The Role of Environment in the Psychiatric Difficulties of Kids on the Spectrum

In a multitude of ways, the environment affects children with Asperger’s and high-functioning autism (HFA), and is a major factor that influences the severity of comorbid psychiatric disorders (e.g., anxiety, depression, OCD, bipolar disorder, ADHD, Tourette Syndrome, personality disorders, ODD, etc.).

Undeniably, the varied expression of psychiatric problems in kids with Asperger’s and HFA is directly related to environmental factors, which suggests the opportunity for planning various interventions. For example, family and daily routines should be considered as environmental factors that can lead to exacerbation (i.e., an increase in severity) or amelioration (i.e., a decrease in severity) of comorbid disorders.



The challenge of understanding the special needs of Asperger’s and HFA kids, and the problems associated with building a close relationship with them, often contributes to increased stress in their moms and dads. Parents of kids on the autism spectrum have been shown to have a reduced sense of happiness and security, and tend to display a general lower quality of life – even in comparison with parents of kids with other disorders (e.g., cerebral palsy or mental retardation). Furthermore, moms were found to experience a higher level of stress than dads, and this higher stress is often related to unusual behavioral traits of the youngster (e.g., hyperactivity, conduct problems, etc.).

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


Other research reports elevated rates of anxiety-related personality traits among the relatives (e.g., siblings, grandparents, etc.) of kids on the spectrum. Moreover, elevated anxiety levels in the moms and dads of these young people can be considered an important environmental factor that can trigger genetically-determined personality traits that are eventually shared with other family members and constitute a genetic family-loading for psychiatric disorders.

The importance of environmental factors in the expression of psychiatric symptoms was investigated in a sample of young people with Autism Spectrum Disorders (ASD), including children with Asperger’s and their siblings, with an evaluation reported independently by parents and educators. Reports by educators showed a much lower prevalence of comorbidity in these children (in particular for somatic, oppositional, conduct, attention, anxiety, and affective problems) as compared to the reports by their moms and dads. These results support the idea that the expression of psychiatric problems in kids with Asperger’s varies depending on the environmental context, and that their identification depends on the type of observer (in this case, teacher versus parent).

There is often a lack of consensus between the reports of parents and educators regarding the behavioral characteristics of kids with Asperger’s and HFA, hence suggesting that caution should be used when making conclusions about the presence of comorbid psychiatric difficulties based simply on the environmental context or a single informant source. Instead, information should be gathered from multiple sources and settings, including direct observation by therapists.

The problems that the youngster experiences in terms of social relationships are even greater outside of the home environment (e.g., school, church, scouts, etc.). The lack of adequate teacher-parent communication, coordination among social service providers, and social support often leaves the parents alone with the burden of providing a more intensive level of care and any additional support.

Unfortunately, schools are not always equipped to deal with the unique needs of the Asperger’s or HFA student, and this often drives him or her to develop feelings of low self-esteem, sadness, and self-blame, which often leads to other problems (e.g., meltdowns, depression, hyperactivity, conduct problems, etc.).

Research has also reported that negative events (e.g., parental discord, frequent changes of own residence, death of a family member, etc.) have significant influence on the youngster’s mood and functioning – and have been associated with clinical depression. These children tend to react to negative life events more severely (and in a different way) than “typical” children do. HFA students are also more vulnerable to developing mood disorders and depressive symptoms than other children (which may be correlated to a genetic predisposition).

Since environmental factors appear to substantially influence the expression of psychiatric comorbidities in children on the spectrum, more attention should be focused on the interactions between these children and their diverse everyday life events. Parents, teachers, and professionals can develop coping strategies and provide a better social support that may contribute to a decrease in the incidence of psychiatric disorders in Asperger’s children.

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


There are numerous accommodations that parents can make to help their child cope effectively with his or her environment. Here are just a few:

