Diagnostic

Assessment for
Aspergers Syndrome
The Continuum of Autism:
From the work of Tony Atwood
What is
Aspergers
Syndrome?
A disorder within the Autistic
Spectrum Disorders
Considered a Neurobiological
disorder
Major symptoms are
Impairments in socialization,
communication and imagination
First discussed by Hans
Asperger in 1944
Brought to international attention
in the 1990s
Suggested that the ratio of boys
Symptoms of
Aspergers
Syndrome
Impairments in social interaction, narrow
interests, an insistence on repetitive routines,
speech and language peculiarities, non-
verbal communication problems and motor
clumsiness
Aloof
Avoid interactions
Mute
Behavior the main
means of
communication
Fascination with
sensory experience
 Passive
Approach adults for
assistance with objects
and for physical stimulation
Prolonged solitary play
Speech requires an
external prompt, (echolalia,
seeing an object/picture,
dialogue borrowed from a
favorite video)
Fascination with
symmetry and collecting
specific objects
Active but Odd
Often initiates interactions of
short duration
Repetitive questions (social
echolalia, script, alternative
meaning, reassurance)
Lack of social play with
others
Fascination with a specific
topic or person.
Six Pathways to a Diagnosis
of Aspergers Syndrome

Diagnosis of autism in early childhood

Significant natural progress between 4 and 6
years of age
Effective early intervention programs
Progression along the continuum of autism
 Recognition of
Characteristics When First
Enrolled at School
No clear signs of autism in early childhood
Teacher notices conspicuous features
Avoids social play with peers
Unaware of the codes of social conduct
Unusual qualities in conversation and
imaginative play
Intense interest in a specific interest
Clumsiness when running, writing and
catching
Teacher completes a developmental
checklist for Aspergers syndrome (ASAS)
Diagnosis of a Relative
with Autism or Aspergers
Syndrome
Another family member
has a diagnosis and
knowledge of the
continuum of autism
leads to other family
members being
diagnosed
Some families have
Aspergers syndrome
within and between
generations
Dual Diagnosis

Attention deficit disorder

Language disorder
Cerebral palsy
Tourettes disorder
Secondary Psychiatric
Disorder
Depression
Anxiety disorder such as
Obsessive Compulsive
Disorder
Anger management
Schizophrenia
Residual Aspergers
Syndrome in an Adult
Self referral due to a
relative having the
diagnosis or information
from the media
Agency referral from
psychiatric services,
forensic psychology and
employment agencies
Diagnostic
Assessment
Social Impairment
Social Impairment

Reciprocity (the balance

between participants)
Inclusion (welcome,
cooperation and control)
Pretending to be Normal
the fun came from setting
up and arranging things.
Maybe this desire to organize
things rather than play with
things, is the reason I never
had a great interest in my
peers. They always wanted to
use the things I had so
carefully arranged. They would
want to rearrange and redo.
They did not let me control the
environment.
Social Impairment
Level of maturity in deceit
Limited ability with team skills
Limited range of facial expressions and
body language
Difficulty reading the facial expressions
and body language of others
Limited ability to conceptualize the
thoughts and feelings of others
Speech and
Language
Characteristics

Pragmatics,
Prosody and
Pedantic
Pragmatic Aspects
The art of conversation
Reciprocity
Repairing a conversation
Knowing when and how to interrupt
Inappropriate comments
Keeping on track
Primarily interested in an exchange
of information
Appropriate topics
Monologues or scripts
Recognizing and accepting
different points of view
Literal interpretation
Prosody or the Melody of
Speech
Lack of change of vocal tone and volume
to indicate emotion and key words
Lack of variation in pitch, stress and
rhythm
Accent not consistent with that of the local
children
Difficulty understanding the relevance of
the change in tone, inflection or emphasis
on certain words when listening to the
speech of others
Pedantic Speech
Overly Formal
Excessive technical details
Adult quality, sophisticated grammar or
phrases
Must correct errors
Precise intonation
Unusual Qualities
of Speech
Idiosyncratic use of
words
Neologisms
Volume
Vocalizing thoughts
Verbal fluency
affected by anxiety
Late onset
Special Interests
Dominate the persons
time and conversation
Statistics, cataloguing
and symmetry
Idiosyncratic
Motor Clumsiness

Locomotion (upper and

lower limb coordination)
Ball catching skills
Manual dexterity
Handwriting
Movement disorder;
Motor tics such as
blinking and grimaces,
vocal tics such as clicks
and animal noises
Cognition
Problems with advanced Theory of Mind Skills
Weak Central Coherence
Impaired Executive Function
Profile on an Intelligence Test
Visualisers or verbalisers
Enclopedic memory
Solitary and idiosyncratic play
Preference for routines
Limited flexibility in thinking
Originality in problem solving
Sensory
Sensitivity
Sound sensitivity
Tactile sensitivity
Sensitivity to the taste or
texture of food
Stoic in response to pain or
temperature
Synaesthesia
Relevant Information
Family history of similar individuals
Reports from teachers and therapists
Medical investigations and medicine
Developmental history
Prior diagnosis
Presence of a psychiatric disorder
Observation at school and home
Issues Relevant to
the Diagnostic
Assessment
Profile of abilities in girls
(same pattern, less severe
expression, coping
mechanisms, fewer referrals)
Assessment procedures and
criteria for adults (time to
respond and the quality of the
response, validity of the
developmental history)
Alternative explanations: shy,
social phobia, gifted emotional
neglect in infancy
Choice of diagnostic criteria
Alternative Terms
High Functioning Autism
HFA and AS at the behavioral and
treatment level, are more the same than
different
Lack of expertise, experience and
confidence in the diagnosis of AS
HFA more likely if the child has a developmental history of
autism
AS not a mild form of autism but a more subtle expression
Diagnosis of HFA can provide automatic access to services
Use the term that provides more resources
Developing Social
Skills and
Understanding
Emotions
Social Play
Observe and make notes of the
social play of the childs peers
Note the script and acts
Rehearse with an adult acting as
a friend
Turn taking and help
Rent a friend as a dress
rehearsal
Practice with same age peers
Social Sandwich
Sharing experiences
Strategies for Social
Integration
Inclusion with Ordinary
Children
Observation of appropriate
social/emotional behavior
Peer group who know how to modify their
behavior to accommodate and support the
child
Knowledge of the
Nature of Aspergers
Syndrome

