Living With An Aspergers Partner/Spouse

Folks with Aspergers often live in their own little world. Intimate relationships with someone identified as having Aspergers is difficult simply because they have a problem with communication and empathy (abilities healthy relationships rely on). Getting into a romantic relationship with an ‘Aspie’ will require you to change your expectation of "normal" behaviors. In exchange, however, you might find yourself part of a lasting and satisfying relationship.

Here are some tips for those who may be in a romantic relationship with an ‘Aspie’:

1. Accept the fact your Aspergers partner views you as an NT or "Neurotypical" (i.e., someone without Aspergers). ‘Aspies’ created this term. They use it to specify men and women without any of the ASD diagnoses. Social-skill training for Aspergers individuals consists of learning how to communicate in the “Neurotypical” style. NTs should try to come to terms with this particular view of their behavior at the start of the relationship.

2. Aspergers individuals do not react to the normal give and take of organic conversation. Though often talkative and articulate, they might speak all night on topics that only interest them. As a word of caution here: do not to try to engage in the monologue or change the topic. When they are done speaking (which they will be eventually), you can then bring up the next subject.

3. Aspergers individuals have a problem with expressing physical affection. They're oversensitive to stimuli (e.g., touch). He might not be comfortable holding your hand, getting unpredicted hugs, or kissing in the beginning. You might not understand this since you may have witnessed him showing affection to close family members. His lack of physical affection doesn't mean he does not care for you. Aspergers individuals don't react well to change and require a great deal of time to adjust to new surroundings and people.

4. Aspergers individuals have a problem with interpreting nonverbal communication (e.g., facial expressions, tone of voice). If you get annoyed with them for some reason (e.g., they don’t seem to listen, they appear to be blind to how you’re feeling), it’s best to talk to them as calmly and rationally as you can. He probably will not "understand" your feelings. Ignore his “mindblindness” – or it'll only irritate you much more.

5. Aspergers individuals take vocabulary at face value. Sarcasm, humor and innuendo befuddle them. When communicating with him, keep the vocabulary clear and direct and steer clear of figurative language. They do not lie, so stay truthful with them.

6. Aspergers individuals understand the “basics” of a romantic relationship. He might not behave as an average sweetheart; however, this does not alter his role in your life – or your place in his. When attempting to indicate your desires to him, be positive and concrete. State the obvious. Dropping hints and coy behavior will get you nowhere fast.

7. Be patient while you help your Aspergers partner develop some necessary social skills. He'll most likely listen to you more than anyone else.

8. Do not take offense if he does not remember to reciprocate feelings, greetings, verbal expressions, or if he doesn’t respond when you ask a question. Aspergers individuals have a problem with social hints so, if anything, carefully remind him you need an answer.

9. Intellectual curiosity to the point of infatuation identifies Aspergers. Respect that they value their space, time and interests. Understand you may be one of these pursuits that they focus on. If after a period of time their curiosity about you weakens, realize that it does not reflect their intimate emotions towards you.

10. Try to make use of technology to your benefit. Text-messaging and internet-based communication will be a better way for you to communicate with ‘Aspies’ since it cuts-down on the amount of social and non-verbal hints you may expect them to interpret in a telephone or face to face dialogue.

For more information on how to relate to an Aspergers partner or spouse, see below:

==> Living with an Aspergers Partner

Comment

Dear Mark

Many thanks for your book, it has helped me a great deal from much despair in dealing with who I am certain is/was an Asbergers boyfriend. He is a lovely guy in so many ways and I love him SO much but the pressures over 2 1/2 years of my having to take responsibility in so many areas (social, financial, organizational) and not receiving much empathy, comfort or support PLUS being completely misunderstood by him when I have criticized this or asked for clarification, led to acrimony, temper tantrums and sometimes violent impulses on both our parts. To the point where we had to part to get some breathing space and to try and reassess the situation. It is 6 months now since we have lived apart.

It is only in the last week or so that I have been convinced he is an Aspergers , I was alerted by a comment someone made who recently met him. I am now trying to encourage him to get a proper diagnosis and being patient and understanding with his resistance to the idea of Asbergers. (He claims to have had an autism test which tested negative) I think he will in time come to listen to me. He is seeking psychotherapeutic support, waiting to be referred to one by his GP (This is for stress and for unresolved trauma when he had the stupid job of nightclub doorman and he constantly got beaten up) plus he is interested in emdr therapy.

The thing is I still adore him and I cant move on. I helped him, two years ago come off anti psychotic drugs and anti depressants which were really making things worse for him, making him slow, obese and he looked like death on them. Physically and mentally he improved so much off the drugs and started doing yoga and other relaxation techniques. He looks great for it now and his art work is attracting professional attention and important exhibitions. BUT I was so puzzled as to why other things didn’t improve. 10 years previously he was diagnosed as a psychotic depressive, which he is absolutely not. He never suffers from psychosis or paranoia (except what is logical from not reading social cues). His depression Im guessing was from the problems that the world has thrown at him that he could not negotiate given his obvious limitations.

