|Movement Experiences for Children|
|Instructor:||Dr. Shannon S.D. Bredin|
|Important Course Pages|
Asperger’s Syndrome (AS) is one of the conditions that make up the Autism Spectrum Disorder (ASD). AS is located higher up in the continuum of ASD and considered a higher functioning form of ASD, however, AS still consists of sufficient distinct features to justify its very own label. AS is a neurodevelopmental disability, which is characterized by continuous and subtle impairment within three domains of development: social interactions, social communication, and social imagination. Children that have Asperger’s Syndrome also display restricted and repetitive behaviors and interest (Borremans, 2011).
Children with AS have similar behavior and social difficulties as others who fall on the Autism Spectrum Disorder continuum, however AS individuals have cognitive and language proficiency within the normal to above normal range (Borremans, 2011). Children with AS will be of normal intelligence compared to children with autism and lower functioning on the ASD. Autistic children will display a great deal of cognitive and language development delays compared to children with AS (Borremans, 2011). Children with other ASD’s will display a severe withdrawal from their surrounding environment, children with AS prefer isolation due to their narrow interests and poor social skills. Children with AS are highly capable of learning about things that interest them, they will gather an immense amount of facts about subjects that appeal to them and talk about it these topics endlessly (National Institute of Neurological Disorders and Stroke, 2014). Children with AS often have IQ’s of above 70 that may continue into the gifted range (Schnure, 2005).
Hans Asperger was a German pediatrician who was the first to describe what we now call Asperger’s Syndrome in 1944 (Borremans, 2011). Hans observed four children whose intelligence was of normal range for their age but displayed lack of nonverbal communication skills, physically awkward, and did not display empathy with fellow peers. These kids had disjointed or overly formal speech behavior and a high propensity to be interested and obsessed with a single topic that would dominate their conversations. Hans initially called this disorder “autistic psychopathy” which he described as a personality disorder due to social isolation (National Institute of Neurological Disorders and Stroke, 2014). His work was widely unknown for many decades until it was published in English. The term Asperger’s Syndrome was first used by Lorna Wing in 1981 in the English speaking medical society (Borremans, 2011). Her findings were published and popularized, and in 1992 AS was deemed a distinguishable disease with criteria for diagnosis (National Institute of Neurological Disorders and Stroke, 2014).
AS has no known cause, research has only concluded that brain abnormalities are the main reason for it occurring. The brain abnormalities may be caused during fetal development when an uncommon amount of embryonic cells migrate, this may lead to negative affects to the neural circuits, which are in charge of controlling thoughts and behavior. Genetic and environmental factors have been deemed reasons for causing the neurodevelopmental problem. AS is highly common in families that have past history of members with the disorder (Borremans, 2011). This is why you may see families with multiple kids who have AS or other developmental problems. Recent research has pointed to a group of genes that have been deleted or altered being the likely cause for individuals being vulnerable in developing the disorder (National Institute of Neurological Disorders and Stroke, 2014).
Physical clumsiness is a problem that is constantly reported. Individuals with AS have gross and fine motor skill difficulties, the impediment occurs with motor planning necessary to complete a task. Handwriting, balance, riding a bike, and ball skills are all difficult for people with AS. It is estimated that 50% - 80% of people with AS will encounter motor skill acquisition difficulties. It is clear that participating in physical activities in or out of school would be a problematic situation and something that is avoided by individuals with AS. The motor skills deficiency was also detailed by Hans Asperger in his paper on AS, he described children as “motorically clumsy or poorly coordinated” when describing their abilities (Borremans, 2011). A history of postponed acquisitions of motor skills may affect an individual with AS, they often visibly exhibit awkwardness in their gait patterns, poor manipulative skills, odd posture, and deficiency of visual-motor coordination (Borremans, Rintale, & McCubbin, 2009). A wide variety of tests can be conducted to analyze a child’s motor proficiency such as the BTOMP, M-ABC, and the Zuricher Neuromotor Assessment. Extensive professional use of these tests in the assessment of children with AS has found agreement in findings that motor impairment is extremely common; with as many as 50%-100% of assessed children meeting the motor impairment diagnosis (Borremans 2011).
