What do others think of this paper from Dr Amitta Shah, U.K. She is the
Consultants who in January 2001, who diagnosed me and wrote the 'clinical
and social care report and recommendation' and 'negligence-report' and is
the 'clinical-expert' within my Civil Court Cases, against all the
public-authorities and 'The-State'(U.K Government).
Regards
Colin R.... |See her article below...
Asperger's Syndrome - Behaviour Issues: A Psychological Approach
by Dr Amitta Shah
This paper addresses the additional or secondary behavioural and
psychological difficulties which occur in adults with Asperger's syndrome.
The discussion is based on clinical experience and psychological
understanding of the underlying characteristics of people with Asperger's
syndrome.
The following is a summary of key points which will be discussed in more
detail during the presentation.
Adults with Asperger's syndrome are highly susceptible to having various
types of psychological breakdown which result in different
manifestations/expressions in different individuals. Some of the most common
ones which cause concern to others and lead to distress and various negative
consequences for the individual include the following:
Anger outbursts (physical or verbal aggression, verbally threatening
behaviour, etc)
Agitation and restlessness
Increase in obsessional/repetitive activities/thoughts/speech
Low mood / "depression"
Apathy and inactivity
Onset of uncharacteristic, bizarre behaviour or thoughts
Increased movement difficulties (including catatonia)
These manifestations of breakdown in adults with Asperger's syndrome are
often misinterpreted, misdiagnosed, misunderstood and mistreated.
This occurs especially if the underlying condition of Asperger's syndrome is
undiagnosed, or if professionals, carers, and services do not understand or
consider the importance of interpreting the manifestations in the context of
the individual's Asperger's syndrome. It is very common for professionals
involved to focus on the presenting symptoms and behaviours and arrive at a
"best-fit" diagnostic category on which to base treatment.
Some common formulations to explain the difficulties presented include:
Schizophrenia
Psychosis
Manic-Depression
Mood Disorder
Obsessional Compulsive Disorder
Depression
Severe Challenging Behaviour
In clinical practice, I come across all sorts of severe consequences for
individuals with Asperger's syndrome when their underlying difficulties or
needs are not understood.
Some common consequences include:
Exclusion from services
Loss of employment
Admission to psychiatric units/hospitals
Mental health section to enforce admission and treatment
Trial and error medical interventions, eg drugs, ECT, etc
Police involvement
Prison sentence
Severe stress and distress for family members
All these consequences add to the individual's confusion, coping
difficulties, stress and anger. This can lead to further deterioration in
their psychological state and behaviour, and leads to the individual having
to be in environments, treatment regimes, etc, which are not most
appropriate to their needs. Sometimes, sadly, the cycle carries on until
there is total breakdown. I have come across various situations where the
individual with Asperger's syndrome is being treated under mental health
section in environments where there is very little chance of their
Asperger's syndrome being understood or managed appropriately. This affects
their behaviour adversely and consequently their chances of coming off the
section and into supported environments which would enable them to function
better and not be vulnerable to 'breakdown'.
In my experience and understanding of Asperger's syndrome, it is far more
helpful to view the overt manifestations/symptoms as expressions of the
individual's inability to cope with having Asperger's syndrome and the
associated stress, anger, frustration, boredom, confusion, anxiety and fear.
I find it more useful to understand and formulate the presenting
difficulties as a psychological 'breakdown' due to various underlying causes
and focus on understanding these. Let me take the example of depression - a
common problem in people with Asperger's syndrome. I know of many
individuals with Asperger's syndrome who have undergone a whole range of
anti-depressant drug treatments without any effect on their 'depression'.
Instead, they have often suffered additional difficulties caused by
side-effects. This is usually because the cause for the depression is linked
to the difficulties of being an individual with Asperger's syndrome and
being unable to cope with all the stress and pressures and conflicts this
entails. In one individual who was severely depressed and who had been
through a range of anti-depressants and ECT, the diagnosis of Asperger's
syndrome which explained why he was different from other people, and not
happy or comfortable in social situations, lifted him out of his depression
totally. He told me that having a diagnosis, and being able to talk to
someone who understood, was like "winning the lottery" for him.
