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Asperger Syndrome and Strength-Based Assessment

Asperger Syndrome and Strength-Based Assessment

This post will look at using a 'strength based approach' to working along side people with an Autistic Spectrum Condition, especially Asperger Syndrome. Strength-based approaches move beyond the significant focus often placed on deficiencies. They support the view that people with congnitive or physical disabilities or neuro-differences also have identifiable strengths, and that focusing on these can can have important results in terms of self-esteem inprovements and overall quality of life.

The 'deficit based' approach that is often taken most commonly compares the dysfunctional aspects people with autism to what might be referred to as a 'neurotypical profile'. Medical assessments of Autistic Spectrum Conditions (ASCs) including Asperger Syndrome (AS), and diagnostic manuals such as the International Classification of Disease and the Diagnostic and Statistical Manual of Mental Disorder in particular, also focus almost entirely on difficulties and deficits, rather than on strengths:

 A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by the following, currently or by history (examples are illustrative, not exhaustive):

  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
  3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):

  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
  4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
    (DSM-V 299.00)

In parallel with a move towards more strength-based approaches generally, the field of positive psychology has grown  in response to perceptions that psychologists have historically been too focused on the reduction of pathology while neglecting other important aspects of the human experience that allow individuals to grow and to flourish. 

Two examples of a 'traditional assessment' and case notes and a 'strength-based assessment' and case notes are provided here and taken from Cosden et al. (2006):

Example One - Traditional Assessment of Johnny

Johnny is a 12-year-old boy diagnosed with autism but appears to be on the high-functioning end of the autism spectrum. Testing and class performance suggest he is functioning in the average range cognitively. However, he exhibits considerable difficulty socially. During break time and lunch, he prefers to play by himself in the computer room. The school staff believes that his excessive interest in computers interferes with his ability to develop appropriate peer relationships. Even when other children or an adult points out what a good job he does on a computer project he does not acknowledge the compliment. Johnny is significantly delayed in pragmatic areas. For example, when he is with other children, he repeatedly offends them by making negative comments about their attire (e.g., Your pants are too short), or their physical characteristics (e.g., Why is your nose so big?). Furthermore, on the rare occasions when he interacts during a group game, he is rigid and inflexible on the rules, which irritates his peers. Further complicating the problem is the fact that his parents visit the school on a daily basis, sometimes watching from the outside of the school grounds and make regular demands on the school staff to prompt him to play with the other children.

Example Two - Strength-based Assessment of Johnny

Johnny is a 12-year-old boy diagnosed with autism. Testing and class performance suggest that he is functioning well within the average range cognitively. At this point, he prefers to interact with adults or go to the computer room at lunch and break time. One of Johnny’s strengths is his complete honesty. He has never been known to talk behind another child’s back, but he does have a tendency to comment on personal attributes at inappropriate times. He would benefit from instruction on appropriate times for commenting. In addition, Johnny is good at memorising rules of games. It may be helpful to use this strength during group activities by having him referee the games. Johnny also has an intense interest in computers and will seek them out during his free time. His computer projects are usually the top of his class, but he never boasts or brags about his work. It is recommended that a school club relating to computers be developed. Johnny’s participation in such a club would accentuate his strengths in this area while also helping the other children. Finally, Johnny’s parents are motivated to help him and have the time to assist with his intervention. It is recommended that they coordinate with the school in developing his peer relationships by setting up after school activities relating to Johnny’s interests. The school can assist by providing the names of children who participate in the computer club and who engage in other activities that Johnny enjoys.

 

It is noted above that Johnny has "an intense interest in computers". About 90% of people with Asperger Syndrome are thought to display "highly restricted, fixated interests that are abnormal in intensity or focus". These are often referred to as 'Specific Interests' or 'Special Interest Areas' (SIAs). The parents and teachers of children with AS often view these as negative, socially hindering and sometimes bothersome behaviours to be controlled and prevented, rather than behaviours to be encouraged. Hans Asperger himself observed that "a special interest enables them to achieve quite extraordinary levels of performance in a certain area".  Whilst Asperger considered such a focus on special interests to be a 'gift', this should not be interpretted, as is commonly and sterotypically held, that people with autism all have a special and extraordinary talent in some specific area.

