Study

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
This case study explored, described and analyzed communication and behavior problems
in child with disorders on the Autism Spectrum of Disorders with a goal of gleaning the
way child interact and behaves. The case for this study is a child: ALI residing in a small
colony in Karachi. The child have diagnose of Asperger Syndrome. The Systematic
Observation method that were used in this study are: participant observation, active
member research (Angrosino & de Perez, 2000), phenomenological interview (Seidman,
1998), and document review (Angrosino, 2002; Cresswell, 1998). Extensive field notes
(Bernard, 1988; Hammersley & Atkinson, 1983; Patton, 1990) were generated for all of
these strategies.
As the principal researcher for this study, I observe the case child 15 days in school hours
This shared living experience availed me to many types of interactions within that group,
aside from those central to my study. While it was the interactions that hope to engender
general and particular social skills in the child(ren) that framed this study those other
interactions were helpful and informative in juxtaposition. So many different kinds of
interactions had implications on the goals of this study.
1.2 STATEMENT OF THE PROBLEM
Children with Asperger face the difficult challenge of social skills for the most part, they
are not able to assimilate these skills through naturally occurring reciprocal social
interactions (Attwood, 1998; Bashe & Kirby, 2001; Holiday-Willey, 1999; Powers &
Poland, 2003; Szatmari, Bremner, & Nagy, 1989; Shaked & Yirmiya, 2003). This
challenge is often exacerbated by the fact that most children with Asperger Syndrome
have normal to above normal intelligence (Henderson, 2001; Little, 2002; Neihart, 2000)
and so, intuitively, many parents and other caregivers feel that social skill learning ought
to occur naturally, as in neuro typical children. Yet this kind of intuitive social learning
rarely happens for these kids.

The literature on Asperger Syndrome also supports the idea that no child with Asperger
Syndrome is like any other child with Asperger Syndrome (Attwood, 1998; Bashe &
Kirby, 2001; Holiday-Willey, 1999; Powers & Poland, 2003). Diane Wilson, former
director of Asperger Training and Parent Support Groups for the Center for Autism and
Related Disorders at Florida Mental Health Institute, states in her sessions.
“When you’ve seen one child with Asperger Syndrome, you’ve seen one child with
Asperger Syndrome” (personal communication). Social skills training, then, will take on
a very individual tone in the kinds of interactions that occur between parent and child.
Children with Asperger Syndrome face different degrees of impairments in the
characteristic hallmarks of the syndrome (see literature review, below) and so where one
family may need to spend a good deal of time and energy on the understanding of gaining
entrance into a social conversation, another might have to spend time on learning the
skills of turn-taking, while another may need to focus on the reasons the child should
even consider becoming more social.
Observing the nature of child interactions, in their school setting, will have the potential
to reveal:
1) The contextual nature of those child-child interactions;
2) Certain teacher beliefs about how such interactions should occur;
3) General and specific frustrations and celebrations in being a individual with Asperger
Syndrome;
4) Differences in background roles and the understanding of those roles;
5) Different manifestations of the effects of Asperger Syndrome.
Goals of Study
My study framed its observation and interview data-gathering strategies on child’s
behaviors (Crowley & Spiker, 1983; Grolnick, 2003; Marfo, 1990) that occur during the
school.
 Directiveness: how much the interactions are based on teacher command and
child compliance
 Elaborativeness: how much the school staff elaborates and acts on the child’s
behaviors.

 Sensitivity: how much the teachers and peers notice the child’s cues and signals
 Stimulation: how much the interactions supply sufficient cognitive stimulation.
 Intrusiveness: how often the disrupts and interrupts the behavior of the child
occur
 Repsonsiveness: how the child responds
1.3 PURPOSE OF CASE STUDY
According to Bashe & Kirby (2001), to think properly about Asperger Syndrome, it is
important to do two things: 1) attempt to experience the life of a child with Asperger
Syndrome from the inside out, and 2) abandon all assumptions about what life is for these
Children. Both of these will ultimately be impossible, just as the child with Asperger
Syndrome will be unable to apprehend how the neurotypical person experiences the
world. But attempting to understand their world from the outside looking in will not get
us very close to what it is like. This is why a systematic observation study was proposed
here: Living with the child, even for such a short time as fifteen days, allowed more of an
insider’s look at Asperger Syndrome. Though in many ways I was still an outsider,
actually being in the school where so many significant activities and interactions
occurred—planned and inadvertent—gave me a chance to see the hidden dilemmas of
daily life these children with Asperger Syndrome experience. As mentioned, the case of
my study is a boy on the Autism Spectrum, (Szatmari, 2004; Wing and Burgoine, 1983).
The child Ali was diagnosed with Asperger Syndrome at age 8; I don’t have knowledge
about the family of that child. On my request the school fix a short meeting between me
and his parents through that interview with parent, I have a base line data about child’s
problem and a little bit knowledge of the family, and they were instrumental in the design
of this study (See Appendix for the introductory letter and other letters I wrote to them
about the study, as well as their first signed consent to agree to take part in the study).
Teaching in these ways, however, in both social and academic contexts, has not been an
easy task for them (father, personal communication). A difficult part of the process, as
they see it, is that this teaching is very different from what they assumed parental
teaching would be like. Skills and understandings they help develop are often those they
see occurring naturally in their boy’ age mates. Another difficulty is that the every child

has different ways of learning. Parents and other caregivers who attempt to teach social
skills will have to be quite savvy of not only the nature of Asperger Syndrome and its
affect on learning, but also on the potential interpretations that will occur later in time,
both by the child with Asperger Syndrome and those with whom she interacts. Caregivers
will need to manifest a kind of self-advocacy in their children so they can have an effect
on the context in which they are interacting. In order to do this, the caregivers will need
to be able to speak Asperger’s (Goldfarb & Devine, 2001). This means they will have to
be able to see through the language and situations their child encounters in order to
decipher and then assist in that situation. Yet they will need to be careful not to see
everything through Asperger’s eyes (Bashe & Kriby, 2001), meaning that some things
that happen to their child is a factor of the child’s age and not a factor of Asperger
Syndrome. In other words, a fairly comprehensive understanding of Asperger Syndrome
and normal child and adolescent development is needed.
Possible Benefits from the Study
This study pushed me toward greater understandings of Asperger Syndrome, qualitative
research. It also made me reflect upon the significance of friendship, a reflection that
continues as I rewrite this opening chapter. I believe this study can benefit the field of
Asperger Syndrome and Autism Spectrum Disorders in many ways. A first way will be a
clearer understanding of how the surroundings of society construct their understanding of
the syndrome. Another is the understanding of how the boy manifests the many
possibilities of the syndrome. But mostly this study will reveal some of the living
situations the child experienced in dealing with others. To me this is highly important as
the newness of the diagnosis of Asperger Syndrome makes it a relative unknown to
educators and to parents. Narrative research can bring insightful understandings of
individual. The paradigm within research on Autism Spectrum Disorders is the bio-
medical model, and I think this is surely not the only way to be investigating a spectrum
of disorders that affects an individual’s experience in the social milieu. This study
allowed me to observe not only the moments when child through tantrums but also those
moments when the teachers may have acted as and become the problems that child faced.

