Medium 9781855759305

The Many Faces of Asperger's Syndrome

Views: 446
Ratings: (0)

This is the first book on the psychoanalytic treatment of children, young people and adults with Asperger's syndrome. It includes multi-disciplinary contributions on psychiatric perspectives and psychological theories of the condition. There is an overview of relevant psychoanalytic theory, and chapters on Asperger's original paper, on first-person accounts, on assessment and on care in the community. Clinical case histories of children, young people and the first published account of work with adults provide the possibility of using psychoanalytic work as a means of diagnostically differentiating between sub-groups, as well as providing a detailed insight into the emotional experience of people with Asperger's syndrome.Both Editors teach on the Tavistock Clinic Training in Child and Adolescent Psychotherapy. They are widely published authors and have both given lectures and papers in the UK, Europe and the United States.

List price: $25.99

Your Price: $20.79

You Save: 20%

Remix
Remove
 

14 Chapters

Format Buy Remix

1. Asperger’s syndrome and Autism: distinct syndromes with important similarities

ePub

David Simpson

In 1944, Hans Asperger published his thesis Die “Autistischen Psychopathen” im Kindesalter [Autistic Psychopathy in Childhood] in which he described “a particularly interesting and highly recognizable type of child”:

The children I will present all have a common and fundamental disturbance which manifests itself in their physical appearance, expressive functions and, indeed, their whole behaviour. The disturbance results in severe and characteristic difficulties in social integration. In many cases the social problems are so profound that they overshadow everything else. In some cases, however, the problems are compensated for by a high level of original thought and experience. [Asperger, 1944, in Frith, 1991, p. 37]

In 1943, unknown to Asperger, Leo Kanner had published his seminal paper on “Autistic Disturbances of Affective Contact” (Kanner, 1943), in which he introduced the clinical entity of “early infantile Autism”. Asperger’s syndrome and Kanner’s autism* are, in my opinion, distinct clinical syndromes, although they show important common features. In this chapter, I consider Asperger’s syndrome in the context of Kanner’s description of children with autism and highlight some important areas of difference as well as correspondence. I then discuss the relationship of Asperger’s syndrome, first, to schizophrenia and, second, to violent behaviour and criminality. Finally I consider the difficulties that those with Autism or with Asperger’s syndrome have with being curious. This is a feature that is important clinically but has received little attention and could be fruitful in furthering our understanding of both conditions.

 

2. A psychological perspective on theories of Asperger’s syndrome

ePub

Sally Hodges

This chapter focuses on different ways of understanding Asperger’s syndrome at a psychological level, which includes cognitive, emotional, and social processes. Psychological processes in autism have generated great interest in the literature. There continue to be disagreements and debate as to the process that may account for the cluster of symptoms that characterize Asperger’s syndrome. Biological, genetic, and environmental factors in the origins of autism are beyond the scope of this chapter, though the importance of explanations at these levels should not be minimized. Present-day therapists working at the psychological level do not dispute the existence of biological or genetic factors, though they focus their therapeutic efforts on the more mutable aspects of the processes that occur as a result of any original or core “damage”.

In order to consider relevant psychological processes—and at the risk of overlapping with other contributions to this volume—it will be important to define Asperger’s syndrome as distinct from autism syndrome, particularly “high-functioning autism”.

 

3. A child psychotherapist’s commentary on Hans Asperger’s 1944 paper, “‘Autistic Psychopathy’ in Childhood”

ePub

Trudy Klauber

In this chapter I reflect and comment on a number of aspects of Asperger’s syndrome, as described by Hans Asperger in his original 1944 paper (Frith, 1991c). Asperger uses the term “autistic psychopathy” for what, since Lorna Wing’s paper (1981), we now call Asperger’s syndrome. I want to think about some of the difficult questions raised in the paper, of which one of the most important is whether or not there is meaning in the children’s behaviour and what the meaning may be. Asperger himself faced this difficulty in looking at the behaviour, test results, and other communications of the boys about whom he wrote. There is a misleading quality in so much of what goes on, and it is easy to become muddled about what is meaningful and what is not. Other questions include the difficulties the children have in learning simple and practical things and the attraction towards complexity, and their “severe and characteristic difficulties of social integration”. I also include some comments on aggression and the question of malice and some brief thoughts on imagination and phantasy.

