How Does One Create Highly Talented Individuals?

The 2008 Beijing Olympics has been awe-inspiring. Incredible world records have been broken. Brilliant sportsmen like Michael Phelps from the USA, and Usain Bolt from Jamaica have held us spellbound.

Even Singapore grabbed a little bit of the limelight when it won a silver medal in table tennis. Never mind many of our table tennis players were born and bred in China.

I have been listening to a considerable amount of discussion asking why Singapore isn’t doing so well not only in sports, but in other fields such as the arts, film, and science.

One of the excuses given as to why Singapore has not produced its own international talent is that Singapore has too small a population. The theory is that geniuses are produced in a sort of mathematical ratio of one per x million population.

This cannot be true. Take Jamaica, for example. It only has a population of 2.8 million, and yet it has recently won 11 Olympic medals, compared to Singapore’s one medal. Even Ireland, New Zealand, and Croatia, with a population slightly smaller than Singapore have won more medals.

And it is not confined to just Olympic medals, but right across the board, including Nobel prizes and outstanding artists and filmmakers, and scientists. Singapore lags behind in all these fields.

I think the problem lies in Singapore’s educational system. But first, allow me to say what I think is good about our educational system. It is universal, affordable, and the standard of mathematics and science teaching is of the highest quality.

Where it falls short is in the area of sports, arts, and creative thinking. My friend (CKJ) has a son who was very creative, making toys, modifying instruments and coming up with new and improved versions. However, when he entered primary school at the age of 6 years, suddenly his creativity vanished. His father said: “it was simply a question of ‘this is the answer, this is what it is, just memorize it.’”

Indeed school children are crammed with an inordinate amount of facts resulting in information overload. So much time is devoted to memorizing that there is scarcely enough time left for anything else. One example of this is that children are made to remember every single part of a microscope including the names of the little screws and other minor components. They are tested on these relatively unimportant facts, instead of being allowed to explore the microscope, the microscopic universe, and then be guided to think through and work out the principles of optics.

If a science experiment goes askew, the typical Singapore student would just copy the “correct” results obtained by a neighbour. Unfortunately this means that the student would miss out on an important learning opportunity, namely to work out what went wrong, and how the error could have been rectified. The solution to what goes wrong in an experiment is obviously not found in a textbook, and requires hard thinking.

Encouraging students to think for themselves, to devise their own experiments, to work out solutions to problems, and to troubleshoot faults, is distinctly lacking in most Singapore schools.

There are other areas of parochial thinking. For example, it is often assumed that creative thinking takes place almost exclusively in the humanities and not in the sciences. Thus science teachers do not place much emphasis on practical observations, do not challenge current theories, and do not prod students to produce original ideas and works.

Another example of blinkered vision is the overemphasis on the commercial value of everything. For example, scientific research in Singapore is only undertaken if it has to potential to make money. Pure research is frowned upon, because it is perceived that it takes too long to achieve commercial success. This restriction of research trickles down to all thought processes, and everyone edits out any ideas that do not obviously lead to profits.

A third problem is that every project must be measured by key performance indicators (KPI). This includes the performance of teachers, which is measured by how well their students do in exams. Research projects are also subjected to such evaluation. This means that certain results are anticipated, and it distorts the focus and direction of research, which, if it is meant to make profoundly original discoveries, will be thwarted.

Turning to sports, there are several reasons why Singapore has not produced its own indigenous sportsmen. Most of our international-standard representatives are born outside Singapore, and are granted citizenship in the hope that they will represent Singapore. A lack of facilities is not one of the reasons. Indeed Singapore is ranked seventh highest in the world with respect to GDP per capita. We have excellent sports facilities that my Jamaican sports friends would envy. So what is the problem?

I believe it is in the mindset. Sports is not valued as a profession worth pursuing. Most parents would discourage their children from devoting too much time to sports, as they fear this would erode into time for academic studies. Only recently has a sports school been started, but it is too early to evaluate how successful this will become.

Sports teachers are sometimes over-restrictive in their selection of students. If a child wants to participate in a particular sport, he would only be allowed to take part if he were already highly proficient in that sport. Beginners are rejected.

By and large, the same comments also apply to the arts. Parents tend to discourage their children from becoming too involved in the arts, and many teachers prefer to accept only those students who are already proven to be adept in that art. The emphasis is almost entirely on performance, and little value is placed on the creation of original art.

