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www.ferrer.dkwww.ferrer.dk

Christian A. Stewart–FerrerSpecialist Psychologist (≈Psy.D.) and Supervisor in Clinical Child and Adolescent Psychology

Specialist Psychologist (≈Psy.D.) in Psychotherapy with Children and Adolescents

Lecturer – Dept. of Psychology – University of Southern Denmark

M.Psych., M.A., Dip.Ed., Dip.Law • Aikido 4th dan, Shidōin

Private practice at “Tidens Psykologer”, Odense, Denmark

♦Autistic (Asperger’s Syndrome)

Tidens Psykologer

WHAT ASC IN AN NT

WORLD LOOKS LIKE

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WHAT ASC IN AN NT

WORLD FEELS LIKE

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Tidens Psykologer

WHAT AN ASC PERSON

IN AN NT WORLD NEEDS

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• Warm acceptance

• Guidance in regard to local

customs and self-knowledge

• Help in adjusting to reality –

especially the darker side of it.

What does he need to know?

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THE WORLD TODAY

”Everybody’s behaving as if

life were one long reception!”(Anders Fogh Jensen)

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BALANCING ENERGY

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TOWARDS AN ASC

IDENTITY

- IN REGARD TO NOT ONLY ASCS, BUT

ALSO THEIR FAMILIES

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Tidens Psykologer

TOWARDS AN ASC

IDENTITY 1

Conformity:

• Want to be ”normal”

• All good things come from ”normality”

• Distance themselves from ASC behavior and actions

• Consider themselves ”normal”, or extremely exceptionalASCs

• Try to form self-image and self-worth on the basis of ”normal” people

• No sense of loyalty or obligation towards ASCs

• Don’t notice the sociopolitical aspects of neural differences

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Dissonance:

• Feel confused at descriptions of different neural ways of functioning

• No clear sense of belonging to one group or the other

• Feel more at home with ”normal” people

• Feel guilty about overestimating the blessings of ”normality”

• Lack role models / positive figures with ASC

• Ignorant about ASC functioning, identity and culture

• Confused about the sociopolitical aspects of neural differences

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TOWARDS AN ASC

IDENTITY 2

Tidens Psykologer

Fundamentalism

• Withdraw into ASC-hood and an autistic world

• Try to act in ”authentic” ASC ways

• Use external criteria to define themselves

• Dislike/despise all ”normal” people

• Idealize ASC, discredit ”normality”

• May express anger at ”closet ASCs”

• Sometimes – at the end of this phase – they might re-

experience ill feelings against ASC and ASCs

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TOWARDS AN ASC

IDENTITY 3

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Resurfacing:

• Develop a flexible ASC identity

• Can distinguish between strengths and weaknesses in

regard to ASC and ASC culture

• Acquire a more positive, non-stereotypical image of ASC

• Get involved in the ASC scene and Cause

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TOWARDS AN ASC

IDENTITY 4

Tidens Psykologer

Self-integration:

• Define themselves through inner criteria

• Get involved in ASC aspects in a more subtle fashion

• Can deal objectively with matters involving NT and ASC

elements

• Center on acceptance and tolerance in regard to both the

ASC and the NT approach to life

• Can withstand other people’s expectations and demands

in regard to neurality

• Reveal a sense of humour

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TOWARDS AN ASC

IDENTITY 5

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SO – WHAT’S A NICE AUTISTIC BOY

LIKE YOU DOING IN A WORLD LIKE

THIS?

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Martin-Buber-

Schule

Sachsenhausen

Frankfurt am Main(Southern Germany)

Jong SkoleSandvika(West of Oslo,

Norway)

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Rygaard Catholic School – Hellerup (North of Copenhagen)

The Metropolitan School (12th century)

(The Copenhagen Cathedral School)

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The Classics Dept.

The English Dept.University of Copenhagen

B.A. M.A.

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The Cathedral

School of

Nykoebing(Falster, Denmark)

Bagsvaerd

Boarding and

High School(Copenhagen,

Denmark)

Dip.Ed.

