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Dealing with Autistic Kids Who Hate Change

"Any advice for a child (high functioning) who absolutely hates change and will meltdown at the drop of a hat?! Help!!!"

Research suggests that the brains of kids on the autism spectrum are quite inflexible at switching from rest to task, and this inflexibility is correlated with behaviors characteristic of spectrum disorders. This behavioral inflexibility can manifest as restricted interests (e.g., preoccupation with particular activities, objects or sounds). These behaviors impact how a youngster attends to the external world.

Compared to “typical” kids, young people on the autism spectrum show reduced differentiation between brain connectivity during rest and task (called “brain inflexibility”). Also, there is a correlation between the degree of brain inflexibility shown in the fMRI scans and the severity of restrictive and repetitive behaviors in this population.

Symptoms of inflexibility or behavioral rigidity are often difficult to quantify, and yet often introduce some of the most disruptive chronic behaviors (e.g., tantrums, meltdowns) exhibited by children with ASD level 1, or High-Functioning Autism (HFA). These can be manifest by (a) changes to plans that have been previously laid out, (b) difficulties tolerating changes in routine, or (c) minor differences in the environment (e.g., changes in location for certain activities). For some HFA kids, this inflexibility can lead to aggression, or to extremes of frustration and anxiety that impede certain activities.

Parents – and even teachers – may find themselves “walking on eggshells” in an effort to circumvent any extreme reaction from the HFA child. Also, the children themselves may articulate their anxiety over fears that things will not go according to plan, or that they will be forced to make changes that they can’t handle. Sometimes these behaviors are identified as “obsessive-compulsive” because of the child's need for ritualized order or nonfunctional routine. The idea that OCD and these “needs for sameness” could share some biologic features is a popular notion among professionals.


Have your child watch this video -- Moving From One Activity To Another:




Some of the causes of inflexibility or behavioral rigidity in HFA include the following:
  • Behavioral problems: Some HFA children are just naturally more “set in their ways” and prone to tantrums. Also, some have a very low tolerance for frustration.
  • Neurological catalysts: Underlying neurological issues may explain inflexibility.
  • Parenting issues: Inflexibility can also be influenced by well-meaning parents (e.g., parents may be too busy with other things to take time to teach their child how to deal with frustration or agitation). Some parents find it easier to just let some things go, thus allowing their child to have his/her way time and time again (i.e., over-indulgent parenting). Also, some parents simply do not know how to redirect inappropriate behavior or to systematically teach flexibility. 
  • Security-seeking: Children on the autism spectrum often thrive on routine – sometimes to the extreme. Routines help these children feel secure, and they often have meltdowns if they encounter unwanted changes in their routine (e.g., changes in schedules, activities, food, clothing, music, pillows, the arrangement of knick-knacks, etc.). Over-reactions may look like tantrums, or they can mimic panic attacks. 
  • Sensory sensitivities: Finely tuned taste/smell/sound/touch may cause the child to develop an extraordinary attachment to certain things (e.g., food, a particular song, a favorite pair of shoes, etc.). Sensory sensitivities paired with obsessive interest often cause problems when things change unexpectedly.

Some of the signs of inflexibility or behavioral rigidity include the following:
  • repeats same movement constantly (e.g., clapping hands, facial tics, etc.), which is a self-soothing technique
  • is highly obsessed with narrow topics of interest (e.g., numbers, symbols, phone numbers, sports related statistics, train schedules, etc.)
  • has great difficulty in adapting to changes in school (e.g., shifting from the classroom to the playground)
  • experiences meltdowns or tantrums when unwanted changes are introduced at home (e.g., an earlier bedtime)
  • reacts strongly when thinking or seeing that something has changed from its usual pattern or setting (e.g., his or her display of toy dinosaurs on the dresser)
  • has a very strong attachment to certain items (e.g., toys, keys, switches, hair bands, etc.)
  • likes watching objects that are moving (e.g., ceiling fan, wheels of a toy car, etc.) 
  • lines up items in a certain pattern or order (e.g., all the blue crayons must be grouped together)
  • difficulty multitasking due to adhering rigidly to tasks in the order they are given

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So what can parents do to help their HFA child learn flexibility? 

Below are some simple ideas that will get you started on this journey (hopefully, you will be able to generalize from these ideas, and then create your own based on your child’s unique needs):

1. Alter routines slightly. This helps your HFA child to learn to accept variation in his or her schedule (e.g., you can have your youngster work on his homework BEFORE dinner one day, then AFTER dinner the next day).

2. Give your youngster the “freedom of expression” (e.g., give her the ability to wear the clothes and items of her liking). Allow your child to express herself in the unique being that she is.

3. Illustrate that categories can change. Young people on the spectrum often put something in only one group, and are not be aware that it can also belong with another group (e.g., a yellow plastic bowl can be used for eating cereal in the kitchen, but it can also be put on the dining room table and used to hold candy, or it can be used as a container filled with soil to grow a small plant).

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism
 
4. Incorporate role playing and storytelling in everyday activities (e.g., while you are eating animal crackers, have your child pick a particular animal cracker, name that animal, eat the cracker, and then imitate that animal).

5. Maintain a variety of activities in a variety of environments (e.g., go to different public parks, at different times, on different days).

6. Offer a variety of creative avenues. For example, theatre activities (whether in-school or out-of-school) can be encouraged. Many local organizations for the arts can help parents find a place for their youngster in their programs. Even if the child is shy and does not feel comfortable acting in a play, the organization can always provide other services for the stage play (e.g., lighting, decorating, sound, costume, narrating, etc.).

7. Offer your child the ability to help provide the rules and regulations of the household, but also teach that there will be occasions when a particular “rule” can be disregarded temporarily (e.g., “no eating in the family room” may be an ongoing house rule – except when the family gets together to watch a movie and eat popcorn).

8. Prepare an indoor play area in a way that encourages diversity (e.g., play dough, small inexpensive musical instruments, books, blocks, crayons and paper, etc.).

9. Provide multiple opportunities for an assortment of activities outside as well (e.g., sand box, teeter totter, swing set, a fort, tree house, trampoline, etc.). The more “total-body movement” experiences your youngster can have – the better!

10. Teach your child how to review alternative ways of problem-solving by evaluating the problem, thinking of a variety of solutions, and then figuring out which is the best way to execute the solution (e.g., if your child’s friend refuses to share a particular toy, then give 3 or 4 alternative methods to solve this problem and have your youngster execute the one that appears to be the best choice).

While teaching kids the alphabet or how to count may be fairly straightforward, teaching them how to be more flexible in matters is often not as clear-cut. Fostering flexibility in HFA kids often involves a lot of creativity – and even some unconventional tactics – on the parent’s part.

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

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

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


BEST COMMENT: This is my daughter but her meltdowns are associated with getting new things and discarding old things. The smaller issues are with hoarding. She keeps kleenex boxes, Pringles can and cake icing containers. She puts them in totes with lids and organizes them in her bedroom. The large stuff she melts down over would be buying a new car, getting new furniture, rearranging or painting a room. Those types of changes will be hours long meltdowns. I would love to know how to teach her that life changes every day with and without her knowledge.

Cognitive and Behavioral Inflexibility in Kids on the Spectrum

“Why are transitions so difficult for my autistic child (high functioning)? It’s impossible to get him to stop what he’s doing at the time without a huge row. What are some strategies which can help when moving from one thing to the next?”

One frequently observed feature of High-Functioning Autism (HFA) and Asperger’s is inflexibility in thought and behavior. Inflexibility seems to pervade so many areas of the lives of children on the autism spectrum. Novel situations often produce anxiety.

