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Special Needs for School-Age
Children: Asperger Syndrome: First Steps Toward Understanding
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What you need to know about
Asperger syndrome.
~A developmental disorder
~Causes
~Behavior that may suggest AS
~Diagnosis
~Treatments
~Help at school
~Strategies for parents
~Learning more
Asperger syndrome is a developmental disorder that can make it
difficult for a child to interact with other people, even though
his intelligence and language skills are normal or above
average. The symptoms can be subtle, when a child just has a
different approach to things; they can also be severe, when a
child has trouble functioning in the world. Each child's
particular combination of behaviors is unique and can change
over time.
This article will help you understand Asperger syndrome: what it
is, how doctors make a diagnosis, possible treatments,
strategies you can use, and the organizations and other
resources that can help you learn more.
A developmental disorder
Asperger syndrome (AS), which is also called Asperger's
disorder (AD), is categorized as an autistic spectrum disorder (ASD).
ASDs are also referred to as pervasive developmental disorders (PDDs).
All ASDs involve a delay or impairment in the development of
social skills.
No language delay
Unlike children with many other ASDs, however, a child with
AS usually learns and uses words with no delay, sometimes
earlier than other children. She may speak in a stilted or
repetitive way, more lecturing than conversational. She may have
trouble with the subtleties of language, interpreting words and
idioms literally.
One intense interest
A child with AS often has one activity or intense interest
that is all-consuming and that she wants to talk about to the
exclusion of all other subjects. She may have trouble making
changes and prefer to do the same activities again and again.
This behavior may take the form of being inflexible about
certain foods, clothing, smells, or sounds. When a parent
doesn't understand this rigidity and the cause, the result can
be battles and tantrums. At the same time, this ability to focus
intensely on one thing can be a source of career success in an
adult with AS.
Causes
The precise cause of AS is not known and there is no known
biological marker that can currently be measured in the blood or
by some other means. Asperger's is generally thought to be
caused by a physical anomaly in the brain, a difference in the
way the brain processes information. AS seems to have at least
some genetic component, because this type of disorder is
diagnosed more frequently in family groups than in the general
population. Also, AS is diagnosed in boys at ten times the rate
it is in girls.
What is known is that bad parenting is not the cause, nor is AS
considered a psychological problem. Children who have AS are not
intentionally rude or difficult. They can learn strategies that
will help them cope with their challenges and change their
behavior.
Behavior that may suggest AS
Many of the behaviors that are associated with AS can occur
in children without AS or those who have a different disorder,
so it is extremely important that a doctor consider the whole
constellation of symptoms before assigning a diagnosis. A doctor
would try to see if a child is...
not using or responding to nonverbal signs, such as eye contact,
gestures, facial expressions, or body language
having difficulty making friends
not sharing interests, by pointing things out or showing an
achievement to others
not returning emotional or social cues
Another common symptom is repetitive patterns, with activities,
body movements, or words. These include
showing an extremely intense interest in a limited number of
topics, and often needing to talk about that interest at length
needing to have certain routines or rituals followed rigidly
making repetitive motions such as hand flapping or twisting
being preoccupied with parts of objects
Diagnosis
Because a child with AS usually progresses along with his
peers from speaking single words to speaking phrases and
sentences between the ages of 2 and 3, problems may not become
apparent until a child enters preschool and begins to spend more
time with other children. Often AS is not diagnosed until late
elementary or early middle school.
Experience matters
It's extremely important that you make sure the doctor you
are talking with has actually seen and worked with other
children who have AS. The syndrome has been officially listed in
the manual of disorders, the DSM-IV-TR, only since 1994, so many
doctors have little experience with it. Most experts advise
seeing a well-trained specialist in developmental disorders,
usually a child psychiatrist, a developmental pediatrician, a
child or developmental psychologist, or a neurologist. It's
important to listen to teachers and others who see your child
regularly, but they may not be familiar with AS. It's critical
that a person with medical training make the diagnosis, and that
you seek out a second opinion, if not a third.
