Aspergers Syndrome

Dysgraphia is a handwriting disability usually associated with a dificiency in fine motor skills.  This term “fine motor skills” refers to the ability to perform tasks that require a high degree of precision and manual dexterity.  Writing is one such skill.

Since motor skills dificiencies are an area often found in children with Aspergers you do often see many with poor handwriting.

 Fine motor skill activities are controlled by small muscle coordination.  Many fine motor skills need to be explicitly taught such as handwriting. 

We researched dysgraphia as well as asked our doctor about tools and techniques that would assist our daughter with her disability.  The suggestions given all are to help build muscle strength in the hands and brain to hand coordination.  Some things we have learned to help our daughter outside her normal dysgraphia classes with school are:

1.  Stress ball or “hand” exercise ball that requires them to squeeze and release.

2.  Playing video games that require rapid finger/hand movements with buttons (like a gameboy).  

3.  Teach them to type and practice to increase their speed.

4.  Practice writing sentences and increase the amount every week.

5.  Learn to play an instrument.  There is a large amount of finger and hand coordination needed to play an instrument. 

6.  String beads, knit, cross stich, sew. 

7.  Coloring, draw, paint or anything that requires the same grip as a pencil for writing.

8.  Using tools.  Hammering, using a screwdriver, gardening with tools all require a grip and muscular strength of the hands.

It is very important in receiving a proper diagnosis to have as much information as possible.   Even after they have received a diagnosis it is a good idea to keep a journal or update a list of actions, symptoms, daily struggles, improvements, etc.  This especially is helpful when you make changes such as medications, start a new school year, move, or other life changes. 

It is also important to keep a copy of all information you receive from anyone in regards to your childs condition.  This might include doctors and school officials.  You may actually be the only person who has ALL this information in one place and may need them for future reference.  If you do not currently have everything on your childs medical or educational history request it.  It is your legal right to have their information. 

Start a file in a filing cabinet or have a binder that has EVERYTHING in it.  Shot records, medications used and the dates.  This might even include doctors bills and insurance claims.  Also include I.E.P. records and accomodations from the school.   You might also start a file that includes names and references of doctors, support groups, books, and other resources you have received that you may not need or use now but might in the future. 

It also would be a good idea to get your Aspergers child to start doing their own documenting.  Give them a notebook to journal for their Aspergers.   We gave our daughter a “feelings journal” which was just a notebook that she had with her at school.  She uses it to write down what she is having a problem with that day.  It could be a sensory issue, being bullied, having a headache, or even just being frustrated with school work.  We discuss these with her to get a better idea of what she is feeling and how we can help her as well as discussing issues with her teachers.  We try to address repetative issues with her doctor. 

Determining others needs or feelings through their facial expressions is a form of communication.  People with Aspergers Syndrome often have an inability to read facial cues and are not able to translate their meaning.  This is another area that can be taught to people with Aspergers. 

First you need to obtain a group of pictures of facial expressions.  These can be purchased from various places online or at bookstores.  These also could be taken with your camera and a few friends!  Start with the basics of sad, angry, happy, scared, etc.  Explain each part of the face and how it identifies the specific emotion.  For example when smiling the mouth is turned up, and the eyes are wide and “smiling” also.  Angry may have clentched teeth and squinted eyes.  Many expressions have more to do with the eyes then anything else.  Describe each picture in depth.  Then review the pictures like flash cards and have them identify each face.  While watching television have them identify the emotion of the people they are watching.   Once they have basic facial expressions down move to others such as confused, bored, excited, etc. 

Also explain the importance of the non-verbal communication of facial expressions.  Most people will not tell you how they are feeling, but you can “read” it on their face.

Social stories are available from various authors and can be researched through any bookstore or online.   Creating your own social stories will save you money, and allow you to address specific situations unique to your child.

Social stories should be written from the perspective of the child and be in first person.   Use vocabulary and wording for their level.  It should resemble the form and level of books they currently read or have read to them.   It should address motivation for specific behavior and why other behaviors are not appropriate.  Identify a specific problems (crying, fighting, tantrums, screaming, not sharing, etc.)  Also identify what may be causing these specific actions and what steps can be taken by them as well as those around them to fix the situation.  You now have the base for your story.

When writing be descriptive and provide as much detail about the situation as possible.  Try to give the prespective of others who may be involved so they can better understand how others see and react to their actions.  Make sure it includes the setting, problem, others reactions, and a solution.  Using pictures and illistrations can help also. 

Depending on the skill to be learned books should be reviewed often.  Daily if necessary until you see results.  Always praise even simple results. 

 We tried the “Help Me Be Good” series by Joy Wilt Berry.  We had purchased these while our daughter was a toddler and before she was diagnosed with Aspergers.  They became a very good tool once we realized her social skills problems.  Today at age eleven she still reads these books.  Each book has a specific topic such as teasing, fighting, lying, stealing, etc.  Each follows these same steps for explaining the situation, giving the perspective of others, and solutions.  Another popular author of social skills books and videos is Carol Gray with the Gray Center. 

