Aspergers Treatment: Improving Communication, Social Skills and Behavior Management

"What does treatment involve for a child with asperger syndrome? We are strongly considering getting our 7 y.o. some type of therapy, but do not know where to start. Also, what can we do as parents to assist in treatment ...or perhaps any self-help strategies to use? Lastly, any tips that we can pass on to our son's teacher to help with this?"

Treatment is geared toward improving communication, social skills, and behavior management. A treatment program may be adjusted often to be the most useful for your youngster.

Take advantage of your youngster's strengths by encouraging him or her to explore interests at home and at school. Activity-oriented groups and focused counseling can also be helpful.

Many kids with Aspergers (high-functioning autism) also have other coexisting conditions, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and depression. These conditions can place extra demands on parents who are already dealing with a youngster with extra needs. These conditions may require treatment with medicines and other therapies.

Medications:

There are no medications to treat Aspergers. But some medications may improve specific symptoms that may be complicating his or her progress — such as anxiety, depression or hyperactivity — that can occur in many kids with Aspergers.

Many kids with Aspergers do not require any medication. For those who do, the drugs that are recommended most often include psychostimulants (methylphenidate , pemoline), clonidine , or one of the tricyclic anti- depressants (TCAs) for hyperactivity or inattention; beta blockers, neuroleptics (antipsychotic medications), or lithium (lithium carbonate) for anger or aggression; selective serotonin reuptake inhibitors (SSRIs) or TCAs for rituals (repetitive behaviors) and preoccupations; and SSRIs or TCAs for anxiety symptoms. One alternative herbal remedy that has been tried with ASPERGERS individuals is St. John's wort.

Psychotherapy:

Aspergers individuals often benefit from psychotherapy, particularly during adolescence, in order to cope with depression and other painful feelings related to their social difficulties. Many kids with Aspergers are also helped by group therapy, which brings them together with others facing the same challenges. There are therapy groups for parents as well.

Therapists who are experienced in treating kids with Aspergers disorder have found that the youngster should be allowed to proceed slowly in forming an emotional bond with the therapist. Too much emotional intensity at the beginning may be more than the youngster can handle. Behavioral approaches seem to work best with these kids. Play therapy can be helpful in teaching the youngster to recognize social cues as well as lowering the level of emotional tension.

Adults with Aspergers are most likely to benefit from individual therapy using a cognitive-behavioral approach, although many also attend group therapy. Some adults have been helped by working with speech therapists on their pragmatic language skills. A relatively new approach called behavioral coaching has been used to help adults with Aspergers learn to organize and set priorities for their daily activities.

Cognitive behavior therapy:

This general term encompasses many techniques aimed at curbing problem behaviors, such as interrupting, obsessions, meltdowns or angry outbursts, as well as developing skills like recognizing feelings and coping with anxiety. Cognitive behavior therapy usually focuses on training a youngster to recognize a troublesome situation — such as a new place or an event with lots of social demands — and then select a specific learned strategy to cope with the situation.

Communication and social skills training:

Kids with Aspergers may be able to learn the unwritten rules of socialization and communication when taught in an explicit and rote fashion, much like the way students learn foreign languages. Kids with Aspergers may also learn how to speak in a more natural rhythm, as well as how to interpret communication techniques, such as gestures, eye contact, tone of voice, humor and sarcasm.

Home treatment:

You can best serve your youngster by learning about Aspergers and providing a supportive and loving home environment. Remember that your youngster, just like every other child, has his or her own strengths and weaknesses and needs as much support, patience, and understanding as you can give.

Educating yourself about the condition and knowing what to expect is an important part of helping your youngster succeed outside of home and develop independence. Learn about Aspergers syndrome by talking to your doctor or contacting Aspergers organizations. This will reduce your and your family members' stress and help your youngster succeed.

The following are some suggestions on how to help your youngster who has Aspergers. Some of the ideas will be helpful, and some may not work for you. Flexibility, creativity, and a willingness to continue to learn will all help you as you raise your youngster.

General strategies for success--

• Be aware that background noises, such as a clock ticking or the hum of fluorescent lighting, may be distracting to your youngster.

• Kids with Aspergers benefit from daily routines for meals, homework, and bedtime. They also like specific rules, and consistent expectations mean less stress and confusion for them.