He easily mentally overloads at work and constantly gets interrupted by distracting thoughts (he is a part time care assistant for the elderly) He is nagged there for not being receptive to simple commands and not being organized enough. His speech is monotone and he mumbles so that sometimes its hard to follow what he is saying. This guy has very high educational achievements but cannot get employed to his educational ability. He can talk obsessively about a subject and then be very shy.

Now I understand what is wrong, my sadness and depression have lifted somewhat and I feel as if I want to try again and need some advice. The problem is that he got so hurt and fed up from my constant nagging when we lived together and then after we split my asking to go over our past and explore our feelings and my subsequent upset when he couldn’t voice his feelings, that he is understandably wary of me now. He is weirdly contradictory about whether nor not he wants to try again and in fact if I press him he yells at me that I do not understand the pressures that he is under (which before I didn’t)

What is confusing is I know he still loves me. He is loving and happy when he sees me (kisses and hugs me) and still accepts my help and speaks/texts to me every day. when I say, ‘look if you don’t want this relationship then why come over, kiss me, hug me tenderly and accept meals, favours etc? Is it just you want me to help you in your life? Please go away and stop doing it as my hopes get raised. You are messing my head around’. He doesn’t seem to take that on board, gets upset and runs away for a bit and then comes back.

So, Mark, I am all confused and feel obsessive about this. And it is affecting me badly in my work and life. I spend too much time feeling sad. I don’t know if I am being rejected or not. I love this guy so much Im willing to take on board the amount of support he needs (yet don’t think I can actually live with him) but I feel really gutted that he keeps telling me to ‘see other men’, when Im still so involved emotionally with him and he seems to encourage it by his actions, his looks, his presence etc.

Its his telling me to see other men that confuses me most - as if I do, I cant invest so much of my time and energy in him and really I should get him right out of my life till I can heal. Perhaps he doesn’t get that.

My friends all say, ‘don’t see him, you are punching below your weight, he is a child and will never give you what you want’. But they don’t know the loveliness and tenderness of when things are good with us.

Yours in confusion Cordelia

(Im in my late 40s and he is 35 there are no kids involved and wont be!)

Comment

I would say to him "can we just be friends" ...and go from there. Unfortunately, it may take a year or two before he trusts in the relationship again.

Just be friends for now, and if it's meant to be, the relationship will be restored back to its original level of intimacy in due time.

You know how to handle the Aspergers-related difficulties differently now. Thus, the relationship can be a "new and improved" version of the original one.

Mark

Low Muscle Tone and Motor Clumsiness in Aspergers Children

In this post, we will address low muscle-tone (Hypotonia), motor clumsiness, and some strategies to improve particular skills for Aspergers (high functioning autistic) children...

Hypotonia is a state of low muscle-tone (i.e., the amount of tension or resistance to movement in a muscle), frequently including decreased muscle strength. Hypotonia isn't a particular medical condition, but a potential outward manifestation of several different diseases and disorders that affect motor nerve control by the brain or muscle strength.

Identifying hypotonia is usually relatively simple, but figuring out the actual cause can be challenging. The long-term results of hypotonia on a kid's development rely primarily on the seriousness of the muscle weakness as well as the cause. Some problems have a particular remedy; however, the primary remedy for most hypotonia of neurologic cause is physical therapy and/or occupational therapy to assist the individual in compensating for the neuromuscular impairment.

The affected muscles may be trained, but not via regular weight training. Proper training to address hypotonia comes from some very specific therapy and may not be 100% effective. In young kids, the difficulties of low muscle tone may decrease in severity as they age (up to about age 10); nevertheless, children with Aspergers will probably continue to adjust and compensate for the remainder of their lives.

Low muscle tone is usually referred to as "floppiness". This is because the muscles are meant to help support the skeletal system and are designed to prevent certain kinds of motion. Because the muscles are not especially tight, individuals with low muscle tone frequently experience "hypermobility" (i.e., the ability to move limbs into awkward positions). Children with Aspergers often find that they're able to very easily carry out feats that require flexibility, but not strength or balance (e.g., splits, back-bending, shoulder rotation, etc.). They might display uncommon flexibility in other joints (e.g., fingers).

This kind of flexibility comes with a price. Aspergers children are generally very uncoordinated and awkward. In running, this plays a role in the so-called "unusual gait". A myth is that muscle tone just impacts the large muscles, but this is not the case. Muscle tone impacts all activities requiring muscles including speech, pencil grip and writing.

