Strategies for improving the social integration of children with Asperger syndrome

There is general agreement that children with Asperger syndrome have difficulties in social integration with their peers. Our current understanding of the nature of these difficulties is explained and specific strategies are described that are designed to encourage greater competence in the skills that are necessary to achieve effective social integration. While we do not have any clear scientific evidence of whether and how these strategies are successful, they provide a source of ideas for future examination by academic research and provisional remedial programmes for practitioners. address Correspondence should be addressed to: dr tony attwood, The Macgregor Medical Centre, PO Box 224, Petrie, Queensland 4502,Australia keywords Asperger syndrome; social integration; theory of mind We currently have general agreement that, to use Hans Asperger’s original words, ‘This disturbance results in severe and characteristic difficulties of social integration’ (1991, p. 37). But what exactly are the characteristic difficulties? We have some tentative knowledge of the difficulties from the diagnostic criteria, research studies, clinical observations and current theoretical models of autism and Asperger syndrome, but the subsequent question is, how do we improve the social integration of such children? The primary aim of this paper is to describe provisional strategies to encourage social integration. Characteristic difficulties in social integration The current diagnostic criteria define the characteristic difficulties of social integration as especially conspicuous when the child is interacting with their peers.There is an inability or lack of desire to interact with their peers or a failure to develop peer relationships appropriate to the child’s developmental level. When the child is engaged in social interaction, one is aware of several conspicuous characteristics, such as a lack of reciprocity, little appreciation of social cues and failure to share enjoyment, interests or at QUEENS COLLEGE LIBRARY on June 15, 2010 http://aut.sagepub.com Downloaded from achievements with other people. Other characteristics include a failure adequately to use eye gaze, facial expressions, body posture and gesture to regulate the social interaction. There can also be socially and emotionally inappropriate behaviour and a difficulty in reading emotion from the facial expression of the child. (American Psychiatric Association, 1994; Gillberg and Gillberg, 1989; Szatmari et al., 1989; World Health Organization, 1993). As we have only recently defined the characteristics of the syndrome, there are very few research studies that have included an analysis of the difficulties of social integration of subjects with a clear diagnosis of Asperger syndrome. Prior et al. (1998) conducted a study that suggests that in comparison to children with typical autism, children with Asperger syndrome can actively look for friendship but in a clumsy and not very successful way. As one of the central diagnostic criteria is a failure to develop peer relationships appropriate to the child’s developmental level, clinicians examine how the child conceptualizes and demonstrates friendship skills. Normal children’s conception of friendship changes over time and it is noticeable that children with Asperger syndrome often have an immature or unusual definition of friendship (Botroff et al., 1995). Their definition may include an opinion on what a friend should not do but the child has little idea of what a friend should do. While there is a lack of research studies in this area, additional knowledge may be obtained by accepting the theory of a continuum or spectrum of autistic disorders (Wing, 1988) and incorporating research studies using children with autism who have been described as high functioning. While it is not the purpose of this paper to discuss the potential differentiation between Asperger syndrome and high-functioning autism, it is important to consider similarities as well as differences between these two groups, especially as research and clinical experience confirm an overlap of symptoms in the area of social interaction (Ehlers et al., 1997). The research on subjects with high-functioning autism suggests they are less competent than normal controls in the understanding and expression of complex emotions (Capps et al., 1992; MacDonald et al., 1989). Clinical experience of children with Asperger syndrome suggests a similar difficulty, especially in the area of the facial expressions, with a tendency for partial expression, such as only moving their eyebrows to indicate the nominated emotion, odd expressions and taking considerable time and apparent intellectual effort with this task. Further information on the characteristic difficulties in social integration can be obtained from consideration of one of the theoretical models used to explain the nature of autism and Asperger syndrome, and the associated research literature. One of the most significant advances in autism 4(1)