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What are peer-mediated interventions, and how do they work?

"What are peer-mediated interventions, and how do they work?"

A peer-mediated intervention is a technique that has demonstrated effectiveness in teaching social skills to kids with Asperger's (AS) and High-Functioning Autism (HFA). The use of peer mentors is an example of an effective strategy for kids with AS and HFA. Peer-mediated interventions allow parents and teachers to structure the physical and social environment in a manner to promote successful social interactions. 

In this approach, peers are systematically trained to make social initiations or respond promptly and appropriately to the initiations of kids with AS and HFA during the course of their school day. Peer mentors should be classmates of the AS or HFA youngster, have age-appropriate social and play skills, have a record of regular attendance, and have a positive history of interactions with the AS or HFA youngster.

The use of peer mentors allows the teachers to act as facilitators, rather than participate as active playmates. The use of peer mentors also facilitates generalization of skills by ensuring that newly acquired skills are performed and practiced with classmates in the natural environment.



COMMENTS & QUESTIONS [for 6/2013]

Since we can not financially go back to the Dr who diagnosed Chance who is 11 with ADD and high functioning autisum we were wondering what natural things a behavioral books we could study until we can go for therapy and maybe medication! The normal person would probably not be able to tell that Chance has a problem but his unruly behavior at home and bad sleeping problems are getting worse ! He loves school and sports and does well in both. He passed into the 6th grade without ever doing his homework or studying at home with a C average. He loves to read and of course loves video games and is very good at them. However his off again on again wild behavior that he can control if he wants to is beyond belief and only a very sturn hand by his father is almost the only thing he respects ! sometimes I think this is food related because of the crazy outbursts ! He bad mouths his Mom and me but never in front of his father. Like I said most of the time you would never know he has a problem unless he is in one of his wild moods ! He also has a problem making and keeping friends . His 8 year old sister is his best friend and how she tolerates him sometimes is beyond me. Chance has been this way from birth but we just thought he was a difficult kid to handle.He was born in a emergency C Section and half of his body was blue when he came out  the umbilical cord was wraped around his neck .Last night he was up all night and just now woke up and it is 8pm.

I am sure your trained eye would have recognized this problem sooner but we just had this diagnosed a couple of months ago. My daughter in law heard them taking about his blood test but they could not see the dr because they did not have the money for the visit ! We found out his diagnosis from the school. The nurses said they might not be able to give him medication because of the blood tests . It will be awhile before we can get back in to this same Dr and we are really in need of help now !

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My middle son ( almost 9) has been diagnosed with the combined type of ADHD with ODD and a possible mood disorder.  For the least year he has been in behavioral therapy which became very inconsistent due to many cancellations.  He was put on Metadate CD by his psychologist who left the practice mysteriously.  When I saw the interim psychologist for another prescription, he suggested a low-dosage antidepressant to treat the mood disorder that now was more prevalent than my son's ADHD.  However, I believe that these two medication interacted in such a way that my son became completely defiant towards his teachers and classmates, disrespecting and hitting.  This lead to two suspensions within the last month.  During the last two weeks I have consulted my PCP who decided to take him off the Antidepressant gradually.  I have also begun the process in looking for new counseling services since I was not able to get any help from my therapist who cancelled again last week or the psychologist other than anew prescription.  He made it through the last weeks of school successfully and will enter fourth grade.  I want to use the summer teaching him social skills which he lacks as well as skills that help him control his impulsivity.  Can you give me any advice or help on how to help him? How can I help him to manage school without facing expulsion which the administrators have already mentioned?

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Mr. Hutten,
My son who has been diagnosed with Aspergers, is facing very serious federal charges as an accessory after the fact. He was directed by his "friend" to trade shoes with him after that "friend" had committed a crime. My son, who has an incredibly difficult time making friends, has always struggled to see the "big picture" and really struggles deciphering intentions or predicting outcomes when faced with situations. It seemed that he had found a "freind" who accepted him and he was unable to see this friend was exploiting him. As I have learned from combing your website and reading your ebook, this is most likely due to his condition. Do you know of any expert in Aperger's that would be willing to work with us in this case? We live in Manhattan, KS and are willing to pay a retainer fee and travel expenses. We are desperate Mr. Hutten. My son, who has the maturity of a 12 year old, is not a criminal. He just unfortunately got tangled up with some pretty bad people.

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Thank you Mark. Over the next few weeks we will be going over both pdf book but also online version with videos, etc. Our daughter is 3 and a half (will be 4 at the end of September) and we are bi-lingual and she does not speak well yet. She does not want to talk other than in her own language. At pre-k 3 she is exposed to English obviously and it really helped her and is picking up a lot of words however she does not form sentences in either English or Slovak. Other than very short sentences. But when she does speak other than her own language she only uses English. However since she has been attending pre-k her language skills picked up.

Hence our situation is so much more frustrating for her and for us in addition to dealing with Aspergers meltdowns. We know that at this age it is a lot more difficult dealing with a 3-4 year old than trying to help an older child. Plus not speaking well or not wanting to speak does not help either. Her speech delay seems nothing uncommon at her age it is just a mix of this + dealing with meltdowns. We are looking forward to going through the material.

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Hi,

I came across your information on an article about your book, Launching Adult Children, and I’m looking for information for adults with aspergers.  My significant other has been struggling with it and it has created a number of challenges both at home and in the work place.  We’re in NJ and unfortunately there’s only one support group that meets once a month and it’s not an ideal fit for her.

She is struggling with career challenges as well as establishing consistency with her goals.  She struggles with mood swings because she is also bi-polar.  Surprisingly she is a recovered alcoholic of 22 years so there are some things that she has maintained consistency with.

