COMPENSATORY & ADJUSTMENT STRATEGIES TO BEING DIFFERENT
The strategy used will depend on the child’s personality, experiences, and circumstances. Those children who tend to internalize thoughts and feelings may develop signs of self-blame and depression, or use imagination and a fantasy life to create another world in which they are more successful. Those children who tend to externalize thoughts and feelings can either become arrogant and blame others for their difficulties, or view others, not as the cause but as the solution to their problems and develop an ability to imitate other children or characters. Thus, some psychological reactions can be constructive while others can lead to significant psychological problems.
A reactive depression
Social ability and friendship skills are highly valued by peers and adults and not being successful in these areas can lead dome children with AS to internalize their thoughts and feelings by being overly apologetic, self-critical, and increasingly socially withdrawn. The child, sometimes as young as 7 years old, may develop clinical depression as a result of insight into being different and perceiving him or herself as socially defective.
The fact is, no one likes others to know their weaknesses, but with an affliction like mine, it’s impossible to always avoid making a fool of yourself or looking indignant/undignified. Because I never knew when the next “fall” was going to occur, I avoided climbing up onto a ‘confidence horse’, so to speak.
There can be increased social withdrawal due to a lack of social competence that decreases the opportunities to develop social maturity and ability. Depression can also affect motivation and energy for other previously enjoyable activities in the classroom and at home. There can be changes in sleep patterns and appetite, and a negative attitude that pervades all aspects of life and, in extreme cases, talk of suicide, or impulsive suicide attempts.
Escape into imagination
A more constructive internalization of thoughts and feelings of being socially defective can be to escape into imagination. Children with AS can develop vivid and complex imaginary worlds, sometimes with make-believe friends.
In their imaginary worlds with imaginary friends, children with AS are understood and are successful socially and academically. Another advantage is that the responses of the imaginary friends are under the child’s control, and the friends are instantly available. Imaginary friends can prevent the child from feeling lonely. Having imaginary friends is not pretend play, so much as the only play that works.
Having an imaginary friend is typical of the play of many young children and is not necessarily of clinical significance. However, the child with AS may only have imaginary friends, and the intensity and duration of the imaginary interactions can be qualitatively unusual.
Searching for an alternative world can lead some children to develop an interest in another country, culture, period of history, or the world of animals.
Another country or culture may fascinate the child as it was nothing like they had seen before and unrelated and removed from our world and our culture. “Because of its foreignness, it is alien and opposite to anyone and anything that is known. That was my escape, my dream world where nothing would remind me of daily life and all it had to throw at me. The people from this wonderful place look totally unlike any people in the ‘real world. Looking at these faces, I could not be reminded of anyone who might have humiliated, frightened or rebuked me. The bottom line is I was turning my back on real life and its ability to hurt and escape.”
The interest in other cultures and worlds can explain the development of special interest in geography, astronomy, and science fiction, such that the child discovers a place where his or her knowledge and abilities are recognized and valued.
Sometimes, the degree of imaginative thought can lead to an interest in fiction, both as a reader and author. Some children, especially girls, with AS can develop the ability to use imaginary friends, characters, and worlds to write some remarkable fiction. This could lead to success as an author of fiction for children or adults. For example, both Hans Christian Andersen and Lewis Carroll had Asperger’s syndrome.
The escape into imagination can be a psychologically constructive adaptation, but there are risks of other people misinterpreting the child’s intentions or state of mind. They may be seen as an inveterate ‘liar’. They do not lie to get out of something that they have done – this is not the problem, as they always told the truth very brazenly – but they tell long, fantastic stories, their confabulations becoming ever more strange and incoherent. In the fantastic stories, they may always be the hero.
Under conditions of extreme stress or loneliness, the propensity to escape into an imaginary world and imaginary friends can lead to an internal fantasy becoming a reality for the person with AS. The person may be considered as developing delusions and being out of touch with reality. This could result in a referral for a diagnostic assessment for schizophrenia.
Denial and arrogance
An alternative to internalizing negative thoughts and feelings is to externalize the cause and solution to feeling different. The child can develop a form of over-compensation for feeling defective in social situations by denying that there is any problem, and by developing a sense of arrogance such that the ‘fault’ or problem is in other people and that the child is ‘above the rules’ that he or she finds so difficult to understand. The child or adult goes into ‘God mode’, an omnipotent person who never makes a mistake, cannot be wrong, and whose intelligence must be worshipped. Such children can deny that they have difficulties making friends or reading social situations, or understanding someone’s thoughts and intentions. They consider that they do not need any programs or to be treated differently from other children. They vehemently do not want to be referred to a psychologist or psychiatrist and are convinced that they are not mad or stupid.
