High Functioning Autism (HFA) & Asperger’s Disorder (AD) in secondary school
“Gary is 14 now and he goes to his local high school. He was diagnosed with Asperger’s Disorder when he was 5. He still has trouble with some things. For example, the other day at school he had to change classrooms for one of his subjects, history I think he said it was. Well, he got all confused, didn’t take his history books with him and he said the teacher was cross because he was late and forgetful. Gary said he just didn’t feel right not being in the usual classroom and then he forgot to go to his locker for his books because he was so worried about going to the different classroom and ended up getting there 12 minutes late. He still doesn’t cope well with change and little things really throw him” Parent
Does this sound familiar to you? Do you have a teenage son or daughter or is there a student at your school who behaves like this?
The core features of Autism and Asperger’s Disorder (we call it Autism Spectrum Disorder now, ASD for short) don’t go away but may look different as kids get older. To really help them you need to be familiar with how their ASD is affecting them now each and every day at home, school and when they are out and about socially. The following fact sheet High Functioning Autism (HFA) & Asperger’s Disorder (AD) in Secondary School
gives information about ASD and answers questions such as-
- What is the difference between ASD, Autism and Asperger’s Disorder?
- How do students with ASD think and learn?
- How might ASD be affecting their health?
- How we can help students with ASD manage at school?
- What else can I read to find out more?
High Functioning Autism (HFA) & Asperger’s Disorder (AD) in Secondary School
Dr Avril V. Brereton
Most students with ASD find school challenging at some time or other. This can be the case no matter what the type of school; specialist or mainstream, primary or secondary. For those high functioning students attending mainstream secondary school, the continuing challenges of ASD (difficulties with communication and social skills, emotional and behavioural difficulties) combined with the added demands of secondary school indicate that support needs are ongoing. These young people are not growing out of their ASD, they are growing with it.
What is the difference between ASD, Autism and Asperger’s Disorder? Why not just call it ASD and treat them all the same?
The key to successfully teaching and working with a student with HFA or AD lies in having a good understanding of who they are, how they think and how their symptoms affect their daily life and learning. Remember, students who have been given these diagnoses during childhood are now adolescents who regard their HFA and AD symptoms as being part of who they are. Below is a description of each of these disorders and their core features during childhood and adolescence.
Autistic Disorder (autism)
American psychiatrist Dr. Leo Kanner introduced the word “autism”, derived from the Greek word ‘auto’ or ‘self’ to the scientific community. Kanner first described the core features of autism in his paper of 1943 in which eleven children with ‘autistic disturbances of affective contact’ showed a distinctive and previously unreported pattern of symptoms that included an inability to relate to people and situations; failure to use language for the purpose of communication; obsessive desire for the maintenance of sameness in the environment (Kanner, 1943). These three core symptoms have remained central to the diagnosis of autism.
1. Social impairments
All children with autism show social impairments, however, the nature of these impairments can vary and may modify as the child grows older. There may be an increase in interest in other people and the development of some social skills often learned in a mechanical or inflexible manner. For example, a teenager may lurch toward a stranger who is walking past him to try and shake his hand because he has been taught to greet people with a hand shake. Adolescents with autism usually have to learn about social skills and personality development without the opportunity of peer group discussion and support that is available to typically developing adolescents (Howlin, 2005).
2. Communication skills
Poor understanding is probably linked to social difficulties and impairments in social
understanding. Inability to express needs by words or gesture, or a significant difference in the adolescent’s ability to use words compared to their level of understanding of the verbal responses of others, is a source of frustration and can cause distress or disturbed behaviour.
Adolescents with HFA usually develop a wide vocabulary and expressive verbal skills but often show difficulty with the pragmatic or social use of language. They may continue to have have impaired ability to initiate conversation, communicate reciprocally with others and maintain the “to and fro” of a conversation. The adolescent with HFA more likely to talk at you rather than with you, to intrude and talk out of context and use speech as a means to an end rather than engage in a social conversation.
3. Ritualistic and Stereotyped Interests or Behaviours
In his original account of autistic disorder, Kanner described children with stereotyped motor mannerisms, repetitive play and behaviours, non-functional routines and rituals and an obsessive desire for the maintenance of sameness (Kanner, 1943). Older children may develop play that superficially appears to be creative, such as re-enacting the day at school with dolls and teddies, or acting out scenes from favourite DVDs. Observation of this type of play over time often reveals a highly repetitive, formalised scenario that does not change and cannot be interrupted. Children with autism rarely involve other children in their play unless they are given a particular role in a controlled situation. Ritualistic and compulsive phenomena such as touching compulsions and rigid routines for daily activities are common. Many adolescents with HFA have unusual preoccupations that they follow, often to the exclusion of other activities. These may involve a fascination with bus routes or train timetables in association with repeatedly asking questions to which specific answers must be given.
