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High-Functioning Autism and Associated (Comorbid) Disorders

“We’re in the process of having our son assessed for high functioning autism. We’ve had numerous problems in the past that have brought us to this point. The doc said he believes our son may have several ‘comorbid’ conditions as well. What other conditions might there be?”

When a youngster has one or more conditions along with the main disorder, it is defined as comorbid and comorbidity. High-Functioning Autism (HFA) – also called Asperger’s (AS) – is listed as an Autism Spectrum Disorder and rarely travels alone. Nearly 100% of the time, the child will have other issues that will need to be addressed.

Here are some of the common comorbid conditions associated with HFA and AS:

1. Attention Deficit Hyperactivity Disorder (ADHD) is a very common comorbid condition of HFA and AS. Here the youngster is unable to concentrate and becomes impulsive to a great degree.

2. Depression and anxiety are the two most common disorders found in a youngster with AS or HFA. Adolescents on the autism spectrum often suffer from depression, which may be caused by (a) being bullied and teased, and (b) coming to the realization that they are different from their “typical” peers. Some of these young people have been known to turn to drugs and alcohol as a way to deal with their plight.

3. Dyspraxia is when a youngster is not able to coordinate or perform certain acts in spite of having the prior plan for it. This disorder is one reason why kids with HFA and AS have always been described as clumsy.

4. Meltdowns are “tantrum-like” behaviors in HFA and AS children. Yelling, hitting, screaming, or a complete shutdown (e.g., covering the face and becoming withdrawn) are common during a meltdown.

5. Obsessive Compulsive Disorder (OCD) is something that is found in most kids on the autism spectrum. The child adheres to strict routines, and she likes to keep every particular object in one particular way – and when changed, she may get very distressed. This is one habit which later on leads to OCD.

6. Oppositional Defiant Disorder (ODD) is a condition in which a youngster displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The youngster’s behavior often disrupts his normal daily activities within the family and at school.

7. Sensory Processing Disorder (SPD) is common among those that have AS or HFA. In this case, the youngster becomes overly-sensitive to the various sensory stimulations (e.g., forms an intense dislike of loud noises, is easily irritated when dealing with unusual textures, avoids certain foods because they taste bitter, etc.).

8. Tourette’s syndrome is when a youngster exhibits repetitive vocal or motor tics. Most kids diagnosed with Tourette’s also have AS or HFA.


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PARENTS' COMMENTS:

