Welcome to Tony Attwood's Website
A guide for parents, professionals and people with Asperger's Syndrome or Autism Spectrum Disorder Level 1 and their partners.
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Regular podcasts in conversation with autismhangout.com founder/reporter Craig Evans > More Info
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to be one of the world’s foremost experts on
Autism Spectrum Disorder.
Upcoming Events
Books by Tony Attwood
Tony has published many books about Asperger's Syndrome and Autism.
He has also co-authored and contributed to publications with other experts.
He has also co-authored and contributed to publications with other experts.
New Release Out Now
Autism Working:
A Seven-Stage Plan to Thriving at Work
By Tony Attwood and Michelle Garnett
Tony Attwood, Michelle Garnett, Julia Cook, Louise Ford, and Stefanie Runham
Attwood & Garnett Events
FOUNDED BY PROFESSOR TONY ATTWOOD & DR MICHELLE GARNETT
Dr Michelle Garnett PhD is a clinical psychologist who has specialised in autism within her own private practice for over 27 years. She has co-authored six highly regarded books on autism, five with Prof Tony Attwood. Her 2018 book with Barb Cook is a seminal work on the female presentation, Spectrum Women: Walking to the Beat of Autism. Her most recent books Having Fun with Feelings on the Autism Spectrum and Ten Steps to Reducing Your Child’s Anxiety on the Autism Spectrum provide guidance to parents of young children on the autism spectrum.
Together Tony and Michelle have created a series of online courses that are available to download. There are also webinars consisting of a series of mater classes.
Recent Articles by Tony
11 July 2022
Autism and sleep Introduction There is an association between autism and difficulties falling asleep, staying asleep and the quality of sleep for autistic individuals of all ages (Bishop-Fitzpatrick and...
11 July 2022
Autism and bullying Are the rates of bullying higher for autistic children? Many of the autistic children and adolescents we see as clinicians have experienced frequent bullying by peers at school, and...
08 July 2022
What is PDA? Introduction The term PDA stands for Pathological Demand Syndrome and was first coined by Elizabeth Newson, a developmental psychologist, in the 1980s in the UK. She described PDA as being...
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Autism and Sleep![]()
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By Prof Tony Atwood and Dr Michelle Garnett![]()
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Strategies to improve the depth, quality, and duration of sleep:![]()
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There is a range of strategies to help autistic children and adults reduce or resolve sleep issues. These include specific medication, addressing sensory sensitivity and anxiety and sleep education programmes.![]()
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Prescribed melatonin (immediate and prolonged release) can significantly improve sleep latency and sleep quality for autistic children and adolescents. A general practitioner or psychiatrist would be able to review potential medical and prescription factors that could affect sleep.![]()
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An assessment of the autistic child or adult’s sensory profile and advice from an Occupational Therapist or Clinical Psychologist may address sensory issues that affect sleep. ![]()
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A Clinical Psychologist specializing in autism and anxiety will be able to provide guidance with regard to reducing overall anxiety levels and developing more appropriate and effective means of reducing anxiety before falling asleep and when waking in the night. This can provide great relief for parents. ![]()
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Sleep education programmes for an autistic child can include the creation of relevant Social Stories on sleep routines and dreams and parents may benefit from parent-based sleep education programmes. We now also have wise advice from autistic adolescents themselves on encouraging greater quality and duration of sleep.![]()
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Where to from here?![]()
During our over 80 years of combined experience in autism, we have often worked on resolving sleep issues with autistic children, teens and adults using a range of assessment and intervention strategies. We have developed a three-hour presentation to assist autistic individuals and families to explore sleep issues and to give guidance on the best approaches we know from our clinical experience and the research literature. Here is the link:![]()
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attwoodandgarnettevents.com/.../live-webcast.../![]()
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Purpose![]()
Our brand-new event, Sleep and Autism, was specifically designed to help autistic children, adolescents and adults improve their ability to fall asleep as well as their duration and quality of sleep. Participants will learn why autistic individuals struggle to fall asleep and stay asleep. Strategies from the latest research, clinical practice and autistic individuals themselves will be shared. ![]()
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Who Will Benefit?![]()
• Autistic adolescents and adults![]()
• Parents, carers, and partners![]()
• Health professionals, including psychologists, occupational therapists, speech pathologists, social workers, counsellors, GPs, paediatricians, psychiatrists, mental health nurses, nurse practitioners – mental health and developmental educators.![]()
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Does your Child or Adolescent have NDIS Funding?![]()
• If you are self-managed or third-party-managed and parent education is in the Plan you may be able to use your NDIS funding to attend this event.![]()
• Once you have purchased your ticket, we recommend creating events@attwoodandgarnettevents.com as a Contact in your email contact list to ensure that you do not miss anything from us.![]()
