Asperger Syndrome Treatment & Management

Observe patients walking and running. Adult patients may model appropriate motions to improve the coordination of their upper and lower extremities.

Helping patients learn to catch and throw balls proficiently can facilitate their ability to participate in team sports and thereby enhance their social skills.

Wearing sunglasses and avoiding intense light may help children with Asperger syndrome who exhibit photosensitivity.

Using earplugs may also help children who exhibit extreme intolerance or sensitivity to sound.

Remedial exercises may improve handwriting. Alternatively, use of assisted technology (eg, laptop computer) often helps.

Social behaviors in school settings

Teachers have many opportunities to help children develop appropriate social behaviors.

Children can learn to watch other children for social cues and for behaviors to imitate. Teachers can model socially appropriate behavior and encourage cooperative games in the classroom.

Teachers can explain appropriate means of seeking help when the child demonstrates problematic social behaviors in the classroom. Videotapes may facilitate self-monitoring of adherence to classroom rules.^[29]

Teachers may identify suitable friends for children and encourage prospective friendships.

Teachers may help children in challenging social situations by supervising breaks between classes and lunchroom and playground activities.

Children may benefit from a full-time, trained, 1-on-1 teacher’s aide to shadow them in the classroom and to coach appropriate behavior.

Because changes in schools, classrooms, and teachers may exacerbate symptoms, attempt to minimize alterations to the patient's schedule and educational environment.

Children, adolescents, and adults with Asperger syndrome typically benefit from a weekly, therapist-guided, social skills group with peers.

Auditory integration training helps some children with social interactions.

Go to Pervasive Developmental Disorder and Autism for complete information on these topics.

Interaction with other children

Children may benefit from an organized club, chaperoned by adult leaders who provide advanced preparation and a discussion forum.

Parents can help children to learn appropriate play by modeling and rehearsing such skills as flexibility, cooperation, and sharing. Parents should encourage an affected child to invite a friend to their home.

Communication and language strategies

Children can be taught to memorize phrases for specific purposes (eg, to open conversations).

Children can learn to seek clarification by asking people to rephrase confusing expressions. Encourage children to ask that confusing instructions be repeated, simplified, clarified, and written down.

Encourage children, when appropriate, to admit that they do not know an answer.

Caregivers, through modeling, can teach affected children how to interpret the conversational cues of others to reply, to interrupt, or to change topics.

Because interpretation of metaphors and figures of speech is often difficult, caregivers should explain these language subtleties when they arise.

Children can be taught to refrain from vocalizing every thought.

When communicating a series of instructions to a child with this disorder, pause between each separate statement.

Role-playing may help a child to learn to understand the perspectives and thoughts of other people. Encourage the child to stop and think how another person will feel before the child acts and speaks.

Some children with Asperger syndrome may have good visual thinking abilities; they may be encouraged to visualize using diagrams and visual analogues.

The social deficits exhibited by many people with Asperger syndrome and related conditions remain major obstacles to their functioning in family, educational, occupational, and community settings. Research is needed to develop programs to train individuals in the nuances of social interaction.

People with Asperger syndrome often have difficulty interpreting the responses of others; determining how to make their own optimal response in particular social situations may be challenging as well. This may lead to inhibition in social situations.

People with Asperger syndrome may appear aloof and disinterested in others. This likely results from perplexity about how to appropriately communicate with others, which can lead to difficulties in many interpersonal encounters.

People with Asperger syndrome typically want to have social relationships like others. However, they may not understand, for example, the sequence of friendship, dating, and courtship taking place over several months or years leading to marriage and may even inappropriately approach strangers to propose marriage. Such actions often precipitate rejection.

To assist people with Asperger syndrome in social encounters, social skills training, with role modeling and role playing, may be helpful. Attwood described techniques for parents to use with children with Asperger syndrome.^[30]

The ability to communicate with groups with people can be developed. Toastmasters International is an organization of clubs that promote the communication and leadership skills of members. Some individuals with Asperger syndrome may develop special skills, such as interpretive reading and storytelling, by participation in the activities of Toastmasters. Toastmasters has local clubs around the world to help members become better speakers in public.

