Aspergers (now referred to as "high functioning autism") is a relatively new category of developmental disorder. Although a group of kids with this clinical picture was originally and very accurately described in the 1940's by a Viennese pediatrician, Hans Asperger, the disorder called Aspergers was "officially" recognized in the Diagnostic and Statistical Manual of Mental Disorders for the first time in the fourth edition published in l994. Because there have been few comprehensive review articles in the medical literature to date and because Aspergers is probably considerably more common than previously realized, this discussion will endeavor to describe the syndrome in some detail and to offer suggestions regarding management. Students with Aspergers are not uncommonly seen in mainstream educational settings, although often undiagnosed or misdiagnosed, so this is a topic of some importance for educational personnel, as well as for moms & dads.
Aspergers is the term applied to the mildest and highest functioning end of what is known as the spectrum of pervasive developmental disorders (or the autism spectrum). Like all conditions along that spectrum it is felt to represent a neurologically-based disorder of development, most often of unknown cause, in which there are deviations or abnormalities in three broad aspects of development: social relatedness and social skills, the use of language for communicative purposes and certain behavioral and stylistic characteristics involving repetitive or perseverative features and a limited but intense range of interests. It is the presence of these three categories of dysfunction, which can range from relatively mild to severe, which clinically defines all of the pervasive developmental disorders, from Aspergers through to classic autism. Although the idea of a continuum of PDD along a single dimension is helpful for understanding the clinical similarities of conditions along the spectrum, it is not at all clear that Aspergers is just a milder form of autism or that the conditions are linked by anything more than their broad clinical similarities.
Aspergers represents that portion of the PDD continuum which is characterized by higher cognitive abilities (at least normal IQ by definition and sometimes ranging up into the very superior range) and by more normal language function compared to other disorders along the spectrum. In fact, the presence of normal basic language skills is now felt to be one of the criteria for the diagnosis of Aspergers, although there are nearly always more subtle difficulties with pragmatic/social language. Many researchers feel it is these two areas of relative strength that distinguish Aspergers from other forms of autism and PDD and account for the better prognosis in Aspergers. Developmentalists have not reached consensus as to whether there is any difference between Aspergers and what is termed high functioning autism (HFA). Some researchers have suggested that the basic neuropsychological deficit is different for the two conditions, but others have been unconvinced that any meaningful distinction can be made between them. One researcher, Uta Frith, has characterized kids with Aspergers as having "a dash of autism." In fact, it is likely that there may be multiple underlying subtypes and mechanisms behind the broad clinical picture of Aspergers. This leaves room for some confusion regarding diagnostic terms and it is likely that quite similar kids across the country have been diagnosed with Aspergers, HFA, or PDD, depending upon by whom or where they are evaluated.
Since Aspergers itself shows a range or spectrum of symptom severity, many less impaired kids who might meet criteria for that diagnosis receive no diagnosis at all and are viewed as "unusual" or "just different," or are misdiagnosed with conditions such as Attention Deficit Disorder, emotional disturbance, etc. Many in the field believe that there is no clear boundary separating Aspergers from kids who are "normal but different." The inclusion of Aspergers as a separate category in the new DMS-4, with fairly clear criteria for diagnosis, should promote greater consistency of labeling in the future.
Epidemiology—
The best studies that have been carried out to date suggest that Aspergers is considerably more common than "classic" autism. Whereas autism has traditionally been felt to occur in about 4 out of every 10,000 kids, estimates of Aspergers have ranged as high as 20-25 per 10,000. That means that for each case of more typical autism, schools can expect to encounter several kids with a picture of Aspergers (that is even more true for the mainstream setting, where most kids with Aspergers will be found). In fact, a careful, population-based epidemiological study carried out by Gillberg's group in Sweden, concluded that nearly 0.7% of the kids studied had a clinical picture either diagnostic of or suggestive of Aspergers to some degree. Particularly if one includes those kids who have many of the features of Aspergers and seem to be milder presentations along the spectrum as it shades into "normal", it seems not to be a rare condition at all.
