Module 1.
What is Asperger syndrome and how is it defined?
- Asperger syndrome and the controversial but compelling ideas of Professor Simon Baron-Cohen, that Asperger’s may be an excess of ‘maleness’
- A syndrome is a collection of signs and symptoms which occur together and are characteristic of a condition, usually a medical condition.
- Claire Sainsbury humorously recorded in her autobiography, while not all people who have Asperger’s are trainspotters, all trainspotters have Asperger’s.
- Tony Attwood remarks Asperger’s can be defined as: ‘A lack of social understanding, limited ability to have reciprocal conversation and an intense interest in a particular subject area.’
- In most cases, interest in their subject and the pedantic, rather grown up speech may give a child with Asperger’s an air of maturity.
- Aspergers inhibits growing up mentally into an adult.
- Exceptional and Math, computers and other scientific pursuits.
- Children with Asperger’s have problems reading nonverbal communication to a level expected of people of the same degree of maturity.
- Subtle clues about group hierarchies in teens, an inability to join in with ideas, arguments, or body language that are linked to the social maintenance of the group. For example: wearing the same clothes, using the same idiomatic speech.
- Unaware of their impact on a social group.
- Different from culture to culture.
- Don't like being touched sometimes.
- Don't understand personal space.
- Can frighten others.
- Become very loud.
- Invades personal space.
- Need a lot of training.
- Likes to lash out if own personal space is invaded.
- May Avoid contact Not always Aspergers.
- Gets confused when subject moves on.
- Don't know how to start or finish conversations.
- Speak in an odd way.
- Unusual speach paterns.
- May mumble or speak too fast.
- Verbal ticks under stress.
There are around 700,000 people in the UK living with autism – that’s more than 1 in 100. People from all nationalities and cultural, religious and social backgrounds can be autistic, although it appears to affect more men than women.
- Have emotional problems.
- Frustrated.
- Sheldon Cooper has Aspergers.
- Professor Simon Baron-Cohen from the Autism Research Centre (ARC) at Cambridge, UK, suggests that empathy is a spectrum and people with Asperger’s often have difficulty with appropriate degrees of empathy.
- Decides to eat alone so problems don't occur.
- Aspergers will say it how they see it and others don't like it.
- Obsesive knowledge.
- Obsesive collections.
- Some students with Asperger’s may also have difficulty focussing on organisation and give the impression of being an ‘absent-minded professor’. Where there are co-morbidities, children can appear distractible, clumsy, messy and immature.
Module 2.
The History of Research into Asperger’s and How it is Diagnosed.
- ASD- Autistic Spectrum Disorder.
- Became prominent in the 20th century.
- Children with Asperger’s are often hypersensitive, have meltdowns and become detatched.
- Eva Sucharewa, a Russian neurologist, suggested schizophrenia is deteriating and Asperger's is more stable.
- Asperger syndrome was named after a Viennese paediatrician.
- He examined groups of boys and noticed the condition was more extreme than autism.
- Lorna Wing, clinician and founder of the National Autistic Society who challenged Kanner’s diagnostic criteria. As a result, Asperger Syndrome was recognised as a variant on the autistic spectrum.
- One out of every one hundred humans have Asperger's.
- Professor Simon Baron-Cohen (uncle of the actor Sacha). Was a main researcher at Cambridge.
- It now refers to Asperger syndrome as ‘Autism Spectrum Disorder Level 1.
- There is no doubt that autism as described by Kanner in the 1940s is different from the condition that we accept as Asperger syndrome.
- Kaner published a paper on it in 1943.
- ‘Autism is a lifelong developmental disability that prevents individuals from properly understanding what they see, hear and otherwise sense. This results in problems of social relationships, communication and behaviour.’
- Many people with autism are severely disabled by their condition and are effectively trapped. This is the stereotype of what is commonly understood to be ‘autistic’.
- Raven’s matrices a test for paterns.
High Functioning Autism:
Delayed and often disordered speech from infancy. Lower than average verbal reasoning. Normal or better than average visual/spatial skills. A good memory for visual stimuli. Gross motor skills in line with developmental age. Capable of sustaining an interest in several areas – may like trains but equally interested in playing music or video games. May need ongoing support e.g. understanding written communication so may not be able to be completely independent.
Asperger Syndrome:
No delay in speech in infancy. Often fluency beyond what would be expected at chronological age. Higher than average verbal reasoning. Visual spatial skills often do not match verbal reasoning and may be below average. May be clumsy and have ‘awkward’ gait. More often have a single interest which borders on obsession. More likely to lead a completely independent life.
- Dyspraxia-like issues are often found in people with Asperger’s.
- Dyspraxia is to do with the way the brain and muscle movement are linked and the thought is transmitted into action.
- Dyspraxia can include both gross motor (hopping / running etc.) and fine motor problems (writing/ drawing or using scissors).
- An additional motor aspect of Asperger’s which is linked to coordination difficulties are the development of tics.
The NAS run 6 specialist schools in the South east for children with Autism and Asperger’s.
- ADHD or attention deficit hyperactivity.
- People with ADHD tend to be impulsive, lack focus, have poor sleep patterns and can be hyposensitive to their environment, which may make them thrill seekers.
- Pathological Demand Avoidance (PDA), high levels of anxiety, now seen as part of autism.
- Avoidance tactics, compulsive behaviour.
- Panik attacks.
- They can function well in extreme social condistions but with supervision.
- Sudden mood swings.
- Language delay or disorder.
- Have obsessions, collecting things or talking about the same thing on-and-on.
- People feel awkaward or uncomfortable.
- Jekyll and Hyde type characteristics.
- This is called Generalised Anxiety Disorder and causes sufferers to become highly anxious, tense and worry excessively.
Here are some examples of symptoms and behaviour of Generalised Anxiety Disorder:
Tearful
Problems swallowing
Tire easily
Breathless
Having to go to the bathroom more often than usual
Migraines or headaches
Hot sweats
Short tempered
Feeling faint
Tense muscles and aches and pains
Feeling sick
Overheating
Trembling
Twitching
- Affects different people in different ways.
- People with Asperger’s may have symptoms which resemble OCD. OCD is where a person is driven by compulsions they can’t control and these can become controlling forces in their life.
- There are four main behaviours:
Checking: This involves continuous and obsessive checking. For example, this can be where a person cannot to leave their house until they have repeatedly checked that all the doors and windows are secured, coming from an irrational fear that their home is about to be burgled.
