「アスペルガー症候群を知っていますか？」Web版・英語
“What is Asperger’s Syndrome?”
Introduction to the Web Page
This web page is a translation of a Japanese booklet “What is Asperger’s Syndrome?” that was published in August 2002 by the Tokyo Chapter of Autism Society Japan with funding from a corporation.
In February 2000, parents of children and adults with Asperger syndrome established a branch within the Tokyo Chapter of Autism Society Japan. Asperger syndrome has not received much attention in Japan until recently. Since we have found it difficult to explain the condition to others, we saw a need for educational tools such as the booklet and this web site to serve those who suffer from Asperger syndrome, their families, and others. In addition, we have found that there are few professionals in Japan who are involved in Asperger syndrome research and practice. Therefore, we also wanted those who come in contact with the individuals with Asperger syndrome to learn about the condition.
We were very pleased that Dr. Tokio Uchiyama agreed to be an author of this booklet, and that Dr. Lorna Wing was able to contribute a foreword and provide editorial assistance. As Dr. Uchiyama wrote in the conclusion, it is our hope that this web page will be “a beginning” towards greater understanding of Asperger syndrome.
The Tokyo Chapter of Autism Society Japan
FOREWORD
Asperger’s syndrome is a developmental condition within the autistic spectrum. It is a condition in which the brain of the person concerned develops in a particular way, which is different from the usual pattern. This has lifelong effects on the way the children and adults concerned see the world and react to other people and everyday events.
Asperger wrote his first paper about the pattern of behaviour, now known as Asperger’s syndrome, in 1944. His work did not become widely known throughout the world until the 1980s. It may seem that his syndrome must be a new condition appearing for the first time in the 20th century. However, the fact is that there have always been people with this syndrome, although of course no one would have been given this diagnosis until comparatively recently. Accounts of such individuals can be found in historical documents, in fiction, and on television – Mr Bean is a perfect example. In my work, I have found that there are people with Asperger’s syndrome in every country in the world. They all share the same characteristics, regardless of their cultural backgrounds. Even their special interests are remarkably similar – I suspect that trains top the list of favourites everywhere that railways exist.
Originally thought to be rather rare, recent studies suggest that the prevalence of Asperger’s syndrome may be in the region of one person in every two or three hundred.
As described so well in this booklet, children and adults with Asperger’s syndrome find the world puzzling and confusing. For this reason they tend to react in ways that are unexpected and can be distressing or annoying to other people. However, they have very positive qualities. They are absolutely honest and do not pretend. They treat everyone the same, regardless of the other person’s age or status in the world. Sometimes the way they see things sheds a new light on a problem and enhances understanding. As Asperger pointed out, great artists and scientists have to have some or all of the traits of his syndrome in order to concentrate on their chosen subject to the exclusion of all else, for at least some of the time.
It is very important for those who live or work with people with this syndrome to understand their special problems and value their special abilities. Those who do make the effort to understand and establish a relationship find this to be a very rewarding experience, as well at benefiting the person with the syndrome. This booklet is an excellent introduction to building this understanding. It covers the basic facts concerning the nature of the syndrome and the ways of helping children and adults concerned. It is written clearly, without jargon and with affection and respect for those who have Asperger’s syndrome.
I am very happy to have been asked to write this foreword. This booklet that will be of great help to all the families concerned and to anyone who meets or works with children or adults who see the world in the unusual and fascinating way the booklet describes.
Lorna Wing
Consultant Psychiatrist, Elliot House Centre for Social and Communication Disorders
Bromley, Kent, BR2 9HT
Contents
Introduction
1. What is Asperger’s Syndrome?
What causes Asperger’s syndrome?
