Acclaimed expert Dr. Tony Attwood answers common questions.
With the help of technology, we recently had a chance to connect with author and clinical psychologist Tony Attwood to talk about Asperger’s syndrome. In this Q&A interview, Tony provides up-to-date information about the disorder and unpacks the most pressing questions parents are asking.
Is Asperger’s syndrome the same as high functioning autism and Autism Spectrum Disorder?
Asperger’s syndrome is an expression of Autism Spectrum Disorder. The new DSM-5 has decided to replace the term ‘Asperger’s syndrome’ with ‘Autism Spectrum Disorder–Level 1, without language and intellectual impairment’. I find that this is a somewhat clumsy and tortuous term and, for simplicity and continuity, I use the term Asperger’s syndrome. In many ways it is the same as High Functioning Autism and the two terms are virtually synonymous.
How is Asperger’s diagnosed?
The diagnostic process explores each of these dimensions using a range of instruments and activities that explore aspects such as Theory of Mind abilities and unusual aspects of both play and behaviour.
What are the symptoms of Asperger’s syndrome?
The key symptoms of Asperger’s syndrome are identified in the new DSM-5, namely deficits in social emotional reciprocity, non-verbal communication, and developing and maintaining relationships and friendships. There is also an unusual profile of behaviour that can include a fascination with particular topics that are unusual in terms of intensity or focus, a preference for sameness and routine, as well as sensory sensitivity.
Is there a typical age when Asperger’s is diagnosed?
Asperger’s syndrome in boys is often diagnosed between the ages of around 4-10 years, however, often girls with Asperger’s syndrome may not be diagnosed until the high school years when their social difficulties may not become apparent until social demands exceed their limited social abilities.
Is it possible that a child is misdiagnosed with or without Asperger’s?
It is possible to have what we describe as a ‘false positive’ or ‘false negative’ in terms of the child may initially appear to have the characteristics of Asperger’s syndrome in early childhood, but there may simply be a developmental delay in the particular aspects associated with Asperger’s syndrome and over time the clinical picture changes. The characteristics of Asperger’s syndrome have now become sub-clinical, that is, not significantly affecting that person’s daily life. It is also possible to have a diagnosis of another developmental or psychiatric disorder that camouflages the characteristics of Asperger’s syndrome. This would be a false negative and, again over time, the clinical picture may become more apparent and confirm a diagnosis of Asperger’s syndrome.
Are there signs and symptoms of Asperger’s new parents should be watching for?
I think the signs and symptoms that new parents should be watching for are the child’s ability to engage in social interaction, especially with their peers. My thoughts are that in terms of social and emotional reciprocity, there are three expressions we look for.
The first is someone who is overwhelmed, confused and reluctant to engage in social interaction. The child is shy, introverted and withdrawn.
There is a second group that are not introverted and withdrawn, but are indeed extroverted and intrusive and socially intense in social situations. I describe such children as Italian drivers in terms of not reading the social signals as much as some Italian drivers do not notice or take heed of the traffic signals. The difference here is that the child is highly motivated to socialize but often unaware of their lack of ability to read the social conventions and social cues.
The third group, often identified in girls with Asperger’s syndrome, are those who are hesitant to engage in interaction but are avid observers and analyzers of social behaviour in their peer group and eventually learn to imitate other children, which camouflages their social confusion.
Other signs that I would ask that parent to explore are difficulties with the pragmatic aspects of language, coping with change and transitions, high levels of anxiety, rather unusual interests; in terms of intensity or focus, sensory sensitivity, and a learning profile that includes areas of conspicuous talents and difficulties.
Is therapy or medication used once a child has been diagnosed?
My recommendation is for therapy in a wide range of areas, not only in terms of friendship and conversation skills, but also in terms of managing emotions and developing an accurate and positive sense of self. This is particularly important for teenagers, whose sense of self-esteem is often based on the criticisms of peers rather than compliments. There may also be benefits in terms of therapy from an Occupational Therapist, who may help in a range of areas from handwriting skills to sensory sensitivity.
Medication may be used to manage anxiety as well as improve attention, but there is no medication that will significantly improve the diagnostic characteristics of Asperger’s syndrome.
When is the best time to tell your child about his diagnoses?
The best time to explain the diagnosis is when the child first knows that they are different. This may be when he/she notices that they are not invited to parties or included in social activities at school. Usually around the ages of 7-9 years the child is more aware of being different to other children and this is the time to explain the nature of that difference in a positive way. Fortunately, we have a number of books that will help explain the diagnosis, most of which are published by Jessica Kingsley Publishers, www.jkp.com, for example, the book ‘All Cats Have Asperger’s Syndrome’ by Kathy Hoopmann.
Does Asperger’s syndrome present differently in girls?
Girls are often more creative and intelligent in coping with their social confusion in comparison to the boys. Their use of observation, analysis and imitation means that they are more likely to acquire the skills that appear to be so elusive for the boys. The girl may also be remarkably well behaved at school but a totally different character at home. Thus, teachers do not recognize the confusion and challenges faced by the girl with Asperger’s syndrome in the classroom. It is almost as though the girl is a Dr Jekyll and Mr Hyde in terms of having a different persona at home and at school. The girls may be able to make friends but not keep them and become very distressed when a friendship ends. Girls may be talented in the arts; for example, drawing with photographic realism, singing in perfect pitch or learning languages.
