Wednesday, December 28, 2011

Executive Functioning Issues and Older Teens

This post follows on from my earlier post "How a Lack of Executive Functioning May Appear in Young Adults" which actually ended up looking at children rather than young adults. (Thanks Sharon for pointing that out.) Hopefully I won't get sidetracked again.  If you haven't read that post, you might want to read it before continuing here as it provides a useful introduction to the topic.

In my earlier post I defined lack of executive function and talked about the problems it can cause in day-to-day scenarios involving simple tasks, like getting dressed.  As children get older however, executive functioning difficulties become more pronounced because they're expected to be able to take responsibility for more far-reaching decisions.

The decisions made by teens can affect lives and can result in legal action, injury and even death.

An Example;
Take, as an example, the problem of driving home after a night out.

The simplified executive functioning would probably flow as follows but each component would have a myriad of ordered sub-tasks as well;

  1. Decide - Am I ok to drive home?  
    This would require both a knowledge of the drink-driving laws as well as a reasonably accurate count of one's own consumption.  Of course, if there's a tester machine handy, this simplifies things but someone with defective executive functioning could easily miss this step and not even consider their own suitability to drive. Of course, if they're well over the limit, then their executive functioning is probably even more impaired than usual and the decision will not be made without outside involvement.
  2. Decide - Are my friends ok
    Chances are, this decision would probably not even occur to an individual with Aspergers syndrome. It's not that they don't care but simply that it takes work to put themselves in someone else's shoes and they won't pick up on subtleties. If someone's speech is slurred or if they're a little unsteady on their feet, it probably won't register but of course, if they fall over - or better still, ask directly for a lift home, they'll be helped.  Even without executive functioning difficulties, this step will probably be missed.
  3. Drive Home
    Driving is an executive functioning nightmare. There are so many sequenced tasks to perform that little things, like putting a seat belt on may be missed.  There's also the constant distraction of one's driving surroundings.  Headlights from oncoming traffic, noise from the radio or passengers, street lights, traffic lights etc. You'd be surprised at how these things can further impair executive functioning.
So far, I've hardly mentioned the worst parts of executive functioning difficulties, distractions and unexpected change but both of these can be deadly..  Driving aged teens rarely seem to drive alone and the distraction of their passengers can be enough to have serious consequences.

Change is just as bad.  You might be wondering what exactly constitutes change on the road since since everything there is in motion but I can tell you that both of my worst teenage driving accidents were the result of cars being in "unexpected places".  Simply driving at different times of the day can put parked vehicles in previously moving lanes.

In the days before mobile phones, street-side telephone boxes used to be a big issue too because cars would be unexpectedly parked there when their owners were on the phone. Although these are less of a worry now, a car turning at a rarely used intersection is enough change to cause an accident.

Beyond Driving
The problems of teenagers with executive functioning difficulties don't end with cars.  Unless they have extremely strong personalities, it's hard for them to make appropriate choices when peer pressure is applied. It's also more likely that they will react incorrectly under pressure.

For example, a person involved in a low-level crime, such as underage smoking, drinking or loitering, may not realize that the crime isn't serious enough for them to be hauled off to jail.  Instead of standing their ground and accepting a lecture from the law, they may try to run or even worse, may react violently.

This is one of the reasons why so there are so many stories about people with aspergers being assaulted by police. It's not police brutality, it's simply that these young adults react inappropriately by either becoming overly defensive or by fleeing.

Finally, the problems are not limited to legal and driving issues. They also have social consequences.  For example. a female with impaired executive functioning may go too far in flirting with someone.  In particular, flirting without a clear plan or intentions.  This can lead to unsavory and dangerous responses.  It would be wrong to suggest that a female is responsible for an aggressive reaction but at the same time, an inability to read warning signals and a failure to plan for safety significantly increases her risk.

What can be done?
It's hard to know exactly what can be done to improve executive functioning skills in young adults and the problem is twofold;

  1. How to recognize a lack of executive functioning?
    If this has been picked up in a young child, and taught constantly, then there's an easy answer.  Unfortunately however most doctors talk about autism, adhd or aspergers in general terms rather than the specifics of executive functioning.
  2. How to teach a young adult to plan more effectively
    If it wasn't difficult enough to pass on the skills of successful planning and awareness to young adults, there is also the problem that young adults are not interested in this sort of "training" from their parents. While role-playing these scenarios could be helpful, it's unlikely that it could be accomplished at home. It really needs to be done as part of their formal education.
What these young adults really need is to have role-playing (and social stories) about real-life teen situations included as part of the school curriculum.  I know that it sounds a bit "sleazy" suggesting that we teach our teenagers to flirt or to prepare to depart a drunken party but role-playing these scenarios is probably the most effective means of combating the problem.  There is also the suggestion that teens with aspergers syndrome should be registered with their local police station (or at least wear a medical band) in case their condition leads to police action.

