Tony Attwood Interview

[oracle]

Generally I like Tony Attwood but I can help but think that some of the problems that we are having now ie what actually is the critera for AS are down to him shifting the goal posts - just my opnion of course.

 

Carole

 

Dr TONY ATTWOOD, a clinical psychologist based in Queensland, Australia, is widely ackowledged to be the world?s leading expert on Asperger?s syndrome Adam Feinstein spoke to him in Melbourne

 

 

ADAM FEINSTEIN: Asperger?s syndrome has been recognised only relatively recently as a specific disorder. What do you think have been the major advances in our understanding of the condition over the past 30 years since Hans Asperger?s 1944 paper was translated into English?

 

 

TONY ATTWOOD: I think the main advances have come not from the research literature but from conversations and discussions with those who have Asperger?s syndrome, by reading not the scientific textbooks but their autobiographies. My greatest knowledge of Asperger?s has come from those who have it. Other great advances are the recognition of the challenges they face, and some way of helping them to cope. What may also be occurring is a change in attitude towards these attitudes and, I hope, a greater emphasis on their talents rather than their deficits.

 

 

ADAM FEINSTEIN It used to be thought that individuals with Asperger?s syndrome had a normal command of language and that this, indeed, was one of the characteristics which distinguished Asperger?s from autism. We now know that the language used by people with Asperger?s is often stilted, not normal. I have spoken to Lorna Wing in the UK about the use of language in autistic children who, like my son, lost their speech, and I agree with Lorna that the nature of that language was non-social. My question is this: is the language used by people with Asperger?s resolutely asocial? Is their obsession with talking about dinosaurs or lightbulbs or Winston Churchill a deliberate attempt to avoid meaningful social interaction?

 

 

TONY ATTWOOD: You?ve asked many questions there. I?ll answer them one by one. The language profile in Asperger?s syndrome is different. Whether or not they were delayed in language when they were young children is, I believe, irrelevant. What is important is how they use language in a social context. The art of conversation is not something in which they are naturally skilled. Also, they are not skilled in translating their thoughts into speech. And quite often, their thoughts may be visualisations or concepts which are not easy to convey in spoken communication but which may be conveyed by written or typed communication in e-mails, drawings, etc. But in a social setting, there are problems in the pragmatic aspects of language - especially social conversation. There can also be difficulties with regard to being somewhat pedantic, with rather odd prosody, and with not picking up the cues. But certainly, when I, as a clinician, socialise linguistically with someone with Asperger?s syndrome, it tends, from their point of view, to be somewhat artificial, contrived, laborious and clumsy. Yet, when you start talking about their special interests, then their eloquence, fluency and enthusiasm can be most captivating. So with speech, it depends on what you?re talking about.

 

 

ADAM FEINSTEIN: In the case of those children who lost their language, some do begin to speak again. I have not seen this question asked before, so here goes. Do any of these individuals ever regain a sufficient level of language to warrant a diagnosis of Asperger?s syndrome? Has this ever happened?

 

 

TONY ATTWOOD: At present, we have not thoroughly examined the longitudinal development of those who have late-onset autism: those who, as far as we can tell, have relatively normal development and then lose not only linguistic skills but social and play skills. Some of these children can - perhaps two, three or four years later - recover some of their speech and go beyond the level they had reached before it started to disappear. We do not really know whether these groups have a distinct prognosis, but I do know that some who lose their speech may achieve speech later on and move into the description of Asperger?s syndrome rather than Leo Kanner?s classic autism.

 

 

ADAM FEINSTEIN: In the case of those children who lost their language, some do begin to speak again. I have not seen this question asked before, so here goes. Do any of these individuals ever regain a sufficient level of language to warrant a diagnosis of Asperger?s syndrome? Has this ever happened?

 

 

ADAM FEINSTEIN: On the vexed question of high-functioning autism versus Asperger?s syndrome, which continues to spark heated debate, I may have misinterpreted a part of your talk here in Melbourne yesterday when you said that there was a simple cure for Asperger?s: you just leave the child alone in his room! My experience of meeting people with Asperger?s is that, on the whole, they do tend to want to make friends, and feel a degree of shame, even pain, that they cannot so. Would you agree?