To recognize the
challenges faced by the
child
To explain their behavior
to other children and adults
The Sixth Sense
Teach Theory of Mind
Skills

Photographs, text, drawings,

games
Metaphor
Social Stories
Comic Strip Conversations
Social Skills Groups
Encourage Friendship
Skills

Behavioral strategies of task analysis,

shaping, prompting and rewards
Cognitive strategies to learn the theory
and script using Social Stories
Four Levels in the
Development of
Friendship
Level 1: Approximately
3 to 6 Years
Recognition of turn taking
Egocentric conceptualization
One way assistance
Proximity and physical attributes
Why is.your friend?
Because I like him
He lives next door
Level 2:
Approximately 6 to 9
Years
Reciprocity and being fair
Mutual assistance
Like the same activities
Aware of the preferences,
feelings and thoughts of the other
person
Why isyour friend?
She comes to my party and I
go to hers
Shes nice to me
Level 3: Approximately 9
to 13 Years

Aware of others opinion of them and how

their words and actions affect the feelings of
others
Shared experiences and interests
Greater selectivity and durability
Gender split
Trust, loyalty and keeping promises
Level 4: Adolescence to
Adult
Peer group acceptance more
important than the opinion of
parents
Greater depth and breadth of self
disclosure
Desire to be understood by
friends
Different types of friendships
He/She accepts me for who I
am
We think the same way about
things
Characteristics Associated
with Aspergers Syndrome

Motivation for friendship

Immaturity
Control the activity
Describe what a friend should not do
Negative experiences
Checklist of Social
Behaviors Used as an
Index of Friendship Skills
Entry Skills
Recognizing when and how to join in
The welcome provided for children who approach them
Assistance
When and how to provide assistance
Seeking assistance from others
Criticism
Knowing when criticism is appropriate and inappropriate
How to criticize
Tolerance of criticism
Compliments
Compliments at appropriate times
Responding to a friends compliment
Accepting Suggestions
Incorporating the ideas of others in the activity
Indicating agreement
Reciprocity and Sharing
An equitable distribution of conversation, direction and
resources
Checklist of Social
Behaviors Used as an Index
of Friendship Skills - Cont
Conflict Resolution
Managing disagreement with compromise
Accepting the opinions of others
Not responding with aggression or immature resolution
mechanisms
Monitoring and Listening
Regularly observing the other person to monitor their
contribution and body language
Their own body language indicating an interest in the
other person
Empathy
Recognizing when appropriate comments and actions
are required in response to the other persons
circumstances and positive and negative feelings
Avoiding and Ending
Appropriate behavior and comments to maintain solitude
Appropriate behavior and comments to end the
interaction
Encouraging Friendship
Skills

Assess which skills are observed or absent

Assess the quality and range of expression
Use behavior and cognitive strategies to
acquire and develop specific skills
Task analysis, prompting, shaping and reward
Reward all participants
Teach the theory as well as the practices
Social stories
Additional
Strategies
Friendship diary

Matching individuals with similar

interests
Support groups for adults
Local and pen pal registries
Internet chat lines
Books of friendship
Recognizing when someone is not
a friend
Maintaining and ending
friendships
Tuition in characterization
Characterization
Skills

Unusual in their perception and description of the

personality characteristics of others and themselves
Limited lexicon to describe the different types of
character
Immaturity and predominance of physical attributes
One dimensional approach
Difficulty reading a persons character and adapting
their behavior accordingly
Teaching
Characterization Skills
The Mr. Men and Little Miss books
Examples are Mr. Grumpy, Little
Miss Chatterbox and Mr. Nosey
Choosing an animal to represent
someones personality
Reading dictionary definitions of
character and identifying someone
who has those characteristics
Identifying the description of their
own character
Social Skills
Groups
Friendship
Theory of mind
skills
Conversation skills
Reading and
expressing body
language
 The Understanding and
Expression of Emotions

A project on a specific emotion

Create a scrap book that illustrates the emotion
Compare and contrast other childrens scrap books
Identify the facial elements that express the emotion
A thermometer to measure the degree of intensity
Place photographs and words at the appropriate
point on the thermometer
Point to the degree of expression in a particular
situation
 The Understanding and
Expression of Emotions Cont

Appropriate tone of voice

Drama games for appropriate body
language
Mirror and video recordings
Story books
Sentence completion exercises
Alternate positive and negative emotions
Imitation
Identify individuals skilled
in a specific ability
Observe their actions and
script
Copy or mimic their style
Speech and drama
training