Interviewer: ninemsn in association with
60 Minutes presents a live interview with Professor Tony Attwood. Dr Attwood, thank you for joining us tonight to shed some light on a problem that remains such a mystery to many in the community.
Tony Attwood: I enjoyed the television program and I am looking forward to some important questions that will be of value to all people in Australia.
Interviewer: Dr Attwood, we will go directly to the questions from our guests.
Alf asks: What is autism exactly? Is it when someone doesn't want to be with people or hyperactivity or what? What has it got to do with not talking? Does autism occur in adults as well?
Tony Attwood: Autism is a developmental disorder that affects brain functions. It makes it more difficult for the child to socialise and play. This can range from a child who has little ability in these areas to someone who has Asperger's syndrome who has fluent speech but finds it difficult and has unusual interests. The condition can be lifelong and exist in adults as much as children. The person finds other people confusing and sometimes would like to interact but is not sure what to do. It can be associated with hyperactivity.
Some do not develop the ability to speak, but some develop fluent speech but have problems with the art of conversation.
roger asks: Is autism hereditary or is it caused by something else?
Tony Attwood: Good question. We are still trying to find the many causes which can be hereditary, in that some families through generations may have autistic children on what we call the autistic spectrum with different levels of autism. In some cases the disorder has no family history. In these cases we may be looking at factors that affect brain development.
JugglyJim asks: How does Asperger's syndrome differ from autism?
Tony Attwood: In Asperger's syndrome the child usually wants to interact but doesn't know how to. The child has sentence speech but problems with conversation skills and has intellectual ability within the normal range.
Lesley asks: If I have one child with autism, what are the chances of having another with autism?
Tony Attwood: We would need to check if there are any relatives with autism or Asperger's or fragments of autism to assess the possible reoccurrence.
There are some families that do have more than one child, but it is at this stage impossible to identify the genetic markers that tell whether a particular conception is likely to result in a child with autism or Asperger's.
Lilly asks: How is the diagnosis of autism made? Are there special tests a doctor can do to determine if a child is autistic? How are children assessed if they can not talk?
Tony Attwood: A lot of the assessment comes from observation, interaction and a developmental history from the parents. Children with autism are notorious for their lack of compliance with standard tests, so I have some caution with the results of some of the standardised tests.
We now have several questionnaires and observational assessments to indicate the degree of autism.
Lisa asks: What are some of the behavioural indicators of autism?
Tony Attwood: We look at behaviour such as eye contact, interest in socialisation, difficulties with emotional expression and certain aspects of their natural play and how well they socialise with family and other children.
We also consider language, co-ordination and movement skills and sensitivity to sensory experiences.
ellen asks: What is the ideal age for a child to be tested for autism and for Asperger's syndrome?
Tony Attwood: Some children with autism can be diagnosed as young as 18 months. Others may not be diagnosed with autism until they are two or three years old. Children with Asperger's syndrome may not be diagnosed until they are six or seven years old.
Tri??ity asks: Is there prevalence in males or females?
Tony Attwood: The ratio is usually four boys to one girl.
Les asks: Can Asperger's and/or autism go undiagnosed?
Tony Attwood: Yes, it can. Especially if the person has an ability to camouflage their conditions or if the child has other conditions such as blindness, deafness or Down Syndrome.
marghat asks: My husband is autistic spectrum, was diagnosed aged 42, my 11-year-old is too, but my 15-year-old is classified as intellectually gifted. Is this common? Thanks.
Tony Attwood: Yes.
Brab asks: What are your thoughts about some claims that there is a link with the MMR vaccination and autism?
Tony Attwood: I am not an immunologist and so have great caution in replying to the question. My own view is that there needs to be more independent research to verify the link between MMR and autism.
travis asks: Is violence often a problem in autistic children? What is the best way to cope, if the parent starts not coping themselves?
Tony Attwood: The problem is one of frustration that may lead to a physical expression. This physical expression may result in damage or injury, but may not be viewed in a way that we consider typical children becoming violent.
There is new neurological evidence to suggest a dysfunction of a part of the brain called the amygdala which regulates emotions, so there may be some neurological reasons why the person finds it very difficult to control their emotions.
Holly asks: I work with children aged zero to five years and appear to have an increasing number of children with ASD. Is this a developing trend?
Tony Attwood: I have specialised in this area for several decades. My clinical judgment is that the number of general referrals is increasing and may be up to a five-fold increase in cases.
Linda asks: Hi Tony, our son is on a myriad of medications at the moment, none of which seem to make a world of difference. How can we justify what is right for them or should we just let them be themselves?