Fine motor skills are hard to learn if you have Aspergers. These fine skills are essential for drawing or coloring, grasping objects, riding a bike without training wheels, zipping-up jeans, and tying shoelaces. However, when muscle tone is low, these skills are much harder to perform properly.

When an Aspergers child isn't proficient at something (e.g., riding a bike), but all his friends can do it, this deficiency can create a sense of isolation in the Aspergers child. Imagine watching all the other children in your neighborhood doing various activities very easily while you don’t appear to have the same abilities. Consequently, Aspergers children can start thinking they're ‘dumb’ or ‘stupid’. This is definitely not the case. Intelligence has nothing to do with it!

Aspergers children often slump a great deal when seated or standing for long stretches. Occasionally, they'll stand with their legs crossed in what seems to be an uncomfortable manner. Even though this appears uncomfortable, this is really an extremely comfortable position for Aspergers kids. Additionally, they frequently sit with their head and shoulders rolled forward and will often lean on walls, furniture, door frames and desks. Moms and dads of Aspergers kids will probably be very familiar with being "leaned on".

Low muscle tone doesn't prevent Aspergers kids from enjoying themselves. They are able to run and have fun with other kids without feeling any harmful effects. The issue is that they are a little slower and they tire easier. Consequently team sports (e.g., soccer, basketball, football) are often not suitable to these children.

While the slumping and leaning habits are not necessarily good posture, they are not particularly harmful to the Aspergers child unless of course the position is adopted for very long intervals without proper breaks.

It is important to remember that “low muscle tone” isn't a diagnosis. Usually, kids are believed to have low muscle tone because they have poor postural stability and poor performance on movement tasks. The presumption is made that these issues result from low muscle tone - but this isn't always the case. Aspergers children might have problems with understanding movement skills and obtaining basic strength needed for action for a combination of reasons: joint hypermobility, a fearful temperament, difficulties with the thinking skills needed for learning, such as predicting what happens next and the ability to learn from watching other people and from their own experience.

Therefore the real question is not what you can do for an Aspergers child with low muscle tone, but instead what you can do to improve overall performance on age-appropriate movement tasks? And that depends on the underlying reasons for the child’s problems, which may or may not have anything to do with low muscle tone.

Children with Aspergers can have a comprehensive assessment by a physiotherapist and/or occupational therapist to determine the nature and degree of the problem. Listed here are a few of the areas where motor clumsiness is evident, and some ways of improve specific skills:

Locomotion-

When the Aspergers child walks or runs, the movements may seem ungainly or "puppet" like, and many kids walk with no associated arm swing. There might be deficiencies in upper and lower limb control. This particular feature can be very noticeable and other kids may mock the Aspergers child, resulting in his/her desire not to take part in running sports and physical education in school.

A physiotherapist or occupational therapist can develop a remedial plan to ensure the child’s movements are coordinated. Therapy might include the use of a large wall mirror, video recording, modeling, and imitating more "fluid" movements using music and dance. An intriguing fact is that the ability to swim seems least affected, and this exercise can be encouraged to allow Aspergers kids to experience genuine proficiency with movement.

Basic skills-

Catching and throwing precision seems to be especially affected in Aspergers children. When catching a ball with two hands, the arm movements of the child are often badly coordinated and affected by problems with timing (i.e., the hands close in the correct position, but a fraction of a second too late). One study noted that Aspergers children would frequently not look in the direction of the target prior to throwing. Clinical observation additionally indicates that Aspergers children have poor coordination in their ability to kick a ball.

One consequence of not being proficient at ball games is the exclusion of the Aspergers child from some of the most well-liked games on the playground (i.e., kick ball). Aspergers children might avoid such games simply because they understand they lack proficiency, or are intentionally excluded since they're a liability to the team. As a result, they're much less able to improve ball skills with practice.

From an early age, mothers and fathers should help their Aspergers child practice ball skills in order to guarantee that he/she has fundamental proficiency to be included in the games. A number of kids might be enrolled in a junior soccer or basketball team to enhance coordination and to learn to play specific games. It's also vital that you have your child’s eyesight examined to determine whether wearing glasses enhances hand-eye coordination.

Balance-

In Aspergers children, there can be an issue with balance, as tested by analyzing the ability to stand on one leg with eyes closed. A number of Aspergers youngsters are not able to balance when placing one foot in front of the other (i.e., tandem walking, which is the task of walking a straight line as though it were a tightrope). This may affect the child's ability to use some adventure playground equipment and activities in the gym. The child may need practice and encouragement with activities that require balancing.