Her biggest challenge at the moment is her job and a boss who clearly doesn’t understand who he’s managing or how to manage her.  She’s a talented writer, but without the right support and encouragement she may never get far with it.  She had a short stint writing for the paper, has written online and can do professional quality work, but she can’t figure out how to get into that field, which is probably well suited for someone with aspergers.

Anyway, I’m looking for resources so thought you might be able to point me in a direction.

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Hi Mark,

I have appreciated the information you offer to parents of children with asperger's as part of the group of people who receive your newsletters.  My 8 year old son was diagnosed with asperger's about a year and a half ago, and we have made a lot of progress through Occupational Therapy.  Social skills training has proven more difficult for him.  He has improved tolerance for social situations through OT by becoming more self-regulatory for being overwhelmed by too much input, but has no intrinsic motivation to socialize with his peers.  If I want him to have any measure of success in a social scenario with children, I have to reward him for doing well, and this becomes his motivation ahead of time to do well.  His OT says a reward is fine, but my concern is that his reward should eventually be his own success, not lunch at a favorite place, or a trip to a favorite store.  He prefers to have no interaction with peers, and so to motivate him to have successful experiences, I offer him these rewards.  What do you suggest is best?  I have spoken with other parents who also use rewards with their children on the spectrum.  Is there any harm in doing this?

Also - are you aware that there have been some recent studies done (one at Ohio State University) on levels of cholesterol in ASD children being too low?  I had my son's cholesterol tested, and it falls in the abnormal range according to the study, however, most doctors don't subscribe to this claim.  There is plenty of medication to lower cholesterol, but none to raise it.  I thought to share the study with you below if you are interested.  I believe there is something important to this.  The embedded video clip is particularly compelling:


Thank you!
Jennifer

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Dear Mr. Hutten:

My 26-year-old son was just diagnosed with (among others) subthreshold Asbergers Syndrome. The psychiatrist who tested him provided us the report. All the information I have found deals with young children or teenagers -- none with a just-diagnosed adult. I do not know how he managed to slip through the system of elementary school, junior and senior high school, numerous therapists and counselors, and two different colleges (neither of which he completed) without being diagnosed. He was under the care of a therapist and psychiatrist for two years. Both of them mis-diagnosed his condition as "bad parenting" and laziness. The psychiatrist merely prescribed higher doses of the same antidepressants rather than trying different meds until finding the ones that actually worked. My untrained friend researched his visible symptoms and suggested he needed testing for Autism. We went to his physician who referred us to a neuro-psych professional.

Because of my son's age he is uninsured. I lost my job seven months ago and am struggling to make ends meet. With the help of the professional who diagnosed him, I am going to locate a psychiatrist who can handle his medication, and a therapist who can work with his depression and anxiety issues. I have also put him on a gluten-free and milk-free diet and am applying for Social Security Disability benefits under his late father's social security number so that we can afford the treatment he so desperately needs.

I am not writing to ask for anything. I just need to vocalize the fact that it is possible for an extremely bright and artistically talented child can go through 26 years of struggling and suffering (and me, as his parent as well). I am now dealing with the guilt of not seeing the symptoms, and the overwhelming anger and frustration of the wasted, wasted years. Thank you for your time.

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My son is ten years old and wants to stay up all night long. When I talk to him about going to bed he argues that it is summer and it does not matter since there is no school. He is keeping his younger brother, who is 7, awake with him to play video games, drink soda, and watch TV to stay up all night. They call it “guys night”, which he got the idea from his favorite cartoon TV show he watches all the time. He is fixated on this and will not stop trying to stay up all night every night. I tried to explain that he can wait to the weekend or do this every once in a while, but not every night. I am not getting through to him. How can I help him understand my point of view about this situation?

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My 11-year-old son who has Asperger’s still has difficulty with wiping after a bowel movement.  I believe it is due to sensory issues, he cannot tolerate the feeling of it even though he has lots of tissue.  He is able to get most of it, but usually not all even when using wet wipes.  He just  becomes completely grossed out by the idea of it and becomes upset.  He wants to be able to do it for himself, but is not there yet.  Do others have this problem and what can we do to help him overcome it?

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We live in the UK and our 8 year old has just been diagnosed with Aspergers. He is extremelly bright, an amazing mathematician, very able to write, but struggles with reading facial expressions, lacks empathy, is unable to catch a ball, can't keep eye contact, can't 2 things at the time (talking and getting dressed), he can't talk and no listen  to others for a long time etc...

He loves riding a bike, but he does not want to swim. He has swimming as part of PE next year in school and I don't want him to feel different, but he really does not like the water in or near his eyes, ear, nose etc.... What shall I do?

I have tried to teach him and he doesn't let me...  Would a private teacher be a good idea? or shall I wait till he wants to learn?

And .... so far I have told him that he has trouble making friends and interacting with others because his brain works in a different way since he is brilliant at Maths , science and has an amazing memory.  

2 years ago we discovered he was able to say the day of the week of any given date up to 2 years earlier.  We thought that it was strange and we kept him away from any calendar. 

When is it the right time to tell him that he has Aspergers or what it is called now high funcioning Autism?

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Dear Mark Hutten
Hope this email isn't too late as I've only just received your email after being away.  I will try to keep it short.
The last question on your email was very interesting as the 14 year old sounded like my grandson only he is 18 this month and has Aspergers.  My son being the strict one of the two.
He was granted a place at a college for teenagers (only allowed home for the weekend every two weeks) who have Aspergers last year but hated the discipline and behaved very badly.  He has hardly been there this year as they have suspended him twice.  Although they are willing to take him back again he now wants to do an apprenticeship and not return there.
His behaviour is still very bad and is obviously affecting not only his parents but his younger brother who is only nine.  He smashed up his bedroom door a week ago and my son has to pay out for a new one.  My son and daughter-in-law are at their wits end - although my daughter-in-law doesn't like anyone to know how bad he is.  I think my son would just like him to leave home although I worry what would become of him if he does.
I would be very grateful for any advice you could give.

