Strategies for Managing
Asperger's Disorder and Asperger's Traits

By Walter B. Branch, Ph.D.
Coastal Psychology

Asperger's Disorder (AD) was first described by an Austrian physician, Dr. Hans Asperger, in 1944.
It is thoughtto be a milder form of autism and such, it has a better prognosis, the symptoms are
not as pronounced as autism.  The disorder can be characterized by the presence of certain
symptoms and the absence of others. According to the DSM-IV, Asperger's is characterized by
the following:

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 a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

In other words, Individuals with Aspergers have significant problems with social skills and often are
viewed by others as being social inept and aloof. They are often described by others as being
"loners." There are impairments in two-sided social interaction and non-verbal communication (e.g.,
eye contact, facial expression, body posture, etc. The are content playing by themselves ro with
a small groups of others with similar interests. To play with other children is to introduce unknowns
into a known, almost scripted and predictable life. Older children may become aware of the social
isolation and may want to interact with others but they don't know how.

The child with Aspergers' does not understand the rules of social discourse and may say or do things
that are embarresing to others. Once they understand the codes of conduct they may be rigidly
enforced, with little flexibility. Tact is not their strength.

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 (e.g., hand or finger flapping or twisting, or
complex whole-body movements).

(4) persistent preoccupation with parts of objects.

In other words, Individuals with Aspergers's are display bizarre and eccentric behavior. They
usually have a circumscribed area of interest which usually leaves no space for more age appropriate,
common interests. They will ave extensive knowledge of a certain subject and unless you also share
that interest, hey often will pay very little attention to you.

C.  The disturbance causes clinically significant impairment in social, occupational, or other
important areas of functioning.

In other words, the AD child stands out from other children in a very real and markedly different
way. Other people, including peers, view them as being different.

D.  There is no clinically significant general delay in language (e.g., single words used by age
 2 years, communicative phrases used by age 3 years) or cognitive development.

In other words, AD children do not show significant language delay's which characterize the typical
autistic child. Though grammatically correct, the AD child's speech is peculiar due to abnormalities
of inflection and a repetitive pattern. Also, unlike the typical autistic child, the AD child intellectual
level is normal.

Genderwise, the ratio of males to females with AD is about 4:1. It has been estimated that the
prevalence rate is about 1:300-400 children, in contrast to Autism, wich has a prevalence rate of
about 1-2: 2,500 children. What causes Asperger's Disorder? We don't know.

Asperger's Disorder: Treatment

There is no specific treatment or "cure" for Asperger's Disorder. All the interventions outlined below are
mainly symptomatic and/or rehabilitative.

Parent Social Skills Training

Teaching social behavior involves literally practicing social skills, including play, with your child.
For young child, teaching them how to play is very important, even the small rules of games. You
shouldmodel what is said and done and how to include others persons. You have to play on the
child's age level. You have to teach your child how to start, maintain, and end play, flexibility
and sharing (it's not "wrong" if it is done a different way), how to avoid social play, and explaining
what the child should have done and modeling it for them.

Next, observe your child playing with their peers and make notes as to what specific behaviors need
to be worked on. It may be the initial greeting, or sharing or whatever the specific behavior may
be. You may need to teach flexibility and cooperating with others. You may need to teach your
child how to cue others that theywant to play by themselves. You may need to invite a potential
friend to visit your house and play with the children to insure social success. Enroll your child in
team sports and scouts may also help to promote social skills.

Sometimes children with AD say embarressing things to others. You must role play situations
in which your child should not speak his or her mind or state the obvious. Teach your rchild that
sometimes it is better to not say anything at all.

Children with Asperger's Disorder oftentimes do not know how to make compliments. This too,
can be demonstrated through thee use of role playing. Show your child how to compliment others
and how to accept compliments.

Another way to teach social skills and problem solving is to have one, or preferably two individuals
model a given social scene and have the child with Aspergers disorder observe the interactions as
a spectator, and try to pick up on when the modelers make a social mistake. This can even be
turned into a game with a certain level of performance being required to earn a certain
treat or privilege.

