A Neuropsychological Perspective

Wednesday, April 15, 2009Gorham Campus, University of Southern Maine

Presented by:Bernice Conklin-Powers, Psy.D.

What is Asperger’s Syndrome?Asperger’s Syndrome is a pervasive developmental disorder characterized by the following diagnostic features or symptoms (DSM-IV Criteria):

Marked impairment in social interaction Marked impairment in non-verbal behavior Failure to develop peer relationships Lack of spontaneous seeking to share interests with others Lack of social or emotional reciprocity

Restricted, repetitive and stereotyped patterns of behavior, interests, and activities Encompasses preoccupations with stereotyped or restricted interests Inflexible adherence to routines or rituals Stereotyped and repetitive motor movements Persistent preoccupation with parts of objects

However…

Each individual with Asperger’s Syndrome (AD) has a unique cognitive, emotional, social, and behavioral profile.

“One size fits all” solutions do not pertain when it comes to working with individuals with Asperger’s Syndrome.

There is no “magic bullet” or “quick fix” when it comes to managing challenges in your relationship with an individual with Asperger’s Syndrome (although maintaining an attitude of openness and curiosity helps!)

Facts About Asperger’s Syndrome Prevalence rates vary by study (@2.5/10,000)

It is a disorder that is more common in boys than girls (ratio rates vary by study (4:1 to 8:1).

Asperger’s Syndrome is caused by a variety of genetic and biological factors.

Common neuropsychological profiles (weak pragmatic language, poor memory, poor motor coordination, weak executive functioning, etc.)

Distinguished from other forms of autism by relatively intact overall IQ and verbal skills.

Frequent co-morbid diagnoses include ADHD and specific learning disabilities (particularly dysgraphia).

Cognitive Features of Asperger’s Syndrome Cognitive perseveration – particularly regarding preferred topics

Cognitive inflexibility or rigidity

Poor processing of information communicated non-verbally (humor, sarcasm, innuendo, etc.)

Challenges with abstract language – can be overly concrete and literal

Poor executive functioning (organization, planning, etc.)

Difficulty with main points or global concepts (perceiving the “forest from the trees”)

Poorly developed “theory of mind” resulting in difficulty observing the situation from the perspective of another individual.

Recognizing the Cognitive Features Difficulty perceiving the perspective, feelings or needs of others in

conversations or interpersonal exchanges.

Rigidity and inflexibility in thinking and/or communication (increases under stress)

May have difficulty getting the “gist” of a conversation.

Difficulty managing time and meeting deadlines

Difficulty completing homework or other academic demands

Difficulty with study skills (developing a study plan, monitoring progress, revising as needed)

Can be overly perfectionistic and inflexible in their approach to tasks

Difficulty with written expression, particularly long-range and/or complex writing assignments

Difficulty with sustained attention, easily distracted

Managing the Cognitive Features

Use clear & specific in your language (avoid humor, sarcasm, idioms, metaphors, etc)

Individuals with Asperger’s Syndrome benefit from clear communication and structure. Be clear and specific in your language and in your expectations.

Check, don’t assume comprehension

Use concrete examples to elucidate abstract points

Break multi-step tasks or communications down into smaller parts or segments

Provide a visual (and refer to it) whenever possible when communicating important information

Provide individualized academic accommodations. Menu of suggestions for academic accommodations will be provided in a handout.

Behavioral Features of Asperger’sSyndrome Repetitive or stereotyped behaviors

Adherence to routines and rituals, particularly calming and stress reduction rituals

Difficulty with transitions or (unexpected) changes

Poor self-monitoring

Poor verbal inhibition

Restless

Difficulty with emotional regulation, particularly if anxious or over-stimulated

Recognizing the BehavioralFeatures Idiosyncratic gestures or behaviors such as hand flapping

“Calming rituals” such as pacing or rocking

Bringing “comfort items” to class

Interrupting lectures with questions

Monopolizing class discussions

Continuing to talk after being asked to stop

Correcting or arguing with instructor or classmates

Strong reactions to small sensory events (noises, lights, etc.)