Manual Dexterity-

This area of movement skills involves the ability to use both of your hands (e.g., learning to dress, tie shoelaces, eat with utensils, etc.). This might also extend to the coordination of feet and legs (e.g., learning to ride a bike). If the Aspergers child has problems with manual dexterity, a good technique to help is "hands on hands" training (i.e., a parent or teacher physically patterns the child's hands or limbs through the required movements, gradually fading out physical support).

Handwriting-

A teacher may invest a lot of time interpreting and correcting the Aspergers youngster’s illegible chicken scratches. This child may also be aware of the poor quality of his handwriting and may be hesitant to take part in activities which involve extensive writing. Regrettably, for many kids, high school instructors and potential employers consider the neatness of handwriting a way of measuring intelligence and character. As a result, the individual with Aspergers may get embarrassed or upset at their own inability to write neatly and consistently. The child might need an assessment by an occupational therapist and remedial exercises, but today's technology might help reduce this issue.

Kids with Aspergers are often very competent at using computers and keyboards, and the youngster might prefer typing over writing homework and exams. In this case, the presentation of their work is then similar to the other kids. A parent or guardian or instructor could also act as the youngsters scribe to guarantee the legibility of his/her written answers or homework. The ability to write longhand may become a lot less important in the future (to the great relief of thousands of children with Aspergers).

Rapid movements-

Research conducted recently noted that, while engaged in activities that require motor coordination (e.g., cutting out shapes with a pair of scissors), a significant percentage of kids with Aspergers were known to hurry through the task. They seemed to be impulsive, unable to take a slow and calculated approach. With such haste, errors occur. This is often infuriating for the Aspergers child and the teacher. The child may require guidance and reassurance to work at a suitable pace, having time to correct mistakes. Occasionally the youngster can be asked to slow down by having to count between actions and using a metronome to indicate a suitable pace.

Lax joints/Immature grasp-

One of the features analyzed during a diagnostic evaluation of Aspergers children is the existence of lax joints. We don't know if this is a structural problem or due to low muscle tone, but the autobiography of David Miedzianik (1986) explains how:

At infant school I can seem to remember playing a lot of games and them teaching us to write. They used to tell me off a lot for holding my pen wrong at infant and primary school. I still don't hold my pen very good to this day, so my handwriting has never been good. I think a lot of the reason why I hold my pen badly is that the joints of my finger tips are double jointed and I can bend my fingers right back. (p. 4)

The Aspergers youngster could be referred to an occupational therapist or physiotherapist for evaluation and remedial activities whenever difficulties occur from lax joints or immature grasp. This ought to be a priority with an Aspergers youngster, because a lot of school work demands the use of a pen or pencil.

Exercises for babies and young children with hypotonia to develop fine motor skills—

• Create tape recordings of your child's own sounds, the sounds of your family, and appropriate music. Play these tapes often, and dance your child around rhythmically in your arms during music or sounds. Again, this helps your child to become aware of her own body.

• Draw feet up to the baby's mouth, circling the mouth with each big toe. Repeat with hands and fingertips in order to increase awareness of extremities and oral motor control.

• Expose the baby to as many different pleasant stimuli as you can think of. This includes mobiles, wind chimes, patterned cloth for crib sheets and bumpers, and musical or noise toys in bright, primary colors. Primary colors are bright red, blue and yellow. Babies see high-contrast things the best, and love these colors. An effective tactic that some parents have used is to cut out suitable pictures from magazines and placing on baby's walls, which allows the frequent change-out of pictures needed to give stimulation without breaking the bank.

• Give a newborn a lot of smiles, hugs and cuddles. This both increases emotional bonding and stimulates baby's senses.

• Help the child with hypotonia to do occasional rounds of heel walking, where all of his weight is balanced on his heel and his toes stick in the air.

• Hold bright or desirable small objects out, encourage reaching for it and praise any attempt or success to do so.

• Lightly brush from the heel to the toe on each foot and from the base up to the fingertips on each hand with light massage strokes or a soft, 1 inch paintbrush.

• Make a safe place for your child in every room of your house, and bring baby along as you go about your normal routine. The frequent changes in environment and constant contact with you will help stimulate your child's mind and awareness.

• Place child-safe mirrors on crib walls or down near the floor where your baby can see himself often. This helps increase your child's self-image and self-reflection.

• Place toys or objects at the midline of the body and encourage drawing the limbs in to pick these objects up successfully.

• Play patty cake and patty foot to bring hands and feet into the center of the body.

• Resist any thrust of your baby's legs while you're holding him, and hold him often in a standing position while supporting him well in the torso.

• Rub the hands and feet together, first left hand to left foot, then right hand to right food, then across the body.

• Talk to the baby often. Tell your child what you're doing, especially when bathing, grooming, dressing or changing her. Verbally repeat each step in the process often. Play mimic games with your baby, repeating the sounds he will naturally make. Encourage your baby to make sounds by making faces, singing, and talking nonsense syllables.

