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Journeying into adolescence with Asperger's Syndrome

Vol.23, No.3, March 2007
1. Journeying into adolescence with Asperger's Syndrome
2. Related articles in the CRN web site

Journeying into adolescence with Asperger's Syndrome
An interview with Margaret Klitzke, D.O.

CABL: First, there appears to be some debate about whether Asperger's Syndrome is the same as high-functioning autism or if it even belongs on the Autism Spectrum at all. Briefly, what are the fine points of this debate? How do you define Asperger's Syndrome in your work?

MK: In almost any book or lengthy article one picks up these days, this debate is waged and it is important. I think that historically there may have been little differentiation by clinicians in how children on the Autism Spectrum presented, but now, as neuroscience and brain imaging advance, and more sophisticated clinical understanding comes into play, we are separating out each of these diagnoses - at least clinically speaking.

The diagnosis of Asperger's Syndrome is clearly defined in the DSM-IV (See this month's handout for the full DSM-IV criteria). However, in working with these children and teens, there is great variety in how they present. One child may be more anguished at having few friends; another may be less aware of their social deficits but be more troubled by the results of their own rigidity in facing the world.

What has your work with individuals with Asperger's Syndrome shown you about the transition into adolescence and young adulthood for these children? How might an individual with Asperger's Syndrome respond to a growing awareness of his or her unique qualities?

The transition from childhood to adolescence and into young adulthood can be challenging for any child, but this is particularly difficult for people with Asperger's Syndrome. Many such children cope reasonably well in early childhood with the support of close family members. But as social demands and greater independence become the developmental challenges in the teen years, it can be almost overwhelming for teens with Asperger's Syndrome.

Teens with Asperger's Syndrome take a wide variety of paths in adolescence. Many observe their peers and, while they very much want the things their peers have - such as being able to approach the opposite sex, embark on dating, "hang out," learn to drive, "just have friends" - they are frequently at a loss as to how to get these things. They may try here and there to approach other kids and be treated as "weird" or be ignored. Some young people respond to this rejection by getting depressed or withdrawing. Other Asperger's teens manage to find their niche - in the Drama Club, playing chess, or doing a non-team sport - and develop a pretty supportive group of friends.

Is depression of particular concern in adolescents with Asperger's? Does this population require a different approach to treatment?

Teens with Asperger's are at higher risk for developing depression, which makes sense since they realize they are different from their peers but really are at a loss as to how to help themselves. In terms of treating the depression, the approach pharmacologically would be the same as when treating a healthy child. But other interventions such as group therapy and social skills groups would be imperative.

CABL: How can parents or other caregivers participate in helping a child cope with this transition?

This can be a terribly painful time for parents. We all want our kids to have friends, be included, and feel happy and self-confident. In the teen years much of this is mediated by a child's peer group. But if a child has trouble negotiating relationships, then they are really in a Catch-22. Kids need good social skills groups either in school or out of school so that they can get support and feedback in a safe setting. Activities that provide socialization in a small group, such as Boy Scouts or a church group might help a teen. In addition, parents can help their children by talking about social interactions the child experiences or observes.

CABL:What about the adolescent who refuses to engage in social interactions?

The adolescent who refuses to socialize can be very challenging! Parents become frustrated and sad; the child may feel hopelessly stuck. I have a young teen with Asperger's Syndrome who found it comforting to be home with his video games and favorite TV shows. He started eating his meals in his bedroom. He refused all bids by his family to go out, and it became easier for everyone to leave him alone. But over time, he became more withdrawn, he was oblivious to the need to clean up after himself - his room was a mess, dishes were everywhere, and he refused to do anything. His parents decided they had to do something and they negotiated, in a very concrete way, in small incremental steps to include their son in their family life. The treats or rewards were things he wanted or even well-defined periods of time to himself.

CABL: Are there resources that might help parents navigate this transition?

There are many resources available to parents. Probably the most helpful single resource is the Internet, which can link people to support groups on- and off-line, to published material and videos. As the recognition of Autism and Asperger's Syndrome grows, more communities have support groups for parents and siblings. Being part of such a group is probably more helpful than any other intervention, by helping people realize they are not alone.

CABL:What about non-Asperger's siblings of persons with Asperger's Syndrome? How do siblings experience this period? Can they play a role in easing the transition?

Probably every sibling has experienced the full gamut of emotions from shame and embarrassment - in the face of some public meltdown - to profound feelings of love - in the face of their sibling's courage to go through with some challenging task, like attending a classmate's birthday party. One sibling of one of my patients described her brother with Asperger's Syndrome as being the person who had most influenced her, and she was profoundly grateful for the life lessons her brother had given her.

Siblings can help their Asperger's Syndrome brothers or sisters by including them in social situations or by explaining the condition to their friends. But siblings should not be expected to shoulder more than they are able to. Otherwise, they risk becoming resentful and emotionally distanced from parents and other family members.

Asperger's Syndrome is often associated with obsessive routines or interests. How might a teacher address this in the classroom?

Obsessive routines or interests can certainly interfere in a classroom. However, a teacher can also use this to his/her advantage. Have students do projects or papers on special topics of interest; help a child develop routines that will bolster organizational skills; modify, modify, modify homework assignments; allow word processing computers for in class and out of class work to minimize a child's possible difficulty in writing. Also, allowing breaks to leave the classroom or to be alone if necessary may be helpful.

If a child is absolutely drawn to engage in a ritual, make it as adaptive as possible to minimize alienating the child. For example, a child who likes to "stim" on a 6-inch shoelace with both hands might be allowed to hold a small rubber band in one hand that he can play with.

Adolescence is obviously also a time of great physical change. Are there techniques for addressing an Asperger's teen's budding hormones and sexuality?

As with any other budding teen, information about bodily changes should be factual and given in as much detail as a teen can handle. Also, masturbation should be viewed as a normal part of growing up and one rule should be clear and unwavering about this: in your room with the door closed, if the room is shared, then in the bathroom with the door closed. If parents are straightforward and willing to answer questions, it will reduce anxiety and embarrassment.

Helping a teen negotiate dating may require more creativity. Parents or counselors may need to go through the steps of dating in a very concrete, simplified way because the nuances of a relationship frequently completely escape the teen with Asperger's Syndrome.

How can parents and teachers begin to prepare an adolescent for more independence as he or she approaches young adulthood?

The teen with Asperger's Syndrome may successfully complete high school, but then what? Parents should consider continuing to receive services from schools or outside agencies as long as possible. Transitional programs which bridge high school and college or work exist in many communities. These programs help the individual develop work skills while they simultaneously cultivate skills in activities of daily living - learning to cook, pay bills, maintain an apartment, learning to ride the bus - as well as building up social ties.

In adulthood, finding a job that is intellectually challenging in a work environment that is tolerant of the eccentricities of someone with Asperger's, while at the same time not being too socially demanding, can in itself be a challenge. Many folks find work that can be more autonomous such as computer science or accounting. But some people find themselves well educated and well trained but unable to hold a job because of their problems interacting socially.

Again, parent support groups can be enormously helpful to find out what is available in any particular community.

Margaret Klitzke, D.O., is Associate Medical Director, Center for Autism and Developmental Disabilities, Bradley Hospital. She is also Clinical Assistant Professor in the Department of Psychiatry and Human Behavior, Brown University.

The Brown University Child and Adolescent Behavior Letter, March 2007
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