May have difficulty regrouping after becoming frustrated or upset

Strong preference for routine

Managing the Behavioral Features Include explicit and specific directions up front (syllabus, residential life

info, etc., regarding behavioral norms and expectations

Be consistent in enforcing behavioral norms and expectations.

Provide an “exit” during classes or activities for the student to take a break and regroup if needed.

If behavioral issues arise, address them privately. Be clear and specific. Keep it simple. Summarize at the end and check comprehension. Provide a written summary or follow-up.

If additional intervention is required use consultation as appropriate to the situation.

Emotional Features of Asperger’sSyndrome Variable motivation is high for preferred tasks, low for non-preferred tasks.

At higher risk for symptoms of anxiety and/or depression

Vulnerable to becoming emotionally overwhelmed under stress or when faced with change

May appear to others to lack empathy for others or lack emotional reciprocity

May have difficulty communicating feelings in a way that is clear to others (verbal communication may conflict with non-verbal communication)

Poor emotional monitoring and regulation

Stress or emotional distress often results in behavioral symptoms (increased perseveration, rigidity, etc.)

Recognizing the EmotionalFeatures May become upset or emotional if routines or schedule is changed or

interrupted unexpectedly

May become excessively stressed by typical academic demands such as quizzes, presentations, group work, etc.

May be particularly emotionally sensitive to common learning events such as making a mistake, getting corrective feedback (even if it is done supportively)

Can be impatient and easily frustrated if they misunderstand or are misunderstood

May have difficulty containing or regrouping once upset

May engage in repetitive calming behaviors or rituals when stressed or upset (rocking, pacing, etc)

Managing the Emotional Features Understanding and planning for emotional needs will minimize behavioral

expressions of distress.

If an individual with Asperger’s Syndrome is distressed, communicate deliberately (allow processing time) and clearly. Focus on a short, basic message.

Avoid engaging in debates or arguments. Simply repeat concise, clear direction. Do not add additional language (additional processing demands).

If the individual continues to be perseverative, or argumentative, end the conversation in a firm but supportive manner. Once an individual with Asperger’s is “stuck” continuing to discuss or debate may be counterproductive (and may produce increased distress and agitation).

Social Features of Asperger’sSyndrome Inability to process non-verbal social information

Difficulty reading the non-verbal feedback of others and adjusting behavior accordingly

Poor understanding of social rules or norms of behavior

Poor flexibility in social skill repertoire

Difficulty understanding social “cause and effect”

Lack of social reciprocity (turn-taking, reciprocal social greetings, etc.)

Difficult seeing another person’s perspective

Difficulty forming age appropriate peer relationships

A tendency to be easily slighted or annoyed in social exchanges

Identifying the Social Features Unusual non-verbal behavior, such as reduced eye contact

Difficulty with the social demands of small group work (choosing group members, negotiating differences of opinion, social give and take, etc.)

May violate unspoken social norms, such as intruding into the personal space of others

Difficulty monitoring and regulating volume of voice

May present as arrogant or rude to others due to poor processing of social information

May have difficulty asking for help or accommodations

May have difficulty responding to feedback or criticism

May have difficulty letting go of an issue and moving on in response to differences of opinion

May lack tact in social situations

Managing the Social Features Try not to take aversive behaviors personally. Keep in mind that aversive

behaviors are often the result of processing challenges and skill deficits. Avoid responding to arguments or debates. Be mindful of the challenges that partner of group work might present. Be mindful of calling on student and putting them “on the spot” unless they

volunteer. Practice flexibility with regard to effort and participation or other expectations

of social participation. Integrate expectations regarding social issues into syllabus or other written

guides. When addressing social concerns, do so privately. If a student has a declared disability, meet with them early in the semester to

develop rapport and establish and clarify expectations. Individuals with Asperger’s may benefit from social algorithms or clear

“if…then” statements of how to handle particular social situations.

Basic Steps to Address Issues or Concerns Understanding the key neuropsychological features of the disorder and

prevention are your best tools in avoiding problems from developing.

The best prevention strategies are introducing clear structure and expectations at the outset (especially in written form).

If issues arise, first speak with the student privately (see handout on tips for successful conferencing).

If concerns continue, contact the Office of Student Services to discuss a plan of action.