Differentiation of asperger syndrome

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Introduction

There have been many debates and lots of studies carried out concerning the differentiation of Asperger Syndrome (AS) and the other autism subgroups (Van krevelen, 1971 cited in Ghaziuddin,2005, Howlin, 1998) since Kanner and Asperger first introduced the two terms. Nowadays, the terms are widely used to describe individuals included in the spectrum of Autism Disorders (AD). AS is becoming more and more common and the number of children diagnosed with AS is gradually rising. Despite the fact that there are many similarities between the two subgroups, for example social and communication deficits, obsession behaviors and lack of imagination, there are also some differences. However, the variety or the severity of the symptoms may differ from one person to another according to age, the variety of abilities and the severity of the problem (Howlin, 1998; Stanton, 2000).

Educating children in the autism spectrum entail the use of methods tailored to the individual needs of every child. Unfortunately, teachers in mainstream schools they are not trained enough to meet these children's needs and often they don't even know how to offer them the appropriate support (Koutroumba, 2006). While the first section of the essay focuses on what ASD is and how the AS is thought to differ from the other autism subgroups, the second part deals with useful ideas on what the teaching staff in mainstream schools should know, in order to help autistic children to make significant progress in an inclusive environment.

The rationale for choosing this topic comes from a meeting I had with a really good student with Asperger syndrome a few years ago. This child enabled me to develop an interest in the strengths and the difficulties Aspergers may have. I have not got any teaching experience yet, and I think that this essay will give me the opportunity to discover the different aspects of AS, which is likely to help me as a secondary school teacher in the future.

Autism Spectrum Disorder (ASD)/ Pervasive Developmental Disorder(PDD)

In the early 1940s Leo Kanner noticed several symptoms in his patients which were much more different from what he knew so far. This condition was then named, after its inventor's name as Kanner's Syndrome. Nonetheless, after lots of renaming this condition was finally named autism (Howlin, 1998). Since autism affects a range of aspects in the autistic's person life, the term has been superseded by the term PDD, in some countries (Ives and Munro, 2002).

The prevalence of autism has significantly increased the last 40 years; however, it is difficult to assess it, since it differs according to the broad or narrow definition that the researchers use (Levy et al, 2009). Autism is a long-life problem and probably it is the result of genetic abnormalities. Despite the fact that autism is not remediable, medical and educational interventions can be very beneficial (Stanton, 2000). All people diagnosed with any autism-related disorder experience difficulties in three social areas: communication, interaction and imagination (The triad of impairments) (Ives and Munro, 2002).

  • Impairment of communication

To begin with, individuals with autism have difficulties in understanding the meaning of language which consequently results to ineffectual communication with others and they usually use the language to express only their daily needs. Often, children's speech is not coherent and sometimes they may repeat words others have already pronounced (echolalia). Furthermore, when some autistic people refer to themselves, they may use their name instead of 'I' (pronominal reversal) (Ives and Munro, 2002) In the case of non-verbal children, other forms of languages are be used to communicate (Screaming, sing language, or putting the hand of another person on what they need) (Bogdashina, 2005; Howlin, 1998). Additionally, they have difficulty in interpreting verbal and non-verbal language. They cannot understand when a person is lying or when he is talking metaphorically and they are unable to perceive jokes and sarcasm (Winter, 2003). Furthermore, children with autism can't understand their interlocutor's feelings and thoughts and they can't perceive his\her facial expressions, gestures and tone of voice, due to their underdeveloped social skills (NAS, 2008; Winter 2003).

  • Impairment of interaction

Toddlers with autistic symptoms fail to socialize with people and deal with situations as other humans normally do. In 1979, Wing and Gould described this failure by categorizing people within the autism spectrum into three subgroups and in 1996 he finalized this idea by adding the stilted group (Ives and Munro, 2002). As the impairment of interaction is common in all ASD, I believe it is worth referring to the most important characteristics of each group. People may show aspects of more than one of these groups or may fluctuate from one to another over the years.

Aloof group: people in this group fail to develop social interaction (Bogdashina, 2005). They live in their own world, they enjoy loneliness and isolation. The only willingness for communication they may have with others is limited to meeting their basic needs (Ives and Munro, 2002). For them, people and objects appear to be the same.

