Austrian pediatrician Hans Asperger first met his 6-year-old patient in 1939. “A highly unusual boy who shows a very severe impairment in social integration… and certain stereotypic movements and habits,” Asperger wrote. The content of the child’s speech was far beyond his years. And though he talked like an adult, he would seldom answer a question. Asperger’s observations, along with the parallel findings of Johns Hopkins’ pediatrician Leo Kanner, gave a name to what we now call autism spectrum disorders (ASD).
All forms of autism are points on that spectrum, meaning each child with ASD has a unique combination of needs. Asperger’s is sometimes referred to as “high-functioning” autism. Because vocabulary and speech fluency issues common in autism are less pronounced in the child with Asperger’s, he may appear “normal,” therefore he may never receive the sensory and social communication services critical to his overall success. As with any “invisible” disability, too many children with Asperger’s slip through these cracks. Some flags to watch for:
- Speech may seem normal or even advanced, but may encompass only limited complex topics (aerodynamics, music, meteorology) for which the child has encyclopedic knowledge.
- Social communication may be severely lacking: no eye contact, greetings, acknowledgment when spoken to, reciprocal conversation. Persons with Asperger’s are aware that social interaction is required of them but do not know how to accomplish it. They are not able to read facial expressions, body language or the emotions of others; they lack the skills to initiate and maintain conversation or play in situations. Inappropriate social responses, such as laughing when someone gets hurt, bring contempt and rebuke, which they truly do not understand. Speech therapy can help facilitate conversational skills and social conventions.
- AS children may lack a sense of danger. This is the child who runs into the street without looking, jumps from the top of the play structure. Constant supervision and clear visual boundaries are necessary (one Mom painted a stop sign at the end of the driveway). Instructions must be phrased in the positive rather than negative: “Wait on the sidewalk” rather than “Don’t run into the street.” Some ASD children will hear only the last verb in the sentence and nothing before it, so your direction “Don’t run!” becomes “Run!”Motor functions can be greatly affected by impairments to the vestibular and proprioceptive senses. Children with such difficulties may literally trip over their own feet, bounce off walls, fall out of chairs. These two lesser-known senses can be very difficult for parents and typical people to understand. And because they are incomprehensible, vestibular and proprioceptive problems may go unidentified and untreated, leaving the child with ASD to cope unaided with a critical part of his environment. In a nutshell:
- The vestibular system regulates the sense of equilibrium by responding to changes in the position of the eyes and head. Its “command center” is located in the inner ear. Vestibular disorder can cause symptoms ranging from dizziness/vertigo to imbalance and nausea (chronic “seasickness”). It can affect hearing, vision (stationary objects appear to be moving, printed material may appear blurry, displaced or in motion), energy level, cognitive function (difficulty with memory, inability to focus) and emotional health (anxiety, depression).
- The proprioceptive sense uses feedback from joints and muscles to tell us where our body is in space and what forces and pressures are acting upon it. Children with proprioceptive difficulties may walk with an odd, heavy gait, have difficulty managing tableware, lose their balance in the dark or when their eyes are closed. Some are “crashers,” forever running into or jumping off things as they seek deep pressure sensory input.
- When these two senses are disordered, navigating through daily life can be extremely challenging. An occupational therapist’s help in addressing vestibular and proprioceptive issues is crucial.
- Physical activity is important. But keep in mind that trying to learn more than one skill at a time may be overwhelming. Emphasize physical activity (motor skill) that doesn’t involve team expectations (social skill), excessive rule interpretation (cognitive skill). An adapted PE teacher will help modify curriculum and equipment so your child can participate with his peers in PE. Ask your school district’s special education motor team.
- The child may exhibit repetitive, self-stimulating behaviors such as hand flapping or collar chewing. These “stims” fill a sensory need; merely interrupting the behavior doesn’t eliminate the need. Help the child find suitable alternatives. For instance, collar chewers and nail biters are seeking calming oral input. Place a piece of rubber tubing on the end of his pencil, let him chew several sticks of gum during stressful parts of the day, keep a water bottle on his desk. A squeeze ball, beanbag or similar fidget toy can provide calming tactile input to a hand flapper or cuticle picker. Consult an occupational therapist for suggestions.
Forms of autism, Asperger’s and other variations on typical neurological development have always been with us. Armed with contemporary knowledge, we can look back in time and see that many remarkable people whose characteristics might suggest Asperger’s have shaped the way we live today: Einstein, Mozart, Edison, Thomas Jefferson. Genius does not lurk within every child on the autism spectrum, but it is our job to open the doors to learning in a manner that makes sense to them so that the extraordinary gift of independent living can be theirs, and so that the gifts that are in fact locked within each one of them can flow back to us.