Martha Herman, Ph.D.

Dr. Martha Herman is on the NYIPT faculty and is a psychologist who has worked for many years with young children on the autistic spectrum. Here she reports on a program that has been recently implemented to address the specific needs of these children, and she gives us some insights for therapists to help these children as well.

Child therapists and parents in New York City should be aware that a ground-breaking program for children with “Asperger Syndrome” (or, wording it in another way, “high-functioning autism”) is expanding throughout the city.  The program is called the “ASD Nest Program,” and it provides children with “Autism Spectrum Disorders” (ASD) who can handle grade-level academic work with a small special-education “nest” group as well as inclusion in larger mainstream classes.  The program began in 2003 at PS 32 in District 15 (Region 8) in Brooklyn.  This year it will be offered in six regions, including one middle school, and by 2007 there will be programs in all ten regions of the city.

The motto of the program is:  “If children cannot learn the way we teach, then we have to teach them the way they learn.”  Although Asperger children may be very bright cognitively and may use language on a high level, there are major areas of functioning where they cannot operate as “normal” children do (or “neurotypical” children, to use a word from the Asperger literature that expresses their different perspective).  Oliver Sacks in his book about Temple Grandin, a very accomplished autistic woman, described her like “an anthropologist on Mars.” 

Asperger children do not automatically and intuitively acquire ordinary social understanding or attain age-expected social and behavioral skills on their own.  They need to be explicitly taught how to understand social reality and the perspective of others.  For example, they need direct instruction on how to engage in a conversation, how to perceive emotions of others and themselves, how to place themselves physically in relation to others, and how to sustain a friendship.  They often have atypical sensory responses and specific obsessive interests that they must learn to moderate, especially in social situations.  Although generally bright (by definition, Asperger children have normal intelligence or higher, and some have areas of genius), they may also exhibit scattered skills, showing significant discrepancies between areas of strengths and   weaknesses,   that  require  specific  remediation.  Also, although their formal language level may be age- appropriate, often their pragmatic use of language is atypical, with inappropriate statements or odd qualities in the sound of their speech, in the tone, volume, or rhythm of their language. 

Therapists working individually with Asperger children should be aware that their behavior problems are deficits caused by a neurological disorder.  These should not be misinterpeted psychologically as conflicts or defenses arising from disturbed experiences in their families or otherwise in their lives.  These children need a more active psychoeducational approach in therapy, to help them understand their experiences, to explain the reactions of others, and to guide them in planning their behavior.  It is also critical to help the children and their parents choose the right environment (the right class or job or social activity) that best fits the individual child.  There may be limits to the extent of change that is realistically possible for these children, and their quality of life will be crucially dependent on providing the best fit with a supportive environment.   Depression is also an issue for some Asperger children, especially adolescents, who want to be accepted by peekors and who suffer from their social failures and rejections.  Also, in addition to their neurological deficits, Asperger children may experience stresses and traumas that can befall any child (such as divorce, illness, abuse, foster care).  In this, the child therapist may have a unique role, not touched by the formal educational program, in helping the child understand and cope with disturbing life events.

Working with Asperger children can be very gratifying to a therapist who becomes aware of a new way of thinking and responding to the world that is fascinating and at times amazing.  Although these children are often said to have limited attachments to others, it is my experience that they can be highly connected to a therapeutic adult, as they are to their parents.  They are attached but may be differently so.

For further information about the program, please call 718-935-3946 in Brooklyn.

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