1. Allow more time to complete chores, homework, etc.
2. Avoid being critical and negative toward your youngster.
3. Avoid over-scheduling him and allow him free time to play, read, listen to music, or just relax.
4. Avoid placing unrealistic expectations on your child.
5. Break tasks down into a few small steps (no more than 5) that can be completed one at a time so that your youngster does not feel overwhelmed with the task. For example, “It’s time to clean your room. So, put your clean clothes in this drawer. Pick up your dirty clothes off the floor and put them in this laundry basket. Then take the basket to the laundry room.”
6. Create a special signal (e.g., tapping the tip of your nose) that you can use with your youngster to redirect his attention back to what you are saying whenever necessary.
7. Demonstrate active interest in your youngster’s school progress and support her with her learning and homework.
8. Encourage physical activity and healthy eating habits.
9. Have a crisis plan in place in the case of meltdowns (e.g., due to your child’s sensory sensitivities, due to his inability to cope or interact with siblings, etc.). This plan may include providing a quiet place for your youngster to go when needed.
10. Help build your youngster’s sense of self-worth by recognizing his achievements.
11. Listen to your youngster and encourage him to talk about his feelings and worries.           
12. Manage your own stress, and be a positive role model.
13. Monitor their youngster’s access to media and ensure she is aware of safe online practices.
14. Prepare your child in advance for any changes in routine or other unexpected activities. For example, use this 3-stage warning: “In 15 minutes, we are going to the grocery store.” Then after 5 minutes have passed, repeat your instruction and say “In 10 minutes, we are going to the store.” Then after 5 minutes, say “We are leaving in 5 minutes.”
15. Provide a written, predictable schedule of events (e.g., “On school days, you get dressed, brush your teeth, eat some breakfast, get your school bag, and then get on the bus”). Remember, Asperger’s kids thrive on routine.
16. Regularly spend calm and relaxing time with your youngster.
17. Set firm expectations regarding house rules. In many cases, Asperger’s kids may not want to follow a rule that holds no interest for them (e.g., “Be sure to wash your hands before you come to the dinner table”). It is important for parents to establish and maintain control – even when their child has an Autism Spectrum Disorder.
18. Show active interest in your youngster’s activities and hobbies, and participate when possible.
19. Support your youngster if he is exposed to bullying.
20. Use less verbal instruction, and replace it with visual instruction. For example, use drawings, pictures, or other images to create a “chores chart” or a “house-rules chart.”
21. Use positive reinforcement for good behavior as often as possible!

When environmental stress becomes too much to handle, the youngster can develop a range of physical, emotional or behavioral symptoms, and can even be at risk of developing other mental health problems. Also, he may find it difficult to recognize and verbalize when he is experiencing stress. Thus, it is important for moms and dads to teach their “special needs” child to recognize and express his emotions, and to use healthy ways to cope effectively with the environment.

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

==> 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



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

Developmental Coordination Disorder in Children on the Autism Spectrum

 "Are children with ASD usually late in developing fine and gross motor skills?"

Initial accounts of Asperger’s (high functioning autism) include descriptions of Developmental Coordination Disorder (DCD). Kids on the autism spectrum are often delayed in acquiring motor skills that require motor dexterity (e.g., bicycle riding, hand writing, tying shoe laces, opening a jar, etc.) and may appear clumsy.

Many of these young people exhibit an odd gait or posture, poor coordination, problems with conceptual learning, difficulty with visual-motor integration, and trouble with visual-perceptual skills.

DCD is a chronic neurological disorder beginning in childhood that can affect planning of movements and coordination due to brain messages not being accurately transmitted to the body, and is diagnosed in the absence of other neurological impairments (e.g., Parkinson's disease, muscular dystrophy, multiple sclerosis, and cerebral palsy). DCD is more common in boys than girls (approximately 4 males to every 1 female).



In addition to physical impairments, DCD is associated with memory problems (e.g., problems with organizing one's time and remembering deadlines, problems carrying out tasks that require remembering several steps in sequence, increased tendency to lose things, and difficulty remembering instructions).

Other problems that Asperger’s children with DCD may experience include:

• struggling to distinguish left from right
• problems with balance 
• poor sense of direction 
• moderate to extreme difficulty performing physical tasks 
• low muscle tone
• fatigue due to so much extra energy being expended while trying to execute physical movements correctly
• difficulty moderating the amount of sensory information that their body is constantly sending them, and as a result, they are prone to sensory overload and panic attacks

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

In the preschool youngster with DCD, common traits reported by moms and dads include a history of delayed developmental milestones, especially crawling, difficulty making friends, difficulty with dressing, immature art work, poor ball skills, speech, and walking.

In the elementary school youngster, common traits include difficulties in copying from the blackboard, slow/immature/laborious handwriting, and persistence of (and no improvement in) the problems noted in the preschool years.

DCD affects both fine and gross motor control. Let’s look at each of these in turn:

Fine-motor problems can cause difficulty with a wide variety of tasks (e.g., brushing one's teeth, doing chores, fastening buttons, locking and unlocking doors, brushing one's hair, using a knife or fork, etc.). As mentioned previously, there tends to be problems with handwriting (e.g., the acquisition of graphemes such as letters of the alphabet and numbers, learning basic movement patterns, establishing the correct pencil grip, developing a desired writing speed, etc.).

