Friday, November 13, 2009
"Congratulations," the psychologist said to his 11 year-old client, "you have Asperger's."
Today, being diagnosed as "on the spectrum", comes with perks. People assume you're smarter than average, and often they're right.
All Cats Have Asperger Syndrome, Kathy Hoopmann's new book for kids, is used by parents and clinicians alike in explaining to kids just what "Asperger Syndrome" means. The book is funny, dead-on and has a strangely intuitive appeal. After all, cats don't need to run up, tail wagging, when you get home. They're not barkers, and are content to simply leave your lap without a backwards glance when they're done being petted. Interaction with cats seems streamlined, without all the fuss and fanfare associated with canine communication.
If you're an adult with Asperger's, you probably didn't receive a congratulatory handshake when you received your diagnosis, if you received a diagnosis at all. This book is for kids, it's true. But it's also for past generations of Aspies, who may have missed out on the feel-good atmosphere surrounding the spectrum today.
If you're an adult with Asperger's, you're not alone, and deserve congratulations for getting through this much of your life without the benefit of school IEPs, sensory interventions and social skills classes.
You deserve a high-five.
Back in 1980, American psychotherapist David Burns published a book which has remained a therapy standard since. Feeling Good: The New Mood Therapy was an instant bestseller. The book details the relationship between thoughts and mood, and offers research-based exercises for taking control of "automatic thoughts", and as a result, mood.
Burns identified ten common cognitive distortions, exaggerated and irrational thoughts, which can negatively affect mood. They are extremely common, and identifying them in yourself can serve as the first step in changing them.
Look over the following list and see if any of these distortions are habits of yours.
1. ALL-OR-NOTHING THINKING: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat.
3. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
5. JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts that convincingly support your conclusions.
a. Mind Reading. You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out.
b. The Fortune Teller Error. You anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact.
6. MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: You exaggerate the importance of things (such as your goof-up or someone else’s achievement). Or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the “binocular trick.”
7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."
8. SHOULD STATEMENTS: You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.
9. LABELING AND MISLABELING: This is an extreme form of over-generalization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him: “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
10. PERSONALIZATION: You see yourself as the cause of some negative event which in fact you were not primarily responsible for.
Cognitive distortions are characteristic of depression and anxiety. Adults with Asperger's are especially vulnerable to adopting distorted patterns of thinking. Cognitive Behavioral Therapy (CBT), a modality of psychotherapy which aims to challenge and change distortions, is the most researched and common form of therapy used to help people with Asperger's change the way they think about themselves. Often adults on the spectrum, when confronted with the illogical nature of some of these automatic thoughts, are eager to change them to adopt a more reality-based perspective.
If you find yourself engaging in distorted thinking, you can begin to replace the illogical thoughts with more accurate (and often forgiving!) thoughts right away. Remember, cognitive distortions which leave you holding the short end of the stick can feel like a form of perfectionsim. But they can often hold you back from enjoying life, feeling confident and reaching potential.
For more on David Burns, visit the Feeling Good website at http://www.feelinggood.com/
Tuesday, November 10, 2009
Listen to NPR's interview with Tim Page, author of Parallel Play: Growing Up with Undiagnosed Asperger's.
Asperger's Disorder is just that - a disorder.
Or is it?
A new wave of people determined to own - and enjoy - their Asperger's status has emerged, and the wave has many clinicians questioning our tendency to pathologize. As we enter a new age of appreciation of diversity, from race to types of intelligence, why, when it comes to Asperger's, are we stuck with diagnoses and tests, therapies and interventions?
One clear answer to this complex question is the notion of distress. An adult with Asperger's (or something close to it) who is in distress as a direct result of the disorder should have access to help. Not help erasing his unique characteristics. Not help being like everyone else. Rather, help enjoying the strengths of Asperger's and minimizing the depression and anxiety that can come with being different.
"That's ridiculous," I hear in the therapy office from some clients, "what good can come of having a developmental disorder?"
