Do Girls Have A Different Expression Of The Syndrome?

The boy to girl ratio for referrals for a diagnostic assessment is

about ten boys to each girl (Gillberg 1989). However, the
epidemiological evidence indicates the ratio is 4:1 (Ehlers and
Gillberg 1993). This is the same ratio as occurs with Autism. Why are
so few girls referred for a diagnosis?
So far there have not been any studies that specifically investigate
any variation in expression of features between boys and girls with
Asperger's Syndrome, but the author has noticed that in general
boys tend to have a greater expression of social deficits with a very
uneven profile of social skills and a propensity for disruptive or
aggressive behavior, especially when frustrated or stressed. These
characteristics are more likely to be noticed by parents and teachers
who then seek advice as to why the child is unusual. In contrast,
girls tend to be relatively more able in social play and have a more
even profile of social skills. The author has noticed how girls with
Asperger's Syndrome seem more able to follow social actions by
delayed imitation. They observe the other children and copy them,
but their actions are not as well timed and spontaneous. There is
some preliminary evidence to substantiate this distinction from a
study of sex differences in Autism (McLennan, Lord and Schopler
1993).
Girls with this syndrome are more likely to be considered immature
rather than odd. Their special interests may not be as conspicuous
and intense as occurs with boys. Thus, they can be described as the
"invisible" child socially isolated, preoccupied by their imaginary
world but not a disruptive influence in the classroom. Although girls
are less likely to be diagnosed, they are more likely to suffer in
silence.
An important issue for girls is that during adolescence the usual
basis for friendship changes. Instead of joint play with toys and

games using imagination, adolescent friendship is based on

conversation that is predominantly about experiences, relationships
and feelings. The young teenage girl with Asperger's Syndrome may
want to continue the playground games of the primary school and
starts to reduce her contact with previous friends. They no longer
share the same interests. There is also the new problem of coping
with the amorous advances of teenage boys. Here conversation is
acceptable but concepts of romance and love as well as physical
intimacy are confusing or abhorrent.
In an attempt to be included in social activities, some teenage girls
have described how they have deliberately adopted a "mask" like
quality to their face. To others at school they seem to continuously
express a smile, but behind the mask the person is experiencing
anxiety, fear and self doubt. They are desperate to be included and
to please and appease others but cannot express their inner feelings
in public.
The author has observed girls with the classic signs of Asperger's
Syndrome in their primary school years progress along the
Autism/Asperger's Syndrome continuum to a point where the current
diagnostic criteria are no longer sensitive to the more subtle
problems they face. The author's clinical experience would suggest
that girls have a better long-term prognosis than boys. They appear
to be more able to learn how to socialize and to camouflage their
difficulties at an early age. This is illustrated by Vanessa's poem.

Ironing Out the Wrinkles

Life was once a tangled mess.
Like missing pieces, in a game of
chess.
Like only half a pattern for a
dress.
Like saying no, but meaning yes.

Like wanting more, and getting

less.
But I'm slowly straightening it out.
Life was once a tangled vine.
Like saying yours, and meaning
mine.
Like feeling sick, but saying fine.
Like ordering milk, and getting
wine.
Like seeing a tree, and saying
vine.
But I'm slowly straightening it out.
Life is now a lot more clear.
The tangles are unraveling,
And hope is near.
Sure there are bumps ahead.
But no more do I look on with
dread.
After fourteen years the tangles
have straightened.
(Vanessa Regal)

How do you get a school system to pay attention to a child

with AS when his/her academic functioning is at least
normal, and often advanced?
Many schools, when they look at differences or disabilities, expect
you to be in a wheelchair, or intellectually disabled. What they can't
conceptually grasp is a child who may be a wiz at math, computers,
or whatever, but is socially odd. The first reaction is that it has

something to do with the parents that they obviously haven't

raised the child properly, or something like that.
Often I become involved with the schools. After a child is diagnosed
at the clinic, I will go to the school, especially high schools, and
meet with them. I explain to the teachers what AS is, and how the
child expresses the AS aspects, their ability profiles go through some
of the heroes, some of the do's and don'ts. For example, sarcasm
isn't going to work. You've got to make sure that the child
understands the concepts you're talking about. When they do their
homework, make sure they are on the right track. Just because he's
not looking, is not to say he's not listening. He is very honest, and
many of the children with AS will tell you your mistakes. So when he
stands up in front of the class and says, "you've missed a comma
there," he's not being rude, he's not showing off to his mates, he
doesn't realize that you're not supposed to tell the teacher that they
have made mistakes. Otherwise, the teachers will review the child
as rude, inconsiderate, etc. I go to the schools to do that.
What we have in Australia is a movement by both parents and
professionals. Between parents and professionals, they have
campaigned for services for such children. The outcome has been
that, not only do we have advisory visiting teachers for such
children, but we have training programs for the teacher aids so that
they can understand such kids.
The way we changed the schools was in part also spotting those AS
kids, going into the school and supporting them, then the school
staff would say "he's not the only one," and we work from there. We
now have a "good school guide" and some parents will actually
move so that their children can attend certain schools that have a
history of doing well with these kids. So, first you have got to get the
Education Department to understand in it's policy and it's training
about AS, but you've also got to go through many aspects of
working with many individual teachers as to what to do. Kids with AS
either get on wonderfully, or atrociously, with their teachers. It's a

