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Malta 26 Mar 2010 New Developments In As


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Malta 26 Mar 2010 New Developments In As

  1. 1. New developments in Asperger syndrome<br />Digby Tantam<br />Clinical Professor of Psychotherapy, University of Sheffield<br />Senior Visiting Research Fellow, University of Cambridge<br />Honorary Consultant Psychiatrist, Sheffield Health and Social Care Trust<br />Director, Dilemma consultancy<br />
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  3. 3. Issues for Asperger syndrome<br />The life-time prevalence may not be the same as the year prevalence in children<br />Does economic cost of services, or lost employment, accurately reflect the reduced quality of life of people with AS?<br />Is prevalence in women still under-estimated?<br />
  4. 4. The life-time prevalence may not be the same as the year prevalence in children<br />
  5. 5. Contributors<br />Sheffield survey<br />Myles Balfe<br />Ting Chen<br />Mike Campbell<br />submitted to Autism<br />Bullying project<br />Paul Naylor<br />Jenny Wainscot<br />Jenna Williams<br />15 medical students<br />International Journal of Psychology<br />24 November 2009<br />Parents, teachers, and people with Asperger syndrome<br />Sheffield Asperger Parents Action Group<br />Brookdale care conference, London<br />
  6. 6. Project Development<br />15 Oct 08<br />Psychotherapy of people with AS Biejing WCP<br />6<br />
  7. 7. Brookdale care conference, London<br />
  8. 8. Data from the US National Survey of Children’s Health (from<br />
  9. 9. Issues for Asperger syndrome<br />Does economic cost of services, or lost employment, accurately reflect the reduced quality of life of people with AS?<br />
  10. 10. Theme analysis of 5 websites of people with AS/ HFA<br />sense of alienation<br />sense of frustration<br />depression as a central emotion<br />a pervasive sense of fear or apprehension<br />
  11. 11. Green et al compared 20 adolescent men with AS with 20 with conduct problems<br />AS group<br />Severely impaired practical social functioning <br />Anxiety<br />Obsessionaldisorders<br />Both groups had<br />Depression<br />Suicidal ideation<br />Tempers and defiance<br />
  12. 12. Outstanding areas for concern: Sheffield survey<br />Reduction of available support in adulthood<br />Lack of paid work (36%, 6% of whom supported)<br />Lack of independence<br />60% living with parents<br />21% living independently<br />56% thought they could be more independent with support<br />Victimization 90% said they had been bullied<br />Brookdale care conference, London<br />
  13. 13. Emotional problems in adolescents and adults with Asperger syndrome(findings from Sheffield survey)<br />Self-harm: thoughts 50%, actual 11%<br />Violence: threats 83%, actual 34%<br />Bullied 90%, 30% currently (includes adults)<br />Majority have anxiety-related disorder<br />
  14. 14. Is prevalence in women still under-estimated?<br />
  15. 15. 60 with AS/HFA had been diagnosed<br />Mean age 24.3 years<br />7.6 men to 1 woman<br />52 with AS/HFA had no previous diagnosis<br />Mean age 35.2 years<br />2.1 men :1 woman<br />15 Oct 08<br />Psychotherapy of people with AS Biejing WCP<br />15<br />
  16. 16. 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.<br />feeling different<br />trying to fit in<br />safe spaces  <br />uncommon sense<br />
  17. 17. Feeling different<br />Being disconnected from the interbrain<br />
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  19. 19. 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.)<br />
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  21. 21. Hunyuan hanging temple, Mt. Hengshan, Shanxi<br />
  22. 22. The interbrain<br /><ul><li>Extended cognition
  23. 23. Automatic processing
  24. 24. Reflexive vs. reflective processing
  25. 25. ‘The borg’</li></ul>Jerry Ryan, 7 of 9 StarTrek<br />Neurotypical<br />Aspie<br />Brookdale care conference, London<br />
  26. 26. 24 November 2009<br />Brookdale care conference, London<br />“l’hommeestnélibre, et partoutilestdans les fers. J.-J. Rousseau<br />
  27. 27. Is it better not to connected to the interbrain?<br />Fewer informational viruses<br />Understand machines in their own right not as defective people<br />Fairness is not prejudiced by sympathy<br />Not in chains<br />
  28. 28. Trying to fit in<br />Many other educational obstacles, plus emotional difficulties<br />Brookdale care conference, London<br />