All studies have agreed that Aspergers is much more common in boys than in girls. The reasons for this are unknown. Aspergers is fairly commonly associated with other types of diagnoses, again for unknown reasons, including: tic disorders such as Tourette disorder, attentional problems and mood problems such as depression and anxiety. In some cases there is a clear genetic component, with one parent (most often the father) showing either the full picture of Aspergers or at least some of the traits associated with Aspergers; genetic factors seem to be more common in Aspergers compared to more classic autism. Temperamental traits such as having intense and limited interests, compulsive or rigid style and social awkwardness or timid demeanor also seem to be more common, alone or in combination, in relatives of Aspergers kids. Sometimes there will be a positive family history of autism in relatives, further strengthening the impression that Aspergers and autism are sometimes related conditions. Other studies have demonstrated a fairly high rate of depression, both bipolar and unipolar, in relatives of kids with Aspergers, suggesting a genetic link in at least some cases. It seems likely that for Aspergers, as for autism, the clinical picture we see is probably influenced by many factors, including genetic ones, so that there is no single identifiable cause in most cases.
Definition—
The DSM-4 criteria for a diagnosis of Aspergers, with much of the language carrying over from the diagnostic criteria for autism, include the presence of:
Qualitative impairment in social interaction involving some or all of the following:
Aspergers is the term applied to the mildest and highest functioning end of what is known as the spectrum of pervasive developmental disorders (or the autism spectrum). Like all conditions along that spectrum it is felt to represent a neurologically-based disorder of development, most often of unknown cause, in which there are deviations or abnormalities in three broad aspects of development: social relatedness and social skills, the use of language for communicative purposes and certain behavioral and stylistic characteristics involving repetitive or perseverative features and a limited but intense range of interests. It is the presence of these three categories of dysfunction, which can range from relatively mild to severe, which clinically defines all of the pervasive developmental disorders, from Aspergers through to classic autism. Although the idea of a continuum of PDD along a single dimension is helpful for understanding the clinical similarities of conditions along the spectrum, it is not at all clear that Aspergers is just a milder form of autism or that the conditions are linked by anything more than their broad clinical similarities.
Aspergers represents that portion of the PDD continuum which is characterized by higher cognitive abilities (at least normal IQ by definition and sometimes ranging up into the very superior range) and by more normal language function compared to other disorders along the spectrum. In fact, the presence of normal basic language skills is now felt to be one of the criteria for the diagnosis of Aspergers, although there are nearly always more subtle difficulties with pragmatic/social language. Many researchers feel it is these two areas of relative strength that distinguish Aspergers from other forms of autism and PDD and account for the better prognosis in Aspergers. Developmentalists have not reached consensus as to whether there is any difference between Aspergers and what is termed high functioning autism (HFA). Some researchers have suggested that the basic neuropsychological deficit is different for the two conditions, but others have been unconvinced that any meaningful distinction can be made between them. One researcher, Uta Frith, has characterized kids with Aspergers as having "a dash of autism." In fact, it is likely that there may be multiple underlying subtypes and mechanisms behind the broad clinical picture of Aspergers. This leaves room for some confusion regarding diagnostic terms and it is likely that quite similar kids across the country have been diagnosed with Aspergers, HFA, or PDD, depending upon by whom or where they are evaluated.
Since Aspergers itself shows a range or spectrum of symptom severity, many less impaired kids who might meet criteria for that diagnosis receive no diagnosis at all and are viewed as "unusual" or "just different," or are misdiagnosed with conditions such as Attention Deficit Disorder, emotional disturbance, etc. Many in the field believe that there is no clear boundary separating Aspergers from kids who are "normal but different." The inclusion of Aspergers as a separate category in the new DMS-4, with fairly clear criteria for diagnosis, should promote greater consistency of labeling in the future.
Epidemiology—
The best studies that have been carried out to date suggest that Aspergers is considerably more common than "classic" autism. Whereas autism has traditionally been felt to occur in about 4 out of every 10,000 kids, estimates of Aspergers have ranged as high as 20-25 per 10,000. That means that for each case of more typical autism, schools can expect to encounter several kids with a picture of Aspergers (that is even more true for the mainstream setting, where most kids with Aspergers will be found). In fact, a careful, population-based epidemiological study carried out by Gillberg's group in Sweden, concluded that nearly 0.7% of the kids studied had a clinical picture either diagnostic of or suggestive of Aspergers to some degree. Particularly if one includes those kids who have many of the features of Aspergers and seem to be milder presentations along the spectrum as it shades into "normal", it seems not to be a rare condition at all.