The next two chapters present a review of the two literatures that inform my work and the
methods I used during my observation of child.
1.4 DEFINITIONSOF TERM
Abnormal: Outside the expected norm, or uncharacteristic of a particular patient.
ADHD: Attention deficit hyperactivity disorder.
Anxiety: A feeling of apprehension and fear, characterized by physical symptoms.
Asperger syndrome: An autistic disorder most notable for the often great discrepancy.
Asperger's syndrome: See Asperger syndrome.
Attention deficit hyperactivity disorder: A disorder in which a person is unable to
control
Autism: A spectrum of neuropsychiatric disorders characterized by deficits in social
interaction
Cognitive: Having to do with thought, judgment, or knowledge.
Depression: An illness that involves the body, mood, and thoughts and that affects the
way
Diagnosis: The nature of a disease; the identification of an illness.
DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, fourth edition,
Genetic: Having to do with genes and genetic information.
Hyperactivity: A higher than normal level of activity. An organ can be described as
hyper
Incidence: The frequency with which something, such as a disease or trait.
Memory: The ability to recover information about past events or knowledge. ...
Motor: Something that produces or refers to motion. For example, a motor neuron is a
nerve.
Neurological: Having to do with the nerves or the nervous system as,

Pain: An unpleasant sensation that can range from mild, localized discomfort to agony.
Pediatric: Pertaining to children.
Prognosis: The forecast of the probable outcome or course of a disease.
Psychiatric: Pertaining to or within the purview of psychiatry, the medical specialty
consultant
Psychotherapy: The treatment of a behavior disorders, mental illness, or any other
condition.
Sensitivity: In psychology, the quality of being sensitive.
Sensory: Relating to sensation, to the perception of a stimulus, to the voyage made
Stress: In a medical or biological context stress is a physical, mental, or emotional fact...
Syndrome: A combination of symptoms and signs that together represent a disease
process.
Taste: A perception that results from stimulation of a gustatory nerve.
Therapy: The treatment of disease. Therapy is synonymous with treatment.

CHAPTER TWO
LITERATURE REVIEW
Two significant literatures inform this study. The first, of course, is the literature on
Asperger Syndrome, a pervasive developmental disorder (Bashe & Kirby, 2000) found at
the higher functioning end of Autism Spectrum of Disorders. Asperger Syndrome was
first identified in a paper published in 1944 by Hans Asperger, though at that time he
referred to the disorder as a kind of “autistic psychopathy” (Asperger, 1999).
The naming of the disorder did not come until 1981, in a paper by Lorna Wing,
“Asperger Syndrome: A Clinical Account” (Wing, 1999). Perhaps more interesting, it
was not until 1989 that there were diagnostic criteria for the disorder, the first being
developed by Gillberg’s of Sweden and the second by Szatmari, Bremner, and Nagy of
Canada (Attwood, 1998). In 1994, the DSM-IV offered its criteria for the disorder for the
first time (Attwood). And in 1995, Attwood (Bashe & Kirby) offered his own scale on
identification, not so much as diagnostic criteria, but more of an aid to parents who were
spotting interesting behaviors in their children.
The prevalence of the disorder seems to be on the rise. In 2000 it was estimated that 1 in
every 250 children have disorders on the Autism Spectrum, a number higher than
childhood cancer, Down’s syndrome, muscular dystrophy, or cerebral palsy (Bashe &
Kirby, 2000). And Asperger Syndrome appears much more often in males than females,
at a rate of nearly 9 to 2. Asperger Syndrome, like other pervasive developmental
disorders offers many issues, which brings about the second significant literature of this
study, child behavior. It is interesting that this field of study has a long history, but one
that was initially focused on only communication non-handicapped children (Marfo,
1988).Connecting the newness of this field to the other literature of this study, a computer
search of peer reviewed journals revealed that only five articles were available that dealt
with child interactions on the autism spectrum, and none of those focused on families
with Asperger Syndrome. And yet, as I hope this literature review and full study
demonstrate, it will be the child interactions in families that deal with childhood disabling
conditions that reveal the greatest degree of possibilities that exist in all such interactions

This study utilised a triangulation approach to explore and guide the development and
evaluation of a clinical forensic nursing educational package. The use of both the
qualitative and quantitative methodologies was necessary to encompass the different
aspects of forensic science and nursing’s holistic approach to patient care. According to
Lynch (2006), providing forensic patient care requires objectivity and neutrality while
attending to the various human dimensions of health and well-being. To address the
diversity and complexity of such nursing and forensic issues, a mixed methodology was
necessary. According to Weaver and Olson (2006), the paradigms most commonly
utilized in nursing research are positivist, post positivist, interpretive, and critical social
theory. The quantitative methodology shares its philosophical foundation with the
positivist paradigm (Weaver and Olson). The positivist paradigm arose from the
philosophy identified as logical positivism and is based on rigid rules of logic and
measurement, truth, absolute principles and prediction (Halcomb and Andrew, 2005;
Cole, 2006; Weaver and Olson). The positivist philosophy argues that there is one
objective reality. Therefore, as a consequence, valid research is demonstrated only by the
degree of proof that can be corresponded to the phenomena that study results stand for
(Hope and Waterman, 2003). In this study, such rigid principles lend themselves more to
the scientific forensicaspects such as scientific knowledge, logic and measurement
incorporated into this study (Weaver and Olson, 2006; Lynch, 2006). However, such
inflexible beliefs did not have the capacity to accommodate the investigatory aspects of
this study that dealt with the social and human experiences. As a result, qualitative
methodologies were also incorporated into the research design (see Table 3.1).
Due to the complex nature of the research study, there was no single paradigm that could
satisfactorily deal with all of the required methodological aspects. Therefore, the
researcher found it necessary to combine the quantitative/positivist paradigm with the
qualitative/interpretive paradigm. The blending of both paradigms provided the
researcher with the ability to statistically analyse the scientific data whilst also
recognizing the complex psychosocial and emotional factors that influence patient care
issues. The discussion that follows will further elaborate and describe in detail how each
paradigm and methodological approach was implemented in this study.

CASE STUDY
A detailed analysis of a person or group, especially as a model of medical, psychiatric,
psychological, or social phenomena.
a. A detailed intensive study of a unit, such as a corporation or a corporate division that
stresses factors contributing to its success or failure.
b. An exemplary or cautionary model; an instructive example: She is a case study in
strong political leadership.
Advantages of Case Study
 Good source of ideas about behavior.
 Good method to study rare phenomena.
 Good method to challenge theoretical assumption.
 Good opportunity for innovation.
 Good alternative or complement to the group focus of psychology.
Disadvantage of Case Study
 Hard to generalize from single case.
 Possible biases in data collection in data collection and interpretation.
 Hard to draw definite cause- effect conclusions.
ASPERGER SYNDROME
Asperger syndrome (AS), also known as Asperger's syndrome, Asperger disorder
(AD) or simply Asperger's, is an autism spectrum disorder (ASD) that is characterized
by significant difficulties in social interaction and nonverbal communication, alongside
restricted and repetitive patterns of behavior and interests. It differs from other autism
spectrum disorders by its relative preservation of linguistic and cognitive development.
Although not required for diagnosis, physical clumsiness and atypical (peculiar or odd)
use of language are frequently reported. The diagnosis of Asperger's was eliminated in
the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) and replaced by a diagnosis of autism spectrum disorder on a severity scale.
The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944,
studied and described children in his practice who lacked nonverbal communication