•    Anonymous said… A friend of mines son is 14 with aspergers. He wants to interact but has so much trouble. We were all introduced to him as a wonderful child who has an interesting view on life. Our group of friends are great. The 14yr old likes to shake everyones had when they arrive and then walks off. We are glad that despite the fact that he knows how different he is he trys to make an effort. I hope that I am blessed to still have this group of friends when my 7yr old is that old.
•    Anonymous said… Good luck to all - its just who they are, and we just have to adapt and continually educate others so they can too. I just keep up my own mantra: "it's all good" and smile broadly at the fact that while he may be socially challenged, my son is smart and has a heart of gold, despite the fact that he doesn't verbalize it.
•    Anonymous said… He must be high functioning. Aspergers is on the high functioning side of autism anyway - but some are higher than others. So, "uncommon"? I would say yes.
•    Anonymous said… I do think the gap gets bigger as they get older. My son really gets along better with either younger children or adults because of this. He used to quote star wars too, btw, lol! Now he is constantly talking about Final Fantasy 7, and most kids don't even have a clue what that is since it is an old playstation game. Thankfully my hubby is a huge gamer and can carry a conversation with him. lol
•    Anonymous said… I will add my vote to that of the other commenters. My son is the same way - playing 'next to' not with, or fully directing the game choices, character choices, rules and all else whenever he does attempt to play 'with' someone - and forbid they don't want to play along by his rules, then we have arguments and meltdowns because he can't tolerate "that's not how you play". His poor sister - she feels like she can't win; its all about him!
•    Anonymous said… My 7 year old is high function Aspergers. He is overly social but has no boundaries. He hugs and has no personal space. We are often told that there is no way he could have Aspergers but they don't realise that this behavour is only one aspect of Him. When he meltdowns over getting dressed or getting in the car I have no doubt. At the end of the day you are his parent and see Him for who he is and everything he does trust yourself.
•    Anonymous said… My aspie is very social in that he loves being around other kids, but he isn't popular. He highly lacks in social skills despite his "socialness". It's like he wants friends but making friends is hard and he doesn't realize whenever someone is being mean.
•    Anonymous said… My son is almost 8 and the "social rules" have gotten a lot more complicated from when he was 5.
•    Anonymous said… My son is is the same as far as boundaries, when he plays with other kids we have to remind him to back up because he will talk (very loudly) into their face instead of to it. @ Jessica, you're absolutely right, what is accepted at 5 won't be at 8. I know my son also won't understand when someone is being mean to him. You guys gave me lots of food for thought and I really appreciate your input :).
•    Anonymous said… My son loves being with other children but just doesn't seem to know how to play WITH them. He orders them around and expects to play all games his own way. Every year seems to get harder as the social gap between the kids getts wider. In his defense he is starting to learn more and more social ideas though doesn't seem to understand why we do them.
•    Anonymous said… Ryan was diagnosed HFA/Asperger's and he is how you guys describe. He loves people, but has no social "skills" -- he can't tell when people don't want to play with him or talk to him. He tries to hug on perfect strangers in stores and such. He is bossy with HOW games are played (everyone has to follow his rules or they can't play anywhere near him). I don't think that this type of social behavior is uncommon at all for Aspies. Many areas of documentation explain this as fairly typical Asperger's behavior... it's one of the determining factors that separates it from other areas on the spectrum. They generally WANT friends, they just don't know HOW to make them, where other auties are more or less oblivious to everyone else around them. What seems to happen as the children get older and the social gap becomes larger and your Aspie son is still quoting comic books and Star Wars characters when all the other boys are chasing girls, they become less social. They learn that the other kids don't want to do the things they want to do, and then they begin to focus less on the social interaction.
•    Anonymous said… This summer we sent them to "social skills camp" for the summer (so they could both learn), where the whole focus was on learning those skills - they are teaching the "how to" very systematically. Rome wasn't built in a day, but after 6 weeks we've seen improvement. 
*    Anonymous said... My 5 year old Aspie has all the tell tale signs of Asperger's syndome, to the point where it seems like everything I've ever read was written with him in mind. Except for one key difference...my son is extremely social. He is very popular among other kids, they almost fight for his attention. They love the fact that he can recite comic books word for word, and remembers the names of even the most obscure Star Wars characters, and because he is a people pleaser he will share anything he has to maintain the friendship. He worries very much about how other kids see him and trys obsessively to fit in. I know all children with Asperger's syndrome are different, but my question is, is this very uncommon in Asperger's? I feel people "don't believe" he is on the spectrum because of his social skills.
 
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Why Teens on the Autism Spectrum Can Suffer from Depression

“I’m concerned that my son is depressed (17 y.o.). Is this something that happens along with high functioning autism? If so, why? How can I know for sure if he is really struggling with depression? He has made some off-handed comments about wanting to kill himself. How seriously do I need to be taking these comments?”

Depression seems to be common among teens and young adults with High-Functioning Autism (HFA) and Asperger’s (AS). Many of the same deficits that produce anxiety often unite to produce depression.

The relationship between serotonin functioning and depression has been explored in detail in this population. There is good evidence that serotonin functions may be impaired in kids and teens on the autism spectrum, which suggests that depression is a common comorbid condition.

In addition to impaired serotonin functioning, (a) deficits in social relationships and (b) poor coping-strategies that allow the teenager to compensate for disappointment and frustration may fuel a vulnerability to depression. (As a side note, there is some genetic evidence suggesting that depression and social-anxiety are more common among first-degree relatives of autistic kids, even when accounting for the subsequent effects of anxiety.)

