MIND MOVES® AND ASPERGER’S SYNDROME Lindsay Hopwood Brief History of Autism and Asperger’s Syndrome The term “autism” was first coined by Eugen Bleuler, a Swiss psychiatrist in 1911 in relation to his work with schizophrenia. The word comes from the Greek “autos” meaning self and was used to describe individuals who isolated themselves (WebMD, 2013). Leo Kanner, an American psychiatrist at John Hopkins University was the first to clearly define autism in a paper published in English in the UK in 1943. Working independently, Hans Asperger, a Viennese psychiatrist and paediatrician first described what we call Asperger’s Syndrome in German in 1944 from his observations of withdrawn children. He called it “autistic psychopathy” and described such children as “little professors” because of their detailed knowledge of subjects of special interest to them (Phoenix, 2008). As withdrawal is a key symptom of schizophrenia, the connection between autism and schizophrenia persisted for many medical professionals until 1960 when it began to be seen as a separate condition. According to Ishikawa and Ichihashi (2007) in the Japanese Journal of Clinical Medicine, Gerhard Bosch, a German physician, was the first author to use the term Asperger’s syndrome in the English-language literature in 1962 (Phoenix, 2008). In the late 1970s Judith Gould and Lorna Wing postulated that autism existed on a continuum and in 1981, Lorna Wing popularised the term 'Asperger Syndrome' in a research paper to describe a distinct group of patients that she had been seeing (Coates. n.d.).

The Autism Spectrum According to the National Institute for Mental Health in Maryland, USA (2011), “Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD).” It is called a “spectrum” as the symptoms and levels of impairment range from mildly impaired to severely dis-abled. Much controversy exists over the diagnosis of autism and the related disorders, especially when a child presents with some, but not all, autistic characteristics (Bishop, 1989). This is because:

      

Different diagnostic criteria are used Subjectivity of the symptoms used as diagnostic criteria Changes in the clinical picture with age. The term Autistic Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD) covers all disorders where there is impairment in the development of: Reciprocal social interaction Verbal and non-verbal communication Imaginative activity

©Mind Moves Institute, Johannesburg. 2014

1

The spectrum ranges from classic autism, the more severe form of the condition that starts early in infancy or childhood to the less severe high-functioning Asperger’s Syndrome. Those cases which do fall neatly into any of the conditions recognised in the spectrum but are clearly showing some developmental abnormalities are referred to as “atypical autism” or PDDNOS, pervasive developmental disorder not otherwise specified (Bishop, 1989). SIGNS AND SYMPTOMS OF ASPERGER’S SYNDROME To be diagnosed with Asperger’s Syndrome (AS), as opposed to classic autism, the child will not have experienced any delay in developing language abilities and will not usually have accompanying learning disabilities. However, the condition will usually interfere with learning. The characteristics of Asperger’s Syndrome vary from person to person but are generally divided into 3 categories:

1. Difficulties with social interaction A person with Asperger’s Syndrome may have problems with:        

seeing life from the perspective of others, understanding gestures, facial expressions and tone of voice maintaining eye contact, seeming aloof managing their own emotions or recognising other people’s emotions knowing when to start or end a conversation or choosing topics to talk about and in “taking turns”. understanding jokes, metaphor and sarcasm as they take things literally seeing life from the perspective of others,.

2. Difficulties with social communication. Many people with Asperger’s Syndrome will want to interact socially but they may experience problems:    

making and maintaining friendships not understanding verbal and non-verbal social cues behaving in what seems inappropriate ways to others speaking too soft or too loud for the situation, with odd inflections and lacking rhythm

3. Difficulties with imagination and cognitive flexibility.    

imagining and predicting outcomes to situations with imaginative play activities as these can be pursued rigidly and repetitively intense interests in a specific subject which can be obsessive taking things literally (Horowitz, n.d; Hutten, 2011; Great Ormond Street Hospital for Children (NHS Foundation Trust), 2011; National Institute of Neurological Disorders and Stroke, 2012).