Passive group: individuals in this group are not characterized by willingness to have social interaction with others; however, whenever this occurs they may not hesitate to participate or even enjoy it. Generally speaking though, in most activities they are passive participants and they never get the role of the leader, even when they play with their peers (Bogdashina, 2005; Ives and Munro, 2002).

Active but odd group: despite the fact that people in this group like social interaction with others, they do not know how to achieve it. Their approach is usually odd and clumsy and they do not pay any attention to what other people say. They want to have friends but they do not know how to form friendships due to their insufficient social skills (Bogdashina, 2005; Ives and Munro, 2002). They may hug and kiss strangers as if they were their close friends or may use verbal or facial expressions in an inappropriate way (Howlin, 2005).

Stilted group: this group usually includes young people and adults with both high cognitive functioning and developed speech and with only some mild difficulties in social interaction (Howlin, 2005). They approach other people and create friendships but usually in a formal manner, for example a son may address his parents as "Mr and Mrs Smith" (Ives and Munro, 2002).

  • Impairment of imagination

Problems in this area appear in a variety of forms and differ from person to person. Individuals with autism may experience difficulties in understanding and predicting the future or the effects of a specific action may cause. They also have problems to enrich their daily activities with new things and sometimes even playing becomes a mechanical action (Ives and Munro, 2002; Winter, 2003). These inabilities usually generate stress and anxiety since surprises are usually unpleasant for them. Everything should follow specific patterns and any disruption may force them to start an activity from the beginning (Howlin, 2005).

It is found that the triad of impairment is closely related to stereotyped behaviors and restricted interest. Since the child perceives the world around him\her as chaos, repetitive behaviors and routine seem to be reassuring, since he\she knows what is going to happen next. Such behaviors may be switching on and off the light, flapping, skin picking or bites (Howlin, 1998; Ives and Munro, 2002). In addition, autistic children love routine and hate changes. Routine may be associated with daily activities such as doing things in a certain way or putting their toys in a particular place, drinking water from bottles of a particular color, or repeating the same question over and over again (Howlin 1998; Winter, 2003).

It is widely acceptable that a person with autism presents hypersensitivity or hyposensitivity of all his/her senses. Flashing or bright lights can be intolerable, certain smells may be unpleasant, a light contact may appear to them like an electric shock and the taste of certain food may cause an allergic reaction. Finally, due to these sensory abnormalities children may either not respond or overreact to pain and even small noises can sound to them like the sound of drums (Winter, 2003).

The autism spectrum comprises many and different form of autism and each of them may be accompanied by other problems such as learning difficulties, mental retardation, Attention Deficits Hypersensitivity Disorders and epilepsy (Ives and Munro, 2002).

Autism/Autistic disorder: it is a neurodevelopmental disorder of the ASD/PDD group and it is the most common form. The basic symptoms are deficits in socialization, interaction, communication and insistence on certain things and behaviors. It usually performs itself at the first 3 years of a child's life (Levy et al, 2009) "Most children diagnosed as having autistic disorders are moderately to severely impaired, having IQs that fall in the range of moderate to severe mental retardation" (Simpson, 2005,p.4).

Rett's Syndrome: It appears only in girls and its first signs are usually noted by parents at the early age of 1-2 years old. While these girls have a perfect development, when reaching this age they start to regress in all aspects of functioning. Patients with Rett Syndrome are usually characterized by having a small head and undeveloped social, verbal and communicational skills. Furthermore, a very common symptom of Rett Syndrome is the uncontrolled hand movements when washing, squeezing and clapping. As the child regresses with the years, autistic symptoms become more and more obvious (Ghazuiddin, 2005; Simpson, 2005).

Disintegrative Disorder (DD): this disorder differs from autism only at the age that the disability appears. The child grows up normally until the 3th or 4th year and suddenly presents abnormalities in the area of communication, motor skills and interaction (Simpson 2005). The regression usually occurs between the 3rd and 5th years of life. Disintegrative Disorder is a very rare form of ASD and often correlates with general behavioral problems (Chaziuddin, 2005; Simpson, 2005).

