Autism Cymru Handouts - AWARES, the All Wales Autism Resource

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Transcript Autism Cymru Handouts - AWARES, the All Wales Autism Resource

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
Social Impairment
(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
 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).
 65 children with a diagnosis of Asperger
syndrome aged 10-13 years - upper primary
 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
 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
Int. + Parents
Social Worries
Int. + Parents
Speech and Language
Pragmatics, Prosody and
Pragmatic Aspects
The art of conversation.
 Reciprocity.
 Repairing a conversation.
 Knowing when and how to interrupt.
(pauses, cues, discomfort, waiting,
Pragmatic Aspects
Inappropriate comments. (revealers of truth).
Keeping on track.
Primarily interested in an exchange of
Appropriate topics.
Monologues or scripts.
Recognizing and accepting different points of
Literal interpretation.
Pedantic Speech
Overly formal and pretentious.
 Excessive technical details.
 ‘Adult’ quality, sophisticated grammar or
 Must correct errors.
 Precise intonation.
Unusual Qualities of
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
 Attention to detail and prodigious memory.
The Consequences and
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,
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
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
“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
 Ball catching skills.
 Manual dexterity.
 Handwriting.
 Movement disorder. Motor tics such as
blinking and grimaces, vocal tics such as
clicks and animal noises.
Profile on an Intelligence Test.
 Verbalizers or Visualizers.
 Self-taught
 Mathematics and reading.
 Fear of failure.
 Refusal to do something unless it is perfect.
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
 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
priorities and
•Talents and
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.
Signs Associated With
Paranoia ( Reality and impaired Theory of
 Fantasy life (Alternative world and to
escape from reality).
 Vocalizing thoughts ( Disengaging mind
from mouth).
 Delusional thinking ( severe anxiety).
Signs Associated With
Delusions of grandeur (God mode).
 Thought Disorder (Pragmatic aspects of
 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
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
 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
How to Explain the
When to explain the diagnosis.
 What’s good about me and not so good
about me.
 Advantages and disadvantages.
 Asperger’s achievers.