• Kids with Aspergers often mature more slowly. Don't always expect them to "act their age."

• Many people with Aspergers do best with verbal (rather than nonverbal) teaching and assignments. A direct, concise, and straightforward manner is also helpful.

• People with Aspergers often have trouble understanding the "big picture" and tend to see part of a situation rather than the whole. That's why they often benefit from a parts-to-whole teaching approach, starting with part of a concept and adding to it to demonstrate encompassing ideas. 

• Try to identify stress triggers and avoid them if possible. Prepare your youngster in advance for difficult situations, and teach him or her ways to cope. For example, teach your youngster coping skills for dealing with change or new situations.

• Visual supports, including schedules and other written materials that serve as organizational aids, can be helpful.

Strategies for developing social skills--

• Encourage your youngster to learn how to interact with people and what to do when spoken to, and explain why it is important. Give lots of praise, especially when he or she uses a social skill without prompting.

• Foster involvement with others, especially if your youngster tends to be a loner.

• Help your youngster understand others' feelings by role-playing and watching and discussing human behaviors seen in movies or on television. Provide a model for your youngster by telling him or her about your own feelings and reactions to those feelings. 

• Practice activities, such as games or question-and-answer sessions, that call for taking turns or putting yourself in the other person's place.

• Teach your youngster about public and private places, so that he or she learns what is appropriate in both circumstances. For example, hugging may not be appropriate at school but is usually fine at home. 

• Teach your youngster how to read and respond appropriately to social cues. Give him or her "stock" phrases to use in various social situations, such as when being introduced. You can also teach your youngster how to interact by role-playing.

• Your youngster may not understand the social norms and rules that come more naturally to other kids. Provide clear explanations of why certain behaviors are expected, and teach rules for those behaviors.

Strategies for school--

• Ask your youngster's teacher to seat your youngster next to classmates who are sensitive to your youngster's special needs. These classmates might also serve as "buddies" during recess, at lunch, and at other times.

• Be aware of and try to protect your youngster from bullying and teasing. Talk to your youngster's teacher or school counselor about educating classmates about Aspergers.

• Encourage your youngster's teacher to include your youngster in classroom activities that emphasize his or her best academic skills, such as reading, vocabulary, and art.

• Orient your youngster to the school setting. Before the school year starts, take time to "walk through" your youngster's daily schedule. You can also use pictures to make your youngster familiar with the new settings before school starts.

• Set up homework routines for your youngster by doing homework at a specific time and place every day. This will help your child learn about time management. 

• Some kids with Aspergers have poor handwriting. Typing schoolwork on a computer may be one way to make homework easier. Using computers can also help kids improve fine motor skills and organize information. Occupational therapy may also be helpful.

• Use rewards to motivate your youngster. Allow him or her to watch TV or play a favorite video game or give points toward a "special interest" gift when he or she performs well.

• Use visual systems, such as calendars, checklists, and notes, to help define and organize schoolwork.

The Aspergers Comprehensive Handbook

Aspergers Checklist: Does Your Child Have Aspergers?

There is a certain set of symptoms common to Asperger’s Syndrome (high functioning autism). However, each case of Asperger’s Syndrome is unique and not everyone experiences the same combination of symptoms. Here is a checklist to help you identify Asperger’s symptoms:

Social Interaction Difficulties—

A child with Asperger’s Syndrome may have difficulty with the following aspects of social interaction:

• Difficulty playing with others: She may not understand how to initiate play with her peers or how to play by common social rules. For example, she may take a ball from a group of kids playing a game without asking to join the game first. She will not return the ball if they ask for the ball back because she does not understand the negative reaction.

• General social skills: She wants to socialize with others but does not understand how to interact.

• Inability to understand common social cues: She may not comprehend common social cues such as facial expressions, body language or gestures.

• Inappropriate responses: She may behave or respond to social situations in an unusual or inappropriate manner. For example, an affected person may laugh at something sad.

• Problems with two-way conversation: She has trouble with initiating and maintaining a two-way conversation. She may appear to talk at someone than with them. Conversation topics may focus on an obsessive interest. She speaks inappropriately such as talking too loudly or softly.

