“If we had to choose only one, what would be the best intervention strategy for our child with HFA?”
For most children with High-Functioning Autism (HFA) and Asperger’s (AS), the most important treatment strategy would definitely be to enhance communication and social competence (i.e., social skills training).
The goal is not to force the child to “conform to societal pressure” or to stifle individuality and uniqueness. Instead, the goal reflects the fact that most kids on the autism spectrum are not loners by choice.
Also, there is a tendency (as these kids develop towards the teenage years) for anxiety, depression, despondency, and negativism as a result of the child’s increasing awareness of personal inadequacy in social situations, and repeated experiences of failure to make and maintain relationships.
The typical limitations of insight and self-reflection found in kids on the spectrum often prevent spontaneous self-adjustment to social and interpersonal demands. Social skills training prepares the “special needs” child to cope with social and interpersonal expectations, therefore enhancing his or her attractiveness as a conversational partner or as a potential friend or companion.
The following are suggestions intended to foster relevant skills in this crucial area:
1. The HFA or AS child should be taught to monitor his own speech style in terms of the following:
adjusting depending on proximity to the speaker
context and social situation
naturalness
number of people and background noise
rhythm
volume
2. Through verbal means, the child should be helped to recognize and use a range of different means to:
disagree
discuss
interact
mediate
negotiate
persuade
3. In order to increase the flexibility with which the child both thinks about - and uses language with - other people, it is be important to help the him or her to:
anticipate multiple outcomes
develop the ability to make inferences
explain motivation
predict
4. The effort to develop the HFA or AS child’s skills with peers in terms of managing social situations should be a priority. This should include:
ending topics appropriately
feeling comfortable with a range of topics that are typically discussed by same-age peers
shifting topics
the ability to expand and elaborate on a range of different topics initiated by others
topic management
5. Explicit verbal instructions on how to interpret other people's social behavior should be taught in a fashion not unlike the teaching of a foreign language (i.e., rote fashion; all elements should be made verbally explicit and appropriately and repeatedly drilled). For example:
facial and hand gestures
gaze
non-literal communications such as humor, figurative language, irony, sarcasm and metaphor
the meaning of eye contact
tone of voice
various inflections
6. The same principles should guide the training of the child’s expressive skills. Concrete situations should be exercised and gradually tried out in naturally occurring situations. All those in close contact with the child (teachers, coaches, etc.) should be made aware of the program so that consistency, monitoring and contingent reinforcement are maximized.
7. Encounters with unfamiliar people (e.g., making acquaintances) should be rehearsed until the child is made aware of the impact of her behavior on others’ reactions to her. Strategies include:
“We are wanting to get our child (high functioning) into some form of therapy. What things should we look for so we can find the best fit for her specific needs?”
The following are positive program specifications to be kept in mind when deciding on an appropriate program for children with High-Functioning Autism (HFA). These may not be applicable to every child; however, they are optimal conditions to keep in mind when dealing with program specifications.
Ideally, the program will include the following:
1. Opportunities for social interaction and facilitation of social relationships in fairly structured and supervised activities.
2. Relatively small setting with ample opportunity for individual attention, individualized approach, and small work groups.
3. The availability of a communication specialist with a specific interest in pragmatics and social skills training who can (a) be available for individual and small group work, and (b) make a communication and social skills training intervention an integral part of all activities. These activities should be implemented at all times, consistently, and across staff members, settings, and situations. This specialist can also act as a resource to the other staff members.
4. A concern for the acquisition of real-life skills and academic goals, making use of creative initiatives and making full use of the child’s interests and talents. For instance, given the fact that children with HFA often excel in certain activities, social situations may be constructed so as to allow him the opportunity to take the leadership in the activity, explaining, demonstrating, or teaching others how to improve in the particular activity.
Such situations are ideal to help kids on the autism spectrum:
Follow coherent and less one-sided goal-directed behaviors and approaches. Also, by taking the leadership in an activity, the child’s self-esteem is likely to be boosted, and her (usually difficult) position vis-a-vis peers is for once reversed.
Follow conversation and social interaction rules.
Take the perspective of others.
5. The availability of a sensitive therapist who can focus on the youngster’s emotional well-being and who could serve as a coordinator of services, serving as a resource to other staff members, monitoring progress, and providing effective and supportive liaison with the family.
6. Lastly, a willingness to adapt the curriculum content and requirements in order to flexibly provide opportunities for success, to foster the acquisition of a more positive self-concept, and to foster an internalized investment in performance and progress. This may mean that the child with HFA is provided with individual challenges in his or her areas of strength, and with individualized programs in his or her areas of weakness.
Resources for parents of children and teens on the autism spectrum:
The best treatment for Asperger's and high-functioning autistic children and teens is definitely “social skills training.” Social skills training is a form of behavior therapy used by therapists to help these "special needs" young people who have difficulties relating to other people. But, parents can teach social skills as well. It's especially easy to do so with the help of social skills DVDs and CDs.
“I have an autistic student (level 1, high functioning) in my 5th grade class this year and was needing to know if there are any communication impairments associated with the condition that I should be aware of. Thanks in advance.”
Although significant problems with speech are not typical of High-Functioning Autism (HFA), there are at least 4 features of these students’ communication skills that should be understood.