 

4. What does it feel like? Two first-person accounts by adults with Asperger’s syndrome

ePub

Maria Rhode

In this chapter I discuss recent books by two women who were diagnosed with Asperger’s syndrome when they were adults. Gunilla Gerland has called her book A Real Person: Life on the Outside (1996a); the title of Liane Holliday Willey’s is Pretending to be Normal (1999). Both of these titles suggest something of the struggle that people with Asperger’s syndrome can face in achieving a sense of identity in a world of people whose experience, in many important respects, is so different from their own.

I have chosen these two books from among many recent first-person accounts because they convey particularly vividly what it is like to live in an “Asperger’s” world, with sufficient detail to allow comparison. This chapter may usefully be read in conjunction with the following one, in which Caroline Polmear describes the experience of adults with Asperger’s syndrome in analysis and in psychoanalytic psychotherapy.

A real person

 

5. Finding the bridge: psychoanalytic work with Asperger’s syndrome adults

ePub

Caroline Polmear

Zara came to her session, one Friday morning in July, exactly on time. She had been in analysis for nearly nine years.

Her barely audible double ring of the bell alerted me to the fact that she was feeling particularly raw. She had perfected a technique whereby she could make the bell vibrate just enough to let me know she was there without making it utter its harsh, shrill sound, which could completely annihilate her fragile sense of self. I tried to respond to her two short rings with a response played on my door buzzer that followed the allegro con vivo beat she had established. Her appearance confirmed my suspicions that today was a difficult day for her. She came into the consulting-room with her pillow clutched tightly to her front, her clear nail-varnish bottle in one clenched fist and her “see-through” key ring in the other. After taking up a position on the floor to the side of my desk, she began to gather herself. With her compelling wish to communicate, however difficult it might be, she told me that she wasn’t normal today and that she had a list of items to talk about.

 

6. Issues in assessment: Asperger’s syndrome and personality

ePub

Anne Alvarez

The impersonality of diagnostic categories can present a cruel contrast to the intense suffering and difficulty experienced by people with Asperger’s syndrome (AS) and their families. But accurate description may increase our understanding. In delineating components of autism and Asperger’s syndrome, I suppose we are still well behind the stage at which chemistry had arrived just before the discovery of the periodic table. It was known in 1869 that the elements could be grouped—horizontally, as it were—in terms of what properties they had in common. It was also known that they differed in atomic weights, and that they could be listed in linear form—vertically, as it were—in terms of their ascending weights, from lead to hydrogen. Yet until Mendeleyev had a dream in which he saw the periodic table and the way the two dimensions of classification were linked, the science of chemistry was stuck (Strathern, 2000). Bion used the model of the periodic table to construct his Grid for understanding the genesis of thoughts, and he also attempted to identify the elements (Bion, 1963). In the field of autism and Asperger’s syndrome, however, we are still far from having identified all the elements (with the exception of neurological vulnerability (Gillberg, 1991b); and there are even arguments about the width of the definition of the syndrome itself. Yet we do have an idea of the existence of sub-types within autism (Wing & Attwood, 1987) and even of sub-sub-types (Alvarez & Reid, 1999b). We also have some idea of levels of severity in autism through research on the Autism Diagnostic Inventory (Rutter et al., 1988) and the concept of the spectrum (Wing, 1996), and also of levels of chronicity (Alvarez, 1992b, pp. 14 and 56–57). Classification of sub-types and of levels of severity and chronicity may offer similar clarification in our understanding of people with Asperger’s syndrome.

 

7. A matter of life and death: bodily integrity and psychic survival

ePub

Graham Shulman

In this chapter I discuss a constellation of catastrophic anxieties concerning bodily integrity and psychic survival, as they featured in the intensive psychoanalytic psychotherapy of a 9-year-old boy whom I shall call “Karim”. I describe the nature of these primitive anxieties and discuss their possible contribution to some of Karim’s personality features and behavioural difficulties. He originally had a diagnosis of Asperger’s syndrome with which other professionals later disagreed, and I consider this in the light of his clinical presentation in psychotherapy.

