Asperger's Syndrome

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Contents

Introduction

John was an extremely intelligent sixth grade student who sometimes had a hard time getting along with other students. John was always late to class and always the last student to his seat. During class, he would ask incredibly intelligent questions at all the wrong times, but seemed not to pickup that during the activity might not be the appropriate time to ask a question that had very little relevance to the topic of discussion.


After more careful observations of John in class and in the hallways, teachers began to notice that he would read every sign in the hallway or on the door to the classroom, even if he already could recite every word that was on the sign. John would stop at his locker at every chance he got, and twist his lock three times just to make sure that his locker was locked. As he passed a drinking fountain, he would always stop to get a drink, furthering his tardiness to class. As a teacher following school rules, John began to accumulate detentions for tardiness.


Ironically, John would be conscious of the fact that he was always late for class, and understood the consequences of his behavior. This student puzzled all of his teachers, he was only 10 years old and in the most advanced classes for sixth grade students. In addition, he was performing two years above grade level in math. How could a student who shows all these intelligent characteristics and whose test scores were in the highest percentile have issues with common behaviors such as getting to class on time? Well, a year after the fact, John was tested for autism, more specifically Asperger’s Syndrome. After his diagnosis, all his behaviors seemed to make sense and teachers could adjust their teaching to help John become a better student.


Definitions of Asperger's Syndrome

Asperger’s Syndrome is characterized as one of the five pervasive development disorders. Asperger’s Syndrome (AS) is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior (National Institute of Neurological Disorders and Stroke). The Autism Spectrum Disorders are characterized by a “delay in the development of multiple basic functions including socialization and communication” (Pervasive Development Disorder in Wikipedia.org).


The term Asperger’s Syndrome was translated and introduced by Lorna Wing in 1981. Initially, Hans Asperger (1906-1980), a Viennese psychiatrist and pediatrician used the term in his paper "Autistic Psychopathies in Childhood" which was written in 1944. It wasn't until 1994 that the term Asperger Syndrome became a diagnosis in the Diagnostic Statistical Manual - Fourth Edition (DSM-IV) [http://www.udel.edu/bkirby/asperger/aswhatisit.html ]

Asperger syndrome is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (See the DSM cautionary statement.) as:

  1. Qualitative impairment in social interaction, as manifested by at least two of the following:
    1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction.
    2. Failure to develop peer relationships appropriate to developmental level.
    3. A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people).
    4. A lack of social or emotional reciprocity.
  2. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
    1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in either intensity or focus.
    2. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
    3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements).
    4. Persistent preoccupation with parts of objects.
  3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
  4. There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years).
  5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
  6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. (DSM –IV-TR 2000)

Characteristics of Individuals with Asperger's Syndrome

Christopher Gillberg’s Criteria for Asperger’s Disorder (Gillberg 2002):

  1. Severe impairment in reciprocal social interaction (at least two of the following):
    1. Inability to interact with peers
    2. Lack of desire to interact with peers
    3. Lack of appreciation of social cues
    4. Socially and emotionally inappropriate behavior
  2. All-absorbing narrow interest (at least one of the following):
    1. Exclusion of other activities
    2. Repetitive adherence
    3. More rote than meaning
  3. Imposition of routines and interests (at least one of the following):
    1. On self, in aspects of life
    2. On others
  4. Speech and language problems (at least three of the following):
    1. Delayed development
    2. Superficially perfect expressive language
    3. Formal, pedantic language
    4. Odd prosody, peculiar voice characteristics
    5. Impairment of comprehension including misinterpretation of literal/implied meanings
  5. Non-verbal communication problems (at least one of the following):
    1. Limited use of gestures
    2. Clumsy/gauche body language
    3. Limited facial expression
    4. Inappropriate expression
    5. Peculiar, stiff gaze
  6. Motor Clumsiness: poor performance on neurodevelopmental examination

All six criteria must be met for confimation of diagnosis.

