# The Complete Guide to Asperger’s Syndrome

## Tony Attwood

#books #kindle

### Highlights from July 26, 2021

• The underlying assumption in the diagnostic criteria is that someone who has an ASD has difficulty ‘reading’ social situations. From my clinical experience, there are three adaptations to this characteristic. The most conspicuous is a tendency to be withdrawn, shy and introspective in social situations, avoiding or minimizing participation or conversations; or, conversely, actively seeking social engagement and being conspicuously intrusive and intense, dominating the interaction and being unaware of social conventions such as acknowledging personal space. In each example, there is an imbalance in social reciprocity. (Location 205)
• to reduced sharing of interests, emotions, (Location 221)
• failure to initiate or respond to social interactions. (Location 222)
• from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. (Location 223)
• in making friends; to absence of interest in peers. (Location 227)
• 2.Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). (Location 236)
• 3.Highly restricted, fixated interests that are abnormal in intensity or focus (Location 238)
• 4.Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). (Location 241)
• Asperger’s syndrome also has a ‘signature’ language profile. (Location 279)
• There may be literal interpretations, with a tendency for the person to become greatly confused by idioms, figures of speech and sarcasm. (Location 280)
• A deficit in emotional reciprocity can be explored by examining whether the person shows reciprocal affect in facial expressions, body language and tone of voice. (Location 284)
• The child may be content with long periods of solitude, preferring to be engaged in a special interest. (Location 300)
• Children who have Asperger’s syndrome are extremely vulnerable to being teased, rejected, humiliated and bullied by their peers. (Location 304)
• Variety is not the spice of life for someone who has Asperger’s syndrome. (Location 321)
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• There is a determination to maintain consistency in daily events, and high levels of anxiety if routines are changed. (Location 321)
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• From my clinical experience, the imposition of routines and rituals may actually be a mechanism for coping with high levels of anxiety as they are soothing and relaxing. (Location 322)
• The special interests all have a ‘use by date’, ranging from hours to decades, and have many functions, such as being a ‘thought blocker’ for anxiety, an energy restorative after the exhaustion of socializing, or an extremely enjoyable activity that is an antidote to depression. (Location 330)
• The special interest can also create a sense of identity and achievement, as well as provide an opportunity for making like-minded friends who share the same interests. (Location 333)
• The sense of well-being associated with the interest can become almost addictive, sometimes leading to concern that it is dominating the person’s time at home to such an extent that it is preventing engagement in other activities. (Location 334)
• Sensory sensitivity can be a life-long problem, with sensitivity to distinct sensory experiences that are not perceived as particularly aversive by peers. These can include specific sounds, especially ‘sharp’ noises such as a dog barking or someone shouting; tactile sensitivity on a specific part of the body; and aversive reaction to specific aromas, light intensity and other sensory experiences. In contrast, there can be a lack of sensitivity to some sensory experiences, such as pain and low or high temperatures. The child or adult can feel overwhelmed by the complex sensory experiences in particular places or situations, such as shopping malls, supermarkets, birthday parties or school playgrounds. Sometimes, social withdrawal is not due to social confusion, but to an avoidance of sensory experiences that are perceived as unbearably intense or overwhelming. (Location 341)
• They may achieve social success by observing and imitating others, creating an alternative persona, or escaping into the world of imagination through solitary fantasy play, reading fiction or being with animals rather than peers. (Location 356)
• It is emotionally exhausting to constantly observe and analyze social behaviour, trying not to make a social error or be perceived as different. (Location 359)
• One of the problems faced by children with Asperger’s syndrome who use their intellect rather than intuition to succeed in some social situations is that they may be in an almost constant state of alertness and anxiety, leading to a risk of mental and physical exhaustion. (Location 672)
• I have noted that the signs of Asperger’s syndrome are more conspicuous at times of stress and change, and during the teenage years there are major changes in expectations and circumstances. The child may have coped well during his or her pre-adolescent years, but changes in the nature of friendship, body shape, school routines and support may precipitate a crisis that alerts the relevant diagnostic authorities to the discovery of Asperger’s syndrome in a child who was previously coping so well. (Location 721)
• Sometimes children with Asperger’s syndrome perceive themselves as more adult than child. (Location 736)
• The child with Asperger’s syndrome is often immature in the art of negotiation and compromise and may not know when to back down and apologize. (Location 741)
• Those children who have exceptionally high IQs may compensate by becoming arrogant and egocentric, and have considerable difficulty acknowledging that they have made a mistake. Such children can be hypersensitive to any suggestion of criticism, yet overly critical of others, including teachers, parents or authority figures. (Location 746)
• Although the person with Asperger’s syndrome may achieve academic success, difficulties with social skills may affect his or her performance at a job interview, the social or team aspects of employment, or the understanding of social conventions such as standing too close or looking at someone too long. Getting and keeping a job may be a problem. (Location 776)