Tony Attwood: Autism could be viewed as the behaviours that the child uses to cope with life. We search for a compromise between the child's needs and the family's needs. There needs to be times in the day when the person is free to be autistic but other times when they need to conform to our expectations.
Anne asks: My five-year-old son has mild Asperger's. My question is how to bring him back when he loses control, ie does not seem to understand the gravity of a certain act.
Tony Attwood: Quick hints:
1. For the adult to try and remain calm.
2. To try and get the child to calm down and relax without talking about the problem that caused the outburst.
3. Recognise and acknowledge the child's perspective.
4. Be logical in the explanation of what is required.
danielle asks: My son was diagnosed with autism at four-and-a-half. He is now eight and has very few characteristics. Should I get him re-tested? And where?
Tony Attwood: My view is the nature and degree of autism in children should be reviewed every two or three years by a specialist in autism. When a child is only four years old, the clinical picture can be confusing. Now that he is eight years old, the clinical picture may be clearer.
Warren asks: My seven-year-old ASD son was diagnosed at the age of 2.8 with severe autism. We did ABA 40+ hours a week with lots of parental incidental teaching. Now he is in regular grade two with a fulltime aide. He is academically near perfect. His main problem is behavioural. Simply, he cannot sit or stand in one place. We have run out of ideas. Any thoughts?
Tony Attwood: Restlessness can be due to three causes. One is anxiety in an overwhelming situation. Two is signs of ADHD. Three is a movement disorder where the child cannot keep still. So with this child, we would need to consider each of those explanations.
Grandma asks: Would lack of eye contact, being unable to speak, walking on tiptoes and temper tantrums be a possible sign of autism?
Tony Attwood: Yes.
PAUL asks: Dr Attwood, do you consider sensory sensitivity to be much of an issue with Asperger's kids?
Tony Attwood: It is a very important issue for those who have it and one that professionals have neglected. I wish we had some strategies to reduce the sensory sensitivity.
neesyp asks: Should you force your autistic child to have eye contact with you?
Tony Attwood: No. You may teach them when to look, but the key problem is the ability to read a face. I do not recommend forcing a child to look when this causes them distress.
CB asks: Have there been research studies done in regard to the efficiency of early intervention?
Tony Attwood: Yes and it works.
katrina asks: What level of early intervention education is offered to autistic children in other civilised countries?
Tony Attwood: This varies from country to country. In the US it varies from state to state. In the US, families have used litigation to provide the services but still not to a level required by the children.
Australia is in the mid range in terms of service provision. For example, it is much better than in France, but there are some states in the US that provide much more early intervention.
parko asks: What are the techniques used to treat autism? How can you help? Is it mainly symptom control?
Tony Attwood: The treatment is primarily through special education and language therapy using a multi-disciplinary team that is labour intensive but shows significant results.
But with each child we see, we can not accurately predict how well the child will respond to the early intervention program. I have five indicators of successful outcome.
1. The development of speech.
2. Intellectual ability.
3. A determined mother.
4. The character of the child.
5. The intervention programs with a minimum of 20 hours a week for preschool children.
AnthonyO asks: How do you view the role of medication in the treatment of Autism or its symptoms?
Tony Attwood: When we recognise clear medical symptoms, medication can be exceptionally helpful. For example, epilepsy and anti-convulsion. If there are signs of ADHD, then stimulant medication can be helpful.
When there are problems with emotion regulation, some medication can be used to treat anxiety or depression.
deanoqld asks: How do you discipline an autistic child?
Tony Attwood: Punishment rarely works with such children. They need explanation and logic to change their behaviour.
Linda asks: Tony, can you explain why my son loves all things "female" ... clothing, dolls etc (not that there's anything wrong with that, of course, lol.)
Tony Attwood: He may recognise that the one group that understands him, loves him and helps him the most is female. He may be absorbing that culture. If the child is very young, then this may also be exploratory play, with the child unaware of the reaction of other people. If you make it a problem, it could become a problem.
Elsapup asks: Do you really consider the determination of a mother to be so vital?
Tony Attwood: Yes. The mother knows the child better than anyone else. If the child is seven years old, that is the amount of time it takes to be awarded a PhD, so a mother of a seven-year-old child has an honorary PhD in the study of that child. I know to listen to mother's knowledge and advice. She will provide continuity and experience for the child's lifetime.
neesyp asks: I have heard that music therapy can help. What are your experiences with this?
Tony Attwood: Music therapy is excellent. It can help with the development of communication and the expression and management of emotions. Some children with autism and Asperger's can develop talents in the area of music.
Sharon asks: How do we get autistic programs introduced into schools, ie satellite classes?
Tony Attwood: There are two problems. The first is financial and having the funds available for the program. The second is attitude and understanding of autism.
Linda asks: Teachers aides are wonderful people, but in your opinion, how much training should they be given, considering most of them have never been in contact with these children before the day they start work?
Tony Attwood: Teacher aides are underpaid, under-trained and under-valued. They are required to undertake an advanced level of teaching for children with autism. Some teacher aides have a natural talent with programs for children with autism, but training programs for the aide will improve their abilities.
Some aides may attend programs but have difficulty implementing the programs because of their status in the classroom.
marga asks: Dr Attwood, when and how do you talk to the child himself about being on the spectrum? My son is eight with AS and has asked me if there is anything wrong with his brain. Thanks.
Tony Attwood: Now is the time. I prefer to explain the child's talents and difficulties that may be due to autism or Asperger's syndrome so that it is not all bad news. There are some books that will help parents explain the diagnosis and I recommend you go to the webpage
www.jkp.com. There is more information on my webpage
www.tonyattwood.com.au
kitkat asks: What are your thoughts on Applied Behaviour Analysis?
Tony Attwood: ABA is perhaps represented by buying a vehicle and it is a Mercedes. In other words, reliable engineering, but it may not be the vehicle for all children. I am impressed with the results received by ABA, but I do recommend that the program is monitored by a speech therapist.
Flutters asks: Can someone who is autistic have a reasonably normal life with help and treatment? Including meaningful and functional relationships?
Tony Attwood: My sister-in-law was diagnosed as severely autistic at six years. Recently her husband died, but they had been married for 26 years and she has a fulltime job. So it can happen.
De asks: Mother of 33 year high-performing autistic male … fed up with ignorance of population, am assisting him with family law matter … court does not even recognise the social communication problems, etc, etc. How do I get help with this?
Tony Attwood: There are very few case examples with law that can be used in legal precedent. You may need to obtain evidence from several expert witnesses to support your son.
annette asks: I have a nine-year-old daughter with moderate to severe autism. Can you advise me on how to stop her attacking younger children? She will kick and push them away when they come into her space and sometimes will go to them.
Tony Attwood: She may need to learn more effective ways of maintaining her solitude. Perhaps with a gesture of "go away" and to ensure the other children respond to that gesture.
PAUL asks: Do you find that support groups are a help?
Tony Attwood: Support groups are essential and have been the driving force that has pushed reluctant politicians to begrudgingly provide some services.
Lil_Laura asks: Is it safe to leave an autistic child by themselves if a parent really needs some time out? Even for a half hour?
Tony Attwood: Children with autism usually enjoy solitude and there are times in the day when they will need solitude, but obviously they will need to be safe.
Karen19 asks: When I was younger I don't remember kids in both primary or secondary school having the problems kids have now. Are we over-analysing too much and some kids are just are being kids? After looking into Asperger's, most people I know have some characteristics.
Tony Attwood: There are fragments of Asperger's in every one of us, but it is the number of fragments and their effect on the quality of that person's life that makes a diagnosis. Also, life has become more difficult for those with Asperger's such that their problems are now more conspicuous and we are better able to recognise their confusion and difficulty.
Pete asks: Most discussion has focused on (early) intervention (generally driven by parents), but I've heard adults with ASD diagnosis say they don't want to be "treated", they want to be accepted as they are. Is there room for both views?
Tony Attwood: Yes, there is room for both views.
Bandit asks: How can we get the politicians to understand the enormous gains of 20+ hours per week of early intervention rather than cutbacks to three hours?
Tony Attwood: By programs like
60 Minutes. It requires a media interest for politicians to take notice.
Joanne asks: Hi Tony, can you recommend any reading material on how to deal with my Asperger and autism estranged husband, as I fear for my one-year-old daughter's safety and he wants custody.
Tony Attwood: Obviously I would recommend my own book,
Asperger's Syndrome: A Guide for Parents and Professionals. You may also be interested in
Asperger in Love by Maxine Astin. Both books are published by Jessica Kingsley Publishers.
kay asks: Tony, can you give me contact details for the four-day autism conference in Canberra in Sept/Oct this year? What dates will you be presenting?
Tony Attwood: The conference will be on October 1-3 in Canberra. More information from (02) 62806143 and (02) 62808122. I will be there for the entire conference for several presentations.
Interviewer: Unfortunately we are out of time tonight, do you have any last words for our many guests?
Tony Attwood: Thank you for some remarkably perceptive questions. I hope that in some brief answers you have some explanations and strategies. I do have a webpage,
www.tonyattwood.com.au, but please remember that due to my clinical commitments to the families I see, I cannot devote time to answer personal e-mail questions.
Interviewer: Once again Dr Attwood, thank you and good night. This concludes our live chat with Professor Tony Attwood, June 20, 2004.