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#autism #autistic #autismawareness #autismacceptance #autismfamily #autismspectrum #autismparents #NDIS #attwoodandgarnettevents #psychologist #psychology #alliedhealth #alliedhealthprofessionals #alliedhealthcare #teachers #specialeducator #specialeducation #specialeducationalneeds #specialeducationteacher #psychiatry
Why Do Autistic Adults Become Depressed? Part 2![]()
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Part Two of a two-part series on why autistic adolescents and adults become depressed. Part one was posted yesterday.![]()
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Autistic adults appear especially vulnerable to feeling depressed, with about one in three adolescents and two out of three autistic adults having experienced at least one episode of severe depression in their life. More adults than adolescents may experience clinical depression because the reasons for depression in autistic adults may intensify during the adult years. The following descriptions about why autistic adults can become depressed are also relevant for adolescents. This is the first in a two-part series on why autistic adolescents and adults become depressed.![]()
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*** The information in this post is from peer-reviewed research and the perspectives and experiences of many autistic individuals from clinical experience and communications and may not apply to each person.![]()
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• A ‘sixth sense’ emotional sensitivity:![]()
One of the diagnostic characteristics of autistic adults is a difficulty with nonverbal communication: that is, the ability to read facial expressions, body language and tone of voice. However, clinical experience and autobiographies describe a ‘sixth sense’ ability to perceive and absorb negative emotions in others; the person is over-sensitive to another person’s distress, despair, anxiety or anger, and this can occur without their actually seeing or hearing the other person. An example is a teenager in bed one morning, facing the bedroom wall with eyes closed. His mother tapped the door and silently walked into the room to open the curtains. He immediately said, “What’s wrong Mum?” which was an accurate appraisal of her emotional state of high anxiety, but without engaging conventional nonverbal cues to provide that information.![]()
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The following quotes describe the experience:![]()
There’s a kind of instant subconscious reaction to the emotional states of other people that I have understood better in myself over the years. If someone approaches me for a conversation and they are full of worry, fear or anger, I find myself suddenly in the same state of emotion.![]()
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I am able to distinguish very subtle cues that others would not see, or it might be a feeling I pick up from them.![]()
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This sensitivity to ‘negative vibes’ can feel like being an emotional ‘sponge’. There is a difficulty creating a sense of detachment from the negative feelings of others which seem to be contageous. Another person’s feelings of sadness can become ‘infectious’ to the autistic person, who is not able to determine ownership of the original depressive thoughts. It is interesting that one of the reasons for self-imposed social isolation for an autistic adult can be to provide protection against negative feelings in others that are detrimental to one’s own mental health.![]()
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• Self-reflection and self-disclosure:![]()
An autistic adult may have considerable difficulty recognizing, defining, conceptualizing and disclosing through speech, their inner feelings to parents, partner and/or peers, preferring to resolve thoughts and feelings in solitude. They may avoid conversation about negative feelings and experiences and try to resolve the depression by subjective thought or by using the special interest as a thought blocker. People not on the autism spectrum (neurotypicals) generally recognize that another person may provide a more objective opinion and comforting validation of emotions, act as an emotional restorative and be able to suggest an alternative explanation and reaction. An autistic adult may discover these possibilities for themselves, but only when they are open to new learning and can trust again.![]()
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Some people can easily recall the good times and anticipate that similarly good times will be part of their future. This style of thinking can be an effective antidote to pessimistic or depressive thoughts. Autistic adults may have difficulty experiencing and remembering times of happiness and joy, other than the excitement associated with aspects of the special interest and anticipate a life-long continuity of feeling sad.![]()
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• Emotion repair mechanisms:![]()
Usually, family and friends of someone who is feeling depressed may be able to temporarily halt, and to a certain extent alleviate, the depressed mood by words and gestures of compassion, reassurance and affection. They may be able to distract or elevate the mood of the person who is depressed by initiating enjoyable social experiences, or using humour, thus providing an infusion of happiness. Autistic adults can have considerable difficulty resonating with, or being infused by, the happiness of others. Thus, some emotional rescue strategies used by family members or friends may be less effective for an autistic person; they are more likely to try to solve personal issues by themselves, finding affection, compassion and others’ optimism less effective emotional restoratives. ![]()
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There may be one person within the family who takes primary or exclusive responsibility for emotion repair when the autistic family member is feeling depressed. The dynamics of this relationship may be of concern with an over-reliance on one person who may become exhausted or exasperated by their role and there can be the development of a mutual dependency.![]()