These kids may be uncomfortable with change in general, which can result in behavior that may be viewed as oppositional and can lead to emotional meltdowns. This general inflexibility is what parents and teachers often label as “rebellion.”



There are two types of inflexibility:
  1. Cognitive inflexibility occurs when the child is unable to consider alternatives to the current situation, alternative viewpoints, or innovative solutions to a problem. The child with inflexible thinking tends to view things in “either-or” terms (e.g., things are either right or wrong, good or bad). He or she wants concrete, black and white answers. The “gray areas” of life are very uncomfortable (e.g., the child often has an exact way of doing things with no variations). 
  2. Behavioral inflexibility refers to a child’s difficulty maintaining appropriate behavior in new and unfamiliar situations. Flexibility enables children to shift effortlessly from task to task in the classroom, from topic to topic in conversation, from one role to another in games, etc.

Children with HFA may have many fears in addition to those related to unexpected changes in schedules. Large groups of people and busy/noisy environments (e.g., school hallways, cafeterias, playgrounds, bus stations, etc.) tend to overwhelm children with HFA. They may also be overwhelmed by unexpected academic challenge or by having too many things to remember or too many tasks to perform.

They often have limited frustration-tolerance and may display tantrums when thwarted. Routines and rules are very important to kids with HFA in providing a sense of needed order and structure, and thus, predictability about the world.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Another form or inflexibility is moralism, a kind of self-righteous and strict adherence to nonnegotiable moral principles that is often out of context with practical reality. An example may be a youngster who criticizes a parent who has run a yellow traffic light when the parent is on the way to the emergency room for treatment of a severe injury.

Inflexibility is also found in the rigidity over matters that are of little consequence, such as arguing about whether the route to the emergency room was the quickest when it might be the difference between a few hundred yards by choosing to take one turn over another. In the classroom, this may be found when an HFA student fixates on a perception that a teacher has not enforced a rule consistently. Such fixations on moral correctness can escalate and interfere with availability for instruction.

Reasons for Inflexibility—
  1. Transitioning from one activity to another. This is usually a problem because it may mean ending an activity before the HFA child is finished with it.
  2. The need to engage in - or continue - a preferred activity (usually an obsessive action or fantasy). 
  3. The need to control a situation. 
  4. The need to avoid or escape from a non-preferred activity (often something difficult or undesirable). Often, if the child can’t be perfect, she does not want to engage in the activity.
  5. Other internal issues (e.g., sensory, inattention (ADHD), oppositional tendency (ODD), or other psychiatric issues may also be causes of behavior. 
  6. Lack of knowledge about how something is done. By not knowing how the world works with regard to specific situations and events, the child will act inappropriately instead. 
  7. Immediate gratification of a need. 
  8. Anxiety about a current or upcoming event (no matter how trivial it may appear to the parent or teacher). 
  9. A violation of a rule or ritual (i.e., changing something from the way it is “supposed” to be). When someone violates a rule, this may be unacceptable to the HFA youngster. 
  10. A misunderstanding or misinterpretation of another's action.

Inflexibility is often the result of anxiety. The cause of anxiety in the HFA child has a lot to do with the fact that she does not have the ability to understand the world like “typical” kids do.

Because of the neuro-cognitive disorder, the child:
  • will have difficulty understanding rules of society
  • needs explicit instructions
  • does not understand social cues
  • does not understand implied directions
  • does not know how to “read between the lines”
  • does not “take in” what is going on around her

“Facts” are what kids with HFA learn and feel less anxious about. Since these “special needs” kids have a hard time with all the normal rules of society, having “rules” has a calming effect on them. They think, “This is the rule. I can handle it o.k.”

Facts also have to be from someone they think is an “expert” in their eyes. Teachers and doctors may have this leverage with them, but moms and dads are, for the most part, not considered “experts.”

Understanding what causes so much anxiety, tantrums, meltdowns, shutdowns, and out-of-control behavior helps parents to know where their HFA child is coming from, and with that, parents will be able to help their kids less stressed-out.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Parenting Strategies—

Here are some strategies for dealing with an inflexible-thinking youngster:

1. While helping your HFA child to deal with change, be prepared to weather the storm. There will be sadness, tears and tantrums – followed by parental guilt. It’s all part of the process. Remain calm, and accept your youngster for who and what she is.

2. Turn the “change” into an adventure. For example, turn “Are you ready to start a new school year” into “Wow, just think. You’ll get to see all your classmates again.” Since any change can seem frightening to children on the spectrum, the language you use can turn the change into a fun adventure. Changing the tone to one of excitement can make a world of difference in your child’s attitude.

3. Read articles and books about the change in question. Almost any change that your child is going through has been written about (e.g., new siblings, moving to a new neighborhood, starting a new school year, etc.). Go to the library and get as many books as you can on the topic and read together. Reading helps open the lines of communication to talk about the difficulties of the change that is coming.

4. Prepare your HFA youngster for what may happen – and be honest. Voice your plans in a reassuring tone. Explain to him in concrete terms where you will be going, or what may happen along the way, so that he is prepared well before and ready for the change. Also, answer your child’s questions, and tell him the truth (i.e., don’t sugar-coat the situation) so that trust develops. Many tantrums and meltdowns can be avoided, because you keep reminding him throughout the day of what’s going to happen. In this way, there are no unwanted surprises.

5. Many kids on the spectrum have difficulty with the concept of time. But, you can provide your child with simple strategies to measure time (e.g., use an alarm clock or kitchen timer for task transitions, clean up times, or evening rituals). Let your child place a calendar centrally, and help her keep track of important dates (e.g., birthdays, holidays, vacations, the first day of school, etc.). Signal your child verbally or set countdowns for when she must leave an activity that she is enjoying (e.g., “I’m going to turn off the computer in 10 minutes because we are getting close to lunch time”).





 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

6. Let your HFA youngster know of some changes in life YOU have undergone – and how you managed them. Your examples are a way of helping your child cope with change in the future. Relate to his situation. Tell stories about when you have had to weather the storms of change. Also, you can talk about what you might have done differently – something that could have facilitated a better outcome. Alternatively, you can talk about the changes within the other family members and how they changed with circumstances.

7. Kids on the autism spectrum love to follow a routine. Anything away from that worries them. They feel best when they are able to predict things. They feel safe when they know what is on the agenda for the day or what they have to do next. They want to know how other people are likely to behave or react, and what will happen from day to day. So, if you and your youngster are undergoing a significant period of change, try to keep most of his routine the same.

8. Help create sameness by repeating a similar “comfort phrase” (e.g., “Sometimes we have to change our plans, and we will be O.K. when that happens”). Use this exact phrase (or something similar) every time flexibility is needed. This helps to bring a sense of control and predictability during chaos. Your youngster will remember that you said that the last time a change was needed – and everything eventually turned out just fine.

9. Focus on just a few areas where flexibility is needed most. For example, if your youngster is constantly distressed when you’re out running errands, this is the place to start. If he is upset over having a babysitter, start there. If he won’t leave the grandparents’ house without a tantrum, focus on that issue.

10. Encourage your HFA youngster to explore and engage in new activities and interests. In this way, you help her cope with change that will come later in life. When she goes through various new experiences, it provides a fundamental base that strengthens her emotional muscles. It helps her feel good about herself and develops self-confidence.

11. Don’t unintentionally reward your youngster for acting-out due to an unwanted routine change. Uncontrolled anger warrants a predictable, swift consequence. Losing a particular privilege may be the best consequence for HFA children. Be firm. Don’t underestimate your youngster’s ability to manipulate you. Even severely autistic kids can be master manipulators.