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The Royal Danish

School of Educational

Studies

(University of Aarhus)

B.A. M.A.

(Psychology)

(Lic.)

(Psy.D.)

(Psy.D.)

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’(ICD-10 only:

Hyperactivity DisorderWith Mental Retardation

And Stereotype Movements)

(Disintegrative Disorder)

(Rett’s Syndrome)

Autism(infantile / classic /

a.m. Kanner)

Asperger’s

Syndrome

Aty

pic

al

Au

-ti

sm

High-Functioning Autism

NvLD(Non-Verbal

Learning Disorder)

A

S

D

Pervasive Developmental Disorders – an ”overview” (ICD-10 & DSM-IV-TR)

NvLD

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NvLD(Non-

Verbal Learning Disorder)

McDD (a.m. Cohen)

PDD-NOS

Tidens Psykologer

Autism(infantile / classic /

a.m. Kanner)

Asperger’s

Syndrome

PDD-NOS

Aty

pic

al

Au

-ti

sm

High-Functioning Autism

NvLD(Non-Verbal

Learning Disorder)

A

S

D

NvLD

MDD (a.m. Cohen)

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NvLD(Non-Verbal

Learning Disorder)DSM-5 – and (probably) ICD-11, as of 2018?

McDD (a.m. Cohen)

A S D

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DSM-5 AND ASC2013:

”THE AMERICAN TRIAD”

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Communication/ social interaction:

• Reciprocity• Non-verbality• Relations

Repetitivity/ focus:

• Stereotypicalmanifestations

• Rigid routines• Special

interests• Sensory

anomalies

Traces early in life

Degree of dysfunctionality:

Severe

Medium

Limited

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ASC 1: SOCIAL INTERACTION

AND COMMUNICATION

Conversations are less reciprocal

Long monologues about own interests

Often talks about the same subject

Difficult for others to get a word in edgewise

Possibly difficult to communicate emotions to other people

Does not ask spontaneously about other people’s emotions and experiences

May produce unsuitable questions or comments

Little small talk

Understands certain things in a far too literal sense

Somewhat neutral or serious facial expression (or ’cartoonish’ or off key in regard to the subject being discussed)

Some difficulty in interpreting other people’s facial expression / tone of voice (e.g. in case of irony)

Not much gesturing (or too much or off key)

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Somewhat unusual eye contact

Tendency to stare at people or into nothing

Somewhat unusual way of using her/his voice

Often placed at an inappropriate distance to other people (too close / too far away)

Somewhat shy / ”weird” in social situations; lackof social initiative

Often problems with turntaking while conversing(especially on the phone!)

May interrupt while other people are talking

Does not allow many people to get ’close’

Often displeased in regard to group work

Often difficulties in finding / keeping friends(especially more than one)

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ASC 2: Social imagination

Massive logic – does not automatically comprehend emotional or social reasoning

Socially naive – does not comprehend social mores, including being taken advantage of

Possibly suspicious paranoid – might not

comprehend / recognize friendliness

Often fails to comprehend friendly teasing / humorous incidents

Often subscribes to a fundamentalist sense of justice

Sometimes fails to comprehend cause and effect

Often fails at pretending, and at devising creative explanations

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ASC 3: INTENSELY FOCUSED / UNUSUAL AREAS OF INTEREST / IMAGINATION

Has one or more intense areas of interest (i.e.: obsessions!) –possibly concerning bizarre subjects

Finds it difficult to change the subject / activity

Is stressed by too many activities / phenomena at once

May get stuck in details, failing to notice the whole picture

Notices details that others may fail to notice

May excel at one or two things and possibly not much else

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ASC 4: REPETITIVE BEHAVIOUR (MAY INCLUDE MOTOR BEHAVIOUR)

Fixed rituals / prefers things to be done identically every time

Somewhat unique body tics or ”habits”

Finds it difficult to change the subject / activity

Is stressed by too many activities / phenomena at once

Possibly parroting / copying (may be sophisticated – [apparent] parodies etc.)

