Helping Aspergers and HFA Children to Control Their Anger

"I'm in desperate need of some strategies to deal with my Aspergers (high-functioning) son's anger. When he starts to stew about something, it's not long before all hell breaks loose. Any suggestions?!"

==> CLICK HERE for the answer...

References—

• American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Health
Disorders. 4th ed. Washington, DC: American Psychiatric Association. 1994.
• Anger Management for Substance Abuse and Mental Health Clients
• Barkley, R.A. (1997). Defiant Children: A Clinician’s Manual for Assessment and Parent
Training. 2nd ed. New York: Guilford Press.
• Beck, R., and Fernandez, E. (1998). Cognitive behavioral therapy in the treatment of anger: A
meta-analysis. Cognitive Therapy and Research, 22, 63-74.
• Berkowitz, L. (1970). Experimental investigations of hostility catharsis. Journal of Consulting
and Clinical Psychology, 35, 1-7.
• Carroll, K.M.; Rounsaville, B.J.; and Gawin, F.H. (1991). A comparative trial of psychotherapies
for ambulatory cocaine abusers: Relapse prevention and interpersonal psychotherapy.
American Journal of Drug and Alcohol Abuse, 17, 229-247.
• Clark, H.W.; Reilly, P.M.; Shopshire, M.S.; and Campbell, T.A. (1996). Anger management treat
ment in culturally diverse substance abuse patients. In: NIDA Research Monograph: Problems
of Drug Dependence, Proceedings of the 58th Annual Scientific Meeting, College on Problems
of Drug Dependence. Rockville, MD: National Institute on Drug Abuse.
• Deffenbacher, J.L. (1996). Cognitive behavioral approaches to anger reduction. In: Dobson,
K.S., and Craig, K.D. (Eds.), Advances in Cognitive Behavioral Therapy (pp. 31-62). Thousand
Oaks, CA: Sage Publications.
• Deffenbacher, J.L. (August 1999). Anger reduction interventions as empirically supported inter
vention programs. Paper presented at the 107th Annual Convention of the American
Psychological Association, Boston.
• Dobson, K.S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression.
Journal of Consulting and Clinical Psychology, 57, 414-419.
• Ducharme, J.M.; Atkinson, L.; and Poulton, L. (2000). Success-based, noncoercive treatment of
oppositional behavior in children from violent homes. Journal of the American Academy of
Child and Adolescent Psychiatry, 39(8), 995-1004.
• Edmondson, C.B., and Conger, J.C. (1996). A review of treatment efficacy for individuals with
anger problems: Conceptual, assessment, and methodological issues. Clinical Psychology
Review, 10, 251-275.
• Ellis, A. (1979). Rational-emotive therapy. In: Corsini, R. (Ed.), Current Psychotherapies (pp.
185-229). Itasca, Il: Peacock Publishers.
• Ellis, A., and Harper, R.A. (1975). A New Guide to Rational Living. N. Hollywood, CA: Wilshire
Books.
• Heimberg, R.G., and Juster, H.R. (1994). Treatment of social phobia in cognitive behavioral
groups. Journal of Clinical Psychology, 55, 38-46.
• Hoyt, M.F. (1993). Group therapy in an HMO. HMO Practice, 7, 127-132.
• Juster, H.R., and Heimberg, R.G. (1995). Social phobia: Longitudinal course and long-term out
come of cognitive behavioral treatment. Psychiatric Clinics of North America, 18, 821-842.
• Maude-Griffin, P.M.; Hohenstein, J.M.; Humfleet, G.L.; Reilly, P.M.; Tusel, D.J.; and Hall, S.M.
(1998). Superior efficacy of cognitive behavioral therapy for urban crack cocaine abusers: Main
and matching effects. Journal of Consulting and Clinical Psychology, 66, 832-837.
• Murray, E. (1985). Coping and anger. In: Field, T., McCabe, P., and Schneiderman, N. (Eds.),
Stress and Coping (pp. 243-261). Hillsdale, NJ: Erlbaum.
• Piper, W.E., and Joyce, A.S. (1996). A consideration of factors influencing the utilization of time-
limited, short-term group therapy. International Journal of Group Psychotherapy, 46, 311-328.
• Reilly, P.M., and Grusznski, R. (1984). A structured didactic model for men for controlling family
violence. International Journal of Offender Therapy and Comparative Criminology, 28, 223-235.
• Reilly, P.M., and Shopshire, M.S. (2000). Anger management group treatment for cocaine
dependence: Preliminary outcomes. American Journal of Drug and Alcohol Abuse, 26(2),
161-177.
• Reilly, P.M.; Clark, H.W.; Shopshire, M.S.; and Delucchi, K.L. (1995). Anger management, post-
traumatic stress disorder, and substance abuse. In: NIDA Research Monograph: Problems of
Drug Dependence, Proceedings of the 57th Annual Scientific Meeting (p. 322), College on
Problems of Drug Dependence. Rockville, MD: National Institute on Drug Abuse
• Reilly, P.M.; Shopshire, M.S.; and Clark, H.W. (1999). Anger management treatment for cocaine
dependent clients. In: NIDA Research Monograph: Problems of Drug Dependence, Proceedings
of the 60th Annual Scientific Meeting (p. 167), College on Problems of Drug Dependence.
Rockville, MD: National Institute on Drug Abuse.
• Reilly, P.M.; Shopshire, M.S.; Clark, H.W.; Campbell, T.A.; Ouaou, R.H.; and Llanes, S. (1996).
Substance use associated with decreased anger across a 12-week cognitive-behavioral anger
management treatment. In: NIDA Research Monograph: Problems of Drug Dependence,
Proceedings of the 58th Annual Scientific Meeting, College on Problems of Drug Dependence.
Rockville, MD: National Institute on Drug Abuse.
• Reilly, P.M.; Shopshire, M.S.; Durazzo, T.C.; and Campbell, T.A. (2002). Anger Management for
Substance Abuse and Mental Health Clients: Participant Workbook. Rockville, MD: Center for
Substance Abuse Treatment.
• Shopshire, M.S.; Reilly, P.M.; and Ouaou, R.H. (1996). Anger management strategies associat
ed with decreased anger in substance abuse clients. In: NIDA Research Monograph: Problems
of Drug Dependence, Proceedings of the 58th Annual Scientific Meeting (p. 226), College on
Problems of Drug Dependence. Rockville, MD: National Institute on Drug Abuse.
• Smokowski, P.R., and Wodarski, J.S. (1996). Cognitive behavioral group and family treatment of
cocaine addiction. In: The Hatherleigh Guide to Treating Substance Abuse, Part 1. (pp. 171-
189). New York: Hatherleigh Press.
• Straus, M.; Gelles, R.; and Steinmetz, S. (1980). Behind Closed Doors: Violence in the
American Family. Garden City, NY: Doubleday.
• Trafate, R.C. (1995). Evaluation of treatment strategies for adult anger disorders. In:
Kassinove, H. (Ed.), Anger Disorders: Definition, Diagnosis, and Treatment (pp. 109-130).
Washington, DC: Taylor and Francis.
• Van Balkom, A.J.L.M.; Van Oppen, P.; Vermeulen, A.W.A.; Van Dyck, R.; Nauta, M.C.E.; and Vorst,
H.C.M. (1994). A meta-analysis on the treatment of obsessive compulsive disorder: A compari
son of antidepressants, behavior, and cognitive therapy. Clinical Psychology Review, 14, 359-
381.
• Walker, L. (1979). The Battered Woman. New York: Harper & Row.
• Webster-Stratton, C., and Hammond, M. (1997). Treating children with early-onset conduct
problems: A comparison of child and parent training interventions. Journal of Consulting and
Clinical Psychology, 65(1), 93-109.
• Yalom, I.D. (1995). The Theory and Practice of Group Psychotherapy. 4th ed. New York: Basic
Books, Inc.

