Aspergers 101: The Basics

Essential Aspergers Information That All Parents And Teachers Need To Know:

Aspergers/HFA Children and Dental Appointments: 40 Tips for Parents

Taking your Aspergers (high functioning autistic) son or daughter to the dentist can be a difficult experience for both child and parent. Here are some helpful tips to effectively deal with dentist appointments:

1. Ask the dentist to lean the chair back before your child gets in it, because sometimes Aspergers and HFA children don’t like the feeling of being moved backwards.

2. Bring along a sibling or friend and let your child watch as the doctor or hygienist performs the task on them first.

3. Collaboration and teamwork are essential for a successful trip to the dentist.

4. Consider some physical exercise (e.g., riding a bike) to be done before and after the visit for calming.

5. Create and read a social story about going to the dentist with your child. The social story should take the uncertainty out of what will happen at the dentist office.

6. Deep pressure can be used before and during the visit for calming.

7. Dentists should review your youngster’s medications and supplements.

8. Discover what could potentially be difficult at future visits.

9. Find some good books about practicing good oral hygiene and going to the dentist that you can read with your child.

10. For those children who grind their teeth or engage in self-injurious behaviors (e.g., picking at the gums, biting the lip), a mouth guard may be recommended.

11. Having a dental professional who can communicate with your child effectively will be very important.

12. If the noises of the office are upsetting, request to be moved to a more quiet or private area. If not available, the use of headphones or an iPod are good ways to limit noise.

13. If you have any dietary or chemical restrictions that you are following for your youngster, be sure to make your dentist aware of these before the appointment begins.

14. If your child has seizures, you will need to discuss this with your dentist. The mouth is always at risk during a seizure, because kids may chip teeth or bite their tongue or cheeks.

15. Ignoring inappropriate behaviors is something you’ll want to inform the staff about.

16. Include an incentive/motivator for when the appointment is over (e.g., stop for a treat afterward).

17. Instruct the staff that your youngster responds best to immediate praise for good behavior (e.g., “Great job keeping your mouth open” … “I like how you are holding still” … “You did great while I cleaned your back teeth”).

18. Instruct the staff to prompt the child with time durations as they work (e.g., “This will be all done when we finish counting to 10” … “I need to touch 20 teeth, so help me count them all” … “That gritty paste will only be there for 1 minute and then you can rinse and spit”).

19. Is your child familiar with daily tooth brushing? If not, consider working with an occupational therapist to teach him good oral hygiene habits.

20. Know that lighting in a dental office is often too strong for a child on the autism spectrum. Let him wear sunglasses and request that the staff try to keep the light out of his eyes as much as possible.

21. Let your child get familiar with the dentist office environment before the actual dental work is performed (e.g., let the child try out the chair, let the hygienist look in his mouth or count his teeth, let him listen to the sound the drill makes, etc.).

22. Let your child squeeze a therapy ball in his hands while he is in the chair (if he finds it comforting).

23. Let your child touch and examine the dentist’s tools before the dentist starts working, if possible.

24. Letting your child know ahead of time how long something is going to last can be very helpful.

25. Maintaining a calm voice may help to minimize behavior problems.

26. Make a fun game out of counting your child’s teeth before the dentist appointment.

27. Schedule a few short “trial visits” to start off with. Keep these visits very positive and short.

28. Sedation is sometimes a good idea (e.g., if the youngster has high levels of anxiety or discomfort, for uncontrolled movements like gagging, when extensive dental treatment is going to take place).

29. Share your child’s coping strategies with the dental staff before the visit.

30. Show the tool or action they are going to use before the procedure.

31. Slowly desensitize your child to the experience by talking about your personal experience with the dentist.

32. Tell your child what they are going to do before you ever get to the dentist.

33. There are many potential sensory challenges at a dentist’s office (e.g., tastes, smells, textures, sounds, lights, etc.). Knowing what areas your child tends to be sensitive will help you know what coping strategies to try.

