Teaching children with Asperger's

Introduction

Asperger’s Syndromes (AS), also known as high-functioning autism (HFA) is neuro-developmental disorder classified as an autistic spectrum disorder (ASD). It is characterised by significant difficulties in social interaction, alongside restricted and repetitive patterns of behaviour and interests (McPartland, 2006). Asperger’s syndrome differs to the majority of the other autism spectrum disorders due to its relative preservation of linguistic and cognitive development (Baskin, 2006).

AS was named after Hans Asperger’s, who in 1944 reported children lacking nonverbal communication skills, limited empathy with their peers and were physically clumsy (Asperger H, 1944). AS was officially added to the American Psychiatric Association’s Diagnostic Statistic Manual in 1994 (Harvard Health Site)

Diagnoses

Diagnoses for all ASD are completed in a two-stage process; the child is first screened during a visit to their GP or paediatrician and then administered a number of neurological and genetic assessments by a team of medical professionals including psychologist, neurologist, psychiatrist and speech therapist. These assessments include in-depth cognitive and language tests to

• Establish IQ 
• Evaluate psycho motor function
• Verbal and non-verbal strengths and weaknesses,
• Style of learning 
• Independent living skills. 
• Communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures)
• Use of non-literal language (metaphor, irony, absurdities, and humour);
• Patterns of inflection, stress and volume modulation; 
• Pragmatics (turn-taking and sensitivity to verbal cues)
• Content, clarity, and coherence of conversation.  (Asperger Syndrome Fact Sheet, NINDS)

The physician will then look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis. (Asperger Syndrome Fact Sheet, NINDS) The most widely accepted diagnostic tool used to diagnose AS is the American Phycology Association’s Diagnostic Statistic Manual IV. For a child to be diagnosed with AS they must meet the following criteria.

 (I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) Marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures and gestures to regular social interaction
(B) Failure to develop peer relationships appropriate to developmental level
(C) A lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g. by a lack of showing, bringing or pointing out objects of interest to other people)
(D) Lack of social or emotional reciprocity.


(II) Restricted repetitive and stereotyped patterns of behaviour, interests and activities, as manifested by at least one of the following:

A. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
B. Apparently inflexible adherence to specific, non-functional routines or rituals
C. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
D. Persistent preoccupation with parts of objects.

(III) The disturbance causes clinically significant impairment in social, occupational or other important areas of functioning.

(IV) There is no clinically significant general delay in language (e.g. single words used by age 2 years, communicative phrases used by age 3 years).

(V). There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behaviour (other than in social interaction), and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.'

From APA DSM-IV 1994.

Due to the complex nature of the diagnoses, limited epidemiology data exists for AS in Australia and the world. The most reliable data comes from Fombonne (2003) after the conducted a review of epidemiological studies of children. They found autism prevalence rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger's syndrome ranging from 1.5:1 to 16:1. In a follow-up paper Fombonne (2007) combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000. The most reliable Australian data shows that on average there is 1 child with an autism spectrum disorder in every 160 children aged 6 to 12 years old. (Advisory Board on Autism Spectrum, 2009)

How Asperger’s Syndrome presents.

Students with AS will present with range of behavioural abnormalities within the school environment. Garnett and Attwood (1994) have identified six behaviours that result from having AS

1. Social impairment (extreme egocentricity with as least two of the follow dispositions: inability to interact with peers; lack of desire to interact with peers; lack of appreciation of social cues; socially and emotionally inappropriate behaviours)
2. Narrow interest to the extant to at least one of the following: exclusion of other activities; repetitive adherence.
3. Repetitive routines including at least one related to self or to others
4. Speech and language peculiarities displaying at least three of the following: delayed development: superficially perfect expression language; formal pedantic language; odd prosody; peculiar voice characteristics; impairment of comprehension, including misinterpretations of literal and implied messages.
5. Non verbal communication problems with at least one of the following: limited use of gesture; clumsy or gauche body language; limited facial expressions; inappropriate expressions; peculiar stiff gaze.
6. Motor clumsiness 

Adaptations 

Teaching adaptations

One of the most effective things a teacher can do is get to know student with Asperger syndrome as an individual, as well as there their interests, family dynamics, areas of additional need and their triggers for anxiety (Shearer, 2006) Ashman and Elkins (2010) identify four essential characteristics that a teacher should maintain, they include, having a calm disposition, being predictable in your emotional response, ability to be flexible in your teaching style and curriculum presentation and finally recognise a child’s positive aspect. Along with some general changes teachers are also encouraged to implement a number of specific teaching strategies that directly address Garnett and Attwood’s six AS specific behaviours.