disaster for both parties if you're not careful. You need to support
the teachers, and help them understand. There are certain schools
in Brisbane that have more than their fare share of kids with AS,
because parents have voted with their feet and moved to that
school district where the principal understands.
I say to the parents you are an expert on your child, you are an
expert on their personality and developmental history. Use your gut
reaction to know whether that's an appropriate school. If your
senses are uncomfortable, don't go! If you feel relaxed and
comfortable, your child will probably be relaxed and comfortable in
that environment. You need to work with the teachers. We do
training programs for parents on how to relate to teachers. I also
visit schools on a regular basis. The schools now are less ignorant,
less fearful of such children, and there is a better structure for
helping them. You will get that in time. However, at the moment, it
does seem a bit down the track before you get that.

Should the child be placed in school based on their academic

level, or their chronological level?
If he's say, grade 4 chronologically, but grade 8 academically - it
depends on the individual child obviously - but generally I would say
to place them with the grade 8 kids. Many of the kids with AS aren't
there to socialize, they're there to learn. And, one of the things that
they hate is other kids disrupting the classroom. But watch out for
grade 8 though, because the kids at that level want only to give
their teachers a nervous breakdown. You've got to chose their
teachers wisely. If you say that if they have got to be with their peer
group, you've got to look at each case individually, but you need
some flexibility.

Actually, many of these kids have been home schooled, and gone on
to university quite successfully. They don't appear to have suffered
from the lack of social interaction as teenagers.

How do you discipline a child with AS?

I tragically see a number of teachers saying "it's a matter of
discipline!" Well, okay. Certainly having AS is not a license to do
whatever you want to do, and there must be natural consequences.
But my view is, with the child with AS, you must spend more time
explaining what they did that was wrong, why it was wrong, what
you are supposed to do, and how to know when you are supposed to
do it.
Quite often, when the child is very emotional and upset, it is not a
good time to explain this. When you've got emotion, you haven't got
logic. Look at love. Love is never logical. The same with anger or
distress. So, that may not be the time to explain consequences, etc.
You may need to deal with the situation when the child is relaxed,
possibly a couple of hours later. You say, okay let's learn from this.
Let's go through what happened. Often what you find is a
miscommunication or a misinterpretation by one or both parties.
Both parties need to see the perspective of the other. But the time
to do that may be when the person is reasonable, not emotional. We
do drawing, pictures, Carol Gray's social stories, all those sorts of
things to go through that process.
Often the child won't follow the rules unless they see a logical
reason why, or if they see a value to themselves. And, if you talk
about "people won't like you" - who cares? Or, "do it to please your
teacher" - why should I please her? So what we have to use is, I'm
afraid, a very mercenary approach. If you do this, this happens - if
you do that, that happens. But it's very logical, it's almost like

having a rule book. There are consequences for what you do, this is
the logic.
If you start getting into complicated personal relationships, you've
lost it. You have to be quite firm in the consequences with that
individual, but you do need to spend time explaining things. For
example, if we have a child who has hurt another child, or their
brother or sister we may say, "say sorry" and the person says
"sorry," and as far as they are concerned, that's the end! If he's
done something wrong, he must do, or donate, something to his
sister for example tidy his sister's room, or share a chocolate bar
that he was going to have at lunch time, half each in other words
something is lost or given, or they lose their time for the person
concerned. They could also make an apology card. They must
actually do something tangible, rather than just "sorry," and that's
it.
It does mean that you have to explain this to teachers, because they
expect the kids to know. You've got to explain that in those
circumstances, the child needs more explanation. I also explain to
teachers, "don't use the degree of disruption as the measure of
guilt." Although the AS child is the one who hit the hardest, he is not
the only participant, and between them it was six of one, and half
dozen of the other. Many AS kids hate the injustice - that they get all
the blame, but the person who called them names gets no
punishment. You need to deal with both parties in that situation.

