Characteristics of Asperger Syndrome - Part 3 Page 1



Characteristics of Asperger SyndromePart 3 - Secondary Characteristics Sensory System Differences, Anxiety, Motor Skill Impairment, & Theory of MindPresentation Hello. This is a training by the Virginia Autism Resource Center. We are going to move to the secondary characteristics associated with Asperger Syndrome and we are going to talk about five different areas. The secondary characteristics we are going to discuss include anxiety, executive functioning, theory of mind, motor, and sensory system differences. We're going to start first with sensory system differences. Now, we all have a sensory system that we utilize, that function, and helps us to get through our days. This system helps us to maneuver through our environments, it helps us to learn and to process. Now, certainly one of the pieces of our sensory system is enjoyment. We get great pleasure from our sensory systems. We may eat a delicious piece of chocolate cake and get great pleasure from eating something very tasty. We may smell chocolate chip cookies baking in the oven and get great pleasure from smelling something really good. We may see the sunrise over the ocean and that's really beautiful. So we get a tremendous amount of pleasure from our sensory systems. Essentially, our primary goal for our sensory systems is to survive. It's a protection mechanism and our sensory system operates on what's called a “fight, flight or fright” response. When there is different stimulation we encounter, whatever that might be, we might break into what's called the fight, flight or fright response based on the level of fear or excitement we sense from that stimulation. Over time, we find our sensory system modulates. In other words, as young children, we were more likely to be aroused by some sort of sensory stimulation –perhaps something happens – perhaps there was a big bang or a clap of thunder or something that scared us. Our fight, flight or fright response would kick in very quickly and we might scream, or we might cry, or we might drop to the floor and be really upset and unsure of what was happening. But as we get older our systems adjust to that. We learn what those noises are a normal part of our environment and we are not so easily disturbed by them. We learn that not all loud noises are bad and we start to modulate over time. Now, for the individual with Asperger Syndrome this fight, flight or fright response doesn't modulate as well and so it's much easier for their sensory systems to become over stimulated. This fight, flight or fright response may occur more frequently than it does in those considered to be typically developing. So let's think about this for a second. In my sensory system, if I hear a clap of thunder I might get startled and I might jump, but I'm not going to run away. If that was to occur for an individual with Asperger Syndrome they might actually break into flight and might actually run away from the room thinking, “Oh goodness, something is falling from the ceiling. What's going on?” I see this with some of my children with whom I work in early elementary school where they get over stimulated at school and their initial response is to leave the room. They get upset, they start to cry and they immediately leave the room. Characteristics of Asperger Syndrome - Part 3 Page 1 They break into this flight response. So, again what we find with individuals with Asperger Syndrome is that their sensory systems do not modulate as well and are overly sensitive resulting in more opportunities for fight, flight or fright. Now, what I also want to mention is that our sensory system also governs our level of alertness. So based on the stimulation that we're receiving, we might be very alert or we might be very flat or very calm. So if I go to a Redskins football game and the Redskins are actually winning, the crowd is excited, there's cheering, and there's the smell of hot dogs, my sensory system is experiencing a lot of stimulation that's going to create more alertness. However, if I'm sitting at home and I have the lights down and I'm reading a book and it's quiet in the house, that's going to create a state of calmness. There's not a lot of stimulation to my sensory system so I calm. That's part of our modulating process as well. So, our sensory system works to provide enjoyment but it also works to protect us and it certainly helps us to maintain the appropriate level of alertness based on our surroundings and based on our context. Now, let's talk about the different types of sensory systems. There are five which are common that we all know about. Visual - we have eyes for seeing. Auditory - ears for hearing. Gustatory - a mouth for tasting. Smelling – a nose for smelling. We have our fingers and our skin and other receptors for touching. Now, there are two additional types of sensory systems that I want to talk about and that I want to briefly discuss. The first one is the vestibular system. The vestibular system is all about movement. It's about our movement through space. Think about your inner ear and we know that our inner ear is responsible for balance. This is our vestibular system at work. It helps us know which way we're moving - what direction, how fast, and helps us with our balance. This is a very important system for us. If we were to swing or go down a slide, our vestibular system is at play to help us. It keeps us from getting sick or too dizzy. if we are to spin in circles, it helps us to remain upright. That's our vestibular system. If we were to go down the hill really fast on a roller coaster our vestibular system is at play there. The next system I want to talk about