12. Create behavior incentives using something that is the same each time (e.g., tokens, tickets, stickers, etc.). Let the sameness of the identical token be the familiar thing during the unfamiliar situation. You can also use marbles dropped into a jar (the smooth texture and “clicks” when they drop is satisfying to most autistic kids). For example, explain to your youngster, “When we leave the park today, if you don’t cry, you’ll get a marble to put in the jar when we get home.” Let her cash in the marbles for a reward at the end of the day.

13. Change itself can come quickly or slowly, but adjusting to the new state of affairs takes time. Make sure you give your youngster – and yourself – the luxury of having time to adjust. Try not to expect too much too soon. Some changes are easy to adjust to, others aren’t. Some HFA children adapt quickly to change, some don’t. As the parent, simply keep doing what you are doing, and know that most changes eventually leave everyone in better places than where they began.

14. Attempt to see things from your child’s point of view. Ask her how she perceives a particular change. A child who airs her misgivings about unwanted changes is more likely to cope better. Talk about the details of what will happen, where she will be, and what she will have to do. Doing so repeatedly helps your child feel prepared.

15. Lastly, always demonstrate love and appreciation when your child “tries” to accept a new situation with courage – even if he is unsuccessful. In other words, be sure to reward “effort” with acknowledgment and praise, regardless of whether or not the desired outcome occurred.

Treatment—

An effective treatment program for inflexibility and “insistence on sameness” actively engages the HFA youngster’s attention in highly structured activities, builds on his interests, offers a predictable schedule, provides regular reinforcement of behavior, and teaches tasks as a series of simple steps. This type of program generally includes the following:
  • specialized speech/language therapy to help kids who have trouble with the pragmatics of speech (i.e., the give-and-take of normal conversation)
  • social skills training, a form of group therapy that teaches HFA kids the skills they need to interact more successfully with their peers
  • parent-training and support to teach moms and dads behavioral techniques to use at home
  • occupational or physical therapy for kids with sensory integration problems or poor motor coordination
  • medication for co-existing conditions (e.g., depression and anxiety)
  • cognitive behavioral therapy, a type of “talk” therapy that can help the more explosive or anxious kids on the spectrum to manage their emotions better and cut back on obsessive interests and repetitive routines

In summary, due to the fact that change causes anxiety in young people with HFA, they will want to live by inflexible rules that they construct for themselves. One of their main rules goes something like this:  “My routine must NOT be disrupted, and involves X, Y and Z. Each time I can do X, Y and Z – in that order – my life has some predictability. When I don’t have this predictability, I feel anxious, which is a very painful emotion that needs to be avoided at all costs!”


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

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

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

Six Symptom Clusters of ASD [level 1] that May Warrant Medication

"We have generally been against trying medication, even to treat the worst symptoms of our autistic child, but is there a point at which the advantages of some form of drug treatment outweigh the disadvantages?"

To answer this question, we will need to look at six clusters of symptoms. They are a convenient way of talking about drug treatments for the common kinds of behaviors that hinder the lives of children and teens who have Asperger’s (AS) and High-Functioning Autism (HFA).

These clusters are not comprehensive, but were chosen because they are common reasons to seek drug treatment for HFA:

1. Inflexibility and Behavioral Rigidity: Symptoms of inflexibility or behavioral rigidity are often difficult to quantify, and yet often introduce some of the most disruptive chronic behaviors exhibited by children with HFA. These can be manifest by minor differences in the environment (e.g., changes in location for certain activities), difficulties tolerating changes in routine, and changes to plans that have been previously laid out.

For some of these “special needs” kids, this inflexibility can lead to aggression, or to extremes of frustration and anxiety that thwart activities. Parents may find themselves “walking on eggshells” in an effort to circumvent any extreme reaction from their “fragile” child. Also, theHFA child himself may articulate his anxiety over fears that things will not go according to plan, or that he will be forced to make changes that he can’t handle. Sometimes these behaviors are identified as “obsessive-compulsive” because of the child’s need for ritualized order or nonfunctional routine.



It is not known whether these symptoms are produced by disturbances in the same cortico-striatal-thalamo-cortical circuitry that is believed to produce OCD. However, the model of obsessive-compulsive disorder has suggested that use of SRI agents can be useful in ameliorating this problem. Whether the effect of SRI medications on this symptom cluster is mediated by a general reduction in anxiety, or is specific for “needs for sameness” is not known. Reports from studies of alpha-adrenergic medications (e.g., clonidine, guanfacine) also suggest a decrease in these rigid behaviors.

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism

2. Stereotypies and Perseveration: Stereotyped movements and repetitive behaviors are a common feature of HFA. As with behavioral rigidity and inflexibility, similar models for stereotypy and obsessive-compulsive disorder have been proposed. Stereotypy also may be closely related to tic disorders in which repetitive behaviors emerge from impairment in dopaminergic and glutamaturgic systems.

The treatments for stereotyped movements and perseveration closely parallel those for behavioral inflexibility, and the two clusters are often grouped together in studies of treatment effectiveness. Thus, serotonin reuptake inhibitors and alpha-adrenergic agonists may be helpful. Also, the hypothesis that dopamine may play a role suggests that dopaminergic blocking agents should be added to the possibilities. Reports from studies of olanzapine, risperidone, and ziprasidone suggest this is warranted.

3. Hyperactivity and Inattention: Hyperactivity and inattention are common in HFA kids, particularly in early childhood. Differential diagnostic considerations are vital, particularly in the context of AS and HFA. Hyperactivity and inattention are seen in a variety of other disorders (e.g., developmental receptive language disorders, anxiety, and depression). Therefore, the appearance of inattention or hyperactivity does not point exclusively to ADHD. The compatibility of the child and her school curriculum is particularly important when evaluating symptoms of hyperactivity and inattention. There is a risk that a school program that is poorly matched to the child's needs (e.g., by over-estimating or under-estimating her abilities) may be frustrating, boring, or unrewarding. If the verbal or social demands exceed what she can manage, they may produce anxiety or other problems that mimic inattention or induce hyperactivity.

Virtually every variety of medication has been tried to reduce hyperactive behavior and increase attention. The best evidence at this point supports dopamine blocking agents, stimulants, alpha-adrenergic agonists, and naltrexone.

4. Anxiety: Young people with HFA are particularly vulnerable to anxiety. This vulnerability may be an intrinsic feature of ASD through a breakdown in circuitry related to extinguishing fear responses, a secondary consequence of their inability to make social judgments, or specific neurotransmitter system defects.

The social limitations of HFA make it difficult for these “special needs” children to develop coping strategies for soothing themselves and containing difficult emotions. Limitations in their ability to grasp social cues and their highly rigid style act in concert to create repeated social errors. They are frequently victimized and teased by their peers and can’t mount effective socially adaptive responses.

Limitations in generalizing from one situation to another also contributes to repeating the same social mistakes. In addition, the lack of empathy severely limits skills for autonomous social problem-solving. For higher functioning kids on the autism spectrum, there is sufficient grasp of situations to recognize that others “get it” when they do not. For others, there is only the discomfort that comes from somatic responses that are disconnected from events and experience.

Several agents have been tried for treatment of anxiety. There is no reason to suspect that children with autism are less likely to respond to the medications used for anxiety in children without autism. Therefore, SRIs, buspirone, and alpha-adrenergic agonist medications (e.g., clonidine, guanfacine) all have been tried. The best evidence to date supports use of selective serotonin reuptake inhibitors. (Note: Kids with HFA may be more vulnerable to side effects and to exhibit unusual side effects.)