Social skills difficiencies in Aspergers and Autistic children can be taught.  One really good tool is social stories.  What are social stories?  They are stories that provide accurate information about situations these children might find difficult or confusing.  They describe in detail and give information on social cues, reactions that might be given by others, suggest appropriate actions and reactions they should take in the situation, and other events that might occur.   This will help to increase their understanding and make them comfortable in given social situation.  

How does this actually help them?  They can better prepare and predict actions and opinions of others.  They give them perspective on how others are thinking as well as their emotions and behaviors.   They are more prepared for consistant and structured settings such as a classroom setting.  Social stories also allow them time to review and practice before the stress of an actual social interaction.  They can distance themselves and become prepared.     

Identify social areas they might need a social story discussion and either find an existing book or even make a story yourself to discuss the social topic.

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For many people with Aspergers Syndrome this wonderful world can actually feel like a confusing place to live. Having routines helps to minimize stress and confusion associated with everyday events. A routine is something that happens in the same way or same order every time. This allows them to “know” what is going to be happening. This to them is comfortable and safe.

Change means things will happen that they are not expecting and they may find that difficult to understand and cope with. Change is easier to deal with when they are prepared for it in advance. Many people with Aspergers do not like surprises. Doing new things are still exciting, fun and wanted, however it is still easier to handle when they know what to expect. For many it might be helpful to not only explain everything, but write it down so they can review it if they need to. Minor changes such as having dinner later or doing homework at a different time are easier to handle, however large changes like moving, a new baby, new teachers, new schools, and so on should be explained in depth.

Routines to consider could be for:

1. Morning routine getting ready for school

2. Morning routine for weekends or when out of school

3. Daytime routine when home (lunch,nap,television,reading,etc.)

4. School routines (usually they have routines, but you need to ask to be notified if there will be changes when possible)

5. Night routine (homework, dinner, bath, bedtime)

6. Make a daily or chore chart

7. Car riding (may prefer a specific seat each time)

8. Scheduled outside activities such as sports, dance, private lessons

Explaining changes or plans:

1. Let them know what will be happening and that you already have a plan for it.

2. Always ask if they have any concerns or questions.

3. Ask if they have anything that might help them feel more comfortable with the situation.

4. Show them pictures, do internet research or use other materials to help explain the situation.

5. Observe their behavior afterwards to see if they exhibit any anxiety or begin acting differently.

It has been said in research that children with Aspergers Syndrome and Autism have a 73% prevelance of sleep problems versus the 50% for typical children.   With many of the traits of Aspergers Syndrome being sensory related, hyperactivity, and just overall having their brains in overdrive it is no wonder they have a problem settling down and going to sleep.  It has also been speculated that some children with Autism/Aspergers with sleep problems may be deficient in Melatonin. 

After observing my daughters inability to get to sleep easliy most nights we identified her problems were due to sensory issues and just not being able to wind down.   Identifying their particular issues will help you make a plan to provide a soothing and inviting atmosphere for sleep.  Establishing a bedtime routine is essential especially with sleep problems associated with Aspergers.  Look into the following suggestions that could help you identify what will work best for them:

1.  Identify if noise is a problem.  Is there a need for a rhythmic noise like a fan in the background?  White noise provides a steady monotone sound that helps filter out distracting noises.  Maybe on the flip side there is noise that is a sensory problem that could be removed such as a ticking clock?  Ear plugs may also help in this situation.

2.  Is light an issue?  Do they need a nightlight?  Do they need complete darkness to help settle their brain as there will be no visual simuli available?

3.  Is there something to the touch that is bothering them?  Certain fabrics can be texturally sensative and annoying.  Pillows not piled up correctly, or a bed not made correctly can be a distraction.  Are they itching all the time and focusing only on that?

4. Is their brain still on overdrive?  Do they have something on their mind that will not allow it to slow down until they resolve it?  Often turning off the television, music, electronic devices and other outside stimuli can help them wind down.  Reading often is a good replacment as it helps them relax and focus.  Often soft flowing music set low can help them relax.

5.  Taking a hot shower or bath can help some children relax, however may have the opposite effect on others.  Often scents like lavender used with a bath helps with relaxation.

6.  Medications have been used as well.  Melatonin is an over the counter supplient found near most Vitamins in stores.  Melatonin is a natural substance that the human body makes to induce sleep.   Discuss ANY use of medication for sleeplesness with a doctor!

7.  Identify foods that should be avoided before bedtime.  There are also many foods that you can find in an online search that naturally help with the sleep cycles of your body as well. 

