Language Comprehension/Auditory Processing Difficulties
Characteristics: Children with Asperger's Syndrome generally interpret auditory information literally and concretely. They can have difficulty understanding figurative language, jokes/riddles, multiple meaning words, teasing and implied meanings.
Example 1: A child with Asperger's Syndrome was participating in a local basketball clinic. He was playing very well, and the coach made the comment, "Wow! Your mom must have put gas in your shoes this morning". The child quickly looked at his mother with a worried expression. His mother shook her head "No" and encouraged him to keep on playing. The child responded to the coach, "Not today."
Example 2: A mother said to her child, "Stop back-talking to me". The child said, "I'm sorry Mom, I'll talk to your front."
It is also important to note that delays in processing information auditorilly may be present in children with Asperger's Syndrome. Even though they may be able to comprehend the auditory information given, it may take them additional time to process this information prior to responding. They may also have difficulty following multi-step auditory directions (e.g., "Go back to your desk and take out your journals, and then write about your weekend.").
Language Comprehension/Auditory Processing - Intervention Strategies:
- Auditory information/prompting should be kept to a minimum, as it can be too overwhelming for some children. Visual cues should be used to assist the child to more readily comprehend directions, questions, rules, figurative language, etc.
- Give the child with Asperger's Syndrome enough time to respond, in order to allow for possible auditory processing difficulties, before repeating/rephrasing the question/directive. The child can be taught appropriate phrases to indicate he needs additional processing time, (e.g., "Give me a minute, I'm thinking") (2).
- Written rules can help the child understand what is expected of him at all times. Reference to the rules can be used rather than verbally telling him what to do, or what not to do.
- Auditory directions can be written on a dry erase board for the child with Asperger's Syndrome, greatly increasing his ability to independently complete tasks/activities.
- The adults in the child's environment should be aware of the child's concrete/literal interpretation of figurative language, and should provide concrete explanations if necessary. Focus should also be given to increasing the child's comprehension of figurative language skills, such as idioms, multi-meaning words, jokes, teasing, etc., through the use of visual supports.
Sensory Processing Difficulties
Characteristics: The child with Asperger's Syndrome may exhibit some sensory processing difficulties that result in atypical responses to sensory input (auditory, visual, tactile, smell, taste and movement). This difficulty in organizing his sensory input, experiencing both hypersensitive (over response) and hyposensitive responses (under response) to various sensory stimuli, can cause him to experience stress and anxiety in trying to interpret his environment accurately. Sensory processing difficulties can also markedly decrease the child's ability to sustain focused attention. It is important to note that the processing of this sensory information can be extremely inconsistent; that is, at one time the child may experience a hypersensitive response to a specific sensory stimuli, but at another time may exhibit a typical or a hyposensitive response.
Example: A child with Asperger's Syndrome was eating in a restaurant with family members and experiencing sensory overload. He ate as quickly as possible and then asked if he could go outside. The child paced for 20 minutes back and forth in front of the restaurant while waiting for the rest of the family to finish eating. While riding home, he pulled the hood of his coat all the way over his face and tied it tightly, to try to block out all sensory stimuli.
Example: While watching television with his family, a child with Asperger's Syndrome put his hands over his ears and exclaimed "That T.V. is driving me crazy".
Example: A child with Asperger's Syndrome exhibited an extreme sensory sensitivity to the sight and smell of eggs, particularly hard-boiled. The child gagged and vomited when exposed to hard-boiled eggs.
Sensory Processing - Intervention Strategies:
- It is important to be aware of possible auditory sensitivities and how the environment might be contributing to the child's marked increase in anxiety and challenging behaviors. Strategies to accommodate for auditory sensitivities can include:
- Use of headphones/headband to muffle extraneous auditory stimuli;
- Use of headphones to listen to calming music - when appropriate;
- Forewarn the child of any fire drills, tornado drills, etc. This can be done both verbally and visually (on his schedule). Although the child may appear calm outwardly and appear able to readily handle this change in routine, he may be experiencing internal stress/anxiety which could appear later.