Gross motor control is the ability to make large, general movements. Body image issues, motor coordination, and whole body movement mean that major developmental targets (e.g., climbing, jumping, running, walking, etc.) can be affected. The problems vary from child to child and can include:

• bumping into people accidentally
• clumsiness to the point of knocking things over
• cross-laterality, ambidexterity, and a shift in the preferred hand 
• difficulty combining movements into a controlled sequence
• difficulty in determining left from right
• difficulty remembering the next movement in a sequence
• poor balance 
• poor muscle tone and/or proprioception
• poor timing
• problems with chewing foods
• problems with spatial awareness
• tripping over one's own feet
• trouble picking up and holding onto simple objects

Developmental Verbal Dyspraxia—

Developmental Verbal Dyspraxia (DVD), sometimes referred to as “childhood apraxia of speech,” is a type of DCD that can cause speech and language impairments. The key difficulties include: 

• controlling the speech organs
• making speech sounds
• sequencing sounds within a word or forming words into sentences
• controlling breathing
• suppressing salivation and phonation when talking or singing 
• slow language development

Research has found that children with DCD and normal language skills still experience learning difficulties despite relative strengths in language. This means that for a student with DCD, her working memory abilities determine her learning difficulties. Any strength in language that she has is not able to sufficiently support her learning.

Assessment—

When the issue is raised, the child’s doctor is likely to make a referral to a physiotherapist and/or occupational therapist to help in the diagnosis of DCD, and may involve educational, clinical or neuropsychologists in the assessment of associated problems.

The two main questions to be answered when assessing a child with possible DCD are, first, does he or she have significant coordination difficulties compatible with DCD and, second, is there an underlying neurological or physical disorder? An underlying neurological or medical disorder should always be considered and excluded.

Assessments for DCD typically require a developmental history, detailing ages at which significant developmental milestones occurred (e.g., crawling, walking, etc.). Motor skills screening includes activities designed to indicate DCD (e.g., variations on walking activities, touch sensitivity, physical sequencing, and balancing). Screening tests that can be used to assess DCD include:

• Bruininks-Oseretsky Test of Motor Proficiency
• Movement Assessment Battery for Children
• Peabody Developmental Motor Scales
• Test of Gross Motor Development

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

Therapists use a range of activities to assess the youngster's level of ability in certain crucial areas (e.g., body awareness, cerebral integration, kinesthetic awareness, limb girdle stability, and motor skills).

Treatment—

In general, therapists use two main methods of treatment: process orientated and task orientated. Process‐orientated therapy concentrates on developing sensory modalities involved in motor performance (e.g., the sensory integration approach). The task‐orientated approach aims to improve specific tasks through practice.

Other approaches have focused on improving the child’s self‐esteem rather than the core problems of coordination. Some clinics offer transitional programs to help kids with DCD meet the increasing physical and educational demands when moving from primary to secondary education.

Although kids with DCD usually benefit from physical therapies, many receive as much benefit from psychological support to help them develop compensatory strategies, and cope with their motor impairment and loss of self‐esteem.

Although there is currently no cure for DCD, early intervention may help to reduce the physical, emotional, and social consequences that are often associated with this condition. Without intervention, Asperger’s kids with DCD will continue to exhibit poor motor skills – and show deficits in other areas as well. These young people can - and do - learn to perform certain motor tasks, but they have difficulty when faced with new, age-appropriate ones and are at risk for secondary difficulties that result from their motor challenges. Also, it is important to note that kids with DCD often experience considerable difficulties at school; therefore, it is necessary for parents to educate their child’s teachers about this disorder.

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

Hidden Meanings Behind Problematic Behaviors in Kids on the Autism Spectrum

Most difficult behaviors are triggered by an event. Just as you might suddenly feel thirsty as you walk past a lemonade stand, there are “triggers” in your youngster’s life that elicit certain behaviors. Use a diary to identify these triggers for your youngster’s most challenging behaviors.

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

 

Poor "People Skills" in Teens on the Autism Spectrum

"Any tips for helping my depressed teenager with ASD to develop some people skills in order to find a few friends that he can relate to?"

The rules of social engagement are unwritten. If an adult makes a “social mistake” (e.g., saying “thank you sir” to a woman who happens to look like a man), it may result in an awkward moment or some embarrassment.

For teens though, social mistakes can have profound and disastrous consequences. If they “fail” socially, they can be ostracized from their peer-group, have difficulty making new friends, and feel a sense of general isolation from everybody.

Many teens with High-Functioning Autism (HFA) and Asperger’s (AS) do not know how to engage with their friends and classmates. They are simply not interested in the current fads or topics of conversation among their peer-group. As a result, they may experience teasing, bullying, and rejection from peers – and may feel isolated to the point of experiencing anxiety and/or depression.