Pervasive Developmental Disorder-Not Otherwise Specified: in this category belong people who do not have all the symptoms to be placed into one of the previously mentioned disorders and children who have undeveloped social and communicational skills, behavioral problems or multiple disorders (Simpson 2005). Since the symptoms may differ from one person to another and they are not as severe as the symptoms in the other subgroups, the problem may not be recognized until the first year in school. The patients usually exhibit slight difficulties in communication and obsession with certain things or activities, but no language and sensory problems. (Ghazuiddin, 2005)

Asperger Syndrome: it is a neurodevelopmental disorder. It is referred to as a "hidden" condition, since it is difficult to be understood through daily common interaction (NAS, 2008). In 1944 a German physician, Hans Asperger, noticed in his patients some signs relevant to autism (Ghazuiddin, 2005). People believed that there was no difference between the two conditions until 1981. The term AS started to be more frequent after Lorna Wing used it in her research and now it is widely used to describe a group of people with a milder form of autism. It usually affects more boys than girls and it's causes are similar to autism (Bogdashina, 2005). This essay will extensively refer to AS by discussing its differences to the other subgroups of autism.

Differences Between the other Autism Subgroups and AS

According to the criteria that the ICD sets for autism, its first signs appear before the age of 3 (Howlin, 1998). The child may develop problems in communication and social interaction, though he/she may have regular language development, from the first 6 to 12 months of their life (Levy et al, 2009). In contrast, in AS the symptoms appear after the 3,5 years. Sometimes the AS may be diagnosed after the child starts school, since it is at this stage of life that students tend to increase the social interaction with their peers. In addition, the first signs of AS that come to the attention of the child's keeper are thought to differ from the other autism subgroups. Parents with autistic children observe language deficits as opposed to the children with AS who develop difficulties mostly in socialization and communication (Howlin, 1998). Since the symptoms appear in different stages of life, there is also a variation in the period at which children can have a normal diagnosis. Howlin (1998) in her book reports that in AS the average age that a child gets a formal diagnosis is 11,3 years, while in autism is 5,5 years.

Individuals with AS might experience the same problems as autistic people as far as the triad of impairment is concerned, even though the symptoms might be milder in their case. Persons with AS may have a desire for social interaction and conversation with others (Ghaziuddim, 2005; Mesibov et al, 2002). According to the four subgroups which Wing and Gould (1979 cited in Howlin, 1998) introduced, most people with AS should be placed in the group of active but odd although this is not always valid. Children with autism may show an interest in interacting with their family and peers, however this struggle is usually odd, unlike the case of people with autism where the interaction is characterized as aloof or passive (Bogdashina, 2005).

Whereas, Kanner observed problematic language or no speech at all on his patients' behalf, Asperger noticed difficulties in the way they used the language, although they had a well-developed vocabulary. In contrast to the criteria that set and define autism, the diagnostic criteria that the ICD recommends for AS make it clear that language delay is not included (Howlin, 1998). Children with AS do not exhibit language deficits and in some cases language skills may develop sooner than normal (Ghaziuddim, 2005). Despite the fact that they are eager to start a conversation, they are unable to do it, since they have profound difficulties in understanding social cues and body language. Usually any attempt for normal conversation take the form of talking 'to' others than talking 'with' them (Howlin, 1998, Winter, 2003). Discussions with others tend to expand to "small lectures", especially if the topic is pertinent to their special interest. Furthermore, their speech may be characterized as pedantic, quick and loud (Ghaziuddim, 2005, Mesibov et al, 2002). Speech problems like echolalia and pronominal reversal, which are very common in autism, are usually absent in AS (Bogdashina, 2005).

In addition, some professionals and researchers are convinced that AS develops in people with average to above average intelligent, while autism is common in people with average intelligent or low functioning (Howlin, 1998; Mesibov et al, 2002). Conversely, nowadays some studies have revealed that AS could be diagnosed to individuals with or without mental retardation (Ghaziuddim, 2005, Howlin, 1998). While this may be true, debates have been also arisen about the IQ of individuals with autism and AS. Although is difficult to prove via researchers that the IQ of people with AS is higher than in people in the other autism subgroups, many studies illustrate that their verbal IQ is higher in relation to their performance IQ. In contrast, people with autism appear to have higher Performance IQ than verbal (Ghaziuddim, 2005; Mesibov et al, 2002). According to Ghaziuddim (2005) more people with AS experience problems with executive functioning and the theory of Mind as opposed to individuals with autism who can pass the lower-order Theory of Mind Test successfully.