©Mind Moves Institute, Johannesburg. 2014

2

Additional features of the syndrome which may be exhibited by AS children, some positive, may include:               

usually have average to above-average intelligence use good grammar and possess an advanced vocabulary for their age excelling at structured activities such as LEGO or puzzles preferring to play alone or be with adults have obsessive or repetitive routines and rituals being averse to change to routines and schedules resulting in anxiety sensory sensitivities-either heightened or lowered sensitivity to sounds, smells, light, touch and textures, and tastes. good attention to detail trustworthy and reliable serious and formal demeanour clumsy, problems with motor skills strange movements or mannerisms seem odd or eccentric and become a target for bullying low self-esteem and depression often do not give in to peer pressure where clothing is concerned, preferring to dress according to comfort as allowed by their sensory sensitivities

AS and is more common in boys than in girls, in a ratio of 4:1 (Gillberg & Coleman in National Autistic Society, 2013a). Children with classic autism are usually diagnosed earlier than those with AS. Symptoms of autism usually appear by age 2 while those of AS may only be recognised much later and with appropriate intervention the prospects for AS children are usually more positive. (Horowitz, n.d; Hutten, 2011; Great Ormond Street Hospital for Children (NHS Foundation Trust), 2011; National Institute of Neurological Disorders and Stroke, 2012.)

CAUSES AND TREATMENT At this stage the exact cause of Asperger’s in not known but research suggests genetic and environmental influences. It has been suggested that the MMR vaccination may play a part but research does not bear this out. Current research, using advanced imaging techniques, suggests AS children may have structural and functional differences that affect the “wiring”, the nerve pathways controlling thought and behaviour. It is also postulated that AS children do not have as much activity in their frontal lobes when faced with certain tasks. There is no known cure but instead there are programmes to assist with specific difficulties that may be impacting the child and the family. The condition may become more problematic during puberty or with the change from primary to secondary school or on leaving school (National Institute of Neurological Disorders and Stroke, 2012)

©Mind Moves Institute, Johannesburg. 2014

3

HOW ASPERGER’S SYNDROME AFFECTS LEARNING Whilst children with AS might be diagnosed as having “high-functioning autism”, and even be described as having a “dash of autism”, they also share some characteristics with children with non-verbal learning disorder (NVLD). Children with NVLD have the following characteristics in common with children with AS:   

physical awkwardness social intrusiveness social isolation.

Thus, NVLD and AS are separate and distinct disorders but with some overlap. As parents, teachers and therapists, it is essential that we see each child’s needs from a holistic viewpoint, taking into account language and cognitive skills as well as social and behavioural issues. Both conditions can range in severity, but those children with AS are usually more severely impaired (Horowitz, n.d.). Children with AS can appear quite normal at times, and may perform well academically, such that their needs can be overlooked, but they will possess unique challenges when in a learning environment that need to be handled sensitively and in a way that will enable them to discover and develop those strengths. Some of these needs are:   

    

having a predictable schedule and routine knowing the agenda at the beginning and being made aware of changes to plans ahead of time where possible learn better when visual methods as well as auditory are used as, typically, their visual processing skills are better than their auditory processing skills. need clear and specific instructions using simple and concise language (state the obvious, as what is common sense to their peers may not be so for them) help in understanding non-verbal cues such as facial expressions and tone of voice and to learn social skills reassurance, frequent feedback and praise extra time to complete assignments and extra practice and recall opportunities to consolidate learning responsible peer buddies who understand them and will be a role model and act as buffer between them and potential bullying and teasing. (Organisation for Autism Research, 2010)

