ABSTRACT
Able autistic (Asperger) children are the most likely to attend mainstream schools, and the least likely to be offered teaching that directly addresses the impairments of their condition; yet their deficits are of the same nature as those of ‘ordinary’ autistic children, albeit usually operating to a milder degree. This chapter is about specific strategies which have proved helpful to such children in weekly two-hour out-of-school sessions; they could be still more effectively offered by support staff within the integrating school, and many would be entirely appropriate for parents to use at home. Most of our research, diagnostic and interventional work at Nottingham in the field of autism has focused on the more usual range of autistic children: those who have intellectual impairments as well as the essential diagnostic criteria. However, we have also had a special interest in children in the normal and above-average range of intelligence, and we have held three Department of Health grants to look at this group specifically. These various contacts, as well as long-term clinical experience, made it abundantly clear that Asperger children do meet the same defining criteria as the less able children, and that the only divergences between the ways in which the criteria are shown in the more able and the less able are entirely accounted for by the effect of better intellectual function, which enables good verbal ability in terms of grammar and syntax. In fact, the differences between less able autistic children and the more able or Asperger children can be seen as no greater than those we expect to find between bright and intellectually disabled children in the areas of deafness, blindness or cerebral palsy. Thus the language problems of Asperger children are in terms of a semantic-pragmatic disorder which impedes their social use of language, even though their grammar and vocabulary may be almost too perfect (pedantic) for natural conversation. Poor social timing governs both verbal and body language, and the pragmatics are almost all affected; while the semantic problem is mainly about understanding the personal meanings or intentions of others. Social impairment is seen in more able, as in less able, children as impaired social empathy. In Asperger children this is shown in more complex contexts, reflecting the different expectations we have of a more able child; for instance, bringing a conversation to an abrupt halt by walking away; not answering, or making personal and derogatory remarks in public in a loud voice; or — my favourite example — the adolescent who failed to check out what a non-autistic person would know was a mis-hearing, and bought his mother clothes when all she had asked for was cloves. Inflexibility of thought processes appears in obsessional, repetitive and stereotypic behaviour (including verbal behaviour), extreme literality (difficulty in playing with words — puns, metaphors, sarcasm, jokes, teasing etc.), and insistence on sameness; there is limited symbolic play (e.g. arrangements of models rather than open-ended stories in action) and difficulty with role-play.
