Repetitive questions (social echolalia, script, alternative meaning, reassurance)
Lack of social play with others
Fascination with a specific topic or person.
Six Pathways to a Diagnosis of Asperger’s Syndrome
Diagnosis of autism in early childhood
Significant natural progress between 4 and 6 years of age
Effective early intervention programs
Progression along the continuum of autism
Recognition of Characteristics When First Enrolled at School
No clear signs of autism in early childhood
Teacher notices conspicuous features
Avoids social play with peers
Unaware of the codes of social conduct
Unusual qualities in conversation and imaginative play
Intense interest in a specific interest
Clumsiness when running, writing and catching
Teacher completes a developmental checklist for Asperger’s syndrome (ASAS)
Diagnosis of a Relative with Autism or Asperger’s Syndrome
Dual Diagnosis
Attention deficit disorder
Language disorder
Cerebral palsy
Tourette’s disorder
Secondary Psychiatric Disorder
Depression
Anxiety disorder such as Obsessive Compulsive Disorder
Anger management
Schizophrenia
Residual Asperger’s Syndrome in an Adult
Self referral due to a relative having the diagnosis or information from the media
Agency referral from psychiatric services, forensic psychology and employment agencies
Diagnostic Assessment
Social Impairment
Reciprocity (the balance between participants)
Inclusion (welcome, cooperation and control)
Pretending to be Normal
“…the fun came from setting up and arranging things. Maybe this desire to organize things rather than play with things, is the reason I never had a great interest in my peers. They always wanted to use the things I had so carefully arranged. They would want to rearrange and redo. They did not let me control the environment.”
Social Impairment
Level of maturity in deceit
Limited ability with team skills
Limited range of facial expressions and body language
Difficulty reading the facial expressions and body language of others
Limited ability to conceptualize the thoughts and feelings of others
Speech and Language Characteristics
Pragmatic Aspects
The art of conversation
Reciprocity
Repairing a conversation
Knowing when and how to interrupt
Inappropriate comments
Keeping on track
Primarily interested in an exchange of information
Appropriate topics
Monologues or scripts
Recognizing and accepting different points of view
Literal interpretation
Prosody or the Melody of Speech
Lack of change of vocal tone and volume to indicate emotion and key words
Lack of variation in pitch, stress and rhythm
Accent not consistent with that of the local children
Difficulty understanding the relevance of the change in tone, inflection or emphasis on certain words when listening to the speech of others
Pedantic Speech
Overly Formal
Excessive technical details
“Adult” quality, sophisticated grammar or phrases
Must correct errors
Precise intonation
Unusual Qualities of Speech
Special Interests
Dominate the person’s time and conversation
Statistics, cataloguing and symmetry
Idiosyncratic
Motor Clumsiness
Cognition
Problems with advanced Theory of Mind Skills
Weak Central Coherence
Impaired Executive Function
Profile on an Intelligence Test
Visualisers or verbalisers
Enclopedic memory
Solitary and idiosyncratic play
Preference for routines
Limited flexibility in thinking
Originality in problem solving
Sensory Sensitivity
Sound sensitivity
Tactile sensitivity
Sensitivity to the taste or texture of food
Stoic in response to pain or temperature
Synaesthesia
Relevant Information
Family history of similar individuals
Reports from teachers and therapists
Medical investigations and medicine
Developmental history
Prior diagnosis
Presence of a psychiatric disorder
Observation at school and home
Issues Relevant to the Diagnostic Assessment
Alternative Terms
HFA and AS at the behavioral and treatment level, are more the same than different
Lack of expertise, experience and confidence in the diagnosis of AS
Developing Social Skills and Understanding Emotions
Social Play
Observe and make notes of the social “play” of the child’s peers
Note the “script” and “acts”
Rehearse with an adult acting as a friend
Turn taking and help
“Rent a friend” as a “dress rehearsal”
Practice with same age peers
Social Sandwich
Sharing experiences
Strategies for Social Integration
Inclusion with Ordinary Children
Observation of appropriate social/emotional behavior
Peer group who know how to modify their behavior to accommodate and support the child
Knowledge of the Nature of Asperger’s Syndrome
Teach Theory of Mind Skills
Photographs, text, drawings, games
Metaphor
Social Stories
Comic Strip Conversations
Social Skills Groups
Encourage Friendship Skills
Behavioral strategies of task analysis, shaping, prompting and rewards
Cognitive strategies to learn the theory and script using Social Stories
Four Levels in the Development of Friendship
Level 1: Approximately 3 to 6 Years
Recognition of turn taking
Egocentric conceptualization
One way assistance
Proximity and physical attributes
Why is….your friend?
