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School Psychology Quarterly, Vol. 21, No. 3, 2006, pp.

349-357

BOOK REVIEW SECTION

Exploring Current Knowledge on Asperger


Syndrome and Best Practices for School-based
Intervention

Monica P. Buettel
University of Northern Colorado

Prior, M. (Ed.). (2003). Learning and behavior problems in Asperger Syn-


drome. New York: The Guilford Press, 326 pages. $45.00.

From an interview with a 27-year-old man with Asperger Syndrome


(Buettel, 2004, p. 13):

You didn't give the kids a reason to make fun of you but they just in-
stinctively had to. They could tell you were just a bit off. You still
had some natural instincts. When kids would make fun of you I
would still hurt, but you tried to make yourself as cold and unemo-
tional and strong as possible.

Although it was largely unheard of two decades ago, Asperger Syn-


drome (AS), described as a consistent pattern of social, behavioral, and
motoric difficulties, has become increasingly prevalent as more and
more children are diagnosed every year. Current research estimates that
from one in 1,000 to one in 385 individuals have this unique and com-
plex disorder, a rate higher than classic autism (Prior, 2003). Often, inter-
ventions for children with AS focus on common classroom problems
such as noncompliance, anxiety, and disruptive behaviors (Klin,
Volkmar, & Sparrow, 2000). Without additional intervention, especially
in the area of social interaction, children with AS can develop despon-
dence, negativism, and depression as they become older and more

Address correspondence to Monica Buettel, University of Northern Colorado, School Psy-


chology Program, McKee Hall 248, Greeley, CO 80639; E-mail:

349
350 BUETTEL

aware of their social inadequacy (Klin et al., 2000). As more children be-
come identified as having AS, schools and professionals working with
these children are challenged with finding effective ways to adapt and to
encourage success in this population.
In her edited book Learning and Behavior Problems in Asperger Syndrome,
Margot Prior addresses this challenge with a compilation of current re-
search and theory, combining the knowledge and expertise of numerous
acclaimed authors and researchers in the area of AS and other Autism
Spectrum Disorders with the practical experience and insight of practi-
tioners and of one individual diagnosed with AS. According to Prior,
"the contents of this volume reflect the wealth of knowledge and skills
that has developed over 50 years of searching for the best ways to help
children with ASD" (2003, p. 6). The book is organized into two main
sections, with the first sharply detailing current thought and research on
diagnostic challenges, cognitive and academic assessment, implications
of specific learning difficulties, and the emotional and behavioral chal-
lenges of AS. The second section, entitled "Asperger Syndrome in the
Schools," includes a poignant personal portrayal of the school experi-
ence of one individual with AS, a discussion of practical advice and
guidelines for optimizing student success and for creating the "ideal
classroom" for students with AS, and ends with an examination of
educational and occupational outcomes.

DIAGNOSIS AND ASSESSMENT OF AS


The DSM-IV currently lists AS as one of five pervasive developmental
disorder (PDD) subtypes, requiring the absence of significant cognitive
and speech delays for a diagnosis of AS (APA, 2000). This definition has
been widely debated, with differing opinions on how to accurately dif-
ferentiate among the PDD subtypes, especially among AS, high-func-
tioning autism (HFA), and pervasive developmental disorder-not
otherwise specified (PDD-NOS). Some researchers have argued that AS
can be conceptualized as a bridge from the PDDs to other conditions
such as schizoid personality disorder, NLD, and semantic-processing
disorder (Volkmar et al., 1996), or as part of a spectrum that differs by so-
cial and cognitive impairment (Prior et al., 1998). The current confusion
on appropriate differentiation among PDD subtypes has lead to difficul-
ties for clinicians and other professionals working with children with AS
and to researchers attempting to conduct accurate studies on etiology
and treatment effectiveness.
In an attempt to assuage this confusion, Mayes and Calhoun (Chapter
1), provide a worthwhile and comprehensive review of the literature on
this debate, with an overall statement that AS is difficult to conclusively
BOOK REVIEW 351

