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Malta 26 Mar 2010 New Developments In Asperger syndrome
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  • Increasingly health costs are driving innovation. There have been many recent studies of health costs in AS, and one of these has influenced the UK government towards considering the needs of adults with ASD for, effectively the first time.
  • Although AS is often said to be ‘less severe’ than autism, the reduction in quality of life may be greater, and this may be reflected in the higher incident of emotional difficulties in adolescenceWomen with AS are still being diagnosed as having personality disorders, rather than AS—and it is a difficult diagnosis
  • Although AS is often said to be ‘less severe’ than autism, the reduction in quality of life may be greater, and this may be reflected in the higher incident of emotional difficulties in adolescenceWomen with AS are still being diagnosed as having personality disorders, rather than AS—and it is a difficult diagnosis
  • Although AS is often said to be ‘less severe’ than autism, the reduction in quality of life may be greater, and this may be reflected in the higher incident of emotional difficulties in adolescenceWomen with AS are still being diagnosed as having personality disorders, rather than AS—and it is a difficult diagnosis
  • Although AS is often said to be ‘less severe’ than autism, the reduction in quality of life may be greater, and this may be reflected in the higher incident of emotional difficulties in adolescenceWomen with AS are still being diagnosed as having personality disorders, rather than AS—and it is a difficult diagnosis

Malta 26 Mar 2010 New Developments In Asperger syndrome Malta 26 Mar 2010 New Developments In Asperger syndrome Presentation Transcript

  • New developments in Asperger syndrome
    Digby Tantam
    Clinical Professor of Psychotherapy, University of Sheffield
    Senior Visiting Research Fellow, University of Cambridge
    Honorary Consultant Psychiatrist, Sheffield Health and Social Care Trust
    Director, Dilemma consultancy
  • Issues for Asperger syndrome
    The life-time prevalence may not be the same as the year prevalence in children
    Does economic cost of services, or lost employment, accurately reflect the reduced quality of life of people with AS?
    Is prevalence in women still under-estimated?
  • The life-time prevalence may not be the same as the year prevalence in children
  • Contributors
    Sheffield survey
    Myles Balfe
    Ting Chen
    Mike Campbell
    submitted to Autism
    Bullying project
    Paul Naylor
    Jenny Wainscot
    Jenna Williams
    15 medical students
    International Journal of Psychology
    24 November 2009
    Parents, teachers, and people with Asperger syndrome
    Sheffield Asperger Parents Action Group
    Brookdale care conference, London
  • Project Development
    15 Oct 08
    Psychotherapy of people with AS Biejing WCP
    6
  • Brookdale care conference, London
  • Data from the US National Survey of Children’s Health (from www.leftbrainrightbrain.co.uk)
  • Issues for Asperger syndrome
    Does economic cost of services, or lost employment, accurately reflect the reduced quality of life of people with AS?
  • Theme analysis of 5 websites of people with AS/ HFA
    sense of alienation
    sense of frustration
    depression as a central emotion
    a pervasive sense of fear or apprehension
  • Green et al compared 20 adolescent men with AS with 20 with conduct problems
    AS group
    Severely impaired practical social functioning
    Anxiety
    Obsessionaldisorders
    Both groups had
    Depression
    Suicidal ideation
    Tempers and defiance
  • Outstanding areas for concern: Sheffield survey
    Reduction of available support in adulthood
    Lack of paid work (36%, 6% of whom supported)
    Lack of independence
    60% living with parents
    21% living independently
    56% thought they could be more independent with support
    Victimization 90% said they had been bullied
    Brookdale care conference, London
  • Emotional problems in adolescents and adults with Asperger syndrome(findings from Sheffield survey)
    Self-harm: thoughts 50%, actual 11%
    Violence: threats 83%, actual 34%
    Bullied 90%, 30% currently (includes adults)
    Majority have anxiety-related disorder
  • Is prevalence in women still under-estimated?
  • 60 with AS/HFA had been diagnosed
    Mean age 24.3 years
    7.6 men to 1 woman
    52 with AS/HFA had no previous diagnosis
    Mean age 35.2 years
    2.1 men :1 woman
    15 Oct 08
    Psychotherapy of people with AS Biejing WCP
    15
  • Themes in adulthood Ryan, S,Räisänen, U "It's like you are just a spectator in this thing": Experiencing social life the [`]aspie' way. Emotion, Space and Society 2008; 1: 135-43.
    feeling different
    trying to fit in
    safe spaces 
    uncommon sense
  • Feeling different
    Being disconnected from the interbrain
  • Correlations over time of spontaneous wavelets provide information about connectivity (Meunier, D, Achard, S, Morcom, A, Bullmore, E Age-related changes in modular organization of human brain functional networks. Neuroimage 2009; 44: 715-23.)
