HIGH FUNCTIONING AUTISM & ASPERGER’S SYNDROME: THE DILEMMA OF THE ...

[Pages:12]ISSUE ONE ? 2008

IN THIS ISSUE

High Functioning Autism & Asperger's Syndrome: The Dilemma of the Autism Spectrum ..............................1

Bringing a New Awareness of Sexuality into Social Work Theory and Practice........2

Translation Please! Integrating Neuroscience into Social Work Practice ........................7

Publication of articles does not constitute endorsement by NASW of the opinions expressed in the articles. The views expressed are those of the author(s).

HIGH FUNCTIONING AUTISM & ASPERGER'S SYNDROME: THE DILEMMA OF THE AUTISM SPECTRUM

By William Shryer, LCSW, BCD

Asperger's syndrome (sometimes referred to as Asperger's) is not a new diagnosis. In fact, it was discovered in 1944 but was not officially included in the Diagnostic and Statistical Manual (DSM) until the fourth edition (DSM-IV-TR). No doubt, this delay contributed to the misdiagnosis of many children over the years with ADD (Attention Deficit Disorder), ADHD (Attention Deficit with Hyperactivity Disorder), autism, OCD (Obsessive-Compulsive Disorder), and even schizophrenia.

Two Austrian behavioral scientists were separately studying disorders in the autism spectrum in different countries at about the same time. While Hans Asperger was describing the syndrome that is named after him in Austria, Leo Kanner was in the United States, half a world away, writing about autism. Although they share similar characteristics, the degree of disability varies widely between the two disorders and within individual cases of each disorder (National Autistic Society, 2008).

What is Asperger's Syndrome?

Asperger's syndrome is a neurobiological disorder that is classified as a pervasive developmental disorder (PDD). It is characterized by "significant" impairment in social interaction, as well as the development of repetitive and restricted fields of interest and activities.

The use of the term "significant" is somewhat controversial as we now understand the complete spectrum of how people are affected. This runs from marginal to severe in their ability to navigate the sometimes confusing world of social interaction (National Institute of Mental Health, 2007).

While there are some similarities with autism, people with Asperger's usually have average to above average IQ, and do not demonstrate clinically significant delays in language or self help skills. They may have an extremely good command of language and have a very rich vocabulary, but they are unable to use language appropriately in a social context and often speak in a monotone with little nuance and inflection in their

(The Dilemma of the Autism Spectrum, continued on page 3)

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BRINGING A NEW AWARENESS

OF SEXUALITY INTO SOCIAL

WORK THEORY AND PRACTICE

By Stephen Hicks, PhD, DipSW

In the past decade, sexuality within social work theory, education and practice, has moved from a position of relative neglect to gain greater prominence (Hicks, 2005; Fish, 2006; Morrow & Messinger, 2006; Bywater & Jones, 2007; Myers & Milner, 2007; Mallon, 2008). This positive change may be due to the tendency to view sexuality as having fixed characteristics and social welfare needs (Hicks, 2008b).

Social work practitioners are finally recognizing that sexuality is present within all social work theory and practice and should be taken into consideration with all clients, regardless of their background. Sexuality is present in our views on homosexual and heterosexual lifestyles, (even if this is often taken-for-granted) in our approaches to social work practice with families, communities, or networks, and in our theories about gender, kinship, parenting, and race.

Even though this new focus on sexuality is a positive step forward, theories and practices in the field of human sexuality remain limited. For instance, there is a tendency to think only about lesbian, gay, bisexual, and transgender (LGBT) people and their unique concerns rather than about sexual expression in general.

Additionally, a LGBT "culture" is often assumed to exist and, from our fixed notions about sexual types, social work defines its needs. This tendency fosters a liberal, functionalist model of practice, which implies that sexual minorities should assimilate into wider cultural and sexual norms and is described by social workers as "anti-discriminatory practice" or "LGBT-affirmative practice."

A more reflective social work theory and practice is needed. Otherwise a number of things will happen: heteronormative ways of thinking will continue to go unquestioned; the view that sexuality applies only to minority "types" will persist; and essentialist and narrow views of what LGBT categories refer to will persist.

(Bringing a New Awareness of Sexuality, continued on page 5)

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(The Dilemma of the Autism Spectrum, continued from page 1)

voices. Once again this is highly variable as there are some that only have what have been described as, "shadow syndromes." This means that they will only demonstrate the slightest of symptoms (National Autistic Society, 2008).

Because Asperger's syndrome is a neurobiological genetic disorder, some will be more highly affected, while others will only show a few odd quirks, such as a fascination with computers or astronomy. They often are found working in the high tech arena where their interests are not condemned, but actually supported. (National Institute of Mental Health, 2007).

