Square Pegs and Round Holes…Understanding Kids with Asperger’s Disorder

As we begin our discussion of how churches can more effectively connect with, welcome and support kids with Asperger’s Disorder as they mature spiritually, a good place to begin is to establish a common understand-ing of the condition.

Listed below are the diagnostic criteria for Asperger’s Disorder from DSM-IV.

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

  • marked impairment in the use of multiple nonverbal behaviors such as eye-to eye gaze, facial expression, body postures, and gestures to regulate social interaction
  • failure to develop peer relationships appropriate to developmental level
  • lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
  • lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

  • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus
  • apparently inflexible adherence to specific, nonfunctional routines or rituals
  • stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  • persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language e.g., single words used by age two years, communicative phrases used by age three years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

American Psychiatric Association. (2000). Diagnostic criteria for Asperger’s disorder. In Diagnostic and statistical manual of mental disorders (Fourth edition—text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 84.

Let’s examine the criteria more closely…

Qualitative impairment in social interaction: Compared to what one would expect based upon age and intelligence, kids with Asperger’s Disorder struggle because of a relative inability to intuitively know how to act in social situations. They may not  process social cues (body language, facial expressions, voice tone, inflection, context) in a manner one would expect for their age and intelligence. They may have difficulty grasping when adults are becoming frustrated by their behavior or peers find them off-putting.

They also tend to struggle with empathy…the ability to identify with and understand another person’s situation, feelings and motivation. As a result, many of my patients with Asperger’s struggle greatly to make and keep friends. When younger, many of them are content and comfortable to play by themselves and dwell on the games and activities they find most interesting. As they become teenagers, many (but not all) express feelings of loneliness. Some are desperate for friends…they struggle because they don’t know how to pursue friendships or fear trying to connect with peers because of lingering hurt from teasing or bullying.

Restricted repetitive and stereotyped patterns of behavior, interests, and activities. The feature most frequently associated with Asperger’s Disorder is intense interest in a subject or topic that seems odd or unusual for one’s age. The first child I met with Asperger’s walked in the room carrying a foot-high pile of books and pictures of buoys. I have a patient who taught himself Japanese when he was in kindergarten. A patient from a Christian home became preoccupied with (and memorized) the Book of Judges. Not every child with Asperger’s has these intense preoccupations or interests, but all kids I’ve met with the condition seem to experience difficulty with cognitive rigidity or inflexibility. Parents struggle when the child needs to transition from an enjoyable to a necessary activity. Changes in routine or unfamiliar situations often evoke great distress for the child and their family.

Clinically significant impairment in social, occupational, or other important areas of functioning. Asperger’s Disorder represents a significant disability. Typically, kids with Asperger’s will struggle to function at a level commensurate with their intelligence in school and experience difficulty making and keeping friends. They are far less likely to be involved in extracurricular activities (especially sports) common for kids of their age and intelligence in their communities. They also tend to struggle with fulfilling age-appropriate roles as a member of their families.

No clinically significant general delay in language. Kids with Asperger’s tend to acquire speech and develop receptive and expressive language in accordance with developmental milestones. Their speech may be different than their peers…marked by a lack of rhythm, an odd inflection, or a monotone pitch.  They often lack the ability to modulate the volume of their voice to match their surroundings.  They may need reminders to speak more softly every time they go to the movies or attend adult worship services with their families.

There is no clinically significant delay in cognitive development. By definition, kids with Asperger’s Disorder have (at least) average intelligence. In my practice, the average IQ of our patients with Asperger’s is significantly above average. This raises a very interesting challenge for churches…

When we think of the term “Special Needs,” what comes to mind? My guess is that most of us think of kids with intellectual disabilities. According to the U.S. Centers for Disease Control (CDC), the majority (59%) of kids diagnosed with autism spectrum disorders are of normal to above-average intelligence! I’ve seen kids with Asperger’s stop attending church after (presumably) well-intentioned efforts to serve them by including them in “Special Needs Ministry” programming. They see themselves as having little in common with kids identified as having “special needs” and in many instances, kids with Asperger’s and high-functioning autism are very sensitive to any public identification of being different. We’ll talk more about strategies for inclusion in later posts, but kids with Asperger’s will confound programmatic solutions.

The bottom line…If you’ve met one kid with Asperger’s, you’ve met one kid with Asperger’s.

Next: More Stuff You Should Know About Kids With Asperger’s Disorder

Join me for the 2012 Children’s Ministry Websummit, from April 2nd through April 6th. I’ll have a video presentation on the topic…Square Pegs and Round Holes: Helping Kids With Asperger’s Disorder and Social Disabilities Grow Spiritually. I’ll be joining many leading speakers in the field of children’s ministry. Free registration is available here for the Websummit! Also, the complete DVD set of conference presentations (including the video of my presentation) is available now through this link at a reduced pre-conference price of $39.00. Proceeds support the availability of free ministry training offered by Pajama Conference, including Inclusion Fusion.

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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