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• Awareness of warning signs of a developing depression:![]()
Another characteristic of autistic adults is a ‘disconnection’ between mind and body, such that the person does not seem to be aware of the internal physical and psychological signals of deepening sadness, such as depleting energy levels; or psychological warning signs or cues, such as increasing pessimism. One example of this is the case of a teenager who was recounting at the clinic his experiences of being bullied at school that morning. As he told the story, tears were welling in his eyes. As tears were about to cascade down his cheeks and were clearly visible to his mother and to us, his mother handed him a tissue. He looked at it in amazement and asked, ‘How did you know I was going to cry?’![]()
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One of the characteristics of autism can be a delay in emotional processing time. An example is a conversation with an autistic woman who was describing an experience she had recently. As she was talking, with a voice that did not convey any specific emotion, tears started to stream down her cheeks. Michelle asked her why she was crying and she replied that she did not know the reason, but after about two hours she would be able to process the events, thoughts and feelings and provide an explanation. This characteristic delay in emotional processing time can explain why an autistic adult may have difficulty giving an instantaneous reason for having (or not having) a particular emotion, perhaps honestly replying to the question “How are/were you feeling?” with “I don’t know”, which means “I am still processing and analysing my feelings. Thus, there can be a considerable delay in the expression of some emotions, such as grief.![]()
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As the autistic person is often the last person to recognize the signs of sadness or depression; these may have to be pointed out by others, with comments such as, ‘You seem especially quite self-critical today, I wonder if you are feeling depressed?’ Alternatively, it is helpful to assist the person to develop a list of behaviours that occur when they are depressed, so that they can recognise their own depression through self-observation of what they do. For example, for one autistic woman we worked with, these behaviours included not tidying up or cleaning the house for a week, not showering for over 3 days and not going to the supermarket to purchase fresh food. Without being able to perceive the early warning signs of deepening depression themselves, the autistic adult cannot take action, and is thus susceptible to the depression becoming deeper. ![]()
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• Vulnerability to extreme, intense emotions:![]()
In instances of intense depression and deep despair, some people – both neurotypical and autistic adults – may consider suicide as a means of ending their pain. This plan may be carefully considered over days or weeks.![]()
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However, in some autistic adults there is a difference in the way they come to this decision. They may experience what can be termed a ‘depression attack’. Suddenly, without any warning signs to themselves and others, they experience intense, catastrophic despair and make a spur-of-the-moment dramatic decision to end their life.![]()
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These out-of-the-blue, extremely intense, emotions are recognized in clinical practice, most often in association with an anxiety disorder and occurring in the form of the panic attacks. The feeling of intense anxiety is sudden, overwhelming and unanticipated.![]()
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Depression attacks are similar, in the sense that there is no prior warning. The overwhelming despair may occur as a catastrophic emotional overreaction to what appears to be a relatively innocuous negative experience, such as making a minor mistake, being late or being teased. However, there may have been a backlog or build-up of despair over a long time that was not cognitively recognized by autistic adult or others. This final, simple event or trigger releases the pressure that has been building for so long. The cap could not stay on the bottle any longer. The resulting conspicuous despair is very deep and genuine, and entirely unanticipated. There may subsequently be an impulsive action, such as jumping from a bridge, resulting in serious injury or death. Friends, family or colleagues who have been with the person immediately prior to this depression attack may not have identified any obvious signs that such an action was imminent. ![]()
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We know that, should the person resist or be distracted from the impulse to act dramatically, the unanticipated, deep despair passes. Remarkably, in a short time it gives way to a more balanced emotional state. For this reason, this programme includes strategies to help create a safety plan in the event of a depression attack. ![]()
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• Suicidal thoughts and actions:![]()
Recent research studies and reviews indicate that thoughts of suicide occur in 66 per cent of autistic adults. In contrast, the rate of such thoughts in the general population is 16 per cent. Research studies also indicate that 35 per cent of autistic adults have in their lives planned or attempted suicide. The actual suicide rate is unknown but could be at least 7 per cent. Thus, the majority of autistic adults have had thoughts of suicide, and around one in three have actually planned or attempted suicide at least once in their lives.![]()
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How Do I Find Out More for professionals working with autistic adults? ![]()
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If you are a Professional who works with adults, we highly recommend attending our upcoming event which may be attended live in Sydney or via webcast: ![]()