 

 

TONY ATTWOOD: What I meant by my comment on how to solve autism or Asperger?s was that, if you keep the person on his own, with no one to socialise with, to communicate with, you allow the child to do what he wants in his own way. In other words, the symptoms of autism or Asperger?s syndrome are proportional to the number of people present and what they are doing. However, there are those with classic autism who may very much prefer to have a life of solitude, whereas there are others who, either by ability level or character, may choose to try to socialise with others. It is then that they experience such confusion and failure. This concerns me - because the psychological costs for such individuals can be enormous. Parents can be concerned that the isolated child wants metaphorically to build a bridge between themselves and others. But the description is that they crossed that bridge and there was no one there to meet or greet them on the other side. That is when they can become quite dejected, because they want to have friends, they want to be part of a social group. They are aware of their difference, and this can lead to reactions of depression, denial, arrogance, anger - intense emotional responses.

 

 

ADAM FEINSTEIN: In my experience, those with a diagnosis of high-functioning autism do not, on the whole, seem to have that same drive to make friends and so do not feel those intense emotions such as depression or dejection which you mentioned - or is that too simplistic?

 

 

TONY ATTWOOD: One of the things that I notice is that those who were diagnosed with classic autism when they were younger - they had major problems with communication, socialisation and play - progressed to a level where they and others view them as an enormous success. They are now able to achieve things which previously would never have been thought possible. So they are happy by what they compare themselves with. But whose with Asperger?s syndrome who compare themselves with the neurotypical will have more depression and dejection. So quite often, those with classic autism who have progressed to high-functioning autism and success are happier, and people will see them as a success.

 

 

ADAM FEINSTEIN: But you are well-known for stating that there is no really valid distinction between high-functioning autism and Asperger?s syndrome, aren?t you?

 

 

TONY ATTWOOD: My view is that, if we are not careful, we are going to have an ?autistic? view of autism. We are going to over-focus on the tiny details and miss the big picture. We are almost having an immediate look for differences, rather than similarities. I think that, at the clinical, behavioural level, and from what parents say, they are more the same than different. There may well be academic studies which suggest that there could be differences between the two groups on some aspects. However, I think that this is more of academic than practical interest, because when it comes to socialising, communicating, community integration, etc, there are more similarities than differences.

 

 

ADAM FEINSTEIN: So you would disagree that those with high-functioning autism are less driven to make friends than those with Asperger?s syndrome?

 

 

TONY ATTWOOD: I think that, when we are looking at drive for friendship in high-functioning autism and Asperger?s, it also depends on the individual?s personality. Some with very limited skills are desperate to relate to others. While others who have remarkable communication and social skills choose isolation, by their character. So we must look at the personality, as much as the diagnostic expression.

 

 

ADAM FEINSTEIN: Do you agree with Dr Rita Jordan when she said here in Melbourne this morning that there was a danger that, in our recognition of high-functioning groups with autism, we tended to ignore the autism among those with profound learning difficulties?

 

 

TONY ATTWOOD: What happens is that there is always a vogue or trend in autism. In various years, there has been a sudden exploration of the ?new biology,? as we moved away from the psychogenic model. Then we became entranced with the language model. Then we developed the social and cognitive Theory of Mind areas. Our newest area of exploration is Asperger?s syndrome. But we must not lose sight of the whole spectrum or continuum, and relatively neglect those who are more challenged by their autism - perhaps with fewer coping mechanisms. What I am hoping is that our knowledge of people with Asperger?s syndrome - because we can talk to them about their feelings and experience more eloquently - can then be of practical use to those who are less able to communicate. So I think it is worthwhile exploring that upper end of the autistic spectrum in order to be able to develop strategies for those who have greater problems.

[Malika]

Hi Carole,

 

You may be right but what now comes more and more apparent to me is that there are too many "experts" talk about ASD AS HFA but not enough action, don't take me wrong it is good to make talk and publication but I think sometimes it is better to keep it more practical and from a realistic point of view the fact that AS and HFA are similar 100% or not is just a way to refine a label while all ASD or AS people are different,and they need support and recognition to help them cope in this society.

This is why I found your paper for the awarness conference much more essential and realistic, which is I think the right way to bring awarness to many people politicien or teachers.

I just wish that all those talk by the "experts" as nice as they can be will help bring and find solutions for the one concern who have to cope with the every day challenge of having ASD or AS in this super functionning and communicative (but not necessarely civilised) society.

 

I do like Tony Atwood but may be he should stop analysing so much now. If you see what I mean.

 

How is Mattew by the way?

 

Take care.

 

Malika.