skills, demonstrated limited empathy with their peers, and were physically clumsy. The
modern conception of Asperger syndrome came into existence in 1981 and went through
a period of popularization, becoming standardized as a diagnosis in the early 1990s.
Many questions and controversies remain about aspects of the disorder. There is doubt
about whether it is distinct from high-functioning autism (HFA); partly because of this,
prevalence is not firmly established.
The exact cause of Asperger's is unknown. Although research suggests the likelihood of a
genetic basis, there is no known genetic cause and brain imaging techniques have not
identified a clear common pathology. There is no single treatment, and the effectiveness
of particular interventions is supported by only limited data. Intervention is aimed at
improving symptoms and function. The mainstay of management is behavioral therapy,
focusing on specific deficits to address poor communication skills, obsessive or repetitive
routines, and physical clumsiness. Most children improve as they mature to adulthood,
but social and communication difficulties may persist. Some researchers and people with
Asperger's have advocated a shift in attitudes toward the view that it is a difference,
rather than a disability that must be treated or cured.
Classification
The extent of the overlap between AS and high-functioning autism (HFA—autism
unaccompanied by intellectual disability) is unclear. The ASD classification is to some
extent an artifact of how autism was discovered and may not reflect the true nature of the
spectrum methodological problems have beset Asperger syndrome as a valid diagnosis
from the outset. In the fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published in May 2013, AS, as a separate diagnosis, was eliminated
and folded into autism spectrum disorder. Like the diagnosis of Asperger syndrome the
change was controversial and AS was not removed from the WHO's ICD-10.
The World Health Organization (WHO) defines Asperger syndrome (AS) as one of the
autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), which are
a spectrum of psychological conditions that are characterized by abnormalities of social
interaction and communication that pervade the individual's functioning, and by restricted
and repetitive interests and behavior. Like other psychological development disorders,
ASD begins in infancy or childhood, has a steady course without remission or relapse,

and has impairments that result from maturation-related changes in various systems of the
brain. ASD, in turn, is a subset of the broader autism phenotype, which describes
individuals who may not have ASD but do have autistic-like traits, such as social deficits.
Of the other four ASD forms, autism is the most similar to AS in signs and likely causes,
but its diagnosis requires impaired communication and allows delay in cognitive
development; Rett syndrome and childhood disintegrative disorder share several signs
with autism but may have unrelated causes; and pervasive developmental disorder not
otherwise specified (PDD-NOS) is diagnosed when the criteria for a more specific
disorder are unmet
Characteristics
As a pervasive developmental disorder, Asperger syndrome is distinguished by a pattern
of symptoms rather than a single symptom. It is characterized by qualitative impairment
in social interaction, by stereotyped and restricted patterns of behavior, activities and
interests, and by no clinically significant delay in cognitive development or general delay
in language. Intense preoccupation with a narrow subject, one-sided verbosity, restricted
prosody, and physical clumsiness are typical of the condition, but are not required for
diagnosis.
Social interaction
Further information: Asperger syndrome and interpersonal relationships.
A lack of demonstrated empathy has a significant impact on aspects of communal living
for persons with Asperger syndrome. Individuals with AS experience difficulties in basic
elements of social interaction, which may include a failure to develop friendships or to
seek shared enjoyments or achievements with others (for example, showing others
objects of interest), a lack of social or emotional reciprocity (social "games" give-and-
take mechanic), and impaired nonverbal behaviors in areas such as eye contact, facial
expression, posture, and gesture.
People with AS may not be as withdrawn around others, compared to those with other,
more debilitating forms of autism; they approach others, even if awkwardly. For
example, a person with AS may engage in a one-sided, long-winded speech about a
favorite topic, while misunderstanding or not recognizing the listener's feelings or

reactions, such as a wish to change the topic of talk or end the interaction. This social
awkwardness has been called "active but odd". This failure to react appropriately to
social interaction may appear as disregard for other people's feelings, and may come
across as insensitive. However, not all individuals with AS will approach others. Some of
them may even display selective mutism, speaking not at all to most people and
excessively to specific people. Some may choose only to talk to people they like.
The cognitive ability of children with AS often allows them to articulate social norms in a
laboratory context, where they may be able to show a theoretical understanding of other
people's emotions; however, they typically have difficulty acting on this knowledge in
fluid, real-life situations. People with AS may analyze and distill their observations of
social interaction into rigid behavioral guidelines, and apply these rules in awkward
ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially
naive. Childhood desire for companionship can become numbed through a history of
failed social encounters.
The hypothesis that individuals with AS are predisposed to violent or criminal behavior
has been investigated, but is not supported by data. More evidence suggests children with
AS are victims rather than victimizers. A 2008 review found that an overwhelming
number of reported violent criminals with AS had coexisting psychiatric disorders such
as schizoaffective disorder.
Restricted and repetitive interests and behavior
People with Asperger syndrome display behavior, interests, and activities that are
restricted and repetitive and are sometimes abnormally intense or focused. They may
stick to inflexible routines, move in stereotyped and repetitive ways, or preoccupy
themselves with parts of objects.
Pursuit of specific and narrow areas of interest is one of the most striking features of AS
Individuals with AS may collect volumes of detailed information on a relatively narrow
topic such as weather data or star names, without necessarily having a genuine
understanding of the broader topic. For example, a child might memorize camera model
numbers while caring little about photography. This behavior is usually apparent by age 5
or 6. Although these special interests may change from time to time, they typically
become more unusual and narrowly focused, and often dominate social interaction so

much that the entire family may become immersed. Because narrow topics often capture
the interest of children, this symptom may go unrecognized.
Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and
other ASDs. They include hand movements such as flapping or twisting, and complex
whole-body movements. These are typically repeated in longer bursts and look more
voluntary or ritualistic than tics, which are usually faster, less rhythmical and less often
symmetrical.
According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in
fiction and a positive preference towards non-fiction is common among adults with AS.
Speech and Language
Although individuals with Asperger syndrome acquire language skills without significant
general delay and their speech typically lacks significant abnormalities, language
acquisition and use is often atypical. Abnormalities include verbosity, abrupt transitions,
literal interpretations and miscomprehension of nuance, use of metaphor meaningful only
to the speaker, auditory perception deficits, unusually pedantic, formal or idiosyncratic
speech, and oddities in loudness, pitch, intonation, prosody, and rhythm. Echolalia has
also been observed in individuals with AS.
Three aspects of communication patterns are of clinical interest: poor prosody, tangential
and circumstantial speech, and marked verbosity. Although inflection and intonation may
be less rigid or monotonic than in classic autism, people with AS often have a limited
range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a
sense of incoherence; the conversational style often includes monologues about topics
that bore the listener, fails to provide context for comments, or fails to suppress internal
thoughts. Individuals with AS may fail to detect whether the listener is interested or
engaged in the conversation. The speaker's conclusion or point may never be made, and
attempts by the listener to elaborate on the speech's content or logic, or to shift to related
topics, are often unsuccessful.
Children with AS may have an unusually sophisticated vocabulary at a young age and
have been colloquially called "little professors", but have difficulty understanding
figurative language and tend to use language literally. Children with AS appear to have
particular weaknesses in areas of nonliteral language that include humor, irony, teasing,

and sarcasm. Although individuals with AS usually understand the cognitive basis of
humor, they seem to lack understanding of the intent of humor to share enjoyment with
others Despite strong evidence of impaired humor appreciation, anecdotal reports of
humor in individuals with AS seem to challenge some psychological theories of AS and
autism.

