How is Aspergers Assessed?

Question

How is Aspergers Assessed?

Answer

Aspergers is a diagnosis based on the behavioral criteria set forth in Diagnostic and Statistical Manual of Mental Health Disorders (DSM). Because it is difficult to provide a diagnosis based on brief personal contacts, mental health professionals often rely on the reports of parents and teachers.

1. Qualitative impairment in social interaction, as manifested by at least two of the following:

• a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

• failure to develop peer relationships appropriate to developmental level

• lack of social or emotional reciprocity

• marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

2. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

• apparently inflexible adherence to specific nonfunctional routines or rituals

• encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in either intensity or focus

• persistent preoccupation with parts of objects

• stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movement)

3. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

4. There is no clinically significant delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The Aspergers Comprehensive Handbook

Aspergers Children and Lack of Eye Contact

A child or teenager with Aspergers or High Functioning Autism may exhibit less eye contact with you and others than expected, and he or she may not read faces for cues about feelings or consequences. This lack of connectivity is often felt in an intangible way, especially by caregivers. We anticipate with open hearts the child who will “give back” our attention. However, in children with Aspergers, there may be very little variation in expressions of emotions and little joy in playing interactive baby games. The arrival of the youngster’s social smile may occur later and infrequently.

What can moms and dads do to help their kids with Aspergers?

• Be understanding when we don't feel like looking - we're not being rude, just feeling insecure.
• Encourage "looking at my face" but don't push it - it's really uncomfortable for us.
• Explain how some folks need to see you looking in their direction before they think you're listening.
• Give your children a few options for controlling gaze avoidance (suggest looking at cheeks) or higher.
• Place less emphasis on eye contact and more on "participation in conversation".

 Eye contact is a form of communication in American culture; we assume a person is giving us their attention if they look at us. The Aspergers child experiences difficulty with eye contact; it is extremely hard for them to focus their eyes on a person for any extended period of time. Limited eye contact is a part of the disability. Don't demand an Aspergers child look you in the eye as you are talking to them--this is extremely difficult for them to do.

One of the key signs of Aspergers in folks is a difference in their use of eye contact in communication. This seemingly trivial variation can cause huge conflicts and misunderstandings when trying to deal with the non-Aspergers world. When to look someone in the eye, when to look away, does lack of eye contact indicate unfriendliness or dishonesty, does eye contact that too lengthy indicate a threat or a seduction? A lot gets expressed and read into a seemingly simple gaze. The confusion gets compounded by the fact that different cultures have different rules for eye contact, and the rules within families can be different than those for friends, acquaintances or strangers. What’s praised as “paying attention” for some cultures is then criticized in others as “not being respectful.”

There are reasons the non-Aspergers world uses eye contact: as an indication of openness, interest, paying attention, as well as to convey less friendly messages such as boredom or dominance. Checking in with the listener's eye contact is a way to verify that you're still getting your point across and not confusing, boring, or offending the listener. While it may be considered impolite to interrupt when confused, a simple squint conveys the message clearly.

For those with Aspergers, eye contact may be very uncomfortable. Just go online and read some of the blogs from adults with Aspergers and you’ll find great discussions about how eye contact can feel threatening, distracting, or overwhelming.

So, what can be done about problems with eye contact? It would be great if everyone acknowledged that eye contact is a trivial matter, and folks were judged by their words and actions instead. Unfortunately, I don't think that's going to happen any time soon. Unless they're clearly affected by Aspergers or autism, most folks probably don't even know what it is. I don’t think individuals without Aspergers are being deliberately bigoted or judgmental, but reading nonverbal messages is an instinctive and lifelong, although mostly unconscious, behavior.

I think the solution comes down to compromise and careful consideration of the situation. Adults should find a way to explain to others why their eye contact is different. I suggest stating that looking away helps the speaker concentrate, or asking the listener to let them know if they’re getting bored. These direct methods are probably most useful for those folks you know fairly well and those you’re going to be interacting with a lot.