5. Depression: Depression seems to be common among teens and young adults with HFA. Many of the same deficits that produce anxiety may conspire to generate depression. There is also good evidence that serotonin functions may be impaired in young people with autism. The basic circuitry related to frontal lobe functions in depression may be affected. In addition, deficits in social relationships and responses that permit one to compensate for disappointment and frustration may fuel a vulnerability to depression. 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 stress.

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism

The medications that are useful for depression in “typical” kids and teens should be considered for those with HFA who display symptoms of depression. Since some features of depression and autism 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 child with HFA should not be considered a symptom of depression unless there is an acute decline from that child's baseline level of functioning.

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

Children and teens on the autism spectrum who display affective and vocal monotony are at higher risk for having their remarks minimized. They 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. In young people with HFA, the content of such comments may be more crucial than the emotional emphasis with which they are delivered.

Drugs that are useful for treatment of depression in children with HFA are serotonin reuptake inhibitors. There also may be indications for considering tricyclic agents with appropriate monitoring of ECG, pulse, and blood pressure. There are no medications that have been shown to be particularly more beneficial for depressive symptoms in children on the spectrum. Therefore, the decision as to which ones to use is determined by side effect profiles, previous experience, and responses to these medications in other family members.




6. Aggression: Aggression is seldom an isolated problem and is particularly complex in children with AS and HFA. It is important to understand that aggressive behavior is not always associated with just one condition and can have highly varied sources. An array of theoretic models has been proposed to understand aggressive behavior in kids on the spectrum. There are promising biologic models that suggest the behavior arises from alterations in dopaminergic reward mechanisms, and cognitive models suggesting that such acts are an outcome of conditioned learning. Tantrums and physical aggression are often responses to a variety of circumstances and occur in the context of diverse emotions.

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism

It is useful to know the circumstances preceding and following aggressive outbursts before selecting a particular medication. For instance, when aggression is a response to anxiety or frustration, the most helpful interventions target those symptoms and the circumstances that produce them rather than exclusively focusing on aggressive behavior.

Unfortunately, the request for drug treatment typically follows a crisis, and the press for a rapid, effective end to the behavior problems may not permit the gathering of much data or discussion. Nonetheless, it is NOT appropriate to “always” begin with one agent or another. Moving to a more “reliable” medication too quickly may mean that the child takes on cardiovascular, endocrinologic, and/or cognitive risks that may be otherwise avoided.

There are reports in support of using serotonin reuptake inhibitors, alpha-adrenergic agonists, beta-blocking agents, mood stabilizers, and neuroleptics for aggressive behavior. When a doctor has the luxury of time, the support of family, and collaboration with staff where the child is attending school, then a drug that is safer, but perhaps takes a longer time to work or is a little less likely to help, can be tried.

In addition to cognitive and behavioral interventions, many children and teens on the autism spectrum are helped by medications (e.g., selective serotonin reuptake inhibitors, antipsychotics, stimulants, etc.) to treat the associated problems listed above. Experts agree that the earlier interventions are started, the better the outcome. With increased self-awareness and therapy, most kids and teens learn to cope with the challenges of AS and HFA.

 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

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Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

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Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

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Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

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Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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to read the full article...

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Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

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Raising Aspergers Children: Symptoms and Parenting Strategies

Aspergers (high functioning autism) is a developmental disorder falling within the autistic spectrum affecting two-way social interaction, verbal and nonverbal communication and a reluctance to accept change, inflexibility of thought and to have all absorbing narrow areas of interest. Individuals are usually extremely good on rote memory skills (facts, figures, dates, times etc.) many excel in math and science. There is a range of severity of symptoms within the syndrome, the very mildly affected youngster often goes undiagnosed and may just appear odd or eccentric.

While Aspergers is much more common than Autism it is still a rare condition and few people, including professionals, will know about it much less have experience of it. It seems to affect more boys than girls. In general terms they find making friends difficult, not understanding the subtle clues needed to do so. They often use language in a slightly odd way and take literal meanings from what is read or heard. They are happiest with routines and a structured environment, finding it difficult to decide what to do they fall back on to their preferred activities. They love praise, winning and being first, but find loosing, imperfection and criticism very difficult to take. Bad behavior often stems from an inability to communicate their frustrations and anxieties. They need love, tenderness, care, patience and understanding. Within this framework they seem to flourish.

Kids with Aspergers are for the most part bright, happy and loving kids. If we can help break through to their 'own little world' we can help them to cope a little better in society. They have a need to finish tasks they have started. Strategies can be developed to reduce the stress they experience at such times. Warnings that an activity is to finish in x minutes can help with older kids. With younger kids attempts to 'save' the task help - videoing a program, mark in a book etc.

As the kids mature some problems will get easier, but like all other kids new problems will emerge. Some teenagers can feel the lack of friendships difficult to cope with as they try hard to make friends in their own way but find it hard to keep them. This is not always the case, many have friends who act as 'buddies' for long periods of time. Social skills will have to be taught in an effort for them to find a place in the world ... so take all opportunities to explain situations time and time again ..... and one day.......it may work!

Please bear in mind that booklets such as this do tend to detail all the problems which can be found within a syndrome but that does not mean every youngster will have all of them. Each youngster will also have different levels of achievements and difficulties. They are after all just as the others ... individuals!

Is Aspergers The Same As Autism?

The debate on this question still continues, some experts say that Aspergers should be classified separately, others argue that the core difficulties are the same, only the degree to which they are seen in the kids actually makes the difference. One expert - Uta Frith - has referred to Aspergers kids as 'Having a dash of Autism'.

Autism is often interpreted as a withdrawal from normal life - to live in the persons own fantasy world. This is no longer the real meaning of Autism. The severity of the impairments is much greater than in Aspergers, and often the youngster will have little or no language. Learning problems are more common in classic Autism. In Aspergers speech is usual and intelligence (cognitive ability) is usually average or even above average.

For the moment it is taken that the similarities are enough for both Autism and Aspergers to be considered within the same 'spectrum' of developmental disorders. Whilst a clear diagnosis is essential, it can change through life. The autistic traits seen in young kids can often seem less severe as the youngster matures and learns strategies to cope with his/her difficulties.

Key Features—

The main areas affected by Aspergers are:

• Communication
• Narrow Interests / Preoccupation's
• Repetitive routines / rituals, inflexibility
• Social interaction

Social Interaction—

Kids with Aspergers have poor social skills. They cannot read the social cues and, therefore, they don't give the right social and emotional responses. They can lack the desire to share information and experiences with others. These problems are less noticeable with moms and dads and adults, but it leads to an inability to make age appropriate friends. This in turn can lead to frustration and subsequent behavior problems. They find the world a confusing place. They are often alone, some are happy like this, others are not. They are more noticeably different among peer groups in unstructured settings i.e. playgrounds. Their naiveté can cause them to be bullied and teased unless care is taken by assistants or buddies to integrate and help protect them. They can often focus on small details and fail to see the overall picture of what is happening in any situation.

Communication—

Both verbal and nonverbal communications pose problems. Spoken language is often not entirely understood, so it should be kept simple, to a level they can understand. Take care to be precise. Metaphor s (non-literal expressions - 'food for thought') and similes (figures of speech - 'as fit as a fiddle') have to be explained as kids with Aspergers tend to make literal and concrete interpretations. Language acquisition - learning to speak - in some cases can be delayed. They make much use of phrases they have memorized, although they may not be used in the right context. A certain amount of translation may be needed in order to understand what they are trying to say.

