How does Asperger’s Syndrome affect a child’s social interactions. What are the common symptoms of Asperger’s in young children. How is Asperger’s Syndrome diagnosed and treated in pediatric patients. What strategies can help support children with Asperger’s Syndrome.

Understanding Asperger’s Syndrome: A Developmental Disorder on the Autism Spectrum

Asperger’s Syndrome is a developmental disorder characterized by difficulties in social interaction, restricted interests, and repetitive behaviors. While it was previously diagnosed as a separate condition, Asperger’s is now considered part of the broader Autism Spectrum Disorder (ASD) classification. Children with Asperger’s typically have average to above-average intelligence and well-developed language skills, but struggle with social communication and flexibility in thinking and behavior.

Key Characteristics of Asperger’s Syndrome

• Challenges in social interactions and understanding social cues
• Intense focus on specific interests or topics
• Difficulty with changes in routine
• Unusual speech patterns or tone of voice
• Limited nonverbal communication skills
• Sensory sensitivities

While the term “Asperger’s Syndrome” is still commonly used, it’s important to note that the official diagnostic terminology has changed. Many healthcare providers now use “Autism Spectrum Disorder – without intellectual or language impairment” to describe what was previously known as Asperger’s Syndrome.

Recognizing the Signs and Symptoms of Asperger’s Syndrome in Young Children

Identifying Asperger’s Syndrome in young children can be challenging, as symptoms may not become apparent until social demands increase. However, there are several signs parents and caregivers can watch for in children as young as 5 years old:

Social Interaction Challenges

Children with Asperger’s often struggle with social interactions. They may have difficulty making friends, understanding social norms, or engaging in reciprocal conversations. These children might appear to lack empathy or struggle to understand others’ perspectives.

Narrow Interests and Repetitive Behaviors

A hallmark of Asperger’s Syndrome is an intense focus on specific topics or interests. Children may display encyclopedic knowledge about their chosen subject and have difficulty discussing other topics. They may also engage in repetitive behaviors or adhere strictly to routines.

Communication Peculiarities

While children with Asperger’s typically develop language skills on time, they may exhibit unusual speech patterns. This can include speaking in a monotone, having a formal or pedantic speaking style, or difficulty understanding figurative language and sarcasm.

Sensory Sensitivities

Many children with Asperger’s experience heightened sensitivity to sensory stimuli. They may be overly sensitive to loud noises, bright lights, certain textures, or tastes. This can lead to discomfort or avoidance of certain environments or activities.

The Diagnostic Process for Asperger’s Syndrome

Diagnosing Asperger’s Syndrome, or ASD without intellectual or language impairment, typically involves a comprehensive evaluation by a team of specialists. This process may include:

1. Initial screening by a pediatrician
2. Referral to specialists such as developmental pediatricians, psychologists, or neurologists
3. Comprehensive developmental assessments
4. Behavioral observations
5. Parent and teacher interviews
6. Cognitive and language evaluations

Are there specific tests for diagnosing Asperger’s Syndrome? While there is no single definitive test, professionals use a combination of standardized assessments, observations, and interviews to make a diagnosis. These may include the Autism Diagnostic Observation Schedule (ADOS), the Childhood Autism Rating Scale (CARS), and various cognitive and language assessments.

Treatment Approaches and Interventions for Children with Asperger’s Syndrome

While there is no cure for Asperger’s Syndrome, various interventions can help children develop skills, manage symptoms, and improve their quality of life. Treatment plans are typically individualized to address each child’s specific needs and challenges.

Behavioral and Educational Interventions

Behavioral therapies, such as Applied Behavior Analysis (ABA) and cognitive-behavioral therapy (CBT), can help children with Asperger’s develop social skills, manage emotions, and reduce problematic behaviors. Educational interventions may include specialized teaching methods, social skills training, and individualized education plans (IEPs) to support learning in school settings.

Speech and Language Therapy

While children with Asperger’s often have well-developed language skills, they may benefit from speech and language therapy to improve pragmatic language skills, such as understanding nonverbal cues and using appropriate conversational skills.

Occupational Therapy

Occupational therapy can help children with Asperger’s improve fine motor skills, sensory processing, and daily living skills. This may include strategies for managing sensory sensitivities and developing age-appropriate self-care abilities.