- The use of a daily sensory diet, consisting of access to various sensory calming activities and/or physical activities (as deemed necessary), which are scheduled throughout the child's day. This can decrease his stress, anxiety and repetitive behaviors, as well as increase his calm/relaxed states and focused attention. Sensory "break" activities should be visually represented on the child's daily schedule. Examples of sensory calming activities include:
- Deep pressure (pressure touch) activities: firm hugs; being rolled within a mat or blanket; wearing a weighted vest/blanket; water activities; ball bath; massage; chewing, wearing a "Body Sock".
- Rhythmic vestibular stimulation: swinging, rocking in a rocking chair; movement on a wagon, scooter board, tri/bicycle; jumping; bouncing; vibration; or rolling in a tube or mat.
- Proprioceptive stimulation: sitting on a T-stool, Dyna-Disk or therapy ball for increased focused attention.
- Incorporating heavy work patterns (i.e., push, pull, carry) into functional
tasks/jobs appears to assist some children in becoming more calm and
focused. For example, taking the attendance or lunch room count to the
office for each classroom; getting the milk cartons for the kindergarten
classrooms and delivering them to each classroom; sweeping a walkway;
carrying books back to the library; cleaning the chalkboard, etc.
- Use of a "quiet space/area" in order to decrease sensory overload and increase self-calming, is another strategy. The quiet space should be a specified location/area with objects which are calming to the child (e.g., kush balls, books, bean bag chair). For children who transition to various classrooms, the use of a "home base" classroom as a safe place to go is suggested when they feel the need for calming (12).
- Access to a "fiddle basket" containing small items for the child to manipulate (e.g., small kush balls, Bend Bands, Fiddle-links, clothespins, etc.) can help calm the child and focus his attention at certain times during the day (e.g., while sitting and listening to a story read aloud by the teacher).
- To avoid sensory overloading transitions such as changing class periods, going to/from recess, or changing clothes for gym in the locker room, allow the child to transition a few minutes earlier or later than the rest of the students.
Difficulty Representing Language Internally
Characteristics: Children with Asperger's Syndrome can "blurt out" their thoughts as statements of factual information, resulting in an appearance of insensitivity and lack of tact. However these children typically do not understand that some thoughts and ideas can and should be represented internally, and thus should not be spoken aloud. Therefore, whatever they think, they tend to say aloud.
Example 1: "Mrs. Jones, why are you wearing that dress? It looks just like a bathrobe."
Example 2: "This is boring. Don't' you think this is boring, Ryan? ".
Typically developing children can internalize thoughts by the time they are five to six years old (2). This aspect of language should show improvement as the child learns how to take the perspective of others. This perspective-taking ability is sometimes referred to being able to "mind-read" or developing "Theory of Mind".
Representing Language Internally - Intervention Strategies:
- Initially, encourage the child to whisper, rather than speak his thoughts aloud . Next, encourage him to "think it-don't say it" (1).
- Role playing, audio/video taping and social scripting can all be used
to teach the child how to initially identify what "thoughts"
should be represented internally, versus aloud. Role playing will allow
the child to practice this skill.
Insistence on Sameness
Characteristics: Children with Asperger's Syndrome can be easily overwhelmed by minimal changes in routines and can exhibit a definite preference for rituals (13). As a result, these children can become quite anxious and worry incessantly about the unknown; that is, when the environment becomes unpredictable and they do not know what to expect.
Example: Unpredictability may occur during less structured activities or times of the day: recess, lunch, free play/time, physical education, bus rides to/from school, music class, art class, assemblies, field trips, substitute teachers, delayed start/early dismissal, etc.
The following features are important to consider for the child with Asperger's Syndrome:
- Rigid, egocentric perceptions: Children with Asperger's Syndrome tend to have very rigid egocentric perceptions of the world, and thus can become quite upset when changes occur that "go against" their preconceived "rules" or perceptions (14). Therefore, when a new situation occurs, they have to learn a "new rule" (perception) which can be very upsetting to them (e.g., indoor recess due to inclement weather) (14).
- Strict adherence to rules: Children with Asperger's Syndrome may generate rules based upon their perceptions of various experiences. As a result, they may strictly adhere to these self-imposed rules, and expect others to adhere as well. When these rules are "broken" by others, this can create a great deal of stress/anxiety in children with Asperger's Syndrome.