Here are some symptoms to look for in your HFA or AS youngster’s behavior when he or she is “failing” socially:

• Behaviors are causing the teen to get into conflicts at school
• Disengagement from friends and classmates
• Increase in anger and/or frustration
• Is so socially anxious that the teen starts refusing to go to school or skips classes
• Poor academic performance
• Preference for isolation at home and school
• Seems genuinely depressed
• Sickness (e.g., frequent stomach aches, headaches, etc.)

The HFA or AS teen needs to decide for himself when he will work on his poor people skills. It can be tough for parents to sit back and watch their “special needs” teen struggle in the social arena, but they should try to let things play out on their own time. To charge-in and assert to the autistic teen that he “needs to work harder on developing some friendship skills” will only add to his low self-esteem and sense of being an “odd ball.”

==> Discipline for Defiant Asperger's and High-Functioning Autistic Teens

Oftentimes, teens on the autism spectrum are not in a headspace where they are ready to make changes (but when they get older, many of them start to feel differently). Here are some reasons why your HFA or AS teen may not be up for addressing his social skills deficits:

• He may recognize he has some social problems, but is ashamed of them. He would rather try to hide them and save face even if that means losing out in the present.
• He may realize he has some things he needs to work on, but doesn't feel they are a priority at the moment. Plus, “trying to change” would be too much work.
• He may not see himself as awkward, just different. At the moment, he doesn't think there is anything wrong.
• He may fully believe the messages that his insecurities are telling him, and he may not think there is any hope of improving (e.g., “You either have it or you don't.” “There's no way I can just talk to other people and then ask them to hang out.” “I'm just bad with people.”)
• So far in life, his lack of social skills may not have cost him enough (e.g., a 16-year-old boy who doesn't need a lot of friends and who is content to spend his free time on the computer is not losing much by being ostracized from his peer-group). As a young adult, he may realize he needs better people skills in order to get a job or find a girlfriend, and then be motivated to do something about it.
• Many HFA and AS teenagers – and even young adults – are somewhat unaware of the fact that they have social issues. They know on some level, but for the most part, they are perfectly content to stay at home all the time and play video games.
• Like most teenagers, the teen on the autism spectrum may have the attitude that his mom and dad don't really know what they're talking about – especially when it comes to his social life. He may think his mom and dad simply don't understand what he is going through. Even if parents tell him they went through the exact same thing at his age, he may still think they are clueless. 
• Most teenagers, autistic or not, don't like to think that they fail to measure-up in their parents’ eyes. Even if they have no problem with their poor people skills, they may still feel like they are disappointing their parents and be reluctant to bring the topic into the open or accept the parents’ help.
• As with most teens, the autistic teen may be particularly unenthused about the idea of accepting help or criticism from his mom or dad. Also, if the teen views his mom or dad as the authoritarian, “impossible-to-please” parent, he will be even less likely to welcome parental assistance.

==> Discipline for Defiant Asperger's and High-Functioning Autistic Teens

In any event, what can parents do to help their socially awkward HFA or AS teen? Here are some tips:

1. Don't give your HFA or AS teen the impression that your opinion of him is conditional on how socially successful he is.

2. Encourage your teen to hang out with peers outside of school or through extracurricular activities (e.g., sports, music, etc.).

3. Encourage your teen to engage in online support groups and chat sites for young people on the autism spectrum. Here’s is a good place to start: www.AspergersTeenChat.com

4. Engage your youngster in an activity or program where there are adult mentors to help him increase his self-esteem and build self-confidence. Research reveals that having just one activity in a youngster’s life where he feels successful will result in a higher sense of self-esteem and a greater ability to negotiate a variety of social situations.

5. If it is painfully obvious that your teen is really suffering due to his social skills deficits (e.g., feels lonely, depressed, suicidal, etc.), you don’t have to sit back and stay completely silent. Bring up the topic once. Odds are good he won't be very open to accepting help. If he isn’t, don't take it personally. That is his choice. In any event, don't keep bringing it up in an attempt to nag him into addressing the issue.

Pick a moment when you have time to speak, and your teen is in a decent mood. Tactfully mention that you've noticed that he seems to be having some trouble with __________ (fill in the blank with the problem in question), and that if there is anything you can do to help, you are there for him. Again, he may deny that there is a problem or want the conversation to be over. But even if he gives that response, you can still lay out some options for him.