is the proprioceptive system and this is looking at pressure. How does gravity impact us? Now, if I had a light blanket across my lap, I might feel a little bit of pressure. However, if I was to take something very heavy, like a weight or a rock and put it on my lap, that would give me a different type of pressure altogether. It's the same thing that if I have on a light sweater versus if I put on a heavy wool coat. It's a different type of pressure on my body. This is our proprioceptive system - pressure on our body. How gravity impacts us. We can think about this in a couple of different ways. Let’s look at how we use it on a day-to-day basis. We use this for our gross motor and our fine motor movements and manipulation. Let me give you a couple of examples of gross motor. As we're moving through space, as we're moving through environments, we can get feedback from the ground on our feet. Based on the amount of pressure I receive from the ground, I can adjust my steps accordingly. if I was to get up in the middle of the night to go get a drink of water and I accidentally walked into a chair, that would give me some direct pressure on my leg to say, "Hmmm, don't go that way. Change your route and move around. Go in some other direction". So proprioception helps us with our gross motor movements. It also helps us with our fine motor movements. I have a pencil in my hand right now. This pencil is giving me feedback on my fingers and pressure so that I know exactly how hard to squeeze it to keep it in my hands so that I don't squeeze it too tightly and so that I Characteristics of Asperger Syndrome - Part 3 Page 2 don't drop it. That is proprioception. If I was to reach inside a bag and look for my lip gloss, I could feel it on the receptors on my fingers. I would receive pressure in order to discriminate lip gloss versus a quarter, versus a pen, versus my phone. I would know this through my proprioceptive system. Now what we find with individuals who have Asperger Syndrome is that there may be many different sensory system differences. So as we look at our seven different sensory systems, individuals with Asperger Syndrome may have a varying pattern of either hypersensitivities or hyposensitivities to different stimulation. So what that means is that they may be really sensitive to sensory stimulation that you and I might find to be non-bothersome or they may be under responsive to sensory stimulation that you and I might find disturbing. So for example, if we were to look at touch, someone with AS may not like to be touched. Touch may actually be really uncomfortable or may even hurt. That is someone who is over sensitive to the sensation of touch. On the other hand, you may have someone who's walking through a crowd and bumps into people frequently and doesn't really respond to the fact that they just hit someone's shoulder and bumped into a chair and just keeps walking without really moving around it, or without saying excuse me to the person. That would be an example of being under responsive. They really didn't have the same sort of sensory response that you and I might have to that same feeling of touch. Let’s look at hearing as an example. There might be sounds that the individual can hear that you and I can't hear. I know a couple of children who can hear a train coming from miles away and they'll say, “Train! There's a train coming!” I'll look at them very puzzled and then about three minutes later I hear the train. It's just astounding. There’s a number of lights in this room – a lot of florescent lights. What we know about many florescent lights is they make this little dull buzzing sound. Some individuals with Asperger who are extra sensitive to sound may hear that buzzing sound and may be greatly disturbed by it. Contrasting that on the other end of this, we may have individuals who are under sensitive to sound and so there might be a loud clap or a big bang and they may act as if they never even heard it because honestly, they really didn't. Often, for individuals on spectrum, I hear parent report that they first thought their child was deaf because of a lack of responding to different sounds. Of course, when the hearing tests are completed, their hearing is just fine but it's this under sensitivity to sound that is resulting in a lack of responding. The sensory differences can impact the individual with Asperger Syndrome in a variety of different ways. As I mentioned, it's there for our protection. So certainly, if you are under sensitive or over sensitive to sensory stimulation, your protection mechanisms are not going to be well refined and are not going to help you as they should - as thoroughly as they should. Also, the sensory system is not going to modulate as well as we want it to. I'll give you a couple of examples of this. I was working just yesterday with a kindergartener who has Asperger Syndrome. His educational team members were talking about lunch and how after lunch he is energized. He is very energetic and is bouncing off the walls and is unable to focus. He can't come in to sit down in circle time with the rest of the kids and he is just talks nonstop. He’s like the little Tasmanian Devil - just all over the place. This was a real concern for the educational team. And as we got to thinking about lunch, it made perfectly good sense. This is a little guy who definitely has a very sensitive sensory system and the stimulation that he received at lunch, the movement, the noise - if you think about all the people moving around in a lunch cafeteria, there's a lot of visual stimulation. Certainly, the Characteristics of Asperger Syndrome - Part 3 Page 3 auditory piece and then the smells all