1. Though inflection and intonation are not be as rigid and monotonic as in classic autism, speech is often marked by poor prosody (i.e., patterns of stress and intonation). Young people with HFA often have an odd manner of speaking (e.g., words enunciated precisely and formally; the speed, volume and rhythm may be strange).
Problem areas to look out for include talking loudly, odd rhythms of speech, stilted or formal speech, monotonous sound, little or no inflection, and difficulties in coordinating speaking and breathing.
2. Speech is often vague and circumstantial, conveying a sense of looseness of associations and disjointedness. The lack of coherence and reciprocity in speech is a result of (a) the one-sided, egocentric conversational style (e.g., endless monologues about the names, codes, names of dinosaurs, etc.), and (b) failure to provide the background for comments and to clearly establish changes in topic.
3. Another aspect typifying the communication patterns of children with HFA concerns the significant verbosity observed (which some researchers see as one of the most prominent traits of HFA). The youngster may talk incessantly (usually about his or her favorite topic) with complete disregard to whether the listener is interested, engaged, attempting to interject a comment, or change the subject of conversation.
Despite such long-winded monologues, the child may never come to a point or conclusion. Attempts by peers to elaborate on issues of content or to shift the conversation to related topics are usually unsuccessful.
4. The possibility exists that all of these traits may be accounted for in terms of significant deficits in pragmatics skills and/or lack of awareness of other people's expectations. Pragmatics refers to language usage and the way that context relates to meaning. Kids on the autism spectrum often have difficulty in holding a normal conversation where there is “give and take” in the social interaction.
Problems with pragmatics manifest in a number of ways, including when the child is oblivious to emotional reactions in others, is oblivious to boredom in others, does not greet others and instead jumps right into a monologue, lacks facial expression and eye contact, interrupts others, gives too much detailed information, focuses exclusively on topics that interest him or her, does not use people’s names, and does not allow the other person to talk.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"How does one tell the difference between meltdowns and temper tantrums in a child with ASD level 1? I certainly do not want to punish my son for something he cannot control."
ASD level 1 or High-Functioning Autism is a neurological condition. The brain is wired differently, making this disorder a lifelong condition. It affects communication, social interaction and sensory issues. ASD is often referred to as the "invisible syndrome" because of the internal struggles these kids have without outwardly demonstrating any real noticeable symptoms. Thus, difficultly assessing someone with the disorder is even more impacted.
Kids with this disorder struggle with a problem and internalize their feelings until their emotions boil over, leading to a complete meltdown. These outbursts are not a typical temper tantrum. For children on the autism spectrum (and for their parents), these episodes are much worse.
Many of these kids may appear under-receptive or over-receptive to sensory stimulation and therefore may be suspected of having vision or hearing problems. Therefore, it's not unusual for parents or teachers to recommend hearing and vision tests. Some kids may avoid gentle physical contact such as hugs, yet they react positively to rough-and-tumble games. Some kids on the spectrum have a high pain tolerance, yet they may not like to walk barefoot in grass.
There are nine different types of temperaments in ASD children:
Distractible temperament predisposes the child to pay more attention to his or her surroundings than to the caregiver.
High intensity level temperament moves the child to yell, scream, or hit hard when feeling threatened.
Hyperactive temperament predisposes the child to respond with fine- or gross-motor activity.
Initial withdrawal temperament is found when children get clingy, shy, and unresponsive in new situations and around unfamiliar people.
Irregular temperament moves the child to escape the source of stress by needing to eat, drink, sleep, or use the bathroom at irregular times when he or she does not really have the need.
Low sensory threshold temperament is evident when the child complains about tight clothes and people staring and refuses to be touched by others.
Negative mood temperament is found when children appear lethargic, sad, and lack the energy to perform a task.
Negative persistent temperament is seen when the child seems stuck in his or her whining and complaining.
Poor adaptability temperament shows itself when children resist, shut down, and become passive-aggressive when asked to change activities.
Some meltdowns are worse than others, but all leave both parent and kid exhausted. Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it ends, both you and the autistic child are totally exhausted. But… don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day, and sometimes into the next, the meltdown can return full force.
Meltdowns are overwhelming emotions and quite common in kids on the spectrum. What causes them? It can be anything from a very minor incident to something more traumatic. How long do they last? It’s anyone’s guess. They last until the kid is either completely exhausted, or he gains control of his emotions, which is not easy for him to do.
If your youngster has to find ways to cope with the disorder, expect her to experience both minor and major meltdowns over incidents that are part of daily life. She may have a major meltdown over a very small incident, or may experience a minor meltdown over something that is major. There is no way of telling how she is going to react about certain situations. However, there are some ways to help your kid learn to control his emotions.
ASD children don’t really have the knowledge to decipher when their actions are inappropriate. When your kid is calm and relaxed, talk to her about her meltdowns if she is of an age where she can reason and learn to work with you. This will probably not be until the kid is seven or eight years old. Then, tell her that sometimes she does things that are not appropriate. Have her talk to you about a sign you can give her to let her know when this happens.
All you can do is be patient with your kid while she is having a meltdown, though they are emotionally exhausting for you as well as he. Never punish her for experiencing a meltdown. Overwhelming emotions are part of the traits associated with the disorder, but if you work with your kid, she will eventually learn to control them somewhat.
