Saturday, August 28, 2010

Adults with Asperger's - The Eyes Have It

Researchers in 1997 (Baren-Cohen) found that adults with Asperger’s have difficulty reading mental states by looking at a person’s eyes – not only the expressions of the eyes, but the location of their gaze. These findings were expanded upon in 2002 (Rutherford), when researchers found that adults with AS have difficulty extrapolating people’s mental states from their vocalizations.

Take just a minute to imagine some of the implications.

  • You might miss the message of a potential friend who uses vocal inflection to communicate her irritation with your long story; her social rejection results
  • You might not see that the person gazing past you is no longer interested in your words; when he abruptly walks away, you’re left confused and mid-sentence
  • You might not notice the heavy-lidded, far-away gaze of your partner, which implies her deep thought; when you interrupt her, her anger seems “out of the blue”
  • You might not see the knowing glance between party goers when you introduce a boring topic; when you proceed to elaborate, group members leave
  • You might miss the sarcasm of a coworker when he shares that a secret is “common knowledge”; when you mention it to a coworker the next day, you’ve unwittingly committed a serious social blunder

We constantly use our flexible and dynamic ability to read and react to myriad social cues to avoid social disasters. Adults with AS who may not have this luxury are left trying to navigate the social landscape with no real map. The negative reactions, indifference and subtle (or not-so-subtle) rejection they deal with can lead to social anxiety, confusion, avoidance, isolation, even depression.

You can cut some slack for those who struggle to keep up with an ever-changing social context by resisting the urge to expel them from the group. You can resist the urge to mock or embarrass. If you have social gifts, you can share them. Remember, adults with AS are often developing the computer programs you work with and performing the neurosurgery you may benefit from.

Tuesday, August 10, 2010

Art and Asperger's

McNall Mason is the mom of a great 7 year old kid with AS. They are working on an amazing art collaboration, and their work will be featured in the DubSea Coffee Shop in West Seattle. The opening is on September 18.

Their ultimate goal is to open an art studio and gallery space for aspie kids in the Olympia area. A portion of their sales will go this end.

Take a look at their work. Whimsical, fun - a sample of the great aspie mind at work!

Adults with Asperger's and Their Rules

Adults with AS often utilize an elaborate system of these beliefs, or rules, to organize their experiences, especially when they find themselves unable to understand what is going on around them in the social realm. Of course this is not a new concept – all of us utilize unwritten rules to help guide decisions and behaviors. Adults with AS might find themselves leaning heavily on rules – which are often inflexible – in an effort to understand social dynamics. Setting rules can be quite adaptive – being held in slavery to them is another story.

Problems arise when the individual constructs rules based on arbitrary or incorrect information. For instance, one man with AS grew up with a father who was a chronic worker, viewed leisure time as useless and unbearable, and passively criticized people who did not work as hard as he did. As an adult, his son with AS struggled living according to a “rule”: that he could only be a man when working. He experienced immense stress outside of the workplace, and hated vacations.

Becoming aware of his “rule” was very helpful to this man. Learning to become aware of, articulate and evaluate these rules can be central to understanding a huge source of self-judgment and self-criticism. This man began to systematically challenge this rule: did he really believe work defines manhood? Did he know of any “real” men who did not work? How could he lower his anxiety when engaging in leisure activities?

This scenario may not ring a bell for you, but you may find that you do adhere to other rigid rules – and you may find you become upset when your rules are broken. Rules can make the world feel safer – they can add structure to a seemingly chaotic and unpredictable reality. When rules stop working for you – and you start working for them – you’ll know it. You’ll find yourself becoming angry and frustrated. Others might complain of your bad attitude or rudeness. Your anxiety may climb.

Becoming aware of your automatic thoughts, or rules, is often the first step in replacing maladaptive rules with healthier rules that reflect your true values. We all have internal rules that help us navigate the social world, and being conscious of them can help you feel more relaxed and be kinder to yourself and others.

Saturday, June 12, 2010

The Hidden Social Curriculum

In a very interesting book published in 2004, authors Myles, Trautman and Schelvan propose that some individuals may lack social intuition. The Hidden Curriculum is a brief survey of commonly missed "rules" that can help inform people who struggle to understand social norms.

The authors explain that social intuition, the skill of automatically understanding social rules, "is the lifeline that saves most of us on a daily basis from an array of potentially disastrous social situations."

It seems that neurotypical people, in contrast to those with AS, constantly, instantly and seamlessly survey the unwritten rules in social environments to make decisions about how to proceed successfully within a given context.

Great. For them.

As most readers know, socializing is not so simple for most people with Asperger's. While many people with AS can accomplish this constant surveying, assessing and decision making, it might use up nearly all his or her energy. With no assurance of success! After an exhausting evening of trying to keep up with conversations, mimic others' behavior, and stay off topics like Star Trek, it's no wonder many people with AS end up avoiding the social settings they crave.

According to the authors, and according to most clinicians, social skills are just that - skills. They can be taught, learned, practiced and mastered. Where to start? Let's start with the category of friendship.