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I have a 16-year-old daughter who has been getting into trouble for two years and I've really had to crack down and check up on her; trying to get her to earn trust back.   A month ago she got caught lying, stealing and called me a nasty name.  When I went to ground her for two weeks, she went to "live with her dad." (We are divorced and I am remarried)  He does not have custody of her, but she wants to continue to live there because he doesn't follow through with checking up on her the way I do.  This is killing me as a mom. I can try to force her to come back home through the courts, but I don't know if that is the best thing to do.  Has anyone been in this situation?  I am so worried she is going to end up doing thing that will affect her for years to come. 

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My son is six with undiagnosed mild Aspergers (suspectd for a year now), first picked up by his teaher in his first primary year.  It is now being suggested i have him officially diagnosed although i am told his needs educationally and emotionally are being met.  i am suspicious of this sudden change in opinion by the school.  What could he gain by a diagnosis when he does not need one to one help and his needs are currently being met.  I have expressed no concerns he has his little quirks but i have read lots and we are coping well and helping our son where we can.  I really worry that the label of Aspergers could do more harm than good for a mild sufferer who needs and would get little or no extra support.
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Dear Mr. Hutten,

My name is Priya and my younger brother ("K") is a 21-year-old with high-functioning autism and Asperger's syndrome. We live in Los Angeles, California. I'm sorry to contact you out of the blue but I'm really not sure what else to do at this point.  The situation with my brother has gotten out of control, and I am now convinced that unless serious action is taken, the future of our family is at risk.  We need help, and I'm not sure who else to ask.  I read your book on Launching Adult Children with Asperger's - many of the steps you mention are ones we are already taking with my brother, but we need a different type of help with him that I'm hoping you might be able to provide.
To give you a little bit of background, K has attended the University of Southern California for the past year (he transferred from a community college last year, and is going to be a junior this fall).  During the past school year, he lived in a dormitory on-campus during the spring term, and stayed there a few days a week and, since we live relatively close by, stayed at home for the other days.  Since the beginning of that term (not sure if there's a connection between the two), his condition has taken a severe turn for the worse.  He has always had trouble controlling his obsessive tendencies, rigid need for predictability and 'sameness' in his schedule, etc, but lately things have taken a very bad turn.

In what continues to be a pattern of progressively worse episodes, K has been going into violent rages and making frightening and graphic threats towards my parents and especially toward me in the past six months.  For instance, a few months ago, Krishna physically attacked our father because of a mishap concerning one of Krishna's projects for school.  For this project, Krishna had interviewed a museum curator during the day using a voice recorder, and he asked our dad to help him transfer the recording to the computer.  In what was a truly unfortunate but obviously accidental error, my dad erased 15 of the 30 minutes recorded on the voice recorder while trying to transfer the recording, and Krishna went absolutely berserk.  He grabbed my dad and slammed his head against the wooden closet door, slapped him, and punched him repeatedly in the chest, arms and knee caps.  Our parents tried to figure out what had happened and desperately tried to retrieve the lost information while trying to get Krishna to stop attacking them, but Krishna was absolutely wild.  

I tried my best to calm him down, speaking in a level voice and explaining again and again that it was a mistake and that he had every right to be angry and devastated but that this was not the way to handle it.  At the very least, I wanted to prevent him from seriously injuring our dad, but he shoved me, grabbed a heavy three hole punch and threw it at my legs - it missed, fortunately, but damaged the hardwood floor.  He then grabbed a vase and flung it as well.  He then ran into the family room next door and grabbed anything he could get his hands on - phones, remotes, etc and threw them at me as I tried to tell him as calmly as I could that I understood why he was so angry, but he needed to stop that behavior before someone got seriously injured. Amid all the broken items on the floor, Krishna repeatedly screamed that he wanted our dad to 'pass away' and if he didn't, Krishna would kill him. My parents also came into the room and tried to explain that there was still lots of material left on the tape that he could use, and that my dad would personally go and try to get him another meeting with the curator, but he would not listen to any of it.  He continued to physically lash out and hurled several unmentionable words as epithets at us countless times, threatened to kill us all, to leave and never come back, and all sorts of other things  I eventually got him to go to his room until he could calm down, but not without getting punched, clawed and scratched over my torso and arms.  I should note that he had brief moments of clarity in the midst of all this - he would briefly acknowledge my remarks that everyone makes mistakes, that our dad also devotes his life to Krishna and that this one error should not trump all of that, etc - but these moments were inevitably overshadowed by the crazed anger that had taken over his mind.  

Few episodes have been quite as violent as that one, but in the course of his many 'rages' (which vary from 2-3 times per week, sometimes more or less often), he has thrown items at each of us, threatened to rape and/or kill my mother or me, fervently and loudly wished that I would die in a plane/car crash, and the like.  He has never attempted to truly physically harm any of us, and is always deeply repentant afterwards - he recognizes that his behavior is completely out of line, dangerous, and irrational in light of the seemingly meaningless triggers that incite his anger (which vary from not getting the particular lunch that he wants, to hearing me discuss how lawyers in a particular branch of government that I may one day apply to get paid $170k per year, etc).  He recognizes that he needs to change, and tries desperately to show that he does love all three of us, cares for us deeply, and appreciates his need for us in his life.  Yet these rages continue, and as my parents are in their 50s, they are less and less able to cope with these 'tantrums', and as I am getting married and moving away this summer, I honestly fear for their safety as long as my brother continues to lash out in these unpredictable ways.