Causes of Asperger's Syndrome

"Researchers and mental health experts are still investigating the causes of autism and AS. Many believe that the pattern of behavior that characterizes AS may have many causes. There seems to be a hereditary component to AS, and research indicates that in some cases AS may be associated with other mental health disorders such as depression and bipolar disorder. Researchers are also looking into whether environmental factors that affect brain development might play a role in the condition" (Meduri 2004).


"Contrary to the incorrect assumptions some may make about people with the disorder, AS is not caused by emotional deprivation or the way a person has been brought up. Because some of the behaviors exhibited by a person with AS may be seen by others as intentionally rude, many people wrongly assume that AS is the result of bad parenting - it isn't. It's a neurobiological disorder whose causes are not yet fully understood" (Meduri 2004).

A part of the neurobiological puzzle may involve the stress hormone cortisol. Researchers found that cortisol levels of AS people do not follow the normal circadian rhythm with high levels in the morning followed by decreasing levels throughout the day. This may help explain why AS people do not handle daily changes very well.[[1]]

According to many experts, there is no cure for Asperger's Syndrome at this point. There are many adults with AS.

Strategies used to teach children with Asperger's Syndrome

According to Karen Williams (1995), teachers of students with Asperger's syndrome should...

  • Provide a highly individualized academic program engineered to offer consistant successes. The child with Asperger's Syndrome 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 Syndrome understand something just because they parrot back what they have heard;
  • Offer added explanation and try to simplify when lesson concepts are abstract;
  • Captialize on these individuals' 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 individuals with Asperger's Syndrome are often repetitious, flit 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 Syndrome 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 Syndrome is not motivated to exert effort in areas in which he or she is not interested.

Critics and their rationale

There is considerable controversy surrounding Asperger Syndrome as a part of the Autism spectrum.

According to Matrix, a publication of the University of California Davis Health Systems, “Some critics dispute whether it and other so-called autism-spectrum disorders, including pervasive developmental disorder-not otherwise specified (PDD-NOS) and childhood disintegrative disorder, are distinct enough to warrant separate diagnostic labels. But with the new labels have come new research efforts, therapeutic approaches and patient support networks.

‘There's not a lot of agreement about the labels,’ acknowledges David Amaral, professor of psychiatry and research director of the UC Davis M.I.N.D. Institute. ‘Unfortunately, there are no biological markers for these disorders. But the problems for people with Asperger syndrome are different from those of people with more profound autism. Those with Asperger's have the potential of living a life in the mainstream.’

Amaral likens the social impairment of Asperger syndrome to tone deafness. Much as a person with a tin ear can't appreciate all the subtleties of a symphony, or sing a song or play an instrument with any ease, ‘people with Asperger's just don't do social behavior appropriately. They simply don't get it.’

According to TIME magazine (What Autism Epidemic? January 22, 2007), Autism was reported to affect 4.7 out of 10,000 American children prior to 1990 but currently affects 60 per 10,000. The increases are mainly in the milder category of Aspergers. Roy Richard Rinker, George Washington University anthropologist, explains in his book Unstrange Minds: Remapping the World of Autism that the broader definition used by the Diagnostic and Statistical Manual of Mental Disorders now includes more people. The increase in labeling children with Autism or Aspergers may be a result of special education services being available or the availability of Medicaid to parents of children with Autism. Children labeled with retardation and learning disabilities has declined as children labeled with Aspergers or Autism have increased. Although Aspergers is a real disorder, a large number of children receiving services today would not have been labeled with the disorder even a few years ago; many children are innapropriately labeled as having Aspergers.

