People with Asperger Syndrome may have very poor organizational skills in spite of intelligence level. While many people find it helpful to have lists, appointment books or other memory "joggers" in order to remember important engagements or errands etc.,the person with Asperger Syndrome may need far more extensive "prompts". Their lists may not be as simple as "Go to school", they may need to have a checklist with what items need to go in their backpack. Such a list might be "pencil, notebook, math book, math homework, eraser, calculator and protractor". The person with Asperger Syndrome may not think in terms of "future needs", but rather in the "now". They can learn however to arrange their lives with visual cues to circumvent this deficit in organizational skills.
Case Study: "Christopher" (name changed to protect privacy) is a twelve-year-old-boy diagnosed with Asperger Syndrome. He has had a one on one support person assigned to him since kindergarten. He had become very dependent on her for just about everything during his school day. She was very effective in getting him to do his work, but needed to prompt him every step of the way and needed to sit with him to keep him on task. He often exhibited negative behavior both in the classroom and on the playground and in other settings such as lunch or assemblies.
About a year ago he began receiving autism specific services in school. The behaviors were being addressed, with a plan on how to deal with him when the behaviors occurred. When autism specific services began, negative behaviors were occuring two or three times a week and sometimes very aggressive behavior occurred. Behavior analysis were done and it became evident that negative behaviors most often occurred when Christopher was confused about changes in his environment, not understanding what was expected of him and when others did not obey "the rules". Transitions were also cited as areas in need of careful consideration.
The team began to work on increasing independence by giving him the "tools" to make sense of his environment. A series of "Social Stories" (TM) were obtained and written to help him with specific problem areas in his school day. He was given "cue cards" with three or four things he needed to do when entering or leaving a class. These are sometimes called "bridge" activities and are especially useful for transitions. Christopher's morning "bridge" was 1) enter class 2) greet teacher 3)unpack backpack and put communication book on table, lunch on desk. The cue card then told him to sit quietly at his desk and wait for the lunch monitor to ask "who has home lunch?". A card instructed him to put up his hand when this call was made, then get his communication book and proceed to his resource class. If at any point Christopher got distracted or stopped the process, an adult would say "check what's next" and point to the cards if necessary. Adults would not tell him what to do next however, merely direct him to his cards. Another set of cards would take him into the next class. This would include greeting the teacher and getting his supplies from his cubby. If anyone attempted to engage him in conversation before the process was complete, he would be reminded about a "Social Story" (TM) written for him that says it's "ok" to tell people you will talk to them later when you have something important to do. Once class starts, Christopher may be oblivious to the instructions the teacher has given the class, not recognizing that they were meant for him too (a common trait in Asperger Syndrome is to not realize that someone speaking to a group is including them or that someone speaking to a group is not speaking ONLY to them). Christopher is given time to process information, usually 20 seconds is sufficient. If he has not started work yet, he is directed to "check the schedule" (which will be written on the board) then to "find the list" he needs for that subject. The list will have a set of instructions such as "take out pencil" "take out Sourcebook" "ask teacher which pages to do" "do the work" "show teacher completed work and get stamps" (further information on "token economy system" in behavior strategy section) Anytime Christopher stops working or becomes distracted, an adult will approach and praise him for what ever he has already done, however minimal (WOW! Great job, you have your pencil out and wrote your name on your paper!) then will ask him "what's next?" or prompt him to check the list to see what is next. If he needs help at anytime, he puts his hand up and an adult approaches him, gives the needed help then quickly moves away. No one sits with him to help with work and he only gets help by putting up his hand and asking properly.
As Christopher's environment became more predictable, the negative behaviors decreased dramatically leading the team to the conclusion that the negative behaviors were Christopher's way of saying that the world did not make sense to him and he did not know how to adequately communicate this to the people around him. Negative behaviors also decreased on the playground, cafeteria and assemblies with the use of specific social stories addressing these issues. When something happens to upset Christopher now and he reverts to the negative behaviors it takes everyone by surprise. The behaviors are also noticibly milder and shorter lived than they were just a few months ago. In every instance of negative behavior recently, it has been because the adult in charge did not follow the recommended plan causing Christopher to be confused about what was expected of him. With the help of lists, bridges and caring adults, Christopher's world is beginning to make sense to him.
Schedules for younger children who do not yet read can be made using pictures or icons attached to a board with Velcro. The child can be taught to remove the icon after the activity has ended and place it in an envelope or pouch nearby. The same strategy of having the child check what's next can be used just as it is done with a written schedule prepared for "readers". As the child becomes more efficient in following schedules and lists they can begin to make their own lists. As they become more familiar with the procedures they begin to rely on the lists less and refer to them only infrequently.
For more information on Visual Strategies, visit the website below