Mental contamination: Mental contamination is the psychological feeling of being dirty, physically or mentally but without actually being so in real life. In many cases it’s caused by events like abuse.
It can affect a person’s behaviour towards anything they view as dirty or contaminated and this can create strong reactions and behaviour. For example, a person may have a fear of being in contact with bodily fluids.
Hoarding: This is displayed by the continuous and obsessive acquiring of objects and an inability to throw anything away, even if it is broken or worn out or it has no practical use. There is also difficulty when it comes to organising belongings and people can end up living in horrendous conditions, overwhelmed by their possessions.
Overthinking and intrusive thoughts: This occurs when a person with OCD spends an excessive amount of time trying to answer unanswerable questions for themselves and for which they could have no way of knowing, for example: ‘What will happen when I die?’ While these thoughts command excessive amounts of the person’s time, they are not as problematic as what is known as intrusive thoughts. These are negative and destructive thoughts often about family and friends that cause the person great distress. They are frequently compulsive and beyond the person’s control.
- People with OCD fear that not cleaning the contaminated object may cause harm to a loved one or even themselves. It is understood that these behaviours could be caused by a mix of factors including neurobiological imbalances, disordered thinking patterns or a family history of OCD, or triggered by a specific event, which is the case in most Asperger’s people living with comorbid OCD.
- Anger issues: They feel alien and not part of society. May copy the angler of a role model, another person.
- The perception of a threat can cause the fight or flight system in the brain to trigger hormones in the adrenal glands.
The goals of anger management are:
Increase understanding about the physiology of anger and recognising symptoms
For children and adults to ‘lengthen their fuse’ and prevent loss of control
To minimise harm from an emotional cascade and help your child to regain control.
And especially with an Asperger’s child or person, it is understanding the antecedents and the environment.
- In this section we have examined the history of research into Asperger syndrome and how an accident of geographical location delayed the recognition of it as a condition in its own right. We have discussed how Asperger’s is related to the ‘family’ of Autistic Spectrum disorders. This section also contains an overview of ‘co-morbidities’ which are often additional difficulties faced by a person with Asperger’s.
Module 3.
The Causes and Diagnosis of Asperger Syndrome.
- Inherited.
- Not linked to down's syndrome.
- Linked it to schizophrenia.
- Poor maternal attachment.
Satzmari & Jones suggested three main aetiologies (biological origins) for Asperger’s:
Exogenous or external causes – prenatal accidents including infections from mother during prenatal period
Recessive genes – which are only expressed if carried by both parents
X-linked genes – carried on the female sex chromosome
It has been suggested that just under 50% of the basis for schizophrenia may be genetic, the other 53% is environmental, and these can include illnesses such as seasonal flu during pregnancy and birth complications.
- Can be caused by maternal problems during pregnancy.
- Hormones.
- This explanation, though unconfirmed by scientific studies of hormone levels may link to Baron-Cohen’s ideas of Asperger’s being an expression of an excess of maleness.
- Twin studies are a main tool to examine Asperger's.
- Genetic.
- Seems to protect females.
One of the researchers, Dr Alicia Halliday, comments:
‘Understanding what protects certain people from developing autism is just as important as is pinpointing the various causes, we don’t know what it is, it could be a gene that girls have and boys don’t. It could also have something to do with the different hormones present during early brain development, or both.’
Turner syndrome is a genetic disorder that affects about 1 in every 2,000 baby girls and only affects females. About 33% of them will have Asperger’s.
- Hans Asperger.
- There is no reliable data on the prevalence (how common) Asperger’s is because it depends upon which tool is used to identify the condition. A commonly accepted figure in the region of 1:250 is accepted in Europe.
- By the 1980s an understanding of Kanner’s autism was well established and Lorna Wing a specialist in this area was the first to attempt an understanding of where Asperger syndrome fitted into the autism spectrum.
Social impairment (extreme egocentricity) at least 2:
Difficulties interacting with peers
Indifference to peer contacts
Difficulties interpreting social cues
Socially and emotionally inappropriate behaviour
Narrow interest (at least one of the following):
Exclusion of other activities
Repetitive adherence
More rote than meaning
Compulsive need for introducing routines and interests (at least one of the following):
Which affect the individual’s every aspect of everyday life?
Which affect others
Speech and language peculiarities (at least three of the following):
Delayed speech development
Superficially prefect expressive language
Formal pedantic language
Odd prosody, peculiar voice characteristics
Impairment of comprehension, including misinterpretation of literal/implied meanings
Nonverbal communication problems (at least one):
Limited use of gestures.
Clumsy/gauche body language.
Limited facial expression.
Inappropriate facial expression.
Peculiar, stiff gaze.
Motor clumsiness:
Poor performance in neurodevelopmental tests
- A person may have a strong sense of social justice, which on its own is insignificant, but when combined with other aspects helps to underline the diagnosis.
- Diagnostically children are checked in school.
- Will a child presenting with behaviours typical of Asperger syndrome always receive a diagnosis, no matter what clinician they are assessed by? Are all checklists used likely to produce the same results? Theoretically the answer to both of these questions should be ‘yes’ but there are many reasons why it may not be.
- Validity too is an issue. Validity means are the criteria and the way they are represented in the diagnostic tool really measuring Asperger’s or something else.
- Need a series of support at any age.
- Ratio of boys to girls is 4:1.
Module 4.
The Effects of Asperger Syndrome.
- Young children with Asperger’s are often usually advanced speakers with a wide vocabulary when they enter school.
- Help a child with Asperger's learn to read before starting school.
- However, not all children diagnosed with Asperger’s develop speech early, some like Albert Einstein learn to talk late and yet their overall cognitive development shows no impairment. Thomas Sowell wrote about this phenomenon in his book The Einstein Syndrome. Albert Einstein is believed to have had Asperger syndrome. He famously wrote loving letters to his wife but could not bear to live together with her.
- Children will drift off in school.
- They drift off as the work does not challange them.
- Aperger's children will argue as they know more than the teachers usually and this gets them into trouble because the teacher is ignorant.
- Asperger's children want perfection thus alienates them from their peers.
- Not all with Aspergers have behavioural problems.
- Children with Asperger’s and sometimes adults too are not very good at observing rules of personal space. This can be linked to both a lack of empathy, but also possibly hyposensitivity. Most people feel uncomfortable if someone gets up too close and will adjust their posture. A person with Asperger’s may lack this sensitivity.
