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Asperger's Syndrome and Autism
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In the last section, we discussed Four Tips for Free Time at School. These included rules, lining up with a friend, developing structured activities and fixation games.
In this section, we will discuss Asperger’s Syndrome because it is closely related to autism. As you are aware, those who have Asperger’s tend to be more high-functioning. Carlin Flora provided a case study of Kiriana in "The Kiriana Conundrum."
As you read Kiriana’s case study, compare this with a client you are currently treating. Keep in mind, Kiriana was not diagnosed until she was 19. Some of Kiriana’s behaviors will include an obsession with puzzles, some social isolation, a greater affection towards animals than towards people and difficulty grasping abstract emotions such as love.
♦ Kiriana, a 24-year-old graduate student, is enamored of details. She's also easily absorbed: A week ago, she worked on a 9,000-piece puzzle for 10 straight hours, without pausing for so much as a sip of water. A clothing maven, she's fashionably put together in chunky jewelry and a black mini-dress with billowing sleeves. But she'd rather stay home with those cardboard pieces than dress up for a night out. She's pretty—slender and pale, with innocently round eyes and long, brown hair—and yet she's never had a boyfriend.
Though smart enough to have earned herself a spot in a top neuroscience program, she often gets lost in her own neighborhood. Such perplexing contradictions are the hallmarks of Asperger's Syndrome, with which Kiriana was diagnosed when she was 19. AS is a condition on the high-functioning end of the autism spectrum. Its sufferers are successful in many realms of life but tend to have obsessive interests. They have trouble reading people and connecting with them. And they can have faulty sensory processing systems that leave them confused in hectic or unfamiliar settings.
Kiriana fits the AS profile quite neatly. What makes her exceptional is her gender. While the overall prevalence of Asperger's is 20 to 25 per 10,000 children, it's much more common in boys than girls. We don't understand what causes autism and Asperger's, or why more boys have these syndromes than girls, but some scientists conceive of them as expressions of extreme "maleness"—a talent for systemizing as opposed to empathizing. Other experts attribute some of the gender gap to the widespread misdiagnosis of girls.
"Girls are pretty neglected," says Shana Nichols, who specializes in treating girls with AS. Most of what we know about the condition is based on research on boys; Theories about how it manifests itself differently in girls stem mainly from anecdotal evidence. Researchers agree that girls with AS tend to be more anxious and less aggressive than the boys. And during their teenage years, they are at an increased risk for awkward sexual situations and even date rape because of their inability to interpret social cues and their tendency to take statements literally.
♦ When Kiriana was 4, she began a long series of obsessions. She moved from dinosaurs to poisonous insects, then reptiles—a phase her mother nurtured by sending her to a lizard-themed summer camp. In school, Kiriana barely spoke at all. One teacher feared she was deaf. "She pretty much refused to interact with other kids," says Melissa. She was often distracted—but not in the ricocheting manner of a kid with an attention-deficit disorder. "When the teacher called on me, I was frozen," recalls Kiriana. "I was often accused of not paying attention or of being on a different planet, but I was actually paying close attention to something else."
At the behest of a teacher at her private elementary school, Kiriana finally did get tested for disabilities. The results were inconclusive, and no one suspected autism in any form. "I knew she felt a little different," says Melissa. "But I never really thought anything was wrong with her." "Girls are generally recognized as superior mimics," says Tony Attwood, a pioneering Asperger's researcher. Those with AS hold back and observe until they learn the "rules," then imitate their way through social situations.
"Girls can fake it quite well," says Liane Willey, a psycholinguist with AS who describes how she assumes different personalities when switching social gears in her autobiography, Pretending to Be Normal. Kiriana's similar strategy amounts to remembering and rehearsing scripts. When she walks into a clothing shop, for example, she pulls up a mental dialogue box: "No thanks, I'm just looking," is what one should say if a saleswoman offers help. But as Attwood points out, such playacting is not intuitive, and is therefore exhausting.
Around age 9, she developed a feverish curiosity about the medical experimentation the Nazis conducted during the Holocaust. "All my obsessions related to something profoundly catastrophic," she says. "I have a really hard time feeling emotionally aroused. Brutal, violent, scary things were interesting to me because that was the best way to feel something." She repeatedly read Bret Easton Ellis’ American Psycho.