Children with Asperger's syndrome may or may not seek out social interaction, but will always have difficulty interpreting and learning the skills of social and emotional interaction with others, leading to "significant" impairment in relationships and peer interaction. They are unusually concrete in their thinking and do poorly at abstractions. A saying such as, "don't cry over spilled milk" will often lead them to ask "why," or say "just clean it up."

Although parents often notice problems at an early age, diagnosis is usually made during preschool. While both boys and girls may have Asperger's, the syndrome is more common in boys. Perhaps girls are not diagnosed as often because they tend to stay out of the spotlight that boys for some reason have a harder time accomplishing.

What is High Functioning Autism?

High functioning autism (HFA) is the traditional diagnosis for individuals with severe social interaction and communication deficits (Dinklage, 2001). Although the distinction with Asperger's is blurred and indeed, Asperger's is often considered a subset of HFA, people diagnosed with HFA tend to have a higher performance IQ (P-IQ) than verbal IQ (V-IQ) and avoid social contact more. They also tend to have had a slower language acquisition during childhood and were late in their developmental

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milestones (National Institute of Mental Health, 2007).

Parent's of these children frequently find this true when reviewing their baby books for information on when their child said their first word, put several words together, and so forth. One of the best known people with "high functioning autism" is Temple Grandin a well known author. Her books such as Thinking in Pictures (2006) have opened the eyes of many to better understand the unique differences in how people perceive the world around them (Dinklage, 2001).

Diagnostic Confusion

Currently we see many clients with Asperger's syndrome in our practice with a diagnosis of bipolar disorder, obsessive compulsive disorder, attention deficit disorder and avoidant personality disorder. This is the price we pay for categorization.

Asperger's syndrome will look similar to obsessive compulsive disorder when, in fact, it is more like having a "stuck thought." People with Asperger's enjoy thinking about their special interests and have no anxiety over their "special thoughts" whatsoever.

Also, people with Asperger's (especially the young) may have terrific temper tantrums, which sometimes lead to a diagnosis of bipolar disorder. However, their anger is due to the incredible frustration they feel when their need or desire to talk about, for example, vacuum cleaners or fish skeletons is interrupted.

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Mental Health ? Issue One ? 2008

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Because they don't understand the vagaries of social interaction and often stay away from the confusion, they may receive a label of avoidant personality, one of the more unusual misdiagnoses.

A misdiagnosis of attention deficit disorder, is very understandable, albeit incorrect. Such children and adults spend an enormous amount of time "inside their own heads", therefore they are often not paying attention to the teacher. However, this example is a classic case of "deficits of attention," not ADD.

The rating scales that are provided to parents and to pediatricians by companies selling psycho stimulants can result in "false positives" for ADD. When an already over-focused Asperger's child or adult takes these drugs, she may display what is jokingly referred to as "attention surplus disorder," and she will likely focus even more on her special interest and do worse in school. Also, people with Asperger's syndrome already carry a high amount of anxiety; therefore, they tend to become even more anxious. Giving psycho stimulants to someone with Asperger's syndrome is like offering a double shot of espresso to calm someone down.

The often confusing nature of autism spectrum disorders presents clinicians with significant challenges. At our behavioral health center, we use the image of an "iceberg"as our logo, because so many children come to us with a diagnosis that addresses only their most obvious symptoms and fails to correctly identify underlying syndromes. Lengthy, detailed case histories are the only way to fully understand what is hidden under the surface. As I often tell my students, "The mark of a true professional is to know when you don't know."

William Shryer, LCSW, BCD, is the Clinical Director of Diablo Behavioral Health Care located in California. He received his MSW from the University of California at Berkeley specializing in children and families. Mr. Shryer currently manages two behavioral clinics with a staff of physicians, counselors, clinical psychologists, and educational psychologists.

References

American Psychiatric Association.(2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR) (4th ed., 2000, text revision). Washington, DC: American Psychiatric Press.

National Institute of Mental Health. (2007, January). Autism spectrum disorders: Pervasive developmental disorders. Washington, DC: Author.

Dinklage, D. (2001, Spring). Asperger's disorder and nonverbal learning disorders: How are these two disorders related to each other? Retrieved from Dinklage_1.htm on March 14, 2008.

Gradin, T. (2006). Thinking in pictures: and other reports from my life with autism. New York: Randon House, Vintage Books.

National Autistic Society. (2008). High-functioning autism and Asperger syndrome: What's the difference? Retrieved from .uk/nas/jsp/polopoly.jsp?d=1049&a=3337 on March 14, 2008.