- In a school context, a lack of obedience can be a big issue, whether that is linked to issues with empathy and social difficulties, or if it is linked to a general lack of executive control. Executive control is the ability to control impulsive behaviour. Where a child with ADHD may act impulsively in a dangerous way a child with Asperger’s may take items or equipment which don’t belong to them, even taking things apart because of curiosity. Another obedience issue may be linked to a child’s special interest, meaning they refuse to switch tasks or put a toy away. This focus can also be linked to perfectionism – ‘I don’t want to change tasks yet because I haven’t finished this one properly’. In young children such scenarios might lead to a meltdown; in older children it may lead to a refusal to do the task in question.
- Asperger’s is above all else a social communication disorder, in the context of behaviour, saying the wrong thing can be as disruptive as doing the wrong thing. Sometimes the language and behaviour can be insulting or even racist and discriminatory. In an education context it is particularly difficult since school bullying policies are often rigid and explicit, which may lead to a person with Asperger’s being punished for speaking their perception of the truth. If this is a persistent problem, then support may be offered in the form of social stories and also a dedicated social skills group. Both interventions would be designed to help a child develop social skills through cognitive means rather than appealing to empathy. Social stories are a patented method for supporting social skills development. It forms a script which the child can learn and apply in a given context. They can be used to explain unfamiliar and new events but also to correct undesirable behaviours.
- Aspergers children suffer in some cases from racism.
- Learning and methods of teaching have changed substantially over the last 30 years or so. Frequently, young people are required as part of assessments to work together in groups which are often not of an individual’s choosing. A refusal of a group member to properly participate can jeopardise the grades of all participants. Yet, for a person with Asperger’s the very act of being part of a group may be more than they can stand – making them anxious and then to refuse.
- Since most people with Asperger syndrome are systemisers this can be both a blessing and a curse to adults in employment.
- Anders Behring Breivik is said to have a form of Asperger’s and he killed 77 young people in 2011. He shows no remorse combined with an obsessive adherence to his own peculiar political philosophy.
An American study in 2008 suggested that over 90% of convicted murderers had Asperger’s (but murder is not very common).
- People with Asperger’s can have both hypertensives – over sensitive and hyposensitivity – which means numbness to environmental cues.
- Travelling between lessons in a crowded corridor is a recipe for disaster. They need personal space and don't enjoy a crowded environment.
So what can be done?
Head teachers need to think about which teacher a child has as their main teacher in primary school, not necessarily the one with the most empathy but possibly the one who runs the calmest classroom.
Make sure seating plans give a young person with Asperger’s an opportunity to be in a less stimulating place e.g. near the door
Consider letting the Asperger child in secondary school travel to and from lessons before the bell.
Having an alternative quieter place to withdraw to.
- Hypersensitivity to overload doesn’t just happen to children in school, but by and large adults have more control over their lives so can avoid such situations. For example, a person with Asperger’s and hypersensitivity to noise may avoid events such as first day of the sales, a football match or gig. As suggested by Lynda above, workplaces too can become hyper stimulating again, something which may cause adults to withdraw from.
- Sensory Integration disorder is now more often known as SPD where integration has been replaced with processing .
- Almost everyone with Asperger’s has unusual patterns of sensory sensitivity with one or more of the senses. This sensitivity can have a profound effect on their lives, particularly if the sensitivity persists from childhood into adulthood.
- Sensory Issues can be both hypersensitive, and hyposensitivity. Hypersensitivity is where a person’s sense is overloaded more easily, sometimes leading to meltdowns.
A person may be under or over sensitive to sight stimulus.
If a person is under sensitive, they may have poor visual perception which can be manifested
A lack of awareness of colour, shade and depth of an object or person so that the object can appear dark.
Differences in the quality of vision between central and peripheral vision.
Problems with negotiating around objects.
Difficulties in places where there is subdued lighting.
Problems in moving from light outside to inside, where it is dark.
Over sensitivity.
Problems with bright lights.
Inability to hold complete images but only perceive a section.
Difficulty with crowds and movement.
Overwhelmed by things they consider to be visually stunning.
Problems with sleeping, especially in summer or in an environment which is not completely dark.
- Help can come from sunglasses and removing florescent lights (which may appear to flicker to hypersensitive people). Using paper in colours other than white when reading and writing can help and some people use Irlen lenses, though the research evidence for their efficacy is limited.
People can be over or under sensitive to what they hear.
Liking or needing loud noises or music.
Not hearing things clearly.
May not hear all sound equally.
May only hear certain sounds in one ear or the other.
Over sensitivity.
Young children with this difficulty often walk around with their hands over their ears.
Some may hum to ‘drown out’ other noises.
May feel sounds are distorted.
Problems with concentration, especially in situations where several people are talking at once.
May find sounds they consider beautiful, overwhelming and emotional.
- There are some strategies which can help such as noise cancelling headphones, music to listen to and separate places to work and where the distraction from noises are minimised.
Under sensitivity combined with a lack of care in personal hygiene could create problems here.
Unaware of smells including themselves.
There is a strong relationship between the sense of.
Taste and smell so this may lead to poor choices of.
Food or even subdued appetite.
- Want good hygiene and C.O.D. want to wash everyday.
Also.
Problems in using toilets or public conveniences.
Lunchtimes in school.
Limiting choice of foods to those which are bland and have fewer associated smells.
Problems with pets.
Not liking a change in brand or formulation of household and personal hygiene products.
- Aspergers will refuse to eat good prodcuts due to appearance.
- They may also eat poor quality food stuff as they look good.
Over sensitivity extend to other aspects of touch too.
Clothing – they may only wear certain types of clothes e.g. wool may prickle.
Young children may take their clothes off in public places, especially shoes and socks.
May take delight in some textures and do it excessively – thumb sucking and hair twizzling.
May not like to be touched, brush hair or even wash.
This is to do with balance.
People who are under sensitive tend to self-stimulate by rocking, those who are over sensitive may suffer from vertigo, car sickness and have difficulty stopping movement.
- Find colours and numbers very odd due to colour and shape of numbers.
- People with Sensory Processing Disorder have problems in their nervous system in coordinating and reacting to sensory input.
- Dr Jean Ayres, likened SPD to a neurological ‘traffic jam’. A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks, motor clumsiness, behavioural problems, and anxiety,
People with SPD are not always affected the same way or with the same degree of difficulty. Symptoms of Sensory Processing Disorder, like those of most disorders, occur within a broad spectrum of severity.