Psychotherapy is often helpful for individuals to recognize their deficits in social skills.

People with Asperger syndrome are prone to be misunderstood by family, friends, neighbors, and the general public. They may encounter harsh, unreasonable criticism from teachers, parents, supervisors, and others. Because people with Asperger syndrome may not understand social situations, they may experience anxiety. Thus, they may be inhibited in social situations and may be shy in the presence of others, which can interfere with their social development.

Additionally, people with Asperger syndrome encounter situations engendering stress daily. Demands increase to impossible expectations. Stress is a challenge of daily life.

Adverse effects of stress include anxiety, panic attacks, and other psychologic disturbances. Chronic stress also constitutes a cause of high blood pressure, a disorder that may result in serious diseases of the heart, brain, and kidneys.

People with Asperger syndrome may benefit from the practice of relaxation techniques to cope with stress. Additional effects of relaxation training may include lowering blood pressure and maintaining and improving health.

Relaxation constitutes a major effect of yoga and meditation. This is a key component of many religious practices. Benson and Klipper identified that the crucial parts of a relaxation session exclude dogma.^[31] Thus, they developed a compendium of the essential aspects of relaxation suitable for practice by the general public.

According to Benson and Klipper, the necessary features of relaxation training include the following:

• Quiet environment
• Mental device
• Passive attitude
• Comfortable position

Quiet environment

This can be procured by setting aside periods of 10-20 minutes twice a day, before breakfast and before dinner. The individual sits in a comfortable chair with eyes closed or open. Lying down is not recommended because sleep may result. Pagers and cell phones should be shut off, and internal and external stimuli should be shut out.

Mental device

The mental device is the silent or spoken repetition of a sound, word, or passage. A nonsense syllable or a neutral word is suitable. Benson and Klipper suggest the repetition of the word “one.” This is equivalent to a mantra used in some techniques. Attending to the pattern of breathing is another alternative mental device. Alternatively, the person may focus on a picture, image, symbol, or other visual stimulus as the item of attention.

Passive attitude

Thoughts are allowed to come and go. Whatever thoughts come should be disregarded. Attention is paid to the sound or word or breathing. The thoughts are passively allowed to enter awareness and are then passed from awareness. Perceptions are allowed to pass.

Comfortable position

The individual sits in pleasant posture. Lying down is not recommended because sleep may result. At the end of the 20 minutes, gradual movement of the hands, feet, and body allow the individual to return to full alertness.

Individuals with Asperger syndrome can often concentrate on activities for hours without interruption and continue this concentration daily for years. With proper instruction, their talents can be developed enormously; therefore, identifying and nurturing the interests and abilities of persons with Asperger syndrome (eg, music, mathematics) at an early age is beneficial. (These talents may also help the child to earn respect from classmates.)

For example, although many children might refuse to practice a musical instrument for even a few minutes a day, a child with Asperger syndrome may enjoy hours of daily practice.

Skilled instruction is necessary to fully develop such talents.

Parents and teachers should creatively uncover skills, abilities, and talents in children with Asperger syndrome.

Career choice is crucial for persons with Asperger syndrome, because social impairment limits their success in many occupations.

Career choices using technology, especially the Internet, are often particularly suitable for people with Asperger syndrome. Computer science, engineering, and natural sciences are common career choices for individuals with this disorder. Other special interests may be developed into careers.

Individuals may need special help to prepare for job interviews and to maintain an appropriate demeanor in a work environment.

Consult a neurologist for examination and neuropsychologic testing.

Consult with an otolaryngologist, audiologist, and speech pathologist to exclude treatable auditory and vocal system anomalies. Speech testing helps assess children with developmental disabilities, and speech therapy is often helpful.

Consult with physical and occupational therapists, because therapy often improves the handwriting and other fine motor activities of patients with lax joints and unusual grasps. Sensory integration therapy reportedly helps some individuals.