1 Understanding Asperger Syndrome and High-Functioning Autism
Most kids of a given age just seem to get social rules, and to various degrees, they instinctively know how to interact with others. Of course, adults, especially parents, family members, and teachers, do lots of instructing, coaxing, persuading, nagging, scolding, and so forth, and they deserve credit when children acquire desired and age-appropriate social skills. Yet, even without parent and teacher assistance, most kids learn innumerable acceptable social behavior without being directly taught. Either by observing others or otherwise acquiring basic skills instinctively and seemingly effortlessly, and certainly without much work on our part, the majority of kids learn acceptable social skills. In many cases, this is a natural part of the normal developmental process: at certain ages, most kids just seem to be able to understand and follow social guidelines and practices. As any parent or teacher can passionately attest, children and adolescents do not always follow those rules; however, the problem is not one of understanding! By a certain age most kids seem to intuitively and naturally understand how close to stand when talking to another child, what should and should not be said in the presence of a teacher, that acceptable behavior in a church service and on a playground are not the same, and countless other conventions.
This is not the case with children and adolescents with autism. By clinical definition (and whatever other standard one applies), children with autism spectrum disorder (ASD, the technical term for the range of types and levels of autism) are lacking in social skills. In the clear majority of cases, their social excesses (behaviors that occur too frequently and that lead to trouble) and deficits (expected behaviors that fail to happen) do not stem from an unwillingness to follow conventional social rules. Rather, the issue often relates to understanding social rules and accepted practices. Children and adolescents with ASD either do not know how to perform and fit in, or in some cases, especially with more severely affected individuals, they do not care, and thus, they are unmotivated to connect with others and be part of a social group. The important conclusion is simple: social problems of these individuals are frequently the result of a failure to understand and consistently perform.
To at least some degree, virtually all children and youth with ASD want to have friends, they desire to be a legitimate part of their school and community, and they want to be able to understand and function within social settings. This in no way suggests that every individual with ASD wants to be just like every other person and thus lose their individuality and uniqueness. Furthermore, this does not imply that every child or youth wants to be the center of attention, a popularity king or queen, or constantly involved in social activities. Nonetheless, quality of life and general happiness clearly align with social understanding and an ability, when needed, to understand social rules and how to be part of a social group. For this to occur, individuals with ASD need to be taught social behaviors and social understanding and skills. This book is designed to facilitate this process, especially related to the needs of children and adolescents with Asperger Disorder and other forms of high-functioning autism. This chapter sets the foundation for the instruction that follows in other chapters. It outlines the needs and characteristics of learners with ASD, specifically those diagnosed with Asperger Disorder and other types of high-functioning autism, thus providing the underpinnings for effective social skill instruction and support.
Autism Spectrum Disorders
Children and adolescents with ASD are remarkably unique. Highly variable intellectual abilities, speech and language capacity, behavior, adaptive behavior, and social abilities frequently make children and youth with ASD difficult to understand and contribute to their often perceived-to-be mysterious qualities. To be sure, individuals with ASD vary considerably in development and functioning. Individuals with ASD, especially those identified as having Autistic Disorder and other classic forms of autism, often have significant cognitive and intellectual impairments, significant language and communication delays and problems, severe behavioral problems such as self-stimulation (e.g., hand flapping, rocking) and related abnormalities. Social abnormalities and social skill deficits and excesses are also part of the ASD picture.
The autism spectrum also includes children and youth who fall at the so-called high-end of the continuum. These individuals share general features and characteristics with others who have been diagnosed with ASD, namely social skill and social interaction traits; certain speech, language, and communication characteristics; and behavioral irregularities and problems. Yet, despite these basic and generic shared ASD features, individuals at the higher end of the ASD continuum characteristically and for the most part appear unlike others with autism. These children and adolescents, commonly identified as having Asperger Disorder and other forms of higher-functioning autism, tend to have average to above-average intellectual and cognitive abilities, basic age-expected speech and language abilities, and academic skills and capacity that typically allow them relatively routine access to standard grade-expected curricula and typical educational opportunities. In spite of these assets and qualities these so-called high-functioning children and youth routinely experience many significant challenges connected to their ASD disability. These students are especially at risk for significant social skill and social interaction problems.