Example: Whenever a particular child with Asperger's Syndrome tells someone "Thank you", he expects the person to respond immediately with, "Your welcome". If the person does not immediately respond, the child will perseverate in saying "Thank you", and become increasingly anxious until the person says "You're welcome").
Conversely, when given rules by others (teachers, parents, etc.), children with Asperger's Syndrome tend to strictly and concretely interpret the rules, as well as exhibit strict adherence to the rule - for both themselves and others.
Example: A child with Asperger's Syndrome was given the following rules in art class by the teacher regarding markers: "No throwing markers; No chewing on the markers; No smashing marker tips". The child with Asperger's Syndrome imitated a peer, and connected the markers together to make a long "sword" type structure. This child and the peer engaged in a "sword fight". Both children got "in trouble" for this behavior, although the child with Asperger's Syndrome was truly confused as to why he was in trouble because he hadn't broken any "rules", according to his perceptions.
- Need for closure/completion: In relation to their ritualistic needs, children with Asperger's Syndrome can exhibit an intense need for closure or completion of tasks/activities before transitioning to the next activity. This can create significant educational implications if not planned for accordingly (e.g., If a math worksheet is not able to be completed prior to going out for recess, the child with Asperger's Syndrome may become quite upset - even though he may enjoy going outside for recess very much). The anxiety relates to the need for closure, a ritualistic need, rather than in relation to the specific activities at hand, and typically cannot be alleviated by being told that the activity can completed later.
Insistence on Sameness - Intervention Strategies:
- It is important to provide a consistent, predictable environment with minimal transitions.
- Use of a visual schedule can assist in providing the child with information relating to his day, as well as preparing him for any changes which might occur in his daily routine.
- Visual and auditory forewarning/foreshadowing are also critical, in order to give the child much needed information relating to possible changes in routines.
- Assignments may need to be modified so that the child can complete them within a specific amount of time, prior to transitioning to the next activity.
- Use of a "finish later" folder or box may be helpful. Even though the child may be verbally reminded that he can finish his math worksheet after recess, this information will not be processed as readily as through the use of a visual strategy, such as a "finish later" folder/box.
Characteristics: Children with Asperger's Syndrome can often appear off-task, and may be easily distracted by both internal (perseverative thoughts/concerns) and external (sensory) stimuli. For example, internal stimuli distraction: a child sees a single cloud in the sky and begins to obsess about whether it is going to rain and/or possibly storm. External stimuli distraction: attending to a fly buzzing around the room rather than the teacher; attending to fluorescent light flickering). Screening out information that is irrelevant can be very difficult, requiring conscious effort by the child with Asperger's Syndrome (13).
In addition, children with Asperger's Syndrome can exhibit significant difficulties regarding both their internal and external organizational skills, including the following:
- Organizing their thoughts and ideas to express themselves in a cohesive manner. For example, a child with Asperger's Syndrome was asked to explain how he figured out the answer to the math problem, 900 x 3=2,700. He responded: "Well, first of all, 9 x 3=27 and 90 x 3=270 and 900 x 3=2,700 and it sort of reminds me of another kind of math problem like the other day when you're multiplying and uh it goes 9 x 3=27 and then uhm, its like... I don't really know what I'm saying.").
- Gathering educational materials needed for specific tasks/activities/homework.
- Keeping track of their belongings - including personal and educational materials such as assignments.
- Desk/locker organization, etc.
Concentration/Distractibility/Disorganization - Intervention Strategies:
- A highly structured educational environment may be indicated for the child with Asperger's Syndrome to experience success (please refer to the "Structured Teaching" article for additional information).
- Use of a timer (either egg or kitchen) provides time constraints and structure for completing tasks. When given an unlimited amount of time, children with Asperger's Syndrome may take an unlimited amount of time for task completion. However caution should be taken in using timers. Some children may become highly interested (distracted) in the amount of time which is passing, via the timer, and thus become less attentive to completing the task. Other children have exhibited extreme anxiety when timers are used because they become overly focused on the amount of time passing, and thus perceive that they cannot complete the task within the time constraint given.
- A written (visual) checklist is used to keep the child focused and "on task" so that he can complete each step listed in sequential order. This visual tool will allow for independent completion of an entire routine or task (e.g., use of a "morning routine" checklist or "homework" checklist).
