Contents

Title
Disclaimer
Quote
Introduction
What Is Asperger's
What Causes Asperger's?
Do You Have Asperger's?
Treatment of Adult Asperger's
Living with Asperger's
Conclusion
Resources for Adults with Asperger's
Bibliography
References
About the Author

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ADULT ASPERGER’S SYNDROME:
THE ESSENTIAL GUIDE

By

Kenneth Roberson, Ph.D.

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 Author’s Note: Nothing in this book implies that the author is
rendering professional advice or services to the individual reader.
The ideas, procedures and suggestions contained in this book are
not intended as a substitute for consulting with your physician or
mental health professional. All matters regarding your health
require medical supervision. The author shall not be liable or
responsible for any loss or damage allegedly arising from any
information or suggestion in this book.
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Only the educated are free.

- Epictetus
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 INTRODUCTION

You’ve heard the word, “Asperger’s.” Perhaps it was from a friend or

family member, through an Internet search, on social media, or a newspaper
article. Regardless of where you heard about Asperger’s, no doubt you’re
not entirely sure what it means. And most likely you have questions, such
as:

What is Asperger’s?

What causes Asperger’s?

Can someone who has Asperger’s be in an intimate relationship?

Does one have to have all the features of Asperger’s in order to be

diagnosed with it?
Should I tell friends and family that I have Asperger’s? If so, how?

Can I be happy and enjoy life if I have Asperger’s?

If I have Asperger’s or know someone who does, where can I go for

help?

Questions like these matter. The friend, relative or spouse of someone

with Asperger’s, the researcher examining the causes of Asperger’s, a
professional in the field of Asperger’s treatment, the administrator of a
community-based support program, and individuals with Aspergers’s
themselves depend upon answers to their questions to solve the important
problems they face. Questions lead to solutions. It is solutions to the
challenges of Asperger’s that we all seek.
In the last ten years, the availability of information about Asperger’s in
adults has increased dramatically. Ongoing research has opened up new
vistas surrounding the origins of Asperger’s. Personal accounts of adults
with Asperger’s bring a humanizing perspective on this condition, making it
less mysterious and more understandable. Conferences, workshops,
continuing education opportunities and many other programs and activities
help professionals design and implement advances in the treatment of
Asperger’s. Peer support groups, blogs, online newsletters, and other ways
of disseminating information bring people together in new and exciting
endeavors, creating an explosion of opportunities to help and support those
concerned about Asperger’s.
This book is about questions, specifically questions regarding
Asperger’s in adults, what it looks like, what causes it, how it is diagnosed
and treated, and how to cope with the challenges of Asperger’s in
adulthood. If you want to know about adult Asperger’s, regardless of your
interests or your concerns, this book is for you.

Why This Book?

My primary aim in writing this book is to describe and explain adult

Asperger’s as clearly as possible, using language that clarifies rather than
obscures, without sacrificing the details that are necessary to understand
this complex phenomenon. I hope this clarification will answer your
questions, allow you to be knowledgeable about Asperger’s, and to provide
support and resources.

It’s no coincidence that you’ve heard about Asperger’s. Currently, about

3.5 million people in the United States are said to have Asperger’s or an
Asperger-like condition. And the number keeps growing, at a rate of 6-15%
each year ( Autism Society, 2015).

Given these statistics and the rapid increase in the diagnosis of

Asperger’s, it is no surprise to find a corresponding rise in the number of
books, articles, videos and other sources of descriptions about Asperger’s as
well as explanations of how to manage the difficulties that it poses for those
affected by Asperger’s.
 Why then another book? Two reasons led me to consider adding another
volume to the sagging shelves of material on Asperger’s. One, when I
looked at the books and articles written by professionals, I found them to be
written in dry, technical language aimed more for fellow professionals than
the average reader.

Take, for example, how the Diagnostic and Statistical Manual (DSM-5),
the preeminent classification of mental disorders, describes one feature of
Autism Spectrum Disorder, of which Asperger’s syndrome is considered a
part:
Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total
lack of facial expressions and nonverbal communication.

The wording itself is not difficult to understand but how easy is it to

apply this description to someone’s actual behaviors? Is it clear what
“deficits in nonverbal communicative behaviors used for social interaction”
look like or how someone with this feature would actually behave? What
about “abnormalities in eye contact and body language?” How would you
know if the abnormalities someone is having in the way they carry
themselves and look at others is because they have Asperger’s?
Admittedly, the DSM is intended to be used by professionals trained in
identifying and diagnosing behavioral problems, but I have seen this
description duplicated word for word in print and on the Internet. I am an
expert in Asperger’s yet I know other experts who have slightly different
impressions of what the above description means, not to mention what the
entire definition of Asperger’s means. If we see Asperger’s differently how
can non-professionals, especially those with little or no familiarity with
Asperger’s, be in a position to answer their questions about this condition?

The second reason for writing this book is that very little has been
written about adults with Asperger’s relative to what is available on
Asperger’s in children. There are numerous reasons for this shortage of
information, the main one being that it is easier in most cases to identify
Asperger’s in children. Children with recognizable differences stand out to
parents, family members and teachers in comparison to the typical child.
Adults, on the other hand, tend to develop behaviors and coping
mechanisms that compensate for their differences so that they don’t stand
out as much. It becomes harder, then, to see as clearly with adults what
exactly is the nature of the difficulties they have.

I believe much more information should be available to adults about

Asperger’s, and if this was the case, many more adults with Asperger’s and
those who care about them could access the support, resources and help
they might need. I hope this book contributes to this aim.
One additional consideration. I do not have Asperger’s. I am a clinical
psychologist who has specialized in Asperger’s for many years. My
perspective is that of someone who has studied Asperger’s, read and written
about it, and who has worked with many adults who have Asperger’s. It is a
certain perspective, with it’s own strengths and limitations, just as is the
case that someone with Asperger’s has their own point of view. My view of
Asperger’s as a neurotypical, non-Aspie, is no better or no worse than the
view of an adult with Asperger’s. I can only trust that what I have to offer is
useful to those who read this book.

What You Can Expect From This Book

In this book you will learn what Asperger’s looks like in adults, the
behaviors that are characteristic of Asperger’s and are necessary for a
diagnosis of Asperger’s, what we currently know about the causes of
Asperger’s, how to determine if you have Asperger’s, the challenges of
being an adult with Asperger’s, and how to be successful in life while living
with Asperger’s.
After reading this book you may want to find out more about specific
aspects of Asperger’s, or reach out to others for support, help and guidance.
For these reasons, at the end of the book I have listed many different
resources and tools for you to use in whatever way you wish.
 My hope and expectation are that you become an expert in your own
right about Asperger’s after reading this book. By expert, I mean you will
know most of what is essential to understanding this condition and be in a
position to help yourself or others get the help needed to address the
challenges of Asperger’s.

What Not to Expect From This Book

Although I talk about how adults with Asperger’s can change their
behavior, there is no guarantee that a reader will change as a result of
reading this book, or any publication for that matter.
As a book, this one is admittedly incomplete. Much more information
on current research into the causes of Asperger’s, how it differs in men and
women, matters of sexuality, employment considerations and features of the
treatment process, to name a few could have been included. Would it have
helped to have included those details? Perhaps, but one could argue that
brevity is more conducive to holding the reader’s attention. Also, in
resisting the temptation to be all-inclusive more questions are raised than
necessarily answered, and in the spirit of this book that might be a good
thing. I will let you, the reader, be the judge of this.

A Helpful Feature
As you read through this book you may find yourself, from time to time,
with a question about Asperger’s that is not answered in what I have
written. Because I want you to be as knowledgeable as possible, I have
included a feature at the end of every chapter allowing you to email me
whatever question you have. I will attempt to answer it to the best of my
ability, and if I don’t know the answer I will refer you to someone, or to
some other resource, who does.

The subject of Asperger’s is important to you. That’s why you chose

this book, and I want you to feel as though you got what you were looking
for after reading it. I urge you to take advantage of this feature and contact
me with whatever questions or comments you have so that you, too, will
become an expert on Asperger’s.

A Final Clarification
In 2013, the word “Asperger’s” disappeared from the DSM and, hence,
from the official vocabulary of mental conditions. Until that date,
Asperger’s was considered related to autism yet distinct from it. After
considerable debate, experts in both autism and Asperger’s discarded this
difference and created a new classification called Autism Spectrum
Disorder (ASD). In effect, Asperger’s is now viewed as a less severe form
of autism.

With the elimination of Asperger’s Syndrome as a separate, unique

condition the tide has slowly, but steadily, turned away from use of that
phrase in professional circles towards an embrace of Autism Spectrum
Disorder as the sanctioned term for the same collection of signs and
symptoms. This change, however, is not complete, and I have elected to use
the more commonly known phrase “Asperger’s Syndrome” (at times,
simply Asperger’s) because of its familiarity and acceptance among the
general public. To be clear, my use of Asperger’s implies the same,
identical overlap between the two conditions that is now accepted within
professional circles.

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 WHAT IS ASPERGER’S SYNDROME?

In 1944, a Viennese pediatrician named Hans Asperger published a paper

describing his observations of four boys who behaved in ways that were
uniquely unusual. For one thing, they paid attention only to things that were
of interest to themselves and cared little about what was important to those
around them. It was not a matter of their being self-centered so much as
they couldn’t understand how other people thought and felt. Their
interactions were driven by what they wanted to do or say without regard
for the impact this had on others. Not surprisingly, these boys were viewed
as self-centered and odd. They were marginalized by their peers and hence
had very few friends.
They also spoke in unusual ways. Their speech varied little in tone and
inflection, almost in a robotic way. If for example, one of them was excited
about a particular event he had witnessed or a discovery he had made, the
enthusiasm he felt was missing from the context of his speech.

The boys also had very narrow, highly specific interests that they were
intensely absorbed in and spent most of their time pursuing. Whether other
children their ages found these interests engaging mattered little to them.
Finally, these boys lacked good sense and sound judgement in practical
matters. They were disorganized and inattentive to much of their
surroundings. Certain sounds, smells, foods and clothing bothered them, to
which they reacted in intense and exaggerated ways. They tended, as well,
to be physically clumsy and awkward.

Dr. Asperger believed these characteristics were interconnected,

pointing to a common origin that had not previously been identified. He
continued to study children with similar peculiarities but it wasn’t until
1981 that his ideas were taken seriously, the condition verified and his name
given to this syndrome.
The Main Problem of Asperger’s Syndrome
The complexity of Asperger’s can be distilled down to one main idea –
trouble understanding what goes on in other people’s minds.
Early in life, children begin to learn what the facial expressions and
behavior of others mean. Infants, for example, will scan their mother’s face
for clues as to whether she is happy or distressed, if she’s approaching to
feed them or cuddle them, or whether something in her expression signals
trouble. Once they are able to reliably interpret facial expressions and
gestures, infants and toddlers begin to use this nonverbal information to
guide their own behavior.

Children, and adults, with Asperger’s cannot reliably and accurately

identify and understand the thoughts, feelings and intentions of others. They
misunderstand how the behavior of others, the expressions on a person’s
face, the tone of someone’s voice, and other nonverbal expressions,
communicate what they are thinking, feeling and planning to do.
As a result, people with Asperger’s:

Are not very good at identifying emotions, both in themselves and

others. Sadness, for example, might seem like confusion to them or
thoughtfulness may appear to be anger. This misidentification of what
someone is feeling creates the appearance of a lack of sensitivity and
empathy. The person with Asperger’s conveys the impression of being
someone who is completely out of tune with what is going on.
Have trouble inferring the intentions of others. If you misread what
people are feeling, it follows that you don’t have a good idea of why
they are doing what they do at any given moment. Predicting what
they plan to do in the future or how the person will feel if such and
such an event happens is similarly difficult. The resulting impression
of social ineptitude is a frequent outcome of interacting with someone
who has Asperger’s.
Cannot explain their own behavior very well since they are not good at
understanding the meaning of behavior. The topic of conversations
 with someone who has Asperger’s tends to be directed towards facts
and information, like the engineering principles involved in stock car
engines, rather than what it might have felt like to have won the
Daytona 500 or what it was like as a spectator to have witnessed a-
down-to-the-wire finish.

Mr. A, a 35-year-old married man, is concerned about losing his job

in advertising sales. A ten-year employee of his company, he was
promoted to his present position having gained a reputation as
detail oriented, organized, comfortable with repetitive tasks and
able to digest large quantities of complex information. Now,
complaints have arisen from several clients who find him to be
almost clueless about what advertising needs they have, even after
numerous explanations. Rather than accepting what his clients say,
he argues with them repeatedly, claiming they shouldn’t want to do
this project, have those goals or expect the results they are aiming
for. He brushes aside their concerns about his style, seemingly
oblivious to how off-putting it is. The latest complaint followed a
meeting where Mr. A spent the majority of the time reminiscing
about a recent visit to Wall Street while ignoring the meeting
agenda.

The Difficulty of Communication

Because people with Asperger’s have trouble understanding what others
think and feel, and are similarly uncertain of what they think and feel, their
communication is peculiar, making them difficult to comprehend and
converse with. The actual words they use is not the cause for this problem,
however. Their grammar, vocabulary and pronunciation are perfectly
normal. The problem is in how they use language.
Back and Forth Conversation

Back-and-forth conversation is difficult for people with Asperger’s. They

tend to talk “at” people rather than “with” them. They will deliver a
monologue to their listener, usually about their favorite topic, even when
it’s quite evident that the listener is bored or disinterested in the topic. They
frequently turn the conversation back to what they want to talk about,
oblivious to the listener’s wish to have input. They don’t think to ask
questions, pause to give the other person a chance to speak or in some other
way invite a response. They tend to say things without considering the
emotional impact on the listener.

Topic Changes
Conversations often have abrupt shifts in topics. Here is an imaginary
exchange between three people:

Person #1: “Did you notice that the Federal Reserve is considering
an interest rate hike soon?”
Person #2: “I wonder what effect that would have on the stock
market.”

Person #3: “I read an interesting book the other day. You both
might like it.”