But enjoying the strengths that come with the package of neurological differences we call Asperger's is not a new concept. For instance, in their 2001 bestseller Now, discover Your Strengths, Marcus Buckingham and Donald Clifton, Ph.D. set out to identify styles of information processing that affect the workplace. The result was a spread of over 30 different relating and information processing styles. This was not necessarily a new concept. What was new was how these different styles were judged: not according to a black and white system of good and bad, but as all strengths to be cultivated, utilized and enjoyed by employees and employers alike.
For instance, one theme, the "Analytical", is a familiar style to many Aspies. "You see yourself as objective and dispassionate. You like data because they are value free. They have no agenda....It is hoped that your analysis is never delivered too harshly. Otherwise, others may avoid you..." (page 86). Depending on one's perspective, this strength can be perceived as a skill set, a style, a character flaw, an indifference to people, and on and on. It is up to each individual person with Asperger's to train his or herself to focus on and enhance strengths.
A second theme described is the "Deliberative", another style which resonates with many Aspies. "You are careful. You are vigilant," the writers assert, "You are a private person. You know that the world is an unpredictable place. Everything may seem in order, but beneath the surface you sense many risks. You like to plan ahead so as to anticipate what might go wrong....If some people don't like you because you are not as effusive as others, then so be it." (page 94). Depending on one's perspective, this strength can be judged as responsible, anxious, obsessive- compulsive, non-spontaneous, and on and on. Again, it is up to the individual with Asperger's to see the beauty in this strength and invest in it.
We all want to find ways to identify, enjoy and share our gifts. Have you identified yours? Are you enjoying them? Sharing them?
Saturday, November 7, 2009
When I ride the bus I am struck with just how different the riders look from how they might have looked just ten years ago.
Of course I am not the first to notice that people are largely in their own bubbles - ears occupied by headphones, eyes occupied by screen. The chit chat, the shared human experience of bus-riding - that awareness of being part of a group of human beings engaging in the activity of travel via public transportation - has changed.
Critics call this dependence on electronics dangerous. Electronics usage, largely a solitary activity (at least in the physical sense), prevents people from connecting with others, and increases isolation, which can be damaging for people who already struggle with socializing. Penelope Trunk writes in the March 19, 2006, Boston Globe,“The human moment is a quality of interaction you don’t get from computers, or even the phone.”
But defenders of technology assert that the people who use technology while in group settings are often the very individuals who would have avoided socializing anyway. Technology, they propose, just gives them a comfortable way to avoid it.
But is it too comfortable?
The issue may not be black and white, however, at least for Aspies. Exposure Therapy, a form of cognitive-behavioral therapy, is a well-researched avenue for facing and overcoming sources of anxiety, such as simple phobias. The therapy involves the creation of a program of steadily escalating steps or challenges, which work towards a final goal of reduced or eliminated anxiety responses. Reducing interactions with others to near zero may prevent Aspies from receiving the very therapy that might reduce discomfort in social situations: real-time interactions with others, with their messy outcomes and unpredictable paths.
Yes Aspies themselves often report reduced anxiety in groups when able to rely, at least partially, on technology. "My iPod had become a security blanket," says one client with Asperger's, "without it I found the bus intolerable, and wouldn't even board before the headphones were in." Yet this very client benefited greatly from a self-imposed regiment of practiced, brief "chit-chat sessions" with riders. They key to his success may have been selective use of his electronic gadget in social settings, such that its function was not total escape, but a support gadget of sorts. After adopting a more balanced understanding of how to use his gadget for anxiety modulation, rather than total prevention, he was able to increase social interactions, lower their associated anxiety and gain a sense of mastery over a previously fear-laden situation: group transportation.
For Aspies, technology may work best as an adjunct to socializing, rather than a substitute. Awareness and self-monitoring are key to the success of the Aspie who aims to lower social anxiety and reduce reliance on mobile electronics. Aspies, like all, largely require both solitary and group connection. After asking teens about this very issue, Neal Starkman of The Journal writes in his March 1, 2007 article on communication and technology, "From their responses, it seems that young people want technology because it secures two basic needs that, seemingly contradictory, are crucial to their well-being: to be left alone, and to connect with others."
If you have Asperger's and and iPod, you may want to push yourself to interact when you can....for some, it may be the only way to ride the bus comfortably. For information on cognitive behavioral techniques and Asperger's visit www.terratherapy.org or http://www.nacbt.org/whatiscbt.htm
Thursday, November 5, 2009
Look Me in the Eye: My Life with Asperger's is John Elder Robison's funny and poignant account of his own experience of Asperger's. the memoir is humorous and bold.