In the case of Asperger’s, the difficulties may include any or all of the following:
Overly sensitive to touch, movement, sights.
Inability to habituate to sounds and fear with unexpected noises.
Easily distracted.
Holding hands over ears in complex environment.
Avoids tastes, smells, or textures normally tolerated by children that age.
Activity level that is unusually high or unusually low.
Impulsive, lacking in self-control.
Inability to unwind or calm self.
Poor self-concept.
Social and/or emotional problems.
Physical clumsiness or apparent carelessness.
Hesitation going up or down stairs.
Holding on to walls, furniture, people, or objects, even in familiar settings.
Delays in speech, language, or motor skills.
Seeks out movement activities, but poor endurance and tires quickly.
- In many cases, the hypersensitivity to stimulation through the sense is not just one sense but several, so much so that in some cases and for some people it can cause complete meltdown.
Module 5.
Techniques for coping with AS.
- Sensory overload, not helpful for Asperger's people.
- It's good to make others understand Asperger's and help intergrate people into a social situation.
- Sensory integration therapy is based on the idea that some kids experience ‘sensory overload’ and are oversensitive to certain types of stimulation.
- Sensory integration therapy exposes children to sensory stimulation in a structured, repetitive manner.
- Make the environment fun and enjoyable.
- Make sure the activities are challanging and not boring.
- Start up on the low and generally increase activities for stimuli.
17% of autistic children have been excluded from school; 48% of these had been excluded three or more times; 4% had been permanently excluded from one or more schools (this is higher than many other groups with specific learning difficulties).
- Overload, be warned this can have a bad effect.
- Noise cancelling headphones are a good source and many times help out with the persons environment.
- Take a check on sensitivity.
- Make the sense and smell enjoyable and do not overload.
- Disguise foods. So maybe chips that are orange (Carrot) or Green (some root vegetable).
- In some cultures food is dyed to make it look pretty so try that.
- Muscle relaxation and massage.
- Deal with anxiety's.
- Fear hierarchy, practise muscle relaxation and muscle excercises to soften the impacts.
- Important to deal with anxiety.
- Reduce sensitivity and visual stimuli, examples strobe lighting offer sun glasses and remove ornaments that are offensive or may scare.
- Try and reduce anger.
- A child who is quite passive at school and finds the environment stressful may behave well at school, but come home and express violence toward a sibling to make themselves feel better.
Avoid raising your voice, this can make the situation worse if a person is already over stimulated.
Keep your emotions out of the situation.
Hug only if it is a successful strategy with a child you know.
Don’t ask questions such as what is the matter, a child may not be able to articulate and this can increase the level of stress.
Use a quiet and assertive voice.
If possible reasonably distract the person so that there can be a release or lessening of the emotional tension.
Access to special interest.
- Make sure those that look after Autistic and Asperger's understand that non-eye contact is not deception.
- People with Asperger's do not know what it is like to be you, you need to understand what it's like to be them.
- Describe certain remarks example: '' pull your socks up'' does not mean literally for a child to do this it means to sort your self out improve et cetera.
- There is an inability to ascribe motivation; an inability to be able to decipher whether an action was deliberate or accidental.
- A person with Asperger’s also faces a myriad of problems in trying to interpret the intention of others and ending up being rude.
- This is well modelled in TV’s Big Bang Theory where Sheldon frequently insults his friends through his lack of ability to mind-read. He isn’t cruel as some people might think, he just cannot put himself in another person’s shoes.
An invocation to ‘look at me when I am speaking to you’ can equally cause confusion because ability to hold a ‘normal’ gaze with someone can also be challenging if you cannot read the emotions on the face opposite you.
Module 6.
Issues for Adolescents and Young Adults with AS.
- Bullying it needs to be dealt with immediately.
- Children with a range of conditions get bullied.
- Asperger’s people often have academic ability which is made more noticeable by features such as being hyperlexic early readers and having a pedantic way of speaking.
- Their interests can also make them sound like ‘little professors’ (boys) and ‘little philosophers’ (girls).
- They are often chosen last for games which is wrong but due to poor teaching Autism and Asperger's children get left out.
There is no data on bullying of Asperger children in UK but in the US the statistics are as follows:
“being teased, picked on, or made fun of” (73%).
“being ignored or left out of things on purpose” (51%).
“being called bad names” (47%).
almost a third of autistic children also experienced physical bullying.
- Asperger's can be robbed or have personal items stolen.
- They are tormented.
- They can be racially abused.
- They can be mistreated due to their religion.
- In the US several of the mass shootings in schools have been linked to people with Asperger traits who have been bullied and isolated. The shootings perhaps say more about the prevalent gun culture than Asperger’s, but nevertheless demonstrate that the issue is an important one.
- Legislation covering both disability discrimination and the code of practice for education, health and care (2014) dictates that provision and reasonable adjustments have to be made for people with Asperger’s.
- Even today when all the new rules came into schools there are still teachers that ignore legislations and do not practice what they have been taught.
- A big cut in local funding for L.S.A. with specialist skills has turned some schools into poor environments.
- Asperger's children in schools need extra support they do not need teachers as bullies.
- Families, it can affect families however the family need to join hands and help their Asperger's child.
There are websites and chat groups that have been set up for brothers and sisters of people with autism.
These include:
http://groups.yahoo.com/subscribe/autism_sibs/
www.sibs.org.uk
Some things to say might include (thanks to the NAS website for these):
They may not show an interest in playing with you or they may completely ignore you because they don’t always understand what you are saying and can get confused.
They may seem to have little or no respect for your belongings (such as your pictures, toys or clothes) and this is because they do not understand that what they are doing is wrong. You may need to show them how to use your toys in an appropriate way.
When your brother or sister does not get into as much trouble as you would for being naughty (such as if they kick someone), it is because they do not realise they have done something wrong.
When your brother or sister needs time alone to be by themselves, give them some space.
Try to be calm and patient with them even when they do something which may hurt your feelings.
Speak slowly and clearly when you are talking to them (so they can understand what you are saying).
Just because your mum and dad have to give more support and persuasion to your brother or sister doesn’t mean you are loved less.
- Being a part of a family with Asperger’s members may cause anxiety of unaffected members about having children affected by Asperger’s or autism.
Module 7.
Adults with Asperger Syndrome.