In other cases, the depression has lifted after they have been supported in
coming to terms with having Asperger's syndrome, and making relevant changes
in their lifestyle; for example, finding suitable occupations, leaving
stressful social environments and finding alternative settings for pursuing
their training and interests. The solutions for each individual with
Asperger's syndrome are of course different, depending on their personality,
interests, circumstances and experiences.
In order to understand and find solutions for overcoming difficulties, we
need to understand some of the reasons which make adults with Asperger's
syndrome so vulnerable to psychological breakdowns. The main factors involve
a complex interaction between individual internal characteristics relating
to having Asperger's syndrome, and external factors relating to life events
and experiences, adulthood, independence and expectations.
The external factors which contribute to the difficulties include:
not having a diagnosis, or explanation
no readily available group of reference
others not understanding Asperger's syndrome and implications
loss of routine, structure, occupation and external life plan
increase in independence
accumulation of experiences of failure
little or limited support networks
increased need for internal motivation and drive
increased self-awareness of limitations and differences
increased gaps between intellectual, cognitive skills and social, self-help
skills.
The internal factors which make individuals with Asperger's syndrome
vulnerable to psychological 'breakdown' and developing additional
difficulties include:
decreasing internal motivation
rigid ways of thinking
limited distractions from negative/obsessional thoughts
limited insight into own difficulties or reasons
poor coping strategies
low threshold for tolerance of stress, frustration and anger
poor self-identity, understanding and esteem.
Managing, reducing and preventing difficulties
General Principles of a Psychological Approach
1. It is important not to focus on the overt behaviours, manifestations or
symptoms.
2. Avoid panic or confrontation. Instead provide opportunity and space for
the individual to overcome the worst effects. Diffuse, distract, leave
alone, as applicable.
3. It is important not to tackle or "treat" the presenting
behaviours/difficulties "head-on".
4. Use indirect methods based on a detailed understanding of the individual,
and what the Asperger's syndrome entails for them in their circumstances.
5. Focus on underlying causes which will be different for different
individuals.
6. Use of holistic approach and multi-dimensional strategies which aim to do
the following:
(a) Provide
diagnosis and explanation
support with understanding of Asperger's syndrome
explanation and understanding to others (parents, carers, professionals,
employers, service providers)
relevant daily occupation and routine
plans and goals
concrete strategies for reducing/preventing anxiety
support and advice for increasing tolerance and developing coping strategies
opportunities and experiences to increase self-esteem
(b) Increase or Encourage
daily routine
daily structure
goal-planning and achieving
regular physical exercise
stimulating occupations and activity
participation in structured social group activity
(c) Reduce
stress
anxiety
pressure
boredom
isolation
This needs a thorough assessment of the individual's life-style and will
involve changes at various levels.
It is not easy to achieve the above. It will require understanding,
co-operation and sustained effort from various parties including the
individual, the family members, professionals from social and health
services, and other organisations. The whole process will become easier as
our understanding of Asperger's syndrome and of their vulnerability and
needs increases and is accepted and acknowledged widely by everyone.
::::::::::::::::::::::::::
Dr Amitta Shah
Consultant Clinical Psychologist
Leading Edge Psychology
Clinical Psychology Consultancy Centre
1 The Close, Dale Road
Purley, Surrey, CR8 2EA
Dr Shah is a part-time consultant with the National Autistic Society at The
Centre for Social and Communication Disorders. She is also a part-time
Specialist Advisor in Autism and Asperger's syndrome with South London
Community NHS Trust. Dr Shah is the founder of Leading Edge Psychology
Services in autism and other complex disorders. She is a Chartered Clinical
Psychologist with over 20 years experience (research and clinical) with
people with autistic spectrum disorders and Asperger's syndrome.
This paper is reprinted by kind permission from Dr Shah from the proceedings
of the conference on 7 October 1999 on 'Asperger's syndrome - Diagnostic and
Management Issues, Looking Beyond Childhood' organised by Mole Conferences
and Pavilion Publishing in association with the South London & Maudsley
NHS Trust.
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