Motor and Sensory Perception
Individuals with Asperger syndrome may have signs or symptoms that are independent of
the diagnosis, but can affect the individual or the family. These include differences in
perception and problems with motor skills, sleep, and emotions.
Individuals with AS often have excellent auditory and visual perception. Children with
ASD often demonstrate enhanced perception of small changes in patterns such as
arrangements of objects or well-known images; typically this is domain-specific and
involves processing of fine-grained features. Conversely compared to individuals with
high-functioning autism, individuals with AS have deficits in some tasks involving
visual-spatial perception, auditory perception, or visual memory. Many accounts of
individuals with AS and ASD report other unusual sensory and perceptual skills and
experiences. They may be unusually sensitive or insensitive to sound, light, and other
stimuli; these sensory responses are found in other developmental disorders and are not
specific to AS or to ASD. There is little support for increased fight-or-flight response or
failure of habituation in autism; there is more evidence of decreased responsiveness to
sensory stimuli, although several studies show no differences.
Hans Asperger's initial accounts and other diagnostic schemes include descriptions of
physical clumsiness. Children with AS may be delayed in acquiring skills requiring
motor dexterity, such as riding a bicycle or opening a jar, and may seem to move
awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated,
or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-
motor integration. They may show problems with proprioception (sensation of body
position) on measures of developmental coordination disorder (motor planning disorder),
balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor
skills problems differentiate AS from other high-functioning ASDs.
Children with AS are more likely to have sleep problems, including difficulty in falling
asleep, frequent nocturnal awakenings, and early morning awakenings. AS is also
associated with high levels of alexithymia, which is difficulty in identifying and
describing one's emotions Although AS, lower sleep quality, and alexithymia are
associated, their causal relationship is unclear.

Causes
Hans Asperger described common symptoms among his patients' family members,
especially fathers, and research supports this observation and suggests a genetic
contribution to Asperger syndrome. Although no specific gene has yet been identified,
multiple factors are believed to play a role in the expression of autism, given the
phenotypic variability seen in children with AS. Evidence for a genetic link is the
tendency for AS to run in families and an observed higher incidence of family members
who have behavioral symptoms similar to AS but in a more limited form (for example,
slight difficulties with social interaction, language, or reading). Most research suggests
that all autism spectrum disorders have shared genetic mechanisms, but AS may have a
stronger genetic component than autism. There is probably a common group of genes
where particular alleles render an individual vulnerable to developing AS; if this is the
case, the particular combination of alleles would determine the severity and symptoms
for each individual with AS.
A few ASD cases have been linked to exposure to teratogens (agents that cause birth
defects) during the first eight weeks from conception. Although this does not exclude the
possibility that ASD can be initiated or affected later, it is strong evidence that it arises
very early in development. Many environmental factors have been hypothesized to act
after birth, but none has been confirmed by scientific investigation
Screening
Parents of children with Asperger syndrome can typically trace differences in their
children's development to as early as 30 months of age. Developmental screening during
a routine check-up by a general practitioner or pediatrician may identify signs that
warrant further investigation. The diagnosis of AS is complicated by the use of several
different screening instruments, including the Asperger Syndrome Diagnostic Scale
(ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Autism
Spectrum Test (CAST) (previously called the Childhood Asperger Syndrome Test),
Gilliam Asperger's disorder scale (GADS), Krug Asperger's Disorder Index (KADI), and
the Autism-spectrum quotient (AQ; with versions for children, adolescents and adults).
None have been shown to reliably differentiate between AS and other ASDs.

 Medication, for coexisting conditions such as major depressive disorder and
anxiety disorder;
 Occupational or physical therapy to assist with poor sensory processing and motor
coordination;
 Social communication intervention, which is specialized speech therapy to help
with the pragmatics of the give and take of normal conversation;
 An ABA procedure known as positive behavior support includes training and
support of parents and school faculty in behavior management strategies to use in
the home and school.
Of the many studies on behavior-based early intervention programs, most are case reports
of up to five participants and typically examine a few problem behaviors such as self-
injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended
side effects are largely ignored. Despite the popularity of social skills training, its
effectiveness is not firmly established. A randomized controlled study of a model for
training parents in problem behaviors in their children with AS showed that parents
attending a one-day workshop or six individual lessons reported fewer behavioral
problems, while parents receiving the individual lessons reported less intense behavioral
problems in their AS children. Vocational training is important to teach job interview
etiquette and workplace behavior to older children and adults with AS, and organization
software and personal data assistants can improve the work and life management

CHAPTER III
METHODOLOGY
3.1 DEWA ACADEMY
DEWA Trust is Non-Government / Non-Profit Organization, working for Special and
Inclusive Education. DEWA is one of the largest Institutions for Special Education in
Pakistan. Established in 1967 at Karachi, at first for hearing speech impaired with a
branch in Islamabad Functioning in a purpose built complex on the area of 2000 square
yards in Gulshan – e – Iqbal Karachi. Presently 950 special students and 200 normal
students are studying at DEWA Complex while about 1500 youth, who have been
successfully rehabilitated in various organizations / set ups. It is the first ever Degree
College of special education in Pakistan affiliated with University of Karachi and this
Year its 7th batch is appearing for bachelor’s exam. The first batch of 18 special students
of DEWA College was awarded with degree and cash awards by the Governor of Sindh
in 2001.
3.2 Selection of Child
The child is selected through convenience sampling.
A convenience sample is a matter of taking what you can get. It is an accidental sample.
Although selection may be unguided, it probably is not random, using the correct
definition of everyone in the population having an equal chance of being selected.
Volunteers would constitute a convenience sample.
The head coordinator randomly picks children and assigned to each student
3.3 Instrument Tools
A case study is usually an in-depth description of a process, experience, or structure at a
single institution. In order to answer a combination of ‘what’ and ‘why’ questions, case
studies generally involve a qualitative (i.e., interviews, focus groups, extant document
analysis, etc.) data collection techniques. Most often, the researcher will analyze
qualitative strategies to look deeper into the meaning of the trends identified in the
numerical data.

Adaptive Behavior Scale
ABS provides a comprehensive standardized assessment of adaptive behavior. Designed
for use with individuals from 0 to 15 years old, ABS provides precise diagnostic
information around the cutoff point where an individual is deemed to have “significant
limitations” in adaptive behavior. The presence of such limitations is one of the measures
of intellectual disability.
Adaptive behavior is the collection of conceptual, social, communication , physical and
practical skills that all people learn in order to function in their daily lives. ABS measures
these five domains:
 Conceptual skills: Literacy; self-direction; and concepts of number, money, and
time
 Social skills: Interpersonal skills, social responsibility, self-esteem, gullibility,
naïveté (i.e., wariness), social problem solving, following rules, obeying laws, and
avoiding being victimized
 Self-help skills: Activities of daily living (personal care), occupational skills, use
of money, safety, health care, travel/transportation, schedules/routines, and use of
the telephone
 Physical development: Use of gross/fine motor skills, actively participation in
sports, eye hand coordination.
 Communication: Eye contact, proper interaction, use of vocabulary, participation
in social conservation
Child Behavior Checklists
The Child Behavior Checklist is a widely used method of identifying problem behavior in
children.
Problems are identified by a respondent who knows the child well, usually a parent or
other care giver. Alternative measures are available for teachers (the Teacher's Report
Form) and the child. It is an important measure for children's emotional, behavioral and
social aspects of life. it is used as a diagnostic tool for a variety of behavioral and
emotional problems such as attention deficit hyperactive disorder, oppositional defiant