All studies have agreed that Aspergers is much more common in boys than in girls. The reasons for this are unknown. Aspergers is fairly commonly associated with other types of diagnoses, again for unknown reasons, including: tic disorders such as Tourette disorder, attentional problems and mood problems such as depression and anxiety. In some cases there is a clear genetic component, with one parent (most often the father) showing either the full picture of Aspergers or at least some of the traits associated with Aspergers; genetic factors seem to be more common in Aspergers compared to more classic autism. Temperamental traits such as having intense and limited interests, compulsive or rigid style and social awkwardness or timid demeanor also seem to be more common, alone or in combination, in relatives of Aspergers kids. Sometimes there will be a positive family history of autism in relatives, further strengthening the impression that Aspergers and autism are sometimes related conditions. Other studies have demonstrated a fairly high rate of depression, both bipolar and unipolar, in relatives of kids with Aspergers, suggesting a genetic link in at least some cases. It seems likely that for Aspergers, as for autism, the clinical picture we see is probably influenced by many factors, including genetic ones, so that there is no single identifiable cause in most cases.
Definition—
The DSM-4 criteria for a diagnosis of Aspergers, with much of the language carrying over from the diagnostic criteria for autism, include the presence of:
Qualitative impairment in social interaction involving some or all of the following:
- and lack of social or emotional reciprocity
- failure to develop age-appropriate peer relationships
- impaired use of non-verbal behaviors to regulate social interaction
- lack of spontaneous interest in sharing experiences with others
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities involving:
- inflexible adherence to specific non-functional routines or rituals
- preoccupation with one or more stereotyped and restricted pattern of interest
- stereotyped or repetitive motor mannerisms, or preoccupation with parts of objects
These behaviors must be sufficient to interfere significantly with social or other areas of functioning. Furthermore, there must be no significant associated delay in either general cognitive function, self-help/adaptive skills, interest in the environment or overall language development.
Christopher Gillberg, a Swedish physician who has studied Aspergers extensively, has proposed six criteria for the diagnosis, elaborating upon the criteria set forth in DSM-4. His six criteria capture the unique style of these kids and include:
Social impairment with extreme egocentricity, which may include:
- socially and emotionally inappropriate responses
- poor appreciation of social cues
- lack of desire to interact with peers
- inability to interact with peers
Limited interests and preoccupations, including:
- repetitive adherence
- relatively exclusive of other interests
- more rote than meaning
Repetitive routines or rituals, that may be:
- imposed on self, or
- imposed on others
Speech and language peculiarities, such as:
- superficially perfect expressive language
- odd prosody, peculiar voice characteristics
- impaired comprehension including misinterpretation of literal and implied meanings
- delayed early development possible but not consistently seen
Non-verbal communication problems, such as:
- peculiar "stiff" gaze
- limited use of gesture
- limited or inappropriate facial expression
- difficulty adjusting physical proximity
- clumsy body language
Motor clumsiness:
- may not be necessary part of the picture in all cases
Clinical Features—
The most obvious hallmark of Aspergers and the characteristic that makes these kids so unique and fascinating, is their peculiar, idiosyncratic areas of "special interest". In contrast to more typical autism, where the interests are more likely to be objects or parts of objects, in Aspergers the interests appear most often to be specific intellectual areas. Often, when they enter school, or even before, these kids will show an obsessive interest in an area such as math, aspects of science, reading (some have a history of hyperlexia--rote reading at a precocious age) or some aspect of history or geography, wanting to learn everything possible about that subject and tending to dwell on it in conversations and free play. I have seen a number of kids with Aspergers who focus on maps, weather, astronomy, various types of machinery or aspects of cars, trains, planes or rockets. Interestingly, as far back as Asperger's original clinical description in 1944, the area of transport has seemed to be a particularly common fascination (he described kids who memorized the tram lines in Vienna down to the last stop). Many kids with Aspergers, as young as three years old, seem to be unusually aware of things such as the route taken on car trips. Sometimes the areas of fascination represent exaggerations of interests common to kids in our culture, such as Ninja Turtles, Power Rangers, dinosaurs, etc. In many kids the areas of special interest will change over time, with one preoccupation replaced by another. In some kids, however, the interests may persist into adulthood and there are many cases where the childhood fascinations have formed the basis for an adult career, including a good number of college professors.