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attwoodandgarnettevents.com/product/masterclass-diagnosis-and-intervention-with-autistic-adults/![]()
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#autism #autistic #autismawareness #autismacceptance #autismfamily #autismspectrum #autismparents #NDIS #attwoodandgarnettevents #psychologist #psychology #alliedhealth #alliedhealthprofessionals #alliedhealthcare #teachers #specialeducator #specialeducation #specialeducationalneeds #specialeducationteacher #psychiatry
Why Do Autistic Adults Become Depressed? Part 1![]()
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Part one of a two-part series on why autistic adolescents and adults become depressed. Part two will be posted tomorrow.![]()
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Autistic adults appear especially vulnerable to feeling depressed, with about one in three adolescents and two out of three autistic adults having experienced at least one episode of severe depression in their life. More adults than adolescents may experience clinical depression because the reasons for depression in autistic adults may intensify during the adult years. The following descriptions about why autistic adults can become depressed are also relevant for adolescents. This is the first in a two-part series on why autistic adolescents and adults become depressed.![]()
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*** The information in this post is from peer-reviewed research and the perspectives and experiences of many autistic individuals from clinical experience and communications and may not apply to each person.![]()
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• Feelings of social isolation and loneliness:![]()
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Autistic adults have the desire for friendship, connection, and social approval, but often struggle to easily achieve these outcomes. The reasons for this are twofold. Firstly, autistic people are not easily read or understood by neurotypicals (nonautistic people) which can cause a sense of disconnection and wish to avoid interaction for both parties. Secondly, because the neurology of an autistic person is not wired innately to assist them to easily understand people and how to navigate social interactions. This double bind has been called the “double-empathy problem” of autism (c.f. Mitchell, Sheppard & Cassidy, 2021). The result can be extreme feelings of social isolation and loneliness: as described by Debbie, an autistic woman, ‘the heartache of having unmet needs.’ The compensatory strategy of analysing social situations and social performance can be exhausting and significantly contribute to feeling depressed.![]()
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• The long-term consequences on self-esteem of feeling rejected and not respected or valued by peers: ![]()
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Autistic adults may see other people as being ‘toxic’ to their mental health because of past experiences of bullying and rejection. These experiences have been described as giving intense physical and emotional pain. It is little wonder that many autistic adults choose solitude rather than company. However, as one of our autistic clients said, ‘I would rather be alone, but I cannot stand the loneliness.’ Most autistic adults have experienced bullying, rejection and humiliation, and without a well-defined and robust self-identity, cannot mentally counter what the bully says or cope with the social rejection and humiliation.![]()
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Many typical teenagers value specific qualities in their peers, such as the ability to make people laugh through quick wit, risk-taking, being socially skilled, sporting ability and being perceived as ‘cool’. Being popular is equated to self-worth. The qualities that an autistic adult bring to a friendship usually include loyalty, compassion, knowledge and open-mindedness, which may not be valued by typical teenagers. It is easy for the autistic adult to believe that their friendship qualities are inferior to their peers, and that perhaps, therefore, they are not as valuable as other people. This may result in feelings of low self-esteem which contributes to feeling depressed.![]()
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• The mental exhaustion from trying to succeed socially:![]()
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Despite the lack of the innate hardwiring for easily socialising, many autistic adults utilize their intellect to achieve social inclusion. Unfortunately, the psychological cost is high. The mental effort of intellectually analysing every interaction to know what to do and say is exhausting. As an autistic Buddhist monk said, ‘For every hour I spend socializing, I need an hour of solitude to recharge my energy levels.’ Energy depletion is a major cause of depression.![]()
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• Internalizing and believing the peer criticisms and torments:![]()
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Frequent bullying and humiliation by peers can lead an autistic adult to believe that they really are defective in the ways described by the predators of the school and workplace. As Faye, an autistic woman and public speaker said, ‘If you are told each and every day by your peers, your teachers and your family that you are stupid, you learn pretty quickly that you are stupid.’ This can lead to beliefs about the self that are judgmental and critical, such as ‘I must be stupid,’ ‘I am defective,’ ‘There is something undeniably wrong with me,’ which can both make the person depressed, and keep them depressed. In contrast, typical adolescents, when criticized by peers, will have several close friends who can quickly and easily repair their emotions and provide reassurance and evidence that the negative suggestions are not true.![]()
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• A thinking style that focuses on errors and what could go wrong:![]()
