The following chapter is an excerpt from School Success for Kids With Asperger’s Syndrome. This book covers topics such as recognizing and diagnosing Asperger’s syndrome, addressing the needs of students with Asperger’s, implementing successful practices in the classroom, working with the school system, and providing interventions in the home to help develop needed skills.

At first, Jack’s parents were so excited and proud. He was reading books before the age of 4. It was clear he was a chip off the old block, as bright as his parents, one a Yale graduate and one a Columbia graduate. It was true that he was a little clumsy and his speech was a little delayed, but initially his parents could focus on how incredibly bright he appeared. But, over time his talent and interest in reading became another area of concern. Reading was all he wanted to do. As the other children played with one another, he was still off to the side with his books. In preschool, his problems interacting socially quickly became evident. Jack was either uninterested in the other kids or when he did want someone’s attention, he was more likely to push them than to speak to them. When his teachers would try to engage him, he would not make eye contact with them. The feeling of pride and expectation that his parents had initially felt was now being replaced by doubt and fear.

There are many aspects of the developing child that emerge as challenges for parents. Certainly, there are some features in your child’s early development that may concern you as parents. In this chapter, we hope to emphasize pivotal developmental concerns that may arise.

A child with AS may exhibit less eye contact with you and others than expected, and he or she may not read faces for cues about feelings or consequences. This lack of connectivity is often felt in an intangible way, especially by caregivers. We anticipate with open hearts the child who will “give back” our attention. However, in kids with AS, there may be very little variation in expressions of emotions and little joy in playing interactive baby games. The arrival of the child’s social smile may occur later and infrequently.

There is significant data to suggest that many children with AS frequently show a very exaggerated response to loud noises such as thunder or unexpected sounds. In addition, your child may show hyperresponsiveness to unexpected experiences in general, because a core attribute of AS is sensorimotor dysfunction. Motor clumsiness is often significant. Very few highly athletic children are found in the AS population. They may display some exquisitely developed skills such as mastery of a musical instrument, but rarely do they display general gross motor precocity. They are often awkward in tasks requiring balance and coordination. They are often late to handle a pencil comfortably, catch a ball, ride a bike, or use playground equipment effectively. They often display hypotonia, a generalized muscular weakness that affects posture, movement, strength, and coordination. Children with AS also may display tactile defensiveness; in other words, they may avoid touch, warmth, and hugs. For these reasons, occupational and physical therapies are among the very earliest interventions that should be employed along with speech/language therapy, the most frequently employed early intervention.

Teitelbaum and colleagues (2004) at the University of Florida have identified motor measures of the early developing smile, and postural and other motor movements that they feel demonstrate the possibility of identifying AS in infancy. Teitelbaum’s group used a notation system for movements (called the Eshkol-Wachman movement notation) in the attempt to find diagnostic clues about AS early in life. They present evidence that abnormal movement patterns can be detected in AS in infancy. This finding suggests that AS can be diagnosed very early, independent of the presence of language. As shown by the group in earlier studies, almost all of the movement disturbances in autism can be interpreted as infantile reflexes “gone astray.” In other words, some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to AS, as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of children with AS or autism. What parents often see, however, are late-developing, immature, and awkward visual-motor skills.

The historically important work of Lorna Wing (1981) has suggested that delays and atypicalities related to AS are observable in the first 2 years of life. Some babies with AS show less-than-expected interest and pleasure in other people. Infants with AS may share interests and activities less and may even babble less than other infants. Your baby may seem less interested in communicating through sounds or physical gestures, and his speech may be delayed to some extent or robotically copied from books or TV shows. Wing points out that not all children with AS talk before they walk and not all children with AS are bright. She also notes that young children with AS seem to display limitations in imagination and pretend play, or they employ play themes that are limited and repetitive. Wing also notes that about 20% of the AS population is female. Today, it is clearly accepted that there are 1 in 4 or 1 in 5 girls in the AS population, and that the majority of children with AS are boys. It is important to note that, in many clinical populations involving learning disabilities and differences, that the ratio of boys to girls is higher.

Children with AS tend to display better attachment to parents than children with more severe forms of classical autism. However, you may notice that despite your child’s bonding with you, she still has difficulty connecting with her peers. Later in childhood, she may be more likely to engage in conversation (although this often is one-way conversation) with you and other adults than with her peers.

Almost all children with any form of autism tend to repeat behaviors, an action referred to as stereotypic behaviors or perseveration. Your child may stare at objects or repeat behaviors that seem to have no purpose for hours at a time. This can be seen in the “flapping” of your child’s hands or other circumscribed, repeated movements, even those that are self-injurious or destructive to others or property.

