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Aspergers, Sensory Integration Disorder, and Anxiety

Question

My son is 8 and has Asperger's with sensory integration disorder. Recently he was having a LOT of anxiety, biting his nails until they bleed, he worries, etc. His pediatrician prescribed a low dose of Prozac and we had 2 weeks of that. It was a disaster… it really badly affected his sleeping habits. We stopped him cold turkey and now realize that wasn't the right thing to do. We stopped the medication about 2 weeks ago.

About one week ago he started having real problems in school with paying attention, etc. Now the Dr wants to put him on Concerta and I am just worried. He is very fidgety and has a really hard time sitting still and paying attention. But I fear that once we start on these meds it will be a merry-go-round that we can't get off of.


Answer

Although parents are often tempted to give up on a medicine when their youngster is having problems with it, since any medicine can cause side effects, it is often better to adjust the dose before switching to a new medicine. This can be especially helpful for kids having side effects from stimulants, with often include aggression, appetite suppression, and insomnia. In many of these situations, decreasing the dosage can eliminate the side effect. Unfortunately, it may also cause the dosage to be so low that it doesn't control your youngster's symptoms anymore.

Other times, a change to a different medicine can make a world of difference. Although similar meds have similar side effects, they do seem to affect kids differently. So, Adderall XR might cause one youngster to be very aggressive and moody, while another might do great and not have any side effects at all.

Although Concerta is a long acting form of Ritalin that does usually last for 10 to 12 hours, it only gives about 22 percent of the dose in the morning. If your son’s Concerta isn't working in the morning, it may be that he needs a higher dose, which would also increase his morning dose. A higher dose would also increase his afternoon dose though, which he may not need if he had been otherwise doing well. In this situation, a different med might work better.

15 year old son recently started having more meltdowns...

Question

My 15 year old son recently started having more meltdowns, is there a way to convince my wife that too much information may start these meltdowns. Such as repeating herself too many times when giving him direction for something that he really doesn't want to do?

Answer

Yes. Please refer to the "Anger Management" chapter [in Session #3] in the online version of My Aspergers Child eBook. Be sure to (a) read the text as well as (b) watch the instructional videos on that webpage.

My son with Aspergers tends to be tactless...

Question

My son with Aspergers tends to be tactless, very literal and overly honest and idealistic-is there any way that I can help him to be able to get a long a little better socially?

Answer

Socialization is a necessary component of life. Social communication is how we interact with the people around us. If a child struggles with socialization and communication, he will have problems getting along with his peers.

Asperger’s Syndrome manifests differently in each individual, although all children with Asperger’s have some form of social and communication deficit. There are ways to help turn your concerns into non-issues. You can help your son achieve a more balanced social life. You can start working on this at home where he is most comfortable.

Social stories are stories written about different real-life situations that follow the desired steps to correct problems in social behaviors. You can find books filled with social stories on the Internet or at your local library. You could even write you own, tailoring the stories to fit your son’s specific trouble spots. If you decide to use social stories, you should also pursue other options. A multiple-therapy approach is your best bet for a good outcome.

If your son has a program in place that includes occupational therapy, ask for a consultation with his therapist to add specific social communication goals. When you think of occupational therapy, you tend to think of something other than these types of problems. In reality, these therapists are very good at helping Asperger’s children learn to use correct social skills, as well as most other living skills. Most therapists will offer parent training sessions, as they are usually happy to know that the parent is interested enough to invest the time in their child.

Finally, check with your local Asperger’s support group or your child’s school system for available social skills groups. These groups are usually led by a psychologist or a therapist and provide opportunities for the Asperger’s child to practice social skills in a controlled environment. You can then follow through with extra practice at home.

There are books available that will help you work on social and communication skills completely at home. One such book is “Social Skills Training for Children and Adolescents with Asperger Syndrome and Social-Communication Problems” by Jed E. Baker”.

This book is an entire social skills curriculum complete with reproducible handouts and activity sheets. It covers all of the skills that cause most of the problems for children with Asperger’s and is a complete training package for Asperger’s kids of all ages. This program is very user-friendly and very detailed. You are sure to find specific examples of and solutions for the issues you see in your child.

All of these suggestions can be applied at home with a little training. You can help your son develop better social skills, enhancing his perspective and insuring a bright future.