• Use a backpack with books or toys in it for weight training.

• Use deep pressure massage on the hands and feet, focusing on the pad of the big toe and each of the fingertips.

• Use small beanbags for weights and movement training.

More resources for parents of children and teens with Asperger's and High-Functioning Autism:

==> Preventing Meltdowns and Tantrums in Asperger's Children

==> Discipline for Defiant Asperger's Teens

==> Teaching Social Skills and Emotion Management

==> Launching Adult Children with Asperger's: How to Promote Self-Reliance 

==> Everything You'll Ever Need to Know About Parenting Asperger's Children

==> Parenting Children and Teens with High-Functioning Autism

==> AudioBook: Unraveling The Mystery Behind Asperger’s and High-Functioning Autism

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Living with an Aspergers Spouse/Partner

Research reveals that the divorce rate for people with Aspergers is around 80%. Why so high!? The answer may be found in how the symptoms of Aspergers affect intimate relationships.

People with Aspergers often find it difficult to understand others and express themselves. They may seem to lose interest in people over time, appear aloof, and are often mistaken as self-centered, vain individuals.

A person with Aspergers may have trouble understanding the emotions of their partner, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. Because of this, a person with Aspergers might be seen as egotistical, selfish or uncaring.

These are unfair labels, because the affected individuals are neurologically unable to understand other people's emotional states, and they are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate!

Click here to read the full article…

Job Interview Skills for Young People with Aspergers

It is a well documented fact that "having poor social skills" is one of the challenges people with Aspergers (high functioning autism) deal with on a day-to-day basis. But this deficit is never as apparent and potentially awkward as during a job interview. Finding a job when dealing with Aspergers is one of the most difficult tasks an Aspie will ever attempt, and even though some are very successful, others struggle with their problems and fail to land jobs even though they are amply qualified.

One Aspie comments, “One of the most nervous things I have EVER done was my first job interview.” This would be true for most people – but especially those with Aspergers. Individuals with Aspergers may have even more problems with such conversations because they (a) have difficulty reading the body language of the interviewer and (b) find it hard to ‘read between the lines’ (i.e., to infer what qualities the interviewer is really looking for in a potential candidate for the job).

In this post, we will be looking at some important "job interview tips" for individuals with Aspergers:

1. Spend plenty of time on preparation:

• Be prepared to talk about how well you have worked one-on-one with customers in previous jobs (e.g., Was there a time when you delivered superior customer service, or a time where you did something different and why? Was there a time when you exceeded your target, and what did you do to achieve this? Was there a time when you had to work out of your comfort zone, and what steps did you take to achieve this, and what was the outcome? When was there a time when you dealt with a difficult customer, what action did you take, and what was the outcome?)

• Find out who the main staff are and how long they have been working for that company

• Have a list of your job experience in the relevant industries and achievements ready

• Have a list of your personal attributes and a list of your strengths ready (e.g., hard working, punctual, determined, team player, etc.)

• Make sure you know as much as possible about the job you are applying for

• Research exactly what the company has achieved over the years

• Research the “reputation” of the company

• Research the job expectations and have some answers ready (preferably on a piece of paper)

• Use the internet and other resources to research the company and the company history

2. Minimize your weaknesses:

Do not go on and on with a long list of what you think are weaknesses if you are asked something like, “What would you consider to be some of your weaknesses.” It’s better to just say something like...

• “I’m probably too giving…”

• “I’m probably too nice…”

• “I tend to be a perfectionist…”

• “Sometimes I take work a bit too seriously…”

3. Practice the interview beforehand:

• Practice the whole interview from start to finish so that you get to know how an interview works and what the interviewer is looking for in an ideal candidate

• Role playing with a trusted friend or family member; one of you play the interviewer and the other person the candidate for the job

• Practice making eye contact

• Work together with a life-skill coach or take classes at the local adult-education center to prepare for the interview process and to learn how to conduct yourself

4. Dress for the interview:

• For females: make sure you are dressed smartly and have showered and have minimal jewelry …also make sure you are wearing the right amount of make-up and not wearing any clothes that are too revealing

• For males: make sure you have a shower and shave before the interview …also get a haircut a day or two before the interview

• Go and check out the place of employment and go dressed like the staff that work there

• Wear deodorant and make sure your clothes are clean

5. Make eye contact:

• Look at the person you are speaking to (this is hard for Aspies, but force yourself to do it anyway; at least look at their forehead or bridge of their nose)

• Have most - or all - of your answers ready in your head and then gave as much eye contact as possible

6. Get to the point:

• Try not to go on for too long on a single topic

• Try not to repeat yourself too much

• Say just enough, then stop and let the interviewer talk or ask their next question

• If the interviewer does not respond immediately, then continue to talk (but only if you have additional relevant points)

7. Pay attention to facial cues and body language:

Being able to read the facial expressions or body language is difficult for Aspies. You may be able to get around this by...

