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Communication Difficulties in Children with ASD Level 1

“What are some of the common communication difficulties that children on the high functioning end of autism have?”

The youngster with ASD level 1, or High-Functioning Autism, usually begins to speak at the age expected in “typical” kids (however, walking may be delayed). A full command of grammar is sooner or later acquired, but there may be difficulty in using pronouns correctly (with the substitution of the second or third for the first person forms).

The content of speech is often abnormal (tending to be pedantic and often consisting of lengthy discussions on favorite subjects). Sometimes a word or phrase is repeated over and over again in a stereotyped fashion. The youngster may invent some words. Also, subtle verbal jokes are not understood, though simple verbal humor may be appreciated.



Non-verbal aspects of communication are also affected. There may be little facial expression except with strong emotions (e.g., anger, irritation). Vocal intonation tends to be monotonous and droning, or exaggerated. Gestures are limited, or else large and clumsy and inappropriate for the accompanying speech.

Comprehension of other people's expressions and gestures is poor, and the youngster may misinterpret or ignore such non-verbal signs. At times he or she may earnestly gaze into another person's face, searching for the meaning that eludes him or her.

The most obvious trait in children with ASD is impairment of two-way social communication. This is NOT due to a desire to withdraw from social contact, rather the problem arises from a lack of ability to understand and use the rules governing social behavior.

These rules are unwritten and unstated, complex, and constantly changing. These hidden rules affect speech, movement, eye contact, choice of clothing, gesture, posture, proximity to others, and many other aspects of behavior.

The degree of skill in the area of communication varies among “typical” children, but those with autism are outside the normal range. For example:
  • A small minority have a history of rather bizarre antisocial acts, possibly due to their lack of empathy
  • Some are overly-sensitive to criticism and suspicious of others
  • Their social behavior is often naive and peculiar
  • They do not have the intuitive knowledge of how to adapt their approaches and responses to fit-in with the needs and personalities of peers
  • They may be aware of their difficulties and even strive to overcome them, but in inappropriate ways

Relations with the opposite sex provide a good example of the more general social ineptitude. One of my Asperger’s clients (male, age 25) observed that many of his peers had girlfriends – and some eventually married and had kids. He wanted to be “normal” in this respect, but had no idea how to indicate his interest and attract a female in a socially acceptable way.

He often asked others for a “list of rules for talking to girls,” or tried to find “the secret” in books. If he had a strong sex drive, he would approach and touch or kiss a stranger, or someone much older or younger than himself. As a consequence, he found himself in trouble with the police on a few occasions, or he tried to solve the problem by becoming solitary and withdrawn.




Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Asperger’s Kids and Back-to-School “Separation Anxiety”

With the start of school, boys and girls begin to spend much of their day in the classroom, a place where pressures and relationships with other children can be quite stressful. While some youngsters with Asperger’s (AS) and High-Functioning Autism (HFA) naturally greet new situations with enthusiasm, others tend to retreat to the familiarity of their home.

For some children on the autism spectrum, merely the thought of going at school – away from home and apart from parents – causes great anxiety. Such children, especially when faced with situations they fear or with which they believe they can’t cope, may try to keep from returning to school. 

It's natural for your AS or HFA youngster to feel anxious when you say goodbye to him or her in the morning. Separation anxiety is a normal stage of development. However, if anxieties intensify or are persistent enough to get in the way of school or other activities, your youngster may have Separation Anxiety Disorder (SAD). This disorder may require professional treatment, but there is also a lot that you, as a mother or father, can do to help.