Signed "life experiences", testimonies and stories

This past school year, was how I became introduced to this condition. Originally, all I knew about the student was that he had a 504 plan and what accomodations were to be made. As the year progressed, he was diagnosed with Asperger's. The first thing I noticed about him was that he was very socially akward. He commments and behavior were very 'off color' and shocked me at times. His parents initially refused to believe that their son could have such a condition. They didn't want a 504 plan but the school assured them that they did. Has this student changed during the course of one year? No, but he did used to forget something everyday and I now provide him with multiple reminders and assignments so that he does not. -J.T.D.

John is now a junior in high school at a very prestigious private school. Although I have lost contact with John, I’m sure that he still has some personality traits that will quite go away, but he understands the disorder, the social adjustments, and social cues that he must take to become a well adjusted young adult.

This past school year I gave lessons to a sixth grade trumpet player who has Asperger's Syndrome. He has an aide that accompanies him to his classes however, she would drop him off at his band lesson each week. He was an excellent student who truly enjoyed playing in his lessons. The biggest osbtacles that we had to work on this year were not in regards to music but in listening. There were several instances when he would continue to play while I would try to give directions. I hope that he learned more about trumpet performance and music this year as I have learned much on how to be flexible in my teachings. M. Rice

I find that children with AS are a rewarding group to work with. The children I have taught have great abilities with numbers and logical concepts. It is in this realm that they could be considered gifted students. Gifted students and students diagnosed with AS both have a tendency to lack social skills in many settings, yet they can recite endless multiplication facts. Teaching students with AS requires patience and consistency, especially with daily routines. Catchy reminders and picture charts that remind children with AS of the steps to accomplish tasks such what to do after recess are quite helpful. Visual schedules and picture prompts are also useful for the other students in the class who need simple reminders. -TYM

I spent one summer in college working at a camp with students with special needs. One of the most intriguing students was a boy with AS - he was incredibly intelligent, spoke with a very advanced vocabulary, and was absolutely in love with Broadway musicals. He had a tendancy to become aggressive and easily upset so as a behavior system, he was allowed to perform one Broadway song at the end of a day if he displayed good behavior. He responded extremely well to this approach and we all looked forward to his performances. -N.R.

I am currently teaching a student with AS and have had no experience with teaching a student with this syndrome before. I have found it to be very rewarding though. The student has shown lots of improvement from kindergarten to first grade. The structure in the classroom has helped him make very huge improvements in his reality of what is happening around him. We have also seen his social skills improve, which was very rewarding to see. I look forward to seeing him grow through his elementary years. I know he has more great gains to show. -R.U.

I currently have a student with AS in a junior high math class. He can be a rewarding student to work with. Since I have a small class size he benefits from repeated instruction and extra attention when he is willing to accept it. As with any student it is helpful to bond with these students and find out what interests them. -R Folkens

I have had students with AS in my high school math classes in the past. At the beginning of a semester you don't know what to expect from these particular students. One of the most rewarding things for me is to see a student's progress throughout the semester. It is very rewarding for me to see an AS student participate in class activities and to see my other students accept them as themselves. R. Fruin

In my first year of teaching, I had a seventh grade student diagnosed with AS. Until then I had never heard of the condition. This student was ostracized by his classmates who didn't understand some of his peculiar behaviors. He loved to stay after school with me to educate me on every detail of the puppy he wanted, or pull down the map and show me all of the places he had lived and tell me what he did there. You see, not only did this boy have AS, he did not know who his father was, his mother had died, and he had been passed around the country to various relatives who didn't know how to manage his condition. They refused any medications as his mother had been an addict. I am so proud of this boy! He called me awhile back to tell me that he had become a youth minister for his church and had just returned from a rebuilding project in New Orleans. He was in the college selection process as well, with the ultimate goal of becoming a minister. I've since had two more students with AS, and I teach them with great joy knowing how much potential they hold. T. Stilts

I have a son with Asperger's. More often than not, factors such as room temperature, how clothing feels, odors, etc., are major contributing factors to work accomplished. As his parents, we have to deal with his daily frustrations before we can even begin to look at homework. That means that homework usually goes undone. This in turns results in a lower grade. No matter how we put it in his IEP to be pre-tested before units/chapters/etc., it never happens and homework keeps coming. We finally decided to end the problems by pulling him from public school. He now takes online classes to finish middle school.