In children with AS these perseverative behaviors may diminish and give way to obsessive interests, usually topical in nature, as the child gets older. This is exemplified by obsessive fascination with a particular narrow field such as sharks, weather, train schedules, airport architecture, maps, and so on. The pursuit of a very limited area of knowledge may encompass a huge amount of detail on the subject. Such persons seem to display an exquisite ability to memorize the smallest facts. In discussion on their favorite topic, they can “nitpick” over the smallest details. In our example in Chapter 1, Grandpa may think he remembers World War II, but his grandson with AS has memorized the details of the war with far greater accuracy. Clearly, the student can display perfectionism in building such a base of information. For this reason, AS has been compared in such respects to obsessive compulsive disorder. Autistic children who are later found not to be categorized as having AS may tend to display stereotypical behaviors longer and at levels that are difficult to extinguish. In many cases, physical perseverative behaviors decrease significantly over time in students with AS, and, in some cases, only obsessive thinking is perseverative in students with AS.

Based on data from psychological testing, it is likely that the memory of the person with AS may not be better than others in general, but the huge collection of facts he or she knows probably represents the amount of time and effort that has gone into accumulating knowledge on one or two subjects to the exclusion of much else. The obsessions are not necessarily characterized by memorization of data alone. The term systemizing applies to the fascination with data that has inherent networks, such as maps, weather patterns, or airline schedules. Although it is commonly thought that obsessions can be strengths that can be utilized in the educational process, these obsessions can interfere significantly with other important daily functions (Russell & Sofronoff, 2005). Baron-Cohen, O’Riordan, Stone, Jones, and Plaisted (1999) postulate that children with AS are more interested in systems that can be described as “folk physics” (an interest in how things work) versus “folk psychology” (an interest in how people work). But, we have found that in female adolescents with AS, obsessions can include some human material, such as Hollywood celebrity facts. And, World War II and other military buffs with AS sometimes focus on the more human aspect of famous military decisions by war commanders. However, the knowledge collected by students with AS is generally focused on crystallized facts instead of interpersonal processes.

Language seems to develop on time in children with AS, but words, while formulated according to the rules, seem to lack functional effectiveness, because they most often are used to express immediate needs or to expound on the child’s favorite subjects. The child with AS seems not to see the main idea or the pivotal point. Children with AS tend to have problems with abstraction, inference, or practical, functional language. Their semantic understanding is limited, which frequently shows up in tests and instructional measures of listening comprehension. A major reason persons with AS are often referred to as “little professors” is due to their stiff and often pedantic and monotonic use of language. The varied, expressive qualities of expressive language may be unusual. This is called prosody, which is the pitch, loudness, tempo, stress emphasis, tonality, and rhythm patterns of spoken language.

Beyond his interactions with parents, an AS child’s slow social development extends to early play dates or simple play opportunities in which the child finds fascination with a toy and decides not to join in a sharing opportunity at another child’s invitation. Kids with AS appear to lack the ability to articulate emotional attachment or to extend relationships to unfamiliar adults or peers. What psychologists call parallel play seems extended in the development of children with AS. In parallel play, children might enjoy toys near each other, but they don’t interact in sharing toys or games with each other. The child with AS may play a game with others, but will not initiate the opportunity and may derive little pleasure from it. These children often require coaxing, prodding, or encouragement to maintain participation in games or group activities.

There may be more than one process operating in social skills deficits. On one level, there is the ability to recognize emotions through reading faces, body posture, and voice inflection, and on another, the ability to make good judgments using the information obtained from “reading” others. Johnson (2004) suggests that social deficits may be due to a lack of integration among various perceptual and intellectual abilities, as well as social memory or recall.

One critical area of experience for persons with AS are social faux pas. Baron-Cohen and his colleagues (1999) have theorized about the mental functions that contribute to these mistakes. The term for the analysis of these embarrassing situations after the fact is social autopsy. This is a method that can be used in counseling or coaching children with AS, by helping them to dissect and correct what went wrong in a social interchange.

Although behavior problems are not unusual at home or school, they are not always a major presenting problem in AS. Negative behavioral outbursts are most frequently related to frustration, being thwarted, or difficulties in compliance when a particularly rigid response pattern has been challenged or interrupted. Oppositional behavior is sometimes found when areas of rigidity are challenged. Rebecca Moyes (2002), a parent of a child with AS, has presented a viewpoint on the development of behavior management plans for children with AS. She stresses the importance of first attempting to analyze the communicative intent of the negative behavior. A harsh, punitive approach to negative behavior is especially ill advised when the negative behavior was intended to communicate the child’s feelings.

The solitary lack of engagement with others may develop to some degree into what can be described as a lifelong egocentrism or apparent selfishness. Your child may seem narcissistically concerned only with his or her own needs. What it reflects is a delay in the development of the idea that the self is equal in importance to that of others. This connects to an idea referred to in the research literature as theory of mind, or the ability to understand that others have minds, a point of view, feelings, and priorities. Theory of mind involves the ability to attribute mental states to others or to be able to describe what others might be feeling in a given situation.