Spoken language can sometimes be odd, perhaps they don't have the local accent or they are too loud for a situation or overly formal or speak in a monotonous tone. If the youngster with Aspergers has a good level of spoken language you must not assume their understanding is at the same level. Some talk incessantly (hyper verbal) often on a topic of interest only to themselves without knowing the boredom of the listener.

Difficulties in using the right words or forming conversations are part of semantic-pragmatic difficulties. They appear often to talk 'at' rather than 'to' you, giving information rather that holding proper conversations. Body language and facial expressions of a youngster with Aspergers can appear odd (stiff eye gaze rather than eye contact) and find 'reading' these things in others gives rise to further difficulties. Early age is known as Hyperlexia. Some kids have remarkable reading abilities although you should check if they also understand the text. The ability to read fluently without understanding the meaning is known as Hyperlexia.

Narrow Interests / Pre-occupations—

One of the hallmarks of Aspergers is the youngster's preoccupation (or obsession) with certain topics, often on themes of transport - trains in particular-or computers, dinosaurs, maps etc. These pre-occupations, usually in intellectual areas change over time but not in intensity, and maybe pursued to the exclusion of other activities.

Repetitive Routines / Inflexibility—

Kids often impose rigid routine on themselves and those around them, from how they want things done, to what they will eat etc. It can be very frustrating for all concerned. Routines will change from time to time, as they mature they are perhaps a little easier to reason with. This inflexibility shows itself in other ways too, giving rise to difficulties with imaginative and creative thinking. The youngster tends to like the same old thing done in the same old way over and over again!. They often can't see the point of a story or the connection between starting a task and what will be the result. They usually excel at rote memory - learning information without understanding, but it can still be an asset. Attempts should always be made to explain everything in a way they can understand. Don't assume because they parrot information back that they know what they are talking about.

Education—

If the youngster with Aspergers is to be educated in a mainstream school it is important that the correct amount of support is made available. In order to get the correct support a Statement of Special Educational Needs should be drawn up from the various advice supplied by you and the specialists. This procedure, when it begins, can take 6 months and be a very stressful and confusing time - don't be afraid to contact people who can help, this need not be a professional it may just be someone who has done it all before.

It is beneficial if the school of your choice is willing to learn about the difficulties that they and the youngster will face, some schools are better than other on this score. Looking at several schools will give a better picture of exactly what is available. The support currently offered in mainstream school is by Special Support Assistants (SSA) for a certain number of hours each week based on the youngster's needs in order to help the youngster access the curriculum and develop in a social setting. A support teacher with specialist knowledge of Autism should support the youngster, SSA, teacher and school in understanding and teaching the youngster. Other professional input may also be required such as speech and language therapy to help develop skills.

The home/school link is vital, a diary can prove invaluable giving two way communication on achievements and problems on a regular basis.

Parenting Strategies—

Parenting your youngster with symptoms of Aspergers can be a daunting task. You may have just discovered that your youngster has a diagnosis of AS and you are thinking “What now?” Or you may have a youngster who you know is different and/or a health professional has said that he or she has some attributes of Aspergers or Mild Aspergers but is still considered in the normal range. You are probably feeling a little overwhelmed and it might seem like you are the only person or family going through these issues. We know because that’s exactly how we felt.

Like you, we are moms and dads who would like nothing more than for all of our kids to reach their maximum potential. Because they only match some of the assessment criteria needed for an Aspergers diagnosis, we have had to find help for our kids ourselves. And we have found this help in some of the most unexpected places. This makes us uniquely positioned to show you how to get help from a variety of sources for your “normal” youngster or kids.

I wonder, do your youngster’s specific behavioral problems seem worse after lunch or a party? He or she may be intolerant to certain types of food. We can give you information about food intolerances and share with you our expertise of what we have learned. While there is not much scientific evidence that foods affect AS, we can show you information that you may want to look into.

Have you noticed that your youngster doesn’t like loud noises, bright lights, tight or loose fitting clothes and reacts inappropriately to any of these particular things? Does your youngster crave fast movement or are they almost impossible to get moving in the morning? The good news is there is an answer. They may have Sensory Integration Disorder (SID). There is growing evidence that links SID and Aspergers. Sensory Integration Disorder is easily manageable with techniques you can learn and do at home.

Do you find routines hard to establish and maintain? Using Visual Aids for your Aspergers youngster might just benefit you and your youngster as it has benefited us.

Moving Forward—

All this might seem a little daunting at the moment. However, with experience and help, including ours, you can teach your youngster to rule their Aspergers rather than have their Aspergers rule them.

On the pages of this site, you will find reference to many useful books and resources that help us and our kids cope with life. The books include those on AS as well as Sensory Integration and Food intolerances. You will also find information and links to other sites that provide information on other disorders related to Aspergers.

There are many things you can do to help your youngster better understand the world and in doing so make everyone's lives a little easier. The ideas below are only suggestions which you may or may not find helpful:
  • Begin early to teach the difference between private and public places and actions, so that they can develop ways of coping with more complex social rules later in life.
  • Don't always expect them to 'act their age' they are usually immature and you should make some allowances for this.
  • Explain why they should look at you when you speak to them.... encourage them, give lots of praise for any achievement - especially when they use a social skill without prompting.
  • Find a way of coping with behavior problems - perhaps trying to ignore it if it's not too bad or hugging sometimes can help.
  • In some young kids who appear not to listen - the act of 'singing' your words can have a beneficial effect.
  • Keep all your speech simple - to a level they understand.
  • Keep instructions simple ... for complicated jobs use lists or pictures.
  • Let them know that you love them - wart's an' all' - and that you are proud of them. It can be very easy with a youngster who rarely speaks not to tell them all the things you feel inside.
  • Limit any choices to two or three items.
  • Limit their 'special interest' time to set amounts of time each day if you can.
  • Pre-warn them of any changes, and give warning prompts if you want them to finish a task... 'when you have colored that in we are going shopping'.
  • Promises and threats you make will have to be kept - so try not to make them too lightly.
  • Teach them some strategies for coping - telling people who are teasing perhaps to 'go away' or to breathe deeply and count to 20 if they feel the urge to cry in public.
  • Try to build in some flexibility in their routine, if they learn early that things do change and often without warning - it can help.
  • Try to get confirmation that they understand what you are talking about/or asking - don't rely on a stock yes or no - that they like to answer with.
  • Try to identify stress triggers - avoid them if possible -be ready to distract with some alternative 'come and see this...' etc.
  • Use turn taking activities as much as possible, not only in games but at home too.

Remember, they are kids just like the rest, they have their own personalities, abilities, likes and dislikes - they just need extra support, patience and understanding from everyone around them.


Children with Aspergers: Tips for Teachers and Parents

Children with Aspergers are unique, and they can affect the learning environment in both positive and negative ways. In the classroom, the Aspergers child can present a challenge for the most experienced teacher. These children can also contribute a lot to the classroom because they can be extremely creative and see things and execute various tasks in different ways. Teachers can learn a lot when they have a child with Aspergers in their class, but the teacher may experience some very challenging days too.

Here are some tips for teachers and parents to consider:

Aspergers children and showing work: Many teachers require children to "show their work"; in other words, illustrate how they got the answer to a problem."Showing work" is a demand that usually accompanies math homework. This may not be the best strategy with the Aspergers child, and may in fact lead to a big disagreement with the child. Since many Aspergers children are visual learners, they picture how to solve the problem in their heads. To make them write out how they got they answer seems quite illogical to them. Why would you waste your time writing out something you can see in your head? The requirement of "showing work" simply does not make any sense to them, and it may not be worth the time it would take to convince them to do the requirement anyway.

