You Matter Very Much

http://twloha.com/blog/you-matter-very-much/

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Your Weakness May Be Your Competitive Advantage

http://blogs.hbr.org/2014/02/your-weakness-may-be-your-competitive-advantage/

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朗程 - 自閉症人士輔助就業服務計劃

智力健全成年自閉症人士前路何去何從?

「朗程 - 自閉症人士輔助就業服務計劃」啟動明朗前程

有本地研究資料顯示，不少智力健全的自閉症兒童成年後仍然在形形式式的大專課程中尋尋覓覓，箇中原因是普遍成年自閉症人士在離開教育體制後，在持續發展上得到的支援相對減少，令他們頓感前路茫茫。近年，自閉症兒童成年後的問題備受社會關注，但社會上投放於成年自閉症人士的資源卻相對不足和缺乏，加上社會大眾一般對自閉症缺乏認識，即使智力健全的自閉症人士亦難以得到就業機會。

新生精神康復會（新生會）承蒙凱瑟克基金撥款資助，今年正式開展「朗程 - 自閉症人士輔助就業服務計劃」（「朗程」計劃），針對上述現況為面對就業困難的智力健全自閉症人士尋找工作培訓及公開就業機會，期望協助他們自力更生，融入社會。新生會專業服務經理（培訓及服務發展）鄧佩珊女士表示：「我們針對智力健全成年自閉症人士的需要，提供全面職前評估至公開就業的一站式服務，特點是以發掘服務使用者的個人優勢為本，透過評估為他們度身訂造一系列職前及社交能力訓練；我們並連繫公私營機構，建立多元化的僱主網絡，根據使用者的能力和興趣提供實習機會及就業配對，以期提昇他們的就業機會。」

新生會特別邀請資深臨床心理學家潘麥瑞雯博士擔任是項計劃的顧問。潘博士在2006至2008年間跟進了64位自閉症人士的成長個案，就「成年自閉症人士前路何去何從?」主題進行深入探討，發現這群年齡介乎18至28歲的自閉症人士中，44%擁有大專學歷，但當中很多人不斷報讀大專課程的原因是難以找到就業機會。雖然半數人已投入職場，但當中52%只能找到非技術性工作，如清潔、速遞、運輸及保安等，相比本港同齡擁有大專學歷的人口則只有17%從事同類工作；而得以晉身專業或管理人員的更只有3%、遠低於同齡人口的29%。

潘博士指出：「調查顯示，自閉症人士即使智力健全並擁有同等學歷，亦難以跟同齡人士一樣得到平等就業機會。大眾普遍對自閉症缺乏認識，令他們在職場上無法得到所需協助，即使從事基層工作，亦往住因未能適應而經常轉換工作，在上述個案中，只有15%人士能夠在同一工作崗位任職一年或以上。就自閉症人士而言，就職成功與否，很大程度取決於社工的協助及僱主的諒解和支持。」

記者會上，「朗程」計劃準服務使用者阿邦及母親張女士即場分享他們的經歷。今年18歲的阿邦是應屆文憑試考生，暑假後將會繼續升學，但已屆成年的他希望找一份兼職賺取零用錢，嘗試獨立自主。可惜，過去數月找工作的失敗經歷令他非常沮喪：「每次面試後，他們都叫我回家等消息，結果都沒有回音，我找過文員、資料整理，甚至是便利店和派傳單等工作，但最終都不成功。」阿邦明白到自己缺乏求職及面試的技巧，亦不了解自己的優勢和適合甚麼工作，期望「朗程」計劃能夠給予所需協助。張女士感慨地說：「眼見兒子處處碰壁，我心裡非常難過，留在學校就像一個避風港，讓他有一個容身之所，但我更希望為他找一個工作機會，讓他真正投入社會，嘗試自力更生。我相信自閉症人士也有能力貢獻社會，希望大家給他們一個機會。」

盧女士亦有過一段艱辛的經歷。她的兒子同時是患有自閉症和過度活躍症，是「朗程」計劃顧問潘博士跟進多年的個案之一。現年28歲的他於2008年畢業後，先後做過速遞、雜工、派傳單等工作，但因為適應困難，每一份都不長久，兩三年間已轉換了四、五份工作，直至遇到現時的僱主，才總算安定下來。盧女士表示：「僱主大多不認識自閉症，不懂如何與自閉症人士相處，其實只要有適當的協助，自閉症人士也能發揮自己的長處，做好自己的工作。我的兒子比較幸運，遇到一位開明的僱主，願意接納他的特殊情況，給予適當的協助。我希望社會關注自閉症人士的就業問題，要幫助他們正常就業，社會的協助和長期跟進非常重要，家長及僱主的支持更是不可或缺。」

新生會期望透過「朗程」計劃，向學員、僱主及家屬三方面提供全面性的輔導服務，為智力健全的自閉症人士尋找明朗前程。本計劃現已開始招募學員，並積極建立培訓實習和工作配對網絡，我們熱切呼籲本港各界公私營機構積極參與。查詢詳情，歡迎致電2327 4045與我們聯絡。

傳媒查詢：
傳訊主任劉銘傑
電話：3552 5107
電郵：keithlau@nlpra.org.hk

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Female Asperger Traits

The original appears in help4aspergers, a website maintained by author Rudy Simone. Rudy, if you are reading this, I hope you don’t mind me reprinting the lists here.

Appearance / Personal Habits:
Dresses comfortably due to sensory issues & practicality.
Will not spend much time on grooming and hair. Hairstyles usually have to be ‘wash and wear’. Can be quite happy not grooming at all at times.
Eccentric personality; may be reflected in appearance.
Is youthful for her age, in looks, dress, behavior and tastes.
Usually a little more expressive in face and gesture than male counterparts.
May have many androgynous traits despite an outwardly feminine appearance. Thinks of herself as half-male / half-female.
Enjoys reading and films as a retreat, often scifi, fantasy, children’s, can have favorites which are a refuge.
Uses control as a stress management technique: rules, discipline, rigid in certain habits, which will contradict her seeming unconventionality.
Usually happiest at home or in other controlled environments.

Intellectual / Giftedness / Education / Vocation:
May have been diagnosed as autistic or Asperger’s when young, or may have been thought of as gifted, shy, sensitive, etc. May also have had obvious or severe learning deficits e.g. poor sense of direction.
May have a savant skill or strong talent.
May have a strong interest in computers, games, science, graphic design, inventing, things of a technological and visual nature. More verbal thinkers may gravitate to writing, languages, cultural studies, psychology.
May be a self-taught reader, been hyperlexic as a child, and will possess a wide variety of other self-taught skills as well.
May be highly educated but will have had to struggle with social aspects of college. May have one or many partial degrees.
Can be very passionate about a course of study or job, and then change direction or go completely cold on it very quickly.
Will often have trouble holding onto a job and may find employment daunting.
Highly intelligent, yet sometimes can be slow to comprehend due to sensory and cognitive processing issues.
Will not do well with verbal instruction — needs to write down or draw diagram.
Will have obsessions but they are not as unusual as her male counterpart’s (less likely to be a ‘train-spotter’).
Emotional / Physical:

Emotionally immature and emotionally sensitive.
Anxiety and fear are predominant emotions.
More open to talking about feelings and emotional issues than males with AS.
Strong sensory issues — sounds, sights, smells, touch, and prone to overload. (Less likely to have taste / food texture issues as males.)
Moody and prone to bouts of depression. May have been diagnosed as bi-polar or manic depressive (common comorbids of autism / AS) while the AS diagnosis was missed.
Probably given several different prescriptions to treat symptoms. Will be very sensitive to medications and anything else she puts in her body so may have had adverse reactions.
9 out of 10 have mild to severe gastro-intestinal difficulties — eg, ulcers, acid reflux, IBS, etc.
Stims to soothe when sad or agitated: rocking, face-rubbing, humming, finger flicking, leg bouncing, finger or foot-tapping, etc.
Similarly physical when happy: hand flapping, clapping, singing, jumping, running around, dancing, bouncing.
Prone to temper, even in public, sometimes over seemingly small things due to sensory or emotional overload.
Hates injustice and hates to be misunderstood; this can incite anger and rage.
Prone to mutism when stressed or upset, esp. after a meltdown. Less likely to stutter than male counterparts but may have a raspy voice, monotone at times, when stressed or sad.

Social / Relationships:
Words and actions are often misunderstood by others.
Perceived to be cold-natured and self-centered; unfriendly.
Is very outspoken at times, may get very fired up when talking about passions / obsessive interests.
Can be very shy or mute.
Like her male counterpart, will shut down in social situations once overloaded, but is generally better at socializing in small doses. May even give the appearance of skilled, but it is a ‘performance’.
Doesn’t go out much.
Will not have many girlfriends and will not do ‘girly’ things like shopping with them or have get-togethers to ‘hang out’.
Will have a close friend or friends in school, but not once adulthood is reached.
May or may not want to have a relationship. If she is in a relationship, she probably takes it very seriously, but she may choose to remain celibate or alone.
If she likes a male, she can be extremely, noticeably awkward in her attempts to let him know, e.g. she may stare when she sees him or call him repeatedly. This is because she fixates and doesn’t understand societal gender roles. This will change with maturity.
Often prefers the company of animals but not always due to sensory issues.
Summary of Some Main Female / Male AS Differences:

Usually a little more expressive in face and gesture than male counterparts.
Better at mirroring than males and so may mirror many different types of personalities. Hence females may not have a strong sense of identity, and can be very chameleon-like, especially before diagnosis.
Will have obsessions but they are not as abstruse or unusual as her male counterpart’s and tend to be more practical (eg, less likely to be a ‘trainspotter’).
More open to talking about feelings and emotional issues than males with AS.
Less likely to receive early, correct diagnosis because the criteria is based on male behaviors / traits. (Hans AS studied males only.) More likely to be diagnosed as bi-polar or manic-depressive (common co-morbids of autism / AS).
Physical gestures / behaviors when happy more expressive than males: hand flapping, clapping, singing, jumping up and down, running around, dancing, bouncing — this pertains to adult women as well as girls.
Adult females are prone to both temper, even in public, sometimes over seemingly small things due to sensory or emotional overload. Hunger / food issues seem to be a common trigger.
Tends to receive less tolerance and more expectation from others, because she appears more adept.
Hate injustice and hates to be misunderstood; this can incite anger and rage meltdowns.
Less likely to stutter than male counterparts when stressed or upset; both may have raspy, choked or monotone voice or suffer mutism.
Females are generally better at socializing in small doses. May even give the appearance of skilled, but it is a ‘performance’. Like her male counterpart, will shut down in social situations once overloaded.

