Saturday, May 26, 2012

The Hidden Autistics - Asperger's in Adults

Recently I encountered a problem while collaborating with a group therapist with whom I share a patient. My patient has progressed quickly in therapy, as do many adults on the spectrum.  However he did not start off as stereotypically autistic.  In fact, initially he presented as many of my patients do: shy, articulate, witty.  Good eye contact.  Appropriate affect.  Typical posture, gait and gesturing.

It took a few sessions to realize this fine gentleman suffered mightly with the symtoms of Asperger Syndrome, which he kept well managed and thoroughly hidden.  Contrary to the stereotyoes of adults on the spectrum, my patient displayed no "meltdown" behavior, was keenly (TOO keenly) aware of people's reactions to him and exhibited no bizarre special interests or encyclopedic knowledge of vaccuum models.

In fact, "Joe", as we'll call him, socialized quite well.  He seemed quietly confident and wry, intelligent and perceptive.  People responded well to him, really liked him, though probably none of them would describe him as a close friend.  No one realized - in fact he often went without realizing - that his baseline anxiety approached panic on a regular basis.  As soon as he was out of bed, existential angst was his constant companion.  His difficulty managing his thoughts made rudimentary conversations minefields to be navigated.  And navigate he did, dodging social errors with the same fright and determination one might actually dodge mines.  After even minor social interactions he routinely found himself exhausted, and would retreat to soothing, isolated activity: sculpture, writing, woodworking.  Not conversation with his wife.

Diagnosing this man was problematic.  He truly did not fit the criteria for Asperger Syndrome.  In fact, the only person to suspect he was on the spectrum was his wife, who puzzled endlessly about this curious man.  He seems so sensitive and kind, she would say.  Yet he ignores my birthday and hangs up before saying goodbye. He's so charming with others, yet so silent at home.  He never misses a deadline at work, yet cannot remember to give our dog his heart medication.

Partners of people on the spectrum are drawn to what they can sense is inside their partner.  Yet they feel shut out, left pining for connection with this special person who remains unreachable.  It can be a confusing relationship, and one that can easily lead to resentment.

So what was the problem I ran into with the collaborating therapist?  She found it hilarious - outrageous! - that Joe had been diagnosed with Asperger's.  When Joe would make an insightful comment during group session, this group therapist and members would share a hearty laugh, rolling their eyes that this sensitive man had been diagnosed as autistic.  When Joe would tear up recounting his wife's rage and disappointment, he'd hear "So Mr. Autistic is shaking because his wife got angry!  Ha ha!  Shouldn't you be indifferent and focusing on dinosaurs?" (I'm sorry to say this is a direct quote.)  The general public, even many clinicians, cannot believe someone like Joe can be autistic.  His social deficits are so well hidden that he has convinced the world his autism does not exist.  And he has perhaps convinced himself.

One person remains unconvinced.  His wife.  After a long day of running what he terms his "social program", feigning natural banter and hiding anxiety, he is exhausted.  His wife comes home to a man who has retreated to isolation as a desperate attempt to find peace and rest.

I'd like to write more about this "hidden autistic" phenomena.  Someone must.  Adults on the spectrum are often too good at convincing others they are fine, have no emotions, are robotic.  This is never the case, and the illusion can be dangerous to long-term mental health for autistics and their partners alike.

Sunday, March 18, 2012

NEW THERAPIST AT TERRA THERAPY P.C.


I'd like to welcome our new therapist, Kimm Klassen. Kimm earned her master's in social work at Eastern Washington University, and currently works as a therapist in the Bellevue Washington school district developing and implementing programs for kids and families with special needs.

Kimm brings a wealth of diverse experience with adolescents and adults on the spectrum, and currently works with couples in which one partner has Asperger's.

Kimm offers Saturday appointments in the Pioneer Building office, located in Downtown Seattle.

For more information please contact Kimm at (425) 445-7669.

Saturday, November 26, 2011

Loving Your Introverted Husband with Asperger's


My husband zones out if too much is going on!
He's always focusing on details other people don't care about!
It's like he needs to hibernate after a party!
Am I the only one with social needs around here?

My name is Cary Terra, and I work with lots of couples on the spectrum. Of course I'm generalizing with the title of this post - many of my clients with AS are female. For the sake of simplicity (for this entry, at least) let's assume our Aspie is male.

So many partners enter into therapy feeling alone and exhausted. Often socially anxious themselves, they are tired of toting the social line alone. Without their efforts, I'm told, no holiday gifts would be sent, no brithday cards mailed, no housewarming parties attended. And I believe them. Their Aspie partners are often happy to hole up at home, friendless and isolated. There's only one problem: it only seems to bother ONE of them - the partner! Often the adult with Asperger's seems content, not only with his number of friends, but with the quality of his relationships. This can serve as a constant source of frustration to the more socially inclined partner, who feels building anxiety as the social circle shrinks over time.

So what to do? Can an introvert be coached to behave as an extrovert? Can your introverted Aspie husband be trained to enjoy cooking classes, weddings and the lindy-hop?

My opinion....is a resounding NO!

