Children with high functioning autism or Asperger's Syndrome are often misdiagnosed and underserved in our country. The difficulty in understanding and acknowledging autism, primarily high functioning autism or Asperger's Syndrome, by the medical, psychological, and psychiatric community, can lead to misdiagnosis and even failure to provide the services needed for students (Autism Today, 2007).
Autism is not a disease, or a reaction; it is a developmental neurobiological difference in brain functions. People with autism may evidence difficulty in social interactions, problems with verbal and nonverbal communication, and odd or restricted activities and interests. Symptoms of autism are usually recognized during the first three years of childhood (Introduction, Autism, 2007); however, high functioning autism or Asperger's Syndrome is often not recognized until children are of school age.
Autism impacts normal development of the brain in the areas of social interaction and communication skills. The disorder makes it hard for us to communicate with others and relate to the social world. In some cases, aggressive and/or self-injurious behavior may be present (Autism Society of Delaware, 2005); however, internal behaviors such as withdrawal, depression, anxiety, eating disorders, and social isolation may be just as prevalent (Fattig, 2007).
"Persons with autism may exhibit repeated body movements (hand flapping, rocking), unusual responses to people or attachments to objects and resistance to changes in routines. Individuals may also experience sensitivities in the five senses of sight, hearing, touch, smell and taste," (Autism Society of Delaware, 2005).
Therefore, a team of professionals, working together, utilizing appropriate measures and information, should be making an informed diagnosis to ensure appropriate supports, accommodations, medications, and systems are in place to provide a free appropriate public education in the least restrictive environment (Smith, 2005).
A number of people have the idea that people with autism are so profoundly affected that they can't talk. If they are talkers, many assume that they converse like Dustin Hoffman's character in "Rain Man." But autism involves a wide spectrum. Asperger's Syndrome is an autistic disorder that is at the high-functioning end of the spectrum. (Brunett & Williams, 2005)
To meet only briefly in a single setting, is not enough to paint a complete portrait of a student's needs and abilities. Often, a student with autism can appear to have the behaviors of a mentally handicapped, behaviorally disordered, or hearing impaired person (Autism Today, 2007). The behaviors noted, are sometimes dismissed as immaturity, odd, or shy (Mudloff, 2007).
Parents frequently begin to suspect that there is something wrong, before the age of two. Many children, who are diagnosed at a very young age with Attention Deficit Disorder (ADD), may in fact have Asperger's Syndrome (Brunett & Williams, 2005).
Asperger's Syndrome is typically characterized by average to above average intelligence, poor social communication, poor social skills, lack of eye contact, rigid need for rules and routine, anxiety and/or depression, pedantic speech, sensory processing difficulty, and perseverative thought processes.
Persons with high functioning autism or Asperger's tend to rely heavily on rigid internal rules and struggle with the unwritten social rules of social interaction. Failure accompanies a student with AS, like a close companion, and we may need much reassurance during stressful periods. A psychologist, and friend, stated, "You have to remind them that for every criticism, it can take upwards of hundreds of complimentary comments to undo the extreme embarrassment or humiliation," (Caton, 2007).
Social isolation, a limitation in reciprocation or give and take interactions, tending to be self-absorbed or aloof, a lack of social discrimination, and/or difficulties with social skills.
Social isolation may look like a child is withdrawn, avoiding contact or interaction with people, family, or peers, and a preference towards playing alone or with "things," rather than peers. Children with autism may appear to play next to, but not with others and establishing friendships, with give and take, may be lacking.
A parent may notice a lack of eye contact or social smiles, or they may observe too much eye contact and an appearance of the child viewing people as interesting to observe, but not necessarily interact with or seek recognition from. These children may not have an interest in sharing toys and interests, and tend to be viewed as "lost in their own little world" at times. They may have a greater interest in sensory and physical play with others, such as tickling, hugging, piggy back, or chasing, or video games, fantasy play, repetitive watching of movies or reading books to the exclusion of social interaction may be present.