Hitting, Biting and Kicking: How to Stop Aggressive Behavior in Aspergers Children


"Our 5 y.o. son with Aspergers [high functioning] can be very aggressive when he's frustrated. He's not beyond attacking whoever is the closest to him at the time, especially his playmates and siblings. He will push, spit, hit, kick ...and it's uncontrollable once his anger reaches that level. Any suggestions?!"

Few situations are more difficult to deal with than having a youngster who is aggressive toward other kids. It can be embarrassing as well as frightening when your Aspergers (high functioning autistic) youngster bites, hits, scratches or kicks to get his or her way. It’s not uncommon for younger Aspergers kids to engage in this type of behavior at various points in their development and in a variety of settings.

However, when it becomes very frequent or seems to be their consistent way of reacting to something they don’t like, it’s time to step in and help them change their behavior. The first step is understanding the underlying reasons why your Aspergers youngster is choosing to act out this way. The more you understand what’s happening, the better you’ll be able to help them find other, non-aggressive ways to solve their problems.

Initially, between the ages of 18 months to 2 years, Aspergers kids find it extremely hard to communicate their needs to their moms & dads, caregivers, and other kids. Negative behaviors are one way they may choose to get their point across. For older Aspergers kids between the ages of three and six, such behaviors may be the result of never having learned appropriate, non-aggressive ways of communicating when they were faced with a difficult situation. The cause of aggressive behaviors may be due to any or all of the following:
  • Being placed in a stressful situation
  • Exhaustion
  • Extreme frustration or anger
  • Inadequate speech development
  • Lack of adult supervision
  • Lack of routine
  • Mirroring the aggressive behaviors of other kids around them
  • Over-stimulation
  • Self-defense

One place to begin is to watch your youngster for cues to see if any of the situations described above brings about aggressive behavior. Learning as much as you can about the factors that trigger bad behavior is the best way to combat it when it occurs next time. Some questions you should ask yourself:

• How is his aggressiveness expressed? Is it through angry words or through angry behaviors? Does he become verbally aggressive first and then physically aggressive, or is his first response to strike out and hit?

• What seems to cause your youngster to act out in an aggressive fashion? Is it triggered by frustration, anger, or excitement? Notice if there are patterns. Does he act this way when toys are involved, and he’s frustrated about sharing? Or does he become aggressive when there is too much going on and he’s over-stimulated? If you observe the situations carefully, you will likely notice patterns.

• Who does my youngster hit, bite or kick? Does he do it to one friend in particular? Does he only do it to me? Or does he tend to be aggressive with whomever he is with? If it’s one person in particular, try to find out if there’s a reason why he’s attacking that youngster such as engaging in overly aggressive play, a poor match of temperaments or a lack of clear cut rules before play begins.

By answering these questions, you are on your way to successfully limiting your youngster’s aggressive behavior in the future. In this article, I’ll outline some ways that you can help your youngster become more aware of his aggressive feelings and teach him to calm himself down, or find alternative ways to solve his problems. We’ll also talk about giving consequences to kids when they do lash out and hurt someone. In my experience, consequences are imperative to ending aggressive behavior in young kids.

They teach your youngster that all behaviors have a consequence, whether good or bad, and will help him make better choices in the future when he is with his friends. Once you’ve narrowed down the reasons why your youngster is behaving aggressively, it’s time to intervene.

Step in and Stop it immediately—

At the first sign that your youngster is about to become aggressive, immediately step in and remove him from the situation. Be careful not to give too much attention to your youngster so that you do not give any negative reinforcement for the bad behavior. Too much attention can include trying to “talk through” the problem.

Young kids are not able to hear long explanations of why their behavior was offensive. A simple yet firm statement such as, “We don’t bite” should suffice while you turn your attention to the victim. Other examples of too much attention include yelling at your youngster while attending to the victim, forcing your youngster to apologize immediately or continuing to talk to the other moms & dads around you about how embarrassed or angry you are.

Make a point of consoling the victim and ignoring the aggressor. If your youngster cannot calm down, remove him or her from the situation without getting angry yourself. When they are calm and ready to talk, you can discuss what happened. If it’s physically impossible to remove your youngster, you will have to remove yourself and the victim from the situation.

By walking an age-appropriate distance away from your youngster after he has acted out, you are sending the message that you will attend to him when he can calm down. In doing so, you are teaching your youngster that it is his responsibility to learn to calm himself and act appropriately.