"I was partly drawn to serial killers because of my interest in patterns, logical induction, and puzzle solving," she remembers. "These twisted individuals took puzzles to a whole new level of interest." Captivated by the process of piecing together an event based on its physical trace, she fell asleep each night trying to come up with the "perfect crime," one that could not be reconstructed.
During her First Year at Vassar
During her first year at Vassar, she found herself part of a group of friends for the first time. But stressed out by greater academic challenges and increasingly aware that she could not process lectures as well as her classmates, she sought help from a doctor, and then another. When a psychiatrist finally pulled the pieces together and diagnosed her with Asperger's, the label alone resolved a lifelong identity crisis. The diagnosis was the only one that reconciled, as she puts it, her special talent for being smart and stupid at the same time. "In this very small world of Asperger's," she says, "that's normal."
After graduation, driven partly by a desire to understand her own "neuro-atypical" mind, Kiriana set out for New York University to begin a Ph.D. program in neuroscience, where she now conducts emotion research on rats. Lacking the internal maps on which most of us depend, she often got lost in her lab, a stark maze of hallways lined with nondescript white doors. But Kiriana makes efforts to work around her deficiencies.
After a few mishaps, she explained to one scientist she works for that she just can't remember spoken instructions. "Now that he's aware of that, I can just run and get a pen and write it down." She tries to remind herself that as neuroscientists, her colleagues are particularly likely to understand that her brain is wired differently. Besides, she says, "It's a profession where everyone is a bit odd."
Last summer, Kiriana went several weeks without speaking to anyone she knew. "I feel most comfortable being alone," she says. "I don't feel lonely very often, and when I do, it's usually not a general feeling of loneliness as much as a wish to be with a certain person or people."
When a friend is upset, she can give advice if she can relate to the dilemma. But when it comes to being there for someone who is crying, Kiriana writhes under the pressure to respond the way a "normal" person would. "Anything schmaltzy makes me squeamish," she says. "My parents try to be affectionate, and they get hurt feelings sometimes because I don't like to hug them." Kiriana gets rushes of happiness, pride, and guilt, but abstract concepts—patriotism, for example, or spirituality—don't rouse her.
"I do cry," she says, "but it's usually out of anger or frustration. Rarely do I feel true sadness." It's a perspective that may account for her fierce identification with animals. "If I saw a person lying on the street, my first response would be, I wonder what's wrong with them, I should call 911. It's not emotional, it's practical," she says.
"If I saw a dog lying on the street, I would be on my knees, in pain." Psychologist Shana Nichols has noticed that nearly all the girls with AS that she sees are avid animal lovers, "Animals don't care if you can't have small talk about the weather," she says. "There's just not as much anxiety as there is with human interactions, so you can really connect."
Kiriana behaves loyally toward her family and friends, but she balks at saying she loves anyone. "While there are many people who certainly matter to me, I'm not sure I can qualitatively summarize whether or not that constitutes love," she says. She doubts she could ever fall in love.
In this section, we discussed an excerpt of Carlin Flora’s, "The Kiriana Conundrum." Do you or a colleague have a Kiriana who was not diagnosed until she was 19 years old that may have Asperger’s? Would it be beneficial to play this section for a colleague or to replay it yourself in light of a client you are currently treating?
In the next section, we will discuss 6 Parts to Making Conversation. These include starting a conversation, food talk, commenting, learning to be appropriate, starting conversations appropriately and making empathetic responses.
Peer-Reviewed Journal Article References:
Lovett, S., & Rehfeldt, R. A. (2014). An evaluation of multiple exemplar instruction to teach perspective-taking skills to adolescents with Asperger Syndrome. Behavioral Development Bulletin, 19(2), 22–36.
Paquette-Smith, M., Weiss, J., & Lunsky, Y. (2014). History of suicide attempts in adults with Asperger syndrome. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 35(4), 273–277.
Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger's syndrome and high-functioning autism. Emotion, 12(4), 659–665.
People with Asperger’s Syndrome are identified as being what kind of autistic people?
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