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ATARU真實版 德公司募自閉症患者為資訊專家

電影、日劇情結成真！善用自閉症患者的天份，德國軟體公司募集自閉患者，把他們培養成專業的高科技資訊專家。
電影《雨人》中，金獎影帝達斯汀‧霍夫曼飾演一位擁有極高數學天份，罹患有自閉症的天才，其驚人的記憶力與閱讀能力，能記住上千本書籍的內容，也能在賭場上算牌，為弟弟償還債款。
日劇《ATARU》中，SMAP隊長中居正廣飾演一名罹患學者症候群的自閉兒青年－ATARU，從小接受FBI洗腦式訓練，擁有過目不忘的觀察力與記憶力，能把看似不相關的事情自行連繫起來，進一步推理出原因，常在事件現場中協助警察破案。嶄新的劇情和嚴密的科學推理，在日本、台灣播出都獲得好評與高收視。
但沒想到日劇中的情結竟在真實生活上演。根據英國《每日郵報》報導，全球員工高達6.5萬人、德國最大的軟體公司SAP，目前從德國、加拿大、美國、丹麥等國家尋找高技能的自閉症患者，並尋覓專家訓練這些天才。公司目標是未來7年（至2020年）內計劃招收數百名自閉症患者，要把他們培養成資訊技術專家，預計1％的僱員是自閉症患者。
該公司解釋說，由於自閉症患者「與其他人思維不同」，自閉症患者可能擁有比一般人更高的智商，公司期望能善用他們的「特殊技能」。
據了解，自閉症患者表現出不同的症狀，如亞斯伯格症候群儘管沒有語言和智力障礙，但卻無法與其他人溝通。其重要特徵是社交困難，伴隨著興趣狹隘及重複特定行為。
另一些人可能擁有很好甚至優秀的語言技能，卻難以把握社會行為規範，如罹患學者症候群的雨人和ATARU，雖有認知障礙，但在某一方面，如對某種藝術或學術，卻有超乎常人的能力的人。他們的IQ大部分低於70，但在一些特殊測試中卻遠勝於常人，也俗稱為「白痴天才」。
英國曾做過實驗，發現自閉症患者具有更高度的「知覺承載能力」，能比一般正常人處理更多的訊息和記住數據、工作也更加專注與細心，這可能解釋為何軟體企業青睞他們的原因。
既然高科技公司也注意到自閉症患者的天才技能，或許真實版ATARU協助警方破獲各種懸疑案件，也是指日可待！

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牧者應如何幫助人格失調的會友

前言
         人格失調的普遍程度雖因不同的國家有不同的標準而難以確定，但單以英國為例，它是被接納為精神科病人的其中一個最常出現的類別(約為7.5%)[1][1]。作為教牧同工，我們在教會遇到這些人的機會實在很高；若能對它有較詳細的認識，不單使我們較能實踐保羅給我們的勸勉：「可能的話，總要盡你所能與人和睦」，也可使我們減少因不明白這些人而在相處上產生不必要的挫折感。

人格失調是甚麼
         一個人的人格是指他/她在各種處境的恆常的行為反應。而一個人的人格之被診斷為失調，在精神病醫生的手冊 – DSM IV-TR中，是因為他/她具有「一明顯地與當事人的文化有所偏差而又不可改變的持久的個人經驗和行為，在青春期或成年早期開始出現，長期地沒有改變，並導致當事人因之而產生困擾和損害。」DSM IV-TR將人格失調分為三組：A組有Paranoid Personality Disorder有妄想狂的人格失調, Schizoid Personality Disorder分裂性人格的人格失調, Schizotypal Personality Disorder類似分裂性人格的人格失調；B組有Antisocial Personality Disorder反社會的人格失調, Borderline Personality Disorder有邊緣人格的人格失調, Histrionic Personality Disorder過份戲劇化的人格失調, Narcissistic Personality Disorder有自戀的人格失調；C組有Avoidant Personality Disorder躲避型的人格失調, Dependent Personality Disorder依賴型的人格失調, Obsessive- Compulsive Personality Disorder強迫型人格失調。[2][2]

人格失調的主要成因
病因學
人格失調至今仍是未找出肯定的成因。雖然研究顯示，某些類型的人格失調，如Paranoid Personality Disorder、Schizotypal Personality Disorder、Antisocial Personality Disorder、Borderline Personality Disorder和Obsessive-Compulsive Personality Disorder，在雙生或近親的研究所得，遺傳加早期經驗似是一重要病因。但事實上，因患者的早期經驗至成年病發巳是事隔多年，此等理論多只建基於成人根據回憶的自我報告，故從科學的角度看有關研究是缺乏客觀的。[3][3]

認知心理學
認知心理學視一個人在各種處境的恆常的行為反應為其用以應付環境要求的基本對策。一個人就某一事件所作出的反應，是與他/她如何看待此一事件、和他/她本人就此具有什麼對策息息相關的。而人格失調患者則是由於個人從遺傳而得的易患某病的身心質素、再加上經歷一些人或災難性事件的不良影響，而發展出一些不良 / 不正常的信念和使用適應不良的對策。
一方面，就發展心理學的觀察所得，人在成長的不同階段中，會出現不同的行為如依附、害羞、反叛等；另一方面，研究結果亦顯示，人是有一相當穩定的天生的脾氣和行為模式。而這個人的天生的脾氣與他/她的重要他人的互動，產生一互相加強的巡迴，漸漸形成這個人的人格 – 即這個人獨特的決定他/她各種行為的認知-情感-動機模式。故人格失調是有著先天和後天的影響的。比如說，某些特別容易感到被排斥、遺棄或阻撓的人，在成長中若遇到此等事件，可能會因而就此等事件產生深刻的恐懼，和一些如 “我是一個不可愛的人”或 “人都是不友善和想操控我的” 等信念，和一些對策如 “我是還不要被人注意好一點”。而從資訊處理理論的角度看，一個人對於他/她所遇到的事(外界的刺激/資訊)的看法(認知)和感受(情緒反應)，是源於他/她所具的信念(內在控制系統所有的網絡)，由是產生不同的動機和行為反應。故一些不良 / 不正常的信念，會使人在處理外界的刺激/資訊上有認知失調，使一些原本是就某一特定情況而有的信念變得包含更多情景；這個人對此信念的真實測試的能力會日漸受損害，而該信念便會變得愈來愈固定。人格失調患者會因由認知失調、產生焦慮而致發展成抑鬱。[4][4]
        故從認知心理學的角度看，人格失調患者的特別之處，不單在於他/她的失效或反社會的行為，且在於他/她所有的一堆與之相關的信念、看法、情感和策略。若單就行為而言，他/她們有些策略是過度發展、有策略些則是發展不足，可表列如下：

人格失調                                       過度發展                                  發展不足
Paranoid妄想狂                            保安、不信任、有疑心          安寧、信任、接納
Schizoid分裂性人格                     自主、孤立                              親密、相交
Antisocial反社會                          好鬥性、利用性、掠奪          同感、相交、
                                                                                                         社會敏感
Passive-aggressive                          自主、抗拒、被動                  親密、肯定、主動
                                                       陰謀破壞                                  合作
Histrionic過份戲劇化                  表現癖、表情十足、              反思、自我控制、
                                                       印象主義                                  系統化
Narcissistic自戀人格                    自大、競爭性                          分享、團體認同
Avoidant躲避型                            社會能受傷害、躲避              自我肯定、社交性
                                                       抑制
Dependent依賴型                         尋求幫助、依附                      自足、機動性
Obsessive-Compulsive強迫型     控制、責任感、系統              順其自然、玩樂

獨特的認知層面則是：
Paranoid Personality Disorder有妄想狂的人格失調
自我觀 – 自己是正義的和被他人不合理對待的
對其他人的看法 – 別人基本上是不誠實、欺騙、不忠、暗中操控，他人均是想干預他們、貶低他們和歧視他們，甚而認為他人秘密地聯合起來與他們敵對
信念 – 核心信念是「我是易受其他人傷害的」、「其他人是不可信的」、「要保持警覺」
威脅 – 害怕被暗中操控 / 貶低 / 歧視
策略 – 高度警戒、小心、多疑，有時會警告懷疑不忠者(因而破壞關係)
情感 – 憤怒、焦慮