I have believed for a long time now, that much of his anger stems from frustration, which is owing in large part to the fact that the academic standards of USC, and standards for most jobs, are not ones he can handle without quite a bit of difficulty.  That frustration, of being constantly found 'lacking', combined with the fact that he has no friends and no one who willingly spends time with him besides my parents and me, is manifesting as violent rages and I'm truly frightened or where that may lead.  Much as it angers me that, despite his efforts to reach out to them, none of his peers see fit to befriend my brother - who is, at heart, a truly good, sincere, and sweet young man - it is not something that is easily fixed.  The best we can do is try to help him handle these things that upset and frustrate him in a more productive way. 

To that end, I think he truly needs some combination of medication (he currently takes about .5 mg of risperidone every night) and intense cognitive behavioral therapy, and whatever else will help him effectively deal with the many things that (rightly) frustrate and upset him. Can you please provide me with some information about the most effective anger management rehab centers in the Los Angeles area that you know of, or suggest another means by which we might be able to help him, and by extension, help ourselves, deal with his condition more effectively?  I strongly feel that some action has to be taken because the status quo cannot be endured any longer.

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Mark,

I downloaded the eBook this morning and have already read half of it.  It is very straight forward and a lot of common sense when you sit and think about it.

Sometime we can’t see the forest from the trees, we need someone to point them out for us.

Thanks for the book.

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I came across your information upon my research of Teens with Asperger's. My 15 year old nephew has never been diagnosed, but I strongly suspect that he may have Asperger's, as the traits I have seen listed, are synonymous with his. 

I am deeply concerned because as a teenager, I know that he probably feels "different" from his peers but can not understand why. 

He attends regular school, but his social skills are not up to par for his age. He prefers to spend most of his time alone and I know that although he can't express it, he is dealing with some pain inside. 

Because it has not been addressed and everyone ignores the elephant in the room, I don't know where to begin to initiate conversation with my sister (his mom) and I don't think she would know how to speak with him without causing him to feel insecure as a result of him possibly believing it is something to feel ashamed of. 

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My son, who is 18, is leaving for college this coming year.  His biggest obstacle is not following through when faced with a challenge he can't reason the answer for.  If he can plan out the end result, all in his head, he succeeds, but he thinks asking for assistance is cheating in some way.  He just stops the process.  I wonder if he maybe put the project aside to let go of frustration; this is a common reaction in people.  However, he doesn't pick up the task again to find the solution and follow through.  With him going to college, this style of problem solving is worrisome.

Also he doesn't take a shower after he has worked up a sweat.  He only seems inclined to shower and brush his teeth at scheduled times.  We have tried explaining that he may not be bothered by his smell or the crud on his teeth, but others really notice both and not keeping your gums clean causes problems down the road.

Do you have any experience with these two tasks?  We live in a remote area so there isn't a lot of assistance, but when he goes to college I'm going to look for an Occupational Therapist, so that he'll have support if/as needed.

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 When I try and explain how I feel towards something he has said, he will usually always deny that is what happened.  Eg for example, he was telling me about his mom who is refusing food because she had a stroke and wants to die, and describing how she will only eat a little bit of a strawberry.  So I join in the conversation and chirp in and say hey how about bacon and puree it; to which his response is no, bacon is no good; I would eat fruit as I like fruit.  Now I felt offended by this as per usual I feel any comments I suggest are dismissed without any thought (he would not do this to any one other than me ie to outsiders he is polite and well mannered and would agree with them and say yes that is a great idea).  I explain to him why I’m offended and it causes an argument cos he proceeds to deny that’s what he meant; to which I respond that I’m not saying that I felt he meant to offend me and that I was trying to explain to him why I was offended and would appreciate if he could perhaps in future listen and consider my feelings; so it doesn’t happen again; otherwise I’ll just end up shutting down from him cos I feel dismissed.  It caused a huge argument which went into the 5 D’s as I call them, ie dodging, ducking, diving, deflection and defensiveness.  

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Whenever I try to break down and share how I feel, my husband’s response, instead of listening, will be to automatically say the opposite of what I’m saying, and I end up not feeling heard.  Most of the times it’s over the most trivial thing that isn’t important; but what hurts is my husband’s lack of emotional response and denial that hurts ie invalidation.  I’ve spent years trying to explain to him how I feel invalidated and he always responds with a no, in the monotone voice, devoid of any emotion apart from a high pitched tone which drives me nuts as I can only hear the irritation in his voice.

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This afternoon before he goes to work, I’d asked him to set up a folded rebounder which was in our bedroom by taking it to the living room.  In our bedroom we have a massage chair and my husband clumsily banged into the very expensive massage chair, damaging it (again as he damaged it last night as well with the rebounder).  I got cross and told him so and he responded in his monotone voice and with a whingey complaining moaning tone that the room was too cluttered.  I then try to explain to him that an NT would just say woops, darn, sorry about that and that’s it, over and done with; but no he has to go and whinge about the room being too cluttered instead of taking responsibility and saying sorry.  It’s the lack of emotion that upset me more than the banging into the massage chair and denting it.  It caused a huge row as he would not acknowledge how I felt or attempt to understand and kept whinging and complaining, saying that sorry wouldn’t change things.  If I was a work colleague or anyone else, I’ve seen my husband in action and he is on his best behaviour with others and would not react the way he did with me.  I’ve been told he’s like this cos he’s comfortable with me; but hell it’s ruining our marriage.