Another technique which may help the child with Asperger's disorder learn to internalizes social
skills it to teach through the use of stories. Thus the child may, for example, benefit from being
read a story about a little boy who had trouble waiting for the bus at the bus stop. The story
describes the situation and includes appropriate actions and expressions.  Rules are explained
in the story and the story teller uses things which the child is already familiar with such as
video games, cars, fans, bugs, etc.) as an aid in telling the story and explaining the rules.

Children with Asperger's disorder often have difficulties interpreting emotions in others and
expressing emotionsin themselves. To teach emotions, a game can be played whereby the adult
picks an emotion, such as anger, and draws a simple gauge or "thermometer"  of the various
stages or ranges of being angry. The child picks the level of anger and points are awarded if the
child picks correctly. The child can also use the gauge to learn to express an appropriate level
of emotion. The child and parent can work on a number of different situations including
someone making fun of the child, getting a bad grade, forgetting a snack, receiving compliments,
etc. Because of it's highly visual nature, many children with Aspergers enjoy making an activity
book in which faces are drawn to illustrate various emotional response to various situations.

Children with Aspergers often have difficulty with labeling their own emotions or even talking
about their emotions. Here, it would be very helpful if the parent would demonstrate this. For
example, you might say something, like, "I would feel a little angry if someone took something of
mine and would not give it back. How would you "feel."  In addition, for older children, keeping
a diary may help express feelings.

Educational interventions

It is impossible for me to give specific advice on what to do in the classroom because what teachers
are able and willing to do, the instructional time and materials, classroom arrangements, and
other factors vary from one class to the next.

In general, teachers can use other children in the classroom, and themselves, as cues to show
the child with Aspergers what they are supposed to do. Thsi is modeling and demonstration.  This
could be up to several times per day.

Teachers can also encourage cooperation in games and small group activities.

Teachers can also model how other children can relate to the child.  Other children may not know
what to make of the child with Asperger's unusual behavior so the teacher can demonstrate
tolerance and positively reinforce situations and times when other children of supportive.

The teacher in the classroom can also encourage prospective friendships with other students by
initially encouraging  friendships.  In other words, "jump start" a friendship.

For many AD children, the playground is a difficult time as it is noisy and tends to be unstructured.
Aspergers children are most vulnerable during times of unstructured activities. They tend to fall
back on poor social skills and coping. The teacher can either encourage the child join in or respect
their desire for solitude.

In addition the school counselor may be able to include the child with Aspergers in a social skill
development groups.  School counselors have had much training in this area and are a great resource.  

Teachers should also be aware that children with AD are often easy targets for bullies. Children
with AD tend to either respond passively to bullying, which further encourages the bully, or they
react aggressively and sometimes violently to the bulliing which of course causes additional problems.
 Bullying should not be toleraed at all in out schools and the child with AD should be encourgexd to let
the teacher know immediately if they are being bullied by another child. 

Psychotherapy Interventions

Individual psychotherapy mainly centers around helping the individual to process the feelings
aroused by being socially handicapped. This is usually done be a mental health professional and may
include social skills training as outlined above.

Psychopharmacological Interventions

There is no direct medical treatment for AD. Medications are sometimes prescribed to help the
child with Aspergers disorder, depending on the child and symptoms. The decision to use or not
use medication is always between parent and physician. For hyperactivity, inattention and
impulsivity, psycho-stimulants such as Ritalin, Adderall, Concerta, and a varity of others or
antidepressants are sometimes prescribed.

For irritability and aggression, Mood Stabilizers such as valproate (Depakote), carbamazepine
(Tegratol) and lithium, Beta Blockers such as nadolol, propranolol (inderal), clonidine and
naltrexone, or Neuroleptics such as risperidone (risperdal), olanzapine (zyprexa) , quetiapine
(seroquel), ziprasidone (Geodon) are sometimes prescribed.

For preoccupations, rituals and compulsions, SSRIs such as fluvoxamine (Luvox), fluoxetine
(Prozac), paroxetine (Paxil), sertraline (Zoloft), or tricyclic antidepressants such clomipramine
(Anafranil) aresometimes prescribed.

For anxiety, SSRIs or Tricyclic Antidepressants are sometimes prescribed.