the way from peanut butter to peas, to pizza to French fries, to cake - whatever it might be. There are all these different smells. If you think about a school cafeteria, it's just a disaster when it comes to the amount of sensory stimulation a person would receive. This was a little guy that once he was done with 20 minutes of intensive sensory stimulation to every single system he has, was really having a difficult time modulating. Now the other kindergartners for the most part, can modulate, can regulate, and can come back down and then focus again and attend for the rest of the day. He was unable to do that without some sort of outside assistance to help his system to modulate in those situations. Also, the sensory input can impact social and emotional responsiveness. Think about a situation where your sensory system is stressed. I can think of couple of my own personal examples. There's a restaurant here in town that has the worst acoustics. It's actually a new restaurant. I've tried it a couple of times and they seem to have nothing on the walls and no carpet on the floors to buffer the sound, so when you go in there, you can hardly hear the waitress or the person across from you. I actually will not go back to the restaurant because my sensory system is so out of whack when I go in there. I'm so disturbed and so stressed. I think about this. The last time I was there, I was with a group of four other individuals and because it was so loud, we essentially sat in silence during the meal because we finally just gave up on trying to yell to each other during the course of the meal. I equate this to an individual with Asperger Syndrome. If your sensory system is so stressed and so fragile, then your ability to socially and emotionally respond appropriately is definitely very impacted. So the sensory piece can have a tremendous impact on the individual with Asperger Syndrome and is something that we have to really take into account for the safety of the individual, for the attending ability of the individual and also for the social and emotional component of the individual. In one account of an adult that I know, her statement to me was I used to get really stressed during social situations. She described receiving a lot of visual stimulation because a communication partner is using their hands, their using their eyes, their using their language and this was over stimulating. She would immediately say, “I've got to get out of here!” Her sensory system would just quickly, through a social exchange , became very, very fragile, very over stressed and her response was that fight, flight or fright response, I've got to get out of here and so she would quickly go darting away from the social situation. She soon learned that this was not the appropriate way to respond so she eventually learned to say, "Excuse me," and would excuse herself instead of darting immediately away from the situation. This provides us with another example of how the sensory piece can greatly impact the individual. Next, we have anxiety. Another secondary characteristic is anxiety. Individuals with Asperger Syndrome certainly are likely to have increased anxiety for a number of different reasons. First of all, there's performance-related anxiety. If we think about all these different components and all these different characteristics of Asperger Syndrome that we've discussed, the individual has difficulty with social interactions and so the stress over performing creates anxiety. Also, there may be a need for sameness, or a need for routine. This may lead to a tendency for perfection. These are also individuals who are very detail-oriented and this leads to a lot of anxiety regarding performance. I know individuals who have difficulty with handwriting because of some of the motor components involved in handwriting, but there is an additional factor that creates difficulty because the individual wants to form every letter so perfectly that it really creates this tremendous amount of anxiety. So at school when it's time to write something, it takes them three times longer because they're erasing and rewriting letters over and over Characteristics of Asperger Syndrome - Part 3 Page 4 again. This performance-related anxiety really kicks in. Now for me, if I try to write every one of my letters correctly, I would be here all day because my handwriting is atrocious, and I think that's probably the case for most of us nowadays. We've learned to cut corners on hand writing. For the individual with Asperger Syndrome, this is not so true. The perfectionism, that need to get it right, that need to do be exact will kick in. Next, we have control-related anxiety. So as we've mentioned with other characteristics, the individual really wants to have a great deal of control over their environment, over their environment, over the people with whom they interact, over conversations they have. As you know, we don't have ultimate control over everything and everyone. There are a lot of things that we can't control and certainly a lot of things are just simply unexpected and we can't plan appropriately. This inability to control things and this need for control certainly creates a great deal of anxiety. Sensory-related anxiety is next. I just discussed in detail the impact of sensory atypicalities. You can imagine how this might lead to anxiety. Imagine, if you will, being at school. During school, you have to do a fire alarm every single week for the first month of school. This is awful for our little guys and girls with Asperger Syndrome because without forewarning, they are surprised every week at school by this atrocious sound - this mass chaos to get out of the