Schizoid Personality Disorder分裂性人格的人格失調
自我觀 – 自足但孤獨、重視機動性、獨立和追求獨處，較喜歡獨自決定而非群體參與
對其他人的看法 – 視他人為打擾、視自我開放為讓他人可以限制自己的自由
信念 – 核心信念是「我基本上是一個人的」、「親密關係沒有好處、只會帶來混亂」
策略 – 與他人保持距離，除非有特別的原因
情感 – 在獨處時有輕微悲哀、在與人接觸時十分焦慮、極少有情緒的表達

Antisocial Personality Disorder反社會的人格失調
自我觀 – 孤獨、自主、堅強，有些因相信自己曾被傷害而認為自己有權傷害他人，也有自視是「人吃人世界」中的捕食者、故犯法是正常甚而是稱心的行為
對其他人的看法 – 剥削的故應受剥削 / 軟弱和易受傷故應被捕殺
信念 – 核心信念是「我要小心」「我要做侵略者，不然我就成了受害人」
策略 – 公然反社會者會公然攻擊、搶奪和欺騙，是passive-aggressive的反社會者則會暗中利用或欺騙他人
情感 – 憤怒

Histrionic Personality Disorder過份戲劇化的人格失調
自我觀 – 富有魅力、使人印象深刻、和應受注意
對其他人的看法 – 若能被他/她吸引的人則一般是可愛的、喜歡與能讓他做中心人物的人形成強的聯盟
信念 – 核心信念可以是「我基本上是不吸引人的」、「我需要別人的欣賞才會快樂」、「我是可愛的、富愉樂性和有趣」，指示方面則是「我可以靠感覺行事」
策略 – 以戲劇化、公開表露感情來收買人心，若未能如願則大發脾氣
情感 – 表現愉快、歡笑，但內心是焦慮，當被阻撓時則是很快轉為憤怒或悲傷

Narcissistic Personality Disorder有自戀的人格失調
自我觀 – 像王子/公主般獨特、高過一般人、應受優待、不必受常規限制
對其他人的看法 – 底過他/她們、是其下屬、在他/她們中尋找欣賞自己的眼光
信念 – 「我是獨特和應受優待的」、「我是高過一般人、他/她們應如此表示」
策略 – 會想盡辦法來堅固其優越/主導地位、追求才富、地位、權力，競爭，使用操縱他人以達到目標
情感 – 當別人不順從時易怒，當受阻撓時易陷於抑鬱[5][5]

Avoidant Personality Disorder躲避型的人格失調
自我觀 – 不擅社交、不勝任於學術及工作
對其他人的看法 – 有可能批評他/她、對他/她沒有興趣、會踩底他/她
信念 – 「我是不可愛. . . 我不能忍受不愉快的感覺」、「與人相近會使人認識我的『真我』而拒絕我 –那實在是不能忍受」、「若我作新嘗試會遇到失敗，那太大風險」、「我要不計代價地逃避不愉快的情況」
威脅 – 害怕被拒絕、貶低、害怕別人發現他/她名不符實
策略 – 逃避被評估的情景、留在社團的外圍、避免被注意，在工作上則避免新的責任
情感 – 煩躁不安、焦慮和悲傷

Dependent Personality Disorder依賴型的人格失調
自我觀 – 有需要、軟弱、無助和不勝任
對其他人的看法 – 理想化其照顧者、當找到這支持時會有不錯的功能
信念 – 「我需要一強人的支持才可生存」
威脅 – 害怕被拒絕或遺棄
策略 – 培育一依賴關係
情感 – 焦慮、失去倚靠時則變得抑鬱

Obsessive-Compulsive Personality Disorder有強迫性行為的人格失調
自我觀 – 要對自己和他人負責、要靠自己去完成各事、要為自己的完美關注負責、有很多『應該』
對其他人的看法 – 太隨便、很多時不負責任、是自我放縱或不勝任的
信念 – 「我會被淹沒」、「我不夠系統和方向」、「我要有條理、系統、規則才能生存」、「我要控制情況」
威脅 – 害怕犯錯、沒有系統或不夠完美
策略 – 策略環繞一系列的規則、標準和「應該」，他們也用這些規則評估和審核他人，為了達到目標，他們會嘗試控制自己和他人的行為
情感 – 容易後悔、失望和嚴懲自己和他人

雖然人格失調是根據人的行為表現來診斷，但從認知心理學、資訊處理理論的角度看，這些病態的行為是源於患者不良 / 不正常的自我觀、對他人的看法和信念的；故心理治療者宜對各種人格失調的典型信念和策略有所了解。[6][6]

人格失調的治理
認知輔導治療人格失調的一般原理和相關技巧
1.將個案概念化
認知心理治療者必須要對每一個人格失調患者有一詳細而精確的概念，以此成為了解其適應不良的行為和失效觀念的架構。治療者在評估時便應確切地按所得資料進行格式化、提出假設(雖然此等初步構思會隨資料的增加而會有所更改)並以此概念與患者分享。因為那不單幫助資料的收集，也提供方向給患者：如他/她要注意什麼經驗、認出什麼理解模式或深層信念。治療者與患者更可以測試這初步概念與資料的吻合度。治療者可以圖像來表達其概念，讓患者帶回家。治療者應使用所得資料來提取出患者的自我形象、賴以為生的規則、社交禮儀、條件式假設、對他人的看法等。治療者也應根據患者所持有的抱負、雄心而找出其核心假設、條件信念和人生目標。
2.強調治療者與患者的關係
認知心理治療的一個主要原理是治療者與患者逐步建立一信任和合作的關係，很多時患者要被鼓勵以致願意做家課。認知心理治療的藝術部份在於使「尋索患者的信念來源、發現創傷事件的意義」等治療過程，變成一帶有冒險味道的探索過程、而非一重複和使人厭煩的工作。治療者需要容許患者對他/她有憤怒、失望或困惑等負面反應(移情作用)，此等對治療者的情緒反應實在是明白患者內心世界的一個窗戶；若能加以公開討論，此等習性、氣質會是了解患者行為的背後意義和信念的豐富材料。再者，移情作用若未被處理，扭曲的詮釋會持續，並可能會干擾合作關係。治療者特別需要有一個不論斷人的心。大多數的人格失調患者需要一較為溫暖和親切的治療關係。在患者病情嚴重時，治療者需要份演一合個較為主導的角色；當關係轉變至較為長期時，治療者需要轉以較朋友關係與患者相處。
除了上面談及的負面情緒的移情作用，還有抗拒、不順從和缺乏順從等困難。研究確認出19種治療上的不順從的原因：1. 患者可能缺乏合作所需的技巧；2. 治療者可能缺乏發展合作所需的技巧；3. 環境壓力可能妨礙改變或加強失效行為；4. 患者對有關治療失敗的看法或信念可能導致不合作；5. 患者對有關改變對其他人的影響的看法或信念可能導致不順從；6. 患者對改變或新的自我的害怕可能導致不順從；7. 患者與治療者的失效信念可能和諧地混為一談；8. 患者對認知心理治療模式的認識不足可能是不順從的原因之一；9. 保存失效行為模式可能會帶給患者利益；10. 介入的時間不當可能是不順從的一原因；11. 患者可能缺乏動機；12. 患者的缺乏彈性可能阻礙順從；13. 患者可能弱於控制衝動；14. 治療目標可能不切實際；15. 治療目標可能使人失去專嚴/地位；16. 治療目標可能流於含糊或雜亂；17. 治療者可能未能就治療目標與患者達至協議；18. 治療者與患者可能因治療缺乏進展而困惑；19. 患者覺得自己地位底微、自我形象底等均是可能導致不順從的因素。總而言之，找出合作困難的成因，計劃出處理有關局面的必須策略和技巧，以使合作的架構得以建立，對於治療能有進展是必須的。
合作關係建立之後，治療者需要因應患者的人格失調類型，使用各種認知行為治療技術如：認知探索、面質其認知綱要、角色扮演、釋放童年經驗和使用意象等來幫助患者。[7][7] [8][8]

各種人格失調患者的治療
人格失調是不容易選取有效的治療的，但也有人就臨床觀察/經驗聲稱某些治療與患者的進展有關聯。
Paranoid Personality Disorder有妄想狂的人格失調
因為他/她們易生氣和多疑，此等患者難於文帶入治療；但若能克服此等困難，支持性的治療可防止患者因多疑和憤怒反應而累積問題。

Schizoid Personality Disorder分裂性人格的人格失調
因為患者避免緊密接觸，常在數次治療後缺席。甚而若他們被說服繼續出席，他/她們會理論化自己的問題和質疑治療的價值。治療者應幫助患者清楚自己的問題和以一較少引起問題的方式與人相處。治療一般是緩慢和成效不大。探索性的心理治療不易成功，葯物也一般沒有幫助。

Antisocial Personality Disorder反社會的人格失調
葯物可以減輕某些負面情緒和攻擊行為，但一般只會在相當肯定患者會緊守用葯指示或為了安全方才處方。若有資源，可考慮以個人或小組進行心理輔導，但成效則不肯定。就個別心理輔導來說，一種改良的動態心理治療曾被報導是有成效 – 治療者重複直接地以當事人的不正常行為與其面質，但治療者必須具一強有力的、強健的個性，而所聲稱的結果至今仍未被證實。就小組心理輔導來說，若將患者放於普通小組不單難見功效、甚而會干擾組的運作；一全是反社會人格失調者組成的小組會較有建設性，但治療者須是一位對心理治療有相當認識和經特別訓練的人。Jones(1952)曾應用治療社群的概念去治療反社會人格失調者，而根據Rapoport(1960)的研究，治療社群的成功因素有：1.容許社群成員道出其感覺；2.共同分擔工作與責任；3.參與規則的訂定；和4.個人的行為對他人的影響的面質。此一方法曾應用於釋囚的復原程序。

