Wales’ 1Wales’ 1stst International Autism ConferenceInternational Autism Conference

Dr Tony AttwoodDr Tony Attwood

High Functioning Autism and High Functioning Autism and Asperger SyndromeAsperger 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 ImpairmentSocial Impairment

Reciprocity (the balance between participants)

Inclusion (“My Way”)End product.Spontaneity and humour.

Pretending to Be NormalPretending 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 ImpairmentSocial ImpairmentMaturity in friendship skills.Limited vocabulary for characterization.Limited response to peer pressure.Conspicuous preference for solitude.Unaware of the codes of social conduct.

Social ImpairmentSocial ImpairmentLevel 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 ImpairmentSocial ImpairmentLimited 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 FriendshipThe Value of FriendshipLearn alternative perspectives and

solutions.Facilitates appropriate conflict resolution.

Team Work Skills for Team Work Skills for EmploymentEmployment

Basis of Adult Relationships.Basis of Adult Relationships.

The Value of FriendshipThe Value of Friendship‘Antidote’ to depression.Avoid bullying.

Cognitive Behaviour TherapyCognitive Behaviour Therapy

Cognitive Deficiency. (maturity, complexity and efficacy).

Cognitive Distortion. (dysfunctional thinking and incorrect assumptions).

Exploring Feelings

ParticipantsParticipants 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

MeasuresMeasures 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 AllocationRandom 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 TestJames and the Maths Test

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Pre Post 6-weeks

InterventionControlInt. + Parents

Social Worries Social Worries QuestionnaireQuestionnaire

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Pre Post 6-weeks

InterventionControlInt. + Parents

Speech and Language Speech and Language Characteristics.Characteristics.

Pragmatics, Prosody and Pedantic.

Pragmatic AspectsPragmatic AspectsThe art of conversation.Reciprocity.Repairing a conversation.Knowing when and how to interrupt.

(pauses, cues, discomfort, waiting, forgetting).

Pragmatic AspectsPragmatic 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 SpeechPedantic SpeechOverly formal and pretentious.Excessive technical details.‘Adult’ quality, sophisticated grammar or

phrases.Must correct errors.Precise intonation.

Unusual Qualities of Unusual Qualities of SpeechSpeech..

Idiosyncratic use of words. (Hoover).Neologisms.Volume.Vocalizing thoughts.Verbal fluency affected by anxiety.Late onset.

Special InterestsSpecial Interests

Nature of the InterestsNature of the InterestsTypical 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 The Consequences and Function:Function:

Parents PerspectivesParents PerspectivesTrying 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 PerspectivesTeachers PerspectivesAttention 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 Perspective of the Person With Asperger’s SyndromeWith 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 Perspective of the Person With Asperger’s SyndromeWith 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 Perspective of the Person With Asperger’s SyndromeWith 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 Perspective of the Person With Asperger’s SyndromeWith 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.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 PerspectiveSociety’s Perspective

Originality in Science and Art (Temple Grandin)

““If the World Was Left to You Socialites, If the World Was Left to You Socialites, We Would Still Be in CavesWe Would Still Be in Caves

Talking to Each Other” Talking to Each Other” Temple GrandinTemple Grandin

Triggers to the Development Triggers to the Development of a Special Interestof 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 ClumsinessMotor ClumsinessLocomotion (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.

CognitionCognition

Profile on an Intelligence Test.Verbalizers or Visualizers.Self-taughtMathematics and reading.Fear of failure.Refusal to do something unless it is perfect.

CognitionCognition

Encyclopedic memory.Solitary and idiosyncratic imaginative play.Preference for routines. Limited flexibility in thinking.Originality in problem solving.

Sensory SensitivitySensory Sensitivity

Sound sensitivity.Tactile sensitivity.Sensitivity to the taste or texture of food.Stoic in response to pain or temperature.

Profile of Abilities in GirlsProfile of Abilities in GirlsSame 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 GirlsProfile 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.

•Pursuit of knowledge and truth.

•Alternative priorities and perception.

•Talents and vulnerabilities.

Asperger’s syndrome

Quotation of Hans Asperger.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 Association With Famous Individuals in Science and ArtIndividuals in Science and Art Ludwig Wittgenstein. Albert Einstein. Bela Bartok. Alan Turing. Bill Gates. Thomas Jefferson. Howard Hughes. Napoleon.

Signs Associated With Signs Associated With SchizophreniaSchizophrenia

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 Signs Associated With SchizophreniaSchizophrenia

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 LevelsLower 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 Cognitive and Personality ProfilesProfiles

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 Diagnostic Criteria and Assessment of AdultsAssessment 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 Diagnostic Criteria and Assessment of AdultsAssessment 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 DiagnosisExplaining 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 How to Explain the Diagnosis.Diagnosis.

When to explain the diagnosis.What’s good about me and not so good

about me.Advantages and disadvantages.Asperger’s achievers.