So where do we go from here? Singapore needs to re-evaluate its educational system, to place more importance on independent and original thinking. In this, it needs to sharpen the use of the tools of thought, which includes a higher level of language abilities, artistic, music and bodily-kinaesthetic expression.

An individual should receive a well-rounded, balanced education. Creativity can be cultivated, but it requires a fertile environment that is friendly, encouraging, and allows freedom of thought.

Like the gymnast leaping and somersaulting on a narrow wooden beam, an educational system needs to achieve a similar delicate balance. It is a balance between freedom and discipline, between active self-exploration and passive rote learning, between creative thinking and repetitive drills (divergent versus convergent thinking), between the learner chosing what to learn versus the educator dictating what needs to be learnt.

To achieve this balance is difficult. Any changes in the educational system or method of teaching, will only bear fruits decades later. Therefore, one should not base long-term educational decisions on short-term exam results. It is well recognized that many of our best inventors, entrepreneurs, businessmen, scientists, artists did poorly in exams.

To plan for the future, one encounters a further complication. The fulcrum of what constitutes a balanced education shifts from time to time, making it difficult for educators and administrators to know where precisely to position it in anticipation of future developments. A good example of this is the rise of information technology and computer education in the past few decades.

There is one more factor to consider. To rise to the absolute top of the heap, one needs to be highly motivated and stubbornly persistent. Listen to the swimmers, athletes, pianists, who all say that they have to train for hours everyday, often giving up other activities and a social life. You might ask: “How can this be regarded as a balanced life?” You would be absolutely right. You cannot have your cake and eat it. At least not initially.

Before I return to the question of balance, there is yet another element to consider. I have been fortunate to have been taught by top scientists, including Nobel prizewinners, and have met a few highly successful entrepreneurs. Almost without exception, they are outstanding original thinkers.  They have a keen sense of humor, and they have an unconventional way of thinking. They dare to think differently.

My friend (CKJ) tells me the story of a team of Formula 1 racing car engineers. When designing increasingly powerful engines that make their cars go faster no longer helps one win a race, because all the other cars are equally powerful, this team of F1 engineers met and brainstormed. Instead of concentrating on acceleration, the team’s designers realized that if they turned their attention to deceleration, they could increase the overall speed especially when turning corners. They therefore focused on brake development. If their car could brake just that little bit later at every corner of the track, it would be able to spend that fraction of a second longer at top speed than the other cars.  If they added all the corners of a race track on each lap, they could go around it maybe 2 or 3 tenths of a second faster than the other cars of equal engine power, straight-line speed and cornering speed. In F1 terms, where there are over 70 laps, this is a lot.  The point here is that it was a bit of really creative thinking by engineers, and indeed their car went on to win.

Talent alone is not sufficient. From the above, it is patently obvious that while innate talent is important, it is not a sufficient condition for winning the Olympics or a Nobel Prize. You need training to develop that talent, you need persistence, and you need to think creatively. Some people add luck to the equation.

Where can education help? I believe that the key to success in education is to remain flexible, to embrace new developments, not to lose sight of balancing the mind and body, and never abandoning the fundamental precepts of cultivating independent thinking, encouraging hard work and persistence, fostering a spirit of creative thinking, a lively sense of curiosity, and a mind that is continuously questioning.

That is the challenge!

Kenneth Lyen

25 August 2008

Confucius (551-479 BC) taught that the perfect gentleman had to excel in the following “arts”: mathematics, poetry, music, calligraphy, archery, charioteering, and rituals.

Howard Gardner (1943- present) suggested that each individual had multiple intelligences, and that these included mathematics, verbal-linguistic, music, visual-spatial, bodily kinesthetics, intrapersonal and interpersonal.

Is it possible that Confucius’ notion of a well-rounded person possessing many talents, might be the precursor of Howard Gardner’s multiple intelligences? If so, his ideas were conceived  over 2 thousand years ago. Think about it.

Historical

Children’s fads are nothing new. Over the years we have seen them come and go. There was He-man, Cabbage Patch Dolls, Teenage Ninja Turtles, Care Bears, Teletubbies, Transformers, Tamagotchi, Pokemon and the incredible Hello Kitty!