Nonetheless, the child does know, but will not publicly acknowledge, that he or she has limited social competence and is desperate to conceal any difficulties in order not to appear stupid. A lack of ability in social play with peers and in interactions with adults can result in the development of behaviours to achieve dominance and control in a social context; these include the use of intimidation and an arrogant and inflexible attitude. Other children and parents are likely to capitulate to avoid yet another confrontation. The child can become ‘intoxicated’ by such power and dominance, which may lead to conduct problems.
When such children are confused as to the intentions of others or what to do in a social situation, or have made a conspicuous error, the resulting ‘negative’ emotion can lead to the misperception that the other person’s actions were deliberately malicious. The response is to inflict equal discomfort, sometimes by physical retaliation: ‘He hurt my feelings, so I will hurt him.’ Such children and some adults may ruminate for many years over past slights and injustices and seek resolution and revenge.
The compensatory mechanism of arrogance can also affect other aspects of social interaction. The child may have difficulty admitting to being wrong and may be notorious for arguing. There is a great danger of getting involved in endless arguments with these children, be it to prove that they are wrong or to bring them some insight. This is especially true for parents, who frequently find themselves trapped in endless discussions.
There can be a remarkably accurate recall of what was said or done to prove a point, and no concession, or acceptance of a compromise or a different perspective. Parents may consider that this characteristic could lead to a successful career as a defence lawyer in an adversarial court. Certainly, the child has had a great deal of practice arguing his or her point.
Unfortunately, the arrogant attitude can further alienate the child from natural friendships, and denial and resistance to accepting programs to improve social understanding can increase the gap between the child’s social abilities and those of his or her peers. We can understand why the child would develop these compensatory and adjustment strategies. Unfortunately, the long-term consequences of these compensatory mechanisms can have a significant effect on friendships and prospects for relationships and employment as an adult.
Imitation
An intelligent and constructive compensatory mechanism used by some children is to observe and absorb the persona of those who are socially successful. Such children initially remain on the periphery of social play, watching and noting what to do. They may then re-enact the activities that they have observed in their solitary play, using dolls, figures, or imaginary friends at home. They are rehearsing and practicing the script and their role to achieve fluency and confidence before attempting to be included in real social situations. Some children may be remarkably astute in their observational abilities, copying gestures, tone of voice, and mannerisms. They are developing the ability to be a natural actor, capturing the essence and persona of people. They can be uncanny in their ability to copy accents, vocal inflections, facial expressions, hand movements, gaits, and tiny gestures. It is as if they became the person they were emulating.
Becoming an expert mimic can have other advantages. The child may become popular for imitating the voice of a teacher or a character from television. The adolescent with AS may apply the knowledge acquired in drama classes to everyday situations, determining who would be successful in this situation and adopting the persona of that person. The child or adult may remember the words and body postures of someone in a similar situation in real life or in a television program or film. He or she then re-enacts the scene using ‘borrowed’ dialogue or body language. There is a veneer of social success but, on closer examination, the apparent social competence is not spontaneous or original but artificial and contrived. However, practice and success may improve the person’s acting abilities such that acting becomes a possible career option. As an actor, they may find the scripts in a theatre far more real than everyday life. Role-playing comes naturally. It may be impossible to talk in a normal voice. They can put on a strong American accent, making up a history and identity for themselves to go with it. They convince themselves that this was a new character and can consistently keep this up for months.
There are several possible disadvantages. The first is observing and imitating popular but notorious models., for example, the school ‘bad guys’. This group may accept the adolescent with AS, who wears the group’s uniform, speaks their language, and knows their gestures and moral code, but this, in turn, may alienate the adolescent from more appropriate models. The group will probably recognize that the person with AS is a fake, desperate to be accepted, who is probably not aware that he or she is being covertly ridiculed and ‘set up.’ Another disadvantage is that some psychologists or psychiatrists may consider that the person has signs of multiple personality disorder, and fail to recognize that this is a constructive adaption to having AS.
Some children with AS dislike who they are and would like to be someone other than themselves, someone who would be socially able and have friends. A boy with AS may notice how popular his sister is with his peers. He may also recognize that girls and women, especially his mother, are naturally socially intuitive; so to acquire social abilities, he starts to imitate girls. This can include dressing like a girl. There are several published reports of males and females with AS who have issues with gender identity. This can also include girls who have self-loathing and want to be someone else. Sometimes, such girls want to be male, especially when they cannot identify with the interests and ambitions of other girls, and the actions of boys seem more interesting. However, changing gender will not automatically lead to a change in social acceptance and self-acceptance.