The word “interest” triggered in Person #3 the recollection of an

interesting book but it was not the same kind of interest as the other two had
in mind. His struggle to grasp the meaning of interest and his desire to
relate what he heard to his own experience led to an abrupt, out-of-left-field
topic change.
Nonverbal Communication

The meaning of a word can vary considerably from one instance to another,
and this meaning is communicated by how the word is used. Facial
expressions, vocal tone, body language, eye contact and gestures are typical
means of conveying meaning. A statement delivered with a frown, as we
know, means something very different than one delivered with a smile.

People with Asperger’s Syndrome have a hard time reading the meaning
of other people’s body language, facial expressions and tone of voice.
Because they don’t fully understand how gestures and non-verbal language
are used to convey meaning, many times they misunderstand what is being
communicated. In turn, their own responses to whomever they are talking
with miss the point. The voice of adults with Asperger’s often appears odd.
It tends to be flat and monotonous, not varying in pitch or tone. They may
have strange rhythms or ways of pronouncing words.

Because of this communicative style, people conversing with someone

who has Asperger’s typically try repeatedly to get across their message.
They will grasp for different words and expressions, experiment with
different gestures, rework the topic and, when all else fails, resort to
throwing up their hands in frustration and giving up. At the heart of this
conversational problem is a mismatch between what is being said, verbally
or non-verbally, and what is being heard by the person with Asperger’s.

Coherence

Because they are not good at looking at things from the listener’s point of
view and considering what type of information would help explain a point,
their conversations often are disjointed and lack logical or meaningful
connections. They tend to ramble on, go off on tangents, or not focus on
any particular point. What drives the way they talk is what they are focused
on, what they are interested in rather than what holds the attention of
whoever they are conversing with. In one-on-one conversations and in
groups, they stand out as disorganized, jumbled and confused due to the
mismatch between what they want to say and the topic at hand.

A frequent reaction of someone conversing with an adult who has

Asperger’s is to experience the person as thinking out loud to themselves,
rather than trying to have a mutual conversation. Whatever comes to mind
is said out loud. This lends itself to the impression of self-centeredness.
Asperger’s and narcissism are sometimes thought of as one and the same.

Annamarie (speaking to a friend): “Sometimes when I go to work,

my sister likes cooking meatloaf whenever the election results are
not as accurate as we think because facts don’t always appear as
you expect them to be. In the springtime, I’ve noticed how birds are
less energetic even though times have changed. What’s not to like
 about that, about how things fit together sometimes when you least
expect them to.”

Intellectualization

Because adults with Asperger’s tend to focus on knowledge apart from how
it connects with personal experiences, they acquire facts and information
without understanding how those facts can be applied to real-world
situations. They focus on details, often missing the overall, larger picture,
and they apply the same level of detail to every situation, whether
appropriate or not. Their style of speaking is stiff and formal, overly
focused on minute details and formal arguments.

It is also the case that people with Asperger’s tend not to initiate or
sustain conversations with others. They don’t see the point of superficial
social contact, niceties or passing time with others. Communication is not a
means to understand or be understood as much as it is a vehicle to acquire
or disseminate information. Absent the need for information, conversing
with someone is not a high priority.

Upon learning of his diagnosis of leukemia, John immediately sat

down and learned everything he could about the disease.
Afterwards, whenever he was asked about his condition and how he
was handling it, he would launch into long recitations about the
science of leukemia, treatment options, latest research and
epidemiological studies, never once commenting on his emotional
state and the impact of the disease on his personal life.

Literal, Rigid Thinking

People with Asperger’s can be very literal and concrete in their thinking.
On a hot day, saying to them “your face is as red as a beet” might elicit a
confused reaction as they wonder how a face could be like a vegetable.
Similarly, to scold someone with Asperger’s by saying, “you’re in the
doghouse” is likely to surprise that person who knows they are in their own
house not in one for dogs. Asked why, “those who live in glass houses
shouldn’t throw stones,” might generate the response, “because they would
break the glass.”

There are few grey areas for someone with Asperger’s. Instead, life is
black and white. Why experiment with doing things more efficiently when
the way it’s always been done has worked? That one way is the “right”
way. If getting up in the morning and showering before breakfast is the
routine you’ve always had, eating first would make no sense, and in fact be
a significant disruption. It is often the case that deviating from instructions,
adjusting to unusual circumstances, or trying new ways of approaching a
problem is rejected by someone with Asperger’s.

The neurological vulnerabilities of someone with Asperger’s make them

especially sensitive to ambiguity and unpredictability, which are typically
overwhelming. Their counter-reaction is to seek orderliness, certainty and
uniformity. To do that they focus on facts in the present moment, they take
ideas and words exactly at their most usual and basic sense, and they avoid
figurative or metaphorical thinking. The world of Asperger’s is an orderly
one. Facts, rather than presumptions, are a priority. Doubt, uncertainty, and
vagueness are avoided. Literal speech, focusing on things exactly as they
are while leaving out figurative explanations and assumptions, is a hallmark
of Asperger’s.

Unusual Interests and Routines

The tendency for rigid, concrete, inflexible thinking in adults with

Asperger’s translates to similar ways of behaving, specifically in adopting
repetitive routines and interests.

Any activity may be turned into a routine. Taking the same walk every
day, along the same route, in the same amount of time is a mundane activity
that lends itself to being molded into a routine. Elaborate bedtime rituals,
wearing the same clothes on certain days, eating foods with certain
combinations of colors, listening to the same music a certain number of
days each week, and a host of other unvarying patterns are common
features of Asperger’s.
 There is an inflexible sameness, with no apparent purpose, to these
routines. Unlike obsessive-compulsive routines, they are not experienced as
invasive or annoying. Instead, the adult with Asperger’s enjoys these
routines and has little interest in stopping them. Also, unlike obsessive-
compulsive habits, the routines are not intended to reduce anxiety. The adult
just appears to enjoy life as she or he has arranged it.

Adults with Aspergers may become attached to certain objects and

refuse to give them up. These may be ordinary items like a favorite pillow,
article of clothing or stamps from a particular country, but often they are
oddities such as pieces of string, used envelopes, empty plastic bottles, or
certain shaped buttons.

Not just objects but certain subjects can be the focus of the
preoccupation. Weather in far off countries, unique properties of
astronomy, certain types of science fiction, camera models, car
specifications, or numerical calculations can be intensely interesting to
someone with Asperger’s. Most often what is of particular interest is
collecting, memorizing and talking about the subject, and usually the person
is fascinated by the mechanical and repetitive characteristics of the subject.
The aim is to accumulate facts about the subject, not necessarily understand
its importance or significance.

To an outside observer this accumulation of objects and facts about

things, together with routines and fixed patterns, has no rational purpose.
But a closer look reveals something different. What the person with
Asperger’s is trying to do is create order out of chaos. Objects are put into
their proper place in relation to each other. Ideas and information are
arranged so that they have a proper function and work together as a whole
unit. Orderly procedures are imposed on whatever is collected and
accumulated. All this serves to insulate the person from his or her own
fears, tensions and anxieties and make a world of change, inconsistency,
uncertainty and ambiguity tolerable.

From the age of three, Susan has been intensely interested in things.
After learning to read, she developed a passion for the My Little
Pony series, memorizing each book to the point where she could
 recite them out loud without missing any word. The same occurred
after watching Barbie movies over and over and the musical,
Chicago. During adolescence, she became fascinated by hypnosis
and memetic engineering, along with an intense passion for World
of Warcraft. In college, she studied ancient languages, including
Cuneiform and Sanskrit, devoting herself to identifying the cultural
and symbolic connections between the two. Currently, she spends as
much time as possible making candles and compiling a complete
genealogical history of the Daughters of the Revolution.

The Asperger’s Puzzle

Like a puzzle, Asperger’s is a collection of pieces. Not everyone who has
Asperger’s talks the same, thinks and feels the same, acts the same or has
the same features. One person may have fewer and less rigid routines, may
be more aware of emotions, may understand nonverbal communication and
converse more directly, with fewer tangents, than another person with
Asperger’s. One piece of the Asperger’s puzzle may be present for one
person whereas someone else may have all the pieces. What does not vary,
however, if they are considered to have Asperger’s, is lacking
understanding that other people have their own plans, thoughts and points
of view and the consequent difficulty recognizing other people’s beliefs,
attitudes and emotions.

I have found that people assume Asperger’s is the same in everyone,

and when they read or hear a description of Asperger’s, particularly if it is a
list of common features, they imagine everyone with Asperger’s has all the
characteristics on that list. That is not true. The features of Asperger’s vary
as widely as they do in other conditions. However, certain core
characteristics must be present if the person has Asperger’s.

Think of the observable symptoms of Asperger’s as involving three

main problems:
 Social interaction: the person has limited ability to form friendships;
makes little or no eye contact; interacts in a one-sided manner; has
trouble understanding what other people think and feel and has similar
difficulty identifying his/her own emotions, and is a poor predictor of
how other people will behave and react.

Communication difficulties: the person speaks in a mechanical or

monotonous, repetitive way; tends to talk “at” people than “with”
them; has one-sided conversations, goes off on tangents and rambles;
has trouble engaging in superficial conversations or passing the time;
and misses the nuances of jokes and subtle references.

Rigid Routines and Interests: the person has rigid and repetitive
routines and interests that are more intense and excessive than one
would normally expect; change is generally disliked: order and
predictability are preferred, and sameness is favored over variation.

Is Asperger’s in Adults Different from Asperger’s

in Children?
The short answer is, Yes. For one thing, Asperger’s plays a larger role in
adult relationships than it does in children mostly because children are
expected to outgrow relationship difficulties through the help of parents,
teachers and other interested parties. Adults who cannot relate successfully
with others, on the other hand, tend to be marginalized and left alone to
handle their difficulties.

The same is true in the work world, where the effects of Asperger’s are
more pronounced for employed adults or those seeking jobs. The impact of
Asperger’s on organization, planning, flexibility, impulsivity, regulating
feelings, and working memory is different for adults in so far as they are
expected to have overcome these difficulties at that stage of life. Sexuality,
and how it is affected by Asperger’s, is more significant in adulthood.
Adults are also more susceptible, I believe, to associated conditions like
anxiety and depression than children usually are as they become aware of
how Asperger’s affects their life. Parenting, obviously, is an area where
Asperger’s has unique consequences for adults. The same is goes for
marriage.

Although the impact of Asperger’s is different in the lives of adults than

it is in children, the central problem of Asperger’s is the same. Whether in
childhood, adolescence or adulthood, Asperger’s is about difficulty
attributing beliefs, intentions, desires and knowledge to oneself and others
and understanding that others have beliefs, desires, intentions and points of
view different from one’s own.

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 WHAT CAUSES ASPERGER’S?

Experts agree that Asperger’s is a disorder of brain development. Certain

areas of the brain, as it develops before and after birth, do not come
together as they normally would, causing abnormalities in the “wiring” of
the brain and how it works.

Three areas of the brain, in particular, develop differently in people with

Asperger’s: the cerebellum, amygdala, and hippocampus (Bauman &
Kemper, 2006). These areas control the ability to:

understand that other people have their own ideas, feelings and ways
of experiencing the world around them, along with the ability to
empathize with others.

take specific details and integrate them into a whole, to create and
understand the “big picture.”

plan and implement actions, develop solutions to problems, focus

attention and think flexibly.

How is it that these parts of the brain are different in people with
Asperger’s?

Genetics

Why some person develop Asperger’s and others don’t has quite a bit to do
with their genes. Studies show that about 36-95% of the time if one
identical twin has Asperger’s the other twin will as well, even if the twins
were separated early in life and grow up in different settings. In the case of
non-twin siblings who share fewer genes, the chances of two or more
siblings in the same family developing Asperger’s drops dramatically, to
about 1.75% of the time. Non-identical twins, those who share a small
amount of the same genetic material, are slightly more likely to both have
Asperger’s, about 4% of the time.
(http://www.cdc.gov/ncbddd/autism/data.html)

The argument for a genetic basis of Asperger’s is further supported by

studies of family characteristics. Parents of children with Asperger-like
conditions have been found to often be “more aloof, untactful and
unresponsive” than parents of normal children (Piven, Palmer, Jacobi et al,
1994). The same Asperger-like conditions have been shown to occur more
often in families of physicists, engineers and scientists. One study found
that around 12.5% of the fathers and 21% of the grandfathers of children
with Asperger’s were engineers, compared to 5% of the fathers and 2.5% of
the grandfathers of children with other syndromes. (Baron-Cohen, Bolton,
et al, 1998)

Although the evidence for a genetic component is strong, exactly what

role genes play in Asperger’s is not known. It may be that one or more
genes undergo some change that leads to development of Asperger’s. It may
also be that different sets of genes undergo changes or different genes
interact in certain ways to produce this condition. Possibly, certain genes or
sets of genes interact in some way with the person’s environment and set
into motion, either before or after birth, the processes that lead to
Asperger’s.

Unfortunately, while a genetic contribution to the development of

Asperger’s syndrome is widely accepted, this does not mean it can be
detected ahead of time through genetic testing. The reality is that no
specific gene or set of genes has been implicated in Asperger’s, only
general evidence of genetic involvement. Hence, there is no physical test or
procedure that can tell whether someone has or will have Asperger’s. No
prenatal test is available to show if a fetus has Asperger’s or will develop it.
The diagnosis of Asperger’s is made entirely on the basis of the signs and
symptoms one has, not a test of genetic material, the anatomy of the brain
or any other physical features of the person.
Environment

Genes are primarily involved in causing Asperger’s but they are not the
only cause. Evidence for this comes from a startling statistic—in the early
1940’s when Asperger’s was first identified, it was considered a fairly rare
condition, occurring in about 2 per 10,000 children. As recently as 2011, the
rates have risen to as high as 90 per 10,000 individuals, an increase of
600%. Such a huge rise cannot be explained by genetics, simply because if
genes were the cause, or the predominate cause, the number of people with
Asperger’s would remain relatively steady over this period of time.

Why such an enormous increase in so a short time?

One answer is how Asperger’s is diagnosed now compared to how it

was earlier. These days, professionals have access to more comprehensive
standards and newer assessment instruments, making it easier to detect
Asperger’s and more people being diagnosed with the condition. Different
ways of deciding rates of prevalence also probably contribute to the recent
increase. And, greater awareness of Asperger’s these days means more
people are reaching out to professionals to see if they, too, might have this
syndrome.