8.  If they are figity or need to be physically calmed  down often a “weighted blanket” can be used.  This is simply a custom made cushion or blanket filled with a heavier filler material like poly-pellets, sand, or even beads.  The deep pressure of the blanket helps calm and promote sleep.

Being a spectrum disorder treatments and therapies for Aspergers Syndrome vary depending on the traits exhibited. Medication is considered when other traits accompany Aspergers such as anxiety, depression, hyperactivity, and obsessive-compulsive disorder. Other options might include using Behavioral Therapists, Occupational Therapists, Speech and Language Therapists, Special Education Instructors, Psychiatrists, Counselors, and parental/family involvment and monitoring.

Behavioral Therapists can assist where children have sensory sensitivities to things like noise, light and touch. They can help identify and manage stressful situations. They also can assist with social skills training programs. Social skills can be like learning a foreign language to an Aspergers child. Training might include illustrations, repetition, and clear explanations of social situations.

Occupational Therapists work with developmental delays and difficulties with motor skills and physical coordination. Children with Aspergers often exhibit difficulty with handwriting, learning to tie shoes, picking up movements in P.E., and other fine motor skills. They have exercises and techniques that help improve motor skills and coordination.

Speech and Language Therapists can assist those having difficulties with volume, rhythm or tone in their speech.

Special Education Instructors will assist in the accommodations the school needs to provide to help them learn and work effectively. There is an IEP (Individualized Education Plan) that is usually necessary for these accommodations. Discussing the IEP with doctors and therapists for advice on what accommodations they recommend will help the teachers provide a proper working and learning environment.

Psychiatrists can assist in observing and diagnosing further problems such as depression, ADHD, schizophrenia and obsessive-compulsive disorders early since people with Aspergers have been shown to have an increased risk for these disorders.

Counselors are there to assist the entire family. Parents, siblings, caregivers and extended family can benefit from special training and counseling. Coping techniques, discipline, and daily living experiences can be discussed to help everyone work through the struggles associated with Aspergers.

Parental monitoring should include regular monitoring and discussing with doctors and therapists the social skills and mental health development of an Aspergers child. Parents need to also continually discuss their child with teachers and school administrators about academic progress and social interactions and updating accommodations when needed. There is not a known way to prevent Aspergers syndrome however it is shown that early diagnosis and interventions are the best way to prevent behavioral, emotional, and family complications.

If you do any research on Aspergers Syndrome you will find there is no one medication that will help Aspergers. Many children still suffer from hyperactivity (ADHD), obsessive-compulsive disorder, depression, anxiety and more due to Aspergers Syndrome. There are many medications out that specifically target those symptoms. The website “Neurology Channel” at: http://www.neurologychannel.com/aspergers-syndrome/treatment.shtml
discusses different symptoms and medications that can be taken and monitored for many different symptoms.

My daughter was already on Concerta for an ADHD diagnosis she had around first grade. Although it might not actually be ADHD but a symptom of Aspergers Syndrome our doctor has left her on this medication. Our biggest concern is since Concerta (and many other ADHD medications) is a controlled substance and we didn’t want her taking any more then she could possibly need to function. Our doctor tried lowering her dosage, but we immediatley saw a drop in her ability to focus, function, and an increase in conflicts with her family members. We were put back on her original dosage of Concerta. Being a Pharmacologist as well as a Neurologist our doctor has seen many different drugs and combinations work for Aspergers children, but it is a matter of trying things to see what works for this specific child.

Our doctor asked if we would be willing to try Prozac. He explained he had seen results in Aspergers children on Prozac because it targets anxiety, obsessions, and depression (even if they don’t exibit it doesn’t mean it isn’t there). His hope was if the Prozac worked to help with specific areas we could the reduce her Concerta. We started on a small dosage of Prozac and slowly built up. Of course we got all the information about side effects and what to watch for. We visited each week to discuss any changes. We go almost all the way to the maximum dosage for her, and yet there was absolutely no change or effect on her. We gradually reduced the dosage and took her off of Prozac. The interesting note from the doctor was the majority of people on Prozac react either positive or negative to the drug. Only about 1% of people have absolutely no reaction what so ever. Well, that is my daughter for you.

With Prozac out of the way, our doctor still was concerned about the high dosage of Concerta that was required to help her stay where she could function and focus. Her weight and size has remained very small for her age. She also has trouble sleeping. Both are symptoms of a controlled substance like Concerta. He decided to try reducing her Concerta again but supplimenting it with Stratera (non-stimulant drug). This has actually worked and allowed her to maintain the level of focus and fuction she needs. By reducing the Concerta she may regain her appetite and sleep better at night.

I am thankful to live in a time of medical technology. We know that each day new techniques, medications and information are found to help in the medical field. We can only hope that as Aspergers Syndrome is continually researched that they can find new information for it as well. I am just greatful we have the diagnosis and know what we are dealing with so we can face it head on!