• Giving short and to the point answers

• Giving some eye contact as explained above

• Learning your answers like a script before you go into the interview

• Not repeating yourself as much as possible

8. Be relaxed – or “act as if” you are relaxed:

• Try to be as relaxed as possible

• Do some breathing exercises

• Do some positive self talk before going into the interview

• Relax and try to treat the interview as if it were just a conversation

• Don’t put too much pressure on yourself in the process of the interview

• Prior to the interview, smile and shake the person’s hand and say “it’s good to meet you”

• At the end of the interview, thank them for their time and say “I look forward to talking with you soon”

Your future employer expects you to breathe, so this calming technique is something you can use during the interview. As you walk into the interview room, take a breath. If you have a break during the interview, remember to take a breath. Tell yourself, "You can do this." Of course you can.

9. Disclose that you have Aspergers:

In most cases, honesty is the best policy. You are better to tell the person interviewing you because he/she can make allowances for your disability. A brief letter from a Psychologist or Doctor is more than adequate. The letter should explain the following:

• What Aspergers is

• How it affects you

• What allowances may need to made

• A list of your strengths

If you decide not to disclose your Aspergers, you may end up standing out as different and still come to the attention of your employer. Your Aspergers may be too hard to camouflage, and you could still have a difficult time working for - and with - your employer. Some, if not most, applicants with Aspergers opt against sharing their condition with prospective employers. In this case, try to compensate for the problems associated with body language and facial expressions by portraying a highly professional exterior …a “fake it until you make it” approach.

==> Launching Adult Children With Aspergers: How To Promote Self-Reliance

Violent Children on the Spectrum: What Parents and Teachers Can Do

Question

I am a special education teacher. I have an autistic (high functioning) student that hits impulsively. We have tried behavior modification, social stories, sensory exercises, and music therapy. She will say what she did was wrong and we will role play the correct behavior. She still hits and is getting in a lot of trouble. There is no pattern or functional cause. I want to help her but am running out of ideas. Does you have any suggestions??

Answer

There is a great concern about the incidence of violent behavior among kids and teens with High-Functioning Autism (HFA) and Asperger's (AS). This complex and troubling issue needs to be carefully understood by parents, educators, and other grown-ups. HFA and AS kids as young as preschoolers can show violent behavior. Moms and dads and other adults who witness the behavior may be concerned; however, they often hope that the young child will "grow out of it." Violent behavior in a youngster at any age always needs to be taken seriously. It should not be quickly dismissed as "just a phase they're going through!"

Faced with a world in which they find it difficult to interact socially, communicate clearly, and control their own behavior, kids on the autism spectrum sometimes respond with aggressive behavior. Aggression - physical and verbal - is a common characteristic of the disorder, and can be directed toward inanimate objects, moms and dads and other family members, educators, peers, and even toward the youngster herself. An observant parent or teacher can take practical steps to soothe and redirect a violent youngster.

Range of Aggressive Behavior—

Violent behavior in kids and adolescents with the disorder can include a wide range of behaviors. Kids who exhibit aggressive behavior intend to deliberately hurt others. Aggression can manifest in a number of ways including:

• biting
• cruelty toward animals
• destroying public or personal property
• explosive temper tantrums
• fighting
• fire setting
• hitting
• kicking
• pushing
• spitting
• threats to hurt others (including homicidal thoughts)
• throwing objects
• use of weapons

Factors Which Increase Risk of Aggressive Behavior—

Numerous research studies have concluded that a complex interaction or combination of factors leads to an increased risk of violent behavior in HFA/AS kids and adolescents. These factors include:

• being the victim of physical abuse and/or sexual abuse
• brain damage from head injury
• combination of stressful family socioeconomic factors (poverty, severe deprivation, marital breakup, single parenting, unemployment, loss of support from extended family)
• emotional problems
• exposure to violence in media (TV, movies, etc.)
• exposure to violence in the home or community
• frustration
• genetic (family heredity) factors
• limited communication or problem solving skills
• low self esteem
• presence of firearms in home
• previous aggressive or violent behavior
• spending time with peers who are aggressive
• stress
• temperament
• use of drugs and/or alcohol

What are the "red flags" for aggressive behavior in kids?

Kids on the spectrum who have several risk factors and show the following behaviors should be carefully evaluated by a Child and Adolescent Psychiatrist:

• Becoming easily frustrated
• Extreme impulsiveness
• Extreme irritability
• Frequent loss of temper or meltdowns
• Intense anger

Moms and dads and educators should be careful not to minimize these behaviors in kids.

