As most teens and adults with Asperger syndrome know, people with Asperger syndrome can be significantly depressed. The rates of diagnoses of depression vary among studies, from 18% to 22%. The most commonly quoted rate of a depression in the general population of the US  is 6.7%. Most of the research shows both genders have these high rates of depression.

Studies focused on males and females and not those who are transgender. There are more people who identify as transgender in the AS population than in the general population and transgender people have a higher rate of depression. One would guess that someone who is both AS and transgender might have a high tendency towards depression.

Interestingly, non-autistic full siblings and half-siblings of individuals with ASD (not just Asperger syndrome) also had higher rates of depression than the general population, although at half the rate of those with ASD. Studies of suicide attempts are also very troubling. In studies of suicide, the rate of suicidal thoughts and attempts are prevalent, especially in adolescence and young adulthood.

It’s critical to identify depression, since it can be treated.

It’s obviously important to understand why rates of depression and suicidal thoughts are so high. One factor, given the findings in siblings, is that there is an increased genetic vulnerability to depression, although large studies haven’t supported a common genetic overlap. We have to look to other factors to account for these high rates of depression.

It’s important to diagnose clinical depression for anyone for a simple reason – depression is treatable with a variety of modalities:

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Your child may not know how to use language appropriately in social situations. This undeveloped social skill can cause your child to unintentionally say harmful or rude comments to others. Even when able to say words clearly in complex sentences with correct grammar, a child still may have a communication problem – if they have not mastered the rules for social language known as pragmatics.

Speaking head

Pragmatics includes three major communication skills:

  1. Using language for different purposes

    • greeting (e.g., Hello, goodnight)
    • informing (e.g., I’m going to go to bed now.)
    • demanding (e.g., Turn out the lights, please.)
    • promising (e.g., I’m going to wake up early and make waffles.)
    • requesting (e.g., I would like an extra blanket.)

  2. Changing language according to the needs of a listener or situation

    • speaking differently to a toddler than to an adult, or with a sibling vs. a teacher
    • sharing background information with an unfamiliar listener
    • speaking differently in a movie theater than on a playground

  3. Following rules for conversations

    • turn taking
    • introducing a topic of conversation
    • staying on topic
    • rephrasing when misunderstood
    • using verbal and nonverbal signals
    • knowing how closely to stand to others
    • using appropriate facial expressions and eye contact

Remember: It is important to understand the rules of your communicative situation.

An individual with pragmatic problems may:

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Our bodies take in information from the world around us through our sensory systems. As this information comes in, our brain filters and processes it for use. This process, called “sensory processing”, all happens automatically and simultaneously without us realizing that it.Depositphotos_37852017_sWhen all of these systems work correctly, we are able to perform our daily activities smoothly and without a problem. When these systems don’t work as well as they should a person may be disorganized, clumsy, have attention difficulties, and become over responsive or under responsive. Individuals with this issue might just have trouble functioning day to day as well as they should.

This is called Sensory Processing Disorder (SPD).

Sensory Processing Disorder can be seen in typically developing children and adults at an estimated rate of 15%. But individuals with autism and Aspergers are far more likely to be affected. It is estimated that 80% of children with ASD have sensory processing difficulties.

Some signs of SPD include:

  • Oversensitive to touch, sound, smell, lights and other visual input
  • Distractibility
  • Clumsiness
  • Decreased play skills
  • Resistance to being touched by others
  • Picky about clothing textures and tags
  • Toe walking and/or hand flapping
  • Picky eating

If you would like to learn more about SPD, visit the SPD Foundation website. If you know your child has sensory issues, you can also find a SIPT Certified Therapists in your area.  

Do you see some of these sign in your child?  How do you handle the difficulties that arise from them? 

By Gayla A. Aguilar, OTR, OTD

Sources

Ayres, A. J. (1972). Sensory integration and learning disorders.  Los Angeles: Western Psychological Services

Tomchek, S.D., Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. American Journal of Occupational Therapy, 61, 190-200

Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face. Feeding issues are especially common in children with autism, including those with Aspergers, because of difficulties with sensory processing. In many cases, this leads to eating challenges at mealtimes.

Little girl eating

“Food chaining,” from the book by the same name, is based on the child’s natural preferences and successful eating experiences—specifically the idea that we eat what we like. Food chaining introduces new foods that have the same flavors or sensory features as foods that are already preferred by the child, increasing the likelihood that the child will like the food.

A food chain consists of four levels that build upon one another. By following the levels of the food chain, the child will be able to build upon success with small changes.