  29. 29. Atypical Asperger syndrome<br />Dysexecutivesyndrome (planning)<br />Dyslexia (writing and spelling)<br />Attention deficit/ hyperactivity disorder (impulsivity, executive functions, task persistence)<br />Also links with<br />Tourette syndrome<br />Expressive speech and language disorder (may lead to elective mutism)<br />Dysgraphia<br />Dyscalculia<br />Topographical disorientation<br />Associated developmental disordersPredominantly fronto-striatal or fronto-cerebellar<br />Brookdale care conference, London<br />
  30. 30. Atypical Asperger syndrome <br />Primary abnormality is lack of empathy, partly due to failure of non-verbal interpretation (‘face blindness’)<br />Ability to make relationships but not to keep them<br />Lack of empathy may lead to antisocial behaviour, but greater problem is lack of persuasiveness and ‘social influencing power’<br />Picture on left from Pelphrey et al, 2002 and on right from the film, “Ripley’s game” starring Matt Damon as Ripley<br />24 November 2009<br />Brookdale care conference, London<br />
  31. 31. Knowing about the world using non-verbal cues<br />Who is being shot? <br />Terrorists or partisans?<br />24 November 2009<br />Brookdale care conference, London<br />
  32. 32. Atypical AS<br />‘Look normal’, because normal NVE. Do not seem like ‘Aspies’<br />Form friendships but they do not last<br />May have many hidden learning difficulties e.g. lack of speech understanding, reduced working memory<br />Vulnerable adults<br />Lack of empathy leads to a lack of persuasiveness<br />This may lead to unassertiveness or exploitation<br />Coercive interpersonal strategies, possibly more likely if associated ADHD<br />Drug misuse, violence, other forensic issues<br />Impulsivity may alternate with compulsivity<br />May seek an identity as adults, and like special interests in other people with AS, may embrace or drop one ruthlessly.<br />Modelling on others may be even more marked<br />
  33. 33. Coping with a lack of identity<br />Fads<br />‘Obsessive’ relationships<br />Lack of identity in many people with ASD<br />Adopting identity wholesale<br />Joining charismatic groups<br />Moving places and work<br />Searching for identity<br />‘Transexualism’<br />‘Aspie’<br />Identities off the peg<br />Gangster<br />Professor<br />Teddy bear<br />21 Mar 08<br />Advances in research and management of AS<br />
  34. 34. Safe spaces<br />Bullying and exclusion at and from school begin a process of narrowing the number of safe spaces<br />
  35. 35. Consequences of bullying<br />Passive failure to be included<br />Reduced use of community resources (social exclusion)<br />Experience of being unwanted/marginalized<br />Active rejection , blaming, scapegoating<br />Stigma as a means of keeping threatening Other at a distance<br />Bullying<br />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 <br />
  36. 36. Who bullies and why? Evidence is limited, but<br />On behalf of a social group<br />Bullies are highly regarded, but not popular<br />Bullies’ in-group status may be tenuous<br />Victims are different<br />Victims may be more aggressive than non-victims, and are perceived, perhaps as more threatening<br />Brookdale care conference, London<br />
  37. 37. A particularly wide ranging tool kit<br />Readiness to consider the most intense emotional issues and in the next moment, the most practical and cognitive ones<br />Having a clear grasp of the individual in front of you, not just in life experience, or temperament, but in cognitive abilities<br />Be aware of shame and shaming<br />The limitless potential of social control by shaming<br />Brookdale care conference, London<br />
  38. 38. Does social exclusion lead to functional movement impairment<br /> Is there a difference in the amount of physical activity of pupils with AS compared to others?<br />Mean number of steps per hour: AS group = 902, control group = 1312 (t = -2.645, p = .027)<br />Brookdale care conference, London<br />
  39. 39. 24 November 2009<br />Brookdale care conference, London<br />
  40. 40. 24 November 2009<br />Brookdale care conference, London<br />
  41. 41. Where were people with AS in Sheffield?<br />Most living at home, even above 30.<br />Most had difficulties coping with changes in everyday environments<br />Difficulties moving between places (for example using public transport)<br />Most common places frequented were libraries and cinemas<br />Brookdale care conference, London<br />
  42. 42. Uncommon sense<br />Is the person with AS king of the cyber world?<br />
  43. 43. Is Asperger syndrome the future?<br />Owen Thor Walker apointed to TelstraClear, who previously wrote code enabling a hacker group to steal £13.9M from bank accounts<br />Bram Cohen, founder BitTorrent, and self diagnosed Aspie<br />
  44. 44. THE END<br />