• This can be, for example, a promotion to management, requiring interpersonal skills, and conferring responsibilities that demand planning and organizational abilities which can be elusive in some adults with Asperger’s syndrome. There can also be issues of not accepting conventional procedures, and difficulties with time management, and recognizing and accepting the organizational hierarchy. (Location 781)
• Once the diagnosis is confirmed and understood, there can be a significant positive change in other people’s expectations, acceptance and support. The child is now understood and more likely to be respected. (Location 950)
• When talking to adults with Asperger’s syndrome about the diagnosis, I often refer to the self-affirmation pledge of those with Asperger’s syndrome written by Liane Holliday Willey. •I am not defective. I am different. •I will not sacrifice my self-worth for peer acceptance. •I am a good and interesting person. •I will take pride in myself. •I am capable of getting along with society. •I will ask for help when I need it. •I am a person who is worthy of others’ respect and acceptance. •I will find a career interest that is well suited to my abilities and interests. •I will be patient with those who need time to understand me. •I am never going to give up on myself. •I will accept myself for who I am. (Willey 2001, p.164) (Location 1004)
• Difficulties in understanding social situations and other people’s thoughts and feelings. (Location 1479)
• Tendency to think of issues as being black and white (e.g. in politics or morality), rather than considering multiple perspectives in a flexible way. (Location 1482)
• 1.Tendency to turn any conversation back to self or own topic of interest. (Location 1490)
• 2.Marked impairment in the ability to initiate or sustain a conversation with others. Cannot see the point of superficial social contact, niceties, or passing time with others, unless there is a clear discussion point/debate or activity. (Location 1491)
• 4.Inability to recognize when the listener is interested or bored. Even if the person has been told not to talk about their particular obsessive topic for too long, this difficulty may be evident if other topics arise. (Location 1494)
• 5.Frequent tendency to say things without considering the emotional impact on the listener (faux (Location 1497)
• Being alone can be a very effective way of calming down and is also enjoyable, especially if engaged in a special interest, one of the greatest pleasures in life for someone with Asperger’s syndrome. (Location 1618)
• Liane Holliday Willey explained in her autobiography that at college, ‘I was accustomed to defining friendship in very simplistic terms. To me, friends were people I enjoyed passing a few minutes or a few hours with’ (Willey 1999, p.43). (Location 1673)
• Becoming a partner Eventually, perhaps when emotionally and socially more mature, the adult with Asperger’s syndrome can find a lifetime partner. However, both partners would probably benefit from relationship counselling to identify and encourage the adjustments needed to make an unconventional relationship successful for both. (Location 1769)
• One of the characteristics of a good friend at stage four is someone ‘who accepts me for who I am’. (Location 2376)
• Animals as friends Animals provide unconditional acceptance. The dog is always delighted to see you, despite the day’s disappointments and exhaustion. (Location 2381)
• And I have found that children and adults with Asperger’s syndrome are sometimes more able to perceive and have compassion for the perspective of animals than humans. (Location 2388)
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• Maintaining the friendship When a friendship does occur, one of the difficulties for people with Asperger’s syndrome is knowing how to maintain it. At this stage, the issues are those of knowing how often to make contact, appropriate topics of conversation, what might be suitable gifts, empathic comments and gestures, as well as how to be generous or tolerant with regard to disagreements. There can be a tendency to be ‘black or white’, such that when a friend makes a transgression the friendship is ended rather than reconciliation sought. A useful strategy is to encourage the person to seek advice from other friends or family members before making a precipitous decision. (Location 2446)
• Children with Asperger’s syndrome are less likely than their peers to report being a target for bullying or teasing as they have impaired Theory of Mind abilities; that is, they have difficulty determining the thoughts and intentions of others in comparison to their peers (Attwood 2004d; Baron-Cohen 1995). (Location 2714)
• The psychological term Theory of Mind (ToM) means the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behaviour and predict what they are going to do next. (Location 2997)
• It has been suggested that impaired ToM also affects self-consciousness and introspection (Frith and Happé 1999). I was talking to Corey, a teenager with Asperger’s syndrome, about the ability to ‘mind read’. He said, ‘I’m not good at working out what other people are thinking. I’m not sure what I’m thinking now.’ Thus there may be a pervasive difficulty in thinking about thoughts and feelings, whether they are the thoughts and feelings of another person or oneself. (Location 3032)
• It is important to recognize that the person with Asperger’s syndrome has immature or impaired ToM abilities or empathy, not an absence of empathy. (Location 3036)
• One of the consequences of impaired or delayed (Location 3074)
• ToM skills is a tendency to make a literal interpretation of what someone says. (Location 3074)
• Children or adults with Asperger’s syndrome can be confused by sarcasm, and prone to teasing by others, as they are remarkably gullible and assume that people say exactly what they mean. (Location 3083)
• The child with Asperger’s syndrome may not notice or read an adult’s or another child’s subtle cues that they are becoming annoyed with his or her egocentric or dominating behaviour or conversation. The child appears to break the social rules and does not respond to the warning signs. If the adult or other child does not know that this behaviour is due to impaired or delayed ToM skills, the interpretation of the behaviour is to make a moral judgement: that the child with Asperger’s syndrome is being deliberately disrespectful and rude. However, the child does not necessarily have any malicious intent, is usually unaware of causing offence and can be bewildered as to why the other person is angry. (Location 3086)
