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Article of Interest - Asperger Syndrome

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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
~Behavior that may suggest AS
~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.

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

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.

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
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.

Center for Autism. Asperger's Syndrome. 1995.

National Institute of Neurological Disorders and Stroke (NINDS). Asperger Syndrome Information Page.

Online Asperger Syndrome Information and Support (OASIS).

2004 Ceridian Corporation. All rights reserved.


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