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Ask Dr. Sears: Asperger Syndrome

Q. I'm afraid my child could have Asperger Syndrome. He's 2½ years old, and he has some of the symptoms: He doesn't speak yet, communicates badly, avoids eye contact, and his social skills are poor. I have been seeking professional help, but so far the experiences with therapists have been bad and disappointing. Could you give me some insight into this condition?

A. Asperger Syndrome (AS)—named after physician Hans Asperger—is a set of symptoms marked by inappropriate communication and social skills. People with AS have difficulty adapting to new situations, prefer sameness, and are often obsessive about routines. They have difficulty reading and exhibiting appropriate body language, and so they find it hard to relate to others. Another sign is difficulty in engaging in eye-to-eye contact.

Often, AS kids are hypersensitive to sound and touch. Parents will sometimes report that, even as infants, these children didn't like tight-fitting clothes. They even have to remove the labels from the sleepwear to keep the infant from squirming. Because kids with AS can't read social clues appropriately, they run into problems when it's time to head off to school. They often blurt out answers to a teacher's question before waiting their turn. Or they don't give an appropriate response to a person when asked a question—they might tune out a friend who invites them to play, for instance.

A Difference, Not a Disorder

AS used to be lumped together with ADD. It is now considered part of the spectrum of autism problems. So you may hear it described as "high-functioning autism." The reason for the term "high functioning" is that these children have normal, even superior, intelligence and they usually have normal motor development. In my pediatric practice, I tend to consider children with AS as part of a group I dub "quirky kids." These kids just perceive the world differently.

It's important to remember that a difference does not necessarily mean a disorder or a disability. These children not only think out of the box, but some grow up to build a better box. They're usually very intelligent. In school they're might be dubbed "little professors." I have been following my first patient with AS for twenty-two years. Even as young as kindergarten, this child was exceptionally precocious, often challenging the teachers and responding with answers no one else had thought of. In fact, many university professors dubbed "brilliant," even "eccentric," could have some form of AS. I recently heard the story of a brilliant, but quirky, professor who said, "My 6-year-old's teacher asked him to stay in his seat. So, he walked around with his chair stuck to his bottom, saying 'But you told me to stay in my seat.'" Like father, like son!

Coping With AS

* Don't take it personally. Because children with AS have their greatest difficulty in social relationships, they are often misunderstood as having a discipline problem. And, as we all know, people falsely judge bad behavior to be the result of "bad parenting." These children do not purposely say inappropriate things or willfully tune out their peers, they just have some neurological quirk that keeps them from responding in the usual way.

* Frame your child positively. Framing is a behavior-improving technique in which you always try to emphasize the positive and unique features your child has to offer, while playing down the negative ones. I'll give you an example: Although your child may be highly intelligent, he may have difficulty focusing in school because he is bored with subjects that appear to have no relevance. Often these children have the ability to hyperfocus, to delve deeply into one subject that has relevance to them or holds their interest. It's important that you always think of these positive features, so that he sees himself in a positive light.

* Match your child and school wisely. When the time comes, you have to do a lot of homework on school placement. These children think, act, and learn differently, so they need a a special style of teaching. Choose a teacher who is willing to use out-of-the-ordinary teaching styles with children who learn differently. These children need to be challenged in school; otherwise they'll get bored. And because of their social inappropriateness, these children are prone to becoming victims of bullying and teasing. As much as possible, surround your child with sensitive and caring peers. Be sure the school enforces a firm policy on bullying as well.

* Give your child high doses of high-touch parenting. 2½ ; years of age is too early to put any label on your child, especially ADD, autism, or Asperger Syndrome. Yet, you are wise in recognizing your child's quirks early and seeking help. The best thing you can do at this stage is to help your child be comfortable with touch. Become a hugging family. Show him that people look into each other's eyes when having a conversation. And model other appropriate social skills. If your child seems to look away when you start talking to him, simply say, "(name of child), I need your eyes; I need your ears." Don't gaze at him so intently that you turn him off, but simply get him comfortable with looking at you when you are talking.

* Choose playmates wisely. Encourage one-on-one play with children who have compatible personalities. This will help your child to become comfortable with people.

* Become an expert in your child. When a child has a quirk, it's important that parents become experts in this quirk. You will need to be your child's best advocate throughout life. The better you understand this quirk, the more likely you are to seek appropriate help and shun inappropriate labels. Keep a diary of the quirks that concern you now and record them over time. Keep track of which ones are getting better, worse, and any new ones that crop up. Besides seeking professional help in your area, two other resources that may be of some help are (the website for OASIS -- Online Asperger Syndrome Information and Support) and MAAP Service's