In addition to these factors, it is possible that changes in lifestyles and

environmental influences over recent decades have triggered an increase in
the diagnosis of Asperger’s. The likely factors are:

Infectious diseases: Some researchers believe that the spread of a virus

or bacteria or some other disease agent is causing an epidemic of
Asperger’s. It has been hypothesized, for example, that a virus is
affecting the mucous membrane lining of many structures of the body,
allowing neurotoxins to enter the bloodstream.
A virus: Since traces of the polyomavirus, a common virus causing
various tumors, have been reported to be found more often in brain
tissue of autistic individuals than normal controls, researchers point to
this as a possible culprit in Asperger’s (LIntas, et al 2010). Their
argument is strengthen by the possibility that the polyomavirus is
transmitted through sperm, thus “explaining” the strong role of
heredity in Asperger’s.

Bacteria: The bacteria, Clostridia, has been found to exist in greater

numbers in children with autism than in normal children (Parracho, H.,
et al, 2005) How this occurs and what relationship Clostridia might
have to Asperger’s has not been determined.

Heavy metal toxicity: Some researchers, and parents, have suggested

that heavy metal poisoning, particularly mercury, is implicated in
Autism Spectrum Disorders (ASD), including Asperger’s. No evidence
exists for a direct role of heavy metals in these conditions but there is
continuing interest in the possibility that individuals with ASD have a
reduced tolerance to heavy metal toxicity and that such toxicity could
amplify the symptoms of ASD.

Vaccines: One theory receiving a great deal of public attention is that

vaccines are to blame for the increase in cases of ASD. Since the
characteristics of ASD often appear around the same age that
vaccinations are typically given, some consider a link between
vaccines and Asperger’s likely. Specifically, it has been argued that
thimerosal, a mercury-based preservative in vaccines is the key
element in causing ASD.

Recent studies, however, have found no connection between

receiving vaccines and developing ASD. Since 2003, there have
 been nine Centers for Disease Control funded or conducted studies
finding no link between thirmerosal-containing vaccines and ASD,
as well as no connection between measles, mumps and rubella
vaccines and ASD.

Furthermore, since 2001, thimerosal has been reduced to trace

amounts in all childhood vaccines except for some flu vaccines as
part of an effort to reduce exposure in children to all types of
mercury.

Parenting: Going back to the 1950s, ASD has been thought to derive
from poor parenting practices. In his 1943 paper identifying the
characteristics of autism, Leo Kanner called attention to what appeared
to him as a lack of warmth among the fathers and mothers of autistic
children. He noted that fathers rarely engaged in play with their
children and mothers displayed a “genuine lack of maternal warmth.”
Later, in the 1950s and 1960s, Bruno Bettelheim promoted the view
that ASD was a product of mothers who were cold, distant and
rejecting (Bettleheim, 1972).

The views of Kanner and Bettleheim coalesced into a notion that

parental coldness, obsessiveness and a mechanical way of giving
attention to their children was akin to acting like a refrigerator.
Kanner described parents of autistic children as, “just happening to
defrost enough to produce a child.”

Numerous studies have shown, however, that no one type of

parenting is common to children with ASD. Indeed, the parents of
these children are as varied in the way they parent as those of
normal children. Although maternal warmth, praise, and quality of
the relationship have a lot to do with reducing behavior problems in
those with Asperger’s, and parental criticisms and neglect improve
the chances of maladaptive behaviors and symptoms, this does not
mean that the condition itself is caused by poor parenting.
 In summary, the preponderance of evidence suggests that genes play a
large role in causing Asperger’s. How they cause Asperger’s, however, is
not yet clear. Furthermore, no specific gene that causes Asperger’s has yet
been detected. Other causes, such as infectious diseases or some sort of
toxicity, are also possible but have not been conclusively identified.
Advances in the assessment and diagnosis of Asperger’s clearly have some
role in the recent rise in detection of Asperger’s.

Questions, Comments or Suggestions?

http://www.kennethrobersonphd.com/contact/

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 DO YOU HAVE ASPERGER’S?

Perhaps a friend of yours acts in ways that make you suspect he has
Asperger’s. Or you are a spouse of someone who appears to have Asperger-
like characteristics. A colleague of yours is aloof and avoids chit chatting at
the office. You wonder if this might have something to do with Asperger’s.
Then again, perhaps you wonder if you might have it. How would you
know for sure?

In this chapter, I describe how Asperger’s is diagnosed. I list the

information that is needed in order to determine if someone has Asperger’s,
the procedures used to collect that information and how that information is
put together to form a diagnosis. I address commonly asked questions about
the assessment and evaluation process, such as how accurate a diagnosis is,
what confidence one can have in a diagnosis of Asperger’s and the
advantages and disadvantages of having a diagnosis. Finally, I describe
mental health conditions that frequently co-exist with Asperger’s, what
makes each of them similar to and different from Asperger’s, and how
Asperger’s is distinct from each of these conditions.

First, a clarification. Every recognizable mental health condition is

distinguished from others by well-defined, clear-cut signs and symptoms.
There may be some overlap between conditions, as, for example with
anxiety which is common to many mental health conditions, but overall, the
characteristics that define any particular condition are unlike the symptoms
in any other condition.

Since this is also true of Asperger’s it would follow that determining

whether someone has Asperger’s should be fairly straightforward. One
assesses whether a person exhibits the characteristics unique to Asperger’s
and, if so, the diagnosis of Asperger’s is made.

Things, unfortunately, are not so simple. Two experts in Asperger’s can

reach completely different conclusions after evaluating the same person,
one concluding that the person has Asperger’s and the other deciding that
he or she does not. Anyone seeking an evaluation for Asperger’s might find
this distressingly frustrating, and rightly so, but it is a very common
occurrence for two reasons. One, if you look at a group of adults all of
whom have been diagnosed with Asperger’s, in every instance you will find
that each of the individuals in that group thinks, feels and acts differently
than the others. Just as no two people are alike, no two cases of Asperger’s
are the same. Understandably, experts can differ as to whether someone has
Asperger’s simply because, unlike how it is depicted in books or articles,
Asperger’s appears differently in different people.

Mr. A, who has Asperger’s, is not able to tell from the way people
act and talk whether they are feeling even the most basic of
emotions, such as intense anger, sadness or happiness. His
conversations are marked by repeated failures to address what is
emotionally significant to the person he is talking with. At the same
time, he has no history of rigid and repetitive routines and interests
that are more intense and excessive than normal.

Early in her childhood, Ms. B developed a preoccupation with

Mahler’s Symphony No. 1. She listened to it over and over,
gradually accumulating ever more knowledge to the point where she
learned every note of the score, how the music was interpreted by
different composers and why separate recordings of the Symphony
either include or exclude the so-called Blumine Movement. She has
no interest in any other piece of classical or contemporary music. In
conversations, she listens thoughtfully and accurately, pays careful
attention to what words convey about what people are feeling,
anticipates often what someone is about to say, and is generally
regarded as socially adept and conversationally skilled.

Both Mr. A and Ms. B both are diagnosed with Asperger’s. In each case,
someone decided that enough of the core characteristics of Asperger’s were
present to warrant that diagnosis in spite of the absence of other, significant
features of the condition.

The second reason experts differ in their diagnoses is because the

symptoms of Asperger’s can be defined only so precisely. Hence there is
plenty of room for interpretation and differences of opinion. Is Ms. B’s
interest in Mahler’s Symphony an unusual preoccupation, for example, or is
it instead a case of someone falling in love with a piece of music and
wanting to know as much about it as possible? Where is the line between a
rigid fixation that leaves no room for subtle understanding and a love of
something, leading to a desire to know it as best one can?

The definition of Asperger’s Syndrome is precise to a certain degree.

Examined more closely, that same definition is open to wide interpretation
and the result is variation in the way it is assessed and diagnosed.

Here is the bottom line: Asperger’s is a descriptive diagnosis. Because

there is no specific laboratory or other type of test, a person is diagnosed
based on the signs and symptoms he or she has, signs and symptoms that
vary from person to person and are often hard to detect. Even experienced
clinicians can, and often do, disagree whether the same person meets the
criteria for a diagnosis of Asperger’s Syndrome.

Diagnosing is often a matter of opinion. With few exceptions no one

can say definitively that someone else has Asperger’s, only that, with a
certain degree of confidence and to a certain degree of certainty, it is likely
to be true.

The Diagnostic Process

With this in mind, what is the actual process of diagnosing Asperger’s in
adults?

I can’t speak for other professionals who have their own procedure but
here is what I do. To begin with, I determine whether it makes sense to
undertake an assessment in the first place. Evaluating Asperger’s is time-
consuming and costly. Why go through with it if there is not enough reason
to think it’s likely to be present? After all, you wouldn’t go to the trouble of
evaluating whether you have a broken foot if there is absolutely nothing
wrong with your foot to begin with. If none of the signs and symptoms of
Asperger’s, broadly defined, are present maybe the evaluation process isn’t
necessary.

Assuming there is good reason to proceed with an evaluation, the next

step is to have the person fill out questionnaires designed to detect more
specific evidence that Asperger’s may be present.

Screening Questionnaires:

There are nine screening questionnaires that have been developed and are
currently in use to identify adults who may have Asperger’s. Most require
the respondent to indicate whether he or she agrees with a statement related
to Asperger’s. Examples of actual statements are:

I find it difficult to imagine what it would be like to be someone else.

The phrase, “He wears his heart on his sleeve,” does not make sense
to me.

I miss my best friends or family when we are apart for a long time.

It is difficult for me to understand how other people are feeling when

we are talking.

I feel very comfortable with dating or being in social situations with

others.
 I find it easy to “read between the lines” when someone is talking to
me.

Completing one or more of these questionnaires can identify abilities,

inclinations and behaviors that are indicative of Asperger’s syndrome.
Depending upon whether a person’s answers to a screening questionnaire
coincide with how adults with Asperger’s typically respond to those same
questions, either it would make sense to continue the diagnostic process or
consider an alternative.

The questionnaires and scales for adults are as follows, in alphabetical

order:

Adult Asperger Assessment (AAA)

Aspie Quiz (AQ)

Autism Spectrum Quotient (AQ)

Empathy Quotient for Adults (EQA)

Friendship and Relationship Quotient (FQ)

Ritvo Autism Asperger Diagnostic Scale (RAADS)

 Social Stories Questionnaire (SSQ)

Systematizing Quotient (SQ)

The Reading the Mind in the Eyes Test (RMET)

These questionnaires indicate whether a person has characteristics that

match those of people with Asperger’s. However, that, in and of itself,
doesn’t prove anything. The person filling out the questionnaire may be
responding to the questions with the intention, conscious or not, of
demonstrating that they don’t have Asperger’s or, for that matter, that they
do. Often people answer these questions based on what they know about
Asperger’s, what they’ve read or been told, or what they imagine it is, and
their answers are not a accurate reflection of the characteristics they
actually have.

Again, screening questionnaires are designed to identify potential cases

of Asperger’s Syndrome but they are not substitutes for a thorough
diagnostic assessment.

To do that, an experienced professional needs to investigate two things:

the person’s medical, developmental, social, family and academic history;
and how the person responds to a face-to-face assessment of social
reasoning, communication of emotions, language use, focused interests, and
non-verbal social interaction.

Documentation

Diagnoses are most valid and accurate when they are based on multiple
sources of information. Previous medical reports documenting signs of
early language delays and peculiarities, coordination problems, behavioral
difficulties or unusual physical abnormalities are one such source. Past
school reports indicating early social and emotional difficulties or academic
tendencies are another. Psychological evaluations, personal diaries, family
recordings, tutoring reports, learning assessments, and employment
histories are all potentially useful ways of assessing the presence of
Asperger’s.

Often, someone seeking an evaluation does not have any such

documentation. That is not an insurmountable problem. We work with what
we have, and a diagnosis, either way, doesn’t depend upon any one piece of
the assessment process. I have had many cases where I was able to
determine with confidence whether the person had Asperger’s without
seeing one single piece of written evidence about that person’s past. It helps
when that evidence is available, but it is not critical.

Clinical Interview

Sitting down and talking to someone makes the difference between a

diagnosis with a high degree of confidence and one that is questionable.
When I assess someone for Asperger’s I ask to meet face-to-face for three
meetings.

The first meeting covers general facts about the person, particularly
those relating to his or her present life. I want to find out as much as I can
about the person’s significant relationships, whether they are friends, work
colleagues, spouse or partner, children or anyone else with whom the person
interacts regularly. I am interested in how the person gets along at work and
his or her work performance, how the person manages daily living, what
initiative the person takes in planning and achieving life goals, and how
satisfied the person is with his or her life. These questions help me assess
whether the individual’s attitudes towards life, conduct in relationships, and
general success in achieving life goals reveal any of the characteristics that
typically are found in people with Asperger’s.

The second meeting focuses on the person’s background, particularly

information about the person’s early family life; previous school
experiences; past friendships, employment and intimate relationships;
childhood emotional development and functioning, and significant interests
throughout the person’s life. Because Asperger’s is a condition that exists at
birth, clues about the presence of Asperger’s are found in the history of the
person’s childhood. Hence a thorough understanding of early social,
emotional, family, academic and behavioral experiences are essential to the
diagnostic process.

The third and final meeting is a time to clarify questions that were not
completely answered in the previous meetings, gather additional
information and raise other questions that have emerged from the
information collected so far. When everything has been addressed to the
extent allowed in this timeframe, the final part of the clinical interview is
the presentation of my findings.

Presenting these findings is a multi-step process. First, I explain that

certain characteristics are central to Asperger’s syndrome. If those
characteristics are not present in the person then he or she doesn’t have
Asperger’s and if they are present a diagnosis of Asperger’s is much more
viable.

I also explain that some characteristics of Asperger’s are also shared by

other conditions. An example of this is difficulty noticing whether people
are bored or not listening to conversations. Lots of people don’t pay much
attention to whether people are listening to them, but that doesn’t mean they
have Asperger’s. On the other hand, in combination with other signs of
Asperger’s, not noticing how people respond in conversations could be a
significant confirmation of an Asperger’s diagnosis.

