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Aspergers Children and Motor Skills Development

There is significant data to suggest that many kids with Aspergers  and High-Functioning Autism (HFA) frequently show a very exaggerated response to loud noises such as thunder or unexpected sounds. In addition, your youngster may show hyper-responsiveness to unexpected experiences in general, because a core attribute of Aspergers and HFA is sensory-motor dysfunction. Motor clumsiness is often significant.

Very few highly athletic kids are found in the Aspergers population. They may display some exquisitely developed skills such as mastery of a musical instrument, but rarely do they display general gross motor precocity. They are often awkward in tasks requiring balance and coordination. They are often late to handle a pencil comfortably, catch a ball, ride a bike, or use playground equipment effectively.

They often display hypotonia, a generalized muscular weakness that affects posture, movement, strength, and coordination. Kids with Aspergers also may display tactile defensiveness; in other words, they may avoid touch, warmth, and hugs. For these reasons, occupational and physical therapies are among the very earliest interventions that should be employed along with speech/language therapy, the most frequently employed early intervention.

Teitelbaum and colleagues (2004) at the University of Florida have identified motor measures of the early developing smile, and postural and other motor movements that they feel demonstrate the possibility of identifying Aspergers in infancy. Teitelbaum’s group used a notation system for movements (called the Eshkol-Wachman movement notation) in the attempt to find diagnostic clues about Aspergers early in life. They present evidence that abnormal movement patterns can be detected in Aspergers in infancy. This finding suggests that Aspergers can be diagnosed very early, independent of the presence of language.

As shown by the group in earlier studies, almost all of the movement disturbances in autism can be interpreted as infantile reflexes “gone astray.” In other words, some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to Aspergers, as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of kids with Aspergers. What moms and dads often see, however, are late-developing, immature, and awkward visual-motor skills.

Fine motor (holding a pencil, cutting with scissors, tying shoes) and gross motor (walking, running, athletic coordination) developmental milestones are often more difficult for kids with Aspergers to attain in comparison to their neuro-typical peers. The difficulties that Aspergers kids face in regard to motor skills development can lead to frustration, low self-esteem, and apprehension toward learning a new task.

Children with Aspergers may struggle academically and socially as a result of difficulties in mastering motor skills. In school, students who lack the dexterity to write legibly and swiftly with a pencil can easily fall behind in completing assignments. Social interactions that involve activities such as competitive sports may result in an Aspergers youngster being teased or mocked by peers, as a clumsy gait or awkward hand-eye coordination is detrimental to overall physical ability. Tasks that are simple for children with typical motor development, such as buttoning a shirt or zipping a coat, can be quite challenging for those who lag behind in motor functioning. The most effective way of minimizing the issues related to fine/gross motor skills and Aspergers is for a child to participate in an occupational therapy program, which is offered as a free service for eligible public school students.

Occupational Therapy and Motor Skills Exercises—

Occupational therapists are able to help kids with Aspergers improve their fine and gross motor development through a variety of exercises. Mom and dads can also work with their kids on these techniques in the home environment. The earlier an Aspergers youngster begins to receive assistance in strengthening fine motor skills and gross motor skills, the more likely that school, social, and daily life experiences will be easier to navigate.

Some methods that therapists use when promoting motor development in children with Aspergers traits are:
  • Developing hand-eye coordination by practicing athletic skills such as catching, throwing, or kicking balls
  • Increasing arm and leg coordination with activities such as swimming and moving to music
  • Offering hands-on assistance when practicing tasks such as buttoning, holding utensils, and tying laces
  • Providing children with ample opportunity to work on physical coordination and balance through supervised use of playground equipment
  • Teaching remedial exercises that are designed to encourage neat handwriting and appropriate pencil grasp

Though kids with Aspergers may always have issues of some degree with fine and gross motor functioning, consistent therapeutic techniques can greatly enhance a child's physical potential. Motor skills development in children with Aspergers can improve over time when proper interventions are taken.

What Parents and Teachers Can Do To Help—

Gross motor skills are typically delayed in young children with Aspergers. Parents and teachers should administer some form of periodic testing to assess the challenges the student is facing in gross motor development. This will enable the teacher to plan effective gross motor goals. The focus for the teacher should be to bring the Aspergers child to a higher level of participation.

Young children love to run, jump, skip, climb, and ride a tricycle. Bringing Aspergers students to a level of participation in the activities young children typically engage in increases the probability that the student will interact socially with his typical peers. Social interaction through play is such a challenge for children with Aspergers, and removing the barriers of gross motor delays increases the probability that the child will interact well with his peers.