Social Skills Training

Structured social skills training programs can help children with Asperger’s learn and practice appropriate social behaviors, understand social cues, and develop friendships. These programs often use role-playing, modeling, and group activities to teach social skills in a supportive environment.

Medication

While there are no medications specifically for Asperger’s Syndrome, some children may benefit from medications to manage co-occurring conditions such as anxiety, depression, or attention deficit hyperactivity disorder (ADHD).

Supporting Children with Asperger’s Syndrome at Home and School

Creating a supportive environment is crucial for children with Asperger’s Syndrome to thrive. Here are some strategies that parents, caregivers, and educators can implement:

Establish Routines and Structure

Children with Asperger’s often thrive on predictability and structure. Establishing clear routines and using visual schedules can help reduce anxiety and improve daily functioning.

Encourage Special Interests

While it’s important to broaden a child’s interests, their intense focus on specific topics can be used as a motivational tool and a way to connect with others who share similar interests.

Provide Clear Communication

Use clear, concrete language and avoid idioms or sarcasm that may be confusing. Provide step-by-step instructions for tasks and use visual aids when possible.

Create a Sensory-Friendly Environment

Minimize sensory triggers by reducing noise levels, using soft lighting, and providing quiet spaces for the child to retreat when overwhelmed.

Foster Social Connections

Encourage participation in structured social activities, such as clubs or groups related to the child’s interests. Provide opportunities for supervised social interactions and teach specific social skills.

The Importance of Early Intervention for Asperger’s Syndrome

Early identification and intervention can significantly improve outcomes for children with Asperger’s Syndrome. Research has shown that early intervention can lead to improved social skills, communication abilities, and overall functioning.

Why is early intervention crucial for children with Asperger’s Syndrome? Early intervention allows for:

• Development of coping strategies before social demands increase
• Improved long-term social and academic outcomes
• Better management of co-occurring conditions
• Enhanced family support and understanding
• Increased likelihood of successful integration into mainstream educational settings

Parents who suspect their child may have Asperger’s Syndrome should seek professional evaluation as soon as possible to take advantage of early intervention opportunities.

Understanding the Long-Term Outlook for Individuals with Asperger’s Syndrome

The long-term prognosis for individuals with Asperger’s Syndrome varies widely, depending on factors such as the severity of symptoms, access to appropriate interventions, and individual strengths and challenges. Many individuals with Asperger’s lead fulfilling lives, pursue higher education, maintain successful careers, and form meaningful relationships.

Challenges in Adulthood

Some adults with Asperger’s may continue to face challenges in areas such as:

• Social relationships and romantic partnerships
• Employment and workplace social dynamics
• Independent living skills
• Mental health management

Strengths and Opportunities

Many individuals with Asperger’s possess unique strengths that can be advantageous in certain fields or professions. These may include:

• Attention to detail
• Strong analytical skills
• Expertise in areas of special interest
• Ability to think outside the box
• Strong work ethic and dedication

With appropriate support and understanding, individuals with Asperger’s Syndrome can leverage their strengths and lead successful, fulfilling lives.

Debunking Myths and Misconceptions About Asperger’s Syndrome

There are many misconceptions surrounding Asperger’s Syndrome that can lead to misunderstanding and stigma. It’s important to address these myths to promote greater awareness and acceptance.

Myth: People with Asperger’s Lack Empathy

Reality: While individuals with Asperger’s may struggle to express empathy in conventional ways, they are capable of feeling empathy and caring deeply for others. They may need support in understanding and responding to others’ emotions.

Myth: Asperger’s Syndrome is Caused by Poor Parenting

Reality: Asperger’s Syndrome is a neurodevelopmental disorder with a strong genetic component. It is not caused by parenting styles or environmental factors.

Myth: Children with Asperger’s Can’t Form Meaningful Relationships

Reality: While social interactions may be challenging, many individuals with Asperger’s form deep, meaningful relationships. They may approach socializing differently but are capable of strong connections with others.

Myth: Asperger’s Syndrome Only Affects Boys

Reality: While Asperger’s is more commonly diagnosed in males, it also affects females. Girls with Asperger’s may present differently, often leading to underdiagnosis or misdiagnosis.

Understanding and dispelling these myths is crucial for creating a more inclusive and supportive environment for individuals with Asperger’s Syndrome.

As our understanding of Asperger’s Syndrome continues to evolve, it’s essential to approach the condition with empathy, patience, and a willingness to learn. By recognizing the unique strengths and challenges of individuals with Asperger’s, we can create a more inclusive society that values neurodiversity and supports the success of all individuals, regardless of their neurological differences.

Asperger’s Syndrome: Symptoms, Diagnosis and Treatment

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Overview

Signs & Symptoms

Causes

Diagnosis

Treatment

Seeking Help

What is Asperger’s Syndrome?

Asperger’s Syndrome is a developmental disorder. Young people with Asperger’s Syndrome have a difficult time relating to others socially and their behavior and thinking patterns can be rigid and repetitive.

Generally, children and teens with Asperger’s Syndrome can speak with others and can perform fairly well in their school work.  However, they have trouble understanding social situations and subtle forms of communication like body language, humor and sarcasm.  They might also think and talk a lot about one topic or interest or only want to do a small range of activities.   These interests can become obsessive and interfere with everyday life, rather than giving the child a healthy social or recreational outlet.

Boys are three to four times more likely than girls to have Asperger’s Syndrome. Most cases are diagnosed between the ages of five and nine, with some diagnosed as early as age three.

What Is the Difference Between Asperger’s Syndrome and Autism Spectrum Disorder?

The name for Asperger’s Syndrome has officially changed, but many still use the term Asperger’s Syndrome when talking about their condition.  The symptoms of Asperger’s Syndrome are now included in a condition called Autism Spectrum Disorder (ASD). ASD is now the name used for a wide range of autism-like disorders. Some providers may still use the term Asperger’s Syndrome, but others will say “ASD – without intellectual or language impairment.”  These two syndromes are, for the most part, the same.

What are the Symptoms of Asperger’s Syndrome?

Children with Asperger’s Syndrome exhibit poor social interactions, obsessions, odd speech patterns, limited facial expressions and other peculiar mannerisms. They might engage in obsessive routines and show an unusual sensitivity to sensory stimuli.

While all children with Asperger’s Syndrome are different, what sets them apart are their unusual social skills and obsessive interests. For a child with Asperger’s Syndrome, you may see one or more of the following symptoms:

• Inappropriate or minimal social interactions
• Conversations that almost always revolve around themselves or a certain topic, rather than others
• Not understanding emotions well or having less facial expression than others
• Speech that sounds unusual, such as flat, high-pitched, quiet, loud, or robotic
• Not using or understanding nonverbal communication, such as gestures, body language and facial expression
• An intense obsession with one or two specific, narrow subjects
• Becoming upset at any small changes in routines
• Memorizing preferred information and facts easily
• Clumsy, uncoordinated movements, including difficulty with handwriting
• Difficulty managing emotions, sometimes leading to verbal or behavioral outbursts, self-injurious behaviors or tantrums
• Not understanding other peoples’ feelings or perspectives
• Hypersensitivity to lights, sounds and textures

Children with Asperger’s Syndrome often show no delays in their language development. They are likely to have good grammar skills and an advanced vocabulary, but they also tend to be very literal. They have trouble using language in a social context.

There may be no obvious delay in their cognitive development. Children with Asperger’s Syndrome can have problems with attention span and organization, but they usually have average intelligence.

What Causes Asperger’s Syndrome?

The causes of Asperger’s Syndrome are unknown. Genetics and brain abnormalities may be involved.

We do know that Asperger’s Syndrome is NOT the result of a child’s upbringing or poor parenting. Asperger’s Syndrome is a neurobiological disorder, meaning it is just a part of the child’s brain development, whose causes are not fully understood.

How is Asperger’s Syndrome Diagnosed?

As mentioned above, Asperger’s Syndrome is no longer diagnosed as a condition in and of itself. It is part of the range of conditions included in Autism Spectrum Disorder.

If a parent is concerned about a child’s social development, unusual language patterns, and odd behaviors, a pediatrician should be consulted.   The pediatrician can determine if the child should be seen by a specialist, such as a developmental pediatrician, psychologist, or other clinician who is familiar with ASD.

Testing and assessment usually involve a team of medical and psychological professionals. The specialists will ask the parent many questions about the child’s development and current skills and problems.  They will also interact with the child and conduct assessments to evaluate what symptoms the child shows when interacting with others.  They may also assess the child’s language and intellectual abilities. A medical doctor might ask questions or order tests to make sure there are no other medical concerns for the child.

Asperger’s Syndrome (also known as “Autism Spectrum Disorder – without intellectual or language impairment”) may be difficult to diagnose.  Sometimes this condition can be confused with other conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD) or Oppositional Defiant Disorder (ODD).   Making sure to evaluate the child’s social and communication skills, their patterns of behavior and thinking, and how these symptoms have developed over time will help the assessor provide the correct diagnosis.

How is Asperger’s Syndrome Treated?

Because each case is different, treatment plans must be built according to each child’s needs. They should be adjusted over time as those needs change.

Treatment of Asperger’s Syndrome usually includes:

• Social skills training
• Behavior supports
• Cognitive behavioral therapy
• Parent education and training
• Speech-language therapy
• Occupational therapy
• Special education classes
• Medication

At present, there is no “cure.” By learning to cope with the symptoms and pick up on social cues, a child can learn to overcome some of the challenges he faces. With help, parents can learn how to best support their child.  People with Asperger’s Syndrome can do well in school and go on to be contributing members of their community.

When Should I Seek Help?

Treatment should be done while a child’s brain is still developing. If you notice signs of Asperger’s Syndrome or any of the symptoms of Autism Spectrum Disorder in your child, see your pediatrician. She or he can refer you to a mental health expert who specializes in diagnosing this type of disorder.

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Symptoms, Diagnosis and Seeking Help



Nationwide Children’s Hospital






Overview


Signs & Symptoms


Causes


Diagnosis


Treatment


Seeking Help

What is Autism Spectrum Disorder?

The term Autism Spectrum Disorder (ASD) refers to a complex neurodevelopmental condition. Its presentation varies for each individual, but primarily, it affects communication and social interactions between a child and their caregivers, peers, and/or teachers. It also impacts the way the child thinks and behaves. It can cause them to play, behave, and think in repetitive or unconventional ways.

ASD is usually diagnosed in early childhood and can have effects throughout life. Current research indicates ASD is identified three times more often in boys than girls, but further work is needed to understand this gender difference.

The main characteristics of Autism Spectrum Disorder fall into two categories:

• Challenges navigating our social environment:: Children with ASD show differences initiating or responding to social interactions. Children may seek connection with others without using eye contact or engaging in physical interactions. Conversations and play may be challenging for some or revolve around topics of high interest. Nonverbal communication (e. g., gestures, facial expressions), subtle social rules, and abstract language may be hard to understand. They may find developing and maintaining relationships to be challenging or stressful.
• Repetitive movements, behaviors, or interests: Children with ASD often show repetitive patterns of behavior, such as hand flapping or repeating certain sounds or phrases. They may be highly interested in certain topics, making it hard to engage in other activities. They may like routines and become distressed when that routine is disturbed. They may be over- or under-reactive to sensory experiences.

The level of support needed can vary widely. Some children and adults with ASD can perform all the normal activities of daily life. Others require substantial support systems throughout their lives. Caregivers, providers, and community members may need to develop individualized supports and environmental adaptations that increase inclusion opportunities and best allow the person with ASD to thrive.

How Do I Know If My Child May Have Autism Spectrum Disorder?

The onset of Autism Spectrum Disorder can vary across children. Sometimes signs of ASD can show up as early as infancy. Other times, children may appear to be developing as expected through their second or third year, then their development slows and signs of ASD become clearer. There may be a regression in their verbal skills and their ability to relate to others. Sometimes the signs of ASD are subtle and not apparent until later in childhood. The signs of ASD are broad and each child will show a different combination of signs.

The signs of ASD you may see in a

toddler include:

• Limited babbling or pointing by 12 months
• No single words by age 16 months or no two-word phrases by age two
• No response to hearing their name by 12 months
• Loss of acquired language or social skills
• Limited eye contact
• Limited smiling or response to others
• Limited pointing, showing, or bringing objects to share their interest with others

The signs you may see in a

child or adolescent with ASD include:

Social Communication

• Language differences, ranging from a complete lack of speech to delayed language development
• Limited understanding of other’s speech, including abstract expressions like slang or humor
• Limited understanding or use of simple gestures, body language, tone of voice, or other nonverbal cues (such as not understanding what it means when someone is pointing toward an object or facial cues)
• Use of echolalia (precise repetition, or echoing, of words and sounds)
• Use of honest and direct language
• Better communication with adults than peers

Social Interaction

• Social difficulties range from limited interest in peers to simply having difficulty responding to subtle social cues
• Limited eye contact
• Limited shared social play or imaginative play
• Difficulty in understanding others’ feelings or being able to talk about their own
• Difficulty in developing and navigating relationships  

Behavioral Patterns (Behaviors, Routines, Interests, Activities)

• Repetitive movements, like flapping arms or rocking from side to side
• Repetitive use of objects, like spinning wheels on a toy truck or lining up toys
• Repetitive language, such as persistent questioning or other repetitive statements or sounds
• Intense and persistent interest in a topic or activity
• Highly focused when engaged in topic of interest
• Prefer routines or rituals and can be upset by changes
• Rigid or repetitive thinking patterns
• Sensitive to or seeking sensory input, such as sounds, sights, textures, or smells
• Limited range of preferred foods

What Causes Autism Spectrum Disorder?

We simply don’t know. Current research suggests that there are genetic factors at work that change a child’s developmental patterns. There is no evidence that ASD is caused by poor parenting or by vaccines.

How is ASD Diagnosed?

There is no medical test for Autism Spectrum Disorder. Diagnosis of ASD starts by assessing a child’s behavior and development in comparison to children of the same age.

It takes a multidisciplinary team of healthcare professionals with experience in ASD and childhood disorders to conduct a diagnostic evaluation. Through interviewing the parents about the child’s development, asking the child about their experiences, observing the child, and conducting psychological and language testing, the team can confirm that an ASD diagnosis is appropriate and not some other physical, developmental, or mental health condition.

Children can usually begin to be diagnosed for ASD by the age of two.

How is ASD Treated?

A combination of behavioral intervention and other therapies (e. g., speech and occupational therapy) can improve a child’s language development, social skills, fine motor skills, executive functioning, and emotional/behavioral regulation. Applied Behavior Analysis (ABA) is the most evidence-based method for supporting children with ASD. Beginning these interventions early can help increase the benefits. Some youth with ASD may benefit from psychotherapy services to assist with mental health concerns. All interventions should be individualized to the child’s profile and include family preferences.

The outcomes of intervention can vary. Most children gain skills and have an improved quality of life. Some children who have received ABA treatment can make quite significant gains in their development, so that services may be faded. Some adults with ASD can live independently, fully integrating into their community. Others will require a life-long supportive environment or need help intermittently as stressors increase.

When Should A Parent Seek Help?

The earlier Autism Spectrum Disorder is identified, and intervention begins, the better the results. With early and intensive treatment, children diagnosed with ASD can increase the opportunity to live more independently as they mature into adults. Also, the sooner caregivers understand their child’s diagnosis and its impacts, the better they can support their child and adapt the environment to meet the child’s needs.

Contact your family physician or pediatrician if you have concerns about your child’s communication, social, or behavioral development. If you are seeking a diagnostic assessment or are ready to begin treatment, contact Behavioral Health Intake at Nationwide Children’s Hospital. If you are seeking information or resources, contact our Autism Resource Clinicians at the Center for Autism Spectrum Disorders.




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Asperger’s syndrome: how to help a child

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Asperger’s syndrome: how to help your child

Asperger’s Syndrome is a developmental disorder in which a child has problems with social communication and non-verbal communication. This disease differs from other manifestations of the autism spectrum in that there is a distortion of normal speech and problems with the development of intelligence.

The disorder is named after Australian pediatrician Hans Asperger. In 1944, he published a paper in which he described four children who lacked non-verbal communication skills and had little understanding of the feelings of strangers. They did not understand how to show empathy for their peers. Because of these characteristics, it was difficult for children to integrate into society. Asperger gave this condition a name – “autistic psychopathy”.

Symptoms

It is difficult for children with Asperger’s syndrome to express themselves emotionally, they do not perceive gestures, facial expressions, voice intonations, it is difficult for them to choose a topic for conversation, to understand when a conversation can be started or ended, it is difficult for them to understand humor, sarcasm, allegories. Difficulties in communication affect social interactions. So, children with this pathology experience difficulties in communicating with other children, in maintaining relationships. In games, it is difficult for such children to accept a role, to show imagination. They prefer logical and mechanical games more. From the outside, these children seem clumsy, they can talk out of place, start inappropriate topics of conversation, get too close to strangers. Children with Asperger’s Syndrome sometimes develop semantic dyslexia – reading without understanding the meaning of what is read.

Problems in social communication with peers – lack of non-verbal social behavior, which is required for social communication with each other. It starts with poorly developed verbal and gestural communication. It can develop to the complete absence of adequate facial expressions.

