Asperger syndrome is an autism spectrum disorder and, as such is a neurodevelopmental disorder in which the patient has difficulty in participating in “normal” social interactions and communication. The person with Asperger's may also perform repetitive behaviors and be hyper-focused on particular activities at the expense of all others. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, classifies Asperger syndrome as one of the many manifestations of autism spectrum disorders yet many still consider Asperger syndrome a separate clinical entity.
Management and treatment of Asperger syndrome
To date, there is no single all-encompassing treatment program for the management of Asperger syndrome or for autism spectrum disorders. Several treatment options exist and several boast individual successes though large-scale comparisons between treatment techniques have not been performed. Therefore, it is difficult to say which treatment option is better or the best, but all experts agree that some form of intervention is better than none at all. Most treatment plans for Asperger syndrome are individualised to the child's age, developmental stage, and particular set of strengths and weaknesses. Thus, assessment and treatment go hand-in-hand. Therapist seek to make full use of a child's strengths such as verbal cognitive ability while creating ways to compensate for weaknesses, such as poor social problem-solving skills. Features of successful programs include low teacher-to-student ratios, individualised and adaptive programs, intensive support, and family involvement.
Communicating with someone who has Asperger syndrome
Since it is one of the most common circumstances, we will describe communication between parents without Asperger's and a child with the syndrome. The parents of a child with Asperger syndrome may need to spend a great deal of time learning how their child communicates and adapting their own style of communication to have better, more meaningful interactions with their child. As the child proceeds through therapy, there may be opportunities to communicate in a more standard fashion. The following applies to children who have more or less untreated Asperger syndrome.
Initiating communication
One common complaint among parents of children with Asperger syndrome is that the child appears to ignore the parents’ verbal calls. This can be terribly frustrating since this exact behavior in a healthy child would be correctly interpreted as the child ignoring the parent. Therefore, it is important for parents to remember that the child with Asperger syndrome is not willfully ignoring, but is rather living in the world according to their abilities. While it is difficult, communication requires a great deal of patience. One effective adaptation is to always use the child's name at the start of conversation or even at the start of each sentence. While eye contact can sometimes be difficult to establish, make sure that you actually have the child's attention. Also, remember that children with Asperger syndrome can be very focused on what they are doing. You may be able to initiate conversation by participating in that activity as well.
Nonverbal and verbal communication
Most human conversation relies heavily on nonverbal communication, and people use these nonverbal cues intuitively. While they have strong verbal skills, people with Asperger syndrome usually find it difficult to read and interpret nonverbal cues. It is generally best to use short, concrete sentences and to refrain from asking too many questions at once. Do not expect that the child with Asperger syndrome will be able to understand that your furrowed brow indicates anger or that a wry smile means that you are joking. Be very deliberate and straightforward in your communication. It may take time for the child to process the information that you are sharing—avoid repeating yourself when possible and leave sufficient time for the child to respond to your communication. Also, make sure that the child understands. Simply because the child repeats what you said (echolalia) does not mean that he or she understood what you said.
The trap of open-ended questions; the trick of multiple-choice questions
For reasons that are not entirely clear, people with Asperger syndrome have particular difficulty with open-ended questions.
The motivated parent will present questions in a multiple-choice format. For example, if you want to find out what the child wants for lunch, provide a menu of options rather than simply asking him what he would like to eat. Interestingly, the choices that are selected for the multiple-choice question do not always have to include the right answer.
Simply presenting the child with several choices may be enough to prompt him or her to provide a spontaneous response.
Theory of mind and social interaction
People with Asperger's syndrome often have difficulty with what is called the theory of mind. They have difficulty understanding the thoughts or motivations of others. This is sometimes considered a lack of empathy, but it is not precisely so. Rather, it reflects an inability to understand the emotional state of others. Likewise, children may need to be taught how to perceive and respond to social cues and how to make and maintain friends. Communication can be improved by working with the child using “mind reading” instruction such as Carol Gray's Comic Strip Conversations. Expanding the child's ability to take turns in conversation and to be polite in social settings can facilitate conversation and communication.
Communication can be draining
People with Asperger syndrome may be able to overcome these deficits or create “workarounds.” These strategies must be learned and logically reasoned rather than intuitive. This additional processing can take a considerable amount of mental energy. In fact, people with Asperger syndrome may feel exhausted after relatively short periods of communication that is laden with nonverbal cues and social content. As such, conversations may need to be kept relatively short to avoid frustration in all parties involved.
Use strengths to improve communication
Some of the positive mental attributes often seen in people with Asperger's syndrome are above-average intelligence, a keen ability to memorise, and undivided attention on tasks that they find interesting. This generally means that people with Asperger's syndrome are highly motivated to learn (if taught in a manner that interests them), able to learn, and able to remember things that may not necessarily come to them intuitively. Energy that is devoted to teaching people with Asperger's how to communicate will pay dividends in the long run.
References
- Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics. Nov 2007;120(5):1162-1182.
- Woodbury-Smith MR, Volkmar FR. Asperger syndrome. Eur Child Adolesc Psychiatry. Jan 2009;18(1):2-11.
- Maglione MA, Gans D, Das L, Timbie J, Kasari C. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics. Nov 2012;130 Suppl 2:S169-178.
- Gray C. Comic Strip Conversations: Colorful, illustrated interactions with students with autism and related disorders. Arlington, TX: Furture Horizons. Inc; 1994.
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