Children with AS have trouble with sensory integration, this problem affects their capability to process, combine, and regulate data received by their auditory, visual, vestibular, olfactory, proprioceptive, tactile, and gustatory systems. At times children with AS will experience problems with one or more of the systems, or their senses are over or under-reactive to stimuli. In some instances smell, taste, and visual sensations can be commonly over or under stimulated along with problems with their vestibular and proprioceptive systems. Also information that is collected by the sensory systems plays a part in the performance of motor actions and movement. Precise processing of sensory data affects the ability to successfully produce coordinated motor movements. Further it has been detailed that motor planning requires tactile, proprioception, and vestibular systems inputs. Due to this we can understand why children with AS have such difficulties with playing with peers and instead prefer isolation. AS leads to habitual perception of ordinary sensations being intense or quite low in intensity, otherwise called hyper or hyposensitive, some of the stimuli that cause this problem are:
- Light touch
- Abrupt change in temperature
- Unanticipated sound
- Visual stimuli
Recent studies have shown evidence that suggests sensory processing is furthermore related to the level of social competence and intelligence of children with AS (Borremans, 2011).
Some other overwhelming sensory issues that a child with AS may encounter in their everyday school life include:
- Cueing in line
- Tying shoelaces
- Using a knife and fork
- Regular recreation activities
(Borremans, Rintale, & McCubbin, 2009)
Children with AS can be motivated to communicate with their peers, however, they will find themselves isolated from social interaction due to their unusual communication style. Their style of communication is seen as overly formal on topics they find intriguing to them, regardless of what their peers may think about the topic (Woodbury-Smith & Volkmar, 2009). The lack of social skills leads to them having trouble in recognizing the feelings and thoughts of those they interact with. Children with AS will usually display difficulty with turn taking and waiting for their turn, this is seen when they play or communicate with peers (DuCharme & Gullatta, 2013). A child with AS will often display abnormal volume, rhythm, or rate when they are speaking. It is common to see a child with AS take very long pauses before answering questions or reciprocating in conversation with a peer, this is based on their difficulty with formulating answers and structuring their dialogue (Woodbury-Smith & Volkmar, 2009). Children with AS may have limited gesturing, inappropriate or limited facial expression, along with a stiff and peculiar eye gaze when it comes to social interactions (Schnure, 2005). All of these problems will obviously create social awkwardness for a child with AS and further cementing their tendency to prefer isolation as mentioned earlier.
Some of the following problems and behaviors may be displayed by a child with AS:
- Failure to make friends
- Decreased use of body language
- Trouble with conversation skills
- Propensity to make literal interpretation
- Inclination for consistency and routine
(Borremans, Rintale, & McCubbin, 2009)
Children with AS tend to be diagnosed later in life, compared to children with lower functioning autism on the ASD. This is due to AS not being obviously different in behavior from the average developing child in adolescence. The earlier a child can be diagnosed will lead to earlier therapy, and may entail the greatest benefits for a child with AS (Borremans, 2011).
Many different screens are available for diagnosing a child, so depending on what test a doctor conducts determines whether or not a diagnosis of AS is given. The first stage of a diagnosis is when someone takes their child to their family doctor or pediatrician and a “well-child” screening is conducted. The second stage is a team approach that is much more thorough, this stage will either rule AS in or out (National Institute of Neurological Disorders and Stroke, 2014). A team may use a couple of screens, such as the ICD-10 or the DSM-V (DuCharme & Gullatta, 2013). A team approach would consist of a neurologist, psychologist, psychiatrist, speech therapist, and other professionals who have experience with diagnosing AS. The team approach testing will consist of:
- Genetic and neurologic assessment
- Verbal and non-verbal weaknesses and strengths
- Learning style
- Independent living capabilities
- Cognitive and language testing
(National Institute of Neurological Disorders and Stroke, 2014)
Most commonly two diagnostic manuals are used when screening potential children with AS, stated above. One of them is the ICD-10 Classification of Mental and Behavioral Disorder. The other is the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM-IV. The World Health Organization (WHO) has published the ICD-10 and The American Psychiatric Association (APA) published the DMS-IV. Recently a new diagnostic manual has been issued by the APA, in which AS, autism, and pervasive development disorder not otherwise specified (PDD-NOS) are classified under an umbrella term called Autism Spectrum Disorders, this new manual is the DSM-V. There has been disagreement between the APA and WHO, which has resulted in the ICD-10 keeping AS as a separate diagnosis (DuCharme & Gullatta, 2013). Both of these diagnostic manuals can be found on each organization’s respective website with details on how the screening process is broken down.