These young people don’t like surprises and some don’t like to be touched. Never rush to your youngster and give her a hug. If you want to hug her, tell her exactly what you are going to do. A surprise hug can send her into an even worse meltdown than she is already experiencing.
ASD kids like to be left alone to cope with emotions. If your kid says something like, “I just want to be left alone,” respect her wishes for at least a while. You can always go back in ten minutes and ask if you can help. Do not be hurt if she refuses.
Work with your youngster as she grows older to help her learn to cope with daily life. Remember, she sees the world much differently than we do and needs help deciphering exactly how we see the world. While working with her on this, she will give you clues as to how she sees the world and a firmer bond will be established.
It is much easier to prevent meltdowns than it is to manage them once they have erupted. Here are some tips for preventing meltdowns and some things you can say:
Avoid boredom. Say, “You have been working for a long time. Let’s take a break and do something fun.”
Change environments, thus removing the child from the source of the meltdown. Say, “Let’s go for a walk.”
Choose your battles. Teach children how to make a request without a meltdown and then honor the request. Say, “Try asking for that toy nicely and I’ll get it for you.”
Create a safe environment that children can explore without getting into trouble. Childproof your home or classroom so children can explore safely.
Distract children by redirection to another activity when they begin to meltdown over something they should not do or cannot have. Say, “Let’s read a book together.”
Do not ask children to do something when they must do what you ask. Do not ask, “Would you like to eat now?” Say, “It’s suppertime now.”
Establish routines and traditions that add structure. For teachers, start class with a sharing time and opportunity for interaction.
Give children control over little things whenever possible by giving choices. A little bit of power given to the child can stave off the big power struggles later. “Which do you want to do first, brush your teeth or put on your pajamas?”
Increase your tolerance level. Are you available to meet the child’s reasonable needs? Evaluate how many times you say, “No.” Avoid fighting over minor things.
Keep a sense of humor to divert the child’s attention and surprise the child out of the meltdown.
Keep off-limit objects out of sight and therefore out of mind. In an art activity keep the scissors out of reach if children are not ready to use them safely.
Make sure that children are well rested and fed in situations in which a meltdown is a likely possibility. Say, “Supper is almost ready, here’s a cracker for now.”
Provide pre-academic, behavioral, and social challenges that are at the child’s developmental level so that the child does not become frustrated.
Reward children for positive attention rather than negative attention. During situations when they are prone to meltdowns, catch them when they are being good and say such things as, “Nice job sharing with your friend.”
Signal children before you reach the end of an activity so that they can get prepared for the transition. Say, “When the timer goes off 5 minutes from now it will be time to turn off the TV and go to bed.”
When visiting new places or unfamiliar people explain to the child beforehand what to expect. Say, “Stay with your assigned buddy in the museum.”
There are a number of ways to handle a meltdown once it has started. Strategies include the following:
When possible, hold the child who is out of control and is going to hurt himself or herself or someone else. Let the child know that you will let him or her go as soon as he or she calms down. Reassure the child that everything will be all right, and help the child calm down. Parents may need to hug their child who is crying, and say they will always love him or her no matter what, but that the behavior has to change. This reassurance can be comforting for a child who may be afraid because he or she lost control.
If the child has escalated the meltdown to the point where you are not able to intervene in the ways described above, then you may need to direct the child to time-away (not to punish, but to remove the child from the current environment!). If you are in a public place, carry your child outside or to the car. Tell the child that you will go home unless he or she calms down. In school, warn the child up to three times that it is necessary to calm down and give a reminder of the rule. If the child refuses to comply, then place him or her in time-away for no more than 1 minute for each year of age (again, not to punish, but to remove the child from the current environment).
Remain calm and do not argue with the child. Before you manage the child, you must manage your own behavior. Spanking or yelling at the child will make the meltdown worse.
Talk with the child after the child has calmed down. When the child stops crying, talk about the frustration the child has experienced. Try to help solve the problem if possible. For the future, teach the child new skills to help avoid meltdowns such as how to ask appropriately for help and how to signal a parent or teacher that the he or she knows they need to go to “time away” to “stop, think, and make a plan.” Teach the child how to try a more successful way of interacting with a peer or sibling, how to express his or her feelings with words and recognize the feelings of others without hitting and screaming.
Think before you act. Count to 10 and then think about the source of the child’s frustration, this child’s characteristic temperamental response to stress (e.g., hyperactivity, distractibility, moodiness), and the predictable steps in the escalation of the meltdown.
Try to intervene before the child is out of control. Get down at the child’s eye level and say, “You are starting to get revved up, slow down.” Now you have several choices of intervention.
Unlike a meltdown, you can ignore a tantrum if it is being thrown to get your attention. Once the child calms down, give the attention that is desired.
You can place the child in time away. Time away is a quiet place where the child goes to calm down, think about what he or she needs to do, and, with your help, make a plan to change the behavior.
You can positively distract the child by getting the child focused on something else that is an acceptable activity. For example, you might remove the unsafe item and replace with an age-appropriate toy.
Post-tantrum management:
Teach the child that anger is a feeling that we all have and then teach her ways to express anger constructively.