Another important point is that both people with autism and AS have special interests, which differ in their intensity or focus. For instance, small autistic children may collect cans, teddy bears or even buggies and leaves, while ordinary young people, may have an obsession with TV stars, football players and cartoon characters (Ives and Munro, 2002). In AS special interests and obsessions with certain things and routines are more intensive. Aspergers are willing to learn as many things as they can for their special object, snap every opportunity given to them and speak about their special interest for hours. However, the range of interest differs from the other subgroups while they are usually fascinated by more sophisticated things such as astronomy and space (Ghaziuddim, 2005; Winter, 2003).

Finally, motor impairment and problems in balance are repeated symptoms in all ASD. People often experience difficulties in activities which need excellent physical coordination and it is hard for them to perform daily activities such as tying shoe laces, doing sports and playing games (Winter, 2003). Regardless of the fact that poor coordination is not in the criteria that the DSM-IV set for AS, people with AS are very clumsy (Mesibov et al, 2001). It is not certain whether clumsiness is more usual in AS or not. A study carried out by Manjiviona and Prior (1995, cited in Howlin, 1998) showed that the frequency of children with AS and high functioning autism which have severe coordination problems are 50% and 67% respectively.

At this point it is also important to mention that the assessment of AS by professionals is a significant stage to be done before the IEP and the interventions are created, in order to define a child's needs and difficulties (Jones, 2002). There are various ways to assess ASD such as observation and interview and each of them is aiming at investigating different aspects of a child's abilities, like social, communicational, language skills and obsessional behavior. For the assessment to be successful several instruments can be used, which are especially created to detect each disorder. For example, AS can be assessed by specifically developed questionnaires and clinical interviews which are given not only to the patients but also to their families and are aiming at investigating certain aspects, from topic management to speech flexibility (Schnurr, 2005).

Strategies for Teaching Staff

Whether children with autism should be included in mainstream schools or not is a topic that has generated many debates in the last few years and has stimulated a lot of studies (Fryxell and Kennedy, 1995; Hunt, Farron-Davvis, Beckstead, Curtis and Goetz, 1994 cited in Leach and Duffy 2009). Some of these studies have revealed a significant impact on children with autism attending mainstream schools, especially in relation to the aspects of making friends and social development (Leach and Duffy, 2009). On the other hand, some researchers maintain that although contact with their peers and the general inclusive environment in the school could be beneficial for children with autism however the inclusion may have an impact on their academic progress (Hunt and Goetz, 1997; Kohler, Strain and Shearer, 1996 cited in Harrower and Dunlap, 2001). Nonetheless, nowadays, the number of children with autism who choose to attend mainstream schools is on the increase since inclusion is a human right. Thus, in order to create an inclusive environment in the classroom, teachers and students should be familiarized with the situation and employ effective strategies that could help them achieve the best. Also, the curriculum should be differentiated and adjusted to a child's special needs (Harrower and Dunlap, 2001). Having looked into the differences of AS and the other subgroups in the ASD, I will now consider some useful ideas for the teaching staff in a mainstream classroom in order to support a child with autism.

First of all, since teachers are in touch with the child on a daily basis, they should be aware of the difficulties s/he may experience. As Robertson et al. (2003) point out, the relationship between teachers and students is closely related to the students' behavior. That is why it is significant for educators to know why a child has a certain behavior and how this behavior can be treated. For instance, teachers should know that a child with AS has a difficulty in interpreting facial expressions and understanding sarcasm and jokes, so during their teaching they should give every information verbally and in a clear way, avoiding every kind of metaphor (Bellando and Pulliam, 2009).

Having reflected on the relevant literature for the purpose of writing this section, I found several methods and strategies that the teachers could employ in their daily teaching. However, since every child is different from the other, these methods should be implemented according to the individual needs and difficulties of every pupil with AS. Those strategies include:

Role play can be used by teachers in order to teach children with AS, through assuming different roles on how to react in certain situations and how people feel in various circumstances. It is also very helpful in exciting students' imagination (Howlin, 1998; Winter, 2003).

Social stories are a useful tool to make a child understand social cues, rules and right conduct. Those stories can be written in such a way so as to meet a student's needs and can be visual, verbal or a combination of the two forms. In addition, social stories improve the ability of others to interpret a child's responses and actions (Howlin, 1998; Leach and Duffy, 2009).

Visual schedule/picture calendars: those will inform a child for what is going to happen next. Consequently, the stress that students may feel towards unexpected situations will be minimized and they will perform better at school (Bellando and Pulliam, 2009).