Because some features of depression and autism spectrum disorders overlap, it is important to track that the changes in mood are a departure from baseline functioning. Therefore, the presence of social withdrawal in a teen with the disorder should not be considered a symptom of depression unless there is an acute decline from his or her baseline level of functioning.

Another important point is that the core symptoms of depression should arise together. Therefore, the simultaneous appearance of symptoms would point to depression (e.g., decreased energy, further withdrawal from interactions, irritability, loss of pleasure in activities, sadness, self-deprecating statements, sleep and appetite changes).

An additional point is that teens who display “affective” (i.e., relating to moods and feelings) and “vocal monotony” (i.e., a droning, unchanging tone) are at higher risk for having their remarks minimized by peers, which often gives the HFA or AS teen the impression that he “doesn’t matter” – which in turn can fuel depression.

Some teens on the autism spectrum can make suicidal statements in a manner that suggests an off-hand remark, without emotional impact. When comments are made this way, parents may underestimate them. The content of such comments may be more crucial than the emotional emphasis with which they are delivered. Thus, comments around “wanting to die” should be taken very seriously.

Medications that are useful for treatment of depression in kids and teens on the spectrum are serotonin reuptake inhibitors, although no medications have been shown to be particularly more beneficial for depressive symptoms in people with the disorder. Therefore, the decision as to which medications to use is determined by side-effect profiles, previous experience, and responses to these medications in other family members.

 ==> Discipline for Defiant Aspergers & High-Functioning Autistic Teens
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Personality Types in ASD Level 1: Fixated, Disruptive, Approach and Avoidant

Fixated Personality--

The fixated personality type can be characterized by a preoccupation with orderliness, perfectionism, and the need to control one’s environment (e.g., to have things in a particular order).

Some of the symptoms of the fixated personality type may include:
  • compulsion to make lists and/or schedules
  • feelings of excessive doubt and caution
  • obsessive need for cleanliness
  • perfectionism (that may sometimes interfere with task-completion)
  • preoccupation with order and organization
  • preoccupation with remembering and paying attention to minute details and facts
  • rigid following of rules and regulations
  • rigidity or inflexibility of beliefs
  • stubbornness
  • unreasonable insistence that others submit to his way of doing things

Some of the specific behavioral manifestations of the fixated personality type among ASD children and teenagers may include:
  • repeatedly checking homework
  • cleaning rituals
  • counting rituals
  • grooming rituals (e.g., hand washing, showering, teeth brushing)
  • hoarding and collecting things
  • ordering or arranging objects
  • repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting)
  • rituals to prevent harming self or others
  • rituals to undo contact with a "contaminated" person or object
  • touching rituals

Parents can look for the following possible signs of the fixated personality type:
  • continual expressions of fear that something terrible will happen
  • dramatic increase in laundry
  • persistent expressions of fear of illness
  • sudden drop in test grades
  • exceptionally long amount of time spent getting ready for bed
  • high, unexplained utility bills
  • holes erased through test papers and homework
  • raw, chapped hands from constant washing
  • reluctance to leave the house
  • requests for family members to repeat strange phrases or keep answering the same question
  • unproductive hours spent doing homework
  • unusually high rate of soap or paper towel usage

Environmental and stress factors can trigger fixated personality traits. These can include ordinary developmental transitions (e.g., starting school) as well as significant losses or changes (e.g., death of a loved one, moving to a different home or city).
 

It can be helpful to keep family routines as normal as possible, and for all family members to learn strategies to help the ASD youngster. It is also important to not let the “fixations” be the boss of the house and regular family activities. Giving in to fixations does not make them go away.

“Fixated” Aspies become less fixated at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it's the disorder that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

Treatment for the fixated personality type can involve the following:
  1. Behavior therapy: Discussing with a psychotherapist ways of changing compulsions into healthier, productive behaviors. An effective form of this therapy has been found to be cognitive analytic therapy.
  2. Cognitive behavioral therapy: A systematic approach to changing unwanted thoughts, feelings and behaviors.
  3. Psychopharmacology: A psychiatrist may be able to prescribe medication to facilitate self-management and also enable more productive participation in other therapies.
  4. Psychotherapy: Discussion with a trained counselor or psychotherapist who understands the condition.


