“Living in our world in their own way”

Asperger’s is a neurologically based disorder of development that typically affects social skills, language/communicative skills and behavior. It is generally considered to be a mild form of autism.  However the relationship between Asperger’s and Autism is still unclear and is the source of much controversy.  While some researchers and scientists consider it to be one of the five spectrums of autism others believe that it is a distinctive disorder with a different cause. The disorder was named after the psychiatrists, Hans Asperger, who in 1944 described a group of children quite similar to those that Leo Kanner had labeled “autistic” the year before. The children all had deficits in their reciprocal social interactions and displayed rigid and repetitive behaviors. However, unlike Kanner’s children with autism, Asperger’s children did not have a delay in language development.  In fact, they tended to have average to advanced early language development as well as a normal to very high IQ.    

 There is no single identifiable cause of Asperger’s.  However, there is a clear genetic component in some cases with one parent, often the father, showing either the full picture of Asperger’s or at least some traits of the disorder.   Additionally, the syndrome is much more common in boys than girls, but the reason for this is unknown. 

As mentioned, these children typically show deficits in their social interactions and rigidity in behavior.  However, there are a number of defining areas in which the disorder is manifested.  Some of these areas are outlined below with perspective characteristics evidenced by children with the disorder. 

 

Behavioral Characteristics:

 Children with Asperger’s can come across as eccentric or odd, having eccentric preoccupations, intense fixations and often develop obsessions such as for animals or obsessively collecting unusual things. They are easily overwhelmed by minimal change, are highly sensitive to environmental stressors, and sometimes engage in repetitive routines or ritual that may be imposed on self or on others.  They have a limited but intense range of interest and preoccupations; are anxious and tend to worry obsessively when they do not know what to expect.  Stress, fatigue and sensory overload easily throw them off balance. They tend to relentlessly "lecture" on areas of interest, ask repetitive questions about interests, have trouble letting go of ideas; follow own inclinations regardless of external demands, and sometimes refuse to learn about anything outside their limited field of interest.

Speech and Language Characteristics

These children tend to have average or advance language development. They usually begin to talk before they can walk.  Although they talk at the expected age, saying their first word around 12 months of age, their actual first words are often unusual (i.e.  Palm Pilot”  “sheetrock”  “clock”  “mountain” “fish” and “hammer”) These words are generally used before the child says  “Mommy” or “Daddy.” As their language develops, these children often have pronoun reversal, such as saying, “you want help” instead of “I want help.”  Their language is precocious or intelligent but it is also odd.  They sound as if they are lecturing or talking at everyone.  Their language is more rote than meaningful.    While they have a well-developed vocabulary and speech they have poor communication and difficulty with social language.

They tend to dominate a conversation, talking over others or engaging in what seems more like a lecture (such as a 4-year-old who talks incessantly about the natural habitat of milk snakes).  For these reasons, they are sometimes labeled “little professor” because their speaking style is so adult-like and doctrinaire. These children tend to engage in repetitive question asking, such as asking everyone what their phone number is, or what kind of car they drive.  They tend to talk at people instead of to them. They have peculiar voice characteristics such as a monotone, stilted unnatural tone of voice and have nonverbal communication problems such as limited or inappropriate facial expressions, “stiff” or inappropriate gaze and limited gestures. Their use of gestures is often either absent or exaggerated.  They often do not wave ‘hi” or “bye” when expected or use a pointing gesture to share items of interest.

Social Characteristics

Children with Asperger’s are said to be "born without social genes”, so to speak, as they lack social instinct and intuition. While most children with Asperger’s want friends and have a desire to be part of the social world they simply do not know how to interact socially and have an inability to understand complex rules of social interaction.  They misinterpret and/or have a poor appreciation for social clues and exhibit socially and emotionally inappropriate responses.  These children exhibit poor ability to initiate and sustain conversation. They are naïve and are easily taken advantage of as they do not perceive that others sometimes lie or trick them.  They are extremely egocentric, insensitive and lack tack. They have difficulty adjusting physical proximity or judging “social distance”.  These children's social judgment improves only after they have been taught rules that others pick up intuitively.

Emotional Characteristics

 Children with Asperger’s are emotionally vulnerable.  Although they have the intelligence to compete in regular education they often do not have the emotional resources to cope with the demands of the classroom. These children are easily stressed due to their inflexibility. Self-esteem is low and they are often very self-critical and unable to tolerate making mistakes. Individuals with Asperger’s, especially adolescents, may be prone to depression.   Rage reactions/temper outbursts are common in response to stress/frustration. They rarely seem relaxed and are easily overwhelmed when things are not as their rigid views dictate they should be. Interacting with people and coping with the ordinary demands of everyday life take continual Herculean effort.