Children with high functioning autism or Asperger's Syndrome may interact very well with adults, but struggle with appropriately initiating peer interaction or maintaining interest. Sometimes, children with autism do not notice if a peer or playmate loses interest, or even wanders away. The unwritten social rules seem to be confusing, and interpreting social comments, facial expressions, tone of voice, or body language can be similar to trying to interpret a foreign language. A general lack of fear or fearlessness may be evident, and children with autism may talk openly with strangers, hug strangers, invade people's personal space, bump into peers in lines, touch or climb people inappropriately, or have excessive or a complete lack of separation anxiety from parents or caregivers (Mayes, 2008).
The majority of all referrals for behavioral concerns and the diagnostic assessment of Asperger's Syndrome are for boys (Attwood, 1999), and "because referral is such a strong predictor of special education eligibility," (Hosp & Reschly, 2004), this disproportionate referral rate may explain why the epidemiological research for Spectrum Disorders indicates that the current ratio of male to female's with a diagnosis of Asperger's should be 4:1, while the actual rate is approximately 10:1 (Attwood, 1999).
Empathy can be defined in numerous ways, and non-verbal communication (e.g., posture, gestures, eye contact, facial expression, tone), are clues in revealing our emotions, attitude, personality, relationships. This helps guide the interpretation of how another feels leading to an empathetic awareness or understanding of others (Helland, 2007, p. 3). This empathetic understanding can be hindered in a person with Asperger's Syndrome, particularly women. Given that characteristics of Asperger's may include a complete lack of the sense of fear or danger, too little or too much eye contact, which can appear as overly aggressive, threatening, or seductive, combined with a hindrance in the ability to judge another person's feelings or intentions accurately, girls and women with Asperger's Syndrome may be at increased threat for assault, abuse, violence, or worse. Girls on the spectrum provide stories of being singled-out or picked on mercilessly due to their odd behaviors or just not fitting in and are "literally disabled when it came to surviving the more sophisticated social complex of teenage female society," (Donvan, 2008, p. 2).
Children with high functioning autism and Asperger's Syndrome may display a very narrow or an unusual range of interests, with elaborate or unusual play-based behaviors. They may act out elaborate rituals, which appear to be creative play, but are actually scripted activities without the variation or creativity of imaginary play. They may demonstrate fixations on things, like pokemon, television shows, computer games, numbers, trains, or cars; and tend toward lining things up, organizing by color, or even repeating lines verbatim. Children with autism may become extremely upset if their routine or ritual is changed in any way, and can become very upset if someone touches their things, moves furniture or toys around, or even takes a different driving route to or from school. They may be very rigid and insist on doing things the same way every time, or demonstrate an extreme aversion or tantrums during transitions. Stereotypical movements, such as: spinning, flapping, lining things up, toe walking, body rocking, grimaces, twirling, pacing, racing around, noisemaking, leg bouncing, clearing of the throat, "And um," repetitions, chair rocking or other may be more significant or frequent during periods of change or transitions. An extreme perfectionism or "having to finish" what they have started, to the point of tantrums, may be evident especially during unexpected or unwanted transitions (Mayes, 2008).
When high functioning autism or Asperger's Syndrome is misdiagnosed or undiagnosed, children and parents are prevented from accessing the proper treatment and services because of the "huge confusion over what Asperger's is and what it isn't, because it has only been diagnosed by the present criteria for the past 12 years," (Hoover, 2006, p. 1). Children with high functioning autism or Asperger's Syndrome may exhibit and excessive desire or intense aversion to sensory input. They may appear hyperactive, and pursue movement to an excessive degree, or they can appear unresponsive or "flat' if overwhelmed hypersensitive to sensory input and movement. Some may have an unusual or extreme response to sounds and cover their ears in response to vacuum cleaners, hair dryers, crying babies, sirens or other loud or unexpected noise. Some may be extremely affected by smells, tastes, textures, heat, or commotions. They may have problems falling asleep, or staying asleep. Children who are overly reactive to crowds and commotion may appear uncomfortable or avoidant of cafeterias, malls, gymnasiums, parties, family gatherings. or even theaters (Mayes, 2008). In reaction they may feel hot, get a stomach or headache, or tantrum/resist going to such places. Children with high functioning autism or Asperger's Syndrome may be highly intelligent and appear capable of communication, "they just don't do it well," (Hoover, 2006, p. 1).