disorder, conduct disorder, childhood depression, separation anxiety, childhood phobia,
social phobia, specific phobia and a number of other childhood and adolescent issues.
The checklist consists of a number of statements about the child's behavior, e.g. Acts too
young for his/her age. Responses are recorded on a Likert scale:
0 = Not True, 1 = somewhat or Sometimes True, 2 = Very True or Often True.
Interviews
In-Depth Interviews include both individual interviews from parents and teacher. The
data recorded in a wide variety of ways including case history forms, observation
checklist or written notes. In depth interviews differ from direct observation primarily in
the nature of the interaction. In interviews it is assumed that there is a questioner and one
or more interviewees. The purpose of the interview is to probe the ideas of the
interviewees about the phenomenon of interest.
Observation
Observation is the selection and recording of behaviors of people in their environment.
That Observation consists of taking field notes on the participants, the setting, the
purpose, the social behavior, and the frequency and duration of phenomena. Observations
may be made of non-verbal behavior, verbal behavior, and physical phenomena. Other
sources of data may include archival records, private records, anecdotes, erosion or
accretion, etc. Problems include sampling, reliability and validity, as well as observer
influence and memory distortion.
1. Descriptive observations: You simply write down what you observe
2. Inferential observations: You may write down an observation that is inferred by
the subject’s body language and behavior.
3. Evaluative observation: You may make an inference and therefore a judgment
from the behavior. Make sure you can replicate these findings.
Questionnaires
Questionnaires are instruments used for collecting data in survey research. They usually

include a set of standardized questions that explore a specific topic and collect
information about demographics, opinions, attitudes, or behaviors.
3.4PROCEDURE
That case study is based on a “Systematic Observation” (Berk, 2003, p.44). I designed a
simple form to record the data based on specimen record and event sampling in which the
researcher records a description of the particular entire steam of behavior, in addition to
all instances of particular behavior during a specified time period. (Berk, 2003, p.44-45)
One of the goals of science is description (other goals include prediction and
explanation). Descriptive research methods are pretty much as they sound — they
describe situations. They do not make accurate predictions, and they do not determine
cause and effect.. This article will briefly describe each of these methods, their
advantages, and their drawbacks. This may help you better understand research findings,
whether reported in the mainstream media, or when reading a research study on your
own.
With the observational method (sometimes referred to as field observation) animal and
human behavior is closely observed. There are two main categories of the observational
method — naturalistic observation and laboratory observation.
The biggest advantage of the naturalistic method of research is that researchers view
participants in their natural environments. This leads to greater ecological validity than
laboratory observation, proponents say.
Ecological validity refers to the extent to which research can be used in real-life
situations
In this study, data collection techniques were applied to a case study methodology
My study focused on a boy who had been diagnosed with a disorder that falls on the
autism spectrum. As it explored the characteristics and generalities of the interactions this
particular had concerning Asperger Syndrome, my study was a case study that employed
descriptive data collection techniques, in order to discern the cultural interpretations the
society constructed about both their interactions and Asperger Syndrome.

Qualitative researchers, and so descriptive and case study researchers, study social
settings in order to understand the meaning of participants’ lives on their own terms
(Janesick, 2000). Descriptive is defined as studies of groups of people embedded in
communities, generally of their own making (LeCompte & Schensul, 1999a). A case
study is an investigation of a bounded system over time within a particular setting
(Cresswell, 1998; Merriam, 1988; Stake, 1995). The ultimate goals of ethnographic
research is the weaving of a multi-voiced text that combines the participants’ story with
the ethnographer’s analysis, without framing one of those as more significant that the
other (Kelly, 2000). Designing my study under the banner of descriptive case study made
good sense.
Assessing the skills and competences of the participants in the current study with the
purpose of collecting the information and data for establishing the baseline level.Batch of
26 students has assigned for collecting data, observing child and designing intervention
plan for a child from DEWA Academy All children from DEWA referred because of
concerns about developmental delays, intellectual disable, Cerebral palsy and/or the
possibility of Autism Spectrum Disorder. Children were presenting for either an initial
diagnosis or review diagnosis.
This case study is conducted under the supervision of Dr Nasir Suleman,Chairperson of
special Education department University Of Karachi. Batch divided into two parts first
group starts their observation in morning another other group starts it work in evening
shift, both group was under the authority of Head Coordinator of DEWA Academy. On
the first day of observation the head coordinator assigned the child to each student
through convinces sampling, I introduced to Ali, he was shy during his first meeting with
me. According to the school rule we cannot observe the child during his class the first
day was passed in introduction with school staff and class teacher.
On second day after assembly I try to build a social relation with Ali through one to one
interaction, in a huge hall Ali shows interest in different activities, he really enjoys
drawing and reading story book, after that he told me about his favorites cartoons THE
SIMPONS and TOM AND JERRY he also told me about his favorite game. In lunch break
he interacts with his peers in friendly mood.

On third day the school call Ali ‘s mother for interview that day his mother fill Case
History Forms and also answer the Adaptive Behavior Scale questions ,that helps us to
give a more broader picture of Ali’s cognition and behavior development. Also take
interview from the class teachers about his academics and interviews the school
psychologist also.
On fourth day the school gave the permission about classroom observation. After
assembly till home time, Ali was excited about the observer presence in class, he
frequently come to the observer and tell her about his friends and shows in class work .
After the break he gets angry on one of his friend for not listening to his story and start
throwing temper tantrums in class. the teacher clam him and allowed him to sit quietly in
the room, his tantrum ended after two lessons.
On the last day the school staff shows the pervious academic records of Ali that related to
his academic, social participation in activities and also shows his Individualize Education
Plan for next three months.
3.5 Analysis of the Data
Analysis within a case study is best seen as an ongoing process that begins as soon as the
researcher knows the general area of investigation. For me, this began with an extensive
reading in the literatures of Asperger Syndrome. That, and a fairly constant long-distance
conversation with the parents and teacher of the child. I’ll be studying framed my
thinking. Questions were formed, revised, jettisoned, and otherwise dealt with. The study
was underway since just after March 2015. These concepts, as presented in the literature
review, framed initial observations, interviews, and active-member engagements. I took
with me a good deal of information about the need for parents of child with Asperger
Syndrome to teach necessary social skills; this was one sensitizing concept I worked
with; so too was my growing understanding of the nature of child behavior .
Of course, what became most significant for the value of this study was my growing
ability to balance the sensitizing concepts with the emerging findings and to let them
direct me to observe and question well while also allowing me to let my participants
relate the experience they have within those events. It was key that human behavior I
observed be explained through the inside view—the participant’s description—and not
just through mine And so I needed a plan—structurally informed by my sensitizing

concepts, but also flexibly empowered by the interactions the school—to lead me into
and through the analysis phase of this study.
Logistics
As has been noted, the analysis of this study was ongoing. As a matter of course, each
time I turned my daily field jottings into my more formal field notes, some analysis
occurred. This helped me see the direction and the nature of my study, both of which
changed to some degree as the study went forward. Such change is a good thing,
provided it is controlled. Indeed, an “overlapping of data collection and analysis
improves both the quality of data collected and the quality of the analysis so long as the
evaluator is careful not to allow these initial interpretations to distort additional data
collection” (Patton, 1990, p. 378).
After leaving the site, after all data have been resource to which I could return when
questions arose during the analysis, and it allowed me, once again, to juxtapose gathered
data with questions asked, as essential part of the analytical process. collected,
transcribed, and copied, I created a ‘contents’ of the information, labeling each audio
tape, and each written document (Patton, 1990). LeCompte and Schensul (1999b) refer to
this process as tidying-up, and they extol its necessity. It put me in touch with my data; it
established.
Anadocs
As with nearly all qualitative data, mine was coded. Essentially, I began building my
coding scheme based on the Bromwich model addressed in the literature review. Her six
levels of child interaction, based on her theoretical frame of mutual enjoyment allowed
me to distinguish and categorize the behaviors within the interactions and behavior I
observed. The common sense nature of her model facilitated the process by which I
discerned the levels of item, pattern, and structure in the data (LeCompte & Schensul,
1999b). Another aspect of my coding came from Marfo’s behaviors (1992), also listed in
the literature review.
As has been noted here, some of that analysis occurred on a daily basis when the field
jottings were turned into the more formal field notes. Though I did look for the
preexisting codes of my study, I also searched for the unfamiliar, the unexpected, and the

