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Language encompasses far more than the definitions of individual words. A spoken sentence takes on much of its meaning through nonverbal cues and the surrounding environment. A carefully written sentence may deliberately use certain words to evoke a feeling in the reader or use abstract concepts to illustrate a scenario. Most importantly, language is a social tool that people control and adapt to suit the situation. It is not enough to simply know what words mean in isolation. Most people take for granted their ability to use and respond to language in its appropriate context and to grasp messages that aren’t explicit. Children and adults with Asperger’s Syndrome often possess language skills but cannot detect or employ these nuances of social interactions.
Asperger’s Syndrome belongs to a group of disorders referred to as Pervasive Developmental Disorders (PDDs). PDDs, as defined in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition), cover five disorders with similar features: Autism, Asperger’s syndrome, Rett’s Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). It is useful to group these disorders because although they comprise slightly different symptoms their treatments all acknowledge that each problem is the result of poor neurological (brain) development.
Asperger’s Syndrome is often discussed in the same breath as autism. It exists under the label of Autistic Spectrum Disorders as many of the indicators are observed in both conditions. Autistic spectrum disorders are named as such because children may be affected by few or many symptoms which can vary in severity. Based on the combination in an individual, their level of impairment will exist at some point on the autistic spectrum. Asperger’s Syndrome is commonly understood as a form of high-functioning autism, though the less overt characteristics of this condition make it harder to diagnose.
Children with Asperger’s usually have considerable problems in the social domain. Their communication skills tend to be adequate and occasionally their vocabulary range is excellent. However children with Asperger’s are generally unable to appreciate language beyond its literal meaning and may not pay attention to nonverbal signals such as body language and facial expressions. This can lead to an inability to adapt to and participate in social situations, resulting in peer isolation. Children with Asperger’s often talk in a monotone and may not demonstrate empathy for other people, though they frequently have particular subjects that they become obsessive about and rote-memorise associated facts or statistics. Occasionally Asperger’s is not diagnosed at all and people function independently within the community – however they would possibly be labelled as eccentric or awkward.
Asperger’s can cause children to become pedantic and inflexible when it comes to daily routines and any changes to these are met with fear or anxiety. Another feature of the disorder is that affected children experience a hypersensitivity or hyposensitivity to sensory stimuli, usually of an auditory or tactile type. This may be a preference for certain textures of clothing, a dislike of soft touch or a reaction of pain to seemingly neutral sound. Motor skills are generally quite poor and children can have difficulty with concepts of spatial awareness. There is also a tendency for children to perform repetitive motor movements such as rocking, spinning or hand twisting.
Autism and Asperger’s Syndrome are often grouped together but it is important to understand their distinction. Occasionally Asperger’s is labelled as a high-functioning form of autism but this does not reflect the major difference between the two disorders. Children with Asperger’s Syndrome do not experience the same language or cognitive deficits as children with autism and for this reason are able to interact more with the people around them and demonstrate interest or knowledge in particular subjects. While children with autism often (but not always) have some form of intellectual disability, children with Asperger’s Syndrome do not, by definition, have significant intellectual problems. This means that children with Asperger’s also have a better chance of responding to treatment and being able to live more independently as they grow older.
The reason that communication deficiencies are not noted in children who have Asperger’s Syndrome is because it has a later onset – initial development of language and cognition has generally taken place which allows basic communication to occur. Although children with Asperger’s may use language to communicate more than those with autism they still tend to lack much of the social awareness that would make their interactions as effortless and adaptive as those of children with no developmental disorder.
As with almost every developmental disorder, Asperger’s Syndrome has no definitive cause or explanation. It seems that most children with developmental problems have experienced complications before, during or after birth. However there is no way to predict what form of disorder, if any, may arise from this or whether preventative measures can be taken. Some studies have indicated that the right side of the brain, specifically the frontal lobe, may be affected in children with Asperger’s as it is this area that is responsible for social awareness and behaviour.
Speech and language develop in synchrony with the growing brain. So do motor skills, balance, coordination and sensory integration. If any part of this process is disturbed, it is highly likely that the resulting problems will not be restricted to only one developmental domain. Developmental interruptions or delay can manifest as anything from dyslexia, auditory processing disorder or learning disabilities to more severe disorders such as Down’s Syndrome, Cerebral Palsy or Autism. It is not possible to predict why some children will be affected by one type of problem and not another or whether it could have been prevented. All of the aforementioned disorders come about through some abnormality in the developmental process and the only way to understand this is to have an appreciation of how normal development takes place.
Although children with Asperger’s do not suffer any significant language delays on a basic level they do not perceive the subtleties of different inflexion or tone, nor does their auditory processing reach the point of allowing them to comprehend abstract uses of language to express humour or irony. Children with Asperger’s rarely have hearing problems but do tend to display abnormal listening patterns.
Our senses are only useful when the connections from the organ to the brain are operating normally, but many children with developmental disorders suffer from neurosensory dysfunction. This is a weakness in the way sensory information from various parts of the body is integrated and transmitted to the brain and is particularly obvious in children with Asperger’s in terms of their hypersensitivity or hyposensitivity to touch or sounds. Because the vestibule is where the initial sensory integration takes place, the Auditory Training Program is often combined with a program of Developmental Movement Exercises so that the vestibule is stimulated through both sound and sensory input.
When children are born, they emerge from the womb with primitive reflexes – physical responses initiated without conscious thought or intention. These reflexes allow the child to cope with the influx of new sensory information from the post-utero environment, but should soon be overtaken and inhibited by voluntary actions – these are referred to as postural reflexes or postural control. It has been found that problems with neurosensory integration may be attributed to partially uninhibited primitive reflexes. The rationale behind Developmental Movement Exercises is that sensory systems and reflexes are indivisible, and that any existing primitive reflexes can be actively inhibited by exercising the postural reflexes. Postural reflexes have the effect of maintaining and controlling posture, physical actions and equilibrium.
Developmental Movement Exercises involves a program of movements designed to retrace motor development as it ideally should have been experienced and has been shown to be of considerable benefit to children with Asperger’s syndrome.
Fast ForWord and Neurofeedback have been shown to also assist individuals with Asperger’s Syndrome. These programs and interventions are complementary to the Auditory Training Program and Developmental Movement Exercises.
At initial assessment, all the programs are evaluated for their effectiveness in reducing symptom presentation. Fast ForWord and Neurofeedback are also considered as the main mode of intervention, once a clear picture of the child’s/individual needs are assessed.
Please refer to Neurofeedback and Fast ForWord.
In order to recommend the most appropriate intervention it is necessary to attend an assessment at the centre.