  • Hunyuan hanging temple, Mt. Hengshan, Shanxi
  • The interbrain
    • Extended cognition
    • Automatic processing
    • Reflexive vs. reflective processing
    • ‘The borg’
    Jerry Ryan, 7 of 9 StarTrek
    Neurotypical
    Aspie
    Brookdale care conference, London
  • 24 November 2009
    Brookdale care conference, London
    “l’hommeestnélibre, et partoutilestdans les fers. J.-J. Rousseau
  • Is it better not to connected to the interbrain?
    Fewer informational viruses
    Understand machines in their own right not as defective people
    Fairness is not prejudiced by sympathy
    Not in chains
  • Trying to fit in
    Many other educational obstacles, plus emotional difficulties
    Brookdale care conference, London
  • Atypical Asperger syndrome
    Dysexecutivesyndrome (planning)
    Dyslexia (writing and spelling)
    Attention deficit/ hyperactivity disorder (impulsivity, executive functions, task persistence)
    Also links with
    Tourette syndrome
    Expressive speech and language disorder (may lead to elective mutism)
    Dysgraphia
    Dyscalculia
    Topographical disorientation
    Associated developmental disordersPredominantly fronto-striatal or fronto-cerebellar
    Brookdale care conference, London
  • Atypical Asperger syndrome
    Primary abnormality is lack of empathy, partly due to failure of non-verbal interpretation (‘face blindness’)
    Ability to make relationships but not to keep them
    Lack of empathy may lead to antisocial behaviour, but greater problem is lack of persuasiveness and ‘social influencing power’
    Picture on left from Pelphrey et al, 2002 and on right from the film, “Ripley’s game” starring Matt Damon as Ripley
    24 November 2009
    Brookdale care conference, London
  • Knowing about the world using non-verbal cues
    Who is being shot?
    Terrorists or partisans?
    24 November 2009
    Brookdale care conference, London
  • Atypical AS
    ‘Look normal’, because normal NVE. Do not seem like ‘Aspies’
    Form friendships but they do not last
    May have many hidden learning difficulties e.g. lack of speech understanding, reduced working memory
    Vulnerable adults
    Lack of empathy leads to a lack of persuasiveness
    This may lead to unassertiveness or exploitation
    Coercive interpersonal strategies, possibly more likely if associated ADHD
    Drug misuse, violence, other forensic issues
    Impulsivity may alternate with compulsivity
    May seek an identity as adults, and like special interests in other people with AS, may embrace or drop one ruthlessly.
    Modelling on others may be even more marked
  • Coping with a lack of identity
    Fads
    ‘Obsessive’ relationships
    Lack of identity in many people with ASD
    Adopting identity wholesale
    Joining charismatic groups
    Moving places and work
    Searching for identity
    ‘Transexualism’
    ‘Aspie’
    Identities off the peg
    Gangster
    Professor
    Teddy bear
    21 Mar 08
    Advances in research and management of AS
  • Safe spaces
    Bullying and exclusion at and from school begin a process of narrowing the number of safe spaces
  • Consequences of bullying
    Passive failure to be included
    Reduced use of community resources (social exclusion)
    Experience of being unwanted/marginalized
    Active rejection , blaming, scapegoating
    Stigma as a means of keeping threatening Other at a distance
    Bullying
    Painted Bird by Edward Gafford, inspired by the novel ‘Painted Bird’ by JerzyKosińsk , itself based on what has been claimed is a fictive war-time experience of the author in Poland
  • Who bullies and why? Evidence is limited, but
    On behalf of a social group
    Bullies are highly regarded, but not popular
    Bullies’ in-group status may be tenuous
    Victims are different
    Victims may be more aggressive than non-victims, and are perceived, perhaps as more threatening
    Brookdale care conference, London
  • A particularly wide ranging tool kit
    Readiness to consider the most intense emotional issues and in the next moment, the most practical and cognitive ones
    Having a clear grasp of the individual in front of you, not just in life experience, or temperament, but in cognitive abilities
    Be aware of shame and shaming
    The limitless potential of social control by shaming
    Brookdale care conference, London
  • Does social exclusion lead to functional movement impairment
    Is there a difference in the amount of physical activity of pupils with AS compared to others?
    Mean number of steps per hour: AS group = 902, control group = 1312 (t = -2.645, p = .027)
    Brookdale care conference, London
  • 24 November 2009
    Brookdale care conference, London
  • 24 November 2009
    Brookdale care conference, London
  • Where were people with AS in Sheffield?
    Most living at home, even above 30.
    Most had difficulties coping with changes in everyday environments
    Difficulties moving between places (for example using public transport)
    Most common places frequented were libraries and cinemas
    Brookdale care conference, London
  • Uncommon sense
    Is the person with AS king of the cyber world?
  • Is Asperger syndrome the future?
    Owen Thor Walker apointed to TelstraClear, who previously wrote code enabling a hacker group to steal £13.9M from bank accounts
    Bram Cohen, founder BitTorrent, and self diagnosed Aspie
  • THE END