Hello Mr. Hutten: I am a Master of Social Work student at the University of Windsor in Canada. I am currently doing a clinical placement at a children’s mental health organization. I am very interested in Asperger’s and would like to move forward with a research proposal for my MSW thesis. More specifically, I am interested in examining whether (through treatment) it is possible to assist adolescents in shifting their fixation/obsession with a specific object. The reason I am interested in this is because we are currently working with an adolescent who has a fixation with cars and this fixation is potentially harmful to him and others due to the fact that he has already been in contact with the law from this fixation. If it is possible to shift a fixation through treatment, my colleagues and I would like to know what treatment approaches are successful. Would you be able to answer this question or point me in the right direction (i.e. specific studies surrounding evidence based treatment)?
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Your school library should have several psychiatric journals that have researched Aspergers fixations and how to address them. I’m not aware of any evidenced-based treatment programs that address fixations specifically.
Fixations (or perseverations) with certain topics or objects (e.g., books, video games, trains, history, movies, etc.) are a classic symptom of Aspergers. In addition to impairments in social functioning, the DSM lists as a characteristic of the disorder restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
- apparently inflexible adherence to specific, nonfunctional routines or rituals
- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- persistent preoccupation with parts of objects
- stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
While these fixations must be understood and accepted as part of the disorder, they are also coping mechanisms that young people with Aspergers use to escape social anxiety.
For example, video games are becoming an increasingly common interest among young people with Aspergers. Although the virtual world of games can be a great place for young people to practice social skills, make friends, and have fun, the interest in video games can quickly become an unhealthy and even dangerous obsession.
For young people who get picked on all day at school or feel ostracized and out of place in their everyday lives, it's soothing to come home and play video games for hours. In the safe haven of online gaming, young people with Aspergers can isolate themselves from real-life people and the complexities of face-to-face interactions.
However, the social setting in online gaming or chat rooms is unrealistic and far more predictable than real-life social situations. While social conversations in real life are highly complex and unpredictable, online gamers share a common and simple language for communicating.
Since most online interaction occurs through typing, there is time to think about a response, and the response can be given in symbols and phrases without regard for facial expressions or nonverbal cues. In addition, curse words, rude remarks, and hurtful jokes may be considered socially acceptable online, but they will not be welcome responses in the real world. This disjunction between socially acceptable interactions in the virtual world and the real world can be terribly confusing to young people with Aspergers who already struggle to understand basic social conventions.
Moms and dads of a youngster with Aspergers are thus faced with a dilemma: Do we limit our youngster's time spent doing the activities that interest him most and run the risk that he will withdraw even more, or do we allow him ongoing, easy access to things like video games and science fiction/fantasy books and movies despite the obvious social repercussions?
It’s important for mothers and fathers to find the balance between accepting their youngster's unique interests, and encouraging him to develop social skills and additional interests that might take him outside of his comfort zone. By granting unlimited access to video games and other fixations, parents offer their young ones nothing more than a quick fix. The perseveration may be a convenient coping skill for facing the hardship of a long, difficult day at school but it will not be the healthiest path into adulthood.
Young people with Aspergers need to be challenged to explore other interests and find healthier coping skills. It's easy to use video games and other antisocial outlets to cope, but easier isn't usually better.
If Aspergers children aren't encouraged and helped to develop social skills and independent living skills, there will be a direct impact on how many friends they have, and how successful they are in school and on the job later in life. They may be soothed in the short term, but that deep underlying desire to make friends or have a boyfriend or girlfriend will remain a source of constant dissatisfaction and further isolation.
Addressing fixations is difficult for the parent. On one hand, video games and other interests encourage more social interaction than young people with Aspergers would ordinarily have, but on the other hand, it's not the kind of social interaction that prepares them for life.
Parents should encourage their youngster to develop interpersonal skills off of the computer, and set limits around how often their youngster with Aspergers uses or talks about their fixations. Mothers/fathers should also offer incentives to their youngster to balance his time spent focused on the fixation and time spent doing social activities. For example, if a youngster is passionate about video games, a parent could agree to allow the youngster a certain amount of time to play each week in exchange for the youngster's participation in an after-school activity.
When young people with Aspergers have “structure” around when they can engage in their particular interest, they are more willing to accept rules limiting its use. In our facility, the Aspergers child is allowed to read his favorite book at designated times, but he is not permitted to bring the book to meals. This way, the child learns that his interest is perfectly acceptable when explored in socially appropriate ways, places, and times.
The fixations of young children with Aspergers fulfill a need in their lives that will likely never disappear completely. However, their usefulness in real life is extremely limited. Everyone needs an occasional break from the rigors of daily life, but Aspergers children depend on their mothers and fathers to set limits around these fixations and offer guidance in navigating the complex social world around them. By making a plan and following through with it, you accept your Aspergers child for the unique being he is while giving him the tools he needs to live up to his full potential.
Many of the advances in history have been made by people who are obsessed with one topic – learning more about it, experimenting with it, sharing their knowledge, etc. Great discoveries can come out of this obsessive focus.
In an ideal world, there would be a way to turn an obsession into a productive job. With some obsessions such as counting ceiling tiles, you might have to be a bit more creative …but if an Aspergers child is consumed by his interest in cars, he may be able to combine his interest with a useful profession.
