Helping Your Adolescent with Asperger’s Syndrome

It’s heartbreaking for parents to discover that their child’s development isn’t on par with other children his or her age.  Asperger’s Syndrome, which primarily impacts social and communication skills, fits into a category of delayed development formerly known as “pervasive developmental disorders”.

Up until 2013, Asperger’s Syndrome was diagnosed as a distinct disorder.  However, since the publication of the latest edition of the diagnostic manual used by mental health professionals, the DSM-5, individuals with symptoms of Asperger’s are diagnosed with autism spectrum disorder, or ASD.

Asperger’s Syndrome (AS for short) is generally considered the mildest and highest functioning type of autism.  Since early intervention is crucial, it’s important to be able to identify the warning signs and know what steps to take if you believe your teen has Asperger’s Syndrome.  This brief guide is designed to help you do just that.  

Adolescent ASD and Asperger’s Syndrome Statistics and Facts

• According to CDC estimates, the prevalence of ASD is 1 in every 68 births in the U.S.
• Asperger’s Syndrome is 3 to 4 times more likely to be diagnosed in boys than girls
• Certain genetic disorders occur in 1 out of every 5 individuals with ASD
• Adults with AS are much more likely to have suicidal thoughts than the general population (10 times as likely per a survey conducted in England, with over 1 in 3 having planned or attempted suicide at some point in time)
• The exact cause of AS has not yet been determined, although environmental factors and genetics likely play a role
• Although there’s currently no cure for AS, proper intervention strategies can be highly beneficial and improve a person’s level of functioning
• Some individuals with AS are able to work full-time and live relatively or completely independently

Mental Health Disorders that Often Co-Occur with Asperger’s Syndrome

It’s not uncommon for adolescents with Asperger’s Syndrome to have other mental health issues, or at least some symptoms of them, as well.  Depression, in particular, is common in teens with AS.  This is often triggered by their increasing awareness of their limited social skills and not fitting in with many of their peers.  Following are psychiatric disorders that often co-occur with AS:

• Depression
• Social Anxiety Disorder
• Obsessive-compulsive Disorder (OCD)
• Bipolar Disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Nonverbal Learning Disorder
• Other Anxiety Disorders

Looking for and Recognizing the Signs of Asperger’s Syndrome

Autism spectrum disorders are often diagnosed in early childhood.  However, since individuals with AS are on the higher-functioning end of the autism continuum, an early diagnosis is more likely to be missed.  As a parent, the sooner your child is diagnosed the sooner he or she can begin benefitting from proper intervention.  Three key things to remember when it comes to Asperger’s Syndrome:

• Symptoms can range from very mild to severe
• The primary problem pertains to social deficits, which can manifest in a variety of ways
• No two teens with AS are alike

Following is a list of warning signs of Asperger’s Syndrome to look for in your teen:

• Misperceived by others as a smart aleck
• Has a very limited tolerance for any kind (e.g. reacts to any disruption to his or the family’s normal routine)
• Has difficulty showing or expressing empathy for others
• Frequently misinterprets obvious social cues, such as body language
• Is socially awkward
• Avoids eye contact or stares at others
• Is immature for his or her age
• Talks a lot about himself or herself / conversations tend to be one-sided
• Intensely focuses on a specific subject (e.g. astronomy or baseball stats)
• Repeats the same movement again and again
• Speaks in a manner than seems robotic or monotone
• Has limited emotional expression (e.g. feels happy but doesn’t smile)
• Doesn’t know how to respond in conversations
• Is naïve in social situations
• Is too trusting
• Prefers clear rules and structure
• Says exactly what he or she is thinking (e.g. frequently comes across as blunt or inappropriate, due to a lack of normal “filters” rather than intention)
• Feels as if he or she doesn’t fit in with peers
• Is often bullied or teased
• Is socially isolated
• Has no interest in fads or trends
• Marches to his or her own drummer
• Tends to take sarcastic remarks literally