Aspergers children frequently are visual learners. Despite difficulties with eye contact, many Aspergers children are visual learners. Much of the information presented in classrooms is oral, and often children with Aspergers may have difficulty with processing language. Often they cannot take in oral language quickly, and presenting information visually may be more helpful. Many Aspergers children are "hands-on" learners.

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

Don't assume the child with Aspergers is disrupting class or misbehaving to get attention. More often than not, children with Aspergers react to their environment, and sometimes the reaction can be negative. Sometimes the child may be reacting to a sensory issue, and other times the child may be reacting to a feeling of fear. The Aspergers child feels fear because of a lack of control over his/her response to the environment or because of a lack of predictability. The child with Aspergers does best with clear structure and routine. A visual schedule can be helpful for the child.

Every youngster with Aspergers is different. As a teacher you want to take the information you have acquired and apply it, but every Aspergers child is different, so it's difficult to take knowledge you have gained from one experience, and apply it to a situation with another child with Aspergers. Remember that each youngster with Aspergers is unique, and strategies that have worked with other children in the past may not work effectively with the Aspergers child because they perceive the world in a unique way, and they sometimes react to their environment in unpredictable ways.

If the child with Aspergers is staring off into space or doodling, don't assume they're not listening. Remember the Aspergers child may experience difficulty with communication, especially nonverbal communication. What appears to the teacher to be behavior illustrating a lack of attention on the part of the child may not be that at all. In fact, the Aspergers child who is doodling or staring off may actually be trying to focus him or herself through the act of doodling or staring. The child is unaware that nonverbally s/he is communicating to the teacher that "I'm not listening, or I'm bored." Doodling or staring may actually help the child with Aspergers focus more on what the teacher is presenting. You might simply ask the child a question to check if he or she is listening.

Sensory issues affect learning for the child with Aspergers. Often Aspergers children are distracted by something in the environment that they simply cannot control. To them, the ticking of the clock can seem like the beating of a drum, the breeze from an open window can feel like a tremendous gust, the smell of food from the cafeteria can overpower them and make them feel sick, the bright sunshine pouring through the windows may be almost blinding to them. This sensory overload the Aspergers child experiences may overwhelm them, so focusing can be difficult and frustration occurs. Frustration can then lead to disruptions from the child. To cope with frustration the child might choose to repeatedly tap a pencil on a desk (or another disruptive behavior) to focus themselves because s/he is experiencing sensory overload. What appears disruptive to the teacher and the rest of the class may actually be a way for the Aspergers child to cope with the sensory overload. Obviously, a teacher does not want disruptions in the classroom. Take time to evaluate the classroom in terms of sensory stimulation, and how the environment affects the child with Aspergers. Perhaps some modifications can be made, or the child can be taught some coping skills that are not disruptive to classmates, like squeezing a squishy ball in their hand or some similar activity.

Children with Aspergers experience difficulty with transitions. Often a child with Aspergers gets "stuck" and has difficulty moving from one activity to another. They may need to be coached through the transition, and if a typical school day is loaded with lots of transitions, the child faces increased anxiety. Moving from one activity to another is not a challenge for most children, but for the child with Aspergers transitions can be monumental tasks. Some possible strategies a teacher, paraprofessional, or parent can use: visual schedules, role-playing or preparing the child by discussing upcoming activities. Appropriate strategies are dependent on the age of the child and his/her abilities.

Children with Aspergers may experience difficulties with focusing as well as lack of focus. Focus involves attention. Sometimes Aspergers children focus all their attention on a particular object or subject; therefore, they fail to focus on what information the instructor is presenting. All their energy is directed toward a particular subject or object. Why? Because that object or subject is not overwhelming to them and they understand it. To overcome this problem, the teacher can try to establish some connection between the object or subject of interest and the area of study. For example, if a child is fascinated with skateboarding, the child could learn reading and writing skills through researching a famous skateboarder and writing a report. Math skills could be taught by looking at the statistics involving competitive skateboarders. The possibilities for instruction are endless, but it will take some time and creative planning on the part of the teacher.

As a teacher, paraprofessional or parent of a youngster with Aspergers, it's important to recognize the youngster's gifts as well as limitations. Children with Aspergers present a challenge for the people who work with them, but these kids also enrich our lives. So when you're feeling frazzled, take a deep breath and remember that tomorrow is another day. This youngster will grow up and make a contribution to our world in some way we can only imagine, and you can help this youngster.

My Aspergers Child: Preventing Meltdowns and Tantrums at Home and School

Parenting Aspergers Children: Helpful Strategies


Aspergers is a developmental disorder falling within the autistic spectrum affecting two-way social interaction, verbal and nonverbal communication and a reluctance to accept change, inflexibility of thought and to have all absorbing narrow areas of interest.


Individuals are usually extremely good on rote memory skills (facts, figures, dates, times etc.) many excel in math and science. There is a range of severity of symptoms within the syndrome, the very mildly affected youngster often goes undiagnosed and may just appear odd or eccentric.

While Aspergers is much more common than Autism it is still a rare condition and few individuals, including professionals, will know about it much less have experience of it. It seems to affect more boys than girls. In general terms they find making friends difficult, not understanding the subtle clues needed to do so. They often use language in a slightly odd way and take literal meanings from what is read or heard. They are happiest with routines and a structured environment, finding it difficult to decide what to do they fall back on to their preferred activities. They love praise, winning and being first, but find loosing, imperfection and criticism very difficult to take. Bad behavior often stems from an inability to communicate their frustrations and anxieties. They need love and tenderness, care, patience and understanding. Within this framework they seem to flourish.

Kids with Aspergers are for the most part bright, happy and loving kids. If we can help break through to their 'own little world' we can help them to cope a little better in society. They have a need to finish tasks they have started. Strategies can be developed to reduce the stress they experience at such times. Warnings that an activity is to finish in x minutes can help with older kids. With younger kids attempts to 'save' the task help - videoing a program, mark in a book etc.

As the kids mature some problems will get easier, but like all other kids new problems will emerge. Some teenagers can feel the lack of friendships difficult to cope with as they try hard to make friends in their own way but find it hard to keep them. This is not always the case; many have friends who act as 'buddies' for long periods of time. Social skills will have to be taught in an effort for them to find a place in the world ... so take all opportunities to explain situations time and time again ..... and one day.......it may work!

Please bear in mind that booklets such as this do tend to detail all the problems which can be found within a syndrome but that does not mean every youngster will have all of them. Each youngster will also have different levels of achievements and difficulties. They are after all just as the others ... individuals!

Is Aspergers The Same As Autism?

The debate on this question still continues, some experts say that Aspergers should be classified separately; others argue that the core difficulties are the same, only the degree to which they are seen in the kids actually makes the difference. One expert - Uta Frith - has referred to Aspergers kids as 'Having a dash of Autism'.

Autism is often interpreted as a withdrawal from normal life - to live in the persons own fantasy world. This is no longer the real meaning of Autism. The severity of the impairments is much greater than in Aspergers, and often the youngster will have little or no language. Learning problems are more common in classic Autism. In Aspergers speech is usual and intelligence (cognitive ability) is usually average or even above average.

For the moment it is taken that the similarities are enough for both Autism and Aspergers to be considered within the same 'spectrum' of developmental disorders. While a clear diagnosis is essential, it can change through life. The autistic traits seen in young kids can often seem less severe as the youngster matures and learns strategies to cope with his/her difficulties.