Some online sites suggest faking eye contact by looking just above the eyes, at the forehead, or the eyebrows. I think this is an intriguing idea, but you’d need to practice first. Find a non-Aspergers friend and see how this works. Most people without Aspergers get an uncomfortable feeling when body language is different, even though they may not be able to explain precisely what is wrong. Don’t try faking eye contact for the first time on a job interview or a first date.

A final option is to try to learn non-Aspergers eye gaze behaviors. This is a big, time consuming project and will probably require training from some sort of professional and lots of practice. I’d suggest finding a qualified therapist, speech professional, or coach to figure out all the technical details and then a close non-Aspergers friend to practice.

Unfortunately, there’s no simple answer to the matter of eye contact, just a lot of compromises. In the end, the folks who matter most to you will probably get your message, whether or not you look them in the eye.

An Aspies Point of View—

“Eye contact hurts... no, not in the painful sense, but it's quite uncomfortable. I always feel that I'm revealing more than I want to with eye contact, and that I'm receiving more information than I want to know. Of course, I know that eye contact is critical to spoken communication, so often I'll compromise by either of two methods:

Method 1: Making brief eye contact every few seconds:

This is the "roving eye" technique whereby you make eye contact at the very start of each sentence and then drift away as soon as the individual you're talking to is reassured that you're listening. There are a few problems with this method. First of all, folks often assume that your concentration is wandering. I'll often get told, "well, I know you're quite busy..." or "I'm probably boring you..." or "I can tell you're not interested..." as a response to using this technique when I really am interested in the conversation. When that happens, I usually have to switch to the other technique.

Method 2: Making eye contact for half of the conversation:

A two-way conversation is made up of two halves (person 1 speaking while Person 2 listens and vice versa). As a general rule, folks like to know that they're being listened to but aren't as worried if you don't make a lot of eye contact while you're talking. The plan with this method is to make reasonably constant eye contact (though you'll probably need to "flit" your eyes away several times during longer diatribes to ease the tension) while they talk to you and rest your eyes while you talk back.

As a partially deaf person I was encouraged to look at lips and I've become quite good at lip-reading. Unfortunately, as an adult, the lips are just too close to breasts and I often find that my female subjects will try to cover themselves during conversations. This is as embarrassing for me as it is for them.

I guess the best rule is to either stare at the face or (cheeks are a good idea) or slightly above and/or to the left or right of their head - never downwards or they'll assume the worst.

Overall, this is a more effective method than the "roving-eye" method but it doesn't work with everybody. In particular, you need to watch out for folks who start turning around mid-conversation to see what you're staring at. If this happens, you need to either make more regular eye contact or switch to the other method.

One way of overcoming uncomfortable situations is to be seated at a desk and work during the conversation. I know that this is rude, but if you're doing related work or even turning to take the occasional note on a computer, it can give you a welcome break.

My background is in computers, so I use this to great advantage, often changing screens or adjusting code as the changes are discussed. This gives the impression that I'm just "raring to go" or that I'm prototyping systems (providing examples) to help the conversation, rather than just being rude.”

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

Parenting Aspergers Teens: Double Trouble?

Most experts do a great job of presenting the problems children with Aspergers (High Functioning Autism) face during their adolescent years, yet they offer few solutions. The years from twelve to seventeen may be the saddest and most difficult time for young people with Aspergers. This is not true of every adolescent with Aspergers. Some do extremely well. Their indifference to what others think makes them indifferent to the intense peer pressure of adolescence. They can flourish within their specialty, and become accomplished musicians, historians, mathematicians, etc.

Click here for the full article...

Aspergers Students: Summary of Educational Considerations

Is your child with Asperger's or high functioning autism going to have a new teacher in the upcoming school year? If so, you will do your child a big favor by emailing the following "summary of educational considerations" to his or her teacher. Here is the link: https://www.myaspergerschild.com/2010/09/aspergers-students-educational.html

Most Asperger's (AS) kids have normal or above-normal intelligence, and are able to complete their education up through the graduate or professional school level. Many are unusually skilled in music or good in subjects requiring rote memorization. On the other hand, the verbal skills of kids with AS frequently cause difficulties with educators, who may not understand why these "bright" kids have social and communication problems.