• Relating to others: She does not understand other's emotions or social responses accurately in a group situation. She may not understand if an activity or conversation is boring or upsetting to another person.

• Rigid range of interests for social interaction: She will only engage in a narrow range of activities or talk about certain subjects.

Communication Problems—

An affected child experiences a number of communication difficulties. Communication problems can include the following symptoms:

• Easily distracted: He has trouble concentrating his attention on people and objects that are not connected with his favorite subjects.

• Eye contact: He may not make eye contact.

• Facial expression: Facial expressions are either absent or inappropriate to the conversation or situation. He may have facial tics.

• Monotone speech: He may speak in a monotone voice, without expression or emotion.

• Personal space issues: He might stand too close to a person during conversation.

• Unusual gestures: He might make unusual or inappropriate gestures during conversation.

Language Skill Challenges—

A child with Asperger’s Syndrome generally has a large vocabulary but experiences problems with language processing. Language skills challenges may include:

• Difficulty processing language: She does not always understand the verbal speech of others or misunderstands the meaning of a conversation. She may have trouble making a decision or answering a question.

• Language rituals: She might have certain word scripts that she repeats ritualistically in conversation with others.

• Literal interpretation of words: She interprets most language on a literal level and misses abstract meanings.

• Trouble with language use: She has trouble using language appropriately in social situations. She may also misunderstand common word meanings.

• Unusual use of words: She may use words in an unusual way or create her own words.

Cognitive and Motor Skill Impairments—

Cognitive and motor skill problems are also common in children with Asperger’s Syndrome. Typical cognitive and motor skill issues include:

• Difficulty with imaginative play: He does not engage in imaginative play as a youngster.

• Learns best visually: He has trouble learning without visual aids.

• Mindblindness: He has mindblindness, meaning he cannot determine what others are thinking and feeling in social situations or in relationships.

• Organizational skills difficulties: He experiences difficulty with planning, implementing and completing tasks.

• Problems with coordination: He may have problems with both fine and gross motor skills. Common examples of motor skill difficulty include bike riding, handwriting and playing ball games.

• Problem-solving issues: He has trouble figuring out how to solve problems outside of his routine.

Limited Interests and Unusual Behavior—

An affected child often has a limited range of interest and may exhibit bizarre behavior. Interests and behavior may include:

• Narrow range of interests and obsessions: She is intensely interested in a small number of activities and subjects and refuses to engage in other activities.

• Self-stimulatory behavior: She may engage in stimming behavior such as hand flapping, rocking back and forth or twirling.

• Strict schedule: She prefers a rigid schedule and experiences anxiety when the schedule is interrupted.

Sensory Input Issues—

Many children with Asperger’s Syndrome have sensory difficulties and may have unusual reactions to certain sights, smells, sounds or tastes. Sensory problems include:

• Limited food choices: He may choose and reject foods based upon smell or texture.

• Odors: He may react strongly to certain smells.

• Sounds: He might be hypersensitive to different sounds.

• Touch: He may not want to be touched.

The Aspergers Comprehensive Handbook

Autistic Traits In Adults: Online Test

The Autism-Spectrum Quotient, or AQ, is a measure of the extent of autistic traits in adults. 
 