- Until recently it was accepted that ASD and Asperger’s were predominantly a masculine issue.
- Females it is different to males.
- It's to do with social aspects.
- Diagnosis of Asperger’s in adults generally begins with a questionnaire which has been validated against a largely male population to have the diagnostic interview schedule.
- Social communication and interaction are different with females and males.
- Society too expects girls to be highly communicative, but Asperger girls can get into trouble because they find social chitchat hard.
- Research evidence suggests that Aspie girls are different, they tend to have more of an active imaginary world, make up stories and enjoy fiction, especially science fiction or fantasy stories.
- Males use their imagination more so it seems through research.
- Stimming is a common trait in both males and females with Asperger’s.
- Males move as a fidget and females play with earings or hair.
- It's a way they both calm themselves.
- Girls have better verbal skills.
- Barbara Jacobson has written very eloquently about how it feels to ‘Love Mr Spock’ but what problems do young people with Asperger’s and HFA have in finding their need for love and affection?
- Mr Spock is beleived to have been written by someone that wanted to show Autism/Asperger's hence also Dr Sheldon Cooper.
- Both females and males are not into lovey dovery touchy feely ways that other without the syndrome are.
- Females will or maybe pick up wrong situations by t.v. shows.
- One of the main problems for people with Asperger syndrome can be to understand someone’s intentions.
- Other bases to cover include: improving knowledge on dating etiquette and dress sense, to learning ways to identify and avoid sexual predators.
- It's advisable for those with Autism and Asperger's to avoid dating sites and off-line agencies as it can contain sexual predators.
- Better to meet ones partner in an open siuation, like a club or group.
The NHS adult prevalence study looked at what percentage of people who had Asperger’s were married.
Married/cohabitating: 0.5%.
Single: 2.5%.
Widowed/divorced/separated: 0.6%.
- On-line is not a safe envrionment for those with Asperger's or autism.
- Do not assume someone with Asperger's or autism is not interested in you they find it hard to show emotions.
- Ask if they like being touched or hugged.
- They cannot read your mind, ask!
- Learn about them, their interests, food tastes, social activities.
- Don't expect them to be a party animal.
- Tell them about your fantasy's and romantic pleasures.
- Do not harras them to use a cell-phone or eat certain food stuffs.
Asperger Characteristic:
Pedantic language, (Behaviour towards child) May expect the child to understand complex language from an early age. May not understand or appreciate childish language. May talk too much at parent’s evenings.
Analytical, (Behaviour towards child) May become an expert parent reading up everything they can to become an expert.
May analyse child’s successes rather than heap praise on them.
Poor social communication, (Behaviour towards child) May have difficulty communicating with teachers, other parents, friends; parties and other social activities may be difficult.
Poor theory of mind, (Behaviour towards child) May not understand when their child is upset or need comforting, can seem cold and detached.
Lack of imagination, (Behaviour towards child) Problems with children’s games, characterising stories and reading to a child.
Sense of justice, (Behaviour towards child) May not be able to refrain from commenting to other children, teachers and anyone he/she perceived as having wronged their child or another. Could become the parent a teacher dreads.
Anxiety, (Behaviour towards child) May wrap the child in cotton wool and become anxious if the child does not perform according to a ‘normal’ childhood.
Hyposensitive to child’s needs, (Behaviour towards child) Could let their children go out in inappropriate clothing for weather, may be seen as neglectful by other parents or even professionals in extreme cases.
- Not all of these traits are necessarily present to the same degree in all parents but they can be spotted.
Module 8.
How to handle Asperger’s in the workplace.
- There are no limits on the particular job a person with Asperger’s can do but there are lots of people with Asperger’s who are underemployed in terms of skills and position.
Strengths.
Conscientious, perfectionist, analytical/ technically competent, high ethical standards, attention to detail, good at spotting errors in logic and protocols, knowledgeable, lovers or routine which many others may hate, good at problem solving, gives attention to detail.
Weaknesses.
Problem taking feedback (sees it as criticism), line management, find change difficult, don't tend to make good line managers, poor teamwork, anxious, misinterpreting instructions, problems with dress codes, can become sensory overload, over qualified, vulnerable to teasing and bullying.
77% of young people with special educational needs such as autism who take A-Levels or equivalent exams will go on to higher education, employment or training.
- There are laws named disability rights and every company should champion these rights.
- They also like people to do their job and no palm it off on others, an injustice.
For the purposes of the act disability is defined as:
‘A person is disabled if they have ‘a physical or mental impairment’ which has ‘a substantial and long-term adverse effect’ on their ‘ability to carry out normal day-to-day activities.’
There are several types of discrimination:
Direct discrimination.
Indirect discrimination.
Harassment.
Victimisation.
There are two additional types which apply solely to this protected characteristic:
Discrimination arising from disability.
Failure to make ‘reasonable adjustments’.
Some of the positive personality traits, typically displayed by a person with Asperger’s:
Good at recalling information.
Find pleasure in tasks that require detail and precision.
Mathematical and technical ability.
Prefer to work under instruction or with clear boundaries.
Honest, open and direct manner.
Large vocabulary.
Like processes and structure.
Differences in social skills can also mean that they are perceived as:
Rude.
Short-tempered.
Forgetful.
Angry.
Nervous.
Chaotic.
Quirky.
Narcissistic.
Inconsiderate.
- As a result, people with Asperger’s can often find themselves falling out with colleagues or in the most extreme cases, subject to disciplinary procedures for their conduct or behaviour, which they may find baffling and fail to understand the reasons behind the disciplinary action.
Some Practical strategies
Bullet point information and reduce complex language, full of metaphor and simile to the minimum.
Provide access to aide-memoires.
Provide clear instructions with a beginning, middle and end.
Give step by step instructions and make sure the person understands what you need them to do.
Flow charts can be helpful.
Clear lines of reporting to managers.
Opportunities for mentoring by a senior colleague who is a skilled and sensitive communicator and can guide their social skills.
- There should be support resources in all companies and managers should be trained.
Advice from a manager with a diagnosis of Asperger’s is as follows:
Tell me in black and white terms what they need to do their job – I’ll miss subtle hints,I’d prefer someone to just come out and say what they are lookingfor.
With interpersonal issues or conflicts among subordinates – I need to know what is going on, and I might not ‘just pick up on it’.
I don’t talk differently to upper management or subordinates – Idon’t ‘translate’ between the languages.