Confusion with other conditions
AS can be confused with other ASDs, attention deficit
disorders, obsessive-compulsive disorders, or learning
disabilities. It can also co-exist with other disorders, making
the diagnosis even more difficult.
The treatment for these other disorders is often quite different
from the treatment for AS, so it's very important for anyone
diagnosing your child to see him over time. Usually a team of
experts can work together to find an explanation for a child's
behavior.
Treatments
There are many treatments that have shown varying degrees of
success with AS. Remember that the particular combination of
symptoms can differ from one child to another. Whenever you are
evaluating a treatment, ask the doctor what symptoms the
treatment is meant to address. Some children need help with
organization and concentration; some need to practice social
skills; others may benefit from medication. An older child
sometimes suffers from anxiety or depression because of the
difficulty he is having making friends, or because he is being
teased at school. Sometimes a combination of a particular type
of therapy and medication can help. Here are some of the
treatments that you might ask your doctor to discuss with you:
social skill training: role-playing and practice of skills such
as joining a group, making a phone call, reacting to teasing
social stories, comic strip conversations: methods that help a
child learn what another person may be thinking or feeling,
through special stories or drawings about interactions
social scripts, social autopsies: a teacher or peer's use of a
short phrase that the child has been taught how to interpret,
such as "not appropriate here," (Autopsies are reconstructions
of an incident, with a discussion of alternatives.)
occupational therapy: basic skills that have been delayed by
certain sensitivities
speech and language therapy: help with misunderstanding of words
and non-verbal cues
psychotherapy: cognitive behavior therapy that addresses
dysfunctional behavior
medication: frequently, treatment for a condition that exists
alongside AS
applied behavioral analysis (ABA): intensive work with an ABA
therapist who analyzes a child's behaviors and reinforces
appropriate behavior
auditory integration training (AIT): sometimes used to help a
child who has extreme sensitivity to sounds or trouble
processing sound
Help at school
Once you begin to understand what the most challenging areas
for your child are, you will be able to talk with your doctor
about whether these areas are interfering with your child's
ability to learn. A child with AS may be able to function well
in a regular classroom, especially if the teacher understands
where and how she may need to make accommodations for him.
Usually a child can benefit from special services. Speak with
the person in charge of such services at your child's school to
find out what is available to your child through the Individuals
with Disabilities Act.
Strategies for parents
As with every aspect of AS, the strategies that work with
one child may not be appropriate for another. You may be able to
help your child with some of these strategies:
speech: keep your words simple and clear; avoid figurative
language, like "under the weather;" with a young child, you can
sometimes sing your words.
instructions: keep them simple; break tasks into small steps;
confirm that your child understands what you are asking him to
do.
skills: explain that you need him to look at you when you speak
with each other; teach him some skills for dealing with stress,
like deep breathing or counting to 10; teach turn-taking, which
can also help with the give and take of conversation.
routine: warn your child of changes; establish a time limit for
his area of special interest; limit choices to two or three;
build a little flexibility into the day.
expectations: allow for some immaturity; avoid stress triggers;
have some distractions available for times of stress.
emotion: remember to show yours even if it's not returned. A
child with AS may have trouble showing his affection, but that
doesn't mean that he doesn't feel it.
Learning more
Books
Asperger Syndrome: A Guide for Parents and Educators, by
Brenda Smith Myles and Richard L. Simpson. (Austin, TX. ProEd.
2003)
The Oasis Guide to Asperger Syndrome: Advice, Support, Insight,
and Inspiration, by Patricia Romanowski Bashe and Barbara L.
Kirby. (New York. Crown Publishers. 2001)
Web sites
Asperger Education Network, Inc. (ASPEN). 12/02/03.
http://www.aspennj.org
Center for Autism. Asperger's Syndrome. 1995.
http://www.autism.org
National Institute of Neurological Disorders and Stroke (NINDS).
Asperger Syndrome Information Page.
http://www.ninds.nih.gov/health_and_medical/disorders/asperger_doc.htm
Online Asperger Syndrome Information and Support (OASIS).
http://www.udel.edu/bkirby/asperger/
© 2004 Ceridian Corporation. All rights reserved.
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