Academic or Learning Characteristics

Children with Asperger’s have average to above-average intelligence, especially in the verbal area. But, they lack high level thinking and comprehension skills. They tend to be very literal, their images are concrete, and abstraction is poor. Their pedantic speaking style and impressive vocabularies give the false impression that they understand what they are talking about when in actuality they are merely parroting what they have heard or read. They frequently have excellent rote memory but it is mechanical in nature. That is, the child may respond like a video that plays in set sequence. They are distracted by internal stimuli, very disorganized and often off task.  Their difficulty in sustaining focus on classroom activities is often not because their attention in poor but rather that their focus is odd, they cannot figure out what is relevant (Happe, 1991) so their attention is focused on irrelevant stimuli. Their problem-solving skills are poor and some may have motor skill problems characterized by clumsiness and stiff, awkward gaits. They are unsuccessful in games involving motor skills and experience fine-motor deficits that can cause penmanship problems, slow clerical speed and affect their ability to draw.

Early Warning Signs of Asperger’s Parents of young children with Asperger’s cited several

characteristics noted in their children with Asperger’s during their early year development.  Thus, to help detect early warning signs of the disorder, these parents reported that their newborns or infants were excessively fussy or “colicky, difficult to comfort and were often soothed by unique means such as listening to the dishwasher or being held high in the air.  Their infants were often described as having been “serious” and or “thoughtful.” They often showed more interest in objects than people. Many parents reported extreme stranger anxiety, where their babies would fuss or become highly anxious whenever anyone other than mom and dad were around. They were able to memorize phrases or chunks of dialogue which they used in their everyday speech. For example, a parent reported that her 30-month-old boy with Asperger’s would say, “Crikey, that’s a big one” whenever he saw an animal of any size. Language was often interpreted extremely literally. A 3-year-old girl would get upset when her mother said that she was going to “fix dinner” because the dinner was not broken.

Children with Asperger’s showed early rigid behaviors, such as having difficulty with change. One parent described how her 5-month-old refused to eat a preferred brand of baby food when the label on the container was changed. These young children showed a high sensitivity to sensory input and reacted negatively to loud noises, bright lights and various textures.  They may be bothered by the tags in their clothing, or the binding on long sleeve shirts. Most of these children have a highly restricted diet. Parents report that their children with Asperger’s will eat only three of four things, and often  will eat only one particular brand of food, such as eating only chicken nuggets from McDonalds.

Most parents reported that their initial attempts at social activities such as a “Mommy and Me” were difficult; either the children cried and fussed the whole time, or the child would follow his or her own agenda and not participate in the activities presented. As these children get older, they are often described as wanting to have friends but lacking the skills to do so.  They may make social attempts but are often unsuccessful. For instance, a 4-year-old boy approached a group of same-aged peers and said, “My ice cream melts when it’s hot.” When the other children asked him his name, he repeated the statement about his ice cream and the children walked away from him.

                                           Additional Early Warning Signs

As young children with Asperger’s grow older, their rigid behaviors often develop into what is often described as obsessive interests. These interests may be highly unusual (wood chippers, airport schedules, aisle location of a particular screwdriver in local hardware stores) or may be more typical interests (dinosaurs, planets) which occupy an excessive amount of the child’s thoughts. Often these interests are all consuming and the children have difficulty talking about other things or engaging in activities that do not involve these interests. The children’s knowledge level about these topics is often highly advanced.

Social behaviors in these children are delayed. Early toy play may be unusual, such that the child is more interested in taking toys apart than actually playing with them. They may show a preference for toys that have letters or numbers associated with them. This is a common fixation for children with Asperger’s. For instance a parent reported that her 18-month-old child’s favorite toy was a basketball hoop because he liked to flick the hoop and watch the numbers on the counter go up. They may be able to spell/read words before they enter preschool. It is also common for young children with Asperger’s to watch the credits to videos or television programs. Due to their literal thinking, these young children often show delayed pretend and symbolic play. That is, they have difficulty understanding that they can pretend a banana is a telephone or that a block can be a car.