Never, under any circumstances, give-in to a temper tantrum. That response will only increase the number and frequency of the tantrums. Also, when an Asperger child has become accustomed to successfully manipulating parents with tantrums in the past -- but then doesn't get his way with today's tantrum -- it can often escalate into a meltdown. Now the parent has two distinctly different problems (that may look the same) to address.
Never let meltdowns interfere with your otherwise positive relationship with the child.
Explain to the child that there are better ways to get what he or she wants.
Do not reward the child after a meltdown for calming down. Some children will learn that a meltdown is a good way to get a treat later.
Resources for parents of children and teens on the autism spectrum:
"Is it common for children with high-functioning autism to have problems relating to their friends and classmates - and be somewhat of a ‘loner’?"
Although the social criteria for High-Functioning Autism (HFA) and classic autism are somewhat similar, the former disorder involves fewer symptoms and has a different presentation than does the latter.
Kids with HFA are often socially isolated, but are aware of the presence of others, even though their approaches may be inappropriate and odd (e.g., they may engage the listener in one-sided conversation using long-winded, pedantic speech about a favorite and narrow topic).
Although some kids with HFA are often self-described "loners," they often express an interest in making friends. These wishes are often hindered by their strange approaches and insensitivity to the other person's feelings, intentions, and nonliteral and implied communications (e.g., need for privacy, signs of boredom, desire to leave, etc.).
Chronically frustrated by their repeated failures to engage others and make friends, some of these children develop symptoms of depression and/or anxiety, which then can escalate into the desire to simply “stay to oneself.”
Regarding the emotional aspects of social interactions, kids on the autism spectrum may fail to interpret the context of the affective interaction, often demonstrating a sense of insensitivity, formality, or disregard to others’ emotional expressions.
Nonetheless, they may be able to describe correctly, in a cognitive and often formalistic manner, others’ emotions, expected intentions and social conventions, but are unable to act on this awareness in an intuitive and spontaneous manner, thus losing the tempo of the social exchange.
Such poor intuition and lack of spontaneity are often accompanied by a strong reliance on rigid social conventions and formalistic rules of behavior, which is mostly responsible for the impression of social naivete and behavioral rigidity that is so vigorously conveyed by these young people.
While children with classic autism are withdrawn and may seem to be unaware of - and disinterested in – others, children with HFA are often highly interested (sometimes painfully so) to relate to others, but may lack the skills to successfully engage them.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Paul S said...This is spot on! I have a 19 YO son with HFA and he wants - absolutely desires - to have close friends. Yet people keep him at a distance and sometimes reject him outright because of his "peculiar" behavior.
Unknown said...I have 3 boys with HFA and I didn't see them really make friends until they started attending schools/classes for HFA. Being around others like themselves seemed to make them more comfortable with approaching others. It has also given them a chance to work on social skills they normally would shy away from with guidance from school staff.
dsnyredhead said...This sounds so much like my 14 year old. He also seems to have no ability to understand how his appearance may affect things. He has refused haircuts now for a year and with high school orientation this week, he still refuses. He will be going to a new school (for him) with all new kids, and he refuses to get his hair cut..or shave to make his appearance better. He says "it's my hair!". Ugh. A whole year later. Nothing has changed. He starts 10th grade this week. He did shave a few times early last year. That's it. Now a pretty full beard and long hair. Fortunately, it's a quirky arts type charter so he fits in there. Still no friendships that I know of.
"My husband and I believe that Ryan, our 6-year-old son, may have the milder form of autism. Is it ever too early to get a child diagnosed? How does one go about seeking a diagnosis? And, what are our treatment options?"
If you are noticing some of the early symptoms of High-Functioning Autism (or Asperger's), then it is not too early to seek a diagnosis regardless of the child’s age. Early symptoms usually include problems with social interaction. For example:
a significant lack of empathy
can become very upset if someone touches their things, moves furniture or toys around
demonstrate an extreme aversion or tantrums during transitions
difficulties with social skills
display a very narrow or an unusual range of interests, with elaborate or unusual play-based behaviors
do not notice if a peer or playmate loses interest, or even wanders away
find interpreting social comments, facial expressions, tone of voice, or body language as difficult as trying to interpret a foreign language
find unwritten social rules to be confusing
have difficulty listening to others and understanding their perspective
have excessive or a complete lack of separation anxiety from parents
invade other people's personal space
lack of eye contact or social smiles
lack of social discrimination
limitation in reciprocation or give and take interactions
may act-out elaborate rituals, which appear to be creative play, but are actually scripted activities without the variation or creativity of imaginary play
may appear hyperactive, and pursue movement to an excessive degree
may appear to never be able to "let it go," or tend towards appearing argumentative or "splitting hairs"
may appear very rigid in their point of view
may become extremely upset if their routine or ritual is changed in any way
may excessively ask the same question over and over
little or no interest in sharing toys and interests
preference towards playing alone or with "things" rather than with friends
tend toward social isolation
tend to be viewed as "lost in their own little world" at times
tend to interact very well with adults, but struggle with appropriately initiating peer interaction
tend toward extreme perfectionism or "having to finish" what they have started
tend toward lining things up, organizing by color, or even repeating lines verbatim
tend to be self-absorbed or aloof
touch or climb people inappropriately
Furthermore, kids with High-Functioning Autism are limited in brain areas that enable them to understand subtle cues. As a result, literal interpretation, misunderstandings, and/or sensory over-stimulation may lead to tantrums, aggressiveness, overreactions, irritability, low-frustration tolerance, anxiety, self-stimulation, depression, or self-injury. In addition, these young people may develop a tendency of distrust towards others due to social failures and negative social experiences over time, which can lead to self-isolation and social phobia. This behavioral reaction can be viewed as "rude" by others, and often kids with this disorder struggle to understand why they are not liked or frequently feel rejected.