Here is some loose paraphrasing of some of the "rules" the authors list. Some of them may sound amusingly obvious; others give the reader pause. See what you think:

  • Friendship takes a lot of time to develop. Just because someone has been nice to you once does not mean he or she wants to be your friend.
  • You should not have to pay someone to be your friend.
  • If someone asks you to hang out, it's probably not a good idea to ask him or her to hang out every day.
  • When someone does not want to hang out, don't pressure him or her to hang out - accept the answer and move on.
  • Just because someone is very popular, it does not mean that he/she is nice or a good person.
  • When you're first getting to know someone, consider doing a structured activity together first, like going to the movies or playing miniature golf. This way, there's a starting and stopping point, and you don't have a lot of time to talk.
  • Friends say nice things to each other, not nasty comments like "You are such a loser."
  • It's ok to feel mad at your friend sometimes. You can work out your differences and tell your friend why you felt mad.
  • Friends forgive each other for mistakes they accidentally make.
  • When you have a friend over, follow these steps:
1. Greet him and lead them inside.
2. Offer him a drink.
3. Ask him what he feels like doing. Have two activities in mind
(like video games or a movie)
  • Consider following your hobbies to find friends - many adults find friends in book clubs, chess clubs, athletic groups, etc. These groups may be independent of work or school.
  • If you're at a friend's house to eat and don't like what's being served, say "Just a little bit, please. I'm not very hungry' instead of "I don't want any - I don't like it
  • When hugging a relative of the opposite sex, keep yourself a little separate, and don't hug for too long.
  • Spend some time talking about what your friend is interested in. This way, you won't dominate the conversation with your own interests, and your friend will feel included.

If you find yourself faltering, please know you're not alone. And remember that you can master these skills so that people want to be around you. Don't lose hope.

Thursday, April 8, 2010

Asperger's and Pinnochio - Wooden Conversations

Did you know that approximately 93% of our communication is nonverbal?

How incredible!

And what bad news for those of us who make little use of paralinguistics - the gesturing, facial expressions, tone modulations and postures which help communicate our message's meaning.

Signs that you may not be infusing your communications with the oopmh! that keeps people interested: when you're speaking people may act bored, look distracted, talk over you, ignore you, or cut the conversation short so they can move on to other, more engaging conversation.

If you notice people reacting to you in these ways, take heart. You can modify how you communicate in ways that change how others perceive you. You can also become aware of signals you give out that can confuse others and cause them to disengage. So start troubleshooting now to avoid conversation that is stiff and wooden. After all, the only one who can get away with wooden conversation is Pinnochio.

How Gestures are Used

Gestures are generally used to either supplement language or to replace language. For instance, if I put my fingers to my lips because I want silence while I finish my phone call, I'm replacing language ("please be quiet") with a gesture. However, if I tell my teammate, "Great game!", and then slap my open, up-facing palm with his (also known as a "high-five"), I've used a gesture to add oomph! to my verbal message.

People use countless gestures to add meaning to their verbal messages in all kinds of settings. Think of the boss who asks where that report is, but pairs the question with a definitive frown: she's just let you know that she's not happy about something - and it probably has to do with the report.

Understanding how gestures play into communication takes practice. If you're speaking to a coworker, who begins tapping his feet and looking around, you'd be wise to understand that he's feeling impatient. Depending on the context, you may want to wrap it up, ask if another time to talk would work better, or remember that he may want a turn in the conversation. This "conversational multitasking" takes cognitive flexibility - and just like stiff muscles, flexibility increases with time and practice.

Posture is an important feature of communication. Many adults with AS struggle with core strength - feeling like Pinnochio with no strings can make it awfully difficult to sit or stand erect. However, slouching can communicate fatigue, boredom and disinterest....often the last messages one wants to send.

Eye contact is another form of communication which falls by the wayside for many with AS. Yet lack of eye contact can communicate disinterest, even disrespect! If you'd like your conversation partner to get the message that you value him or her, are listening and care, the importance of sporadic eye contact cannot be overstated.

Did you know that hygiene also can be considered a form of communication? We actually communicate a great deal to others via our daily cleaning and grooming habits. Ineffective or inconsistent hygiene says much to others about your self-esteem, confidence and intelligence. Hygiene can be considered the foundation for good communication - if it's not there, it's unlikely that the best repertoire of jokes and gestures will get you anywhere.

Avoiding the Wooden Conversation with Improved Paralinguistics

How can one go about increasing the effectiveness of his or her paralinguistics?

Start with the basics. The first thing others notice about us is usually our grooming. Daily showering and teeth brushing, deodorant use and clean, wrinkle-free clothing can do wonders for the impression we send to others. Of course this sounds pretty basic, but it's not for many adults with AS. Why? Often it comes down to sensory overload: the sensitive system can be overloaded by the cold blast of shower water or the pungent taste of peppermint toothpaste. There are so many products on the market to help the individual with sensory issues manage daily tasks which can produce overload: from soft, tagless washcloths to mild, bland toothpastes - why not invest in making hygiene as comfortable as possible? This is the time for action, not shame.

As discussed above, posture says a lot. Remember that posture often communicates mood, intent or attitude. Taking the time to practice and perfect this small aspect of communication is well worth the effort and time. You may catch yourself sagging against walls or shifting and slouching down in your seat. When you do, straighten up. Exercises designed to increase core strength can help immensely. For examples, see the Mayo Clinic's site:

If you struggle making eye contact, try looking at the small space between the eyes of the person you're speaking with. Intersperse this with real eye contact - it will lessen the burden on you while preserving the message that you want to send - that you are actively engaged in the conversation and want to connect with the person you are speaking with. Constant eye contact is not necessary...but intermittent eye contact really is. As with most things, practice helps the behavior become more natural, comfortable and automatic.

Lastly, the smile. So many adults with AS have a standing face that feels neutral to them - but looks angry or bored to others! Don't fall into the habit of the wooden, expressionless face. Smiling briefly takes practice but lets others know you're not just a puppet. People generally respond very well to being smiled at, and smiling can communicate friendliness and openness, which fosters connection.

