Tuesday, September 20, 2011

Imagine having Aspergers by Dr Richard Eisenmajer with Amanda Golding

Over the past decade many adults with high functioning autism and Asperger Syndrome (these terms are used interchangeably) have written and published books about their experiences and feelings. These works have given the ‘neuro typical’ population an insight into the autistic world.

We can now begin to understand how children and adults with autism think and feel. This increased understanding has led to more successful management techniques.

The major diagnostic areas of impairment in autism are social interaction, communication and play, but I think these are secondary to the impairment of imagination. The “Theory of Mind Deficit” hypothesis proposed that a person with little or no imagination would find it difficult to understand what another person might be thinking. The predicted behaviours in the social, communication and play skills are confirmed in people with autism.

How does our imagination dictate our day-to-day thinking processes? We have an ‘imagination factory’ inside our heads, used often without us really being conscious of it. As we observe someone else’s behaviour we are very quick to theorise or imagine why they are behaving in that way. We cannot ‘read their mind’, but we are very good at imagining what they may be thinking in order for them to behave in that way. An example is when we see someone waving to us. Do we ask why she is shaking her hand in the air? No, we make an instant guess – she wants to communicate with me. We are equally as quick to dismiss other possibilities, like the possibility that she is shooing flies, based on our instant judgement.

Another everyday example of our use of imagination is in conversation. As someone is speaking, we make constant use of our imagination – “why are they saying that and what can I say to join in the dialogue, and what will they think if I say that?”

Children’s pretend play is an important part of the development of imagination. Children frequently pretend, or imagine, that one object, such as a banana, could be ‘used’ as a telephone.
Children with autism find pretend play very difficult -they tend to engage in ‘reality’play by copying what they see around them -the other children or their favourite video. The lack of pretend or imaginative play is a key diagnostic tool – the young child with autism is rarely capable of spontaneous, creative, flexible play.

What is it like to not have the imagination skills to be able to instinctively guess what is going on in someone else’s head? A more able person with autism has reported that he is exhausted by the end of the day from the time and effort required to ‘compute’ everything to help him decide what to say, do and think. Because it takes him time to work out how to respond, he is easily misunderstood, thus compounding his confusion. By the end of the day (when he returns home) he is exhausted and this is often reflected in his behaviour. Being in crowds with people behaving differently is a further complication. Most people with autism dislike groups of people – sometimes they get excited but don’t know how to engage with the group; other times they
can withdraw, or become angry, or panic.

To understand a little of what it must be like, picture those times you have tried to come into a conversation half way through. It takes time to ‘work out’ what is going on and when, or if, it would be appropriate to enter the conversation.

Many people with an autistic disorder report experiencing frequent panic attacks. One person has talked about living from minute to minute because he is unable to anticipate or guess what is likely to happen next. When his tram for work is late, he has a panic attack because he is unable to ‘imagine’ how he will be able to get to work. To be able to predict what may happen later on, the next day or next year is nearly impossible.

Imagine having Autism – Dr Richard Eisenmajer


Many people with an autistic disorder develop rigid structures or routines. From reports we now know they do this, consciously or unconsciously, to help them ‘manage’ the chaos they experience. Some more able people have stated that if most events happen in a predictable sequence, they have more energy available to somehow manage the unpredictable. Even then, assistance, often in the form of visual prompts or rehearsed ‘scripts’, is often needed – a card in the pocket prompting to get a taxi if the tram is more than 10 minutes late, or a script (such as a Social Story) outlining the routine if a teacher is absent – these are important strategies to develop.

Everyone experiences anxiety, some more than others. So too for people with an autistic disorder. This goes some way in accounting for the variation we have observed along the autistic spectrum. The more anxious a person with autism is, the more rituals and routines they are likely to develop. Low functioning children with little or no capacity for imagination have a great need for rigid and inflexible routines, as well as stereotypies such as hand flapping and rocking. At the higher end of the spectrum, the person with more imagination may have a decreased dependence on routines and rituals once they become familiar with a situation or

Parenting the child with an autistic disorder is made more difficult by their imagination deficits. How many parents have felt that punishment seems to make no difference to correcting ‘naughty’ behaviour? Autistic children are often deemed to be manipulative or behaving badly on purpose. For a child with little or no imagination this is almost impossible. To manipulate or purposely distress a parent requires the child to imagine what his or her parent is thinking and to try to change those thoughts to their advantage. ‘Naughty’ autistic behaviour usually reflects the child’s difficulty in understanding what is going on around them – their behaviour is a reflection of their increased anxiety and confusion and routine ‘punishments’ only make them
more distressed. In fact, ‘time out’ is often just what they want (and need) – a quiet space with no ‘people’ demands!

We ask huge things of children with an autistic disorder. We send them into adverse environments that are full of people and events, such as schools and shopping centres. We demand social interaction. We want them to join in conversations. We want them to play with other children. We often require them to give up a ritual, routine or obsession which has been helping them to reduce their anxiety. We send them from the structured classroom to the unstructured playground ‘for a break’. Children with autism have to work even harder in the playground – to make sense of the myriad of rules for social interaction. Playtime or recess is no break unless a structured, predictable recreation routine is developed to support the child with autism. This can and should include a small group of peers who understand the child and have been taught how to respond positively. An autistic child at a school that has set up a small PlayStation room, where one peer per break is allowed to share the activity, has gone from being the bullied outcast to the most popular child in the class!

It is important that everyone – parents, extended family, teachers and friends – understand that children and adults with autism are not like average people. They do not think in the same way and they should not be treated ‘like everyone else’. Choose recreation activities carefully – team games like football or basketball are not overly successful, but individual activities such as tennis, golf, tenpin bowling or chess are more so. Computers, video games and the internet are much enjoyed by many people with an autistic disorder. Careful guidance can ensure they become shared activities in a number of ways – interactive and shared games and programs, chat rooms and special interest clubs. Make allowances for the enormous effort they put into getting through each day – is homework more important than time to recover from a highly
stressful day?

Try to imagine what it is like for the person with an autistic disorder to live in our world.
Dr Richard Eisenmajer with Amanda Golding

Dr Richard Eisenmajer
BBSc(Hons), PhD, MAPS
The ASD Clinic
Suite 2, 830 High Street
Fax (03) 9857 0975 Phone (03) 8851 3600

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