Family background and early history

Karim’s parents, Mr and Mrs A, were of Asian origin. He was the third of four children, and the only boy. His parents reported an unremarkable early history. Problems began when Karim started at playgroup after his younger sister was born: he was unable to mix with other children and was aggressive towards them. He became more withdrawn, made less eye contact, and grew more difficult to manage. These and other problems, including impulsive and, at times, over-active behaviour, gradually became more pronounced. They intensified further at primary school and led to a referral to a children’s mental health service. Karim was eventually diagnosed with Asperger’s syndrome by a child psychiatrist, though a number of professionals later disagreed.

 

8. Sleeping beauty: the development of psychic strength, love, and imagination in a 4-year-old girl

ePub

Samantha Morgan

When she was 4 years old, “Olivia” was referred with a diagnosis of Asperger’s syndrome. Her GP enclosed a letter from her nursery teacher, which gave a closely observed account of Olivia’s behaviour. She was described as having intense and unusual preoccupations, and as forming inseparable attachments to a particular object. She avoided eye contact, responded “inappropriately”, and did not appear to listen. She was insistently demanding and bossy, had fixed ideas, and hated change. She was also described as intelligent, with a sophisticated and impressive vocabulary and advanced verbal and imaginary abilities. I saw Olivia for three years, including a period of intensive work.

Olivia’s parents were highly intelligent professionals. Her mother, Mrs Katie B, became physically ill in Olivia’s early infancy, though this was not diagnosed until Olivia was 7 months old. It was possible that her condition had been triggered by pregnancy. She was at times exhausted and physically fragile, and although there were periods of recovery, her condition slowly deteriorated. After an early miscarriage, Mr and Mrs B went on to have another child, a boy, who was robust and lively. Olivia was initially very jealous of her brother but subsequently ignored him. A succession of live-in nannies helped Mrs B to look after the children.

 

9. Out of the nightmare: the treatment of a 5-year-old girl with Asperger’s syndrome

ePub

Tanja Nesic-Vuckovic

When she was referred for assessment, “Linda” was 5 years old. At school her behaviour was unmanageable, and she was considered to be odd and difficult. She could not play with other children, respond to their initiatives, or enter into any kind of ordinary exchange with them. She often collapsed in uncontrollable distress and was impossible to comfort. Adults could not understand what had brought on the collapse: there seemed to be no obvious link with preceding events.

Linda’s teachers agreed with the educational psychologist that she was intelligent, but she seemed unable to learn in an ordinary way. Instead, she garnered facts that she assembled into random collections of information that others found difficult to relate to. She might tell people, a bit pompously, the Latin name of a particular plant or an animal, but she was unable to assimilate more ordinary, age-appropriate knowledge. Early on in her treatment, she asked me, “Where does the letter k come in the word, please?” The question seemed bizarrely lacking in context but still conveyed a genuine confusion. Sometimes she would say, “I’m going to play now”, but her play did not unfold: it was as though the announcement had been made by a different person.

 

10. Hiding and learning to seek: becoming a somebody

ePub

Lynne Cudmore

When “Marco” came to psychotherapy, he had very little concept of being a “somebody”. Discovering that he was somebody, that he could be separate and a person, was the central achievement of our work together.

Marco loved playing hide-and-seek, but for long periods his version of this game was about hiding, not seeking. He did not want to be found, to emerge into what felt to him a very unpredictable world. The idea that he possessed a mind of his own was inconceivable, because while he remained under cover, he could not discover anything about himself. This chapter describes the often painful and frustrating process for Marco and his therapist of discovering that he was somebody to discover.

Marco was 7 years old when he was referred by a child psychiatrist who had seen him at his parents’ request. He described a child with an “excessive pedantic persona”, a rigidity to his personality exemplified by an obsessive interest in tramcars and an enormous dislike of any change. He agreed with the diagnosis of Asperger’s syndrome suggested by the educational psychologist at Marco’s primary school. However, the psychiatrist also described a boy with a lively and imaginative side to his personality and was impressed by his evident curiosity and zest for life (see the discussion of curiosity in chapters 1 and 2).

 

11. The lure of a mad world: supporting a 10-year-old boy’s capacity for ordinary contact

ePub

Michèle Stern

When I first met “Kane”, he was 10 years old, a sturdy, slightly plump boy with dark eyes that hardly ever met mine. At that time, he insisted that he was an animal. He drew Disney cartoons with great speed and accuracy, and when he was in one of his “mad” states of mind, he behaved like a cartoon character. His eyes rolled in their sockets, his hair flew to right and left, furniture was sent crashing: there seemed no possibility of a sense of balance, let alone perspective. He appeared not to know where he was, where the therapy-room was, or even whether he was inside it or outside.