[Malika]

 

Just notice this last bit that is not quite right don't people with AS or "HFA" do not deserve attention and get help or should they just be use to help others who are "more impaired" but when those have made progress what is going to happen then....

 

So I think it is worthwhile exploring that upper end of the autistic spectrum in order to be able to develop strategies for those who have greater problems

 

I understand what you mean now I would call it the "syndrome of mildness"

 

Malika.

[baddad]

Hi Carole -

 

thanks - really interesting interview...

I semi - agree with you about TA 'shifting' the goalposts, but one other thing that bothers me about him recently is that he seems to have started believing his own hype. I have no doubt whatsoever that he has for more knowledge and observational experience than most in his field, and that his intrepretation of what he sees is very incisive. For all of that, though, they're an observer's interpretation, and he's just as capable as anyone of (uncosciously) reviewing that information in a way that confirms his theories rather than viewing them in isolation. It may not be very authoritative, but I'd like to see him offering more 'alternative interpretations' for the observations he makes - I'd just find it reassuring! One thing we can say generally about medical experts throughout the ages is that subsequent research will almost invariably prove they were wrong!!

 

Sorry - pushed for time, so this post may not make much sense!

L&P

BD

[Zemanski]

I mentioned the problem with diagnostic criteria being ignored in an earlier thread

 

People like Tony Attwood who believe that a person can progress from kanners autism to AS and even to 'residual AS' have encouraged clinicians to change diagnoses and they have done this for very good reasons; first it emphasises that the conditions are all autism with different presentations, secondly it allows progress to be marked and celebrated - it is an esteem-boosting thing for a person to be told they have made so much progress that they no longer fit the 'bottom' of the spectrum but are climbing their way to the 'top'. The problem which I think Attwood didn't recognise when he began to promote this is the way it would be used to undermine a person's right to appropriate resources, just as Lorna Wing failed to realise that the idea of a spectrum could be corrupted to make people think of people being placed at the top or bottom (a spectrum doesn't, in fact, have a top or bottom).

 

http://www.asd-forum.org.uk/forum/index.ph...wtopic=6630&hl=

 

I think Attwood is good and I think a lot of what he says is relevant but on this I have to say he was too short-sighted to see the implications of what he was suggesting.

 

Diagnostic criteria need to be clear and need to be respected (already confusing within ASCs) - if there is a problem with the criteria then they need to be queried and adjusted by a community of specialists who all know what they are talking about, not just ignored because one specialist thinks he knows best (I agree with BD, he is a bit full of his own hype).

 

Zemanski

[oracle]

Pleased that it's not just me then who thinks that the spin has finally spun around the doctor

 

Baddad you state your case clearly - and I agree with you. It is easy to slip into a mindset and then stick with it becoming blind to other alternatives.

 

Zemanski - agree with you 100% when you posted in the other thread.

 

It does worry me because Mr Attwood does not appear to be the leading authority on AS. I have never thought that it was a good idea for someone to hold 100% of anything.

 

Carole

[Zemanski]

TA is one of the lecturers (by video) on my course and although I enjoyed listening to him I must admit to finding some of what he says just a little trite and a bit quaint

 

I still haven't come across another starter book on AS that is better but I'm not sure he's really moved on from there in any real sense in the last few years.

 

Z

[DaisyProudfoot]

I read the interview with interest.

 

As I've only come into the world of AS recently - well the diagnosis anyway - the AS has been there all the time - I am only just beginning to read what the experts say.

 

I do respect Tony Attwood's views but I find the whole AS thing very confusing so what I read in that interview won't be the same as what you more experienced folk read (if you get my drift).

 

In science goalposts will always be shifted, if they didn't we would never progress, and experts often find what once they preached as gospel won't always be the case, such turnarounds can be seen all the time, take Baroness Warnock for instance - major goalpost move there.

 

At the end of the day I think Mr Attwood is right we can learn a lot about the more severe end of the spectrum from those more verbally competent like AS folks. But what the experts must not do is forget that AS people have their own difficulties and these must also be addressed.

 

That may sound like complete cobblers people, but it's how I think.

[oracle]

I have a huge respect for Tong Attwood and I have not read many books, if any, that help a parent to understand AS as well as he does. However it is the 'severity' end if the argument and the spectrum that does worry me. And I think that people like Tony Attwood have a responsibility to underline the fact that AS can be a very severe condition for many who have it.