For people like myself who do not find any of these creatures particularly appealing, the obsession displayed by their fans seems completely bewildering. What would entice large numbers of people to queue up overnight just to buy a Hello Kitty doll? What generates the incredible demand for these dolls such that the black market price for them is inflated several fold? Why did some of those who queued up for these dolls lose their tempers and come to blows over such a trivial matter? And as for those who got hurt when they pushed so hard that the glass door shattered, we ask why?

As a parent and as a paediatrician, I look at behavioural problems from a developmental point of view. Namely, what did we do wrong as parents? Why did we fail to vaccinate our children (some of them already grown up) with values and judgements so that they would not succumb to peer pressure, or to advertising’s ugly influences? How did we as parents, fail to inculcate independent thinking in our children?

Alexander Pope once wrote: “Tis Education forms the common mind; just as the twig is bent, the tree’s inclined”.” I fully agree with him. It is through education, in its widest sense of the word, that we can shape our children, so that they will develop into upright citizens. But recent events suggest that we have not been as effective parents-cum-educators as we thought we were. Let me stick my neck out, and make a sweeping generalisation. Let me preface this by saying that I don’t have any research data to back up my impressions.

I believe that parents these days seem more intent on getting their children to do well at school, to pass exams, with a view to securing better paid jobs and a more comfortable lifestyle. Children nowadays seem to be taught more and more facts, and less and less about values; they are taught more about the techniques of passing exams, and less about moral judgements; they are taught more about winning, and less about coping with failure; more about following instructions, and less about independent thinking. Now, before I get a flood of criticisms, let me immediately apologise if the above generalisation provokes a negative reaction from parents, educators, and others who feel that I have got it all wrong.

But have I really got it wrong? I think that the events rising from the Hello Kitty madness has already vindicated my beliefs. Let me give you some further observations. I have seen people queuing up behind a sign placed by the fast food chain that the Hello Kitty dolls are sold out at this point. My colleagues have noticed that their several of their office staff have arrived late to work because they had queued up for a doll. Many rubbish bins outside the fast food chain were full of discarded food uneaten, because once the person queuing obtained the doll, the food became redundant.

Some parents feel that they are displaying love to their children when they shower them with presents. They indulge their children’s every craving. This is exacerbated by the highly successful advertising on television. The child becomes obsessed with the desire to own the object advertised. Their peers exert further pressure. Parents think that they are doing their child a great favour by giving in to their demands. Sometimes the child becomes insufferable and goes into a temper tantrum. To stop these tantrums, the parent might give in, even though the parent may initially object to buying the toy. As a paediatrician, often asked to advise parents on how to deal with childhood tantrums, I always tell the parents never to give in to their child’s tantrums. Children are often smarter than we realise. They know how to manipulate their parents. They are fast learners. If they go into a temper tantrum, and the parents give into their demands, they will learn that this technique works. In future they will always go into a temper tantrum to get what they want. If, on the other hand, the parents consistently deny the tantrum child’s demands, that child soon learns the futility of launching into a tantrum. Over the course of time, the tantrums will extinguish.

Thus, if we as parents are obsessed with acquiring material wealth, or we ourselves queue up for our condominiums, or cars, our country clubs, then unwittingly we transmit these values to our children. If we would rather spend our money on expensive holidays rather than helping destitute families, we are also making a value statement. Hence to some extent, the misbehaviour of those obsessed with buying the latest fads can be traced to our own misplaced sense of values, our own obsessions, our own misbehaviour.

What can we do? As doctors, I believe we have a responsibility to society. Like it or not, society scrutinises our every act, our every word, our every deed. We are already seen to be a role model for society, and we should therefore be seen to fulfil this role responsibly. Furthermore, we are also educators. We are constantly educating our patients and the parents of our patients. We have that opportunity to allow others to “catch” our own views and values.

Education needs balance. Currently it is imbalanced towards competition rather than cooperation, towards wining at all costs rather than coping with failure, towards acquiring facts rather than values. The least we can do is to discuss the problems, to air our views, to listen to the views of the public. Maybe by engaging in dialogue we can find new solutions to achieving a balanced education. That is the direction we should be heading towards.

(In 2000 a well-known fast food restaurant gave out Hello Kitty dolls for each meal purchased, and sparked off a nation-wide craze.)

Am I normal?

Apparently not. My psychologist friend tells me that I have a hidden dyslexia. It will explain why I did so badly at school, why I was a D student, why I nearly failed all my exams.