differentiate from HFA and could be removed from the next edition of
the DSM, with HFA continuing to be denoted as an Axis I diagnosis of
autism without an Axis II diagnosis of mental retardation. It further con-
cludes that autism is best described as existing on a continuum with
most relevant differences among subtypes explained by IQ and
symptom severity.
This chapter includes studies on the impact of age and IQ on autistic
symptoms, the insignificance of speech delays, and the diagnostic reli-
ability and validity of the DSM-IV (concluding that the different sub-
types are empirically unsubstantiated). In general, it has been found that
children with higher IQs present with milder autistic symptoms and
tend to be identified later and that children at all phases of the autistic
spectrum show restricted interests and obsessive preoccupations. As
different labels are being used by different clinicians for the same child,
there is understandable confusion for both parents and professionals.
Mayes and Calhoun provide a succinct, though well-supported and
convincing, argument for redefining AS as indistinguishable from HFA
and for visualizing a single spectrum disorder, instead of differing sub-
types with intrinsically different characteristics. While addressing the
literature supporting the current DSM-IV diagnostic criteria, they point
out the limitations in those studies while detailing the wealth of research
underlying their position. This chapter could provide a useful tool for
practitioners involved in both the diagnosis and treatment of those with
Autism Spectrum Disorders.
The next two chapters contain ample information on learning charac-
teristics of those with AS and on strategies and instruments for assessing
children with AS who may experience school distress from both the
complexity of social demands and from an academic curriculum that is
designed for "typical" students. Children with AS have been found to
have core deficits regarding attention impairment, information process-
ing, organization and planning, the inability to complete academic tasks
satisfactorily, disconnectedness from other children, pragmatic lan-
guage, and problemsolving. These deficits can present a risk for aca-
demic failure and low self-esteem. Using a longitudinal study compar-
ing children with AS and HFA, as well as an examination of case studies,
these chapters closely examine the cognitive and academic abilities of
children with AS.
To encourage the appropriate assessment of this population of chil-
dren, the authors present an overview of the assessment process and of
specific instruments to use in the overall assessment as well as a descrip-
tion of assessment guidelines. These chapters stress the importance of
qualitative data received during the assessment process, especially in re-
gard to planning/organization, tangentiality on verbal tasks, and rigid
352 BUETTEL

and inflexible behaviors. They also promote thorough assessment in


multiple areas, viewing AS within the developmental context, and ad-
ministering more complex tests of problemsolving and executive func-
tioning. Harnessing and enhancing the students' strengths as found in
assessment is given as a means of improving school success and
self-esteem.
Overall, these chapters present a nice overview of the areas of cogni-
tive and academic ability and of the assessment of children with AS. Al-
though there was a measure of redundancy within the two chapters,
taken together they provide a fairly complete handbook for those re-
sponsible for school-based assessment, given the limited and often con-
flicting research on AS. In Chapter 2, the authors described a longitudi-
nal study involving assessments of cognitive functioning, autistic
symptoms, and adaptive behavior that attempted to ascertain whether
children with AS have a different outcome from those with autism. This
study affords further empirical knowledge on the cognitive nature of AS
and HFA and their association with learning disabilities, while the case
studies in Chapter 3 reveal complete psychoeducational profiles by ex-
perts for several children with AS as a model for those undertaking the
task of assessing students in this population.

AS CHARACTERISTICS
Regardless of the diagnostic definition, the most salient features of this
syndrome have been described with remarkable consistency, with the
majority of features falling into the categories of language-related, so-
cial, sensory, motor, and cognitive-processing characteristics, including
the ever-present circumscribed interests. Common social characteristics
include awkward interactions with their peers, a lack of desire to inter-
act with their peers, a lack of appreciation for social cues, socially and
emotionally inappropriate behavior, limited gesture use, limited facial
expression, and inappropriate expression with a peculiar, stiff gaze
(Mesibov, Shea, & Adams, 2001). Individuals with AS interpret lan-
guage literally and make sense of the world as a series of facts (Attwood,
1998). They can have odd speech patterns that may be pedantic, repeti-
tive, perseverative, monotonous, or characterized by unnatural rythmn
or rate (Attwood, 1998; Moyes, 2002), and their understanding of social
or pragmatic language can be quite limited (Attwood, 1998; Moyes,
2002).
Although a sizable body of literature exists on the characteristics of
AS, as well as on its effect on learning and behavior, this book effectively
gathers this information into one volume, while providing thorough,
and even some unique, guidance on managing and supporting these is-
BOOK REVIEW 353

