Due to the numerous complaints I have received over the years from parents regarding the (alleged) lack of effective teaching strategies specific to students on the autism spectrum – and teachers’ general lack of knowledge in instructing this population – I’ve decided to do a series of posts on the matter. This is Part 1…
Although AS and HFA differ from Autism with respect to language acquisition and early cognitive development, they do have similarities (e.g., in the areas of social impairment, impairment in reading social non-verbal language, inflexibility, and persistent preoccupation). Problematic behavior in AS and HFA students is essentially the result of (a) failure to learn necessary adaptive behaviors (e.g., how to establish satisfying personal relationships), and (b) the learning of ineffective responses (e.g., discovering that one can avoid unwanted tasks by acting-out behaviorally).
AS and HFA students are impaired socially, and often do not detect social clues. They are frequently unaware that a peer is irritated if the only clue is a frustrated facial expression. If they miss a social clue, then they miss the lesson associated with the experience. They will likely repeat the irritating behavior because they are unaware of its effects.
Although a young person on the autism spectrum has difficulty figuring out most principles of human interaction, he is usually good at picking up on cause-and-effect principles. This suggests that although he may be unaware of others’ desires or emotions, he is aware of his. This can be useful in education if the teacher takes the time to determine what is pleasing to the AS or HFA youngster. Once this pleasure has been discovered, the teacher can request the desired behavior and reinforce the behavior with the object of desire.
Many of the traits of AS and HFA can be "masked" by average to above average IQ scores, which can result in the student being misunderstood by teachers. Teachers often assume that the student is capable of more than is being produced. Lack of understanding of the child in this way can significantly impede the desire of the teacher to search for techniques useful in overcoming the hindrances caused by the disorder.
Another misunderstanding is the relationship between curriculum and social education. For instance, a youngster with AS or HFA may find a social setting overwhelming and distracting. If pupils are placed in a small group for project work, this may predominantly become a social setting to an AS or HFA student. It is possible that she would be so over-stimulated by the social aspect that it would be extremely challenging to focus on the curriculum aspect of the group.
If asked to design an environment specifically geared to create anxiety in a child with AS or HFA, one would probably come up with something that looked a lot like a classroom. The ingredients for a stressful experience would include the following:
regularly scheduled tours into what can only be described as socialization hell (e.g., recess, lunch, gym, the bus ride to and from school, etc.)
regular helpings of irritating noise from bells, schoolmates, band practice, alarms, and crowded/echoing spaces
periods of tightly structured time alternating with periods lacking any structure
countless distractions
an overwhelming number of peers
a dozen or so daily transitions with a few surprises thrown in now and then
All of these types of stressors must be taken into consideration when evaluating what types of techniques will be helpful to the AS or HFA student. In fact, the learning environment is itself a strategy, which we will cover in Part 2 of this series on “Teaching Strategies for Students with Asperger’s and High-Functioning Autism” – so stay tuned!
"The older my teenage son gets, the more depressed he seems to be. I think something may be going on at school that he is hiding from us (perhaps not getting the acceptance from his 'friends' that he wants to like him - IDK). Any suggestions? Anyone else have a teen with ASD who seems depressed 24/7?"
Teens with Asperger’s (AS) and High-Functioning Autism (HFA) are particularly vulnerable to mental health problems (e.g., depression, anxiety). One study found that 65% of their sample of patients with AS presented with symptoms of a psychiatric disorder. However, the inability of AS and HFA teens to communicate feelings of distress can also mean that it is often very difficult to diagnose depression.
Likewise, because of their impairment in non-verbal expression, they may not appear to be depressed. This can mean that it is not until depression is well developed that it is recognized (e.g., in the form of aggression, alcoholism/drug abuse, increased obsessional behavior, paranoia, refusal to go to school/work/college, refusal to leave home, threatened/attempted/actual suicide, and total withdrawal).
In addition, teens with AS or HFA leaving home and going to college frequently report feelings of depression. As one young man said, "I had to deal with anger, frustration, and depression that I had been keeping inside since high school."