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 I still do not understand the key to communication with an Aspie.  I run on emotions; my husband runs on whinging and what I find is a lack of emotions with a monotone complaining voice which comes across as negative.  I walk on egg shells around him; and am at the end of my rope with him.  I’ve been trying for almost five years to fix and heal our marriage and communication problems.  You mention that counselling wouldn’t not work much over social education or something along those lines?  My husband always responds that he feels normal and that I’m the abnormal one who is overly sensitive.  It takes all my strength inside to find a way to talk to him so that he understands me; and it usually works by example ie if I talk him through an example.  Eg he complains that I tend to say my life was better when I was single before him; so he feels he should leave when the marriage gets tough; so I explain that hey, I complain that the house was tidier before our 4 cats lived there with their cat towers, beds, cat fur, throwing up, food bowls everywhere and the house was much quieter before the 7 budgies we have with the aviary and feathers and poo and the horrendous noisy chatter when they are happy to see us; and I complain when I’m frustrated but it doesn’t mean that I want the budgies to leave or the cats and I try and find solutions to make our lives work together ie noise absorbers, ear plugs, more tidying up etc.  Only then did he understand.  

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What do I do when he always says the oppositve of what I say, doesn’t listen or hear me, claims he’s normal and I’m overly sensitive and doesn’t hear what I say and constantly denies everything when I’m trying to explain my feelings?  We saw an Aspergers therapist yesterday who said to write it down; we’ve tried this and it used to work and there’s not much time these days as we have much going on in our lives; and we had agreed when he moved in that if we don’t nip it in the bud when it happens, he will forget the sequence of events.  Then he’ll deny everything saying no, that didn’t happen and will have forgotten.  Am I supposed to just put up with behaviour and comments that hurt just cos he’s got Aspergers, I’ll just switch off from him and shut down instead emotionally and the love will shrivel up.

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Hi Mark,

I just recently found your site and have found a lot of beneficial and reinforcing info on it. Thank you. It is the best site I have found so far on information on raising a child on the spectrum. My son is 9 and I have suspected HFA since age two. His pediatrician of the last year is now leaning towards that too. He has not been tested for it yet, has many indicators, and is on Paxil and Adderrall currently. I am considering heavy metal or chemical toxicity from early childhood (he was adopted from Russian orphanage). Do you have any info on this or know of any sites on toxicity I can research also?

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I love you Mark Hutten....joking. But really, on days that are difficult and I'm left wondering, how do I help, your emails pops up and gives me tips, guidance, and understanding. Thank God I found you! Jill 

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Dear Mark I am really struggling with my 15 year old son. He has not been tested yet but I am almost positive he has aspergers. When he was younger I contacted the children's mental health association in our area and was told if he was doing okay in school to leave him alone which he was at the time.This is his first year of high-school and it has been very trying. He is really struggling with Math and is going to fail. When I try and tell him to get a high-school diploma you must have 3 maths he just says he doesn't care . I have even hired him a tutor but he says he just tunes out because it is so boring. I have asked the school about having tested for aspergers but they advised me to go through our family physician. Is Math a particularly difficult subject for aspergers.

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My grandson is a 17 Y/O with undiagnosed Aspergers. I am sure of this because I have worked for most of my career with Special populations,before that in mental health and before that in medical. Amazingly I am having Difficulty getting help for him. he has now reached such a state of anger that he refuses any help. He has frighten away an in home case mgr and walked out on a therapist. What I want is a diagnosis. but he refuses. Can you offer any suggestions? I know this should have been addressed long ago. Soon he will be 18 may of 2014 and I am afraid he will wind up in prison. 

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I live in WV and my 7 year old daughter has just completed 1st grade.  We had a terrible experience, she has an IEP and her teacher did not tell the truth with things going on in the classroom.  She has spent the year being punished for normal Aspie reactions: standing, singing not standing on the line in the hall and etc.  This is behind us, we have had a tudor for over two weeks and she goes to Speech and regular counseling.  The Speech person is not helping at all she is focused on attentive answers and full statements.  The normal counselor says she is adjusting just fine and wants to wien her off from the visits.  It took us a year to get into this place, and we have to drive 45 minutes for each appointment, sorry I go on and on.  The point is she is not reading!  She states “she does not need to learn to read”  She also states “there is no benefit to me to learn to read”  we have deep talks on the benefits.  She can not blend sounds.  She is high functioning and she of course the other part ADHA and OCD.  My concern is she is going into second grade and we have made no progress on reading from Kindergarten.  She was writing before 2 and she could recognize her name, my name, her dad’s name in any type of print.  She is very bright.  In Kindergarten she tested 115 on the bell curve whatever that means.  Her school went from treating her as a problem hard headed child to what she is.  In first, it stopped and she lost all zeal for school or learning.  I have exhausted every avenue I can think of.  Because she is not abusive, she is not allowed in any type of programs.  My daughter is falling through the cracks and I can not catch her.  I work 45 plus hour and most of the time she is with me.  She is now developing the separation issue we had when she started Pre-K.  My heart is breaking and I don’t have any place to turn.  Please any suggestions would be really welcomed.  It is not fair that it seems every program has failed her.  I keep telling her there is a special world just waiting for her if she would start to read, she of course questions how that is possible.  I AM LOSING HOPE FOR MY CHILD PLEASE HELP.

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My 18 year old is on academic probation from 2 college universities,  just has been arrest for possession of marijuana and drug paraphenalia.  He is currently attending an Intensive outpatient program (IOP).  He does have a full time job in a maintenance dept.   He wants to go back to college for a technical degree in auto mechanics.  My husband and I agree that we would pay his tuition as long as he is drug free (which would mean he would have to submit to drug testing by his parents (IOP ) would be be completed by then.  He wants to move out,  he would pay for his own apartment. My son has clearly said to us he wants to continue smoking pot.  Remember he is currently in treatment.    Are we being fair to him if he pays his own rent,  we pay for college,  but he would still have to do drug testing?.   He wants to be free to make his own choices since he is paying his own rent.   What do you think?

