Asperger's Syndrome in Gifted Individuals.
This article examines the characteristics of gifted children with Asperger's Syndrome and appropriate strategies for serving them. The two conditions tend to mask one another, making identification of either more difficult, particularly when professionals are generally trained in either giftedness or autism spectrum disorders but rarely in both. In this article I will review the history of Asperger's Syndrome (AS), describe the characteristics of persons with AS, discuss the identification of persons with Asperger's Syndrome, and then describe some common characteristics and suggested educational modifications recommended for members of this subgroup.
Hans Asperger, an Austrian psychologist, first published his description of a developmental syndrome in Europe in 1944. Due to the war and the difficulties of accessing research in other languages, English-speaking psychologists did not recognize the syndrome until after Wing's (1981) paper on Asperger.
Research into the disorder resulted in wider acknowledgement of its existence as a separate disorder (Gillberg & Gillberg 1989; Szatmari, Bartolucci, & Bremner, 1989) and a consensus regarding its definition (Volkmar & Klin, 1994). The current definition bears limited resemblance to the original one (Miller & Ozonoff, 1997). The syndrome was included as a variant of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) DSM-III (APA, 1980) and DSM-IIIR (APA, 1987) until its inclusion in the DSM-IV (APA, 1994) as a distinct diagnosis. Table 1 provides the DSM-IV definition.
Table 1 DSM-IV Definition DSM-IV Diagnostic Criterion I A. Qualitative impairment in social interaction, as manifested by at least two of the following: (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (2) failure to develop peer relationships appropriate to developmental level (3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest to other people) (4) lack of social or emotional reciprocity DSM-IV Diagnostic Criterion II B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (2) apparently inflexible adherence to specific, nonfunctional routines or rituals (3) stereotyped and repetitive motor mannerisms (hand or finger flapping or twisting, or complex whole-body movements) (4) persistent preoccupation with parts of objects DSM-IV Diagnostic Criteria III C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases by age 3 years). E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. Note. From American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author (p. 77).
The estimations of prevalence cited in the literature range from .02-6% in children over the entire range of intellectual ability. AS occurs 2-7 times more often in males as in females (Ehlers & Gillberg, 1993). The prevalence of AS in gifted individuals may be roughly estimated based on the percentage of individual cases in published reports of AS for which intellectual level is reported. Of the 42 cases presented individually in the AS literature prior to 2000, 5 (11.9%) could be designated as intellectually gifted. Using the most stringent criterion of IQ [is greater than] 130 to define giftedness, one can speculate that as many as 72 out of 1000 children might be gifted individuals with AS. These prevalence numbers are constantly changing, as Asperger's Syndrome becomes well known, and the number of professionals familiar enough with it to properly diagnose it increases. It seems as though the prevalence of AS in the gifted population may have contributed to the mythological stereotype of the socially impaired gifted child. It is also possible that some of the intensity issues and introversion attributed to gifted individuals with AS may have more to do with their giftedness than any neurological differences attributable to AS (Silverman, 1997).
Identification of Asperger's Syndrome has tended to occur later in life than an autism diagnosis (Twachtman-Cullen, 1997). This can be attributed to the relatively normal early development of persons with AS, as well as to the relatively recent recognition among practitioners of the diagnosis (Myles & Simpson, 1998). Persons with AS tend to have a history of combination diagnoses/changing diagnoses prior to an appropriate diagnosis (Twachtman-Cullen, 1997). The relatively recent distinction of AS from Autism and PDD-NOS, as well as the inclusion of Attention-Deficit/ Hyperactivity Disorder (ADD/ ADHD) and sensory integration disorder under the AS diagnosis have made the road to appropriate treatment a long and winding one for many older persons with AS. Other diagnoses which can co-occur with or be mistaken for AS are Oppositional/Defiant Disorder, Conduct Disorder, Schizoid or Schizotypal Personality Disorder, Tourette Syndrome, and Obsessive Compulsive Disorder (Twachtman-Cullen, 1997).