 

At the risk of being highly controversial I think that it needs to be remembered that the suicide rate amongst males with AS is very high. To the point that our Out Reach Team have even take this on board and pointed this out to Senco's attending a meeting looking at provision for 11 plus children in our Authority. If the suicide rate is high, and it is, then that would not point to a condition that is not severe in my opinion.

And that is why I worry about the mixed message that is given about AS. You can't have your cake and eat it. Living with AS is a world way from observing it.

 

Carole

[Zemanski]

That was really Lorna Wing's fault for coming up with the idea of a spectrum in the first place which Tony Attwood is just following through - she now regrets the way the idea of a spectrum has been used to define level need as well as presentation, it was never meant to do that.

 

Tony Attwood doesn't really think it is not a serious disability but the way he talks does make it seem that way, he almost seems to be saying that you can grow out of autism which we all know is tripe, what he should be saying is that you can make progress in your development to the point that you can cope well with the disability and enjoy a fulfilling and successful life, the disability remains the same but the presentation changes as a person learns to deal with it.

 

perhaps?

 

Zemanski

[Flora]

you can make progress in your development to the point that you can cope well with the disability and enjoy a fulfilling and successful life, the disability remains the same but the presentation changes as a person learns to deal with it.

 

perhaps?

 

Zemanski

 

I agree with you Zemanski, he should have also further added that in order to achieve that level of progress, to learn to deal with the disability etc, then a person needs an appropriate education, level of support and intervention throughour their formative years and, where necessary, throughout their lives.

 

Lauren

[Zemanski]

perhaps we should write his next book for him?

 

Z

[call me jaded]

I think the goalposts *have* to keep shifting. Otherwise we'd be trying to fit new knowledge into a static position.

 

Having said that I have never read any Tony Attwood, ever, so have no opinion on him

[Zemanski]

I think the goal posts need to shift too but Attwood has become a bit of a one man show and the influence hasn't been as positive as it might have been because of the way it has been done/phrased.

 

I know that if I went to someone like Digby Tantum or Rita Jordan I would be unlikely to get a diagnosis of AS but if I went to someone who followed Attwood (can't think of anyone off-hand) I might well get a diagnosis of at least residual AS - I'm not sure I like that.

It's not so much about whether or not the goal posts should shift but more about being certain that there are actually some goal posts to aim at.

 

Zemanski

[Tilly]

Sorry but I've never heard of Tony Attwood before I joined this forum.

Can anyone recommend any of his books - nothing too heavy or I'll be back on the Seroxat

 

Tilly

[Flora]

Tilly, he has his own website... think it's tony attwood .com.

 

Hope this helps.

 

Lauren

[Zemanski]

http://www.tonyattwood.com.au/

 

Z

[Malika]

Hi to all, <'>

 

Zemanski I have just read both thread where you clarify so well As and ASD dx as well as T Atwood point of view,I think if specialist want to stick to the original description of AS from Hans Asperger then somebody with autism with speech delay or non verbal cannot fit the criteria as this was present in the first place and cannot be change.

 

Kanner autism use to be connected with children who are not verbal, Now my son who had speech delay and still has some confusion of pronoums or time was DX with Atypical autism which should be an atypical presentation of Kanner autism but now his speech has improved enomously he is more likely to present himself like an AS child but stricktly speaking will never be except if his developmental history could be deleted, this just prove that all those DXs are autism and may the use of Asperger autism would be the most appropriate for fluent children, then a child could go from typical or kanner autism to atypical autism then reclassified with "Asperger autism" just to give the indication that the speech has developed to become fluent, but this should not be taken as a pretext from various authority to widraw all help and support.

But as far as I am concern they do not need pretext anymore they just do it anyway.............

 

Malika.

[curra]

I agree with you Zemanski, he should have also further added that in order to achieve that level of progress, to learn to deal with the disability etc, then a person needs an appropriate education, level of support and intervention throughour their formative years and, where necessary, throughout their lives.

 

Lauren

 

Lauren,

 

I agree entirely with you!

 

Curra

[Suze]

I,m not sure quite what to comment here, but I have always respected TA his knowledge and work.I went to a day presentation by him last year, he spoke in great depth about the struggles AS children have , with depression, bullying, and socialising.He did,nt make AS sound mild to me.He also spoke quite movingly about his wifes sister who has autism , his family lives with it aswell.He has done much more for AS in a positive way than a negative way.