Hence I am delighted that the British Dyslexia Association, in conjunction with the University of Westminster is spending £478,000 in a quest to uncover latent dyslexia, dyspraxia, and dyscalculia … people who struggle with reading and writing, who have problems in motor skills, or have difficulty handling numbers.

But I am worried by this study. You see, the boundary between normal and abnormal is blurred. When is dyslexia just poorly taught reading and spelling? When is dyspraxia just clumsiness? And dyscalculia just a disinterest with mathematics?

Come to think of it, is anybody normal? Are we all borderline sufferers of one psychological disorder or another? Or as John Ratey put it, do we have “shadow syndromes”?

In the 1960s there was a movement led by Thomas Szasz that claimed there was no such thing as psychiatrically abnormal people. It was society that was abnormal. Nowadays the pendulum has swung to the opposite extreme. Psychiatrists, psychologists, doctors, educationalists, busybodies, are very keen to dish out labels on everyone. There are even new labels to be distributed liberally, like “borderline personality disorder.”

If I were a hypochondriac, I would claim to suffer from a touch of everything. I would love to add a few more maladies to my inventory of complaints. I could add borderline attention deficit because I could never concentrate on anything for very long. Plus borderline autistic because I am a shy quiet type, and do not like crowds or parties. Then I would add borderline manic-depressive disorder as I have mood swings. And maybe a touch of obsessive-compusive disorder, and possibly a borderline personality disorder to boot.

Joking aside, there will undoubtedly be some genuine cases of learning disorder that will be detected by the University of Westminster’s study. However, I fear they will open Pandora’s Box, because dyslexia, dyspraxia and dyscalculia are ubiquitous. The cutoff between normal and abnormal is arbitrary. And treatment is largely unsatisfactory.

I guess you have to start somewhere, and I can only wish them the best of luck.

Sometimes I wonder how my life would have changed if they detected my dyslexia earlier. Maybe I wouldn’t have become a writer. What a dumb idea for a dyslexic to choose to be a writer!

What the little boy has is a condition called the Tourette Syndrome. It was first described in 1884 by a French physician, Gilles de la Tourette (1857-1904). He wrote about nine patients who were affected with the symptoms that were later to bear his name. One of these was the Marquise de Dampierre, an aristocratic lady who developed compulsive tics from the age of seven years, and they persisted until her death at the age of 80 years. She became a recluse and according to another doctor, she “ticked and blasphemed” all her life.

This condition affects 2% of the population, and among famous patients afflicted with this disease was Amadeus Wolfgang Mozart. Perhaps Mozart had outbursts of profanities, or coprolalia, which may have inadvertently upset poor Salieri, who is alleged to have murdered Mozart.

By the way, “coprolalia” is derived from the Greek words “kopros” (dung) and “lalein” (to babble).

The condition is inherited as an autosomal dominant, which means that it can be passed on by either parent. But to date, the gene has not been identified, nor the biochemical aberration which gives rise to the condition. Medical treatment is available but drugs only suppress the symptoms, and when the medication is stopped, the manifestations may recur.

When I asked the parents where the boy may have picked up his scatology, they immediately blamed the school. Apparently it is the norm for schoolboys to use four-letter swear words that would shock any grandmother. Definitely they would not have picked it up from Singapore television which is squeaky clean. How then, I asked, is it possible to make a diagnosis of Tourette Syndrome, if the only manifestation was the coprolalia?

The disease remains as baffling and mystifying as it did 120 years ago when Dr Tourette published his findings.

Sauntering back to my office, punctuated by casual window shopping, I suddenly saw hurtling towards me, a high speed lump of child. He couldn’t stop in time, and my reflexes were dulled by post-prandial hypoglycaemia. “Hey, watch it” he shouted at me, as if it was my fault that I trespassed into his flight path. I was too stunned to react appropriately, and my instinct, trained by my conservative middle class parents, was to be perpetually polite. “Are you all right?” I asked the boy. Without even a word of apology, he sped off quick as The Flash.

I realised that the problem arose because he was wearing shoes with wheels embedded into the heels (heelies). These shoes are now ubiquitous, and has largely replaced both the squeaky sports shoes, and heels that light up when you put your weight on them. This is a new fad. Children think it is cool to race across shopping centres and any pedestrian walkways wearing these heels on wheels.

“Freedom is a wheel in your sole”, screams a poster advertising these shoes. “Freedom obligates responsibilities”, I thought to myself.