Histrionic Personality Disorder過份戲劇化的人格失調
此等患者對其照顧者諸多要求。一般問題包括嘗試要求不切實際的治療、要求不適當的葯物、和在不合理的時間要求幫助。其他問題包括引誘行為、以自我傷害為恐嚇、嘗試無理地加長面談時間。治療者須及早認出此等問題、與及清楚設立界線。應避免進行探索性心理治療，和應集中於發展患者處理壓力的能力。除非患者同時患有抑鬱失調，否則葯物一般幫助不大。

Borderline Personality Disorder有邊緣人格的人格失調
處理此等患者的困難，一般與(上述的)過份戲劇化的人格失調患者相似。但可選擇的治療則較多。針對處理日常生活所面對的困難的解難輔導可能有效。葯物處方可減低攻擊性行為，但要避免倚賴。若有資源，可考慮某些心理輔導治療，但沒有任何一種心理治療曾被證實有長期或肯定的成效。此等患者不適合以一般的動態心理治療輔導，但Kernberg(1984)聲稱一改良方式expressive psychotherapy可處理患者的核心信念。有興趣於「邊緣人格的心理輔導治療」的讀者，可參考 Higgitt & Fonagy(1993)。以小組心理輔導處理則有關係轉移的問題、需要一有高技巧的治療者、和一次只可放一個邊緣人格患者入小組，有興趣的讀者可參考Clarkin et al. (1991)。Linehan發展出的Dialectic behaviour therapy則是結合每星期一次的個別面談、心理教育、小組形式的行為技巧訓練與及有需要時的電話資詢。此方法能減低邊緣人格患者的自我傷害，但進一步跟進則發現成效是會隨時日減低Linehan et al. (1991, 1993)。[9][9]

Obsessive Personality Disorder強迫型人格失調。
此等患者對心理輔導治療反應不佳，缺乏良好技巧的治療者甚而可能會使患者情況更差。治療應避免指向增加患者困難的處境、和發展患者應付壓力的能力。患者一般在繼發了抑鬱失調之時尋求幫助，故宜先判斷是否有此問題並先行處理。

Avoidant Personality Disorder躲避型的人格失調
此等患者一般自我形象底，一重視他/她們的治療關係、能幫助他/她們認識自己的自我觀，會對他/她們有幫助。患者害怕被批評和拒絕等情緒亦要預先與他/她們一起處理。患者可以是在繼發了抑鬱失調之時尋求幫助，治療者宜小心此問題並作出處理。

Dependent Personality Disorder依賴型的人格失調
動態心理治療可能會増加患者的依賴。他/她們較能從鼓勵他/她們慢慢負起更多責任的解難輔導中穫益。除非患者繼發了抑鬱失調，否則應避免使用葯物。[10][10]

牧者可如何幫助人格失調的信徒
輔導治療人格失調患者是不易有療效的，單以治療有邊緣人格的人格失調者為例，很多有邊緣人格的人格失調患者在資深治療師的多年努力下也未見顯著改善，又或在略見成效時即與治療者陷入一僵持局面。[11][11] 故我建議教牧同工若在教會遇到這些會眾時，首先要注意的是千萬不要以治療者自居；教牧同工的第一個定位，較宜是作為此等會友的一個接納他/她這個人，但又不一定同意他/她的看法/做法的一個誠實的朋友。

人格失調的不同組別在一定程度上亦代表不同的可治療度。相對於A組和B組的患者而言，C組的患者是較可能在輔導面談中與治療者合作而最終得見成效的。故就人格失調中A組和B的會友而言，我想教牧同工對他/她們的認識，除了因此較易掌握「不會使我們將Schizotypal Personality Disorder的會眾的冷漠看作拒絕、懂得跟Borderline Personality Disorder的人立下界線和協商彼此的角色、和若真的遇到Histrionic Personality Disorder的會友時會得保持醒覺和公事公辨的距離[12][12]」等技巧外；我想我們一般可以做的，是對其家人作出支援性輔導。

若我們有會友是人格失調中A組和B組的患者，而他/她們在接受葯物治療外亦就此來向我們尋求幫助的話；我想，因為這些患者需要的是相當長時間的輔導面談，最理想的是轉介至專業的輔導員，牧者則在他/她們因這樣的面對自己而有情緒波動時教導其處理情緒、在他/她們氣餒時作出鼓勵等，這樣的作出支援性輔導。若因經濟等問題沒有合適的轉介，教牧同工不得不要嘗試幫助他/她們時，則更應以「倍他/她們走一段長路」來定位。我的意思是，我們要明白到這是很長時間的付出，故在時間和密度的付出、一開始便注意以長期都應付得來的份量來設定。我們還得步步小心，知道這些關係隨時都會有各種困難和可能會陷入一僵持局面的，可能的話，我們應與當事人的家人和醫生有一緊密聯繫，多禱告和讓自己有空間看到 神親自的帶領。

C組的人格失調患者是較可以從輔導關係中得益的。但我仍建議教牧同工在嘗試幫助他/她們時，以「倍他/她們走一段長路」來定位。我們應該有計劃、有進度，但不要預計短期可以完成；我們實在要以一較長期的輔導 (如：至少10次為期約一年) 來定位。

總結
作為教牧同工，神不單賜我們有較深入認識不同的人的機會，神也吩咐我們要「愛[這些]人如同自巳一樣」。若要以愛牧養上述難纏的人，我想Les Parrott III給我們的忠告：「靠著 神，時常懷著一個謙卑的心、一而再的接納使我們受不了的人、別放棄對人心存希望、和有決心與上述難纏的人維持和睦的關係。」是很值得我們參考的。在靠著 神去以我們自己的生命來影響別人的生命這一個召命中，願意我們能夠做到是一個「雖然與他/她們不同，但卻又能夠體諒他/她們」的人，以致可以在一定程度上幫助到這些有人格失調的人。

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Avoidant Personality Disorder

People with avoidant personality disorder are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these individuals will choose to be lonely rather than risk trying to connect with others.

• Hypersensitivity to rejection/criticism
• Self-imposed social isolation
• Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships[10]
• Avoids physical contact because it has been associated with an unpleasant or painful stimulus
• Feelings of inadequacy
• Severe low self-esteem
• Self-loathing
• Mistrust of others
• Emotional distancing related to intimacy
• Highly self-conscious
• Self-critical about their problems relating to others
• Problems in occupational functioning
• Lonely self-perception, although others may find the relationship with them meaningful
• Feeling inferior to others
• Utilizes fantasy as a form of escapism and to interrupt painful thoughts[11][12]

The World Health Organization's ICD-10 lists avoidant personality disorder as (F60.6) anxious (avoidant) personality disorder.[1] It is characterized by at least four of the following:[24]
persistent and pervasive feelings of tension and apprehension;
belief that one is socially inept, personally unappealing, or inferior to others;
excessive preoccupation with being criticized or rejected in social situations;
unwillingness to become involved with people unless certain of being liked;
restrictions in lifestyle because of need to have physical security;
avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.
Associated features may include hypersensitivity to rejection and criticism.

Research suggests that people with avoidant personality disorder, in common with sufferers of chronic social anxiety disorder (also called social phobia), excessively monitor their own internal reactions when they are involved in social interaction. However, unlike social phobics they also excessively monitor the reactions of the people with whom they are interacting. The extreme tension created by this monitoring may account for the hesitant speech and taciturnity of many people with avoidant personality disorder; they are so preoccupied with monitoring themselves and others that producing fluent speech is difficult.
Treatment of avoidant personality disorder can employ various techniques, such as social skills training, cognitive therapy, exposure treatment to gradually increase social contacts, group therapyfor practicing social skills, and sometimes drug therapy.[30] A key issue in treatment is gaining and keeping the patient's trust, since people with avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.[31]
People with AvPD can improve social awareness and skills, but with deep-seated feelings of inferiority and significant social fear, these patterns usually do not change dramatically.  Childhood peer group rejection are associated with an increased risk for the development of AvPD.

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Interview w/ Tony Attwood about autism in women and girls

Posted in Uncategorized by Tera on November 11, 2010

This is a transcript of Autism Women’s Network’s November 2, 2010 interview with Dr. Tony Attwood about autism in girls and women.

[Music]

Sharon daVanport: Good day, and welcome to AWN radio. We are the Autism Women’s Network on Blogtalk. I am your host, Sharon daVanport, and today is Tuesday, November 2, 2010. Thank you for joining us for this special broadcast with Dr. Tony Attwood. We’re pleased that he could stop by and visit us here on the show before he heads back home to Australia, I guess it’s going to be this Friday.

A quick note before we do get started with the show: I just wanted to mention to our listeners that our radio sponsor,LifePROTEKT is continuing to provide a lucky listener with a GPS locator and one year of service through a prize drawing that we have monthly here on AWN radio. So if you have a child or your know someone whose child can benefit from this device due to wandering, you only need to submit your story to us, nd that would be at our info AT autismwomensnetwork DOT org e-mail and we will enter you in for the contest.

Well, as you guys may have noticed, I didn’t bring on co-host Tricia Kenney. She, as our regular listeners are aware, was very fortunate to get her twin sons who are on the spectrum into a really, really good school, so she’s actually on the road moving. She’s finally moving this week, and she’ll be back joining us again next week for our regular show. But today I’m flying solo, so I’m not going to be having the chat room up, because I’m not going to be able to multitask that without Tricia here. So we’re just going to have our listeners in through the switchboard and on the Internet.

With that said, then, I’d like to welcome our special guest for the hour, author, psychologist and public speaker, Dr. Tony Attwood. Good afternoon, Dr. Attwood.