Assessment Tools Used in Identification
To determine if Asperger's Syndrome is an appropriate diagnosis for an individual, the person's intellectual ability, academic achievement, developmental history, behavioral patterns, adaptive behavior and even motor skills should be assessed by an experienced psychologist, preferably one familiar with autism spectrum disorders (Myles & Simpson, 1998). Individual assessments of cognitive ability might be obtained using the Stanford-Binet IV (Thorndike, Hagen, & Sattler, 1986) or the WISC III (Weschler, 1991), or non-verbal measures of intelligence such as the TONI-3 (Brown, Sherbenou, & Johnsen, 1997). Ehlers' research group (1997) found children with AS to exhibit strengths in verbal IQ, with arithmetic subtest scores lower than those on other verbal subtests. This may be reflective of the attentional challenges children with AS face as the arithmetic subtest requires one to maintain a problem-solving mindset while manipulating numbers in one's mind (Anastasi & Urbina, 1997). Lower performance IQ scores were characterized by troughs in the Object Assembly and Coding sub-tests (Ehlers et al.). Accurate measures of the intellectual ability of persons with AS may be more readily obtained if one is flexible in responding to the person's individual perceptions of and apparent needs in the assessment process (Myles & Simpson, 1998).
Behavioral patterns relating to Asperger's Syndrome characteristics may be measured in groups of young children using a screening tool specific to AS, the Australian Scale for Asperger's Syndrome (Garrett & Attwood, 1998). Individual assessment of behavioral patterns over a wider age range can use two new behavioral rating scales specific to AS, the Asperger's Syndrome Diagnostic Scale (Myles, Jones-Bock, & Simpson, 2000), or the Gilliam Asperger Disorder Scale (Gilliam, 2001). Prior to the availability of these AS specific tools, the more established observational scales appropriate to all autism spectrum disorders were widely used, such as the Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988). The Vineland Adaptive Behavior Scales (VABS; Sparrow, Balla, & Cicchetti, 1984) broadly measure a person's ability to accomplish everyday self-care tasks, as well as communication, socialization, and motor skills. Other measures of motor skills are the Test of Motor Impairment-Henderson Revision (TOMI-H; Stott, Moyes, & Henderson, 1984) and the Bruininks-Oseretsky Test, (Bruininks, 1978). Both have been used in research studies to assess the motor skill abilities of persons with AS. Ghaziuddin, Butler, Tsai, and Ghaziuddin (1994) could not substantiate clumsiness as a necessary marker of Asperger's Syndrome, but Attwood (1997) stated that it was important to include questions concerning motor skills on the ASAS based on his clinical judgement (Garrett & Attwood, 1998). Smith, as stated in Klin, Volkmar, and Sparrow (2000), agreed that an evaluation of adaptive motor skills is recommended and occupational or physical therapy services should be provided for those who need them.
In a small sample of gifted individuals with AS, which included both adults and children, Henderson (2000) found that the Gifted and Talented Evaluation Scale, (GATES; Gilliam, Carpenter, & Christensen, 1996) was an adequate measure for identifying gifted characteristics, particularly when deficits in leadership are not counted against the person with AS. A greater percentage of the GATES scores of 20 gifted persons with AS were above 70 (predictive of giftedness) than below 70. To apply the GATES as an identification tool, one would expect to find that not all of an individual's scale scores fall at the gifted level. For example, scores on the Leadership Scale were lower than scores on other scales and could be reflective of a possible bias in the Leadership Scale toward an extroverted form of leadership (M. Morelock, personal communication, October 7, 1999). One unexpected descriptive finding was the extent to which the respondents and their significant observers reported creative and artistic ability on this scale. In using the GATES to identifying giftedness in a person with AS, inclusive criteria would be most descriptive of the individual's talent potential.
