Asperger's / Autism

What Type of Therapy is Best for Asperger's/Autism?

Ordinary therapy is not usually indicated for autism; in fact, talk therapy would be relatively impossible for autistic children, and only useful with higher functioning adults or with clients diagnosed with Asperger’s disorder. This disorder is sometimes called “the little professor” syndrome, as children with this diagnosis do not show the intellectual delays associated with autism, and, unaware as they are of social cues, may tend to show-off their knowledge, in addition to becoming extremely interested in one or two areas of knowledge, another symptom of autism spectrum conditions.

A good therapist can identify the signs of autism, help rule out other possible causes of the child’s behavior (perhaps with the assistance of other professionals),  and refer the child to a specialist in behavioral therapy, most commonly Applied Behavioral Analysis, the approach with the most proven success. Adults with autism, especially milder forms, and children and adults with Asperger’s may benefit from talking therapy in order to overcome social isolation, though they are unlikely to seek such help as this situation usually does not bother them – it bothers their families.

• DSM Definition of Autistic Disorder
• DSM Definition of Rett's Disorder
• DSM Definition of Childhood Disintegrative Disorder
• DSM Definition of Asperger's Disorder
• DSM Definition of Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)
• Adolescent Boy with Autism - Case Example
• Autistic Middle Age Woman in Therapy - Case Example

DSM Definition of Autistic Disorder:

(A) Total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

1.    Qualitative impairment in social interaction, as manifested by at least two of the following:

• Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

• Failure to develop peer relationships appropriate to developmental level

• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

• Lack of social or emotional reciprocity

2.     Qualitative impairments in communication as manifested by at least one of the following:

• Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime)

• In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

• Stereotyped and repetitive use of language or idiosyncratic language

• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

3.     Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

• Encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus

• Apparently inflexible adherence to specific, nonfunctional routines or rituals

• Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

• Persistent preoccupation with parts of objects

(B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

(C) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

DSM Definition of Rett's Disorder:

(A) All of the following:

• Apparently normal prenatal and perinatal development

• Apparently normal psychomotor development through the first 5 months after birth

• Normal head circumference at birth

(B) Onset of all of the following after the period of normal development:

• Deceleration of head growth between ages 5 and 48 months

• Loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing)

• Loss of social engagement early in the course (although often social interaction develops later)

• Appearance of poorly coordinated gait or trunk movements

• Severely impaired expressive and receptive language development with severe psychomotor retardation

DSM Definition of Childhood Disintegrative Disorder:

(A) Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

(B) Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:

• Expressive or receptive language

• Social skills or adaptive behavior

• Bowel or bladder control

• Play

• Motor skills

(C) Abnormalities of functioning in at least two of the following areas:

• Qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)

• Qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

• Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

(D) The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.

DSM Definition of Asperger's Disorder:

(A) Qualitative impairment in social interaction, as manifested by at least two of the following:

• Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

• Failure to develop peer relationships appropriate to developmental level

• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people(e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

• Lack of social or emotional reciprocity.

(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

• Apparently inflexible adherence to specific, non-functional routines or rituals

• Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

• Persistent preoccupation with parts of objects

(C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

(D) There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

(E) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

(F) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

DSM Definition of Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism):

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes atypical autism --- presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

Sometimes, these disorders, with exception of Rett’s, are referred to as “autism spectrum” because they have much in common with Autism, the most commonly diagnosed of the group. Autism is a controversial diagnosis, as its incidence as increased tremendously over the last few decades, and because its criteria are widely debated. Some clinicians believe that the ability to communicate verbally at a functional or near functional level rules out autism; others diagnose autism more readily, despite DSM guidelines. In addition, new behavioral treatments (especially if applied during childhood) have shown great success in improving the social behavior of autistic individuals, whereas in the past autism was seen as, at best, manageable with intensive support and structure, its symptoms essentially fixed. Finally, the causes of autism are essentially unknown, although there seems to be a strong genetic component. Several advocacy groups have insisted that chemicals in childhood vaccines are responsible, but a great deal of research does not support this, and leading medical groups, including the AMA and CDCP have ruled out this theory. Still, the increase in autism diagnoses does coincide with an increase in the use of certain chemicals in vaccines, and the theory remains popular, neither proven nor disproven.

Adolescent Boy with Autism - Case Example

David, 12, was diagnosed as autistic as an infant, but his intellectual skills indicate he has Asperger’s disorder. He wants to sit by his computer all day, and cannot get along at school. Even in a special school, he is isolated from the other children, and constantly brags about his supposed intellectual superiority. He has a good if bizarre sense of humor, but no clue how to get along with other people. His parents bring him to therapy in the hopes of “normalizing” his behavior “just a little bit”, and, thanks to David’s fair intelligence and his desire “to stop getting beat up” his therapist is able to make some progress, helping David understand that he can choose to get along with others, that others may offer him something enjoyable sometimes, such as a joke or new computer game, and how to begin learning social cues and speaking appropriately with others. The therapist also helps the parents set realistic goals for David, and continue teaching him social skills at a reasonable pace.

Autistic Middle Age Woman in Therapy - Case Example

Jaycine, 39, is autistic and lives at home with her aging mother. The two come to therapy, but Jaycine cannot participate much, as she is almost completely nonverbal, and is uninterested in any relationship but the one with her mother, on whom she is entirely dependent.  The therapist helps the mother identify her choices, and when the mother decides it is time for Jaycine to move out, refers the family to a group home, and helps Jaycine’s mother work through feelings of guilt and grief.

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