When adults with AS have used imitation and acting to achieve superficial social competence, they can have considerable difficulty convincing people that they have a real problem with social understanding and empathy; they have become too plausible in their role to be believed.
OTHER DEVELOPMENTAL DISORDERS that could be AS
Some developmental disorders can be associated with Asperger’s syndrome.
Attention Deficit Hyperactivity Disorder (ADHD)
Characterized by problems with sustained attention, impulsivity, and hyperactivity, but does not explain the child’s unusual profile of social, linguistic, and cognitive abilities, usually included in the diagnostic criteria for Asperger’s syndrome. ADHD was diagnosed first, but this is not the end of the diagnostic trial.
Children with AS can also have signs of ADHD. The two diagnoses are not mutually exclusive, and a child may benefit from the medical treatment and strategies used for both disorders.
Young children with AS who also have hyperactivity may not have ADHD but rather are hyperactive as a response to high levels of stress and anxiety, particularly in new social situations, making the child unable to sit still and relax. Attention span can also be influenced by factors like motivation.
A Language Disorder
A young child with AS may first be recognized with a delay in the development of speech. There may be both a delay in language development and specific characteristics that are not typical of any of the stages in language development. Semantic Pragmatic Language Disorder has relatively good language skills in the areas of syntax, vocabulary, and phonology but poor use of language in a social context, i.e. the art of conversation or the pragmatic aspects of language. The child tends to make a literal interpretation of what someone says. An assessment of abilities and behaviour by be explained by a diagnosis of AS. The diagnostic boundaries between the two are not clear-cut. A child with difficulty understanding someone’s language may become anxious and withdrawn in social situations. The reason is then due to language impairment rather than the impaired social reasoning that is part of AS.
A Movement Disorder
Children with clumsiness, coordination, and dexterity may have difficulty in tying shoelaces, learning to ride a bicycle, handwriting and catching a ball, and an unusual or immature gait when running or walking. They may also be due to AS. The child will benefit from programs to improve motor skills.
Some children with AS can develop motor tics (involuntary, rapid, and sudden body movements), or vocal tics (uncontrollable vocalizations) that resemble signs of Tourette’s syndrome.
A Mood Disorder
Young children with AS are prone to develop mood disorders. Some children seem to be almost constantly anxious, which might indicate a Generalized Anxiety Disorder (GAD). AS children who use their intellect rather than intuition to succeed in some social situations, they may be in an almost constant state of alertness and anxiety. leading to a risk of mental and physical exhaustion.
The child may have developed compensatory mechanisms to avoid anxiety-provoking situations, such as school, by refusing to go to school or being mute at school. There may be intense anxiety or a phobic reaction to certain social situations, to sensory experiences such as a dog barking, or to a change in expectations such as an alteration in the daily school routine. This may lead to a diagnosis of AS.
Some children with AS can become clinically depressed as a reaction to their realization of having considerable difficulties with social integration. The depressive reaction can be internalized, leading to self-criticism and even thoughts of suicide, or externalized, resulting in criticism of others and an expression of frustration or anger, especially when the child has difficulty understanding a social situation. Blame is directed at oneself: “I am stupid”, or others: “It’s your fault.” These could be the first signs of AS.
An Eating Disorder
This can include refusal to eat foods of a specified texture, smell, or taste due to sensory hypersensitivity. There can also be unusual food preferences and routines regarding meals and food presentation. AS is overrepresented with low body weight, which may be due to anxiety or sensory sensitivity associated with food.
Serious eating disorders such as anorexia nervosa can be associated with AS. About 18-23% of adolescent girls also have AS, and this could be the starting point for a diagnostic assessment for AS.
Non-Verbal Learning Disability
Formal testing may show a significant discrepancy between verbal reasoning abilities (verbal IQ) and visual-spatial reasoning (performance IQ). If the discrepancy is a significantly higher verbal IQ may indicate a diagnosis of Non-verbal Learning Disability (NLD).
The main characteristics of NLD are deficits in visual perception – organizational abilities, complex psychomotor skills and tactile perception, adapting to novel situations, time perception, mechanical arithmetic, and social perception and social interaction skills. They are good at auditory perception, word recognition, rote verbal learning, and spelling. This pattern of abilities suggests right-hemisphere dysfunction and white matter damage to the brain. The teacher needs to adapt the school curriculum for a distinct learning style.