You can change the way you communicate without changing what you say. Adults with AS often have vastly impressive stores of knowledge and incredibly unique perspectives to share. Don't let a Pinnochio-like presentation prevent friends and coworkers from benefiting from all the richness of what you have to say.

Monday, February 15, 2010

Asperger's: Standing Face and Zero Order Skills

Soft signs is a term used to refer to "soft neurological symptoms", or differences in skills involving coordination.

The symptoms are observable when tested for (usually by a neurologist), and are often evaluated with diagnostic activities such as "touch your finger to your nose". The child with difficulties with such tasks exhibits "soft signs", behaviors which are expected to mature with age.

Back in 2006, researchers at the University of Helsinki and the Hospital for Children and Adolescents in Finland looked at soft signs in adults with Asperger's, and found that they persisted through adolescence and adulthood.

As typical children age, these soft signs often diminish, and evolve into Zero Order Skills. This set of skills is described by Richard Lavoie, M.A. as "skills that are only significant when they fail to exist". He describes a common soft sign as a child's inability to track with his eyes without moving his head. Seems like no big deal, right?

But imagine the behavior of the adult who does not possess this Zero Order Skill. Out with a group at a bar, he does not make eye contact with each person he speaks with. Instead of moving his head slightly and moving his eyes to meet the gaze of his conversation partners, he keeps his eyes in a fixed position, and moves his head in order to maintain eye contact. How does it come off? Robotic.

The ability to track during a conversation, then, is an example of a Zero Order Skill. This skill is not a social asset - no one wins praise for this skill - rather, it is an expected skill, necessary for others' comfort during conversation.

The adult with a deficit in Zero Order Skills will suffer resulting social effects. Yet Zero Order Skills can be taught, learned and mastered.

One Zero Order Skill which may be missing in the skill set of the adult with Asperger Syndrome is his or her STANDING FACE. The standing face is our most basic, relaxed and frequently adopted facial expression - the neutral expression we use when reading or watching TV. It may be worth your time to look in the mirror and taking a look at what yours looks like. You may also want to ask a trusted loved one or professional for their feedback.

Often adults with Asperger's find their "game face" is slack, open-mouthed, stern-looking or comes across as aloof. This is just fine if you're intending to send messages of boredom, superiority or anger (and who isn't, from time to time?). But if you'd like to come across as open and interested, these expressions can be obstacles.

The goal may not be to adopt an artificial wardrobe of empty smiles (see cartoon above), but to master the facial posture of someone who comes across as engaged and relaxed. This can involve "cocking" the head to the side to convey interest, making 8-second interval eye contact, changing physical position (such as leaning slightly forward), gestures of approval such as sporadic smiles, nods, and "aha" looks, and non-verbal cues ("hmmmm", "uh-huh" and "ah").

With practice, your standing face can communicate warmth and openness, and your demeanor can give others clear indications of how you feel. These skills can be mastered with practice, practice, practice. And I encourage you to do just that.

Thursday, February 11, 2010

Asperger's: Top Ten Behaviors Girlfriends Love

WANTED: Boyfriend to demonstrate interest in chit chat and casual affection. Especially interested in playful banter, eye contact and active listening.

FOUND: Man with Asperger's who completed Top Ten List, enjoyed a burst of confidence and will probably enjoy positive feedback (and maybe more!) from partner.

If you've found yourself baffled at your girlfriend or wife's requests for nebulous actions such as "show more empathy" or "show a pulse" during interactions, just know that you're not alone. If you've found yourself puzzled by what exactly these kinds of phrases mean, and how to break them down into concrete behaviors, you're in good - and ample - company.

It's often very difficult for partners of Aspies to understand why they need to ask for exactly what they need - not in vague, esoteric terms - but in clear, honest and behavior-based terms. But this must be done for their needs to be met. Aspies are not, in general, wired to make assumptions and gather the gist of nuance.

Thank goodness!

This "deficit" on the part of the Aspie forces his partner to adopt clear communication, honesty about limits and needs, and accountability.

One cannot complain about not getting needs met by an Aspie partner if one is afraid to communicate clearly what those needs are.

I find that, in strange synchronicity, partners of Aspies often are those women (or men) who most need to learn that their needs are OK. They are often individuals who can scream their needs. They can silence their needs. But clearly state their needs? TERRIFYING!

How comfortable are you with acknowledging and sharing what you want? What do you want out of this moment? Out of this week? This month? Year? Lifetime?

Women who can acknowledge, without anger or blame, that they need to feel safe, comforted, reassured, treasured, adored, respected, valued....these women are often ahead of the game when it comes to intimacy.

Women who can, without anger or blame, break these needs down into specific desired behaviors - a hug, hand-holding, a date, a question, sustained attention for five minutes during a description of a work issue....these women are often crossing the finish line while others are in the stands feeling resentful and alone.

Why is asking for what you need so difficult? Because, as you may know, women are often encouraged to take care of everyone but themselves. This sounds cliche, but it's true. How often have you found yourself judging a woman who takes time for pedicures, massages or yoga as self-absorbed or superficial? Women often subconsciously view taking care of themselves and acknowledging their needs as taboo - while they rage against their partners for not doing it for them.

So where do you start? By first becoming aware of how you feel and what you need. Do you feel hungry? Anxious? Dehydrated? Lonely? Overwhelmed?

Then, ask yourself what you need. Do you need a snack? To lower your anxiety by practicing deep breathing? A glass of water? A quick check-in with a loved one? A task taken off your plate by a partner?

Now that you have awareness of how you feel and what you need, you are in a position to either meet that need or ask for help from your partner. Asking for help in getting a need met does not look like this:

"Well, I can see you didn't bother to think about what anyone else is going to eat for dinner."
"I wish I were married to someone who could actually see the trash overflowing onto the floor!"
"I feel totally alone in this worthless marriage."