building - this visual stimulation. Knowing that I might have something offensive happen in relation to my sensory system can create a great deal of anxiety. Next, we have social-related anxiety. Go back to what Dr. Schall was talking about in her portion of the training and for these individuals who want to interact, who want to have social relationships, who want to have friendships and intimate relationships. There’s a tremendous amount of anxiety that surrounds this difficulty and these challenges. This is something really important for us as practitioners, as professionals, as parents, as siblings, as family members to keep in mind. This is typically a group who wants to have social relationships but simply do not have the skills to foster those relationships. And this social element can create a tremendous amount of anxiety. Well, how do I get friends? Why doesn't he like me? Why won't he be my friend? Why isn't he sitting by me on the bus anymore? All of these questions create this tremendous amount of anxiety. Lastly, we have generalized anxiety. This is sort of the pessimistic attitude - the doomsday sort of attitude. This is the belief that things aren't going to go right. Having this negative attitude can create anxiety as well. It is not uncommon for individuals with Asperger Syndrome to be co-diagnosed with an anxiety disorder as they enter into adolescence and young adulthood. These different types of anxiety can really culminate into someone who really needs some assistance in managing this effectively in their lives. Our next secondary characteristic is motor skill impairment and there are a variety of different ways motor skills can be impacted. We might see impairments in basic motor control, muscle tone, difficulty with balance and posture. We might also see difficulty with manual dexterity and coordination. Again, a variety of different areas related to motor may be impaired in the individual with Asperger's. We might see this impairment lead to difficulty with more complex movements such as imitation and we will also see this create difficulty with motor planning. I think the best example to think about with motor planning is doing something like handwriting. If we're going to write a letter, I need to know the steps to do so. If I write the letter M, I'm going to make four distinct lines and I'm going to plan my sequence to do that. I'm not going to go from left to right to middle - that wouldn't make much sense. Instead, I'm Characteristics of Asperger Syndrome - Part 3 Page 5going to make four distinct lines from left to right. They’re going to be planned. We have the ability within our brains for us to be able to take a message from our language center to our motor center. In this instance, we say "make a letter M" and then we carry out the actions. What we might find with individuals with Asperger Syndrome is something called dyspraxia. This is where there is a disconnect between what the brain is saying to do and what the hand or the mouth or some other part of the body might actually do. This leads to some sort of motor difficulties. We see difficulty with motor planning. We also see difficulty with motor sequencing. So when there are multiple activities to complete, it might be quite difficult. For example, if you have to complete the task of cleaning your bedroom, it requires a great deal of planning and a great deal of sequencing of activities. It may involve picking up the dirty laundry and putting it in the basket. It may involve making the bed. It may involve putting away the laundry into the drawers, putting the toys into the bin and so on. There’s a lot of different motor activities and sequencing that has to take place just with that one task that we consider to be relatively simple. I have a little boy with whom I work. He is in third grade and he recently has started climbing on the jungle gym at school. I was observing him at recess the very first time he climbed on it an and his teacher was so excited, she came over to me and said, "Oh my, John has never climbed on the jungle gym. Look at him." Aswe were watching, we watched as there was great trepidation with every move he made. He carefully moved a hand, moved a second hand, moved a foot, moved a second foot. It was a very slow and methodical movement as he moved about three rungs up on the jungle gym. Now, as he climbed high on the jungle gym, he froze there at the spot. He was almost frozen in space thinking, "Hmm, how am I going to get down?" As he stood there for several minutes, other kids were on the jungle gym and were moving around him. Well, his strategy was to kick them away. As we were watching him, none of the adults standing there were really focused on his kicking other students, but realized quickly that he was kicking out of protection for himself. He wasn't sure motorically how to get himself out of this precarious situation. He'd managed to get up there. He had the planning to be able to do it finally, but was not able to do the planning to get back down from the jungle gym. So that's where we went over and assisted. This is a good example of how that motor planning can really be impacted. I have an adult with whom I work. We were looking at possible jobs for him and he immediately dismissed a job I mentioned. It was a professional job and I asked him why he didn’t want the job. His answer was rather atypical. He said he didn’t want to wear a tie to work. He can't tie a tie and doesn’t want to struggle with that every day. Fortunately, we were able to come up with obviously other strategies for him to not have to worry about tying the tie. Now let's move to theory of mind. This is another secondary characteristic