Facilitate the development of gross motor skills in young children with Aspergers with play. Since peer acceptance during social and play situations can be a challenge anyway, children with Aspergers can really benefit from developing better gross motor skills on the playground. Play opportunities on the playground facilitate gross motor as well as social interaction.

Here are some examples:
  • "Big toy" climbing stations are great fun for children, and many skills are developed during play on this popular playground apparatus.
  • A basketball goal set up for young children with a lowered basket is another great playground gross motor activity for children with Aspergers.
  • A swinging bridge helps strengthen walking skills, while slide ladders provide a fun way to meet climbing goals.
  • Circle soccer can be played with the whole group. Make a big circle and throw a soccer ball into the circle. The children will kick the ball around with the goal being to keep the ball in the circle. It's a fun way to practice kicking skills with a game.
  • Play hopscotch with some colorful sidewalk chalk and a bean bag. Have the child bend over with one leg up to pick up the bean bag.
  • Skipping and galloping races are also great playground gross motor activities.
  • Swings are great too. Teach Aspergers children to "pump" their own swings, building up leg muscles in the process.

When planning gross motor goals for kids with Aspergers, parents and teachers should plan to address the overall clumsiness that is typically seen with a variety of activities that improve overall gross motor skills. “Play” is the best way to accomplish these goals.

How to Create a Behavioral Management Plan for Aspergers and HFA Children

Behavior problems are often observed in kids with Aspergers and High-Functioning Autism. Negative behavioral outbursts are most frequently related to frustration, being thwarted, or difficulties in compliance when a particularly rigid response pattern has been challenged or interrupted. Oppositional behavior is sometimes found when areas of rigidity are challenged.

First, attempt to analyze the “communicative intent” of the negative behavior. A harsh, punitive approach to negative behavior is especially ill-advised when the child’s negative behavior was his attempt to communicate his feelings.


Example Positive Behavior Support Plan

1. Issues impacting behavior are:
  • aggression 
  • attention-seeking 
  • excessive “dawdling” whenever parent requests a task to be completed 
  • no internal regulatory “sensors” to move forward while experiencing tasks too demanding or difficult 
  • non-compliance 
  • possible abusive verbal outbursts 
  • unable/unwilling to complete chores/tasks

2. Estimate of current severity of behavior problem: moderate to serious

3. Current frequency/intensity/duration of behavior: 3-4 times/week to multiple times/day; lasts a few seconds for aggression, a few minutes to a few hours for non-compliance

4. Current predictors for behaviors:
  • being misunderstood 
  • challenging task 
  • entering into a new social situation 
  • feelings of rejection 
  • inability to express himself 
  • not understanding task or instruction 
  • sensory challenges 
  • uncomfortable emotional state (e.g. anxiety, embarrassment, shame, anger, frustration)

5. What should child do instead of this behavior:
  • complete tasks/chores with appropriate attempts to seek help when needed 
  • participate in activity/conversation in context 
  • use socially and situationally acceptable strategies for calming himself 
  • verbally express difficulties and feelings appropriately

6. What supports the child using the problem behavior:
  • attention for inappropriate behaviors 
  • escape from demands 
  • return of control 
  • sensory stimulation (sometimes in the form of confrontation or power struggles)

7. Behavioral Goals/Objectives related to this plan:
  • compliance 
  • development of age and context appropriate social skills 
  • coping skills and self-monitoring 
  • increased tolerance to frustration 
  • sensory stimulation and challenging tasks/chores 
  • staying on task 
  • development of positive replacement behaviors

8. Parenting Strategies for new behavior instruction:
  • check for understanding of directions/expectations 
  • consistent encouragement to express difficulties 
  • discuss rules/consequences in advance and ensure comprehension 
  • immediately reinforce all appropriate attempts at communication and other appropriate behaviors 
  • model appropriate behaviors 
  • proactive and periodic checking for understanding and issues 
  • probe to understand root causes of problem behaviors 
  • role play challenging situations 
  • validate feelings and offer alternative replacement behaviors in the form of limited choices

9. Environmental structure and supports:
  • anticipate predictors of behavior and avoid or prepare for intervention 
  • avoid confrontation through calmness, choices, negotiation 
  • designate a “safe place” to calm down (not for punishment) 
  • reduce distractions 
  • set up situations for success