Aspergers Q & A: "My step-son has had numerous meltdowns off and on for most of his life..."

Question

My step-son is about to turn 12. He has been diagnosed with Asperger's Syndrome. He currently lives with his mother and step-father and half sister. My husband and I live with our son and my two daughters. My step-son has had numerous meltdowns off and on for most of his life. He seems to pick one thing out of his life and fixate on it until he is so afraid of it that he has a meltdown. These fixation normally last for six months or more until all of a sudden, he is no longer afraid of it but finds a new thing to fear. Currently, he is fixated on being scared of coming to visit his dad and is constantly making up excuses not to visit. We have tried to explain to him that there is nothing to be afraid of. We love him very much. He told me that he is afraid that his dad will yell at him or get on to him. Now, I have been with my husband for 7 years and I have seen that the only thing he gets in trouble for is the normal everyday stuff that children get into trouble about. We treat him as we do the other three. From everything that I have read I feel that he should face his fears in order to get past it. But, me being just a step-mom, anything I say doesn't matter or is taken the wrong way. We are getting no help from his mother or any of the other family members who all feel that if he doesn't want to visit, then it must be something that we have done to cause. But, last year when he freaked out about going to school every morning, did they just let him quit? NO! I know this is a tough one. Any opinions would be greatly appreciated. This is not only affecting my husband emotionally, but also my son. He misses him terribly too!


Answer

What you are dealing with here is anxiety. Although little is known about what anxiety symptoms look like in kids with Aspergers, the following symptoms, which overlap with Anxiety Disorders, indicate anxiety:

• Avoidance of new situations
• Irritability
• Somatic complaints
• Withdrawal from social situations

Another set of anxiety symptoms may be seen and may be unique to kids with Aspergers:

• Becoming "silly"
• Becoming explosive easily (e.g., anger outbursts)
• Increased insistence on routines and sameness
• Increased preference for rules and rigidity
• Increased repetitive behavior
• Increased special interest

Cognitive behavioral therapy, a time-limited approach designed to change thoughts, emotions, and behaviors, has been shown to be successful in treating Anxiety Disorders in kids.