What you may be called to do is much scarier than this. What you may be called to do is to substitute statements like the above with statements like:

"I would love for you to make me a snack. Will you make me a bowl of Cap'n Crunch?"
"I feel overwhelmed. Will you take the trash out? That will help."
"I'm feeling lonely. Will you hold me?"

Can you see how much more difficult the second set of statements is? Making yourself vulnerable, feeling worthy of asking for what you want, is frightening for many women. Yet it is this clear and honest communication, with yourself and your partner, that has the potential to save your relationship.

So if you've read this article in hopes of finding a list of ten behaviors you can copy and email to your loved one, you're in for disappointment. Likewise, if you've read this article hoping to divine the secret to meeting your girlfriend's unspoken needs, you're out of luck.

Only you can design a list of top ten behaviors that can meet your unique needs, or ask your partner for this list. While there are general habits that are often functional in relationships, needs are unique, and emerge according to no one's schedule but your own.

Facing the fact that you need your partner, mustering the courage to ask for what you want, and then being willing to receive what your partner has to give.....these are the true triumphs of intimacy, and worth every ounce of effort you can offer.

If you're consumed by bitterness in your relationship, I challenge you to stop expecting your partner with ASD (or without!) to read your mind. I challenge you to identify a need, share it, and ask for a specific behavior. If this feels silly or contrived, you're on the right path. It won't feel this way for long if you keep it up. Rather, these new habits can begin to feel natural, healthy and intimate.

If you can complete this task, I believe you have the tools for great change and hope in your relationship.

Thursday, January 21, 2010

Asperger's: Are You Thinking What I'm Thinking??

"It just doesn't FEEL like you GET how I'm feeling..."

Have you ever heard this from a loved one?

Adults with Asperger's in relationships often hear similar complaints from their partners. Yet highly intelligent Aspies often find ways around this effect in work and other settings. What is it about intimate relationships which magnifies this effect, and what can Aspies do about it?

Adults with Asperger Syndrome are well known to have challenges with social interaction. Often, even long after the obvious signs of these challenges are gone, the adult Aspie often continues to "feel different". But they may be missing their own successes by focusing on the differences, rather than the similarities, between theirs and the social interaction outcomes of NTs.

It's often thought that these typical "social deficit symptoms" stem from so-called "mind-blindness" -- an inability to express a "theory of mind", or to grasp what other people may be thinking, feeling and intending. Yet did you know that adults with Asperger's, who are often highly intelligent, routinely pass tests designed to evaluate theory of mind?

In 2009 a team led by Uta Frith, of University College, London, and Atsushi Senju, of Birkbeck College, London, tracked the eyes of people with Asperger's while they took part in a standard test of theory of mind. The results were surprising.

The test, known as the Sally-Anne False Belief Task, works like this:

One character, Sally, places a marble in a basket and leaves the room. In her absence, another character, Anne, moves the marble to a box. When Sally returns, children are asked where she will look for her marble. If children understand that Sally's actions will be based on what she believes to be true, rather than the actual state of affairs, they should answer that she will look in the basket, rather than the box. This correct answer requires the child to predict Sally's behavior based on her now false belief.

Neurotypical children aged 4, and children with Down's syndrome, pass this test, while children and adults with autism spectrum disorders generally do not. Adults with Asperger's pass it -- but Professor Frith's study shows that their success may be due to a very different mechanism.

The team asked adults with Asperger's, and neurotypical (NT) adults, to take the Sally-Anne task while their eye movements were tracked. Both groups got the task right when assessed verbally, but their eye movements told a different story.

The NTadults generally took their first glance towards the correct place -- the basket where Sally thinks her marble is -- in anticipation that that is where she will look. However, members of the Asperger's group looked equally often at both the box and the basket before making their choice. They did not seem to have a spontaneous understanding of the right answer -- the direction of their first glance was a matter of chance.

The implications of this are fascinating. It may be that people with Asperger's do have difficulties with theory of mind: unlike those with NT brains, they lack the ability to jump straight to the right decision, almost as a matter of instinct. What they seem to do instead is to work out other people's beliefs and intentions by means of logical reasoning.

The finding is also encouraging news for therapy. Theory of mind in itself, it seems, can be learned. That is, the same results can be attained via "intuition" AND logic.

Adults with Asperger's may arrive at social conclusions via logic, but feel exhausted after their success. It may be true that social interactions never do take on the intuitive, fluid quality many adults enjoy when communicating.

Perhaps when it comes to the social interactions of adults with Asperger's the most important part may not be the means, it may be the end itself. If you have Asperger's, you may benefit from focusing less on how you operate differently, and more on the results you achieve or want to achieve.

Chances are you're not coming across as poorly as you think.

Friday, January 1, 2010

This Emotional Life - Asperger Syndrome

Premiering on PBS January 4-6, 2010 is This Emotional Life - Asperger Syndrome. The preview looks very interesting, though I am not sure the conclusions drawn by the social psychologist who speaks about the damaging effects of loneliness can be applied to those with Asperger's. While many adults with Asperger's do feel lonely, some do not. It's unlikely those adults who do not experience profound feelings of loneliness suffer the same health effects as those who do.

Watch the preview and please leave your own thoughts in the Comments section.


Asperger's and Couples Therapy

My name is Cary Terra, LMFT and I am a psychotherapist in practice in Seattle, WA. In graduate school I received much training in working with couples, and went on later to my practicum work, where I worked with couples struggling with issues of all sorts.

