What is Asperger Syndrome?

Strangers in a Strange Land: The Core Characteristics of AS

A Foreign and Fuzzy World

To a child with AS, the world of people and social interaction may seem fuzzy and out of focus, while the world of objects and information is distinct and familiar. Social cues, facial expressions, and motivations may not be well understood, or may even be missed entirely. Imagine a world where you were aware of physical objects, but blind to the thoughts, motivations, desires, beliefs and intentions of those around you. This inability would make it impossible to predict or comprehend other’s actions. People who live in such a world lack a theory of mind (TOM). Theory of mind enables people to attribute thoughts, beliefs, motivations, desires, feeling and intentions to others in order to make sense of their behavior. Having a theory of mind relies on three assumptions: the human ability to comprehend, first, that I have a mind; second, that you have a mind, and third, that our minds may not always be feeling or know the same things. Lacking a theory of mind is also referred to as mindblindness. Simon Baron-Cohen, a psychologist from the UK, has pioneered work in this area. Baron-Cohen offers the following mental exercise to illustrate mindblindness: Consider the statement, 'John walked into the bedroom, walked around, and then walked out.”

Someone without mindblindness, a mindreader , would make sense of this statement by asking why did John behave in this way. They then would attempt to ascribe intention, thoughts, and desires to explain the possible motivations underlying John’s actions. For example,
“Maybe John was looking for something he wanted to find, and he thought it was in the bedroom.” Or, an alternate hypothesis might be that “John heard something in the bedroom, and wanted to know what had made the noise.”

Now, try to explain John’s behavior without assuming any motivation, intention, thought or desire on his part. The assumption that John had misplaced something and walked into the bedroom to find it wouldn’t come to mind. Nor would the hypothesis that he had walked to the bedroom to investigate a sound arise in your mind. Both conjectures, though reasonable, are lost on someone who lacks a theory of mind.

Taken a step further, consider how being mindblind would impact comprehension of a more complex social situation in which different people, with varying beliefs, intentions, and emotions interact. Imagine the complexities and multiple levels of nuance involved at a board meeting, a political rally, or during the plot of a movie. For someone who lacks theory of mind, the world of human behavior might seem irrational, random or completely bizarre. This world might be confusing, frustrating and frightening. Such is the plight of many children with AS. Under such circumstances, one can understand why they would gravitate to the more predictable realm of material objects, facts, numbers and information. In general, understanding that children with AS lack a theory of mind will explain a great deal of their with communication and social interaction.

Misunderstood Social Cues

It’s commonly accepted that a great deal of communication occurs non-verbally through facial expression, eye contact, gesture and body language. In some contexts, non-verbal communication speaks louder than words. What if you were in Rome, having just learned Italian in a six-week crash course. You might be able to understand most of the words individually, but could still have difficulty fitting them into meaningful sentences. The use of slang and idiom would probably be completely confusing. To make things worse, the hand gestures and body motions of the Italians might seem so varied, forceful and intense, that you could only understand a small portion of what was actually being conveyed. For example, you might innocently think that the large man patting his bicep forcefully while raising his right arm in your direction means he wants to demonstrate how strong he is. In fact, he is making an extremely obscene and disrespectful gesture.

This example is analogous to the state of the child with AS, who may already have some difficulty with understanding verbal communication, but often hasn’t a clue when it comes to gestures, facial expressions, and body language. If you show a child with AS photographs of people with facial expressions that any NT child could easily identify, the child might be at a loss to explain the differences among depictions of happiness, sadness, anger or fear.

Considerable training and practice may be necessary before a child with AS can even begin to read facial expressions in real-life situations. Other more complex forms of gesture and body language, or the combination of these with known facial expressions, may be even more difficult to grasp. A mother who is looking angry, speaking loudly, and shaking her index finger becomes meaningful to a NT child, but may have little impact on a child with AS, who may not alter his behavior in response to such a display. The mother, puzzled, may use a louder tone or more forceful gestures, further confusing the child, who then still “ignores” the gestures.