For kids with both anxiety symptoms and Aspergers, an innovative group therapy program using cognitive behavioral therapy has been developed. The program includes specific modifications for working with kids with Aspergers and Anxiety Disorder and consists of both a child component and a parent component.

Modifications designed to address the cognitive, social, and emotional difficulties include:

1. More education on emotions—Activities such as feeling dictionaries (i.e., a list of different words for anxiety) and emotional charades (i.e., guessing people's emotions depending on faces) are helpful in developing emotional self-awareness.

2. Greater parent involvement—To build on the attachment between youngster and caregiver, it is important to have moms and dads learn the techniques and coach kids to use them at home.

3. Games and fun physical activities are important to include in group therapy to promote social interactions.

4. Combining visual and verbal materials—Use of worksheets, written schedules of therapy activities, and drawings can be added to increase structure in therapy sessions.

5. Behavioral management—Addition of a reward and consequence system maintains structure and prevents anger outbursts.

6. "Individualizing" anxiety symptoms—Kids should be helped by the therapist to identify what their own anxiety symptoms look like as anxiety symptoms may present differently.

There is some early evidence to suggest that cognitive behavioral group therapy with specific modifications can be successful in treating anxiety symptoms in kids with Aspergers. In a study involving kids with both disorders, most benefited from their participation in the group therapy program and showed fewer anxiety symptoms after 12-weeks of consistent attendance. Future research is being done to get stronger evidence for the effectiveness of the group therapy program.

Aspergers Adolescents & Suicide

Email from a father of an Aspergers son:

In Orange County, California a young adolescent killed two neighbors before committing suicide. He had not worked since graduating high school two years earlier. It sounded like a bizarre mystery to me when I first learned of this through the news outlets. I figured the fact that this person did not have a job was a factor in the outcome. It seemed like depression and rage took over.

Today when driving to our social skills therapy appointment, the talk radio station I listen to had an update on the young man who committed the crimes. It was stated that he suffered from Aspergers. On the one hand I was quite surprised to hear this since I do not recall those with Aspergers being violent.

Over the years I have heard that there is a suicide risk among those with Aspergers. Moms & dads, families and teachers need to keep a watchful eye on the emerging adolescent who has Aspergers. Know the warning signs and learn about the three D's = drugs, depression and dangerous activity.

Some refer to Aspergers as the Geek Syndrome, with many referring to themselves as an Aspie. The term NT means neurotypical, another way of saying normal. When having an internet conversation these terms are often utilized. Kids, adolescents and adults get diagnosed with Aspergers. Usually a child will get the diagnosis of autism, where the age varies for AS. I personally have heard of many being diagnosed as a adolescent or young adult.

The major component differentiating autism with Aspergers is the language deficits are in Autism. Both those who are higher functioning with autism and those with Aspergers have socialization difficulties. They lack reading social cues and empathy. They may have fleeting eye contact and perseverate on interests and hobbies. They are also literal and visual thinkers to some degree or another.

The incident that took place here in Southern California is a tragedy all around for the community and families involved. The parents to the boy did not know he had a gun. It was reported that he was crying out on the internet seeking a friend. I know from our personal experience that kids on the Autism Spectrum are often friend-less. My son would love to have a playmate and enjoy a sleepover.

He will use the phrase "best friends" whenever he has finished having a conversation with someone. That is his new best friend, even if he has no clue to the kid’s name. The last day of the autism day camp this past summer he and his friend were having a hard time saying goodbye. I was quite surprised when I saw Robert lean over and give the boy a hug and was happy that he made the gesture.

They publish a directory with the data for the families each year. Robert has already drawn a birthday card for this boy. Each year on the last day of camp they give out framed photos of the child. This past summer the photo for Robert has the two of them walking hand in hand on one of their outings. This does concern me somewhat because they are 10 and 11 and I wonder how others in the community would perceive "tweens" holding hands.

A lot of the gestures, movements and body language my son has developed could be misconstrued by adolescents once he hits middle school and high school. This has me very worried, so I am learning all I can now about the teenage years for kids on the Autism Spectrum.

I believe another issue to be on guard to is Bipolar Disorder. From what I have read this is developed around the same time - teenage years through young adults. My kids also have a 50% chance of becoming Paranoid Schizoprehnic during the same time period due to their Father having the same disorder.

I am in no rush for my kids to mature and get into those years. I think Craig is prime for Bipolar and not sure why I have this feeling. There is also Alzheimer's Disease in my family genes and hope it does not afflict me the same time the boys might be emerging with other issues.

I have no qualms about snooping if it is warranted as Robert gets older. From what I have read the signs to note are:

• clothing styles drastically change

• disinterested in sports/hobbies that were once a major importance

• distracted, aloof

• driving tickets

• eating less or more

• gaining or losing weight

• grades plummeting

• not taking their meds

• outbursts

• personal hygiene has changed

• sleeping in class

• sleeping patterns are out of whack

Kids start experimenting with alcohol, sex and drugs at this phase of their lives. A child on the Autism Spectrum might go with the flow if they are trying to fit in and making new friends without following body language. Their quirkiness might be looked at as something of interest by the Neurotypicals and they could strike up a conversation that seems innocent to the young person with Aspergers or Autism.