Dr. Tony Attwood: Hello, Sharon.

Sharon daVanport: Hello. Thank you for joining us today, and stopping by before you head back to Australia.

Dr. Tony Attwood: Thank you, yes. I’m feeling somewhat exhausted, but I’m looking forward to our conversation here that’ll be transmitted and recorded.

Sharon daVanport: Wow, very good. Thank you, again, for joining us. There’s something that I told you before the show started that I really wanted us to touch base on, and maybe we could start there, since we’re going to be talking about female-specific Asperger’s and autism. A question that is posed to us at the AWN not to often but on occasion is: “Why is it important to pay attention to qualities specific to autistic females?

Dr. Tony Attwood: Oh, good question! Really because the girls and women are often not picked up, and tend to suffer in silence. If they were identified, then they may be able to get help—not only necessarily in terms of school supe’sport or whatever, but also, more importantly, understanding from parents, teachers. It may well be from employers, friends, etc.

But it’s also to understand yourself and why you’re different but not defective, because otherwise your view can be: “There’s something inherently wrong with me,” and the person may need to know that: “No, you’re just different and there’s a word that describes it.” It doesn’t mean to say once you’ve had the diagnosis, you’re a different person. You just know why you’re different.

Sharon daVanport: Right. And that makes so much sense. I remember reading somewhere before that you had actually made mention that you believe, along with several other experts in the field of Asperger’s, that the more that we understand about the differences in how to pick up on female-specific Asperger’s, the greater understanding we’ll have of the spectrum as a whole.

Dr. Tony Attwood: Yes, indeed. And also how some of the girls have worked out strategies to learn social understanding and to cope with neurotypicals that we could say: “Okay, well, the boys could benefit from this, and we’ll pass it over to the boys.”

Sharon daVanport: Right. Why do you think that is, Dr. Attwood? I know that’s a blanket, open-ended question, but you could probably break this down better than I could break it down in a question. But just throwing it out there: why is it that we see so many differences…not just because a man is a man and a woman’s a woman. That’s obvious. But if we could talk about maybe some of those differences and then break it down about why, for instance, it’s not recognized in women.

Dr. Tony Attwood: I think one of the things is that the girls and the women seem to have a more constructive way of coping with their social confusion and difference. The boys tend to be abrasive, obnoxious and [chuckles] annoying [unknown] on. Whereas the girls say: “I’ve got to do something about this. I’ve got to either observe others and absorb their persona and copy them, or I will camouflage my social confusion by hiding in a group, letting others go and doing other things.” So what can happen is that the girls will have their way of hiding, camouflaging, imitating others, which means that they’re often not picked up. But what people don’t realize is the degree of exhaustion from that approach.

Sharon daVanport: Mm. That’s very true. Very, very true, the exhaustion. I used to think until I was diagnosed a few years ago, I used to think that everybody just by carrying on a conversation got exhausted. [Chuckles] When I found out that not everybody gets exhausted from a conversation or to go and make a public appearance, when I found that out I was shocked.

Dr. Tony Attwood: Yes. What you described is a contrast, because for the majority of neurotypical women, they are infused and energized by social chit-chat. They seek it out; they enjoy it. And the trouble is that the women with Asperger’s are then expected to be the same. And when they’re not and decline things, or leave earlier, they say: “Well, what’s wrong with her?”

Sharon daVanport: Right. And that’s true, and then we start feeling that isolation. We pick it up. Maybe it’s not said to us, and then maybe we try harder the next time to blend a little bit longer at a social event. But I like the way you give a lot of really good pointers about different things we can do when we find ourselves in those situations to advocate for ourselves, to say: “Listen, I need five minutes or ten minutes,” and back away.

Dr. Tony Attwood: Yeah. What I’d encourage the women and the girls to do is to have more confidence in describing their personality. Not necessarily using a diagnostic term, but just say: “I’m the sort of person who often prefers to read a book than social chit-chat. I’m the sort of person who is not interested in disclosing about my family and showing pictures of my children and my partner.” And just say that: “I’m the sort of person who keeps to myself, is quiet,” and using the terms like “introvert” and “personality” rather than necessarily broadcasting the name of the syndrome.

Sharon daVanport: Right. And now that we’re on this topic, if we could maybe elaborate on some of the challenges that you see clinically for…say an adult woman comes in, and you discover that she is on the spectrum. We want to encourage people to know how serious this is, that we’re trying to get earlier diagnostic tools for females and be able to have them identified so that they have those supports in place. What are some of the things that you see that women come in and present with by the time that they’re adults that is so blatantly obvious to you as a clinician that, yes, they’re on the spectrum?

Dr. Tony Attwood: I think what kind of happened is if they’ve been seeking help, there may have been a history of inappropriate diagnoses or almost-right diagnoses. There can be a history of the possibility of anorexia nervosa or borderline personality disorder, and so people have approached the person because of that sort of interpretation of what the person is doing. But from my clinical experience, often the person has the characteristics of Asperger’s Syndrome, but what may be more pressing is actually is anxiety and depression.

Sharon daVanport: Okay.

Dr. Tony Attwood: That anxiety can be a constitutional feature of Asperger’s Syndrome, but it means that the strategies to treat anxiety in someone with Asperger’s Syndrome need to be modified for the profile and experiences and challenges and stresses of someone with Asperger’s Syndrome. But also, the exhaustion, low self-esteem. I would also say that empathic attunement that women with Asperger’s Syndrome can have means that they may feel quite depressed.

Sharon daVanport: And when you see someone presenting with those different things, what are some of the responses or reactions that you might get? I know that when I was first approached and told that it might be good for me to have an assessment, my son had been seeing a psychologist in a clinic that I was taking him to. For several years he was going there, and I was shocked, because I compared everything about myself to how my son presented, and I laughed, Dr. Attwood.

Dr. Tony Attwood: [Laughter]

Sharon daVanport: I was like: “Are you kidding? I don’t have Asperger’s!” And then, of course, years later it’s just so obvious, and I’ve learned to accept who I am and I’m fine with it. But it was just…I laughed. But also, too, I was relieved. Once I read about it and it all made sense and fell into place, it was very relieving and like a huge burden had just been lifted off my shoulders because I finally understood myself. Everything made sense. Do you tend to get those responses from females?

Dr. Tony Attwood: Yeah. I think people in general, their main experience of what we call autism spectrum disorders is in the severer range, with high support needs or various challenges. And the person says: “But I’m not in that range.” And yes, that to a certain extent is true, but the way I describe what we call the autism spectrum or continuum is like the continuum of visual impairment. There are people who are “blind” who are severely autistic; there are those who need glasses. They can read the headlines, but not the fine print, and it’s like saying to someone who needs glasses to read: “You’re blind.” “No, I’m not blind. I can see.” No. What it means is you’ve got visual impairment. You need glasses or help to see some aspects of the social world that are out of focus for you.

Sharon daVanport: I see. That is true.

Dr. Tony Attwood: And you just used the term: “I see.”

Sharon daVanport: [Chuckles] Right. And actually, I was just…yeah, okay. I get that. So why is it other than the obvious…what are some of the more subtle reasons why females will typically fly under the radar? You said in the very beginning that: “Well, if a boy behaves some way, it might be more blatantly obvious to parents or educators.” What are some of the more subtle things that you’re seeing as a clinician that’s really important for people to observe and understand what’s going on?

Dr. Tony Attwood: The girls aren’t stupid. [Chuckles] If somebody says: “Have you got any friends?” of course they’re going to say: “Yeah, I’ve got lots of friends.” But the question is then: Would the other people call them acquaintances rather than friends?

Sharon daVanport: Oh, okay.

Dr. Tony Attwood: And the girl may know the game of diagnosis easier, to give a false trail, which can lead clinicians to false impressions. Or people may talk about interests, and yes, she’s interested in Barbie dolls and [horses?] and so on. But it’s the intensity of the interest that may be unusual, rather than the focus itself. So in a clinical sense, we’ve also got to look at how the person has coped with their social confusion.

Girls will often in a social setting not let on that they’re actually confused. So when you ask them: “Do you know what to do?” they’ll say: “Yes, yes! I do; I do.” But in the eyes, there is terror that the person won’t let on, or appease other people. So the girls seem to have an ability to sometimes fake it ’til they make it, and to really cope in a social situation with a degree of exhaustion and success. It’s like I call Cinderella at the ball, and they’re really successful socially for a certain length of time. Then the wheels fall off and they can’t do it anymore.

Sharon daVanport: Right. I had someone ask me the other day, Dr. Attwood, and I didn’t quite know how to answer her, so I’m going to ask you this question that she asked me. She’s self-identified at this point. There are a couple family members who when they found out about Asperger’s [feel] that that really does fit her. But she’s felt this way for a couple of years, but she’s been hesitant to go in and seek a formal diagnosis. She’s not quite sure if she wants to. But she did have another family member approach her, and she was asking me about this. They said to her: “Do you think because you’ve read about Asperger’s that you think that you can identify and have it?”

I tried to explain to her: In my mind, when I’m thinking of Asperger’s when it was told to me, you were saying how people usually go the opposite way and they fake it until they make it. They’re trying to fake and blend in. It’s usually just the opposite. So what I told my friend in this situation, Dr. Attwood, is that it’s going to be difficult for a lot of people and families to understand sometimes differences. How do you as a clinician help encourage people when they get a diagnosis to help their family understand that?

Dr. Tony Attwood: Okay, I think there are two issues here. One is quite often, the women that I see for a diagnostic assessment have read up on Asperger’s Syndrome. They wouldn’t be there unless they felt it fits them. So in a way, the initial part can be almost a self-diagnosis. That that person says: “I identified with all those sort of features,” etc.