Key Features—

The main areas affected by Aspergers are:

• Communication
• Narrow Interests / Preoccupation's
• Repetitive routines / rituals, inflexibility
• Social interaction

Social Interaction—

Kids with Aspergers have poor social skills. They cannot read the social cues and, therefore, they don't give the right social and emotional responses. They can lack the desire to share information and experiences with others. These problems are less noticeable with moms and dads and adults, but it leads to an inability to make age appropriate friends. This in turn can lead to frustration and subsequent behavior problems. They find the world a confusing place. They are often alone, some are happy like this, others are not. They are more noticeably different among peer groups in unstructured settings i.e. playgrounds. Their naiveté can cause them to be bullied and teased unless care is taken by assistants or buddies to integrate and help protect them. They can often focus on small details and fail to see the overall picture of what is happening in any situation.

Communication—

Both verbal and nonverbal communications pose problems. Spoken language is often not entirely understood, so it should be kept simple, to a level they can understand. Take care to be precise. Metaphor s (non-literal expressions - 'food for thought') and similes (figures of speech - 'as fit as a fiddle') have to be explained as kids with Aspergers tend to make literal and concrete interpretations. Language acquisition - learning to speak - in some cases can be delayed. They make much use of phrases they have memorized, although they may not be used in the right context. A certain amount of translation may be needed in order to understand what they are trying to say.

Spoken language can sometimes be odd, perhaps they don't have the local accent or they are too loud for a situation or overly formal or speak in a monotonous tone. If the youngster with Aspergers has a good level of spoken language you must not assume their understanding is at the same level. Some talk incessantly (hyper verbal) often on a topic of interest only to themselves without knowing the boredom of the listener.

Difficulties in using the right words or forming conversations are part of semantic-pragmatic difficulties. They appear often to talk 'at' rather than 'to' you, giving information rather that holding proper conversations. Body language and facial expressions of a youngster with Aspergers can appear odd (stiff eye gaze rather than eye contact) and find 'reading' these things in others gives rise to further difficulties. Early age is known as Hyperlexia. Some kids have remarkable reading abilities although you should check if they also understand the text. The ability to read fluently without understanding the meaning is known as Hyperlexia.

Narrow Interests / Preoccupations—

One of the hallmarks of Aspergers is the youngster's preoccupation (or obsession) with certain topics, often on themes of transport - trains in particular-or computers, dinosaurs, maps etc. These pre-occupations, usually in intellectual areas change over time but not in intensity, and maybe pursued to the exclusion of other activities.

Repetitive Routines / Inflexibility—

Kids often impose rigid routine on themselves and those around them, from how they want things done, to what they will eat etc. It can be very frustrating for all concerned. Routines will change from time to time, as they mature they are perhaps a little easier to reason with. This inflexibility shows itself in other ways too, giving rise to difficulties with imaginative and creative thinking. The youngster tends to like the same old thing done in the same old way over and over again! They often can't see the point of a story or the connection between starting a task and what will be the result. They usually excel at rote memory - learning information without understanding, but it can still be an asset. Attempts should always be made to explain everything in a way they can understand. Don't assume because they parrot information back that they know what they are talking about.

Education—

If the youngster with Aspergers is to be educated in a mainstream school it is important that the correct amount of support is made available. In order to get the correct support a Statement of Special Educational Needs should be drawn up from the various advice supplied by you and the specialists. This procedure, when it begins, can take 6 months and be a very stressful and confusing time - don't be afraid to contact individuals who can help, this need not be a professional it may just be someone who has done it all before.

It is beneficial if the school of your choice is willing to learn about the difficulties that they and the youngster will face, some schools are better than other on this score. Looking at several schools will give a better picture of exactly what is available. The support currently offered in mainstream school is by Special Support Assistants (SSA) for a certain number of hours each week based on the youngster's needs in order to help the youngster access the curriculum and develop in a social setting. A support teacher with specialist knowledge of Autism should support the youngster, SSA, teacher and school in understanding and teaching the youngster. Other professional input may also be required such as speech and language therapy to help develop skills.

The home/school link is vital; a diary can prove invaluable giving two way communication on achievements and problems on a regular basis.

Helpful Strategies—

There are many things you can do to help your youngster better understand the world and in doing so make everyone's lives a little easier.

The ideas below are only suggestions which you may or may not find helpful:

• Begin early to teach the difference between private and public places and actions, so that they can develop ways of coping with more complex social rules later in life.
• Don't always expect them to 'act their age' they are usually immature and you should make some allowances for this.
• Explain why they should look at you when you speak to them.... encourage them; give lots of praise for any achievement - especially when they use a social skill without prompting.
• Find a way of coping with behavior problems - perhaps trying to ignore it if it's not too bad or hugging sometimes can help.
• In some young kids who appear not to listen - the act of 'singing' your words can have a beneficial effect.
• Keep all your speech simple - to a level they understand.
• Keep instructions simple ... for complicated jobs use lists or pictures.
• Let them know that you love them - wart's an' all' - and that you are proud of them. It can be very easy with a youngster who rarely speaks not to tell them all the things you feel inside.
• Limit any choices to two or three items.
• Limit their 'special interest' time to set amounts of time each day if you can.
• Pre-warn them of any changes, and give warning prompts if you want them to finish a task... “When you have colored that in we are going shopping.”
• Promises and threats you make will have to be kept - so try not to make them too lightly.
• Teach them some strategies for coping - telling individuals who are teasing perhaps to 'go away' or to breathe deeply and count to 20 if they feel the urge to cry in public.
• Try to build in some flexibility in their routine, if they learn early that things do change and often without warning - it can help.
• Try to get confirmation that they understand what you are talking about/or asking - don't rely on a stock yes or no - that they like to answer with.
• Try to identify stress triggers - avoid them if possible -be ready to distract with some alternative 'come and see this...' etc.
• Use turn taking activities as much as possible, not only in games but at home too.

Remember, they are kids just like the rest, they have their own personalities, abilities, likes and dislikes - they just need extra support, patience and understanding from everyone around them.


==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

Asperger's Syndrome: Social and Emotional Difficulties

Hyperactivity—

There has recently been considerable interest and research into the possible connection between autism spectrum disorders and Attention Deficit Hyperactivity Disorder (ADHD). This interest includes both the similarities in symptoms as well as genetics. Hyperactivity, inattentiveness and impulsivity can be present in a number of childhood onset disorders, including ADHD as well as autism spectrum disorders. Kids with Attention Deficit Disorder (ADD) are often considered as having some characteristics indicative of Aspergers. Although they are two distinct disorders, they are not mutually exclusive and a youngster could have both conditions.

One nine year old boy with Aspergers, Jake, displayed severe symptoms of hyperactivity. He could barely contain himself when in his therapist's office, preferring to remove all the books from her bookshelf and trying to race down the hallways.

Another possibility is that of misdiagnosis. Some kids originally diagnosed with ADHD have later been re-diagnosed with a diagnosis on the autistic spectrum.

Perhaps the central feature of Aspergers is the unusual profile of social and emotional behavior... with ADHD, the kids tend to know how to play and want to play, but do so badly... kids with ADD have a diverse range of linguistic skills and interests, while there is a distinct language and interests profile for those with Aspergers. Their interests tend to be idiosyncratic and solitary, in contrast to those kids with ADD whose interests are more likely to be conventional for kids of that age. Kids with both conditions prefer and respond well to routines and predictability, can experience sensory sensitivity and have problems with motor coordination... Both conditions can be associated with impulsivity but this feature tends to be less of an issue with Aspergers... The youngster with ADD has a propensity to have problems with organization skills... With Aspergers, the profile includes unusual aspects of organizational skills such as unconventional means of solving problems and inflexibility.