absences of data .This process was a more difficult one, as it is somewhat counter
intuitive to basic observation. We are not ‘trained’ to look for those things that are not
there. However it is central to the understanding gleaned here. This emergent coding
began to appear in the third day of the study.
Observation Frame
I organized the data as systematically as possible, to make for better analysis and
interpretation. Frames of mind helped construct the routes by which my analytical and
interpretive thoughts traveled. Loftland and Loftland’s (in LeCompte & Schensul,1999b)
posit that human interactions include a narrow range of elements and that by focusing on
those elements in particular interactions, inferences into the larger groups from which the
interactions are observed can be made. The six elements of their hierarchy include:
 Acts and actors
 Activities
 Settings
 Ways of participating
 Relationships
 Meanings
This made sense for my study as it allowed me to begin to look at my data in a systematic
and manageable way .I began with the child, identifying basic behaviors within the
school structure. Then I can described the sets of the activities I spent my time observing.
I described places of importance where the family interacts, and I included how each of
the members—and I—participated in the activities and settings mentioned. I outlined the
relationships the teacher developed, attempting to see the many facets of the
interrelationships. And ultimately I outlined the meanings I observed in the child.
This kind of organizing strategy helped me discern the essential items that began the
analysis of my data. In concert with the coding strategy I used, this put me in close
contact with my data, a necessary step toward the process of understanding the patterns
and structures that emerged
Ali is a 14 year old male student in DEWA Academy. Currently Ali is in learner class
which is not an appropriate grade level for an Autistic possible Asperger student. Ali

identified with the Punjabi ethnic category and speaks both Urdu and English Ali is the
younger child of his family. Ali belong to the Middle socioeconomically status. All the
milestone were at normal phase except speech. Ali said his first word at the age of five
and a half year. According to Ali’s mother he did not babble or coo, he expressed his
need mostly through pointing and through crying. Adaptive Behavior scale ABS Ali is on
the borderline of intellectual functioning .he score good in physical development and
daily living skills but average scored in social and communication.
In the speech language tests Ali has good speech but his language is unintelligible for a
stranger, and mostly he through tantrums when the other person did not understands what
he said?
According to the functional behavior checklist/ observation Ali seems lethargic in the
class, he become fuse and show period of excessive irritability, his irritability tend to
build, and then explode, then recedes.

Chapter IV
Findings
4.1 Demographic Features
Ali is a 14 year old male student in DEWA Academy. Currently Ali is in learner class
which is not an appropriate grade level for an Autistic possible Asperger. Ali identified
with the Punjabi ethnic category and speaks both Urdu and English. English is spoken at
times in his home among family, however he is predominantly an English speaker but he
understands Urdu as well. Ali is taught within special classroom and he also receive
supplemental teaching assistance from his resource teacher. The teaching assistant works
with Ali to improve his reading, writing and spelling skills. Beyond this service Ali
receive no other special services. After one brother Ali is the younger child of his family.
Ali belong to the Middle socioeconomically status. His mother is a house wife while his
father is in banking field. Ali is an enthusiastic energetic child, characterized by his
smiling face and his desire to communicate with others freely. Although Ali appears to be
talkative with adults and peers, He is also mindful of classroom rules and does not disrupt
the class intentionally. Ali demonstrate athletic ability by jumping, doing push-ups. Ali
two favorite sports are football and basketball. He enjoys participating in these two sports
as well as watching them on television. He also expresses interest in joining the sports.
4.2 Developmental History
Based on the information gathered from his cumulative file and interview with his
teachers and parents Ali has no history of any serious medical illness or physical
limitation. According to his mother her pregnancy was normal she did not face any
complication relate to her pregnancy. At infancy the child had no difficulty in breathing,
crying and sucking.
The motor milestone were normal Ali crawled at 8-10 months, sat alone at 1 year walked
unaided at the age of 3 years, however all the milestone were at normal phase except
speech. Ali said his first word at the age of five and a half year. According to Ali’s
mother he did not babble or coo, he expressed his need mostly through pointing and
through crying. His mother said that Ali was an angry child. The unusual behavior noted

by his family after his 3rd birthday. When he did not utter a word and show inappropriate
behavior like spitting, throwing things etc.
4.3 ASSESMENT REPORT
Several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum
disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by
impairment in social interaction accompanied by restricted and repetitive interests and
behavior; it differs from the other ASDs by having no general delay in language or
cognitive development. Problems in diagnosis include disagreement among diagnostic
criteria, controversy over the distinction between AS and other ASD forms or even
whether AS exists as a separate syndrome, and over- and under-diagnosis for non-
technical reasons. As with other ASD forms, early diagnosis is important, and differential
diagnosis must consider several other conditions.
According to the psychological report from AKU Ali has been diagnosed with Autism
possible Asperger at the age of 8th.
During my study I apply some informal checklist and forms in order to collect data to
make my observation up to the mark This finding suggest by broad configuration of
behavioral data as well as a consistent pattern of scores from standard test of intelligence,
perceptual development and academic achievement.
Adaptive Behavior scale ABS Ali is on the borderline of intellectual functioning .he score
good in physical development and daily living skills but average scored in social and
communication.
he said?
build, and then explode, then recedes. He is very organized child, care for his things,
shows extra care for animals
Characteristics Checklist for Asperger's Syndrome

The characteristic list is presented in a checklist format. It will be useful in determining
initial diagnosis. Later, it will help those working with your child to better understand
how particular attributes are translated into behaviors. The result will be a clearer
understanding of the reasons behind the behaviors displayed by your child. It is important
to remember that the more you understand about Asperger behaviors and the reasons
behind them, the more effective you will be when you begin to intervene and change
behaviors.
Functional Behavior Assessment (FBA)
A Functional Behavior Assessment (FBA) is not one single thing; it is a broad term used
to describe a number of different methods that allow researchers and practitioners to
identify the reason a specific behavior is occurring (Cooper, Heron, & Heward, 2007).
These assessments are typically, but not exclusively, used to identify the causes of
challenging behaviors such as self-injury, aggression towards others or destructive
behaviors. There are three specific functional assessment methods:
(a) Direct Observation (b) Informant Methods and (c) Functional Analysis.
Adaptive Scale Behavior
Adaptive behavior is a critical part of assessing students who have or are suspected of
having autism spectrum disorder (Volkmar, et al., 2014). The use of a formal adaptive
behavior measure allows the assessment team to determine the student’s level of
functioning in daily tasks required to be successful in the home, community, and work
place. This type of assessment will assist in transition planning and ensure the student has
the necessary skills to be productive when he leaves the school environment. Assessing
adaptive behavior in both school and home settings can provide additional valuable
information about generalization of skills across settings.
Speech & Language Assessment
Ali speech muscles are normal and his speech rate is also normal .Ali only assess for
intelligibility and language
Intelligibility:
Ali’s speech is mildly affected His speech is 61 % intelligible in word level and 30 %
utterances is intelligible. Although his speech is unintelligible for a new person.