Communication may not appear to be delayed, but comprehension, social language requiring give and take may be lacking, an unusual tone or quality, rote or repetitive speech may present. Blurting out, excessively asking the same question over and over, echoing or mimicking, large vocabulary, or difficulty listening to another and understanding another perspective can be apparent. Some people with high functioning autism or Asperger's Syndrome demonstrate extreme abilities in remembering facts, numbers, phone numbers, maps, words, birth dates, or other factual information, (Mayes, 2008, p. 2). They may appear very rigid in their point of view, and unable to accept or understand another's perspective. They may appear to never be able to "let it go," or tend towards appearing argumentative or "splitting hairs." A conversation can lead to tantrums, emotional meltdowns, or withdrawal with seemingly little provocation (Fattig, 2007).
Motor clumsiness or fine motor difficulties may be present, and intuitive physics may be higher than intuitive psycho/social abilities (Baron-Cohen, 2000, p. 16). A child may be able to dismantle and recreate elaborate lego designs, set a clock, reprogram a VCR, match shapes, or display, artistic or musical talents (Mayes, 2008, p. 2). "Fathers of children with autism, as well as grandfathers, are over-represented in occupations such as engineering, whilst being under-represented in occupations such as social work. Engineering is a clear example of an occupation that requires good folk (intuitive) physics," (Baron-Cohen, 2000, p. 16).
Children with high functioning autism or Asperger's Syndrome are "limited in brain areas that enable people to understand subtle cues," (Hoover, 2006, p. 1), and often misunderstandings, literal interpretation, and/or sensory over stimulation can lead to overreactions, irritability, a low frustration tolerance, tantrums, aggressiveness, appearing to have an explosive (or bipolar) temperament, self stimulation, anxiety, depression, or self injury (Mayes, 2008, p. 2). Children with high functioning autism or Asperger's Syndrome develop a tendency of distrust towards others, because of social failures and negative social experiences over time, which can lead to self-isolation and social phobia. This behavioral reaction can be viewed as "rude" by others, and often people on the spectrum struggle to understand why they are not liked or frequently feel rejected (Hoover, 2006, p. 1).
Early identification and intervention are considered key to positive outcomes for children on the spectrum. In order to reach all students on the spectrum, school psychologists, mental health professionals, physicians, and parents should work together to become better informed regarding research, assessment tools, and diagnostic criteria, as well as the best proactive interventions to increase social skills, personal communication, behavior, and peer interaction for students. Autism is life-long, and there is no quick fix or cure. However, early diagnosis and effective treatments can provide for better outcomes for children on the spectrum. The more people are able to expand learning and research to include and appreciate the vast diversity of individual personalities and characteristics, the more likely society to place value on uniqueness and individuality (Wilson, 2006, p. 63.).
Annie Books Series ©: Experience Asperger's Syndrome and Attention Deficits Through the Eyes of a Child, Written by Michelle Fattig, Pictures by Josh Fattig.
Michelle and Josh have Asperger's Syndrome and Attention Deficit Disorder. They use their unique insight and experience to fight crime, battle evil, and promote world peace. Annie Books are fun to read, provide useful information, allow for empathetic understanding, for those of you, who don't get to understand it from the inside, and those of us, who don't know, that those of you, don't understand it from the inside! We think that everyone feels this way, so we wonder what is wrong with us, and why can't we just be normal...
Michelle Fattig is a school psychologist and medical technologist, who volunteers as a parent advocate, and provides professional development to parents and educators, regarding Individuals with Disabilites Education Act (IDEA), Improving Learning for Children with Disabilities (ILCD), Hidden Disabilities, and Response to Intervention (RTI).