34. To ensure that tastes are familiar and favorable, bring your child’s own toothpaste and toothbrush to the visit.

35. Try using a bean bag chair in the dentist’s chair during the exam to provide some snug comfort.

36. Use of visual routines and a timer are helpful for good daily brushing habits.

37. Use the child’s toothbrush or a plastic tooth mirror and get him comfortable with letting you put it in his mouth.

38. Vibration toys that are safe for oral use, or even electric toothbrushes, are good for getting your youngster accustomed to the strange sensations in his mouth.

39. Ask if the dentist has experience with Aspergers and HFA kids and if he/she has special procedures in order to optimize each visit. Ask about those procedures. Some procedures you might ask about are:

• having a short wait time
• having an appointment at a time of day when your child is at his best
• having the same staff at each visit for consistency
• sitting with your child in the room while doing the exam

40. Consult your child’s Occupational Therapist for additional suggestions.  


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

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

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Effective Teaching Strategies for Aspergers and HFA Students (Summary of PowerPoint Presentation)

The following summary identifies the specific learning difficulties of Aspergers and high functioning autistic students and suggests a number of possible classroom strategies:

Difficulties with language—

• “Comic Strip Conversations” can be applied to a range of problems with conversation skills
• difficulty understanding complex language, following directions, and understanding intent of words with multiple meanings
• encourage the student to ask for an instruction to be repeated, simplified or written down if he does not understand
• explain metaphors and words with double meanings
• limit oral questions to a number the student can manage
• pause between instructions and check for understanding
• small group instruction for conversational skills
• teach appropriate opening comments
• teach rules and cues regarding turn-taking in conversation and when to reply, interrupt or change the topic
• teach student to seek assistance when confused
• tendency to interrupt
• tendency to make irrelevant comments
• tendency to talk on one topic and to talk over the speech of others
• use audio taped and videotaped conversations
• watch videos to identify nonverbal expressions and their meanings

Insistence on sameness—

• use pictures, schedules and social stories to indicate impending changes
• wherever possible prepare the student for potential change

Impairment in social interaction—

• difficulty reading the emotions of others
• difficulty understanding "unwritten rules" and when they do learn them, may apply them rigidly
• difficulty understanding the rules of social interaction
• educate peers about how to respond to the student’s disability in social interaction
• encourage cooperative games
• explicitly teach rules of social conduct
• interprets literally what is said
• lacks tact
• may be naïve
• may need to develop relaxation techniques and have a quiet place to go to relax
• may need to provide supervision and support for the student at breaks and recess
• problems with social distance
• provide clear expectations and rules for behavior
• structured social skills groups can provide opportunity for direct instruction on specific skills and to practice actual events
• teach flexibility, cooperation and sharing
• teach the student how to interact through social stories, modeling and role-playing
• teach the student how to start, maintain and end play
• teach the students how to monitor their own behavior
• use a buddy system to assist the student during non-structured times
• use other children as cues to indicate what to do

Restricted range of interests—

• incorporate and expand on interest in activities and assignments
• limit perseverative discussions and questions
• set firm expectations for the classroom, but also provide opportunities for the student to pursue his own interests

Poor concentration—

• break down assignments
• difficulty sustaining attention
• distractible
• frequent teacher feedback and redirection
• may be disorganized
• often off task
• reduced homework assignments
• seating at the front
• timed work sessions
• use nonverbal cues to get attention

Poor organizational skills—

• help the student to use "to do" lists and checklists
• maintain lists of assignments
• picture cues in lockers
• pictures on containers and locker
• use schedules and calendars

Poor motor coordination—

• consider the use of a computer for written assignments, as some students may be more skilled at using a keyboard than writing
• involve in fitness activities
• may prefer fitness activities to competitive sports
• provide extra time for tests
• take slower writing speed into account when giving assignments (length often needs to be reduced)

Academic difficulties—

• areas of difficulty include poor problem solving, comprehension problems and difficulty with abstract concepts
• avoid verbal overload
• be as concrete as possible in presenting new concepts and abstract material
• break down tasks into smaller steps or present it another way
• capitalize on strengths, e.g., memory
• check for comprehension, supplement instruction and use visual supports
• do not assume that they have understood what they have read
• don’t assume that the student has understood simply because he/she can re-state the information
• good recall of factual information
• may do well at mathematical computations, but have difficulty with problem solving
• often strong in word recognition and may learn to read very early, but difficulty with comprehension
• provide direct instruction as well as modeling
• show examples of what is required
• use activity-based learning where possible
• use graphic organizers such as semantic maps
• use outlines to help student take notes and organize and categorize information
• usually average to above average intelligence