Therapists are trained to recognize and decode relationship patterns. There are many patterns, and no couple adheres to a single pattern all the time. But by and large the training prepares the therapist for recognizing these familiar dances couples do with one another. Recognizing these patterns is the foundation for any work with couples, regardless of the type of therapy used in treatment.
There are so many different approaches to treatment when it comes to couples, and of course there is much debate amongst professionals regarding which treatment modalities are most effective.

When it comes to couples in which one partner has Asperger Syndrome (or something close to it), research on effective treatments for couples is scarce. So what works?
Most research on therapy and adults with Asperger’s supports Cognitive Behavioral Therapy (CBT) techniques. This modality assists the client in identifying and changing cognitive distortions, thereby enabling him or her to change their resulting feelings and behaviors. This modality is well researched, and is built upon the assumption that cognitions preface affects. Of course it is useful to understand how our thoughts, emotions and behaviors are linked. Without this understanding, the adult with Asperger’s can experience their inner emotional world as a chaotic, foggy maze without a logical destination. Adding the logic piece to this world via CBT can demystify the land of emotion, easing the client’s anxiety and increasing the client’s sense of mastery.

Sounds simple. But is it?

CBT can be very effective, no doubt. But it does little to help the client clarify any issues originating in the unconscious. Unconscious motives, which often steer relationship choices, are often affect-laden, and often have little conscious thoughts associated with them. Thus, the individual with Asperger’s may see obstacles involved in a relationship with a specific potential partner, may find the relationship fraught with drama he or she finds unbearable, and may feel controlled by relationship anxieties and fears. Yet this same individual, even after identifying cognitive distortions and working to change behaviors, may feel viscerally drawn to the relationship, with little insight as to why.

Yet understanding why often feels necessary for a deep sense of clarity for many individuals.

In my experience, a blend of Cognitive Behavioral Therapy (CBT) and Family Systems works best. Family Systems is a modality which focuses on how systems of relationships evolve and are perpetuated, even passed down through generations. Writer and Systems therapist Harriet Lerner, PhD writes in her book The Dance of Intimacy, “An intimate relationship is one in which neither party silences, sacrifices, or betrays the self and each party expresses strength and vulnerability, weakness and competence in a balanced way.”

Family Systems attempts to assist clients in identifying blocks to this aim in their current relationships and past family relationships, so that these obstacles can be slowly removed in a way that fosters independence and dependence, in healthy balance.

I find that individuals with Asperger’s often pair up with partners who are emotionally driven and expressive. This can serve as a wonderful complementary dyad at first, but often over time the system becomes magnified in its intensity and polarity. Individuals in such relationships can benefit from striving for balance individually. If this does not happen, the Aspie adult can over time become dependent on his or her partner for a sense of emotional engagement, connectedness to others and “normal” appearance.

So how can the Aspie in such a relationship make gains towards balance? I have found many Aspie adults have had success with volunteering, joining special interest clubs and working on mindfulness. A therapist can also help with addressing specific trouble spots in a regimented way to help diminish anxiety and that “alien feeling” which can be a source of superiority, but also of confusion and pain.

Relationships can be extraordinarily challenging for adults with Asperger Syndrome. The stress of navigating intimacy for the individual with AS can be extremely high, and this is crucial information for both the Aspie and his or her partner to understand and respect. It is important to remember that if you have Asperger's and are in a relationship, you must take time to nurture your own unique ways of being in the world. This includes scheduled time for solitary activities and planned opportunities for engagement in special interest activities. I often tell clients that investing in these activities is like eating for the Aspie - it is non-negotiable, and going without it can cause damage to not only the relationship, but to the Aspie's mental health. This investment is part of, as Lerner points out, working towards individual competence and balance. And this balance can help prevent a host of relationship mishaps, such as dependence, resentment, passive-aggressiveness and more.

For more information on Harriet Lerner, PhD, visit her website at .

Monday, December 14, 2009

Asperger’s: The Itchy Tag Effect

Most of us familiar with the basic symptoms associated with Asperger Disorder understand that people with Asperger’s often seem hypersensitive. Children with Asperger’s today often readily voice their discomfort with textures, noises and scents they find uncomfortable, and this discomfort has become, if not an accepted diagnostic criteria, a very familiar phenomenon for parents.

In their April, 2009 article Talent in Autism, Simon Baron-Cohen et al. describe sensory hypersensitivity, a form of enhanced perceptual functioning typical of many individuals with autism spectrum conditions (ASC). Indeed, the article states that “studies using questionnaires such as the sensory profile have revealed sensory abnormalities in over 90per cent of children with ASC.” How individuals process information (both cognitive and sensory) may be highly impacted, even organized according to, these differences: and the differences may cause distress, but also predispose to unusual talent.

In my practice, adults with Asperger's frequently report highly sensitive senses of taste, touch, hearing, sight and smell. Sensory oversensitivities often reported by adults with Asperger’s include:

oversensitivity can cause the individual to feel physical sensations such as light touch, itchy fabrics, hugs and bare feet as unbearable.

Visual: oversensitivity can cause the individual to find fluorescent lights, bright sunlight, flashing lights and overly stimulating visual environments (e.g. casinos) to cause great discomfort.

Auditory: oversensitivity can cause the individual to find auditory input to be impossible to ignore. Foreground and background noises can compete with one another, leaving the listener unable to selectively attend. Shrill or high pitched noises, such as those of dental drills, children’s squeals or shrieks, and blenders can cause extreme discomfort. Discordant music can cause discomfort.

oversensitivity can cause the individual to feel uncomfortable with new tastes, or to find them intolerable. Children with gustational oversensitivity can prefer the same foods over and over again, refusing new foods and finding new flavors distressing.