Diagnosis
Column: Problems with diagnosis
2. The Characteristics of Asperger’s Syndrome
(1) Difficulties with social relationships
“Undemanding babies” / Naive but not malicious / Not understanding “unwritten rules” / Not getting along with peers
(2) Difficulties in communication
Overemphasis on details and difficulty in “coming to the point” / One sided conversation, abrupt change of subject / An idiosyncratic use of words, interest in prosody rather than context / Incorrect use of language suitable to the situation / Limited understanding and poor expression of intent / Cannot read “between the lines” or do not understand “ambiguity”
(3) Problem with imagination and creativity
Limitation in pretend or imaginative play / Collecting things / Good rote memory / Repetitive patterns of behaviour / Too serious to be flexible / Good at imitation / Interest in TV programmes and books
(4) Other problems
*Sensory sensitivity
Sound sensitivity / Visual sensitivity / Sensitivity to taste / Sensitivity to smell / Tactile sensitivity / Sensitivity to pain
*Movement
Stereotyped movements / Motor co-ordination / Manual dexterity
*School work
Problems with writing / Problems with mathematics
*Challenging behaviour
3. Strategies to Help Children with Asperger Syndrome
Creating a secure environment / Changing behaviour over time / Making rules and directions clear / Using schedules or visual time-tables / Protection from bullying / Promoting positive interactions / Not to be selected as the sole person to be told what to do / Utilising special interests for motivation
4. Asperger’s Syndrome in Adolescent and Adulthood
Work
A beginning
The difficulties of a child with Asperger syndrome can easily be misunderstood.
You may know of such a child.
He/she may:
– like to play on his/her own
– know a lot of things (i.e. have a lot of factual knowledge of certain topics or areas of interest)
– talk at you without listening to your response
– be very good at tasks he/she enjoys, such as jig-saw puzzles, though may be clumsy with tasks that do not interest him/her.
– get upset when things change or if asked to move from one activity to another
– have an excellent memory for birthdays and train timetables
– like to repeat the same play sequence many times or repeat the same questions even if he/she already knows the answer
– use complex and/or very precise language with adult like “little professor”
– be good with a word processor but have difficulties with handwriting
– know a lot about sports such as baseball or football but is not interested in playing (may also have poor physical skills/co-ordination)
– be inappropriately honest in expressing views – may offend with the truth
– be confused and upset when told off by teacher – he or she often does not know what he/she has done wrong
– not give very much eye contact when speaking
This “odd” or “weird” may be a child with Asperger’s syndrome. Asperger’s syndrome is a type of brain dysfunction and is not caused by inadequate parenting.
Because of the lack of awareness of this syndrome, Asperger children and their parents may be judged harshly and unfairly …
I would like to contribute towards a better understanding of this syndrome.
1. What is Asperger’s Syndrome?
Asperger’s syndrome is a type of autism named after the paediatrician, Hans Asperger, who first described a small number of children with unusual development and behaviour. It is now known that those affected may not see and understand the world as others do. This is because of impairments in communicating and lacking empathy and the ability to see things from another person’s perspective. Their thinking may seem rigid and inflexible – sticking to rules and very literal understanding of language.
What causes Asperger’s syndrome?
The cause of Asperger’s syndrome is not known. It is not caused by inappropriate parenting, abuse or neglect. Because a child with Asperger’s syndrome may learn Kanji or Chinese characters from early childhood or be good at calculation, people may think the parents put too much emphasis in their education and lack affection. Also before getting a diagnosis, the child may be considered as “spoilt child”.
The main cause of Asperger’s syndrome can be thought to be generic factors leading to a dysfunction in parts of brain during pregnancy or soon after birth. Asperger’s Syndrome belongs to the group of developmental disorders such as autism and learning difficulties.
Diagnosis:
Asperger syndrome is a type of autism. People with Asperger’s syndrome can be diagnosed by having impairment in three areas: 1) social interaction, 2) communication, 3) imagination and creativity.
Autism and Asperger’s syndrome are in a spectrum.