sues in the classroom. Although most of the information on characteris-


tics is similar to that found elsewhere in the literature on AS, new knowl-
edge (e.g., language-based differentiation of AS, the role of specialized
interests in AS) is presented along with implications for school-based
practice and further research.
Chapter 4 offers a thorough review of studies on language and com-
munication in those with AS, while revisiting the debate over the differ-
entiation between autism and AS in the area of language, often parallel-
ing the information provided in the first chapter. The author, Helen
Tager-Flusberg, posits the idea that the best outcomes for children with
AS come with a normal IQ combined with normal language skills, argu-
ing that these abilities should be used in differentiating between AS or
autism. This author conceptualizes language as both causing trouble ne-
gotiating the social world at school as well as offering the potential solu-
tion to this pervasive problem. She suggests using explicit verbal train-
ing of social cognitive skills and compensatory strategies to help these
children learn about and understand this social world.
The following chapter provides an overview of social difficulties for
these children, offering both a review of the current findings in this area,
as well as unique information about interventions. The authors, Shaked
and Yirmiya, expound upon the "theory of mind" difficulties in concep-
tualizing and appreciating the thoughts of others, which generally lead
to problems in understanding and predicting people's behavior. They
also explain that children with AS often apply the rules of conduct that
they do learn rigidly and inflexibly and as unable to understand situa-
tional nuances. The natural consequences of distress, low self-esteem,
teasing and bullying, abuse by those who recognize their naivete, the de-
sire for sheltered individual activity, and the propensity to take refuge
from social confusion in a world of special interests, are described fol-
lowed by a list of interventions and strategies. While most of the strate-
gies provided parallel those found elsewhere in the literature (see Att-
wood, 1998; Klin et al., 2000; Moyes, 2002), the ideas of providing careful
supervision and guidance of social encounters, informing school per-
sonnel about AS and its social difficulties, and the use of specialized
skills and interests to improve social interactions and increase
acceptance in the classroom are relatively distinct.
The noted AS researcher Tony Attwood provides a rich and
thought-provoking chapter on managing circumscribed interests. His
vast expertise shines through with a fascinating discussion of this
unique AS trait. He proposes that the affinity for the physical world co-
mes from the need for predictability and patterns, and the enjoyment in
specialized interests is garnered from the accumulation of information,
the identification of a pattern, and the development of a cataloging sys-
354 BUETTEL

tem, all of which reflect an attempt to soothe anxiety from the confusing
social world through achieving coherence and making order out of
chaos. These interests can benefit both the children and society as they
pursue their interests with single-minded determination, often reach-
ing a high degree of excellence in their areas of interest. They also lend
fluency and animation to conversations that they conceptualize as a
means of exchanging information rather than for promoting social cohe-
sion. Attwood goes on to discuss strategies and reasons for either
reducing or utilizing these interests in the classroom.
Chapter 7 presents a complete and well-organized discussion of the
assessment and treatment of comorbid emotional and behavior prob-
lems, focusing on cognitive deficits and AS comorbidity with atten-
tion-deficit/ hyperactivity disorder and various psychiatric disorders,
including obsessive-complusive disorder, phobic disorders, bipolar
disorder, and schizophrenia. The author, Digby Tantam, proceeds to
touch briefly on issues around transition, crisis, and trauma; reactions to
the AS diagnosis; friendships; sexuality; aggression; and identity from
her expertise and experience. Although a broad spectrum of weighted,
and only marginally related topics was introduced in this chapter, the
inclusion of issues rarely discussed in relationship to AS provides a
unique contribution. Especially interesting is new, though empirically
unsupported, information on the common attribution by children with
AS of social exclusion to the "badness" of people, and on the tendency to
count brief acquaintances and professionals as "friends." The possible
delay of sexual puberty and resulting infatuations and fetishes and the
role of rigid routines supports identity development in the child with
AS.

ASPERGER SYNDROME IN THE SCHOOLS


Many articles and books detail specific challenges of those with AS in a
school setting and posit detailed strategies for helping these students be-
come successful (see Attwood, 1998; Klin et al, 2000; Moyes, 2002). This
section, entitled "Learning and Behavior Problems in Asperger Syn-
drome," revisits and summarizes much of the information currently
available from other sources. However, the chapters written by Wendy
Lawson, a professional with AS; Val Gill, a principal of a large school for
children with autism and AS; and Linda Kunce of Illinois Wesleyan Uni-
versity, all offer in-depth, unique insight into both the experience of and
possible solutions for AS challenges in a school setting. Lawson writes a
compelling chapter detailing her personal, and often painful remem-
brances of attending school as a child with AS. She described the confu-
sion resulting from literal interpretation of conversations and from
BOOK REVIEW 355

