Autism Spectrum Disorder – Asperger’s Syndrome is now subsumed under the classification of Autism Spectrum Disorder.  However, many of us who have worked with this population for many years realize that the brain organization with AS is much different from others who fall on the autism spectrum.

 

Asperger’s Syndrome

In helping a student with Asperger’s Syndrome, it is important to understand not only the challenges associated with it but the notable strengths involved.  Students with Asperger’s Syndrome are often very creative, especially in music and drama.  They are basically excellent “systematizers”, with a drive to create or impose systems on the world and to analyze these systems.  This contributes to a “gift for detail” which can often be seen in areas of special interest – or a fascination with a particular system.  The fundamental concept of a system is that it is predictable. Therefore, students with Asperger’s Syndrome prefer routines and generally respond well to them.  This can become a problem when such students insist that certain routines must be completed and they cannot flexibly shift to another way of doing something.

Students with Asperger’s Syndrome often display an extensive vocabulary and collect factual information readily.  They often can become extremely knowledgeable about topics of special interest to them, wanting to collect as much factual information as possible. This can sometimes become a problem when special interests dominate the person’s time and conversation and they do not pick up that others are not as interested in these topics.  They tend to have excellent rote memory and long-term memory skills.  Generally, these students are very honest with a strong moral code and sense of justice.  They may display an interest in art with a fascination for perspective, detail, or architecture.  Generally, language is a strength for students with Asperger’s Syndrome. They often speak like an adult from an early age; however, speech is often pedantic, with an odd prosody and unusual voice characteristics.  As the student ages, speech can become overly formal and AS students are often overly precise.

Academically, they are usually strong in reading and spelling but as they get older tend to have more difficulty with aspects of reading comprehension and math concepts and sometimes the organization required in written expression. They may have more difficulty in later years with inferential thinking or in taking the perspective of others in literature.  Pragmatic language can be more of a challenge and they may not pick up on nuances of speech or social situations.

AS students find it a challenge to deal with changes in routine or the way they expect things to be.  They are often more rigid thinkers, are prone to take things literally and have more difficulty generalizing to other situations.

Difficulties in social and emotional areas are a hallmark of Asperger’s Syndrome.  These students often avoid eye contact or make less eye contact, display “theory of mind” difficulties or problems in understanding the perspective of others and are especially less inclined to initiate interaction with peers.  They tend to have high-stress levels, are particularly sensitive to failure or perceived criticism, are often perfectionistic and often display sensory issues.  They often do not seem motivated to know how to interact with other students of their age so that they are “in tune” with a social activity.  Often AS students do not see themselves as a member of a particular group and follow their own interests rather than that of peers.  They are often not interested in competitive sports or team games.  Many AS individuals do not seem to be aware of the unwritten rules of social conduct and will inadvertently do or say things that may offend or annoy other people.  Students with Asperger’s Syndrome are often confused by the emotions of others and/or have difficulty expressing their own emotions.  Typically, the AS student does not display the anticipated depth and range of facial expression.  Such students do not pick up on non-verbal cues so that they may not recognize or respond to changes in another person’s facial expression or body language. AS students have difficulty in expressing and modulating their emotions or difficulty with regulation of emotions.  They may seem to overreact to what appeared to be minor events or changes and have difficulty controlling their emotional responses. Social situations are not easily “systematized” so that AS students may want to avoid social situations, especially larger groups or in new or novel situations.  It is difficult for them to pick up on all the nuances of social interaction including both non-verbal social cues and in understanding how others may react to their particular behavioral characteristics.  AS students can be particularly prone to internalizing disorders including withdrawal, anxiety and depression.

These students often find it hard to remember the sequence of things that are spoken and have difficulty thinking or predicting ahead along with other executive functions. Many AS students often display some motor coordination problems, often with an odd gait or posture and some motor stereotypies.  They are often considered to be more clumsy.