Donna Chavez of Booklist writes, "Robison's memoir is must reading for its unblinking (as only an Aspergian can) glimpse into the life of a person who had to wait decades for the medical community to catch up with him."
What is central coherence, and how can different drives for central coherence affect communication?
Allow me to share a vignette:
Shari and Kevin have just celebrated Thanksgiving.
Shari recounts her experience of the holiday in their couples counseling session. "I was exhausted," she states, "I had no time off from the kids or work to really prepare, had to clean and prepare the house and yard for company, shop, cook for 11 people, manage relationships with Kevin's family members and get this kids ready, ALL while keeping my cool. It was exhausting and miserable. I'm never hosting Thanksgiving again."
Kevin recounts his account of the same holiday. "It was quite lovely. We had turkey, homemade stuffing, homemade cranberry sauce, homemade pumpkin pie. I played chess with my brother and beat him four times, a personal record. I also made spiced cider that was delicious, and adjusted the recipe I normally use by adding peppercorns. It was a nice holiday. I'm looking forward to next year's celebration."
Q: Which person is telling the truth?
Q: Which is more valid, her perspective or his?
Is it truly possible for two people to have such starkly differing views of an event and both be referring to the same Thanksgiving? A resounding YES! Welcome to the duplicitous world of life with an Aspie, where there are no right or wrong perspectives - only different perspectives.
Central Coherence Theory
People with ASD often have difficulties with central coherence. Central coherence can be described as getting the point, or gist, of things. It is the ability to pull information from different sources, experiences and schemas, both internal and external, to glean a higher meaning. Lacking central coherence can leave an individual vulnerable to misinterpreting of situations and communications.
In our vignette, Shari was able to describe her experience in a global fashion, pulling relevant internal and external details in, while leaving less relevant facts out. This was important to her ability to communicate and justify her sense of misery. She knew, "intuitively, what facts to include in her efforts to incite in the listener a sense of empathy for her - after all, who wouldn't be miserable after participating in the holiday she described?
Kevin, who lacks a sense of central coherence, was not just largely unable to include the details of his or her emotional experience of the holiday. For Kevin, these details were irrelevant to his message - what happened during the event, what was eaten, etc. He was unaware that Shari was having a miserable experience, and could not understand, given the factors he attended to during the event, why she was unhappy. "He can't see the forest for the trees" is a common criticism heard by Aspies regarding their ability to synthesize information to get the gist of a situation.
People without ASD often have a high need for central coherence in their efforts to understand situations. Aspies approach situations in a detail-oriented fashion, often through one channel at a time. The disparity between these two approaches to understanding and dealing with life can cause distress in relationships, leaving partners feeling they "speak different languages".
De-personalizing Disparate Neurology
While opposite approaches to collecting and synthesizing information can leave couples frustrated at times, it is crucial that both partners remember that Aspies who attend to data which do not include feelings often are not doing so due to indifference. Remembering that neurological differences are often the underlying causes of these differences can "de-personalize" what might otherwise feel hurtful. Communication skills such as active listening can help couples learn to listen to each other with their hearts - and the language of the heart is universal.
Back in 2006, researcher teams in the USA and Germany teamed up to assess empathy in adults with Asperger's. Their findings were published in the Journal of Autism and Developmental Disorders. The results were deemed surprising by many in the field at the time. Why? Because they contradicted many widely held beliefs about people on the spectrum, who are often described as "robotic" and "incapable of empathy". "They just can't read between the lines!" is a common complaint regarding Aspie adults.
Consider, however, the abstract below:
Who Cares? Revisiting Empathy in Asperger Syndrome
A deficit in empathy has consistently been cited as a central characteristic of Asperger syndrome (AS), but previous research on adults has predominantly focused on cognitive empathy, effectively ignoring the role of affective empathy. We administered the Interpersonal Reactivity Index (IRI), a multi-dimensional measure of empathy, and the Strange Stories test to 21 adults with AS and 21 matched controls. Our data show that while the AS group scored lower on the measures of cognitive empathy and theory of mind, they were no different from controls on one affective empathy scale of the IRI (empathic concern), and scored higher than controls on the other (personal distress). Therefore, we propose that the issue of empathy in AS should be revisited.
