.”

Be alert to changes in behaviour that may indicate depression, such as even greater levels of disorganization, inattentiveness and isolation; decreased stress threshold; chronic fatigue; crying; suicidal remarks; and so on.

Be aware that adolescents with AS are especially prone to depression. Social skills are highly valued in adolescence and the student with AS realizes he or she is different and has difficulty forming normal relationships. Academic work often becomes more abstract, and the adolescent with AS finds assignments more difficult and complex.

It is critical that adolescents with AS who are in regular classes have an identified support staff member with whom they can check in at least once daily. This person can assess how well he or she is coping by meeting with him or her daily and gathering observations from other teachers.

Individuals with AS who are very fragile emotionally may need placement in a highly structured special education classroom that can offer them individualized academic program. These students require a learning environment in which they see themselves as competent and productive.

If the student uses repetitive verbal arguments and/or repetitive verbal questions you need to interrupt what can become a continuing, repetitive litany. Continually responding in a logical manner or arguing back seldom stops this behaviour. The subject of the argument or question is not always the subject, which has been upsetting. More often the individual is communicating a feeling of loss of control or uncertainty about someone or something in the environment.

Try writing down, or drawing the problem, as you perceive it. Invite the student to add or change the “picture” by writing or drawing. Stick figure drawings can be very helpful in focusing the student on what is distressing while distracting him or her from the escalating verbal aspect of the situations.

Poor Concentration

A tremendous amount of regimented external structure must be provided if the child with AS is to be productive in the classroom. Assignments should be broken down into small units, and frequent teacher feedback and redirection should be offered.

Students with severe concentration problems benefit from timed work sessions.

Make sure the student knows what to do, when it will be finished and what activity will follow. This will help the child to focus on the task rather than wasting time and energy stressing over the volume of work, the perceived time it will take and worrying about what will be next.

In the case of the AS student in the regular class, poor concentration, slow clerical speed and severe disorganization may make it necessary to lessen his or her work load and or provide time in a quieter room such as a resource room where a special education teacher can provide the additional structure the child needs to complete work.

Discuss the feasibility of homework with the students’ parents. Some AS students are extremely exhausted at the end of a school day. Homework can place undue stress on the student and on parents.

Seat the child with AS at the front of the class to minimize distractions and help to facilitate involvement in class discussions and lessons.

Consider the visual stimulation in the classroom. If possible, keep bulletin boards simple and avoid hanging work, signs or posters within the range of vision of the student with AS.

Use dividers or work carrels to block visually distracting stimulus

Actively encourage the child with AS to leave his or her inner thoughts / fantasies behind and refocus on the real world.



Poor Organizational Skills

Provide the student with a personalized daily schedule. Activities can be crossed off, checked off or removed (if on cards attached with paper clips or Velcro) as they have been completed.

People with AS have trouble with organizational skills regardless of their intelligence or age. Even an “A student” with a photographic memory can be incapable of remembering to bring a pencil or remembering an assignment. Strategies could include having the student put a picture of a pencil on the cover of his or her notebook or maintaining a list of assignments to be completed. A lecture on the subject will NOT help; it will often make the problem worse.

AS students either have the neatest or messiest desks and lockers in the school. Remember that the individual is not making a conscious choice to be mess and is most likely incapable of organizational tasks without training. Attempt to train him or her in organizational skills using small, specific steps.

Teach the use of organizers such as charts, word webs, story maps, street maps and graphs.

Poor Motor Coordination

Refer the child with AS for occupational therapy for gross motor and fine motor difficulties.

Do not push the student to participate in competitive sports, as his or her poor motor coordination may only invite frustration and the teasing of team members. The individual with AS lacks the social understanding of coordinating one’s own actions with those of others on a team.

Individuals with AS may be more successful typing that writing. Consult with an occupational therapist to determine if the student can be taught keyboarding skills and whether a computer or other assistive device might be helpful.

When assigning timed units of work, make sure the child’s slower writing speed is taken into account. Whenever possible provide graphic organizers or fill-in-the blank types of work activities to reduce the amount of writing required.

Academic Difficulties

Provide a highly individualized academic program engineered to offer consistent successes. The student with AS needs great motivation to not follow his or her own impulses. Learning must be rewarding and not anxiety provoking.

Do not assume that students with AS understand something just because they parrot back what they have heard.

Provide as much visual structure to lessons as possible. Students with AS will more readily grasp information and retain information that is presented in a pictorial format or in writing than they will the spoken word.

Some individuals will acquire abstract skills but others never will. When abstract concepts must be used, use visual cue to augment the abstract idea. Capitalize on these individuals’ exceptional rote memory. Retaining factual information is their forte.

Emotional nuances, multiple levels of meaning, and relationship issues as presented in novels will often not be understood.

Students with AS often have excellent reading recognition skills, but language comprehension is weak. Do not assume they understand what they so fluently read.

Academic work may be of a poor quality because the student with AS is not motivated to exert effort in areas in which he or she is not interested. Firm expectations must be set for the quality of work produced.

Assume nothing when assessing skills. For example, the individual with autism or AS may be a “math whiz” in Algebra, but not able to make simple change at a cash register. He or she may have an incredible memory about books read, speeches heard, or sports statistics, but still might not remember all the materials required for class or remember to put the date and his name on the piece of work.

Asperger’s Syndrome – Resources

Books:

Asperger’s Syndrome: A Guide for Parents and Professionals

Tony Attwood

Jessica Kingsley Publishers, London, 1998.

ISBN 1 85302 577 1

Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage and Meltdowns

Brenda Smith Myles and Jack Southwick

Autism Asperger Publishing Co., 1999.

ISBN 0 9672514 3 5

Higher Functioning Adolescents and Young Adults with Autism: A Teacher’s Guide

Ann Fullerton, ed., Joyce Stratton, Phyliss Coyne, and Carol Gray

PRO-ED, Austin, Texas, 1996.

ISBN 0890796 815

Pretending To Be Normal: Living with Asperger’s Syndrome

Liane Holliday Willey

Jessica Kingsley Publishers, London, 1999

ISBN 1 85302 749 9

The Out of Sync Child: Recognizing and Coping with Sensory Integration Dysfunction

Carol Stock Kranowitz

Perigree, 1998.

ISBN 0 39952 386 3

Thinking in Pictures and Other Reports from My Life with Autism

Temple Grandin

Vintage Books, Random House, New York 1995.

ISBN 0 679 77289 8

Understanding the Nature of Autism

Janice E. Janzen

Therapy Skill Builders, San Antonio, Texas, 1996.

ISBN 0761643796






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