HOW A MIND MOVES REFLEX ASSESSMENT AND MIND DYNAMIX® PROFILE CAN HELP Children with AS usually appear to experience difficulties in processing information. This is because the ability of their brains to take in, store and use information results in a different perspective on the world. This unique processing often hinders them from accurately recognising and interpreting abstract information. They tend to be visual learners with difficulties processing auditory information. (Stokes, n.d). AS children often have low muscle tone and dyspraxia, (problems with motor coordination that makes it difficult to think out, plan, and perform planned movements or tasks) (Autism Speaks, 2013). If these are the common barriers to learning in children with AS, consulting an Advanced Mind

©Mind Moves Institute, Johannesburg. 2014

4

Moves Instructor who can perform an assessment of the primitive reflexes and the dominance profile will provide invaluable assistance. Learning is an active process that requires a fully developed and integrated brain, sensory, nerve and muscle system. Even many so-called “normal” children find learning challenging or are not living up to their potential and a Mind Moves Assessment would reveal if there are any aberrant reflexes whilst the Mind Dynamix Profile would give insight into learning style and preference. What is an Aberrant Reflex? During our neurological development certain primitive reflexes, or involuntary movements, “hardwire” the brain by making connections between the senses, organs, brain and muscles so that they can communicate with each other. This process is controlled by the brain stem from conception until 14 months and prepares the baby for birth and the first year. Once the reflex has completed its function it should become dormant, unless it is triggered again by illness, constant stress or trauma. Reflexes that are still active are called aberrant reflexes and may make it harder for a child to sit still and concentrate, for example. A Mind Moves Assessment will reveal any such aberrant reflexes which can be helped to retire with a series of exercises called Mind Moves. (De Jager, 2009)

What is a Mind Dynamix Profile? Each person is unique as a result of genetics, neuro-chemical wiring and life experiences. Consequently we all have genetically dominant pathways which determine how we think, feel and act as a result of how we take in, process and respond to sensory information. A Mind Dynamix Profile is an assessment that determines the dominant:          

eye and ear, indicating how the child will tend to receive in formation brain hemisphere, indicating how the child will tend to process information hand and foot, indicating how the child will act upon the information, solve problems and communicate. This instrument helps us to know: what we are good at, our preferred learning style, how we function under stress, what career we are best suited for, what areas need development why we respond to social inter-action the way we do (De Jager, 2009).

PLEASE NOTE: A profile is not a label and there are no good or bad profiles. However, certain profiles have an advantage in a classroom setting and knowing the characteristic of the profile helps the parent/teacher to better understand the child. The assessments are physical tests. A short academic history is taken and once the tests are completed feedback is given and advice is offered re the particular concern/reason for the assessment. A selection of Mind Moves® will be recommended and demonstrated. From this it can be seen that these assessments will benefit AS children.

©Mind Moves Institute, Johannesburg. 2014

5

What are Mind Moves? Mind Moves are basic movements that mimic primitive reflexes to develop neurological pathways to promote sensory-motor integration, posture and learning ease. Mind Moves can be done individually at home or in groups in a classroom https://www.mindmoves.co.za/. Case Study Perhaps the best way to explain the benefits of these assessments is with a case study of a 14 year old diagnosed with AS. Let’s call him Andy. Andy is no different in appearance from his peers but is perceived as different from the time that you meet him in that he is shy, does not easily make eye contact, rarely smiles and seems reticent to engage in conversation and, when he does, his conversation is flat and emotionless. He is anxious, often having “asthma attacks” just before a maths test. These asthma attacks, which have not responded to treatment are now seen as anxiety attacks, but have become rare since he has been doing his Mind Moves. He has also started volunteering answers to questions in the classroom and engages more readily with his peers. Andy’s Mind Moves Assessment: On a scale of 0 to 4, this assessment showed that, of the 7 primitive reflexes, only 1 scored 0, and was therefore normal, whilst 3 of Andy’s reflexes scored 4 and were fully aberrant. These aberrant reflexes would represent “cracks” in the wiring and would interfere with the transmission of information through the nervous system. Scoring 0 for the Asymmetrical Tonic Neck Reflex would be consistent with a child with good reading skills as this reflex is responsible for establishing the neural connections between the eyes and the hand, the first step needed for reading (De Jager, 2009). Since AS children usually have an extensive vocabulary, and reading may contribute to that, we might expect to see this result in other AS children as well. The fully aberrant reflexes were: Moro Reflex which stimulates balance and the development of the ear and vestibular system and thus the hearing apparatus. It is an involuntary survival mechanism and an aberrant Moro would result in a child being in a constant state of “flight or fright”, producing high levels of adrenalin and cortisol (De Jager, 2009). Tonic Labyrinthine Reflex (TLR) helps to straighten the body and develops head control, balance, muscle tone and proprioception (to recognise orientation in space). An aberrant TLR would explain the symptoms of awkward movements, low muscle tone, poor planning and organisation skills seen in AS children (De Jager, 2009).