Characteristics of Persons With AS
"Every human being has a need to be effective, competent, and independent, to understand the world and to act with skill" (Twachtman-Cullen, 1997). Perhaps the defining characteristic of persons with Asperger's Syndrome, the organizing principle of all AS characteristics is that "behavior is rule-governed" (Twachtman-Cullen, 1997). It is helpful in understanding persons with AS to seek that person's perception of a situation and determine what rules might be operating in their perception of the situation. In working to support gifted students with AS, two questions can be useful: "What is the child's sense of what is happening?" and "How can my perception of the rules be communicated clearly and consistently?"
Extensive explanations and descriptions of AS behaviors can be found in books on AS (Attwood, 1997; Klin, Volkmar, & Sparrow, 2000; Myles & Simpson, 1998), but the following list by Twachtman-Cullen (1997) offers a brief overview of characteristics common to persons with AS. Included with each characteristic are recommended coping strategies and skill builders demonstrated to be helpful to children in school settings with AS. As with all characteristics, these are exhibited in individuals on a continuum from typical to problematic, and a person's learned coping skills may compensate for a previous difficulty in any of these areas. The characteristics include difficulties with processing the environment, cognitive processing, and communication.
Those characteristics related to processing the environment include:
* An inefficient sensory system, in which sensory thresholds may be poorly calibrated, a difficulty in extracting information from the environment. "Sensory overload" may seem to overwhelm the person with AS suddenly, particularly in loud, crowded, or confusing places. Direct instruction on what places are likely to trigger these feelings, and what signals one's body may send to warn one of the oncoming overload can help children learn to be forewarned and gather coping strategies. Initially, a successful coping strategy may include a visit to a calming place set aside for the purpose. As a child develops self-awareness and self-soothing strategies, the calming place may be less and less isolated from the typical activities of his or her classmates.
* An amorphous sense of time, in which the person with AS is less able to plan time-use or estimate time passage reliably. Consistent structure and schedules with visual cues are helpful in facilitating smooth transitions. Effective time use can be supported with assignment books and visual timelines for long-term projects or goals. Young children may need a visual schedule with pictures of activities that are planned.
* Difficulty with social/emotional cues, in which the person with AS does not perceive or decode facial expressions, body language, intonation, or other social conventions. Indexing the environment for the person with AS can improve their competence. Some examples of indexing for children might include (a) social indexing, "Look, Don's waving at you. Can you wave back?" (b) emotional indexing, "Oh, Mary got hurt. She is crying. Can you tell Mary, `I'm sorry'?" (c) anticipatory indexing, "Look, here comes the bus. Pick up your backpack." (d) indexing feelings and reactions "You feel angry at Stu for hitting. Can you say, `stop' to Stu?" and (e) indexing perspective taking, "You feel (emotion). She feels (emotion). See how her face shows how (emotion) she is?"
Characteristics related to cognitive processing, particularly executive function deficits, which are descriptive of persons with AS, include:
* Cognitive inflexibility, in which the person with AS has difficulty adapting to changing expectations, schedules, word or concept definitions, and perseverates on prescribed areas of interest. Consulting models of acceptable academic products and overt modeling of the appropriate metacognitive strategies are two helpful support strategies for learning activities. The prescribed interests can be used as motivation for schoolwork, or to build organization or research skills, if the interest is appropriate. If one is asking a person with AS to repress an interest, particularly during a school day, one should ensure decreasing amounts of down time to indulge once one is in an appropriate setting.
* Attentional problems, in which the person with AS has difficulty concentrating, sharing attention between two tasks, suppressing attention to non-salient information, and switching from one task to another (Stuss, Shallice, Alexander, & Picton, 1995). Coping strategies include visual cues to accompany auditory messages,, controlling the environmental distractions, and providing structured environments as well as visual warnings of change. Other methods proven beneficial to students with ADD/ADHD may be useful in addressing individual needs.
* Problems with perspective taking, in which the person with AS has difficulty acknowledging the possibility that a perspective other than their own could exist. This is exhibited in failure to anticipate other's feelings, reactions or interests in social situations, and can also make some literary analysis tasks difficult. Taking the perspective of another can be improved with training (Hurlburt, Happe, & Frith, 1994).
