Effective Interventions for Children and Adolescents with Asperger Syndrome

Written by Pam MS, NCSP | Fact checked by Psychology Dictionary staff 

Asperger syndromeAsperger syndrome is a Pervasive Developmental Disorder manifested by neurogenetic abnormalities.  Pervasive Developmental Disorders are characterized by impairments in social reciprocity, communication, activities, and interests.  In this paper, a brief overview of Pervasive Developmental Disorders is followed by a more extensive explanation of Asperger syndrome.  The goal is to highlight characteristic impairments relating to Asperger syndrome and provide intervention guidelines, which have proven effective for afflicted school-aged children.

Pervasive Developmental Disorder is a term used to encompass neurogenetic disorders that result in a child having impairments primarily dealing with social reciprocity.  These disorders also generally include levels of abnormality in communication and behavior.  The five disorders that fall under the umbrella of Pervasive Developmental Disorders are: Asperger syndrome, Autistic Disorder, Rett’s Syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder – Not Specified.  Although no findings have isolated the cause for these disorders, numerous findings have established that they have a prenatal biological origin.  Since chromosomal heredity is the only factor involved, the prevalence of these disorders and their defining characteristics are the same across the world.

Asperger syndrome is one Pervasive Developmental Disorder that does not affect cognitive abilities as much as it does social development; however, cognitive impairments are present (Batshaw, 2002). Many consider Asperger syndrome to be either at the higher functioning end of the autism spectrum or as a separate autism-related disability. Because intervention appears to be critical for individuals with Asperger syndrome, it is important that educators, families, and physicians have a comprehensive understanding of this complex disorder.
In 1944, psychiatrist Hans Asperger was the first to document observations on a group of children who exhibited a fundamental difficulty with social integration (Wenar & Kerig, 2006).  He also noted some exhibited “a particular originality of thought and experience which may well lead to exceptional achievement in later life.”  Asperger’s name became associated with this subset of children whose deficits are more subtle and whose intellectual and language functioning is higher than that of those children who fit the Autistic Disorder label (Wenar & Kerig, 2006).  The DSM-IV-TR criteria for Asperger syndrome has separated it from Autism by including that no general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) or clinically significant delay in cognitive development be present (American Psychiatric Association, 2000).

The trademark of Asperger syndrome is the presence of social deficits despite comparatively normal language and cognitive development.  Idiosyncratic social skills prevent school-aged individuals from engaging in age-expected reciprocal social interactions. Their desire for friends exists; however, their difficulty in interpreting subtle social cues inhibits them.  Being unable to read nonverbal body language makes it difficult to read the intentions of others, understand emotions, and understand how their behavior affects others (Myles & Simpson, 2002).  As these children grow older, they generally become more aware of their deficits.  The advancement of complex social interactions, as well as heightened academic learning demands, may result in recalcitrant, combative behavior or loneliness and depression (Wenar & Kerig, 2006).
Some children with Asperger syndrome have acquired the epithet “little professors” for their pedantic propensities to discuss their very restricted range of interests. Hypotheses surrounding this aspect of the disorder have led some to say these individuals indulge in these interests to (1) facilitate conversation, (2) indicate intelligence, (3) provide an enjoyable activity for themselves, or (4) provide order and consistency in their lives (Griffin et al., 2006). Although there is little empirical data backing these hypotheses, obsessive interests are characteristic of a child with Asperger syndrome.  In some cases these topics are age-appropriate, but individuals with Asperger syndrome will often fixate on them in a manner that seems inconsistent with their non-disabled peers. Their inflexibility in thought may exacerbate the aforementioned socialization problems.  Low self-esteem, loneliness, and feelings of frustration or depression may result from the inability to satisfy their desire for social relationships (Myles & Simpson, 2002).

