Goals

The Even Better Project aids the teaching of emotions and social skills to children with Asperger and other disorders on the autism spectrum (ASD), through the creation of a web page with a collection of educational computer games. It will provide anyone who works with autistic children with a valuable tool to aid their first contact by reducing the usual initial resistance children put up during assessment. It can also teach them different skills.

Even Better is a program which has been specifically designed to be used by children on the autism spectrum, geared to help work on:

• The evaluation of the child’s capacity to recognize emotions in both drawings and real pictures.
• The teaching and recognition of basic and cognitive emotions.
• A greater adaptation to apply these learned abilities to different social contexts.
• An improvement in the children’s collaboration to work on the abilities that they need to develop.
• The substitution of dated paper-based materials.
• The traditional learning system with a new approach that is interactive and fun.

But not only Asperger/ASD kids can benefit from the games and content of the Even Better web page, but also other people who have difficulty in recognizing emotions can use this tool to their advantage (syndromic autism, ADHD, cognitive disabilities or even adults whose disorders involve loss of facial recognition, such as Alzheimer and Parkinson sufferers etc.)

The games repertoire is still being developed, but we hope to add many more games and also activities that focus on areas of such importance as the theory of the mind. We hope too that in time the project will become self-sustaining, a basis so that Asperger’s syndrome will become the object of further research and future developments that will allow this page to keep growing and be free and accessible to all.

Asperger´s Disorder

Definition

The person with Asperger has intellectual and language skills in the normal range, but has difficulties in three fundamental areas: social interaction, social communication and mental and behavioral flexibility. You can refer to the diagnostic criteria in the DSM manual (you can access the IV and V editions by clicking on CRITERIA).

Asperger´s syndrome is present in every race and culture; it affects the social skills of millions around the world and doesn´t understand socioeconomic levels. It has existed since the beginning of the human race and in every country.

Until now Asperger´s has been known as 'the invisible syndrome', simply because nothing about a person´s external appearance that indicates they have a neurological functional diversity. Out of many possible definitions, we like this one:

Asperger´s syndrome isn´t an illness or a disease. You can´t catch it, cure it or spread it…Its 'sufferers' aren´t sick, but people born with a different neurological development, in other words, this development is produced in an alternative way to the statistically considered 'normal' or 'neurotypical'. Asperger syndrome means neurodiversity!

Criteria

Diagnostic Criteria for 299.00 Autistic Disorder DSM-IV

A. Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

1. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
2. Failure to develop peer relationships appropriate to developmental level.
3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest).
4. Lack of social or emotional reciprocity

2. Qualitative impairments in communication as manifested by at least one of the following:

1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
3. Stereotyped and repetitive use of language or idiosyncratic language.
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
2. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
3. Stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements).
4. Persistent preoccupation with parts of objects.

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Diagnostic Criteria for 299.80 Asperger´s Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to eye gaze, facial expression, body postures, and gestures to regulate social interaction.
2. Failure to develop peer relationships appropriate to developmental level.
3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people).
4. Lack of social or emotional reciprocity.

B. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus.
2. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements).
4. Persistent preoccupation with parts of objects.

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Resource: DSM-5 Diagnostic Criteria

The DSM-V committee down to two the three criteria above, linking deficits in social communication and social interaction difficulties, going to establish itself as the only category 299.00 Autistic Disorder: new name for the category, which includes autistic disorder (autism), the Asperger´s disorder, Asperger´s disorder and childhood disorder widespread development not otherwise specified.

Diagnostic criteria for Autism Spectrum Disorder 299.00 (F84.0)

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.
4. Severity is based on social communication impairments and restricted repetitive patterns of behavior (see next table)

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
5. Severity is based on social communication impairments and restricted repetitive patterns of behavior (see next table)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:

• With or without accompanying intellectual impairment.
• With or without accompanying language impairment.
• Associated with a known medical or genetic condition or environmental factor.
  (Coding note: Use additional code to identify the associated medical or genetic condition.).
• Associated with another neurodevelopmental, mental, or behavioral disorder.
• Associated with another neurodevelopmental, mental, or behavioral disorder
  (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].).
• With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition)
  (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.).

As can be seen, over the DSM-IV to DSM-V, the three classical domains are reduced to two: social and communication / fixed interests and repetitive behavior deficits, Asperger syndrome disappears as a separate clinical entity.

The people behind the project

Vodafone Foundation / Grahame Maher Awards

The project Even Better has won a Grahame Maher Award in 2012. This has allowed us to continue developing the project thanks to the Vodafone Foundation.

Pilar Chanca Zardaín

Pilar Chanca Zardain has a PhD in psychology and has been working for the Asperger Association of Asturias since 2008. In addition to this work experience she adds the personal experience of having a younger brother with AS. Bgratefulnessoth experiences prompted her to enter the Grahame Maher Awards. She has already won one of the “Build A Better World” prizes as well as designing projects and workshops for children on the autistic spectrum. It was precisely this experience of using computerized activities with children that made her realize that the information given through these new technologies is crucial to optimize the learning of children with special needs.

'Even Better' was devised to be used by social entrepreneurs, people that develop projects in areas that aren´t catered for by either the authorities or the business world or the markets, to come up with and develop new responses which can help build up sustainable services.

The author has devised the Even Better project to increase awareness about Asperger’s syndrome and to design a tool to help with disseminating and , but with the potential to widen its starting objectives, benefiting more people, be it extending to other countries o adapting it to apply it to other kinds of disabililties: other autism spectrum disorders, ADHD, Down’s syndrome, cognitive delays etc., and also other disorders where sufferers lose their ability to recognize emotions( such as Alzheimer, Parkinson´s etc.)

Previous publications.

• Asperger-syndrome. Authors: Pilar C. Zardain Trelles and Gema Garcia. Guide published by the Asperger Association of Asturias. SPANISH available here.
• Leo TEAyuda. Las emociones Básicas. Editorial Psylicom. Visit the web page of the book at leoteayuda.com. You can also read (in Spanish) he aulautista.com comments about leoteayuda.com clicking on this link

Asperger Association of Asturias

The original idea for 'Even Better' is Pilar Chanca Zardaín´s and it has been endorsed by the Asperger Association of Asturias.

Asperger´s syndrome (AS) associations perform an important social role in these times. They receive families that are going through a hard time prior to the diagnosis by making initial assessments or completing existing tests. After diagnosis, the association offers help to the boys and girls (and also to other ages) through social skills workshops and other services, but not only to them but also to their family, school, etc. These services fill in the void many people with Asperger´s find themselves in by the administration and health services.

On the other hand, AS is still not well understood, not only by the general public but also by many professionals in the sphere of medicine, psychology, or education. Behind this ignorance lies the suffering of many boys and girls, young people, and even adults, as well as those around them.

Even Better was also devised to increase awareness, with the firm conviction that only through acknowledging diversity can acceptance and proper treatment be reached (this is crucial so that today’s kids can have a full life tomorrow).

Gratefulness

• Llara García Estrada - Spanish voice
• Kevin de Castro Cogle - English voice
• Dalia Álvarez Molina - French voice