Some AS kids are dyslexic; others have difficulty with writing or mathematics. In some cases, AS kids have been mistakenly put in special programs either for kids with much lower levels of functioning, or for kids with conduct disorders. AS kids do best in structured learning situations in which they learn problem-solving and social skills as well as academic subjects. They frequently need protection from the teasing and bullying of other kids, and often become hypersensitive to criticism by their teenage years. One approach that has been found helpful at the high-school level is to pair the adolescent with AS with a slightly older teenager who can serve as a mentor. The mentor can "clue in" the younger adolescent about the slang, dress code, cliques, and other "facts of life" at the local high school.

Asperger's kids are characterized by a number of elements:

• Abnormal eye contact - either avoidance or prolonged intense gaze
• Clumsy and uncoordinated
• Competence with expressive speech and number often masks poor comprehension Literal interpretations of speech
• Competent with puzzles
• Consistent unawareness of non-verbal feedback (including consequences of actions)
• Cope well in a structured predictable environment with clear and simple rules stated in concrete terms - they will follow the rules to the letter
• Holistic approach to tasks and does not cope with approximations
• Lack of interest in pleasing people (e.g., educators and parents) and unresponsive to the usual subtle cues of displeasure such as head shaking etc
• Lack of spontaneity in exploring new situations
• Learn from direct instruction, not intuitive perception
• More interested in books and factual information
• Poor or absent capacity to use or understand facial expression, gesture, tone, pause or body language
• Precocious visual and auditory memory
• Slow development of speech without the usual approximations
• Use of speech to gain gratification or impart information and rarely for communicative intent
• Very egocentric

Areas of Difficulty—

The school environment is a complex, constantly changing and often unpredictable. Children are required to cope with changing stimuli; varying behavioral expectations; complex social interaction with adults, peers and children of other age levels; the academic challenges of each day; their own mood and state of health and are expected to behave appropriately at all times. This can be a challenge for neurologically typical kids but for those with learning and social disabilities, it can, unless properly, managed be almost insurmountable.

Kids diagnosed with AS may not be able to understand or express their emotions, understand what is expected of them or be able to apply the rules learned at other times and in other situations to the situation with which they are faced.

These children are often of average or above average intelligence and as they mature, they become aware of their difference and want to fit in but don't know how to. This can lead to intense frustration which may either result in outbursts of verbal and/or physical violence or withdrawal into themselves. The quiet, well behaved student is often the most at risk because the problem issues are unseen and thus unaddressed.

The student may have a "reputation that precedes them" for both children and staff. Older children may have low self esteem and an expectation of failure both academically and behaviorally.

The main characteristics of Asperger's, which hinder both academic and social progress are:

• Cognitive Skills

• Communication Skills

• Physiological Deficits

• Social Skills

An effective program will among many things, recognize the children' strengths and build on them to give them a feeling of achievement and thus improve their confidence. It will also recognize the problem areas and provide strategies to deal with behaviors, strategies to teach both academic and social concepts, which start with the concrete and move to the abstract at the student’s pace. Overall the program will not just teach 'academic fact' but teach strategies and skills that will assist future academic learning, social interaction and the development of the children self control and self discipline.

Learning Structures—

Kids diagnosed with AS require a mixture of the following structures to successfully achieve in the classroom. Behavior is often an indicator of frustration and stress and the following can assist in their management and reduction. Often, these ideas are beneficial to all the children.

Physical:

• Be aware that the student may be defensive of their person and/or personal space and plan for this if applicable.
• Consider isolating the student for short periods to teach new concepts or build on pre-existing knowledge in a distraction free setting.
• Ensure that the youngster is in a position of least distraction from the source of the information to which the youngster must respond (i.e., up the front and away from visual and auditory "clutter").
• Structure the physical environment to facilitate learning and minimize frustration (providing visual and physical order assists in focusing).
• Watch for peers who feed-off and feedback inappropriate behaviors and position them away from the student - often the student will like these peers but the relationship is not necessarily the best for either student.
• Watch for peers who obviously or subtly annoy the student and position them away from the student.

