FW: Monthly Article from Roselione

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From: Sent: Sunday, December 04, 2011 2:01 PMTo: Subject: Monthly Article - Good Afternoon, In an effort to stimulate conversation and interest in a variety of topics I have created a monthly article review. If you have any topics of interest or any articles that you think others would enjoy please send them to me and I will create a compilation of articles that I will send out once a month. Thanks for sharing in the knowledge. Understanding Asperger’s Disorder Across Ages and GenderBy: F. Roselione, M.S., LMHC, P.A. Defining Asperger’s disorder (also referred to as Asperger Syndrome or AS) and its key features has been an evolving challenge for professionals since it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. With the proposed changes to the new DSM-V and a new name for the category, autism spectrum disorder (ASD), which includes autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) a host of even more challenges awaits in distinguishing ASD from other conditions. The following information was created to help families and professionals better understand Asperger’s disorder before it is removed as a diagnostic category. Background and Foundation of Understanding (a) Asperger’s disorder is a developmental disability that starts at birth and has a continuum of severity in all areas of development. Asperger’s is considered a neurological brain based condition. It is genetic and not " caused " by anything a parent or caregiver did or didn't do. Asperger’s is a way of thinking and learning. Asperger’s has been around as long as humans have been around. Some famous historical people with Asperger’s are believed to be Edison, Albert Einstein, Mozart, Bill Gates, etc. ( When professionals question whether or not a skill is present they are looking for more than an understanding or knowledge of a skill or concept. They are looking for both an understanding and application in daily life. For example a person can understand the social rules during Thanksgiving dinner with family but not follow those same rules during the dinner. So when you ask the question, " What are two topics we are not going to talk about this year at Thanksgiving dinner?” The answer in return might be “politics and video games.” However at dinner when someone brings up a video game or political topic the person does not ignore or avoid the topic but joins in and ignores the previous discussion about conversational rules at Thanksgiving dinner. © When conducting a differential diagnosis we are looking at a totality of symptoms over time, in various situations, with a variety of people. Many children appear socially able when they are with adults, at home, or doing something they enjoy. Take the same person and observe them with same aged peers, over a three or four day period engaging in a variety of activities that involve the peer’s interests and determine whether there are any social challenges, communication difficulties, or problem behaviors. (d) Males and females with Asperger’s will not typically present the same way diagnostically. Females have a tendency to be more social in general. The difference between males and females with Asperger’s is usually in their obsessions or restricted area of interests. Males have a tendency to become obsessed with toys and objects where females become obsessed with people and relationships. Quite often females with Asperger’s will talk about other people a lot. They will do anything, say anything, be anything to be accepted into a group or relationship. When professionals hear this report from the parent they immediately rule out Asperger’s disorder. Parents will quite often hear, “your daughter can’t have Asperger’s, she is too social”. Asperger’s disorder is not about wanting or not wanting to be social, it is about not knowing how to be social. The number one feature in Asperger is called - Theory of Mind Dysfunction (ToMD). ToMD can be used to explain almost every challenge, behavior or social skill deficit. ToM is the ability to put yourself in someone else's shoes and know the knowledge they know, feel the feelings they feel, understand the beliefs they have. In addition ToM also means having the ability to understand and accept that someone elses feelings, thoughts, and beliefs are as equally important as their own. This ability happens within less than a second as if it is a reflex. ToM is not the same as understanding how someone feels when they win the lottery or lose a family member to cancer. Individuals with Asperger’s know how people feel in basic life situations. People with Asperger’s and ToMD are not thinking about other people's feelings, thoughts, and interests. When someone has a ToMD they have a tendency to assume everyone feels the same way as they do. They also have a tendency to take everything personally. Understanding how people think and feel impacts areas such as what you wear and the questions you ask or don't ask. Not having this ability can increase anxiety and create increased paranoia and agitation. The DSM IV-TR areas of impairment: 1. Individuals with Asperger’s have difficulty in the area of social development, social skills, and social understanding/ social thinking. a. Difficulties range from personal hygiene issues like not showering, brushing your teeth, or picking your nose at the dinner table to hurting someone's feelings by not including them in an activity or by saying something.b. Individuals might have difficulty " reading " facial expressions, body language or environmental situations quickly. In addition they might have difficulty using this information to change their behavior and language to meet the social situation at hand. They are not taking into consideration these variables when talking and interacting with others. Social interactions are not linear in nature. Social situations are more similar to a biofeedback, interactive, flowing model in which input effects and changes output. 2. Individuals with Asperger’s typically have a restricted range of interests, intense feelings or strong opinions of certain topics, such as religion, politics, laws, etc. a. At times can look like obsessive compulsive disorder.b. Difficulty getting intrusive or unwanted thoughts out of their mind.c. Can get absorbed into an activity that they lose track of time or can block out everything going on around them.d. When these intense interests or activities are restricted or controlled by others you will typically see a " rage " episode like the world is coming to an end.e. These restricted interests will impact social interactions if peers want to do something different. 3. Individuals with Asperger typically have communication challenges. This is a difficult area to assess at first but is critical. a. Usually want to talk about themselves, things they did or things they are interested in.b. Typically will not ask questions related to other people's interests.c. Small talk or social chit chat is usually not easy or liked.d. Might have a difficult time knowing what to say in social situations outside a work function or topics they love.e. Difficulty with the unwritten social communication rules. For example, not calling or texting a person before 8:00am, not answering a cell phone in the movie theater, nor never asking a women her age or weight. 4. Other Challenging or Difficult Areas a. Sensory issues such as smells, textures, sounds, etc. May have a difficult time blocking out noises when trying to read or sleep.b. Might be a picky eater. c. Sleep problems such as difficulty falling asleep, waking up during the middle of sleep and not being able to fall back to sleep, early wakening. In addition there is tremendous anxiety created about sleep and the problems they know they are going to have that night about not being able to sleep. d. Difficulty with handwriting or written language.e. Might be able to solve math problems but not able to show the work. f. Individuals with Asperger’s may have very good verbal skills and high level reading skills but may not be able to explain what it is they read. g. During anger or meltdowns usually can not remember things that were said or done. F. Roselione, M.S., LMHC, P.A. Roselione is a Licensed Mental Health Counselor with a practice in Broward and Palm Beach Counties. He the founder and director of the Center for Counseling, Coaching, & Change. He specializes in working with families and individuals with varying challenges. For example, Bi-Polar, ADHD, Autism, Asperger’s, etc. For more information please visit www.brianroselione.com F. Roselione, M.S., LMHCOffices in Plantation and Boca RatonOffice Number: www.brianroselione.com

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Defining Asperger and its key features.doc