Now, the thing is, if that person has been reasonably good at camouflaging it, other people—friends and family—may say: “No, no, you haven’t” because they’ve done so well, and their concept of autism spectrum disorders is the classic autistic child. And so some family members may say: “Ah, this does explain you. I now understand,” where others will reject that and say: “No, no, no, no. You can’t have that.” So it’s one of those things that when you explain the characteristics to family members, they can go either way—either acceptance and say: “Yep. that explains you,” or rejection. And it’s difficult to predict which way people will go.

Sharon daVanport: Right. What do you see more of, in your experience?

Dr. Tony Attwood: I think those who know the person really well and have got close to that person say: “Yes, that’s true.”

Sharon daVanport: Right. I’ve seen that in my experience with other females on the spectrum, and their stories seem to actually fit that quite well. People who know them fairly well will be like: “Oh, okay. Yeah, that makes sense.” What about when you’re dealing with parents and a diagnosis? There’s some chatter going on over at our forum a lot about parents wanting to know: What is the right age or the right time or should they tell their child that their child has Asperger’s? There’s a big, huge discussion going on, where some parents absolutely do not even want to tell the child. Clinically, what do you advise?

Dr. Tony Attwood: Okay. My preference is that when the child starts to know they’re different, they need to know. That’s assuming that the diagnosis has been made earlier on. So if it has, when that child feels or says: “I’m not like the other children. I don’t fit in; I’m feeling very upset about it,” then may be a time to explain the diagnosis. My concern is explaining the diagnosis to teenagers, because they are at that stage so emotionally fragile and unsure of their concept of self, they’re quite likely to completely reject the diagnosis and any information or support from that diagnosis. So I’m usually cautious with teenagers, because it can lead to an alienation and rejection of the suggestion.

Sharon daVanport: Oh, okay.

Dr. Tony Attwood: When the person is, say, graduating from high school and needs help in career or relationships or emotions, that may when they’ve got a greater degree of maturity be a time that the diagnosis could be explained. Now, it doesn’t mean not to explain it to teenagers, but if you are, it’s got to be explained very carefully. And I prefer it if it’s explained by a professional, not the parents. So if there’s an antagonism towards the diagnosis, it’s towards the professional, not the parents.

Sharon daVanport: Okay. So it helps the parents be able to stay empowered as a parent in helping that child, and not be the one that the child is trying to reject, so to speak.

Dr. Tony Attwood: The parents remain neutral about the diagnosis until they know the child’s reaction.

Sharon daVanport: I see. Okay, that makes sense. Now, you mentioned about if a child is a teenager, that’s when it really handled pretty strategically. What if a child gets an early diagnosis and maybe a parent is thinking about telling a child in grade school, before they’re actually a teen? What do you think about that?

Dr. Tony Attwood: I think if you explain to the child from the age of about six to pre-puberty, I think go for it. I think it could be very helpful. You’ve obviously got to explain it in a positive way. I go through the qualities and difficulties: “This explains why you’re different. This explains why you sing in perfect pitch, why you draw in photographic realism, why you’ve got those particular qualities, but also difficulties making friends.” So at an earlier age, there’s a greater ability to accept difference in a positive way. But for the teenagers, they can be so desperate to be part of a group and know that teenagers are so critical of anyone who’s different, the kid is saying: “If people know I’m different, it’s going to be a reason for rejection of me from my peer group.”

Sharon daVanport: I see. Now, can you give us a few examples or even just one of a conversation that a parent could have with a child in that situation? They know they’re different if it’s before they’ve hit puberty and the parent has decided: “I’m going to sit my child down and I’m going to tell them why they’re different or why they’re feeling that way.” Could you give an example of a conversation that would be good?

Dr. Tony Attwood: Okay. I think what you do is you go through with the child what their qualities are. The many kids with Asperger’s, they view their qualities in terms of their knowledge or the things that they do. I would then add to that list by parents giving information on their personality, their kindness or those sorts of things, and also go through not only their qualities, but some of their difficulties in things like social confusion, sometimes getting very anxious, may or may not be good at mathematics or things like that. And then say that: “There is a pattern in your characteristics of abilities and personality that actually has a name.” And then I introduce that concept that that name is Asperger’s Syndrome, but it explains why you have particular qualities, in terms of your artwork, in terms of your ability with animals, for example, your imagination.

Sharon daVanport: Right.

Dr. Tony Attwood: And be grateful for the Asperger characteristics. They can actually give you those qualities, but at the cost of some of the difficulties. But we’re working on the difficulties and we’re trying to enhance your qualities.

Sharon daVanport: Okay. The talk that you’re going to be giving there in Toronto, I noticed, has a lot to do with anxiety, and dealing with anxiety with your Asperger’s. Can you talk to us a little bit about that?

Dr. Tony Attwood: Oh, yeah. It [just seems?] that those with Asperger’s Syndrome are very good at worrying. [Chuckles] They’re natural worriers. And that can make you a bit pessimistic because you’re worried about what could go wrong. And anybody who is anxious tries to cope with it, and the ways people in general try to cope with it is to become controlling in your life. That is, to avoid certain situations where you may become anxious, frightened, [unknown] or etc.

But you also have routines and rituals to calm you down, and if someone takes those away, how are you going to cope? And the interest is not only a source of enjoyment intellectually. What the interest does is act as a thought blocker to keep away anxious, negative thoughts. So when someone’s anxious, the emotion of anxiety isn’t a bad emotion. It’s a survival emotion for fear of animals eating you, for example, but it’s how you cope with it and the intensity that can be the problem for the person with Asperger’s Syndrome.

So what I’ve got to do clinically is find out what strategies the person is using that may be better replaced by other ones, and really enhancing their range of strategies. Girls can sometimes be what we call passive-aggressive, using oppositional methods to control their environment—not go to school, stay in their bedroom, etc. So we’ve got to look at: Why is that person engaged in that behavior? Often, it’s a mechanism of coping with anxiety, uncertainty, failure and fear, and not only helping them cope with those situations, but boosting their self-confidence in those situations.

Sharon daVanport: Okay. And when you talk about the anxiety and how it can elevate and escalate at different times, and then you’ll see the different behaviors coming out, do you find it’s because people with Asperger’s, we tend to have just a great ability to focus. Some people call it “obsessions.” It doesn’t bother me either way if somebody calls something of mine that I’m super focused on, if it’s an obsession or a special interest. It’s neither here nor there to me; it doesn’t bother me. But do you think it’s because of that propensity that we have towards that?

Dr. Tony Attwood: Yes. I think what it is, it’s a tendency to focus on detail, but it’s often focusing on errors. One of my hobbies is [gardening,] and the trouble is that when I’m gardening, I tend to see the weeds, not the flowers. And other people say: “What a lovely garden!” and I’ve noticed a weed that I need to pull out. [Chuckles]

Sharon daVanport: Okay. [Chuckles]

Dr. Tony Attwood: So the trouble is, in that great attention to detail and tendency for perfectionism, there can be an overfocus on errors which distorts your thinking and perception of things.

Sharon daVanport: Right. Do you find with females, I hear this a lot over at our forum, Dr. Attwood, so I wanted to get your take on this for something that we see on a regular basis at discussions going on. And that has to do with what we were talking about a little bit earlier, about women being able to mask certain different things, and being able to blend into certain situations. But at the same time, because our challenges or whatever we might be dealing with at the moment is invisible to what others see, it’s [still] affecting us.

So sometimes it can be a curse, and I don’t mean that in a negative way. Some people would think: “Oh, you’re saying that people are cursed who are on the spectrum.” I’m not meaning that at all. But I’m talking literally about the challenges that we find ourselves in, that particular situation. What are some practical tips that you can give that can help us avoid those situations, when we find ourselves going towards that?

Dr. Tony Attwood: Yeah. I think [another?] way of describing it, not a curse, is the price you pay for some of the success. That the price you pay is personal, and other people often don’t see it. So the person with Asperger’s is successful and then goes home or goes to their bedroom and totally crashes. Now, in those situations, some sort of advice is find out how long you feel you can cope in a social setting. Now, that may vary from day to day—good days and bad days—but then have a plan of how you can retreat from that situation with an appropriate almost excuse or justification.

So you may think: “Okay, we’re going to meet up or going to do something social or whatever it is. I could probably cope for about an hour at most. Okay. I need a plan, because they’re going to go on for two to three hours, for me to get out after an hour. So I’ll need to make an appointment. Somebody can give me a phone call on my cell phone or something, so that after an hour, when my capacity’s been completely exhausted, I can go, but with a sense of justification.”

Sharon daVanport: Okay. I see. And when we talk about the differences, too, I want to get back to teenagers for the parents out there. What are some things that parents can do to help girls. I know, I was a teenager on the spectrum, and this means boys, too. I mean, boys want to fit in. Teenagers just want to fit in, so much. Girls, however, are making those choices to be able to blend in an do some things. What can we as parents do to help our daughters realize that it’s not always necessary to have to pretend through a situation:? How can you get a teenager to even take those chances?

Dr. Tony Attwood: It requires a sort of maturity and insight into yourself and acceptance that you are different, and that teenager is desperate to be viewed as just the same as everyone else. The peer pressure in adolescence is horrendous for such individuals. So sometimes when parents are saying: “Just be yourself, be true to yourself,” it’s very hard for the teenagers to accept that, especially if the parent hasn’t fsced the challenges that they are facing.