Olfaction: Current research does not support evidence of oversensitivity for the sense of smell.

Clinicians who work with adults with Asperger’s often find that this sensory hyperacuity has been coped with and channeled in creative ways. Following are some of the positive coping mechanisms reported to me by clients who have struggled with sensory oversensitivity without knowing exactly what the problem was.

Clients who struggle with tactile hypersensitivity often:
• Wear soft, heavily washed, loose-fitting clothing, such as t-shirts and baggy shorts
• Avoid body piercings and tattoos
• Find showering unpleasant due to oversensitivity to sensations of water and changes in temperature
• Remove tags from clothing, which can be itchy
• Choose specific brands of clothing, underwear and shoes which provide minimal restriction
• Find ways to gain tactile input which is soothing, such as hair-pulling, hair twirling, hand tapping, etc.
• Enjoy stroking soft materials, such as the fur of cats

Clients who struggle with visual hypersensitivity often:
• Avoid visually overwhelming environments
• Wear sunglasses or hats to minimize bright lights
• Remove lamps or bulbs in work areas to reduce glare
• Cover fluorescent lights
• Close blinds during work time to prevent interruption by visual stimuli such as passers-by
• Keep work areas neatly organized to prevent becoming visually overstimulated
• Find visually predictable environments, such as video games, rewarding and comfortable

Clients with auditory oversensitivity often:
• “Tune out” when conversation becomes too overwhelming to attend to
• Avoid interacting in crowded settings, such as parties, or use substances to mediate oversensitivity
• Rely on electronics, such as iPods, to provide predictable auditory stimulation
• Wear noise-cancelling headphones when concentrating or meditating
• Spend quiet, solitary time to “recover” from overstimulating experiences
• Avoid telephone and cell phone use to minimize unanticipated auditory input
• Hum, sing or make noises to cancel out noises beyond individual’s control
• Listen to music excessively

If you have noticed your own or a loved one’s sensory hypersensitivity, be sure and treat it as condition to take seriously. Some researchers (see Belmonte et al., 2004) hypothesize that this sensory “magnification” may result from neural overconnectivity in sensory parts of the cerebral cortex. While research on brain structure and development differences is still being conducted, sensory oversensitivity in adults with ASC is well documented, and is most likely physiologically based.

Implementing some simple interventions can help the individual with Asperger’s feel much more comfortable in the world. An increase in sensory comfort can have drastic effects on cognition, avoidance behaviors and the ability to attend to other stimuli. Many of my clients report irregular sleep/wake cycles, with much “down time” spent recovering from situations which cause sensory overload. Taking care of yourself ahead of time when facing a sensory challenging setting can prevent “sensory hangover”, and is part of taking care of yourself.

Stay tuned for more on how sensory oversensitivity may be a contributing factor to talent and giftedness so often seen in adults with Asperger’s.

Thursday, December 3, 2009


A poem written by an adult with Asperger's was shared with me. It follows:

i have built and live in all around me
a castle made of glass for all to see
it reflects the sun in a dazzling way
so as to keep the intruders at bay

it stands atop a verdant hill
away from where the villagers mill
its clean fa├žade a temple makes
for clean efficient infallible grace

its prism walls do split the light
till rainbows do my soul ignite
i sit at my window and i see
how the others live away from of me

they live, laugh, cry, work, love, hate and die
while i first count the clouds, then stars in the sky
and though their homes sink and sag and then fall
my castle stands silent immovable through all
its construction is clockwork, its lines perfect clean
no fault can be found in its faces seen

i tell no one the castle is cold in the night
that its rooms are empty, its windows sealed tight
its walls are clean but cannot hold fast
and they give scant protection when stones are cast
and when the clocks strike midnight, morning, noon
it is only me in my still quiet room
and the castle i built for silent safety
is locked by the one with no key, no key


Saturday, November 28, 2009

Asperger’s is a T.V. with One-Channel Reception

As many of us have, I’ve often noticed couples in which one partner has Asperger’s struggle greatly with communication, especially when discussing highly emotional subjects.

But what does this really mean?

It means different things for each partner.

For partners with AS, understanding the different channels of information can help. Couples communicate largely through behaviors, but we’ll concentrate on the senses as channels:

Visual (sight)
Auditory (hearing)
Tactile (touch)

I’ve seen conversations such as this work beautifully:

Partner #1:
I’m upset and I want to talk with you. What channel can I use?

Partner #2: (Takes a minute to think before responding) Auditory

Partner #1: (Closes eyes, leans back, lowers voice) O.K. When you walk away in the middle of my sentence, I think you are bored by what I am saying. I think you know it comes across that way, and that you are willing to hurt my feelings. I feel really sad about that. I want you to stop walking away when I’m talking and let me finish my sentence.

Partner #1: I’m sorry your feelings got hurt. That was not my intention. I was distracted, not bored. I couldn’t stay focused. I will remember this and not walk away while you’re talking.

Partner #2: (Crying) I want you to be interested in me.

Partner #1: I am, it just doesn’t always show.

Believe it or not, this dialogue worked. This couple had been working hard on communicating, and was beginning to enjoy the fruits of their hard work. Partner #1 was soothed by this interaction, and Partner #2 was left not feeling attacked, but informed. Partner #1 was able to share feelings, thoughts and a request. Partner #2 was able to hear this information, and because there was no overwhelm, the information was not just received, but digested. Because the couple consciously worked at reducing interference, and focused on communicating in a low-key manner via one channel (auditory), Partner #1 was forced to reduce reactivity, and Partner #2 was able to receive and assimilate information. The result for both partners was increased clarity.

