Wednesday, July 11, 2012

What Treatments are there for Adults with Asperger's Syndrome or Disorder?

I am often asked: "What Treatments Are Available for Adults with Asperger Syndrome?" Many adults who have been having low level but continuous problems socially, at college, work or in their own family go on line and seek out a diagnosis. Often they complete a check list somewhere and it tells them they MAY have Asperger's Syndrome or Asperger's Disorder. Of course, one of the problems is the short check list was designed to do nothing more than search out signs and symptoms of Aspeger's, and honestly, there are a lot of people who you see most of those signs or symptoms in. A real diagnosis would have taken a broader view, and looked at alternative causes for these symptoms. This process is called "differential diagnosis" and a licensed psychologist or medical doctor familiar with Asperger's would have ruled in or out several very similar disorders. But, at any rate, you have completed the checklist, it says Asperger's and your symptoms are of concern. Many people wonder why someone would even go through an examination to get a diagnosis, because they aren't sure what "therapies" are even available. For children with Asperger Syndrome (AS) and other forms of autism usually there is a fairly common set of treatment interventions available through the school district. This might include physical, occupational and speech therapy along with some kind of social skills (social reciprocity) training and behaviour support. But for adults it's a very different matter. Most people start treatment because of some event that is currently going on in their lives. They may have had difficulty at school with more complex subjects, and their difficulty is related to Asperger's tendency to limit cognitive flexibility. This can be addressed through psychoeducation, practice and feedback. Others may be having problems at work. They could be similar to those just mentioned, or include time management issues, focus and attention problems very similar to ADHD, or social interaction issues. All of these are addressed through fairly common techniques, and the issue of social interactions, or social cognition, is usually addressed through psychoeducation (readings and discussions about how the brain works in social interactions) and modelling, then practice in using social cognition skills. For the individual with Asperger's this is a very different issue than "social skills training," which many people are pointed to by therapists who are not familiar with the complexity of Asperger's Syndrome or Disorder. As I always do, let me mention the work of Michelle Garcia Winner here. Here web page, www.socialthinking.com explains this issue really well. When adults come to my offices in Burnaby or Vancouver for treatment of aspects of their Asperger Syndrome I often recommend trying to look over Michelle's materials to get a firm grip on what exactly is going on when they have difficulty in social settings. Family issues is another point that often brings individuals with Asperger's Syndrome to the office. Sometimes we work together one-to-one on understanding and improving communications, sometimes we work on things as simple as arranging appropriate schedules and interaction times. Couples often need relationship counselling as well. And of course, educating your spouse can make a big difference. This is another place where a trained professional comes in handy. Finally, many individuals come in for the same symptoms and problems anyone might come to a therapist or psychologist for. They may have anxiety issues, phobias or depression. For these issues we often use an adapted form of CBT - Cognitive Behavioural Therapy to address the thoughts and feelings of loneliness, depression and isolation. Of course others come in because of legal issues after work place incidents, or to help get social services and so on. Some individuals need help with daily living skills like keeping a bank account, eating properly, exercising and finding a job. Others with Asperger's have anxiety because of their limited ability reading social cues at work where they may be a department head, director of research or university faculty. Asperger's is a spectrum disorder and individuals come in with a spectrum of issues they can use support and help with. These are just a few of the reasons individuals come to my office seeking help with Asperger Syndrome symptoms. For more information on the services I provide please feel free to contact me, or check out the information on my web page at www.relatedminds.com

Tuesday, July 10, 2012

Adolescents and Young Adults with Aspergers and High Functioning Autism

Treatment for adolescents (teens) and young adults with Asperger's Disorder or High Functioning Autism are few and far between. One of the reasons is that many of these individuals are fairly high functioning and reluctant to join in groups, so, we have a really hard time outside of major/major metropolitan areas forming groups. What we often rely upon is individual therapy and coaching for these individuals. What does individual therapy consist of? Well, it usually starts with psycho-education. That is, learning the ins and outs of the disorder. Often this means learning it from the perspective of others, because one of the major difficulties people have is getting and understanding the perspective of others. While there are a lot of materials and training programs out there for younger teens and children with Asperger's Disorder there really aren't many for older teens and young adults. Still, we are able to make use of some of the materials from Michelle Garcia Winner which can easily apply to and be adapted for young adults and the work place. One set of materials we often use is her "social Behavior Mapping" method, which refocuses their attention on how they are perceived by others. This lack of "reciprocity" or use and understanding of "pragmatic language" is a common source of difficulty. An example of this is the individual who, while at work, is asked to sign a get well card for the office manager's daughter, who he has never met. While everyone else in the office signs the card as it is passed around, this individual, let's call him Tom, instead of signing says, "Well, I don't really know her." While this is true, and often family, friends and even therapists spend a lot of time arguing about the "truthfulness" of such statements, it becomes a work issue because such a reaction and comment is simply unexpected in the workplace, where social rules instruct you to sign the card, and if you can't think of anything just....sign your name and write "get well." How many arguments about this I've had with clients with Asperger's I can't tell you. Like Tom they know the social norm, they could recite it to you, but don't implement it because they need to stick to the facts of the situation. The big leap for them is to understand 1 How other's see their actions; and 2) Learn how to use the reaction of others to monitor and adjust their own behaviour. Something that just doesn't go on often enough. Michelle's work addresses these issues, not by going right to a problem area and ...well "sticking a finger in someone's eye while pointing out their problem." Instead we address the learning and thinking process as a who, and give students simple techniques to support their use of appropriate social interactions. Therapy for adolescents, teens, and young adults with Asperger's Disorder also often focuses on some of the same themes you would expect anyone their age to be dealing with. Individuals with Asperger's and high functioning Autism almost always tell me they want to develop relationships, make friends and become close to others. But because of these social cognitive deficits, like the one described above, this can be difficult task. This isolation can lead to anxiety, stress and depression just as it could with anyone else. So often these individuals with Asperger's Disorder and high functioning autism are often seen for the same reasons anyone else is seen. Therapies that are effective with others, such as Cognitive Behavioural Therapy 9CBT) is often just as effective, and can be easily adapted to make use of external and visual support systems. Finally there is the use of self-help books. Often individuals with Aspegers Disorder or high functioning autism can't afford the services of a psychologist or other licensed health professional. For those individuals a coaching mode using self help / self directed materials may be a good place to start. One book I often recommend, especially for young adults entering college or the workplace, is "Social 'Thinking at Work," again, by Michelle Garcia Winner. This is an excellent book, written especially for those with Aspeger's or high functioning autism. I would suggest this is one of the best books around for young adults, and recommend it highly. You can call around and find it at several bookstores, find it through the "suggested readings" link on my web page (at www.relatedminds.com) or borrow it through your local library. Checking out Mitchelle's web page at www.socialthinking.com may also reveal some more recent books and materials. I'd give a look there. I hope this has been helpful. All i can do is recommend you find a clinician, therapist, counsellor or registered psychologist, who has expertise in this field. And that would mean working for several years with all age groups, children, adolescents and dults, in order to understand the complexity of this developmental disorder. The good news is that overall research has shown we are highly successful at helping higher functioning children, adolescents and adults than we could have hoped. 'Good luck in your reading!