Communication and a watchful eye by the moms & dads are necessary at this time. Having a trusted adult around when school gets out, even being at the school to pick them up or watch from afar if they are taking the bus is worth looking into. Attending conferences and discussing anything out of character with teachers, aides, therapists and counselors is a must. Note any change in sleeping and eating to these professionals that work with the young person at school and maintain communication via email.

Bullies are not just boys either, and a child on the Autism Spectrum might miss the fact that a girl is interested in him when she starts picking on him and becomes aggressive. Kids might be experimenting with smoking or inhaling substances. Spend time each day or night with your child and discuss all these issues ahead of time. Prepare them for the locker room drama, role playing with family members.

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

Aspergers Children & Mental Health Issues

Individuals with autism or Aspergers are particularly vulnerable to mental health problems such as anxiety and depression, especially in late adolescence and early adult life (Tantam & Prestwood, 1999). Ghaziuddin et al (1998) found that 65 per cent of their sample of patients with Aspergers presented with symptoms of psychiatric disorder. However, as mentioned by Howlin (1997), "the inability of individuals with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states, particularly for clinicians who have little knowledge or understanding of developmental disorders". Similarly, because of their impairment in non-verbal expression, they may not appear to be depressed (Tantam, 1991).This can mean that it is not until the illness is well developed that it is recognized, with possible consequences such as total withdrawal; increased obsessional behavior; refusal to leave the home, go to work or college etc.; and threatened, attempted or actual suicide. Aggression, paranoia or alcoholism may also occur.

In treating mental illness in the patient with autism or Aspergers, it is important that the psychiatrist or other health professional has knowledge of the individual with autism being assessed. As Howlin (1997) says, "It is crucial that the physician involved is fully informed about the individuals usual style of communication, both verbal and non-verbal". In particular it is recommended, if possible, that they speak to the parents or care-givers to ensure that the information received is reliable, e.g., any recent changes from the normal pattern of behavior, whilst at the same time respecting the right of the person with autism to be treated as an individual. Wing (1996) asserts that psychiatrists should be aware of autistic spectrum disorders as they appear in adolescents and adults, especially those who are more able, if diagnostic errors are to be avoided. Attwood (1998) also stresses the importance of the psychiatrist being knowledgeable in Aspergers. Tantam and Prestwood (1999), however, state that treatments for anxiety and depression that are also effective for individuals without autism are effective for individuals with autism. They go on to say that practitioners and psychiatrists with no special knowledge of autism or Aspergers can be of considerable assistance in treating these conditions. Typically, however, it is of great advantage if the psychiatrist has experience of autism/Aspergers.

This post will concentrate on mental health in individuals with high-functioning autism or Aspergers although references will be made to autism per se where appropriate. Emphasis will be on depression, anxiety and obsessive compulsive disorder, but it is important to realize that individuals with Aspergers also experience other problems, such as impulsive behavior and mood swings. To date there has been little research in this area but, as Carpenter (2001) has found, these can sometimes be incapacitating. Treatment can include conventional mood stabilizing drugs, but helping the person to improve their self-awareness is also important.

Depression—

Depression is common in individuals with Aspergers with about 1 in 15 individuals with Aspergers experiencing such symptoms (Tantam, 1991). Individuals with Aspergers leaving home and going to college frequently report feelings of depression as demonstrated by the personal accounts that can be found at www.users.dircon.co.uk/~cns/index.html As one young person says, "I also had to deal with anger, frustration, and depression that I had been keeping inside since high school". A study by Kim et al (2000) also found depression to be more common in children aged 10-12 years with high-functioning autism/Aspergers than in the general population of children of the same age.

Depression in individuals with Aspergers may be related to a growing awareness of their disability or a sense of being different from their peer group and/or an inability to form relationships or take part in social activities successfully. Personal accounts by young individuals with Aspergers frequently refer to attempts to make friends but "I just did not know the rules of what you were or were not supposed to do" www.users.dircon.co.uk/~cns/jeanpaul.html Indeed, some individuals have even been accused of harassment in their attempts to socialize, something that can only add to their depression and anxiety; "I also did not know how to approach girls and ask them to go out with me. I would just walk up and talk to them, whether they wanted to talk to me or not. Some accused me of harassment, but I thought that was the way everybody did that." www.users.dircon.co.uk/~cns/jeanpaul.html

The difficulties individuals with Aspergers have with personal space can compound this sort of problem. For example, they may stand too close or too far from the person to whom they are speaking.

Other precipitating factors are also seen in many individuals without autism who are depressed and include loneliness, bereavement or other form of loss, sexual frustration, a constant feeling of failure, extreme anxiety levels etc.