 Disruptive Personality--

The disruptive personality is:
  1. a type of cognitive-behavioral style in which the "Aspie's" way of thinking, perceiving situations, and relating to others is sometimes destructive
  2. often comorbid with ADHD and/or ODD
Autistic children and teens with disruptive personality typically have little regard for right and wrong. They may often violate the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. Also, Aspies with disruptive personality may not be able to fulfill responsibilities to family, school, or work.

Disruptive personality traits may include:
  • Aggressive or violent behavior
  • Agitation
  • Impulsive behavior
  • Intimidation of others
  • Irresponsible school-related or work-related behavior
  • Lack of remorse about harming others
  • Persistent lying or deceit
  • Poor or abusive relationships
  • Recurring difficulties with the parents and teachers
  • Repeatedly violating the rights of others
  • Using charm or wit to manipulate others

There may be a link between an early lack of “empathy” (i.e., understanding the perspectives and problems of others) and later onset of a disruptive personality style. These personality problems may be inherited, and identifying them early may help improve long-term outcomes.

Complications and problems associated with the disruptive personality include:
  • Aggression or violence
  • Alcohol or substance abuse
  • Anxiety
  • Depression
  • Reckless behavior
  • Relationship difficulties
  • School and work problems
  • Social isolation
  • Strained relationships
  • Suicidal behavior

Psychotherapy is the main way to treat a child or teen with a disruptive personality style. Types of psychotherapy may include:
  • Psycho-education: This education-based therapy teaches coping strategies and problem-solving skills.
  • Psychodynamic psychotherapy: This approach aims to raise awareness of unconscious thoughts and behaviors and — by bringing them to light — change their negative impact.
  • Cognitive behavioral therapy: This type of therapy helps to uncover unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.

Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The right type of psychotherapy depends on each person's individual situation. 
 

If you have a child or teen with a disruptive personality style, it's critical that you also get help for yourself. Mental health professionals can help teach you skills to protect yourself from the aggression, violence and anger common to this personality type. They can also recommend strategies for coping.

Parents can help their child with disruptive personality traits in the following ways:
  1. Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.
  2. Take a time‑out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if he decides to take a time‑out to prevent overreacting.
  3. Pick your battles. Since this particular child has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time‑out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."
  4. Set up reasonable, age appropriate limits with consequences that can be enforced consistently.
  5. Maintain interests other than your "disruptive" Aspie so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) in dealing with your child.
  6. Manage your own stress with exercise and relaxation. Use respite care as needed. 
  7. Come up with a specific parenting-plan to address the behavioral problems associated with a disruptive personality.


Approach Personality--

This type usual occurs in the ASD child who also has ADHD, although this is not always the case.

The two primary characteristics of the “approach personality” are (a) excessive talking about one’s special (or obsessive) interest, and (b) significant violations of other’s personal space.

Excessive Talking About Special Interests—

Excessive talking in the Aspie can present a number of problems. No one particularly likes to be referred to as a "motor-mouth," but they can be exactly that. While some people have much to say of value, excessive talkers usually do not. They talk either because they can't help it due to “mind-blindness” (i.e., they are unaware that the listener is both bored and annoyed with the one-sided conversation), or because they simply love to tell others about their favorite hobby/activity out of a huge sense of passion about that particular hobby/activity.

Aspies who talk excessively can sometimes get along well with one another, probably because neither is paying much attention to what the other is saying. For those with normal speaking habits however, excessive talking often borders on being socially unacceptable. We are brought up to be attentive to what others are saying, to speak mainly when spoken to, while at the same time hoping that when we do talk, we sound intelligent and say the right things in as few words as possible.
 

Excessive talking in the Aspie often translates into an inability to understand or follow instructions. The very act of learning can be seriously impeded, and the chattering Aspie may be unable to concentrate on those things where concentration is vital to success.