Many children with AS and HFA experience separation anxiety that doesn’t go away, even with mom’s best efforts. These kids experience a reoccurrence of intense separation anxiety during their elementary school years or beyond. If you see any of the “red flags” listed below, and your interventions don’t seem to be enough, it may be necessary to “take the bull by the horns” and help your son or daughter by implementing a different set of interventions listed later in this article:
  • Withdrawal from friends, family, or peers
  • Refusing to go to school for weeks
  • Constant complaints of physical sickness
  • Excessive fear of leaving the house 
  • Preoccupation with intense fear or guilt 
  • Age-inappropriate clinginess or tantrums

SAD is not a normal stage of development, but a serious emotional problem characterized by extreme distress when a youngster is away from the parent. However, since normal separation anxiety and SAD share many of the same symptoms, it can be confusing to try to figure out if your youngster just needs time and understanding – or has a more serious problem. 

The main differences between healthy separation anxiety and SAD are the intensity of your youngster’s fears, and whether these fears keep her from normal activities. Kids with SAD may become agitated when away from the parent, and may complain of sickness to avoid attending school. When symptoms are extreme enough, these anxieties can add up to a disorder.

Children with SAD feel constantly worried or fearful about separation. Many are overwhelmed with one or more of the following:
  • Worry that an unpredicted event will lead to permanent separation: Children with SAD may fear that once separated from a mother or father, something will happen to keep the separation (e.g., worry about being kidnapped or getting lost).
  • Nightmares about separation: Kids with SAD often have scary dreams about their fears. 
  • Fear that something terrible will happen to a parent or sibling: The most common fear a youngster with SAD experiences is the worry that harm will come to a family member in the youngster's absence (e.g., may constantly worry about his mother becoming sick or getting hurt).

SAD can get in the way of normal activities. Kids with this disorder often:
  • Cling to the parent: Kids with SAD may shadow the parent around the house or cling to her arm or leg if the parent attempts to step out. 
  • Complain of physical sickness (e.g., headache, stomachache): At the time of separation, or before, kids with SAD often complain they feel ill.
  • Display reluctance to go to sleep: SAD may make these kids insomniacs, either because of the fear of being alone or due to nightmares about separation.
  • Refuse to go to school: A youngster with SAD may have an unreasonable fear of school, and will do almost anything to stay home.

SAD occurs because a youngster feels unsafe in some way. Take a look at anything that may have thrown your youngster’s world off balance, or made her feel threatened or could have upset her normal routine. If you can pinpoint the root cause(s), you’ll be one step closer to helping your youngster through her fears.

The following are common causes of SAD in kids:
  • Anxiety: Stressful situations (e.g., switching schools, loss of a family member, loss of a pet, divorce, etc.) can trigger SAD. 
  • Over-protective parent: In some cases, SAD may be the manifestation of the mother’s or father’s own anxiety—moms and dads and kids can feed one another’s anxieties. 
  • Change in environment: Changes in surroundings (e.g., a new house, school, or daycare situation) can trigger SAD. 

For AS and HFA kids with Separation Anxiety Disorder, there are steps parents can take to make the process of separation easier:

1. Be ready for transition points that can cause anxiety for your youngster (e.g., going to school, meeting with friends to play). If your youngster separates from one parent more easily than the other, have that parent handle the drop off.

2. At times of stress at school, a brief phone call (e.g., a minute or two) with a parent may reduce separation anxiety.

3. Develop a “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss. 

4. Educate yourself about SAD. If you learn about how your youngster experiences this disorder, you can more easily sympathize with his or her struggles.

5. If a school-related problem (e.g., a bully, an unreasonable teacher, disgust of school cafeteria lunches) is the cause of your youngster's anxiety, become an advocate for your child and discuss these problems with the school staff. The teacher or principal may need to make some adjustments to relieve the pressure on your youngster in the classroom, cafeteria, or on the playground. 

6. Remember that every good effort, or a small step in the right direction, deserves to be praised. Use the smallest of accomplishments (e.g., going to bed without a fuss, a good report from school) as reason to give your youngster positive reinforcement. 

7. Help your youngster develop independence by encouraging activities with other kids outside the home (e.g., clubs, sports activities, overnights with friends, etc.). 

8. Find a place at school where your youngster can go to reduce anxiety during stressful periods. Develop guidelines for appropriate use of the “safe place.”