Some researchers believe that the ability to guess others’ states of mind is related to one’s ability to effectively practice introspection on one’s own. Some of these things can be acquired late in life and learned. The inability to guess others’ mental states can result not only in faux pas but also in paranoia, by attributing negative intentions in others that aren’t there. Blackshaw, Kinderman, Hare, and Hatton (2001) found that the lack of developed private self-consciousness was a predictor of paranoia. This suggests, again, that the ability to know one’s self in some way may relate to our skill in attributing feelings and motivations to others. More severely autistic individuals may lack these facilities. Because of these deficits, persons with AS generally will take statements by others in a more concrete and literal fashion (Kaland et al., 2002). Williams (2004) suggests that, at the very least, people with AS must work harder at theorizing what others are experiencing than most persons. Educationally, this means that children with AS need more prompt questions and more time than others to understand social subtleties in language, such as irony, sarcasm, and some forms of humor.

One frequently observed feature of AS is rigidity in thought and behavior. Rigidity seems to pervade so many areas of the lives of people with AS. Novel situations often produce anxiety for these children. They may be uncomfortable with change in general. This can result in behavior that may be viewed as oppositional and can lead to emotional meltdowns. This general rigidity is what parents, neighbors, and teachers often label as stubbornness. Children with AS may have many fears in addition to those related to unexpected changes in schedules. Large groups of people and complex, open environments like school hallways, cafeterias, playgrounds, or bus stations tend to overwhelm kids with AS. They may also be overwhelmed by unexpected academic challenge or by having too many things to remember or too many tasks to perform. They often have limited frustration tolerance and may display tantrums when thwarted. Routines and rules are very important to children with AS in providing a sense of needed order and structure, and hence, predictability about the world. More will be discussed about the need to ease children into changes in school or class routines in Chapter 6.

Another form or rigidity is moralism, a kind of self-righteous and inflexible adherence to nonnegotiable moral principles that is often out of context with practical reality. An example might be a child who criticizes a parent who has run a yellow traffic light when the parent is on the way to the emergency room for treatment of a severe cut or burn. Rigidity is also found in the inflexibility over matters that are of little consequence, such as arguing about whether the route to the emergency room was the quickest when it might be the difference between a few hundred yards by choosing to take one turn over another. In the classroom, this may be found when a student fixates on a perception that a teacher has not enforced a rule consistently. Such fixations on moral correctness can escalate and interfere with availability for instruction.

Just as parents have difficulties in identifying the early signs of AS, teachers also may be uncertain of key features to address educationally. During the individual development of the child, parents and teachers must take notice as skills blossom or fail to develop as expected. Many children suspected of AS are brought to the psychiatry, psychology, or early childhood departments of pediatric medical centers. Other children with AS in the U.S. are spotted as having unique delays by child find screenings and soon receive pull-out or part-time programs for preschool children with developmental delays. They frequently require speech/language, occupational, and physical therapy interventions. They are monitored for further crystallization of symptoms. Frequently, behavior management programs and parent support programs are employed.

There are many jurisdictions, however, where these early assessment and intervention opportunities are not in place. Early on, children suspected of delays might be classified in general as having pervasive developmental disorders, an umbrella category for many of the varieties of autism. They may be seen as multiply handicapped or multiply disabled. They may be placed in a diagnostic center or in a diagnostic mode while they are being monitored. Schools are some of the best laboratories for differentiating appropriate classification schemes, as the strengths and weaknesses crystallize in the child’s attempts to absorb, adapt to, and master the world of learning. The problems children with AS face in school will be covered in greater detail in Chapters 5 and 6. Tips for helping your child succeed in school are included in Chapters 7 and 8.

The primary aspect of AS that characterizes it as autistic is the problem of human connectedness. The term most commonly used to describe this core weakness of human connection is reciprocity. This refers to the individual’s ability to engage other people in a way that makes others feel connected or not. In adult social conversation with a person with AS, eye contact is often poor, fleeting, or absent. The person with AS may not be able to read subtle gestures and facial changes or to interpret subtleties in language such as irony or sarcasm. They do not read or respond as most people do to small changes in body posture or to gestures. They seem either distant, stiff, or in other ways unconnected. Persons with AS not only seem disconnected, but in some cases uninterested in being in relationships with others. They may generally have very little interest in the feelings, experiences, other human qualities, or possibilities of others and, hence, lack empathy. They do not seem to derive pleasure from engaging others, learning about them, talking with them, or sharing experiences. In the many cases where the symptoms are milder, the individual may wish to connect with others but simply does not know how. They may have feelings for others but can’t seem to mobilize the demonstration of those feelings.