10. Reinforcers/rewards:
  • immediately reward appropriate behaviors with smiles, verbal praise, thumbs up, pat on the back for sitting quietly 
  • positive report to other parent 
  • standard aversive disciplinary techniques (e.g., red cards, punishment time-outs, citations) are ineffective and will not be used 
  • video-game time for work completed

11. Reactive strategy to employ if behavior occurs again:
  • offer “safe place” to calm down 
  • offer limited choices 
  • validate feelings

12. Monitoring results and communication:
  • discuss results of plan 
  • ensure consistency 
  • make any necessary changes



Follow-up Question:

My daughter is 5 years old and was diagnosed with PDD-NOS last December. My husband and I have known "something" wasn't right pretty much from the start as a baby. However, we aren't entirely convinced if she has PDD-NOS, high functioning autism, aspergers, ADHD, or a combination of them. Based on her behaviour and the multitude of tests and profiles we've filled out, we feel that she had 75% ADHD (hyperactive, and especially no impulse control) and 25% high functioning autism or aspergers (same thing?).

From a medical perspective, she has been tested for thyroid issues and diabetes (as her behaviour gets worse when she has low blood sugar) but both were fine. She hasn't been tested for allergies, but we did have her on a dairy/gluten free diet for about 2 weeks and she was amazing the first week (a different child), but regressed the second week. The diet was tough to do, so we stopped it, but we're still considering putting her back on it for a longer period of time. The positive change in her was too significant, and too well timed to be a coincidence.

Her main symptoms are no impulse control, doesn't recognize clear danger (will bolt into traffic or walk away with any stranger), talks excessively and loudly, interupts her parents talking constantly, defiant to her parents (not her teachers), frequently cranky/unhappy, has both tantrums and meltdowns frequently, has much difficulty in transitioning from one activity to another, and sensitive to sensory overload (loud noises and bright lights). She also has what I'm told is a "stim" - since she was about 1 years old, she will squeeze her arms together in a hugging action when excited or happy. She also will often line up toys. She is quite hyper-active, although she can focus at length on activities that she enjoys (crafts, puzzles, etc). Also, while she can look you in the eye for more than 2 seconds, it doesn't happen often. I don't know if this is from an autistic origin, or if she's just hyperactive and unfocused. She has been diagnosed as needing some speech therapy for issues with not using pronouns correctly and the past tense, and from describing the story in a picture kind of like a memory instead of using descriptive words. She has had some speech therapy, but now they are mainly focusing on her ability to read and understand social cues from the other kids, and respond accordingly. Where she doesn't fit the autism diagnosis is that she is extremely outgoing and sociable, she will point and look where pointed to, she will mimic (although she doesn't play pretend with her dolls or anything that much), and she has excellent gross and fine motor skills.

From a treatment persepctive, she is receiving 1 hr/week of speech therapy in the classroom, attends 2 days per week pre-school, and we are working with a child psychologist about once every 3 weeks. The psychologist has helped us with parenting strategies, including child focused play and using social stories (which are helping). We have an appointment with a pediatrician who specialises in autimsm, PDD, adhd in July, as we are hoping for a second opinion on the diagnosis.

OK, so enough history! My question to you is about a key issue that is causing much angst and strife in our family. Whenever we are together as a family (in the evenings  and on the weekends), my daughter will interrupt my husband and I constantly, to the point that he goes out every evening until she's in bed, and we only spend 1 day on the weekend together typically (and it's often a stressful, cranky day). She will pointly ask dad to leave, she wants to see mom. She will talk louder, jump around us, and try to divert all of my attention. My husband thinks that part of this is driven simply by the fact that she wants some one on one time with me (understandable), but also that my time with her is more fun and child-focused (we play crafts, do baking, etc) since I don't see her that much. Also, he thinks that I am more lenient with her, so she prefers that. Just a note, I work full time Mon to Friday, and my husband is a stay-at-home dad (has been since I returned to work full-time when Keira was 7 months old).

We are currently coping with this issue with weekly babysitting sessions, so that my husband and I can have time together. As well, we give her mommy time most evenings and at least one day per weekend. But, we want to be a family! We've also just purchased an RV to hopefully create some quality camping time together.

Answer:

Without seeing you and your daughter interacting in person, I will have to guess that your are unintentionally rewarding her for this attention-seeking behavior. In other words, is it possible that, when she is getting in your face and trying to dominate the conversation, you provide the very attention she is seeking?

This is a behavior problem by the way. And as such, there needs to be some ground rules established - in writing - along with consequences for violating the rules.

