The Social, Behavioural, and Academic Experiences of Children with Asperger Syndrome

By Church, C.,Alisanski, S., and Amanullah, S. (2000) Focus on Autism and other Developmental Disabilities, Vol. 15, No. 1, pp 12-20.

Very little information is available that describes the social, academic, and behavioural experiences of children with Asperger syndrome. This article describes those experiences in 40 children with Asperger syndrome between the ages of 3 and 15 years. The study illustrates both the variability and consistency of the characteristics of this disorder over time and during specific developmental stages. The results indicate that social skill deficits were variable but remained the greatest challenge of these intellectually bright and verbal children.

A retrospective chart review was conducted for this descriptive study of children diagnosed with AS at a university medical center child development program between the years of 1986 and 1998.

Of the sample, 67% experienced auditory sensitivities, 62% tactile sensitivities, and 73% were described as clumsy.

Results - Preschoolers
As preschoolers, the children in this study stood out from their peers as uniquely different, but often not different enough to come to the attention of primary care providers as needing comprehensive assessment.

Many children had difficulty separating from their mothers and were described as “slow to warm”.

Many children misread social situations and failed to read the social cues of teachers and other children. As a result, they were inappropriately silly (75%), loud (62%), aggressive (50%), or completely withdrawn (15%).

Preschoolers had a strong need for routine and little rituals. When routines were broken, tantrums often appeared.

Transitions were difficult for most children and required creative strategies by their parents for them to go smoothly.

A majority of the children had an uncanny ability to memorize videotapes and act them out exactly. Animated Disney movies were a particular favourite.

Of the preschoolers, 67% had sensory issues that were dramatic and included hypersensitivity, hyposensitivity, or mixed thresholds. Some children required considerable stimulation to get aroused, whereas other children were completely overwhelmed by noises and certain textures. Many had issues relating to oral defensiveness. Parents described their children as hating to have their hair washed or combed, hating the feel of fingerpaint of shaving cream, and becoming very anxious if their hands got dirty. Auditory sensitivities to vacuum cleaners, blenders, food processors, singing, or their parents; raised voices (even though they may frequently scream) were also reported.

The majority of children could recite the alphabet and count well before their peers. Many were early readers. Ninety percent of the children were felt to have language pragmatic problems.

Elementary School Years
Data were available for 39 children in this age group (ages 6 to 11 years). Parents, teachers, and physicians recognised serious developmental problems, although only 25 of the 39 children (64%) were formally diagnosed with AS by the end of this age period. By the time the diagnosis off AS was made, 92% had carried other diagnoses or educational labels given by school psychologists, primary care physicians, psychologists, or psychiatrists. The most frequent diagnosis or educational label was attention-deficit/hyperactivity disorder (ADHD) (20%), followed by “other health impaired” (15%), autism (15%), learning disabilities (12%), and emotional disturbance (10%).

The children fell into two distinct patterns of interaction. Either they were quiet, unassuming, and very low demand, or they were exuberant, active, and violated social boundaries, adopting and “in your face” style of interacting.

Two children were described as having a very specific sense of right and wrong and were upset with other children if their sense was violated.

By mid-elementary school, many of the obvious stereotyped and repetitive behaviours, such as hand flapping or spinning, had disappeared, except for times of very high anxiety or frustration. “Self-talk”, humming, drumming, and pacing were common. There continued to be a need for routine and ritual. The children were very rule based and became very upset when rules were violated. This was particularly true for playing board games with other children. There was no tolerance for made-up rules or cheating.

During these early school-age years, the need for sameness or specific order, as well as some obsessive-compulsive behaviours, appeared.

For older school-age children, these long monologues on topics of their choosing and perseverations on the same topics day after day tended to put off other children and further impede social relationships. The children with AS never understood their own contribution to this dynamic relationship and, therefore, did not adjust the interaction.

During the elementary school years, the children continued to have a variety of sensory integration problems, but by the end of this period many of the problems had nearly resolved.

Auditory sensitivities appeared to remain over the course of this time period but improved over time. Several children had considerable difficulty with noise in the cafeteria of the auditorium.

A theme that had not been discussed by parents or teachers for the younger children but was well represented in the elementary age group was motor clumsiness. More than half of the group had histories of being klutzy, clumsy or awkward.

At this age, 96% of the children received speech-language therapy to address pragmatic and prosody issues,; 58% received occupational therapy to address fine motor issues such as poor grasp, handwriting, scissor manipulation, or utensil use; and 33% received physical therapy services to address large motor movements such as bike riding and safety issues such as climbing. Only 6 of the 26 children (23%) in this age group were receiving any type of formal, social skill building curriculum, even though social skill goals were on every child’s individualised education program regardless of his or her academic label.

Handwriting was an exceptionally difficult task for most of the children, several of whom were assigned aides to scribe for them. Several children were very slow and meticulous workers, obsessive about every single detail. A few teachers reported that the students would erase their work so many times, trying to make it perfect, that they left hole in their papers.

Middle School Years
Data for 13 children were considered for this subgroup. Of the children at this age, 38% had a secondary diagnosis of a behaviour disorder (oppositional defiant disorder, conduct disorder) or were considered by their parents as defiant, non-compliant, manipulative, or difficult.

Most parents reported that their children were emotionally more labile than typical peers. Three had explosive tempers.

Parents of middle school-age children reported dramatic improvements in social abilities but also reported that lack of social skills was the area of great weakness.

Some of the early teens had a wonderful sense of humour. They delighted in slapstick and were good at making silly, simple puns.

About one third of the children were described as passive and would go without, rather than ask anyone for anything. In school, these more passive children would not ask for clarification during lessons or ask for help when information was not understood.

Thirty percent of this group still had some tactile or auditory sensitivities at this age, but not nearly to the degree as when they were younger.

All students at this level did very well with factual knowledge, but had more difficulty with abstract concepts. Teachers and parents felt that one of the biggest school challenges, aside from social difficulties, was finding ways to motivate these students to be interested in anything outside of their particular areas of interest. Several of the children saw no value whatsoever in completing homework or projects.

High School
Five boys were followed from middle school through high school.

Social skill difficulties were rated by the parents as the clearest and most challenging problems facing these young men.

Three of these teenagers were described as oppositional, defiant, or belligerent.

On the other hand, all five boys were also noted to have a wonderful, offbeat sense of humour. The boys enjoyed creating silly puns.

Each of the boys in high school had at least one friend of the same age and gender. Usually the friendship was based on common interest, such as love of computer games, and was more superficial in nature than the relationships of other classmates.

In general, these teenagers were rigid thinkers.

During the high school years, obsessive-compulsive behaviours were reported frequently by parents. The obsession over a particular girl was just one dramatic example.

Two of the boys were very good at creative fictional writing. All five boys found writing to be physically challenging. Three of the five used laptop computers almost exclusively for completing assignments.

As children with AS matured, most desperately wanted to fit in with their peer group but lacked the skills and social knowledge to do it. These intellectually gifted children were frequently able to learn many of the social skills necessary to be at least partially successful in their day-to-day interpersonal relationships. This learning, however, took considerable effort on the part of the child and the parent.