Students with Asperger syndrome frequently experience academic problems linked to their social and communication deficits. Cognitive abilities range from average to high, but their expressive and receptive language skills hurt their performance in school settings.  Impairments linked to verbal communication include difficulty expressing ideas, while the receptive ability affects the student’s capability to listen to instructions and other students’ verbal cues.  They frequently experience difficulty with generalizing information, comprehending abstract materials, and applying skills and knowledge to solve problems (Lincoln, Courchesne, Kilman, Elmasian, 1988). They have significant difficulties in understanding orally-presented messages.  They also can become over-stimulated in a crowded or busy classroom and have poor organizational skills.  In some instances, these children may give the impression that they understand more than they do academically.
Poor motor skills, coordination, and balance are also common problems. The implications of such deficits are very significant, affecting sports, social skills, writing, art, industrial arts, and more.  Although there is some dispute over the existence of motor delays and abnormalities among individuals with Asperger syndrome, there seems to be sufficient evidence to indicate to educators that this is a potential problem.  One common belief for these motor deficits point to the child’s selection of play. The play interest of children with Asperger syndrome is very circumscribed and may result in the child developing unbalanced degrees of gross and fine motor abilities (Shea & Mesibov, 1985).

Over the years, there has been evidence that effective interventions can be implemented for social and communication concerns (Shriver et al., 1999). Current effective school-based interventions emphasize: (1) systematic social skill and language training, (2) social mentoring, and (3) highly-involved school personnel (Kaufman, 2002).  Some of the most commonly applied school interventions include social skills training, social stories, instructional strategies, occupational therapy, and counseling.

Systematic social skills training is extremely important because it offers the child an opportunity to communicate with peers while subsequently developing social problem-solving skills.  Explicit verbal instructions on how to interpret other people’s social behavior should be taught and exercised in a rote fashion (Elder et al., 2006).  The same principles should guide the training of the individual’s expressive skills. Concrete situations should be exercised in the therapeutic setting and gradually tried out in naturally occurring situations. Encounters with unfamiliar people (e.g., making acquaintances) are particularly important, and should be rehearsed until the individual understands how his/her behavior affects people’s reactions. Techniques such as practicing in front of a mirror, listening to the recorded speech, watching a video recorded behavior, and so forth, should all be incorporated in this program. Social situations contrived in the therapeutic setting that usually require reliance on nonverbal skills for interpretation should be used and strategies for deciphering the most salient nonverbal dimensions inherent in these situations should be offered (Tse, et al., 2007).  Common social skills practiced with the Asperger population include maintaining eye contact, being aware of body space, giving and receiving complements, reading body language, and initiating and ending conversations (Bauminger, 2002).

Although evaluations of social skills training have been mixed, there is good evidence for short-term specific changes in trained social behaviors.  For example, one study (Tse et al., 2007) indicated that social skills groups did effectively help verbal adolescents with high-functioning autism to develop comfort and confidence in social interactions, but made no mention of longitudinal effects.  Thus, many experts agree with Ogilvy’s (1994) conclusion that social skills training is not a panacea, but may be used effectively by practitioners as part of a more general treatment program.   Gresham (2001) elaborated by cautioning that effective social skills training must be frequent and intense.  Further, he affirmed that intervention must be directly linked to the individual’s social skills deficits, which may include performance deficits, acquisition deficits, fluency deficits, or any combination.  Kaufman (2002) added that social skills training is most effective in a school setting, as it offers a frequent assortment of social interaction opportunities with peers.  Experts agree that the goal of social skills training is to have students with Asperger syndrome generalize what they have learned to real life settings, and maintained those skills over time (Ogilvy, 1994).  Since social skills training holds a clear rationale for intervention for children who demonstrate difficulties with social competence, researchers support its use and are progressing toward perfecting its delivery and monitoring its long-term effects so it has empirical backing.

Social stories are a relatively recent intervention recommended for children with Asperger syndrome. Social stories are brief, individualized short stories that describe a social situation and provide specific behavioral response cues through visual supports and text (Gray, 1998). A social story provides instruction regarding the who, what, when, where, and why of a social situation (Gray, 1998). In addition, the story would include direct information of what appropriate behavior would look like.  Thus, a social story helps ensure a child’s accurate understanding of social information for a given setting (Gray, 1998) and provides instruction for initiating, responding to, and maintaining appropriate social interactions (Sansosti, Powell-Smith, & Kincaid, 2004).