9. If the school can be lenient about late arrival at first, it can give you and your youngster a little wiggle room to talk and separate at your youngster’s slower pace.

10. If your child has missed several days of school due to separation anxiety, initiate a plan for him to return to school immediately. This may include gradual reintroduction with partial days at first. The longer he stays home, the more difficult his eventual return will be. Explain that he is in good health and his physical symptoms are probably due to concerns he has expressed to you (e.g., grades, homework, relationships with educators, anxiety over social pressure, legitimate fears of violence at school, etc.). Let him know that school attendance is required by law. He will continue to exert some pressure on you to let him stay home, but remain determined to get him back in school. Recruit school staff (e.g., school nurse) to help with this.

11. Keep calm during separation. If your youngster sees that you can stay cool, he is more likely to be calm, too.

12. If you allow your youngster to stay home, be sure he is safe and comfortable, but he should not receive any special treatment. His symptoms should be treated with consideration and understanding. If his complaints warrant it, he should stay in bed. However, his day should not be a holiday. There should be no special snacks and no visitors, and he should be supervised. 

13. Keep familiar surroundings when possible, and make new surroundings familiar (e.g., have the sitter come to your house; when your youngster is away from home, let her bring a familiar object).

14. Leave without fanfare. Tell your youngster you are leaving and that you will return, then go – don’t hang around.

15. Make a commitment to be extra firm on school mornings whenever your child begins to complain about her symptoms. Keep discussions about physical symptoms or anxiety to a minimum. For example, do not ask her how she feels. If she is well enough to be up and moving around the house, then she is well enough to attend school. When in doubt, err on the side of sending your youngster to school. 

16. Listen to and respect your youngster’s feelings. For kids who might already feel isolated by their disorder, the experience of being listened to can have a powerful healing effect.

17. Minimize scary television shows and movies. Your youngster is less likely to be fearful if the shows you watch are not frightening.

18. Offer choices as much as possible. If your youngster is given a choice or some element of control in an activity or interaction with a grown-up, she may feel more safe and comfortable. 

19. Place a note for your youngster in his lunch box or locker. A quick “I love you!” on a napkin can reassure a SAD youngster.

20. Practice separation. Leave your youngster with a caregiver for brief periods and short distances at first. 

21. Provide a consistent routine for the day. Don’t underestimate the importance of predictability for kids with separation anxiety. If your family’s schedule is going to change, discuss it ahead of time with your AS or HFA youngster. 

22. While you may try to manage separation anxiety on your own, if your child's fretfulness lasts more than a few weeks, you and your child may need professional assistance to deal with it. First, he should be examined by your doctor. If his anxiety persists, or if he has chronic or intermittent signs of separation difficulties when going to school (in combination with physical symptoms that are interfering with his functioning), your doctor may recommend a consultation with a psychiatrist or psychologist. Even if your youngster denies having negative experiences at school or with other kids, his unexplainable physical symptoms should motivate you to schedule a medical evaluation. 

23. Schedule separations after naps or meals. AS and HFA kids are more susceptible to separation anxiety when they’re tired or hungry. 

24. Set limits in a compassionate way. Let your youngster know that although you understand his feelings, there are rules in your household that need to be followed.

25. Support your youngster's participation in activities. Encourage him to participate in healthy social and physical activities.

26. Talk about the problem. It’s very healthy for kids to talk about their feelings. They don’t benefit from “not thinking about it.” Be empathetic, but also gently remind your youngster that she survived the last separation.

27. Try not to give in. Reassure your youngster that he will be just fine. Setting some healthy limits will help the adjustment to separation.

28. If your youngster's anxiety is severe, she might benefit from a step-wise return to school. For example: 
  • On day one, she could get up in the morning and get dressed, and then you could drive her by the school so she can get some feel for it before you return home with her.
  • On day two, she could go to school for just half a day, or for only a favorite class or two.
  • On day three, she could return for one full day of school within that week.
  • The following week, she could attend school for three of the five days.
  • The week after that, she could attend on all five days.