Emotional vulnerability—

• easily stressed due to inflexibility
• educate other students
• help the student to understand his/her behaviors and reactions of others
• may be prone to depression
• may have difficulties coping with the social and emotional demands of school
• may have difficulty tolerating making mistakes
• may have rage reactions and temper outbursts
• often have low self-esteem
• provide experiences in which the person can make choices
• provide positive praise and tell the student what she/he does right or well
• teach techniques for coping with difficult situations and for dealing with stress
• teach the student to ask for help
• use peer supports such as buddy systems and peer support network
• use rehearsal strategies

Sensory Sensitivities—

• be aware that normal levels of auditory and visual input can be perceived by the student as too much or too little
• confusing, complex or multiple sounds such as in shopping centers
• having the student listen to music can camouflage certain sounds
• high-pitched continuous noise
• it may be necessary to avoid some sounds
• keep the level of stimulation within the student’s ability to cope
• minimize background noise
• most common sensitivities involve sound and touch, but may also include taste, light intensity, colors and aromas
• sudden, unexpected noises such as a telephone ringing, fire alarm
• teach and model relaxation strategies and diversions to reduce anxiety
• types of noises that may be perceived as extremely intense are:
• use of ear plugs if very extreme

***Additional Guidelines***

General Behaviors—

• At times, the student may experience "meltdowns" when nothing may help behavior. At times like this, please allow a "safe and quiet spot" where the student will be allowed to "cool off." Try to take note of what occurred before the meltdown (was it an unexpected change in routine, for example) and it's best to talk "after" the situation has calmed down.
• Foster a classroom atmosphere that supports the acceptance of differences and diversity.
• Generally speaking, a grown-up speaking in a calm voice will reap many benefits.
• It is important to remember that just because the student learns something in one situation, this doesn't automatically mean that they remember or are able to generalize the learning to new situations.
• Note strengths often and visually. This will give the student the courage to keep on plugging.
• The student may have vocal outbursts or shriek. Be prepared for them, especially when having a difficult time. Also, please let the other students know that this is a way of dealing with stress or fear.
• The student may need help with problem-solving situations. Please be willing to take the time to help with this.
• The student reacts well to positive and patient styles of teaching.
• This syndrome is characterized by a sort of "Swiss cheese" type of development (i.e., some things are learned age-appropriately, while other things may lag behind or be absent).
• Students may have skills years ahead of normal development (e.g., a student may understand complex mathematics principles, yet not be able to remember to bring their homework home).
• When dividing up assignments, please ASSIGN teams rather than have the other students "choose members", because this increases the chances that the student will be left out or teased.
• When it reaches a point that things in the classroom are going well, it means that we've gotten it RIGHT. It doesn't mean that the student is "cured", "never had a problem" or that "it's time to remove support". Increase demands gradually.
• When you see anger or other outbursts, the student is not being deliberately difficult. Instead, this is in a "fight/fright/flight" reaction. Think of this as an "electrical circuit overload." Prevention can sometimes head off situations if you see the warning signs coming.

Perseverations—

• Allowing the student to write down the question or thought and providing a response in writing may break the stresses/cycle.
• It is more helpful if you avoid being “pulled in” by answering the same thing over and over or raising your voice or pointing out that the question is being repeated. Instead, try to redirect the student's attention or find an alternative way so he/she can save face.
• The student may repeat the same thing over and over again, and you may find that this increases as stress increases.

Transitions—

• Giving one or two warnings before a change of activity or schedule may be helpful.
• The student may have a great deal of difficulty with transitions. Having a picture or word schedule may be helpful.
•  Please try to give as much advance notice as possible if there is going to be a change or disruption in the schedule.

Sensory Motor Skills/Auditory Processing—

• Breaking directions down into simple steps is quite helpful.
• Directions are more easily understood if they are repeated clearly, simply and in a variety of ways.
• The student has difficulty understanding a string of directions or too many words at one time.
• The student may act in a very clumsy way; she may also react very strongly to certain tastes, textures, smells and sounds.
• Speaking slower and in smaller phrases can help.
• Using picture cures or directions may also help.