We also make a point of telling people we aren't trying to "fix" him. He's not broken! He has a great sense of humor, is incredibly intelligent and insightful. You just have to know how to reduce his frustration level to be able to see past the diagnosis. -Susan Sheahan

Over the past four years I have been the case manager for a student who has been diagnosed with Asperger's Syndrome. Watching him grow up into the person he has been today, it has been great to see that he is coming a little bit out of his shell and being more accepted into social situations with his peers. He has had on the job training at a local hospital and is currently a job coach for other students who are working their now. This student has made significant gains with his social skills due to the classes that he has been through his 5 years of school in our high school. I feel that this is a success story that with the right training and education, students with Asperger's Syndrome can succeed. C. Grice

I have a sophomore student who was just diagnosed with AS about a month ago. When I found out she was being tested, her behaviors all started to make sense. I then began to question why she wasn't tested long ago. I found out that she is in foster care and has been with her current foster parents for a couple years. They are the first ones who have taken notice to her behaviors because she's been with them the longest. I'm glad that she is now receiving help regarding organization and social skills, but I have to wonder if her social skills will improve while she is in high school. Many of her peers have outcasted her because she's "weird" and makes very odd comments. She is not able to really talk to them at this point, and I wonder if her image has already been tainted to the point where she feels like she'll never fit in. I really hope this isn't the case, so I try to make her feel as involved as possible. - A Clow

Next year, I will have three Autistic boys in my class. They have an aide to help them stay on task. In preparation for this, I attended a workshop that focused on strategies for working with students with Asperger's and high functioning autism. The presenter was a mother of an autistic boy and this was delivered with a lot of heart and personal observations. I learned about "power cards", which can take an autistic child's obsession and work to make a point. For example, if a student is often singing aloud in school and this can lead to that child being picked on, the power card will focus on Hillary Duff (a singer that this student likes). The card will remind the student that nobody can sing like Hilary, so the student should only sing at home. This keeps the student focused and free from embarassment. This is an amazing idea and one I hope to use next year. The book is referenced below. D. LePla

References and other links of interest

American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000). Retrieved June 16, 2006 from http://www.behavenet.com/capsules/disorders/asperger.htm

Asperger’s Syndrome. (2006). Retrieved on June 16, 2006 from Wikipedia, the Online Encyclopedia: http://en.wikipedia.org/wiki/Asperger_syndrome

Falk-Ross, F., Iverson, M. & Gilbert, C. (2004). Teaching and Learning Approaches for Children with Asperger’s Syndrome: Literacy Implications and Applications. TEACHING Exceptional Children 36 (4), 48-55.

Gillberg, C. (2002). A Guide to Asperger Syndrome. Cambridge, UK: Cambridge University Press.

Meduri, A. (2004). Asperger Syndrome. Retrieved June 21, 2006 from http://kidshealth.org/parent/medical/brain/asperger.html

Ozbayrak, R. K. (1996). Asperger’s Disorder Homepage. Retrieved June 21, 2006 from http://www.aspergers.com/

http://www.ninds.nih.gov/disorders/asperger/asperger.htm

Williams, K. (1995). Understanding the students with Asperger's Syndrome: Guidelines for teacher. Retrieved June, 27, 2006 from http://www.udel.edu/bkirby/asperger/karen_williams_guidelines.html

http://www.ucdmc.ucdavis.edu/matrix/vol8_no3_april01/html/autism2.html

Gagnon, E. (2001). Power cards. Shawnee Mission, KA:Autism Asperger Publishing Co.,

Links to support groups

  • Online Asperger Syndrome Information & Support - O.A.S.I.S.[2]
  • Asperger's Family Forum[3]
  • Daily Strength[4]
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