You need to address this from both sides of the equation: nurture and discipline.

Sounds like you got the nurturing piece in place (i.e., sufficient amount of 'mommy time'), but what is the consequence for interrupting? I'm guessing there is none.

Unfortunately, this is teaching your daughter how to be a 'master manipulator'. And the longer this goes on, the harder it will be to get it stopped.

This should be a fairly simple fix...

1. Co-create (with her) some rules (e.g., no speaking when mom and dad are talking to one another; no climbing between mom and dad). Keep this short and simple with just a few specific behaviors to target.

2. Stipulate both the consequences for violating the rules (e.g., will have to go to your room for a 5 minute timeout) and the rewards for compliance (e.g., will get and extra 5 minutes with mommy).

3. Put all this in writing WITH PICTURES (get creative here - and make it fun - it will take a little extra work, but we want this to be effective - so do it!). This is the formal contract.

4. Revise the contract as needed. Also, be sure to follow through with the consequences as needed, otherwise this teachers your daughter another bad lesson: Rules are meaningless.

Be prepared for a lot of resistance here. You are getting ready to turn her world upside down. 

By the way, IF (and I say "if") you are the kind of mother who errs on the side of over-indulgence and over-protectiveness, then this is going to be very difficult for you to do. And IF you find that you simply cannot do this, then ...well, heaven help your marriage.

____________________________


COMMENTS:

•    Anonymous said... Hmmm - someone should tell Caeden's (former) school this!!
•    Anonymous said... Ok my kid has been acting out bad since coming to live with me and I'm not sure how to approach it. He has had big changes in his life....new school new home etc...would that trigger such stand off behavior? Any advice would be appreciated!!
•    Anonymous said... This article couldn't have come a better time.....my 7yr olds behaviour has been atrocious this week and am at my wits end..,..but then it's back to school this week from 2 wks off....so I'm assuming it correlates with that 😐
•    Anonymous said... This week has been horrific for my son. I can't figure out why but something set him off at school this week.

Please post your comment below…

Behavior Problems in Teens with Aspergers and High-Functioning Autism

Parents often have difficulty recognizing the difference between variations in “normal behavior” versus “Aspergers-related behavior.” In reality, the line between ‘normal’ and ‘Aspergers behavior’ is not always clear – usually it is a matter of expectation.

A fine line can often divide normal from Aspergers teen behavior, in part because what is normal depends upon the teen's level of development, which can vary among teens of the same age. Development can be uneven, too, with a teen's social development lagging behind his intellectual growth, or vice versa. In addition, normal teen behavior is in part determined by the particular situation and time, as well as by the teen's own particular family values, expectations, and cultural or social background.

Understanding your Aspergers (high-functioning autistic) teen's developmental progress is necessary in order to interpret, accept or adapt his behavior (as well as your own). Remember, teens have great individual variations of temperament, development and behavior – especially when they have to deal with the Aspergers condition.

Your responses, as a parent, are guided by whether you see the adolescent's behavior as a problem. Frequently, parents over-interpret or over-react to a minor, normal short-term change in the teen’s behavior. At the other extreme, moms and dads may ignore or downplay a serious problem. Also, they may seek quick, simple answers to what are, in fact, complex Aspergers teen problems. All of these responses to teen behavior may create more difficulty or prolong a resolution.

Adolescent behavior that moms and dads tolerate, disregard or consider acceptable differs from one family to another. Some of the differences come from the parent’s unique upbringing. They may have had very strict parents themselves, and the expectations of their kids follow accordingly. Some behavior is considered a problem when parents feel that others are judging them for their teen's behavior. This leads to inconsistent responses from the parent, who may tolerate behavior at home that he/she would not tolerate in public.

Sometimes moms and dads feel so hurt by their Aspergers teen’s behavior that they respond by returning the “disrespect” – which is a mistake. Teens know that they still need their parents even if they can't admit it. The rollercoaster they put the parent on is also the one they're feeling internally. As the parent, you need to stay calm and try to weather this teenage rebellion phase, which usually passes by the time a child is 16 or 17.

But no one's saying your Aspergers teenager should be allowed to be truly nasty or to curse at you, for example. When this happens, you have to enforce basic behavior standards. By letting your teenager know that you're here for him no matter what, you make it more likely that he'll let down his guard and confide in you once in a while.

My Aspergers Teen: Discipline for Defiant Aspergers Teens

How is Aspergers Assessed?

Question

How is Aspergers Assessed?

Answer

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.

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