		Definitely agree	Slightly agree	Slightly disagree	Definitely disagree
1	I prefer to do things with others rather than on my own.
2	I prefer to do things the same way over and over again.
3	If I try to imagine something, I find it very easy to create a picture in my mind.
4	I frequently get so strongly absorbed in one thing that I lose sight of other things.
5	I often notice small sounds when others do not.
6	I usually notice car number plates or similar strings of information.
7	Other people frequently tell me that what I've said is impolite, even though I think it is polite.
8	When I'm reading a story, I can easily imagine what the characters might look like.
9	I am fascinated by dates.
10	In a social group, I can easily keep track of several different people's conversations.
11	I find social situations easy.
12	I tend to notice details that others do not.
13	I would rather go to a library than to a party.
14	I find making up stories easy.
15	I find myself drawn more strongly to people than to things.
16	I tend to have very strong interests, which I get upset about if I can't pursue.
17	I enjoy social chitchat.
18	When I talk, it isn't always easy for others to get a word in edgewise.
19	I am fascinated by numbers.
20	When I'm reading a story, I find it difficult to work out the characters' intentions.
21	I don't particularly enjoy reading fiction.
22	I find it hard to make new friends.
23	I notice patterns in things all the time.
24	I would rather go to the theater than to a museum.
25	It does not upset me if my daily routine is disturbed.
26	I frequently find that I don't know how to keep a conversation going.
27	I find it easy to 'read between the lines' when someone is talking to me.
28	I usually concentrate more on the whole picture, rather than on the small details.
29	I am not very good at remembering phone numbers.
30	I don't usually notice small changes in a situation or a person's appearance.
31	I know how to tell if someone listening to me is getting bored.
32	I find it easy to do more than one thing at once.
33	When I talk on the phone, I'm not sure when it's my turn to speak.
34	I enjoy doing things spontaneously.
35	I am often the last to understand the point of a joke.
36	I find it easy to work out what someone is thinking or feeling just by looking at their face.
37	If there is an interruption, I can switch back to what I was doing very quickly.
38	I am good at social chitchat.
39	People often tell me that I keep going on and on about the same thing.
40	When I was young, I used to enjoy playing games involving pretending with other children.
41	I like to collect information about categories of things (e.g., types of cars, birds, trains, plants).
42	I find it difficult to imagine what it would be like to be someone else.
43	I like to carefully plan any activities I participate in.
44	I enjoy social occasions.
45	I find it difficult to work out people's intentions.
46	New situations make me anxious.
47	I enjoy meeting new people.
48	I am a good diplomat.
49	I am not very good at remembering people's date of birth.
50	I find it very easy to play games with children that involve pretending.

How to score: 

"Definitely agree" or "Slightly agree" responses to questions 2, 4, 5, 6, 7, 9, 12, 13, 16, 18, 19, 20, 21, 22, 23, 26, 33, 35, 39, 41, 42, 43, 45, 46 score 1 point. 

"Definitely disagree" or "Slightly disagree" responses to questions 1, 3, 8, 10, 11, 14, 15, 17, 24, 25, 27, 28, 29, 30, 31, 32, 34, 36, 37, 38, 40, 44, 47, 48, 49, 50 score 1 point. 

In the first major trial using the test, the average score in the control group was 16.4. Eighty percent of those diagnosed with autism or a related disorder scored 32 or higher. The test is not a means for making a diagnosis, however, and many who score above 32 and even meet the diagnostic criteria for mild autism or Asperger's report no difficulty functioning in their everyday lives. 

Undiagnosed and Misdiagnosed Aspergers

One of the worst problems is that you can never really understand what is going on inside your youngster's head. This makes it so difficult for you to understand his behavior. This can leave you feeling emotionally beat-up and completely useless as a parent. You may have to cope with crisis on a daily, hourly or even minute-by-minute basis.

 

==> Full article...

Aspergers in Adults

The number of Aspergers adults, like the diagnosis, is hard to pin down. Anecdotal growth in their ranks and a burgeoning online "Aspie" adult subculture that includes dating sites, advocacy groups and chat rooms raises the question: Are we starting to discover generations who escaped diagnosis? The condition officially wasn't recognized until 1994, which leads people to believe doctors are playing catch-up with adult diagnoses.

Symptoms of Aspergers—

• Special Interests: Individuals with Aspergers are sometimes found to have an intense or even obsessive interest or hobby. Sometimes these continue for one's entire lifetime. However, in some cases, an individual may get smitten with a completely unrelated activity. However, this obsessive involvement with particular topics help them in gaining an amazing insight into those fields. These topics could vary from computers to knowing how to play the guitar. Encouraging such individuals to continue with their interest helps them to acquire an in-depth knowledge in certain fields. This could help them to gain employment in their fields of interest.

• Love for Routines: Adults with Aspergers seem to follow routines and rituals religiously. They do not take very well to a sudden change in their daily time table, and have set hours for everyday work. The reason behind such mechanical behavior is not very clear. However, it could be an attempt of further simplifying even the simple things that baffles the mind of an individual who suffers from Aspergers.

==> Living With Aspergers: Help for Couples

• Lack of Social Imagination: Although adults with Aspergers can be accomplished musicians and writers, they are unable to imagine alternatives to social incidents. They cannot predict a normal course of action according to social norms. For example, going to a wedding reception of a newly married couple may baffle them.

