This video discusses assertive parenting skills for dealing with problematic behavior in teenagers on the autism spectrum. Learn how to "fight fair" and "confront bad behavior" in a way that yields positive outcomes for both parent and child.
“Do you have any advice on how we can make my 6 year old daughter’s upcoming visit to our doctor less stressful? She was diagnosed with high functioning autism recently, and has a history of not doing well while being examined, crying hysterically from start to finish. It’s a real ordeal for all of us, including the doc! Also, my daughter has pica.”
Most children with Asperger’s and High Functioning Autism have difficulties with social interaction, communication, and accepting novelty. Therefore, spending the extra time to acclimate the “special needs” child to the new environment/experience will be crucial, for example:
Allow ample time while talking before touching the child
Allow the child to manipulate instruments and materials
Exaggerate social cues
Familiarize the child with the office setting and staff
Have family and/or familiar staff available
Keep instructions simple, using visual cues and supports
Slow down the pace of the overall doctor’s visit
These accommodations will be helpful in reducing the obstacles to health care provision presented by the child’s social skills deficits and resistance to new and unusual encounters.
Often, more time is required for outpatient appointments. In a nationally representative sample, it was found that kids on the autism spectrum spent twice as much time with the doctor per outpatient visit compared with kids in control groups.
RE: Pica— Asperger’s children with pica or persistent mouthing of fingers or objects should be monitored for elevated blood lead concentrations, particularly if the history suggests potential for environmental exposure. Pica often goes away in a few months without treatment.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
That remains to be seen, is the short answer here (and it's certainly an interesting idea). Some people do believe that High-Functioning Autism (HFA) is indeed nothing more than a “different way of thinking” (i.e., a variation of "normal"). This notion is quite believable due to the fact that everyone has some characteristics of the "disorder." All the traits that typify HFA - and Asperger's - can be found in varying degrees in the “typical” population.
For example, collecting objects (rocks, stamps, old glass bottles, etc.) are socially accepted hobbies; individuals differ in their levels of skill in social interaction and in their ability to read nonverbal social cues; people who are capable and independent as grown-ups have special interests that they pursue with marked enthusiasm; and, there is an equally wide distribution in motor skills.
As with any disorder identifiable only from a pattern of “abnormal” behavior (with each trait varying in degrees of severity), it is possible to find numerous individuals on the borderlines of Asperger’s and HFA whose diagnosis is particularly difficult. While the usual case can be recognized with ease by professionals with experience in the field of Autism Spectrum Disorders, in practice, the disorder blends into eccentric normality and into certain other clinical pictures. Until more is known about the underlying mechanism at play, it should be accepted that no precise cut-off points can be defined. As an experiment, take a moment to scan through the following traits associated with Asperger’s and HFA (count the number of traits that apply to you)...
Social traits of Asperger’s and HFA include:
Abrupt and strong expression of likes and dislikes
Apparent absence of relaxation, recreational, or “time out” activities
Bizarre sense of humor (often stemming from a “private” internal thread of humor being inserted in public conversation without preparation or warming others up to the reason for the “punchline”)
Bluntness in emotional expression
Constant anxiety about performance and acceptance, despite recognition and commendation
Difficulty in accepting criticism or correction
Difficulty in distinguishing between acquaintance and friendship
Difficulty in forming friendships and intimate relationships
Difficulty in offering correction or criticism without appearing harsh, pedantic or insensitive
Difficulty in perceiving and applying unwritten social rules or protocols
Difficulty judging others’ personal space
Difficulty with adopting a social mask to obscure real feelings, moods, reactions
Difficulty with reciprocal displays of pleasantries and greetings
Discomfort manipulating or “playing games” with others
Excessive talk
Failure to distinguish between private and public personal care habits (e.g., brushing, public attention to skin problems, nose picking, teeth picking, ear canal cleaning, clothing arrangement)
Flash temper
Flat affect
Immature manners
Known for single-mindedness
Lack of trust in others
Limited by intensely pursued interests
Limited clothing preference (e.g., discomfort with formal attire or uniforms)
Low or no conversational participation in group meetings or conferences
Low to medium level of paranoia
Low to no apparent sense of humor
Often perceived as “being in their own world”
Pouting frequently
Preference for bland or bare environments in living arrangements
Difficulty expressing anger (i.e., either excessive or “bottled up”)
Difficulty in judging distances, height, depth
Difficulty in recognizing others’ faces (i.e., prosopagnosia)
Difficulty with initiating or maintaining eye contact
Elevated voice volume during periods of stress and frustration
Flat or monotone vocal expression (i.e., limited range of inflection)