Social Impairment 

In order to combat the sometimes-intense social impairment that comes with having AS, teachers are encouraged to undertake social skills training to help interact with the student.  Attwood (2000) identified a number of specific support mechanisms that can help with social impairment, they include

• Encouraging to be social, flexible, and cooperative when playing and working
• Help the child to recognise social cues and learn the codes of social conduct
• Personal tuition to understanding and managing events
• Tuition and practise to improve friendships and teamwork skills
• Help for the student to develop special interest as a means of improving motivation, talent and knowledge
• A program to improve gross and fine motor skills
• Encourage to take the perspective of others
• Encourage to develop conversational skills

Narrow interest

Many students with Asperger's syndrome become obsessed with a particular topic of interest and can surpass their peers in a specific area of academic learning (e.g. history, mathematics, music). Yet the same student may become frustrated by the challenges of another subject area and may refuse to engage in this area of learning (e.g. science, physical education, languages). Teachers can use students’ areas of strength and interest for more in-depth learning (Myles & Simpson, 2001a)

Repetitive behaviours 

Children with AS take comfort in repetition and routine, for this reason teacher are highly recommended to Maintain routines. Routines should include "sameness" in activities, including using the same equipment and the same class organisation
(Auxter, Pyfer, & Huettig, 2005). Any changes in school – particularly in the transition phase from early education to primary are critical times, and multiple orientation sessions are important.

Speech and language peculiarities

Literal interpretation is also a characteristic of Asperger syndrome. For example, understanding phrases such as “Has the cat got your tongue?” or “I am over the moon” is difficult for individuals with Asperger syndrome because of their logical and concrete thinking pattern (Attwood, 1998)

Non-verbal communication problems

Because children with AS usually have some form of non-verbal communication problems, teachers must clearly present rules, schedules and expectations through a number of different channels. Providing a visual representation of the rules and schedules serve as a visual cue for what is expected or coming up (Griffin, 2006). Each of these visual cues must be accompanied by an auditory message to provide reinforcement, which helps students refocus attention to the task (Henderson, 2001). Another important factor is establishing rules and consequences, this helps provide a predictable environment for children with AS (Silverman & Weinfeld, 2007).

Motor clumsiness

Individuals with AS may have a history of delayed acquisition of specific motor skills such as walking, pedalling a bike, catching a ball, standing on one leg, hopping, climbing parallel-bars, and so on. They are often visibly awkward, exhibiting stiff gait patterns, odd posture, poor manipulative skills, and deficits in visual-motor coordination (Borremans, 2009) In order to provide appropriate exercises and activities teachers must plan lessons on the basis of individual interest. Building on the interests of the learner can serve as a motivator and bring meaning to the activity for the learner (Auxter, Pyfer, & Huettig, 2005). When teaching physical activity to a child with AS Menear & Smith (2008) state that the physical educator should keep their interactions with the child predictable, Silverman & Weinfeld (2007) add that unstructured time should be limited.

Assessment adaptations

There a number of adaptations that must be made when giving any form of assessment to a child with AS. Below is a list of general modifications that can be easily implemented to most assessment pieces

• Increasing the time or reducing the size of the task. Safran, (2002)
• Organise their workload, reduce confusion and appease anxiety, seemingly minor alterations or assistance can help a student with Asperger syndrome immensely to achieve educational tasks (e.g. providing written notes for those who have difficulty with oral interpretation (Safran, 2002), 
• Presenting text on yellow paper to reduce glare (Falk-Ross, 2004) 
• Colour coding books according to subject areas (Adreon & Stella, 2001; Gagnon & Robbins, 2001). 

It is also important that support is provided to students before they are in crisis, as well as liaising with their families and other teachers to share knowledge and to work in partnership Working close with the family increases the likelihood of success for students with Asperger syndrome and reduces the incidence of challenging behaviour at school and at home. (Shearer, 2006)

Managing behaviours

Managing the behaviour of a child with AS can seem impossible at times, but if the teacher implements the correct behaviour management strategies a child can flourish. Some basic techniques include

• Create space for withdrawal when needed.
• Have clear structures, routines and procedures in the classroom, and ensure all students in your class know these.
• Forewarn students with Asperger syndrome of any changes to the normal routine, and plan for these changes with your students
• Develop an agreement for managing challenging behaviour, which is supportive of the whole school community as well as families.
• Plan with families for times when a student needs a break from the intensity of school or when an alternative school activity is planned 
• Students with Asperger syndrome need to develop a relationship with at least one staff member whom they trust and who is easily accessible to them (Shearer, 2006)
• Have clear behavioural guidelines and procedures that are negotiable (Shearer, 2006)
• Discuss individualised behavioural expectations and support requirements to accommodate students with Asperger syndrome with special education consultants, staff and families (Shearer, 2006)

Students with AS vary greatly in their performance from day to day. One day they concentrate, conform, socialize, and learn pretty well, while on other days the reverse is true, Attwood (2000) identifies this as a series of internal waves and tides in the student’s performance. Shearer (2006)
Believe that the teacher should teach on the positive tides and revise during the off tides.

Conclusion

Working with children with AS can be as challenging as it is rewarding. The single most important strategy is to maintain a routine throughout the day. It is also important that teachers learn to be flexible in their assessment and content delivery, yet strict and consistent with their behaviour management.

References

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