Difficulty Blending In
Kids with AS are typically viewed by their more socially aware peers as behaving oddly and awkwardly in social settings. They may appear eccentric, emotionally immature and have difficulty adapting to the complex and shifting social scene. Their awkward body language, limited facial expression or use of gestures, and peculiar gaze set them conspicuously outside of the social norm. Attempts to initiate social interaction are frequently unsuccessful. Forgoing a standard greeting such as “hello, my name is…” they may introduce themselves by launching into a long-winded diatribe about the ten fastest trains in the world. As their ability to make and sustain friendships is limited, they are often left with a feeling of bewilderment, loneliness, and defeat.

Life on the Sidelines
During childhood and adolescence, group activities such as team sports are a common venue for establishing friendships. Children with AS may have little interest or ability in sports and games that are so often key to social acceptance on the playground and the neighborhood soccer field. These children may be clumsy and suffer deficits in muscular and hand-eye coordination. They often have limited fine and gross motor skills. Throwing, kicking and catching balls may be difficult, if not impossible. While all of the other youngsters else run off to play soccer or jump rope during recess, the AS child may wander around the periphery of the playground, absorbed in the intricacies of his mind.

Self-Stimulatory and Bizarre Behaviors
Habits such as picking, poking, flapping, flicking fingers, walking on toes, looking at objects sideways, or spinning can be pronounced in kids with AS. Though they may be involuntary and unnoticed on the part of the child engaged in such activities, the sheer repetitive bizarre quality of the behaviors often sets up further obstacles to fitting in with NT peers.

Apparent Lack of Empathy
Due to deficits in social communication, kids with AS may be perceived as aloof and uncaring. They may appear wooden and awkward during interactions and fail to respond with the expected facial expressions or body language when someone expresses emotion to them. However, this should not be interpreted as an inability to care for others or an incapacity to experience emotion. Because they have theory of mind problems, the emotions of others in their lives may be confusing, and they may not know how to respond. Likewise, their expression of emotion may be different than it is for neurotypical people. Adding to their emotional challenges, sometimes children with AS become overwhelmed by strong emotions, even positive ones. They may become “flooded” and shut down, not being able to figure out what to do or say.

Honesty to a Fault
Lacking an understanding of tact, or the sophisticated, socially appropriate “white” lies that spare hurt feelings, these children may come across as blunt. For example, on observing an obese or disfigured person, a child with AS may loudly proclaim out how fat and ugly the person is, to the point of offering suggestions concerning weight reduction and beautification. One patient of ours once publicly corrected a classmate’s grammatical error while her peer was in the midst of giving a public performance in the school auditorium. Although kids with AS may recognize their social faux pas once the error is explained to them, they often have difficulty generalizing this knowledge for use in a similar situation.

Minimal Eye Contact
Lack of eye contact is one of the most overt social difficulties for many AS children. Meeting eye to eye might make the child feel acutely uncomfortable, or even terrified, and such direct contact is often deliberately avoided. Although neurotypicals may not be aware of it, eye contact contributes a significant amount of information during a social exchange. This additional stimulation may be distracting for the child with AS, since trying to comprehend verbal information while maintaining eye contact may, in fact, break his concentration. Some adults with AS have likened making eye contact to watching one hundred televisions at once! As a result, an AS child is likely to look away or even close his eyes, often to the consternation and bewilderment of the person with whom he is speaking.

Rigid, Rational and Restricted: Structure and Routine

In light of how chaotic and unpredictable the NT social world appears to a child with AS, routine and structured play an immensely important role in giving him a semblance of control over his life. This desperate need for structure is especially intense when there have been life changes such as a new school, new house or new family member. Repetition and routine may be perceived as anxiety-reducing, soothing, and pleasurable. Changes in routine, interruption, or sudden transitions may be intolerable. Your simple request that your youngster turn off the Lion King, which he has watched thirty-four times, or put away his Yugio cards to come to dinner, may turn rapidly into an explosive episode. A change in classroom schedule or a transition from recess to art may be met with fierce opposition and an accompanying meltdown. Your child may be so entrenched on a particular track, that rerouting him may pose an insurmountable task, or at least one that is not worth the resulting mayhem. Consequences are likely to be ignored, regardless of their severity.
This need for sameness and routine is played out within social groups too, especially when it comes to rules and regulations. Once the rules have been set out, your child may rigidly enforce them; perhaps by becoming the class or family policeman who becomes easily angered when a peer or family member violates a rule. Such self-appointed “police” status does little to help him fit in with his peers, resulting in further marginalization.

