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

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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

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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
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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.