Long Island Behavior Analysis Conference

Do Parents and Teachers Get Children with AS/HFA? These Children Lack the Insight or Social Skills to Explain Themselves

Many teachers and parents miss the connection between the diagnosis of children with Asperger’s Syndrome (AS) or high functioning autism (HFA) (and nonverbal learning disabilities) and the behaviors of the child in day-to-day life. When adults don’t get this connection, they can’t communicate understanding to the child. Children usually react negatively to feeling misunderstood, and a cycle of misinterpretation, anger and hurt can result. Parents and teachers often label these behaviors as rude, oppositional or “attention seeking.”

What are the symptoms of Asperger’s Syndrome that are often misunderstood? Concrete thinking is typical of these children, yet many adults misinterpret concrete thinking because children with Asperger’s Syndrome, HFA or nonverbal learning disabilities (NLD) are often quite bright and verbal. Their apparent verbal skills set unrealistic expectations for their level of comprehension and behavior. The comments of the child are often seen as due to rudeness or a “bad” attitude.

I was called into a school to observe a 7th grade boy whom the staff feared was “pre-Columbine.” He was described as withdrawn and hostile. The staff shared one story in particular to illustrate his negative attitude. His science teacher had decided to take a break by showing a short funny film. The class enjoyed it, but this boy raised his hand and asked, “What does this have to do with science?” His teacher saw this comment as rude and inappropriate. I observed this boy during the day. He thought an “electric car wash” was a wash for electric cars. His question was simple and authentic. He didn’t understand what the movie had to do with science. His poor social judgment did not warn him that his comment would be out of place. Children with AS may ask many apparently inappropriate questions, much to the annoyance of their teachers, who don’t believe that a “bright” child would miss the point.

Another boy I evaluated was frequently “melting down” at home. He described to me how much he enjoyed his mother’s homemade cookies. As we were talking, I was trying to describe to him how unexpected things happen, and used the example of a time when his mother’s cookies might not come out right. He yelled, “That can’t happen!” and burst into tears. Eventually I figured out that he thought I meant that his mother couldn’t open the oven door so the cookies could “come out.”

This concreteness and failure to grasp ideas especially interfere with inferential thinking and generalization. Children with AS usually have excellent rote memories and remember facts well, but they can completely miss a main idea. These children fail to see the forest for the trees; they focus on details and miss the “big picture.” History can be easy to understand if the material is factual, but open-ended questions can stump even bright students with AS. Literature in which information is implied can be completely confusing. “Huck Finn” is a great example of literature that is incomprehensible to some children with AS, since so much information has to be inferred from details. Writing is a huge problem if details aren’t prioritized and connected to main ideas. Parents often don’t understand why their bright children can’t produce a paper, and are pressured by teachers to have their children get homework completed.

This focus on details can make it very hard to generalize, whether in math problems or in behavioral rules, because if you focus on details, each situation seems unique. Frequently, when I’m testing child with AS, he will ask about the directions, which he had already followed successfully, but in a new section of the test – he won’t know if the same rules apply. A 3rd grade boy often made truthful (for him) but inappropriate comments that were critical of his peers, such as, “That’s an ugly sweater.” He was finally told, “If you don’t have something nice to say, don’t say it, so don’t say something is ugly.” The next day, he asked a girl why she was eating a yucky bologna sandwich. To him, this wasn’t a “not nice” comment. He thought it is just a fact that bologna is “yucky,” so this wasn’t a question of “niceness,” and he had been told not to use the word “ugly,” not “yucky.”

Inflexibility is also a typical problem. These children have what I call “railroad track thinking.” Most of us think like we drive: if a road is blocked, we detour around it. These children’s thought process often can’t detour; it’s straight ahead or nothing. A parent told a child that he would get to go to McDonald’s after his tutoring session. While he was in session, his sister got hurt, possibly breaking her arm. The mother picked him up and told him they had to rush to the emergency room. McDonald’s was off. He was furious, screaming, “You lied!” He had no appreciation of the fact that his sister was injured, only that he had been promised McDonald’s and McDonald’s wasn’t happening. His mother saw his behavior as a selfish lack of compassion for his sister, and he was punished.

These children are often punished or given detentions in school, and have no idea why, so they feel teachers and parents are unfair. An 8th grade boy was following friends who would misbehave. He might join in, or not, but to him, the behavior wasn’t violating the listed rules. He had no idea why he was given detention and came to the conclusion that his teacher “was out for him” and hated him. In class, a high school student was supposed to work on a group project. To him, there was only one “right” way to do it; his teammates disagreed. He walked out of the room and refused to do the task, resulting in a grade of zero. Younger students often become guardians of the rules, and report classmates for minor infractions. It is a surprise to them that this often isn’t appreciated by the teacher, and certainly isn’t appreciated by the classmates.

It is evident by now that the inability of these children to appreciate theory of mind, the idea that someone might have a different point of view (and one that is legitimate) often gets in the way. The lack of social skills and social understanding makes it hard for them to anticipate the outcome of their behavior, and often if others object to their ideas, the children with AS think the teachers or peers are just “wrong.” These children often express their ideas without appreciating “fine points” such as the authority of a teacher or parent. A high school student felt it was necessary to criticize his teacher in front of the class, since the teacher’s lesson plan and behavior were “wrong.” When we talked, he said his teacher was stupid and biased, and he was tempted to tell him that as well. A 7th grade girl announced to her assembled extended family that religion was stupid and she didn’t believe in God during a religious celebration. Unsurprisingly, her grandparents felt she needed discipline and her parents were lax.

When working with these children, it’s often very challenging to change their point of view; one has to settle initially for redirecting the response to something more socially appropriate and less offensive. I had a teenaged patient with AS who unfortunately was also quite depressed. At one point, the treating psychiatrist hospitalized him on an adolescent unit that I was assured “understood” AS. After two days, I received a call from the psychologist on the unit complaining about my patient, who was sitting in group therapy with his laptop open, despite the limits set by the psychologist. I told the therapist that in my opinion, my patient was doing pretty well, since in the past he would have announced that the group was stupid and he didn’t care about it. Quietly working on a laptop was a much more acceptable choice and the product of hard work.

“What am I supposed to do,” the therapist asked, “tell him he’s doing well?” He obviously didn’t get “concrete.” “No,” I told him. “You should tell him you understand that he probably isn’t interested in the group and that you appreciate his social judgment in not saying so. Then either take him out of group, or let him have his laptop.”

The point of this example, and this article, is how important it is for these children to feel understood, and how the adult must communicate respectful understanding of child’s point of view before trying to correct his behavior. The adult in these situations must ask why this behavior might be happening, and essentially to perform a functional behavioral analysis, figuring out the child’s thinking that had triggered the response. One we “get it,” we can communicate understanding, building a more trusting relationship that gradually allows us to work towards more flexible and socially appropriate behavior.

 

Dr. Eckerd is a licensed psychologist working for over 25 years with children, teens and adults with Asperger’s Syndrome, Nonverbal Learning Disabilities and PDD NOS. She provides therapy, neuropsychological evaluations, social skills coaching, and consultations for parents, schools, advocates and attorneys. She is a licensed psychologist on the National Register of Health Service Providers in Psychology, a resource clinician on OASIS/MAAP (Aspergers.com) as well as NLDline.com, a professional board member of CT Association for Children with Learning Disabilities and Smart Kids with LD, a member of the Council of Parent Attorneys and Advocates (COPAA). Her blog, “People Skills” is found on PsychologyToday.com.

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