My friend who owns a shop, said that when he was shown a pair of these shoes, before the fad caught on, he dismissed it. “It would never catch on” he told the distributor. Now he lives to regret his decision. Trying to comfort him, I told him the true story of Timex Watch, who was offered the distributorship of shiny colourful plastic watches, before they became fashionable. They turned their noses at these cheap-looking “toy” watches, and lived to regret turning down one of the most profitable distributorship of Swatch watches.

Curiously enough, I would have expected the rate of fractured arms and head injuries to have shot up with the sale of these heelies. But this does not seem to have happened. I guess the reflexes of young children are lightning fast and they usually avert disaster in the nick of time.

Like all fads, I’ll give it a year or two, tops. And these heelies will end up in the eternal resting place of all yesteryear’s fads. Yep, I know, at bottom, I’m a heel! Hehe!

Would we have thought about gravity if Isaac Newton didn’t help identify it? Or how about the concept of “space-time” before Einstein defined it?

Without words, could we have been able to conceive of the following abstract ideas: “soul”, “reason”, “energy”, “subconscious”, “conscience”, “remorse”, “quark”, “pi”, “square root”, “calculus”, “absurd”, “meaning”, “endurance”, etc?

Does language shape our views and influence our thoughts? This question was first posed by Benjamin Lee Whorf in the 1930s. The Whorfian Hypothesis, as it is sometimes referred to, claims that the particular language a person speaks, independent of the culture in which he resides, affects the way that he thinks, by determining the framework for his perceptions and thoughts. Whorf and his teacher Sapir argued further that a person’s world view is largely determined by the vocabulary and syntax available in his language.

The extreme version of this hypothesis is that all thought is constrained by language. If the word does not exist, then that thought cannot be thought. Of course this is patently untrue. For example, we all experience difficulties in expressing ourselves. We know what we are thinking of, but we are stumped to find the word to express it. Hence we do not need words to think.

At the opposite extreme, to say that language has absolutely no influence on thought, is also false. For example, if a language organized colour names differently, it has been shown that a person’s discrimination of similar shades of colors can be influenced.

To explore this question further, Peter Gordon of Columbia University studied the Pirahn Indians. This tribe of hunter gatherers living on the banks of the Maici River in Brazil do not possess a vocabulary for numbers other than two words, “one” which stands for “one or two”, and the other meaning “many”. Members of this tribe are intelligent, but they have difficulty counting beyond 8 objects. Peter Gordon wrote: “They do not have the word for “number”, pronouns do not encode number (e.g. “he” and “they” are the same word), and most of the standard quantifiers like “more”, “several”, “all”, “each” do not exist.” Peter Gordon concluded that without having numbers, the Pirahn Indians were handicapped in their ability to conceive of mathematical calculations. This tribe could survive without this concept because their commerce was a form of barter, in which there was no exchange of money. Numbers did not exist as there was no need for them.

Numbers, symbols and words, act as convenient labels for concepts. They help clarify one’s thinking. For example, the 19th century physician Langdon Down discovered a subset of intellectually disabled who were later labelled as Down Syndrome individuals. This enabled better delineation of this group and allowed for further studies, such as their the genetic origins.

Words are like building blocks or stepping stones that allow us to advance concepts one step at a time. Armed with the concept of gravity, Isaac Newton took the next step and formulated the inverse square theory of gravity. Similarly, with Einstein’s concept of mass and energy, he could formulate the equation linking the two, which led to further discoveries.

One additional point of interest. Not only do the Pirahn Indians not count, but they also do not draw. Gordon wrote. “Producing simple straight lines was accomplished only with great effort and concentration, accompanied by heavy sighs and groans.”

This leads us to the next issue, namely the written representation of words. Benjamin Lee Whorf was acutely aware of the role culture and society played on the development of concepts. Take two cultures, Western and Far Eastern. In the west, words are represented by an alphabet script, whereas in the Far East, words are represented mostly by pictograms. Does the representation of words in alphabet form versus pictograms lead to qualitatively different modes of thinking? Can it explain the differences between, say, Far Eastern philosophy from Western philosophy?

Trying to display abstract ideas in pictograph form is particularly challenging, because it is very tough converting pictures into abstract concepts. The Chinese do it quite cleverly. For example the word for endurance shows a knife directly above the heart, and the word for peace is a woman under the roof of a house.

Whether this pictographic representation of concepts can subconsciously lead to a different way of thinking and a different world view remains largely unexplored. Cross-cultural studies are therefore of immense interest, not only in understanding differences in thought processes, but also in unravelling other mysteries, such as dyslexia.

I was one of the judges for a concert where the disabled co-wrote songs with the able. For the closing theme song, we were taught how to sign the lyrics. All my fellow judges learnt the sign language very quickly. But I just could not remember the action sequences, frequently getting it wrong. It was quite embarrassing.

On another occasion, I was part of the committee that made the decision to introduce the Makaton sign language, a simple system, for learning-disabled children. As committee members, we were taught some of these easy signs, and I discovered that I was actually the more learning disabled, because of my inability to learn this simplified sign language.

It is therefore with astonishment that I read about a group of Nicaraguan hearing-impaired children who created from scratch, a brand-new sign language.

It all began after the 1979 Sandinista revolution, when the new Nicaraguan Government started a nationwide program to educate deaf children. Hundreds of students were enrolled in two Managua schools. Before then, deaf Nicaraguans stayed at home and interacted with family members using a personal system of communication. They could only communicate basic needs like “eat,” “drink,” and so on.

Unfortunately the new teachers were inexperienced. They were advised by the Soviet advisors to teach the children finger spelling, which meant manually stroking with the index finger the outline of each individual alphabet onto the children’s open palms. But having no knowledge of either the alphabet or the words they were meant to spell, the children could not make head or tail what it all meant, and the effort was totally futile. The teachers even tried other methods, including lip-reading, but once again all their attempts to communicate ended in abject failure.

Then, to the teachers’ amazement, the children started communicating with each other through a unique system of hand gestures. A new sign language was being born right in front of their very eyes.

There are three major findings in the evolution of this extraordinary sign language. First, the originators of the language were children, and the signs were gradually improved upon as they entered their 20s. Secondly, a few years later, when a new generation of younger deaf children were learning this sign language, they modulated the cruder signs of their elders, enriching them so that they became more nuanced and streamlined. Their improvements were soon adopted by everyone in the community. All this was done without any assistance from their teachers or parents, who were mere spectators to this creation. The third observation is that the new sign language had rules of grammar that were similar not only to all the other sign languages in the world, but also to spoken languages.

Steven Pinker, author of “The Language Instinct,” says that what happened in Nicaraguan children is proof that language acquisition is hardwired inside the human brain. The development of this unique sign language by young children supports Noam Chomsky’s postulate that children have an innate ability to produce language, and that they are equipped with the rules of a universal grammar.

It should not surprise one that sign language can arise so relatively easily. Anthropologists claim that before the development of spoken language, early man was already communicating nonverbally. The earliest mention of sign language is by Xenophon in 431 BC. The philosopher Condillac proposed in the mid 18th century that language originated as gestures. It was the Abbé de l’Épée who observed that deaf people roaming the streets of Paris were communicating with one another using an animated system of hand gestures. The abbé established a school for the deaf in 1755, and used his deaf students’ natural signs to further their education. This French system of sign language was later to become the foundation of the American Sign Language.

It seems that sign language is closer to the origin of language than speech. Sign language appears to have arisen spontaneously and independently in different parts of the world. For example, Chinese sign language is very different from American, or Danish, or Nicaraguan sign language.

Inventing a brand-new sign language is not easy. Try it yourself. Create a new system of sign language. Pose yourself the following questions. How would you communicate the passage of time? How would you use signs to differentiate between something you have done just a few seconds ago, versus something you did last week? How would you differentiate between an act done by a male or a female, between a young person or an old person, or between people of different races, or between one solitary person versus a large group of people? How would you sign that you have just watched the film “The Eternal Sunshine of the Spotless Mind”? Then tell us what the film is all about. It is like playing the game Charades, except it quickly becomes infinitely more difficult.

Whoever invented sign language must be a true genius!

Asperger syndrome is defined as a condition resembling autism in which there are speech and language abnormalities, problems with nonverbal communication, severe impairment in social interaction, a fixation on a narrow field of interest, rigidity in following unchangeable routines and motor clumsiness.

Historical

In 1944, Hans Asperger described a distinctive pattern of behavior that resembled autism and is now referred to as Asperger syndrome. A year earlier, Kanner had published his observations on autism. Unlike Asperger syndrome in which the intelligence is normal or high, Kanner’s autistic subjects were quite severely intellectually disabled.