Depression in these young people is often related to a growing awareness of their disorder, a sense of being different from their friends, and an inability to form relationships or take part in social activities successfully. Personal accounts by AS and HFA teens frequently refer to attempts to make friends, but with little success. One teen stated, "I just did not know the rules of what you were and were not supposed to do."
Some of these “special needs” teenagers have even been accused of harassment in their attempts to socialize, which only adds to their depression and anxiety. Rodney, a 19-year-old with AS had this to say: "I did not know how to approach girls and ask them to go out with me. I would just walk up and talk to them, whether they wanted to talk to me or not. Some accused me of harassment, but I thought that was the way everybody did it." The difficulties AS and HFA teens have with personal space can compound this sort of problem (e.g., they may stand too close or too far from the person they are talking to).
Negative childhood experiences (e.g., peer-rejection, teasing, bullying, etc.) can also result in depression, as can a history of misdiagnosis. Another possibility is that the teenager is biologically predisposed to depression.
The depression in teens on the autism spectrum resembles that of teens without the disorder, although the content may be different. For instance, it may show itself through the AS or HFA teen’s particular preoccupations and obsessions.
If parents believe their autistic teen is suffering from depression, an attempt should be made to assess his or her mental state. Symptoms to look for would include:
aggression
agitation
changes in appetite (e.g., decreased appetite, weight loss, increased cravings for food, weight gain)
crying
disruptive or risky behavior
exaggerated self-blame or self-criticism
extreme sensitivity to rejection or failure
feelings of sadness
feelings of worthlessness
fixation on past failures
frequent absences from school
frequent complaints of unexplained body aches and headaches
frequent thoughts of death, dying or suicide
frequent visits to the school nurse
guilt
increased time spent with special interests to the point of addiction (e.g., spending most of the day playing video games)
increased/decreased activity
insomnia or sleeping too much
irritability, frustration or feelings of anger, even over small matters
isolation
loss of interest in, or conflict with, family and friends
loss of interest or pleasure in normal activities
neglected appearance (e.g., mismatched clothes and unkempt hair)
ongoing sense that life and the future are grim and bleak
poor school performance
restlessness (e.g., pacing, hand-wringing, an inability to sit still)
self-harm (e.g., cutting, burning, or excessive piercing or tattooing)
slowed thinking, speaking or body movements
the need for excessive reassurance
tiredness and loss of energy
trouble thinking, concentrating, making decisions and remembering things
use of alcohol or drugs
worsening of autistic traits (e.g., increased proportion of echolalia, the reappearance of stimming, etc.)
It can be difficult to tell the difference between depression and the normal ups-and-downs that are just part of adolescence. Talk with your teenager. Try to determine whether he or she seems capable of managing uncomfortable emotions, or if life seems overwhelming. If depression symptoms continue or begin to interfere in his or her daily functioning, talk to a mental health professional trained to work with autistic teens. Your family physician is a good place to start, or your child’s school may recommend someone.
You are your adolescent's best advocate. Here are some important tips parents can use that may help lessen the symptoms of depression in their autistic teens:
1. AS and HFA adolescents may be reluctant to seek support when life seems overwhelming. Encourage your teen to talk to a family member or other trusted adult whenever needed.
2. As long as your teen’s “special interest” (e.g., playing video games) doesn’t interfere with his normal day-to-day functioning (e.g., doing homework, completing chores, taking care of personal hygiene, having a modicum of a social life, etc.), allow him full access to this particular interest. It is most likely a great depression and anxiety reducer.
3. Create an environment where your teen can share concerns while you listen.
4. Do your part to make sure your adolescent eats regular, healthy meals.
5. Education about depression can empower your adolescent and motivate her to stick to a treatment plan.
6. Encourage your adolescent to carefully choose obligations and commitments, and set reasonable goals. Let him know that it's OK to do less when he feels down.
7. Even if your adolescent is feeling well, make sure she continues to take medications as prescribed.
8. Even light physical activity can help reduce depression symptoms.
9. Help your adolescent plan activities by making lists or using a planner to stay organized.
10. It can benefit you and other family members to learn about your adolescent's depression and understand that it's a treatable condition.
11. Journaling may help improve mood by allowing your adolescent to express and work through pain, anger, fear or other emotions.