Those Aspies who persist in excessive talking about their obsessive interest are more apt to be victims of another type of disorder, the Obsessive-Compulsive Personality Disorder (OCPD). Not all of those with OCPD are excessive talkers – it is just one of the symptoms. You can usually spot those with OCPD, because they tend to be preoccupied with perfectionism and orderliness, pay excessive attention to detail, and are most comfortable in an environment where there are rules to follow, schedules to meet, and an organizational structure in which they know their place.

The drive for perfectionism often results in such individuals being unable to complete certain assigned tasks, or being unable to follow rules which don't conform to their own strict standards. Some OCPD Aspies are extremely introverted (living in their own carefully regulated and orderly world) while others can be quite extroverted (these are the attention seekers, the ones who violate your personal space, and who often over-dramatize any and every situation). It is from among this group that excessive talking is apt to be one of the more noticeable symptoms.

Tips for the excessive (obsessive) talker:

1. Appreciate what others have to say. Listening to other person’s viewpoint allows you to permit him or her to express an opinion.

2. Be a good listener. People like to be listened to.

3. Be more conscious of your behavior patterns. Acknowledge that you speak too much and behave accordingly.

4. Do not talk for the sake of talking. Restraint is good.

5. One can take up courses in being a good conversationalist.

6. Seek professional help if excessive talking is a compulsive behavior. Often people speak due to some psychological disorder or problem. A person with a nervous disposition will speak more.

7. One need not express everything on one’s mind. Certain things you must keep to yourself.

8. One should always have something important to contribute. Whatever you say should have an impact on others. They should want to listen to you. Conversation should be interesting.

9. One should avoid being pushy or aggressive while conversing. Try to convey things in fewer words. Be brief in what you say.

10. Think before you speak. It may be difficult if you are nervous. But it is better to be aware of what you are saying. You need not regret later.

11. Try not interrupting another person’s conversation as far as possible.

12. Try to allow the other person to say something. It may be difficult, but one needs to practice self-control. A good conversation is a two-way process. All of those taking part in the conversation have much to contribute. Each person must get a chance to say something.

Violating Personal Space—

Interpersonal space refers to the psychological "bubble" that exists psychologically when one person stands too close to another. There are four different zones of interpersonal space:

1. Intimate distance: ranges from touching to about 18 inches (46 cm) apart, reserve for lovers, children, close family members and friends, and pets.

2. Personal distance: begins about an arm's length away starting around 18 inches (46 cm) from the person and ending about 4 feet (122 cm) away. This space is used in conversations with friends, to chat with associates, and in group discussions.

3. Social distance: ranges from 4 to 8 feet (1.2 m - 2.4 m) away from the person and is reserved for strangers, newly formed groups, and new acquaintances.

4. Public distance: includes anything more than 8 feet (2.4 m) away, and is used for speeches, lectures, and theater. Public distance is essentially that range reserved for larger audiences.

Aspies with approach personality traits tend to be mostly in the “intimate distant” mode (i.e., they will stand within arm’s reach – even with strangers). It goes without saying that most people are taken aback by such behavior.

The absence of strong emotional responses to personal space violation is, again, the result of the Aspie’s “mind-blindness” (i.e., an inability to develop an awareness of what is in the mind of the other person). If you, as a neurotypical, did an experiment in which you purposely stood excessively close to a stranger to read his/her reaction, you would readily notice a pained expression on the other person’s face, sending you a very clear non-verbal message that he/she is alarmed. The mind-blind Aspie with approach personality traits does not receive this non-verbal cue – even though the cue was indeed sent.

Tips for the personal space violator:

1. Understand that (a) people have certain expectations about verbal and nonverbal communication behavior from other people, and (b) violations of these expectations cause arousal and distraction in them.

2. Only stand or sit within arm’s reach of close family members and romantic partners.

3. With your friends, stand or sit no closer than arm’s length.

4. With all others, stay at least 4 feet away.

5. Pay attention to the facial expressions of those you stand or sit close to. Are they grimacing, for example? If so, then you may be too close.