Issue One ? 2008 ? Mental Health

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(Bringing a New Awareness of Sexuality, continued from page 2)

Facing the Challenges

Why is gaining a greater understanding of LGBT people a potentially negative thing? It is true that knowledge is beneficial, but only if it includes all people, not just those in certain groups. Social workers should be aware of the pitfalls of these attitudes and approaches.

First, some approach epistemological questions in a purely factual way, as though knowledge itself were fixed and had no moral or ethical implications. A classic social work version of this is the "myths versus facts" approach, in which "bad, homophobic, irrational" ideas about LGBT people are replaced with "good, anti-discriminatory, factual" ones.

For example, the "myth" that children need a mother and father in order to have proper male and female role models, is answered by the "fact" that children get their role models from many people besides their parents (Mallon & Betts, 2005, p. 23).

Although this statement is positive and is designed to support lesbian and gay parents, it also brings up several issues. For instance, it assumes the validity of the notion that homosexuality is equivalent to taking on the gender of the opposite sex--that lesbians and gay men are essentially "gender inverts."

A more useful approach might be to examine our assumptions about gender--the behavioral, cultural, or psychological traits typically associated with one sex. Social workers may legitimately ask whether gender is congenital or acquired--or, as is more likely, both. We may also challenge the idea that children need traditional gender role models (Hicks, 2008a).

The "myths vs. facts" approach also perpetuates the idea that prejudices are simply maladaptive beliefs, frequently addressed within social work theory. Homophobia is seen as something to be countered through education and reflection. This idea leads to a paternalistic attitude that separates

social workers and the LGBT community from the rest of society. Moreover, it frames the problem in terms of individual behavior, instead of systemic epistemological and pragmatic issues.

Social work is a normative profession. Therefore, it is crucial for social workers to examine the theories and practices that are heteronormative-- not only taking heterosexuality for granted but also giving it a privileged status. The influence of heterosexual normatively on social work assessments, interviews, case discussions, reports, and other practices and interventions is a crucial area for investigation (Hicks, 2008b).

The notion that a social worker must gain a greater understanding of LGBT issues is heteronormative, because it presumes a privileged knower and the known. This approach draws attention away from sexuality in general and is likely to do more harm than good, by engendering other limiting views of sexuality such as lesbian feminism, gay liberation, queer theory, and interactionist ideas. By asserting that sexuality is a system of knowledge rather than an innocent expression of the self, such theories serve to constrain, rather than enable, self-realization.

Beginning the Dialogue

Everyone is influenced in some way by the dominant discourses on sexuality, but it is possible to rethink how we approach sexuality in social work education and practice so that we

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Mental Health ? Issue One ? 2008

may offer better care to all our clients, regardless of their sexual orientation (Hicks, 2005).

Even when an agency is committed to equality, tacit assumptions of heterosexual normatively may be at play. I strive to challenge these assumptions in my work with LGBT foster and adoptive parents.

At a recent training event that I co-facilitated, for example, a member of the adoption panel (the body that decides whether to approve and register applicants) stated that she did not approve of gay or lesbian adopters as it went against her Catholic beliefs.

Moreover, a survey of US adoption agencies also found that concerns "about offending community standards, violating religious doctrine and/or alienating possible funding sources evidently [led] many of these agencies to have, at most, a low-key approach to recruiting homosexuals as prospective adoptive parents" (Evan B. Donaldson Adoption Institute, 2003, p. 38).

In addition to research and writing about this topic, I also work alongside social work practitioners and offer guidance as well as provide training for foster care and adoption workers, managers and panel members. Through these venues, social workers are able to raise and discuss questions about sexuality, and to look at practice implications in detail.

Social workers can call attention to the limited range of ways in which sexuality has been theorized about, and the myriad ways we can think about it. We can do this by asking the difficult questions about normative practices, such as the search for "gender role models" or opposition to gay or lesbian parents. This practice also sheds light on the ways in which an account of `sexuality' is produced via the talk and textual work that goes into a social work assessment report.

Opening up dialogue does not--and should not-- produce easy answers, nor should it be expected to change attitudes overnight. Instead, the goal should be to encourage broader "thinking about sexuality and enable social workers to practise reflexively, that is, to consider how their actions

are producing particular constructions of sex and sexuality that have consequences for people" (Myers & Milner, 2007, p.169).

Social work research must critically examine the historical impact of these discourses on theory and practice if we are to understand how sexual knowledge categories are produced and held in hierarchies within the everyday, as a part of mundane social relations (Hicks, 2005).

Stephen Hicks, PhD, DipSW, is a registered social worker and reader in the Faculty of Health and Social Care at the University of Salford (UK). He is a co-editor of Lesbian & Gay Fostering & Adoption (1999), and a founder and member of the Northern Support Group for gay and lesbian foster carers and adopters (.uk). He may be contacted at s.hicks@salford.ac.uk.

