Special - Asperger's Syndrome

"knock, knock, knock, 'Penny?'...knock, knock, knock, 'Penny?'.... knock, knock, knock, 'Penny?' "

If you recognize this, you have seen at least one episode of The Big Bang Theory television series. The character Sheldon, referred to as a brilliant über geek, always knocks three times at neighbor Penny's door. Here is part of the description of Sheldon from The Big Bang Theory fansite: "He lacks empathy, is unable to discern sarcasm, doesn't like change, and has an inflated ego. He does not understand social norms, and makes little attempt to do so."

From WebMD, here are the main characteristic of a person with Asperger's syndrome:
* Problems with social skills
* Eccentric or repetitive behaviors
* Unusual preoccupations or rituals
* Communication difficulties
* Limited range of interests
* Coordination problems
* Skilled or talented

Sounds like Sheldon to me. What is also missing from this list is a high sensitivity to sensory input.  Sheldon is extremely fussy about where he sits, evaluating all the possible sensory parameters that could interfere with his ability to focus in any given spot in a room. He also likes to have clean hands at all times and isn't tolerant of sticky fingers. Watching The Big Bang Theory as a person familiar with Asperger's syndrome, I am continually amazed at how accurate it is. And it is funny.

Living with a child with Asperger's syndrome is not generally amusing, however. It can be extremely challenging. The show gives a nod to this whenever Sheldon says, "No, I don't have (fill in the blank with some abnormality). My mother had me tested." Parents of children with Asperger's syndrome will spend hours and hours visiting specialists of all sorts, going to a variety of therapies, and working with school officials to get the needed resources for their children. Asperger's children can be disruptive in class because of their lack of understanding of social patterns and their challenges with processing sensory input.

Since Asperger's syndrome is generally considered to be high-functioning autism, it is not unusual for medication roulette to be involved. In some cases, especially with young children, the medication is designed to keep them focused during the school day, but it wears off not long after the last bell. This is usually when you will be working with this student in your studio.

When working with a student with Asperger's syndrome in a one-on-one music lesson, it is possible to be able to work around some of these behaviors by gearing everything to that child's ability to focus. Just as with autism in general, Asperger's syndrome creates challenges for maintaining healthy, flexible focus. A student with Asperger's may either exhibit hyperfocus - staying on a conversation topic for a very long time,  for example - or may have intense but limited intervals of attention.

However, this student may very well have a remarkable memory and be talented in some way beyond the norm. If this student shows outstanding musical ability, your efforts to accommodate could be well-rewarded.

Some basic tips on working with a student with Asperger's syndrome:

* Be organized. Have a pattern of teaching that gives this student security from lesson to lesson.

* Be very clear with instructions, and avoid double-meanings in conversation. Being literal is one of the communication trademarks of an Asperger's student. He or she may not understand metaphorical language or even common idiomatic expressions. Recently I was joking with my Asperger's nephew that his mom couldn't even remember her own name - we've all had those days, right? He said, yes, she can remember her own name and wondered why I even said that.

* Build on the student's ability and desire to find patterns. Again, this is a comforting way of functioning for this student.

* Avoid too many visual distractions in the studio. (This is a tough one for me!)

* Be aware of when the student is losing focus. Once it goes, it is usually gone. While all kids have "bad" days in school, Asperger's children have a harder time to shake them off. They may go into tantrum mode without warning, in which case you are probably not equipped to work with the student that day.

* Set up studio rules for behavior, especially with younger children. Since they don't automatically understand social norms but like structure, rules can be the key to keeping things moving in the right direction. You may also allow the student to be part of the rule-writing process.

* Enjoy this child. Asperger's students are often unwilling to work with people they don't like or that they sense don't like them.

* Most importantly, stay in contact with the parents. If the process is not going well, either at home or in the studio, you need to re-evaluate. Parents can also let you know whether the child is adapting to new medication and to expect some disruption while that is happening.

Special - autism

When my very young nephew was identified as autistic, his parents were told that he may spend much of his time rocking and staring at the wall. In extreme cases of autism, this is an unfortunate truth. My nephew developed quite differently, however.

The biggest challenge in discussing autism is that the scientific community is not yet in agreement on its definition. Currently the American Psychiatric Association is updating its Diagnostic and Statistical Manual of Mental Disorders for the first time in 17 years, the last edition having occurred around the time my nephew was diagnosed.  When the definition of autism is rewritten by December of 2012,  the identification of the disorder will change accordingly. This will no doubt affect statistics on the prevalence of autism, which now stands at about 1 out of every 110  children, with males being four times more likely to be identified than females. At this point, there is no ability to predict the impact of these changes.