6. Pay attention to whether or not the other person moves away, creating addition distance between the two of you. Does he/she seem to be taking steps backwards during the conversation? If so, you may be too close.

7. If you are uncertain, ask the other person “Am I violating your personal space?” Most people will respect that question and answer honestly.

Some of the behaviors exhibited in the “approach personality” have a good side to them when these behaviors can be correctly channeled. There are many activities in which paying greater than normal attention to detail can be a definite plus, and those with a short attention span often find a place in activities demanding creativity and thinking outside the box. As far as excessive talking is concerned, it is best that it be treated with counseling (usually in the form of “social skills training”), although there are occasional openings for stand up comics and radio talk show hosts. As far as personal space violations are concerned, it is best to reserve close proximity for those who enjoy being close to you (e.g., your mother, girlfriend, cat, etc.).
 

Avoidant personality is characterized by a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. This type of autistic child is often described as being extremely shy, inhibited in new situations, and fearful of disapproval and social rejection. Avoidant personality becomes a major component of an Aspie’s overall character and a central theme in how he relates to others.

Aspies with avoidant personality tend to do some of the following:
  • Views self as socially inept, personally unappealing, or inferior to others
  • Stays quiet or hides in the background in order to escape notice
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is unwilling to get involved with people unless certain of being liked
  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
  • Is preoccupied with being criticized or rejected in social situations
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Drinks before social situations in order to soothe nerves
  • Avoids social situations to a degree that limits activities or disrupts life
  • Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

The following situations are often stressful for Aspies with avoidant personality:

• Attending parties or other social gatherings
• Being called on in class
• Being teased or criticized
• Being the center of attention
• Being watched while doing something
• Eating or drinking in public
• Going on a date
• Making phone calls
• Making small talk
• Meeting new people
• Performing on stage
• Public speaking
• Speaking up in a meeting
• Taking exams
• Talking with “important” people or authority figures
• Using public bathrooms

Emotional symptoms of avoidant personality include:
  • Excessive self-consciousness and anxiety in everyday social situations
  • Extreme fear of being watched or judged by others, especially people you don’t know
  • Fear that others will notice that you’re nervous
  • Fear that you’ll act in ways that that will embarrass or humiliate yourself
  • Intense worry for days, weeks, or even months before an upcoming social situation

Physical symptoms of avoidant personality include:

• Feeling dizzy or faint
• Racing heart or tightness in chest
• Red face, or blushing
• Shortness of breath
• Sweating or hot flashes
• Trembling or shaking (including shaky voice)
• Upset stomach, nausea (i.e. butterflies)

For kids and teens with avoidant personality, evaluating for the presence of psychiatric disorders, particularly major depression, substance abuse, and other anxiety disorders, is extremely important. Because “social anxiety tendencies” are often found in other family members, a family psychiatric history is beneficial. 
 

Help for Children with Avoidant Personality—

1. Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms.

2. Challenge negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.

3. Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol actually increases your anxiety in the long run.

4. Face the social situations you fear in a gradual, systematic way, rather than avoiding them.

5. Get adequate sleep. When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.

6. Learn how to control the physical symptoms of social anxiety through relaxation techniques and breathing exercises.

7. Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.

8. Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.

9. Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign — anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.

10. Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Why Your Child on the Autism Spectrum Experiences a Significant Degree of Anxiety

“Why does it seem to be the case that many (if not most) children with ASD also suffer from a significant degree of anxiety?”

Kids with High-Functioning Autism (HFA) and Asperger’s (AS) are indeed particularly vulnerable to anxiety. This vulnerability may be an intrinsic feature of the disorder through a breakdown in circuitry related to extinguishing fear responses, a secondary consequence of their inability to make social judgments throughout development, and specific neurotransmitter system defects.

Specific reasons for experiencing high degrees of anxiety include the following:

1. Limitations in generalizing from one situation to another contribute to repeating the same social errors.

2. Limitations in their ability to grasp social cues and their highly rigid style act in concert to create repeated social gaffs as well.