Lower Your Voice, Don’t Raise It—

As moms & dads, we need to show self-control and use gentle words if we want our kids to do the same. It’s easy to respond with yelling or anger, but remember, your youngster is looking to you for cues on how to control his impulses and have good behavior. While it can be terribly embarrassing to have a youngster that continues to act out towards their friends, keep in mind that their negative behavior is most likely happening because they are still navigating their way through their social circles. This can be very difficult for some kids, so try not to over-react or personalize it.

One technique that works very well for some kids is to change the tone and volume of your voice. You can help your youngster stay calm by immediately lowering your voice when attending to the victim as well as to your youngster. If he is unable to calm down, before helping the victim, turn to him and say quietly, “I need you to calm down now. I am going to help Josh and when I am done I want you to be done screaming.”

For some kids this will work, and when your youngster returns to you, calm and collected, feel free to quietly praise him, saying, “Thank you for calming yourself down. We don’t bite. It hurt Josh and he is sad.” Repeat the phrase “We don’t bite” and inform your youngster that if it happens again, the consequence is that you will leave.

If this does not work for your youngster and he simply cannot calm down, leave him where he is (again, at an age-appropriate distance) and ignore the tantrum. Most young kids will not continue to act out if they no longer have an audience.

Practice Ways to De-fuse your Aspergers Child’s Anger—

For younger kids, help them recognize their anger by stating, “I know you're mad, but we don’t hit. No hitting!” For kids aged 3-7, talk about anger as an important feeling. You can practice ways to de-fuse your youngster's anger during calmer moments. You can say, “Sometimes I get angry too. When that happens, I say ‘I’m angry’ and I leave the room.”

You can also teach your youngster how to count to ten until he is less angry, how to do deep breathing in order to calm down, or how to use his words by making statements such as “I am really, really angry right now!” All of these methods help take the immediate focus off of your youngster’s anger and teach them to recognize this important emotion.

Before you enter into a potentially difficult social situation, review the consequences with your youngster about what will happen if he cannot control his anger. Tell your youngster, “I feel you can handle your anger, but if you can’t, we will have to leave the park and not come back until next week. Do you understand?” Make certain that you follow through with whatever consequences you pose to your youngster.

Teach Aspergers Kids that Aggression is wrong—

It’s also important to talk to your kids about aggression during a calm moment. In a steady voice, explain to your youngster that hitting, biting, kicking, and other aggressive behaviors are wrong. For younger kids, those between 18 months and 2 years, keep it simple. Hold them and explain, “No hitting. It is wrong.”

Remember that you may have to repeat this rule numerous times, using the same words, until your youngster gets it. Be firm and consistent each time your youngster becomes aggressive. Have a plan in place for consequences if aggressive behavior starts.

At home, this can include a time-out chair away from the rest of the family where your youngster can stay until he can calm down. If you are away from home, pick a safe place, such as a time-out in a car seat or another place where your youngster is removed from the fun. This reinforces that you are not tolerating aggression in any form.

For older kids, those between 3 and 7, remember that they may be experimenting with cause and effect. In other words, they want to see what you will do when they act out. It’s your job to provide the consequences for the "effect" to work. Since older kids are more verbal, you can use a variety of phrases when they misbehave.

Examples include, “Biting is not OK,” or “Hitting hurts others. You need to stop.” It is okay to tell your little biter/hitter/kicker that once he misbehaves, he’s lost a privilege for the day. Consequences can include leaving a play date immediately or losing video time.

Tell Your Aspergers Child to “Use Your Words”—

Many times kids who display aggressive behaviors simply lack the communication skills necessary to help them through a stressful situation. For a young youngster, biting or hitting someone is a whole lot easier! Plus, aggressive behaviors often give kids a false sense of power over their peers.

It’s up to you to work diligently with your youngster so that he or she can practice the art of diplomacy in a tough situation. Help your youngster find their voice when they feel like acting out. By explaining and then practicing using their words, you are helping them to trade off aggressive behavior in favor of more socially acceptable behavior. Some examples are:

• Teach your youngster to say “No!” to their peers instead of acting aggressively. Too often a youngster reacts negatively to a friend or sibling instead of asserting themselves. By using the simple word “no,” you are helping your youngster to get his point across verbally, not aggressively.

• Give your youngster a series of phrases to use with their friends when they are feeling angry or frustrated. Some examples are, “No, that’s mine,” “I don’t like that!” or “Stop! That hurts.” This helps your youngster substitute words for striking out.

