asperger - summary symptoms and help

8/14/2019 Asperger - Summary Symptoms and Help

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ASPERGER'S SYNDROME (AS)

BEHAVIORAL DEFINITION

The autism spectrum extends from classic autism which lies at the lower end of the

spectrum through ASPERGER'S SYNDROME, which is characterized as being at themildest and highest functioning end of the spectrum or Pervasive Developmental Disorder Continuum

The major source of stress in life for the person with Asperger's Syndrome is

social contact, and increased stress generally leads to anxiety disorders &

depression

Attwood, T. Asperger's Syndrome:A Guide for Parents and Professionals, 1998, p. 148.

AS represents a neurologically-based disorder of developmentAS reflects deviations or abnormalities in four aspects of development:

(1) Social relatedness and social skills

(2)The use of language for purposes of communication

(3)Certain behavioral and stylistic characteristics such as repetitive orpersevering features

(4)Limited, but intense, range of interests

These dysfunctional features can range from mild to severe

it is estimated that the prevalence of Asperger is 2.6 per 1,000 individuals.

AS is characterized by:

high cognitive abilities - or, at least, normal IQ levelextending into the verysuperior range of cognitive ability

normal language function when compared to other autistic disorders

difficulties with pragmatic, or social language

a better prognosis than other Autism spectrum disorders

Individuals with autism also have gifts. The gifts of autism occur as a result of the strongvisual abilities, attention to minute details, unusual interests, and amazing memory. Othercommon traits, such as honesty, naivet, gentleness, compliance, and perfectionism, areexceedingly refreshing and unexpected in this increasingly cynical world

Janzen, J. E. (1999).Autism: Facts and strategies for Parents

Nurses are in a position to identify children with Asperger's early. After identification, thenecessary referrals, treatment options, support, and follow-up are essential for thesechildren. Nurses need more knowledge about this disorder and need to be proactive in

defining their role to help children with the disorder in the schools and the community.

Marshall, M.C. Asperger's syndrome: Implications for nursing practice


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Diagnostic Criteria from DSM-IV-TR (2000)

American Psychiatric Association, Washington, D.C. www.psych.org(Diagnostic and Statistical Manual of Mental Disorders)

Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of thefollowing:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate socialinteraction

(2)failure to develop peer relationships appropriate to developmental level

(3)a lack of spontaneous seeking to share enjoyment, interests, orachievements with other people (e.g., by a lack of showing, bringing, or pointingout objects of interest to other people)

(4)Lack of social or emotional reciprocity

B.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 stereo-typed and restrictedpatterns of interest that is abnormal either in intensity or focus

(2)apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flappingor twisting, or complex whole-body movements)

(4)persistent preoccupation with parts of objects

C.The disturbance causes clinically significant impairment in social, occupational, orother important areas of functioning.

D.There is no clinically significant general delay in language (e.g., single words usedby age 2 years, communicative phrase used by age 3 years)

E.There is no clinically significant delay in cognitive development or in thedevelopment of age-appropriate self-help skills, adaptive behavior (other than insocial interaction), and curiosity about the environment in childhood

F.Criteria are not met for another specific Pervasive Developmental Disorder orSchizophrenia

While there is no cure for Asperger's, experts agree that the earlier a child is properlydiagnosed and receives individualized assistance, the better the chance that he can lead aquality life

Parade Magazine, February 2, 2003; pp. 4-5

People with Asperger's Syndrome may have unusual qualities to their language skills thatsuperficially resemble the speech and thought disorder associated with schizophreniathiscan be confusing to the clinician who is not aware of this aspect of Asperger's Syndrome

Attwood, T. (1998). Asperger's Syndrome: A Guide for Parents and Professionals, p. 149.
http://www.psych.org/http://www.psych.org/


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AS: CLINICAL FEATURES

One of the primary features of Asperger's syndrome is their passion for favoritetopics or special interests

Some of these areas include:

math, science, reading, history, music

geography, social studies, metereology, astronomy, weather, maps

extraterrestrials, machines or machinery, trains, dinosaurs, space travel

Socialization deficits

Different from "typical" Autism

Described as being "in OUR world, but, ON THEIR OWN terms"

Preoccupied with own agenda, seldom interested in other's interests/concerns

By school age express desire to fit in socially

Highly frustrated by their social awkwardness/alienation Lack effective interaction skills not desire