[Zemanski]

He's still very good, loads better than Rita Jordan and Simon B-C in my book, and I do like his more positive stance, but nobody's perfect and some of the things he has proposed have been used by others to distort how AS is seen - specifically that you can 'grow out of it'

 

People with influence like Attwood need to be very careful, I think he has become just a bit too complacent perhaps?

 

Zemanski

[oracle]

He's still very good, loads better than Rita Jordan and Simon B-C in my book, and I do like his more positive stance, but nobody's perfect and some of the things he has proposed have been used by others to distort how AS is seen - specifically that you can 'grow out of it'

 

OMG Did he really say that? Sorry but if he did and I accept that he did then he just lost my respect - not that that will bother him too much I expect. I have a friend who has met Mr Attwood many many times now as one professional to another. She also 'had' a huge respect for him until she last met with him in Australia a couple of years ago and she rang me very upset saying that she had not seen a guy so consumed with himself and his own opinions.

 

AS is for life not just for childhood and maybe we should use that as a slogan © There's my copy right Sorry I know that it's not a laughing matter.

 

We need clarification here. The goal posts may well be shifting but the criteria has not - so what's happening?

 

Carole

[Zemanski]

SORRY - no he didn't say that - just implies it with his emphasis on being able to develop through to 'residual AS'; I mean; what does that mean?

 

Z

[Kathryn]

Hi everyone,

 

moderator hat on

 

This is a really interesting thread but I think the discussion of Tony Attwood is beginning to get a bit personal. Can I please ask everyone to confine their critical comments to the views expressed by him.

 

thanks

 

Kathryn

Edited March 1, 2006 by Kathryn

[curra]

TONY ATTWOOD: I think that, at the clinical, behavioural level, and from what parents say, they are more the same than different. There may well be academic studies which suggest that there could be differences between the two groups on some aspects. However, I think that this is more of academic than practical interest, because when it comes to socialising, communicating, community integration, etc, there are more similarities than differences.

 

... But we must not lose sight of the whole spectrum or continuum, and relatively neglect those who are more challenged by their autism - perhaps with fewer coping mechanisms. What I am hoping is that our knowledge of people with Asperger?s syndrome - because we can talk to them about their feelings and experience more eloquently - can then be of practical use to those who are less able to communicate. So I think it is worthwhile exploring that upper end of the autistic spectrum in order to be able to develop strategies for those who have greater problems.

 

In my view Attwood is vague and to a certain extent he contradicts himself. I've read a book by him and found it good, but I would expect more concrete terms from a world expert in Aspergers.

 

Curra

[researchboffin]

I like Tony Attwood. He sees people as people of all shapes and sizes not conditions of all shapes and sizes.

I am fed up with people describing differences as disorders. I am fed up with mild v severe. i am fed up with Asperger's study of 22 people being treated as a valid exercise at all. I am fed up with people saying people with ASDs have no empathy. I am fed up with patronising medics, social workers, care workers, nurses, housing peopleeducational people. (Not all are that of course.)

People are people and should be valued for what they are, not devalued by pejorative labels. That was what I agreed with about Tony Attwood. Also, I have found it profoundly more helpful reading the writings of ASDsand talking to ASDs than the kind of mumbo jumbo that is put out about ASDs by people who frankly do not know what they are talking about.

It is not helped by the media who talk about it as a behavioural disorder, and play up cases about people with ASDs that may well not be ASDs at all.

The bridge metaphor is brilliant but not maybe a good idea for a group of people who find grasping the concept of metaphors difficult?

If only there were a few more Attwoods for the UK lucky Oz I reckon.

[Malika]

Hi to all. <'>

I had many thought about how to avoid a label of behaviour disorder (which is very dangerous as it throw us back to 30 years ago when the fault was given to bad mothers and bad parenting) the only way is to go back to scientific research and find out about "biological differences" at the root of the problems I know that some people may not agree with that but I can see that when there is a know scientific cause for a condition people do not dare then to push certain arguments through, today nobody would dare to argue that Down syndrome is due to family up bringing one reason is the evident physical differences the second is the finding of the genetic difference.

 

As for Tony Atwood he certainly did a lot toward recognition and awarness of AS and ASD but may be he should take a stand by for a while and reflect about what really people with AS can learn to improve the way they function and cope with their disability. What I have notice is that people who have set up care centre in some way can sometimes become too comercial and lose the insight about a real impact a form of treatment can have on the people concerned and the fact that it may not work for all.

 

Malika