• Stephen Shore sent me the following comment. ‘When I am asked what I would like to eat or drink when at another person’s home as a guest, it is impossible for me to answer. My response is to ask ‘What is available?’ Once the options are laid out for me it is easy to make a choice. Otherwise the question just feels too big.’ (Location 3100)
• Equally, those topics or activities that are of interest to others may be perceived as boring by the person with Asperger’s syndrome. For example, at school young children usually sit still during ‘show and tell’ and take a genuine interest in the experiences of the child who is standing before the group. The child with Asperger’s syndrome may not be able to empathize with the storyteller or be interested in his or her experiences. He or she can become bored and be criticized for not paying attention. The tendency therefore to talk at length without recognizing another person’s boredom, or to be inattentive to others’ interests, may be due to impaired ToM rather than a lack of respect or a desire to misbehave. (Location 3103)
• Adults with Asperger’s syndrome can be renowned for being honest, having a strong sense of social justice and keeping to the rules. (Location 3134)
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• They strongly believe in moral and ethical principles. These are admirable qualities in life but can cause considerable problems when the person’s employer does not share the same ideals. I suspect that many ‘whistle-blowers’ have Asperger’s syndrome. I have certainly met several who have applied a company’s or government department’s code of conduct to their work and reported wrongdoing and corruption. They have subsequently been astounded that the organizational culture, line managers and colleagues have been less than supportive; this can lead to disillusionment and depression. (Location 3135)
• One of the consequences of impaired or delayed ToM skills for the person with Asperger’s syndrome is a difficulty in distinguishing between deliberate or accidental actions of another person. (Location 3140)
• At a very young age, typical children realise that someone else may have a solution to a practical problem and that others might be interested and able to help. This insight into the thoughts and abilities of other people is not automatic for children with Asperger’s syndrome. When presented with a problem, seeking guidance from someone who probably knows what to do is usually not a first or even (Location 3156)
• second thought. The child may be sitting or standing next to someone who could obviously help but appears ‘blinkered’ and determined to solve the problem by him- or herself. (Location 3159)
• They may fail to understand that they would be more likely to achieve what they want by being nice to the other person. When an argument or altercation is over, the person with Asperger’s syndrome may also show less remorse, or appreciation of repair mechanisms for other people’s feelings, such as an apology. (Location 3166)
• The relevant conflict resolution characteristics associated with Asperger’s syndrome at this stage are: •a difficulty conceptualizing the other person’s perspective and priorities •limited skills in persuasion •a tendency to be confrontational and rigid •reluctance to change a decision and admit making a mistake •an aversion to being interrupted •a compulsion for completion •a tendency to punish rather than praise •a tendency to avoid demands •a lack of knowledge of alternative strategies. (Location 3172)
• Uta Frith and Francesca Happé (1999) have suggested that due to differences in the acquisition and nature of ToM abilities in the cognitive development of children with Asperger’s syndrome, they may develop a different form of self-consciousness. (Location 3192)
• The child may acquire ToM abilities using intelligence and experience rather than intuition, which can eventually lead to an alternative form of self-consciousness as the child reflects on his or her own mental state and the mental states of others. (Location 3194)
• Being unsure of what someone may be thinking or feeling can be a contributory factor to general feelings of uncertainty and anxiety. Marc Fleisher is a talented mathematician with Asperger’s syndrome and, like most people with Asperger’s syndrome, is a very kind person who does not want to cause someone to be confused or distressed. (Location 3221)
• Because of my lack of confidence, I am terribly afraid of upsetting others without realising it or meaning to, by saying or doing the wrong thing. (Location 3225)
• I wish I could read minds, (Location 3226)
• then I would know what they wished for and I could do the right thing. Socialising is harder than any maths equation for me. What works for one person doesn’t for another. People do not always say what they mean, or stick to what they say. (Fleisher 2003, p.110) (Location 3226)
• However, we also need to recognize the degree of mental effort required by people with Asperger’s syndrome to process social information. Using cognitive mechanisms to compensate for impaired ToM skills leads to mental exhaustion. Limited social success, low self-esteem and exhaustion can contribute to the development of a clinical depression. One of my clients has an excellent phrase to describe her exhaustion from socializing. She says, ‘I’m all peopled out.’ (Location 3255)
• KEY POINTS AND STRATEGIES •Effects of impaired Theory of Mind abilities in daily life: •difficulties reading the messages in someone’s eyes •a tendency to make a literal interpretation of what someone says •a tendency to be considered disrespectful and rude •remarkable honesty •a sense of paranoia •an inability to see that another person may have the knowledge and a desire to be of help •delay in the development of the art of persuasion, compromise and conflict resolution •a different form of introspection and self-consciousness •problems knowing when something may cause embarrassment •anxiety •a longer time to process social information, due to using intelligence rather than intuition •physical and emotional exhaustion. (Location 3354)