Kids with High-Functioning Autism are usually not diagnosed as early as kids with more severe forms of autism, because the symptoms are not as noticeable. Symptoms may not become a problem until the youngster starts school. Your youngster's doctor will look for signs of developmental delays at regular checkups. If your youngster shows any symptoms of High-Functioning Autism, you'll probably be referred to a specialist who treats kids on the autism spectrum (e.g., pediatric neurologist, developmental pediatrician, child psychologist) for a thorough clinical evaluation.
Because Autism varies widely in severity, making a diagnosis can be difficult. There isn't a specific medical test to determine the disorder. Instead, a specialist may do any of the following:
Seek a speech and language assessment
Recommend genetic testing to identify whether your youngster has a genetic disorder (e.g., fragile X syndrome)
Request physical, neurological, or developmental testing
Present structured social and communication interactions to your youngster and score the performance
Establish the history of the youngster's development
Conduct psychological testing
Observe your youngster and ask how his or her behavior, social interactions, and communication skills have developed and changed over time
Interview the parent(s) and others who have frequent contact with the youngster
Give your youngster tests covering developmental level, language, social and behavioral issues, and speech
Involve other specialists in determining a diagnosis
For your youngster to be diagnosed with High-Functioning Autism, he or she must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual used by mental health providers and by insurance companies to reimburse for treatment.
High-Functioning Autism often includes (a) problems with social interaction (e.g., lack of eye contact, an inability to understand another person's feelings), (b) problems with communication skills (e.g., not speaking, repeating a phrase over and over again), and (c) restricted, repetitive patterns of behavior, interests or activities that cause impairment in social, occupational or other areas of functioning.
To meet Autism criteria, your youngster must have problems across multiple situations with:
Developing, maintaining and understanding relationships (e.g., showing a lack of interest in others, difficulty adjusting behavior to suit various social situations, problems sharing imaginative play, problems in making friends)
Nonverbal communication behaviors used for social interaction (e.g., problems using and understanding body language or gestures, problems making eye contact, lack of facial expressions, difficulty using or understanding nonverbal cues)
Social and emotional give-and-take in social settings (e.g., reduced ability to share experiences or emotions with others, problems initiating or responding to social interactions, inability to engage in normal back-and-forth conversation)
In addition, your youngster must experience at least two of the following:
Extra sensitivity or a lack of sensitivity to sensory input, or an unusual interest in sensory aspects of the environment (e.g., visual fascination to lights or movement, negative response to certain sounds or textures, excessive smelling or touching of objects, apparent indifference to pain or temperature)
Insistence on sameness, rigid routines, or ritualized patterns of verbal or nonverbal behavior (e.g., needing to take the same route to school every day, extreme distress at small changes, expecting activities or verbal responses to always be done the same way)
Interests in objects or topics that are abnormal in intensity, detail or focus (e.g., excessively limited narrow areas of interest, interests that are excessively repetitive, strong attachment to unusual objects or parts of objects)
Odd or repetitive motor movements, use of objects or speech (e.g., mimicking sounds, repeating phrases verbatim without understanding how to use them, lining up toys or flipping objects, body rocking or spinning)
The DSM-5 includes functional levels along the autism spectrum. Children who are generally quite functional and in need of less support are usually given the diagnosis of Level 1 Autism Spectrum Disorder. Hence, the term “high-functioning autism.”
The high-functioning autistic child may:
have significant speech and language delays, but is able to take part in an inclusive academic program because of his or her age-appropriate academic skills
have anxiety, learning disabilities, and sensory challenges, but has age-appropriate speech and exceptional abilities in music, math, or engineering
have relatively mild speech and social delays, but has sensory issues which make it difficult for him or her to take part in an inclusive academic program
be able to complete daily tasks, do math, read, show affection, use age-appropriate language, and write – but may not be able to pick up on social cues, maintain a conversation, hold eye contact, or engage in imaginative play
As you can see, the possible combinations of strengths and deficits are abundant. In any event, even though high-functioning autistic children may not need help with toileting or basic hygiene, many do need a good deal of support in other settings. For instance, a very bright autistic student with severe sensory sensitivities and anxiety may have a more difficult time in the classroom than a less intelligent “typical” student with less anxiety and fewer sensory sensitivities.
The symptoms of these “special needs” children will fall on a continuum, with some showing mild symptoms, and others having much more severe symptoms. This “spectrum” allows professionals to account for the variations in symptoms and behaviors from child to child.