Spinal Galant Reflex develops hip rotation and flexion. If this reflex is aberrant it might explain the difficulties AS children have with poor motor skills, and would interfere with concentration and memory (De Jager, 2009). Andy had a score of 3 for the Rooting and Sucking Reflex. This reflex wires the baby for survival and stimulates the emotional brain, providing “the glue needed for memory and the fuel needed for motivation”. If this reflex is aberrant it might explain the emotional and social difficulties experienced by AS children (De Jager, 2009).

©Mind Moves Institute, Johannesburg. 2014

6

Andy’s Mind Dynamix Profile Andy has a dominant left eye and left ear controlling the input of information, a dominant left brain with which he will prefer to process information and a dominant right hand and foot to control information output. The dominant eye and ear are under the control of the nondominant creative right brain and would, under normal conditions, receive information holistically but also subjectively and emotionally. For this information to be processed effectively in the dominant logical left brain, an integrated brain (where both hemispheres work optimally) would then automatically review the information in order to obtain the detail needed for it to analyse it rationally and objectively. From there, the information would flow easily to the dominant right hand and right foot. These are also under the control of the logical left brain and the response would therefore be communicated concisely, logically and factually. Decisions would be based on the facts and any problem would be solved sequentially and the resultant action would be planned and controlled (De Jager 2009).

For Andy, as a child with AS, the picture would be very different. As mentioned above, his aberrant reflexes on their own would create sufficient internal stress for his non-dominant right hemisphere to “gear down” resulting in an un-integrated brain (De Jager, 2009). He is literally physically and chemically challenged in the face of new information and situations, creating many challenges for him. The flow of information would be blocked at the input stage (De Jager, 2009) as the dominant eye and ear are not compatible with the dominant hemisphere resulting in a barrier for the flow of information. Andy’s profile indicates that his cognitive brain dominates his emotional brain and may explain the fascination for certain facts experienced by AS children. I suggest that these factors may explain why, as a child with AS, Andy battles to relate to the emotions of other people. He is actually equipped to pick up facial expressions, body language and tone of voice (De Jager, 2002) but his aberrant reflexes and dominant receptive (back) brain combine to keep him “stuck” trying to understand abstract concepts with insufficient factual information. I also suggest that this might be consistent with the research findings of reduced activity in the frontal lobe of AS children as mentioned above. Compounding the problem is the dominant left eye tracking from right to left, the opposite direction for reading in his home language (De Jager, 2009) making reading tiring, and the dominant left ear’s sensitivity to noise making it difficult for him to tune out background noise (De Jager, 2002), adding to his stress and making it difficult for him to concentrate and to follow instructions. But all is not lost. For children like Andy I would recommend:    

seeing an optometrist who can prescribe glasses that correct for left eye dominance and take the strain out of reading sitting on the left of the classroom towards the front and without anyone on the left to reduce distractions for the easily distracted left eye and ear. using a notebook to jot down important verbal information that might be forgotten doing the following Mind Moves to correct the Moro Reflex (De Jager 2009):

