Notes on The Complete Guide to Asperger’s syndrome by Tony Attwood (Emmett)

Being alone can be a very effective way of calming down and is also enjoyable, especially if engaged in a special interest, one of the greatest pleasures in life for someone with Asperger’s syndrome (Attwood 55-56).

The child with Asperger’s syndrome may also be sen- sitive to change and be anxious if things are not where they have been or should be. Fur- niture and objects in the bedroom will be a known configuration, and family members will have learned not to move anything. The child’s bedroom is a refuge that is sacrosanct (Attwood 56).

The essential feature of Asperger’s syndrome is a qualitative impairment in social inter- action, which is acknowledged in all diagnostic criteria. The criteria also refer to a lack of social or emotional reciprocity and failure to develop peer relationships appropriate to developmental level (Attwood 57).

Children with Asperger’s syndrome can develop imaginative play but usually as a solitary and idiosyncratic activity (Attwood 59).

Children with Asperger’s syndrome tend to notice and describe objects and physical actions with a relative lack (in comparison to their peers) of reference to the thoughts, feelings and intentions of the participants in the picture (Attwood 60).

In much the same way that actors in a theatre play learn how to act, and rehearse their roles, the child can be taught how to engage in reciprocal play (Attwood 65).

Children with Asperger’s syndrome often enjoy watching the same movie many times. This is a common preferred activity of typical children but the child with Asperger’s syndrome may be unusual in terms of the number of times the film or programme is watched. This is not necessarily a self-stimulatory behaviour, as suggested in some of the behaviourist literature on autism, but in my opinion a constructive way of learning without the confusion and effort of having to socialize or talk (Attwood 67).

When discussing childhood social experiences with young adults with Asperger’s syndrome, I have listened to many descriptions of social confusion, and how, very often, the response of adults was criticism of social mistakes but rarely praise for what was appropriate. The child often assumed that at the end of an interaction, a lack of criticism, sarcasm or derisory laughter meant the interaction was successful but had no idea what he or she had done that was socially appropriate (Attwood 68).

In stage two of friendship, children develop greater cooperation when playing with their peers and develop more constructive means of dealing with conflict. It is important that the child with Asperger’s syndrome learns the theory of, and gains practice in, various aspects of cooperative play using Social StoriesTM and role-play activities (Attwood 73).

Another reply to the question ‘What makes a good friend?’ can be ‘Someone with a sense of humour’. Children with Asperger’s syndrome tend to make a literal interpretation of what someone says and may not understand when someone is joking; however, there can be a wonderful, though sometimes idiosyncratic, sense of humour (Attwood 75).

Children with Asperger’s syndrome are usually brutally honest and speak their mind. Their allegiance is to the truth, not people’s feelings. They may have to learn not to tell the truth all the time. While honesty is a virtue, peers at this stage are starting to tell white lies so as not to hurt friends’ feelings, or to express solidarity and allegiance to friendship by not informing an adult of the misbehaviour of a friend (Attwood 77).

Extensive clinical experience and autobiographies confirm that while the person with Asperger’s syndrome can have considerable intellectual ability, especially in the area of knowing facts, there is invariably confusion and immaturity with regard to feelings (Attwood 128).

There are many different types of psychotherapy that have been used with children and adults with Asperger’s syndrome, but very few published case studies. In my opinion, traditional psychoanalytical psychotherapy has very little to offer a child or adult with Asperger’s syndrome, an opinion shared by some psychotherapists (Attwood 316).

The methods of analysis used in traditional psychoanalytical therapy are based on a conceptualization of the development of typical children, but children with Asperger’s syndrome perceive and relate to a very different world. In psychoanalytical therapies, the pretend play of the child is analysed to explore his or her inner thoughts. The natural pretend play of young children with Asperger’s syndrome is often an accurate re- enactment or ‘echo’ of a scene from the child’s favourite story, and is not necessarily a metaphor for his or her life or to be attributed with projected meanings (Attwood 316).

Psychotherapy can be of considerable value to parents in helping understand the psychological reactions to having a son, daughter or partner with Asperger’s syndrome, and the frustration of saying, ‘I shouldn’t have to tell you’ (Jacobsen 2003). This comment, often said in exasperation, would probably have been said many times to a person with Asperger’s syndrome and is usually due to not understanding the nature of Asperger’s syndrome (Attwood 317).

Children and adults with Asperger’s syndrome can benefit from psychotherapy, but the therapy needs to be based on a thorough understanding of the nature of Asperger’s syndrome, especially the ability of the person to understand and communicate thoughts and feelings, and the concept of self in terms of self-image, self-esteem and self- acceptance, based on the life experiences of someone with Asperger’s syndrome (Attwood 317).

The development of a rapport between client and psychotherapist is essential, but clients with Asperger’s syndrome can either instantly, and permanently, like or dislike other people, especially professionals (Attwood 318).

Although psychotherapy can be extremely valuable in helping a person with Asperger’s syndrome, there are difficulties in finding a psychotherapist with extensive experience with clients who have Asperger’s syndrome, and meeting the cost of lengthy therapy (Atwood 318).

Conventional psychotherapy relies on a conversation between client and psycho- therapist in a face-to-face interaction. We know that the client with Asperger’s syndrome will have a limited ability to express inner thoughts and emotions eloquently using speech, and greater difficulties, in comparison to typical clients, in processing the psychotherapist’s speech and intentions and deciphering subtle social and emotional cues (Attwood 319).

People with Asperger’s syndrome have considerable difficulty with the social and conversational aspects of life, and when these are minimized, the person is better able to explain and learn (Attwood 319).

Another approach is to use art as a means of expression, such as drawing an event, and using speech and thought bubbles as occurs when making a ‘Comic Strip Conversa- tion’ (see Chapter 6). The client may prefer to choose music that accurately expresses the thought or emotion or, in the case of children, re-enact a scene from a favourite movie or story that resembles the event or emotions. These indirect strategies can give a remark- able insight into the inner world of the person with Asperger’s syndrome (Attwood 319).

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