Throughout World Autism Awareness Month 2013, our readers were offered the opportunity to ask JKP authors a question of their choice. Best selling author and contributor to the JKP ask the author campaign, Tony Attwood answers your questions here:
Norelle asks,”I have read both the Exploring Feeling Books and have a question relating to warning signs. We are supporting an 18 year old man who frightens himself when he gets angry and frustrated and then doesn’t remember the moment that he loses control. How do we help him identify the warning signs of a meltdown when he is unable to identify what is happening to him?”
Thank you, Norelle, you raise a very interesting point in that sometimes, the intensity of the emotion almost wipes out the frontal lobe ability to control but also remember specific events. We sometimes use the term, a blind rage. With regard to the warning signs, often the last person to know they are about to lose control is the person with Asperger’s syndrome. However, there may be internal physical signs such as increasing heart rate and perspiration. It may be possible to use some of the new sports equipment that measure heart rate which can be used by the 18 year old to monitor his level of agitation, or for those who support him to check his level of agitation. This may provide the warning signs. Another option is to list the behaviours and thoughts that indicate increasing agitation and have these down on a Thermometer to measure is intensity of emotion. Those who support him may then point out that such behaviours or thoughts seem to indicate an imminent meltdown and that it may be wise to use some of the strategies from the Toolbox.
We have had a lot of questions relating to boys hitting puberty and struggling to control their emotions, do you have any top tips on how to help teenagers regulate their anger and anxiety?
I think in many ways, the previous question will also answer some of the points raised in Question 2, especially to be aware of the physiological signs of increasing anxiety or anger and those who are friends, teachers or family members knowing the situations or behaviours associated with increasing anger and anxiety. We particularly now work with peers at High School to help such individuals recognise the increasing level of agitation and to give them guidance in how to help the person in situations where there may not be a teacher nearby. For typical children, they may have many friends who notice that their friend is becoming anxious or angry and either reassure or calm down effectively. The person with Asperger’s syndrome may not have a friend who can do this but there may be one or two individuals in the person’s class or peer group who could help the person monitor their emotions and step in to manage the anxiety or anger. The other strategies are once agitation is recognised, the wisest response is to walk away from the situation that could lead to feelings of anger, especially when being bullied, teased or rejected. I am not sure that this would be the wise approach with anxiety as it would be best if possible, to be brave and cope with the situation that produces strong feelings of anxiety. It is very important to maintain self-control when feeling angry or anxious and sometimes, strategies used the in Martial Arts can help that person stay calm, cool and intelligent.
Our followers were also interested in how to help children acknowledge and verbalise their concerns. Nancy asks, “How can I get my child to open up about when things are bothering him instead of internalising his problems?”
This raises another important component in emotion management with regard to the ability to disclose the cause of the emotions and to describe inner feelings. Often, the person with Asperger’s syndrome can be asked “how are you feeling” or “what caused your feelings of anxiety, anger or sadness” and often the person may reply, “I don’t know”. This may be translated to “I don’t know how to put my feelings into words so that you will understand” or “I really do not know what is going on in my mind”. It may help to have direct questions, for example, “is this an emotion associated with home or school?” If the person replies “school”, ask “is it associated with the schoolwork, a teacher or your peers”. The next question, “is it associated with what someone said, did or both”. I would also recommend Carol Gray’s Comic Strip Conversations to draw the event using stick figures and speech and thought bubbles. Another option is to ask the teenager to find a music track on iTunes that perfectly describes in the music or lyrics, their feelings and the music may speak volumes. Another option is to type rather than talk and to send an email describing the emotions and the causes. Those with Asperger’s syndrome have considerable difficulty in looking at someone and talking as a means of expressing inner thoughts, feelings and experiences.
Zoe asks, “My daughter (5 years old) has autism / Asperger’s – I know girls present differently from boys – is there anything I can expect in the future or watch out for that I need to be prepared for?”
With regard to daughters as well as with sons, one of my concerns will be in terms of bullying and teasing and I do know that girls can be particularly cruel in using verbal forms of teasing and bullying. I think it is important to identify one or two other girls who can act as your daughter’s guardian in terms of stepping to stop the rejection, bullying and teasing of other children. Another concern I would have is that some girls can be angels at school but devils when they return home. That is, that they know that they have to be compliant and well behaved at school but this has been so exhausting and stressful that when they come home, they can be a very different character. This indicates that there is great stress that is not being communicated at school and you would need to go through with your daughter, ways of decompressing and releasing her stress when she comes home in constructive ways. I would also be concerned that some girls may take advantage of your daughter’s naivety and develop almost a master/slave relationship. It is important to check the integrity of those who may become her friend.
Angela asks, “What are your thoughts about autism and diet? My 3 year old autistic daughter also suffers from temporal lobe epilepsy. Consultants have suggested the few foods diet, but I am not happy with this suggestion; I find it hard to believe autism and epilepsy can be related to diet and allergies?”
I think there is a relationship between the degree of expression of ASD characteristics and diet but we have no biological or even psychological way of determining who would benefit from a diet. This can include taking away items in the person’s diet that may have gluten or casein but also whether additional components to the diet, especially in terms of vitamins and fish oils, may help. From my clinical experience, I know of those with autism and Asperger’s syndrome who have benefited from a restricted diet yet there are many others for whom diet has had no effect on abilities and behaviour. In many ways, you will not know until you try. With regard to the three year old daughter who suffers from temporal lobe epilepsy, there have in the past, been specific diets that have helped manage epilepsy but usually, this has been after conventional strategies such as anticonvulsant medication have not been successful. I am not sure what the consultants mean by the few foods diet and in many ways, I also trust the intuition of a mother in knowing what would be appropriate for her child. There does not appear to be a clear link between autism and epilepsy and diet and allergies, so I would be cautious as to how diet and allergies may effect epilepsy but there could be an effect on your daughter’s profile of autistic characteristics. I would generally urge caution and certainly, monitoring the situation with a dietician.
Edward asks, “I have just been diagnosed with Asperger’s Syndrome. I’m 61 this month. What do I do now?”
With regard to being diagnosed with Asperger’s syndrome, the person says they are 61 and clearly did not have an opportunity to benefit from the programs that are available today for those who are at school and are young adults. However, knowledge of Asperger’s syndrome may explain past experiences and lead to a greater level of self-understanding and the ability to explain one’s self to others. With regard to what do I do now, I suggest that you go to jkp.com, and explore some of the autobiographies that you may be able to identify with. While this information may not be relevant in terms of career or relationships, those who know you may then benefit from a greater understanding of why you are different and you may be able to appreciate some of your talents that are due to Asperger’s syndrome. Thus, when asked what do I do now, I suggest that you read some of the books written by adults with Asperger’s syndrome of similar age. I would also recommend going on to the Internet to seek advice from those with Asperger’s syndrome, again from your generation, as they may be able to provide support and understanding.
Tony Attwood is the author of The Complete Guide to Asperger’s Syndrome (2000), Asperger’s Syndrome (1997) and the forthcoming titles, From Like to Love for Young People with Asperger Syndrome and Mild Autism (2013) and CBT to Help Young People with Asperger’s Syndrome or Mild Autism to Understand and Express Affection (2013) all published by Jessica Kingsley Publishers.