The rate of prevalence of AS in children varies with different research that has been conducted. Disagreement with what exactly constitutes AS has lead to no clear consensus on the prevalence of AS amongst children (Borremans, 2011). In Finland recently a research concluded that the prevalence of AS may be 1 in 250 people (Mattila, 2007). Another study found the prevalence rate to be between 1 in 150 and 1 in 500 people (Borremans, Rintale, & McCubbin, 2009). What is clear is that the rate of AS has increased noticeably over the past decade (Borremans, 2011). With rising statistics it would be safe to assume we will be seeing more children with AS in our classrooms for which appropriate steps for proper integration need to be made.
AS is more prevalent in males than in females with a male/female ratio around 4:1 (Ehlers, Gillberg, & Wing, 1999). Recent research is indicating that the ratio may be 2:1 now, with male prevalence of AS still higher (Mattila, 2007).
There is data that shows those with AS display an array of additional psychiatric conditions, it is accepted by professionals in the field that they are directly correlated to the autistic characteristics linked to AS. Some of the alternative psychiatric conditions are:
- Tourette syndrome
- Obsessive-compulsive disorder
- Attention deficit/hyperactivity disorder
As high as 74% of children will experience comorbid psychiatric disorders, some of which are listed above. Another 44% of those with AS will show behavioral disorders, 42% will display anxiety disorders, and 26% display tic disorder (Borremans, 2011).
No cure has been found to date; due to this the method of treatment is a combination of intensive therapy and intervention (National Institute of Neurological Disorders and Stroke, 2014). A lot can be done for children with AS, with proper education and support their lives can be made easier and active participation within society can be achievable. Each therapy plan will be tailor made for children to their specific needs and abilities; they are called Individual Education Plan (IEP) (Borremans, 2011). Effective IEP’s will consist of some of the following:
- Social skills training
- Physical or occupational therapy
- Cognitive behavioral therapy
- Support and training for parents
- Specialized speech/language therapy
(National Institute of Neurological Disorders and Stroke, 2014).
Through therapy and intervention children with AS can grow up to master their disabilities and be contributing members of society working normal jobs (National Institute of Neurological Disorders and Stroke, 2014).
The importance of physical activity at a young age for a healthy lifestyle has been well documented. This level of importance is no different for those with disabilities; physical activity is vital for growth and optimal health. Children with Asperger’s Syndrome have challenges with sensory sensitivities, movement, and coordination. These factors play a role in why physical activity participation is challenging for children with AS. Other characteristics that impact physical activity involvement are lower motivation, motor clumsiness, and minor interests in group games; this results in them playing in solitary. In order for children with AS to be physically active and gain access to group play activities at a young age, they must be provided an environment where basic movement sills are taught. Throwing, running, jumping, skipping, and catching are all skills that are lacking in children with AS. Creating an inclusive learning environment with the help of special education assistance would allow elementary school to be an environment in which development can be fostered. Integration into normal play environments can possibly lead to skills such as fair play, teamwork, and spontaneous communication being learned (Borremans, 2011).
Further research as to why children with Asperger’s Syndrome experience these problems is still needed. Early research has suggested those with motor learning difficulties or poor motor coordination gravitate towards being less physically active compared to their coordinated counterparts. Children with AS deal with elevated levels of anxiety for which they take anti-anxiety medications, which can result in weight gain leading to additional deficits in physical fitness. The recommended amount of physical activity for children and adolescents that are developing is 60 minutes each day. This further makes us realize that children with AS are no different from their peers who do not have any disabilities. Therefore the importance of gaining knowledge on the manner in which to administer physical activity as well as a baseline of what is considered appropriate physical activity for children with AS is important. Professionals that study and work with individuals with AS believe with increased levels of physical fitness and activity through exercise training may very well foster the habilitation process of those with AS (Borremans, 2011).
