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J. Dale Munro Mission! Teens & Adults J.J. DaleDale MunroMunro with Asperger MSW, RSW, FAAIDD Syndrome: Regional Support Associates (London) Creative Psychotherapy Creative Psychotherapy Redpath Centre & [email protected] Treatment Approaches (519) 433 -7238, Ext. 2107 I’m Speaking Today as a … 39 Years Individual psychotherapist with Asperger ’s Family Therapist Syndrome! Couple Therapist New Article “An Integrated Model of Psychotherapy for Teens and Adults with Mission!Mission! Asperger Syndrome ” Journal of Systemic Therapies Fall 2010, Vol 29, 83 -97 Agenda Raise awareness of needs of Agenda adults with AS! Focus on Teens & Adults with AS Help families! Discuss Counselling , Treatment & Support Approaches [What happens after the diagnosis is made?]. Improve counselling , treatment & support Discuss cases/real people. services! Common Asperger Myths Strengths & Assets [revised from Gaus , p. 34 -36] [revised from Gaus , p. 36 -38] Only a childhood disorder. Creativity & “Unconventional ” View of World. Always aloof & uninterested in others. Have no relationships. Honesty Do not make eye contact. Sense of humour . Lack insight & empathy for others. Responsive to structure & routines. Are intellectual geniuses. Willingness to Observe & Evaluate Just a mild form of autism. Self, & are often open to feedback. Cannot benefit from counselling . Most Alone & “David ” Misunderstood People! 61 Two university degrees Look “normal ”! Obsessed w/ computers, Star Trek, washing machines No longer can find a job, marriage dissolved, Becomes evident when bright individuals fail to son has disowned him. finish school, dev friendships, date, drive, or Two weeks ago, diagnosis →→→ great relief retain employment. Police, gov ’t & utility companies Public mischief When relationships break down, & emotional I feel like an alien …. & behavioural problems increase. Prevalence of AS FORGOTTEN PEOPLE ! Lack of support for these adults One in 210 -280 children (Attwood) is a human rights issue every One in 300 children (John Robert Brasic ) bit as important as that of any Male 4:1 other civil rights group since the 1940s! ___________________ Teenagers Psychological problems are the rule , rather than the exception! LITTLE KIDS WITH A.S. DO GROW UP! May be Systemic Recent Presenting Problems Marital issues (40, 65) 57 year, old, unemployed man, hates police Parenting problems Biases towards Gay, anxious & isolated Marriage preparation Highly anxious, Convicted/possession of avoidant,sleeping under providing Clinical child pornography avoidant,sleeping under bridges. Stalker/Stares/Touches Fear of retirement too much Fear of retirement Services to Men! Depressed, suicidal, Substance abuse can ’t finish high school. Anger & rage issues Paranoid & delusional. Can ’t distinguish fantasy 16 automobile accidents. Similar to male survivors of from reality (games, etc) 16 automobile accidents. Contamination fears childhood sexual abuse Failure at school Obsessed w/ getting Repeated job loss. girlfriend Wants to move Calgary Stabbed self in neck Can ’t get writing going. But we can ’t forget the females! Baby stillborn SKILLSKILL UnderstandingUnderstanding thethe basicsbasics ofof DSMDSM --IVIV --TRTR diagnosis!diagnosis! There are 5 Disorders in the THOROUGH Family of PDDs PSYCHOLOGICAL Autistic Disorder ASSESSMENT, CLEAR Asperger ’s Disorder DIAGNOSES WITH PDD -NOS RECOMMENDATIONS Rett ’s Disorder Childhood Disintegrative Disorder Some welcome/proud of diagnosis Some highly defensive 3 of these fall on the Autism Spectrum: 67% have mood disorder 67% have mood disorder Autism, Asperger ’s, PDD -NOS Asperger Syndrome Complex neurologically -based psychiatric & behavioural condition on the high functioning end of the autism spectrum. Only Developmental May be impairments in: Disability without an -Social relations -Communication/information processing Intellectual -Sensory & emotional responsiveness -Movement & coordination Impairment! -Independent living Restricted repetitive interests Not mad, bad or defective, Diagnostic Confusion? but have a different way of High Functioning Autism is not a diagnostic but have a different way of category. thinking! Nonverbal Learning Disability has a similar [Tony Attwood] presentation. Early diagnoses of Asperger (mid -late 1990s) actually Autistic. Process Information PDD -NOS w/ average IQ. Schizotypal Personality disorder Differently ADHD OCD Spectrum Within the Label Only Thing You Can Say … Bright individuals with “very autistic ” traits (e.g., Rainman ) “When you meet Tormented & delusional Immature, social phobic, reserved, one individual w/ highly anxious Pedantic, absent minded, ‘nerdy ’ AS, you have met Somewhat