People with Asperger’s usually collect labels like ADHD, anxiety disorders, or bipolar disorder before they’re diagnosed with AS. The label that annoys me is Oppositional Defiant Disorder. Is there a difference between people whose Asperger’s-related behavior is misunderstood and ODD? I find that ODD is sometimes simply a description of behavior without a cause.
Insurers ask for diagnoses based on ICD 10, the “handbook” of diagnoses. One of the official ICD 10 descriptions of AS is that it’s a “neuropsychiatric disorder whose major manifestations is an inability to interact socially; other features include poor verbal and motor skills, single mindedness, and social withdrawal.”
ICD 10 describes ODD as a behavior disorder and a psychopathological disorder. It’s described as a “recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures.” The criteria include “frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with requests or rules of adults, deliberately annoying others, blaming others for own mistakes, and being easily annoyed, angry or resentful.”
ICD 10 is right in my experience in describing those with Asperger’s Syndrome as “single minded.” This is a real strength when doing tasks, following rules and being honest. However, single mindedness can also include inflexibility or even severe rigidity in sticking to a point of view.
When an inflexible demand is made of an inflexible person, you have rigidity meeting rigidity. That’s not going to work. For people with AS, what’s being perceived as oppositional, hostile or rule breaking is actually more about having a fixed way of viewing the world.
Especially when rules or demands seem illogical or unfair, those with AS can dig in and stand their ground. Many with AS and NLD also have concrete or literal thinking, which adds to the mix of misunderstanding and “rule breaking.”
As most teens and adults with Asperger syndrome know, people with Asperger syndrome can be significantly depressed. The rates of diagnoses of depression vary among studies, from 18% to 22%. The most commonly quoted rate of a depression in the general population of the US is 6.7%. Most of the research shows both genders have these high rates of depression.
Studies focused on males and females and not those who are transgender. There are more people who identify as transgender in the AS population than in the general population and transgender people have a higher rate of depression. One would guess that someone who is both AS and transgender might have a high tendency towards depression.
Interestingly, non-autistic full siblings and half-siblings of individuals with ASD (not just Asperger syndrome) also had higher rates of depression than the general population, although at half the rate of those with ASD. Studies of suicide attempts are also very troubling. In studies of suicide, the rate of suicidal thoughts and attempts are prevalent, especially in adolescence and young adulthood.
It’s critical to identify depression, since it can be treated.
It’s obviously important to understand why rates of depression and suicidal thoughts are so high. One factor, given the findings in siblings, is that there is an increased genetic vulnerability to depression, although large studies haven’t supported a common genetic overlap. We have to look to other factors to account for these high rates of depression.
It’s important to diagnose clinical depression for anyone for a simple reason – depression is treatable with a variety of modalities:
Anxiety-related symptoms are frequent concerns in children, adolescents and adults with Aspergers and HFA, which may be treatable with Cognitive Behavioral Therapy.
Anxiety is commonly found in high functioning individuals on the spectrum in particular because they have an increased awareness of their own social difficulties. This cognitive awareness may intensify their anxiety toward social interaction and promote isolation.
Recent numbers found that 11-84% of children on the autism spectrum experience impairing anxiety, while only 4.7% of all children aged 3-17 years have experienced anxiety.
Cognitive Behavioral Therapy (CBT) is a type of psychotherapeutic treatment that helps individuals recognize how thoughts and feelings influence behavior and cope with these challenges.
CBT is used to treat a wide range of issues, in addition to anxiety, including:
When a child with Aspergers or High-Functioning Autism demonstrates challenging behaviors, we tend to blame the child’s autism. However, these challenging behaviors are not a byproduct of autism, rather learned due to ineffective means to get needs met—especially when there are barriers to communication.
Bottom line: if an individual does not have a way to communicate appropriately, he or she will find a way to communicate in another way (e.g. screaming or hitting).
Keeping in mind the ABCs of behavior from our previous post, let’s discuss the key to changing behavior.
Behavior is changed when we know the function—or purpose—of the behavior.
As I mentioned in my previous blog, there are thousands of published research studies to support the effectiveness of ABA in treating autism and Aspergers. Specifically, ABA seeks to decrease challenging behaviors and increase appropriate skills that are seen in many individuals with autism or Aspergers.
To help understand what your ABA therapist seeks to accomplish, let’s cover what these terms mean:
Challenging behaviors refer to those behaviors that put the individual in danger, put others around them in danger, or prohibit/limit a person’s use and access to community facilities (Emerson et al., 1987).
Let’s say a 12-year old with high functioning autism, “Jake,” told his overweight teacher that she is fat. The teacher, who was very insulted by the comment and the conversation that followed, sent him to the principal’s office for bad behavior.
From Jake’s perspective, he didn’t understand why he was in trouble for telling the truth. If Jake engages in these types of behaviors regularly, he may soon be unable to access his general education classroom.
As such, this behavior is considered a challenging one that an ABA therapist can help address.
On the other hand, appropriate skills refer to skills that a person needs to be successful. Those skills take into account the person’s chronological age and their cognitive level of functioning.
Appropriate skills include the following:
Announcing a new resource on Aspergers101! Today we launch Aspergers 101 Frequently Asked Questions section. We polled the 101 top requested questions on Asperger Syndrome and put them in one place for those seeking information on High Functioning Autism or Asperger Syndrome! These questions range from the origins of Asperger Syndrome, the early signs all the way through adulthood. Some questions merited a one word response while others provide you with a detailed bullet-point answer. We would like to thank our underwriting sponsor: The Starfish Social Club for supporting and providing you this on-going free resource! To access Aspergers101 FAQ page either click on the ad below or it will be permanently available at the top menu bar on our website under the “Asperger Syndrome” tab.
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We are all vulnerable to black and white thinking during times of emotional distress: “He NEVER appreciates the sacrifices I make!” or “She ALWAYS chooses work over time with me!”
Children and young adults with Aspergers are no different—except they may be more vulnerable to polarized thinking. These emotional regulation difficulties stem from differences deep within their brains, along with other extraordinary gifts such as strong attention skills or heightened visual and auditory detail.
The cost of this gift may appear as limitations in the ability to see the big picture and the social nuance (or gray areas) of a situation. This means that many Aspies are susceptible to assessing daily bumps on the road of life as fixed, rather than flexible.
I’m emailing with Kris Jones, an eloquent writer on Linkedin about his Asperger’s Syndrome. We’re talking about the stressors he experiences that can create extremely self-limiting anxiety. We’re going to use several blogs to talk about different stressors. Kris’s first stressor was his lack of self–fulfillment. One of the causes of this lack of self-fulfillment was Kris’ social anxiety.
Tony Attwood, expert on Asperger’s Syndrome, suggests that around 65% of adolescents with Asperger Syndrome have a secondary mood or affective disorder (such as depression or anxiety); most have anxiety.
Kris describes his thoughts and feelings which I’m calling social anxiety like so: “No one likes you. No one wants to know you. You are not interesting. Stay where you feel most comfortable – inside your house and away from others. You are not fit to be out there amongst the human race.” He says that this is representative of how he feels and it is what keeps him from going out and mingling with others his age. Even though he knows these thoughts about himself aren’t true, he can’t get past the anxiety.
Let’s break this down into parts. What causes this social anxiety?
Social Communication Disorder is marked by difficulties with pragmatics—aka practical everyday use—or the social use of language and communication. Therefore, SCD is concerned with an individual’s use of verbal and nonverbal social communication in everyday life.
The condition is of particular interest to individuals with Aspergers or HFA.
In the DSM-V, it specifically states that individuals who have marked deficits in social communication but whose symptoms do not otherwise meet the criteria for autism spectrum disorder (ASD) should be evaluated for social (pragmatic) communication disorder.
Sensory processing disorder (SPD) can make participation in life activities—what occupational therapists refer to as occupations—very difficult. Luckily, there are options and strategies to help improve sensory processing and make life much smoother and more enjoyable.
Sensory-based occupational therapy (OT), may look like play to adults, but to the child it is their work and necessary for improving overall abilities to process sensory information more appropriately. Jumping, swinging, climbing and playing in multisensory mediums—such as shaving cream, beans, rice, or play dough—all have a place in their growth and the development of sensory processing abilities.