“Because I like him”
“He lives next door”
Level 2: Approximately 6 to 9 Years
Level 3: Approximately 9 to 13 Years
Aware of other’s opinion of them and how their words and actions affect the feelings of others
Shared experiences and interests
Greater selectivity and durability
Gender split
Trust, loyalty and keeping promises
Level 4: Adolescence to Adult
Peer group acceptance more important than the opinion of parents
Greater depth and breadth of self disclosure
Desire to be understood by friends
Different types of friendships
“He/She accepts me for who I am”
“We think the same way about things”
Characteristics Associated with Asperger’s Syndrome
Motivation for friendship
Immaturity
Control the activity
Describe what a friend should not do
Negative experiences
Checklist of Social Behaviors Used as an Index of Friendship Skills
Entry Skills
Recognizing when and how to join in
The “welcome” provided for children who approach them
Assistance
When and how to provide assistance
Seeking assistance from others
Criticism
Knowing when criticism is appropriate and inappropriate
How to criticize
Tolerance of criticism
Compliments
Compliments at appropriate times
Responding to a friend’s compliment
Accepting Suggestions
Incorporating the ideas of others in the activity
Indicating agreement
Reciprocity and Sharing
An equitable distribution of conversation, direction and resources
Checklist of Social Behaviors Used as an Index of Friendship Skills - Con’t
Conflict Resolution
Managing disagreement with compromise
Accepting the opinions of others
Not responding with aggression or immature resolution mechanisms
Monitoring and Listening
Regularly observing the other person to monitor their contribution and body language
Their own body language indicating an interest in the other person
Empathy
Recognizing when appropriate comments and actions are required in response to the other person’s circumstances and positive and negative feelings
Avoiding and Ending
Appropriate behavior and comments to maintain solitude
Appropriate behavior and comments to end the interaction
Encouraging Friendship Skills
Assess which skills are observed or absent
Assess the quality and range of expression
Use behavior and cognitive strategies to acquire and develop specific skills
Task analysis, prompting, shaping and reward
Reward all participants
Teach the theory as well as the practices
Social stories
Additional Strategies
Characterization Skills
Unusual in their perception and description of the personality characteristics of others and themselves
Limited lexicon to describe the different types of character
Immaturity and predominance of physical attributes
One dimensional approach
Difficulty reading a person’s character and adapting their behavior accordingly
Teaching Characterization Skills
The Mr. Men and Little Miss books
Examples are Mr. Grumpy, Little Miss Chatterbox and Mr. Nosey
Choosing an animal to represent someone’s personality
Reading dictionary definitions of character and identifying someone who has those characteristics
Identifying the description of their own character
Social Skills Groups
The Understanding and Expression of Emotions
A project on a specific emotion
Create a scrap book that illustrates the emotion
Compare and contrast other children’s scrap books
Identify the facial elements that express the emotion
A “thermometer” to measure the degree of intensity
Place photographs and words at the appropriate point on the “thermometer”
Point to the “degree” of expression in a particular situation
The Understanding and Expression of Emotions – Con’t
Appropriate tone of voice
Drama games for appropriate body language
Mirror and video recordings
Story books
Sentence completion exercises
Alternate positive and negative emotions
Imitation
Identify individuals skilled in a specific ability