The other major characteristic of Aspergers is the socialization deficit, and this, too, tends to be somewhat different than that seen in typical autism. Although kids with Aspergers are frequently noted by educators and moms & dads to be somewhat "in their own world" and preoccupied with their own agenda, they are seldom as aloof as kids with autism. In fact, most kids with Aspergers, at least once they get to school age, express a desire to fit in socially and have friends. They are often deeply frustrated and disappointed by their social difficulties. Their problem is not a lack of interaction so much as lack of effectiveness in interactions. They seem to have difficulty knowing how to "make connections" socially. Gillberg has described this as a "disorder of empathy", the inability to effectively "read" others' needs and perspectives and respond appropriately. As a result, kids with Aspergers tend to misread social situations and their interactions and responses are frequently viewed by others as "odd".
Although "normal" language skills are a feature distinguishing Aspergers from other forms of autism and PDD, there are usually some observable differences in how kids with Aspergers use language. It is the more rote skills that are strong, sometimes very strong. Their prosody--those aspects of spoken language such as volume of speech, intonation, inflection, rate, etc.--is frequently unusual. Sometimes the language sounds overly formal or pedantic, idioms and slang are often not used or are misused, and things are often taken too literally. Language comprehension tends toward the concrete, with increasing problems often arising as language becomes more abstract in the upper grades. Pragmatic, or conversational, language skills often are weak because of problems with turn-taking, a tendency to revert to areas of special interest or difficulty sustaining the "give and take" of conversations. Many kids with Aspergers have difficulties dealing with humor, tending not to "get" jokes or laughing at the wrong time; this is in spite of the fact that quite a few show an interest in humor and jokes, particularly things such as puns or word games. The common belief that kids with pervasive developmental disorders are humorless is frequently mistaken. Some kids with Aspergers tend to be hyper-verbal, not understanding that this interferes with their interactions with others and puts others off.
When one examines the early language history of kids with Aspergers there is no single pattern: some of them have normal or even early achievement of milestones, while others have quite clear early delays on speech with rapid catch-up to more normal language by the time of school entry. In such a youngster under the age of three years in whom language has not yet come up into the normal range, the differential diagnosis between Aspergers and milder autism can be difficult to the point that only time can clarify the diagnosis. Frequently, also, particularly during the first several years, associated language features similar to those in autism may be seen, such as perseverative or repetitive aspects to language or use of stock phrases or lines drawn from previously heard material.
Aspergers Through the Lifespan—
In his original 1944 paper describing the kids who later came to be described under his name, Hans Asperger recognized that although the symptoms and problems change over time, the overall problem is seldom outgrown. He wrote that "in the course of development, certain features predominate or recede, so that the problems presented change considerably. Nevertheless, the essential aspects of the problem remain unchanged. In early childhood there are the difficulties in learning simple practical skills and in social adaptation. These difficulties arise out of the same disturbance which at school age cause learning and conduct problems, in adolescence job and performance problems and in adulthood social and marital conflicts." On the other hand, there is no question that kids with Aspergers have generally milder problems at every age compared to those with other forms of autism or PDD, and their ultimate prognosis is certainly better. In fact, one of the more important reasons to distinguish Aspergers from other forms of autism is it's considerably milder natural history.
The preschool youngster:
As has been noted, there is no single, uniform presenting picture of Aspergers in the first 3-4 years. The early picture may be difficult to distinguish from more typical autism, suggesting that when evaluating any young youngster with autism and apparently normal intelligence, the possibility should be entertained that he/she may eventually have a picture more compatible with an Asperger diagnosis. Other kids may have early language delays with rapid "catch-up" between the ages of three and five years. Finally, some of these kids, particularly the brightest ones, may have no evidence of early developmental delay except, perhaps, some motor clumsiness. In almost all cases, however, if one looks closely at the youngster between the age of about three and five years, clues to the diagnosis can be found, and in most cases a comprehensive evaluation at that age can at least point to a diagnosis along the PDD/autism spectrum. Although these kids may seem to relate quite normally within the family setting, problems are often seen when they enter a preschool setting. These may include: a tendency to avoid spontaneous social interactions or to show very weak skills in interactions, problems sustaining simple conversations or a tendency to be perseverative or repetitive when conversing, odd verbal responses, preference for a set routine and difficulty with transitions, difficulty regulating social/emotional responses with anger, aggression, or excessive anxiety, hyperactivity, appearing to be "in one's own little world", and the tendency to over-focus on particular objects or subjects. Certainly, this list is much like the early symptom list in autism or PDD. Compared to those kids, however, the youngster with Aspergers is more likely to show some social interest in adults and other kids, will have less abnormal language and conversational speech and may not be as obviously "different" from other kids. Areas of particularly strong skills may be present, such as letter or number recognition, rote memorization of various facts, etc.