Kane’s behaviour was making life a misery at home, and his primary school had not been able to cope with him. Although a psychological assessment had established that he was of superior intelligence, he was underachieving in all school subjects. He interfered with assembly by squealing and rolling about, he damaged his school equipment, and he objected strenuously when anyone used words that he had banned. Since these included words like “a” and “and”, conversations were seriously disrupted. In class, he shouted out “rude” words like “poo” and “smelly feet”. He lifted girls’ skirts in the playground to look at their bottoms, and on once occasion he did the same to a teacher.

 

12. “I need my scripts”: A boy with Asperger’s syndrome entering adolescence

ePub

Jane Cassidy

This chapter focuses on the treatment of “Jonathan”, a pubertal boy with a diagnosis of Asperger’s syndrome. He had psychoanalytic psychotherapy for nearly three years, three times weekly, during the course which his behaviour changed markedly.

It has been noted that puberty and adolescence present opportunities for useful work with young people who are diagnosed on the autistic spectrum (Howlin, 1997). The relationship with his psychotherapist at this time of Jonathan’s life seemed to afford him the opportunity to take a somewhat different developmental path from the one he had been set on. Finding that difficult situations could be managed, and that his very strong projections could be responded to helpfully, were significant factors in enabling him to begin to feel differently about himself, and, most particularly, to feel more secure in the face of his anxiety and aggressive impulses.

Whatever Jonathan’s underlying neurological difficulties may have been, his improvement in a number of areas suggests that he had some interest in the unconscious meaning of his behaviour, which changed through his relationship with his psychotherapist.

 

13. On becoming of consequence

ePub

Brian Truckle

A crazy chase in circles
Ends up pursuing the pursuer.
The light at the end of the tunnel
turns out to be a tiger’s eye.
A hundred disasters
mean a hundred comic somersaults
turned over a hundred abysses.

Wislawa Szymborska, “Slapstick”*

This chapter begins with a vignette about a little boy who was not diagnosed with Asperger’s syndrome. However, his behaviour communicated extreme emotional experiences, including terror, which have been the subject of psychoanalytic writings on infancy and which seem relevant to the adolescent boy with Asperger’s syndrome whom I go on to discuss. “Albert” had loving parents, but his behaviour impacted profoundly on their lives, and they did not know how to begin to address his worries.

A crazy chase in circles

A small, elfin-like face with bright, sparkling black eyes peeped round the edge of the playroom door, one foot from the ground, and startled me. A large red dummy protruded from the mouth. I had been engrossed, fully occupied by a distraught and overwhelmed mother, who was telling me of her concerns for her son of 15 months. He slept for only 20 minutes twice a day; he was hyperactive and very destructive; he refused to eat, just drank copiously from his bottle, and had a constant supply of dummies in every room—she dreaded leaving the house without at least six of them.

 

14. Psychotherapy and community care

ePub

Margaret Rustin

This chapter describes a model of ongoing support devised as a follow-up to long-term individual psychotherapy with a young woman diagnosed variously as borderline psychotic, on the autistic spectrum, severely emotionally disturbed, and learning-disabled. In many ways a diagnosis of Asperger’s might have been a more helpful indication of her unusual mix of extreme oddness, hyper-sensitivity, and idiosyncratic intelligence. She was, however, given the varied diagnoses I have mentioned before Asperger’s syndrome achieved its present currency, and this made her rather unusual mixture of characteristics difficult to understand.

“Holly” had been referred with a view to psychotherapy by a consultant child psychiatrist who had known her for many years. At a regular review consultation when she was 12 years old he judged that there was a window of opportunity for psychotherapeutic intervention, which should be explored. At that time Holly was in a local special school, and she lived at home with her parents and a younger sister. She was very difficult to manage both at school, where she provoked anxiety in staff and children by her very odd behaviour, and at home, where her obsessional preoccupations and frequent panics were profoundly exhausting for her parents and controlled family life to a massive degree.

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000036357
Isbn
9781780496283
File size
895 KB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata