Tony Attwood - Author of The Complete Guide to Asperger's Syndrome

Behaviour

A Clinical and Neurobehavioural Review of High-Functioning Autism and Asperger's Disorder

N. Rinehart, J.L Bradshaw, A.V. Brereton and B.Tonge, Australian and New Zealand Journal of Psychiatry 2002, 36: 762 - 770.

This paper reviews past and contemporary conceptualisations of autism and Asperger's Disorder, together with epidemiological information, genetic and neurobehavioural findings. This paper focuses on neurobehavioural studies, in particular, executive functioning, lateralization, visual-perceptual and motor processing, which have provided an important source of information about the potential neurobiological dissociation that may exist between autism and Asperger's Disorder.

In light of the growing body of epidemiological information, genetic, and neurobehavioural evidence that distinguishes autism from Asperger's Disorder, it is premature to rule out the possibility that these disorders may be clinically, and possibly neurobiologically separate.

Defining the Broader Phenotype of Autism: Genetic, Brain, and Behavioural Perspectives

Geraldine Dawson, Sara Webb, Gerard D. Schellenberg, Stephen Dager, Seth Friedman, Elizabeth Aylward, and Todd Richards, Development and Psychopathology, 14 (2002), 581 - 611.

In this article, the current state knowledge of the cognitive neuroscience of social and language impairments in autism is reviewed. Following from this, six candidate broader phenotype autism traits are proposed: (a) face processing, including structural encoding of facial features and face movements, such as eye gaze; (b) social affiliation or sensitivity to social award, pertaining to the social motivational impairments found in autism; (c) motor imitation ability, particularly imitation of body actions; (d) memory, specifically those aspects of memory mediated by the medial temporal lobe - prefrontol circuits; (e) executive function, especially planning and flexibility; and (f) Language ability, particularly those aspects of language that overlap with specific language impairment, namely, phonological processing.

Decreasing Disruptive Behaviours of Children with Autism using Social Stories Dorothy Scattone

Susan M Wilczynski, Ron P Edwards, Brian Rabian Journal of Autism and Developmental Disorders, Vol 32, No 6, 2002 P 535-543.

Few studies have been conducted in the area of social stories, and the limitations of these studies (i.e., improper story construction and methodological confounds) raise questions about effectiveness of social story interventions. This study examined the effectiveness of properly constructed social stories that have been introduced into the natural environment to target the disruptive behaviour of three children with autism. A multiple baseline design across participants was employed, and a decrease in disruptive behaviour was evidenced wen the intervention was implemented for all participants. Based on the results of the present research, future areas of investigation outlining the limitations and potential benefits of social stories were discussed.

A social story is a short story that is written in a child specific format describing a social situation, person, skill, event, or concept in terms of relevant cues and appropriate social responses. Each social story is designed to teach children with autism how to manage their own behaviour during a given social situation by describing where the activity will take place, when it will occur, what will happen, who is participating, and why the child should behave in a given manner. Gray outlined specific guidelines for the development of social stories in her book addressing the intervention. Unlike many other interventions for children with autism, social stories may draw on a unique quality these children may have. Specifically, because children with autism often rigidly adhere to routines, the social story may serve to establish a routine or a rule that the child may then apply to the social situation. In addition to drawing on this strength, the format of the social story may be less intrusive than alternative treatments for addressing social skill deficits in children with autism. By presenting the instructions in a written format (as opposed to interaction verbally to present the instructions), the social aspect of instruction delivery is minimised and may reduce the aversiveness of receiving instruction.

Overall, the participants demonstrated a reduction in their respective disruptive behaviours. The greatest reduction of disruptive behaviour occurred for Kenny, whose chair tipping decreased from a mean of 50% of intervals during baseline to a mean of 4.6% of intervals during intervention, and John, who decreased staring from a mean of 66.9% of intervals during baseline to a mean of 18.25% of intervals during intervention. Howard demonstrated the smallest reduction of disruptive behaviour, decreasing shouting from a mean of 18.15% of intervals during baseline to a mean of 5.1% of intervals during intervention.

The positive outcomes of this study are especially important because social stories are convenient, are unobtrusive, and may draw on a strength many children with autism demonstrate (i.e., adherence to rules/routines).

In conclusion, the present study replicated and extended the literature by demonstrating that properly constructed social stories may decrease the disruptive behaviours of some children with autism and that social stories may be used without planned systematic behavioural interventions such as token economies. However, future research is necessary to further validate the effectiveness of this intervention with and without planned prompts using rigorous experimental designs.

Asperger's Disorder: a case report of repeated stealing and the collecting behaviours of an adolescent patient

P.S. Chen, S.J. Chen, Y.K. Yang, T.L. Yeh, C.C. Chen and H.Y. Lo, Acta Psychitatrica Scandinavica, 2003; 107; 73 - 76.

The case and treatment of a 21-year-old male patient is described. A 21-year-old male developed obstinate stealing behaviours when he was 17 years old. He was regarded as a schizophrenic at first, and was suspected of kleptomania later. Asperger's Disorder was diagnosed after we reconsidered the relationship between the schizoid psychopathy in childhood and the stealing behaviours, which occurred in adolescence. A wide variety of bizarre behaviours and so-called borderline behaviours occur in late adolescence and adult life of patients with Asperger's Disorder. But classic schizophrenia is very rare. Psychiatrists unacquainted with the clinical diagnosis/context may find it difficult to evaluate 'concrete', 'childish', or 'bizarre' symptoms in patients with Asperger's Disorder, and thus are prone to misdiagnosing them as having schizophrenia disorders or other similar disorders. He repeatedly committed theft after he learned how to teal from his elder classmates when he was 17 years old. He even collected objects such as paper, boxes, cups and plastic bags. The objects he had stolen or collected were hoarded in his living room. He was easily annoyed if others touched his collections. His explanation for the stealing was self-centred, showing limited understanding of its consequences and little empathy for the distress he might have caused. He admitted that he enjoyed stealing. He obviously did have a conduct problem. However, he had no other behaviour usually associated with the diagnosis of conduct disorder, his presentation did not meet the diagnostic criteria for a secondary diagnosis of conduct disorder.

A cognitive behaviour therapy intervention for anxiety in children with Asperger's Syndrome

Kate Sofronoff and Tony Attwood Good Autism Practice, Volume 4, (2003) pp 2-8.

Sixty-five children aged between 10 and 12 years of age took part and their parents were involved in this work to differing degrees. Measures were taken on three occasions, pre-intervention, immediately post-intervention and at 6-week follow up. Two forms of the intervention were compared, one in which only the children participated but parents were given written material and a second, in which parents were taught all strategies and information in the same manner as the children. The intervention groups were compared with a waiting-list control group.

Strategies to manage anxiety
Strategies and techniques initially developed for children with autism have been used with some success with children with Asperger's Syndrome (eg Social Stories and Comic Strip Conversations (Gray, 1998)). The intervention described in this paper, however, was developed specifically for children with Asperger's Syndrome and has its basis in the sound theoretical framework of Cognitive Behaviour Therapy (CBT). The aim of the intervention was to work with children experiencing significant anxiety to teach them effective strategies to manage their feelings and to encourage a broadening of their emotional and behavioural repertoire.

Parents as co-therapists
A second and equally important aim of the intervention was to work with parents to encourage them to act as co-therapists for their children. This is an especially important component because without the assistance of parents it is unlikely that the child will generalise strategies learned within sessions to other situations and locations. We also anticipated that involving parents in the program would lead to an increase in parental self-efficiency in the management of common behavioural problems. Following the intervention we actively sought feedback from parents both about the program itself and about any changes they were able see, either positive or negative, in their child.