In Class Structure:

• Break tasks up into manageable segments and train the student to schedule and plan.
• Brief, precise, concrete instructions and make sure that they understand - don't assume that repeating the instruction means that the student has understood.
• Predicable environment and routine with preparation for any changes.
• Set behavioral limits and monitor to implement consequences or provide coping strategies.
• State clearly what is expected - be concrete and allow time for the student to process the information.
• Teach the student to ask for help and appropriate methods of doing so.

Presentational Issues:

• Break work into small steps.
• Have written instructions for older primary children and include visual cues and mark clearly the things that need to be completed.
• Keep black/whiteboard presentation as neat as possible.
• Know and use the student's strengths.
• Present new concepts in a concrete manner.
• Show examples of what is required.
• Use activity based learning where possible.
• Use visual prompts as appropriate.

Teaching Issues:

• Do not do for the student what they can do for themselves.
• Don't expect the student to automatically generalize instructions.
• Use language to tie new situations to old learning.
• Don't rely on emotional appeals or presume that the student will want to please you.
• Concentrate on changing unacceptable behaviors and don't worry about those which are "simply" odd.
• Use the obsessive or preferred activity as a reward.
• Use opportunities which arise to teach the student about how other children feel and react when they are hurt or upset.
• Be absolutely consistent and don't give options if there are no options.

Work closely with the parents and listen to them - they have already had much experience coping with the youngster. And don't judge atypical parenting as odd – it is often a coping reaction to the student's behavior rather than the cause of the behavior.

Other Strategies to Support Development:

• Explain metaphors and avoid where possible (i.e., 'Frog in your throat').
• Explain the timetable to the secondary youngster so they understand the daily structure - a simple written timetable also helps primary age kids and can benefit all the class.
• Explicitly teach rules of social conduct so that the youngster does not constantly interrupt or interrupt with questions relevant 20 minutes ago.
• Have a Communication Book and use it daily to inform parents of successes and failures, ask for parental advice and receive information from parents (it is difficult for parents to find out what is happening at school but it is vital that they know so they can inform the Doctors and therapists of issues and receive and transmit advice from medicos to educators).
• Have a strategy to employ when the youngster can't cope due to over-stimulation or confusion.
• Have a time out area for discipline when needed (it is important to enforce consequences and to ensure that the 'time out' isn't more attractive than the activity).
• Provide a formal "peer support network" or "mate/buddy" system for the safety of the youngster.
• Provide the parents with a timetable to ensure that the youngster can be rehearsed for the following day and has the necessary equipment required for the day’s activities because they are not strong on organizational skills and need assistance in this area.
• Teach "safety phrases" such as "Are you pretending? or What do you mean? or Why should I do that?" to give the youngster a vocabulary of questions to help them gain information (they won’t know how to do it naturally) so they can determine the nature of a situation and respond accordingly.
• When an issue begins to surface, do not ignore it or think it too minor to mention to parents (parents prefer more information than less and often something minor points to a serious issue which has bearing on behavior at home).

Kids diagnosed with Asperger's have a propensity to disrupt the class due to:

• lack of ability to focus
• confusion
• literal interpretation of instructions
• inability to read social rules and cues
• overloading of the 'senses' (too much noise, visual stimulation or physical stimulation)
• lack of desire to 'please'
• inability to explain feelings plus other factors.

These kids are rarely disruptive for the sake of it and are amenable to behavior modification providing that clear and simple instructions are given and consequences are consistently applied if the inappropriate behavior continues.

It is very important to keep the parents informed because that is their only way of knowing what is happening at school. This information is vital to the youngster's doctors to ensure that the management program is relevant and effective and that problems can be identified and managed quickly to minimize disruption to the youngster and fellow children.

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 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