For example, if your child’s accepted food is chicken nuggets, a sample food chain might look like this:

Level I Level II Level III Level IV
Maintain & Expand Current Taste & Texture Vary Taste & Maintain Texture Maintain Taste & Vary Texture Vary Taste & Texture
Other brands and sizes of chicken nuggets (i.e., strips/popcorn/bites, both fast food & home-prepared); fried chicken patties cut into pieces (fast food & home prepared) Different flavored chicken nuggets (barbeque, honey mustard, hickory smoked, etc.) Use sauces/dips to vary tastes. Chicken strips (not breaded); chicken leg/drumstick; chicken breast; ground chicken patties Breaded seafood (scallops, shrimp); breaded fish (fast food & home-prepared); breaded turkey breast; breaded vegetables; breaded baked chicken; crusted/breaded pork tenderloin; ground meats

Here are some other food chaining tips:

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Fidgeting is a common result of excess energy in children and can interfere with positive behaviors. Excess energy and fidgeting can be distracting and disrupt learning. According to an article on Autism Speaks, by Geraldine Dawson and Michael Rosanoff, “Increased aerobic exercise can significantly decrease the frequency of negative, self-stimulating behaviors that are common among individuals with autism, while not decreasing other positive behaviors.” Exercise is a positive outlet for children exhibiting these behaviors.

Physical activity will release some of this energy and in turn, promote positive behavior. Lack of time is a common barrier to fitness with therapy sessions, school, and doctor visits. To help facilitate this we have come up with some ideas for fun exercising regardless of a busy schedule. We have provided different options based on various children’s interests, in order to keep them fully engaged, as well as different variations depending on the level of comprehension in each child.

For those children interested in sports, you can set up “routes” or “bases” with cones for the children to run around.

At the end of each course, you can leave a football, baseball, or soccer ball for them to throw or kick to you. If your child comprehends and reads numbers well, you can label each cone and call out which number for them to run to.

Otherwise, you can use flashcards to label each cone, and you can hold up the matching card that you want them to run to. This will add some cognitive thinking to the exercise. Have them run these routes for about 30 minutes or until you feel they have released all their excess energy.

Especially in the summertime, some children might enjoy water sports or games. Water gun tag is an easy way to get the children involved in playtime outside to shed some energy. You can utilize a similar labeling system as the sport ideas mentioned above, but feel free to switch it up a bit and use some pool noodles or other water toys for them to run to.

You can incorporate colors to help the children engage in their visual senses. Motivate the kids to run to the next cone or noodle so they can get a nice and refreshing spray of water or spray you and any siblings with water. Again, play for around 30 minutes or until fatigued.

For children who enjoy a challenge, you can set up a fun obstacle course for them to run through.

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The summer of 2017 Aspergers101 hosted a free informational series on Aspergers at the San Antonio Public Library. We have recorded each of these valuable sessions in video and powerpoint format so that you can have access to them at any time. Below, watch the first workshop from our Informational Summer Series on Aspergers focusing on diagnosis in childhood. First, Jennifer and Sam Allen discuss the initial steps of recognizing signs of Autism in a child and seeking a diagnosis. Next, Berenice de la Cruz, Ph.D., BCBA-D and COO of Autism Community Network, gives details on the diagnosis process and the medical terminology behind Autism and Aspergers.

The following checklist for Autism and Asperger behavioral signs comes from Jennifer and Sam’s powerpoint. This checklist is not meant to be used as a professional or standalone diagnosis, but rather as a helpful guide that can support you in your journey of diagnosis for your child.

Informal Childhood Developmental Checklist

Social Interactions

 The child prefers to play alone

 The child is rarely invited by others to play in the neighborhood or to participate in activities outside of school

 The child’s social interactions and responses are immature, not keeping with his/her age or his/her cognitive abilities in other areas

 The child has difficulty interacting in group settings

 The child does not play with other children as expected: he/she may not appear interested in their games, or may not know how to join in

 The child appears to be vulnerable to teasing, bullying and being taken advantage of by others

Behavioral Observations

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Once a child is becomes more competent in his or her ability to think multi-causally, the next focus of higher level social-emotional thinking is the capacity to understand the gray areas of life. Adolescents and young adults with Aspergers or HFA are especially prone to hitting an emotional rut when speaking in terms of “never” and “always”—hallmark terms associated with “black and white” thinking.

IMG_0365

“He never calls on me during class” or “She always gets to play the game first” are common phrases that parents or peers hear when the speaker’s ability to think and feel in more varied degrees is constricted. Not only is this harder to negotiate socially for the partner, but it’s not a very fun state for the black and white thinker either. Such polarized patterns of thinking can lead to social isolation brought on by the extremity of the speaker’s emotional response.

Getting unstuck can be supported through Floortime, where the parent or the therapist can spotlight the child or adolescent’s black and white ideation.

For example, Jason is a young teen with Aspergers who states that he never gets to play his media after school. Jason becomes agitated when discussing this with his mother and his therapist, flooded by feelings of anger and sadness that he has difficulty modulating.

The role of Floortime therapist or supported parent in this dynamic might be to:

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Many children with sensory processing disorder or related issues can have difficulties in the school setting. Problems can arise anywhere: in the classroom, cafeteria, gymnasium, hallway, playground, and even the bus. Some of these issues can be as subtle as not eating lunch, or as difficult as destroying a classroom.

Knowing what causes these problems and how to prevent them is important for both the school and the child. This is where parents can be the best advocate for their child with Aspergers or HFA and sensory issues.

Preparing a child for school is important, but it is equally important to prepare the school for the child.

Sharing their sensory concerns with the teachers, para-professionals, principals, and others is imperative to limiting sensory difficulties in the classroom.