There is a new trend amongst therapists, one of acknowledging the benefits and realities of introversion. Often passive and accomodating (though not always, of course), many men with AS will force themselves through work lunches, daily meetings, kids' birthday parties and holiday celebrations without acknowledging - even to themselves - their own anxiety and exhaustion. The truth is, socializing is not for everyone. Introversion is not pathology. Social anxiety is a reality for many, many adults - both introverted and extroverted.

In fact, many of my couples experience similar levels of social anxiety - with one member pushing through it (extrovert) and one less likely to (introvert). Unfortunately many introverted clients come to treatment convinced they have a fundamental defect, even shame and guilt. It is crucial that partners, despite frustration and sometimes social embarassment, resist the urge to shame their introverted partner. Husbands with AS often have few sources of emotional support, leaving them vulnerable to partners' guilting or shaming.

So why do partners guilt or shame their introverted partners? Sometimes it's out of loneliness, or a sense that things look "off" to neighbors or friends. Sometimes it's just being tired. But herein lies the key: the extroverted partner can meet her own needs by connecting with friends and maintaining relationships, all while respecting that her partner does not share these needs - and this might be part of what she found attractive in the first place!

While this concept may seem simple, it does often mean adjusting your idea of what your relationship should look like. What expectations do you have regarding your social circle? What fears do you have regarding being isolated? How much responsibility do you take for your own social life? Are you holding your husband responsible for your own hidden social anxiety?

Partners of adults with Asperger's often benefit, as much as do their partners, from learning that it is OK to be introverted: to pass on holiday obligations, to limit time at parties, to set boundaries on family time. In fact, such habits may be crucial to resource management for your relationship and for yourself.

STRAYING FROM THE MID-LINE - ADULTS WITH ASPERGER'S AND THEIR PARTNERS


Through working with many Aspie couples I've come to notice an interesting phenomenon. The apparent lack of emotionality of the Aspie partner seems superficial. After gentle questioning it becomes apparent that many adults with AS are quite emotional - sometimes even overly sensitive - and many of them are suffering in silence.

It is a fascinating thing to watch, indeed. The adult with AS, often times experiencing severe anxiety, becomes....quiet. To the neurotypical adult, who expresses emotions interpersonally, this silence can mean only a handful of things, from disengagement to disinterest. In fact, I have worked with only a few adults with AS who do not suffer with severe anxiety or depression. While a few clients exhibit anger, sometimes overwhelming anger, most do not. Rather they retreat, and become unreachable when they feel threatened. The untrained therapist might view this retreat as passive-aggressive, even evidence of sociopathy. However as I experience this behavior in many different kinds of adults with AS, it is becoming clear to me that the behavior is not only means of protecting oneself, it may be largely involuntary.

Partners of adults with AS may stray from the mid-line too, though in the opposite direction. The more their partners retreat, the louder they become, desperate to effect a response. The cycle is self-perpetuating, of course: the louder one becomes, the more the other involutarily withdraws. Yet who among us has been taught another approach? What options are there for cajoling a withdrawn adult to communicate?

Answers to these questions are not easy to hear. They are painfully complex in their simplicity. They arouse in partners emotions such as righteous indignation and outrage. But the answers are solutions to bridging what appear to be unbridgeable gaps. The foundation to this bridge, of course, must be basic emotional stability and, above all, humility. It appears to this therapist that usually both partners stray from the mid-line of thought-emotion integration. Recognizing this and strategizing ways to meet in the middle can help couples - even those who seem miles apart - come together in deeper and more balanced ways.

Sunday, May 8, 2011

Can Aspies Write Science Fiction? Ask Katie Bridges.



Recently I received word that an ingenious woman with Asperger's had written a fascinating book called Warriors of the Edge: The Search for Stone. Intrigued, I learned more about this new author. So many of my clients dream of writing of the incredible worlds and plots swirling around in their wonderful minds. Here's a quick bio by a woman who (in April!) made it all happen.
My name is Katie Bridges and I am a science fiction author with a diagnosis of Asperger’s syndrome. I’ve had the diagnosis since 1998. Long before Asperger’s syndrome became known to the public, I would search for ways to describe what life was like for me. I would often say, “I feel like I’m suffering from a chronic state of culture shock while living within my own culture. Why is it so difficult to figure out what’s going on around me and adapt to it?”
I had perplexing communication disabilities, with a huge gap between my ability to communicate verbally and in written form. Writing came with ease for me. Forming thoughts verbally did not. I also had an intense need for repetition and sameness in my routine and activities.
I lived a mostly secluded life. Being around people left me feeling anxious and awkward. Having no friends of my own, I was kept from utter loneliness by an understanding husband and three loving children.
But even at home things were difficult for me. To keep myself from becoming completely unglued during times of distress, I would rock back and forth for long periods of time. I also figured out early on that pressure around my midsection would help to soothe me. If my panic sky-rocketed on me, I would yell for my husband saying, “Hurry! Squeeze me tight. I need pressure.” Hugs didn’t help. I needed a certain amount of pressure to help me get through my distress, almost to the point where I could barely breathe. No one understood why this would be of help to me.
It wasn’t until I received a diagnosis of Asperger’s syndrome that things began to turn around for me. I overcame difficulties I never thought would be possible to overcome. I didn’t do it alone. Assistance came from every direction as my husband sought out those who could help me.
The end result was that I was able to utilize the incredible focus I had and put it to work to write a novel. What had once been a problem for me was now an asset. I’d always been a writer, but I took that natural ability to focus and wrote a complex work of juvenile science fiction. My brain is wired to create details which can bring about a realistic feel, even when the subject matter is fictional. This has given my book a unique perspective. It’s what I have to offer as a person with Asperger’s syndrome. It has been thrilling for me to tell people about my book, which won the Rising Star award, a very rare designation for a children’s book. It’s not just the fact that I have a book on the market that makes me excited. It’s the fact that I overcame so much to get this far.
The name of my book is Warriors of the Edge: The Search for Stone by Katie Bridges. I hope you find it enjoyable!
To buy Katie's book (or just read about it!), click here:

Sunday, March 20, 2011

The Badger and The Mole


When one partner in a couple has Asperger's, things can be....challenging. I often hear from partners of adults with AS statements like:

I fell in love with him/her because of a rare sweetness and vulnerability.

I never thought I'd find someone so authentic - he/she plays no mind games.

No matter how mad I get, my partner never shouts back or calls me names.

I love his/her amazing mind and intelligence.


So why then do couples struggle?

So many couples I work with are or were in love. But as daily stressors increase, or the demands of everyday life multiply, couples get stuck, then angry. One partner may be reactive and need to process feelings verbally. The other partner may, when faced with intense emotion, freeze, withdraw, go silent or even flee.

I sometimes picture these Aspie relationships as if between a badger and a mole. The more the badger digs, the more frantically he or she tries to connect, the deeper the mole retreats. The badger thinks the harder and faster he or she digs, the sooner the mole will be reached. The mole flees, hoping the badger will eventually give up and peace will be restored. It's as if each is operating on instinct, both wanting to connect, but unable to. This can lead the partner playing the beaver role exhausted and angry. It can leave the partner playing the mole role frightened and blank.

This system is not unusual. Therapists have for years been describing a common "dance" of marriage as one involving two roles - one pursuing and one distancing. Under stress the pursuer steps up her or her efforts to connect. Under stress the distancer seeks less connection. The two partners struggle with opposite instincts, which increases the stress on the system and adds feelings of misunderstanding, anger, even abandonment. The system is stable and becomes exaggerated over time, as both partners become more and more reactive to their partner's behavior.

In my experience, partners of adults with AS do well to unlearn the universal lesson of digging and relearn ways to communicate which are perceived as less threatening by their partners. Adults with AS, if they are to connect, must find a way to communicate with their partners in ways their partners can understand - usually verbally. This takes guidance and hard work.

Can this really be done? Absolutely! While adjusting expectations (the beaver may never sit quietly and mute, the mole may never chatter away) can be helpful, I almost always find that there is much room for change in both partners, contrary to much published information on Asperger's marriages.

Adults with AS often provide stability, loyalty, consistency. Others provide a childlike playfulness and an authenticity rare in adults. As with any marriage, accepting your partner while clearly communicating your needs can be crucial. A therapist familiar with AS may help you and your partner have these conversations and make real headway.


Thursday, December 2, 2010

MRI Scans and Asperger's - New Research

The online journal Autism Research published a new study today on how MRI scans of brain circuitry might help us understand how the brains of people with HFA differ from the brains of people without spectrum disorders.

Researchers were able to measure six physical differences of microscopic fibers in the brains of 30 males with confirmed high-functioning autism and 30 males without autism. How these findings might relate to adults with Asperger's is unknown. The scans helped researchers identify adults in the study with HFA with over 90% accuracy. While the study was small, the progress is promising, as researchers are increasingly in search of definitive evidence of brain differences related to autism. Identifying such differences may serve to clarify diagnosis, which is a largely subjective process at present.

While the study authors find the results promising, MRI scanning for diagnostic purposes is a long way from becoming a widely used tool.

Using the MRI, the study authors measured how the water in the brain flows along the axons or nerve fibers in the parts of the brain that control language, social and emotional functioning. The scans revealed that the wiring of the brains of those with autism was disorganized compared with the brains of a typical person without autism.

Such results are important for adults with Asperger's to consider, and important for their partners to consider. The communication difficulties which can cause immense frustration for the partner of an adults with AS are understood today, with increasing clarity, to result from neurological brain differences.

Currently there is no biologic test for autism; clinicians working with adults must gather information about current and past functioning to piece together a clinical picture. This process can be tricky, as adults have often adapted to social rules and settings, making what might be more easily identifiable "Aspie" behaviors difficult to see. Often family members are the true observers of these behaviors, but are left without a framework with which to understand them.


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:http://www.mayoclinic.com/health/core-strength/SM00047

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.
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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."
or
"I wish I were married to someone who could actually see the trash overflowing onto the floor!"
or
"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?"
or
"I feel overwhelmed. Will you take the trash out? That will help."
or
"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.
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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.
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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 www.harrietlerner.com .
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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:

Tactile:
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.

Gustation:
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

GLASS CASTLE

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



-anonymous