anything unfamiliar or new. She promotes structured playtime for chil-


dren with AS at school and explains that time outside or away from so-
cial demands is necessary and important. She also mentioned the
importance of having people who admired her persistence and
determination and were willing to support her.
Val Gill, writing from personal experience on the challenges faced by
teachers, provides solid, practical, and very specific advice for teachers
working with children with AS. He stresses the importance of gaining
understanding of the child within and of listening to the parents, while
acknowledging the intense emotional highs and lows, and the need for
humor, that accompany work with children with AS. He covers all areas
of school interaction, from relationships and professional issues to the
curriculum and motivation, in addition to detailing the common prob-
lem areas of playgrounds, physical education, and homework.
Kunce proposes a well-rounded, evidence-based "integrative model
of effective education intervention" for students with AS or HFA, in-
cluding f oundational elements, such as ongoing parent-teacher collabo-
ration and a comprehensive assessment of the child's unique learning
profile; structural elements (cognitive, social emotional, and behavioral
supports); and curricular elements that cover traditional academics to
self-management. The model is designed for implementation in a regu-
lar classroom and is described in great detail. In addition, Kunce defines
an "ideal" teacher for children with AS as caring, trustworthy, respect-
ful, knowledgeable about AS, flexible, and open to diversity. Together,
these two chapters provide a wealth of practical and easily utilized in-
formation on meeting the specific needs of these students with
understanding and expertise.
Although also revisiting much of the available information on specific
interventions for helping children with AS, Rita Jordan does an excellent
job of compiling and adding to this information in Chapter 10. She ad-
dresses the areas of inclusion, all specific subject areas, common prob-
lems faced, socialization, and specific learning problems. Adding to the
current knowledge on AS, she touches on the issue of false expectations
of children with AS deriving from their mature grammatical structure
and vocabulary and explains that these children often learn conversa-
tional rules from teacher modeling, which is more appropriate for their
'Tittle professor" role than for peer interactions. Additionally, she pro-
motes sensitive discernment in deciding whether to include children
with AS in group activities; letting them police their own behavior
according to clear, written rules; and putting them in charge of their own
learning.
An extremely pertinent chapter on outcomes is also provided, which
not only compiles all current outcome research, but also provides clear
356 BUETTEL

guidelines for supporting students with AS in higher education and in


employment. The author, Patricia Howlin, describes the difficulties
these children face in getting appropriate support in secondary educa-
tion and believes that alternatives to mainstream education should be
made available. Prior then concludes the book with an overview and
discussion of the main issues that were raised and discussed throughout
the book, including those of the diagnostic dilemma (spectrum or sub-
groups?), appropriate educational system support inclusion versus
mainstreaming (again promoting the need for available alternatives to
mainstreaming), and educational and employment outcomes.

SUMMARY: IMPLICATIONS FOR SCHOOL PSYCHOLOGY


Although offering much redundancy both within the edited volume and
with the current literature in the field of AS, this volume truly represents
a definitive and comprehensive examination of AS as it relates to school
professionals. A multitude of information on all current school-based
AS issues is presented and the diversity of authors provides both theo-
retical and personal and practical wisdom on all facets of professional
work with children with AS. The chapters on assessment are specifically
applicable to school psychologists, as are the chapters detailing class-
room interventions. The up-to-date and in-depth information on AS
characteristics contributes to the overall knowledge and understanding
of school professionals. Although similar in nature to the edited books
by Klin et al. (2000) and by Ozonoff, Dawson, and McPartland (2002),
this volume is unique in its primary focus on the aspects of AS research,
characteristics, and interventions most relevant to school professionals,
providing a well-rounded, well-researched, and sizable body of
information in one easily utilizable reference.

References
American Psychiatric Association. (APA). (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC: Author.
Attwood, T. (1998). Asperger's Syndrome. Philadelphia: Jessica Kingsley Publishers.
Buettel, M. (2004). "Off by a Hair": Understanding the Life Experience of an Adult Male with
Asperger Syndrome. Manuscript submitted for publication.
Carrington, S., Templeton, E., & Papinczak, T. (2003). Adolescents with Asperger syn-
drome and perceptions of friendship. Focus on Autism & Other Developmental Dis-
abilities, 18(4), 211-219.
Klin, A., Volkmar, F., & Sparrow, S. (2000). Asperger Syndrome. New York: The Guilford
Press.
Mesibov, G.B., Shea, V., & Adams, L.W. (2001). Understanding Asperger Syndrome and
high-functioning autism. New York: Kluwer Academic/Plenum Publishers.
BOOK REVIEW 357

Moyes, R. (2002). Addressing the challenging behavior of children with high-functioning au-
tism/Asperger Syndrome in the classroom. Philadelphia: Jessica Kingsley Publishers.
Ozonoff, S., Dawson, G., & McPartland, J. (2002). A parent's guide to Asperger Syndrome and
high-functioning autism: How to meet the challenges and help your child thrive. New
York: The Guilford Press.
Prior, M., Eisenmajer, R., Leekam, S., Wing, L., Gould, J., Ong, B., & Dowe, D. (1998). Are
there subgroups within the autistic spectrum? A cluster analysis of a group of chil-
dren with autistic spectrum disorders. Journal of Child Psychology and Psychiatry,
39(6), 893-902.
Volkmar, F., Klin, A., Schultz, R., Bronen, R., Marans, W., Sparrow, S., & Cohen, D. (1996).
Asperger's Syndrome. Journal of the Academy of Child & Adolescent Psychiatry, 35(1),
118-123.

Action Editor: Robyn Hess

Monica Buettel, M.A., is a doctoral student in school psychology in the


School of Applied Psychology and Counselor Education at the Univer-
sity of Northern Colorado. Her research interests include school-based
interventions for students with Asperger syndrome and consultation by
school psychologists. The School Psychology Program at the University
of Northern Colorado is accredited by the APA.

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