Epidemiology

In Sweden, the prevalence of Asperger syndrome is around two per 1,000 school children, and boys outnumber girls by quite a large margin. Asperger syndrome is more common and less severe than Kanner autism.

Inheritance

A number of families have a mix of members with Asperger syndrome and Kanner autism. This suggests that there is an overlap in these two conditions, and it may eventually turn out that they actually represent different degrees of severity of the same condition.

Clinical Features

Persons with Asperger syndrome may have a history of school difficulties. They display abnormalities in speech, nonverbal communication, social interaction skills, and motor coordination. They may engage in repetitive activities and are resistant to changes in routine. Other family members may have similar disturbances. Asperger syndrome is more commonly associated with normal or high intelligence.

Speech

The development of speech may be delayed. The words expressed may be sing-song in intonation, or they may be flat, with inappropriately exaggerated inflections. There may be pronoun substitution, so that “you” is used instead of “I”. The Asperger subject may invent new words (neologisms) or use long and obscure words instead of simpler ones. Speech content can be pedantic and repetitive. Simple humor may be appreciated, but complex jokes may elude them.

Nonverbal Communication

There may be a paucity of facial expressions. Eccentric gestures, like holding the arms in the air and other odd posturings are sometimes manifest. They may frequently misread the body language, intentions or facial expressions of other people. Eye contact is said to be poor, but in Asians, this can be difficult to assess, because it is not the usual practice to look someone in the eye when communicating with that person.

Social Interactions

They have difficulties in initiating and sustaining relationships with others. Social rejection may result from a failure to grasp the rules of etiquette or social conduct, including rules which govern speech, hand gestures, body posture, choice of clothing and proximity to others. They may have a preference for machines or fantasies rather than human interactions. Even hygiene can be at the same time obsessionally clean and filthy. The Asperger subject may shower several times a day, but never brush the teeth. There may be extreme lack of common sense.

Resistance to Change

Once they develop a daily pattern, they resist any change in their routines. In a similar vein, they may form intense attachments to certain belongings, and may become very unhappy when away from home.

Motor Coordination

Their movements are awkward and clumsy, their posture appears peculiar, and they may have a tremor which can affect their writing and drawing.

Skills and Interests

Persons with Asperger syndrome may have an exaggerated interest or skill in one or two areas of expertise, and they may absorb every detail in these subjects. This is similar to those individuals with Kanner autism who sometimes display quite brilliant talent in a certain skill (autistic savants).

School Experiences

Children with Asperger syndrome tend to behave quite oddly and, because of their poor social defenses, may be bullied at school. They tend to do badly in their studies because they may prefer to pursue their own interests rather than complete their homework.

Differential Diagnosis

There is controversy over whether Asperger syndrome is part of the autism continuum or a separate entity. Asperger syndrome individuals tend to have higher intelligence than those with Kanner autism, but there is some overlap.

Currently there are no valid tests that can reliably differentiate Asperger syndrome from infantile autism. The observation that people with Kanner autism may transform into Asperger syndrome after intensive treatment further supports the notion that Asperger syndrome is part of the autism spectrum.

The unusual behavior, anxieties and fixed habits of those suffering from Asperger syndrome superficially resemble a number of psychiatric conditions, such as schizophrenia, the manic phase of manic-depression, generalized anxiety disorder, and obsessive-compulsive disorder.

Therapy

There is no specific medical treatment for Asperger syndrome. Therapy is largely educational and behavior modification.

- Teach the Asperger syndrome individual how to interpret facial expressions and physical gestures.

- Teach him how to analyze social situations.

- Encourage him to do some voluntary work.

- Find out what motivates that particular individual with Asperger syndrome, e.g., he may be willing to work for money to buy more computer equipment, and use it as positive reinforcement.

- Be sensitive to the person’s emotions, e.g., do not laugh at a joke that was not intended.

- If the person with Asperger syndrome uses “faultless logic leading to nonsensical conclusions”, then he needs to be aware of the absurdity of his conclusions.

- Some individuals can even gain insight into their own condition by reading about Asperger syndrome.

- It may be helpful to introduce people with this condition to each other.

Drug Treatment

Individuals with Kanner autism sometimes respond to high doses of vitamin B6 or pyridoxine. As this is a relatively safe drug with preventable side effects, it can be given an empirical trial. If a person with Asperger syndrome has a coexisting problem, such as an anxiety disorder, then treatment for this should be given. If there are fits, anticonvulsants should be administered.

