2006). The article introduces an innovative research strategy; doctors are observing - in magnified format - key movement patterns in infants who may be showing early signs of as. To open the door to a "more accurate way of distinguishing autism from as," Teitelbaum explains, researchers are employing the "Eshkol-Wachman" movement notation (EWMN), which was originally developed for dance and choreography. The EWMN, in short, allows the most delicate deficits in infant movement to be detected.
Because the EWMN system was designed to allow choreographers to write movement down on paper "that dancers could later reconstruct in its entirety," the EWMN is proved to be "very detailed in analyzing a person's movement." Thus, the research team from the University of Florida asserted, when 16 videotapes from parents whose children had been diagnosed with as were analyzed using the EWMN, this system of research was borne out as valid. The EWMN technology detailed patterns of movements in those 16 infants - "Moebius mouth (abnormal shape during smiling); "abnormal or asymmetrical tonic neck reflexes when the child rights from supine to prone positions"; failure to use "protective reflexes when falling" and more - in such a graphically accurate portrayal that the research article concludes EWMN may well reveal "early detection markers" in many infants for the future.
Is as hereditary? The Harvard research letter alluded to earlier explains that about "a third" of parents of children with as will have "at least some related symptoms"; still, there is "no evidence" as yet for a "specific organic cause" for as. One working hypothesis regarding people with as is that they lack a "theory of mind" - in other words, they lack the intuitive understanding that people they come into contact with have their own thoughts and feelings. As a result of that gap in intuitive understanding, the as person "...cannot imagine their way into the minds of others to anticipate their responses," the Harvard letter explains.
The use of brain scans in research reveals that "normal" people use the amygdale (the "center of emotion") when talking to another person and making intuitive value judgments about the facial expressions the other person exhibits during the conversation. But in those afflicted with as, the area that "lights up" is the "prefrontal cortex," which is a seat of "judgment and planning," the Harvard letter states. In other words, the as person is pondering the meaning of facial expressions he or she sees, rather than responding to it immediately.
Treatment and Intervention available for Asperger's
According to the National Institute of Neurological Disorders and Stroke (NINDS), the "ideal" treatment for as coordinates therapies that address the three "core symptoms" of as: "poor communication skills; obsessive or repetitive routines; and physical clumsiness." What is agreed upon by professions in the healthcare industry is, first, the "earlier the intervention the better" (and hence the earlier the detection of as the better); second, any effective program "builds on the child's interests" and "actively engages the child's attention in highly structured activities"; and thirdly, a successful intervention "provides regular reinforcement of behavior."
Meanwhile, children who suffer from as are eligible, under federal law, for special educational services appropriate to their needs, according to the Harvard Mental Health Letter. The as child qualified for teacher aide assistance, tutoring, "a special curriculum," and in some instances, a special school. What as students need in terms of educational support are consistent and very clear instructions, and a "routine" they can count upon. The instruction they require includes learning to "maintain eye contact," learning to read others' facial expressions, and to grasp "what is and what is not socially acceptable."
Their teachers need to work on them so they understand, for example, why they need to wait in the lunch line and why teachers and strangers cannot be approached in the same way as their family members and dear friends. "Sometimes," the Harvard letter concludes, "it is less important to change" the as child than it is to "change the attitudes of others towards them."
Tony Attwood's lectures and printed materials are widely praised for the quality of their intervention strategies; in Attwood's "Appropriate Educational Placements for Children with Asperger's Syndrome," he emphasizes intervention through small-group interaction. His strategies are as follows: "Encourage the child to be social, flexible, and cooperative..."; "help the child recognize social cues"; "provide personal tuition on...managing emotions"; help the as child to "develop special interests"; implement a program to "improve gross and fine motor skills"; help the child improve "Theory of Mind" and conversational skills.
Attwood asserts that the "most important attributes" in a learning environment for the as child "are the personality and ability of the class teacher." The worthwhile teacher in an as environment has a "calm disposition," is "predictable" in emotional reactions, "flexible" with the curriculum vis-a-vis the as child, and has the ability to see the world as the as child does. Moreover, the teacher needs to have "emotional and practical support from colleagues and the school administration."
Indeed, there are medications that are being prescribed - cautiously, in a controlled research setting - for as, according to www.aspergers.com;those include, for preoccupations, rituals and compulsions, SSRIs (fluvoxamine, fluoxetine, and paroxetine); and Tricyclic Antidepressants (clomipramine); and for irritability and aggression, mood stabilizers like valproate, carbamazepine, and lithium, and Beta Blockers such as nadolol and propranolol.
And meanwhile he U.S. National Institutes of Health (www.ClinicalTrials.gov) is currently conducting several important as studies; one, with the Indiana University School of Medicine, testing Aripiprazole on children 4 to 17 years of age (Kohn, et al. 2005); another clinical trial is ongoing at the UCLA, testing cognitive behavioral therapy for anxiety disorder in children with as (Drahota, et al., 2006); a third project in search of a treatment for as is the Janssen Asperger's MRS Risperidone Study (Medical College of Georgia), which will target 14 patients older than 6 years, using the drug Risperidone (Hutcheson, et. Al, 2006). There are no results available for any of the above clinical trial procedures, but the fact that there are numerous / diverse approaches to finding potential solutions to the as problems is encouraging.
Tony Attwood, among the leading researchers into the dynamics of as, has written an article which could be helpful on a very realistic, hands-on level for parents, family members, teachers and others who work with as patients. It is titled "Strategies to Reduce the Bullying of Young Children with Asperger Syndrome," and anyone who has been around schools at any level or any grade knows bullying is an ongoing and serious problem in the playground and elsewhere around schools.
When considering how vulnerable all children are to bullying, imagine how much more vulnerable Asperger Syndrome children would be to bullying, given that they are very "different" and not very social in many instances. Attwood explains that typically an as child has a problem developing friendships that are "...appropriate to the child's developmental level"; and as children have impairments when it comes to regulating social interaction through the use of "non-verbal behavior such as eye gaze, facial expressions and body language."
Also, Attwood mentions that as children lack the social and emotional ability to reciprocate and empathize with others around them (causing some to think they are insensitive when actually they can't help themselves in this regard); and finally, as children have a tough time being able to "identify social cues and social conventions" (Attwood, 2004).
Additionally, the as child may suffer from signs of "motor clumsiness" and may well be "hypersensitive to auditory and tactile experiences," Attwood goes on. Moreover, the as child likely has difficulty planning, organizing and keeping up with his or her own performance in school and elsewhere. All these shortcomings make it difficult for the as child to be placed in a mainstream school situation per se, let alone in a mainstream situation where a bully may be lurking around the corner during recess. In this regard, Attwood suggests there is a "distinct risk associated with integration" - the "propensity of children with Asperger Syndrome to be bullied" (Attwood, 2004). In the event that bullying is a reality for the child with as, Attwood offers a number of ideas to prevent the as child from being harassed mercilessly, especially in the preschool years, but continuing on through the grades.
The most likely times that bullying can occur (for as children and all children who are vulnerable) is in the hallway, on the bus between school and home, during sports activities - and anytime when a "peer audience or bystanders" are present. The tactics are "obscene gestures," the stealing of possessions, verbal torment, and malicious gossip and actually hitting or pushing. Other forms of bullying can be just "not being invited to a social event," Attwood explains, or being excluded ("peer shunning") from a group that is engaged in a game; bullying can take the form of "not being included in a group at meal time" too, Attwood explains.