Column: Problems with Diagnosis
Asperger’s syndrome may not always be considered when giving a diagnosis because the concept has not penetrated the world of child psychiatrists and psychologists in Japan. Also in Japanese medical settings, the time allocated for the first medical appointment is so brief that the children with Asperger’s syndrome may not display any suggestive features in the clinic setting. Parents may be dismissed as being “over anxious” or worrying too much.
When the problems with learning, lack of attention or hyperactivity are more easily noticeable than (sometimes subtle) communication problems, children are often diagnosed as having “Learning Disabilities (LD)” or attention deficit – hyperactivity disorder “ADHD”.
Sometimes because of an intense interest in a topic or activity or resistance to change, some are labelled and treated as having obsessive compulsive disorders (OCD). These confusions can also be found overseas. In the UK, children with Asperger’s syndrome may be diagnosed as having only motor coordination problems (dyspraxia). Also some are diagnosed as having only developmental language disorder (dysphasia).
2. The Characteristics of Asperger’s Syndrome
(1) Difficulties with social relationships
Children with Asperger’s syndrome have a particular style of social interaction. To describe it in a sentence, the individual may not become fully “intune” or involved with others.
“Undemanding babies”:
Many children with Asperger’s syndrome are described by their parents as having been very passive, undemanding babies. Others, however, screamed a great deal of the time and could not be comforted by social means. Both of these types of babies did not seem interested in social interaction even at that stage.
Naive but not malicious:
They may appear Naive or too direct. The child may not understand that unwritten rules of behaviour exist when interacting with others and may therefore unintentionally create trouble with others. However, such acts are not deliberate but may be interpreted as “bad” or malicious. The child may not understand social conventions and may point out the “truth” as they see it thus appearing insensitive to other people’s feelings or “too honest”.
For example, saying “You are fat” to a friend who is rather plump or cheerfully greeting an older teacher, with “Good Morning Old Woman!”
Not understanding “unwritten rules”:
The social interactions of children and adults are governed by unwritten rules of behaviour. Many children with Asperger syndrome irritate other children or may be bullied because they do not understand these rules. The child may incorrectly be regarded as being disloyal or as having bad intentions.
For example, he/she may reveal secrets to others when asked.
Not getting along with peers:
Many children with Asperger’s syndrome initially play alone, but most become interested in others, although they often do not get along with their peers and prefer to follow the lead of an older child when playing or control the play of younger children.
For example, they may seem happy if other children are playing to their rules but will often get upset and withdraw when not getting their own way or the other children make their own suggestions on how to play.
(2) Difficulties in communication
Children with Asperger’s syndrome have difficulties in communication. They do not understand the natural rhythm and reciprocal nature of every day conversation. They can often speak clearly and fluently but do not use this for real two-way communication, tending to throw out words or information irrespective of the effect on the listener.
Overemphasis on details and difficulty in “coming to the point”:
Children with Asperger syndrome often give a lot of irrelevant detail in conversation. This is because they cannot choose information appropriate to the situation and often talk out of context rather than giving the most important or essential information required. They may appear to be teasing but in fact are “dead serious”.
For example, in response to the question “How did you come here?” the reply may be: “Well, I left home at 8:03 a.m., got a number 10 bus …”
One sided conversation, abrupt change of subject:
The child may keep on talking about his collection or obsession regardless of the listener’s interest. This is because the individual is not only intensely preoccupied with the subject, but also realises that this is a “safe” area of conversation as he/she has a lot of information and knowledge to convey. However he/she fails to notice or interpret the reactions of the listener to what is being said.
When the child finishes what he wants to say, the subject may be changed abruptly. The child may think that others are as interested in the subject as they are and assume that others will want to talk about it too. They do not easily understand that other people have thoughts and feelings which differ from theirs and that they may not have the same degree of prior knowledge of the subject.
An idiosyncratic use of words, interest in prosody rather than context:
The child may murmur or whisper, talk excessively to himself, often “thinking aloud”. Some children with Asperger syndrome repeat in a whisper what they have just heard (echolalia) before answering. Others seem more interested in the sounds and rhythm of words rather than their meaning and may repeat puns and familiar phrases.