Characteristics descriptive of persons with AS that are related to communication include:
* High-level pragmatic communication deficits, in which the person has difficulty extracting the subtleties of normal conversation, particularly those related to affect and intention. It is helpful for a person with AS if academic rules and expectations are communicated clearly and consistently, preferably in writing. Autobiographical social stories and role-playing can help young students intellectualize the social tasks. Some social indexing by peers can help clarify the expectations of the social culture for the student with AS. Then the student with AS can make choices about conforming to or departing from the expectations, rather than making potentially painful involuntary social "mistakes."
* Difficulty with sense making, in which the person with AS has very literal thinking. Avoid or explain idioms. Use written or visual cues to help clarify implicit understandings. Explore humor to illuminate the consequences of meaning and literal thinking.
* Difficulty with perceiving and abiding by socially expected communication behaviors, in which the person with AS has difficulty with conversational skills, eye contact, or social distance. Persons with AS can memorize social rules and incorporate social information from self-help books for interpersonal interactions. Shared interests are often a great place to start. Two other people who are in awe of the expert with AS's grasp of comic book, anime (Japanese animation), music, history, or trivia can provide a small social group for practicing and learning social interactions. Computer-based interactions are a vital part of most students' social world and provide students with AS with a more comfortable format for social interaction. These interactions may be with others (with AS) or with neurotypicals, a slang term used by AS's when referring to AS people without social difficulty. Practicing skills in a systematic way can improve a person's understanding of conversational turn-taking procedures, topic changes, appropriate ways to initiate and choose conversational topics and maintain comfortable social distance. Social skills training can help AS students learn how to navigate.
In all of these characteristic challenges, the direct and specific skill training indicated may improve a person's function. Coping strategies can be implemented to mitigate the difficulty a person with AS may have in dealing with school or social situations. Stress or uncomfortably unfamiliar settings may cause skill degeneration or loss in persons with AS. Therefore, learning to recognize and monitor one's own comfort levels is the ultimate coping strategy.
Expected Outcomes for Persons With AS
Many persons with Asperger's Syndrome are academically successful and attend college. The student's intellectual ability, the severity of the person's behavioral challenges, and the availability of a personal support system appear to be factors in determining academic success. The focused nature of academia or research can be a good career fit for persons dedicated to compiling an exhaustive database of information on any particular subject. Bright persons with AS may develop their focused interests into science and computer-related vocations. Fact- and detail-based jobs are another way of achieving a good fit between the person with AS and a career. As improved interventions, public awareness, and telecommuting increase the workplace options of adults with AS, problematic interpersonal skills and sensory discomfort may no longer interfere with the ability of an adult with AS to prosper in the workplace.
Persons with AS often desire social interaction and actively pursue friendships. They may do this most successfully with others who share similar social styles or interests. Early intervention for social skill improvement can reduce the instances of rejection, hurt feelings, and the low expectations for themselves in social settings experienced by older persons with AS. Persons with AS may experience depression related to their unfulfilled social needs. All proven therapy and pharmaceutical interventions, as well as interventions to increase the person's satisfaction with their social life can be beneficial. Persons with AS often marry and have families, though not usually early in life. Many parents of children recently diagnosed with AS are encouraged by having renewed understanding of themselves and their own social history through their education about Asperger's Syndrome.
Even though they long for peer companionship, many children with AS are more comfortable talking with adults. This may be due to the extra conversational work load that adults may be willing to carry, then again, preference for adults is often noted in gifted individuals. This preference for adults makes it particularly imperative that the classroom teacher act in supportive ways. Suggestions for adults working with students who are intellectually gifted and have AS include:
* Be sincere. In working with persons with Asperger's Syndrome it is particularly important to be sincere and respectful, as subtlety, duplicity, or sarcasm only adds to the person's confusion and fears of incompetence. These students can be very creative, talented in math, science, writing, and the arts. Recognize the gifts and praise-worthy accomplishments in a sincere manner.
