CBT to Help Young People with Asperger's Syndrome (Autism Spectrum Disorder) to Understand and Express Affection

A Manual for Professionals

Michelle Garnett, Tony Attwood

• Publisher: Jessica Kingsley Publishers
• Year: 2013
• ISBN:
  9780857008015
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

Children and adolescents with Autism Spectrum Disorders (ASD) are often not instinctive and intuitive in expressing their liking or love for someone, or in understanding that family members, friends and others need affection. Expressing affection to teachers, other close professionals, or family friends, can be even more challenging.

This book, by the leading experts in the field, provides a carefully constructed CBT programme for professionals to help boys and girls with an ASD to feel confident recognising, expressing and enjoying affection. The activities will help the young person identify their own and others' comfort and enjoyment range for gestures, actions and words of affection. They will also learn the variety of appropriate ways they can express liking or loving someone, helping them to strengthen friendships and relationships.

This book will be an invaluable resource for professionals supporting a child with an ASD.

PART 1

Introduction

1

WHY CHILDREN AND ADOLESCENTS WHO HAVE ASPERGER’S SYNDROME (AUTISM SPECTRUM DISORDER) NEED A PROGRAMME TO UNDERSTAND AND EXPRESS AFFECTION

Affection in childhood

Within families and friendships, there is an expectation that there is a mutually enjoyable, reciprocal and beneficial regular exchange of words and gestures that express affection. From infancy, children enjoy and seek affection from their parents, and toddlers are able to read the signals when someone expects affection and recognize when to give affection. One of the early signs that clinicians use to diagnose an autism spectrum disorder (ASD) in an infant or child is a lack of appearing to be comforted by affection when distressed. As a typical child matures, there is an intuitive understanding of the type, duration and degree of affection appropriate for the situation and person. Children of under two years know that words and gestures of affection are perhaps the most effective emotional repair mechanism for themselves and for someone who is sad. Unfortunately, for some children with an ASD, a hug can be experienced as an uncomfortable and restricting physical sensation, and the child may soon learn not to cry, as crying will elicit a ‘squeeze’ from someone. The child with an ASD may also be confused as to why a parent or friend responds to his or her distress with a hug. As an adult with Asperger’s syndrome said, ‘How does a hug solve the problem?’ Sometimes a hug is perceived and enjoyed by a child with an ASD as relaxing deep pressure rather than a gesture to share or alleviate and repair feelings.

From our clinical experience, we have noted that young boys and girls with an ASD may prefer to play with hard toys, such as plastic models of dinosaurs and metal vehicles, rather than soft toys that represent human characteristics and tend to elicit strong feelings and gestures of love and affection in typical children and even adults. Children with an ASD are conspicuous for not sharing when playing with peers. Sharing an activity or toy is perceived by typical children as an indication of their liking for someone, while an aversion to sharing can lead to the perception that they are not being friendly and do not like someone. Children with an ASD may also not recognize the social conventions regarding affection; for example, the child might express and expect in return the same degree of affection with a teacher as they would with their mother. There are also gender differences in the expression of affection between friends, with typical girls anticipating that affection will be integrated within their play. The absence of affection in the play of a girl with an ASD can be a barrier to friendship, and appearing indifferent or aloof to the affection of peers can inhibit social inclusion and contribute to the loss of a potential friendship for both boys and girls.

In general, a child with an ASD may enjoy a very brief and low intensity expression of affection, but become confused or overwhelmed when greater levels of expression are experienced or expected. However, the reverse can occur for some children with an ASD, where they need almost excessive amounts of affection sometimes for reassurance or sensory experience, and often express affection that is too intense or immature. The person with an ASD may not perceive the non-verbal signals and contextual cues in order to know when to stop showing affection, leading to feelings of discomfort or embarrassment in the other person.

When a parent expresses his or her love for an ASD child, perhaps with an affectionate hug, the child’s body may stiffen rather than relax to match and fold into the body shape of the parent. The child may also not be soothed by words and gestures of affection when distressed. When an expression of love and affection is rejected or is not effective, parents may wonder what they could do to repair the distress, or whether their son or daughter actually loves or even likes them. The ASD child’s rare use of gestures and words of affection can be lamented by parents and friends, who may feel affection-deprived and not demonstrably liked or loved. A mother of a daughter with Asperger’s syndrome said that her daughter’s lack of affection to family members was ‘basically breaking her father’s heart, he’s devastated’. Another parent said, ‘It really hurts that you can’t have the relationship you wanted.’ If affection is not reciprocated, a parent may try to elicit a greater degree of affection by increasing the intensity and frequency of his or her expressions of affection. This can lead to even greater withdrawal and mutual despair. Another characteristic we have identified from our clinical experience is that of a child with an ASD having a strong attachment to one parent and only accepting and expressing affection with that one parent. This can lead to feelings in the other parent of rejection and jealousy.

When it comes to expressing affection, those with an ASD have a limited vocabulary of actions and gestures, tending to lack subtlety, and (in the case of adolescents) be inappropriate or immature for their age. Their expression of affection and of liking or loving someone may be perceived by family members or friends as too little or too much – drought or flood. An adolescent with Asperger’s syndrome explained, ‘We feel and show affection, but not often enough, and at the wrong intensity.’ Each person has a capacity for expressing and enjoying affection. For a typical person this capacity can be conceptualized as a bucket, but for someone with an ASD, the capacity is a cup that is quickly filled and slow to empty. If the parent fills the affection cup to capacity, the child or adolescent with an ASD can feel saturated with affection and be unable to return the same degree of (or sometimes any) affection.