Obsessive-Compulsive Traits—

Inflexibility regarding routines and rituals is a very common characteristic of people with autism and Aspergers. In Leo Kanner's writings about autism in 1943, he referred to the youngster with autism as having an "obsessive insistence on sameness".

While many people with autism spectrum disorder display inflexibility and rigidity, sometimes the symptoms are extreme and may warrant an additional diagnosis of Obsessive-compulsive disorder (OCD). It is conceivable that some higher-functioning autistic people's quasi-obsessive behaviors reflect true symptoms of a co-existing OCD. There was a woman with Aspergers who needed to check her doors and stove many times a day. Also, there was a man with Aspergers who needed to wash his hands very frequently because he feared contamination by germs. In these two examples, the extreme nature of the symptomatology and the fact that the people involved were troubled by their rituals support the diagnosis of OCD.

A commonly asked question is how to make a distinction between obsessive-compulsive symptoms and the unusual preoccupations of many people with Aspergers. In general, people with OCD realize their behavior is odd and are upset by their inability to control their symptoms. The special interests of people with Aspergers are different from a compulsive disorder in that the individual really enjoys their interest and does not try to resist it. As Janice, an adult with Aspergers said, "It's fun!"

There is considerable controversy in the field about whether people with autism or Aspergers who have milder ADHD or OCD symptoms should be diagnosed with multiple disorders. In other words, does the individual have Aspergers with hyperactive traits or is it preferable to diagnose him with Aspergers as well as ADHD? Does he have Aspergers with obsessive-compulsive characteristics or Aspergers plus OCD? Some clinicians feel that autism spectrum disorder, including Aspergers, is a broad category encompassing a wide variety of symptoms, with some people displaying more of some symptoms than others. On the other hand, other clinicians worry that many symptoms which respond well to psychopharmacological treatment may go untreated if not specifically diagnosed.

Anxiety—

Anxiety appears to be extremely common among people with autism and Aspergers. As one might expect, there are certain situations that typically lead to anxiety in this population. These situations include such things as changes in routine, interference with rituals, things not happening in the expected way, failing at tasks, and sensory overload.

Interestingly, for some people on the spectrum, it is the "little" things which seem to cause the most distress, while more major changes may be experienced with less disruption. Brandon, the boy who became overwhelmed with a change in television programming, looked forward with eager anticipation as his family prepared to move to a new house and, in fact, did quite well before, during and after the move.

If anxiety builds up to a critical level in any child, a temper tantrum may be the end result. Unfortunately, for a youngster on the spectrum, a temper tantrum may be an overwhelming and prolonged event. Furthermore, the techniques often used with typically developing kids may not work and may even prolong the difficulty. Trying to talk the youngster through the experience or reasoning with him is usually not effective. In addition, after the temper tantrum has subsided, trying to process with the youngster what happened and why may even contribute to the return of anxiety as well as the temper tantrum. Brenda Smith-Myles has referred to this phenomenon as "recycling".

Clearly, it is preferable to be proactive in preventing temper tantrums whenever possible, rather than trying to stop them once they have begun. In a proactive approach, thought is given beforehand to the kinds of things likely to provoke a temper tantrum in any particular child and either trying to avoid them or preparing for them. For example, for an individual greatly upset by change, one approach is to try to keep things as consistent and predictable as possible. When changes are unavoidable, if they are known in advance, it is often helpful to prepare the child for this fact. Another approach is to teach the child in a gradual, but systematic way, techniques for dealing with the changes and disruptions in life.

In addition to trying to prevent temper tantrums whenever possible, it is useful to have a plan in place to deal with them should they occur. This approach has more likelihood of success if utilized early in the temper tantrum; circumventing a temper tantrum is usually much easier than trying to stop one in full swing. The plan needs to be tailor made to the child; what works for one individual may be quite different from what works for another. It is often useful for teachers to speak to parents about what approaches are helpful in dealing with their kids. Undoubtedly, they have had many opportunities to try out different techniques! For some kids, removing them from the scene and providing them with "settling" activities may be useful. For example, Fred was often helped by being led to a quiet place where he could look at his calendars and yearbooks. For some kids, touch, especially firm pressure, can be a useful technique. On the other hand, for kids who are sensory defensive, touch can be too overwhelming. The following example illustrates one approach to containing a temper tantrum.

Mike had been eagerly looking forward to going on the Swan Boats in Boston. One day, his parent planned an outing in which they rode the subway into town, an experience Mike loved, and then went on to the boats. Unfortunately, just as they were about to board, the skies opened up in a downpour and the attendant announced the Swan Boats were closing. Mike began a full-fledged temper tantrum, complete with screaming, name-calling and flailing. His parent somehow managed to usher him into the subway station and onto the train, where, naturally, everyone else was also congregating because of the weather! Although the train was extremely crowded, the other passengers gave Mike and his parent a wide berth. She sat him down on a seat and knelt before him, placing her face very close to his and cupping his face in her hands. In a soothing voice, she told him repeatedly to look at her and reassured him that he was okay. His sobbing and flailing soon ceased.

Depression—

Like anxiety, depression is quite common in people with Aspergers. Many people develop problems with low self-esteem and depression during adolescence. It is at this time that many become acutely aware of their differences from their peers. Unfortunately, this is also the time in life when fitting in becomes so critical.

Some people with Aspergers develop affective disorders, which include true clinical depression and bipolar disorder. There is some data to suggest the incidence of these disorders in Aspergers is higher than in the general population. When these disorders do occur, there may be changes in the individual’s predominant mood or in his view of himself and the world. Vegetative symptoms, e.g., changes in sleep, eating, and activity level, may also occur. Of critical importance is the fact that some people with Aspergers and autism display an increase in “autistic” behaviors, for example, stereotyped motor mannerisms, self-injurious behaviors, or aggressiveness, when they become depressed. This fact seems to contribute to the problem of mental illness not being accurately diagnosed in this population, because clinicians sometimes attribute the increased “autistic” symptoms to the autism or Aspergers, rather than to the affective illness. Affective disorders are also more difficult to diagnose in this population because many people with autism spectrum disorders have difficulty communicating their feelings, both in words and in facial expressions. As a general rule of thumb, a significant change from the individual’s baseline level of functioning should raise questions about the possibility of an additional diagnosis.

In "Emotional Disturbance and Mental Retardation: Diagnostic Overshadowing", Steven Reiss, Grant W. Levitan and Joseph Szyszko of the University of Illinois conducted an important study outlining difficulties similar to those described above. They conducted two experiments showing that people with mental retardation were less likely than controls to be diagnosed with emotional disturbances. They coined the term diagnostic overshadowing, meaning that the emotional problems seemed less significant, or were overshadowed in importance, by the presence of mental retardation. Although this study did not include people with autism or Aspergers, it seems highly likely that similar results would occur. The following example illustrates this point.

Tony, an 8 year old with high functioning autism, was a gentle, rather easy-going youngster and was included in a Montessori classroom. During the fall of 3rd grade, he seemed to become more and more depressed, with increasingly frequent episodes of weeping with no apparent precipitant. His condition continued to deteriorate throughout the fall and by Christmas he required psychiatric hospitalization. By this time, he was weeping almost constantly, had become assaultive, and was trying to escape from his family’s home, which was situated near a major highway. In addition, he kept repeating bizarre demands, such as insisting the names of the days of the week be changed to those of the names of the kids in his class. After discharge from the hospital, he went to a residential school, where the psychiatrist viewed his symptoms as indicative of his autism. It was not until sometime later that another psychiatrist correctly concluded that Tony carried the additional diagnosis of bipolar illness.


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