(1) Millhauser Laboratories (MHL-400), Center for Brain Health, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
(2) Institute of Experimental Psychology, University of Dusseldorf, Dusseldorf, Germany
(3) Nathan Kline Institute, Orangeburg, NY, USA
This research is contrary to most stereotypical versions of the Aspie as cold-hearted and uninterested in the feelings of others. So why does the common stereotype persist? Perhaps it is easy to miss empathy which is heartfelt, but not explicitly expressed. Perhaps, in this case, the burden is on the typical partner, friend or loved one to do the reading between the lines.
The couple was in the midst of a heated argument.
"Please stop looking at me like a dead cod fish!"
Believe it or not, statements like this from partners of adults with Asperger's are not all that uncommon. When confronted with a highly upset partner, some adults with Asperger's respond by shutting down completely, staring baffled at their partner instead conversing and adopting the pose of a....well....dead cod fish.
Often adults with Asperger's (ASD) are accused of by loved ones and friends, even coworkers, as LACKING EMPATHY. This is puzzling, as many Aspies report a heightened alarm system when confronted with emotional intensity. Do Aspies really lack empathy? Or are they shutting down when easily overwhelmed in emotionally charged situations, leading to a "non-empathic" presentation? Or is there some other explanation?
Theory of Mind
The typical individual, at an early age, develops the innate capacity to know and understand that other people have thoughts, feelings and desires that are different from his or her own. This understanding develops without effort, and is supported by the innate ability to engage in the nuances of interaction: body language, tone of voice, eye contact and other subtleties. This conceptualizing of "other" versus "self" is, what many researchers believe to be, the first step in empathy. In other words, it is very difficult to "empathize" with a separate person's unique experience without first understanding that their experience is just that - unique, or more aptly put, not the same as that of the self.
One of the most important milestones in theory of mind development is gaining the ability to attribute false belief: that is, to recognize that others can have beliefs about the world that are incorrect. To do this, it is suggested, one must understand how knowledge is formed, that people’s beliefs are based on their knowledge, that mental states can differ from reality, and that people’s behavior can be predicted by their mental states.
Researchers have investigated the false belief concept in intriguing ways. In one such experiment (often called the ‘Sally-Anne’ task), children are told or shown a story involving two characters. For example, the child is shown two dolls, Sally and Anne, who have a basket and a box, respectively. Sally also has a marble, which she places in her basket, and then leaves to take a walk. While she is out of the room, Anne takes the marble from the basket, eventually putting it in the box. Sally returns, and the child is then asked where Sally will look for the marble. The child passes the task if she answers that Sally will look in the basket, where she put the marble; the child fails the task if she answers that Sally will look in the box, where the child knows the marble is hidden, even though Sally cannot know, since she did not see it hidden there. In order to pass the task, the child must be able to understand that a person's mental representation of the situation is different from their own, and the child must be able to predict behavior based on that understanding. The results of research using false-belief tasks have been fairly consistent: most normally-developing children are unable to pass the tasks until around age four. Yet the test is often not passed by adults diagnosed with ASD.
Is Theory of Mind a necessary foundation for compassion? Compassion is a human emotion prompted by the pain of others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another person's suffering. It is often, though not inevitably, the key component in what manifests in the social context as altruism.
Though adult Aspies get stuck when it comes to understanding the WHY of another's emotions, they rarely seem to present with true indifference. Rather, many seem to adopt a position of indifference as a defense against an inherent lack of understanding of the basis for the emotions of others. It is, perhaps, this fundamental lack of understanding, COMBINED WITH an ultra sensitive and reactive physiological system, which leads to withdrawal. This withdrawal can leave loved ones feeling abandoned and uncared for, a recipe for problems in relationships.
"I love email," says one Aspie adult, "there's no overwhelm. I can read about my friend's upset without having to respond in the moment, manage eye contact, witness first hand things like crying and gesturing. Email is the grease of our relationship."