Difficulties making social connections

Unable to read others' needs and perspectives

Unable to appropriately respond to social cues

Frequently described as odd or selfish

Nave and lack common sense in connection with human relations and rules ofsocial convention

Are inflexible and incapable of coping with change Easily stressed and emotionally vulnerable

Use of Language

Rote skills are strong

Prosody - speech volume, intonation, inflection, rate - is frequently deficient orunusual

Excessively formal or pedantic language

Misused or not used cultural slang or social idioms

Concrete language rather than abstract

Weak pragmatic-conversational-skills, like problems with taking turns inconversations

Typically revert to favorite topic area

Difficulty understanding humor in social context, tend to laugh at wrong timewith jokes or interactions.

Often have good sense of humor, outside of rapid social dynamics. Usually likeword games and puns

Hyper-verbal (highly developed vocabularies) especially in fields of interest

Early years: repetitive phrases or language or stock phrases from memorizedmaterial


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Some have normal or early language development, others have speech delays,then rapidly catch up, making diagnosis between AS, autism, and speechdisorders difficult.

TEACHING STRESS REDUCTION SKILLS

AS children are:

easily overwhelmed - highly sensitive

often engage in rituals - often anxious and worrisome

Practical Suggestions:

provide predictable, safe environments - minimize transitions

consistent routines - let them know what to expect

prepare them for altered plans, schedules or changes - minimize fears ofunknown

Examples: Introduce to teacher, therapist or para-professional before work begins.

Take tour of building child will be working or learning in.

Learn about child's favorite topics or special interests

Williams, K. (1995). Understanding the student with Asperger's Syndrome:Guidelines for Teachers. Focus on Autistic Behavior, Vol. 10, #2.

AS children typically display impaired Social Interaction

Practical Suggestions:

Shield them from bullying and teasing - Educate peers

Praise classmates when supportive - Promote empathy and tolerance

Create cooperative learning situations

Examples:

Use AS child's strengths in exchange for liabilities to foster acceptance

Teach and support proper reaction to social cues - Rehearse proper responserepertoires

Teach WHAT to say, WHEN, and HOW to say it

Model two-way interactions - Teach/model correct emotional responding

Insensitive or inappropriate comments from AS are usually innocent

Teaching WHY & WHAT response is appropriate is necessary

Encourage participation in conversations

Adapted from: Williams, K. (1995). Understanding the student with Asperger's Syndrome:

Guidelines for Teachers. Focus on Autistic Behavior, Vol. 10, #2 .


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COMMUNICATION AND GESTURES

Six steps for understanding challenging communications:

(1)Trytofigure outwhatthe childiscommunicatingwithitschallengingbehavior

- This is too difficult for me- I can't remember what I'm supposed to do

- I'm mad scared confused

(2) Consider how you can adapt the situation

Child expressing confusion? ==> consider how to make the situation easier tounderstand. Make it more concrete, routine, or predictable

Child overwhelmed or overstimulated? ==> Try reducing amount of time insituation, or avoiding it in future.

(3) If the message must be communicated, come up with alternate way in whichyour child can communicate his or her needs or wishes more appropriately

Help your child develop appropriate ways of conveying requests/needs.

If screaming when confused by a task, teach child to raise hand, ring a bell,or say: I need help with thisthis is too hard

(4) Practice the new way of communicating

model more appropriate phrase or nonverbal signals

have child practice the new phrase or behavior

during the situation, remind (prompt) child to use new phrase or behavior

(5) Reward your child for using the strategy by showing that it gets his or herneeds met.

if your child requests help assist her immediately

if asks to leave situation, provide her with immediate break

if needs attention, stop what you're doing and provide some time/interest

(6) Be sure that the challenging behavior is no longer effective in getting yourchild's needs met.

ignore problem behaviors

provide prompt for the new, appropriate one

if child screams to avoid situation, prompt her to use an appropriate phrase.Do NOT allow her to leave the situation while she is screaming.

Ozonoff, S., Dawson, G., & !"art#and, $. %(.A parent's guide to asperger syndrome and high-functioningautism: How to meet the challenges and help your child thrive.)ew *or+, )*: Te G-#ford "ress.pp. 1/14.

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