One of the things we’ve been developing in Brisbane, Australia—two things. One is at our clinic, Minds and Hearts. we have teenage girls with Asperger’s groups. So in other words, they’re girls with Asperger’s who support each other, in terms of ideas and strategies. And in part, it has a greater credibility, because it comes from other girls who are facing the same situation.

Sharon daVanport: I see. Okay.

Dr. Tony Attwood: But we’ve also developed in Brisbane a new group that Camilla has started and others that are mature women with Asperger’s Syndrome, who are mentoring the teenagers.

Sharon daVanport: Oh, nice. Okay.

Dr. Tony Attwood: And so they’re saying: “Yep, I felt like that, but I realized it nearly killed me.” Or: “I was exhausted.” Or: “It wasn’t worth it.” But it has credibility, because they’ve been through it. And as a teenager, you have a natural antagonism to parents. They’re the enemy. But when you have someone who’s outside the family who’s been a hero in many ways of coping, their advice may be listened to more than a parent.

Sharon daVanport: So what you’re saying is that it’s good to get these girls involved in girls’ groups and have mentors and people they can look up to?

Dr. Tony Attwood: Yes, because the mentors have been through it, and the advice that they give is usually highly practical. But they’ve also given information on the long-term consequences of what that teenager may be doing, and so they may say: “Well, you’ve chosen to go down this path. You actually have choices. There are different paths you can go down, and these are the options. It’s up to you to decide what to do, but you need to know the particular outcome of this path that you’re going down.”

Sharon daVanport: So as parents, we can separate ourselves from that, and realize at that point—and I can say this with confidence, having raised teenagers, that is a tough time, when you don’t need to be your children’s friend. You do need to be their parent, and that’s a real critical time during those teen years, so I like that idea of stressing a mentor kind of relationship.

Dr. Tony Attwood: Yeah. It’s just that their neurotypical peers really may not understand, and they need someone who genuinely sympathizes and empathizes with their situation. And that is what they need at that stage.

Sharon daVanport: Right. You were talking about there in Brisbane having girls’ groups. What ages do you have? What do you recommend for other—?

Dr. Tony Attwood: Oh. This is sort of a pre-puberty group, because they’re interested in their own sort of things and their own sort of social relationships of friends at school amongst the pre-puberty girls. But then the teenagers have their own issues, in terms of boyfriend/girlfriend relationships, their vulnerability to sexual predators, the dating game, but also the pressure at school to be part of the peer group, the horrible, bitchy girls, and how to deal with those. But then when dealing with the adults with that support group, it’s looking at careers and relationships and society’s expectation of you as a woman.

Sharon daVanport: Right. That’s nice. When you’re talking about taking those girls at different stages, what do you recommend for when we’re looking at talking to girls about, I guess it would be a natural thing about dating and stuff. But what are your recommendations? We know there’s so many vulnerabilities that females have on the spectrum. I really encourage parents to really be honest with their children about these things, because we take language very literally. At times I know I do; I could be the first to say that. And so we do find ourselves in vulnerable situations, maybe just by miscommunications, not picking up on subtle cues, and when it comes to dating kind of things, are they working with that in the girls’ groups, too?

Dr. Tony Attwood: Oh, yes. It’s one of the major topics. But the best advice actually came from Liane Holliday-Willey, who unfortunately, did come across a number of predators. But what she did was have a group of friends or relatives who were good at character judgement and spotting what I call “the wolf in sheep’s clothing.” Some neurotypicals are really good at identifying those who appear credible, but in fact are not.

So when you meet that person, make sure that they also meet one or two people you know and trust, seen to be good at identifying good guys versus bad guys. And after that time they’ve met them, you say to them, when that person is gone: “What do you think? Are they genuine or are they really too dangerous, in the sense I’m listening to what they say, not what their intentions are?” And if those friends say: “Nope. I think they’re okay,” you go to the next stage. If they say: “Oh, I’ve just got this bad vibe about them. I just wouldn’t trust them. I wouldn’t go out with them,” in that case, don’t go near them again.

Sharon daVanport: And I think that’s important to stress to people on the spectrum, whether they’re male or female: that it’s important to have a good support system. It took me a while, I don’t know if it’s just because I’ve been so independent for so many years, to really learn to trust other people and their judgements, because I can’t always see what is right there. I don’t pick up on a lot of the subtleties. So it was a matter of conditioning myself, and I think that that’s really good advice, Dr. Attwood, to really, really reach out and trust other people, to build a support system.

Dr. Tony Attwood: Some women with Asperger’s can get it eventually, but we’re at the moment talking about the teenagers who sometimes become intoxicated by the attention of someone, that they’re actually there and they’re pleased to see them and all those sorts of things. What they don’t realize is this person’s intentions are not honorable.

Sharon daVanport: Right. And that is so true. The next thing I wanted us to touch about was a conversation I had with you before, and we got really good feedback every time I’ve ever talked to anybody about this topic. A discussion I had with you on females on the spectrum and their ability really have a sixth sense about them. Talk to us a little bit about that. That was just an amazing conversation I had with you before about that.

Dr. Tony Attwood: This is not exclusive to the women; some of the men can have it, too. It’s the ability to walk into a room and just sense danger or negativity. [Chuckles] What they’re doing is not the usual channels of facial expressions or body language or tone of voice. I think what happens is that there are many channels actually to assess people and the situation, and for survival, our species has had to have a variety of mechanisms.

We’ve talked about people who have a sixth sense, who seem to sense danger: that there’s somebody behind, or that there’s just something going on. And I think some of those with Asperger’s have a heightened awareness of that, like they have a heightened sensitivity to sound, light, taste, touch, texture and so on. So I think there can be a heightened sixth sense, and that person may not know how they got it, but they just feel it. And that’s usually something that they can’t define what it is, and that leads the person with Asperger’s to really feel: “Do I talk about this? Do I say anything about it?” I’ve known some with Asperger’s, for example, know when someone’s pregnant when they haven’t told anyone. “Oh, you’re pregnant.” “How did you know?”, etc. It’s those sorts of things that can occur.

Sharon daVanport: Right. My teenage son has Asperger’s, and he just has an ability to pick up certain things, but I have to work with him a lot just trusting his gut and instinct, because he second-guesses himself. He knows that in so many social situations that he has to work hard and he might not catch subtleties, and he might feel later that maybe he didn’t quite understand something right. So then he doesn’t trust his gut; he takes it to the next step and just doesn’t even trust himself, and I have to encourage him: “No. Go ahead and trust that gut feeling.” Every time he does, he’s right.

Dr. Tony Attwood: Yep. I think what you can do is open up all channels and not fear those channels. And sometimes you can pick up messages, but they’re not by the conventional facial expression, tone of voice. I think something else is being picked up that exists in the animal kingdom, could exist in humans, but in some ways we’ve repressed it in our neurotypical way.

Sharon daVanport: I think that’s amazing, Dr. Attwood, to really point these abilities out. I think there’s so much to learn from the human mind and the brain about this, and the instincts that we have that we do need to trust more.

Dr. Tony Attwood: Yeah.

Sharon daVanport: It’s so important because it’s like a person who may have a challenge with their sight, maybe they have better hearing because they’ve learned to tune into that part to communicate. So it’s like, you don’t always need words to communicate and we can trust other avenues.

Dr. Tony Attwood: Now there’s a new book out by Olga Bogdashina, published by Jessica Kingsley Publishers. Now, Olga is very keen on assessment and strategies, the sensory sensitivity, and in her latest book, she actually explores the sensitivity in the sixth sense, which gives it now some credibility.

Sharon daVanport: Okay. That’s just amazing. Well, I know that we had just a limited amount of time to have with you, because you’d just gotten into Canada today. So in wrapping things up today, I wanted to give you an opportunity to just say anything to our listeners that you’d like—anything to anyone on the spectrum. Give us some words of encouragement. First of all, before you do that and close out the show, what is your website information, Dr. Attwood, so people can go there?

Dr. Tony Attwood: Oh, TonyAttwood.com.au People can also be interested to know that when I was in Dallas, Future Horizons asked me to do an hour and three-quarter session just on girls and women and have it recorded on DVD. And this should be available probably in about a month or two’s time.

Sharon daVanport: Oh, really. Okay.

Dr. Tony Attwood: So if you Google “Future Horizons” and “autism and asperger’s” you’ll find them. That should be available. It’s nearly two hours, actually, that I talk about girls and women and that can be something that people can then show to others to give credibility to what they know.

Sharon daVanport: Okay. So it’s an actual DVD you were filmed doing.

Dr. Tony Attwood: Yep.

Sharon daVanport: Okay. And I know who Future Horizons is. That’s really good to know. So it’s almost a two hour presentation that you did there in Dallas?

Dr. Tony Attwood: Yes.

Sharon daVanport: Okay. That’s good to know. All right. Well, listen, even though it was very brief today, our discussion, I just so much appreciate you taking the time to stop by and visit with us here at AWN radio. You go back on Friday, then?

Dr. Tony Attwood: I do, Sharon, and thanks so much. You’ve asked some very good questions.

Sharon daVanport: Well, we’d like to have you back again the next time you’re in the States, so we’ll be in touch.

Dr. Tony Attwood: I think that’s an excellent idea. Mark me down for that.

Sharon daVanport: Okay; all right. Thank you, Dr. Attwood.

Dr. Tony Attwood: Okay. Thank you, Sharon.

Sharon daVanport: Okay. Bye-bye.