12. Make sure your adolescent attends appointments, even if she doesn't feel like going.
13. Many AS and HFA adolescents judge themselves when they aren't able to live up to unrealistic standards (e.g., academically, in athletics, or in appearance). Let your teen know that it's OK not to be perfect.
14. Participation in sports, school activities, or a job can help keep your adolescent focused on positive things, rather than negative feelings or behaviors.
15. Positive relationships can help boost your adolescent's confidence and stay connected with others. Encourage him to avoid relationships with peers whose attitudes or behaviors could make depression worse.
16. Sleeping well is important for all adolescents, especially those with depression. If your adolescent is having trouble sleeping, ask your physician for advice.
17. Talk to your adolescent about the changes you're observing and emphasize your unconditional support.
18. Talking with other AS or HFA adolescents facing similar challenges can help your adolescent cope. Local support groups for depression are available in many communities. Also, support groups for teens with autism spectrum disorders and depression are offered online.
19. Work with your adolescent's therapist to learn what might trigger depression symptoms. Make a plan so that you and your adolescent know what to do if symptoms get worse. Also, ask family members or friends to help watch for warning signs.
20. Your adolescent may feel like alcohol or drugs lessen depression symptoms, but in the long run, they worsen symptoms and make depression harder to treat.
If all efforts to reduce your AS or HFA teen’s depression fail to produce effective results, medication may be a good last resort. However, they do not make an impact on the primary social impairments that underlie autism spectrum disorders. As with any treatment for depression, adjustments may have to be made to find the appropriate drug and dosage for that particular teenager.
Side effects should also be monitored and effort made to ensure that the advantages of treatment outweigh the disadvantages. Also, it is important to identify the cause of the depression, which may necessitate counseling, social skills training, or meeting up with peers with similar interests and values.
Resources for parents of children and teens on the autism spectrum:
Diagnosis as an adult can be a mixed blessing. Some people decide they are O.K. with being self-diagnosed and decide not to ask for a formal diagnosis. However, for those who DO want a formal diagnosis, there are a variety of benefits.
A lot has been said about the gluten-free, casein-free (GFCF) diet and its use to help kids on the autism spectrum. There is growing interest in the link between autism spectrum disorders and gastrointestinal ailments.
Research studies have revealed the following:
autistic kids were more likely to have antibodies to gluten than typically-developing kids, which may point to immune and/or intestinal abnormalities in those kids
kids on the autism spectrum were more likely to have abnormal immune responses to wheat, milk, and soy than typically-developing kids
kids on the autism spectrum were 7 times more likely to have diarrhea or colitis than children with no disorder
In a different study, researchers used survey information from moms and dads to conclude that the GFCF diet may improve behavior and GI symptoms in some autistic children.
One theory suggests that some autistic children can’t properly digest gluten and casein, which results in the formation of peptides (i.e., substances that act like opiates in the body). The peptides then alter the child's perceptions, behavior, and responses to his or her environment. Also, some researchers now believe that peptides trigger an unusual immune system response in certain children. Studies have found peptides in the urine of a significant number of autistic kids.
A theory behind the use of the GFCF diet in autism is that if a child is having GI responses to gluten and casein, the resulting inflammation can damage the lining of the intestine, thus leading to absorption of molecules that are not normally absorbed by healthy intestines. Evidence suggests that these molecules (or the inflammation they cause) may interact with the child’s brain in ways that cause significant problems (e.g., mood abnormalities, anxiety, mental difficulties) that worsen the behavioral symptoms of autism.
If your youngster has gastrointestinal problems and sensitivity to certain foods that contain gluten or casein, then the GFCF diet is worth considering. If you do decide to embark on a trial of the diet, the first thing you should do is make a list of the benefits you want to see (e.g., better sleeping patterns, less acting-out behaviors, increased ability to focus, etc.). Make this list a week before you start your youngster on the diet.
Next, keep a diary of the behaviors or other symptoms of concern to you. For instance, if you hope the diet will improve your child’s diarrhea, you need to know exactly where you are starting (e.g., he or she has diarrhea 7 days a week). Then, continue to log relevant information in the diary as your youngster starts the diet. Two weeks later, does he or she still have diarrhea 7 times a week? If not, then the diet may be beneficial.