Gross or fine motor coordination problems
Low apparent sexual interest
Nail-biting
Self-injurious or disfiguring behaviors
Sleep difficulties
Stims (i.e., self-stimulatory behavior serving to reduce anxiety, stress, or to express pleasure)
Strong food preferences and aversions
Strong sensory sensitivities (e.g., touch and tactile sensations, sounds, lighting and colors, odors, taste
Unusual and rigidly adhered to eating behaviors
Unusual gait, stance, posture
Verbosity
Cognitive traits of Asperger’s and HFA include:
An apparent lack of “common sense”
Compelling need to finish one task completely before starting another
Concrete thinking
Dependence on step-by-step learning procedures (note: disorientation occurs when a step is assumed, deleted, or otherwise overlooked in instruction)
Difficulty in assessing cause and effect relationships (e.g., behaviors and consequences)
Difficulty in assessing relative importance of details (an aspect of the trees/forest problem)
Difficulty in drawing relationships between an activity or event and ideas
Difficulty in estimating time to complete tasks
Difficulty in expressing emotions
Difficulty in generalizing
Difficulty in imagining others’ thoughts in a similar or identical event or circumstance that are different from one’s own (“theory of mind” issues)
Difficulty in interpreting meaning to others’ activities
Difficulty in learning self-monitoring techniques
Difficulty in understanding rules for games of social entertainment
Difficulty with organizing and sequencing (i.e., planning and execution; successful performance of tasks in a logical order)
Disinclination to produce expected results in an orthodox manner
Distractibility due to focus on external or internal sensations, thoughts, and/or sensory input (e.g., appearing to be in a world of one’s own or day-dreaming)
Exquisite attention to detail, principally visual, or details which can be visualized (“thinking in pictures”) or cognitive details (often those learned by rote)
Extreme reaction to changes in routine, surroundings, people
Generalized confusion during periods of stress
Impulsiveness
Insensitivity to the non-verbal cues of others (e.g., stance, posture, facial expressions)
Interpreting words and phrases literally (e.g., problem with colloquialisms, clichés, neologism, turns of phrase, common humorous expressions)
Literal interpretation of instructions (e.g., failure to read between the lines)
Low understanding of the reciprocal rules of conversation (e.g., interrupting, dominating, minimum participation, difficult in shifting topics, problem with initiating or terminating conversation, subject perseveration)
Mental shutdown response to conflicting demands and multi-tasking
Missing or misconstruing others’ agendas, priorities, preferences
Perseveration best characterized by the term “bulldog tenacity”
Poor judgment of when a task is finished (often attributable to perfectionism or an apparent unwillingness to follow differential standards for quality)
Preference for repetitive, often simple routines
Preference for visually oriented instruction and training
Psychometric testing shows great deviance between verbal and performance results
Rage, tantrum, shutdown, self-isolating reactions appearing “out of nowhere”
Relaxation techniques and developing recreational “release” interest may require formal instruction
Resistance to or failure to respond to talk therapy
Rigid adherence to rules and routines
Stilted, pedantic conversational style (“the little professor” concept)
Substantial hidden self-anger, anger towards others, and resentment
Avoids socializing or small talk, on and off the job
Deliberate withholding of peak performance due to belief that one’s best efforts may remain unrecognized, unrewarded, or appropriated by others
Difficult in starting project
Difficult with unstructured time
Difficulty in accepting compliments, often responding with quizzical or self-deprecatory language
Difficulty in handling relationships with authority figures
Difficulty in negotiating either in conflict situations or as a self-advocate
Difficulty with “teamwork”
Difficulty with writing and reports
Discomfort with competition
Excessive questions
Great concern about order and appearance of personal work area
Intense pride in expertise or performance, often perceived by others as “flouting behavior”
Low motivation to perform tasks of no immediate personal interest
Low sensitivity to risks in the environment to self and/or others
Often viewed as vulnerable or less able to resist harassment and badgering by others
Out-of-scale reactions to losing
Oversight or forgetting of tasks without formal reminders (e.g., lists or schedules)
Perfectionism
Punctual and conscientious
Reliance on internal speech process to “talk” oneself through a task or procedure
Reluctance to accept positions of authority or supervision
Reluctance to ask for help or seek comfort
Sarcasm, negativism, criticism
Slow performance
Stress, frustration and anger reaction to interruptions
Strong desire to coach or mentor newcomers
Tendency to “lose it” during sensory overload, multitask demands, or when contradictory and confusing priorities have been set
Very low level of assertiveness
If you were honest with yourself, you found that many of the traits listed above directly apply to you. Does that mean you are technically located somewhere on the autism spectrum? Some will argue that the answer to that question is a profound “yes.” Also, many professionals are now noticing that the younger population (approximately ages 5 – 25) is becoming more “autistic-like” due to their significant obsession with digital devices (e.g., iPhones, iPads, computers, etc.).