A diagnosis of Asperger’s requires the person have:

Persistent difficulty in communicating with, and relating to, other

people, including a preference for one-sided conversations in which
there is little sharing of interests and a lack of emotional give-and-take.
The person has trouble recognizing when the listener is either
interested or bored.

Minimal interest in casual social contact, spontaneous conversation

and passing time with others.
Poor nonverbal communication, which translates into poor eye contact,
unusual body language, and gestures and facial expressions that seem
out of place.

Difficulty developing, maintaining and understanding relationships.

Insistence on inflexible routines, such as eating the same foods daily,

brushing teeth in exactly the same way and dressing in the same
sequence, essentially avoiding changes in one’s lifestyle. In addition,
the person reacts either very dramatically or hardly at all to changes in
temperature, sound volume, brightness of lights, or texture of clothing.

Signs of these characteristics emerge as early as 12-24 months of age,

although the difficulties with social communication and relationships
typically become apparent later in childhood.

Indications that these characteristics are causing significant problems

in relationships, work or other important areas of the person’s life.

Clear evidence that these characteristics are not caused by low

intelligence or broad, across-the-board delays in overall development.

Ms. G arrived at her evaluation having completed ahead of time the

Ritvo Autism Asperger Diagnostic Scale and the Autism Spectrum
Quotient. She brought with her copies of Individualized Educational
Plans from her elementary and middle school years, together with
pediatric reports, an assessment from a psychologist she saw in her
adolescence and a letter from her current therapist describing her
psychological status and treatment goals. During our first session,
Ms. G described her childhood years living on a farm in Vermont,
hours spent as a young child rocking back and forth, hand flapping
and spinning her body, watching Star Trek episodes over and over
on TV, memorizing personal information of past US presidents, and
later immersing herself in studies of planetary geological
formations, eventually pursuing a career in advertising. In our
second session, Ms. G told me of her paternal uncle who had similar
 oddities and of her shy, retiring maternal grandfather who never left
the town he grew up in. Ms. G described her own lack of close
friends, her marriage that, while stable, lacked physical intimacy,
and the fact that she quit ten jobs over the previous five years due to
dislike of the casual conversations that frequently occurred in her
office settings. In our third session, we looked at her recurring
symptoms of mild to moderate depression and her accompanying
tendency to isolate herself. She described her sensitivities to various
clothing, her avoidance of florescent lighting and her dislike of
venues with large crowds of people. As the session progressed, I
presented my findings of Asperger’s Syndrome (Autism Spectrum
Disorder), we discussed treatment options and agreed to continue
meeting for three more sessions to discuss ways of improving her
work/career stability.

How Accurate is a Diagnosis?

What happens if a person has some of these difficulties but not all? Would
they qualify for a diagnosis of Asperger’s? If so, how accurate would that
diagnosis be?
Whether or not a person has Asperger’s depends upon how many core
characteristics of this condition he or she has and to what extent they affect
that person’s life. If, for example, someone talks in a flat, toneless,
mechanical way, typically doesn’t get jokes and subtleties, has narrow,
unusual interests, rarely understands other people’s beliefs, attitudes and
emotions, is hypersensitive to lights, sounds and textures of clothing, is
underemployed and socially isolated, we could safely say that a diagnosis
of Asperger’s is quite reasonable.

If, on the other hand, the person engages in limited back-and-forth

communication, is not especially interested in reaching out to others but
will try, speaks in a normal tone, and has limited, but not unusual interests,
a diagnosis of Asperger’s could be considered but not assured.
 A diagnosis of Asperger’s is most proper when the defining
characteristics are present all the time and they have an obvious effect on
the person’s success in life. Additionally, when the information used to
make a diagnosis comes from multiple sources, like one’s family history, an
expert’s observations, school, medical and other reports, questionnaires and
standardized test instruments, it is likely to be more accurate and reliable.

Advantages and Disadvantages of an Asperger’s

Diagnosis
The advantages of having an accurate, reliable diagnosis of Asperger’s are
many. It can eliminate the worry that a person is severely mentally ill. It can
support the idea that the person has genuine difficulties arising from a real,
legitimate condition. Other people, once they are aware that the person has
Asperger’s are often able to be more accepting and supportive. A new, and
more accurate, understanding of the person can lead to appreciation and
respect for what the person is coping with.

A diagnosis of Asperger’s opens up avenues to resources for help as

well as access to programs that can improve social inclusion and emotional
management. Acceptance by friends and family members is more likely. An
acceptable explanation to other people about one’s behavior is now
available, leading to the possibility of reconciliation with people who have
had problems with previous actions.

In the workplace and educational settings, a diagnosis of Asperger’s can

provide access to helpful resources and support that might otherwise not be
available. Employers are more likely to understand the ability and needs of
an employee should that employee make the diagnosis known.
Accommodations can be requested and a rationale for those
accommodations can be provided based on a known diagnosis.

Having the diagnosis is a relief for many people. It provides a means of

understanding why someone feels and thinks differently. It can be exciting
to consider how one’s life can change for the better knowing what one is
dealing with. There can be a new sense of personal validation and
optimism, of not being defective, weird or crazy. With the knowledge that
one has Asperger’s, joining a support group, locally or online, may provide
a sense of belonging to a distinct and valued culture and enable the person
to consult members of the group for advice and support.

Acceptance of the diagnosis can be an important stage in the

development of successful adult intimate relationships. It also enables
therapists, counselors and other professionals to provide the correct
treatment options should the person seek assistance.

Liane Holliday Willey, an educator, author and speaker, diagnosed with

Asperger’s syndrome in adulthood, wrote the following self-affirmation
pledge for those with Asperger’s syndrome:

- I am not defective. I am different.

- I will not sacrifice my self-worth for peer acceptance.

- I am a good and interesting person.

- I will take pride in myself.

- I am capable of getting along with society.

- I will ask for help when I need it.

- I am a person who is worthy of others' respect and acceptance.

- I will find a career interest that is well suited to my abilities and

interests.

- I will be patient with those who need time to understand me.

- I am never going to give up on myself.

- I will accept myself for who I am.

 Are there disadvantages to a diagnosis of Asperger’s? Yes, but not as
many as the number of advantages.

Some people receive a diagnosis of Asperger’s with discouragement and

disapproval, believing they necessarily will be severely limited in how they
can lead their lives. No longer, they assume, can they hope to have a
satisfying, intimate relationship. Instead, their future will be filled with
loneliness and alienation from others with no expectation of improvement.
This, of course, is an unrealistic and exaggerated depiction of what living
with Asperger’s is like.

Certainly, it is possible that people in one’s life will react to the

diagnosis of Asperger’s with rejection and alienation. Stigmatizing and
disapproval of differences are still prevalent in our society. Damage to one’s
self-esteem as a result of disapproval, ridicule, discrimination and rejection
is possible when knowledge of an Asperger’s diagnosis is disseminated.

Job discrimination is a realistic possibility if an applicant reveals an

Asperger’s diagnosis. While it is not legally acceptable to do so, we know
that silent discrimination happens, hiring decisions are not always made
public and competition can leave someone who has an atypical profile out
of the picture.

Similarly, having a diagnosis of Asperger’s may lead others to assume

the person will never be able to be as successful in life as neuro-typical
people. It is commonly assumed that Asperger’s makes someone too
difficult to be around, unable to get along with people, too narrowly focused
on their own interests, and too stubborn, self-absorbed and lacking in
empathy to be a contributing member of society, a view that is narrow in its
own right and sadly mistaken in many cases. Nevertheless, attitudes like
this can arise when a diagnosis of Asperger’s is made public.

John, a 47-year-old software engineer, was recently diagnosed with

Asperger’s Syndrome. Past work performance evaluations described
numerous complaints about his apparent insensitivity to the long
 hours and constant deadlines causing strain among his
subordinates. After reading about the tendency of those with
Asperger’s to miss emotional signals, both within themselves and in
others, John devised a system to track and respond to the concerns
of employees who reported to him in a way that reduced complaints
and improved his overall performance reviews.

Dual Diagnoses
Some people suspect they might have Asperger’s because answers to an
online quiz they have taken indicate so. Just as often, friends or relatives
read a newspaper story or article and imagine their friend or loved one is
likely to have Asperger’s.

No doubt articles, books, online descriptions, and conversations with

others are useful ways of suggesting that someone has Asperger’s. The
problem with this is that several other conditions share many of the same
symptoms with Asperger’s. Just knowing how the person behaves, thinks
and feels does not, in and of itself, tell you whether he or she has
Asperger’s. It very well might be that some other condition is the real
problem or, as if often true, Asperger’s is overlapping with an entirely
different, yet related, condition. In this case, it is more accurate to say the
person has co-existing conditions rather than it being a straightforward
matter of Asperger’s.

Here is a description of the mental health conditions most frequently

associated with Asperger’s:

Attention Deficit Hyperactivity Disorder (ADHD)

People with ADHD typically have difficulty paying attention to what’s

going on around them, they are easily distracted, they tend to do things
without thinking about the results, they are often forgetful, have trouble
finishing what they intended to do, are disorganized, jump from one activity
to another, are restless and have poor social skills.
 Many of these symptoms overlap with those of Asperger’s. Research
has shown growing evidence for a connection between Asperger’s and
ADHD. Genetic studies suggest the two disorders share risk factors, and
studies of the incidence and distribution of both conditions confirm that
many people with Asperger’s have symptoms of ADHD and vice versa.
Brain imaging and studies of brain structure show similarities between the
two disorders.

Having said this, there are significant differences between the two.
People with ADHD often try to do multiple activities at the same time.
They get distracted easily and jump from one interest or activity to another.
Focusing on one thing for a long time is hard for them. People with
Asperger’s, on the other hand, tend to concentrate on only one activity at a
time, and they focus on that activity intensely with little regard for anything
else going on around them. They are hyper-focused rather than unfocused.

There is a similar difference with respect to impulsivity. People with

ADHD will do things without considering the outcome of their actions.
They act immediately and have trouble waiting. They interrupt, blurt out
comments and seem unable to restrain themselves.

People with Asperger’s think through their actions more carefully. They
may interrupt and say things without regard to whatever else is going on but
that is because they don’t understand how conversations are carried out
rather than not being able to restrain themselves.

There is a big difference in how adults with ADHD use language

compared to adults with Asperger’s. They do not tend to have specific
weaknesses in their understanding and use of language. They readily
understand that a statement such as, “it’s raining cats and dogs” is being
used as a figure of speech and not as a literal statement. They also speak
with a normal tone of voice and inflection.

As I have described previously, difficulty interpreting non-verbal

communication and subtle aspects of how people relate to each other is
characteristic of adults with Asperger’s. They confuse behaviors that may
be appropriate in one setting from those that are appropriate in another, so
that they often act inappropriately for the situation they are in. They find it
hard to interpret the meanings of facial expressions and body posture, and
they have particular difficulty understanding how people express their
emotions.

Adults with ADHD, on the other hand, understand social situations

more accurately and they engage more easily in social situations even
though they are easily distracted and often not observant of what’s going on
around them. They can consider what other people are thinking more easily
than adults with Asperger’s and they participate in the give-and-take of
social interactions more readily.

Adults with ADHD tend to express their feelings directly and clearly
whereas adults with Asperger’s do not show a wide range of emotions.
When they do communicate their feelings they are often out of synch with
the situation that generated them.

Adults with ADHD tend to process sensory input in a typical manner.

They may have preferences for how they handle sensory input like music,
touch, sounds, and visual sensations but generally the way they handle these
situations is much like other adults.

In contrast, adults with Asperger’s have more specific preferences about

the kind of sensations they like and dislike. They may be overly sensitive to
one kind of sensation and avoid that persistently. Or they may prefer a
certain type of sensation, a certain type of music for example, and seek it
over and over. Overall, intense sounds, temperature differences, visual
images and tastes more easily overwhelm adults with Asperger’s than adults
with ADHD.

Obsessive-Compulsive Disorders

The core features of Obsessive-Compulsive Disorder (OCD) are frequent

and persistent thoughts, impulses or images that are experienced as
unwelcome and uninvited. Along with these thoughts are repetitive
behaviors or mental acts that the person feels driven to perform in order to
reduce stress or to prevent something bad from happening. The person may
recognize that he or she is generating these thoughts and behaviors but at
the same time can’t stop them

Some people spend hours washing themselves or cleaning their

surroundings in order to reduce their fear that germs, dirt or chemicals will
infect them. Others repeat behaviors or say names or phrases over and over
hoping to guard against some unknown misfortune. To reduce the fear of
harming oneself or others by, for example, forgetting to lock the door or
turn off the gas stove, some people develop checking rituals. Still others
silently pray or say phrases to reduce anxiety or prevent a dreaded future
event while others will put objects in a certain order to reduce discomfort.

These behaviors, repeating the same action over and over, are similar to
the repetitive routines associated with Asperger’s. Individuals with both
conditions engage in repetitive behaviors and resist the thought of changing
them. The difference is that people with Asperger’s do not view these
behaviors are unwelcome. Indeed, they are usually enjoyed. In addition,
whereas Asperger’s occurs early in the person’s life, OCD develops later in
life. Furthermore, adults with OCD tend to have better social skills,
empathy and social give-and-take than those with Asperger’s.

Social Anxiety Disorder

Social Anxiety Disorder, also known as Social Phobia, occurs when a

person has a fear of social situations that is excessive and unreasonable. The
dominant fear is of being closely watched, judged and criticized by others.
The person is afraid that he or she will make mistakes, look bad and be
embarrassed or humiliated in front of others. This can reach a point where
social situations are avoided completely.

Asperger’s and Social Anxiety Disorder share the common element of

discomfort in social situations. Typically, along with this discomfort is lack
of eye contact and difficulty communicating effectively.

The difference between these two conditions is that people with Social
Anxiety Disorder lack self-confidence and expect rejection if and when
they engage with others. Adults with Asperger’s, on the other hand, don’t
necessarily lack self-confidence nor are they afraid of being rejected. They
are simply not able to pick up on social cues. They don’t know how to act
appropriately around people and thus tend to avoid them. Also, Social
Anxiety Disorder may be present in children but more commonly it
develops in adolescence and adulthood whereas Asperger’s can be traced
back to very early childhood.

