The Exceptional Child Weekly
A Closer Look At Asperger's Syndrome
- What is Asperger's Syndrome?
- Asperger's vs. Autism
- How common is Asperger's Syndrome?
- Characteristics of Asperger's
What is Asperger Syndrome?
Asperger’s syndrome was first defined in the 1940s by a pediatrician Hans Asperger who observed autistic like behaviors. He observed these behaviors and the difficulties with social and communication skills in boys who had normal intelligence and language development. Many professionals felt Asperger’s syndrome was simply a milder form of autism and used the term “high-functioning autism” to describe these individuals. The Institute of Cognitive Neuroscience of University College London and author of Autism and Asperger’s Syndrome, describes individuals with Asperger’s syndrome as “having a dash of Autism”. Asperger’s syndrome was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1994 as a separate disorder from autism. There are still many professionals who consider Asperger’s syndrome a less severe form of autism.
Asperger's Syndrome vs. Autism
Children with Asperger’s syndrome may not understand irony and humor, or they may not understand the give and take nature of a conversation. Another distinction between Asperger’s syndrome and autism concerns cognitive ability. While some individuals with autism experience cognitive delay, by definition a person with Asperger’s syndrome possess an average to above average intelligence. While motor difficulties are not a specific criteria for Asperger’s, children with Asperger’s syndrome frequently have motor skill delays and may appear clumsy or awkward.
How Common is Asperger's Syndrome?
It is four times more likely to occur in males than in females and usually is first diagnosed in children between ages 2 and 6, when communicative and language skills are emerging and settling. In recent years, the number of autism spectrum disorders has increased dramatically in the U.S. The reason for the increase is not fully clear, but it likely due to both improvements and modifications in the diagnostic process that result in an increase in the number of children being identified, as well as some degree of true increase in the incidence of the disorders themselves. The most recent studies show that one out of every 110 children in the U.S. has an autism spectrum disorder.
Asperger's syndrome has been estimated to affect two and a half out of every 1000 children, based upon the total number of children with autistic disorders.
The diagnosis of Asperger syndrome is complicated by the lack of a standardized diagnostic test. In fact, because there are several screening instruments in current use, each with different criteria, the same child could receive different diagnoses, depending on the screening tool the doctor uses.
Asperger syndrome, also sometimes called high-functioning autism (HFA), is viewed as being on the mild end of the ASD spectrum with symptoms that differ in degree from autistic disorder.
Some of the autistic behaviors may be apparent in the first few months of a child’s life, or they may not become evident until later.The diagnosis of Asperger syndrome and all other autism spectrum disorders is done as part of a two-stage process. The first stage begins with developmental screening during a “well-child” check-up with a family doctor or pediatrician. The second stage is a comprehensive team evaluation to either rule in or rule out AS. This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical and neurological exam. Many individuals with Asperger’s have low muscle tone and dyspraxia, or coordination issues.
Although there are no tests for Asperger's syndrome, the doctor may use various tests -- such as X-rays and blood tests -- to determine if there is another issue or physical disorder causing the symptoms.
If no physical disorder is found, the child may be referred to a specialist in childhood development disorders, such as a child and adolescent psychiatrist or psychologist , pediatric neurologist, developmental-behavioral pediatrician, or another health professional who is specially trained to diagnose and treat Asperger's syndrome.
The doctor bases his or her diagnosis on the child's level of development, and the doctor's observation of the child's speech and behavior, including his or her play and ability to socialize with others. The doctor often seeks input from the child's parents, teachers, and other adults who are familiar with the child's symptoms.
Characteristics of Asperger's Syndrome
What distinguishes Asperger’s Disorder from classic autism are its less severe symptoms and the absence of language delays. Children with Asperger’s Disorder may be only mildly affected, and they frequently have good language and cognitive skills. To the untrained observer, a child with Asperger’s Disorder may just seem like a neurotypical child behaving differently.
Children with autism are frequently viewed as aloof and uninterested in others. This is not the case with Asperger’s Disorder. Individuals with Asperger’s Disorder usually want to fit in and have interaction with others, but often they don’t know how to do it. They may be socially awkward, not understand conventional social rules or show a lack of empathy. They may have limited eye contact, seem unengaged in a conversation and not understand the use of gestures or sarcasm.
Their interests in a particular subject may border on the obsessive. Children with Asperger’s Disorder often like to collect categories of things, such as rocks or bottle caps. They may be proficient in knowledge categories of information, such as baseball statistics or Latin names of flowers. They may have good rote memory skills but struggle with abstract concepts.
One of the major differences between Asperger’s Disorder and autism is that, by definition, there is no speech delay in Asperger’s. In fact, children with Asperger’s Disorder frequently have good language skills; they simply use language in different ways. Speech patterns may be unusual, lack inflection or have a rhythmic nature, or may be formal, but too loud or high-pitched. Children with Asperger’s Disorder may not understand the subtleties of language, such as irony and humor, or they may not understand the give-and-take nature of a conversation.