3. The lack of empathy severely limits skills for autonomous social-problem solving.

4. The social-skills deficits of HFA and AS make it difficult for kids with the disorder to develop coping strategies for soothing themselves and controlling difficult emotions.

5. There is the discomfort that comes from “somatic responses” (i.e., relating to the body, especially as distinct from the mind) that are disconnected from events and experience.

6. They are frequently victimized and teased by their peers and can’t mount effective socially adaptive responses.

7. With these “special needs” children, there is sufficient grasp of situations to recognize that others “get it” when they do not.

Several medications have been tried for treatment of anxiety in young people on the autism spectrum. There is no reason to suspect that kids with the disorder are less likely to respond to the medications used for anxiety in “typical” (i.e., non-autistic) children. 

Therefore, selective serotonin reuptake inhibitors (SSRIs), buspirone, and alpha-adrenergic agonist medications (e.g., clonidine or guanfacine) all have been tried. The best evidence to date supports use of SSRIs.

Note: Kids with HFA and AS may be more vulnerable to side effects of medications - and many exhibit unusual side effects. “Disinhibition” (i.e., a lack of restraint manifested in disregard for social conventions) is particularly prominent and can be seen with any of the SSRIs. 

Similarly, excessive doses may produce  “amotivational syndrome” (i.e., a lack of desire to complete tasks, a sense of apathy about the future, poor concentration, and decreased interest in social and other activities).

By

Children on the Autism Spectrum and Tips for Completing Assignments

Question

"Can you offer tips for completing assignments?"

Answer

Children with High-Functioning Autism (HFA) have the same motivational needs as other kids. Sometimes less, and other times, a lot more motivation is needed to accomplish the same assignment. However, children on the autism spectrum will always have the need for a little extra help due to the challenges associated by the disorder.

Because HFA affects functional skills in socialization and communication, teachers and parents will need to get creative in order to find ways to help these kids succeed.

Here are a few tips to help with school assignments:
1. Children on the spectrum crave order, structure and routine. These desires can be utilized to help with assignment completion. Classroom time for the "special needs" child must be an organized and structured environment. Consistent structure will provide comfort, allowing the child to make progress on his assignments.

2. Use visual schedules. These young people need a balanced schedule that will alternate core subjects with chances to de-stress, usually with structured down time. For example, the student may be scheduled for an hour of math, thirty minutes for lunch, and then an hour of music. Assuming that music is a class he thoroughly enjoys, that hour would be his time to de-stress.

3. Allowing further breakdown of assignments into mini-assignments will also help ensure successful completion. This breakdown will appeal to the child’s sense of order as he sees each step is simply written and manageable.

4. The breakdown of assignments into steps leads to another suggestion. Additional time is useful when assigning work to the student. Children with HFA may find additional time helpful to complete their assignments. Meeting a deadline on an assignment can create stress that causes the child to become completely overwhelmed, wiping out any chance of completing the assignment.

5. Teachers of children with the disorder should also keep in mind the need to use straightforward instructions stated simply and clearly. Language is difficult for kids on the spectrum. Sarcasm and slang go right over their heads. Remember that they need to know what, when, and how. Basic instruction goes a long way.

6. Some homework assignments will be of no interest to the youngster. In this case, there may not be any clever tricks to get him or her to complete the assignment. Thus, when possible, it will be helpful if the teacher tailors the "boring" assignment to the individual needs of the HFA student.

Most teachers welcome feedback and want to assign homework that children can complete successfully. Most teachers try to structure assignments so that a wide range of children will find them interesting (e.g., they may offer options for different approaches to the same topic, give extra assignments to those who want more of a challenge, or give specialized assignments to those who are having trouble with a particular subject).

7. Finally, praise the student for the work that is completed. Praise from his teacher will motivate the child with HFA - and the typical child alike. Teachers should always praise their students if possible. Children with the disorder may have weaknesses to battle, but praise is a weapon that can be used successfully in the classroom.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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