Wales’ 1st International Autism Conference Dr Tony Attwood High Functioning Autism and Asperger Syndrome Autism Cymru 04 “ The nature of these children is revealed most clearly in their behaviour towards other people. Indeed, their behaviour in the social group is the clearest sign of their disorder and the source of conflicts from earliest childhood.” Social Impairment Reciprocity (the balance between participants) Inclusion (“My Way”) End product. Spontaneity and humour. Pretending to Be Normal ..the fun came from setting up and arranging things. Maybe this desire to organize things rather than play with things, is the reason I never had a great interest in my peers. They always wanted to use the things I had so carefully arranged. They would want to rearrange and redo. They did not let me control the environment. Social Impairment Maturity in friendship skills. Limited vocabulary for characterization. Limited response to peer pressure. Conspicuous preference for solitude. Unaware of the codes of social conduct. Social Impairment Level of maturity in deceit. (fantasies not lies or psychosis). Busy but not playing with anyone. See a room full of toys to play with not friends to play with. Limited ability with team skills. Social Impairment Limited range of facial expression and body language. Difficulty reading the facial expressions and body language of others.(11, Corey). Limited ability to conceptualize the thoughts and feelings of others. Empathy. (mother: characterization and being sad.). The Value of Friendship Learn alternative perspectives and solutions. Facilitates appropriate conflict resolution. Team Work Skills for Employment Basis of Adult Relationships. The Value of Friendship ‘Antidote’ to depression. Avoid bullying. Cognitive Behaviour Therapy Cognitive Deficiency. (maturity, complexity and efficacy). Cognitive Distortion. (dysfunctional thinking and incorrect assumptions). Exploring Feelings Participants 65 children with a diagnosis of Asperger syndrome aged 10-13 years - upper primary school Children further screened using the Children’s Asperger Syndrome Test (CAST) – children who did not meet criteria included in groups but no data collected No children excluded from participating on the basis of other diagnoses (e.g. ADHD) Anxiety endorsed by parents Measures Spence Children’s Anxiety Scale (SCAS) – child version – parent version – six subscales Social Worries Questionnaire (Spence, 1995) – child version – parent version James and the Maths Test (Attwood, 2002) – case scenario Random Allocation Intervention Group 1 – 26 children each allocated to a group of 3 with two therapists per group Control Group – 28 children wait-listed for intervention Intervention Group 2 – 28 children each allocated to a group of 3 with two therapists per group – two parent groups following the same intervention James and the Maths Test 6 5 4 Intervention Control Int. + Parents 3 2 1 0 Pre Post 6-weeks Social Worries Questionnaire 14 12 10 Intervention Control Int. + Parents 8 6 4 2 0 Pre Post 6-weeks Speech and Language Characteristics. Pragmatics, Prosody and Pedantic. Pragmatic Aspects The art of conversation. Reciprocity. Repairing a conversation. Knowing when and how to interrupt. (pauses, cues, discomfort, waiting, forgetting). Pragmatic Aspects Inappropriate comments. (revealers of truth). Keeping on track. Primarily interested in an exchange of information. Appropriate topics. Monologues or scripts. Recognizing and accepting different points of view. Literal interpretation. Pedantic Speech Overly formal and pretentious. Excessive technical details. ‘Adult’ quality, sophisticated grammar or phrases. Must correct errors. Precise intonation. Unusual Qualities of Speech. Idiosyncratic use of words. (Hoover). Neologisms. Volume. Vocalizing thoughts. Verbal fluency affected by anxiety. Late onset. Special Interests Nature of the Interests Typical and idiosyncratic. Self-directed and self-taught. Solitary and intuitive activity. Development of a cataloguing system. Creative arts, drawing, sculpture, music and poetry. Attention to detail and prodigious memory. The Consequences and Function: Parents Perspectives Trying to quench an almost insatiable thirst for access to the interest. Special trips, late for appointments, detours unusual vacations and leaving a social gathering early. Access without permission.