Students with Asperger’s Syndrome typically display both strengths and challenges with attentional functioning.  They tend to be quite strong in controlled focused and sustained attention.  They are also able to inhibit more automatic/impulsive responses.  Where they tend to have a problem, however, is in regulating input attention.  Input attention is involved in determining what information from the world is examined and “passed on” for further processing and which information is ignored.   They are less likely to detect changes in their environment and are less likely to shift their attention or adjust the size of their attention spotlight when a change is detected.  Due to this characteristic, a great deal of information can be simply missed.  This is especially true in settings that involve quickly presented, peripheral information. This is also referred to as “divided attention”.

Students with Asperger’s Syndrome display some variability in working memory. They tend to have very little problem with “maintenance working memory” such as trying to remember a phone number in working memory. They are more likely to have some difficulty in “manipulation working memory” where they must actively do something with material as they are remembering it.  AS students may reach a plateau in working memory so that it becomes more problematic in adolescence and later years.

Every student with Asperger’s Syndrome is different. While some display a majority of these characteristics some will display only a partial amount.  It is important for AS individuals to find their “niche” and for teachers and parents to understand their particular neuropsychological makeup.

Is it a tantrum or a meltdown?

Many children with various learning differences, such as Asperger’s Syndrome, Autism Spectrum Disorders, anxiety disorders, sensory integration problems, ADHD and non-verbal learning disabilities have difficulties with emotional regulation. It is sometimes hard for parents and teachers to tell the difference between a “tantrum” and a “meltdown”. It is important, however, to try to distinguish between these two entities. This is especially important for students within the autism spectrum.

Although we will focus on autism spectrum disorders and Asperger’s Syndrome in this discussion, much of this information is applicable to many other children. First, let’s see if we can come up with a way to distinguish these two. When a child is involved in a “tantrum” he or she has a specific goal in mind. The tantrum action is likely an attempt to manipulate another person into doing something they want. This requires some pre-thinking and even planning before the tantrum occurs. In contrast, what we will refer to as a “meltdown” is primarily a reaction to overwhelming stress that slips beyond the control of the child.

Especially in students on the autism spectrum, there can be a little blending of what first looks like a tantrum with a meltdown. For example, if a student experiences tremendous stress when asked to do an academic task in a different way than he thinks it should be, this causes stress.  He may exhibit an emotional reaction that first appears simply to be an attempt to avoid the situation.  However, in students on the autism spectrum, this may be an overreaction to the added stress, which coupled with existing stress can lead to a meltdown. So even if it is important for us to try to distinguish between a “tantrum” and a meltdown, it can sometimes be a little difficult to do.

Meltdowns are usually the result of stressful events and overwhelming sensory situations that make it to the point that they can no longer be tolerated. Since many individuals within the autism spectrum have much difficulty tolerating change, this can be a trigger to a “catastrophic reaction” or meltdown. Adding to the complexity of the situation is that every individual with an autism spectrum disorder is unique. They will have  certain sensitivities and triggers that may or may not be shared by others and they have certain calming strategies that will be particularly beneficial for them but maybe not for another. Some individuals having a meltdown may have a more explosive, overt behavioral reaction while another might show physical withdrawal and a shutdown from communication.

Regardless of the constellation of emotional/behavioral reactions and the precipitating triggers to meltdowns, there are two major factors of most concern to parents and teachers when dealing with these difficult situations.

The first is prevention.  We would all like to prevent meltdowns from occurring, at least as much as possible. It’s important to be aware that a tantrum can blend into a meltdown and individuals with an autism spectrum disorder can display both.  AS individuals tend to be very literal, need concrete expectations and timelines and generally don’t do well with open-ended scenarios or questions. They have usually learned through time to depend on certain routines and their own scenarios of how to handle different situations.  They may be sensitive to words or actions that others may have no clue about.  When something is out of the ordinary they may begin to ask tons of questions in an attempt to figure out a way of handling the situation as their anxiety mounts.