These are just some of the most common characteristics of Asperger’s that are seen in children younger than 5 years of age. It is important that we better understand the early presentation of Asperger’s as too many of these children are overlooked during the crucial years. The later diagnosis for children with Asperger’s mean that these children are not granted the benefits of early intervention during the “window of opportunity” for making the greatest therapeutic and/or educational impact upon their lives.  This brings us to the next section of the article which deals with strategies and interventions for children with Asperger’s.

Strategies and Interventions

Keep in mind that not all children with Asperger’s are alike. Symptoms are manifested in ways specific to each individual child.  Therefore, there is no exact recipe for classroom approaches that can be provided for every child with Asperger’s just as there is no one educational method that fits the needs of all children without Asperger’s   However, suggestions and classroom strategies for addressing various symptoms are given below. The suggestions and illustrations are from a person’s own teaching experiences at the University of Michigan Medical Center Child and Adolescent Psychiatric Hospital School, Karen Williams and are credited to her.

Since children with Asperger’s are easily overwhelmed by minimal change and are highly sensitive to environmental stressors, the following suggestions are given:

• Provide a predictable and safe environment.
• Minimize transitions.
• Offer consistent daily routine: These children must understand each day's routine and know what to expect in order to be able to concentrate on the task at hand.
• Avoid surprises: Prepare the child thoroughly and in advance for special activities, altered schedules, or any other change in routine, regardless of how minimal.
• Dispel fears of the unknown by exposing these children to the new activity, school, class, teacher as soon as possible after they have been  informed of the change, to prevent obsessive worrying. (For instance, when children with Asperger’s must change schools, they should meet the new teacher, tour the new school and be apprised of their routine in advance of actual attendance. School assignments from the old school might be provided the first few days so that the routine is familiar to the child in the new environment. The receiving teacher might find out the child's special areas of interest and have related books or activities available on the child's first day).

Since children with Asperger’s evidence impairment in social interaction the following suggestions are given:

Protect the child from bullying and teasing. Praise classmates when they treat the child with compassion. This may prevent scapegoating, while promoting empathy and tolerance in the other children. Emphasize the proficient academic skills of the child with Asperger’s by creating cooperative learning situations in which his or her reading skills, vocabulary, memory and so forth will be viewed as an asset by peers, thereby encouraging acceptance.
Teach these children how to react to social cues and give them repertoires of responses to use in various social situations. Teach them what to say and how to say it. Model two-way interactions and let them role-play. Since they lack social instinct and intuition, children with Asperger’s must learn social skills intellectually.  When they have been unintentionally insulting, tactless or insensitive, it must be explained to them why the response was inappropriate and what response would have been correct. Older students with Asperger’s might benefit from a "buddy system."   . Children with Asperger’s tend to be reclusive. Therefore, the teacher should foster involvement with others by encouraging active socialization and limit time spent in isolated pursuit of interests. For instance, a teacher's aide seated at the lunch table could actively encourage the child with Asperger’s to participate in the conversation of his or her peers not only by soliciting his or her opinions and asking him questions, but also by subtly reinforcing other children who do the same.
Encouraging a young child with Asperger’s to play a board game with one or two others under close supervision not only structures play but offers the child with Asperger’s an opportunity to practice social skills.

Since children with Asperger’s have a restricted range of interest or odd, intense fixations the following suggestions are given:

• Use of positive reinforcement selectively directed to shape a desired behavior is the critical strategy for helping the child with Asperger’s (Dewey, 1991). These children respond to compliments (e.g., in the case of a relentless question-asker, the teacher might consistently praise him as soon as he pauses and congratulate him for allowing others to speak). These children should also be praised for simple, expected social behavior that is taken for granted in other children.
• For particularly obstinate children, it may be necessary to initially individualize all assignments around their interest area (e.g., if the interest is dinosaurs, then offer grammar sentences, math word problems and reading and spelling tasks about dinosaurs). Gradually introduce other topics into assignments.
• Students can be given assignments that link their interest to the subject being studied. For example, during a social studies unit about a specific country, a child obsessed with trains might be assigned to research the modes of transportation used by people in that country.
• Use the child's fixation as a way to broaden his or her repertoire of interests. For instance, during a unit on rain forests, the student who was obsessed with animals was led to not only study rain forest animals but to also study the forest itself, as this was the animals' home. He was then motivated to learn about the local people who were forced to chop down the animals' forest habitat in order to survive.

