They’re often smart and talented, but kids with Aspergers Syndrome have no idea how to relate to family and peers on an interpersonal and social level. How can families help them to make connections?
Joshua is an exceptionally bright 12-year old student who excels at math and science. He can tell you just about everything about Greek mythology. In fact he has a particular preoccupation with the subject and will often provide long-winded details about his favorite gods without regard to who his listener is or how they might be reacting. He cannot “read” the body language or facial expressions of others.
Joshua is rather inflexible as well. He doesn’t like changes to his schedule as he craves structure and a predictable environment and when this is interrupted without notice he “explodes.” He also cannot tolerate loud noises, strong smells (he refuses to eat fish), and touches everything.
When he was younger he used to spend the entire recess running his hand along the chain-linked fence while the other children played. Joshua has Asperger’s Syndrome. Asperger’s Syndrome is one of the autism spectrum disorders. It is characterized by abnormalities of social interaction and communication, and by restricted and repetitive interests and behavior.
Joshua has a difficult time “navigating” the social world and prefers to be by himself much of the time. This is typical of AS: the failure to develop friendships or to seek shared enjoyments or achievements with others, a lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture. He doesn’t understand humor, irony or sarcasm because the underlying language is non-literal. Joshua is very literal.
Joshua was diagnosed with AS when he was six years old. His parents report he started talking very early and had an extensive vocabulary by the time he reached two years of age. In fact, he talked incessantly. On the other hand he was, and still is, quite clumsy and uncoordinated.
Life at home was challenging. He wouldn’t wear certain clothes. For example, his mother had to order socks that didn’t’ have seams and all tags had to be removed. Tantrums were an everyday occurrence. He had very poor sleep habits waking up frequently during the night.
Joshua was lucky. His pediatrician saw the red flags when he was three and referred him for further assessment by a psychologist, speech-language pathologist, and occupational therapist, and he began therapies immediately. Many children with AS are not diagnosed until much later, when their antisocial behavior becomes much more noticeable.
As he got older it was clear that Joshua still lacked social awareness and skills and began to get teased at school. That’s when developing social communication became the primary focus of therapy.
Like other kids with AS, Joshua is interested in others and wants to have friends but he doesn’t know how to “do” social. Will he learn by simply observing others? No. One of the greatest misconceptions is that by placing a child with autism or AS in a typical classroom he or she will have plenty of models to learn how to socialize appropriately. In fact, these students are often isolated. By all means Joshua should attend a mainstream school but only with proper support.
Fortunately, Joshua has been working with a speech-language therapist both individually and, more importantly, in weekly social skills groups with other children. But it’s more than simply teaching social skills and how to interact with others. Students with AS lack social thinking. That is, they don’t understand why they and others react and respond the way they do; how their behaviors affect the way others perceive and respond to them; and how this affects their own emotions, responses to and relationships with others. They must learn to recognize that they and others have different perceptions and abilities to process social information; to navigate their social thinking, social interaction and social communication, and to learn to better adapt and respond to the people and situations around them.
There are a variety of research-based techniques for AS including:
•Direct instruction
•Role-playing
•Structured problem-solving and coaching
•Video modeling
•Scripting (like memorizing lines for a play)
Because children with AS are known to have superior visual memories, pictures, picture schedules, drawings and comics are commonly used in therapy. Some programs to teach social strategies include:
•Social Stories (Carol Gray)
•Comic book stories
•Super-Flex (Michelle Garcia-Winner)
Eventually, social interactions become more natural.
Joshua’s parents and family play an integral role, using rules and daily routines, visual aids, and role-playing at home. At school, Joshua has an individualized educational plan (IEP) that details his goals and objectives, and his teachers have been given strategies to ensure success both in and outside the classroom. For example, Joshua carries a daily schedule. He has a visual reminder (a picture of a stop sign) to use when he needs a break, as he is quite anxious (also typical of AS). Class “buddies” are paired with him at recess and lunch, and he is allowed to work alone as group work can be difficult for him.
Last summer Joshua went to a month-long sleep away camp for the first time. Prior to the camp his therapists worked intensively with him so that he knew what conflicts could potentially arise and how to avoid them. He practiced using eye contact, maintaining a variety of conversation topics, being flexible, and taking risks.
Camp was a success. Afterwards, he proudly showed his ceramics and carpentry items and, while he sometimes related back to Greek mythology, was easily redirected to talk about water skiing, rock climbing and archery. “This isn’t the same boy who left home a month ago. He’s way more confident,” his dad reported.
We live in a social world. Joshua plans to thrive in it.