I'll be very interested to hear what my readers feel could be appropriate solutions.

Wednesday, December 14, 2011

Working on Your Asperger-Neurotypical Relationship - Part 1 Talking

Over the years I've written quite a bit about AS/NT relationships. I've written about accepting your aspergers partner for who they are and how to reach them in the relationship.

I guess that it's all been a bit one-sided but today I'm starting a series which might rectify the balance. These  posts is directed at people with Asperger's sydrome and are about being the best partner that you can be.

All relationships need work. They're not "fire and forget". You can't simply say, ok we've ticked the boxes; we're married, we have a house and we have kids. That's not where the work ends.

There's a saying from Marriage Encounters which I like to repeat. "Sometimes I love my partner -- and sometimes I have to work harder at it",

Life is all about change. As aspies we often don't like change but we're powerless to stop it. Like it or not, people change and situations change. In order to adapt to these changes, we too need to change.

We may have loved our partner because among other things, she shared our love of Star Wars but that was twenty years ago. As aspies, we often retain our special interests for life but our neurotypical partners do not. We have to accept that these things change and conversations which were once interesting to them are now considered "boring".

An Example
It took me years to learn that my wife no longer loved movies. She didn't care who the director was or what else they were working on. For her, a movie at the cinemas is an "escape" from the rigurs of daily life and kids. No matter how good the movie was, she does not want to talk about it afterwards.

Of course, that's all I want to do after a film and our rides home were probably torture for her. It didn't help when she told me to stop talking about it either because she'd mostly use fake excuses like; "I have a headache".  "Oh, Ok", I thought, "I'll save this interesting diatribe for some time when she's feeling better".

It was a long time before she was honest with me about her reasons and even then I'd get it wrong thinking that she didn't want to talk about that specific movie.  After all, when her words were; "I don't want to talk about the movie!" what else can I think?

When it finally sunk in, I said "well, you talk then and I'll listen", probably quite snappily. She didn't talk though because she claimed to be busy driving and our conversation dropped into awkward silence which was only broken about ten minutes later with her saying; "so what? are you not talking to me now or what?"

I was confused. On the one hand, she wants me to talk about something but on the other, it needs to be things directly related to her - and outside the realm of my special interest.

Instead of a wall of talk, I need to be more give and take. I need to guess something that she wants to talk about and ask questions.

It's not easy. I'll ask about the kids or family or budget but I'm often met with "oh, so now you want to talk about it .... after I've been doing it for years....".  Obviously they're not the right conversations either.

It seemed that there was no easy answer but apparently there is.

You're supposed to talk about "us". When you're out as a couple, the conversation should be about "us".  The questions you need to ask are;

  • How are you feeling?
  • How was your day?
  • Is there anything that I can do to help?
  • What do you need from me?
  • Are you happy in this relationship?
  • How do you feel our relationship is going? (don't ask this one while she's driving).

Once she picks herself up off the floor and answers you, you need to think about the answer she's given you and try to find a way to work at delivering it. Also, don't be surprised if you get asked the same question back - be prepared to give an answer.

In my case, the answer was; "I want to be appreciated more" ... and I guess that's the topic of my next post.

In the meantime, if you're an aspie, then your homework is to ask your partner one of those questions.  Also... If you're a female aspie, I'm keen to know if your partners have similar needs or if they're just happy to talk about special interests?

BTW: A big shout out to Aspie Wife Aspie Mom who first got me thinking about "the other side".

Friday, December 9, 2011

Book Review: What I wish I'd known about Raising a Child with Autism by Bobbi Sheahan and Kathy DeOenellas PH D.

"What I wish I'd known about Raising a Child with autism: A mom and a psychologist offer heartfelt guidance for the first five years", Bobbi Sheahan and Kathy DeOenellas PH D, Future Horizons Inc, 2011.

This is a mother and psychologist writing team book with a difference. This time, the person with autism is female.

The book in general is very well laid out and there is never any doubt as to which of the authors is writng at any given time.  Bobby has written the majority of the text while Kathy, the psychologist writes less frequently and always in a grey box.

There are scattered tips highlighted throughout the book and each chapter includes at least a few entitled "it bears repeating" or "what I wish I'd known".

Bobbi's writing style is breezy, funny and engaging. She covers some very difficult topics and makes it clear that as a parent nothing is ever easy.