Before you enter a situation that you know may cause your youngster to act aggressively (i.e., a play date or daycare) remind your youngster to “Use your words.” Repeat this to your youngster throughout the course of the week when you feel they are getting frustrated.

Recognize Your Aspergers Child’s Limitations—

This means knowing when to leave a potentially volatile situation or choosing to engage your youngster in a different activity to avoid aggressive confrontations. If you know that your youngster targets a particular youngster at play group, you may have to hold off going to play group for a few weeks until he learns to control himself. Or, if certain videos, games, or activities frustrate your youngster, remove them from your daily routine to see if this has a placating effect on your youngster’s behavior.

Finally, if your youngster is exhausted, hungry, or over-stimulated, respect that and engage in low-key, slow-paced activities that will make aggression less likely. With your older, more verbal youngster, talk openly about situations that make him angry and work together to come up with solutions to help him through the problem next time.

Be Appreciative of their Efforts—

When you catch your youngster being good, be sure to praise their hard work and efforts. For instance, if you observe your kids in a power struggle over a toy that ends in them working it out peacefully with their friend, tell them how proud you are that they chose to use their words instead of resorting to aggression to get their way. Look for and continue to praise good behavior as a way to motivate your kids to do better next time.

What Not to Do—

• Do not expose your youngster to violent television or video games. Too often TV and videos portray the most violent character as the hero, which sends the message that violence is a means to an end for problem-solving. This message can easily be avoided if you are on top of their viewing habits. While TV or video violence may not affect some kids, it may greatly influence others who have a tendency to act out aggressively with their friends. By knowing your youngster’s temperament and what he or she can withstand, you are helping them on their way towards their best behavior possible.

• Do not personalize your youngster’s bad behavior. All too often moms & dads get frustrated and angry at their youngster when they are aggressive, because many times we feel that our youngster’s poor behavior is a reflection of our parenting skills. If you have an aggressive youngster, switch your focus towards helping them express themselves in a more appropriate way and follow through when an incident occurs.

• Never bite or hit back. It can be tempting to want to teach your youngster a lesson in how it feels to be the victim of aggression, but when you succumb to a childlike form of communication, you are teaching your youngster that aggression is the answer to resolving a conflict. Even though it’s difficult, try your best to maintain your composure.

When Aggression is Extreme—

While aggression can be normal in many kids, you should be aware of when your youngster’s behavior has gone beyond the scope of what is considered within the normal boundaries for their developmental level. Look for the following signs in your youngster:
  • A pattern of defiant, disobedient, or hostile behavior towards you or other authority figures such as teachers or day care providers. A pattern means behavior that is not fleeting, but is chronic and does not respond to the above interventions.
  • Acts annoyed or is chronically touchy
  • Acts spiteful or vindictive
  • Blames others
  • Constantly argues with adults
  • Deliberately engages in activities that knowingly annoy others
  • Exhibits ongoing anger
  • Loses their temper easily

It is important to recognize that all young kids may exhibit any or all of the above problems at some point during their development. However, if your youngster persistently displays these behaviors and it affects their daily functioning, such as their ability to behave at school or maintain friendships, contact your pediatrician, as it may indicate that they have other psychological problems that need attention. In this case, you will need to have your youngster evaluated by a mental health professional.

Parenting an aggressive child with Asperger Syndrome can be one of the greatest challenges you will face as you weave your way through the maze of his or her development. Even though it may seem like it at times, it’s not impossible to teach your youngster new and appropriate ways to interact with other kids and the adults around them. The key is developing a clear, uncomplicated, consistent plan and following it in a composed manner. Remember: the best example of appropriate behavior is you, and your young kiddo is watching.

==> My Aspergers Child: Help for Parents with Aggressive Aspergers Children

Learning and Behavioral Characteristics of Students with Aspergers

Kids with Aspergers (high functioning autism) share some of the same characteristics as kids with autism, and there is debate on whether Aspergers is an independent diagnostic category or another dimension at the higher end of the autistic continuum (Szatmari, 1995). Although Aspergers shares some characteristics with higher-functioning autism, there are some unique features, and a different developmental progression and prognosis (Myles & Simpson, 1998) for children with Aspergers.