Physical activity improves the movement and coordination abilities of children with AS, it can also help with emotional restoration for these individuals because they deal with emotional expression and management challenges (Attwood, 2007). Increased physical exercise will likely benefit children with AS, not just with physical health, but with reduction of maladaptive behavior. Physical activity has the potential of increasing adapted behavior of children with AS as well (Lang et al,. 2010). Numerous reviewed research studies show physical exercise is associated with a reduction in negative stereotypical behaviors. What this means is that physical exercise can help a child self-regulate and self-stimulate so they do not become hypo or hypersensitive to stimuli through their day (Borremans, 2011). Their very well may be a reduction in stereotypical behaviors a child with AS would normally display when they become over stimulated. Some of the behaviors that were seen to decrease with regular physical activity were:
- Self injury
Researchers conclude the reason for the seen benefits may be due to lowered anxiety levels, which indirectly result from being physically active and exercising. Exercise may have the potential to ‘burn-off’ or perhaps even ‘burn-out’ unconstructive behaviors (Borremans, 2011). One study reported mild exercise had insignificant effect on behavior; intense aerobic exercise had greater reduction in stereotypical behaviors or improved functioning in other areas (Elliot et al., 1994). Another study reported that children with AS that participate in moderate aerobic activity for 20 minutes might show an increase in their attention span along with on-task behavior. Other researchers have suggested the possibility of improved movement and coordination abilities which may lead to emotional repair for those with AS. Exercise can be extremely beneficial during Cognitive Behavior Therapy programs; it also provides opportunities for social interaction, socializing, and social skill training (Borremans, 2011).
The scarcity in physical activity amongst children’s therapy programs is due to the limited amount of data and research available. The main reason for limited research and data on children with AS and physical activity benefits is due to their delayed motor skill acquisition, so historically these children don’t take part in physical activity because they cant. With more research, effective training programs and protocols can be constructed for children with AS which will hopefully help them acquire motor skills at a younger age (Borremans, 2011).
Current suggestions on how to implement an affective exercise program for children with AS is as follows:
- Manageable by the child
- Tailored to child’s interest
- Adequate supports for the child
- Tailored to child’s fitness level
- Chaotic and difficult activities may reduce future involvement
- Include children in planning the program
- Listen to child’s reflection on activities
- Collect feedback on what child enjoyed and did not
- Use visual cues
- Use clear language that is to the point
- Using prompts
- Positive reinforcement
- Organize and structure events
- Aspy, R., & Grossman, B. G. (2007). Assessing autism spectrum disorders: Guidelines for parents and educators. Autism Advocate, 48 (3), 11–14.
- Attwood, T. (2007). The complete guide to Asperger's syndrome. London: Jessica Kingsley Publishers.
- Borremans, E. (2011). Asperger syndrome and physical exercise: A study about senso-motor profiles, physical fitness, and the effectiveness of an exercise training program in a group of adolescents with Asperger syndrome. Retrieved from https://jyx.jyu.fi/dspace/bitstream/handle/123456789/40877/978-951-39-5078-1_vaitos2011.pdf?sequence=1.
- Borremans, E. Rintala, P. & McCubbin, JA. (2009). Motor skills of young adults with asperger syndrome: A comparative study. European Journal of Adapted Physical Activity, 2(1). 21-33.
- DuCharme, R. W., & Gullotta, T. P. (2013). Asperger syndrome: A guide for professionals and families. doi:10.1007/978-1-4614-7016-8
- Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for asperger syndrome and other high-functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 29(2), 129. doi:10.1023/A:1023040610384
- Elliott, J.,R O., Dobbin, A. R., Rose, G. D., & Soper, H. V. (1994). Vigorous, aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation. Journal of Autism and Developmental Disorders, 24(5), 565-576. doi:10.1007/BF02172138
- Lang, R., Koegel, L. K., Ashbaugh, K., Regester, A., Ence, W., & Smith, W. (2010). Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4(4), 565-576. doi:10.1016/j.rasd.2010.01.006
- Mattila, M. (2007). An epidemiological and diagnostic study of asperger syndrome according to four sets of diagnostic criteria. J Am Acad Child Adolesc Psychiatry, 46(5), 636-646. doi:10.1097/chi.0b013e318033ff42
- National Institute of Neurological Disorders and Stroke. (2014). Asperger Syndrome fact sheet. Retrieved from http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm
- Schnur, J. (2005). Asperger syndrome in children. Journal of the American Academy of Nurse Practitioners, 17(8), 302-308. doi:10.1111/j.1745-7599.2005.0053.x
- Woodbury-Smith, M. R., & Volkmar, F. R. (2009). Asperger syndrome. European Child & Adolescent Psychiatry, 18(1), 2-11. doi:10.1007/s00787-008-0701-0