Is Asperger’s syndrome inherited?
Asperger’s syndrome has many causes, one of which is genetics, in terms of inheritance and, from my clinical experience, for half the families that I see, there seems to be Asperger’s syndrome between and within generations. It is also important to remember that someone must fall in love with a person who has Asperger’s syndrome, otherwise it would have died out years ago. Therefore, I am often involved in relationship counselling where one of the parents has the undiagnosed characteristics of Asperger’s syndrome, which has a significant effect on the relationship. There can be a considerable difference between the management strategies of a parent with Asperger’s syndrome and a neurotypical parent.
Other causes are currently being investigated, such as a dysfunction of the autoimmune system, and circumstances that may affect the development of specific areas of the brain, especially those involved with social reasoning in the frontal and temporal lobes.
Do all children with Asperger’s syndrome act out and have aggressive behaviour? Or do some children internalize their feelings?
As a clinical psychologist we recognize that children can internalize or externalize their feelings. Sometimes aggressive behaviour can be acting out inner emotions, in particular feeling sad and anxious. Thus, the person may not be ‘aggressive’ in the conventional sense, but may be frustrated due to being thwarted from strategies that reduce anxiety, or feeling low self-esteem and being rejected by others, which is then not channeled to the self but to others. Sometimes I call this going into ‘attack mode’.
In contrast, those who internalize and suppress their feelings may be more prone to depression and low self-esteem, and we do recognize a high level of clinical depression in teenagers with Asperger’s syndrome. One of the major causes being a low sense of self, but also the effects of being bullied, teased and rejected by peers.
Do all children with Asperger’s struggle with eye contact? If yes, how can a parent help develop this skill?
Eye contact is a fascinating area in relation to Asperger’s syndrome and while those with Asperger’s syndrome may know when to look, they may not be able to read the ‘messages in the eyes’ as well as you would expect considering their intellectual ability. We now have a range of programs to teach children with Asperger’s syndrome how to read meaning, not only in the eyes, but also in body language and tone of voice.
Are you familiar with a program called PEERS?
The PEERS program is increasingly being recognized as a very valuable program for those with Asperger’s syndrome. It is a program that I recommend to parents, as well as a range of other programs such as the ‘Secret Agent Society’ which was developed here in Brisbane, Australia.
What are some of the gifts a child with Asperger’s has and how to you help them to develop them?
Those who have Asperger’s syndrome can have particular talents in both the arts and sciences, but also talents in terms of being very kind and having a successful career in caring professions as well as working with animals, such as the success of Temple Grandin in the cattle industry. It seems that if the person is less able with regard to social reasoning they may be more able in other areas of ability. My opinion is that most of the major advances in science and art have been made by people with Asperger’s syndrome. I have also noted originality in problem solving with a phenomenal memory. Our society has benefitted from, and will continue to need, the different way of thinking of those with Asperger’s syndrome.
What is the prognosis for kids, youth and adults with Asperger’s.
The prognosis for children with Asperger’s syndrome is improving every year and we now have transition programs from high school to the adult world including strategies to help that person at college and university, as well as to find and flourish in an appropriate career. There are also resources to help those with Asperger’s syndrome in terms of relationships as a partner and a parent.
Can you recommend resources for parents: Books, videos, websites?
I recommend the resources published by Jessica Kingsley Publishers, with more information at www.jkp.com and my webpage www.tonyattwood.com.au often includes information on new resources.
Readers may also be interested in the website of the Minds and Hearts clinic, here in Brisbane, www.mindsandhearts.net
If you could give one piece of advice for a parent who has walked the road of Asperger’s with their child and are now preparing for high school graduation, what would it be?
If I could give one piece of advice for a parent of a child who is now preparing for a high school graduation it would be to focus on the qualities that that teenager has, in terms not only of ability but also in terms of personality. From the parents perspective, their son or daughter is not only loved for who they are, they are also that parent’s hero for how far they have progressed as they graduate from high school.
- The Complete Guide to Asperger’s Syndrome
- Asperger’s Syndrome: A Guide for Parents and Professionals
Professor Tony Attwood
Tony is a clinical psychologist who has specialised in autism spectrum disorders since he qualified as a clinical psychologist in England in 1975. He currently works in his own private practice, and is also adjunct professor at Griffith University, Queensland and senior consultant at the Minds and Hearts clinic in Brisbane. His book Asperger’s Syndrome – A Guide for Parents and Professionals has sold over 350,000 copies and has been translated into over 25 languages. His subsequent book, The Complete Guide to Asperger’s Syndrome, was published in October 2006 and is one of the primary textbooks on Asperger’s syndrome. He has several subsequent books published by Jessica Kingsley Publishers, Future Horizons Inc. and Guilford Press.
Tony has been invited to be a keynote speaker at many Australasian and International Conferences. He presents workshops and runs training courses for parents, professionals and individuals with Asperger’s syndrome all over the world and is a prolific author of scientific papers and books on the subject.
He has worked with many thousands of individuals of all ages with Asperger’s syndrome or an Autism Spectrum Disorder.