Taking into consideration the above mentioned features that characterize people within the ASD, the school environment appears to be and should be a treating environment for the child with AS. Winter (2003, p 62) in his book describes schools as "Vast open spaces, complex social interactions, a myriad of unwritten rules to adhere to, and a plethora of sounds, sights and smells combined to make a child with AS feel at a loss". Sensory hypersensitivity, undeveloped social and motor skills hinder child's ability to achieve successful inclusion and interaction (Leach and Duffy, 2009). This implies that teachers should create certain places like study rooms and libraries, where students with sensory or social problems could go and avoid the chaotic school atmosphere (Humphrey and Lewis, 2008). In addition, stress reducing toys, like squeeze balls could be provided to children with AS at any time this is thought to be needed (Brownell and Walther-Thomas, 2001).

It is also found that family, and more specifically parents, is an inexhaustible source of information since it is pertinent to a child's historical background, specific behavior and school progress. Parents have to undertake multiple roles; they must be the educators at home, the affective parents and family members. Many teachers recognize the significant role of parents' involvement in their child's education. Collaboration between parents and teachers creates an atmosphere of consistence between a child's life at school and at home. For example, behaviors like washing hands after using the toilet and keep their working place tidy must be rules pervading a child's everyday life (Brownell and Walther-Thomas, 2001). However, it is fundamental for parents to be familiarized with their child's condition and how this affects his/her socialization, learning and behavior. By providing parents with helpful strategies and useful information, teachers can help them cope successfully with the situation and release them from the stress that naturally comes about within the family after their child diagnosed with AS syndrome (Lord and McGee, 2003).

At this point, it is important to mention that students with AS usually have a special interest that many times dominates in their daily life and for which they have extremely good knowledge. Teachers can be truly helped in their work if they know about this special interest and use it to motivate a child to be more active in class (Brownell and Walther-Thomas, 2001; Debra and Duffy, 2009). This can be accomplished in lots of different ways. For example, if the child is fond of astronomy, the teacher can use this special interest in a science lesson, to teach him/her about the distance and the speed of planets in the outer space. If the interest is in computers, then the idea of being the helper who assists his classmates with the use of a computer will excite him (Winter, 2003).

Many schools have adopted peer support strategies since they are now thought to be very useful. Peers can help children with AS to develop their social skills and behaviors. To encourage interaction and communication among the SEN children and their peers, teachers should employ different forms of peer support like peer tutoring, peer buddy systems and circle time in order to maximize learning (Cowie and Wallance, 2000; Lord and McGee, 2003). In addition, teachers should inform other classmates about the condition of the child with autism and help them to interpret his behaviors. If children accept the diversity of other students in their classroom, then will be easier to be accomplished an inclusive environment (Cowie and Wallance, 2000). However, these strategies may not be effective with all students with AS since those children might experience severe problems in communication, interaction and speech, may be hypersensitive in touch and loud noises, or may prefer isolation and "safe places". Finally, teachers should be aware of bulling. Students with AS are more likely to be victims of bulling by their peers, due to their disabilities and repetitive behaviors (Humphrey and Lewis, 2008; Stanton, 2000).

Conclusion

This paper provides an insight into the ASD and more specifically into the extent of severity of AS compared to other autism subgroups. As it has been already mentioned, there is great confusion when it comes to the differences between Asperger's and autism. Even professionals and researchers encounter difficulties in distinguishing between those two disorders and providing a clear and fully definition. Taking into consideration all the above mentioned things we can say that although autism and AS are considered to be part of the autism spectrum there are some significant differences mainly as far as language development and social skills are concerned. Nevertheless, since AS is a mild form of autism, Asperger's are perfectly able to achieve progress in every aspect of their life.

Obviously, educators should always have in mind, firstly, the difficulties that an Asperger may experience and secondly, the way that children with AS behave and think. This is essential in helping them understand the needs of the individual with AS and adjust their teaching strategies in order to provide him/her proper support and help him/her do his best not only in academic but also in social aspects. Finally, it is particularly important for teachers to remember that each person has different abilities and individual needs. Similarly, people with AS are unique and should be treated accordingly.

Let me close this assignment with the words of a person with AS:

"I want to prove that even though life with AS seems to be a constant battle; it's a battle that I'm fully capable of winning". Willow Marsden (NAS, 2008)

References

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