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Autism & Asperger’s Conference with Dr. Tony Attwood, Part 3

Posted Nov 08 2010 4:00am

Welcome! This is Part 3 in a series related to the recent Future Horizons conference I attended with Dr. Tony Attwood speaking on Autism & Asperger’s. I know this is a lot of information in a relatively short period of time, but my hope is that you will find something you relate to or that you can bookmark these posts for a later time when it may apply to your situation.

Part 1 covered the topics of Autistic Personality, Prevalence of ASDs and Asperger’s in Girls.
Part 2 included the Reaction to Being Different, How to Explain the Diagnosis and the Social Tree versus the Sensory Tree.

Today we are looking at Exploring Feelings, specifically related to Cognitive Behavior Therapy, the Amygdala and Common Emotions.

Cognitive Behavior Therapy (CBT) is a treatment for mood disorders that is logical and therefore suited to individuals with Asperger’s. CBT can help an individual to better manage anxiety, sadness, anger and affection.

Tony shared about two critical areas during this section of his presentation–affective development and cognitive distortion. Affective development relates to three areas:

  • Maturity – may have tantrums or show affection in a way that’s much younger than their actual age
  • Vocabulary – needs words to describe how they are feeling or may express anger in response to a variety of feelings
  • Repair – ability to fix negative feelings may be limited and they may not understand why neurotypicals use emotional restoratives and affection (i.e. hugs and such) to feel better

So much of what I have learned about emotions over the last few years has been related to maturity and vocabulary, that is, identifying and talking about feelings. I really hadn’t thought or read much about the concept of repair.

But when an individual does not have good repair strategies, they will react in whatever way gets them away from the bad feelings. This might be through destruction (using anger as a quick fix), solitude (best way to calm down) or focusing on their special interest (to block the negative thoughts).

Congnitive distortion relates to dysfunctional thinking and incorrect assumptions. For example, a person with Asperger’s may not understand why people are laughing in a situation. They may think the people are laughing at them when they are really laughing with them, or vice versa. There are several types of laughter and distinguishing between them requires social skill.

As Tony shared with us, difficulty with the perception, expression and regulation of emotions in an inherent characteristic of Asperger’s. This is due in part to the amygdala.

The amygdala is responsible for alerting us to the need for fight or flight. Our breathing and heart rate changes, adrenalin is released to alert the frontal lobe, which is where we control our impulses. If you imagine that the amygdala is like a car dashboard and the frontal lobe is the driver, the amygdala tells us when the engine is going too fast or is overheating, i.e. when we are going to have a personal meltdown.

In people with Asperger’s, the amygdala is 10-15% larger and has less white matter for connections to be made with the frontal lobe. So the dashboard is not being consistent or accurate in notifying the driver of a problem brewing, and that is why meltdowns and explosions often seem to come out of the blue, even to the person with the disorder.

Now, an important point to be made is that all of this is an explanation, not an excuse, for inappropriate behavior. Individuals with Asperger’s need teaching and support regarding how to recognize the signals.

One ingenious device that Tony found at Brookstone (otherwise known as a toy store for men!) is a Heart Rate Ring . To use it, you simply place the ring on your finger and turn it on, and it monitors your heart rate. This could be used to identify when your heart rate is going up and possibly alert you to your level of agitation before a meltdown or explosion occurs. Pretty neat, huh?

Anxiety
Individuals with Asperger’s are very good at worrying and may also have generalized anxiety, obsessive compulsive disorder, performance anxiety, social anxiety or even post-traumatic stress disorder from being teased or bullied. Controlling or oppositional behaviors can be based in anxiety, as can anger and aggression.

Depression
One in three adolescents and adults with Asperger’s suffers from depression as a result of low self-esteem, a painful awareness of being different and sometimes an empathic attunement to the suffering of others. As I can attest to personally, depression is a difficult thing to overcome as it often results in extreme loneliness and both physical and mental exhaustion. Just as with anxiety, we can see sadness expressed as anger.

Anger
Two out of three people with Asperger’s have a problem with anger management. However, we need to be aware that anger is a quick fix for feelings of sadness, depression or anxiety. Anger can also be a sign of an externalized depression. Because of this, it is vitally important to do a thorough assessment and figure out what is really going on when a person is exhibiting a lot of anger.

This can be done using tools such as self-report scales, a mood diary and a list of triggers. If you chart a person’s moods over a period of time and take away the extremes, you should see a cycle and be able to even predict when a difficult time is coming so additional supports can be provided during that time.

Assessments should also include a clinical interview, observations in different contexts, family history of mood disorders, unconventional signals of distress and misinterpretations of situations and information. A couple of things to keep in mind when working with a child with Asperger’s:

  • Three words that are guaranteed to trigger agitation are no, wait and change.
  • Once the atmosphere becomes emotional, the child with Asperger’s amplifies it.

One of the ways that Tony recommends to respond to these needs is what he calls “affective education.” He has even developed a program called the CAT-kit that he has designed to work on this area with individuals. I’ll talk more about this concept of Affective Education in my next conference post.

I would love to hear your thoughts on any of the topics discussed here. Is there anything that sticks out to you as being especially true or even not true in your experience?

For more information on other conferences, please visit the Future Horizons website. They also have a variety of books and other materials by Tony Attwood and a number of other authors in their online store .

Note: I attended this conference for free as a member of the Future Horizons blogger review team. I did not receive any other compensation for this post.

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