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Tips for Parents: High Functioning Autism Spectrum Disorders Q & A

This Tips for Parents article is from a seminar hosted by Dr. Melanie Crawford. She answered questions related to High Functioning Autism Spectrum Disorders (ASD), including the 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.
  • Topics
    • For Parents: Tips for Parents from YS Seminars
    • Twice Exceptional: Asperger's/Autism Spectrum
  • Author
    Crawford, M.
  • Organization
    Davidson Institute for Talent Development
  • Year
    2013

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 at https://www.psychiatry.org/psychiatrists/practice/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.

2011 Seminar

Q: What is High Functioning ASD? How is it diagnosed?

ASD includes Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified. All children with ASD show qualitative impairment in social interaction, which can include problems with non-verbal behaviors, peer relationship difficulties, and/or problems with social reciprocity. 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 that is unusually intense, a strong adherence to routines and rituals, difficulties with transitions and change, and/or a preoccupation with parts of objects. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), children with autistic disorder have impairment within all three domains of functioning (i.e., social interaction, communication, and restrictive repetitive behaviors), whereas children with asperger syndrome have deficits in reciprocal social interaction and demonstrate restrictive, repetitive interests or activities, but do not show qualitative impairments in communication and there is no observed delay in language or cognitive development. The diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) is often described as atypical autism and is reserved for those who show significant impairment in the domains noted above, but do not meet diagnostic criteria for autistic disorder or asperger syndrome. High functioning ASD generally refers to individuals that meet criteria for ASD, but do not show significant cognitive impairment (i.e., have IQs at or above the Average range).

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 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.

    Permission Statement

    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.

    Comments

    Educator on 9/29/2020
    A reply to the post above about the daughter. As to social skills/norms, the high-functioning autistic person does not understand how to make or switch friend groups. Most of the time, they gravitate toward someone they think they have a kinship with or to those who give them attention. She probably prefers to be around those who are quiet and share similar interests, including special interests that they find interesting. By no means will she be capable of just moving to another friend group without significant help from peers- which won't happen. Maybe the best suggestion I can give is to take (or pretend to take) an interests in the same things your daughter is interested in, and asking questions about it. Any adult mentor other than the parent is a godsend, as well. Many of us unconsciously struggle with this out whole lives. The buggest issue is that no one understands why the autistic person seems "off." This results in others' tendency to stay away or exclude. The autistic person, also, has no basis of understanding why they seem alone. Emotions are literally unable to be completely processed. Maybe parents can steer the child to a group with similar interests. Art classes, in particular, maybe multimedia or even other fine arts may result in a different group of friends.
    Parent on 2/20/2019
    Hello, My oldest daughter was diagnosed with PDDNOS when she was 3years old. She is now 13. Her father and I have noticed that she has a very difficult time choosing friends that are healthy for her. Most of the girls she hangs out with seem to be those that self harm ( we have not seen any signs of that in her ) or are into very dark things. She is extremely artistic, and even her art work tends to be in a dark nature. Nothing violent, but literally dark in color. He and her brother are in the same grade and he has told us that the girls she is around tend to be called into the principals office alot. She is not on any medication. I would love some input!
    Other on 5/26/2017
    Thank you for your explanation :)
    Other on 4/9/2016
    Hi, I'm on the higher end of the Autism Spectrum (it used to be called Asperger Syndrome). And yes, I do have sensory issues, I do have social and communication difficulties, and yes, I do have a 'rigid' sense of right and wrong. Keep in mind that the rigid sense of right and wrong is typical for most preschool and early elementary school age children. But by the preteen or teen years, most neurotypical kids have figured out (or are starting to figure out) that the rules the adults and older kids in their lives gave them when they were younger don't apply in all situations. However, even when I was in high school, I thought the rules the adults in my life gave me when I was younger applied in all situations, until the school speech therapist explained to me that they didn't. I like to think of the way a person on the Autism Spectrum understands rules and codes of behavior as being like a traffic light with only a red light (STOP) and a green light (go/keep going). No yellow light (slow down and be ready to stop, and you may or may not need to stop). For a lot of people on the Autism Spectrum, something is either always right or always wrong. Either it's always this or it's always that, with no middle ground.
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