Stimuli—

• Allow the student to "move about" as sitting still for long periods of time can be very difficult (even a 5 minute walk around, with a friend or aide can help a lot).
• He may get over-stimulated by loud noises, lights, strong tastes or textures, because of the heightened sensitivity to these things.
• Unstructured times (e.g., lunch, break, PE) may prove to be the most difficult for him. Please try to help provide some guidance and extra adults help during these more difficult times.
• With lots of other kids, chaos and noise, please try to help him find a quiet spot to which he can go for some "solace".

Visual Cues—

• Hand signals may be helpful, especially to reinforce certain messages, such as "wait your turn", "stop talking" (out of turn), or "speak more slowly or softly".
• Some Aspergers and HFA students learn best with visual aids, such as picture schedules, written directions or drawings (other students may do better with verbal instruction).

Interruptions—

• At times, it may take more than few seconds for my student to respond to questions. He needs to stop what he's thinking, put that somewhere, formulate an answer and then respond. Please wait patiently for the answer and encourage others to do the same. Otherwise, he will have to start over again.
• When someone tries to help by finishing his sentences or interrupting, he often has to go back and start over to get the train of thought back.

Eye Contact—

• At times, it looks as if the student is not listening to you when he really is. Don't assume that because he is not looking at you that he is not hearing you.
• She may actually hear and understand you better if not forced to look directly at your eyes.
• Unlike most of us, sometimes forcing eye contact BREAKS her concentration.

Social Skills and Friendships—

• Identifying 1 or 2 empathetic students who can serve as "buddies" will help the student feel as though the world is a friendlier place.
• Students with Aspergers and HFA may be at greater risk for becoming "victims" of bullying behavior by other students. This is caused by a couple of factors: (1) there is a great likelihood that the response or "rise" that the "bully" gets from the Aspergers or HFA student reinforces this kind of behavior; (2) Asperger kids want to be included and/or liked so badly that they are reluctant to "tell" on the bully, fearing rejection from the perpetrator or other students.
• Talking with the other members of the class may help, if done in a positive way and with the permission of the family. For example, talking about the fact that many or most of us have challenges and that the Aspergers or HFA student's challenge is that he cannot read social situations well, just as others may need glasses or hearing aids.
• They may want to make friends very badly, yet not have a clue as to how to go about it.

Routine—

• Let him know, if possible, when there will be a substitute teacher or a field trip occurring during regular school hours.
• Please let the student know of any anticipated changes as soon as you know them, especially with picture or word schedules.
• This is very important to most students o the autism spectrum, but can be very difficult to attain on a regular basis in our world.

Language—

• Sarcasm and some forums of humor are often not understood by my student. Even explanations of what is meant may not clarify, because the perspectives of an Aspergers or HFA student can be unique and, at times, immovable.
• Although his vocabulary and use of language may seem high, students on the autism spectrum may not know the meaning of what they are saying even though the words sound correct.

Organizational Skills—

• If necessary allow her to copy the notes of other students or provide her with a copy.
• It may be helpful to develop schedules (picture or written) for him.
• Many students on the spectrum are also dysgraphic and they are unable to listen to you talk, read the board and take notes at the same time.
• Please post schedules and homework assignments on the board and make a copy for him. Please make sure that these assignments get put into his backpack because he can't always be counted on to get everything home without some help.
• The student lacks the ability of remember a lot of information or how to retrieve that information for its use.

==> The Complete Guide to Teaching Students with Aspergers and High-Functioning Autism

How to Conduct an Assessment for Aspergers

How does a diagnostician or clinician conduct an assessment for Aspergers?

Autism Spectrum Disorders are very complex, yet their features can be very subtle; they are not always obvious on the surface. As a result, an Aspergers (high-functioning autism) assessment will take more time than most other assessments. Below are the methods that clinicians who are new to the field of Aspergers can use as a guide. These are also the methods that moms and dads should look for to make sure they are getting a good assessment for their Aspergers child.