Treatment—
The goal of treatment is to maximize the youngster's ability to function by (a) reducing the symptoms of High-Functioning Autism and (b) supporting development and learning. Treatment options may include the following:
Behavior and communication therapy: Many programs address the range of social, language and behavioral difficulties associated with High-Functioning Autism. Some programs focus on reducing problem behaviors and teaching new skills, while others focus on teaching kids how to act in social situations and how to communicate better with others. Though kids don't usually outgrow the symptoms of High-Functioning Autism, they can learn to function well.
Educational therapy: Kids with High-Functioning Autism often respond well to highly-structured educational programs. Successful programs often include a team of specialists and a variety of activities to improve behavior, social skills, and communication.
Family therapy: Moms and dads can learn how to play and interact with their “special needs” youngster in ways that manage problem behaviors, promote social interaction skills, and teach daily living skills and communication.
Medication: No medication can improve the core signs of High-Functioning Autism, but certain medications can help control symptoms (e.g., anxiety, depression, behavioral problems, hyperactivity, etc.).
Early identification and intervention are considered key to positive outcomes for kids with High-Functioning Autism. Parents, teachers, school psychologists, mental health professionals, and doctors should work together to become better informed regarding assessment tools, research, and diagnostic criteria, as well as the best interventions to increase appropriate behavior, social skills, personal communication, and peer interaction.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
• Anonymous said… I had a mda multi discipline assessment. through my son's school...he had assessment s and questionnaires, now awaiting diagnoses on the 29 th sept,we have waited no many years for this.my son is nearly 8 next week,he is being assessed for adhd and asbergers, he also has hypermobilty.schools don't normally refer till they are 7-8 years maybe bit younger.good luck x
• Anonymous said… I hope aged 6 isn't too young as my child is 2 1/2 and has just been referred for diagnosis of Aspergers/ASD. I've been warned that as he is so young he might be turned down until he is older. Health professionals such as health visitor and GP are in agreement that my son is definitely somewhere on the spectrum. I'm under the impression we are in for a long wait though. We are in Northern Ireland. Good luck, I hope you get answers.
• Anonymous said… If your in the UK you'll be waiting a long time for a diagnosis as those professionals that perform this task seem to hibernate for 11+ months of the year, or is it reluctance since once diagnosed the council have to fund the schools etc to help them.
• Anonymous said… I'm in Qld Australia and my son was diagnosed before turning 3. We are very fortunate as it means we've been able to access the early intervention funding available for under 7s, and I truly believe this has made a huge difference for him.
• Anonymous said… My son was also diagnosed with Aspergers, just before 3 years old. Early intervention is the best thing for these kids and for their parents as well.
• Anonymous said… My son was diagnosed at 6 years old with ADHD, anexity disorder and HFA (aspergers) we talked to our pediatrics and the recommended a psychotherapist who put his through 21/2 mths of testing. I was thrilled it wasn't just thrown togeather and hear ya go. We have opted with meds and therapy which has turned his world around. Still have some rough days. But they are decreasing.
* Anonymous said... I am 60 years old and can't imagine how much better my life would have been if I had been diagnosed as a child. It would surely have saved me a lifetime of difficulties. If you suspect your child of having this disorder and are not able to get a diagnoses for financial reasons, go to the library and get books. Education and understanding how to help your child will benefit them greatly. This would also relieve some of your own frustrations, especially if you are neuro-typical. Please post your comment below…
"I need some ideas on how to handle behavior problems in my students who have autism spectrum disorder. Thanks in advance!"
Managing children with High Functioning Autism (HFA), or Asperger’s, will present you with some unique and distinctive challenges. Not only will these children demand more of your time and patience, many will require specialized instructional techniques in a structured environment that supports and enhances their learning potential. It is important to remember that HFA children are not “disabled” or inept – they simply need differentiated instruction tailored to their unique learning abilities.
Preschool—
Currently, there is no single, uniform presenting picture of HFA in the first 3-4 years of life. The early picture may be difficult to distinguish from typical Autism, suggesting that when evaluating any autistic youngster with apparently normal intelligence, there is a strong possibility that he may eventually have a picture more compatible with an HFA diagnosis. Other kids may have early language delays with rapid "catch-up" between the ages of 3 and 5. Some of these young people – particularly the brightest ones – may have no evidence of early developmental delay (perhaps with the exception of some motor clumsiness). However, in almost all cases, if you look closely at the youngster between the age of about 3 and 5, clues to the diagnosis can be found. In most cases, a comprehensive evaluation at that age can at least point to a diagnosis along the autism spectrum.
Although these young people may seem to relate quite normally within the family setting, problems are often seen when they enter preschool. Problems may include:
aggression
appearing to be "in one's own little world"
difficulty regulating social/emotional responses with anger
difficulty with transitions
excessive anxiety
hyperactivity
odd verbal responses
preference for a set routine
problems sustaining simple conversations
tendency to avoid spontaneous social interactions
tendency to be perseverative or repetitive when conversing
tendency to over-focus on particular objects or subjects
tendency to show very weak skills in interactions
As you can see, this list is much like the early symptom list in classic Autism. However, compared to lower-functioning autistic kids, the youngster with HFA will have less abnormal language and conversational speech, may not be as obviously "different" from other kids, and is more likely to show some social interest in peers as well as grown-ups. Also, certain special skills may be present (e.g., letter or number recognition, rote memorization of various facts, etc.).