For many if not most children with an autism spectrum disorder, their primary need is to feel safe and they often live in heightened states of fear. Just think about it for a minute. They may be afraid of breaking social rules that they don’t really understand, may misinterpret or miss information in school because of their particular learning differences, feel forced to transition either physically or in a thinking way and not be confident in their ability to do so, be fearful of bullying and be afraid of being criticized or viewed negatively.  That’s a lot of stress to handle. What AS kids tend to want is order, routine and predictability. They are usually great systematizers and systems are predictable.

Being aware of these characteristics is the first step in prevention of meltdowns. It is important for the AS student to have a strategy or plan for when they are experiencing an increase in stress. It can be reassuring and reinforcing to them to have a set routine that has become the “go to plan” for a pre-meltdown phase. There are some obvious “prevention” techniques such as preparing students in advance for any unexpected events or transitions and allowing for sensory or other break times when students seem to be showing an escalation in frustration or anxiety. Many AS students experience overwhelming stress in novel situations or when there is too much sensory stimulation around. It is logical to preplan events to avoid such extreme stimulation and provide a more calm atmosphere.  This is especially important in learning environments as all children, but especially AS children, cannot learn in an atmosphere of threat or fear.  It is especially important to understand that the source of stress may be totally invisible to the observer but is keenly felt by the child. Stress can even come from having too many choices and not knowing how to proceed or not receiving answers to questions in a manner they can understand.

Remember the old fight or flight response. When a meltdown occurs this is what’s happening within the child. With heightened fear or anxiety, the student may start to show signs of venturing into a meltdown. These could include things such as showing pressured speech, showing extreme resistance in leaving something they were doing or a preferred activity or ritual they were involved in, pacing or physical manifestations of stress, refusal to communicate or having difficulty letting go of a topic and repeating it over and over.  Once the tipping point has been reached, the child may exhibit outward explosive behaviors or may try to run away from the threatening situation to try to be more secure. This can be really disconcerting to parents and teachers and greatly misunderstood by those not familiar with the child. Meltdowns usually don’t last for very long but tantrums can go on for long periods of time.

Our second major issue is in dealing with the meltdown.  Our first goal should be to restore a sense of safety by being calm and remembering to understand that the child can be terrified and in need of understanding.  That’s the first thing we should say to ourselves. If there is a lot of sensory stimulation going on, try to reduce it. It is extremely important to not use force or restraint and to avoid asking open-ended questions. Rather, use the child’s name, talk directly to him or her, tell them in reassuring, explicit statements that you are there to provide a safe environment. It is also very important to approach the child in a non-threatening manner and to avoid quick movements and touch unless you are familiar with the calming strategies that have been helpful for the child in the past. It is also important that the child not be left alone until the meltdown has been totally resolved.

We all have different ways that we have found that can calm our anxieties and AS students are no different than others in this regard.  But again, what works well for one may not work well for another. I have some students who are calmed by water or taking a warm bath which can diffuse the overreaction from a meltdown. Others are calmed by deep pressure, which could be simply holding the student close after asking if he wants a close hug, a weighted vest, wrapping up in a blanket, retreating to a safe place where there are items of particular comfort, a specific physical activity or music through an MP3 player.  Over time, parents and teachers can often identify these particular individualized calming procedures for AS kids and they can also be used as preventative measures in the pre-meltdown phase.  As AS students mature it is important for them to become aware of their own calming strategies and call upon them as needed.

AS individuals can often feel humiliated after a meltdown. It is very important to convey a non-judgmental attitude and it is helpful to make statements about understanding what it feels like to be scared.  They will not be helped by being lectured to, by being asked what they are feeling, since it is so hard for them to describe it anyway, by demanding eye contact and by taking what they may say personally. They do need you to show empathy and reassurance and compassion for this very difficult experience. Over time, with your help, they will develop ways to avoid meltdowns when they can on their own and to utilize the calming strategies that can help them manage the world of meltdowns.