* Respect individual differences. There are a wide range of acceptable behaviors; not every student should have to display the most frequently observed ones. You are also modeling tolerance for student peers.
* Use a neutral tone of voice, showing no irritation. For some individuals with AS, anger may be the most accessible and easily understood emotion they can evoke in others. This restriction on available emotional sensation may lead them to develop a habit of "pushing people's buttons," and a cycle of negative interaction patterns may result. Not falling into this cycle may be more constructive in the long run.
* Protect the student from bullying by educating peers. This may be the most frequent complaint concerning school environments. I often hear parents of gifted individuals with AS lament the fact that their highly sensitive and compassionate child who works so hard at understanding others, is the focus of so much intentional cruelty by "normal" children. Proactive training in prosocial and character education for entire school populations, as well as educational information for children who come in contact with gifted individuals with AS can help provide some supportive people in the social environment. Deciding to share information with peers is a group decision involving, the student, parents, and professionals. One gifted high-school student who chose to give a report in her psychology class on her AS found her classmates had become more accepting of her as their understanding increased. The current educational safety climate has increased education professionals' awareness of the danger of bullying and other oppressive school climates, and meaningful interventions on behalf of victimized children must be explored.
* Work as team with parents. Whatever one's role in the collaborative process, whether professional or parent, it is vital to be true to the collaborative spirit of IDEA (1997), as well as to the letter of the paperwork it mandates. Frequent communication regarding areas of progress or challenge is vital to supporting the education of the gifted individual with AS. The level of interpersonal conflict in the lives of these students should not be increased because the adults are not modeling good communication and negotiation skills. Informed parents and educators are more likely to be seeking similar solutions.
* Seek information about Asperger's Syndrome and giftedness. Table 2 contains some Internet resources that can be beneficial to parents, educational professionals, and students. The reference list contains books written to several audiences. Contact your local or state Autism Society; they often include support for Asperger's Syndrome in their meetings, activities, and informational gatherings. Additional research information on neurophysiological differences, etiology, genetic studies of AS, interventions, and new therapies, can be accessed through professional journals in medicine, psychology, child development, and education.
Table 2 Web Resources for Educators and Parents ASPEN[R] Asperger Syndrome Education Network http://www.aspennj.org/ ASPEN[R] is a terrific site for professional high-quality information and connections to people in the field. Welcome to Asperger's Syndrome Web Ring Home Page. http://aspie.freeservers.com/main.html The web ring allows a web surfer to visit several sites connected by a shared topic. This is a good starting place to find information, people's experiences, and support. Asperger Syndrome Coalition of the U.S. http://www.asperger.org/about/about_main.html This is an advocacy and information site. A.S.P.I.E. Asperger's Syndrome Parent Information Environment http://aspie.freeservers.com/main.html A parent focused site with tips. OASIS: Online Asperger Syndrome Information & Support http://www.udel.edu/bkirby/asperger/ Oasis is another excellent site for information, advocacy and support.
* Involve personnel who have expertise in meeting both the gifted and AS needs of the student. In planning for meeting the educational needs of the gifted individual with Asperger's Syndrome, a team may become too focused on deficit areas and forget to address areas of strength needs. Henderson (2000) identified specific services, which were designed to meet the intellectual needs of gifted persons with Asperger's Syndrome, as the most beneficial of the many possible interventions. Although some individuals may have expertise in both, it is important to expand the multidisciplinary nature of the collaborative team to include experts in several areas.
It became clear to me several years ago that every year parents place a year of our children's lives on the line. We hand that year over to a professional educator, who can make it sublime, life illuminating, irrelevant, uncomfortable, or miserable. As an educator myself, I am humbled by the worth and power of that year. I challenge the teachers I train to strive to be that teacher who returned gold on the investment. For gifted children with Asperger's Syndrome, the stakes may be even higher since that year's outcome is more dependent upon that professional educator's willingness to understand and ability to meet the needs of this special population.
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|Author:||Henderson, Lynette M.|
|Publication:||Gifted Child Today|
|Date:||Jun 22, 2001|
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