Elementary School—
Most young people with HFA will enter kindergarten without having been adequately diagnosed. In many cases, there will have been behavioral concerns (e.g., hyperactivity, inattention, aggression, outbursts, etc.) in the preschool years. Also, there may be concern over "immature" social skills and peer interactions. These children may already be viewed as being somewhat odd or unusual. If these problems are severe, special education may be suggested, but most kids with HFA usually enter a mainstream setting.
Oftentimes, academic progress in the early grades is an area of relative strength. For instance, calculation skills may be strong, and rote reading is usually quite good (although writing skills are often considerably weaker).
Educators may be astounded by the HFA youngster's "obsessive" areas of interest, which often intrude in the classroom setting.
Most HFA kids will show some social interest in other classmates, but they are likely to show weak “friend-making” and “friend-keeping” skills. They may show particular interest in one or two peers around them, but the depth of their interactions will be relatively superficial. On rare occasion, however, some HFA kids present as very pleasant and "social," particularly when interacting with grown-ups.
Depending on a range of factors (e.g., anxiety, quality of management at school, quality of parenting at home, hyperactivity/attentional problems, intelligence level, learning problems, temperamental style, etc.), the course through elementary school will vary considerably from youngster to youngster, and overall problems can range from mild and easily managed to severe and intractable.
As the HFA youngster moves into middle school, the most difficult issues continue to be those related to social skills and behavior management. Due to the fact that kids with HFA are frequently managed in mainstream educational settings, and because their specific developmental problems may be more easily overlooked (especially if they are relatively smart), they are often misunderstood at this age by both educators and peers.
In middle school, educators have less opportunity to get to know a youngster well, thus problems with behavior or study habits may be misinterpreted as emotional or motivational problems.
In certain less structured settings (e.g., cafeteria, physical education class, playground, etc.), the HFA youngster may get into escalating conflicts with educators and/or peers who may not be familiar with his developmental style of interacting. This, in turn, can lead to more serious behavioral problems in the HFA child, because stress and anxiety have built-up to the point of “meltdown.”
In middle school, where the tolerance for differences is minimal and the pressures for conformity are maximal, kids with HFA may be teased, bullied, ignored, and misunderstood. Wanting to “fit in,” but unable to, these “special needs” kids may withdraw even more, and their behavior may become increasingly problematic (e.g., school refusal, aggression, non-cooperation, etc.). Also, some degree of anxiety and depression are common complicating factors during this time.
If there are no significant learning disabilities, academic performance can continue strong, particularly in those areas of special interest. However, learning and attentional/organizational difficulties may be present (e.g., there may be ongoing subtle tendencies to misinterpret information, particularly abstract or figurative/idiomatic language).
Fortunately, by high school, peer-tolerance for individual variations and odd behavior often increases to some extent. Also, if the HFA youngster does well academically, it can bring a measure of respect from his peers.
Some HFA kids will fit-in socially as "geeks," a group which they actually resemble in many ways and which may overlap with HFA. The HFA teenager often forms friendships with peers who share his interests through avenues like Star Trek clubs, science fairs, math clubs, and computer clubs.
With a little luck and proper management, many of these “special needs” teens will have developed considerable coping and social skills, as well as a general ability to "fit-in" more comfortably by this age.
Ideas for Behavior-Management in the Classroom—
1. Avoid escalating power struggles. HFA kids often don’t understand rigid displays of authority – 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 educator to back-off and let things cool down. When possible, anticipate such situations and take preventative measures to avoid the confrontation through presentation of choices, negotiation, and diversion of attention elsewhere.
2. Care should be taken to protect the HFA youngster from teasing and bullying – both in and out of the classroom.
3. Classroom routines should be kept as consistent, structured and predictable as possible. Kids with HFA usually don't like surprises. They should be prepared in advance for changes and transitions (e.g., schedule breaks, vacation days, etc.).
4. 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.
5. Educators can take advantage of the strong academic skills that many HFA kids have in order to help them gain acceptance with their classmates.
6. Educators should take full advantage of the HFA youngster's areas of special interest when teaching. The youngster will learn best when an area of high personal interest is on the agenda. Educators can also use access to the special interests as a reward to the youngster for successful completion of other tasks, adherence to rules, and meeting behavioral expectations.
7. Efforts should be made to help classmates arrive at a better understanding of the HFA youngster in a way that will promote tolerance and acceptance.
8. HFA kids can be fairly rigid about following "rules" quite literally. While clearly expressed rules and guidelines (preferably written down) are helpful, they should be applied with some flexibility. The rules don’t automatically have to be exactly the same for the HFA youngster as for the other kids, because their needs and abilities are different.
9. HFA kids with very high-management needs may benefit from assistance from a classroom aide assigned to them.
10. If learning problems are present, resource room or tutoring can be helpful to provide individualized explanation and review.
11. If motor clumsiness is significant, the school Occupational Therapist can provide helpful input.
12. It is often helpful for the educator and parent to work closely together, because the parent is most familiar with what has worked in the past for the HFA youngster.
13. It is very helpful if the HFA youngster can be given opportunities to help other kids at times.
14. Keep teaching fairly concrete. Avoid language that may be misunderstood by the HFA youngster (e.g., sarcasm, confusing figurative speech, idioms, etc.) Try to simplify more abstract language and concepts.