Independent of Kanner, Austrian Psychiatrist Hans Asperger published a paper that reported on a group of children and adolescents with what he described as “autistic psychopathy” (Asperger, 1944). These school-aged boys had problems with social interaction, unusual and intense interests, behavioural problems and clumsiness, but no significant delays in cognitive or language development.
Some typical features of children with Asperger’s Disorder include:
• Acquisition of language follows a normal or even accelerated pattern, but content of speech is abnormal. It may be pedantic and centre on one or two favourite topics. The social use of language (pragmatics) is usually impaired
• Little facial expression, vocal intonation may be monotonous and tone may be inappropriate
• Impairment in two-way social interaction including an inability to understand the rules governing social behaviour. May be easily led
• Problems with social comprehension despite superior verbal skills
• Very rigid, prefer structure
• Well developed verbal memory skills, absorb facts easily, generally good level of performance at maths and science
• Highly anxious with a dislike of any form of criticism or imperfection
• Motor skills are often impaired with general gross motor clumsiness and difficulty with fine motor skills including hand writing
How do secondary students with ASD think and learn?
Adolescents with HFA and Asperger’s disorder continue to have difficulties with social skills and accessing community activities. They may also have a discrepancy between their IQ score and their ability to achieve academically at school because social and behavioural difficulties get in the way of learning and adapting to school life. Children diagnosed with Asperger’s Disorder do not have an intellectual disability (IQ >70), yet may have a scattered profile of abilities with strengths in verbal skills but poorer non verbal performance skills and motor clumsiness. Children with Asperger’s Disorder are likely to have more right brain functional problems and children with autism more left brain (language based) cognitive difficulties (Rinehart et al. 2002).
Students with HFA and AD usually appear quite capable because they can absorb facts and figures and have extensive knowledge in specific areas that interest them. However, they do have difficulty in some areas such as social cognition, difficulty with abstract thought and concepts and have academic difficulty in the areas of problem solving, concept development, reading comprehension, making inferences and judgments, and organisational skills. Because they have difficulty with cognitive flexibility, they are rigid thinkers which leads to poor adaptation to change and they may continue to have difficulty with cause and effect, particularly in the context of a social interaction.
The diagram below shows three learning profiles. One for an adolescent with HFA and overall average intelligence (IQ >70), one for an adolescent with Asperger’s disorder and one for an adolescent with autism associated with an intellectual disability.
How might ASD be affecting their health?
Adolescence can sometimes bring the development of symptoms such as aggressive and oppositional or obsessive compulsive behaviour
, and an increase in anxiety, tension and mood disturbance. The prevalence of anxiety problems in school-age children and adolescents with ASD is in the range of 40–45 % (White et al. 2009), considerably higher than prevalence of anxiety disorders in epidemiological studies of children and adolescents in the general population. The symptoms of anxious behaviour include fear of separation from familiar people, specific fears or phobias (e.g. certain sounds, smells, objects, animals), resistance to change (e.g. new clothes, food, routines), panic and emotional distress for little or no apparent reason, tenseness, shyness and irritability. These co-morbid symptoms of anxiety, apart from the distress they cause the young person
, have the potential to disrupt education, further impair social interaction and create management problems and stress for the parents and teachers. The identification of anxiety in an adolescent with ASD creates an opportunity for management.
Around 30% or more of children with autism have significant problems with distractibility, inattention, impulsiveness, fidgetiness and motor over activity which is more than you would expect to see in children of their intellectual level of development. Fortunately, these symptoms, which also interfere with learning and social interactions, generally reduce as the child matures. If ADHD symptoms worsen or appear for the first time in a teenager with autism
, then this is an indication of another problem such as anxiety about change or stressful events, or an emotional response to a stressful life event such as serious illness in a parent. Sometimes episodic disruptive behaviours or ADH symptoms might indicate the onset of epilepsy symptoms or even an illness such as urinary tract or ear infection.
How we can help students with an ASD manage at secondary school?
Students with HFA and AD at mainstream secondary school, may experience difficulties because of their ASD symptoms but also because of the level of social skills required to interact with teachers and students throughout the day and their response to these social and emotional demands. The young person’s learning and thinking style and symptoms of HFA or AD may also make it more difficult to cope at school where skills are needed to manage stressful situations, be well organised, cope with change, and limit or “turn off” special interests or preoccupations.
What can we do to help?
Keep stress to a minimum, get organized and manage change by:
providing a safe space the student can go to when feeling overloaded and stressed. This may be a quiet area in a resource room, computer room or library. All staff should know where the safe place is and direct the student to it or give the student the option of going there if he/she is becoming distressed.
helping the student understand each day's routine/timetable and know what to expect. Make sure that the student and support staff have a personal timetable, detailing when and where lessons are to take place and who will be there to help.
giving the student advance warning of changes in routine.
providing clear visual information.
providing specific instructions and timeframes to limit distraction from tasks
The risk of being bullied or teased or socially manipulated continues and may even escalate at this time. Bullying is more likely to occur in the school playground, in corridors and locker rooms, or outside the school rather than in the classroom where the authority of the teacher is a protection for the student with ASD. It is a priority to ensure the safety of the adolescent at school. Protection from bullying and teasing is of primary importance. All of these situations and demands contribute to making going to secondary school and coping with school harder for adolescents with HFA and AD.