A lot of autistic bosses got where they were not through social networking but rather through ability. So don’t feed them’bull’ about their area of expertise.
Don’t expect flattery or compliments unless the latter are deserved.
So there you have it. Be clear, truthful, honest and don’t play games with an autistic boss.
Module 9.
Famous people with Asperger’s.
- Sir Isaac Newton – Physicists and Fellow of The Royal Society probably had Asperger’s and displayed a surprising lack of understanding about the world around him,
- Alan Turing – computer genius, mathematician who saved millions of lives in WWII.
- Susan Boyle – With the voice of an angel, singing talent Susan Boyle has left the world in amazement at both her talents and her very public meltdowns. Although she is perhaps the most famous talent to have come out of Britain’s Got Talent, her Asperger’s has caused her some very public difficulties.
- Chris Packham – The naturalist whose appearances on TV demonstrate the strength of his special interest.
- Daniel Tammet – An Asperger’s savant with an extraordinary ability to remember, and a gift for languages.
- Asperger's syndrome has a lot in common with dyslexia.
- The most common savant abilities are mathematics, feats of memory, musical ability and figurative art.
- Sir Issac Newton, The story goes that Isaac was very fond of his cat, but didn’t like getting out of bed in the cold night to let her in and out so he constructed a cat flap in his bedroom door. When later she had kittens, the literal minded physicist was said to have cut a smaller hole for each kitten, not realising that they could enter through the larger hole used by their mother.
- Alan Turing, Alan Turing, mathematician and father of computer science is one of the stellar scientists of the 21st century, not least of which because his work in cracking the enigma code at Bletchley park shortened WWII by several years, saving millions of lives in the process.
Turing, they concluded, met all six criteria:
His school reports described him as antisocial, having only one friend at school and he also struggled to socialise with fellow academics (impairment in social interaction).
He had a narrow focus on his work which was all absorbing. Often worked through the night (narrow interests).
He always ate an apple before bed each night including the last thing he ever ate, one laced with cyanide for his suicide; insisted on “teaching” what he knew to others without a scientific background (Imposition of routines on self or others).
Lack of eye contact, unaware of his own personal appearance and frequently used stereotypical movements when excited (nonverbal communication issues).
Misunderstood everyday forms, unusual speech expressions and over analysed colleagues verbal communication (verbal communication issues).
Illegible handwriting, untidy dress, and always had ink on clothes at school (motor clumsiness).
- Susan Boyle, Public meltdowns, these were seen and not her bautiful singing voice.
- Tony Attwood, the Australian Asperger “guru” suggests that girls with Asperger syndrome may be more difficult to identify because of the camouflage they develop of social skills. He suggests though, that these are learned skills rather than natural. Girls with Asperger syndrome use their intellect rather than social abilities to “learn what to do” in social situations, watching until they are sure of the rules before joining in.
- Aspie girls are more likely to display emotions, perfectionism and may even develop an eating disorder as part of the confusion they may feel with the illogicalities of the world they find themselves in.
- One of the biggest differences between Asperger boys and Aspie girls is their tendency to emote.
- Asperger girls often seem to be immature compared to their peers in terms of interests but also in terms of managing themselves. They may be overly sensitive especially not understanding teasing, or even jokes.
- Chris Packha, diagnosed himself with Asperger syndrome after comparing a list of symptoms to his own behavioural traits.
He had been quite successful academically in his own field of natural history, partly completing a Ph.D. on badgers.
- Daniel Tammet, is an Autistic Savant who has an extraordinary memory.
He also is a polymath in that he can turn his thoughts and abilities to more or less any academic discipline. He was most famous for remembering Pi to 22,400 places. His abilities are remarkable. His ability to remember a string of information is almost twice that of an averagely intelligent person yet his facial recognition of others is only as good as an average 6-8 year old.
Module 10.
How to support people with Asperger Syndrome.
- School is a difficult place for all manner of children whether they have Asperger’s or not, but as we established earlier it is usually the first social minefield which Asperger kids and their carers must navigate.
- Because a person with Asperger’s or HFA has difficulty understanding unfamiliar social situations they often need someone to help them make sense of the event – for example that friends can be shared.
Now what does the child need to understand:
Toilets are places where there are lots of germs.
We can’t see germs as they are invisible.
These germs can make people ill.
When we use the toilet we touch things which have germs on them.
Washing hands using soap, cleans the germs off hands.
Gather information about the person for whom the story is being written
How old are they?
How long can they concentrate for?
How well do they read or would a cartoon be a better option?
Where and in what context do they need to enact this story e.g. at school, at home.
What currently happens.
The title: Must reflect the intent of the story e.g. Using the lavatory in school.
Descriptive sentences: answers the where, when, what question for example:
‘When I/we need to do a poo or a wee (the words will be specific to the child) I/ we need to use the lavatory.’
Perspective: States how other people are involved, or would view the event:
‘I need to ask Mrs Jones if I can go to the lavatory by putting my hand up and asking permission.’
Directive: Gives gentle encouragement toward the goal:
‘After I have used the toilet I will try remember to wash my hands with water and soap.’
Affirmative: Relates to the impact the correct behaviour will have:
‘Washing my hands thoroughly means I won’t get ill or spread germs to others.’
Control: A sentence written by the person themselves about the situation:
‘Remembering to wash my hands is very important.’
There is a formula for writing social stories:
1 x directive + 1 x control + 1-3 of other sentence types.
So the example above put together looks like this:
- Descriptive: What is it? Answers the ‘wh’ questionswhere does the situation occur,whois it with,whathappens andwhy? Descriptive sentences need to present information from an accurate and objective perspective. (Examples) Chirstmas day is Decmber 25th, most children go to school, somtimes I get sick.
- Perspective: What is it? Refers to the opinions, feelings, ideas, beliefs or physical/mental well-being of others. (Examples) My Mum and Dad know when it is time for me to go to bed. Teachers like it when students raise their hand to ask a question in the classroom. Some children believe in Santa Claus.
- Directive: Gently offers a response or range of responses for behaviour in a particular situation. It is important that these sentences have a positive focus and are constructed in ways which allow flexibility (i.e. avoid statements likeI must or I have to). (Examples) I will try to cover my mouth when I cough. I might like to play outside during lunchtime. When I am angry, I can, take three deep breaths, go for a walk, jump on the trampoline.