- A daily (individualized) visual schedule should be used to communicate to the child what is currently happening, when he is "all done" with something, what is coming up next, and any changes that might occur. (Please refer to the article on Structured Teaching for more information regarding visual schedules).
- Use of a visual calendar at both home and school will give the child information regarding up-coming events/activities. When the child asks when a particular event will occur, he can easily be referred to the visual calendar, which presents the information through the visual mode, which the child can more readily understand (e.g., class field trip, "bath night", swimming lessons, etc.).
- Give written directions/cues whenever possible in various contexts/environments. Small dry erase boards and index cards are good tools to use for written directions as they are easily portable. (e.g., In computer lab, a three step direction could be written down to give the child information as to what he needs to do independently, rather than giving him continual auditory prompting for completion of the task).
- Use color-coded notebooks to match academic books.
- Use an assignment notebook consistently.
- Worksheets may need to be reorganized. Modifications could include fewer problems per sheet; larger, highly visual space for responding and boxes next to each question to be checked when completed.
- For class lectures, peer buddies may be needed to take notes. No Carbon Required (NCR) paper can be used or the student's notes could be copied on a copy machine.
- Use of an "Assignments to be Completed" folder as well as a "Completed Assignments" folder, is also recommended.
Characteristics: Children with Asperger's Syndrome often have the intellectual ability to successfully participate in the regular education curriculum. However, they may lack the social/emotional abilities to cope with the demands of the regular education enviroment, such as regular class room, recess, and lunch (13). As a result, these children may exhibit a low self-esteem, may be self-critical and may be unable to tolerate making mistakes (perfectionist) (13). Thus they can become easily overwhelmed, stressed and frustrated, resulting in behavioral outbursts due to poor coping strategies/self-regulation. These children can appear quite anxious for most of their waking day as they continually attempt to manage an ever-changing, sensory stimulating, social world. As stated by Tony Attwood, children with Asperger's Syndrome "are emotionally confused, not emotionally disturbed" (2).
Emotional Vulnerability - Intervention Strategies:
- Utilize the child's strength areas and incorporate them into special projects/assignments to be presented to the class by the child. This activity may increase his self-esteem with peers (e.g., a child with a high interest in geography could give a presentation to the class relating to the current area of study).
- Teach the child relaxation techniques that he could learn to implement on his own to decrease anxiety levels (e.g., "Take a big breath, count to ten", etc.) These steps could initially be written down as visual "cue" cards for the child to carry with him, and refer to as needed.
Restricted/Perseverative Range of Interests
Characteristics: Children with Asperger's Syndrome tend to have eccentric preoccupations or odd, intense fixations, as noted by the following characteristics (13):
- Relentless "lectures" on their specific areas of interest;
- Repetitive questions about interests, concerns or worries;
- trouble "letting go" of thoughts or ideas, particularly relating to concerns or worries;
- Refusal to learn about anything outside of their limited field of interest, as they do not appear to understand the significance.
Common high interest areas for many children with Asperger's Syndrome may include: "Wheel of Fortune" game, transportation, astronomy, animals, dinosaurs, geography, weather and maps. It is important to note that these behaviors can often resemble obsessive/compulsive types of behaviors.
Example: Perfectionism regarding written work: erasing the same printed letter or drawing numerous times in succession due to the seemingly imperfect quality of the letter formation/drawing, resulting in increased frustration/anxiety; One child with Asperger's Syndrome exhibits a high interest in Barbies. She cannot go to bed unless all of her Barbies are lined up in the exact same way).
Restricted/Perseverative Range of Interests - Intervention Strategies:
- Set aside specific times of the day, and specific time periods, for the child to discuss his high interests. This "discussion time" can even be included on his visual schedule. If the child brings up a perseverative topic/question at another time, refer him to his visual schedule to indicate when he can converse about this topic.
- Provide a written answer to repetitive questions asked by the child. When the child repeats the question, he can be referred to the written answer, which may assist in comprehension, and thus decrease the occurrence of the repetitive question asking.
- Incorporate the child's high interests into academics (e.g., if the child has a high interest in maps, use maps to teach math skills). With creativity and individualization, almost any high interest area can be infused into any academic area. Many students with Asperger's Syndrome have sustained their high interests into higher educational studies and subsequent vocations (e.g., Temple Grandin - holds a Ph.D. in animal sciences and has designed over one third of our country's animal livestock holding facilities).