Incorrect use of language suitable to the situation:
Even if the child seems to speak fluently and correctly, there are subtle mistakes in the use of language. They seem to pick up and use statements from TV programmes or books rather than through conversations with peers. They frequently use expressions learnt from the dictionary. Some boys are ridiculed because they sound more like girls.
Whereas most children understand naturally the difference in male and female use of the Japanese language and discriminate between these different ways of speaking from early childhood, children with Asperger syndrome sometimes cannot make such a differentiation. For example, people around them get confused because they mix formal and informal expressions: “I wouldn’t do such a thing – that’s crap”. Instead of “No, I don’t want it”, a boy would say, “No, thank you”, or “I wouldn’t do such a thing” or “Less haste more speed” and “it never rains but it pours”. The grammar may be correct but the child is not using socially acceptable language and may come across as “too sophisticated”.
Limited understanding and poor expression of intent:
Because they speak well, and can use complex expressions and phrases, their ability to understand and use language may be overestimated. Children and adults with Asperger’s syndrome always find it difficult to conceptualize their own feelings, including the fact that they need help, so they do not put this into words. They may struggle to use simple requests such as “Please help me”, “Can you tell me” or “I don’t understand”. They have enormous difficulty in understanding and talking about emotions, even if they have a huge vocabulary and fluent speech. Also, they do not seem to know that they can use words to affect other people’s more complex behaviour. They know they can ask for an object, which is simple request, but they do not seem to understand that they can ask for something as complicated as help with a task. The child may assume that he/she has understood and offer what they see as an appropriate answer but this will often be out of context. People around them should speak within the limitation of their understanding; language may have to be simplified.
In addition to a limited understanding of language, Asperger children are often easily distracted from following the context of a conversation by external events and stimuli.
Watches, bracelets, hairstyles or details on the speaker’s clothing may create an irresistible distraction, which disrupts the conversation.
Immature “conversation skills” prevent the child from “repairing” or maintaining a conversation when things go wrong or become unclear by asking the partner to repeat, confirm or clarify what they have said etc.
Cannot read “between the lines” or do not understand “ambiguity”:
As they tend to take what is said literally, they cannot deal with ambiguity. They struggle to answer “open” questions, which do not have a clear direct answer. Reading between the lines is difficult especially when irony, sarcasm or idioms are being used in the conversation. Subtle “hints” may be missed. Those around Asperger children need to use less abstract language and check regularly that what they say has been understood. People living or working with children with Asperger’s syndrome should never tease them, even in a kindly way.
For example, when asked “How have you been?”, one child answered, “What do you mean by that? Do you mean to ask if I am fine or about my work? Or are you asking about my relationships with friends?”
When a mother is angry and said, “You are not my child”, a child actually went to check the family registration document.
(3) Problem with imagination and creativity
Children with Asperger syndrome tend to have strong fascinations and a limited range interests. Inflexible thinking can lead to obsessional interests, impairments in imagination, limitations in pretending play, and a tendency to collect facts or objects and a repetitive pattern of behaviours and a liking for routines.
Limitation in pretend or imaginative play:
Pretend plays depends on imagination to be or become a character, “If I were …”
Imaginative plays need to be flexible; changing according to how others play.
Children enjoy imaginative games because unexpected things happen. However, children with Asperger’s syndrome do not have flexibility to deal with unexpected situations; they tend to avoid imaginative play in a group.
Collecting things:
Children with Asperger syndrome often collect objects including popular items such as miniature trains, airplanes or more unusual things such as toilet brushes and till receipts from convenience stores. Older children are often fascinated by facts and statistics such as the number of floors in buildings, or products unique to different countries.
Good rote memory:
Because of having good rote memory skills, they may be good at school subjects which need repetitive practice such as language, history, geography and computer science.