Receptive Language
Ali receptive developmental age is equivalents to his chronological age. His receptive
vocabulary is very good and sharp.
Expressive language:
Ali receptive developmental is equivalents his chronological age, his comprehension is
not as below his cognition level ,His favorite cartoon is Tom and jerry, He talks about his
favorite movie
Several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum
disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by
impairment in social interaction accompanied by restricted and repetitive interests and
behavior; it differs from the other ASDs by having no general delay in language or
cognitive development. Problems in diagnosis include disagreement among diagnostic
criteria, controversy over the distinction between AS and other ASD forms or even
whether AS exists as a separate syndrome, and over- and under-diagnosis for non-
technical reasons. As with other ASD forms, early diagnosis is important, and differential
diagnosis must consider several other conditions.
According to the psychological report from AKU Ali has been diagnosed with Autism
possible Asperger at the age of 8th.
During my study I apply some informal checklist answer forms in order to collect data to
make my observation up to the mark This finding suggest by broad configuration of
behavioral data as well as a consistent pattern of scores from standard test of intelligence,
perceptual development and academic achievement.
Adaptive Behavior scale ABS Ali is on the borderline of intellectual functioning .he score
good in physical development and daily living skills but average scored in social and
communication.
he said?

build, and then explode, then recedes. He is very organized child, care for his things,
shows extra care for animals.
4.5 Observation Report
Ali was compliant and sociable on the first day of the metting.ali appeared joyful and
excited about meeting the examiner leaving the classroom for testing. He was joyful and
very inquisitive during the entire session frequently asking questions .in addition to
seeming cheerful, Ali so seemed incredibly active during the meeting frequently standing
up ,grabbing the examiner sheets ,looking around the room, scratching the table and
flapping his feet. Ali place great value on the work he was doing and expressed frequent
concern about the correctness of his answer. When asked a question Ali would respond
and then ask ‘Is this right?’ although I encourage him generally but that was not
satisfying enough for Ali frequent feedback was very important for him.
The second meeting with Ali was in his classroom , at first he act very different in the
class he seems confuse, but later as the class begin he get normal , in the class he mostly
looks around in the class ,he was more interested in what his class mate doing rather than
the lecture. In the second period he slept in the class during the lesson and in break time
he starts throwing tantrum he beats his class mate very badly, but late he felt guilty and
also ask for sorry. When Ali interact with other classmate he appeared to interact in a
positive manor, but generally didn’t chose to interact with his peers very often. Ali
seemed quiet and shy as evidence by his desired to sit away from the rest of the class
voluntarily during a free activity. Ali appeared lazy and lethargic sleeping all the time in
school. At time he bring some story books from home and reading different stories
instead of following with the class lesson. Sometime he seemed active during the class
frequently ask questions from the teacher tell her cartoon stories , he is very good in arts
his favorite subject are arts and science, he confuse in math and history.ali like to play in
lunch time, often he is the punctual student well organized child.
In order to gain more information about Ali learning environment an instrumental
observation sheet was used to asses’ class teacher instructional style. Oral instruction
appeared to be the class teacher’s main method of teaching her students Practically all of
teacher’s lesson were taught without the use of visual aid or demonstration .neither the

child nor the teacher were using the whiteboard during the class this would prove to be
problematic for students who require visual aid and demonstration during instruction,
teacher address the students individually by frequently calling on them for answer and
visiting their desk frequently to make sure these students remained on task.

CHAPTER 5
SUMMARY DISCUSSION AND CONCLUSION
5.1 SUMMARY
This case study explored, described, and analyzed communication and behavior problems
in child with disorders on the Autism Spectrum of Disorders with a goal of gleaning the
way child interact and behaves. The case for this study is a child: Ali, I observe the child
15 days in school hours. Children with Asperger face the difficult challenge of social
skills for the most part, they are not able to assimilate these skills through naturally
occurring reciprocal social interactions (Attwood, 1998; Bashe & Kirby, 2001; Holiday-
Willey, 1999; Powers & Poland, 2003; Szatmari, Bremner, & Nagy, 1989; Shaked &
Yirmiya, 2003). This study pushed me toward greater understandings of Asperger
Syndrome, qualitative research. It also made me reflect upon the significance of
friendship, a reflection that continues as I rewrite this opening chapter. I believe this
study can benefit the field of Asperger Syndrome and Autism Spectrum Disorders in
many ways. A first way will be a clearer understanding of how the surroundings of
society construct their understanding of the syndrome. Another is the understanding of
how the boy manifests the many possibilities of the syndrome. But mostly this study will
reveal some of the living situations the child experienced in dealing with others. Due to
the complex nature of the research study, there was no single paradigm that could
satisfactorily deal with all of the required methodological aspects. Therefore, the
researcher found it necessary to combine the quantitative/positivist paradigm with the
qualitative/interpretive paradigm. The blending of both paradigms provided the
researcher with the ability to statistically analyse the scientific data whilst also
recognizing the complex psychosocial and emotional factors that influence patient care
issues. The discussion that follows will further elaborate and describe in detail how each
paradigm and methodological approach was implemented in this study. The diagnosis of
Asperger's was eliminated in the 2013 fifth edition of the Diagnostic and Statistical

Manual of Mental Disorders (DSM-5) and replaced by a diagnosis of autism spectrum
disorder. Asperger syndrome (AS), also known as Asperger's syndrome, Asperger
disorder (AD) or simply Asperger's, is an autism spectrum disorder (ASD) that is
characterized by significant difficulties in social interaction and nonverbal
communication, alongside restricted and repetitive patterns of behavior and interests. It
differs from other autism spectrum disorders by its relative preservation of linguistic and
cognitive development. Although not required for diagnosis, physical clumsiness and
atypical (peculiar or odd) use of language are frequently reported. The instrument used in
case study generally involve a qualitative (i.e., interviews, focus groups, extant document
analysis, etc.) data collection techniques. Most often, the researcher will analyze
qualitative strategies to look deeper into the meaning of the trends identified in the
numerical data. That case study is based on a “Systematic Observation” (Berk, 2003,
p.44). I designed a simple form to record the data based on specimen record and event
sampling in which the researcher records a description of the particular entire steam of
behavior, in addition to all instances of particular behavior during a specified time period.
.Batch of 26 students has assigned for collecting data, observing child and designing
intervention plan for a child from DEWA Academy All children from DEWA referred
because of concerns about developmental delays, intellectual disable, Cerebral palsy and
or the possibility of Autism Spectrum Disorder. Children were presenting for either an
initial diagnosis or review diagnosis.
This case study is conducted under the supervision of Dr Nasir Suleman, Chairperson of
special Education department University Of Karachi

5.2 Intervention Plan
Some interventions listed below are just good teaching practices, whereas others were
created specifically for our kids with AS and related conditions, by Milestones staff or by
other professionals. An asterisk indicates that a professional from outside our agency
created the specific strategy.
Another interpretive technique, the Situation, Options, Consequences, Choices,
Strategies, Simulation (SOCCSS) strategy, was developed to help students with social
interaction problems put interpersonal relationships into a sequential form (J. Roosa,
personal communication, June 4, 1997). It helps students understand problem situations
and lets them see that they have to make choices about a given situation, with each choice
having a consequence. The steps of SOCCSS are:
1. Situation
When a social problem arises, the teacher helps the student to understand the situation by
first identifying (a) who was involved, (b) what happened, (c) the date, day, and time of
occurrence, and (d) reasons for the present situation.
2. Options
The student, with the assistance of the teacher, brainstorms several options for behavior.
At this point, the teacher accepts all student responses and does not evaluate them. This
step encourages the student to see more than one perspective and to realize that any one
situation presents several behavioral options.
3. Consequences
Then the student and teacher work together to evaluate each of the options generated. The
teacher is a facilitator, helping the student to develop consequences for each option rather
than dictating them.
4. Choices
The student selects the option or options that will have the most desirable consequences
for him or her.
5. Strategy
Next the student and teacher develop an action plan to implement the selected option.