related to Asperger Syndrome. Theory of mind is having difficulty understanding the perspectives of others - understanding that other people have their own separate ways of thinking and of feeling and this leads to their own ways of behaving. Now think about this for a minute. Take a minute and think about the impact of theory of mind. We know innately that we have our own thoughts, our own feelings and they are based on our own experiences. Individuals with Asperger Syndrome believe that everyone thinks the way they think and have access to the same knowledge and information they have access to. So imagine the difficulty this creates for the individual with Asperger Syndrome. With theory of mind, the individual Characteristics of Asperger Syndrome - Part 3 Page 6with Asperger Syndrome has difficulty attributing internal motivation to other behavior. So if the individual is not aware or doesn't understand that the person next to them has a different perspective, a different opinion, then they don't understand why they act the way they do. Let's take a couple of examples of this. If I'm driving home, and I have a tailgater behind me, I might not like it but I'm going to be able to think about why this person is tailgating. I might first look at my speedometer and say, well, maybe I'm going to slow, maybe he thinks I'm driving too slowly. I might think he must be in a hurry. In this day and age, I might actually think he's on the phone and really not paying any attention to what he is doing. But what I'm able to do is understand there is internal motivation on that person's part. The individual with Asperger Syndrome might actually look at this situation and say I'm going 55, he should be going 55 and he should not be driving this closely. I am two car links behind the car in front of me, he should be two car links behind me. I'm thinking this way, I'm behaving this way, therefore, everyone should be. And so this is an example of how the individual with Asperger may not be able to attribute internal motivation. Next, the individual might rely on temporal and spatial reasoning to explain behavior. Now temporal means time. They might rely on relationships based in time or space to explain some sort of behavior. So in other words, the individual with Asperger does not understand or recognize the internal motivation, the internal thinkings, the perspectives of another person, so they've taken the information they can see and try to make relationships out of it. So in the example with the tailgater, if I drive home every night at 6 o'clock I might reason that 6 o'clock means the time for tailgating. This is when I drive really close to other cars instead of thinking, "Oh, it's a rush hour. He is heading home from work, he's had a bad day, and he's in hurry to get to his child's soccer game." I would be able to apply that internal motivation to others as to why 6 o'clock result in more tailgating. I have another example. I mentioned a little guy a few minutes ago who has difficulty with meals and one of the things that he has learned is that dinner is at 6 o'clock. I mentioned this a few minutes ago and he has definitely applied a temporal relationship to this. Dinner is at 6 o'clock, that's when we eat versus dinner is when we're hungry. Dinner is when Joey, the little brother, is up from his nap and has been dressed and his diaper changed. Or dinner is when mom gets home from work and dad gets home from work and one person can take care of the baby while the other one has time to fix dinner. This all leads to great difficulty accepting other's behaviors because they don't understand the way they are thinking or their motivation for acting the way they do. The little boy who knows a lot about prehistoric whales really was astounded that I didn't have the same level of knowledge and during our time together he kept saying to me, "I can't believe you don't know that! How do you not know that?" At some points in the conversation, I just wanted to you know say some information that I knew that he didn't know just to feel better about myself but certainly, there is some difficulty accepting the behavior of others because they don't recognize the internal motivations. This difficulty with theory of mind leads to the social naivety. Dr. Schall talked about the victim piece. There's certainly potential for bullying and being victimized because they are not aware that others have different motivation. They assume that everyone is acting under the same premises they are. If I want to be a friend, therefore, he is trying to be my friend when he tells me to yell a cuss word on the bus or when he tells me to eat a dirty tissue, or when he tells me to go up and hit someone. One of the last things I want to say about theory of mind is telling you where you can see good examples. I don't want to encourage you to watch this, but this is a good example. If you watch American Idol and you look at the opening shows when they're trying to choose the contestants, you will see a number of individuals who would have tremendous difficulty with theory of mind. Not understanding that people have different perspectives or different opinions. So, in the example of American Idol, you'll see individuals go on who really don't have a lot of singing talent, maybe no singing talent, and will believe wholeheartedly that they are the next American Idol. They are unable to see other people's perspectives, they're unable to realize that I'm really not that good at this. So it is a really, really good example of difficulty with theory of mind. ==== Transcribed by Automatic Sync Technologies ==== ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download