This article is from a seminar hosted by Dr. Melanie Crawford. She answered questions related to High Functioning Autism Spectrum Disorders (ASD), including the signs and symptoms of ASD as well as other commonly associated behaviors. Dr. Crawford also answered questions regarding the assessment and treatment of gifted children with ASD including school-based accommodations and social skills training.
Author: Dr. Melanie Crawford
Q: What is ASD?
ASD has historically included multiple separate diagnoses such as Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified. All individuals with ASD show qualitative impairment in social interaction, which can include problems with non-verbal behaviors (i.e., eye contact, reading facial cues and body language), peer relationship difficulties (i.e., has trouble making and keeping friends), and/or problems with social reciprocity (i.e., trouble with the give and take of conversation or turn taking). Another core deficit in ASD is within the domain of communication. This can include a delay in language development, but may also involve problems with initiating and sustaining conversation, stereotyped or repetitive language, idiosyncratic use of language, as well as lack of spontaneous or varied play. A third core deficit of ASD is within the domain of restrictive and/or repetitive behaviors. This can include a preoccupation with a narrow interest (i.e., trains, vacuums, dinosaurs) that is unusually intense, a strong adherence to routines and rituals (i.e., can be quite rigid, insistence on sameness), difficulties with transitions and change, and/or a preoccupation with parts of objects (i.e., like to take things apart, rather than play with it as a whole).
The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was released on May 18, 2013, introduces two fundamental changes in the diagnosis of ASD. First it collapses previously distinct autism subtypes (including autistic disorder, PDD NOS, and Asperger syndrome) into one unifying diagnosis of ASD. Second, the current three symptom domains of social impairment, communication deficits and repetitive/restricted behaviors now become two (social communication impairment and repetitive/restricted behaviors). The the DSM-5 also includes a diagnostic specifier based on severity level (1 = need support through 3 = needs substantial support). The DSM-5 committee assures that few with a current diagnosis on the autism spectrum should “lose” their diagnosis because of the changes in diagnostic criteria. The DSM-5 also introduces a the new diagnosis of social communication disorder for those individuals that have difficulty in the social use of verbal or nonverbal communication, but do not meet criteria for ASD. You can find out more about changes in the DSM.
Q: Are there other behaviors that are commonly associated with ASD?
Many children with ASD also struggle with attention, impulsivity, and hyperactivity as well as show deficits in other areas of executive functioning (skills that help us plan and regulate our behavior). They often struggle with regulating their emotions and can be prone to emotional outbursts. Many children with ASD also report problems with sensory regulation/integration.
Q: What are the similarities between profoundly gifted (PG) kids and kids with ASD?
As described in the book Misdiagnosis and Dual Diagnosis of Gifted Children and Adults, by Webb et al., gifted children often have excellent memory for facts and events, strong verbal skills, hypersensitivity to stimuli, and uneven development (i.e., social skills may lag behind intellectual development). They may have difficulty relating to same age peers due to a miss match of interests and intellectual abilities. Gifted children are also often highly concerned with justice and fairness, which may be perceived as rigidity. Furthermore, gifted children can become absorbed in a special interest or a particular content area. For these reasons, it is not uncommon for PG kids to be mislabeled as having an ASD. However, being gifted does not rule out the diagnosis of ASD and being profoundly gifted should not cause significant impairment across multiple domains of functioning.
Q: When should a diagnosis of ASD be considered for a child that is PG?
An important thing to consider when making any psychiatric diagnosis is the amount of functional impairment the symptoms are creating for the individual. For example, is the child experiencing great frustration, sadness, or emotional distress? Is their school performance significantly below expectations based on estimates of their intellectual ability? Are they unable to do tasks that other children their age do without difficulty (i.e., tasks of daily living). If their is no significant impairment then a diagnosis is not warranted.
Q: What should I do if I think my PG child might have ASD?
If you notice some signs of ASD in your child and are concerned that they are causing him/her significant impairment, it is probably best to consult with a professional to help rule in/out the presence of ASD. Ideally, I would recommend seeking a comprehensive assessment with a child clinical neuropsychologist or multidisciplinary assessment team that has knowledge and experience in working with GT (ideally PG) populations. However, this is not always possible due to limited availability and cost. The book A Parent’s Guide to Asperger Syndrome and High Functioning Autism by Sally Ozonoff, Geraldine Dawson, and James McPartland, does a good job of explaining high functioning ASD as well as the assessment process, which may be helpful in trying to decide if an assessment would be necessary.
Q: What are some typical school-based accommodations for children with high functioning ASD?
While my recommendations do vary greatly depending on the particular strengths and weaknesses of the child, below are some of the more common school-based accommodations that are often helpful to children with high functioning ASD:
- Help with Social Skills Development: Social behaviors may need to be explicitly taught and clearly explained. School staff should also help monitor and facilitate in-school peer interactions.
- Increased Structure and Consistency: Children with ASD generally benefit from additional environmental structure and feel more comfortable in environments and with individuals that are predictable and consistent. Children with ASD also typically need help with transitions (i.e., give a 2 minute warning or short break between activities).
- Help with Academic Skills: Some children with ASD also need support and intervention in academic skills such as written language (i.e., explicit instruction and step-by-step “recipes” to help guide him/her through the writing process) and reading comprehension (i.e., techniques to help him/her distinguish what is most relevant from minor issues)
- Help with Executive Functions: Many student with ASD require support in implementing organizational and time-management strategies including help with the use of an assignment planner and breaking down large assignments into smaller, more manageable parts. Frequent communication and coordination between school and home regarding homework assignments and other behaviors of concern is crucial. Many student with ASD do best when seated near the teacher and away from distractions.
- Help with Understanding Directions: Directions should be explicit and the teacher should check-in to make sure that the student has understood. Because children with ASD often focus on the details, I have also found that children with ASD often miss the main point of the task (i.e., What is the teacher looking for?, What is the overall goal of the task?). Providing this type of context when explaining an assignment or activity is often quite helpful to children with ASD.
Q: How can I help my child with ASD improve his/her social skills?
Children with ASD generally benefit from formal social skills training focused on helping them develop strategies for emotion regulation, friendship skills, skills for understanding thoughts and feeling, conversation skills, as well as social problem solving skills. This therapy is often best implemented in the group setting where children have the opportunity to practice newly acquired skills with peers as well as meet other children with similar difficulties. However, social skills training may also be implemented within the context of individual therapy. There are also some group activities that are conducive to social skills development. Look for group activities without a competitive atmosphere that emphasize cooperation, and are structured (i.e. scouts, 4H, church youth groups, Lego league). Activities that involve adult supervision are often best for children with ASD.
This article was originally published in 2013. Please also see the 2020 article, Here’s Why You Should STOP Using Functioning Labels.
This article is provided as a service of the Davidson Institute for Talent Development, a 501(c)3 nonprofit dedicated to supporting profoundly gifted young people 18 and under. To learn more about the Davidson Institute’s programs, please visit www.DavidsonGifted.org.
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