- Affirmative: Statements that enhance the meaning of the previous sentence (which may be a descriptive, perspective or directive sentence) and can be used to emphasise the importance of the message or to provide reassurance to the person. (Examples) (I will try to hold an adult’s hand when crossing the road).This is very important. (Thunder can be very loud). This is ok.
- Co-operative: Sentences which identify how others may be of assistance to the person (developed by Dr Demetrious Haracopos in Denmark). (Examples) Mum and Dad can help me wash my hands. An adult will help me cross the road, My teacher will help me to try stay calm in school.
- Partial: Incomplete sentences, which allow the person to guess the next step in a situation, and may be used with descriptive, perspective, directive, affirmative, co-operative and control sentences. (Examples) My name is___________(descriptive sentence) Mum and Dad will feel ____________ if I finish all my dinner(perspective sentence).
- Social skills are the unwritten rules we have for managing our social interactions.
- Most people tend to ‘pick up’ social skills in the same way they pick up language skills, in their early years and through practice an imitation.
- Social skills training has to be formally taught in a learning environment which is suitable in terms of location.
- Social skills can be taught better in a group.
There is an acknowledged 7-step process too:
Clear objectives or goals which need to be specific.
Formal teaching about the behaviour.
The coach models the behaviour.
The children practise the skills.
The behaviours are prompted in a setting relevant to the skills.
The desired behaviour is recognised and rewarded.
The behaviour is generalised to an everyday setting.
- Clear objectives or goals which need to be specific. The Goal behaviour needs to be specific and appropriate for the individual’s age and level of functioning. It must be a small step up from the individual’s current level of functioning. It needs to be measurable and specific when complete: ‘I will be able to begin a conversation with someone in my class group using a greeting’.
- Formal teaching about the behaviour. The coach/teacher needs to explain about the skill and the context using help from group members. She can use explanation such as: ‘Can anyone tell me about….?’ or ‘What is a conversation like?’ The teacher/coach can then lead a discussion about the skill and its importance.
- Practising the behaviour. Gives the individual a chance to try the behaviour in the safety of the group. Together with working out how it feels they can get feedback about fine tuning the behaviour before they practise it for real.
- Prompt the behaviour. Start with fairly explicit prompts and work your way to the subtle. — For example, giving the individual specific instructions to ‘find one thing to compliment your partner on’. Then later ‘What should you do?’ or even a gesture.
- Reinforce the behaviour. Reinforcement generally leads to much stronger response patterns. They should be fairly small, immediate, and most importantly, of value to the individual. It is good if it relates to a particular interest – a football star, trains, etc… Make sure they know what they are being rewarded for.
Praise does not have to be in the form of things; it can be verbal too: ‘You did a great job of starting a conversation.’
- Beginning a conversation: This should cover knowing when to approach a person or politely interrupting them. The distance to stand and what to say as a conversational opener. It can also include an understanding of formal and informal greetings. Tips include writing down some greetings and who they might use them with.
- Turn taking in conversations: Compare a conversation to a tennis match where the conversational ball is passed between people in a rally. So it is with conversations. It is important to let people answer questions.
- Remembering and commenting on other people’s interests: Teaching a person with Asperger’s to talk about things that they know the other person likes as well as the things that they like. Asperger people need to be reminded that not everyone is interested in their favourite topics of conversation. If they know it will be boring to others, then to avoid it if they can. Students can be encouraged to make lists of things to talk about and things to avoid, for example see below, but it will be more effective is students can compile their own lists.
Things to talk about: Weather, T.V. programmes, animals, holidays, social media, sports.
Topics to avoid: Their appearances, money, religion, politics, personal relationships.
- Be careful about getting too involved in your special interest: Remind the student that it is hard to understand why another person may not be knowledgeable or interested in your special topic.
- Checking their interest: Students can be reminded to check whether a person wants to continue on this topic or not, phrases such as ‘Would you like me to tell you more?’ or ‘Would you like to talk about something else?’ are helpful.
- Checking how people are feeling: People with Asperger’s are not always good at reading body language and other nonverbal communication. Teaching students that what people say and what they mean are at odds with each other. Students need to learn to ask.
- Understanding empathy: This is the most difficult of emotions for a person with Asperger’s to understand. An example which is perhaps easier to grasp is the loss of a friend as they leave for somewhere new. They may feel sad to leave and the person with Asperger’s may feel sad to lose them.
- How to understand facial expressions: This is something which is difficult to teach without proper examples. In 2007 The Autism Research centre in Cambridge developed a teaching resource which was a DVD containing 412 separate emotions acted out by actors and actresses, including a very young Daniel Radcliffe. It is still relatively expensive and the only one of its kind but it is useful.
According to the NAS website the ASC research team is trying to make a device which can read emotions during a conversation and give feedback to people with ASD. However, research into this is in the very early stages and so it will be a while before this is available.
- How to end a conversation: This includes learning signals such as people not asking further questions, people looking at their watch or around the room, yawning. The skills teaching also needs to include polite phrases to use at the end of a conversation.
- How to observe personal space: Some people with Asperger’s get too close or not close enough. Getting young children to practise with hole hoops holding them straight-armed and at waist height can teach the physical distance so that they can learn the not-too close stance by ensuring the hoop touches the person they are practising with, but that it is not so tightly pressed that it bends.
- Eye contact: This a subtle and hard skill to learn.
There are some simple rules which can be taught though:
Try to look at people directly, if this is hard pick a point on their face, perhaps eyebrows and try to look at it 1/3rd of the time the other 2/3rds looking at the rest of the face.
Staring directly at someone’s eyes for a long time can send signals of aggression or love. So teach the 1/3 rule.
- The correct use of pointing: The difference between pointing at something on the horizon to share an interest (good) and pointing for a long time at a person in the same room or environment (judged to be rude or aggressive).
- How to make and keep friends: People with ASD and Asperger’s can’t easily distinguish between true and false friends. This makes them vulnerable to bullies as children and as teens prey for predatory types. Marc Saggar wrote about his experiences in a survival guide for people with an ASD to help them learn to distinguish good and bad. A summary of his ideas is set out below:
True friends: Treat you the same way they treat all friends. Make you feel welcome in the long term as well as the short term. If they give you compliments they will be genuine and sincere. Will treat you as an equal. May help you to see the truth behind other people’s hoaxes when suitable.