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QUESTION:

Hi Mark
I found your website and book on-line and purchased and downloaded your Booklet "Launching Adult Children with Aspergers".  I found it very informative and helpful.

I have a 19 year old son who was diagnosed with NLD. He fits some of the Asperger criteria/behaviour but not all. He really does fit NLD more.  I have done extensive reading on Aspergers and less so on NLD as there does not seem to be as much published.
Do you have any material on the similarities and  differences between these two?

Also, do you have any material on Asperger's or NLD and Gender Identity Disorder?  I understand there can be a co-morbidity and some believe that the Gender Identity Disorder can fit with the OCD piece of this.  Is the Gender Identity Disorder permanent (likely) or have there been cases of it resolving without transition?


ANSWER:

RE: ... found your website and book on-line and purchased and downloaded your Booklet "Launching Adult Children with Aspergers".  I found it very informative and helpful.

Thanks... be sure to listen to all the audio files on your download page.

RE: Do you have any material on the similarities and  differences between these two?


RE: Also, do you have any material on Asperger's or NLD and Gender Identity Disorder?  

There have been several recent studies linking Aspergers in adults with gender identity disorder (i.e., a disorder where an individual feels like they are actually a member of the opposite gender they appear to be). Much more research is currently underway to look for the causes of Aspergers and possible solutions to managing the condition.

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Sensory Diets for Kids on the Autism Spectrum

"What are your thoughts on 'sensory diets' for children with high functioning autism? Do they work? How do you implement them?"

Very few moms and dads have heard of a “sensory diet” for kids with Asperger’s (AS) and High-Functioning Autism (HFA).  Yet, a sensory diet may be the most important thing parents can do to help their children on the spectrum get through the “unstructured” summer months. In this article, we will look at what this diet is – and how you use it:

Just as your AS or HFA youngster needs food throughout the course of the day, his or her need for sensory input must also be met. A “sensory diet” is a carefully designed, personalized activity plan that provides the sensory input that a child on the autism spectrum needs to stay focused and organized throughout the day. Just as you may chew gum to stay awake or soak in a hot tub to unwind, AS and HFA kids need to engage in stabilizing, focused activities too. Infants, younger kids, teenagers – and even grown-ups with mild to severe sensory issues can all benefit from a personalized sensory diet.



Each AS and HFA youngster has a unique set of sensory needs. Generally, a youngster whose nervous system is on “high trigger/too wired” needs more calming input, while the youngster who is more “sluggish/too tired” needs more arousing input. Qualified occupational therapists can use their advanced training and evaluation skills to develop a good sensory diet for your youngster, but it’s up to you as a parent - and your youngster - to implement the diet throughout the course of the day.

Developing a sensory diet for your child is well worth the time and effort, because the effects of this diet are usually immediate AND cumulative. Activities that perk up your youngster or calm him/her down are not only effective in the moment – they actually help to restructure your youngster’s nervous system over time so that he or she is better able to (a) handle transitions with less stress, (b) limit sensory seeking and sensory avoiding behaviors, (c) regulate alertness, (d) increase attention span, and (e) tolerate sensations and situations that are challenging.

A sensory diet is like a diet that a nutritionist may recommend for proper nutrients and calories. It is developed to provide your AS or HFA youngster with the sensory stimulation (nutrients) that he or she requires for (a) helping maintain an optimum level of arousal, (b) promoting a level of alertness needed to develop self-regulation and behavioral organization, (c) increase gross/fine motor skills, (d) increase self-care and play/leisure skills, and (e) reducing sensory defensiveness.

The qualities of the sensory-motor activities recommended below impact the nervous system and have a modulating (i.e., calming or alerting) influence on behavior. Initially, the activities need to be repeated throughout the day (3 times works best) to help your youngster maintain an optimal level of behavior.  As behavior changes, it can be determined as to how much and how frequent sensory input is needed.





A sensory diet is made up of activities from several sensory systems, each having a different effect on the youngster’s nervous system. Below are descriptions of these sensory systems and their associated sensory-motor activities:

1. The Proprioceptive System: This system receives input from the joints and muscles and provides the child with information about the position of his or her body.  This input is strongest during movement and heavy work activities and helps with the integration of tactile input. Examples of activities which provide proprioceptive, deep pressure and heavy work input include the following:
  • Arm wrestling
  • Carrying heavy objects (e.g., filled laundry baskets, large soft drink bottles, a load of books, removing wet laundry from the washing machine, dragging or carrying grocery bags from the car to the kitchen) 
  • Climbing on monkey bars, jungle gyms, or a chin-up bar
  • Crashing into several large cushions, beanbags or comforters (e.g., have the youngster dive, jump, roll, stretch and burrow in the cushions; use a crash cushion by stuffing large foam scraps into a comforter cover or into a large bag made by sewing two sheets together)
  • Have the child clean a mirror or window to help develop shoulder strength and stability
  • Hide objects in play-doh or silly putty
  • Make a sandwich out of the youngster between pillows, and add pressure as you pretend to put on pickles, cheese, lettuce, smooth on mayo, etc.
  • Swimming
  • Tug-of-war
  • Wheelbarrow walking

Ways to get heavy work orally:
  • Blowing bubbles
  • Chewy foods (e.g., fruit leather, bagels, turkey jerky, gum, taffy, etc.)
  • Crunchy foods (e.g., apple chunks, chips)