The current definition classes autism as a developmental disorder which appears between birth and the age of three and continues throughout life. The cause is unclear, despite several attempts to link the disorder to vaccines and other causal factors.  Current thinking includes genetic predisposition and the potential impact of various environmental factors. The symptoms include difficulties with social interactions, delayed speech, constant movement, need for routine, hyper-sensitivity to sensory input, abnormal response to pain, challenge in shifting focus, and tendency toward repetitive actions and/or speech patterns (perseveration). Some autistic children will be extremely literal and not able to translate symbolic language such as metaphors.

What is commonly acknowledged is that autism is a spectrum disorder. A child with a spectrum disorder may exhibit the described behaviors connected to the disorder but to varying degrees. It is for this reason that one autistic child may be more socially skillful than another, for example.  My nephew has quite a good sense of humor, even though he sometimes misses teasing jokes that are based on double meanings, and not all children on the spectrum are as able to be purposefully amusing.

Because of the inability to reach complete agreement on the definition of autism, medical professionals may present a variety of diagnoses for the same child. It is not clear as to whether forms of autism mimic attention deficit hyperactivity disorder (ADHD) or whether they are the same condition, for example.  Many children exhibiting the behaviors of autism are treated with medications intended to calm the nervous system, as are children identified with ADHD. The efficacy of treatments for children with autism involves a reasonable amount of experimentation with prescription medications, and this experimentation may go on for years and have side effects that require maintenance.

Take some time to digest this information before the next blog on the autism disorder known as Asperger's syndrome. There are many excellent websites dedicated to information on autism, if you are interested in more details. The site at www.fightingautism.com will link you with many of these sites. 

Special - identifying the challenges

If you have never heard Steven Blier perform live, please put this experience on your bucket list. Steven Blier is a co-founder of the New York Festival of Song and coaches singers at the Juilliard School.  He collaborates and records with top artists. (http://www.juilliard.edu/journal/portraits/faculty/archive/2011-12/1112.php) His knowledge of songs is bested only by his joyous ability to play them.  He gets on stage by riding a mobility scooter to the piano, at which time he gets to the bench with a little assistance. From that point on, you will completely forget that he has a debilitating muscular disease.

Because he learned to play well early in life, he has strong neuromuscular connections already in place. He continues to perform in order to keep these connections strong, and because he loves performing, but he does need some help getting around. Would you want him in your studio?

A student with mobility challenges is going to require a level of access that you may or may not have at present. My studio does not have a ramp, for example, so I would need to build one and make other changes to the entryway. I would probably need to clear some pieces of furniture out of the way, and I don’t have a bathroom with handicap access.  This may be a student I would choose to teach at his home rather than in my studio, or I may able to search out a grant for equal access modifications.

However, if I were introduced to a student with muscular control problems who had no past history of pianistic development, I would have to think about the probability of his being able to achieve much as a pianist. In that case, I would weigh both the architectural mobility issues and the determination of appropriate goals.

As you can see, when deciding how best to work with a potential student, it is necessary  to understand what your instrument requires and the physical set-up of your studio. I once had a Vietnam veteran in my university piano class. He was a solid percussionist, despite having lost several fingers in an explosion. Could he play the piano? Yes. Did he require modifications to his piano assignments? Definitely. But he could be very successful as a percussionist even with a few missing digits. He also didn’t require any changes to the physical set-up of the piano lab or the percussion room, unlike a student who requires mobility assistance.

Here are examples of some of the types of challenges a student may present: 

• Medical: disease, congenital impairment, catastrophic injury

• Social/emotional:  interaction problems, behavioral problems, unsupportive family or personal environment, inappropriate response to learning or performing situations

• Processing and perception: limited ability to process sensory input effectively, attention disorders, color blindness, auditory processing disorders

• Cognitive impairment: learning disability (Dyslexia is usually considered a learning disability, although people with dyslexia may be very “intelligent” in the traditional sense, think Warren Buffet), brain disorders, low IQ

• Communication: speech impediments, stuttering, hearing impairment that affects speech and ability to follow directions, low verbal and syntactic skills due to motor limitations or other neurological impairment

Be aware that some students will demonstrate more than one challenge. Also, be aware that the student’s personal motivation is key to success.  Reading all you can read about autism won’t necessarily result in your autistic student wanting to learn what you want to teach him or her. For some special needs students, music is the best part of their lives, but not for all.

In the next blog, I will present some ideas about working with students with autism. Stay tuned.