When looking for signs of AS, it can be helpful to reflect on your adolescent’s early childhood and pre-teen years.  Symptoms that may have been present early on include:

• Motor skill development was delayed
• Posture or facial expressions were unusual
• Spoke in a formal manner that seemed advanced for his or her age
• Got very agitated or upset with any change in routine
• Had a heightened sensitivity to loud noises or other types of stimulation, such as strong tastes or bright lights
• Was very pre-occupied with certain subjects or things

As with most disorders, the many of the warning signs listed above are observed in many teens who don’t have Asperger’s Syndrome or qualify for a diagnosis of autism spectrum disorder.  For example, many teens will say exactly what’s on their mind (even if it comes across as rude), become obsessed with a subject that interests them, or lack many age-appropriate social skills.  But if several warning signs are present, it’s important to have your teen evaluated, as it’s far better to err on the side of caution.

Knowing the First Steps to Take  

If you’re concerned that your teen is exhibiting signs of Asperger’s Syndrome, and he or she has never been formally diagnosed with AS, don’t ignore it.  Adolescents with AS have unique needs that require specialized education and other forms of intervention.  A formal diagnosis can open the door to resources for your child.  Following are important first steps to take:

1 – Consult with your primary care doctor or your child’s pediatrician.  Discuss your concerns regarding the warning signs you’ve noticed, such as difficulties reading social cues, quirks in communication, or making friends.  Your doctor can refer you to someone who specializes in diagnosing and treating individuals with ASD.  This leads to the next step:

2 – Have your child evaluated by someone who specializes in ASD – It’s not uncommon to have a team of professionals treating your child.  These professionals may include:

Mental health professionals:

• Psychologist
• Psychiatrist

Other healthcare professionals:

• Developmental Pediatrician
• Pediatric or Child Neurologist

The evaluation process will determine whether the signs you’ve been noticing are related to Asperger’s Syndrome, warranting a diagnosis of autism spectrum disorder.  The evaluation process may include any or all of the following:

• Psychological assessment
• Communication assessment
• Neuropsychological evaluation
• Psychiatric evaluation

3 – Get your teen into treatment.  Once your teen has been evaluated and diagnosed, a treatment program will be recommended based on his or her unique needs.  Treatment for ASD usually involves a combination of the following:

• Applied behavior analysis – Focuses on increasing positive / desired behaviors and reducing unwanted behaviors using behavioral methods, such as positive reinforcement
• Social skills training – Focuses on learning more appropriate social skills
• Speech-language therapy – Focuses on improving conversational skills and overall communication, including reading social cues more accurately
• Parent education and training – Focuses on teaching parents how to help their child with Asperger’s
• Sensory Integration / Occupational Therapy
• Cognitive behavioral therapy (CBT) – Focuses on changing negative / unhealthy thoughts patterns with more positive / healthy ones that will improve both emotions and behaviors
• Medication – This may be prescribed to reduce symptoms of co-existing disorders such as depression or anxiety. Medication can also help the following:
  • Aggressive behavior
  • Hyperactivity
  • Difficulties with attention
  • Repetitive behaviors
  • Irritability

Remember, every child with AS is different so there isn’t a one-size-fits-all approach to treatment and intervention.  What is true, regardless of your teen’s unique needs, is that the sooner intervention starts, the brighter his or her future will be.

4 – Get your teen into an IEP (individualized education program).   Public schools are required by law to offer appropriate services for anyone between the ages of 3 and 21 years who has a disability (which includes ASD).  Contact your local school district and meet with them to set up an IEP for your teen.