“This is ridiculous! Who can do this?” is a question I’ve been asked, with much outrage, by partners without Asperger’s. In truth, it is challenging. The key, perhaps, is trusting that your partner with AS cares. Keeping this in mind can serve as a foundation for this difficult communication work.

The benefits? Your relationship may not be fraught with mind games, drama and chaos which develop and become habit in many relationships. Do you want it easy? Or do you want it to work?

Your relationship may not be inherently easy, but with practice, it can become more automatic and natural. And it can work beautifully.

Stay tuned for more tips on “One-Channel Communicating”. Please feel free to leave feedback in the comments section.

Tuesday, November 24, 2009

Asperger's and the Holidays - Face them with Open Eyes

In my private practice I’ve noticed a trend. Around November, old, current and new clients call wanting to schedule sessions to talk about one topic: the holidays.
The trend is not surprising: most therapists find themselves busy at this time of year, when expectations and realities can clash, and even the most mature find themselves stuck in teenager roles and feelings long since discarded.

But for a therapist who counsels adults with Asperger’s the increase in client need may be surprising to some. Aren’t Aspies supposed to be unconcerned with the judgments of others, even family members? Don’t Aspies face holiday family time with few, if any, expectations for intimacy or fun? Don’t Aspies who find themselves alone during the holidays consider their solitude a “Get Out of Jail Free” card, rather than a reason for loneliness or depression? After all, Aspies don’t really seek out relationships, right?

If any of these assumptions sound familiar to you, beware of the Aspie Stereotype, which pervades media (think “Rainman”), research teams (think “Yale”), pop culture (think SNL’s “Nick Burns: The Computer Guy”) and even some therapist circles (not me!).

Contrary to popular notions regarding Asperger’s, many clinicians, those who work in the trenches with adults struggling with the challenges of Asperger’s, find their Aspie clients confused and overwhelmed by the holidays.

Most of us harbor conscious or unconscious expectations about the holidays – how they should feel, who they should be spent with, how tall the tree should be, who should host dinner…the list can go on. A lack of awareness of one’s own “rules” regarding the holidays can set the stage for confusion, disappointment, impulse coping skills and depression.

If you have Asperger’s, you may be surprised at your own “automatic” answers to questions such as:
Should holidays be spent with friends or family?
Should loved ones exchange gifts, or not?
Who should travel where for the holiday celebration?
Tinsel, or lights?

While these questions may seem trivial, they’re not – and often they shed light on our automatic thoughts that go unchallenged and cause problems. For instance, if your “rule” is that Christmas or Hanukkah is a commercialized money-making holiday to benefit department stores, you may refuse to participate, and thus miss genuine opportunities to connect with loved ones. If you automatically decree that holidays should be spent with family or friends, you may miss the comfort that solitude can bring you.

Please don’t fall into the trap of trying to live up to what you think “normal holidays” (an oxymoron) should be like. Holidays for Aspies are often riddled with “shoulds”, which trigger resentment and resistance.

Adults with Asperger’s who give themselves permission to meet their own unique needs for togetherness and solitude, fun and rest, engagement and disengagement, often find themselves less pressured, less anxious and more accepting of themselves and others. This balanced approach can prevent total shutdown mode, which is a natural response to overstimulation and helplessness.

Here are some tips Aspies may find helpful:

Plan for taking breaks during visits.
Examples are taking a walk outside, taking a nap with a book, taking some quiet time for deep breathing, taking a quick ride or offering to run an errand in the car, playing a video game with someone or alone, or announcing a time-out and removing yourself from the group.

Schedule realistically.
Over scheduling during the holidays can lead to burnout when being around people is gratifying, but stressful (or just plain difficult). While it’s great to push yourself to socialize, the holidays are a time to be reasonable – don’t expect yourself to go from no parties to three or four in a month.

Beware of the lure of substance use. Many of us rely on the cocktail or two to help ease party anxiety. While there may not be too much harm in this, most clinicians see a surge in substance use during the holidays, which can lead to hangovers, a shaken sense of self, embarrassment, or worse. Remember that as long as you’re using substances to quell the anxiety, you’re not truly growing in your ability to handle social situations.

Be extra kind to yourself.
This sounds corny, and it is. But think about it: we spend so much time during the holidays thinking about giving to others (or avoiding it!), but how much do we think about truly giving to ourselves? This is the time to use kind words and actions to take care of yourself. Ideas include buying or checking out a new book, going to the movies alone, eating a favorite meal, spending quiet time petting the cat.

Seek help if you need to. Holiday therapy can be a temporary bridge to January 2!

Here’s to your success in creating a holiday this year that you can anticipate with groundedness and optimism.

Monday, November 16, 2009

The Case for Mastering the Art of Eye Contact - Part I

Adults with Asperger's often have difficulties modulating appropriate eye contact. Because many do not pick up the skill automatically, they must decide whether to master it with direct intention and action. Appropriate eye contact is often fundamental to effective communication, so deciding to master the skill is a no-brainer, right?


Why do so many adults with Asperger's continue to avoid eye contact, even when they're aware the avoidance can cause others confusion or worse?

The answer may have to do with how Aspies experience eye contact and direct gaze. Research back in 2005 published in Nature Neuroscience lent some insight into why autistic children avoid eye contact: they perceive faces as an uncomfortable threat, even if they are familiar.