Extensive clinical experience and research provides evidence of the positive potential of social stories.  The social story intervention has been effective in (a) improving mealtime behaviors (Bledsoe, Myles, & Simpson, 2003), (b) improving social behaviors (Sansosti & Powell-Smith, 2006), and (c) decreasing behavior challenges (Lorimer, Simpson, Myles, & Ganz, 2002).  One study conducted by Kuoch and Mirenda (2003) provided evidence that social stories alone were responsible for reduction in target behaviors.  A post-measure of inappropriate behavior was taken, and results indicated that behavior reduction had maintained even after the intervention was discontinued, suggesting that learning of appropriate social behaviors occurred. Other studies, like the one conducted by Swaggart el al. (1995) combined the use of stories with social skills training to teach new skills, and found them to be successful interventions as well.  Gray (1998) says that the effectiveness of social stories is tied to how information is presented, and the kind of information that is highlighted.  If done properly, social story interventions appear to be another promising tool to help students with Asperger syndrome develop their social intelligence.

There are a number of instructional strategies used to accommodate for these learning impairments.  Priming is a tactic that familiarizes students with academic material before a lesson is taught, establishing predictability, facilitating comprehension, and reducing stress.  Structural strategies such as visual supports, graphic organizers, outlines, assignment notebooks, and timelines help the student process what is being asked as well as comprehend the over-arching objectives (Safran, Safran & Ellis, 2003).  Visual structures present an abstract concept in a more concrete fashion; manipulatives, posters and three-dimensional models help students see what they are learning.  Due to their high distractibility, these students may also benefit from preferential seating near the front of the class where they can focus more on the lesson rather than other students (Griffin et al., 2006).  Earplugs, sunglasses, or other distracting techniques to reduce distracting stimuli are also helpful (Safran, Safran & Ellis, 2003).

There are also a number of classroom strategies available to stop a student with Asperger syndrome from perseverating on their obsessive interests.  Providing the student with verbal reminders or prompts when he/she starts to redirect conversations back to the obsession will help them stop before overwhelming their peers (Solomon et al., 2004).  Reinforcing the student for adjusting his/her focus away from the topic may motivate them to self-regulate in future social situations (Connor, 1999).  By explicitly stating the benefits of self-restraint (for example, telling the child he/she will be welcomed back into a social setting) the child may begin to internalize the positive effects of these interventions.
Children with Asperger syndrome can also benefit from occupational therapy. Such therapy can be used to enhance fine motor development used in the areas of writing, self-help, and vocational skill development.  Fine motor deficiencies make daily activities such as handwriting and getting dressed very frustrating for these individuals, and explicit attention through therapy has proven valuable (Griffin et al., 2006).  Concerning physical activity, engaging these students in fitness programs that focus less on athletic ability and more on fitness allow the student to evade potentially uncomfortable situations in front of peers (Griffin et al., 2006).  Helpful accommodations include word processors, which relieve the student from handwriting.  Additionally, allowing computer-aided assignments, administering multiple-choice tests rather and essay tests, or assigning hands-on projects over written reports (Safran, Safran & Ellis, 2003) offer alternatives for these students while his/her motor skills are being developed.

Individual counseling or therapy may be helpful to the child since anxiety and depression is common in this population (Batshaw, 2002).  Children with Asperger syndrome struggle with low self-esteem, isolation from peers, and the realization of their differences but are unsure how to address these problems. Counseling may be necessary for the child as awareness of his or her differences from peers increases. Stoddart (1999) reported case studies, which addressed adolescent problems such as self-esteem, self-concept, peer problems, issues at home, and more with cognitive-behavioral therapy, and found it to be very effective with the Asperger population.   Through ongoing individual contacts with a counselor, children and teens may begin to develop insight into their behaviors and feelings, understand social norms and interactions, gain skills and confidence in judging and understanding the perceptions and feelings of others, take more responsibility for their behavior, and develop a more positive self-perception (Stoddart, 1999). Discussions can focus on day-to-day issues that the individual encounters, or cover applications of variations of social rules and norms to situations that he or she may encounter in the future.  Anxiety control and relaxation therapy are other key issues that can be addressed in individual counseling (Griffin et al., 2006).

Asperger syndrome is a severe developmental disorder characterized by difficulties with social integration, communication, and unusual behaviors or interests.  The prevalence of this disorder is on the rise, making it imperative for school staff to educate themselves on Asperger characteristics and effective interventions.  Intervention and dedication is essential when supporting these individuals.  With the right aid, students with Asperger syndrome have the potential to go on to college and become successful adults.  Social skills training, social stories, and various forms of therapy and counseling have proven to ameliorate some of these children’s lives.  A multifaceted approach can ensure these individuals receive a strong network of help and enable them to meet their highest potential.





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