Psychiatrist Anthony Thomas from America was in town to share with parents ways and methods through which they could help children with Asperger’s lead meaningful lives

 

It was lunch time. All the children rushed dashed to the canteen. This school has a rule, where the pupils have to enter the canteen through door A and exit using door B. After finishing their food, the students ran out to play while waiting for the next class at 2pm.

There was one pupil who stood out from the rest. He left using door A and went to a corner and sat there alone, playing with a toy he always carried with him.

In the evening the quiet child was called in by the school for breaking school rules. The boy was suspended for two days and when he returned to school, he still continued using door A to exit. Just what was wrong with this child that he kept flouting school rules?

This pupil has Asperger’s syndrome (AS).

Help College University recently organised a talk on the children with Asperger’s and ways to deal with them. At hand was Thomas Anthony, a psychologist from America who spoke on Asperger’s and raise awareness on this syndrome.

Asperger’s syndrome is one of the autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), which are a spectrum of psychological conditions  characterised by abnormalities in social interaction and communication that pervade the individual’s functioning and by restricted and repetitive interests and behaviour.

Like other psychological development disorders, ASD begins in infancy or childhood, has a steady course without remission or relapse and has impairments that result from maturation-related changes in various systems of the brain. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development.

People with the autism do not know how to express their feelings, knowledge or experiences. In AS, while diagnosis is not required, physical clumsiness and a typical use of language are frequently reported.

Intervention is aimed at improving symptoms and function. The main stay of management is behavioural therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines and physical clumsiness.

Most individuals improve over time but difficulties with communication, social adjustment and independent living continue into adulthood. Asperger’s syndrome is also  called Asperger’s disorder (AD) or just Asperger’s. Some researchers and people with Asperger’s have advocated a shift in attitude with the view that it is different, rather than see it as a disability that must be treated or cured.

In Malaysia, there are over 4,000 special classes integrated into regular mainstream schools throughout the country for autistic children. There are also private schools run by non-governmental organisations and private centres for autistic kids.

But what about AS? It is discussed in developed countries but not in developing nations. For example, in India, doctors do not talk about AS because their focus is on dealing with serious problems only.

When society becomes more sophisticated, it becomes focussed on more specific issue. That is why especially in America, you see differences or the increasing number of autism cases because government funding has raised people’s awareness on this.

 

Psychiatrist Anthony Thomas
Psychiatrist Anthony Thomas

 

 Research shows that you can identify problems in a child when she or he is a year old. But in developing countries such training is not available.

 

Most of the children with AS face difficulty in interacting socially. This causes them to refuse attending school. And for those who do attend school, they are at a lost when it comes to facing a teacher who is strict. One bright child in New Zealand was asked to perform a task by his teacher but he could not, failing which he was asked to leave the class. The child became scared and took ill. His mother decided to stop school and tutor  him personally.

In New Zealand, many children with AS are taught at home either by parents or by a hired tutor. The government pays an allowance to help such families meet their cost of living.

To ensure children with AS get an education, modifications must be made to the school systems to meet the needs of such children.

To be a good teacher to children with AS, you need to be friendly with them. A good teacher will develop a close relationship with that child to win the child’s heart and get him or her to follow the instructions given.

 

Problems and how to solve them      

 

One of the major problems with AS is that most of the social rules are not discussed openly. For example, when we meet a person we must smile at them. When somebody is talking you have to wait for your turn.. This is called unwritten rules of social interaction. Asperger’s people have difficulty with that.

Anthony also shared his experience while he was a psychologist in New Zealand.

“I came across a boy who was always isolated from the other children. Then, I noticed that this boy did not smile at all. I thought that I had to teach him how to smile. I appointed a teacher to guide this boy on how to smile. It took us nearly two months. We used a video to show the ‘smile’, then asked him to follow it. At last, he could smile. Besides that, we also taught him how to interact with the other people, like greeting and understanding facial expressions.”

Anthony said using a video was the most effective medium in teaching children with Asperger’s, especially on non-verbal communication.

The AS have another problem, that of being egocentric. This means they look at everything from their perspective. For example, the child is crying because he wants something but he is not getting it. When the child plays he wants to win at all cost. It is not being selfish as this is the way his brain is programmed, where he creates rules in his  mind and expect others to follow them.