- Hoax Friends: May treat you differently to how they treat others. Might make you feel welcome in the short term and then drop you in the dirt. Might give you many compliments which are NOT genuine. Might often make unfair requests of you. Might want you to make a spectacle of yourself. May threaten not to be your friend anymore or play on your guilt if it is to help them get their own way.
- Enemies: May ignore you most of the time. Will make you feel unwelcome and will notice all your mistakes and may bring them to the attention of other people. May give you anything from sarcasm, put-downs and temper tantrums to the silent treatment. Will often treat you as a less important person than them. May set you up to receive aggression or scorn from others.
What to do: Friends, Repay them with the same attention they give you and listen to them. Accept any compliments they give you by saying a simple ‘thank you’ and then you won’t make them feel silly in any way for having complimented you.
Try to show that you like them using the rules given under eye contact.
What to do: Hoax friends, Stand up to them and don’t feel guilty about telling them to go away if they have said something which is obviously unfair. They could be the kind of person who gets pleasure out of hurting people more vulnerable than themselves because they feel weak and inadequate inside. Remember that.
What to do: Enemies, You might have done something to annoy them or they might just be jealous of certain skills or knowledge you have. If it is jealousy, they will never admit to it. If you find them on their own at any time they might switch to being quiet and shy towards you and you might be able to ask them awkward questions as to why they behave differently towards you than they do towards other people. Also, if they can give you a good enough reason, it might be a chance to apologise if you have annoyed them in some way and say that you will try not to annoy them as much in future.
- What are white lies and how to use them: The reasons why it is OK not to always tell the truth and how not to hurt someone’s feelings.
- Social groups can be organises in school or the community.
- Mediation is a another example to help cure ill feelings.
In the study, 60 students, all on the autism spectrum, attending classes in standard education were randomly assigned to one of four groups:
Group one had six weeks of one to one training with an adult. The child was taught social skills for example, how to have a conversation or join in with other children in the playground to play a game.
Group two had three typically developing classmates learn strategies to engage children that had social difficulties. These classmates were unaware of which child had autism.
Group three received both one to one training and classmate training.
Group four did not receive any training in the first stage of the study but took part in one of the training sessions later on.
- Do not remove children with Apsergers or autism from school groups it will make things worse if you isolate them.
- Aspergers need to be shown the way forward with good organisation skills and love and understanding.
- Organisational strategy: Making lists, (When useful and how used), taks based, time based, particular times day or night, reminders of what to say to tutors or other supporters, allow to use tablet/phone software to record messages, homework diaries, mnemonics. Lists are generally useful for short term organisational demands such as what has to be accomplished in a particular time frame. We can get a sense of achievement when something is crossed off the list as achieved.
- Colour or picture coding, for subjects, example biology is green, pictures timetable, using animals for specific characteristics, example and Elephant never forgets, this is useful for helping to organise notes of things which we need to keep for longer.
- Being on time: Use of electronic reminders, clock alarm or cell phone beep. Make sure their scales are correct so if they need to be in school at 08:00 a.m. and it takes a half hour walk they need to leave at 07:15 a.m. to be there in plenty of time.
- Make a task box or a task wall hanging: These can be used to make sure that time isn’t wasted hunting for things; a box for each need can be useful, likewise, a wall hanging calendar with seven pouches can be used as a reminder of what needs to be done on each day of the week and help to establish routines, especially if the person with Asperger’s is living alone.
- Social stories: Good way of understanding the importance of being organised.
- Time and sequence teaching: Order and attention, picture cards, timers.
- Decent bag: If the person has a habit of carrying everything around with them a compartmentalised bag with limited space might have an impact, ‘Have a bag weighing x‘ – a target to keep it below a certain weight.
- At home: try to have a routine for each day of the week; if you have a child with Asperger’s teach them the routine. You could use the visual timetable or just a weekly calendar.
- Shopping: can be done online. This is a good idea if the person suffers from hypersensitivity to noise and crowds. This is good if a young person with ASD / Asperger’s moves from home and a pre-determined list can be ordered at regular intervals. A warning though – get them to do an inventory so that they can modify what they buy or not. One Asperger girl ended up with a cupboard full of pasta because she didn’t use it often and it came with every shopping list!
- Budgeting: make a spreadsheet with income and expenditure and a running total spent too. It is really important that a young person with Asperger’s be helped to become independent in this skill because they will one day need to be able to manage without parental support.
Social stories can be used to explain the consequences of not budgeting well.
- Family events: a calendar on their phone or on paper with name and relationship written down helps a person organise birthdays. Having regular family times too like going out to the cinema on a particular day/evening.
- Education requires a lot of organisation, and the expectations grow as a person progresses through the system. The reaction to homework can vary from complete panic to complete ignoring of a deadline. It is important to recognise which of these two responses are normal for the person. A person with anxiety may need help with breaking up the task into manageable chunks and help to recognise when they have done a particular task to the satisfaction of the needs of the course.
- Students who fail to see deadlines also need help, but this may be in the form of breaking down the task against a calendar and checking that they have kept to the timetable.
It is important however, to recognise that if a student had PDA they may hide away. This then needs a different approach, acknowledging their difficulties and not giving up on the person.
- Carrying around a heavy bag with all their textbooks and notes in an overloaded bag means that a student often spends a long time settling into class, and may apparently lose things which are actually buried in a cavernous bag which appears to have properties of The Tardis! This is a case for simplifying. Change bags and with parental help or mentor help, encourage the student to file away or throw away paper they don’t need, swapping bags regularly so that the sorting has to happen.
- Asperger students may need mentor support throughout their academic career and particularly at University to help them organise their materials and to ward off excess anxiety. They may also need help with advocacy if they have trouble with deadlines or anxiety.
- Dictaphones are ideal as it's a useful device to help keep a person organised and on time.
- If an Asperger's person is in the right employment they will succeed. If in a poorly formed job with no framework to help their needs they might fail.
- For those who need help with organisation the following may be useful:
Colour code files to identify and clarify the importance and deadlines for particular pieces of work. For example, Red could be urgent and green for work to do.
Making a clear to-do list at the beginning of the day.
Ask for regular meetings with your line manager to check progress.
Using technology to support you – use a tablet to keep track of your day and tasks.
If you can delegate tasks do so even though this may be difficult.
- Understanding motivation and using it at home to support normalising behaviour in young children.
- In neurotypical small children a desire to be social exists and it seems they have an almost innate desire to please those around them.
- Asperger's need praise, nice smile, feel welcome and given all the help available.
- As children a reward scheme will help.