Difficulty Taking the Perspective of Others (Mind Reading/Theory of Mind Deficit)
Characteristics: Children with Asperger's Syndrome can have great difficulty understanding that other people can have thoughts, intentions, needs, desires and beliefs different from their own (6). Thus their perceptions of the world are often viewed as rigid and egocentric, when in reality they are unable to infer other people's mental states. Typically developing children acquire "Theory of Mind" skills by age four, yet it estimated that this concept develops between the ages of 9-14 in children with Asperger's Syndrome (6). The following are educational implications for children who have "Theory of Mind" deficit (6):
- When the teacher asks a question to the class, the child thinks that the teacher is speaking directly (and only) to him, and therefore calls out the answer.
- A child with Asperger's Syndrome can be extremely vulnerable to wrongful intent initiated by other children. He can have great difficulty reading the intentions of others and understanding the motives behind their behavior (e.g., a fifth grade student "befriended" a child with Asperger's Syndrome and told him to say and do many inappropriate verbalizations/actions, for which he got into trouble).
- Due to difficulty in being able to understand the emotional perspective of others, the child may exhibit a seemingly lack of empathy (e.g., a child with Asperger's Syndrome may laugh seemingly inappropriately when another child gets hurt).
- The child may have difficulty understanding that his behavior (both actions and words) can affect how others think or feel. He doesn't appear to understand that his words or actions can make someone feel different than his own emotional state. He is not purposefully trying to hurt others. He is factually relating information, without regard to the other person's feelings.
Example: The child with Asperger's Syndrome may want to play on the computer during free time, and will attempt to do so with little to no regard to the child who is already occupying this activity. Another example: The child may state quite bluntly, "Someone stinks in here. I think it's Lori. Lori, you stink!".
- Cooperative learning groups can be extremely challenging for the child with Asperger's Syndrome. Again, he may have difficulty understanding that the other children in his group can have thoughts and ideas different than his own. This can often result in a significant increase in the child's stress, frustration and anxiety leading to the possible occurrence of challenging behaviors.
- The child may have difficulty taking into account what other people know or can be expected to know, leading to confusion on the part of the listener. Because the child can have great difficulty in considering the listener's perspective, he may exhibit the following shortfalls when relating information:
- Provide insufficient background information to establish the subject;
- A lack of referents;
- Excluding important pieces of relational information, as he already knows this information;
- Giving an excessive amount of irrelevant details when relating information, again oblivious to the listener's needs.
- These children may exhibit an inability to deceive or to understand deception. They are sometimes described as the "classroom cops", due to their concrete and literal interpretation of information given. When rules are broken, they willingly identify the guilty party, with no awareness that they should participate in any sort of deception, even if they are the guilty party.
Mind Reading/Theory of Mind Deficit - Intervention Strategies:
- Training designed to specifically address the above features will assist the child in learning to consider the perspective of others. "Teaching Children with Autism to Mind-Read: A Practical Guide" is a good resource book with specific skills and activities clearly outlined for intervention (11).
- The child will need to be taught to recognize the effect of his actions on others (6). If he says something offensive, let him know very concretely and literally that "words hurt, just like getting punched in the arm". Encourage the child to stop and think how a person will feel before he acts or speaks.
- Comic strip conversations can be used as a tool to visually clarify communicative social interactions and emotional relations through the use of simple line drawings. Specific colors are used to convey various emotional states for both the speaker and listener (8).
- Children's literature, videos, movies, or T.V. shows can be used to teach the child to interpret the actions of the characters, thus teaching him how to figure out what other people know (5).
Children with Asperger's Syndrome exhibit significant social communicative difficulties, as well as other defining characteristics, which may severely impact their ability to function successfully in all facets of life. However, when given appropriate support strategies, through direct teaching and various accommodations and/or modifications, the child with Asperger's Syndrome can learn to be successful in our unpredictable, sensory overloading, socially interactive world. It is critical that a team approach be utilized in addressing the unique and challenging needs of a child with Asperger's Syndrome, with parents being vital members of this team.