Schizoid Personality Disorder

People with Schizoid Personality Disorder (SPD) avoid social relationships

and prefer to spend time alone. They have a very restricted range of
emotions, especially when communicating with others and appear to lack a
desire for intimacy. Their lives seem directionless and they seem to drift
along in life. They have few friends, are infrequently involved in intimate
relationships, and often have trouble in work settings where interaction with
other people is necessary. They are the person that others think of as the
typical “loner.”

A noticeable characteristic of someone with SPD is their difficulty

expressing anger, even when they are directly provoked. They tend to react
passively to difficult circumstances as if they are directionless and drifting
along in life. Being withdrawn makes life easier for them. They don’t gain a
lot of happiness from getting close to people. Often this gives others the
impression that they lack emotion.

While this may strike some as similar to Asperger’s, adults with SPD
can interact with others normally and can get along well with people when
they want to. They don’t have the strong preference for logical patterns in
things or the inability to read facial expressions or “blindness” to what is
going on in other people’s minds, two common features of Asperger’s
Syndrome.

In addition, people with SPD typically do not show these features until
late adolescence or adulthood. The characteristics of Asperger’s must be
noticeable in infancy or early childhood to receive the diagnosis of
Asperger’s.
 Most importantly, people with SPD have mostly neuro-typical
characteristics, that is, except for extreme introversion and emotional
detachment, they are in most other ways normal.

Antisocial Personality Disorder

Individuals with Antisocial Personality Disorder (APD) disregard and

violate the rights of others. They don’t conform to social norms with respect
to lawful behavior and invariably end up destroying property, stealing,
harassing others, and cheating. They are frequently deceitful and
manipulative so as to obtain money, sex, power or some other form of
personal profit or pleasure. They tend to be irritable and aggressive and get
into physical fights or commit acts of physical assault (including spousal or
child beating).

They are consistently and extremely irresponsible financially, in their

employment, and concerning their own safety and the safety of others. They
show little remorse for the consequences of their actions and tend to be
indifferent to the hurt they have caused others. Instead, they blame victims
for their own aggression, irresponsibility and exploitation. They frequently
lack empathy and tend to be callous, cynical and contemptuous of the
feelings, rights and suffering of others.

They often have an inflated and arrogant view of themselves and are
described as excessively opinionated and cocky. They can seem charming
and talk with superficial ease, attempting to impress others and appear
experts on numerous topics.

It may appear there is some overlap between Asperger’s and APD, but
the resemblance is superficial. Individuals with Asperger’s have trouble
understanding how people operate but they do respect others, whereas
people with APD have no regard for people. People with Asperger’s are
rarely deceitful, in fact, they are often considered excessively, even naively
honest, quite unlike those with APD who are predictably deceitful and
lacking in remorse. Adults with Asperger’s do show and feel guilt whereas
people with APD do not. While those with APD are not intimate with
others, adults with Asperger’s are quite capable of feeling genuine love and
affection.

Bipolar Disorder

Adults with Bipolar Disorder (BD) have distinct ups and downs in their
mood. At one moment they will have extreme energy, be unusually happy,
energetic, talkative, feel wonderful about themselves and “on top of the
world, have little need for sleep, and be drawn to unimportant or irrelevant
activities. At other moments they are down, they feel sad, empty, hopeless,
worthless and inappropriately guilty. They may have little interest in their
usual activities, feel no need to eat, sleep more than usual, have difficulty
concentrating and in some instances have suicidal thoughts.

When someone with Bipolar Disorder is in a manic state or depressed

they may not interact socially as they might if they were feeling normal,
they might be withdrawn, lack much emotional response to situations in
their life and lose interest in relationships but the changes in their emotional
condition are much different than people with Asperger’s.

The challenges of Asperger’s do not vary much from moment to

moment unlike someone with BD. Moods do not change swiftly and
dramatically. In fact, the characteristics of Asperger’s have little to do with
transient emotions. While they may feel down at times or on other
occasions be unusually happy, their concerns are stable over time and have
much less to do with emotional ups and downs.

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 TREATMENT OF ADULT ASPERGER’S

If you have Asperger’s Syndrome or know someone who does, you are
probably less concerned about what causes it, how it is different from other
psychological conditions or how it is diagnosed than you are about how to
change it. The important questions are whether it’s possible for someone
with Asperger’s to change and, if so, how. Helping someone overcome
Asperger’s is at the forefront of most people’s minds.

Let me address the topic of overcoming Asperger’s by raising the

following questions:

Can Asperger’s Be Cured?

The short answer is - not at the present. Remember, Asperger’s Syndrome is
a neurologically based condition and currently there are no means of
permanently changing the processes in the brain that lead to Asperger’s.

That does not imply, however, that someone cannot develop ways of
coping effectively with Asperger’s. Many therapies have emerged recently
that assist adults with Asperger’s in living successful, meaningful and
happy lives. In fact, the question of whether Asperger’s can be cured may
not be terribly helpful. It implies that Asperger’s is a disease, and many
people disagree with this definition. They argue that Asperger’s is an
alternative way of thinking and living, and as such it does not need to be
cured.

Asperger’s can be likened to color blindness. Whereas most people

would see green in a certain image, those with color blindness might see
yellow. Their eyes are different, not defective. What they see is not
necessarily wrong, it is different.

Similarly, those with Asperger’s think, feel and respond differently from
what is considered normal. This doesn’t mean there is something wrong
with their minds, just that they have an alternative way of experiencing
things.

Can Someone with Asperger’s Change?

Yes. Thinking and acting are, in effect, skills and like any skill they can be
learned. It’s entirely possible to learn how to think and behave differently
than one is used to, even someone with Asperger’s. The fact that Asperger’s
has been traced to neurological differences does not mean those differences
cannot be modified such that someone can think and act differently.

But if there is no cure how is it possible for someone with Asperger’s to

think and act differently? Just as with color blindness, it may not be
possible to completely reverse Asperger’s but it’s entirely possible to
develop effective means of adjusting to, and coping with, it.

How Does Change Happen?

Before answering this question, I want to make an important point about
treating Asperger’s. That is, there is no one, uniform treatment for adult
Asperger’s. Every person is different. Every person’s circumstances are
different. The degree to which each person has Asperger’s and the effect it
has on that person is different. For these reasons, and others, no single
approach can be used in each and every case. The only way to effectively
help someone with Asperger’s is to understand the unique characteristics
and challenges of that person and tailor a course of action befitting those
special circumstances. A one-size-fits-all treatment program, in my
experience, simply doesn’t work.

Having said this, there are general principles of treating Asperger’s that
should part of every treatment plan for every person. These principles are:
There must be an accurate and comprehensive understanding of the
person’s psychological, social, emotional, and intellectual strengths
and challenges. Helping someone to change without fully knowing
their capabilities, how Asperger’s impacts them, which characteristics
of Asperger’s they have and do not have and the degree to which they
have them, and what their own goals for treatment are means that in
most cases trying to help someone change is doomed to failure. An
accurate assessment is key to successful change.

The person’s desire to change is a critical factor in whether they will

succeed. In fact, I would say that motivation is THE most important
ingredient in change. One’s desire to change, how much effort he or
she is willing to put into making change happen, the extent to which it
is a priority in one’s life and the consistency and stability of one’s
motivation to change are all-important in determining whether change
will happen.

A thorough understanding of, and experience working with, adults

with Asperger’s on the part of a helping professional correlates highly
with treatment success.

Treating adult Asperger’s must address two core problems: the ability
to put oneself in somebody else’s shoes, that is, to imagine how they
think and feel, and the drive to analyze and construct systems. People
with Asperger’s have a great deal of difficulty understanding and
predicting what other people are thinking and how they are feeling. On
the other hand, they have a greater understanding of how systems
work, the rules and structure that govern how collections of parts fit
together, be they mechanical systems (e.g. a camera or computer),
natural systems (e.g. weather patterns, agricultural methods),
numerical systems (e.g. train timetables, mathematical calculations),
collectable systems (e.g. stamp collections, knowledge of the
taxonomy of minerals), or abstract systems (e.g. musical theory,
esoteric mathematics). These two core features and how they both
affect the person, positively as well as well as negatively, must be
addressed in order to help an adult with Asperger’s.
 Developing adaptive life skills must be a core part of the change
process. Having a clear and consistent focus on this goal will mean the
difference between a successful treatment and one that may ease
worries and diminish symptoms but will ultimately lead to non-
productive change. Understanding, without change in behavior, is a
recipe for ineffective treatment.

What Are the First Steps in Treating Asperger’s?

Having argued against a cookie-cutter approach to treatment, let me
describe how an individually focused and directed therapy for Asperger’s
works. I’ll do so by explaining the process I typically undertake when I am
asked to treat someone with Asperger’s.

First, I undertake an assessment to determine what, if any, of the

characteristics of Asperger’s are present in the person. Even if someone
comes to me having already been diagnosed with Asperger’s, I want to
conduct my own evaluation. Previous assessments of the person may be
outdated, may have been done by someone with a different understanding
of Asperger’s, or may not have been a thorough as needed in order to plan
and undertake a successful treatment. This doesn’t mean I always start from
scratch. I see what can be used from previous evaluations and, in cases
where the evaluation has been done by a knowledgeable professional, my
own assessment is mainly aimed at updating old information and
determining the person’s functioning and skills at the time they are meeting
with me.
In addition to assessing what aspects of Asperger’s are present in the
person, I determine the person’s motivation to change and their goals for
change. This is a significant part of the treatment process. If the person
lacks a certain drive to change or is wanting to change aspects of
themselves that I can’t assist them with, all the help I, or anyone, might
provide ultimately will not succeed.

When I am confident that I have a thorough understanding of the degree

to which Asperger’s is present in the person, which characteristics of
Asperger’s are present and which are not, what the person would like to
change and not change, and their motivation, I put together a treatment plan
that incorporates all of these factors. I then present the plan to the person
and discuss what are mutually agreeable treatment goals and methods to
reach those goals.

Example of a Treatment Plan for Adult Asperger’s

Rick is a 35-year-old, computer programmer who was recently
diagnosed with Asperger’s Syndrome. He sought help with social
communication, specifically difficulty initiating and sustaining
conversations with strangers, and concerns about work evaluations
that described a pattern of negative interactions towards colleagues.
He also exhibited symptoms of depression and anxiety.

A treatment plan was developed focused on building Rick’s social

skills through direct instructions, role playing, modeling, practice
with peers and constructive feedback. Additionally, the problematic
areas of his social difficulties were broken down into smaller sub-
skills, such as greeting others, initiating topics, staying on topic,
using eye contact, facial expressions, and gestures, observing the
listener’s responses, and appropriately ending conversations. Other,
more advanced skills, such as accepting suggestions, handling
criticism, resolving conflicts and showing empathy were also
discussed, practiced and reviewed.
Rick’s low self-esteem was addressed by examining implicit and
explicit assumptions he held towards his own competency and
unwarranted expectations of failure, along with exploring the ample
indications of his ability to succeed socially that he was ignoring.
With his consent, he sought a medication consultation and was
prescribed a selective serotonin repute inhibitor to treat his anxiety
and depression.

After a course of 15 sessions, Rick met his treatment goals and

ended therapy.
How Does Treatment of Adult Asperger’s Work?
Generally speaking, two things happen in the actual treatment of
Asperger’s. The first is developing the skills necessary for understanding
and responding to what other people think and feel. This is not just an
abstract matter, dealing with a hypothetical, impractical problem. Rather it
gets to the heart of a person’s ability to form satisfying, lasting, mutually
effective relationship. Without being able to have a reasonably good idea of
what people think and feel and why they do what they do, it’s virtually
impossible to connect with someone else.
At some point, learning to read other people’s intentions, the nuances of
what they are saying, their subtleties, what makes them feel the way they
do, and what they might be referring to when they speak indirectly about
something has to be the focus of therapeutic work.

The way to do that is to study the connection between a person’s

communications, both verbal and non-verbal, and the intentions driving
those communications. Here is a simple example of this. One person says to
another, “Wow, when Joe asked me in today’s meeting what happened to
the new promotional campaign I felt like I’d been hit by a bus.” The phrase,
“hit by a bus” is the communication that is likely to confuse someone with
Asperger’s. Looking at what that phrase meant and how it is used to convey
a certain feeling both in that and other situations is what the therapeutic
work would involve.
This “study” of communication and what it is intended to convey
gradually builds up a person’s skill in interpreting and understanding human
interactions. It also forms the building blocks of appropriate responses. As
one learns how to read what is in someone’s mind by understanding the
meaning of their communication it becomes much easier to know how to
respond in an appropriate way. Understanding what the phrase, “I feel like
I’ve been hit by a bus” is intended to convey makes it possible to think of a
response like, “I’m sorry. I can imagine how surprised and concerned you
were when Joe asked you that question.”

Studying communication like this has to occur over and over for the
skills involved in reading someone to develop. It doesn’t happen overnight.
Enough time must be allowed for the growth of this skill to take root and
flourish. Once it does, however, the process can take on its own impetus to
the point where therapy, and its teaching function, is no longer necessary.

The interventions that I typically use in helping to build competence and

success in relating effectively include:

Explicitly instructing the adult on how to interpret other people’s

social behavior. The meaning of eye contact, tone of voice, facial and
hand gestures, and non-literal communication such as humor, figures
of speech, irony and metaphors can all be taught much like the
teaching of a foreign language.

Monitoring the adult’s own speech, focusing on volume, rhythm,

context and social situation.

Discussing problematic, disruptive behaviors, such as interrupting,

yelling, raging, ignoring and criticizing, along with discussing the
benefits of acting in a different, more positive way.

Encouraging an active social life, particularly around in mutually

enjoyable activities and shared interests.

Showing how the person’s actions impact other people, having the
person practice engaging with others, analyzing the outcomes of these
engagements and adjusting the necessary social skills accordingly.

Teaching how to infer and to predict what is likely in social situations,

to understand why people do what they do and anticipate the outcome
of social interactions.

Helping the person to be more flexible in thinking about why other

people are doing what they do and in responding to them.