Kim M. Dalton of the University of Wisconsin-Madison and her colleagues studied 27 autistic teenagers who looked at pictures of faces while a magnetic resonance imaging (MRI) machine scanned their brains. Also tracked were the subjects' eye movements as they studied the images. When the image included a direct gaze from a nonthreatening face, brain activity in the amygdala--a brain region associated with negative feelings--was much higher for autistic children than it was in members of the control group. "Imagine walking through the world and interpreting every face that looks at you as a threat, even the face of your own mother," remarked study co-author Richard Davidson, also at UW-Madison.

The results also indicate that while a brain area associated with face perception, known as the fusiform region, is fundamentally normal in autistic children, it does exhibit decreased activity. This could result because the over-aroused amygdala makes an autistic child want to look away from faces. Further, when subjects with autism averted their gaze away from the eye region of a face, they showed reduced activity in the amygdala, suggesting that the gaze aversion is serving a functional purpose.

If you have Asperger's, you may want to pay attention to how you feel when making eye contact during conversation. Does it make you feel nervous? Overwhelmed? Frightened?

Little wonder many Aspies struggle to make eye contact while simultaneously tackling conversation, which may also be challenging. Is it worth it to Aspies to force themselves to make eye contact and endure the barrage of discomfort associated with it? This question is complex, both practically and philosophically. Yet it's widely agreed upon that decreased eye contact, or gaze aversion, during conversation can be interpreted as a sign of depression, dishonesty, disengagement, or any number of unpleasant messages.

Answering the question is further complicated by research on gaze aversion and its relationship to information processing. When people are engaged in difficult cognitive activity (e.g., retrieving information from memory, on-line processing, speech planning), they typically look away from the object upon which their attention had previously been focused (be it a face, book, VCR monitor, etc.). This tendency may be heightened in adults with Asperger's, who have an extra load of processing to deal with when making conversation, and an extra load of threat to deal with when making eye contact.

While there's little question that many folks with AS find eye contact unnecessary and/or unpleasant, there's also little question that most Aspies are capable of enduring enormous discomfort in their efforts to connect with others. Being informed and educated about your own reactions, and the basis for these reactions, to eye contact can be the first step in addressing changing your automatic tendencies when the benefits outweigh the challenges.

Stay tuned for tips on how you can work on selectively increasing your level of eye contact with others during conversation.

Sunday, November 15, 2009

It's Not What You Said... It's HOW You Said It!

Imagine a couple, Sarah and Simon, talked together about a recent spat. As they revisited their argument, Sarah asked Simon, "Why did you say that?".

How Sarah used tone could have made all the difference in Simon's deciphering of the question's meaning. Emphasis on the word "say" would most likely imply the Sarah's level of shock - the more emphasis on the word, the higher the shock.

"Why did you SAY that?" implies that Sarah thinks something shocking was said, or that Sarah was surprised by what was said.

However, let's imagine that Sarah put vocal emphasis (via tone increase) on the word
"you". This might imply a completely different message. It might imply a confusion not with what was said, but with the fact that Simon said it, rather that someone else.

"Why did YOU say that?" implies questioning who said it, not what was said.

Now let's suppose that Sarah assumes that her question's content is understood by Simon. But let's also assume that Sarah assumes that the question's TONE is understood, a tone which clarifies and qualifies the question's meaning.

If Simon has Asperger's, it's likely he'll understand the question's content meaning, but not the question's implicit meaning, its tone. He may answer the question that was asked, but not answer according to the WAY it was asked.

When receiving the answer to the content question, Sarah becomes frustrated. "Why don't you get it? You just don't get it!", she replies. Both are stumped and frustrated.

But understanding how people with Asperger's - and how people without Asperger's - interpret implicit communications like vocal tone can take all the mystery out of these kinds of misunderstandings.

Adults with Asperger's may have a hard time understanding the messages many send utilizing vocal tone. Being content-driven, they may not attend to changes in vocal tone which partially determine the meaning of verbal communications. Without a well developed sense of Theory of Mind to rely (the ability to attribute mental states(beliefs, intents, desires, pretending, knowledge, etc.) to oneself and others and to understand that those of others may differ from one's own), adults with Asperger's are often left playing a painful and confusing guessing game, especially during emotionally-charged interchanges.

How to Clarify Communications between Aspies and Non-Aspies

Clients have found success in limiting the amount of "guessing" occurring during interactions. Couples can do this by first understanding the differences in how they each process information, and consciously limiting the role tone plays in conveying information. This can be especially important during heated discussions, when tone can become escalated and overwhelming for people with Asperger's, causing withdrawal and avoidance.

If you and your partner are aiming to discuss a heated topic, you may benefit from two strategies:

1) Tone it down. This can be difficult when emotions are running high, but is necessary for productive communication. Try speaking quietly and calmly, using little intonation to get your point across. If you have Asperger's, let your partner know that his or her efforts to do so can help you listen and hear better when they are speaking to you.

2) Ask and answer. This technique is a form of active listening, a popular communication skill for any couple. It involves listening to what your partner has to say without interrupting. Aspies may benefit from looking away from their partner during this time. When your partner is finished talking, ask questions. "Do you mean...", "What I'm hearing is....", "Am I right in thinking you're saying...". Consider this technique to be information gathering. When you've asked all your questions, see if you can re-state your partner's message, getting the "gist" of it. Your partner's feelings of being heard can increase dramatically, and your sense of competence can, too.

But This Seems Like a Lot of Work!

It is. Having drastically different ways of taking in and processing information can make communication feel laborious. But it can also be a source of humor and fascination. Working to understand each other is in itself a step in the right direction, and though it takes patience and hard work, the rewards are significant.

For more information on research on communication and Asperger's see and

Also, visit for new therapy updates.

Friday, November 13, 2009

All Cats Have Asperger Syndrome

"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.

Cognitive Distortions and You

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.

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