At first, neurotypical (“normal”) people in common social contexts (such as around the water cooler at work) may see people with AS as shy and retiring, quiet, stiff, or withdrawn. As the uninitiated begin to talk with persons with AS, it may appear that they seem to respond robotically. They have a monotonic voice that often comes across as reminiscent of the aforementioned geeks or nerds. The initial impression is that one is dealing with an eccentric. People with AS, including children, seem to lack warmth to their more socially apt peers. There is a sense that the person with AS just isn’t there when he or she is interacting with you. He may not know what to do when someone has finished making a point. She may not know when to stop talking and may seem overly interested in her topic of conversation and not yours, unless you are equally fascinated with her areas of interest. All too frequently, however, persons with AS seem not just alien and unconnected, but preoccupied with one or two subjects, which they will talk about endlessly. They may take offense easily over unrelated trifles or become upset when others do not share their enthusiasm for a given area of interest. There is a kind of immaturity or somewhat fixed developmental delay, in which the needs, interests, feelings, perspectives, and thoughts of others just aren’t real or important to them. Intervention in teaching about the lives of others is important here.

In conversation with a person with AS, you may find yourself doing most of the work in the exchange, asking most of the questions, and waiting for obvious follow-ups that don’t occur. His frequently robotic language and responses seem to suggest that others might as well be inanimate. It is not just a question of only lacking the ability to read social cues. There is an output problem, not knowing how to engage and maintain relationships with others, and most certainly an internal problem, in which social/emotional information is absent, confusing, undeveloped, and/or not valued. He may not have labels for feelings. The person with AS may seem odd, making you uncomfortable. The simplest conversation among neurotypical people is kind of a naturalistic dance, a flowing interchange of cues and fitting responses. Because there really is quite a lack of tolerance in the workplace for not being able to engage in this kind of behavior (especially with the workplace being the “gossip mill” that it normally is), a person with AS soon becomes grist for that gossip mill and finds himself unemployed for vague reasons. It is difficult not to overemphasize the power of having the appearance of being a “regular person” in the workplace.

“Aspies,” as adult persons with AS sometimes like to refer to themselves when they congregate physically or in Internet chat rooms, are often quite aware as they get older that there are differences between themselves and normal or neurotypical persons who they call “NT’s.” They may spend a lifetime trying to identify and adjust to those differences if they do not shut down their attempts to try. Aspies have created their own “in groups,” support groups, and Web sites where they feel valued and where their strengths are valued. Writers like Temple Grandin have spent many years explaining to the rest of us these experiences in learning, adjusting, and living shared by persons with AS. There is an excellent portrayal of a young adult with AS by Josh Hartnett in the film Mozart and the Whale. In his portrayal, Hartnett appears to convincingly embody all of the characteristics and many of the challenges of a person with AS. The lead character demonstrates considerable awareness of the challenges associated with AS and shows adaptation to the world of people with neurodevelopmental differences and the world at large.

When parents recognize these characteristics, it is helpful to make note of them when meeting professionals for the first time. In the following chapter, we will discuss how professionals will utilize the parents’ observations and discoveries in making diagnoses and recommending interventions.

Baron-Cohen, S., O’Riordan, M., Stone, V., Jones, R., & Plaisted, K. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 29, 407–418.

Blackshaw, A. J., Kinderman, P., Hare, D. J., & Hatton, C . (2001). Theory of mind, causal attribution and paranoia in Asperger syndrome. Autism, 5, 147–163.

Johnson, S. A. (2004). Social processing in Asperger’s disorder. Dissertation Abstracts International, 64(7-B), 3552.

Kaland, N., Moller-Nielsen, A., Callesen, K., Mortensen, E. L., Gottlieb, D., & Smith, L. (2002). New “advanced” test of theory of mind: Evidence of children and adolescents with Asperger’s syndrome. Journal of Child Psychology and Psychiatry, 43, 517–528.

Moyes, R. A. (2002). Addressing the challenging behavior of children with high-functioning autism/Asperger syndrome in the classroom: A guide for teachers and parents. Philadelphia: Jessica Kingsley.

Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39, 633–638.

Teitelbaum, O., Benton, T., Shah, P. K., Prince, A., Kelly, J. L., & Teitelbaum, P. (2004). Eshkol-Wachman movement notation in diagnosis: The early detection of Asperger’s syndrome. Proceedings of the National Academy of Sciences of the United States of America, 101, 11909-11914.

Williams, E. (2004). Who really needs “theory” of mind? An interpretative phenomenological analysis of the autobiographical writings of ten high-functioning individuals with an autism spectrum disorder. Theory & Psychology, 14, 704–724.

Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11, 115–129.