2. The Tactile System: This system is responsible for providing feedback about how something feels and where the child feels touch.  It allows the child to interpret if something is cold, hot, wet, dry, sharp or dull – and whether it is safe touch or unsafe touch. Examples of activities with tactile input (touch) include the following:
  • Cut a hole in the top of a shoe box and place different objects in the box (e.g., a spool, marbles, plastic animals, little toys).  Hide items the child wants in this box (e.g., puzzle pieces or balls to a game) and have the child find the item he or she wants. 
  • Fill a large washtub or kitchen sink with sudsy water and a variety of unbreakable pitchers, bottles, turkey basters, sponges, eggbeaters and toy pumps.  Pouring and measuring are excellent for developing the tactile system.
  • Try finger painting on a tray or mirror with paints, sand mixed into paint, peanut butter, shaving cream or pudding.
  • Offer different kinds of soap (e.g., oatmeal soap, shaving cream, lotion soap) and differently textured scrubbers (e.g., loofa sponges, thick washcloths, foam pot scrubbers, plastic brushes).

3. The Vestibular System: This system responds to motion, changes in head position and gravitational pull.  It is a very important system because of its influence over muscle tone, balance and equilibrium, posture, coordination of the two sides of the body, and the coordination or eye movements with head movements. Examples of activities with vestibular input (movement) include the following:
  • Have the child swing on a swing set lying on his or her back, on the stomach, sitting, or standing.
  • Have the child swing forward, backward, side to side, or rotating.
  • Bouncing on a ball, or jumping on a trampoline or bed is a great activity.
  • Throwing beanbags at a target while swinging is another effective activity.
  • Use slides and merry-go-rounds.
  • Wrapping the child in a blanket and unrolling him quickly (roll in both directions or down a hill) is yet another helpful activity.  
  • Bouncing on a “hippity hop” ball is good too.

These sensory diets don’t have to take a long time.  Try to do them at the same time for 5-10 minutes throughout the day – especially during the unstructured summer months. It’s recommended that they are done at least 2-3 times a day, or immediately before the child is expected to do an activity requiring his or her undivided attention (e.g., doing homework). Also, be sure to ask your youngster’s occupational therapist for more ideas.


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

Obsessions and the Autistic Mind: Help for People on the Autism Spectrum

Lecture by Mark Hutten, M.A. - Part 1 discusses obsessive thinking among individuals with Asperger's and High-Functioning Autism:



More about intrusive thoughts in the autistic mind:


Obsessive thinking is like a CD in a CD-player that’s stuck and keeps repeating the same lyrics. It’s replaying an argument with a friend in your mind. It’s retracing past mistakes. When people obsess, they over-think or ruminate about situations or life events (e.g., school, work, relationships).

Research has shown that obsessive thinking is associated with a variety of negative consequences, including depression, anxiety, binge-drinking and binge-eating. For some people, drinking or binge-eating becomes a way to cope with life and drown out their obsessive thinking.

When people obsess while they are in depressed mood, they remember more negative things that happened to them in the past, they interpret situations in their current lives more negatively, and they are more hopeless about the future. Obsessive thinking also becomes the fast track to feeling helpless. Specifically, it paralyzes your problem-solving skills.

You become so preoccupied with the problem that you’re unable to push past the cycle of negative thoughts. It can even turn people away. When people obsess for an extended time, their family members and friends become frustrated and may pull away their support.

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





Creating an Effective “Social Skills” Training Program for Kids on the Spectrum

Impairment in social functioning is a core feature of Aspergers (AS) and High Functioning Autism (HFA). Typical social skill problems include the following: 
  • taking another person’s perspective
  • sharing enjoyment
  • responding to the initiations of others
  • reading the non-verbal cues of others
  • maintaining eye contact
  • initiating interactions

The cause of these social skill difficulties varies, ranging from neurological impairment to the lack of opportunity to acquire skills (e.g., social withdrawal). Most important, these skill problems make it difficult for the child to develop - and keep - fulfilling personal relationships. Although social skill problems are a core feature of AS and HFA, many of these kids do not receive adequate social skills training. This is a sad reality, especially considering that the presence of social deficits may lead to the development of more damaging outcomes (e.g., poor academic performance, social failure, peer rejection, anxiety, depression, etc.). The lack of proper social skills training is particularly troubling given the fact that most of the associated deficits can be corrected.



The long held notion that kids with AS and HFA lack an interest in social interactions is inaccurate. Most of these kids do indeed desire social involvement; however, they typically lack the necessary skills to interact effectively. This lack of “know-how” often leads to feelings of social anxiety. Many moms and dads report that social situations typically evoke a great deal of anxiety from their AS and HFA kids. 

Kids on the autism spectrum often describe an anxiety that resembles what many of us feel when we are forced to speak in public (e.g., increased heart rate, sweaty palms, noticeable shaking, difficulty concentrating, etc.). Not only is public speaking stressful, but just the thought of it is enough to produce a heightened state of anxiety. Now imagine living a life where every social interaction you experience was as stressful as having to make a speech in front of a big crowd. The typical coping strategy for most of us is to reduce the anxiety by avoiding the stressful situation.

For kids with AS and HFA, social anxiety often results in the avoidance of social situations, and subsequently, the development of social skill problems. When a youngster continually avoids social encounters, he denies himself the opportunity to acquire social skills. For many kids on the spectrum, these social skill difficulties lead to negative peer interactions, peer rejection, isolation, anxiety, depression, substance abuse – and even suicidal ideation. For others, it creates a pattern of engaging in solitary activities (a pattern that is often difficult to change).


So, what can parents do to help their AS and HFA children overcome social skills deficits?

