By Freedman, Brian; Silverman, Wayne
The Exceptional Parent , Vol. 38, No. 5
If you've ever vacationed in a foreign country or have friends who have recently come to the United States, then you have probably noticed the importance of understanding social rules. In some nations, certain gestures can have a completely different meaning than they do in the United States and using the wrong ones, making physical contact, or even infringing on someone's personal space can result in an embarrassing, awkward, or even dangerous situation.
For children with an autism spectrum disorder (ASD), a group of developmental disorders which include autistic disorder, Asperger syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS), difficulties arising from the lack of understanding of social rules and cues are everyday occurrences. These can be especially troubling for affected children and adults who are "high functioning," a group that has grown dramatically in size in recent years and represents at least 40 percent of all children with an ASD. Because people within this group do not have substantial impairments in their overall cognitive functioning and have relatively good language skills, their peers, teachers, and even their parents can find it very hard to appreciate the seriousness of their disability. These children typically receive a diagnosis of either high functioning autism (HFA) or Asperger syndrome (AS), but despite the criteria indicated in the Diagnostic and Statistical Manual, Fourth Edition Text Revision (DSM-IV TR) for telling one from the other (e.g., early language delay only with HFA), respected clinicians have pointed out that the distinction can be hard to draw in practice. Therefore, many people have been focusing more on the similarities between these groups, especially since research has suggested that similar interventions are helpful for both groups of children.
Reciprocal social interaction, the process of reading, understanding, initiating, and responding to the social cues of others, is a core deficit and hallmark symptom for children with autism spectrum disorders (although it is clearly not the only concern). Research at Kennedy Krieger Institute has found that these social deficits can be identified as early as 14 months of age, well before communication deficits and stereotyped behaviors typically appear. This suggests that deficiencies in social interaction lie at the heart of these conditions and may even contribute to language delays and problem behaviors. (Intuitively, this idea seems reasonable, given that language functions to promote social interactions and considering that problem behaviors often are defined in a social context.)
Children with HFA and AS have unique social challenges because they often look and act like "typical kids" in many situations. Their language skills are, by definition, pretty good, and they achieve, or even over-achieve, in learning basic academic concepts. This can generate increased expectations among family members, teachers, and peers who assume that affected children will also be able to understand the rules of social interaction. Unfortunately, these children rarely meet these expectations, but recent research has led to a greater understanding of this core deficit and is being translated into evidence-based interventions.
For children with HFA and AS, deficits in social engagement might include poor eye contact, difficulty initiating and maintaining conversations, lack of appreciation of other people's perspectives, a poor understanding of relationships, and an overly literal interpretation of language. Some children with HFA and AS might have little interest in socializing with their peers, while others may want to socialize but lack the skills to be successful. Individuals with HFA and AS typically have "one-sided conversations," and often have an area of intense interest, which tends to drive their conversations with others. Children with HFA and AS also tend to have other subtle deficits, particularly in terms of emotional self-regulation (e. …