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Managementof Asperger’s
Brian Bushart MS and Martha Rich RN, ANPKeuka College
HistoryIdentified in 1944 by Hans AspergerLabeled “autistic psychopathy”Rate is approximately 4-7/1000
DefinitionAsperger's is a wide spectrum of disabilities
with many different levels of severity.
HallmarksImpoverished social skillsObsession with a certain area of interestRigid and inflexibleA “Black and White” view of the worldIntelligence remains intact
CauseUnknown, but there are theories
Genetic tends to run in families, but no gene has been
identified males > females
EnvironmentalCombination of the two
Multiple brain structures involvedLimbic system: emotions, “Fight or Flight”Corpus Callosum: connection of the hemispheres
of the brainHypothalamus: emotionsReticular Formation: information screeningThalamus: relay station for messagesAmygdala: emotions of fear and aggressionFacial images are processed in an area usually
used for perceiving inanimate objects10% larger brain Ability islands separated by areas of inability
PreventionNone yet identified
Core Group of BehaviorsAbnormal eye contactAloofnessFailure to turn when called by nameFailure to use gestures to point or showLack of interactive playLack of interest in peers
SymptomsOver focused or obsessed on a single topic,
ignoring all others.Difficulty sociallyMany with above average intelligenceNo cognitive delayNo impairment of ADL’sDo not withdraw from the world
Symptoms continuedMay show delays in motor developmentMay show unusual physical behaviorAre not flexible with schedules and routinesDo not express pleasure at others happinessSpeech and language difficulties in social
situations lead to isolation
TreatmentNo single best treatmentTeach skillsPsychosocial interventionsPsychopharmacological interventions
Childhood therapeutic strategiesWhat therapy was done in childhood
Relation based (DIR)Applied behavioral analysis (APA) Social stories (Carol Gray)Relationship development (RDI)
Psychosocial InterventionsCognitive behaviorPsychotherapyParent education and trainingPhysical or occupational therapySocial skills trainingSpeech and language therapy
Behavioral ApproachesLimit setting
i.e. 3 question ruleEmphasize abilityChoose your battlesStimulus change associate something you
wear with making choicesSocial norms
Coexisting conditionsAttention deficit hyperactivity disorder
(ADHD)Social anxiety disorderBipolar disorder DepressionNonverbal learning disorderObsessive-compulsive disorder
Psychopharmacological InterventionsADHD and the hyperactivity, inattention and
impulsivityPsychostimulentsClonadineTricyclic antidepressantsStrattera
For anxietySSRI’sTricyclic antidepressants
Psychopharmacological InterventionsFor irritability and aggression
Mood stabilizersBeta blockersClonidineNaltrexoneNeuroleptics
For preoccupations, compulsions and ritualsSSRI’sTricyclic antidepressants
What Can We DoTeaching for faculty, staff and peersSocial norms-teach acceptanceHousing-create mini culture, single roomPeer mentorsContract
What Can We DoCounselingSafety netAcademic support- use alternative learning
stylesClubs of interestDevelopmental disabilities awareness-let
them help
Questions/discussion/sharing
ResourcesAsperger Foundation International
www.aspfi.orgAsperger Syndrome and High Functioning
Autism Assoc. http://www.ahany.orgAsperger Syndrome Education Network http
://www.aspennj.orgAutism Society Of America (A.S.A.)
http://www.autism-society.orgGlobal and Regional Asperger’s Syndrome
Partnershiphttp://www.grasp.org
National Alliance for Autism Research (U.S.)http://www.naar.org
N.Y.U. Child Study Center – Asperger Institute http://www.aboutourkids.org/aboutus/programs/asperger.html
Online Aspergers Syndrome Information and Supporthttp://www.udel.edu/bkirby/asperger/
Federal level Office of Mental Retardation and Developmental Disabilities (OMRDD)www.omr.state.ny.us
State level Developmental Disabilities Services Offices (DDSO)www.ddso.org
Local level: The ARCwww.thearc.org
RESEARCH INFORMATION
An Introduction to clinical trials from the National Institutes of Healthhttp://clinicaltrials.gov/ct/gui/c/w2r
M.I.N.D. INSTITUTE (Medical Investigation of Neurodevelopmental Disorders)http://mindinstitute.ucdmc.ucdavis.edu/index.htm
National Alliance for Autism Research (NAAR)http://www.naar.org
National Institute of Child Health and Human Development (NICHD) Autism Site http://www.nichd.nih.gov/autism/
Organization for Autism Research(OAR)http://www.researchautism.orgThe Autism Research Foundation (TARF)
http://ladders.org/tarf/index.htm