Those with AS also have difficulty in turn-taking. You have to teach them how to take     turns.  For instance, the child wants to play but another child is already playing out there. So, you have to teach this child to wait for his turn to play.  Sometimes, they want to talk and do not allow others the chance to talk. So they must be taught about waiting for their turn. When the teacher asks a question in the class, the teacher makes the rule that children have to raise their hand before answering. Quite often children with AS will not do this.

They always immediately give the answer. They do not understand why the teacher is unhappy even when he knows the answer. So you have to teach in small group and say “ok now your turn. Raise your hand and answer it.” Even teachers can do that. When the student gives the answer without raising his hand, you can ignore it. Only when he raises his hand can he answer the question. That is what modifying means.

There is another confusion with Asperger’s. Sometimes, they can become too friendly. For example, when the child goes to the supermarket, whoever he meets, he will say hi, or he will go with that person. In the western culture, it is not appropriate to go and talk to strangers. Quite often, the doctors think this is being sociable but it is not. Children with AS do not understand body language and must be taught.

Another problem faced by the children with AS in social interaction is that they do not know how to deal with the same age group or otherwise they get rejected because they do not have proper social understanding.

People with AS do not have problems in one-to-one communication. They have  problems in social interaction, meaning in dealing differently with different person. For example, when a teenager with AS sees a psychiatrist in the clinic, he can behave like a  normal person, especially if the psychiatrist comes out with the topic that he is interested in. The psychiatrist will say the boy has no problems. The best way to convince the psychiatrist is by asking his teachers and friends on how the boy interacts with others in school.

Asperger’s and autism are quite different. A person with autism has a difficulty communicating. But in AS this is not the case. It is called pragmatic use of language; how to deliver, what distance you keep, when to ask question, how to answer, how to talk to a teacher and so on.

I have also noticed that a child with AS may make a joke, maybe even sexual, which makes people laugh. What this child has learned is to joke and when he returns to class he makes the joke in front of his teacher.

The teacher has to prompt an AS student to carry out a task. This is called prompt deficiency. If you can make a person with AS flexible their Asperger is reduced and this is called flexibility training.

One of the major problem with Asperger’s is impairment in non-verbal communication skills such as body language, eye contact and facial expressions. Quite often, children with Asperger’s have difficulty in expressing emotions and feelings. They may understand one or two expressions. But there are many different feelings and emotions you have to teach them about.

“I was teaching the students that they have to look at other people. But then, they asked back, why must I look there? I know he is there. They think that they only have to look at  the person to get the information required. But they fail to realise the importance of eye contact and facial expression. Are you happy listening or are you getting bored? You have to show those facial expressions and ask them to repeat.

Sometimes, a person can live his life without knowing these things. You may think that he does not have manners but this is not so. It is because no one has taught him.

Sometimes, we might think that children with Asperger’s are very bright because they can talk like the others. They can talk non-stop about anything like little a professor. They are very good with knowledge but they do not understand the impressions.

Another important thing about Asperger’s is that they have some kind of repeated behaviour. They may want to do certain things every time regardless of whether it is convenient or not. For instance, they always want their things on the table in the same order. If there is a change they will become very upset. They may also have attachment to certain objects like dolls etc.

In a severe case of autism, you can see obvious signs like their looking to the right all the time. This is a symptom of severe autism.

Another aspect to note is that those with AS will ask you repeated questions. It is not that they do not know the answer, they just like hearing the same answer over and over and to feel reassured.

Some children with AS have difficulty dealing with changes. If everything is the same, they are happy. If a change occurs, they become sad. For instance, a change in subject during class. Likewise, they prefer the same teacher to be around. All of these obsessive interests and repeated behaviours can go on for years or they might change at some point.

Understanding that people with AS or autism have a tendency to repeat their behaviour,  you have to bring something that interests them. Because if they are bored, these people will indulge in whatever they know and this can be dangerous. Engage them in social activities and never leave them alone at home.

People with AS also suffer from a lot of anxiety, especially when dealing with new situations or new faces.

Those with AS also have difficulty with multi-tasking. For instance, when the bell rings, the teacher will ask the children to stop their work. But children with Asperger’s do not want to stop. They cannot suddenly stop their work and do something else. So, you have to train them to be multi-tasking. For example, while they are writing, you can stop them by saying “I’m going to say something, and you have to repeat it”. So we can create multi-tasking situation in one-to-one settings. We can teach them how to develop this  skill.

 

Challenges Vol3Issue2, 2010 (Challenges Magazine is a journalism skills training project for persons with disabilities started in 2007)