A typical plan should include setting up a sensory-friendly classroom with a place for the student to “get away” if necessary, providing sensory activities throughout the day to help prevent problems that may arise, catering to sensory diets, and preparing the student for changes or surprises that may come up.

A school occupational therapist can help make all of this easier, if they get involved. The occupational therapist can help teachers discover problem areas and learning differences, while providing suggestions to improve success.  Some ideas they may implement include setting up lunch bunches to relieve lunchtime stresses, providing sensory activities to use throughout the day that support the student’s ongoing needs, or modifying instruction for classroom success.

Together, the parents, teachers, and occupational therapists can develop a program that is individualized for the student with sensory issues and make this year both successful and rewarding.

For more information on sensory friendly classrooms and teacher resources, go to Future Horizons Inc. There are multiple books and other resources to help the teacher prepare for these students.

by Dr. Gayla A. Aguilar, OTR, OTD

One of the hallmarks of Asperger’s Syndrome (AS) is that individuals often have strong points of view, and they have trouble seeing other points of view as equally valid. Most see themselves as extremely logical and therefore right in their conclusions; for them, the points of view of others can seem illogical. This is often perceived by neurotypicals as being oppositional, stubborn or lacking empathy.

Brain hemispheres sketch

What’s interesting is that often when people think they’re being logical, research shows that their emotions can be driving their cognition. Emotions are frequently substantial influences in people’s thinking without their knowing it. In his eloquent writing for LinkedIn, Kristopher Jones makes clear what is my experience as well:

People with AS can have very strong feelings.

Peter Salovey and Marc Beckett of the Center for Emotional Intelligence at Yale University www.ei.yale.edu have done compelling research on the topic of feelings influencing thinking. In one study by Brackett and his colleagues on the influence of teacher emotion on grading practices, they took a large sample of middle school teachers. Using techniques demonstrated to be effective to induce a positive or negative frame of mind, they had half the teachers influenced to be positive and half to be negative. All were given the identical essay to grade. The scores given by the two groups differed by 1 to 2 grades, yet all of them were certain that mood had nothing to do with their scoring.

Why is this significant for people with AS?

The Dialectical Behavior Therapy model of cognition suggests that we all have a logical mind and an emotional mind.

It’s where these two overlap (are integrated) that genuinely “wise” thinking can get done. Otherwise, we’re unaware (like the teachers) of the extent to which emotion that hasn’t been acknowledged is dictating what seems to be logical thinking. Most AS/NLD individuals I know operate out of one kind of mind or the other, but fail to meaningfully integrate the two.

I worked with a young man who was very reactive to what he perceived as criticism. A person who criticized him at a temporary job became someone he never wanted to see again; in fact, the entire setting became somewhere to be avoided.

He felt this was logical – you don’t go where you are treated badly.

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When a child with Aspergers or High-Functioning Autism demonstrates challenging behaviors, we tend to blame the child’s autism. However, these challenging behaviors are not a byproduct of autism, rather learned due to ineffective means to get needs met—especially when there are barriers to communication.

functions of behavior

Bottom line: if an individual does not have a way to communicate appropriately, he or she will find a way to communicate in another way (e.g. screaming or hitting).

Keeping in mind the ABCs of behavior from our previous post, let’s discuss the key to changing behavior.

Behavior is changed when we know the function—or purpose—of the behavior.

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Challenging Behaviors and Appropriate Skills in ABA

As I mentioned in my previous blog, there are thousands of published research studies to support the effectiveness of ABA in treating autism and Aspergers. Specifically, ABA seeks to decrease challenging behaviors and increase appropriate skills that are seen in many individuals with autism or Aspergers.

Challenging Behaviors and Appropriate Skills in ABA

To help understand what your ABA therapist seeks to accomplish, let’s cover what these terms mean:

Challenging Behaviors

Challenging behaviors refer to those behaviors that put the individual in danger, put others around them in danger, or prohibit/limit a person’s use and access to community facilities (Emerson et al., 1987).

Let’s say a 12-year old with high functioning autism, “Jake,” told his overweight teacher that she is fat. The teacher, who was very insulted by the comment and the conversation that followed, sent him to the principal’s office for bad behavior.

From Jake’s perspective, he didn’t understand why he was in trouble for telling the truth. If Jake engages in these types of behaviors regularly, he may soon be unable to access his general education classroom.

As such, this behavior is considered a challenging one that an ABA therapist can help address.

Appropriate Skills

On the other hand, appropriate skills refer to skills that a person needs to be successful. Those skills take into account the person’s chronological age and their cognitive level of functioning.

Appropriate skills include the following:Continue Reading

We are all vulnerable to black and white thinking during times of emotional distress: “He NEVER appreciates the sacrifices I make!” or “She ALWAYS chooses work over time with me!”

Children and young adults with Aspergers are no different—except they may be more vulnerable to polarized thinking. These emotional regulation difficulties stem from differences deep within their brains, along with other extraordinary gifts such as strong attention skills or heightened visual and auditory detail.

The cost of this gift may appear as limitations in the ability to see the big picture and the social nuance (or gray areas) of a situation. This means that many Aspies are susceptible to assessing daily bumps on the road of life as fixed, rather than flexible.

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