How do you draw the line between an 8 year old trying to

get away something, and a boy doing what he is doing
because he has AS?
I think in a way that's been answered. AS is a difference, but not a
license to do whatever you want to do. If they want to do what they
want to do, then often we use a timer. If they're watching TV, we

often say, "you can watch TV for 15 minutes" one day it's 10
minutes, and other it's 15 minutes it's very inconsistent. The child
knows that if it's your opinion of when it stops, they can use
emotional blackmail to get you to change your mind. That's why we
get a timer, "okay, you've got 15 minutes, and when the timer goes
off, that's the end." I read in a computer magazine the other day
about a wonderful computer program that you can load onto your
computer, and every so often, it flashes a message across the
screen, "time to take a break, you've been on this long enough."
That's what they want! It's not you, the computer says "I've had
enough, I need a break, you must go have a cup of tea!" And then
they'll believe it! So find one of those programs. So, we use a timer
in that process, so it's the timer that says you've got to stop, not you
in that situation.

What about the child who says no to every proposed

appointment - medical, dental, eye, even school at times - as
well as to most proposed family outings. Should we force
him, persuade him, give up, leave him home alone?
Probably what's happening with that child is fear of new
circumstances. Any new circumstance is fraught with danger of
making a mistake, hard work of working out the cues and what to do
- there's change, there's no script. In other words, where others
would like variety and novelty, here the person wants consistency
and predictability.
What you've got is a child who needs knowledge and scripting. I
talked earlier about Social Stories by Carol Gray. What you would do
is create a Social Story about where you're going. If it's to the
dentist, you'd write a Social Story about that, why you're going,
what the person is going to do, what's going to happen next, etc. By
writing that story, illustrating it, and going through it, that child is

more likely to be scripted in what's going to happen, so it's giving

that information.
It means you have to anticipate. You start off with some minor
excursion somewhere that's short and sweet, and keep it successful.
It means throughout the process, the parent has got to think ahead.
You've got to think like your child, and before you go round that
corner, you've got to know what they're going to be concerned
about, what's going to happen. So when Auntie Joan comes up and
goes "oh, let's give him a kiss," you grab her quick, and just push
him off to the side, knowing that will upset him in that situation. You
have to think ahead in that, or, you write a Social Story that Auntie
Joan is going to give you a big hug, it's going to be very quick, then
you pull back, say thank you Auntie Joan, and I'll take you upstairs
and you can play.

I meant to say that this boy is 14 years old. . .

If he's 14, I'd also be looking at whether his world is actually
shrinking, because he may be aware at 14 of his differences, and
retreating from the world, so I'd also be looking at some of the signs
of depression as a possibility at this stage. That lack of interest in
other activities, etc. may be a sign of depression.
With a teenager at 14, I would look for that because often at 14 not
only is it a time of hormonal change - but he may be going through
an insight into being different. So, he may need a bit of help in that
area too.

What is the best way to handle meltdowns and temper

tantrums with youngsters?
With the temper tantrums, you may know with an individual that a

certain situation is fraught with frustration, and potential anger. You

know that the stress and strain of school days, which are so long
and arduous - it's like a compressed spring. It's compressed, and
compressed, and compressed, and when they get home, there's an
explosion, and there's that Jeckyl and Hyde component. You may
know that after school, it may be a time for going for a run, going for
a walk, watching a TV program, or whatever it is, to get it out of
their system, to debrief or to get rid of that tension.
There are ways that parents may pick up the signs it may be rigid
thinking, it may be being intolerant of imperfection - but there are
warning signs that this person is starting to get agitated. So, in other
words, the circumstances or warning signs may be a clue.
However, with AS, there are times when it comes out of the blue.
When you have no expectation that it's going to occur, that it's out
of proportion to the situation - it takes everybody by surprise. Often
what occurs is that it's very, very intense, but brief, and at the end
of it - "I'm fine, why are you crying? Why are you upset, I'm all right
now" - not realizing that with that whole process, everybody else is
unstable for some time. What you have to go through is a program
on emotions and anger management for that individual, so that they
can, hopefully, telegraph their anger before hand in more
constructive ways.
We use what we call constructive destruction it's basically
vandalism, and it's what teenagers do because they hate the
system, they will wreck things so we call it recycling. One child we
have has major problems with his mood swings, which seem to go
up and down quite phenomenally, and includes periods of severe
anger. But when he's coming up to those periods of anger, he's got
cans to crush, telephone directories to tear up, there are all sorts of
things that he's recycling because he's fascinated by the
environment, geography, and recycling. He can be channeled to do
that and feel better, having done that sort of mini-vandalism to get
it out of his system.

Anger is an issue, because it can be the one reason that children are
expelled from school. They may be okay with their school work, they
may be reasonably coping with their social life, but if you have one
or two periods of anger, especially if somebody is hurt, then you're
often excluded from school. So, there are a number of kids,
especially in adolescence, because of one or two episodes where the
person has been teased, or has been wanting to join in a group, or
misunderstood circumstances, that the anger and the intensity of it
gets everybody frightened about the situation. So there are areas in
anger management that need to be gone through, but really it
requires someone with expertise in both AS and emotions