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

Adolescents

Ten-Year Follow Up of Adolescent Onset Anorexia Nervosa: Personality Disorders

E. Wentz Nilsson, C. Gillberg, Christopher Gillberg, Carina Gillberg and M. Rastam, Journal of the American Academy of Child and Adolescent Psychiatry, November 1999, Volume 38, Issue 11, Pages 1389.

Objective: To study the development of personality disorders, especially those involving obsessions, compulsions, and social interaction problems, in a representative group of anorexia nervosa (AN) cases. Method: The prevalence of personality disorders, obsessive-compulsive disorder, and autism spectrum disorders at mean age 24 years (10 years after reported onset) was examined in 51 adolescent-onset AN cases recruited after community screening and 51 comparison cases matched for age, sex, and school. All 102 cases had originally been examined at age 16 years and followed up at 21 years. At 24 years, structured and validated psychiatric diagnostic interviews were performed by a psychiatrist who was blind to original diagnosis. The majority of AN cases (94%) were weight-restored. Results: Personality disorders, particularly cluster C, and autism spectrum disorders were over represented in the AN group. Obsessive-compulsive personality disorder and/or autism spectrum disorder was diagnosed in a subgroup of AN cases in all 3 studies. This subgroup had a very poor psychological outcome.Using the labels identified by the student, the examiner asks the student which cues he or she used to identify the emotions.

Validation of the Child and Adolescent Perception Measure

C. Koning and J. Magill-Evans, The Occupational Therapy Journal of Research, Winter 2001; 21, 1, Pages 49 - 67.

The Child and Adolescent Social Perception Measure (CASP) was developed to assess children's ability to identify the emotions of others based on non-verbal cues. Adolescent boys with social skills deficits consistent with the diagnosis of Asperger's Syndrome were compared to controls matched on age and intelligence quotient (IQ). Significant differences were found between groups on CASP scores. Correlations between CASP scores and general social skills scores were moderate and positive; lower significant correlations were found with language scores; and significant negative correlations were found with problem behaviour scores. Validility for the CASP was demonstrated by the measure's ability to distinguish differences between groups and by correlations between scores on the CASP and scores on constructs related to social perception. Implications for occupational therapy assessment and treatment of social skill deficits are discussed.

A new measure of social perception, the Child and Adolescent Social Perception has attempted to overcome the limitations of other measures of social perception in children by examining social perception through use of videotaped scenes where nonverbal cues must be interpreted from many channels to understand what is happening.

The CASP (Magill-Evans et al., 1995) consists of 10-videotaped scenes depicting situations that children and adolescents frequently encounter. The sound has been audio filtered so that verbal content is unintelligible, but tone and rate of speech are still evident. The student must rely on nonverbal and situational cues understand the scene. Each scene contains two to five actors and lasts 19 to 40 seconds. After each scene the student identifies the emotions portrayed by each of the characters. Using the labels identified by the student, the examiner asks the student which cues he or she used to identify the emotions.

The Comprehension of Humorous Materials by Adolescents with High-Functioning Autism and Aspergers Syndrome

David M. Emerich, Nancy A. Creaghead, Sandra M. Grether, Donna Murray and Carol Grasha, Journal of Autism and Developmental Disorders, Volume 33, No.3, June 2003.

This study investigated the ability of adolescents with Asperger's Syndrome or high-functioning autism and an age-matched group of typical adolescents to comprehend humorous materials. The analysis of humour focused on picking funny endings for cartoons and jokes. As expected, the adolescents with autism had significantly poorer comprehension of cartoons and jokes. Both groups had more difficulty with the joke than the cartoon task, but when compared with the typical group, the adolescents with autism performed significantly poorer. Examination of the error patterns revealed that subjects with autism had difficulty handling surprise and coherence within humorous narratives.

Why are complex forms of humour challenging for individuals with autism? Most research has emphasized that individuals with autism have an impairment of coherence, including difficulties in integrating content across narratives and discourse (Ozonoff & Miller, 1996). This explains some of the responses of individuals with autism when asked to pick humorous endings to jokes. Non sequitur endings or incorrect endings that are unrelated to the content of the joke were preferred by adults with high-functioning autism (Ozonoff & Miller, 1996). In particular, individuals with autism seem to enjoy slapstick comedy (Ricks & Wing, 1975) and often incorrectly choose humorous non sequitur endings (Ozonoff & Miller, 1996). However, Ozonoff and Miller (1996) also discovered that subjects with autism picked straightforward endings that did not make a joke humorous. This implies that adults with high-functioning autism may not achieve a feeling of surprise if and when they understand the punch line. If they do achieve a feeling of surprise, it may not be converted to one of humour. Previous research on adults with high-functioning autism has indicated that some impairment exists in their use and comprehension of humour. The goal of this study was to investigate the ability of adolescents with Asperger's Syndrome or high-functioning autism and age-matched typical adolescents to comprehend humorous materials. This research focused on the ability to pick humorous endings to jokes and cartoons.

Use of a Social Story Intervention to Improve Mealtime Skills of an Adolescent with Aspergers Syndrome

R Bledsoe, Smith-Myles, B and Simpson, R.L., Autism, Volume 7, (3), Pages 289-295.

This study assessed the utility of a Social Story intervention to improve the lunchtime eating behaviours of an adolescent diagnosed with Asperger's Syndrome. Using an ABAB design, the Social Story program appeared to result in a decrease in the number of food and drink spills and an increase in the frequency of appropriate mouthwiping during lunch at school.

Can I join the club? A social integration scheme for adolescents with Asperger's Syndrome

Claire Broderick, Robert Caswell, Sarah Gregory, Sarah Marzolini, Olwen Wilson Autism Vol 6 (4) 427-431.

This scheme set out to explore the benefits of providing young people with Asperger's Syndrome with social skills training within the setting of a youth group, aided by a trained volunteer. This aimed to maximise successful generalisation of the learned social skills, thus enabling the young people with Asperger's Syndrome to maintain membership of the groups. The project therefore set out to help youngsters with Asperger's Syndrome not only to meet each other in a social skills group and benefit from shared experiences, but also to go that one important step further and, with trained adult assistance, practise these skills in a selected local youth group. The project involved running two small, consecutive, social skills groups (five and four members respectively) for adolescents with Asperger's Syndrome, boys and girls aged 12 to 15 attending mainstream schools. Questionnaires were completed by all the young people, their families, their teachers and their adult helpers to measure social skills (Spence 1995) and self-esteem (Piers 1984).

During the eight sessions of social skills training, the young people were trained in conversational skills, eye contact, body posture, expressing and recognising non-verbal signals, conflict resolution skills, rescue comments and relaxation techniques. They were also given practice in the use 'Social Stories' (Gray 1999) which employ comic strip conversations to encourage consideration of others' thoughts and feelings in social interactions. The adult helpers were given a similar training but with the added introduction of coded signals such as 'emotional thermometers', 'traffic light cards', and 'break tickets' so that they could feed back to the young people when to be careful or even withdraw for a moment for a private piece of advice.

The results of the project were very encouraging. The young people maintained excellent attendance at the social skills groups (90 per cent) and at their youth clubs (79 per cent). The adult helpers reported that the young people needed very little support by the end of the intervention period and according to the feedback from the questionnaires many of the youngsters gained confidence in their social skills.

Guide Packs
As a result of the project a guide pack of the most successful elements has been developed for use by community youth group leaders, teachers, social workers, youth offending teams, clinicians etc. as well as a guide pack for parents. Interested readers are welcome to contact us at the address indicated for further information.