These young people are literally (a) living in an altered reality (i.e., digital rather than real life experience), (b) spending inordinate amounts of time with their “special interest,” and (c) engaging in far fewer face-to-face social interactions – all of which are considered autistic traits. So, is autism on the rise, or are there simply more “normal” people engaging in “autistic-like” behavior (in the higher-functioning form)?
To complicate the matter of coming to an accurate diagnosis even further, there is the issue of “differential diagnosis.” For example, the lack of empathy, single-mindedness, odd communication, social isolation and over-sensitivity of individuals with Asperger’s and HFA are features that are also included in the definitions of Schizoid Personality Disorder (SPD).
To demonstrate this point, I had a client (19 year-old male) diagnosed with SPD who had no friends at college, he was odd and awkward in social interaction, always had difficulty with speech, never took part in rough games, was oversensitive, and very unhappy being away from home. He thought-out incredible digital inventions and, together with his younger brother, invented a detailed imaginary world. Sounds like Asperger’s – doesn’t it?
There is no question that HFA and Asperger’s can be viewed as a form of Schizoid Personality; however, the question is whether this grouping is of any value. The capacity to withdraw into an inner world of one's own special interests is available in a greater or lesser measure to everyone. This skill MUST be present in those who are highly creative (e.g., inventors, artists, scientists, etc.).
However, the difference between an individual with Asperger’s or HFA and the “typical” individual who has a complex inner world is that the latter DOES take part appropriately in two-way social interaction at times, while the former does NOT. Also, the “typical” individual, no matter how elaborate her inner world, is influenced by her social experiences, while the individual with Asperger’s or HFA seems cut-off from the effects of outside contacts.
Many “typical” grown-ups have excellent rote memories – and even retain eidetic imagery into adult life. Pedantic speech and a tendency to take things literally can also be found in “typical” individuals. Some individuals could be classified as having Asperger’s or HFA because they are at the extreme end of the normal continuum on all these traits. In other people, one particular characteristic may be so marked that it affects the whole of their functioning.
Even though Asperger’s and HFA do appear to merge into the normal continuum, there are many cases where the difficulties are so striking that the suggestion of a distinct disorder seems to be a more credible explanation than a “variant of normality.”
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
“Is it common for children with Asperger syndrome and high functioning autism to have epileptic seizures? What signs should parents look for if they think their child may be having mild seizures?”
Some of the brain irregularities that are associated with autism spectrum disorders can contribute to seizures. These irregularities can cause changes in brain activity by interrupting neurons in the brain.
Neurons are cells that process and transmit information and send signals to the rest of the body. So overloads or instabilities in the activity of these neurons can result in imbalances that cause seizures.
The reported prevalence of epilepsy among children on the autism spectrum disorders ranges from 11% to 39%. The prevalence of epilepsy was higher in studies that included teens and young adults, because the onset of epilepsy in autism spectrum disorders has 2 peaks: one before 5 years of age and another in the teenage years.
Epileptiform abnormalities on electroencephalography are common in kids on the spectrum, with reported frequencies ranging from 10% to 72%. Due to the increased prevalence of seizures in this population, a high index of clinical suspicion needs to be maintained, and electroencephalography should be considered when there are clinical spells that might represent seizures.
Characteristic symptoms include:
Facial twitching
Involuntary jerking of limbs
Marked and unexplained irritability or aggressiveness
Regression in normal development
Severe headaches
Sleepiness or sleep disturbances
Stiffening of muscles
Unexplained confusion
Unexplained staring spells
There are several types of seizures, each with somewhat different symptoms:
Absence seizures can be difficult to recognize. Also known as petit mal seizures, they are marked by periods of unresponsiveness. The child may stare into space. He may or may not exhibit jerking or twitching.
Atonic seizures involve sudden limpness, or loss of muscle tone. The child may fall or drop her head involuntarily.
Clonic seizures involve repeated jerking movements on both sides of the body.
Myoclonic seizures involve jerking or twitching of the upper body, arms or legs.
Tonic seizures involve muscle stiffening alone.
Tonic-clonic seizures are the most common. Also known as gran mal seizures, they produce muscle stiffening followed by jerking. Gran mal seizures also produce loss of consciousness.
If you suspect your child may be having seizures, find a neurologist that specializes in seizure disorders. The neurologist will order an electroencephalogram, which is a non-invasive process that involves the placing of electrodes on the child’s head in order to monitor activity in the brain. By analyzing the activity patterns, the neurologist can determine if the child is having seizures.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