Childhood experiences such as bullying or abuse may also result in depression, as can a history of misdiagnosis. Another possibility is that the person is biologically predisposed to depression (Attwood, 1998). However, there are, of course, many other factors that may trigger the depression and this list should not be taken as exhaustive.

Tantam and Prestwood (1999) describe the depression of someone with Aspergers as taking the same form as in individuals without the condition, although the content of the illness may be different. For example, the depression might show itself through an individual’s particular preoccupations and obsessions and care must be taken to ensure that the depression is not diagnosed as schizophrenia or some other psychotic disorder or just put down to autism. It is important to assess the individual’s depression in the context of their autism, i.e. their social disabilities, and any gradual or sudden changes in behavior, sleep patterns, anger or withdrawal should always be taken seriously.

Symptoms of depression can be psychological (poor concentration/memory, thoughts of death or suicide, tearfulness); physical (slowing down or agitation, tiredness/lack of energy, sleep problems, disturbed appetite (weight loss or gain)); or affects of mood and motivation (e.g., low mood, loss of interest or pleasure, hopelessness, helplessness, worthlessness, withdrawal or bizarre beliefs etc.) Individuals with depression can also experience periods of mania.

Lainhart and Folstein (1994) cite three approaches that need to be made in diagnosing depression in a person with autism. The first concerns a deterioration in cognition, language, behavior or activity. The complaint is rarely couched in terms of mood. Secondly, it is important to take the patients history to establish their baseline, patterns of activity and interests. It is this pattern with which the presenting patterns can be compared. Thirdly, an attempt should be made to assess the patient’s mental state, both directly and through the parent or care-giver, if present. Examples would include reports of crying, difficulties in separating from their parent/care-giver for an interview, increased/decreased activity, agitation or aggression. There may be evidence of new or increased self-injury or worsening autistic features, such as increased proportion of echolalia or the reappearance of hand-flapping.

Attwood (1998) also refers to the inability that some individuals with Aspergers have in expressing appropriate and subtle emotions. They may, for example, laugh or giggle in circumstances where other individuals would show embarrassment, discomfort, pain or sadness. He stresses that this unusual reaction, for example after a bereavement, does not mean the person is being callous or is mentally ill. They need understanding and tolerance of their idiosyncratic way of expressing their grief.

In treating depression, medications used in general practice may be prescribed (Carpenter, 1999). It is important to realize, however, that such agents do not make an impact on the primary social impairments that underlie autism. See Gringras (2000) for a discussion on the use of psychopharmacological prescribing for children with autism or Santosh and Baird (1999) for a analysis of psycho pharmacotherapy in children and adults with intellectual disability (including autism). As with any treatment for depression, adjustments may have to be made to find the appropriate drug and dosage for that particular person. Side effects should also be monitored and effort made to ensure the benefits of the treatment outweigh the penalties (Carpenter, 1999). It is also important to identify the cause for the depression and this may involve counseling (see below), social skills training, or meeting up with individuals with similar interests and values.

Anxiety—

Anxiety is a common problem in individuals with autism and Aspergers. Grandin (2000) writes that, at puberty, fear was her main emotion. Any change in her school schedule caused intense anxiety and the fear of a panic attack. Anxiety attacks started shortly after her first menstrual period. Muris et al (1998) found that 84.1% of children with pervasive developmental disorder met the full criteria of at least one anxiety disorder (phobia, panic disorder, separation anxiety disorder, avoidant disorder, overanxious disorder, and obsessive compulsive disorder). This does not necessarily go away as the child grows older. Attwood (1998) states that many young adults with Aspergers report intense feelings of anxiety, an anxiety that may reach a level where treatment is required. For some individuals, it is the treatment of their anxiety disorder that leads to a diagnosis of Aspergers.

Individuals with Aspergers are particularly prone to anxiety disorders as a consequence of the social demands made upon them. As Attwood (1998) explains, any social contact can generate anxiety as to how to start, maintain and end the activity and conversation. Changes to daily routine can exacerbate the anxiety, as can certain sensory experiences.

One way of coping with their anxiety levels is for persons with Aspergers to retreat into their particular interest. Their level of preoccupation can be used a measure of their degree of anxiety. The more anxious the person, the more intense the interest (Attwood, 1998). Anxiety can also increase the rigidity in thought processes and insistence upon routines. Thus, the more anxious the person, the greater the expression of Aspergers. When happy and relaxed, it may not be anything like as apparent.

One potentially good way of managing anxiety is to use behavioral techniques. For children, this may involve teachers or parents looking out for recognized symptoms, such as rocking or hand-flapping, as an indication that the child is anxious. Adults and older children can be taught to recognize these symptoms themselves, although some might need prompting. Specific events may also be known to trigger anxiety e.g., a stranger entering the room. When certain events (internal or external) are recognized as a sign of imminent or increasing anxiety, action can be taken for example, relaxation, distraction or physical activity.