Children and Youth With Asperger Disorder and Other Types of High-Functioning Autism
Hans Asperger, a physician who was living in Vienna, published a seminal paper in 1944, which described four children with an unusual pattern of ability and social behavior. The children were described as having poor social skills and other atypical behavior; however, they appeared to have average or above-average cognitive and language abilities. The children had an affinity for social isolation and were described by Asperger as socially odd, socially uninformed, and awkward. Asperger also noted that the children frequently displayed typical autistic behaviors, such as self-stimulation and insistence on environmental sameness. However, despite these features they were unlike other children with autism, primarily because of their average intellectual ability and normal language development. Asperger (1944) asserted that these children represented a unique and independent diagnostic classification, one he termed āautistic psychopathyā in childhood. He also contended this newly identified disorder had a neurodevelopmental cause. That is, Asperger contended the disability was neurodevelopmental in nature (an impairment of the brain) and unrelated to other causes, such as psychological problems or exposure to family difficulties. Today, higher functioning autism disorders are commonly included among the ASD continuum. And Asperger Disorder is commonly and increasingly subsumed under the generic umbrella of higher functioning autism disorders.
Interest and attention in Asperger Disorder was initially slow to develop. Even though first identified in 1944, significant attention was not given Asperger Disorder until the 1980s. Lorna Wing (1981), a British psychiatrist, is often credited with bringing Asperger Disorder to the attention of researchers and clinicians by translating Hans Aspergerās original work into English and clarifying and identifying the disorder through extensive clinical descriptions and case examples. Uta Frith (1991) also significantly facilitated this translation and interpretation process. Once the disorder came to the attention of professionals, it quickly became of major interest to a variety of professionals as well as other stakeholders, such as parents and families. Today, Asperger Disorder is widely recognized around the world by professionals, parents, and the general public. High-functioning autism spectrum disorders have followed the trends of the more specific condition Asperger Disorder and, increasingly, the two conditions are commonly and increasingly viewed as generally encompassing a single classification (American Psychiatric Association, 2013).
The remarkable increase in the number of individuals diagnosed with Asperger Disorder and high-functioning autism, including school-age children and youth, has dramatically affected schools, social agencies, communities, and families around the world. The remarkable increase in interest in Asperger Disorder is directly linked to recognition of the syndrome as a subclassification of pervasive developmental disorder in the Diagnostic and Statistical Manual of Mental DisordersāFourth Edition (DSMāIV; American Psychiatric Association, 2000) and the corresponding international classification system, International Statistical Classification of Diseases and Related Health Problems (World Health Organization, 2007). The most recent edition of the Diagnostic and Statistical Manual of Mental DisordersāFifth Edition (DSMāV; American Psychiatric Association, 2013) lists Asperger Disorder as one component of the ASD spectrum; in fact, it no longer identifies Asperger Disorder as a separate diagnosis. This amendment in no way eliminates the presence and existence of Asperger Disorder, rather only a modification in diagnostic classification. For this reason, we include and intersperse use of both the terms high-functioning autism and Asperger Disorder in subsequent chapters of this book.
Notwithstanding the extraordinary interest in ASD in general, and high-functioning autism and Asperger Disorder in particular, understanding these disabilities lags significantly behind their recognition. First, there is misunderstanding and lack of clarity related to the precise defining and unique characteristics of high-functioning autism and Asperger Syndrome relative to other forms of ASD. Lack of diagnostic reliability is another problem. That is, it is common for different professionals to arrive at a different diagnosis for the same child. There is also significant debate about whether Asperger Syndrome is an independent diagnostic category or simply another dimension of the so-called spectrum of autism. There are arguably subtle differences among individuals diagnosed with Asperger Disorder and the more generic condition of high-functioning autism spectrum disorders. Nevertheless, increasingly, as noted in our earlier discussion of current DSM-V diagnostic terminology (American Psychiatric Association, 2013), those terms are interchangeably used. More importantly, the methods and strategies for individuals with these conditions, including social skill and social interaction interventions and supports, are generally the same. As noted above, we use both the terms high-functioning autism and Asperger Disorder. For purposes of convenience and readability, we frequently use an abbreviated term: HF/AD.
Children and youth with HF/AD are typically classified and characterized based on their social skills and social interactions, speech and communication, cognitive abilities, academic traits, behavior and emotion, sensory characteristics, and physical and motor skills. These characteristic components are discussed below.
Social Skill and Social Interaction
By definition, children and youth with Asperger Disorder and other forms of high-functioning autism demonstrate social excesses and deficits. Moreover, these atypical patterns and irregularities frequently continue into adulthood. Scores of children and adolescents with these disorders are socially motivated and are interested in interacting with others. These interactions, however, tend to be socially awkward; and all too often these individuals struggle to understand social rules and conventions and effortlessly and naturally engage in age-appropriate interactio...