 

Since children with Asperger’s have poor concentration, are distracted by internal stimuli and are very disorganized the following suggestions are given:

Seat the child with Asperger’s at the front of the class and direct frequent questions to him or her to help him or her attend to the lesson. Work out a nonverbal signal with the child (e.g., a gentle pat on the shoulder) for times when he or she is not attending.

If a buddy system is used, sit the child's buddy next to him or her so the buddy can remind the child to return to task or listen to the lesson. Assignments should be broken down into small units, and frequent teacher feedback and redirection should be offered. Children with severe concentration problems benefit from timed work sessions. This helps them organize themselves. Class work that is not completed within the time limit (or that is done carelessly) within the time limit must be made up during the child's own time (i.e., during recess or during the time used for pursuit of special interests. Poor concentration, slow clerical speed and severe disorganization may make it necessary to lessen homework/class work load and/or provide time in a resource room where additional structure the child needs to complete class or homework can be provided. Some children with Asperger’s are so unable to concentrate that it places undue stress on parents to expect that they spend hours each night trying to get through homework with their child.

Since children with Asperger’s tend to have poor motor coordination the following suggestions are given:

Refer the child with Asperger’s for adaptive physical education program if gross motor problems are severe.
Involve the child in a health/fitness curriculum in physical education, rather than in a competitive sports program. The child with Asperger’s lacks the social understanding of coordinating one's own actions with those of others on a team. Do not push the child to participate in competitive sports, as his or her poor motor coordination may only invite frustration and the teasing of team members. Children with Asperger’s may require a highly individualized cursive program that entails tracing and copying on paper, coupled with motor patterning on the blackboard. The teacher guides the child's hand repeatedly through the formation of letters and letter connections and also uses a verbal script. Once the child commits the script to memory, he or she can talk himself or herself through letter formations independently.
Younger children with Asperger’s benefit from guidelines drawn on paper that help them control the size and uniformity of the letters they write. This also forces them to take the time to write carefully. When assigning timed units of work, make sure the child's slower writing speed is taken into account.

Since children with Asperger’s tend to experience academic difficulties the following suggestions are given:

Provide a highly individualized academic program engineered to offer consistent successes. The child with Asperger’s needs great motivation to not follow his or her own impulses. Learning must be rewarding and not anxiety-provoking. Do not assume that children with Asperger’s understand something just because they parrot back what they have heard.
Offer added explanation and try to simplify when lesson concepts are abstract. Capitalize on their exceptional memory. Retaining factual information is frequently their forte. Emotional nuances, multiple levels of meaning and relationship issues as presented in novels will often not be understood; The writing assignments of children with Asperger’s are often repetitious, flutter from one subject to the next and contain incorrect word connotations. These children frequently do not know the difference between general knowledge and personal ideas and therefore assume the teacher will understand their sometimes abstruse expressions. Children with Asperger’s may need more time than their peers to complete exams. Taking exams in the resource room not only offer more time but would also provide the added structure and teacher redirection these children need to focus on the task at hand. Children with Asperger’s often have excellent reading recognition skills, but language comprehension is weak. Do not assume they understand what they so fluently read. Academic work may be of poor quality because the child with Asperger’s is not motivated to exert effort in areas in which he or she is not interested. Very firm expectations must be set for the quality of work produced. Work executed within timed periods must not only be complete but done carefully. They should be expected to correct poorly executed class work during recess or during the time they usually pursues their own interests. Some children with Asperger’s will not want to do assignments outside their area of interest. Firm expectations, again, must be set for completion of class work. It must be made very clear to the child that he or she is not in control and that he must follow specific rules. At the same time, however, meet the children halfway by giving them opportunities to pursue their own interests. A child with Asperger’s can sometimes be stubborn.  They need firm expectations and a structured program that teaches them that compliance with rules leads to positive reinforcement. This kind of program motivates the child with Asperger’s to be productive and thus enhances self-esteem and lowers stress levels because the child sees himself as competent.
The teacher must actively encourage the child with Asperger’s to leave his or her inner thoughts/ fantasies behind and refocus on the real world. This is a constant battle, as the comfort of that inner world is believed to be much more attractive than anything in real life. For young children, even free play needs to be structured, because they can become so immersed in solitary, ritualized fantasy play that they lose touch with reality.
A tremendous amount of regimented external structure must be provided if the child with Asperger’s is to be productive in the classroom.