The choice of relaxation method depends very much on the individual and many of the relaxation products available commercially can be adapted for use for individuals with autism/Aspergers. Young children may respond to watching their favorite video. Older children and adults may prefer to listen to calming music. There is much music on the market, both from specialist outfits and regular music stores that is written specifically to bring about a feeling of tranquility. It is important the person does not have social demands, however slight, made upon them if they are to benefit. It is also important that they have access to a quiet room. Other techniques include massage (this should be administered carefully to avoid sensory defensiveness), aromatherapy, deep breathing and using positive thoughts. Howlin (1997) suggests the use of photographs, postcards or pictures of a pleasant or familiar scene. These need to be small enough to be carried about and should be laminated in order to protect them. Howlin also stresses the need to practice whichever method of relaxation is chosen at frequent and regular intervals in order for it to be of any practical use when anxieties actually arise.

An alternative option, particularly if the person is very agitated, is to undertake a physical activity (Attwood, 1998). Activities may include using the swing or trampoline, going for a long walk perhaps with the dog, or doing physical chores around the home.

Drug treatment may be effective for anxiety. Individuals may respond to buspirone, propranilol or clonazepam (Santosh and Baird, 1999) although Carpenter (2001) finds St. Johns Wort, benzodiazepines and selective serotonin reuptake inhibitors (SSRI) antidepressants to be more effective. As with all drug treatments it may take time to find the correct drug and dosage for any particular person. Such treatment must only be conducted through a qualified medical practitioner.

Whatever method is chosen to reduce anxiety, it is crucial to identify the cause of the anxiety. This should be done by careful monitoring of the precedents to an increase in anxiety and the source of the anxiety tackled.

Obsessive compulsive disorder—

Obsessive compulsive disorder (OCD) is described as a condition characterized by recurring, obsessive thoughts (obsessions) or compulsive actions (compulsions) (Thomsen, 1999). Thomsen goes on to say that obsessive thoughts are ideas, pictures of thoughts or impulses, which repeatedly enter the mind, whereas compulsive actions and rituals are behaviors which are repeated over and over again.

Baron-Cohen (1989) argues that the stereotypic obsessive action seen in children with autism differs from the child with OCD. As Thomsen (1999) explains, the child with autism does not have the ability to put things into perspective. Although terminology implies that certain behaviors in autism are similar to those seen in OCD, these behaviors fail to meet the definition of either obsessions or compulsions. They are not invasive, undesired or annoying, a prerequisite for a diagnosis of OCD. The reason for this is that individuals with (severe) autism are unable to contemplate or talk about their own mental states. However, OCD does appear often to coincide with Aspergers, although there is very little literature examining the relationship between the two (Thomsen, 1999).

Szatmari et al (1989) studied a group of 24 children. He discovered that 8% of the children with Aspergers and 10% of the children with high-functioning autism were diagnosed with OCD. This compared to 5 per cent of the control group of children without autism but with social problems. Thomsen el at (1994) found that in the children he studied, the OCD continued into adulthood.

Individuals with Aspergers can sometimes respond to conventional behavioral treatment to help reduce the symptoms of OCD. However, as with anyone, this will only be effective if the person wants to stop their obsessions. An alternative is use medication to reduce the anxiety around the obsessions, thus enabling the person to tolerate the frustration of not carrying out their obsession (Carpenter, 2001).

Schizophrenia—

There is no evidence that individuals with autistic conditions are any more likely than anyone else to develop schizophrenia (Wing, 1996).

It is also important to realize that individuals have been diagnosed as having schizophrenia when, in fact, they have Aspergers. This is because their odd behavior or speech pattern, or the persons strange accounts or interpretations of life, are seen as a sign of mental illness, such as schizophrenia. Obsessional thoughts can become quite bizarre during mood swings and these can be seen as evidence of schizophrenia rather than the mood disorder that actually are. However, should someone with Aspergers experience hallucinations or delusions that they find distressing, conventional antipsychotic medications can be prescribed? However, it is recommended that only the newer atypical antipsychotics are used, as individuals with Aspergers often have mild movement disorders (Carpenter, 2001). Cognitive behavior therapy and other psychological management methods may be effective.

Psychological Treatments—

A primary psychological treatment for mood disorders is cognitive behavioral therapy as it is effective in changing the way a person thinks and responds to feelings such as anxiety, sadness and anger, addressing any deficits and distortions in thinking (Attwood, 1999). Hare and Paine (1997) list ways in which the therapy can be adapted for use with individuals with Aspergers: having a clear structure e.g., protocols of turn-taking; adapting the length of sessions therapy might have to be very brief e.g., 10-15 minutes long; the therapy must be non-interpretative; the therapy must not be anxiety provoking as any arousal of emotion during therapy may be very counterproductive; group therapy should not be used. It is also important that the therapist has a working knowledge and understanding of Aspergers in a counseling setting i.e., the difficulty individuals have dealing things emotionally, finding it best to deal with things intellectually. The therapist and client can work towards explicit operational goals, the focus being on concrete and specific symptoms. Attwood (1999) gives a succinct overview of the components of the counseling process. Hare and Paine (1997) stress that such therapy is not a treatment or even an amelioration of the characteristics of Aspergers itself. It merely opens the psychotherapeutic door for individuals with such a diagnosis.