References

Bywater, J., & Jones, R. (2007). Sexuality and social work. Exeter, UK: Learning Matters Ltd.

Evan B. Donaldson Adoption Institute. (2003). Adoption by lesbians and gays: A national survey of adoption agency policies, practices, and attitudes. New York, NY: Author.

Fish, J. (2006). Heterosexism in Health and Social Care. Basingstoke, UK: Palgrave Macmillan.

Hicks, S. (2005). Sexuality: Social work theories and practice. In R. Adams, L. Dominelli and M. Payne (Eds.), Social work futures: Crossing boundaries, transforming practice (pp.141-153). Basingstoke, UK: Palgrave Macmillan.

Hicks, S. (2008a) Gender role models...who needs `em?! Qualitative Social Work, 7(1), 43-59.

Hicks, S. (2008b) Thinking through sexuality. Journal of Social Work, 8(1), 65-82.

Mallon, G.P. (2008). Social work practice with lesbian, gay, bisexual, and transgender people (2nd edition). Binghamton, NY: Haworth Press.

Mallon, G.P. & Betts, B. (2005). Recruiting, assessing and supporting lesbian and gay carers and adopters. London, UK: British Association for Adoption & Fostering.

Manchester City Council: Children, Families, and Social Care. (2004). Practice guidance on assessing gay and lesbian foster care and adoption applicants. Manchester, UK: Author.

Morrow, D.F. & Messinger, L. (2006). Sexual orientation & gender expression in social work practice: Working with gay, lesbian, bisexual, and transgender people. New York, NY: Columbia University Press.

Myers, S., & Milner, J. (2007). Sexual issues in social work. Bristol, UK: Policy Press.

Issue One ? 2008 ? Mental Health

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TRANSLATION PLEASE! INTEGRATING NEUROSCIENCE INTO

SOCIAL WORK PRACTICE

By Frank J. Kros, MSW, JD

Have you talked to a neuroscientist lately? Exciting discoveries from neuroscience hold great potential for improving social work services. The fields of medicine, business, law, and education have already embraced brain research and integrated into professional practice. In particular, educational professionals have applied neuroscience findings to significantly improve theory and practice.

Social work, however, appears reluctant to use and influence neuroscience research. Perhaps social work could borrow a strategy from education, and encourage the development of "translators" to interpret brain research for the profession and guide researchers to more in-depth study of topics such as trauma.

The Decade of the Brain

The latest brain-science breakthroughs suggest social work professionals can expand and enhance interventions for a variety of clients by tapping into the explosion of research on the human brain. Starting in the mid-1980s, scientists developed an array of new technologies that

allowed researchers to image the brain through non-invasive methods.

These powerful technologies, including positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI), illuminated both the structure and function of the brain as never before. Perhaps most important, the imaging technology permitted researchers to observe the brain in action-- whether at rest, under stress, in conflict, or during problem solving.

So revolutionary was this technology and its contribution to human understanding of the mind, the United Nations declared the 1990s the "Decade of the Brain."

Embracing the New Technology

Several professions, are quickly and aggressively embracing the new technology:

? Medicine: Because the technologies were developed in the context and confines of medicine, medical research using the scanning

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Mental Health ? Issue One ? 2008

Ensure an adequate and viable social work workforce for the future.

The Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act (H.R. 5447), when enacted, will enable our nation's 600,000 professional social workers to better serve individuals, families and communities in need. Learn more at



and related technology revealed thousands of new insights, understandings, and therapies.

? Pharmaceuticals: Piggybacking on the medical insights--and sponsoring research of its own-- the pharmaceutical industry joined the neuroscience revolution and developed scores of new drugs.

? Business: Corporations soon followed, developing new marketing strategies based on newly revealed brain processes.

? Law: The legal profession built innovative arguments, bolstered by brain scans illuminating developmental, anatomical, and functional deficiencies in minors accused of adult crimes.

? Education: Over the past 10 years in particular, our colleagues in education embraced neuroscience. The lessons they learned helped dramatically enrich educators' and educational leaders' knowledge and skills.

Does Social Work Embrace Neuroscience?

Gaining insight and understanding into poverty, resiliency, gender differences, and the adolescent mind would be helpful to almost any social work professional. But this brief examination of the beneficial relationship between neuroscience and education raises the questions: Does social work have such a relationship with neuroscience? If not, why not?

Currently, social work appears not to have the same collaborative relationship with neuroscience that exists between neuroscience and education. Research, for example, on the neurobiological impact of psychotherapy on the brain is notoriously difficult to find. Vitally important research topics on which social work and neuroscience could collaborate might include:

? How talk-based therapies affect brain structure and function

Issue One ? 2008 ? Mental Health

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