Possibly singing / humming / ”making noises”

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ASC 5: LUNGUISTIC ANOMALIES

Parroting / copying / ability to “collect” languages

Singing / humming / ”noises”

Possibly unusual tone of voice / prosody

Neologisms

”Old-fashioned” mode of communication / liberal use of literary / academic vocabulary

Pronoun confusion

May refer to her-/himself in the third person

Inappropriate questions / comments

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ASC X: MOTOR / BODY ANOMALIES

Possibly slightly robotic movements

Limited body-to-brainfeedback(proprioception)

Imperfect balance

Often not good at sports

Often very bashful – prefers to avoid showering with others (girls esp. during their period)

Possibly very unabashed

Possibly very skilled at (certain types of) sports

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Tidens Psykologer

THEORY OF MIND IN

REG. TO ASC?

(Teacher:) ”You’re not supposed to say to your

classmate that he has a disability!”

(Child with ASC:) ”Why not? He does have a

disability – he’s autistic?!”

(Teacher:) ”Well, yes, but – you’re just not supposed

to say things like that!”

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Tidens Psykologer

THE OTHER WING TRIAD:

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Three basic manifestations of autistic sociality:

Formal, old-fashioned

Socially

energetic, but

with a hint of

oddness or

awkwardness

Socially reserved,

withdrawn, avoidant.

Extrovert Introvert

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THE DANGERS OF BEING SOCIALLY ACTIVE

ASC BEHAVIOUR

Hesitates in taking a social initiative, beinguncertain as to how.

Takes an (uncommon) social initiative, but is misunderstood.

Takes a social initiative, referring to a special interest.

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THE DANGERS OF BEING SOCIALLY ACTIVE

ASC BEHAVIOUR

Hesitates in taking a social initiative, beinguncertain as to how.

Takes an (uncommon) social initiative, but is misunderstood.

Takes a social initiative, referring to a special interest.

NT INTERPRETATION

Probably stuck up or doesn’t care about otherpeople.

Is annoying, insistent, weird.

Is boring, has a one-track mind, is insensitive to the interest of others.

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(See example on next slide)

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ASC BEHAVIOURNT INTERPRETATION

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Ethan Hunt (posing as a traffic analyst): ” ‘You hit the brakes for a second,

just tap them on the freeway, you can literally track the ripple effect of that

action across a two-hundred-mile stretch of road, because traffic has a

memory. It’s amazing. It’s like a living organism.’ ”

Male guest (after Hunt has turned away): [Makes snoring sound.]

THE DANGERS OF BEING SOCIALLY ACTIVE

(M.I. 3)

Tidens Psykologer

ASC SCHOOL PHOBIA /

REFUSAL

Children have a 1-5% risk of school phobia.

(Fremont, 2010 – American Family Physician, Vol. 68 (8), ss. 1555-1561)

ASC children have a 27% risk of school phobia!

(Kurita, 1991 - Journal of Autism and Developmental Disorders, 21 (1), 1-15)

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ASC SCHOOL

PHOBIA / REFUSAL

Time

Sch

oo

l a

tte

nd

an

ce

Teaching in a standard class setting

Level of unhappiness

Tidens Psykologer

ASC SCHOOL

PHOBIA / REFUSAL

Time

Sch

oo

l a

tte

nd

an

ce

Teaching in a standard class setting

Supervision / counseling (mainly directed at the staff and the parents)

Level of unhappiness

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Tidens Psykologer

ASC SCHOOL

PHOBIA / REFUSAL

Time

Sch

oo

l a

tte

nd

an

ce

Teaching in a standard class setting

Supervision / counseling (mainly directed at the staff and the parents)

Level of unhappiness

Tidens Psykologer

ASC SCHOOL

PHOBIA / REFUSAL

Time

Sch

oo

l a

tte

nd

an

ce

Teaching in a standard class setting

Supervision / counseling (mainly directed at the staff and the parents)

Level of unhappiness

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Tidens Psykologer

ASC SCHOOL

PHOBIA / REFUSAL

Time

Sch

oo

l a

tte

nd

an

ce

Teaching in a standard class setting

Supervision / counseling (mainly directed at the staff and the parents)

Level of unhappiness

Tidens Psykologer

ASC SCHOOL PHOBIA /

REFUSAL

(In psychological antiquity:) They probably fear separatingfrom their family (sep. anxiety, symbiosis)

[NB: This is partially true for ASC – because their familyprotects them!]