What can be done if a youngster shows aggressive behavior?

Whenever a mother/father or other adult is concerned, they should immediately arrange for a comprehensive evaluation by a qualified mental health professional. Early treatment by a professional can often help. The goals of treatment typically focus on helping the youngster to:

• accept consequences
• be responsible for his/her actions
• express anger and frustrations in appropriate ways
• learn how to control his/her anger

In addition, family conflicts, school problems, and community issues must be addressed.

Can anything prevent aggressive behavior in this population?

Research studies have shown that much violent behavior can be decreased or even prevented if the above risk factors are significantly reduced or eliminated. Most importantly, efforts should be directed at dramatically decreasing the exposure of kids and adolescents to violence in the home, community, and through the media. Clearly, violence leads to violence.

In addition, the following strategies can lessen or prevent violent behavior:

• Early intervention programs for violent youngsters
• Monitoring the child's viewing of violence on TV/videos/movies
• Prevention of child abuse (use of programs such as parent training, family support programs, etc.)
• Sex education and parenting programs for adolescents

Treatment—

To be effective, treatment approaches for aggressive children need to take these factors into account:

• ‘Me against the world’ attitude. Kids who become aggressive have often learned to see the world as a cold and hostile place. They develop a habit of thought that attributes hostile intentions to others. This attitude leaves them little choice but to fight virtually all the time. If, for example, another youngster bumps up against them in the hallway at school, they immediately take offense, certain that they were attacked. They cannot imagine that perhaps the bumping was just clumsiness on the other youngster's part or an attempt to tease that really wasn't hostile.

• Always the victim. Even while they are the aggressors, aggressive children almost always think of themselves as victims--of unfair educators, of other bullies, of prejudice--and believe that their aggressive acts are therefore totally justified.

• Distorted thinking. Aggressive kids come to believe that overpowering another child is a mark of strength and worth, and that violence is a legitimate way to resolve conflict. Popular media support this idea, with wrestlers who pound their opponents without mercy and so-called action heroes who slaughter foes by the truckload. For good or bad, the government unwittingly encourages the idea that "might makes right" when it engages in shows of strength celebrating the Army and police. Aggressive kids needn't look far for evidence that force is what really counts.

• Never safe. The violent youngster sees the world as an unsafe place in which there are only victims and victimizers, so he (unconsciously) chooses to be one of the latter. The power and delight he takes in hurting others, in combination with his already numbed emotions, can make for a lethal mixture.

• Self-esteem. For some kids, violence toward other kids may be a powerful source of self-esteem, particularly if they lack other confirmation of their human worth. In many cases, the problem is not lack of self-esteem as much as lack of self-esteem related to positive, peaceful accomplishments.

• The loss of empathy. Aggressive kids often don't even recognize (much less feel) the suffering of others. Empathy develops early in infancy. Most nine-month-old infants register concern if they see their moms and dads crying, for example. Kids who have been emotionally traumatized learn to protect themselves from further emotional damage by shutting off their own feelings along with any empathic feelings they might have for others.

Specific Strategies for Parents and Teachers—

• Acknowledge your child’s feelings while setting boundaries. Maintain eye contact with your youngster and find ways to help him verbalize his anger. Let him know that it’s okay to be angry but hurting others in not acceptable behavior. You can say, "I understand that you’re angry but I expect you to (state the boundary)."

• Acknowledge your role. When one youngster is acting out, the family will blame him for the family's dysfunction. Oftentimes, you will see a family that will present a disruptive youngster for treatment ... this is the sacrificial lamb for the family's toxicity. Parents need to examine their own behavior, and if need be, the entire family should seek counseling.

• Be selective about the types of television programs your kids watch. Don’t let them view shows that depict violence as humorous, or as a way to deal with problems.

• Clearly State Expectations. Power struggles will be reduced when the youngster knows what is expected of him.

• Don't get into a power struggle with a youngster. Sometimes aggressive kids know that if they struggle long enough with their parents (e.g., yelling, screaming, throwing temper tantrums in a crowded store, etc.), they will get their way. Be firm in disciplining your youngster and let them know that there boundaries that they have to observe.

• Evaluate Outside Influences. If aggressive behavior has developed suddenly or has gotten worse over time, then find out if the youngster has a food allergy. Other factors to consider are environmental conditions, change in medication or a change in the home or school setting. Some drugs cause aggression. Seasonal or food allergies can cause discomfort that the youngster can't describe, leading to extreme behavior.

• Every youngster has currency. Use it! There's not a youngster born that doesn't have currency, whether it's toys, clothes, games, or television. Access to this "currency" needs to be contingent upon proper behavior (e.g., if a youngster throws a temper tantrum in a crowded store, he should not be rewarded with a toy or a coloring book). He needs to (a) understand the consequences of his behavior, (b) be able to predict the consequences of his actions with 100% accuracy.

