Nelle Frances - Information on Aspergers
As Parents, Teachers and Professionals of children with Asperger’s Syndrome we are all familiar with the enigma of their unequal reaction to pain and injury. A stubbed toe or paper cut may set off a pain response (crying, screaming, and sobbing) such as is equalled by the loss of a limb; yet a burst ear drum or broken limb may go seemingly unnoticed. As carers of children with Asperger’s Syndrome we are often bewildered by this ‘unequal’ response to pain stimuli. Anecdotal evidence from clients worldwide is full of reports on this topic. So, what’s the answer to this confusing puzzle? The questions surrounding Asperger’s children’s unequal response to pain can be explained scientifically.
The assumption that, physiologically, humans are equipped to limit the amount of stimuli entering our brains thereby preventing the brain from becoming overloaded, has led to the establishment of a ‘normal’ range of feeling. However, those with Autistic Spectrum Disorder are recognised as having a hyper/hypo sensitivity to stimuli i.e. above average range of feeling or super-sensitivity, first written about in 1949 by Bergman and Escolona.
Accounts written by people with Asperger’s Syndrome state that their disability is directly linked to their senses and their sensory processing. So let’s look at the biochemical processes that occur when our senses are stimulated.
Stimulation from the environment enters our brain through our eyes, ears, skin, nose and mouths. Our nervous system passes this information around our brain and body by the use of biochemical neurotransmitters. The amount of stimulation felt is determined by the amount of neurotransmitter processed in each neuron. The enzyme dopamine beta hydroxylase is released from nerve endings during stimulation. Dopamine beta hydroxylase (DBH) is essential for cell communication and regulating neurons in the central and peripheral nervous systems. An increase in stimulation results in an increase in the level of this enzyme. Scientific studies have shown that individuals with Asperger’s Syndrome have much higher levels of dopamine beta hydroxylase in their systems than in ordinary individuals. The presence of this enzyme is also linked to behaviours such as repetition, agitation and aggression.
Repetitious activity, such as rocking, flapping or pacing, results in the release of Endorphins through the system. Endorphins reduce the sensation of pain and have the ability to block pain. In other words, when endorphins are present, the amount of sensory reaction is reduced or stopped completely. Children with Asperger’s Syndrome have the ability to purposely, but unknowingly, overload their sensory system in order to shut it down completely i.e. by rocking, flapping or pacing etc.
Blocking out all sensation by the production of endorphins might seem like a simple and easy way of coping with sensory overstimulation; however, in caring for Asperger children we must realize that reaction to ALL sensation becomes limited. They won’t recognize hunger, tiredness, body temperature (risk of overheating), full bladder/bowel or pain.
Children with Asperger’s Syndrome display agitation through use of repetitious behaviors such as rocking, flapping, pacing, head-banging, staring, screaming, spinning, chanting or humming. Our job as Carers, Teachers and Professionals of children with Asperger’s Syndrome is to recognize these signals of agitation. These behaviors are used to block out
• direct over stimulation from their environment;
• their emotions (happy, fearful, or excited) and
• their response to pain.
These repetitive behaviors also serve to calm an Asperger child, if their use is monitored rather than unlimited.
For Asperger children, the build-up or cumulative affect of these endorphins throughout the day also needs to be taken into consideration. This is why Asperger children who suffer accidents in the afternoon or evening may not show pain or seem to feel it.
All physical exercise causes the release of natural endorphins into the system that can help to ‘protect’ the child with Asperger’s Syndrome without switching off the sensory response. So exercise such as walking, running, and swimming is extremely beneficial in your child’s daily routine as a preventative measure. It may be used during periods of agitation to help calm the child with Asperger’s Syndrome. In this way exercise is used to develop appropriate social responses e.g. it is more acceptable to jump on a trampoline rather than on the furniture.
With this information revealed it becomes obvious that we must monitor our Asperger child’s production of endorphins, because the presence of excess endorphins causes them to lose the ability to respond to any stimulation. This means that children with Asperger’s Syndrome miss much of what they are meant to be learning.
Also, we must realize that these stereotyped/repetitive behaviours have social consequences for children with Asperger’s Syndrome – they are a visual reminder that these children are different from their peers. We must take into account the Asperger child’s socializing skills and ability when monitoring and setting limits on the use of repetitive behaviors. That is, we should tell them times and places when flapping/rocking/head-banging are acceptable, for controlled periods of time.
We should not attempt to eliminate sensory stimulation in order to protect children with Asperger’s Syndrome. Without stimulation, our world becomes meaningless to them. Rather we should attempt to provide them with a safe sensory environment – dim lights, softer noises/voices, reduced odors - giving them the opportunity to learn and respond appropriately.
Asperger’s Syndrome and Transition Difficulties.
Transition is defined as “passage from one form, state, style, or place to another”. A characteristic common to children/adults with Asperger’s Syndrome is the difficulty they experience with making transitions.
For neurotypicals the transition process happens effortlessly (without us noticing), countless times a day. So it can be challenging for parents/carers/teachers to comprehend the impact that problems with transition create for those with Asperger’s Syndrome.
Transitions occur in an Asperger child’s physical environment from the moment they open their eyes each morning.
From bed to breakfast table to living room. From pyjamas to school uniform. From bare feet to socks and shoes. (Keep in mind the sensory transition from comfortable PJ’s to crisp, clean school clothes; bare, cool feet to enclosed, clammy feet.) Feeling empty (hunger) to feeling full.
Be aware that when you call your Asperger child away from the television to brush their teeth, the transition involves:-
Stopping the visual/auditory processing of watching T.V.;
Physically moving from living room to bathroom;
Visually processing the bathroom environment; and
The taste in their mouth changing from morning breath to fresh, minty breath.
For your Asperger child, the simple act of going to school involves multiple transitions:-
From home to car/bus (processing the passing scenery of the journey) to school.Have you ever noticed that your Asperger child seems reluctant/slow to get out of the car/bus at school and doesn’t seem to hear your last-minute instructions? That’s because all their energy is focused on processing the transition. (A better time to give last minute instructions would be at the beginning of the car journey.)
Once your Asperger child arrives at school, transitions continue to bombard his/her processing system. From the school grounds/corridors to inside the classroom; from classroom to recess area; recess area to playground; playground to classroom and so on.
At the end of the school day your Asperger child must cope with the transition from classroom to car/bus to home. So how do we parents/carers/teachers help minimize the impact transition has on our Asperger children?
The responsibility is on us to be able to recognize every transition our Asperger children are faced with each and every day, and allow them time to process/catch up with their environment. We also need to understand that on some days for our Asperger children, too many transitions can lead to overload and meltdown. We must also accept that our Asperger child won’t “grow out” of having difficulty with transition – it will be an ever-present challenge in their lives. Our awareness of transition difficulties will mean we can facilitate this Asperger characteristic by allowing extra time for our children to process their transitions. This understanding will also guide us as to when our Asperger child is the most receptive to hearing instructions or important information we have to impart to them. In this way we can minimize their transition difficulty and maximize their learning outcomes.
This article produced with the kind permission of Nelle Frances, author of several children's books specifically written to help children with autism, and also to assist us better in understanding them.