==> Discipline for Defiant Asperger's and High-Functioning Autistic Teens

6. If there is a relative or family friend your teen may be more open to talking to, mention that person’s name. Maybe your teen will be more open to chatting with his uncle who he looks up to, for example.

7. If your HFA or AS teen agrees to see a therapist, it's important to be patient and let things play-out between them. A common mistake many moms and dads make is they expect the professional to quickly and cost-effectively “fix” their youngster.

8. Let your teen know that if he ever wants to brainstorm some ideas or hear some suggestions, you are there to help.

9. Parents should not feel that they have “failed” somehow because their “special needs” youngster is awkward, or because they didn't step in earlier. You may be prone to feeling guilty or blaming yourself if your teenager is going through a tough time. The fact is that most HFA and AS teens are simply emotionally immature compared to their “typical” peers. After all, they have a “developmental disorder.”

10. Point your teen to some resources (e.g., books, videos, CDs, etc.) that discuss self-help strategies for people looking to develop interpersonal skills.

11. Reduce ambiguity in your youngster’s life by addressing his concerns and helping him understand what to expect on a daily basis so you can help lessen his anxiety.

12. Tell your teen that if he ever just wants to vent to someone about some social problems he is having, you are more than willing to listen in a non-judgmental way and be his sounding board and/or advocate.

13. Tell your teen that if he ever wants to talk to a therapist or look into a social skills training group, you will help make that happen. Also, point out that you don't view professional help as a big deal, just an option people have if they want some outside advice and support.

14. While the HFA or AS youngster may have some real social weaknesses, in other ways he may be different from the norm in a way that is perfectly valid. Those differences may be tied to social skills deficits, but parents need to distinguish between true deficits and normal variations in personality. For instance, there's nothing wrong with being a bit reserved, being uncomfortable in certain social situations, having a unique hobby, having an odd sense of humor, preferring to spend time alone, etc. Thus, parents should not come across like they are rejecting their teen’s core self.

15. With older teenagers on the autism spectrum, parents don't have a lot of ability to further influence their social development – they are almost adults. However, with younger teens, parents still have the authority to enroll them in a social skills training group or insist they see a counselor. A 13-year-old may not like it, but he still recognizes his mom and dad are allowed to make him go to things. But, if parents try to do that with a 19-year-old, he will likely resist any form of treatment or intervention.

==> Discipline for Defiant Asperger's and High-Functioning Autistic Teens

We have just talked about some things that parents can do to help their socially awkward HFA or AS teen. Next, let’s look a few things to avoid doing:

• If you have already tried to help your youngster with his social awkwardness, but he shot you down, try to avoid feeling slighted or resentful. Don’t take it personally. He will take a hard look at himself and the changes that may need to happen when the timing is right.
• If you were socially awkward as a teen, some of your own baggage may come up as you witness your teen struggling. You may frantically want to help him avoid some of the social blunders you made. But, he will need to learn from his own mistakes rather than from yours.
• Avoid the urge to “force” your teenager to try to improve his social skills, even if his deficits are making him unhappy. 
• Try to avoid feeling disappointed in your youngster. Maybe you were somewhat popular in school and can't really understand how your teen seems to be having the opposite experience you did. Maybe you always hoped he would be a great trumpet player or football player, and you can't help but roll your eyes when he spends a Sunday afternoon playing “childish” video games in his bedroom (i.e., games that much younger children might play).
• Don’t fall into the trap of feeling sorry for your HFA or AS teen. It's only natural that you want to make his pain go away, but that attitude often results in over-protective parenting that tends to make a bad problem worse (e.g., doing too much for your teen to the point where he never learns to do things for himself).
• Try not to get angry with your teen for not realizing he has a problem, or not wanting to do anything about it. True, the problem seems so obvious to you, but your teen doesn’t see things the same way. For instance, he may tell you that it is impossible for him to make friends. His logic and explanations may not make sense to you, but he still seems to believe them.

It takes time for teens on the spectrum to improve their social skills. If your teen does start working through his issues, don't feel like he is dragging his feet or not working hard enough if he doesn't transform over a period of a few weeks. In addition, give him space to change at his own pace. Maybe he will be eager about making some changes for a few months, but then get distracted by other things for a while.

In any event, don't make your teen feel monitored, or that your approval is connected to his rate of progress. For instance, you go to a family cookout and your teen doesn’t feel like mingling with other family members, but you watch him to see if his ability to socialize has improved. As mentioned before, give your HFA or AS teen the impression that you accept him for who he is – unconditionally! Of course, you will be delighted for him and share in his success if he makes some positive changes. But if he doesn't, you're O.K. with that too.

==> Discipline for Defiant Asperger's and High-Functioning Autistic Teens