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Autistic adults are very good at recognizing patterns and spotting errors, which is ideal when designing a bridge or analysing an MRI scan but not so great when thinking about oneself or the future. Being able to focus on errors or anomalies is a very important employment skill; however, when the person always uses this style of thinking when contemplating themselves or their future, depression may be the outcome. An example of this style of thinking is: ‘I never get things right, I am hopeless, and I always will be.’ There can be a relative lack of optimism; as the autistic adult achieves greater intellectual maturity, there may be increased insight into being different, with the resulting self-perception of being irreparably defective and socially stupid. ![]()
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There can also be high expectations of social competence and an aversion for social errors and self-criticism. As Caroline stated, ‘The worst thing about disappointing yourself is that you never forgive yourself fully,’ or Ruth’s comment that, ‘When something happens, such as not having your homework done, your inner voice blames and shames you for failing.’ ![]()
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• Belief that change is aversive and unattainable:![]()
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Autistic adults often have great difficulty adjusting to change or the unanticipated, and usually actively seek and enjoy and feel relaxed when there is consistency and predictability in their daily lives. This can lead to a mindset that change is unpleasant and to be avoided. Another characteristic of autistic adults is cognitive inflexibility, which is not being able to conceptualize an alternative: in other words, a ‘one track mind’. Thus, as described by Joshua, ‘I may not want to change, know how to change, or believe that change is even possible.’ This can lead to the belief that feeling depressed will continue and be consistent throughout my life.![]()
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• Not being able to cope with specific sensory experiences:![]()
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An extremely difficult part of autism for many people can be the way they experience their sensory world, for example smells, sounds, textures and light intensity. Specific sensory experiences that are perceived by others as not particularly intense or aversive can be perceived by autistic adult as being unbearably intense and painful. If the person does not have coping or escape strategies for avoiding or tolerating these intense sensory experiences, they may begin to feel very hopeless and depressed about how they are ever going to cope with this aspect of their life. The anxiety they feel while both anticipating and being overwhelmed by aversive sensory experiences can be paralysing, and paradoxically, can increase their sensory sensitivity.![]()
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• Being diagnosed as Autistic:![]()
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Autism has historically been perceived in our society as being a disability, which it can be, or a mental illness, which it is not. However, when we confirm the diagnosis of autism in our diagnostic clinic the most common reaction from an adult who has sought the diagnosis is tears of relief. Finally, there is an explanation for the differences that the person has been observing and analysing for a lifetime. Now the explanation can be that ‘My brain is wired differently’ instead of, ‘I have a defective personality,’ ![]()
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Unfortunately, for some adolescents and young adults, there is a rejection of the diagnosis due to genuine concern as to how it might be interpreted by society and especially by peers. There is understandably a sensitivity to the potential for being labelled in a pejorative way, which could then be perceived as an official confirmation of being defective. Adolescents can also be acutely aware that peer ignorance of the nature of autism may lead to subsequent rejection. The diagnosis and diagnostic label can become ammunition for verbal and physical abuse.![]()
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• Family history of depression:![]()
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We have known for some time that there is a higher-than-expected incidence of mood disorders, including depression, in the family members of an autistic person. Recent research has suggested that 44 per cent of mothers and 28 per cent of fathers of an autistic child have reported having had a clinically diagnosed depression. In more than 50 per cent of cases, the diagnosis occurred before the birth of the child. If a parent has episodic depression, then their son or daughter may have a higher genetic risk of experiencing depression themselves.![]()
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Tomorrow, part two will include:![]()
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• A ‘sixth sense’ emotional sensitivity![]()
• Self-reflection and self-disclosure![]()
• Emotion repair mechanisms![]()
• Awareness of warning signs of a developing depression![]()
• Vulnerability to extreme, intense emotions![]()
• Suicidal thoughts and actions![]()
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How Do I Find Out More for professionals working with autistic adults? ![]()
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If you are a Professional who works with adults, we highly recommend attending our upcoming event which may be attended live in Sydney or via webcast: ![]()
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attwoodandgarnettevents.com/.../masterclass.../![]()
![]()
#autism #autistic #autismawareness #autismacceptance #autismfamily #autismspectrum #autismparents #NDIS #attwoodandgarnettevents #psychologist #psychology #alliedhealth #alliedhealthprofessionals #alliedhealthcare #teachers #specialeducator #specialeducation #specialeducationalneeds #specialeducationteacher #psychiatry