eccentric, married, one individual w/ working, raising family ‘Superstars ’ AS! ” [Myhill & Jekel , 2008] SKILLSKILL HauntedHaunted byby UnderstandingUnderstanding HistoryHistory History!History! Bettelheim Dr. Hans Asperger (1906 -1980) Austrian pediatrician ( U. of Vienna) not a Nazi! 1944 landmark paper “autistic psychopathy ” Published 350 papers As a child, reported to have AS traits (remote & lonely child, difficulty making friends, talent for language) Daughter, Maria, child psychiatrist in Switzerland. Clinical Question WhoWho ’’ss YourYour AspergerAsperger Hero?Hero? Possibly Asperger ’s Steven Spielberg Moe Norman Nikola Tesla -Greatest ball striker Vincent van Gogh -Unusual swing/accuracy/fast Gregor Mendel -33 course records/17 holes in one Andrew Lloyd Webber -Won many tournaments Albert Einstein -Pants over ankles/stained shirt Bill Gates -Case of coke/day Thomas Edison -Debt -ridden/sleeping in car Ludwig Wittengenstein [philosopher] -Fifth hole Charles Darwin Mozart Carl Sagan Glen Gould Thomas Jefferson -Diet arrowroots/scrambled eggs Bobby Fischer -Obsessive work habits/music Elvis -Sensitivity to light, sound, temp. Temple Grandin -Wore gloves/no hand shaking Donna Williams -Wouldn ’t perform after age 31 -Wouldn ’t perform after age 31 Catherine the Great -Amazing memory “Jonathan ” SKILLSKILL Left home to attend college Harassed by some in residence. Being Aware of Door slimed, money stolen, called names past Harassment Fake 911 suicide call Marks have dropped & feels & Bullying! hurt & confused Low self -esteem, gullibility, hypersensitivity to criticism, approval seeking, social naivete SKILLSKILL Leave individuals vulnerable ( “predator magnets ” to -Cyber bullying Recognizing -Ridicule, teasing -Physical or sexual abuse Comorbidity ! Precipitate paranoia or post traumatic stress “Gloria ” Mental Health Concerns [V. Gaus ] 16 “The mental health problems often are related to Smokes dope every day & abuses their attempts to fit in with society. ” alcohol Believes her keys & money are “A history of isolation and a sense of failure leave contaminated the adult tremendously vulnerable to anxiety and mood disorders. ” Cuts herself on occasion mood disorders. ” Believes terrible people are scheming to exterminate everyone with AS. But adults have not missed the boat. They can still learn and grow! Mental Health Concerns Anxiety (OCD, GAD) SKILLSKILL Depression Suicidal ideation Phobias, Fears, & Paranoia Understanding Delusional Disorders Behavioural disorders (verbal & physical aggression) “Executive Self -injury Eating disorders (women) Function ”! Substance abuse/Self medication Problems With “Mary ” EXECUTIVE FUNCTIONING Transitions 17, superior IQ Initiating Organizing Generalizing learning Takes 90 min. showers & 3 hours Planning Working memory Monitoring to get ready for school. Self -monitoring Flexibility Regulating Bedroom “an absolute mess ”. Making choices Making choices emotions/behavior Impulse control Therapist discontinued sessions Time & space Switching attention because late or forgotten. Mental flexibility because late or forgotten. Keeping appts Homework/chores Multi -tasking Goal setting Keep in Mind … “Asperger Time ” Highly Intelligent …, [Brenda Smith Myles in Gaus , p. 72] But Lacking “Half done in twice the time! ” Lifeskills /Adaptive Families/professionals need to pace themselves, so they don ’t overwhelm Behaviour !* the individual. Considerable knowledge & verbal skills Anger management, Anxiety, Depression E.g., may need multiple meetings to gather all necessary information & *RSA eligible to develop a working relationship. Inability to Fill “Empty Time ”* The Need for an Summer vacation ””ExecutiveExecutive Stat holidays Retirement SecretarySecretary ”” Empty weekends Loneliness + Depression *People don ’t understand this! SKILLSKILL “Gordon ” 18 Understanding Shaves only half his face. Trying to understand what Theory others are thinking is a mystery. Has no real friends, except a gay of Mind! partner who is losing patience with his insensitivity. “Mind/Face Blindness ” [Theory of Mind, Attwood 114 -123] Difficulty with … “Mind reading ” Empathy [may feel too much] Reading social cues, eye messages, & tone of voice. Literal interpretations [“Let ’s toast the bride ”] Being considered rude or confrontational. Bluntness & honesty. Failure to see need for apologies. Sense of paranoia. Being argumentative with less remorse. Delayed reactions making others perceive individual as unusually formal or pedantic. Exhaustion – “I’m all peopled out! ” SKILLSKILL Recognizing Limitations in Pragmatic (Social) Language Pragmatic (Social) Language One individual equated trying to Ability to understand body language
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