Stereotypical body movements, thoughtless use of objects or verbal constructions (for example, constant movements in the same ways, following patterns of behavior and movement, meaningless repetition of new words and phrases).

The lack of full communication with people in children in the future can lead to the development of clinical depression or anxiety neurosis. Therefore, parents should turn to specialists as soon as possible and begin psychological and pedagogical correction of a child with Asperger’s syndrome, aimed at social adaptation.

Doctors of related specialties are involved in the diagnosis of Asperger’s syndrome: a child psychiatrist, a psychologist, a child neurologist, a teacher-defectologist. First of all, an anamnesis is collected from the parents, as well as a conversation with the child in a playful way. The level of intelligence, psychoverbal development of the child and his ability to communicate are assessed.

The treatment of this syndrome is psychotherapeutic. The main task is to teach the child to live with this syndrome, to help him adapt to social life. Classes are held with a psychologist, teacher, speech therapist, neuropsychologist. The prognosis of the disease is favorable. By adulthood, the symptoms of Asperger’s syndrome subside and such people can have a full social life, work and create families.

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Asperger’s Syndrome | Autism FRC

Asperger’s syndrome-, like Kanner’s syndrome, belongs to non-procedural, dysontogenetic forms of RDA. Recently, it has been referred to as a constitutional pathology of the autistic type.

1) As with other types of autism, the condition in Asperger’s syndrome is determined by communication disorders, underestimation of reality, a limited and peculiar, stereotypical range of interests, which distinguishes such children from their peers.

2) Violation of social interaction can manifest itself in the following forms:

• extreme egocentrism – inability to interact with peers;
• peer interaction is possible but not attractive, meaningful or highly valued;
• social and emotional inadequacy of communication.

3) The child gives the impression of being old-fashioned, a “little old man”, perceived by other children as an eccentric professor. Lives in his own world with narrow, unusual interests. Demonstrates unusual tendencies (collecting). Collects facts related to certain events, but does not always understand the meaning (reads encyclopedias about dinosaurs – remembers everything (they often have a good mechanical memory), but they may not understand what an era is).

4) Some children show an early ability for an unusual, non-standard understanding of themselves and others. Logical thinking is preserved or even well developed, but knowledge is difficult to reproduce and extremely uneven.

5) A child can be surprisingly successful at one thing and unsuccessful at another. For example, he is fluent in the language, but finds it difficult to adapt to the social context and various hearings (it is difficult for him to conduct a dialogue). There are difficulties in understanding the figurative meaning of metaphors (which is not related to the level of intelligence).

6). Active and passive attention are unstable, but individual autistic goals are achieved with great energy.

7) There is a deviant, unusual style of communication:

• the communicative function of speech is weakened. Speech – formal, pedantic, boring, poor intonation, unusually modulated, peculiar in melody, rhythm and tempo (robot-like, slightly modulated language, the child speaks as if in different voices), the voice sounds either quiet or cuts the ear and in general speech is often similar to recitation. There is a tendency to word creation, which sometimes persists after puberty. The child often involuntarily makes various sounds “clears his throat”, laughs;
• problems of non-verbal communication are revealed: inability to use gestures, clumsiness, limited mimic expression,
• An unusual style of eye contact (very gazing or gaze avoidance) is noted.

8) Children with Asperger’s syndrome have reduced empathy (reduced ability to understand the feelings of other people and adapt to them). Attachment to the house, and not to relatives, is characteristic.

9) They have no close friends. They are often offended. At the same time, the child wants to communicate, to be socialized, but it is extremely difficult for him to do this. He can be with other children, but only if these children adjust to him. There is an attraction to autistic games. Team games are difficult because the autistic child is only interested in his own score, not the score of the team.

10) In appearance, the detached expression of the face attracts attention, which gives it “prettyness”, the facial expressions are frozen, the gaze is turned into emptiness, the fixation on the faces is fleeting. There are few expressive facial movements (minimal expression), gesticulation is depleted. Sometimes the facial expression is concentrated and self-deep, the gaze is directed “inward”.

11) Behavior is determined by impulsiveness, contrasting affects, desires, ideas (often behavior lacks internal logic).

12) Motor sphere is poorly developed:

• there is clumsiness, awkwardness;
• motility is angular, movements are irregular with a tendency to stereotypes.