Tony Attwood on Aspergers Syndrome
I’ve got some excellent insights from my recent interview with Dr. Tony Attwood that I want to share with you:
The 100 Piece Autism Spectrum Jigsaw Puzzle
Tony talked about the diagnosis process as being a jigsaw puzzle, here’s what he said about making a diagnosis:
“It’s almost like having a mental check-list that you’re identifying. Now, all the characteristics of Asperger’s exist in the ordinary population. A typical person who is not perfect at reading body language, doesn’t have hundreds of friends, who may not like the noise when you note down on the blackboard, etcetera. So, what makes the condition significant is not a unique characteristic but the strength and dominance and effect of certain characteristics. So we’re doing a check-list of them. Now I say that it’s like completing a 100-piece jigsaw puzzle and there are certain essential social relatedness bits and pieces. But 80 or more pieces of the 100-piece jigsaw puzzle makes the diagnosis.
I’ve never met anyone with all 100, but I’ve never met a typical person with less than 10. So basically, I’m counting them up through the assessment, but the issue then incurs if it’s 80 or more to be diagnosed, what do you do with someone who got say, 70 to 80 pieces? So more than the ordinary population, but not quite enough to confirm the diagnosis. They’re in a grey area, what we call sub-clinical, but may still benefit from some of the strategies for the fragments that they have. So that sort of person I would say they have fragments of Asperger’s syndrome and need help for the fragments they have.”
What Behavior is due to Aspergers?
I asked Dr. Tony Attwood how to tell if a child’s particular behaviour is due to Aspergers or something else. He said:
“It is a very important question because what you often try to disentangle is what is Asperger’s and what’s typical adolescence or typical seven-year-old’s conflict resolution (of “an eye for an eye.”) It really requires expertise to disentangle the two. Certainly having Asperger’s is not an excuse to get away with things and there needs to be appropriate consequences. But the difference with Asperger’s is you’re going to have to spend more time explaining why. And logic is what they’re going to need in what to do or a script of what’s required. But it means if the child has double issues, one of the typical issues that you’d expect of that age, but the other is due to the social confusion, different learning styles, all those sorts of things, that makes life even more of a challenge for them.
Girls Vs Boys with Aspergers
I next asked Dr. Attwood “Can you tell me what some of the significant differences are for clinicians when working on assessment for a girl as opposed to a boy with Asperger’s Syndrome?” Here’s what he told me…
“As far as we know, the core characteristics of Asperger’s in girls is the same as the boys. The difference is how they react to it; not the condition itself. And so, boys tend to be clumsy, oppressive, annoying, argumentative and difficult. And if they get upset, they’re likely to become quite agitated. Whereas the girl may have an approach which is more intelligent but may cause them to be camouflaged. One of the things that they may do is for example, imitation or mimicry. If you’re not very good at socializing, okay. I’ll look at those who are good. I will watch. I will observe from a distance. I will try and work out what’s going on and then I’ll give it a try. Or I will become someone for the situation. I will learn how to act, to “fake it till I make it”.
And so for that individual, what they’re doing is taking someone at school who’s popular and becoming that person in terms of body language, clothing, et cetera, so it’s imitation. Sometimes the girls would escape into imagination. And what they will do is have imaginary friends and imaginary worlds and witches and wizards and all sorts of things including imaginary friends. And by escaping into imagination, you’re not a problem.
You are just considered to have attention deficit disorder and you’re off with the fairies, literally. But you’re no trouble. But you’ve escaped into another world because you don’t understand this world. And they also know how to be on the periphery of activities and to be good. And when I watched the girls as they progressed, they can either be a goody-goody in terms of they’re almost too good at school, not necessarily at home. But they know, “I don’t want to be noticed. I don’t want people to see that I make a mistake.” And so, they’re very well behaved.
But to some, especially in adolescence, they may go completely off the rails and be a major problem. They tend to be the goody-goody or just totally destroy all conventions. So the girls often seem to suffer in silence. They seem to adjust to the situations by mimicry, intelligent working things out. But also, girls tend, with Asperger’s, not to be bitchy. And so they may have one genuine friend who is almost like their personal teacher assistant in the classroom who guides them. In return, the girl with Asperger’s is a very kind, supportive, and loyal person, with one friend who provides the support. But if that friend moves to another town, unfortunately, the person has no idea how to make new friends.
And I think what tends to occur is that that girl can cope reasonably well in a primary school. But at high school, just like in secondary school, when they are in more intense social interpersonal situations, all the problems of hormones, the chaos and confusion of a secondary school, it means that sometimes their stress levels are so great that they develop an anxiety disorder, selective mutism, they have all sorts of problem, may be depression, self-injury. They actually come to people’s attention due to fairly extreme behaviour in some ways, self-injury maybe, things like that.”
Aspergers in Adults
Another question that I asked Dr. Attwood was “What kind of things should parents of children with Aspergers (who are now adults but undiagnosed) be considering and what can they do to help their son/daughter?
Dr. Attwood said “There are lots of things. When I do a diagnostic assessment of an adult and I often ask them things like when did you first know you were different? Very young. And then they had a reaction to that. But I also asked them, when would you have liked to have known of your diagnosis? Especially, all of them say as soon as possible. They say I wish I’d have known as a kid because I wouldn’t be called psycho, stupid, people would’ve understood me, people would have helped me. But once the diagnostic process is complete and confirmed, it means that the person now has access for accurate information, has a self-understanding to make better decisions in terms of relationships and in terms of career and explaining themselves to other people. And that can be highly successful.
But when I look at the diagnostic assessment of adults, it is very important that the clinician has considerable experience in recognizing how adults can camouflage their difficulties and sometimes can give you answers to deflect you from the real issues. That’s why I think it’s very important in diagnosing an adult. If you can, to have someone who knows them, hopefully for a number of years, who can give a second opinion. Because for example when you say, have you got many friends? And they say yes, I’ve got lots of friends. And then the person with him says, well actually they’re acquaintances. The people who just says hello to him when he comes into the office. But nobody has ever invited him around for dinner, nobody ever comes to the house, nobody phones him up. They’re acquaintances but he says, oh they are friends because they say hi. This is so important when assessing adults.”
I hope these tips from Dr. Attwood have been helpful.
I am still working on completing all of the expert Aspergers interviews and they should be all ready in the next couple of weeks – watch this space!
Thanks for reading,
Dave Angel












