The autism spectrum extends from “classic autism” (which lies at the lower end of the spectrum) through to Aspergers (which is characterized as being at the mildest and highest functioning end of the spectrum).
Aspergers reflects deviations or abnormalities in four aspects of development:
1. Certain behavioral and stylistic characteristics such as repetitive or persevering features
2. Limited, but intense, range of interests
3. Social relatedness and social skills
4. The use of language for purposes of communication
These dysfunctional features can range from mild to severe.
Aspergers is characterized by:
• a better prognosis than other Autism spectrum disorders
• difficulties with pragmatic, or social language
• extending into the very superior range of cognitive ability
• high cognitive abilities - or, at least, “normal” IQ level
• normal language function when compared to other autistic disorders
Diagnostic Criteria from DSM—
Aspergers:
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
- 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)
- failure to develop peer relationships appropriate to developmental level
- lack of social or emotional reciprocity
- marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
B. 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 stereo-typed 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)
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrase used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
CLINICAL FEATURES—
One of the primary features of Aspergers is the child’s passion for favorite topics or special interests. Some of these areas include:
• astronomy
• dinosaurs
• extraterrestrials
• geography
• history
• machines or machinery
• maps
• math
• meteorology
• music
• reading
• science
• social studies
• space travel
• trains
• weather
Socialization deficits:
• Are inflexible and incapable of coping with change
• By school age express desire to fit in socially
• Described as being "in OUR world, but, ON THEIR OWN terms"
• Different from "typical" Autism
• Difficulties making social connections
• Easily stressed and emotionally vulnerable
• Frequently described as “odd” or selfish
• Highly frustrated by their social awkwardness/alienation
• Lack effective interaction skills — not desire
• Lack understanding of human relations and rules of social convention
• Naïve and lack common sense
• Preoccupied with own agenda
• Seldom interested in other's interests/concerns
• Unable to “read” others' needs and perspectives
• Unable to appropriately respond to social cues
Use of Language:
• Concrete language rather than abstract
• Difficulty understanding humor
• Early years: repetitive phrases or language or stock phrases from memorized material
• Excessively formal or pedantic language
• Hyper-verbal (highly developed vocabularies)
• Laugh at “wrong time” with jokes or interactions
• Many have good sense of humor
• Misused or not used cultural slang or social idioms
• Problems with taking turns in conversations
• Prosody (speech volume, intonation, inflection, rate) is frequently deficient or unusual
• Rote skills are strong
• Typically revert to favorite topic area
• Usually like word games and puns
• Weak pragmatic-conversational-skills
• Some have normal or early language development while others have speech delays, then rapidly catch up, making diagnosis between Aspergers, autism, and speech disorders difficult
TEACHING STRESS REDUCTION SKILLS—
Aspergers kids are:
• are often anxious and worrisome
• easily overwhelmed
• highly sensitive
• often engage in rituals
Practical Suggestions:
• consistent routines
• let them know what to expect
• minimize fears of unknown
• minimize transitions
• prepare them for altered plans, schedules or changes
• provide predictable, safe environments
Examples:
• Introduce to teacher, therapist or para-professional before work begins
• Take tour of building child will be working or learning in
• Learn about child's favorite topics or special interests
Aspergers kids typically display impaired social interaction…
Practical Suggestions:
• Create cooperative learning situations
• Educate peers
• Praise classmates when supportive
• Promote empathy and tolerance
• Shield them from bullying and teasing
Examples:
• Encourage participation in conversations
• Insensitive or inappropriate comments from Aspergers child are usually innocent
• Model two-way interactions
• Rehearse proper response repertoires
• Teach and support proper reaction to social cues
• Teach WHAT to say, WHEN, and HOW to say it
• Teach/model correct emotional responding
• Teaching WHY & WHAT response is appropriate is necessary
• Use Aspergers youngster’s strengths in exchange for liabilities to foster acceptance
COMMUNICATION AND GESTURES—
Six steps for understanding challenging communications…
1. Try to figure out what your youngster is communicating with the challenging behavior:
• “I can't remember what I'm supposed to do”
• “I'm mad…scared…confused”
• “This is too difficult for me”
2. Consider how you can adapt the situation:
• Child overwhelmed or over-stimulated? Try reducing amount of time in situation, or avoiding it in future.
• Child expressing confusion? Consider how to make the situation easier to understand; make it more concrete, routine, or predictable.
3. If the message must be communicated, come up with alternate way in which your youngster can communicate his or her needs or wishes more appropriately:
• Help your youngster develop appropriate ways of conveying requests/needs. If screaming when confused by a task, teach youngster to raise hand, ring a bell, or say: “I need help with this…this is too hard.”
4. Practice the “new way” of communicating:
• during the situation, remind (prompt) youngster to use new phrase or behavior
• have youngster practice the “new phrase” or behavior
• model more appropriate phrase or nonverbal signals
5. Reward your child for using the strategy by showing that it gets his or her needs met:
• if asks to leave situation, provide her with immediate break
• if needs attention, stop what you're doing and provide some time/interest
• if your youngster requests help assist her immediately
6. Be sure that the challenging behavior is no longer effective in getting your youngster’s needs met:
• ignore problem behaviors
• provide prompt for the “new, appropriate one
• if youngster screams to avoid situation, prompt him to use an appropriate phrase; don’t allow him to leave the situation while he is screaming
==> The Aspergers Comprehensive Handbook