Asperger’s Syndrome: Assessment and Intervention in the Mental Health Setting By Ariadne V. Schemm, MA Pediatric Psychology Intern Munroe-Meyer Institute.

Asperger’s Syndrome:Assessment and Intervention in the

Mental Health Setting

By Ariadne V. Schemm, MAPediatric Psychology Intern

Munroe-Meyer Institute for Genetics and Rehabilitation

University of Nebraska Medical Center

April 5, 2006

History of Asperger’s Syndrome

Hans Asperger and Leo Kanner first described similar forms of autism in the 1940’s

Asperger’s description differed from Kanner’s in that speech was less delayed, motor deficits were more common, the onset was later, and it appeared to be most prevalent in boys

Kanner’s work has defined recent views of autism, as a lack of responsiveness to other people and severe language impairments

There was growing concern that the diagnosis of Autism could no longer be given to children who had developed fluent speech and an interest in socializing with others. The term “Asperger’s Syndrome” was first used by Dr. Lorna Wing in 1981.

Current View

Asperger’s Syndrome is now considered to be a less severe form of autism and a Pervasive Developmental Disorder

The syndrome is also placed on the spectrum of autistic disorders and was recognized and provided with its own diagnostic criteria in 1994 in the DSM-IV

(Attwood, 2000)

Clinical Features

Lack of empathy and perspective-taking Naïve, inappropriate, one-sided

conversations Limited ability to form friendships Pedantic and repetitive speech Poor non-verbal communication Intense absorption in certain subjects (little

professor) Clumsy movements and odd postures

(Burgoine & Wing, 1983)

Asperger’s Syndrome 299.80

Qualitative impairment in social interaction (at least 2): Marked impairment in the use of

nonverbal behaviors Failure to develop peer relationships

appropriate to developmental level Lack of shared interest with others Lack of social or emotional reciprocity

Restricted repetitive and stereotyped patterns of behavior, interests, and activities (at least 2): Encompassing preoccupation with one

or more patterns of interest Inflexible adherence to rituals, routines,

and rules Repetitive motor movements Persistent occupation with object parts

Disturbance causes clinically significant impairment in social, occupational, or other areas of functioning

No clinically significant general delay in language, cognitive development, or adaptive behavior

Criteria are not met for other PDD or Schizophrenia

(APA, 2000)

What it’s not:

Children and adolescents with one of these characteristics do not meet the criteria for AS: Social akwardness or poor social skills Limited repertoire of interests Being described as a “weird kid”

These children fall between the criteria- “tweeners”

Statistics

Prevalence estimated at 20-25/10,000

More common in males

Genetics seem to play a larger role in AS than in autism

(Simon-Cohen, 2005)

Neurologically Based Disorder

Limited information on brain development differences in AS

In autism, absolute increases in the total brain volume, total CNS tissue, and lateral ventricular volume Especially in temporal/parietal/occipital

region Cerebrum

Decrease in neuronal size Increased cell packing density in the

limbic system

Differentiating Asperger’s Syndrome from Related Disorders

Autism

Rett’s Disorder

Asperger’s Syndrome

Childhood Disintegrative Disorder

Pervasive Developmental Disorder, NOS

Social Anxiety Fear/avoidance Child has capacity forof social situations age-appropriate

relationships; anxiety is situation specific

Mental Retardation Social & communication Impairments are impairments; quantitative rather repetitive behaviors than qualitative

Speech Disordered Delayed/Absent Social intact;language development socially motivated;

receptive language is higher

ADHD Impaired social Social quality betterfunctioning; easily distracted Distracted by anything

Behavior Disordered Inappropriate behavior Socially motivated; compared to peers; socially awareoppositional

Disorder Similarities Differences

Assessment Procedures

Initial Interview Rating Scales Observations Direct Interactions Environmental Assessment

Initial Interview

Developmental History (age onset, milestones, delays)

Medical History ( TBI, fragile X, ADHD, fetal alcohol)

Previous Evaluations (medical, psych, genetic, GI)

Presenting Concerns and Symptoms Severity of Symptoms (frequency, duration,

intensity)

Rating Scales

Gilliam Asperger’s Disorder Scale Easily completed by parents Items are confounded across domains Provides a nice interpretation guide Word of caution-norm group, over-identification

None are adequate to use independently in assessment

All are best used as screening devices

Consider having multiple raters across settings

Direct Observation

Interest is in observing behavior across the relevant domains

Interest is in observations not just of target child behavior but also of environment

Direct Observations

Child-teacher interactions (child behavior and teacher behavior)

Child-peer interactions (child behavior and peer behavior)

Child-parent interactions (child behavior and parent behavior)

Child-therapist interactions

Child-Therapist Interactions

Unstructured interview (school, home, friends, preferences)

Assessing perceptions of social norms (Dewey)

Perspective taking experiment (Frith)

Direct Interactions

Reinforcer Assessment

Successful intervention requires motivation to learn the skill

Generating motivation to learn requires functional reinforcers

Identifying functional reinforcers can be difficult

Function can change day-to-day and moment-to-moment

Assess the Environment

Do environments include demands that are within the capabilities of the child

Is there direct teaching of social interactions?

Is there limited social stimuli (noise, pace, crowd)

Collaboration between home and school

appropriate educational objectives

Look also for environments that: Use primarily positive motivation strategies

Prevent frequent errors and rely on prompting strategies

Identify functional reinforcers

Arrange consistency across settings and team members

Treatment and Intervention

Teach the acquisition of basic social interaction skills

Teach the acquisition of adaptive skills

Social Skill Training

Social skills will need to be taught in an explicit, scripted, and rote fashion

Skills taught may include: Appropriate nonverbal behavior Verbal decoding of other’s nonverbal

behaviors Social awareness and perspective-taking

skills(Klin & Volkmar,

1995)

Behavioral therapy vs. Psychotherapy

Individuals with AS have great difficulty with insight-oriented therapy

Standard problem-solving techniques are not effective as the socially appropriate response is not socially meaningful to a child with AS

More effective to script out appropriate reactions in problematic situations and practice.

Prognosis

Children with AS are more likely to become independently functioning adults than children with other forms of PDD

Adults with AS often gravitate to professions that mirror their own areas of special interest

They will continue to demonstrate difficulties in social interactions

It is estimated that 30-50% of adults with AS are never correctly diagnosed

(Bauer, 2006; Gillberg,

Resources

OASIS-Online Asperger Syndrome Information and Support

www.aspergersyndrome.org/ Autism Society of Nebraska

www.autismnebraska.org

Asperger’s Syndrome- Parent Support Group: Cindy Roden, 334-9594

or Celeste Montoya, 891-6166 Munroe-Meyer Institute, Psychology

Department: 559-6408

Questions and Comments?

References

Attwood, T. (2000). Asperger’s Syndrome. New York: Jessica Kingsley Publishers.

American Psychiatric Association (2000). DSM-IV-TR. Arlington, Virgina: American Psychiatric Association.

Baron-Cohen, S. (2000). Is Asperger’s Syndrome/ High-Functioning Autism necessarily a disability? Special Millenium Issue of Developmental and Psychopathology.

Burgoine, E. & Wing, L. (1983). Identical triplets with Asperger’s Syndrome. Journal of Child Psychology and Psychiatry, 21, 303-313.

Klin, A. & Volkmar, F. R. (1995). Asperger’s Syndrome: Guidelines for Assessment and Diagnosis. New Haven, Connecticut: Learning Disabilities Association of America.