According to DSM-IV (1994) criteria, the youngster must meet the criteria for social impairment, repetitive activities and age of onset, but have normal cognitive and language development. Aspergers involves fewer symptoms than autism.

Learning and Behavioral Characteristics of Children with Aspergers—

1. Although kids with Aspergers usually speak fluently by five years of age, they often have problems with pragmatics (the use of language in social contexts), semantics (not being able to recognize multiple meanings) and prosody (the pitch, stress, and rhythm of speech) (Attwood, 1998).
  • Social communication problems can include standing too close, staring, abnormal body posture and failure to understand gestures and facial expressions.
  • Speech may be characterized by a lack of variation in pitch, stress and rhythm and, as the child reaches adolescence, speech may become pedantic (overly formal).
  • Children with Aspergers may have an advanced vocabulary and frequently talk incessantly about a favorite subject. The topic may be somewhat narrowly defined and the individual may have difficulty switching to another topic.
  • They may have difficulties with the rules of conversation. Children with Aspergers may interrupt or talk over the speech of others, may make irrelevant comments and have difficulty initiating and terminating conversations.

2. Anxiety is also a characteristic associated with Aspergers. It may be difficult for the child to understand and adapt to the social demands of school. Appropriate instruction and support can help to alleviate some of the stress.

3. Aspergers is characterized by a qualitative impairment in social interaction. Children with Aspergers may be keen to relate to others, but do not have the skills, and may approach others in peculiar ways (Klin & Volkmar, 1997). They frequently lack understanding of social customs and may appear socially awkward, have difficulty with empathy, and misinterpret social cues.

4. Children with Aspergers are poor incidental social learners and need explicit instruction in social skills.

5. Children with Aspergers may also be inattentive and easily distracted and many receive a diagnosis of ADHD at one point in their lives (Myles & Simpson, 1998).

6. Children with Aspergers share common characteristics with autism in terms of responses to sensory stimuli. They may be hypersensitive to some stimuli and may engage in unusual behaviors to obtain a specific sensory stimulation.

7. It is estimated that 50%-90% of people with Aspergers have problems with motor coordination (Attwood, 1998). The affected areas may include locomotion, ball skills, balance, manual dexterity, handwriting, rapid movements, lax joints, rhythm and imitation of movements.

8. The child with Aspergers is of average to above average intelligence and may appear quite capable. Many are relatively proficient in knowledge of facts, and may have extensive factual information about a subject that they are absorbed with. However, they demonstrate relative weaknesses in comprehension and abstract thought, as well as in social cognition. Consequently, they do experience some academic problems, particularly with reading comprehension, problem solving, organizational skills, concept development, and making inferences and judgments. In addition, they often have difficulty with cognitive flexibility. That is their thinking tends to be rigid. They often have difficulty adapting to change or failure and do not readily learn from their mistakes (Attwood, 1998).

Strategies for Teachers—

Many of the strategies for teaching children with autism are applicable for children with Aspergers. The professional literature often does not differentiate between high-functioning autism and Aspergers when outlining recommended practices. However, it is important to give consideration to the unique learning characteristics, to provide support when needed, and to build on the child’s many strengths.

The following identifies the specific learning difficulty and suggests a number of possible classroom strategies:

Difficulties with language—
  • Comic Strip Conversations (Gray, 1994) can be applied to a range of problems with conversation skills
  • difficulty understanding complex language, following directions, and understanding intent of words with multiple meanings
  • encourage the child to ask for an instruction to be repeated, simplified or written down if he does not understand
  • explain metaphors and words with double meanings
  • limit oral questions to a number the child can manage
  • pause between instructions and check for understanding
  • small group instruction for conversational skills
  • teach appropriate opening comments
  • teach rules and cues regarding turn-taking in conversation and when to reply, interrupt or change the topic
  • teach student to seek assistance when confused
  • tendency to interrupt
  • tendency to make irrelevant comments
  • tendency to talk on one topic and to talk over the speech of others
  • use audio taped and videotaped conversations
  • watch videos to identify nonverbal expressions and their meanings

Insistence on sameness—
  • use pictures, schedules and social stories to indicate impending changes
  • wherever possible prepare the child for potential change

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

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

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

Poor organizational skills—
  • help the child to use "to do" lists and checklists
  • maintain lists of assignments
  • picture cues in lockers
  • pictures on containers and locker
  • use schedules and calendars

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

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

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

Sensory Sensitivities—

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


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

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