Literal-Minded
Interpreting the world literally and concretely rather than metaphorically or abstractly often causes AS children (and adults!) to see things as “black and white” with little opportunity for interpretation of “gray” areas. Such a limited way of perceiving the world may provide safety and comfort to a child with AS by helping to make the incomprehensible more “concrete.” Overly literal interpretation of proverbs or common expressions such as the “cat got your tongue?” can provoke unexpected and socially aberrant reactions. For instance, a child may be able to tell you everything observable about a brown and white cow standing in a field, but absolutely nothing about the proverbial purple cow, who can not be seen in a literal fashion. The memory of what has been observed can in some cases be prodigious, even eidetic, with exquisite attention to detail, but with some difficulty in “seeing the forest for the trees.” (Which, of course, is an expression many people with AS would find confusing!)

Preoccupied and Pedantic Professors

Verbal Communication

Children with AS struggle with communication and their speech maybe distinctly odd. While their vocabulary development may be far beyond their years, using words correctly in spontaneous conversation, or communicating within a social context may be noticeably impaired. Their main struggle seems to be with pragmatics, the practical use of language in a social setting. Effective pragmatics requires a theory of mind which enables one to figure out what another person does or doesn’t know, or to determine what they are interested in hearing about. Lacking a theory of mind implies that everyone around you is thinking, feeling, and motivated by the same thing. Thus, another person’s potential conversational interests remain unrecognized because their interests are exactly like yours.

Problems with the pragmatics of communication are often most noticeable. The child may initiate a conversation with a completely irrelevant and untimely comment, such as asking a stranger, immediately before a church service, if he is familiar with the straight-six, two-hundred-horsepower engine used in the 1966 Ford Mustang. As the service commences, the youngster might proceed to launch into an extensive description of his favorite car engine, oblivious to the social codes surrounding a church service. Another common feature consists of the introduction of unrelated comments in the midst of an ongoing conversation, perhaps word associations, fragments memorized from a previous dialogue or a favorite story or film. Such interruptions can be frustrating for the unsuspecting conversational partner, and they tend to increase the child’s social isolation.

Additionally, children with AS struggle with prosody: an unusual rhythm, stress, pattern or pitch. They may talk in a flat or high-pitched, sing-song or mechanically robotic tone of voice. As a result, an AS child’s intonation pattern may be incongruent with what the child wishes to communicate. Likewise, rhythm and stress on particular words may be off, giving the mistaken impression that English is a second language.

Non-Reciprocal Communication
Conversation is typically one-sided, more monologue than dialogue, and often revolves around one all-encompassing, repetitive topic. A child with AS tends to unilaterally dominate conversations, interfering with the usual give and take of two-way conversation. Memory for facts and details can seem astonishing, even mesmerizing, at first. The novelty soon wears off when the one-sided nature of the interaction becomes evident. Unless the listener is family, or is socially obligated to engage in conversation, he may look for the nearest exit, and leave the youngster at the quickest opportunity for escape. While adults may put up with this kind of monologue for a while, children have no patience for it, and quickly lose interest. This is one reason why kids with AS gravitate to adults rather than to peers. Even if the special interest is peer-appropriate, such as Harry Potter or GameBoy, the level of detail and monopolizing often lead to frustration and an expression of “enough is enough” or “can’t you talk about something else?”

Precocious Reading Abilities
Children with AS may demonstrate a precocious ability to read which parallels their extensive vocabulary development. This is called hyperlexia. However, the problem with comprehension and contextual understanding remains in both cases. Although a five-year old with AS may be able to pick up the Wall Street Journal and begin reading out-loud about a recent hike in interest rates, his comprehension of the meaning of the article will lag far behind. With hyperlexia, there is a discrepancy between one's ability to read a word and the interrelated skills involved in comprehending the meaning of a word within its context.