It is important to emphasize that the medical treatment of Asperger syndrome is only a small part of the total therapy. Adequate comprehensive treatment requires education, analysis of the environment with appropriate behavioral adjustments and psychotherapy if indicated. In addition, there should be meticulous evaluation and treatment of other concomitant medical problems. Thus, a team approach to treatment is essential. Medication cannot be used as a substitute for these other components of therapy.

Prognosis

The outcome of Asperger syndrome is very unpredictable, and may range from poor to excellent.

Case Studies

John is a 14-year-old in a special school. He had a normal delivery at birth but did not talk until he was six years old. Now, he is able to express himself in short sentences and has a reading age of a nine-year-old boy. However, his understanding of what he reads is below that. He has no friends. When he is not engaged in any activity, he sings to himself, bites himself and puts his fingers in his mouth and nose. John was diagnosed as having autism with developmental delay.

Ahmad is a 13-year-old boy who comes from a low income family. Despite not having any tuition and coming from a family background that does not speak English at home, Ahmad did well academically and was in the top academic stream. As a child he had delayed speech. Over the years, his speech improved, and he liked to talk, but had difficulty communicating his thoughts. He has a high-pitched voice with a flat tone. Up till today, he has no friends because he is unable to relate to others. He has a strong interest in television programs and knows a lot about them. In fact, he has learned a lot of “communication skills” like reflective listening, summarizing, and interpreting body language, from watching TV interviews. He has a very strong logical memory. He is diagnosed with Asperger syndrome.

Both John and Ahmad lie within the spectrum of autism.

Learning Styles

People with autism spectrum disorder learn in a different way from others. They tend to learn much better when information is presented to them in a visual way. While the phrase “a picture is worth a thousand words” applies to the average person, “a picture is worth ten thousand words” applies to most people with autism spectrum disorder. They also tend to have a strong memory for details, but have difficulties piecing the bits of information together to form a whole. In other words, they see the trees but not the wood. Gary Mesibov illustrates the way they see the world like a laser pointer, while non-autistic people see the world like a regular torchlight. A laser pointer is a highly-focused beam of light and causes an intense concentration in energy on one aspect of the environment. Organizing, sequencing, and time concepts are generally areas of difficulty for people with autism spectrum disorder and Asperger syndrome.

Savant

About 10 per cent of people with autism spectrum disorder have talent or are “gifted” in some specific area. Some are gifted in writing poetry, while others are talented in music, drawing, designing, computers, and calculating the day when given a date. The movies Rain Man and Mercury Rising are examples of individuals with autism spectrum disorder who have special talents.

What is the Most Effective Intervention Program?

The most common and effective form of intervention for individuals with Asperger syndrome is structured teaching, communication training, applied behavioral analysis, and social skills training. The best intervention programs come from having a deep understanding of how they see the world. These intervention programs can then be crafted to help them to see the world meaningfully. Individuals with Asperger syndrome need help in understanding the social environment and learn best when information is communicated to them in a visual way.

To meet their learning needs, TEACCH , a division of the University of North Carolina, USA, developed a structure teaching approach that focuses on the use of visual information to prepare the individual with autism spectrum disorder to learn. There are three main components to this approach: physical structure, visual schedule, and work system.

There is no one clear approach or program that works for all people with autism spectrum disorder. An effective intervention program should have the following components:

- Clear assessment of needs.

- Development of learning goals in his immediate environment with a long term aim of creating independence.

- A variety of learning opportunities for the child. This should include direct teaching, group teaching (for older children), independent practice, incidental teaching, generalization to other people and situations, and repeated practices.

- All teaching activities should be meaningful.

What are the Long-Term Goals of Intervention?

In terms of priority for goal setting, personal skills are the most important and form the foundation for skills building. Both parents and professionals place independence as the long-term goal for individuals with autism spectrum disorder. This is followed by intellectual skills and interpersonal skills.

Conclusions

We believe Asperger syndrome to be part of the autism spectrum disorder. The diagnosis is often missed by parents and teachers because children with this condition have normal to high intelligence. Nevertheless they have difficulties socializing, and may have some learning difficulties. Using visual cues to assist in their learning, giving them social skills training, can be most helpful to them.

This article by Vera Bernard-Opitz, Kenneth Lyen, Lam Chee Meng, first appeared in Rainbow Dreams (2002).