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Mindfulness In Adults With Autism Spectrum Disorders

Guest post by: Dr. Annelies Spek. She writes at : Autism and Minfulness.org

Information about the author:

Dr. Annelies Spek is clinical psychologist and senior researcher at the adult autism center in the southof the Netherlands (Eindhoven). Her Ph D thesis was entitled: cognitive profiles of adults with high functioning autism (HFA) or Asperger syndrome. Now she examines the effects of treatment in adults with autism. She also gives lectures about diagnosis and treatment in adults with autism.

Furthermore, she gives mindfulness training to adults with autism and she developed a training program for clinician s (who work with adults with autism) on this subject. For more information about (mindfulness in) adults with autism: here- mail address is anneliesspek@hotmail.com

The original book ‘Mindfulness in adults with autism’, has not been translated in English yet. If you would like to be informed about this in the future, send me an email. If you have any ideas that might help to have the book translated in English, please contact me!

anneliesspek@hotmail.com

Kind regards,

Annelies Spek

_____________________________________________________________________ 

Introduction

Autism is a lifelong developmental disorder that affects functioning in multiple  areas. Recent studies show that autism is often accompanied by other psychiatric  symptoms, including depression, anxiety, hyperactivity, inattention and distress in general. Evidence suggests that depression is the most common psychiatric  disorder seen in autism (Ghaziuddin et al., 2002). Especially adults with relatively high cognitive ability seem at risk for developing symptoms of depression, possibly because they are more aware of expectations of the outside world and their inability to meet those.

Symptoms of depression in adults with autism seem different than in other individuals, ranging from irritability to an increase in difficulty with change and sensitivity for sensory stimuli (Ghaziuddin et al., 2002). An important aspect of depression and distress in people with autism is the tendency to ruminate. This can be described as a drive to think repetitively and experiencing difficulty to let thoughts go. For instance, adults with autism often lay awake at night, pondering about the events of the day and analyzing those in detail. The tendency of people with autism to ruminate appears related to the detailed information processing style that characterizes autism.


Treatment in autism

Various interventions have been developed to alleviate distress and co morbid symptoms in autism, although evidence for their efficacy is still limited. Most of these interventions aim to adapt the environment to meet the needs of the person with autism. Despite  the importance of such interventions, it has become increasingly clear that there is a need for therapies that offer tools that people with autism can use themselves to actively tackle problem situations and reduce distress. Especially the high functioning group may be able to acquire and use self-help techniques they can use in daily life. 

Recently, cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) have been modified for high-functioning individuals with autism. Both therapies aim to reduce co morbid symptoms in autism and alleviate  distress in general. In CBT, dysfunctional thoughts and emotions are analyzed and modified into more functional thoughts and emotions. Recent  preliminary studies  in autism show promising results, especially for symptoms of anxiety and depression (Weiss & Lunsky, 2010). However, generalizability of the CBT skills seems limited. Furthermore,  CBT appears challenging for individuals with autism because it requires analyzing and talking about thoughts and feelings, which calls upon communication and theory of mind skills that are usually impaired in autism. This stresses the need to develop and examine more interventions for people with autism.

In MBSR, one learns to regulate attention in order to stay in the present moment and be less hindered by ruminative thoughts and emotions. MBSR has recently been modified for people with autism, taking into account their information processing characteristics. A clear advantage of this intervention is that it requires few theory of mind and communication skills since thoughts and emotions are not analyzed. During the MBSR training, meditations skills are taught, which the individual can use him/herself in the home situation in order to reduce rumination and symptoms of distress. This seems to induce generalizability to daily life situations. A disadvantage  of MBSR is that participants need to practice at home for half an hour to an hour a day during the training. For the individuals with ASD who are able to spend this amount of time, MBSR seems an effective treatment to reduce symptoms of anxiety, distress and rumination (Spek et al., submitted).
In the following paragraphs we will elaborate on the theoretical and practical elements of an MBSR group intervention for adults with ASD. Finally, we will discuss the effects of MBSR in these groups, as they appeared in a randomized controlled trial and in clinical practice.

Theoretical elements of MBSR in adults with ASD

In the MBSR training module, the concepts ‘doing-mode’ and ‘being-mode’ are central. Both modes are described as conditions of the brain: When the brain is in a doing-mode, it is thinking and actively seeking solutions for problems. The brain is than focussed on achievement and outcome. However, when there is nothing you can do or say to solve the problem, it is not useful and often even frustrating to keep searching for solutions (ruminating). In these situations it seems more healthy to stop searching and accept the situation how it is. This state of mind in can be described as a being-mode: not wishing to change, not worrying about goals in the future, but experiencing what is present in the moment. Often, participants in the MBSR group ask if it is possible to do something when you are in the being-mode. Than we explain that you can ride a bike in the being-mode if you pay attention to the present moment, for example the wind in your hair or feeling your muscles. If you ride the bike in the doing-mode, you are not aware of the present moment, but instead thinking about work or other things that are in the past or future. 

While the doing-mode can be very useful when trying to achieve something,  people with autism often stay in the doing-mode when this is not functional. For instance, when lying in bed and wanting to fall asleep, or when there is a problem that cannot be solved, people with autism often keep pondering. In these situations they often feel the urge to ‘stop thinking’, but are unable to do so. For many people with autism, it is very difficult to create a peaceful or still mind. During the MBSR training, the participants learn to reach more control over the focus of the mind, for instance by actively direction attention to the breath or the parts of the body. When the attention is directed to the breath or body, it can feel as if the mind is more at peace, because the attention is away from thoughts and actions, towards a more peaceful focus and thus into the being-mode. This can help by stopping the thought cycle and fall asleep.  When people with ASD learn to influence the mode of the brain, it helps them to actively create a more peaceful mind, by shifting from the doing-mode  to the being-mode.

Another key aspect of the MBSR training for people with ASD is acceptance of the situation as it is.   Many people loose energy by trying to change things that can not be changed. Accepting often requires less energy than keep fighting for something that is not realistic. This is always a theme MBSR training and it is recognizable for many adults with ASD,  in various areas of their life.

Practical elements

MBSR can be taught in a group, but also individually, by using the book ‘Mindfulness in adults with ASD’. This book has so far been published in Dutch and German, an English translation is yet to come.
During the MBSR training, different meditation techniques are taught. These techniques are practiced in daily life situations (for instance at home or at work), accompanied by an audio file. The meditations are modified to the information processing style of autism, for example by avoiding words or sentence that are unclear or that require imagination skills. An example  is that in regular mindfulness, participants are asked to breath in and let the breath go to the toes. In our try-out MBSR training, a man with autism remarked, while pointing at stomach: ‘I can’t do that because my lungs end here’. Based on those and other experiences of the try-out group, we modified the text of the meditations (with regard to the example above: ‘breath in and perhaps you can feel the breath go down’).

 The meditation techniques can be practiced lying down, sitting, walking  or in any other way that feels comfortable. The length of the meditations vary between five and forty minutes, which is dependent on what fits best with the individuals needs and opportunities. Eventually, during the MBSR training the participants explore which meditation techniques are helpful for them and in which situations they experience most benefit. After the nine-week mindfulness training, each individual writes a plan of which meditations they want to integrate in their daily life and when and where to execute them. Often, they choose a person in their environment who helps them to keep practicing mindfulness. 

Treatment effects of MBSR in autism. 

MBSR in ASD has been studied in adolescents and adults. Two studies were performed in adolescents with either high-functioning autism or Asperger syndrome and results were promising (Singh et al., 2011a,b). In these intervention studies, the adolescents were taught to shift their attention from their emotion (anger, frustration), to the soles of their feet. The results showed a decrease in aggression.

In our study, 42 adults with ASD were randomly assigned into a 9-week MBSR training or a wait-list control group. The results showed a significant reduction in depression, anxiety and rumination in the group who received the MBSR training, as opposed to the control group. Furthermore, positive affect increased and negative affect decreased in the intervention group, but not in the control group. We concluded that adults with ASD can acquire meditation skills and generalize these into their private life in a way that reduces distress and improves wellbeing (Spek et al., submitted). Besides this scientific  trial, we also asked the participants in person if and how the MBSR group training helped them.  Firstly, we noticed that on average, each group (with 10 to 12 participants) contained one person who reported no benefit from MBSR. Although more research is necessary to examine predictors of benefit from MBSR in this group, an interesting suggestion came from one of adults with ASD who participated in an MBSR group. She hypothesized that treatment benefit might be related to the ability to feel the body; If one can not feel any bodily sensations, it may be difficult to focus on the body or the breath, which might reduce the ability to benefit from MBSR. 

When looking at the participants who did report positive effects from MBSR, the most mentioned improvement was the ability to fall asleep more easily, often by direction attention to the body (body scan) or to the breath. Secondly, many participants mentioned that MBSR helped them to let go of thoughts and be less hindered by ruminative thoughts, by directing attention to another focus. Most of these participants practiced the thinking meditation (focusing on thoughts going by) or the breathing meditation, mostly during the day, in order to stop ruminating and creating a moment of rest in their mind. This helped them to reduce distress in challenging situations, for instance at work. Thirdly, participants mentioned that MBSR enabled them to be more kind and accepting toward themselves, some realized that they set the bar too high, which inevitably leads to failure and distress.

Concluding, MBSR seems an effective intervention for reducing co morbid symptoms of depression, anxiety and distress in general in high functioning adults with ASD. Furthermore, they are able to actively acquire techniques that can help them gaining more control over their wellbeing.



 It is important to also mention that in some situations, MBSR is not advised. For instance when expecting large changes in life, people may not have the energy for the MBSR training, since it requires daily home practice.  Furthermore, acute psychiatric conditions (psychosis or severe depression) are contraindications for following MBSR and require other interventions before MBSR should be considered.  

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