Autism: Asperger Syndrome
By Sunmy Brown







Definition of the exceptionality

Asperger Syndrome (AS) is a neurobiological disorder on the higher-functioning end of the autism spectrum. An individual's symptoms can range from mild to severe. While sharing many of the same characteristics as other Autism Spectrum Disorders (ASD's) including Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) and High-Functioning Autism (HFA), AS has been recognized as a distinct medical diagnosis in Europe for almost 60 years, but has only been included in the U.S. medical diagnostic manual since 1994 ("Asperger Disorder" in the DSM-IV).

ASPEN Corporation (2010). What is asperger syndrome.
Retrieved from http://aspennj.org/aspergers-syndrome.asp



Characteristics associated with the exceptionality


Each person is different. An individual might have all or only some of the described behaviors to have a diagnosis of AS.

These behaviors include the following:
  • Marked impairment in the use of multiple nonverbal behaviors such as: eye gaze, facial expression, body posture, and gestures to regulate social interaction.
  • Extreme difficulty in developing age-appropriate peer relationships. (e.g. AS children may be more comfortable with adults than with other children).
  • Inflexible adherence to routines and perseveration.
  • Fascination with maps, globes, and routes.
  • Superior rote memory.
  • Preoccupation with a particular subject to the exclusion of all others. Amasses many related facts.
  • Difficulty judging personal space, motor clumsiness.
  • Sensitivity to the environment, loud noises, clothing and food textures, and odors.
  • Speech and language skills impaired in the area of semantics, pragmatics, and prosody (volume, intonation, inflection, and rhythm).
  • Difficulty understanding others' feelings.
  • Pedantic, formal style of speaking; often called "little professor," verbose.
  • Extreme difficulty reading and/or interpreting social cues.
  • Socially and emotionally inappropriate responses.
  • Literal interpretation of language. difficulty comprehending implied meanings.
  • Extensive vocabulary. Reading commences at an early age (hyperlexia).
  • Stereotyped or repetitive motor mannerisms.
  • Difficulty with "give and take" of conversation.

Individuals with AS and related disorders exhibit serious deficiencies in social and communication skills. Their IQ's are typically in the normal to very superior range. They are usually educated in the mainstream, but most require special education services. Because of their naivete, those with AS are often viewed by their peers as "odd" and are frequently a target for bullying and teasing.

They desire to fit in socially and have friends, but have a great deal of difficulty making effective social connections. Many of them are at risk for developing mood disorders, such as anxiety or depression, especially in adolescence. Diagnosis of autistic spectrum disorders should be made by a medical expert to rule out other possible diagnoses and to discuss interventions.
ASPEN Corporation (2010). What is asperger syndrome.
Retrieved from http://aspennj.org/aspergers-syndrome.asp



Prevalence

The prevalence rates for Asperger syndrome range 0.3 to 48.4 per 10,000, a huge variation which reflects methodological differences across studies. However, it is noteworthy that in all studies the rate of Asperger disorder was consistently lower than that of autistic disorder (Fombonne, 2001).

Thus, with a conservative prevalence estimate of 10 per 10,000 children with autistic disorder (Fombonne, 2001), these figures suggest that the prevalence of Asperger disorder might be in the neighborhood of 2 per 10,000.

Fombonne, E. (2001). What is the prevalence of asperger disorder.
Journal of Autism and Developmental Disorders, 31(3), 363-364


Types
In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation.
Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome. Wing’s writings were widely published and popularized. AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10), and in 1994 it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.
National Institute of Neurological Disorders and Stroke, (2010). What causes asperger syndrome: Is it
genetic. Retrieved from
http://www.ninds.nih.gov/disorders/asperger/asperger.htm


Causes



Current research points to brain abnormalities as the cause of AS. Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific regions of the brains of normal versus AS children. These defects are most likely caused by the abnormal migration of embryonic cells during fetal development that affects brain structure and “wiring” and then goes on to affect the neural circuits that control thought and behavior.
For example, one study found a reduction of brain activity in the frontal lobe of AS children when they were asked to respond to tasks that required them to use their judgment. Another study found differences in activity when children were asked to respond to facial expressions. A different study investigating brain function in adults with AS revealed abnormal levels of specific proteins that correlate with obsessive and repetitive behaviors.
Scientists have always known that there had to be a genetic component to AS and the other ASDs because of their tendency to run in families. Additional evidence for the link between inherited genetic mutations and AS was observed in the higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form. For example, they had slight difficulties with social interaction, language, or reading.
A specific gene for AS, however, has never been identified. Instead, the most recent research indicates that there are most likely a common group of genes whose variations or deletions make an individual vulnerable to developing AS. This combination of genetic variations or deletions will determine the severity and symptoms for each individual with AS.
National Institute of Neurological Disorders and Stroke, (2010). What causes asperger syndrome: Is it
genetic. Retrieved from
http://www.ninds.nih.gov/disorders/asperger/asperger.htm