• Identify Triggers to Aggression. Sometimes violent outbursts are predictable. For example, does wearing a warm winter sweater cause him to become angry? Maybe the fabric feels uncomfortable against his skin, or the smell of the drier sheet is offensive to him. Examine every component of a situation that seems to trigger aggressive actions and making adjustments.

• If you know that your child is prone to frequent aggressive outbursts, always be prepared to avert trouble by sticking close by when he is playing with others.

• Maintain a unified front. Sometimes aggressive kids know that if they engage in "divide and conquer" tactics with their parents, they will be able to get their way. If you're together, if you're unified and if you're there for each other, then all of a sudden there's strength in numbers.

• Make sure that your kids have opportunities to expend excess energy by getting plenty of physical activity each day.

• Obtain a proper diagnosis from a psychologist. Many times, mothers/fathers are quick to make evaluations of their kid's unruly behavior, such as blaming aggressiveness on ADHD, attention deficit hyperactivity disorder. Parents need to revisit their evaluations, because a youngster's violence may be stemming from other issues. Don't make judgments until you get to the root of the problem.

• One of the best ways to teach your youngster nonviolence is to control your own temper. If you express your anger in quiet, peaceful ways, he’ll probably follow your example.

• Reduce Stress. Sometimes stress over not being able to verbalize frustration causes aggressive behavior. If a youngster is angry that he can't button his coat, but is unable to describe how he feels about lacking that skill, he could act out inappropriately. Examining the root problem and addressing it may help to curb angry behavior. Calm reactions on the part of the parent or teacher are important here.

• Remove kids from the stimulant that triggers violent outbursts.

• Seek a Doctor's Advice. Medication may be needed, especially if the youngster's behavior is hazardous to him or those around him. The U.S. Food and Drug Administration has not approved a medication specifically for HFA or AS. But some drugs used to treat other conditions have been shown to be useful in treating young people with an autism spectrum disorder. A health care professional can help you determine whether medication will be helpful for your aggressive youngster.

• Simplify the Environment. Arrange furniture in a sensible way for the youngster so that he can easily maneuver through rooms. If a youngster often tries to escape through a certain door, change the path of the room so that he is unlikely to go near that door. Keep surfaces clear, taking special care to place breakables and dangerous or messy items out of reach. Organize and structure the youngster's living space to minimize frustration. Again, labels can help the youngster understand where things belong and make him less likely to become overwhelmed or anxious. Restrict access to items that tend to cause power struggles.

• Since kids tend to repeat behaviors that are reinforced, it is important for you to provide them with consistent, positive attention for behaviors that are acceptable.

• Stop being intimidated by your youngster. Many moms and dads are afraid to discipline an unruly youngster for fear that their youngster will hate them for being an authority figure. Your youngster doesn't have to like you or even love you, but he does have to respect the parent-youngster relationship and realize that there will be consequences for negative actions. Recognize that you don't have to be your youngster's friend, but you do have to be his parent.

• Your surroundings can set the tone for calm or chaos. So minimize stress levels in the immediate environment.

Pharmacologic Treatment of Aggression—

Medications are frequently used in the management of aggression, and current psychopharmacologic treatment strategies involve treating aggression as part of each particular syndrome.

• Antidepressants— Antidepressants reduce fear, irritability, and anxiety, emotions that are in the same spectrum as agitation. Current findings point to decreases in negative mood and aggressive attacks, as well as positive changes in personality traits after antidepressant treatment.

• Antipsychotics— Antipsychotic medications are not recommended for people who do not have a psychotic or bipolar disorder. Lorazepam or another nonspecific sedating agent is preferred.

• Benzodiazepines— Lorazepam is a good choice to treat acute agitation or aggression, particularly when the cause is not clear. Benzodiazepines also have a risk for abuse, and therefore should not be used on a regular basis.

• Beta Blockers— Beta-adrenergic blockers, especially propranolol, have been used to treat aggressive behavior in a number of diagnoses, including autism.

• Mood Stabilizers— Mood stabilizers are primarily used for the treatment of bipolar disorder and as an adjunct treatment for schizophrenia. They are also used to treat aggression, although they are not prototypical for this purpose.

Before prescribing medication for aggression, the clinician should ensure that the child or adolescent has a medical evaluation to rule out contraindications to treatment and to determine whether the aggressive symptoms might improve without the use of drugs (e.g., cognitive-behavioral therapy). Psychiatric evaluation is also necessary to determine whether depression, anxiety, substance abuse, or other problems are present. Treatment of these conditions may also result in reduced symptoms of aggression.

==> Preventing Aggressive Behavior in Aspergers and HFA Children

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