Some will remember facts such as names of classmates and teachers, their birthdays, seating arrangements and the exact sizes of classrooms. But this knowledge is often not an expression of a “social interest”. A child in a kindergarten memorised all other children’s names, birthdays and their horoscope sign and reported to the teacher anyone absent from school or arriving late for class! He was not interested in playing with any of his classmates.
Many children with Asperger’s syndrome and other autistic spectrum disorders love working with computers because, unlike people, computers are so absolutely predictable (that is as long as you know what you’re doing with them!).
Repetitive patterns of behaviour:
Daily routines may be very prominent even when certain actions seem inappropriate for example opening shutters first thing in the morning and insisting on doing so even on stormy days or during a typhoon. Some follow exact routines throughout the day e.g. getting on the train from the same position of the same platform, at the same time and always wanting to use the same car to make a familiar journey.
This can be used in constructive way. A college student said, “I like language because I am not criticized even when I repeat things over and over and the more I repeat the better I get”.
Too serious to be flexible:
Inflexibility may create problems at school. Some get anxious or panic when schedules change unexpectedly or a teacher is absent without prior notice.
Because they adhere to rules, they may criticise students arriving late to school, or on school trips, they are the ones who insist that the lights go out on time. Naturally this does not make them popular with their peers or classmates.
Good at imitation:
Many children with Asperger’s syndrome are good at imitation. This is different from pretend or imaginative play as they tend to reproduce exactly what TV characters say and do in “on screen” scenes. Some children actually “become” the TV animation character but are unable to develop the character beyond the well-known TV programme scenarios.
Interest in TV Programmes and books:
Children with Asperger syndrome often like documentary films or medical programmes and may enjoy visual humour or slapstick comedy programmes.
They may enjoy science fiction, stories with clearly defined heroes and villains. Very few get interested in stories that portray complex human relationships. They are more likely to be interested in the factual information found in an encyclopaedia or dictionary. Teen-age students may be interested in history topics, science fiction, medical or crime stories. They rarely show interest even as adults in novels depicting the psychological aspects of complex human relationships.
(4) Other problems
*Sensory sensitivity
Sound sensitivity:
Sensitivity to particular sounds may be one of the first features to be noticed in a child with Asperger syndrome. They may like certain sounds or hate loud ones. Some children are sensitive enough to notice the subtle difference in tone, which may make it hard for them to be part of a choir when some children are out of key.
For example, they may be upset at the sound of the starter gun at a school sports day. They may not tolerate the noise of a crowd or a restaurant. Some can identify the model of car by it’s engine sound or differentiate types of train by in the same way.
Visual sensitivity:
This may manifest as an obsession with certain marks or logos often learning Chinese characters or alphabet from an early age. Some wear sunglasses to avoid bright sunlight. When visual sensitivity affects reading, they may have trouble in learning or making progress with academic work.
For example, when reading they are attracted by the shape of Chinese characters and take some time before understand the meaning. There may be a strong fascination with certain complicated Chinese characters.
Sensitivity to taste:
Taste sensitivity may result in a child only eating certain foods. In some extreme cases, children eat only a particular brand. This may be interpreted as difficult behaviour they may be experiencing an unpleasant taste sensation for items enjoyed by most people. The visual appearance of food may also be a factor; this may be overcome at times by cooking.
For example, one child will enjoy Brand A pouch curry but refuses brand B. Another refuses to go to school as his teacher may insist that he eat all his school lunch.
Sensitivity to smell:
Some hate the smell of perfume or hair shampoo but often will not be able to explain what the problem is. Problems with smells may be hard to detect especially if no one thinks of the possibility. Sensitivity to body odour or bad breath may result in a child refusing to join a group. Without meaning to cause offence some may point out to other children that they “smell” or have bad breath.
For example, some children may refuse to use the toilet at school or avoid the swimming class, as they cannot tolerate the smell of chlorine in the pool. Others may be intolerant of teachers wearing perfume.