Elementary school:
The youngster with Aspergers will frequently enter kindergarten without having been adequately diagnosed. In some cases, there will have been behavioral concerns (hyperactivity, inattention, aggression, outbursts) in the preschool years; there may be concern over "immature" social skills and peer interactions; the youngster may already be viewed as being somewhat unusual. If these problems are more severe, special education may be suggested, but probably most kids with Aspergers enter a more mainstream setting. Often, academic progress in the early grades is an area of relative strength; for example, rote reading is usually quite good and calculation skills may be similarly strong, although pencil skills are often considerably weaker. The teacher will probably be struck by the youngster's "obsessive" areas of interest, which often intrude in the classroom setting. Most Aspergers kids will show some social interest in other kids, although it may be reduced, but they are likely to show weak friend-making and friend-keeping skills. They may show particular interest in one or a few kids around them, but usually the depth of their interactions will be relatively superficial. On the other hand, I have known quite a number of kids with Aspergers who present as pleasant and "nice", particularly when interacting with adults. The social deficit, when less severe, may be under appreciated by many observers.
The course through elementary school can vary considerably from youngster to youngster, and overall problems can range from mild and easily managed to severe and intractable, depending upon factors such as the youngster's intelligence level, appropriateness of management at school and parenting at home, temperamental style of the youngster, and the presence or absence of complicating factors such as hyperactivity/attentional problems, anxiety, learning problems, etc.
The upper grades:
As the youngster with Aspergers moves into middle school and high school, the most difficult areas continue to be those related to socialization and behavioral adjustment. Paradoxically, because kids with Aspergers are frequently managed in mainstream educational settings, and because their specific developmental problems may be more easily overlooked (especially if they are bright and do not act too "strange"), they are often misunderstood at this age by both educators and other kids. At the secondary level, educators often have less opportunity to get to know a youngster well and problems with behavior or work/study habits may be mis-attributed to emotional or motivational problems. In some settings, particularly less familiar or structured ones such as the cafeteria, physical education class or playground, the youngster may get into escalating conflicts or power struggles with educators or kids who may not be familiar with their developmental style of interacting. This can sometimes lead to more serious behavioral flare-ups. Pressure may build up in such a youngster with little clue until he then reacts in a dramatically inappropriate manner.
In middle school, where the pressures for conformity are greatest and tolerance for differences the least, kids with Aspergers may be left out, misunderstood or teased and persecuted. Wanting to make friends and fit in, but unable to, they may withdraw even more, or their behavior may become increasingly problematic in the form of outbursts or non-cooperation. Some degree of depression is not uncommon as a complicating feature. If there are no significant learning disabilities, academic performance can continue strong, particularly in those areas of particular interest; often, however, there will be ongoing subtle tendencies to misinterpret information, particularly abstract or figurative/idiomatic language. Learning difficulties are frequent and attentional and organizational difficulties may be present.
Fortunately, by high school peer tolerance for individual variations and eccentricity often increases again to some extent. If a youngster does well academically, that can bring a measure of respect from other kids. Some Aspergers kids may pass socially as "nerds", a group which they actually resemble in many ways and which may overlap with AS. The Aspergers adolescent may form friendships with other kids who share his interests through avenues such as computer or math clubs, science fairs, Star Trek clubs, etc. With luck and proper management, many of these kids will have developed considerable coping skills, "social graces", and general ability to "fit in" more comfortably by this age, thus easing their way.
Aspergers in adults:
It is important to note that we have limited solid information regarding the eventual outcome for most kids with Aspergers. It has only been recently that Aspergers itself has been distinguished from more typical autism in looking at outcomes and milder cases were generally not recognized. Nonetheless, the available data does suggest that, compared to other forms of autism/PDD, kids with Aspergers are much more likely to grow up to be independently functioning adults in terms of employment, marriage and family, etc.