Restricted Repertoire of Interests
The propensity to become utterly engrossed by a special interest that dominates the person’s time and conversational repertoire occurs to an exaggerated degree in a child with AS. These fascinations are engaged in with an intensity, exclusivity, and undivided focus that sets them apart from the favorite subjects or interests of NT children. Special interests are usually solitary and often quite arcane. The excessive nature of these preoccupations may be trying for parents and teachers alike. The focus of obsession can periodically change over months or years. Younger kids may focus all of their attention on collecting specific objects such as bottle openers, keys, pop cans or green pens. Often nothing can separate such a child from acquiring his desired item, and his highly developed radar system will uncannily hone in on the object in the most amazing places and at the most inconvenient times.

As a child becomes older, the special interest often transitions to a subject, or preoccupation. Regardless of whether the subject is spiders, train models, stars and planets, fire trucks, dinosaurs, bus schedules or maps, the youngster accrues extraordinary amounts of raw data, facts, and statistics. He may develop an encyclopedic knowledge of the subject, reading every related book in the library, and exhausting all available sources of information.

Special interests are likely to serve multiple purposes for the child. As they often involve data, facts and orderly statistics, they are reliable and predictable. This type of information can be a safe haven from the onslaught of a confusing and changing world. Since conversation doesn’t come easily, the youngster is likely to find himself unable to 'make small talk.' On the other hand, extensive knowledge of a familiar subject permits him to speak fluently and knowledgably for hours.

Sensitive, Selective and Susceptible

Hypersensitivity
Oversensitivity to a myriad of stimuli, including touch, texture, pressure, light, odors and tastes, is common in children with AS. Sirens, school bells, crowd noise, yelling and screaming, or even the buzz from fluorescent lights, can range from annoying to painful, causing extreme reactions that may leave those around them wondering: what just happened? Bright or blinking lights, scratchy tags on shirts, tight clothing, or seams in socks, easily ignored by all but the most sensitive kids, may be literally unbearable. Conversely, some people with AS have decreased sensitivity to stimuli, and are unruffled by or seem not to notice sensations that most neurotypicals would consider over the top. Children with AS may have both over- and under-sensitivity. For example, they may refuse to wear socks or tight clothing, while at the same time ignoring strong odors or changes in temperature.

Sensitivity to Criticism
The ability to learn new things, generalize learning, adapt to new and shifting situations, and learn from one’s mistakes is often crucial for success in most social and school situations. Because of their rigidity, youngsters with AS may repeatedly fail. This inability to adapt and be flexible may trigger ongoing criticism. Although negative feedback is unpleasant for most of us, it may be especially painful for a child who finds himself the resident of an incomprehensible world in which he doesn’t know how to play by the mostly unspoken rules

Picky, Picky, Picky!

Many of the sensory issues examined above cause AS kids to be described as selective or picky about food, drink, clothing, environment, objects, and people. This selectivity can mightily test parents, teachers, and caregivers, who, try as they may, can’t seem to please their “picky” kids.
Take the case of youngsters who will only eat foods from a specific category like white foods, soft foods, crunchy foods, or dry foods. Others may refuse to eat mixed foods, slimy foods, or foods “contaminated” by utensils or by barely touching some other “gross” food that they consider inedible. Then there are those who will drink only milk, or pop, or a certain juice. Just imagine preparing meals for such a child each day. While all parents may occasionally run into such battles, the rigidity of AS children is legendary. Many parents simply give up and let their child survive on what he will eat, perhaps sneaking nutritional supplements into those few “acceptable” foods.

An Alternative Path Helps the Stranger Return Home
Hopefully, the catalogue of characteristics above has piqued your interest in AS, or reminded you of experiences you’ve had as a teacher, parent, or caregiver of such a child. Perhaps you fit the AS profile yourself. As we explore the multi-faceted world of children and adults with AS throughout this book, we hope to show you how, with the help of homeopathic medicine, being a “stranger in a strange land” can be transformed into the familiar feeling of arriving home.

Conventional doctors often use psychiatric medication to assist in this process. Sometimes medication is presented as the only option. Though medications have their place and can be helpful at times with some target symptoms, we offer viable alternative to drugs. That is what this book is all about. In the next chapter, we provide an overview of the psychiatric drugs used to treat ASD, and, if available, the research supporting the use of these various medications. We will then launch into a discussion of homeopathy, the most effective alternative to conventional drugs we know.