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How is Aspergers Assessed?

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How is Aspergers Assessed?

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Aspergers is a diagnosis based on the behavioral criteria set forth in Diagnostic and Statistical Manual of Mental Health Disorders (DSM). Because it is difficult to provide a diagnosis based on brief personal contacts, mental health professionals often rely on the reports of parents and teachers.

1. 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

2. 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 in either 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 movement)

3. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

4. There is no clinically significant delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

5. 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.

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

Aspergers Children and Lack of Eye Contact

A child or teenager with Aspergers or High Functioning Autism may exhibit less eye contact with you and others than expected, and he or she may not read faces for cues about feelings or consequences. This lack of connectivity is often felt in an intangible way, especially by caregivers. We anticipate with open hearts the child who will “give back” our attention. However, in children with Aspergers, there may be very little variation in expressions of emotions and little joy in playing interactive baby games. The arrival of the youngster’s social smile may occur later and infrequently.

What can moms and dads do to help their kids with Aspergers?
  • Be understanding when we don't feel like looking - we're not being rude, just feeling insecure.
  • Encourage "looking at my face" but don't push it - it's really uncomfortable for us.
  • Explain how some folks need to see you looking in their direction before they think you're listening.
  • Give your children a few options for controlling gaze avoidance (suggest looking at cheeks) or higher.
  • Place less emphasis on eye contact and more on "participation in conversation".

 Eye contact is a form of communication in American culture; we assume a person is giving us their attention if they look at us. The Aspergers child experiences difficulty with eye contact; it is extremely hard for them to focus their eyes on a person for any extended period of time. Limited eye contact is a part of the disability. Don't demand an Aspergers child look you in the eye as you are talking to them--this is extremely difficult for them to do.

One of the key signs of Aspergers in folks is a difference in their use of eye contact in communication. This seemingly trivial variation can cause huge conflicts and misunderstandings when trying to deal with the non-Aspergers world. When to look someone in the eye, when to look away, does lack of eye contact indicate unfriendliness or dishonesty, does eye contact that too lengthy indicate a threat or a seduction? A lot gets expressed and read into a seemingly simple gaze. The confusion gets compounded by the fact that different cultures have different rules for eye contact, and the rules within families can be different than those for friends, acquaintances or strangers. What’s praised as “paying attention” for some cultures is then criticized in others as “not being respectful.”

There are reasons the non-Aspergers world uses eye contact: as an indication of openness, interest, paying attention, as well as to convey less friendly messages such as boredom or dominance. Checking in with the listener's eye contact is a way to verify that you're still getting your point across and not confusing, boring, or offending the listener. While it may be considered impolite to interrupt when confused, a simple squint conveys the message clearly.

For those with Aspergers, eye contact may be very uncomfortable. Just go online and read some of the blogs from adults with Aspergers and you’ll find great discussions about how eye contact can feel threatening, distracting, or overwhelming.

So, what can be done about problems with eye contact? It would be great if everyone acknowledged that eye contact is a trivial matter, and folks were judged by their words and actions instead. Unfortunately, I don't think that's going to happen any time soon. Unless they're clearly affected by Aspergers or autism, most folks probably don't even know what it is. I don’t think individuals without Aspergers are being deliberately bigoted or judgmental, but reading nonverbal messages is an instinctive and lifelong, although mostly unconscious, behavior.

I think the solution comes down to compromise and careful consideration of the situation. Adults should find a way to explain to others why their eye contact is different. I suggest stating that looking away helps the speaker concentrate, or asking the listener to let them know if they’re getting bored. These direct methods are probably most useful for those folks you know fairly well and those you’re going to be interacting with a lot.

Some online sites suggest faking eye contact by looking just above the eyes, at the forehead, or the eyebrows. I think this is an intriguing idea, but you’d need to practice first. Find a non-Aspergers friend and see how this works. Most people without Aspergers get an uncomfortable feeling when body language is different, even though they may not be able to explain precisely what is wrong. Don’t try faking eye contact for the first time on a job interview or a first date.

A final option is to try to learn non-Aspergers eye gaze behaviors. This is a big, time consuming project and will probably require training from some sort of professional and lots of practice. I’d suggest finding a qualified therapist, speech professional, or coach to figure out all the technical details and then a close non-Aspergers friend to practice.

Unfortunately, there’s no simple answer to the matter of eye contact, just a lot of compromises. In the end, the folks who matter most to you will probably get your message, whether or not you look them in the eye.

An Aspies Point of View—

“Eye contact hurts... no, not in the painful sense, but it's quite uncomfortable. I always feel that I'm revealing more than I want to with eye contact, and that I'm receiving more information than I want to know. Of course, I know that eye contact is critical to spoken communication, so often I'll compromise by either of two methods:

Method 1: Making brief eye contact every few seconds:

This is the "roving eye" technique whereby you make eye contact at the very start of each sentence and then drift away as soon as the individual you're talking to is reassured that you're listening. There are a few problems with this method. First of all, folks often assume that your concentration is wandering. I'll often get told, "well, I know you're quite busy..." or "I'm probably boring you..." or "I can tell you're not interested..." as a response to using this technique when I really am interested in the conversation. When that happens, I usually have to switch to the other technique.

Method 2: Making eye contact for half of the conversation:

A two-way conversation is made up of two halves (person 1 speaking while Person 2 listens and vice versa). As a general rule, folks like to know that they're being listened to but aren't as worried if you don't make a lot of eye contact while you're talking. The plan with this method is to make reasonably constant eye contact (though you'll probably need to "flit" your eyes away several times during longer diatribes to ease the tension) while they talk to you and rest your eyes while you talk back.

As a partially deaf person I was encouraged to look at lips and I've become quite good at lip-reading. Unfortunately, as an adult, the lips are just too close to breasts and I often find that my female subjects will try to cover themselves during conversations. This is as embarrassing for me as it is for them.

I guess the best rule is to either stare at the face or (cheeks are a good idea) or slightly above and/or to the left or right of their head - never downwards or they'll assume the worst.

Overall, this is a more effective method than the "roving-eye" method but it doesn't work with everybody. In particular, you need to watch out for folks who start turning around mid-conversation to see what you're staring at. If this happens, you need to either make more regular eye contact or switch to the other method.

One way of overcoming uncomfortable situations is to be seated at a desk and work during the conversation. I know that this is rude, but if you're doing related work or even turning to take the occasional note on a computer, it can give you a welcome break.

My background is in computers, so I use this to great advantage, often changing screens or adjusting code as the changes are discussed. This gives the impression that I'm just "raring to go" or that I'm prototyping systems (providing examples) to help the conversation, rather than just being rude.”

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

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