Moms and dads should be concerned if their AS or HFA youngster regularly complains about feeling sick or often asks to stay home from school with minor physical complaints. Not wanting to go to school may occur at any time, but is most common in kids 5-7 and 11-14 (times when they are dealing with the new challenges of elementary and middle school). AS and HFA kids may suffer from a paralyzing fear of leaving the safety of their home. Their panic and refusal to go to school is very difficult for moms and dads to cope with, but these fears and behavior can be successfully managed by using the steps listed above.

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

Sleep Disturbance in Kids and Teens on the Autism Spectrum

“Any advice for helping our HFA child (age 6) with sleep difficulties? She has a hard time getting to sleep, will wake up numerous times through the night. We have a real chore with trying to wake her up in the morning, and we are getting reports from her teacher that she frequently doses off during class.”

Sleep disturbance is common in kids and teens with Asperger’s (AS) and High Functioning Autism (HFA) at all levels of cognitive functioning. Sleep disturbance correlates with family distress and may have significant effects on daytime functioning and quality of life for these young people. In some cases, there may be an identifiable cause (e.g., obstructive sleep apnea, gastroesophageal reflux).



Assessment and treatment for sleep problems are guided by history and physical examination. When there is not an identifiable medical cause, behavioral interventions often are effective (e.g., sleep-hygiene measures, restriction of daytime sleep, positive bedtime routines, extinction procedures).

Relatively little information is available regarding drug treatment for sleep issues in kids with AS and HFA or other developmental disorders. Recommendations typically are based on case reports and open-label trials, extrapolation from the adult literature, and expert consensus.

There is some evidence of problems with melatonin-regulation in kids on the autism spectrum. Melatonin may be effective in improving sleep onset in young people with sleep/wake disorders. 
 
A recent study suggested that controlled-release melatonin improved sleep in a group of 25 kids with AS and HFA, and that treatment gains were maintained at 1- and 2-year follow-up. Many children on the autism spectrum respond well (with no apparent adverse effects) to treatment with the melatonin receptor agonist “ramelteon.”

Trazodone, α2-agonists, newer non-benzodiazepine hypnotic agents (e.g., zolpidem and zaleplon), chloral hydrate, benzodiazepines, and antihistamines are sometimes used to treat pediatric insomnia. In some cases, other conditions (e.g., epilepsy, depression, anxiety, aggressive outbursts, etc.) warrant drug treatment, and an agent that also assists with sleep can be chosen.


  
COMMENTS:

•    Anonymous said... Cranio sacral therapy should do the trick
•    Anonymous said... Our son used to do the same and she suggested taking melatonin 20 min before bed ' it's an over the counter supplement. Helped a lot.ask your Dr about it because there are different doses available.
•    Anonymous said... See your specialist about getting a script for melatonin, works wonders, is a natural thing , also look at her mattress that will also help
•    Anonymous said... Tart Cherry juice before bedtime naturally produces and releases melatonin. This has helped my son as well as using essential oil Lavendar on his feet before going to bed every night.
•    Anonymous said... We do a 1 mg melatonin split in half.
•    Anonymous said... We used valerian hops homeopathic drops and after a while they did the trick!! More restful than agitated sleep too. X

*   Anonymous said... my son slept in my bed for years..being close caused him to be more calm and therefore fall back to sleep quicker than if he was alone.. its to do with how much their brain works..if there is stuff it is trying to process no chance its going to let the person sleep until the processing has been done.. look after yourself through it ..use afternoon naps etc...
*  Anonymous said...We use 6 mg of melatonin but our son is on many other medications for his Aspergers
*   Anonymous said...My son takes 6 mg of melatonin along with several medications. He is 7 yrs old and when my husband and I do get a full night of sleep we are blessed. Also our little man needs to sleep through the night. He has Aspergers, hyfunctional autism and the list of diagnoses goes on.
 
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