All about Signs and Symptoms of Asperger's Syndrome

One morning during my clinical training, I was called by my superior for doing a psychological assessment of an OPD case. The child named Samar (the actual name has not been shared to maintain confidentiality) was waiting outside my room. He was 10 years of age and had been brought to the hospital by his mother with complaints of poor social interaction.

According to the mother, Samar found it difficult to understand non verbal communications like for instance those that entail body gestures and facial expressions. Moreover, she shared that he would invariably shut his ear whenever the mixer grinder would be on and that he was lazy with his daily chores. Also his normal developmental milestones, especially his speech related milestones had happened later compared to the other children of his age group. After conducting an IQ test, it was found that Samar's intellectual ability was in accordance with his developmental age. After assessing his intellectual functioning, based on the complaints, I assessed him for autism signs and the test results revealed that Samar was functioning with Asperger's Syndrome.

This incident gives us a glimpse of 'what' Asperger's Syndrome looks like. Asperger's is a neurodevelopmental condition, which causes deficits in terms of social interactions. However, the intellectual functioning tends to be average or above average. Currently the term 'Asperger's' is no longer used (as a separate diagnostic condition) but has been classified under a group of neurodevelopmental conditions called as 'Autism Spectrum Disorder'. The only difference between both the conditions is that Asperger's is the milder form of Autism and the intellectual functioning is not impaired.

Children with this condition may have (usually have) difficulty in social interactions. They find it very hard to convey anything through gesticulations and facial expressions and struggle to understand the same. They are usually sensitive to flashy objects and loud noises (which mostly include sounds of mixer grinders, car honks, telephone ringtones and cries of human infants.) They also show attachment to inanimate objects like a broken pencil, empty can, animal figures and easily get irritated when any changes are made in a daily routine. They also have motor coordination issues and display clumsiness while performing daily chores and require repeated instructions. Repetitive activities and restrictive behaviors such as body rocking, lining up toys, hand flapping are also noticeable signs of children with Asperger's Syndrome.

There is no specific cause of Asperger's Syndrome. However, genetic mutations or structural abnormalities as well as hereditary factors may contribute to the development of the condition.

The final question (after assessment) which is usually asked by the parents or caregivers is what can be done for my child? How can we empower him/her with the basic skills for functioning in life? Well the answer lies in managing the condition. Any condition of disability cannot be wholly cured. However, the management principles emphasizes on the importance of early intervention or early care (which starts from birth till 6 years of age) where the child is assessed on the specific areas of delays and accordingly generalized symptomatic management strategies are planned and carried out.

Apart from early intervention, there are other management approaches too. These include social skills training for improving social interactions and communication and behaviour modification training for management of problem and deficit behaviours. Teaching them adaptive ways (in terms of behaviour) is another effective management approach. Cognitive behaviour therapy for management of negative (automatic) thoughts and irrational thought patterns, speech therapy for functional ways of verbal as well as non-verbal communication and physiotherapy and occupational therapy for coordination of fine and gross motor skills are recommended as part of the management (of the condition) approach. Today, complementary therapies like music, art and massage therapy are also gaining importance in terms of the management of the emotional, social and sensory symptoms of children with Asperger's Syndrome.

I strongly urge all parents and caregivers to be vigilant as early identification and screening plays a very important role for designing an optimum management plan for their improved quality of life.

By

Tanushree Choudhury

Rehabilitation Psychologist (RCI)

Consultant, MIND India, Guwahati

Ask Dr Sangeeta Goswami

Question: I have a teen-age boy who has Asperger's. How do I parent him well?

Parenting is always a difficult task and we cannot label ourselves as good or bad parents. It's the parenting style which is effective or ineffective. Children and adolescents with Asperger's or ASD need a comprehensive team comprising of a speech therapist, occupational therapist, behavior therapist, special educator and clinical psychologist. The interventions will be effective, only when the parents understand and become part of the process and only then we can see some progress in the child.

Here is something important that can be done by all parents (of such children) at home:

Teaching practical social skills: Children with Asperger's Syndrome find social interactions challenging because they are often unable to establish proper eye contact and understand the subtleties of body language and tone of voice. Show your child a picture and ask him/her to identify the feeling that the picture is conveying. Make sure that your child is talking about his/her emotion in relation to the picture. Once the emotion is identified, ask your child what other situations in his/her life make him/her feel this way. Help your child to correctly identify social cues, social norms and body language.

In your case, encourage your teen ager to initiate conversation with his peers. This will help to gain self- confidence.

Work on your child's problem solving skills. A large part of enhancing a teen ager's problem solving skills involves helping him/her to correctly identify what's appropriate and what's not appropriate in different situations. Parents can facilitate problem solving skills by reading a simple story and asking the child (teenager) to identify the problem. Have a discussion regarding the different ways of solving the problem and what the most effective approach would/should be.

Parents should keep in mind that while there isn't only one way to solve a problem, this is a skill that children with Asperger's Syndrome need to practice as often as possible. If you incorporate problem solving into your child's daily life, he/she will develop the confidence to respond calmly while facing problems in real life.

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