The first step in social skills training should consist of conducting a thorough evaluation of the youngster’s current level of social functioning. The purpose of the assessment is to answer one very basic question: “What is preventing my youngster from establishing and maintaining social relationships?” For most kids, the answer takes the form of specific social skill problems. For others, the answer takes the form of cruel and rejecting peers. And for yet others, the answer is both. 

The evaluation should (1) detail both the strengths and weakness of the child related to social functioning, and (2) involve a combination of (a) observation (e.g., watching how your child interacts with others, (b) interviews (e.g., talking to your child, his teachers, his peers, etc.), and (c) standardized measures (e.g., behavioral checklists, social skills measures). 

Parents need to ascertain current level of functioning and effectively intervene at the youngster’s area of need. For example, if the evaluation reveals that your youngster is unable to maintain simple one-on-one interactions with peers, then the intervention should begin at this point, and not at a more advanced group interaction level. As another example, if the evaluation revels that your youngster does not know how to play symbolically - or even functionally - with play items, then the intervention will probably begin by teaching play skills prior to teaching specific interaction skills. 

After a thorough assessment of social functioning is complete, parents should then determine whether the skill problems identified are the result of “skill acquisition” issues or “performance” issues. A skill acquisition deficit refers to the absence of a particular skill or behavior (e.g., the youngster may not know how to effectively join-in games with peers, thus she will often fail to participate). A performance deficit refers to a skill or behavior that is present, but not demonstrated or performed (e.g., the youngster may have the ability to join-in an activity, but for some reason, fails to do so). 

In discerning between a skill acquisition deficit and a performance deficit, ask yourself the following question: “Can my youngster perform the task with multiple people and across multiple settings?” For example, if your youngster only initiates interactions with you at home, but not with peers at school, then you will need to address the initiation difficulty as a skill acquisition deficit.


Too often, social skill problems and inappropriate behaviors are incorrectly viewed as performance problems (i.e., parents assume that when their youngster does not perform a certain task, it is the result of refusal or lack of motivation). Parents need to understand that the majority of social skill problems in kids with AS and HFA can be attributed to skill acquisition problems (i.e., they are not performing socially because they lack the necessary skills to do so). If parents want their kids to be successful socially, then they will need to teach them the skills to be successful. 

The benefit of discerning between “skill acquisition” versus “performance” problems is that it guides the selection of intervention strategies. The intervention selected should match the type of deficit present. Once a thorough social skill assessment is completed, and the parent is able to attribute the social deficits to either skill acquisition or performance issues, social skills training can begin. 

When selecting intervention techniques, parents need to understand the concept of “accommodation” versus “assimilation.” Accommodation refers to the act of modifying the physical or social environment for the youngster in order to promote positive social interactions (e.g., training peer-mentors to interact with the youngster throughout the school day, autism awareness training for peers, having the child participate in various group activities like the Girl Scouts). While accommodation addresses changes in the child’s environment, assimilation focuses on changes in the child herself. Assimilation refers to training that facilitates skill acquisition that allows the youngster to be more successful in social interactions. 

The key to successful social skills training is to address both accommodation and assimilation. Focusing on one, but not the other, sets the youngster up for failure. In other words, providing social skills training (i.e., assimilation) without modifying the environment to be more accepting of the youngster (i.e., accommodation) is a recipe for a failed training program (e.g., when an eager youngster attempts a newly learned skill on a group of non-accepting peers).


There are number of important questions to consider when selecting appropriate social skill strategies. For example:
  • What is the plan to evaluate the strategy’s effectiveness with the youngster?
  • Is there research to support the use of this strategy? 
  • Is the strategy developmentally appropriate for the youngster? 
  • Does the strategy target the skill problems identified in the social assessment?
  • Does the strategy promote skill acquisition?
  • Does the strategy enhance performance?

Once parents have (a) assessed social skill functioning, (b) identified skills to teach, (c) discerned between skill acquisition and performance problems, and (d) selected intervention strategies, it is time to implement the strategies. Parents cannot do this alone however. Social skills training should be provided in multiple settings (e.g., home, classroom, resource room, playground, community, etc.) and by multiple providers (e.g., parents, teachers, coaches, therapists, etc.). 

There is no “best” place to teach social skills, though it is important to keep in mind that the purpose of all social skills training should be to promote social success “with peers in the natural environment.” For example, if the youngster is receiving social skills training from a private therapist, it is crucial that a plan be put in place to facilitate transfer of skills from the clinic to the child’s natural environment. Moms and dads and educators should look for opportunities to prompt and reinforce the skills that are being taught in the clinic. 

The rate of social skills acquisition will differ widely from one youngster to the next. Some kids will begin using their new skills after only 3 or 4 sessions, while other kids may require over 6 months before they begin to “get it.” In any event, simply trying a new skill is just the first step towards success. The youngster will need additional time to master the skill that he is learning and developing. 

“Assess and modify” is the last stage in the intervention process, but it is not the last thing to think about when designing a social skills training program. As soon as parents are able to identify the social skill problems to be addressed, they should begin to develop the methods for evaluating the effectiveness of the intervention. For example, if the target of the intervention is social initiations, then parents and teachers should take baseline data on the frequency of initiations with peers, and then continue to collect data on social initiations throughout the implementation stage of the intervention. 

Accurate data collection is important in evaluating the effectiveness of the intervention. It allows all parties involved to determine whether the youngster is benefiting from the training, and how to modify the training to best meet her needs. In school settings, accurate data collection is especially important. When parents work with school staff, the focus should be on integrating the social skills program with the youngster’s behavioral and social objectives. Also, the “assess and modify” stage is typically a very important part of IEP development and implementation.

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

2024 Statistics of Autism in Chinese Children

Autism Spectrum Disorder (ASD) has emerged as a significant public health concern worldwide, and China is no exception. As of 2024, new rese...