Supporting and Encouraging Your Child

One of the best things you can do for your teen with AS is provide ample support and encouragement.  There are many ways you can do this including:

• Learn everything you can about Asperger’s Syndrome and ASD so you’ll know what to expect and how you can help
• Encourage your teen to explore his or her interests, both at school and at home
• Find ways to facilitate friendships between your teen and other kids his or her age (e.g. have your teen invite a friend to spend the night or go on a fun family outing)
• Be flexible
• Create a routine at home (e.g. for meals, bedtime, etc.) and stick to it as much as possible to minimize stress for our teen
• Set rules and expectations that are clear and specific
• Take note of (and minimize, if possible) things that may be distracting your teen, such as certain noises (e.g. a ticking clock)
• Help your child learn and practice coping skills for stressful situations that can’t be avoided; prepare him or her in advance if possible (e.g. company coming to visit, moving to a new home, etc.)
• Learn what things are particularly stress for your teen and avoid (or at least minimize) them as much as possible
• Help your teen develop better social skills by using role-play and discussing people’s behaviors you see while watching TV or movies together
• Be generous with your praise, focusing on frequently praising desired behaviors
• Use visual props and aids (e.g. calendars or lists) to help your teen stay organized and on track
• Use clear, verbal instructions and explanations (e.g. for rules, expectations, etc.)
• Strive to be patient and calm, even when you’re feeling frustrated or overwhelmed
• Be understanding and empathetic regarding your teen’s limitations and challenges

What to Do When Things Escalate    

Adolescence is difficult for almost everyone.  With Asperger’s it can be particularly difficult to navigate.  Occasional emotional “meltdowns”, which can lead to withdrawal, shouting, aggression, or fits of rage, are also not uncommon in teens with AS.  Social challenges, sudden changes, academic pressure, and rejection are just a few things that can trigger a meltdown or worse.

Many teens with Asperger’s develop co-existing disorders, such as depression, anxiety (particularly social anxiety), and substance use disorders (the latter often develops as a way to cope).  In the U.S., suicide is the second leading cause of death among all teens between the ages of 15 and 19.  Teens with AS and one or two other disorders, particularly depression alone or combined with substance abuse, the risk for suicide can be dangerously high.

If your teen has become violent or suicidal, it’s essential to take immediate action to ensure everyone’s safety.  This may include:

• Enlist the help of a family member or friend / make sure your teen isn’t left alone
• Contact your teen’s therapist or doctor asap
• Take your teen to the nearest hospital ER
• Call 911

A brief hospitalization may be necessary, especially if your teen is actively suicidal.

When Individual or Regular Outpatient Treatment isn’t Enough

While many teens with Asperger’s (and a stable, supportive home environment) do well with a comprehensive outpatient individual treatment program (discussed above), others need a higher level of treatment.  This is even more likely if your teen is battling more than just AS.  More intensive levels of treatment include:

• Intensive outpatient treatment (IOP) / Psychiatric day treatment
• Residential treatment
• Dual diagnosis treatment
• Inpatient psychiatric treatment

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how often (e.g. twice a week, 5 days a week) your child is required to go.  These programs are the next step up from regular outpatient treatment.

Residential treatment involves having your child stay at a non-hospital treatment facility that specializes in treating adolescents with ASD and other mental health disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the disorder and its severity.

Dual diagnosis treatment may be necessary if your teen has a serious substance use disorder.  This can occur on an outpatient or residential level.

Inpatient psychiatric treatment is involves admitting your child to an adolescent psychiatric hospital unit where medical staff is monitors patients 24/7. It may last for a few days to a few weeks, and is particularly beneficial for adolescents who are an imminent danger to themselves or others, usually due to severe depression, psychosis, or mania.

Taking Care of Yourself

Parenting a teen with AS is a difficult and, at times, exhausting task, so it’s important that you make a conscious effort to take care of yourself.  Some things you can do include:

• Make sure you get sufficient sleep and rest
• Make time for yourself
• Surround yourself with supportive people
• Join a support group geared towards parents of children or teens with ASD

Many teens with Asperger’s Syndrome become adults with relatively happy, fulfilling lives despite the challenges they face daily.  Getting your teen help now will help ensure a bright future for him or her.