Kathy tends to write on a whole different level and at times seems to have difficulty restraining the urge to cite all manner of research. Much of what she has to say is informative and supports bobbi's experience but I'd prefer to have heard things in her own words.

There are one or two places where the authors get side-tracked by common myths about autism but they're minor quibbles. This is primarily a book written by a mother, for a mother. It's written from the outside looking in and it tells things as they seem.

I was delighted to find Bobbi acknowledging this in a later chapter where she talks to her daughter about a long-past incident. Who hasn't had a child with asd's eat a lightbulb? I know I have. Bobbi's daughter, Grace's recollection of the incident highlights the fact that there was a lot more going on than was immediately obvious. It was a very touching moment in the book.

The book is full of great ideas and indeed, I'm already sold on a couple. It's prompted me to change my thinking on a couple of common ASD behaviours.

All in all, this book is a fun and breezy read packed with facts, experience and ideas. It's aimed at parents with children in the first five years of an ASD but I think it stretches much further than that.

It covers not only the child with autism but also the need to look after the rest of the family and the problems of dealing with others who can't accept your child. Bobbi's journey to many of these realisations is difficult and we could all benefit from the lessons she learned along the way.

I'd highly recommend this book to parents, psychologist and people supporting special needs children in general.

"What I wish I'd known about Raising a Child with autism: A mom and a psychologist offer heartfelt guidance for the first five years" is available from Future Horizons, Amazon and Bobbi's Web Site (

Honesty Clause: I was provided with a review copy of this book at no charge.

Wednesday, December 7, 2011

TV Series Review - Doc Martin

My wife and I have just spent the last few months watching every episode of "Doc Martin" a British TV series about a Doctor (not that other Doctor) who relocates from a job as a top surgeon in London to general practitioner in Portwenn, a tiny fictional village in Cornwall. 

It's mostly a comedy series but it has some drama and romance elements as well.  The reason I'm reviewing it here however is because Doc Martin's character is, I believe, intended to "have Aspergers Syndrome" and for neurotypical adults this gives you a good glimpse into both sides of an AS/NT relationship.

Nobody does situation comedy for Television better than the British and Doc Martin doesn't disappoint in this area. Although it is very funny, it's actually in the development of Doc Martin's relationship that the show really excels.  Each story is relatively self-contained but it is strongly recommended that you watch the series in the correct order to get a good sense of this development.

The words "Aspergers Syndrome" so far have only made a single appearance in the show when a psychologist tells Doc Martin that he has it - shortly before being unceremoniously bundled out the door but there's no doubt that the writers intended it to be a talking point. Remember that there's no litmus paper test for Aspergers Syndrome and someone may display many of the symptoms without actually having it.

In Doc Martin's case, who but the scriptwriter really knows?

I will however point out a few things I've noted;

  • Doc Martin certainly feels emotions and empathy but usually doesn't show them in the way you'd expect. Some close people however are able to read them some of the time.
  • It's clear that he has an unusual gait (walk).
  • He has significant difficulty in conversations and minimal ability to small-talk. He does prove that he can "act normal" though but it's obviously an act.
  • He has two obsessions, medicine and clocks - I'm aware that you'd expect a good doctor to be interested in medicine but Doc Martin takes things a little too far at times (Series 5).
  • He's obviously quite confused at times as to why his remarks hurt other people.
  • He's clearly completely unaware of some of the signals that others are giving off (pharmacist).

If we were using the DSM IV-TR diagnostic criteria on Doc Martin, he'd arguably flag the following;  
(skip past this bit if you find it dull)

Part A
Failure to share interests, enjoyment or achievements with others.
Lack of social or emotional reciprocity.

Part B
Preoccupation with one or more narrow interests which are abnormal in intensity or focus.

C. The disturbance causes clinically significant problems in social, occupational or other areas of function.
D. There is no clinically significant delay with language milestones.
E. There is no clinically significant delay in cognitive development
F. The disorder does not meet the criteria for any other Pervasive Developmental Disorder or for Schizophrenia

But I'm not here to say whether or not he's an aspie.

It's a great show and my wife and I have gotten a lot of enjoyment out of watching him and his situations. Our discussions during and after the show have been quite good too because sometimes it's easy to see what a particular character should have done when a communications problem occurs.  It's very educational for people in mixed AS/NT relationships.

Doc Martin Series 1-4 is currently available at Amazon (and it's on special).  Series 5 is currently airing around the world and there's currently a campaign going around to get Series 6 filmed.

Honesty Clause
Doc Martin was recommended by my parents and I watched it purely on their advice. I was not given any review materials but sought the show out on my own.