This procedure is called “establishing a baseline.” The problem with NOT establishing a baseline is that you and your physician are left with uncertainties about the effectiveness of the diet. This makes it difficult to decide whether to continue with the diet or not. So, take the time to establish a baseline.
In addition to establishing a baseline, you may want to discuss the diet with your youngster’s physician. Some physicians are more familiar than others with the GFCF diet’s popularity in treating the symptoms of autism. But, most physicians understand the dietary restrictions involved and how they interact with a youngster’s unique nutritional needs and health conditions.
Also, a nutritionist can provide guidance around the GFCF diet. Some parents believe they are providing a GFCF diet, but actually continue to offer their child foods that contain gluten or casein. These proteins can be in some foods that parents don’t suspect.
How long should you continue the GFCF diet with your child? It can take months for your child’s gut to heal with clear improvements in gastrointestinal symptoms. So, a trial of 3 to 6 months should be enough to see the benefits. If you do continue with the diet beyond the 3 month period, your youngster should take a daily multivitamin supplement to ensure adequate amounts of recommended vitamins and minerals.
Some advocates of the GFCF diet suggest removing one food from the diet at a time so you will know which food was causing a problem. It's often recommended to remove milk first, because your child’s body will clear itself of milk/casein the quickest. Then, gluten can be removed a month or so after eliminating milk. Also, it is helpful to ask other adults (e.g., teachers, babysitters, etc.) who know your child and see him or her frequently – and who do not know about the dietary change – if they see any improvements after a couple months.
Try to find a substitute for milk that your youngster can tolerate (e.g., almond milk, coconut or rice milk). Also, you can find gluten-free flours in many grocery, specialty and health food stores (e.g., waffles, pretzels, pasta made of rice, crackers, cookies, cereal, bread, etc.). Many products are already gluten-free and casein-free (e.g., rice, quinoa, amaranth, potatoes, buckwheat flour, corn, fruits, vegetables, beans, tapioca, meat, poultry, fish, shellfish, nuts, eggs, sorghum, etc.).
In addition to gluten and casein, some moms and dads report that removing soy or corn led to equal or greater improvements in their autistic kids. Since soy protein is similar to gluten and casein, some diet advocates suggest removing it if the youngster seems very sensitive or does not improve on the GFCF diet.
Almost 2 years ago now we were at our wits-end trying to find a medication/treatment that would alleviate my son's constant anger & irritability. He has been taking Risperdal for many years & it has helped, but it wasn't a "miracle" situation that seemed to solve everything. We went GLUTEN-FREE. It is known that gluten, an un-digestable protein found in wheat & other grains, is a "poison" for the brain & body..especially for those with neurological conditions such as Aspergers or ADHD. It was our last-ditch effort. It seemed daunting because there are many things you just can't eat..but nowadays almost every store or restaurant you may go to has gluten-free foods & options. Anyway..It took a few weeks to "kick-in" but my son's anger & irritability literally WENT AWAY! His general mood was happy & at-ease rather than on a constant short fuse. His hyperactivity did not go away..but his antics became more silly & fun in nature instead of mischievous & problematic. He absolutely loves all the food too! So as I mentioned my son has other mental issues that simply going gluten-free will not resolve but as far as his general mood on a day-to-day basis, it has made an amazing difference!
There are a number of reasons why kids develop autism. Genetics may play
a part, but the vast majority of the causes are not genetic, which
means parents can do something about them. Correcting the underlying
causes of your youngster's autism will produce significant improvement
in his or her functioning.
The diagnosis of autism is overwhelming and stressful for parents and other family members. However, contrary to popular belief, with a concerted effort from parents, some of the youngster’s symptoms of autism may be reversed.
A noticeable difference is often seen in a short period of time, with amazing, sometimes miraculous long-term results. One parent eliminated almost all autistic behaviors her son suffered from, and so have many thousands of other parents around the world. You can too!
Note to skeptics: If you believe that reversing the symptoms of autism is an impossibility, do a Google or YouTube search for "reversing autism" and witness for yourself accounts from other parents who have had such good fortune!