(Now mostly:) They don’t wantto be at school (soc. anxiety, meaninglessness, etc.)

”The Cure”: Very gradualeasing back, via constantnegotiations with the peoplewith ASC!

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PDA (Pathological Demand Avoidance)

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WHAT IS PDA?E. Newson (198* - ):

• A separate part of ASC

• Early onset

• Passivity during first few years

• Avoiding all demands, regardlessof size

• Social externally, but lackingidentity, pride, or shame

• Poor affect regulation and impulse control

• No problems engaging in pretend behaviour

• Language delay, but catches up

• Compulsive behaviour

2010 - :

• An extra, anxious dimension of ASC –and in some cases the most visible.

• Develops over time (typically) as a result of stress (eps. In connectionwith school phobia).

• (Normal or ASC during first years).

• Avoiding all demands, regardless of size

• May be socially strong or challenged.

• May exhibit illogical, desperate behaviour in order to avoid demands and expectations.

• Meltdown likely when avoidance attemptsfail.

• Some PDAs can engage in pretend behavior, others can’t.

• Some PDAs have language delay, manydon’t.

• Compulsive behaviour

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Essentially: Anxiety !!

Variations: ASC >< MCDD

Often quite intelligent!

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NLD

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MCDD

A S C

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NEED TO AVOID THE DEEP

• Apparently highly psycho-allergic to demands and

expectations.

• Probably due to early traumatization in regard to

experienced demands or expectations, coupled with

perceived inability to honour these.

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”MELTDOWNS”

• Sometimes: Even worse than the standard ASC variety.

• Sometimes: Behaviour easily confused with the kind

typically labeled drama queen activity.

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CHAMELEON /

PASSIVE AGGRESSION

• May sometimes almost ”fade away”.

• May take an exceedlingly long time completing an

assignment / doing a chore.

• May take an inconceivably long time completing whatever

just needs to be done before said assignment can be

completed or said chore be done.

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SOMETIMES ACTIVELY

AGGRESSIVE

• May explode in physical violence.

• May employ extremely offensive language.

• The person’s family may feel that they are walking on

eggshells, feeling desperate and on edge at the thought of

easily awoken volcanoes.

• Even pleasant moments engender anxiety – is this the eye

of the storm?

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PERFECTIONISM /

ISSUES OF SELF-ESTEEM

• May sometimes complete tasks perfectly, seemingly happy and carefree.

• Appears discouraged most of the time, because it’s improbable that a given

assignment can be completed in a perfect manner.

• May display complete lack of confidence in own ability to perform a simple task.

• May be unable to take pleasure in a successful accomplishment.

• May sometimes destroy a successfully completed task, seconds after having finished

it, and in complete despair.

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BUILDING

SKILLS

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Tidens Psykologer

WORLD OF WARCRAFT

Role:

• Basic values in

life.

• Characteristics

• Skills

• Other people’s

expectations

= Safety!

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WORLD OF WARCRAFT

You may try the

functionality of

several roles!

- And they will still

be clearly defined!

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Tidens Psykologer

WORLD OF WARCRAFT

Communication

practice:

• Verbal (!)

• In writing (think

before you talk)

• Adding clear

”emotes”

• Degrees of privacy

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ANIMALS• No hidden agendas

• Positive

• Unprejudiced

• ”Simple” range of

emotions

• Invite entering the animal’s

mind

• Invite gauging

consequences

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Tidens Psykologer

ANIMALS

• Introduction to

body language

• NB: Can be

explained!

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ANIMALS

Introduction to non-

verbal auditory

signals:

• Prosodic patterns

• Pitch

• Volume

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HOW TO TEACH US

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TEACHING US …

requires the presence of a

model / manual /plan

for any kind of assignment!

