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

    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 />
    2. 2.
    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 www.leftbrainrightbrain.co.uk)<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 />
    18. 18.
    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 />
    20. 20.
    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 />

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