One of the most interesting and useful sources of data on outcome comes indirectly from observing those moms & dads or other relatives of Aspergers kids, who themselves appear to have Aspergers. From these observations it is clear that Aspergers does not preclude the potential for a more "normal" adult life. Commonly, these adults will gravitate to a job or profession that relates to their own areas of special interest, sometimes becoming very proficient. A number of the brightest kids with Aspergers are able to successfully complete college and even graduate school. Nonetheless, in most cases they will continue to demonstrate, at least to some extent, subtle differences in social interactions. They can be challenged by the social and emotional demands of marriage, although we know that many do marry. Their rigidity of style and idiosyncratic perspective on the world can make interactions difficult, both in and out of the family. There is also the risk of mood problems such as depression and anxiety, and it is likely that many find their way to psychiatrists and other mental health providers where, Gillberg suggests, the true, developmental nature of their problems may go unrecognized or misdiagnosed.
In fact, Gillberg has estimated that perhaps 30-50% of all adults with Aspergers are never evaluated or correctly diagnosed. These adults are viewed by others as "just different" or eccentric, or perhaps they receive other psychiatric diagnoses. I have met a number of individuals whom I believe fall into that category, and I am struck by how many of them have been able to utilize their other skills, often with support from loved ones, to achieve what I consider to be a high level of function, personally and professionally. It has been suggested that some of these highest functioning and brightest individuals with Aspergers represent a unique resource for society, having the single mindedness and consuming interest to advance our knowledge in various areas of science, math, etc.
Thoughts for Management in the School—
The most important starting point in helping a child with Aspergers function effectively in school is for the staff (all who will come into contact with the youngster) to realize that the youngster has an inherent developmental disorder which causes him or her to behave and respond in a different way from other kids. Too often, behaviors in these kids are interpreted as "emotional", or "manipulative", or some other term that misses the point that they respond differently to the world and its stimuli. It follows from that realization that school staff must carefully individualize their approach for each of these kids; it will not work out to treat them just the same as other kids. Asperger himself realized the central importance of teacher attitude from his own work with these kids. In 1944 he wrote, "These kids often show a surprising sensitivity to the personality of the teacher...They can be taught, but only by those who give them true understanding and affection, people who show kindness towards them and, yes, humor...The teacher's underlying emotional attitude influences, involuntarily and unconsciously, the mood and behavior of the youngster."
Although it is likely that many kids with Aspergers can be managed primarily in the regular classroom setting, they often need some educational support services. If learning problems are present, resource room or tutoring can be helpful, to provide individualized explanation and review. Direct speech services may not be needed, but the speech and language clinician at school can be useful as a consultant to the other staff regarding ways to address problems in areas such as pragmatic language. If motor clumsiness is significant, as it sometimes is, the school Occupational Therapist can provide helpful input. The school counselor or social worker can provide direct social skills training, as well as general emotional support. Finally, a few kids with very high management needs may benefit from assistance from a classroom aide assigned to them. On the other hand, some of the higher functioning kids and those with milder Aspergers, are able to adapt and function with little in the way of formal support services at school, if staff are understanding, supportive and flexible.
There are a number of general principles of managing most kids with PDD of any degree in school, and they apply to Aspergers, as well:
- Try to avoid escalating power struggles. These kids often do not understand rigid displays of authority or anger and will themselves become more rigid and stubborn if forcefully confronted. Their behavior can then get rapidly out of control, and at that point it is often better for the staff person to back off and let things cool down. It is always preferable, when possible, to anticipate such situations and take preventative action to avoid the confrontation through calmness, negotiation, presentation of choices or diversion of attention elsewhere.
- The classroom routines should be kept as consistent, structured and predictable as possible. Kids with Aspergers often don't like surprises. They should be prepared in advance, when possible, for changes and transitions, including things such as schedule breaks, vacation days, etc.
- Staff should take full advantage of a youngster's areas of special interest when teaching. The youngster will learn best when an area of high personal interest is on the agenda. Teachers can creatively connect the youngster's interests to the teaching process. One can also use access to the special interests as a reward to the youngster for successful completion of other tasks or adherence to rules or behavioral expectations.
- Rules should be applied carefully. Many of these kids can be fairly rigid about following "rules" quite literally. While clearly expressed rules and guidelines, preferably written down for the child, are helpful, they should be applied with some flexibility. The rules do not automatically have to be exactly the same for the youngster with Aspergers as for the rest of the kids--their needs and abilities are different.
- Most kids with Aspergers respond well to the use of visuals: schedules, charts, lists, pictures, etc. In this way they are much like other kids with PDD and autism.