Tactile sensitivity:
When asked about infancy, some parents will remember that the baby did not enjoy being held or cuddled, often becoming rigid with head thrust back rather than snuggling up to the parent. This may represent the early indication of a tactile sensitivity. This may be one of the reasons why many babies who were later found have Asperger’s syndrome did not ask for or want social attention, and were described as very undemanding in infancy.
For example:
– Some like the texture of smooth surface, or stuffed animals and carry them to stroke.
– Some do not like the label tag of shirts and take them off or want to wear loose clothing as they do not like tightness.
– Some hate to be touched or hugged.
– Some hate to have ear wax removed or have a hair cut; if this is attempted when they are asleep, they will wake and become distressed.
Sensitivity to pain:
Some appear too sensitive to pain but at other times the same children may not respond to an accident or injury which would be very painful for most people.
For example:
– They show strong anxiety to have injection.
– Even if touching something hot, they do not withdraw the hand immediately.
*Movement
Stereotyped Movements:
Some children with autism, especially with severe leaning difficulties, have repetitive movements such as rocking the body back and forth, jumping up and down or flapping the arms when excited or flick their fingers in front of their eyes. These stereotyped movements are less commonly seen in young children with Asperger syndrome but may become apparent facing exams or when people are not looking.
Motor co-ordination:
When the child walks or runs, the movement is often awkward or clumsy. Sometimes the child seems to run into the furniture for no good reason. In elementary school they often have problems with physical education and experience difficulty with the balance beam or ball games. (This may also cause problems with playground games and activities.)
Manual dexterity:
Some of the children have problem with craft activities requiring fine motor control and others may have very poor handwriting skills as if “a spider has walked over the page!” These motor problems do not reflect the intelligence of the child. Some able children at middle school level may not use chopsticks properly. However a few children have particular skills such as spinning a top or playing the piano.
*School work
Children with Asperger syndrome may achieve scores ranging from top marks down to below average marks in all subjects at school. Most of them are in mainstream classes until the age around 10 but as they get older their difficulties with learning and social interaction become more apparent and some move to special units attached to mainstream schools.
Many enjoy Social Studies and Science and can acquire detailed knowledge from textbooks and illustrated encyclopaedia. Some learn by rote many idioms from Chinese character dictionaries or proverb dictionaries. Some goes to college and study hard but continue to have difficulty in planning their work and with laboratory work.
Problems with writing:
As explained above writing may be difficult and very untidy with frequent errors in writing characters, which sound the same in Japanese or producing even simple Chinese characters. This may occur with children with good ability and capable of achieving good results in school. Some produce mirror image writing reversing the left to right orientation of Chinese characters on the page.
Problems with mathematics:
Although many have good calculation skills, some have an idiosyncratic way of calculating. For example when working out “47-15” they may choose to add 3 to 47 to make 50 first, then subtract 15 and then 3 to get the correct answer!
There may be more difficulties coping with written problems. However rote multiplication and division skills may be excellent even with large complex numbers and fractions. A few children are able to make accurate calendar predictions far into the past or future; for example naming the day of the week for July 4, 2025. This aspect of schoolwork may be an area of special weakness in some children with Asperger’s syndrome, in contract to those who have remarkable skills with calculation etc.
*Challenging behaviour
Some children with Asperger syndrome have challenging behaviour such as being defiant to teachers or doing some thing to upset or annoy other children. This may or may not be a deliberate act. Many problems arise out of misreading of the situation. A few children seem aggressive. However, it is rare for Asperger children to be violent by nature. Challenging behaviour is often the result of anxiety and fear stemming from a lack of understanding of fellow students or teachers’ expectations.
3. Strategies to Help Children with Asperger Syndrome
It is vital to have a good understanding of this syndrome if we are to support these children and develop strategies to help them cope with school and home life as well as other social situations.