Catatonia—

Catatonia is a complex disorder covering a range of abnormalities of posture, movement, speech and behavior associated with over- as well as under-activity (Rogers, 1992; Bush et al, 1996; Lishman, 1998).

There is increasing research and clinical evidence that some individuals with autism spectrum disorders, including Aspergers, develop a complication characterized by catatonic and Parkinsonian features (Wing and Shah, 2000; Shah and Wing, 2001; Realmuto and August, 1991).

In individuals with autistic spectrum disorders, catatonia is shown by the onset of any of the following features:

a. difficulty in initiating completing and inhibiting actions

b. increased passivity and apparent lack of motivation

c. increased reliance on physical or verbal prompting by others

d. increased slowness affecting movements and/or verbal responses

Other manifestations and associated behaviors include Parkinsonian features including freezing, excitement and agitation, and a marked increase in repetitive and ritualistic behavior.

Behavioral and functional deterioration in adolescence is common among individuals with autistic spectrum disorders (Gillberg and Steffenburg, 1987). When there is deterioration or an onset of new behaviors, it is important to consider the possibility of catatonia as an underlying cause. Early recognition of problems and accurate diagnosis are important as it is easiest to manage and reverse the condition in the early stages. The condition of catatonia is distressing for the individual concerned and likely to exacerbate the difficulties with voluntary movement and cause additional behavioral disturbances.

There is little information on the cause or effective treatment of catatonia. In a study of referrals to Elliot House who had autistic spectrum disorders, it was found that 17% of all those aged 15 and over, when seen, had catatonic and Parkinsonian features of sufficient degree to severely limit their mobility, use of speech and carrying out daily activities. It was more common in those with mild or severe learning disabilities (mental retardation), but did occur in some who were high functioning. The development of catatonia, in some cases, seemed to relate to stresses arising from inappropriate environments and methods of care and management. The majority of the cases had also been on various psychotropic drugs.

There is very little evidence about effective treatment and management of catatonia. No medical treatment was found to help those seen at Elliot House (Wing and Shah, 2000). There are isolated reports of individuals treated with anti-depressive medication and electro-convulsive therapy (ECT) (Realmuto and August, 1991; Zaw et al, 1999).

Given the scarcity of information in the literature and possible adverse side effects of medical treatments, it is important to recognize and diagnose catatonia as early as possible and apply environmental, cognitive and behavioral methods of the management of symptoms and underlying causes. Detailed psychological assessment of the individuals, their environment, lifestyle, circumstances, pattern of deterioration and catatonia are needed to design an individual program of management. General management methods on which to base an individual treatment program are discussed in Shah and Wing (2001).

Conclusion—

Individuals with Aspergers can experience a variety of mental health problems, notably anxiety and depression, but also impulsiveness and mood swings. They may be misdiagnosed as having a psychotic disorder and it is therefore important psychiatrists treating them are knowledgeable about autism and Aspergers. Conventional drug treatment can be used to treat depression, anxiety and other disorders. Behavioral treatments and therapies can also be effective. However, any treatment must be careful tailored to suit an individual and overseen by a qualified practitioner. However, any psychotropic medicine should be used with extreme caution and strictly monitored with individuals with autism due to their susceptibility to movement disorders, including catatonia.

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

References—

• Attwood T. (1998) Aspergers syndrome: a guide for parents and professionals. London: Jessica Kingsley.

• Attwood T. (1999) Modifications to cognitive behaviour therapy to accommodate the unusual cognitive profile of people with Aspergers syndrome. Paper presented at autism99 internet conference ( http://www.autismconnect.org ).

• Baron-Cohen S. (1989 ) Do autistic children have obsessions and compulsions? British Journal of Clinical Psychology, Vol. 28 (99), 193-200.

• Bush G. et al (1996) Catatonia. I. Rating scale and standardising examination. Acta Psychiatrica Scandinavica, Vol. 93 , pp. 129-136

• Carpenter P. (1999) The use of medication to treat mental illness in adults with autism spectrum disorders . Paper presented at autism99 internet conference ( http://autismconnect.org ).

• Ghaziuddin E., Weidmer-Mikhail E. and Ghaziuddin N. (1998) Comorbidity of Asperger syndrome: a preliminary report. Journal of Intellectual Disability Research Vol. 42 (4), pp. 279-283.

• Gillberg C. and Steffenburg S. (1987) Outcome and prognostic factors in infantile autism and similar conditions: a population based study of 46 cases followed through puberty. Journal of Autism and Developmental Disorders, Vol. 17 (2), pp. 273-287.

• Hare D.J. and Paine C. (1997) Developing cognitive behavioural treatments for people with Aspergers syndrome. Clinical Psychology Forum, no. 110, pp. 5-8.