15. Know that the HFA student usually shows a surprising sensitivity to the personality of the educator. He can be taught, but only by those who give him true understanding and affection. The educator’s underlying emotional attitude influences (involuntarily and unconsciously) the mood and behavior of this “special needs” youngster.
16. Most kids with HFA respond well to the use of visuals (e.g., schedules, charts, lists, pictures, etc.).
17. Put as many details as possible into an Individual Educational Plan so that progress can be monitored and carried over from year to year. It can sometimes be helpful to enlist the aid of outside consultants familiar with the management of young people on the autism spectrum (e.g., psychologists, psychiatrists, etc.).
18. Realize that the HFA youngster has an inherent developmental disorder which causes her to behave and respond in a different way compared to other students. Oftentimes, behaviors in the HFA student are interpreted as "manipulative" or some other term that misses the point that she responds differently to environmental stimuli. Thus, school staff must carefully individualize their approach for this “special needs” child. It will likely be counterproductive to treat her just the same as her peers.
19. The school counselor or social worker can provide direct social skills training, as well as general emotional support.
20. The use of a "buddy system" can be very useful since HFA kids relate best 1-1. Careful selection of a peer-buddy for the HFA youngster can be a tool to help build social skills, encourage friendships, and reduce stigmatization.
21. There will be specific situations where medication can occasionally be useful. Educators should be alert to the potential for mood problems (e.g., anxiety or depression), significant compulsive symptoms or ritualistic behaviors, and problems with inattention. Occasionally, medication may be needed to address more severe behavior problems that have not responded to non-medical, behavioral interventions.
22. Try to insure that school staff outside of the classroom (e.g., physical education teacher, bus driver, school nurse, cafeteria monitor, librarian, etc.) are (a) familiar with the HFA youngster's style and needs and (b) have been given adequate training in management approaches. Those less structured settings where the routines and expectations are less clear tend to be difficult for the HFA youngster.
23. Try to promote appropriate social interactions and help the youngster “fit-in” better. 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. By rehearsing and practicing how to handle various social situations, the HFA youngster can learn to generalize the skills to naturalistic settings.
It is inevitable that you will have the opportunity of working with children on the autism spectrum in your classroom. You may need to make accommodations for some and modifications for others. Providing for the needs of these young people will certainly be one of your greatest challenges as a teacher. Consider the tips and strategies listed above to make behavior-management and the learning process run as smoothly as possible.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
“Is it common for children on the high functioning end of autism to hate touch and avoid being hugged, held, etc.? My grandson will rarely show affection.”
Although it can happen, it is rare for kids with Level 1 Autism (High-Functioning Autism) to "refuse" to be touched at all times - in all situations. However, it is fairly common for these kids to have tactile sensory issues, which may make them avoid certain types of physical contact with others on occasion.
BUT... this really has nothing at all to do with the inability - or lack of desire - to show or receive affection. Autistic kids are the most loving and affectionate people I know! So please don't make the mistake of taking your grandson’s lack of interest in physical contact as a personal insult.
One of the most pervasive myths that surround Level 1 Autism is that a youngster who has it will never show affection and can’t accept getting affection from anyone. There have been hundreds of stories of parents taking their youngster to a psychologist and the doctor telling the parents something like, "Your youngster can’t possibly have an Autism Spectrum Disorder because he gives you a hug now and then."
While this assessment is incorrect, studies have shown that Level 1 Autistic kids do process sensory touch differently than a "typical" youngster, and that this is where the myth that kids on the spectrum don’t like to be touched comes from.
Level 1 Autism and the way it affects kids really runs the gamut from light to severe. An excellent point to remember when dealing with an autistic child is that everyone is different and will react to almost everything differently.
Here are some tips for showing your grandson affection:
1. For a few Autistic kids, a simple, random hug can be sensory overload. They can become agitated, upset and even violent if they are touched without prior warning. You will probably need to have a trial and error approach when it comes to hugging and touching your grandson. Some methods may be responded to in a positive way, other ways won’t be. You just have to try and see.
2. If you think your grandson needs a hug, instead of rushing into his personal space and just taking one, speak to him, bend down to his level and open your arms. Smile and let him know that he is loved and see what the response is. If he doesn't come running in for a hug, don’t be offended. It may just not have been the right time.
3. If your grandson is too sensitive to hugs or touches to show affection, you can try positive reinforcement in addition to hand singles. Things like a simple thumbs up accompanied by a smile and some positive comments can let him know he is loved and what he did was good. You can also offer him a chance to hug during these situations - and he might just take you up on it.
4. Make sure everyone is on the same page. If you are starting to make progress on getting your grandson to be more affectionate, you don’t need his sibling, another family member, or a teacher who doesn’t know or understand his boundaries messing up all of your hard work. If you’ve begun to implement an affection program with him, make sure everyone who would possibly try to hug or touch him knows the rules.
Consistency and repetition are crucial to kids on the autism spectrum, and this applies to a situation like this as well. Trying to figure out a puzzling condition like high-functioning autism and Asperger’s can be a lifelong challenge. For many parents and grandparents, the affection issue may be the biggest. But with patience and learning to go by the youngster’s cues and not your own, you will be able to connect with your grandson in a deep and meaningful way.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