The second part of treating Asperger’s involves helping the person to

put these skills into practice. The actual performance depends on the
motivations of the person to succeed. Skills alone don’t guarantee success
in relating to others, living independently, coping with adversity, managing
emotions, broadening one’s interests or solving problems. The desire to
succeed in these areas is critical. In many instances, success is impeded by
fears, anxieties, unrealistic expectations, irrational assumptions, poor self-
image, negative self-esteem, lack of self-acceptance and concurrent
disorders.

Treatment of Asperger’s cannot succeed itself unless these emotional

and psychological factors are addressed. In addition to helping someone
with Asperger’s develop better social skills, empathize more easily, think
more flexibly, expand lifestyle routines, communicate more effectively and
adapt more readily to their work, family and social environment, I try to
help people achieve a realistic appreciation of who they are and to
emphasize their strengths more so than their weaknesses. I promote a
concept of self that is grounded and realistic, based on an appreciation of
personal qualities, understanding and accepting who one is.
The matter of concurrent psychological conditions is critical to this part
of the treatment. Oftentimes, in seeking help for Asperger’s, conditions
such as depression, anxiety, phobias, obsessive-compulsive traits and other
problems reveal themselves. These must be uncovered and identified, their
sources examined and the solutions to these problems established in
specific, understandable and manageable ways.

Finally, treating Asperger’s cannot succeed unless the necessary

conditions exist to support one’s improvement and success. No one lives in
a vacuum. If the people in someone’s life are not encouraging, take no
interest in the person’s success, actively interfere with the person’s
improvement or in some way sabotage one’s attempts to deal with
Asperger’s no amount of effort can be successful. Addressing the help and
support a person needs to deal with Asperger’s is crucial to overcoming the
challenges of this condition.

Which Therapy is Best for Adult Asperger’s?

There are several approaches to treating Asperger’s. Mine is just one. The
literature on therapy for Asperger’s is sparse but occasional references have
been made to the advantages of a treatment method based on the principles
of cognitive psychology. The foundation of this approach is that thoughts,
feelings, and behavior are all connected. Individuals can overcome their
problems by identifying and changing unhelpful or inaccurate thinking,
problematic behavior and upsetting emotions. This involves the person
working collaboratively with the therapist to develop skills for testing and
modifying beliefs, identifying distorted thinking, relating to others in
different ways, and changing behaviors.
Schools of therapy such as Cognitive Behavioral Therapy (CBT) and
Dialectical Behavioral Therapy (DBT) adopt this approach and have been
shown to be effective in treating Asperger’s. A psychoanalytic frame of
reference is more suitable to my own background and training, and that is
what I use in my work with Asperger’s.

What are the Benefits of Therapy for Adult

Asperger’s?
Assisting someone with Asperger’s in living a successful, meaningful and
happy life is the overall goal of therapy. One part of that goal is learning to
express oneself effectively. This involves learning to interpret gestures,
facial expressions and tone of voice of others so that their intentions and the
meaning of their communication is clearer.

Therapy helps one to become less literal and to comprehend the

meaning of complex words and phrases, including metaphors and analogies,
so that it is easier to understand what people mean. Interpreting the body
language of others and how nonverbal cues are used in communication is
possible through instruction and practice in therapy.
Therapy also helps to center one’s interests on subjects that provide for
broad acquisition of knowledge and increase one’s employment
opportunities or better align one’s strengths, interests and skills with one’s
current job.
 One important benefit of therapy is to build social skills. These skills
can be learned, and through guided practice, refined and improved,
resulting in more flexibility in social situations and less need to isolate
oneself. Problems recognizing how people interact often leads to social
isolation for those with Asperger’s. Not understanding sarcasm or humor, or
having difficulty maintaining eye contact, recognizing facial expressions,
body posture or nonverbal gestures all make it harder to interact
successfully one-on-one and in groups. Correcting these and other problems
of relating to others is an important part of the therapy process.
Therapy for Asperger’s helps one achieve a realistic appreciation of
who one is, greater acceptance of one’s unique qualities, and to recognize
one’s strengths more than one’s weaknesses. It helps to reduce self-doubt
and self-criticism and increase social success and self-esteem.

Can Medication Help?

Being a psychologist, not a psychiatrist, I don’t prescribe medication.
Nevertheless, in my many years working with adults who have Asperger’s I
have come to appreciate the benefits of medication and to believe it should
be given due consideration in the treatment of this condition. Here is why:

Doubts, confusion, worry and low self-esteem plague many adults with
Asperger’s. Medication, particularly anti-depressants and, in some
cases, anti-anxiety medications help lessen these feelings; as clarity,
confidence and self-acceptance return, happiness thrives, life becomes
easier and the challenges of Asperger’s no longer pose as great an
obstacle as they once did.
Many people with Asperger’s suffer the same symptoms as those with
ADHD. For close to 100 years, medication has been used successfully
to treat ADHD and frequently have the same success in treating the
distractibility, inattentiveness, forgetfulness, and disorganization often
accompanying Asperger’s.
 In a small number of cases, adults with Asperger’s exhibit very
unusual thinking, aggressive and self-hurtful behaviors. Medication
can lessen, and sometimes eliminate these problems.

In and of itself, medication does not cure Asperger’s. Its role is to

reduce the extremes of problematic behavior. With fewer difficulties to cope
with, Asperger’s becomes a condition to adapt to, rise above and take
advantage of. What follows are the rewards of a more enjoyable and
fulfilling life.

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 LIVING WITH ASPERGER’S

If you read enough of the literature on Asperger’s it’s likely you’ll come to
this unfortunate conclusion: those who have Asperger’s are fated to a life of
unhappiness.
So often, books, articles, blogs, and news stories emphasize the
troubling challenges of Asperger’s, with hardly anything positive to say
about it. And, it’s no wonder. Being unable to imagine what other people
are thinking and feeling, responding inappropriately in social situations,
focusing a great deal on narrow, often unusual, interests, communicating in
odd ways and being overly sensitive to sounds, lights, numerous stimuli and
other sensations are not characteristics normally associated with a happy,
well adjusted individual. The life of an adult with Asperger’s is assumed to
be gloomy, troubled and sad. One is expected to adopt a stiff upper lip
attitude and a philosophy of grudging acceptance and tolerance in order to
carry on with such a debilitating condition.

This attitude towards Asperger’s, in my opinion, is as far from reality as

the assumption that poor people are uniformly unhappy and all wealthy
people live in a permanent state of bliss. It is a generalization based on
little, if any, actual evidence and reflects a stereotype about the
requirements of a successful life that is all too often accepted
unconditionally.

This is not to say that everyone with Asperger’s is living the “good
life.” It is a struggle to get along in a world designed for, and populated by,
people who think very differently than you do. Trying to fit into “normal”
society is not easy nor is it always successful. But life is that way for
everyone. No one escapes having to learn, sometimes painfully so, to adapt
to societal expectations and pressures. Adversity is a given in life. We all
fail in some form, in some way or another. However, the goal is to make use
of what life offers, to take advantage of hardships and profit from them. As
the renowned football coach, Vince Lombardi, remarked, “it doesn’t matter
how many times you get knocked down but how many times you get up.”

In the following pages, I want to present a view of Asperger’s that

recognizes the many positive characteristics of this condition. I want to
show how success in life is entirely possible for those with Asperger’s and
how that success is not just a pie in the sky idea but a realistic expectation,
one that can be achieved by anyone who is willing to see Asperger’s as an
opportunity to be taken advantage of and who desires to put the time and
effort into making it so.

Intimacy and Romance

It’s true; intimate relationships don’t come easy for adults with Asperger’s.
Because it’s hard for them to understand that other people think differently
and have their own plans, thoughts and points of view, it’s difficult for them
to recognize other people’s beliefs, attitudes and emotions. They often come
across as self-centered, eccentric and uncaring, hardly desirable attributes to
form intimacy.

It’s also true that their special interests can crowd out the needs of their
partner and limit sharing of interests. For example, having limited interest
in, and significant problems with, calendaring, time management and
organizational skills, make joint activities and planning frustrating for their
partner.

An adult with Asperger’s can be content with his or her own company
for long periods of time. Conversations with a partner may be infrequent
and primarily involve an exchange of information rather than an enjoyment
of each other’s company, experience and shared interests. The Asperger’s
partner wants to be a friend and lover but has little idea of how to do either.
Being alone is the main emotional recovery mechanism for an adult with
Asperger’s and he/she assumes that is true for their partner.
 But this is far from the whole story. My own clinical experience and the
existing literature leads me to believe that adults with Asperger’s have
many different strengths to offer in intimate relationships, whether romantic
or friendships. Strong values, morals and beliefs are common characteristics
in those with Asperger’s and these can form the bedrock of successful
relationships. Dependability, intense focus, attentiveness and intelligence
are additional qualities of those with Asperger’s and these are also keys to
successful relationships.The ability to focus leads to the power to
concentrate on complications that invariably surface in any relationships
and to stay with those over time no matter how difficult or unpleasant the
problem is. Additionally, one of the strongest characteristics of Asperger’s
Syndrome is patience, a key ingredient in any successful relationship.

In many cases, having Asperger’s often leads to the development of a

strong sense of justice and, perhaps due to frequent early exposure to
disapproval and/or rejection, the ability to handle conflict and
disagreements with calm, steady behavior. A lifetime of mistakes,
experiencing disappointment and confusion in social situations, often
results in the willingness to take one’s time once a relationships has been
established and to reassure a partner that honesty and trustworthiness are
available. Once a decision has been made to make the relationship work, it
does not change. Faithfulness matters a great deal to someone who has
overcome obstacles through the help of others.
Another tendency of adults with Asperger’s, one that also promotes
successful relationships, is the ability to be objective. When emotionality
runs high, passions distort the ability to think through misunderstandings,
miscommunication and disagreements. Being able to put aside emotions in
the service of a rational, measured approach to problem-solving often helps
a couple reach a mutually agreeable and workable solution to problems.

Many adults with Asperger’s lean towards being predictable in what

they do. Habitual tendencies and strong inclinations to think, act and feel a
certain way are favored by people with Asperger’s, mostly because they
prefer to know how things are going to work. They find uniformity and
regularity comforting. This has advantages in a relationship in so far as they
can be relied upon to do exactly what they say they will do. There are few
surprises for someone with Asperger’s and while this may be unappealing
to the person who wants a “wild and crazy” partner, for those who value
certainty, predictability and the knowledge that things will happen as they
are expected to, consistency is quite appealing.

Another advantage of having Asperger’s is that it provides an

explanation for many of the problems in a relationship. By knowing that
Asperger’s is a factor, both partners can see and understand more clearly
why their difficulties exist.
While building an intimate relationship with someone with Asperger’s
is not easy, several factors make that likely. When both partners are aware
of and accept the diagnosis of Asperger’s, misunderstanding and
miscommunication are reduced and they have an easier time agreeing on
the core problems in their relationship rather than arguing about what is
wrong.

It is helpful for the partner without Asperger’s not to accept a

disproportionate amount of blame for the relationship difficulties and to
seek support and validation from friends, family members and others who
have a balanced understanding of the relative contributions of both partners
in the relationship.
Having a realistic understanding of the strengths and weaknesses of the
relationship helps minimize blame. Cooperating in identifying changes to
improve the relationship also makes it easier to address and overcome
barriers to loving intimacy.

Access to a professional therapist or counselor who understands

Asperger’s greatly enhances the couples’ ability to meet and overcome
challenges to the integrity of their relationship.

Here are tips for adults with Asperger’s to create greater intimacy in their
relationships:

Your partner can’t read your mind, and so you must work hard to
communicate your needs and your limitations. Unless you say what
you want and don’t want, what works for you and what doesn’t, your
relationship will suffer and you will as well. Communication is
 fundamental to successful relationships. It is the key ingredient to
maintaining a relationship in a workable and functional state.

You must regularly express your love and affection for your partner.
Love can’t be assumed. It must be affirmed, said directly, and repeated
over and over, otherwise it is left up to each of you to imagine what the
other person feels. Imagination, without affirmation, can incite
misunderstanding, disagreements, doubts and conflict.

You must be willing to resolve conflicts, listen to the other’s point of

view, negotiate and follow through with compromises and agreements.
Disagreements do happen in relationships but too much strife, friction
and divisiveness poisons intimacy and is a path to unhappiness.

Downtime is essential. Keep always in mind your need for quiet time
and time alone. This is necessary in order to bring your mental,
emotional, and sensory system back into equilibrium. Let your partner
know this is not a rejection but a way of restoring your composure and
calmness, and a way of preventing unnecessary meltdowns.

After ten years of marriage, Susan was growing more and more concerned
that her husband, Jonathan, had reached a breaking point in their
relationship and was considering separating. She felt relieved and
supported by having been diagnosed six months earlier with Asperger’s
Syndrome but Jonathan was discouraged by what he considered to be the
futility of change in someone with this condition.

The couple worked together to identify the misunderstandings that

frequently resulted when Susan would roll her eyes when she was bored or
annoyed, when she sat apart from him at dinner parties, looked away when
he was talking to her and other forms of non-verbal communication. They
practiced active listening techniques, wrote out rules for their relationship
in order to make them explicit and worked on offering constructive
feedback to each other that emphasized what was changeable rather than
focusing on fixed character traits. They also addressed specific problematic
situations rather than general behaviors, avoided accusatory feedback and
focused on positive characteristics in each other.
Five months later, both Susan and Jonathan reported improved satisfaction
and less conflict in their marriage. These improvements continued as they
continued practicing these techniques on a daily basis.

Employment
Despite having, as a group, extremely useful and marketable skills, earning
a living is a challenge for many adults with Asperger’s. Shockingly, studies
show that 74-86% are either unemployed, underemployed in jobs that
underutilize their knowledge, skills and experience or wrongly employed,
that is, working in jobs for which they are not suited (Barnard et al, 2001,
Scheiner, 2011, Simone, 2010).

Additionally, adults with Asperger’s have a high degree of job

switching, resulting in fragmented work histories that negatively impact
their potential for successful employment and career development (Müller,
2003).
The reasons for this are many and varied:

• Organizational and attention problems.

