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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.
Cognitive Behaviour TherapyCognitive Behaviour Therapy
Cognitive Deficiency. (maturity, complexity and efficacy).
Cognitive Distortion. (dysfunctional thinking and incorrect assumptions).
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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6
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.
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).
““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.