Research by Winter-Messier et al. (2007) found that when people with AS talked about thier special interests, they all showed improved functioning in one or more of their areas of 'deficit' such as social interaction, communication, emotional management, sensory processing or executive functioning. 

Difficulties with social interaction can include problems with interpreting and reciprocating social signals, failure to make and maintain friendships and an inability to offer appropriate social and emotional responses to other people. Winter-Messier et al. found that participants in their study became more enthusiastic and less reserved or wary when talking about their special interests and that they were better able to engage and socailly interact with peers. Many showed a much higher level of social sophistication when talking about their SIAs, and were more aware of how long to talk about them for, than with other areas of conversation.

Similarly Winter-Messier et al. found that communication difficulties such as reciprocal verbal and body language were reduced and speech was more fluent, vocabulary was more sophisticated and conversation skills were generally improved whilst talking about SIAs. Eye contact and greater use of appropriate gestures to emphasis speech and reduced fidgeting were also noticed.Thus opportunities for children and young people to talk about thier interests can improve overall communication skills through creating a safe space in which to practice. 

Accurate detection of other peoples' emotions and emotional self-regulation can also be skills that people with Asperger Syndrome (and ASCs) often find difficult. Living in a world of incomprehensible social signals can lead to emotional meltdowns, anxiety, and depression. Again it has been noted that people with AS and musical skills often find it easier to communicate their emotions through music rather than speech and that stress and anxiety levels are substantially lower when people with autism are engaging in the focus of their interests (although this is also true for neurotypicals too!).

Engaging in special interests also appears to have positive effect on sensory problems such as tactile, visual, auditory and olfactory hypersensitivity, or least participation serves to distract them from the negative experiences.

Much in the same way that wider support strategies and interventions seek to identify peoples' motivation for engaging in positive activities, SIAs can be used to channel the focus of people with an ASC into positive and slef-esteem building activities. However, accurate identification of special interests can be crucial. For example, a special interest in the local football team may be related more to the statistics and the players' goal scoring credentials, rather than the game itself. Within an academic environment, incorporating a students' area of interest into the curriculum may greatly improve their academic performance, an area in which people with autism often underachieve.

The example used by Winter-Messier et al. explores an special interest in dinosaurs into the curriculum as follows:

Reading                    Read The Complete Guide to Prehistoric Life
Writing                      Research and write an essay on Tyranosaurus Rex
Spelling                    Learn to spell the names of dinosours
History                      Research the Precambrian period
Speech                     Present a life history of paleontologist George Simpson
Maths                       Calculate the leaf consumption in toms per week by Triceratops
Science                    Research the asteriod theory of dinosuar extinction
Art                            Build a clay model of a Stegosaurus
IT Skills                     Research the Paleontology section of the Natural History Museum and consult with paleontologists online

Most importantly, especially for adults with Asperger Syndrome, peoples' special interests and their focus on detail can give them huge advantages in the job market where these interests can be identified and their natural talents harnessed (although employers often also need to understand how interact and support people with autism to use their skills to the full and to reduce workplace friction). As Mary Temple Grandin said “Society loses out if individuals with autism spectrum disorders are not involved in the world of work or make other kinds of contributions to society” and “For those on the autism spectrum, finding a satisfying job also provides social opportunities through shared interests.”

 

 

Further Reading

Cosden, M., Koegel, L.K., Koegel, R.L., Greenwell, A. and Klein, E. (2006) Strength-Based Assessment for Children with Autism Spectrum Disorders. Research and Practice for Persons with Severe Disabilities Vol 31, Issue 2, pp. 134 - 143

Winter-Messiers, M., Herr, C.M., Wood, C.E., Brookes, A.P., Gates, M.A., Houston, T.L. and Tingstad, K.I. (2007) How Far Can Brian Ride the Daylight 4449 Express? Focus on Autism and Other Developmental Disabilities Vol 22, Issue 2, pp. 67 - 79

 

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