Another distinction between Asperger’s Disorder and autism concerns cognitive ability. While some individuals with autism have intellectual disabilities, by definition, a person with Asperger’s Disorder cannot have a “clinically significant” cognitive delay, and most possess average to above-average intelligence.
Social Skills Defecit
Weak Theory of Mind
Individuals with Asperger Syndrome may often face challenges related to their ability to interpret certain social cues and skills. They may have difficulty processing large amounts of information and relating to others. Theory of Mind refers to one’s ability to perceive how others think and feel, and how that relates to oneself. Both of these issues can impact the behavior of individuals with AS.
Theory of Mind can be summed up as a person’s inability to understand and identify the thoughts, feelings and intentions of others. Individuals with Asperger Syndrome/HFA can encounter have difficulty recognizing and processing the feelings of others, which is sometimes referred to as “mind-blindness”. As a result of this mind-blindness, people with AS may not realize if another person’s behaviors are intentional or unintentional.
This challenge often leads others to believe that the individual with AS does not show empathy or understand them, which can create great difficulty in social situations.
Theory of Mind deficits can oftentimes have a large impact on individuals with AS. Some social deficits caused by theory of mind:
1. Difficulty explaining ones behaviors
2. Difficulty understanding emotions
3. Difficulty predicting the behavior or emotional state of others
4. Problems understanding the perspectives of others
5. Problems inferring the intentions of others
6. Lack of understanding that behavior impacts how others think and/or feel
7. Problems with joint attention and other social conventions
8. Problems differentiating fiction from fact
Social Development Interventions
Social skills groups. These groups offer an opportunity for individuals with ASDs to practice social skills with each other and/or typical peers on a regular basis. Some social skills groups consist solely of children with ASD while other groups have a mix of participants, children with ASD along with typically developing children.
This strategy involves teaching "scripts" for common social situations.In a social scripts intervention, sometimes used to assist individuals with ASD to initiate social contact and conversation, the child learns a scripted question or phrase such as, "Did you like playing on the swing today?" The child initially uses a support, such as a reminder card with the script available to read, and then is gradually weaned from this support until he or she can use the question or phrase spontaneously.
Hidden Curriculum. These strategies involve directly teaching "unspoken" social rules.The "hidden curriculum" refers to a set of social rules or guidelines that most people understand intuitively. These are the rules that everybody seems to pick up naturally, that everybody just knows. However, individuals with ASD do not pick up these rules naturally, and these rules need to be taught directly to them. A child who does not intuit or know these rules is at risk for social isolation.
Social Stories and Comic Strip Conversations. These resources use stories and drawings to build social understanding. Social Stories are brief, personal stories written for children to help them understand social situations.The story describes the situation, with the child's and others' feelings and/or thoughts as key elements. Possible social responses may be included, in a positive way, to help the child understand a social situation or cope with a stressful encounter. In the end, the story could relate options for socially desirable behavior in the situation. The aim is to increase insight and help guide future behavior.
Comic Strip Conversations involve "drawing" conversations to help the child learn the social rules that others learn more naturally. Bubbles representing a conversation can bump into or overlap one another to illustrate "interrupting" and "thought" bubbles can show others' thoughts during conversation. For example, a child with ASD who takes offense at a peer's comment, "You can't catch me!" can be shown that the peer may not have been rejecting, but trying to start a fun game of chase.
ASD Nest Program
The ASD Nest Program is the New York City Department of Education’s Integrated Co-Teaching (ICT) program for higher functioning children with autism spectrum disorders (ASDs).
The ASD Nest program helps children with ASD learn how to function well academically, behaviorally, and socially in school and in their community.
Each ASD Nest Program is integrated into the fabric of its school. The goal is to provide a therapeutic environment and supports within a grade- appropriate academic environment. The entire school embraces positive behavioral support.
- ICT kindergartens serve four children with ASDs and eight typically developing children.
- ICT classes for grades one through three serve four children with ASDs and twelve typically developing children. ICT classes for higher elementary grades may be slightly larger.
- ICT classes for grades 6-12 serve five children with ASDs and twenty typically developing children.
Each classroom has two teachers with training in the specialized curricula and instructional strategies used in the program.
In addition to the standard academic curriculum, specialized curricula and instructional strategies to foster relationship development, adaptive skills, language and communication development and sensory/motor development are infused throughout the day, thus minimizing the supports needed for children outside the classroom. Staff receive pre- and in-service training in these curricula and strategies.
Language development and sensory/motor skill development are integrated into the academic day, using a trans-disciplinary collaborative approach.
Collaborative problem solving is used to assess children’s needs and progress. Times for staff to co-plan and conduct case conferences take place on a regular basis.
A strong home/ school component includes an initial phase-in process, frequent ongoing two-way communication, collaborative planning meetings, monthly parent support groups, support for families in home based skills and referrals to outside services.