• Responding inflexibly to unexpected work situations.

• Difficulty juggling multiple tasks

• Low frustration tolerance

• Poor emotional regulation

• Ineffective communication with co-workers

• Unusual responses to sensory experiences

These difficulties are compounded by the fact that many adults with
Asperger’s do not receive the support they need at work in order to perform
successfully (Beardon and Edmonds, 2007).
 In spite of the employment challenges for adults with Asperger’s, there
are numerous assets they bring to the workplace:

Adults with Asperger’s tend to have a higher than typical ability to pay
attention to details and to notice errors easily.

When a job task is meaningful and/or related to a special interest they

have, their ability to concentrate on a job task is greater than the
average worker.

They are well suited to engage in work that requires repetitive activity,
where routines are a core part of the job.

They are skilled in understanding large quantities of complex and

disparate information, recognizing abstract ideas and drawing clear,
simple conclusions from complex material.

The systemizing ability of adults with Asperger’s lead them to be

highly logical and to quickly and accurately perceive relationships
between people, objects and systems. Along with this they have a
strong desire to solve a problem once they are committed to it. Their
dedication to getting the job done makes for highly successful
employees.

I think a good case can be made that adults with Asperger’s want to fit
into the workplace, compete for meaningful, rewarding jobs, excel in
whatever vocation they chose and advance in their careers just as other
adults do. They may struggle with challenges that make these goals and
aspirations difficult but they offer numerous advantages to employers
across many different job and career settings. These benefits include the
ability to remember and process huge amounts of information, think
logically, organize and order disparate facts and knowledge, maintain focus
in repetitive job sequences, attend to details and solve complex problems.

The list of successful people who have, or are considered to have

Asperger’s, is long and distinguished. This include:

Alfred Hitchcock
 Bill Gates

Albert Einstein

Jane Austen

Dan Aykroyd

Thomas Edison

Daryl Hannah

Hans Christian Anderson

Thomas Edison

Isaac Newton

Obviously, having Asperger’s is no barrier to success, and one should

not think of it as such. Adults with Asperger’s have many varied and
important ways of contributing to society. It should not be an excuse to stay
out of the workforce nor a reason to doubt one’s ability to succeed.
Asperger’s is a platform for growth, achievement, progress and
effectiveness if thought of as such.
A recent law school graduate, Ms. M was increasingly despondent
by the regular rejections she received after interviewing with local
law firms. Knowing that having Asperger’s Syndrome made her
susceptible to being misunderstood and considered odd and
unusual, she practiced interviewing skills rigorously. But it was not
until she realized that her interest in family law was a poor match
for her talent digesting and understanding large quantities of
complex information that she realized a change was in order. She is
now a successful, and contented, patent attorney.

Parenting
Can someone with Asperger’s be an effective parent? Absolutely. Having
Asperger’s Syndrome does not make a person a bad parent, anymore than
not having Asperger’s makes someone a good parent. Loving your child
and wanting to be the best parent possible are the key ingredients of
successful parenthood.
This is not to say parents with Asperger’s have it easy. Realizing that
one’s child thinks and perceives the world quite differently is not an easy
task. Having trouble understanding how their children’s mind works makes
it hard for them to see the true nature of their children, their personal
qualities and essential makeup. They tend to treat their children as mini-
adults and have the same expectation of them as they do of themselves. The
complexity and unpredictability of children make relating to them stressful
and challenging much of the time. The tendency of adults with Asperger’s
to pull away from social interactions adds a source of misunderstanding,
heightens feelings of rejection, increases self-doubt among children of these
parents and may provide less of the acceptance, reassurance,
encouragement and love they hope for and need.
Notwithstanding these challenges, parents with Asperger’s offer many
potential benefits to their children:

Direct Communication
It’s true that adults with Asperger’s generally have trouble expressing how
they feel but on the other hand precisely because emotional expressiveness
is difficult they often learn to verbalize directly what they think they are
feeling. It may come out overly abstract, rational and composed yet in
speaking directly the message is delivered fairly accurately.
Children of parents who have Asperger’s learn, in many cases, to expect
to be told about the emotional state of affairs in the family rather than
learning about it from the emotive expressions of their parents. It may not
help in learning how emotions are expressed behaviorally but at least the
child knows what his or her parents are trying to communicate about what
they feel.

Routine and Organization

All children thrive on routine, planning and goal setting, and parents with
Asperger’s need and rely on regularity and predictability. Their tendencies
to plan things in detail, establish routines and ensure that the operations of
the household are run smoothly, efficiently and predictably often match
well with the needs of their children.
Clear expectations are one outcome of this focus on routine and
organization. Children in families where one or both parents have
Asperger’s benefit from knowing exactly what they can and cannot do,
what consequences will follow from each and what they need to do to get
back on track when their behavior deviates from the family expectations.
While the price of parental focus on routine and predictability can be
rigidity, the benefit is clarity in knowing how one is supposed to behave and
what that behavior will bring.

Honesty and Integrity

People with Asperger’s Syndrome are widely regarded as honest and
principled. They believe strongly in telling the truth and avoiding
deception, keeping to rules, and acting in accordance with moral and ethical
principles. They hold high the ideal of fair and equal distribution of
opportunities and privileges.
Clearly this has benefits in parenting. Parents who are honest raise
children who have similar values, who follow rules, communicate openly
and honestly, are less judgmental of others, have clear values and have a
strong sense of justice.

Empathy
It might come as a surprise to list empathy as one of strong suits of parents
with Asperger’s, but often the difficulty they had growing up with their
condition helps them understand the hardships children inevitably face in
their own maturation. They know what it’s like to be rejected, shunned, and
made fun of, to doubt, and to feel unloved. In a way, that makes them more
empathic with what the normal course of development is like for most
children.
 Special Interests

Adults with Asperger’s typically have a preoccupation with certain

interests, usually collections of objects or the acquisition of knowledge on a
specific topic or concept. When those interests mesh with the child’s
interest, both parent and child share an important bond that enhance each
other’s growth.

Don had a fascination with boats and water. When his children were
young he would take them out on his ski boat almost every weekend
during the summer months. Sometimes he would invite other
families along and when the children were old enough they invited
their friends to join. Those weekends led to amazing memories the
children later cherished.

Responsibility

Parents with Asperger’s don’t have a monopoly on responsibility,

obviously, but they often take life seriously, having struggled to fit into a
world that is different in many ways. That seriousness can coincide with a
clear and determined sense of responsibility in their lives and the lives of
their children.

They may not always understand what the appropriate response is in

difficult situations, having always struggled to “get” what’s right to do, but
many parents with Asperger’s do want to get it right and will try hard to
figure out what that is. If one area of parenting is foreign to them, like
setting limits on the children’s behavior, they will study the problem, learn
what to do, and try hard to implement solutions. Sometimes it may appear
mechanical and unemotional, but the trying is important.

Love

It’s untrue that parents with Asperger’s cannot love their children. They are
just as capable of being loving parents as neuro-typicals. The difficulty they
have in connecting with people should not be interpreted to mean a lack of
caring.
 Many adults with Asperger’s have strong loving, caring feelings that are
difficult for them to process, understand and communicate because of their
condition. The fact that it is hard for them to articulate their emotions,
especially those that are powerfully felt, should not be interpreted to mean
loving, affectionate feelings don’t exist.

The task for the parent with Asperger’s is to learn to express those
feelings more directly and frequently to their children. With the support and
encouragement from others and help in developing the skills to express
these feelings, communicating positive emotions is entirely possible.

All relationships take patience, hard work, and understanding. That is

even more the case when one person has Asperger’s Syndrome. While it
may seem that Asperger’s poses too great an obstacle for effective
parenting, in fact, parents who want to excel can do so regardless of the
barriers in their way.

Having Asperger’s is a challenge for parents, but wanting to do a good

job at it is the most important ingredient for effective parenting.

Both Allen and Karen have been diagnosed with Asperger’s

Syndrome. They realize that their heightened sensitivities,
preference for structure and organization and difficulty focusing
make the unpredictable, demanding, messy world of their two young
children difficult to cope with. They have spent the previous three
months working to develop more effective parenting strategies. They
wrote out a list of parenting rules, such as no name calling and
praising family members for their efforts even if they are not
performed perfectly, and focusing on compromise. They clarified
their responsibilities as co-parents and concentrated on highlighting
their respective strengths as parents in order to build greater
confidence and appreciation of what both of them have to offer.
Their work has paid off. They have found the means to get beyond
the challenges of Asperger’s and use their many strengths in the best
interests of their children.
Mental/Emotional Health

As I indicated previously, often Asperger’s Syndrome is accompanied by

other mental health conditions, a common one being depression. Depression
accompanied by social isolation, loneliness, social exclusion, and
unemployment, all risk factors with Asperger’s, tends to be entrenched,
rigid and severe. Damaging, fatal consequences are sometimes possible
outcomes.

A recent study confirmed the link between Asperger’s and suicide risk.
According to the results, adults with Asperger’s are nine times more likely
to experience suicidal thoughts than people without Asperger’s (Cassidy et
al, 2014). In addition, the study found that 66% of adults with Asperger’s
had contemplated suicide at some time during their life and 35% had
planned or attempted suicide. Furthermore, adults with Asperger’s who also
reported sustain feelings of depression were four times more likely to
experience suicidal thoughts and twice as likely to plan or attempt suicide,
compared to adults with Asperger’s Syndrome without a history of
depression.These statistics are cause for concern, and the problem of
suicide among adults with Asperger’s is a matter for attention by all those
who love and care for them.

Substance abuse is another area of concern. Previous research has

reported that abusing drugs or alcohol is not a significant problem among
people with Asperger’s, which is understandable since people on the
spectrum generally do not need alcohol or drugs as a social lubricant and
prefer not to take the risks that substance abuse often involves.
But new research suggests the opposite. In a large sample of adults,
35% of those with symptoms along the autistic spectrum were alcohol
dependent and 39% were habitual users of marijuana. Interestingly, the
study found that this large percentage occurred among adults who had traits
of autism but not a formal diagnosis. It seems that being diagnosed, which
implies a more severe form of an autistic disorder, may keep people from
even experimenting with substances. Those with less severe forms,
including those with Asperger’s, are more likely to try substances and
having done so they are more at risk of developing an addiction.
 Of course, one’s mental and emotional health, along with the use of
alcohol and drugs, should be of interest to anyone. For those with
Asperger’s, these are aspects to pay particular attention to. Heightened risk
factors make ignoring them potentially risky.

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 CONCLUSION

Seventy years after Hans Asperger first described the condition that was
later to bear his name, our understanding of Asperger’s Syndrome has
expanded dramatically. We know much better what makes Asperger’s
different from other, sometimes overlapping, conditions such as classic
autism, ADHD, depression, language and communication difficulties, and
learning disorders. More precise and accurate diagnostic instruments make
it easier to determine whether someone has Asperger’s and assess for the
presence of associated conditions. Resources to assist those dealing with
Asperger’s, including therapy, social skills training, support groups,
vocational counseling, and self-help programs are more available than they
have ever been and are becoming ever more effective. Research into the
causes of Asperger’s gives realistic hope to the goal of finding a cure for
this challenging condition.
The future for those with Asperger’s is promising. But a major concern
persists. Most of what we know about Asperger’s and the majority of
services directed towards this condition have been focused on children and
adolescents, for obvious reasons. We, as a people, value helping the
youngest and most vulnerable among us. What kind of society would we be
if we neglected the needs of our children? How can we not direct our efforts
towards helping those with differences grow and prosper in a world that
does not always accept them?
But, children grow up, and Asperger’s doesn’t disappear when
adulthood begins. What is Asperger’s Syndrome like for those facing the
demands and challenges of being an adult? What support is available for
them? What can they do themselves to make their lives easier, richer, more
rewarding and less fraught with struggle, complication and aggravation?
What can we do to help them?

These are only a few of the questions to be answered. It is time that

more attention is directed toward the needs of adults with Asperger’s so that
they can enjoy the benefits of friendships, marriage, parenting and work
like everyone else. We must understand better how adults with Asperger’s
can cope successfully with ADHD, depression, social anxiety and other
associated conditions. More attention should be given to educating the
public about Asperger’s Syndrome in adults. Additional assistance, public
and private, should be directed towards their overall success and wellbeing.
We can do more to help them advocate for themselves effectively. Certainly,
more effective societal resources, including employment assistance and
mental health treatments, are in order.
Too often the focus has been on negatives aspects of Asperger’s. It is
time to give more consideration to strengths that adults with Asperger’s
have. We need to acknowledge the positive outcomes of Asperger’s, the
diverse skills and abilities of adults with Asperger’s and the benefits these
skills and abilities bring to individual relationships and to society.
We need to recognize the amazing ability of those with Asperger’s to
order, group and arrange information, knowledge, and a host of other
important aspects of life into meaningful arrangements, to see relationships
among things that others cannot see as clearly, to connect diverse matters
into coherent patterns and to make meaning where meaning is not obvious.
We need to appreciate the directness of those with Asperger’s, their
ability to speak sincerely, to be honest and determined, their intelligence,
perseverance, conscientiousness and diligence.
We need to value the fact that people with Asperger’s often see and
accept the world as it is. They know what it’s like to be different, to be
marginalized, separated and discriminated against. They have experienced
rejection. They understand the world is not always embracing of
differences. People who are different, as they are, often are looked at with
suspicion and treated with impatience. They receive blame for things they
didn’t do just because of their differences, and having endured all of these
throughout their lives they learn to accept the immense diversity in life.
People with Asperger’s appreciate others for who they are because they’ve
come to grips with who they are themselves.

The ways that adults with Asperger’s make sense of other people’s
behavior, how they predict what people may do next and how they think
about their own behavior in relation to others, all help them lean away from
making too many inferences about what is going on and instead focus on
the immediate facts in front of them. When others are overwhelmed with
fear, panic or confusion, people with Asperger’s often are able to calmly
and rationally observe, analyze and search for solutions. We need to
appreciate these valuable skills.

We also need to welcome the preference for routines and maintaining

order and accuracy that is characteristic of Asperger’s. Predictability may
bore those in need of constant change, the thrill seekers and excitement
junkies among us, but for most people regularity is a welcomed respite from
a topsy-turvy life. What’s wrong with knowing what you’re dealing with
now and what’s coming next?