- Insure that school staff outside of the classroom, such as physical education educators, bus drivers, cafeteria monitors, librarians, etc., are familiar with the youngster's style and needs and have been given adequate training in management approaches. Those less structured settings where the routines and expectations are less clear ten to be difficult for the youngster with Aspergers.
- In general, try to keep teaching fairly concrete. Avoid language that may be misunderstood by the youngster with Aspergers, such as sarcasm, confusing figurative speech, idioms, etc. Work to break down and simplify more abstract language and concepts.
- Explicit, didactic teaching of strategies can be very helpful, to assist the youngster gain proficiency in "executive function" areas such as organization and study skills.
A major area of concern as the youngster moves through school is promotion of more appropriate social interactions and helping the youngster fit in better socially. Formal, didactic social skills training can take place both in the classroom and in more individualized settings. Approaches that have been most successful utilize direct modeling and role playing at a concrete level (such as in the Skillstreaming Curriculum). By rehearsing and practicing how to handle various social situations, the youngster can hopefully learn to generalize the skills to naturalistic settings. It is often useful to use a dyad approach where the youngster is paired with another to carry out such structured encounters. The use of a "buddy system" can be very useful, since these kids relate best 1-1. Careful selection of a non-Aspergers peer buddy for the youngster can be a tool to help build social skills, encourage friendships and reduce stigmatization. Care should be taken, particularly in the upper grades, to protect the youngster from teasing both in and out of the classroom, since it is one of the greatest sources of anxiety for older kids with Aspergers. Efforts should be made to help other kids arrive at a better understanding of the youngster with Aspergers, in a way that will promote tolerance and acceptance. Teachers can take advantage of the strong academic skills that many Aspergers kids have, in order to help them gain acceptance with peers. It is very helpful if the Aspergers youngster can be given opportunities to help other kids at times.
Although most kids with Aspergers are managed without medication and medication does not "cure" any of the core symptoms, there are specific situations where medication can occasionally be useful. Teachers should be alert to the potential for mood problems such as anxiety or depression, particularly in the older youngster with Aspergers. Medication with an antidepressant (e.g., imipriamine or one of the newer serotonergic drugs such as fluoxetine) may be indicated if mood problems are significantly interfering with the youngster's functioning. Some kids with significant compulsive symptoms or ritualistic behaviors can be helped with the same serotonergic drugs or clomipramine. Problems with inattention at school that are seen in certain kids can sometimes be helped by stimulant medications such as methylphenidate or dextroamphetamine, much in the same way they are used to treat Attention Deficit Disorder. Occasionally, medication may be needed to address more severe behavior problems that have not responded to non-medical, behavioral interventions. Clonidine is one medication that has proven helpful in such situations and there are other options if necessary.
In attempting to put a comprehensive teaching and management plan into place at school, it is often helpful for staff and moms & dads to work closely together, since moms & dads often are most familiar with what has worked in the past for a given youngster. It is also wise to put as many details of the plan as possible into an Individual Educational Plan so that progress can be monitored and carried over from year to year. Finally, in devising such plans, it can sometimes be helpful to enlist the aid of outside consultants familiar with the management of kids with Aspergers and other forms of PDD, such as Boces consultants, psychologists, or physicians. In complex cases a team orientation is always advisable.
COMMENTS:
• Anonymous said... A MUST READ for Parents!
• Anonymous said... Maybe people should read this and have a better understanding
• Anonymous said... The best article I've seen to date. My 13 y/o would have benefited greatly in her younger years had family and school officials known this information. In many places nailed our experience exactly.
• Anonymous said... The information about how Asperger's presents is very informative and interesting; just be aware that the diagnostic information in the beginning of the article is outdated - the new DSM-5 has changed the diagnostic criteria somewhat and no longer separates Asperger's from other autism spectrum disorders.
• Anonymous said... It's not outdated for those in other countries - just the U.S. It's still "Aspergers" in the U.K., for example. Also, those who have been diagnosed with "Aspergers" prior to the DSM-5 keep their original diagnosis of Aspergers.
• Anonymous said... This is a wonderful and informative article! It is spot on with our daughter. I wish more people would take the time to read things like this so they will better understand what Asperger's is all about.
• Anonymous said... This is the best and most complete article ive ever read for my 8 yr old.
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