Identification


The diagnosis of AS is complicated by the lack of a standardized diagnostic screen or schedule. 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.
To further complicate the issue, some doctors believe that AS is not a separate and distinct disorder. Instead, they call it high-functioning autism (HFA), and view it as being on the mild end of the ASD spectrum with symptoms that differ -- only in degree -- from classic autism. Some clinicians use the two diagnoses, AS or HFA, interchangeably. This makes gathering data about the incidence of AS difficult, since some children will be diagnosed with HFA instead of AS, and vice versa.
Most doctors rely on the presence of a core group of behaviors to alert them to the possibility of a diagnosis of AS. These are:
  • abnormal eye contact
  • aloofness
  • the failure to turn when called by name
  • the failure to use gestures to point or show
  • a lack of interactive play
  • a lack of interest in peers
Some of these behaviors may be apparent in the first few months of a child’s life, or they may appear later. Problems in at least one of the areas of communication and socialization or repetitive, restricted behavior must be present before the age of 3.
The diagnosis of AS is 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.
The comprehensive evaluation includes neurologic and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and non-verbal strengths and weaknesses, style of learning, and independent living skills. An assessment of communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities, and humor); patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity, and coherence of conversation. The physician will look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis.

National Institute of Neurological Disorders and Stroke, (2010). What causes asperger syndrome: Is it
genetic. Retrieved from

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

Instructional strategies and tips

Some of the strategies for teaching students with autism may be applicable to students with AS. However, it is important to consider the unique learning characteristics of the individual student, provide support when needed, and build on the student’s many strengths. The following chart identifies some specific learning difficulties and suggests a number of possible classroom strategies, adapted from a variety of sources in the literature.
Learning Difficulty
Classroom Strategy
Difficulties with Language
• tendency to make irrelevant comments
• tendency to interrupt
• tendency to talk on one topic and to talk over the speech of others

• difficulty understanding complex language, following directions, and understanding intent of words with multiple meanings
• use Comic Strip Conversations (Gray, 1994) to teach conversation skills related to specific problems
• teach appropriate opening comments
• teach student to seek assistance when confused
• teach conversational skills in small group settings
• teach rules and cues regarding turn-taking in conversation and when to reply, interrupt, or change the topic

• use audio-taped and video-taped conversations
• explain metaphors and words with double meanings
• encourage the student to ask for an instruction to be repeated, simplified, or written down if he does not
understand

• pause between instructions and check for understanding
• limit oral questions to a number the student can manage
• watch videos to identify non-verbal expressions and their meanings
Insistence on sameness
• prepare the student for potential change, wherever possible

• use pictures, schedules, and social stories to indicate impending changes
Impairment in social interaction
• prepare the student for potential change, wherever possible

• use pictures, schedules, and social stories to indicate
impending changes
Impairment in social interaction
• has difficulty understanding the rules of social interaction
• may be naive
• interprets literally what is said
• difficulty reading the emotions of others
• lacks tact
• has problems with social distance
• has difficulty understanding “unwritten rules” and once learned, may apply them rigidly

• lacks awareness of personal space
• provide clear expectations and rules for behaviour
• teach (explicitly) the rules of social conduct
• teach the student how to interact through social stories, modelling and role-playing

• educate peers about how to respond to the student’s disability in social interaction

• use other children as cues to indicate what to do
• encourage co-operative games
• provide supervision and support for the student at breaks and recess, as required

• use a buddy system to assist the student during nonstructured times
• teach the student how to start, maintain, and end play
• teach flexibility, co-operation, and sharing
• teach the students how to monitor their own behaviour
• structure social skills groups to provide opportunities for direct instruction on specific skills and to practise
actual events

• teach relaxation techniques and have a quiet place to go to relax

• model and practise appropriate personal space
Restricted range of interests
• limit perseverative discussions and questions
• set firm expectations for the classroom, but also provide opportunities for the student to pursue his own
interests

• incorporate and expand on interest in activities
Poor organizational skills
• use personal schedules and calendars
• maintain lists of assignments
• help the student use “to do” lists and checklists
• place pictures on containers and locker
• use picture cues in lockers
Poor motor co-ordination
• involve in fitness activities; student may prefer fitness activities to competitive sports

• take slower writing speed into account when giving assignments (length often needs to be reduced)