What can we do to help?
The student may not realise that their behaviour is sometimes inappropriate or that others may wish to take advantage of them or bully them. Students may hesitate to disclose their experience of being bullied, partly because they have less understanding of subtle forms of bullying such as verbal bullying and partly because they can be aware of their difficulties in understanding the intention of their peers — i.e., whether a particular encounter was verbal bullying or an attempt to develop a friendship. The support coordinator should meet with the student at the end of each day to talk about how things went during the day. This person should also check in with other staff members about any incidents that may have occurred.
Discuss what the student has managed well and give positive feedback. The student needs to feel safe and secure at school
There may be an opportunity for the young person with ASD to work in a resource unit or other area for some of their lessons or homework so that they can have some quiet time and are not always out in the mainstream.
Classroom support should be subtle and not provided in a way that is obvious to other students in order to reduce the student with ASD feeling different from their peers.
The class room teacher may have opportunities to directly teach students with ASD to differentiate between peers’ attempts to initiate a friendship and instances of verbal aggression or bullying.
A teacher may choose to establish a general code of conduct in the classroom. The students may be involved in discussion about what they consider to be acceptable and unacceptable behaviour. A class policy around bullying is more likely to be followed when students have been involved in its inception.
Although adolescents with HFA and AD share some common features, no two individuals are the same. The pattern and extent of difficulties change with development so it is important to combine what we know about the core features of HFA and AD and additionally consider knowledge of the current specific interests, abilities, interpersonal skills and mental health status of each student.
What can we do to help?
Have written protocols in place to ensure that everyone understands and is aware of the student’s needs. (One page summary sheets are helpful that include information about what this young person does well, struggles with, what sorts of things might make them anxious or upset).
Regularly share information at SSG meetings about:
how the ASD currently affects the young person
information on the effectiveness of current strategies and programming ideas at home and school
academic performance and progress
adjustment and well-being
References and further reading
Monitor mental health and report at regular parent teacher meetings. In particular, monitor anxiety, discuss issues and refer on to mental health professionals as appropriate.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders
. (4th ed.). Washington
, DC: American Psychiatric Association Press.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed.). Washington, DC: American Psychiatric Association Press.
World Health Organisation. (1992). ICD-10: Classification of mental and behavioural disorders. Clinical description and diagnostic guidelines. Geneva: World Health Organisation.
Beaumont, R., & Sofronoff, K. (2008). A multi-component social skills intervention for children with Asperger syndrome: The junior detective training program. Journal of Child Psychology and Psychiatry, 49(7), 743–753. doi:10.1111/j.1469-7610.2008.01920.x.
deBruin, E. I., Ferdinand, R. F., Meester, S., De Nijs, F. A., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.
Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M. et al. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism & Developmental Disorders. doi:10.1007/s10803-010-0996-9.
Kim, Y. S., Bennett, L. L., Koh, Y. J., Fombonne, E., Laska, E., Lim, E. C., et al. (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 168, 904–912. doi:10.1176/appi.ajp.2011.10101532.
Lounds Taylor J, Dove D, Veenstra-VanderWeele J, Sathe NA, McPheeters ML, Jerome RN, Warren Z. Interventions for Adolescents and Young Adults With Autism Spectrum Disorders. Comparative Effectiveness Review No. 65. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 12-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality. August 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm
Tonge, B. J., Brereton, A. V. Gray, K. M., & Einfeld, S. L. (1999). Behavioural and emotional disturbance in high-functioning autism and Asperger’s disorder. Autism: The International Journal of Research and Practice, 2, 117-130.
United States Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders-autism and developmental disabilities monitoring network, United States, 2008. MMWR Surveill Summ, 61 (No. SS-3).
White, S. W., Schry, A. R., & Maddox, B. M. (2012). Brief report: The assessment of anxiety in high-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-011-1353-3.
Witwer, A. N., & Lecavalier, L. (2010). Validity of comorbid psychiatric disorders in youngsters with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 22, 367–380. doi:10.1007/s10882-010-9194-0.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioural therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.
Wray J, Williams K. The prevalence of autism in Australia. Report commissioned by the Australian Advisory Board on Autism Spectrum Disorders, 2007.
Autism Speaks is working with the National Center for Learning Disabilities, PACER's National Bullying Centre and Ability Path in partnership with the new documentary film BULLY to raise awareness about how bullying affects children with special needs. For more information see: Autism Speaks: Combating Bullying