What if we were to look at Asperger’s Syndrome as a collection of

special strengths, useful abilities and positive talents? Would we see
Asperger’s as a disorder, an aberration to be avoided, a syndrome to be
corrected, treated and changed? Would we focus on what is wrong with
people who have Asperger’s instead of what works for them and what they
have to offer? Would we affirm, value and praise those with Asperger’s, and
would we support the diversity they bring to society? Would we recognize
their personal strengths and accept who they are, or would we continue to
focus on the challenges they face with little patience for what life with
Asperger’s is like?

The answers to these questions are debatable, no doubt, but a reasonable

argument can be made that acceptance, encouragement, support, and
appreciation more often lead to positive outcomes than the opposite
response to differences. We can’t make everyone be the way we would like
them to be and why would we try? When we focus on what is right with
others we focus on what is right with ourselves and, along the way,
everyone benefits.

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 RESOURCES FOR ADULTS WITH
ASPERGER’S

Asperger’s Association of New England

Www.aane.org

One of the largest organizations in the US devoted to Asperger’s Syndrome,

AANE provides support groups, conferences, seminars, workshops and
online resources to promote awareness and acceptance for people with
Asperger’s and those who support them.

Asperger Syndrome and High Functioning Autism Association

(AHA)
http://ahany.org/

Based in New York, AHA provides monthly support groups, educational

presentations, conferences and online resources for individuals on the
autism spectrum, their families, professionals and others. The focus of AHA
is to encourage awareness and support for those on the spectrum.

Wrong Planet
http://wrongplanet.net/

Wrong Planet is an online community for individuals, parents and

professionals concerned about Asperger’s and those on the autism
spectrum. Wrong Planet provides a discussion forum, articles, blogs and
other resources to promote communication and awareness.

Advancing Futures for Adults with Autism

http://www.afaa-us.org/
AFAA is a US based consortium of organizations working to promote
public and private sector help for policy initiatives to support individuals
with autism, including adults, and their families. Their website provides
information on research, programs and services for adults with autism.

US Autism and Asperger Association

http://www.usautism.org/

An organization of professionals in the field of autism and Asperger’s

whose mission is to support the community of autism through a yearly
conference in the US, a newsletter, scholarships and financial aid, online
resources and other endeavors.

Chat for Adults with High Functioning Autism and Aspergers

http://www.adultaspergerschat.com/2011/09/high-functioning-
autism-diagnosis-in.html

An online blog, chat room, newsletter and resource center for adults with
high functioning autism and Asperger’s.

Autism Speaks
https://www.autismspeaks.org/

Autism Speaks provides tools and information for adults with Asperger’s,
including networking groups, housing support information, educational
resources, research information, family services, advocacy programs and
online information.

OASIS@MAAP
http://www.aspergersyndrome.org/

Online Asperger Syndrome Information and Support (OASIS) together with

MAAP Services for Autism and Asperger Syndrome is a resource center for
families, individuals, and professionals who deal with the challenges of
Asperger’s Syndrome and related conditions. Their website provides
articles, educational resources, links to local, national and international
support groups, resources for professional help, conference information,
recommended readings, and message boards.

Global and Regional Asperger Syndrome Partnership (GRASP)

http://grasp.org/

GRASP, the Global and Regional Asperger Syndrome Partnership, is the

largest educational and advocacy organization in the world serving adults
who are diagnosed along the autism spectrum. GASP provides an
educational clearinghouse, online support groups, and blogs. As an
Asperger’s organization, GRASP is unique in that 100% of the Advisory
Board and 50% of the Board of Directors all must be diagnosed on the
autism spectrum.

Families of Adults Affected by Asperger’s Syndrome

http://faaas.org/

The mission of this group is to provide support to family members of adults

with Asperger’s. They offer articles, research materials, information on
Asperger’s specialists and support centers, and a bulletin board for
members.

LOCAL AND REGIONAL SUPPORT GROUPS

Below is a list of peer run support groups focused on adults with

Asperger’s:

Adult Aspergers Spectrum Coalition for Education Networking and

Development (San Francisco, CA)
http://www.aascend.org/
Autism Society of Western New York
http://www.autismwny.org/support.aspx

Milwaukee area
http://www.namigrm.org/#!support/c1b08

Autism Society of Illinois

http://www.autismillinois.org/resources/support-groups/support-
groups/

Portland Adult Asperger Support Group

http://aspdx.org/

GRASP Support Group Chicago

https://www.autismspeaks.org/resource/grasp-support-group-
chicago-evanston

Alaska Support Group

http://www.sesa.org/pub/AARC/AARCSSSGF0312.pdf

The Asperger Adults of Greater Washington (DC)

http://aagw.net/meetings/

Autism Society of San Francisco Bay Area

http://www.sfautismsociety.org/support-groups.html

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 BIBLIOGRAPHY

Ariel, C. (2012) Loving Someone with Asperger’s Syndrome:

Understanding and Connecting with your Partner. New Harbinger
Publications.

In-depth understanding of the effects of Asperger’s on relationships.

Practical strategies for developing effective communication skills,
working through conflict and developing ways of meeting each
other’s needs. Helpful for both partners with Asperger’s and those
without it.

Aston, M. (2014) The Other Half of Asperger Syndrome (Autism Spectrum

Disorder): A Guide to Living in an Intimate Relationship with a Partner
who is on the Autism Spectrum. London: Jessica Kingsley Publishers.

Expanding on an earlier book, the author provides useful guidance

and research based strategies to address the challenges of an
Asperger’s relationship. Written mainly for partners of someone
with Asperger’s, topics cover a variety of useful suggestions for
improving communication, deepening intimacy and managing the
stress of this challenging condition.

Bashe, P, R. (2104) Asperger Syndrome: The OASIS Guide, Revised Third

Edition: Advice, Inspiration, Insight, and Hope, from Early Intervention to
Adulthood. Harmony.

A comprehensive resource guide to Asperger’s. Full of practical and

sensible suggestions for dealing with the many complexities of this
condition. Covers problems of childhood and adolescence but
includes strategies and advice for adults with Asperger’s.

Bassinet, B. (2012) The Complete Guide to Getting a Job for People with
Asperger’s Syndrome: Find the Right Career and Get Hired. London:
Jessica Kingsley Publishing.
 This book addresses practical considerations for obtaining and
maintaining employment for those with Asperger’s. Topics range
from developing the proper interviewing attitude, building
confidence, narrowing career options, communication skills in the
workplace, managing anxiety, handling stress and many others.

Bassinet, B. (2013) Asperger’s Syndrome Workplace Survival Guide: A

Neurotypical’s Secrets for Success. London: Jessica Kingsley Publishing.

Once you have a job, how do you keep it? This is the central
questions addressed in this book, intended for adults with
Asperger’s who are learning the skills needed for steady
employment. Includes realistic strategies for working as a team
member, managing projects, conflict resolution and problem
solving, among others. .

Bentley, K. (2007) Alone Together: Making an Asperger Marriage Work.

London: Jessica Kingsley Publishing.

The author’s account of her long-term marriage to a man with

Asperger’s. She describes how they struggled successfully to
achieve mutual understanding, acceptance and appreciation of their
differences. A poignant tribute to the power of positive thinking and
effort in coping with Asperger’s. With a forward by Tony Attwood.

Carley, M.J. And Gerhardt, P.F. (2008) Asperger’s From the Inside Out: A
Supportive and Practical Guide for Anyone with Asperger’s Syndrome.
Perigee Books.

Michael John Carley is the founder of GRASP, the largest

organization for adults on the autism spectrum. Diagnosed with
Asperger’s years ago, his book is filled with practical advice for
adults coping with the challenges of this condition and those
supporting them.

Finch, D. (2012) The Journal of Best Practices: A Memoir of Marriage,

Asperger Syndrome, and One Man’s Quest to Be a Better Husband.
Scribner.

A wonderfully honest, engaging, humorous, sensitive and insightful

book about the author’s efforts to make his marriage succeed while
coping with Asperger’s. Highly recommended.

Gas, V.L. (2011) Living Well on the Spectrum: How to Use Your Strengths
to Meet the Challenges of Asperger Syndrome/High Functioning Autism.
New York: The Guilford Press.

Rare among books on Asperger’s written by professionals, this is a

strength based, positive oriented approach to managing this
condition in adulthood. Includes many practical strategies,
examples, vignettes and other methods of teaching and informing
the best ways of making a success of Asperger’s.

Grandin, T and Panek, R. (2014) The Autistic Brain: Helping Different

Kinds of Minds Succeed. Mariner Books.

Co-authored by one of the pioneers in the field of autism together

with an engaging writer, this book explores the science of autism,
it’s causes, diagnosis and treatment. No one knows more on this
subject than Temple Grandin and, as she has in many other books,
her voice brings authority and passion to a complex problem in an
readable, understandable way.

Grandin, T. (2015) The Way I See It, Revised and Expanded 2nd Edition: A
Personal Look at Autism and Asperger’s. Future Horizons.

This collection of articles, illustrates Dr. Grandin’s invaluable

personal and professional insights as someone with autism, about
autism and Asperger’s, including many direct suggestions on coping
with Asperger’s in adulthood.

Grossberg, B. (2015) Asperger’s and Adulthood: A Guide to Working,

Loving, and Living with Asperger’s Syndrome. Althea Press.
 A helpful and easy read with valuable tips on employment,
independent living, relationships and intimacy, and other practical
matters for adults with Asperger’s.

Harmon, A. (2014) Asperger Love: Searching for Romance When You’re

Not Wired to Connect. Byliner

Beautifully written account of a couple (he is the son of John Elder

Robisson) who both have Asperger’s, in their search for love and
compatibility. New York Times correspondent Amy Harmon,
expands on an award-winning article she published in the Times in
2011.

Hoopmand, K. (2012) Inside Asperger’s Looking Out. London: Jessica

Kingsley Publishing.

A different kind of book from most, this is filled with evocative

photographs and text that show what the world of Asperger’s is like,
through a positive and uplifting perspective.

Kim, C. (2013) I Think I Might be Autistic: A Guide to Autism Spectrum

Disorder Diagnosis and Self-Discovery for Adults. Narrow Gage.

Diagnosed with Asperger’s in her forties, the author shares her

insights on the impact of discovering Asperger’s as an adult and her
journey towards self-acceptance and love.

Marshack, K.J. (2009) Life with a Partner or Spouse with Asperger

Syndrome: Going over the Edge? Practical Steps to Saving You and Your
Relationship. Autism Asperger Publishing Company.

Psychologist Dr. Marshak writes about the issues that couples face
when one partner has Asperger’s and the other is neuro-typical. She
focuses on the sources of disagreements and miscommunication and
how these can best be addressed, using helpful vignettes from her
own experiences and those of her patients. She discusses new ways
 of looking at these relationships and how to make them as
successful as possible.

Mendes, E. A. (2015) Marriage and Lasting Relationships with Asperger’s

Syndrome (Autism Spectrum Disorder) London: Jessica Kingsley
Publishing.

Strategies to help couples where one or both have Asperger’s

Syndrome. This is practically oriented, covering topics such as
sexual compatibility, communication, co-parenting, and relationship
building.

Price, S.E. (2015) Asperger Syndrome Explained: How to Understand and

Communicate When Someone You Love Has Asperger’s Syndrome. Create
Space Publishing.

A useful book for those seeking to understand what Asperger’s is all

about. Covers the causes of Asperger’s, signs and symptoms,
diagnosis, communication strategies, and coping strategies.

Robison, J.E. (2008) Look Me in the Eye: My Life with Asperger’s. Three
Rivers Press.

Diagnosed at age 40, John Elder Robison realized what his oddities
had been all about throughout his life. A moving and, at times,
funny memoir of life living within the spectrum.

Silberman, S. (2015) NeuroTribes: The Legacy of Autism and the Future of

Neurodiversity. Avery.

An award winning, brilliantly written study of autism-how it came

to be and why it has dramatically increased in recent years. A must
read for those interested in the phenomenon of neurodiversity.

Simone, R. And Grandin, T. (2010) Asperger’s on the Job: Must-Have

Advice for People with Asperger’s or High Functioning Autism and their
Employers. Future Horizons.
 A highly useful resource for adults on the spectrum, and those
helping them, who wish to find and keep meaningful employment.
Lots of practical tips provided with appropriate sensitivity and
expert knowledge.

Simone, R. (2009) 22 Things a Woman Must Know: If She Loves a Man

with Asperger’s Syndrome. London: Jessica Kingsley Publishing.

Written for women who seek to overcome the difficulties of loving a

man with Asperger’s, this book combines research finding and the
author’s compilation of personal experiences to provide tips on
improving relationships and finding happiness within the spectrum.

Stanford, A. and Willey, L.H. (2014) Asperger Syndrome (Autism Spectrum

Disorder) and Long-Term Relationships. London: Jessica Kingsley
Publishing.

Married to a man with Asperger’s, the author provides numerous

strategies for untangling the complications of a relationship with
someone along the spectrum.

Willey, L. H. (2014) Pretending to be Normal: Living with Asperger’s

Syndrome. London: Jessica Kingsley Publishers.

Diagnosed as an adult, the author reflects on her life along the

spectrum, in a compelling, delightfully written memoir of value to
anyone seeking to understand neurodiversity.

Wylie, P. And Beardon, L. (2014) Very Late Diagnosis of Asperger

Syndrome (Autism Spectrum Disorder): How Seeking a Diagnosis in
Adulthood Can Change Your Life. London: Jessica Kingsley Publishing.

A well-written, exceedingly useful book about the process and

consequences of an Asperger’s diagnosis in adulthood. Practically
oriented strategies, combined with wisdom gleaned from personal
experience, provide support and guidance for adults who seek
understanding of their differences.

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 ABOUT THE AUTHOR

Dr. Kenneth Roberson is a clinical psychologist and psychoanalyst in

San Francisco. He has had a long-standing interest in Austin Spectrum
Disorders, writing on the subject and working with adults on the spectrum.
Currently, he is working on a book about diagnosing Asperger’s Syndrome.

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