(journeys and conflict with the law) Teachers Perspectives Attention to other activities. Monologues make the child appear eccentric and ridiculed. A barrier to social inclusion. The nature of the interest (weapons). Benign eccentric or a pedantic bore. Perspective of the Person With Asperger’s Syndrome May be oblivious to the feelings and concerns of others regarding the interest. Natural understanding of the physical rather than the social world. To understand the physical world (weather, geography). To learn about and overcome fears (vacuum cleaners and thunderstorms). Interests are like air. Perspective of the Person With Asperger’s Syndrome Theory of Weak Central Coherence. (The pattern or gestalt). Taxonomies such as the different types of insects or the Periodic Table to be able to achieve coherence and predictability. This can include an interest in the laws of science, statutes and the Bible. Perspective of the Person With Asperger’s Syndrome Achieving success in the intellectual world. Topics on conversation (confidence, fluency and knowledge). The interest can be valued by peers. A successful career. “ The best thing about academia is that we get paid to talk about our favorite topic and students take notes and feed back our words of wisdom at exams”. Perspective of the Person With Asperger’s Syndrome Enjoyment and Anxiety reduction. Survey results: Genuine enjoyment, comfort and relaxation.(negative reinforcement). Facilitation or avoidance of social interaction. Clinician’s Perspective. Diagnosis (a change in ‘persona’). Morbid or macabre interests a sign of Depression or bullying). Progression from an activity for pleasure to a compulsive act. (OCD). Society’s Perspective Originality in Science and Art (Temple Grandin) “If the World Was Left to You Socialites, We Would Still Be in Caves Talking to Each Other” Temple Grandin Triggers to the Development of a Special Interest Association with fear or pleasure. ( a fear of toilets leading to an interest in plumbing). Commemorative of a happy time (trains) To seek a simpler and happier world. Motor Clumsiness Locomotion (upper and lower limb coordination). Ball catching skills. Manual dexterity. Handwriting. Movement disorder. Motor tics such as blinking and grimaces, vocal tics such as clicks and animal noises. Cognition Profile on an Intelligence Test. Verbalizers or Visualizers. Self-taught Mathematics and reading. Fear of failure. Refusal to do something unless it is perfect. Cognition Encyclopedic memory. Solitary and idiosyncratic imaginative play. Preference for routines. Limited flexibility in thinking. Originality in problem solving. Sensory Sensitivity Sound sensitivity. Tactile sensitivity. Sensitivity to the taste or texture of food. Stoic in response to pain or temperature. Profile of Abilities in Girls Same pattern, less severe expression. Coping mechanisms: a. Hiding and mimicking. b. Imitation, doll play, peer support, reading. less disruptive, rate of learning. Special interests (animals, classic literature). Imaginary friends. Profile of Abilities in Girls Changing their name or adopting the persona of another person. Elective mute when starting school. Self-help literature. A part of their life is missing. Asperger’s syndrome •Pursuit of knowledge and truth. •Alternative priorities and perception. •Talents and vulnerabilities. Quotation of Hans Asperger. “It seems that for success in science or art, a dash of autism is essential. For success, the necessary ingredient may be an ability to turn away from the everyday world, from the simply practical, an ability to re-think a subject with originality so as to create in new untrodden ways, with all abilities canalised into the one speciality.” (1979). Association With Famous Individuals in Science and Art Ludwig Wittgenstein. Albert Einstein. Bela Bartok. Alan Turing. Bill Gates. Thomas Jefferson. Howard Hughes. Napoleon. Signs Associated With Schizophrenia Paranoia ( Reality and impaired Theory of mind). Fantasy life (Alternative world and to escape from reality). Vocalizing thoughts ( Disengaging mind from mouth). Delusional thinking ( severe anxiety). Signs Associated With Schizophrenia Delusions of grandeur (God mode). Thought Disorder (Pragmatic aspects of language). Mood congruent delusions. Inner voice. Literal interpretation.(Do you hear voices? – Wendy Lawson)). Lower and Upper Levels Inclusion of individuals with a mild intellectual disability? The Asperger’s Personality Type. The boundaries with other disorders and dual and multiple disorders. Cognitive and Personality Profiles Verbalisers ( Higher verbal IQ –diary, Social Stories, metaphor and discussion, career lawyers). Visualisers (Higher performance IQ-Comic Strip Conversations and role play, career-engineers ). Active (disruptive, anger management, early diagnostic assessment). Passive (camouflage difficulties, depression, later diagnostic assessment,). Diagnostic Criteria and Assessment of Adults Theory of mind tasks. (The Eyes Test). Self report instruments. (Autism Social Quotient and the Empathy Quotient by Simon Baron-Cohen and colleagues). Quality and timing of responses. Diagnostic Criteria and Assessment of Adults Developmental history. (validation). Photographs of childhood and school reports. Description of self. (Social references). When first noticed being different and what were the differences. Explaining the Diagnosis Three reactions: Depression and social withdrawal. Arrogance and anger (God mode). Imagination and fantasy. Without a diagnosis, others will make moral judgments. How to Explain the Diagnosis. When to explain the diagnosis. What’s good about me and not so good about me. Advantages and disadvantages. Asperger’s achievers.