• Difficulty with Social Interaction: It is their inability to communicate that hampers their ability to maintain friendships. They might be confused at the way other people behave, because they are unable to understand social ways of conduct. They may lose interest in people and appear aloof most of the time. They are often mistaken as ignorant and vain individuals.

• Difficulty with Social Communication: People with Aspergers often find it difficult to understand others and express themselves. They fail to interpret gestures, facial expressions and change of tone. They are usually at a loss in choosing a topic to speak on, and do not know when to start or stop a conversation. They are very literal in what they say and fail to comprehend complex words and phrases, expressions like metaphors and even jokes. The best way to interact with individuals with Aspergers to keep one's sentences short and concise.

Treatment of Aspergers—

There is no cure for this syndrome. However, there are a number of therapies for adults with Aspergers. It should begin with a trained therapist first of all helping the patients to come to terms with their disability. It is important to make such individuals realize that they are just as functional as others, and that they could minimize the drawbacks of their disabilities with certain therapies.

While some may be overjoyed as they start to understand that it was not their fault if they did not understand how the world around them worked, there are those that simply abandon further treatment. It is important to make individuals with Aspergers feel confident about themselves, so that they respond positively to further course of treatment. This can be done through counseling. After that cognitive behavioral therapy sessions could be used successfully. Social training could also be adopted as it teaches individuals how to behave in different social situations.

==> Living With Aspergers: Help for Couples

Employment Opportunities—

Aptitude in social behavior is required in every aspect of life. Hence, despite their intelligence being average or above average levels, the chances of employment for adults with Aspergers get limited due to their social disabilities. However, there are agencies and services that help such individuals in getting jobs. It is important to remember that Aspergers does not retard one's intellectual development. If only the society is a little patient with their inability to understand social norms, they can fend for themselves as engineers, mathematicians, video game designers or photographers. They should avoid jobs of a receptionist, cashier or waiter as these involve a lot of social interactions.

Aspergers and Adults in Relationship—

Although research into the sexual interests of adults suffering from Aspergers is still in the stage of infancy, the studies have revealed that they have a normal sexual urge as other adults, but their sexual codes may not be as mature as expected of their age. Hence, inappropriate sexual behavior can be expected. Biologically, they are capable of having kids. However, due to their inability to understand people's emotions, they may face some challenges in issues related to married life and parenting. If only the partner understands the symptoms and does not expect the spouse suffering from Aspergers to shoulder equal responsibilities of the family, married life could still be carried out on near-normal levels.

Life is like a complex puzzle for adults with Aspergers at every step. Matters become worse for them as most of us can't recognize Aspergers in adults. If you know that a person is suffering from this syndrome, be patient with him. With time you will be able to see why his behavior that seems inappropriate to you, is the only right way for him to react.

==> Living With Aspergers: Help for Couples

BEST COMMENT:

Thank you Mark. I have been reading about Asperger's refreshing my memory ever since I started wondering if my love has it. He didn't come out and say it until the night I told him about the positive pregnancy test. I asked him for genetic information to tell the obstetrician's office when I went to my first pre-natal appointment. He talked about heart disease, anxiety, and 'mental health issues'. I said, "Tell me about Asperger's" and he told me he has it. He had mentioned things like being on the borderline of having a mental illness but not requiring medication. 

He had asked me things like, 'Would you ever leave someone for being sick?" I had told him things like the labels don't really matter to me. I like the person you are. And that's true. I have an MA in child development and worked as a Developmental Specialist with toddlers with special needs in an early intervention program at a non-profit. I had some kids in the program that may one day have been diagnosed with Asperger's. They were only 2.5 when I knew them, too young for a diagnosis. Whenever he and I struggle, I go online and read more about Asperger's. That's how I found your e-book and you.

Thank you very much! I am a very patient person and I know that I am not exactly typical either. I have highly emotion-based so I think it unlikely that I have Asperger's..but I know that I have characteristics that can be labeled non-typical. And in many ways, I feel like I have no trouble relating to my boyfriend and what he's feeling. I can empathize and I work very hard to see it from his altered perspective. Your e-book really helped me build on my knowledge of the ways in which his perspective is altered.

Many Thanks Mark :)