Module I: Description of Sensory and Motor Problems in Asperger’s Syndrome and Impact on Function

Introduction

Let’s pretend you are looking at a young boy, perhaps four years old, who appears to be normally intelligent but who does not really interact with other children. You also note that he has a remarkable capacity for focusing his attention on his toy train and that most other play materials are eventually turned into “trains” and pushed around the floor or table. He also knows facts about trains unusual for a four-year-old and this subject dominates his conversation. Would you think he was different from other children who are four?

In 1944 Hans Asperger, an Austrian physician, described a group of children with normal intelligence that had significant problems in social engagement and unusual and/or restricted interest.¹ These characteristics, along with normal language development, are the primary indictors of the syndrome that now carries his name. Asperger also described these children as having problems with motor coordination. As an example, he describes “Fritz” as having weakly developed musculature with slouched posture, shoulders slumped, shoulder blades protruding. He also notes that “Fritz” exhibited “no mastery over his body”. He described “Hellmuth” as clumsy to an extraordinary degree” and “Haro’s” clumsiness was particularly demonstrated during PE class. Two of the children were also said to have difficulty with handwriting and “Erst’s” mother felt that her son’s problem with dressing was due to his motor clumsiness.

Asperger also talked about unusual response to sensory input.¹ He described children who had an abnormally strong dislike to particular touch sensations such as the feel of the texture of some clothes. These children could not tolerate the roughness of new clothes or of mended socks. Bathing and having their nails cut were also times of tantrums and stress. Asperger further mentions extreme sensitivity to noise, but at other times the children would also appear to be under responsive to auditory input. He describes an incident where a child appeared to have an unusual response to pain and was said to be “thrilled” when he obtained a wound needing medical attention. Alternately, this same child was described as fearful of falling out of his chair and of fast moving vehicles on the road.

Therefore, if we again look at our four year old with his train, we might also note awkward motor movements or an unusual gait or posture. We might see him become upset and begin to “meltdown” when the noise level of the classroom is increased or if another child is crying or yelling. “Circle time” in nursery school might be a source of discomfort for him as other children inadvertently bump or touch him.

Although originally described by Asperger, motor and sensory problems are not well discussed in the literature. This is particularly true of sensory problems. Motor clumsiness is listed as an associated problem in the description of Asperger’s Syndrome in the Diagnostic and Statistical Manual of the American Psychiatric Association but sensory problems are not mentioned. ² Despite the lack of an “official” recognition of sensory problem in Asperger’s Syndrome, first person accounts and parental reports of children with Asperger’s Syndrome, often indicate unusual reaction to sensory stimuli as a significant problem area.^3-10

Recognition of these two problems is important because both can have a major impact on a child who is already struggling to fit in with his/her peers. Imagine the pain of a young boy told by his schoolmates that he “walks like a duck” or the child who is always the poorest at every sport he tries. Imagine if you were going through school and all written assignments felt like you were using your non-dominate hand. Would your hand tire easily? Would you be able to keep up? How legible would your work be and how much extra effort and concentration would need to go into keep your writing legible? Imagine if your clothes were constantly uncomfortable. If it felt like you were wearing a hair shirt on top of a bad sunburn. Imagine you are in the middle of a TV show room with all the televisions turned on and the sound turned up. Would you begin to “meltdown” and need to get out of that space immediately? Imagine if you had this same reaction to more common environments such as when at a mall, or a birthday party or in the lunchroom at school. How uncomfortable and stressful life would be. For some children with Asperger’s Syndrome all of these examples are part of their life. What we need to do is try and understand the child’s perspective, to see a situation from inside his/her shoes. If we can do that we are in a position to be understanding and empathetic and have also taken the first step to making modifications and putting into place programs to help the child be more adaptive.

What we are going to do in this module is briefly look at the limited research on these two problems and also look at what parents of children with Asperger’s Syndrome or adults with Asperger’s Syndrome have written about how these problems impact their lives. Module two will address assessment and module three will talk about intervention.

Next