Challenging, inappropriate or odd behaviour, should be interpreted in the context of our understanding of the condition. These behaviours may not be intentional or directed at individuals with the intention of causing harm. Many behaviours are a direct manifestation of the condition. Others are a reflection of the child’s personality. It is essential to analyse carefully the possible triggers and “reasons” factors for any “difficult behaviour”.
The following strategies may help children with Asperger syndrome.
Creating a secure environment:
Having a safe and calm environment is essential as the child may react to a noisy setting and will become upset or too aroused when there is a lot of stimulation. Scolding or shouting may have an adverse effect; one should talk firmly but calmly.
When an adult loses his/her temper, the child easily becomes overwhelmed by the emotions being expressed and may not understand anything other than the “rejection”. They may not follow what is being said or what is expected of them at the time.
Changing behaviour over time:
Changing a child’s behaviour often takes a long time as it involves replacing long established patterns of reacting or behaving with new ones. Most challenging behaviour should improve over time if appropriate measures are taken and applied consistently. It is essential to have realistic expectations and targets, given the child’s developmental level. Occasionally behaviours change in a positive way with maturity (e.g. hyperactivity may reduce) but others will require direct intervention. If one expects the child to deal with the situation by himself without help he may lose confidence or become even more self directed, choosing to do what he wants all the time without regard to others. It is essential to engage and involve the child in any programme to change behaviour if at all possible.
Making rules and directions clear:
For children with Asperger syndrome “unspoken or unwritten rules” are difficult to understand. Rules should be clear and should reflect the child’s level of language understanding and general ability. The child may not understand ambiguity, implied meaning or inference and sarcasm. Making instructions visual may help e.g. writing out rules and putting this on display (this may be helpful for all children in a class setting).
If the child keep asking irrelevant questions or talking out of context to the situation specific instructions may help e.g. saying: “I cannot talk about it now here … you need to wait till break time …” or “You can talk about this for another 5 minutes … or till I ring this bell”. Trying to limit the time or place when/where something occurs is often a good strategy.
Using schedules or visual time-tables:
The child might get distressed when unexpected things happen or change occurs. To minimise this it helps to give clear advance warning about what is going to happen next and where it will take place. Pictorial or visual schedules using line drawings or photographs (or written ones for more advanced pupils) help with this. In real life, however, things do not always go as planned. It is important to teach this concept by introducing a change symbol so that the child is more able to deal with the unexpected when it occur even with little prior notice.
For example:
– Use pictures or symbols to make up daily or weekly schedule or sequence of activities / events
– Try to minimise unnecessary changes
– When change is to occur, try to give notice and prepare in advance
– Also indicate when activities are to finish
– Always notify what will happen next
– When change is necessary, implement it gradually
– If at all possible “practice for change”
Protection from bullying:
Children with Asperger syndrome can often be the target of bullies. It is impossible for them to resolve this problem without help. Because they often cannot or don’t want to tell that they are being bullied and will not talk to teachers or parents it is necessary to supervise them closely or to implement a “buddy” system or organise peer support through schemes such as “Circle of Friends”.
Promoting positive interactions:
Because the child is often sensitive to negative comments or attitudes, even trivial teasing and may have excellent long-term memory, they tend to remember negative experiences for a long time. One child remembered being scolded by the teacher at the age of 6 years and wrote a protest letter apparently “out of blue” when he became an adult.
During adolescence, the individual may become increasingly aware that he is different from others and feel depressed. This is often the result of feeling isolated and unable to make friends or interact successfully with the peer group. They may spend long periods alone in their room or playing computer games or involved in a favourite activity.
At elementary school level, because they tend to do things which attract reprimands or scolding from teachers, they might lose confidence and develop poor self-esteem. By recognising strengths and positive features about the child and offering praise frequently it may be possible for the child to maintain a more positive self-image.