Sometimes the obsession is so all-encompassing that it's hard to get the youngster to pay attention to anything else. This means that he'll be missing some of the learning time he needs to develop his other skills.
In my experience, it's very difficult, almost impossible to remove a kid's obsession. If you absolutely forbid access to the obsession, the upset might be huge and last for a long time and the child might cling even more tenaciously to what he wants.
Rather, you may have better luck in limiting his access to his current fixation. You could employ the "First.....then....." strategy. First, he must complete this task, then he gets so many minutes of ______ time …or you could ration his time by clocks or timers. Every half hour, he gets five minutes of _____. You'd have to adjust the times to whatever is reasonable for your Aspergers youngster. You could gradually increase the time intervals or the amount of work he must accomplish before he gets time for the activity of his choice.
Rather than attempting to remove his access to it totally, you could try to find a substitute. Just plain removing an obsession may not work, but finding a substitute may.
The substitute would need to fill some of the same purpose that the Aspergers child finds in his obsession. This takes some detective work on the parent’s part. Does he like the sound? Is the appeal visual? Feels? Smells?
Once you figure out what the appeal may be, then you can start to find appropriate substitutes. A word of caution though; whatever you substitute could then become the child’s obsession. So, make sure the substitute is socially acceptable, age appropriate and something that could endure for several years.
If you have access to an Occupational Therapist (OT), they're great at helping determine the possible sensory appeal some obsessions may have for your client and in coming up with acceptable substitutes. If there is no OT available, you can play detective yourself.
Sometimes, an Aspergers child will cling more tenaciously to his obsession when he's upset or unsure. The more calm and sure he is of his routine, the more he may feel he can let the obsession go or at least spend less time on it.
Children with Aspergers love routine. When you have trouble making sense of your world, it's hard to predict what may come next, how it might affect you and what other people will expect of you. That's why routines and schedules are so important. A visual schedule lets the youngster know what will happen next in his day. And a visual schedule, whether in words or in pictures is better than just telling the kid. Besides, teaching him to rely on a schedule rather than on an adult telling him what to do helps in his independence.
Comment:
I would really like to know some ideas for computer/video game substitutes. My son particularly relies on these "fixations" during out-of-the-ordinary social times and we often let him play the games so that we're not all miserable. What else can we do?
Response:
Video games may seem like the dominant form of entertainment for kids nowadays, but it has proven to have its share of consequences, too. For example:
• growing waistlines
• lack of real social contact (cell phones, texting, and emails do not count here)
• shortened attention spans
But moms and dads have it in their power to show their kids there are in fact better ways than spending 5 plus hours a day in front of the X-Box or Nintendo. Assuming the youngster has schoolwork in addition to attending classes, video games can be cut down to a mere fifteen minutes a day, or not at all, in order to help increase a youngster's intellectual and emotional growth.
1. Action figures increase kid’s visual motor skills, spatial skills, strategic planning skills, concentration and creativity. Winston Churchill considered action figures one of his favorite toys.
2. Books should always have a place in a youngster's bedroom, and they can be both fiction and non-fiction. Most grammar schools offer suggestions as to what is age appropriate for kids, but if your youngster is an advanced reader, library books will also work out fine. Being able to sit quietly and read will open up worlds for your youngster, stimulating not only intellectual but also creative capacity. If your youngster has dreams to become a writer, reading is very important as it will show him or her how a story or essay is well constructed.
3. Drawing and painting is another great alternative to video games. Creative skills are especially important for kids who do not have the opportunity to take art classes in school. As sad as it sounds, art and music classes are usually the first to be eliminated when school budgets need tightening. Art is helpful as it also allows a youngster to tell a story about the drawing or painting made.
4. Exercise is one of the best alternatives to a sedentary life of video games, too. Childhood obesity has grown in the past ten years as the result of this lifestyle. Playing outside, running around, bicycling, and creative play outdoors has been beneficial to kids in decades past, along with the monkey bars on the gym set. A few hours a day playing outside will get your youngster in shape and be close to nature, which will also stimulate and extend a youngster's attention span, which is required for reading and schoolwork.
5. Mad Gab increases auditory processing, divided attention and executive processing. It is an excellent game for kids that are learning to read! Mad Gab forces kids to think about words rather than guessing at them.
6. Music lessons have long been shown to help boost those math scores. The ability to read music and play a favorite instrument will also allow a youngster to appreciate cultural heritage, versus just listening to the rap and hip-hop so frequently played on the radio today.
7. O, Monopoly; so many moms and dads and kids have turned to this tried-and-true game, and for good reason. Monopoly teaches money skills, math concepts, investing and planning.
8. Pictionary increases visual memory.
9. Simon Says increases kid’s deductive reasoning skills, executive processing, numerical concept, planning, processing speed, selective attention, sustained attention and visual processing. Simon Says can be played anywhere – and it delivers fun and cognitive enrichment.
10. Taboo enhances word retrieval, builds vocabulary skills, increases one’s ability to think and create synonyms.
11. Yoyos enhance kid’s fine motor skills, dexterity, spatial planning skills and muscle coordination. Additionally, kids love yo-yoing! Learning yo-yo tricks is challenging; there will be frustrated moments for your youngster, but these moments present challenges the youngster must work through. Yo-yoing also assists kids with peripheral vision.
And the list would go on and on…
Be creative, use your imagination!