• provide extra time for tests
• consider the use of a computer for written assignments, as students may be more skilled at using a keyboard
Academic difficulties
• usually average to above-average intelligence
• good recall of factual information
• areas of difficulty include problem solving, comprehension, and abstract concepts

• often strong in work recognition and may learn to read very early, but has difficulty with comprehension

• may do well at math facts, but not problem solving
• do not assume that the student has understood simply because she or he can re-state the information
• be as concrete as possible in presenting new concepts and abstract material

• use activity-based learning where possible
• use graphic organizers such as semantic maps, webs
• break tasks down into smaller steps or present in another way

• provide direct instruction as well as modelling
• show examples of what is required
• use outlines to help student take notes and organize and categorize information

• avoid verbal overload
• capitalize on strengths (e.g., memory)
• do not assume that student has understood what he or she has read—check for comprehension, supplement
instruction, and use visual supports
Emotional vulnerability
• may have difficulties coping with the social and emotional demands of school

• easily stressed because of inflexibility
• prone to anxiety
• often have low self-esteem
• may have difficulty tolerating making mistakes
• may be prone to depression
• may have rage reactions and temper outbursts
• provide positive praise and tell the student what she or he does right or well

• teach the student to ask for help
• teach techniques for coping with difficult situations and for dealing with stress, such as relaxation strategies

• use rehearsal strategies
• provide experiences in which the person can make choices

• help the student to understand her or his behaviours and reactions of others

• educate other students
• use peer supports such as buddy system and peer support network
Sensory sensitivities
• most common sensitivities involve sound and touch, but may also include taste, light intensity, colours, and aromas

• types of noise that may be perceived as extremely intense are:

• sudden, unexpected noises such as a telephone ringing, or fire alarm

• high-pitched continuous noise
• confusing, complex, or multiple sounds, such as in shopping centres
• be aware that normal levels of auditory and visual input can be perceived by the student as too much or
too little

• keep the level of stimulation within the student’s ability to cope

• avoid sounds that are distressing, when possible
• use music to camouflage certain sounds
• minimize background noise
• use ear plugs if noise or reaction is very extreme
• teach and model relaxation strategies and use of diversions to reduce anxiety

• provide opportunities and space for quiet time
• arrange for independent work space that is free of sensory stimuli that bother the student

Ministry of Education, (2000). Teaching students with autism: A resource guide for schools.
Retrieved from http://www.bced.gov.bc.ca/specialed/docs/autism.pdf

Key resources for Professionals
I. Websites
  1. Autism Speaks: Asperger Syndrome

  2. Asperger Syndrome and High Functioning Autism

  3. Asperger Syndrome Education Network

  4. The Global and Regional Asperger Syndrome Partnership

  5. OASIS: Online Asperger Syndrome Information and Support

  6. Parenting Asperger's Blog

  7. Parenting Aspergers Community

  8. Teaching Strategies for Students with Asperger Syndrome

  9. Teaching Students with Autism

II. Books

  1. Asperger Syndrome and Bullying: Strategies and Solutions by Nick Dubin

  2. Autism and Asperger Syndrome: Busting the Myth by Lynn Adams

  3. Dinosaur Diego: The World’s Smartest Dude: Asperger’s Syndrome

  4. Finding Kansas: Decoding the Enigma of Asperger’s Syndrome by Aaron Likens

  5. School Success for Kids With Asperger's Syndrome: A Practical Guide for Parents and Teachers by Stephan Silverman

  6. Baj and the Word Launcher: Space Age Asperger Adventures in Communication by Pamela Victor

III. Articles

  1. Gifted Child Quarterly-2000-Neihart-222-30.pdf

  2. Prevalence of Asperger Syndrome.pdf

  3. Asperger's_Sydrome_Diagosis_Treatment.pdf

  4. Asperger_Syndrome_Center_for_Disease_Control_Fact_Sheet.pdf

  5. Asperger_Syndrome_Developmental_Screening_Fact_Sheet.pdf


References

ASPEN Corporation (2010). What is asperger syndrome.
Retrieved from http://aspennj.org/aspergers-syndrome.asp


Fombonne, E. (2001). What is the prevalence of asperger disorder.
Journal of Autism and Developmental Disorders, 31(3), 363-364

Ministry of Education, (2000). Teaching students with autism: A resource guide for schools.
Retrieved from http://www.bced.gov.bc.ca/specialed/docs/autism.pdf


National Institute of Neurological Disorders and Stroke, (2010). What causes asperger syndrome: Is it
genetic. Retrieved from
http://www.ninds.nih.gov/disorders/asperger/asperger.htm