Power on

Rise and Shine

©Mind Moves Institute, Johannesburg. 2014

Lip Workout

Confidence Booster

7

REFERENCES Autism Society. [n.d.] Asperger’s Syndrome. [online]. Available from: http://www.autism-society.org/aboutautism/aspergers-syndrome/ [Accessed 6 December 2013]. Autism Speaks. 2013. What Is Asperger Syndrome? [online]. Available from: http://www.autismspeaks.org/whatautism/asperger-syndrome [Accessed 6 December 2013]. Bishop, D. V. M. 1989. Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries? British Journal of Disorders of Communication 24, 107-121 (1989) [online]. Available from: http://www.mugsy.org/bishop.htm [Accessed 6 December 2013]. Coates, L. 2013. History of Asperger Syndrome [online]. Available from: http://www.aspergersyndrome.me.uk/history.html [Accessed 6 December 2013]. De Jager, M. 2009. Mind Moves-removing barriers to learning. Welgemoed: Metz Press. De Jager, M. 2002. Mind Dynamics. Cape Town: Human and Rousseau. Great Ormond Street Hospital for Children. (NHS Foundation Trust). 2011. Asperger's syndrome information. [online]. Available from: http://www.gosh.nhs.uk/medical-conditions/search-for-medical-conditions/aspergerssyndrome/aspergers-syndrome-information/ [Accessed 6 December 2013]. Horowitz S. D. [n.d.]. Learning Disabilities and Asperger’s Syndrome [online]. Available from: http://www.ncld.org/types-learning-disabilities/adhd-related-issues/autism-spectrum-disorders/learningdisabilities-aspergers-syndrome?start=1 [Accessed 6 December 2013]. Hutten, M. 2011. The Learning Style of Asperger’s Students. [online]. Available from: http://www.myaspergerschild.com/2011/04/learning-style-of-aspergers-students.html [Accessed 6 December 2013]. National Autistic Society. 2013a. High-functioning autism and Asperger syndrome: what's the difference? [online]. Available from: the at http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-anintroduction/high-functioning-autism-and-asperger-syndrome-whats-the-difference.aspx [Accessed 6 December 2013]. National Autistic Society. 2013b. Autism: why do more boys than girls develop it? [online]. Available from: http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-an-introduction/gender-andautism/autism-why-do-more-boys-than-girls-develop-it.aspx [Accessed on 6 January 2014]. National Institute of Mental Health. 2011. A Parent’s Guide to Autism Spectrum Disorder. [online]. Available from: http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-spectrum-disorder/parent-guide-toautism.pdf [Accessed 6 December 2013]. National Institute of Neurological Disorders and Stroke. 2012. Asperger Syndrome Fact Sheet. Available from: http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm [Accessed 6 December 2013]. Phoenix. 2008. A Brief History of Asperger Syndrome [online]. Available from: http://glassjail.wordpress.com/2008/04/14/a-brief-history-of-asperger-syndrome/ [Accessed 6 December 2013]. Organisation for Autism Research. 2010. 6 Steps To Success For Asperger Syndrome [online]. Available from: http://www.researchautism.org/educators/aspergersteps/index.asp [Accessed 6 December 2013]. Stokes, S. 2000. Children with Asperger's Syndrome: Characteristics/Learning Styles and Intervention Strategies [online]. Available from: http://www.specialed.us/autism/asper/asper12.html [Accessed 6 December 2013].

University of Salford. [n.d.] Students with Asperger Syndrome or Autistic Spectrum Disorder. [online]. Available from: http://www.advice.salford.ac.uk/cms/resources/uploads/File/Students%20with%20Asperger%20Syndrome%20or %20Autistic%20Spectrum%20Disorder.pdf [Accessed 6 December 2013]. WebMD. 2013. History of Autism. [online]. Available from: http://www.webmd.com/brain/autism/history-of-autism [Accessed 6 December 2013].

©Mind Moves Institute, Johannesburg. 2014

8