Since these children are emotionally vulnerable the following suggestions are given:

Prevent outbursts by offering a high level of consistency. Prepare these children for changes in daily routine to lower stress.  Children with Asperger’s frequently become fearful, angry, and upset in the face of forced or unexpected changes.
Teach these children how to cope when stress overwhelms them to prevent outbursts. Help the child write a list of very concrete steps that can be followed when he or she becomes upset (e.g., 1-Breathe deeply three times; 2-Count the fingers on your right hand slowly three times; 3-Ask to see the special education teacher, etc.). Include a ritualized behavior that the child finds comforting on the list. Write these steps on a card that is placed in the child's pocket so that they are always readily available;
Affect as reflected in the teacher's voice should be kept to a minimum. Be calm, predictable, and matter-of-fact in interactions with the child with Asperger’s, while clearly indicating compassion and patience. Hans Asperger (1991), the psychiatrist for whom this syndrome is named, remarked that "the teacher who does not understand that it is necessary to teach children with Asperger’s seemingly obvious things will feel impatient and irritated" (p.57).  Do not expect the child with Asperger’s to acknowledge that he or she is sad/ depressed. In the same way that they cannot perceive the feelings of others, these children can also be unaware of their own feelings. They often cover up their depression and deny its symptoms. Teachers must be alert to changes in behavior that may indicate depression, such as even greater levels of disorganization, inattentiveness and isolation, decreased stress threshold, chronic fatigue, crying, suicidal remarks and so on. Do not accept the child's assessment in these cases that he or she is "OK". Report symptoms to the child's therapist or make a mental health referral so that the child can be evaluated for depression and receive treatment if this is needed. Because these children are often unable to assess their own emotions and cannot seek comfort from others, it is critical that depression be diagnosed quickly.
Be aware that adolescents with Asperger’s are especially prone to depression. Social skills are highly valued in adolescence and the student with Asperger’s realizes he or she is different and has difficulty forming normal relationships.  It is critical that adolescents with Asperger’s who are mainstreamed have an identified support staff member with whom they can check in at least once daily. This person can assess how well he or she is coping by meeting with him or her daily and gathering observations from other teachers.
Children with Asperger’s must receive academic assistance as soon as difficulties in a particular area are noted. These children are quickly overwhelmed and react much more severely to failure than do other children; Children with Asperger’s who are very fragile emotionally may need placement in a  structured special education setting that can offer them individualized academic support. These children require a learning environment in which they see themselves as competent and productive. Keeping them in the regular program where they cannot grasp concepts or complete assignments serves only to lower their self-concept, increase their withdrawal behavior and set the stage for a depressive disorder.

The contents of the article were based on the following reference sources.

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Asperger, H. (1991). Autistic psychopathology in childhood. In U.Frith (Ed.), Autism and Asperger syndrome (pp.37-92). Cambridge, England: Cambridge University Press.

Dewey, M. (1991). Living with Asperger’s syndrome. In U.Frith (Ed.), Autism and Asperger syndrome (pp. 184-206). Cambridge: England: Cambridge University Press.

Everard, M.P. (1976, July).Mildly autistic young people and their problems. Paper presented at the International Symposium on Autism, St. Gallen, Switzerland.

Happe, F.G.E. (1991). The autobiographical writings of three Asperger syndrome adults: Problems of interpretation and implications for theory. In U.Frith (Ed.), Autism and Asperger Syndrome (pp.207-242). Cambridge, England: Cambridge University Press.

Sacks, O. (1993, December 27). An anthropologist on Mars. The New Yorker, 106- 125.

Satter. Doreen Bradley, “Understanding Asperger's Syndrome: The Mildest and Highest

Functioning Form of Autism. May 17, 2007

Stephen, Laurie Ph. D Director, The Help Group’s Autism Spectrum Disorders Program “Understanding Asperger’s Disorder in Young Children, Related NPR Stories.

Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine 11, 115-129.

Wing, L. (l991). The relationship between Asperger’s syndrome and Kanner's autism. In U. Frith (Ed.), Autism and Asperger syndrome (pp. 93-121). Cambridge, England: Cambridge University Press.                                                                                                                                      Williams, Karen “Understanding the Student with Asperger’s Syndrome: Guidelines for Teachers,’ 1995, FOCUS ON AUTISTIC BEHAVIOR, Vol. 10, No. 2, Copyright, June l995 by PRO-ED, Inc     

Subtopic “Living in our world in their own way” is a paraphrase of Van Krevelen concept and quote who noted that the low-functioning child with autism "lives in a world of his own," whereas the higher functioning child with autism "lives in our world but in his own way" (p.99). (cited in Wing, l99l)