6. Simulation
Finally the student is given an opportunity to role-play the selected alternative.
Simulation may be in the form of (a) role play, (b) visualization, (c) writing a plan, or (d)
talking with a peer.
This strategy offers many benefits to the child or youth with AS. It allows students to (a)
understand that many options may be available in any given situation, (b) realize that
each option has a naturally occurring consequence, and (c) develop a sense of
empowerment by acting on the environment (i.e., individuals with AS realize that they
have choices, and by selecting one they can directly determine the consequences of their
actions).
Executive Functioning Interventions
Post the daily schedule by writing out the daily schedule (at home or school), we make
the child’s day more predictable, and help the child be more prepared to meet each
challenge. At school, make the schedule large enough so the child can see it clearly. Post
it at the child’s eye level, somewhere so that it is in view at all times. When a subject is
completed, erase it or check it off, so the child can easily see what is coming next.
Oops Board
(* primary method of Bateson Therapy) Post a list of daily events that are unexpected
changes (i.e., “Surprise math test today” or “No Gym today”). Usually students do better
when they know in advance to expect a change, rather than learning about it two minutes
beforehand. Keep this list in a consistent place. (Some students may perseverate on these
changes, in which case this is not a useful technique.)
Physical Boundaries
Because children with AS have difficulty inferring, they may miss cues about where to
stand or where they can and can’t go, or place or move their bodies or body parts. Create
a visual support by adding shapes by the door so the children know where to stand when
they are lining up. If the child tends to bump into people while in line, have him/her be
the leader or caboose so there are fewer kids to bump into. If the child is fidgety and
pokes people when seated at his desk, move his/her desk a little further away from

people, or put tape outline on the floor around the child’s desk, so the child has a physical
marker and knows where the boundaries are. During meeting times, use carpet squares,
shapes, or desk chairs so the children know where to sit, and do not invade each other’s
personal space.
Bin System & Graphic Organizers
Instead of having children keep their work in their desks, provide the children with a set
of clear plastic bins in which they can keep their work for each subject. This will limit the
chaos of having all subjects in one binder and will also increase the likelihood that papers
will stay sorted. Graphic organizers can help children focus and guide them in a good
direction. Giving children a system to use also frees up their brains for other tasks.
Consistency
Whatever rules you create, stick with them and be consistent with follow-through.
Sudden changes which might seem logical to the teacher or parent may go right over the
head of a child who has difficulty making inferences. While all the other kids have caught
on, the child with AS is still following the old rules. By only picking a few rules, but
always following through consistently, you will achieve success with these students.
Point of the Lesson
(*primary method of Bateson Therapy) Although it may seem obvious to you, it is crucial
to tell children the main point of the lesson and write it down on the board. Children with
AS often retain only random facts from a lesson. By making clear the main point of the
lesson, you are giving the child a framework to attach the facts to, and helping them
create a whole picture. Additionally, if the student’s attention wanders, it is a great tool to
pull the child back and help him/her refocus.
Be Specific
Always tell the child what you want him to do, not what you want him to abstain from. If
you say, “Stop that!” (Which is too vague) or “There’s no talking out in class!” (all
negative), it doesn’t tell the child what he should do. By saying, “Write down your

questions,” or “Hold your questions until 11:00 am and then you can ask me,” you are
giving the child tools for what is appropriate, and curbing the child’s anxiety.
Reciprocal Teaching
*primary method of Bateson Therapy To assure that a child really understands the
concept you are teaching, first teach the group and then have individual children re-teach
others. One fun method is also to provide an assignment for homework or in small
groups, and have the children then teach others what they have learned. This also helps
children with AS learn perspective-taking, since they need to take their audience’s
reactions to the lessons into account to determine whether the audience needs more
information, or if they have given too much information.
Decrease Clutter
Organize the environment so everything has its place and is labeled. Decrease any
extraneous stimuli (i.e., nothing hanging from the ceiling, cover shelves with sheets,
taking down old class work from the walls). Use privacy boards (screen that goes around
the top of the child’s desk, minimizing distractions so s/he can concentrate on his/her
work) as necessary. For many children with AS, all stimuli seem equally important;
therefore the teacher is competing with objects dangling from the ceiling. Decrease visual
clutter so that the teacher can be the most important thing to focus on (or at least the child
will have fewer distractions). This can really help with sensory regulation as well.
Transition Warnings
At 5 minutes, 3 minutes, and 1 minute prior to ending activity, give children warnings. If
you are teaching, set a timer to go off 5 minutes before the lesson is over, or assign this
task to a student. This technique slowly prepares the child for the upcoming transition to
a new activity or task.
Ignoring Points
(*primary method of Bateson Therapy) Have children earn points (tally marks) when she
ignores inappropriate or irrelevant information in the environment (such as peers who are
acting inappropriate or something s/he is perseverating on). This is a helpful way to “train
your brain” to ignore unimportant things.

Thought Boxes
(*primary method of Bateson Therapy) Provide a box on the child’s desk so when s/he
has thoughts that are inappropriate (wrong topic, wrong time, wrong person), s/he can put
them in the box, close it, and put the thoughts away.
Math
If children who have difficulty with visual organization, have them use graph paper to
write out math problems. Use one box per number. This can help keep numbers in line.
Sensory Interventions
Classroom Warm Ups have kids up and moving every 20-30 minutes. They can do
simple things such as ten wall pushups, ten jumping jacks, get up and run around your
desk three times, etc. This physical activity break will help children switch gears and
calm their fidgety bodies.
Reduce the number of problems on a page
For children who become overwhelmed easily by work. Take the 20 math problems you
have assigned, and instead of giving the child one page with 20 problems, give 5 pages
with 4 problems each. This will help decrease anxiety.
Auditory Interventions
Close the classroom door to decrease noise, permit the child to use an iPod when working
on individual quiet assignments, place tennis balls on the bottoms of chairs, have a one-
person-talks-at-a-time rule, or place a rug on the floor to muffle sound.
Tactical Interventions
Have a fidget box filled with small manipulables such as modeling clay, play dough,
pocket koosh balls, lotion, and other small things that kids can use to fidget with. Offer
the option of working on the floor or standing, instead of only sitting at a desk. (This can
help with low muscle tone as well.) Use weighted blankets to provide sensory input to
students.

Scheduled Frequent Breaks
Provide the child with frequent, regularly scheduled, short breaks. Think of breaks like
food; if you wait too long between breaks, or don’t give them until the child absolutely
needs them, the child will be distressed, just as s/he would be if s/he had to wait too long
between meals. If you provide regular, predictable, short, frequent breaks, the child can
remain regulated.
Keep Furniture Placement the Same
For children with motor planning and sensory issues, for whom it is a struggle to
remember where things are and how to avoid furniture, keeping furniture placement the
same all year reduces anxiety. This includes where the children sit. If you need to move
furniture, have the child help you move the furniture; this way there is some participation
on the child’s part, which may help with visual memory.
Recommendations for School
 Increased school Resources and activities for both teachers and students.
 Vocational education is strongly associated with positive employment outcomes
for students with mild disabilities.
 Early reading instruction emphasizing phonological awareness is promising and
should be expanded.
 Should provide full range of services and placements to students.
 Changes in Instruction style Supported by Teacher Training.
Recommendations for parents
 Teach the child some practical skills to integrate into social settings. It may be
helpful to practice introductory conversational tactics,
 The Social Stories technique is a method of creating short stories for everyday
situations that help explain the social cues and appropriate responses for given
situations.
 Teach a "safety phrase" for kids to use when they are confused or unsure.
 Identify naturally-occurring situations when the child used appropriate social
skills.

 Encourage the child to look at what other children are doing.

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