Not to be selected as the sole person to be told what to do:
People with Asperger’s syndrome also strongly object to being selected as the sole person to be reprimanded and told what to do. The best approach is to present rules as applying to everyone in the household, class, or school. For example, do not say “You must wash your hands before lunch”. Instead say, and write down or illustrate in some way that can be understood, “Everyone in the class must wash their hands before lunch”.
Utilising special interests for motivation:
If adults try to change the child’s special interest, this may prove very difficult and in many cases the interest may change spontaneously at some point. It is more productive to use and work with special interests if they are not dangerous or harmful. For example, the child with a strong interest in trains may be motivated to learn Chinese character for the names of train stations, or take an interest in geography as it relates to train lines and routes. They may go on to learn basic scientific principles from the functioning of train engines One should promote interests to grow in a positive direction.
4. Asperger’s Syndrome in Adolescent and Adulthood
Most of what we have said so far relates to children. Most of this also applies to adults with Asperger syndrome. Although the features of Asperger syndrome can be recognised during childhood, many features will change gradually as the child gets older but in principle the condition is a life long one.
It is not unusual for the diagnosis of Asperger syndrome to be made in adulthood. In order to diagnose, it is necessary to confirm that the person has significant difficulties in social interaction, communication and flexibility of thought at the time of the examination and that these have been present from early childhood. Therefore it is essential to take a detailed family and developmental history from people who know the person well.
Work
People with Asperger syndrome tend to work conscientiously, obey rules and often focus on the quality rather than quantity of their work (i.e. have a perfectionist streak). If the type of work and the environment is suitable and supportive they can fully utilize their ability.
In order to facilitate continuing employment, it is necessary to deal with the inevitable changes in the work place in a timely and appropriate way using the principles previously mentioned.
Work is vital in utilising one’s ability in maximising one’s mental and economic potential. However, in reality, many cannot get a job or remain in employment. In order for people with Asperger syndrome to work effectively, the understanding and support of employers and work colleagues is essential.
A beginning
What is Asperger’s syndrome? You may know that people who have this syndrome find it hard to relate to people around them. They may sound a little awkward in conversation, and sometimes seem to act oddly. Asperger’s syndrome, a type of autism, affects the way the individual views the world; they see it a little differently from the “majority”. Because this syndrome has only recently become known in Japan, there are unfortunately misconceptions and prejudice caused by a lack of knowledge.
Have you learned a little about Asperger’s syndrome? In Japan there are few professionals involved in this area and information about this syndrome is scarce. It is our wish that this booklet will contribute towards a greater awareness and understanding of this fascinating syndrome.
To understand Asperger’s syndrome is to know something about the difficulties it presents for those with this condition. The aim of this booklet is to help the reader understand the condition by describing it as accurately as possible. It is the writer’s sincere wish that it will be of help to many people as a first step towards understanding this syndrome.
Professionals should be aware of the most recent medical and psychological research and management strategies available. Accurate diagnosis is essential; careful assessment by a multidisciplinary team should lead to an individualised intervention plan.
As each individual has to be supported in a different way, this booklet can only outline the general principles of good practice. For more detailed information, please refer to the web page of the Tokyo Chapter of Autism Society Japan where a more comprehensive version of the booklet is available.
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Author:
Tokio Uchiyama, M.D.
Director, Yokohama Psycho-Developmental Clinic
Associate Professor, Human Relations Faculty, Department of Human Welfare, Otsuma Women’s University
Foreword written by:
Lorna Wing
Consultant Psychiatrist, Elliot House Centre for Social and Communication Disorders
Bromley, Kent, United Kingdom
Copyright 2002. The Tokyo Chapter of Autism Society Japan. All Rights Reserved.
The Tokyo Chapter of Autism Society Japan
National Welfare Foundation for Disabled Children Bldg. 3F
2-2-8 Nishi-waseda, Shinjuku-ku, Tokyo 162-0051 Japan
Phone & Fax : +81-(0)3-3232-6169