• Howlin P. (1997) Autism: preparing for adulthood. London: Routledge.

• Kim J. et al (2000) The prevalence of anxiety and mood problems amongst children with autism and Asperger syndrome. Autism, Vol. 4(2), pp. 117-132.

• Lainhart J.E. and Folstein S.E. (1994) Affective disorders in people with autism: a review of published cases. Journal of Autism and Developmental Disorders, Vol. 24 (5), pp. 587-601.

• Lishman W. A. (1998) Organic psychiatry: the psychological consequences of cerebral disorder pp. 349-356. Oxford: Blackwell.

• Muris P. et al (1998) Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, Vol. 12 (4), pp. 387-393.

• Realmuto G. and August G. (1991) Catatonia in autistic disorder; a sign of comorbidity or variable expressions? Journal of Autism and Developmental Disorders, Vol. 21 (4), pp. 517-528.

• Rogers D. (1992) Motor disorder in psychiatry: t owards a neurological psychiatry. Chichester: Wiley.

• Santosh P.J. and Baird G. (1999) Psychopharmacotherapy in children and adults with intellectual disability . The Lancet, Vol 354 , July 17, pp.233-242.

• Shah A. and Wing L. (2001) Understanding and managing catatonia in autism. A clinical perspective. To be published.

• Szatmari P., Bartoluci G. and Bremner R. (1989) Aspergers syndrome and autism: comparison of early history and outcome . Developmental Medicine and Child Neurology, Vol. 31 , pp. 709-720.

• Tantam D. (1991) Asperger syndrome in adulthood . In U. Frith (ed.) Autism and Asperger Syndrome, pp. 147-183 Cambridge University Press.

• Tantam D. and Prestwood S. (1999) A mind of one's own: a guide to the special difficulties and needs of the more able person with autism or Asperger syndrome.

• Thomsen P.H. (1994) Obsessive-compulsive disorder in children and adolescents. A 6-22 year follow-up study. Clinical descriptions of the course and continuity of obsessive-compulsive symptomatology . European Child and Adolescent Psychiatry, Vol. 3 , pp. 82-86.

• Thomsen P.H. (1999) From thoughts to obsessions: obsessive compulsive disorder in children and adolescents. London: Jessica Kingsley.

• Wing L. (1996) The autistic spectrum: a guide for parents and professionals. London: Constable.

• Wing L. and Shah A. (2000) Catatonia in autistic spectrum disorders. British Journal of Psychiatry, Vol. 176 , pp. 357-362.

• Zaw F. K. et al (1999) Catatonia, autism and ECT . Developmental Medicine and Child Neurology, Vol. 41 , pp. 843-845.

Aspergers Children & Social Anxiety

"I am trying to get my 11 yr old son to participate in group therapy. When it is time for him to go in, he flips out and gets so upset that he physically gets sick. What are some tips to help him with this?"

Social anxiety isn't something that only affects children with Aspergers and High-Functioning Autism. It affects children with all kinds of mental conditions as well as those with physical issues, weight issues and other differences that mentally or physically distinguish them from the general populace. The distinction may not necessarily be a real one but could, and often does, only exist in the subject's mind. Social anxiety is so great an issue that it's considered to be the third largest psychological problem in the world today.

Social anxiety isn't limited to difficulty meeting people in face to face conversation but also includes:

• Being Watched
• Chats
• Facebook
• Instant Messaging
• Recording (video and photo Cameras, microphones, etc.)
• Simply Going Outdoors in Public Places
• Social Occasions
• Telephone Conversations

Aspergers kids tend to walk a line that varies between total fear and no fear, depending largely upon the individual. Some Aspergers kids aren't afraid of face-to-face verbal interactions but just aren't very good at it. Constant negative feedback however can often tip the scales.

The best ways to reduce social anxiety, particularly in the school years, revolve around "jumping straight in" – regardless of how scared the individual might be. This doesn't work well at younger ages (5 and below), where such fears can lead to meltdowns, but it's quite acceptable for school-age children and teens.

When I was at school, I had a "buddy" teacher (a teacher who became a good and trusted friend). One day this teacher picked me out of the class and said that he had noted that I was good with history and thought that I should join the debating team. He gave me a couple of days to sign up on my own – but I didn't. Then he joined me up and informed me that I was now committed. At first, I was a little annoyed but he made it clear that he thought it would be good for me and that he would be supporting me all the way.

The teacher led me on with the promise of replacing me when a suitable person could be found. Of course, now I can see that it was all a ploy and I went on "debating tour" and was forced to confront my demons.

Around the same time, the teacher suggested that I take "drama" as one of my elective subjects. I had absolutely no desire to act and I really couldn't see the point of drama but he told me that it was an essential skill. In retrospect, I have to agree.

There's absolutely no mistaking the importance of public speaking and acting for children with Aspergers. Amongst other things, it helps you to lose the "monotone" in your voice – a feature that Aspergers kids are famous for. It also prepares you for "acting the rest of your life".

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