Affection in adolescence

A teenager with an ASD may not understand the value in an adolescent friendship of mutual exchanges of appreciation and affection that range from liking to loving. Such teenagers may have learned a vocabulary of words and gestures to express affection when very young, and then not modified the actions in recognition of their own maturity and current social conventions. For example, they may invade personal space and not know which parts of someone’s body are now inappropriate to touch. The teenager with an ASD may also not know how to progress beyond a reciprocal but platonic friendship, or how to express deeper feelings of affection. There can also be a problem when an adolescent with an ASD develops a ‘crush’ on a peer. The expression of interest and affection can be perceived as too intense, and the adolescent may not recognize the need for mutual consent or age-appropriate social conventions and boundaries. We use the term ‘impaired Theory of Mind’ to explain that children and adults who have an ASD are impaired in the ability to conceptualize and reflect on the thoughts and feelings of other people as well as their own thoughts and feelings. Thus, a friend or acquaintance’s act of kindness may be misinterpreted as having a more significant meaning than was intended. The person with an ASD may assume that the other person’s feelings of affection are reciprocal, and may persistently follow the other person, seeking more acts of kindness. This can result in allegations of stalking and the destruction of the friendship.

Typical adolescents have many friends to provide guidance on the expected and appreciated levels of affection in a friendship or a romantic relationship. Adolescents with an ASD can become increasingly aware of the expressions of affection that occur between their peers and the apparent enjoyment of sensory experiences between a boyfriend and girlfriend. Such relationships can be elusive for a teenager with an ASD, but there may be an intellectual and emotional curiosity and a longing to have similar experiences. The adolescent may seek information and guidance on expressing affection to peers from other sources such as television programmes, which tend to emphasize dramatic expressions of affection; or from pornography on the internet, which portrays age-inappropriate or illegal actions. When such behaviour is suggested or imitated with peers, the adolescent with an ASD can be in serious trouble. Immature and naïve expressions of affection or using a script from a movie or soap opera from a girl who has an ASD can be misinterpreted by those attracted to her as indicating a desire for greater intimacy, which was not her intention. This can lead to accusations of ‘leading someone on’, and to serious and traumatic experiences.

Another concern for some adolescent males with an ASD is knowing when to stop expressing affection in a romantic relationship. Typical teenagers recognize the verbal and non-verbal signals, the ‘amber’ or ‘red light’ signals, that indicate there is no consent to continue. If these signals are not recognized, then there can be accusations of assault and subsequent legal implications.

In their desire to be popular, adolescents with an ASD are vulnerable to being ‘set up’ by malicious peers. We have known of instances when the person with an ASD has been deliberately misinformed of someone’s romantic interest in him or her. When this false assumption leads to unwelcome advances or suggestions, the adolescent is confused, and accused. In contrast, some adolescents who have an ASD are confused by aspects of affection and develop almost a phobia of experiencing, or even seeing, expressions of affection. The person is then perceived as prudish or puritanical.

This programme has been designed primarily for children from 8 to 13 years with an ASD and an intellectual ability within the normal range. However, young children and older adolescents with an ASD who are conspicuously immature may also benefit from the activities and strategies used in the programme. Adults with an ASD may also benefit from aspects of the programme that can be modified to be age-appropriate.

Empathy

A family member or friend could consider that because the person with an ASD rarely expresses affection, especially in situations where affection is anticipated, he or she lacks empathy. Why would such an accusation be made toward someone who may demonstrate many acts of kindness? We know that those with an ASD can be some of the kindest people we have met, for example, a child with an ASD donating all his savings for starving children in Africa. There are two problems that could imply a lack of empathy. The first is the limited ability of the person with an ASD to read subtle body language and contextual cues that indicate someone is feeling distressed. If the subtle signs are not perceived, there will not be the anticipated response of concern, compassion and affection. The second is that the person with an ASD may not know how to respond appropriately, and may fear making a mistake such that it may feel safer to do nothing. In addition, often the first choice for the person with an ASD in such a situation is to repair someone’s feelings with a practical act. This can include completing chores, making something or offering help. People who have an ASD can express and enjoy feelings of genuine and deep love and compassion for someone, but usually by practical demonstration rather than words or gestures of affection such as a hug or a kiss. For example, if the distress is due to a damaged or broken object, the first response would be to repair or replace the object. However, if the cause of distress is a broken heart, perhaps because someone has died, the person with an ASD may not know what to do and may be frozen in uncertainty. Thus, the person with an ASD may not recognize that a gesture or words of affection are a quick, powerful and inexpensive emotional restorative for friends and family members.

Affection to repair feelings

We have found that the three most effective emotional repair strategies for someone with an ASD are being alone, being with animals, or engaging in a special interest. This may explain why someone with an ASD may choose to leave alone or avoid his or her parent or friend who is distressed. Another response that can be perceived as uncaring or annoying and indicative of lacking empathy, is to try to engage in a conversation about a special interest. The person is not being callous but actually showing compassion: in other words, if it makes me feel better, it must work for you.

People with an ASD seem able to relate to and express affection and love more easily to animals than people. Thus, parents may observe that the child or adolescent with an ASD can, and often does, express affection for a pet to a level far greater than is expressed for a parent. This can lead to feelings of envy of the pet and resentment that the person can express love but not for a parent. From the ASD perspective, people have complex needs, can deceive or tease you, interrupt and prevent you from engaging in your preferred activities. In contrast, animals are loya...