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Tidens Psykologer

”HOW DO YOU WRITE

A SUMMARY?”

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requires that

meaning and purpose

are clear to the student every step of the way!

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TEACHING US …

Tidens Psykologer

”BUT HOW CAN WE ACTUALLY

KNOW ANYTHING?”

Answer: Carneades’ principle.

”We cannot know anything for

certain, but we can assess

whether something is

improbable, possible,

probable, or highly probable”.

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”HOW DO I CREATE SOMETHING

THAT I HAVEN’T SEEN BEFORE?”

Answer: Bandura’s principle.

Psychologically speaking,

creativity consists in combining

known elements/data in novel

ways.

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”WHY DO WE HAVE TO

STUDY LITERATURE?!”

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Jane Austen’s explanation:

[Literature is the only

place where we can

communicate the full truth

in regard to human

personality.]

(Cfr. Plato’s observation that reading fiction means reading lies)

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SENSE AND

SENSITIVITY

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ACQUIRING A SENSE

OF SELF64

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UNFAMILIAR SITUATIONS

PRODUCE EXHAUSTION

Provide ”feed forward”

Explain as you go – each

step of the way

Structure and predictability

Teach a strategy for

handling the unforeseen.

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OVERVIEW AND

PROCEDURES 1

• The tracks must be present before

the train comes.

• Demonstrate the procedure in

question

• AVOID trial and error!

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• Talk the ASC person through the

procedure in question the first

couple of times.

• This is the prerequisite for being

able to think one’s own way

through the procedure at a later

stage.

OVERVIEW AND

PROCEDURES 2

Tidens Psykologer

OVERVIEW AND

PROCEDURES 3

• Help is needed to uncover the actual nature

of the problem in question (!).

• Help is needed to uncover solution

strategies.

• Help is needed to structure and simplify the

procedure and the accompanying narrative.

• End goal: Knowing the plan for making a

plan!

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ATTENTION REGULATION AND PRIORITIZING DO

NOT OPERATE SMOOTHLY

Multi-tasking is diffcult.

One assignment at a time.

Brief instructions – avoid multiple elements.

Aid in finding things in drawers, cupboards, etc.

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Tidens Psykologer

ATTENTION REGULATION AND PRIORITIZING DO

NOT OPERATE SMOOTHLY

Multi-tasking is diffcult.

One assignment at a time.

Brief instructions – avoid multiple elements.

Aid in finding things in drawers, cupboards, etc.

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DIFFICULTIES IN NAVIGATING

PROPORTIONS AND SELECTING

Deciding requires administeringdivided attention (A is largerthan B).

What is more / less important?

Risk of falling prey to the strongest or most recent sensory input.

Avoid giving more than onealternative.

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Tidens Psykologer

DIFFICULTIES IN REENGAGING

IN INTERRUPTED ACTIVITES

Plan short activities, ensuring that they can be concluded beforea break.

Otherwise: Design the activities so that ”natural” breaks occur.

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DIFFICULTIES IN LEARNING FROM

EXPERIENCE – AND IN TRANSFERRING

EXPERIENCES TO NEW CONTEXTS

Guidance required!

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HELP NEEDED IN NAVIGATING

GAMES, PROCEDURES ETC.

Manuals for games.

Manuals for drawing.

Manual for visualdecoding (”reading” pictures)

Help packing school bags etc.

Help navigatingarithmetic

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SOCIAL

SITUATIONS 1

Structured interactions

1. Being together – IN REGARD TO

something.

2. Games el.lign. (rules and structure

are already part of the activity)

Team games may not be optimal

Humour and irony should be used

sparingly

Do not demand eye contact

Give instructions in when and how to

help others

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Tidens Psykologer

SOCIAL

SITUATIONS 2

Family gatherings

1. ”When are we going home?”

2. A safe place

3. Ipad, books …

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NON-VERBAL

COMMUNICATION

Needs translation of body language.

Needs to have prosody and pitch explained.

Tends to interpret things literally – wherefore input should be

adapted to this fact.

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Tidens Psykologer

SPACE AND

DIRECTIONS

Help planning routes etc.

Companion, cell phone, or GPS may aid greatly.

Known areas are lessstressful.

Finding locations amongother locations is as difficult as finding certainobjects among otherobjects.

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TIME AND

ENVIRONMENT

Needs help in structuring own presence and movements.

May find digital timekeeping much more accessible than

analogue intruments.

Selecting clothing may require assistance in regard to weather

conditions.

May dress somewhat incoherently.

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Tidens Psykologer

THE ESSENCE OF

MATHEMATICS

Mathematics are about getting an overview over numbers, amounts, and sizes.

Numerals are sign codes for numbers, amounts, and sizes.

Figures are graphic codes for numbers, amounts, and sizes.

”Sets” are groups of numbers, and they have a certain size.

I.e.: Keep everything as visual or tactile as possible.

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UNDERSTANDING TEXTS

People with ASC ”readwith a magnifying glass” in unfamiliar situations.

Help focusing on the essence.

1. E.g. by briefly stating the essence beforehand.

Help adding structure to the process.

1. E.g. in the shape of guiding questions, designed to be answeredwhile reading the text (as opposed to afterwards).

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CONFLICTS &

MELTDOWNS 1

People with ASC:

- do not calm down by being told that they needto calm down!

- find it easier to calmdown when theirsurroundings (includingpeople) exude calm AND when they receive the appropriate amount of relevant information.

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” This is a public announcement: Please remain perfectly calm.

There is absolutely no reason to get agitated …”

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CONFLICTS &

MELTDOWNS 2

Conflict de-escalation:

1. Remain calm! (Beware of affect

contagion!)

2. Divert (if possible).

3. (Back off.)

4. Help the person get out of the

situation.

5. Give comfort.

6. No ”we need to talk about this” until

were in the green (not yellow!) zone!

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DOWN TIME

• When the person gets home from

school / work.

• For at least an hour.

• Elective activity.

1. Often by oneself.

2. Often involving e.g. a computer.

• No social expectations.

1. - despite the parents’ needs …

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CHORES

Often: Reduce.

All students in this school

are psychiatric patients.

All students in this school

stress easily – and have

often been in a state of

permanent stress for years!

We are painfully aware of

the effects of long-term

stress on the organism.

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EXTRA-CURRICULAR

ACTIVITIES?

Maybe! They should not become an added stress factor!

Follow the person’s owndesire/choice.

1. Often a structured, feed forward governed activity –e.g. a martial art …

2. Often an individually focusedactivity – e.g. swimming, running, archery, maybetennis …

Not too much

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TRAUMA - PTSD

Bullying (from peers –or teachers??) in the person’s previousschool?

Teacher neglect in the previous school?

”The Cure”: The same as for war veterans!

[EMDR; SE; TFT]

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Identity

Partners and sexuality

Physiologicaland mental

changes

Career plans and leaving

home

Education and curricula

Friendshipsand

acquaintances

Group belongingness

CHALLENGES FACING

ALL ADOLESCENTS:

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Identity

Partners and sexuality

Physiologicaland mental

changes

Career plans and leaving

home

Education and curricula

Friendshipsand

acquaintances

Group belongingness

ADDED COMPLICATIONS:

Tidens Psykologer

BENEFICIAL FOR SIBLINGS

Knowledge and understanding of the nature of ASC in

regard to sibling.

Well-developed strategies.

Own identity and place in the family.

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Tidens Psykologer

THUS, PARENTS SHOULD …

… think as proactively in regard to siblings as in regard

to children with ASC.

… be mindful of siblings’ need for knowledge,

appreciation, and approaches in regard to ASC.

… be mindful of siblings’ need for knowledge,

appreciation, and approaches in regard to themselves.

Tidens Psykologer

POSSIBLY OF INTEREST

www.ferrer.dk 92

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Tidens Psykologer

THANK YOU

FOR YOUR ATTENTION