Before jumping to conclusions regarding your own or your partner's ability to empathize, remember that one truly cannot judge an Aspie by his or her cover. Professionals trained in working with autism spectrum disorders can help with adjusting terms of communication to prevent overwhelm and withdrawal, so that Aspies with compassion can be perceived as such.
There's nothing fishy about that.
In my psychotherapy practice, I often receive referrals for couples dealing with one partner's real or suspected diagnosis of Asperger Syndrome. More often than not, the partner who is frustrated and seeking therapy is the partner who has not been diagnosed.
Most of us know that adults with Asperger Syndrome (Aspies) have dramatically different ways of communicating and behaving in relationships. Some of these ways work beautifully! Some do not. If you are an adult who has been diagnosed with Asperger Syndrome, or suspects you might have the disorder, how can you begin to navigate the foggy, unpredictable, irrational land of intimacy? Following are five tips which may provide some beginning help.
1. Don't give in to feelings of hopelessness or futility.
Adults with Asperger Syndrome can at times feel overwhelmed by frustration. There are times these adults can feel that no amount of effort on their part can ever change their ability to understand how their partner operates. This is sometimes true - no adult can ever really become an expert on their partner's perceptions, thoughts, feelings and behaviors. The best strategy may be becoming an expert on yourself. This can serve as a foundation for learning new skills, having compassion for yourself and even learning to laugh at how different you and your partner may approach problems and issues.
2. Ask questions of your partner -gather as much information as you can about the situation you're facing together.
Faced with having to operate without an intuitive understanding of how your partner feels and thinks, you may rely on your logic and assumptions. This can be dangerous! Remember, your mind works differently than your partner's. A great strategy can be simply asking questions. For instance, instead of assuming that your partner is ready to end the relationship over a fight, ask for clarification. Good questions can include, "I'm wondering if you feel...." Or "Can you tell me more about that?".
3. Hold tight to the truth that your thoughts and emotions matter.
Though they may be expressed differently (or not at all!), your feelings and perceptions are valid, and are worth just as much as your partner's feelings and thoughts. This can be a difficult perspective to maintain, especially if your partner is articulate and quick. Remember, working out a problem is not a verbal jousting competition, though it can sometimes feel like one.
4. Decide how you would like to pursue and operate in relationships.
This takes thought. Do you want to connect with others? Do you experience loneliness? Do you want to increase your ability to talk about your inner world or negotiate problems? Not everyone aspires to these ways of relating. Decide for yourself if you do. If you decide to work to strengthen your connections, you may benefit from learning to monitor your "togetherness tolerance" - Aspies often are helped by frequent breaks, shorter visits, etc. Your level of need in connecting with others may differ vastly from that of your partner. This is fine, and may serve as a great balance for your relationship.
5. Find help. Often a cliche tip, there is no substitute for consulting an expert - a communication coach, a therapist, a well-written manual. Remember that though you may have not received the understanding of relationship nuance through osmosis, like many adults, you CAN learn skills that can close the gap you may feel between your ability to relate and the abilities of others.
One last tip - don't be too quick to judge yourself harshly. Aspies often provide wonderful advantages to their relationships, such as "groundedness", logic, a refusal to become violent or aggressive, a heightened desire to do the right or moral thing, an inability to participate in the emotional "games" so many adults struggle with in relationships, in intense sensitivity buried under layers of defense. As always, self-acceptance is the best position to take as you navigate the wonderful - and sometimes terrifying - frontiers of intimacy.
Daniel Tammet, author of Embracing the Wide Sky: A Tour Across the Horizons of the Mind, describes his life with high-functioning autistic savant syndrome. Daniel holds an official diagnosis of Asperger's, and many adults with Asperger's who read his biographical Born On A Blue Day describe his ability to relate the world of the Aspie mind to those without Asperger's as groundbreaking.
Tammet's newest book expands on such topics as the neurological basis for creativity, the benefits of meditation and training the brain to experience more happiness. The book is an excellent survey of the diversity and beauty of the minds of people who appear so different. He is a tireless advocate for Aspies, and believes stereotypes such as Rainman do much to confuse and bias the public towards those whose brains work a little (or a lot) differently.
Check out Tammet's blog at http://www.optimnem.co.uk/blog/index.php