An assessment should be conducted by a doctor, psychologist, or psychiatrist who has expertise in Autism Spectrum Disorders (ASD). This is important because most degree programs may only give passing information about Aspergers. A clinician may have a lot of experience in evaluating and may know the DSM criteria for Aspergers – but knowing the criteria on paper is not the same as having the background to really know all of the subtle features to look for. If you are a clinician and do not have the background experience with Aspergers yet, consult with a clinician who does. If you are a mother or father getting an Aspergers assessment done, ask about the background experience of the clinician.

Assess each of the core areas of difficulty along with the more subtle characteristics. Aspergers involves qualitative difficulties in language, social interactions, and more stereotyped and repetitive behaviors and interests; however, there cannot be a real delay in language – but it does often involve difficulties in how language is being used.

It is not enough to question parents about language delays or social interactions or interests. A good assessment will look at how behaviors are being exhibited. Even if the Aspergers child is social, the clinician needs to look at whether he/she can take other people's perspective:

• Does he have imaginative play?
• Does he demonstrate sensory preferences that interfere with required or socially desires activities?
• Does he approach others and initiate interactions?
• Can he talk about someone else' preferred topic?
• Can he switch tasks when redirected fairly easily?
• Can he listen as well as talk?

These are just some of the more subtle behaviors that need to be observed in Aspergers kids who may be higher functioning. This goes beyond just asking, "Does your son or daughter socialize?"

Use observation in a variety of settings as the core of the assessment. Behaviors can be exhibited for more than one reason. For example, escape, reactions to sensory processing difficulties, attention seeking, and seeking rewards can all be the basis for behaviors. A question on a form reveals that a behavior is being exhibited, but does not reveal why or exactly what the behavior looks like. The only way to know the "why" of many behaviors is to observe in natural settings and to spend time with the Aspergers youngster.

It is not enough to simply observe the Aspergers child in a clinical setting. If clinicians take the child to an unfamiliar location and put her in a room with grown-ups that she has never seen before and then ask the parent to leave the room, you will not get a good picture of how this child interacts with others. If it is not possible to observe the child in a natural setting, then ask the parents if they can videotape their child during various activities.

It is critical to observe the child – close up – in a small playgroup. Observing play and social interactions may look good from a distance; however, when the clinician can (a) hear everything that is being said, (b) follow the child’s eyes, (c) see how he responds to interruptions and so forth, then the clinician can really assess the details of those interactions and begin to interpret them as possibly on the spectrum or not. The clinician can also tell if the child’s play is “parallel play” or if it is really “cooperative play.” Observations not only support the diagnosis, but they are essential in order to give individualized, rather than generic, recommendations.

Clinicians should pair observations with interviews, ratings scales and direct assessment. One rating scale alone should not be the actual assessment. However, rating scales should be given to support observations. If the results do match what is being observed, then check to make sure that the rating scales were completed correctly and ask the rater for examples of what was being rated high in the scales. For example, a behavior could be rated as being "frequently" observed. If it is occurring about 2 times per day, it may seem frequent, but according to the key on some scales, "frequent" is defined as 6 or more times in a 6 hour period. Thus, 2 times per day should be rated as "sometimes" observed. Also, make sure that the scoring follows the key, and get information about what the behavior looks like as well as examples of when and how it occurs. Many of the rating scales (e.g., Gilliam scales, CARS) have a high validity rating, and they are usually fairly correct; however, they are not always correct and cannot be used to make a diagnosis because the reported behaviors could be due to different causes.

Rule out other disorders that have similar characteristics. Many behaviors can be associated with more than one diagnosis. The trick is to look at what the underlying causes of the behaviors are – and what is maintaining the behaviors. With an Aspergers diagnosis, it is crucial to put all of the information together to get the big picture because Aspergers is a spectrum disorder (i.e., a spectrum of behaviors across three major areas of difficulty). If the clinician only looks at behaviors on the surface, then multiple diagnoses will be given for the same behaviors – or the child will get a misdiagnosis. If, for example, a child receives the diagnoses of ADHD, Bipolar, Autism, and ODD all at the same time, it’s likely that the clinician “cut some corners” and conducted a poor assessment. It is definitely possible to have a dual diagnosis that is accurate, but a good assessment will differentiate between diagnoses.

The Aspergers Comprehensive Handbook