William Shryer is the Clinical Director of Diablo Behavioral Health Care in Danville, CA. Mr. Shryer earned his BA degree in Sociology at California State University in Hayward. He received his MSW from the University of California at Berkeley specializing in Children and Families. Mr. Shryer has been in private practice since 1981 specializing in Autistic Spectrum Disorders, Mood Disorders, and the Anxiety Spectrum in children, adults and their families. Mr. Shryer has lectured frequently to college classes and professionals in the areas of ADD and Autistic Spectrum disorders and their implications in the educational setting. He has been active in a number of CHADD chapters. Mr. Shryer manages three behavioral clinics with a staff of MD’s, Counselors, Clinical Psychologists, and Special Education teachers. He has been the moderator on CCTV, (Contra Costa Television) for both “Mental Health Perspectives”, and “With the Family in Mind” which discussed topics such as Asperger’s Disorder, Autism, Bipolar disorder and Attention Deficit Disorder in children and adults.
Q. What is Asperger’s syndrome and how is it different from ADHD?
Asperger’s Syndrome is a variant of autism therefore on the autism spectrum. While it is indeed possible to have ADHD and Asperger’s it is often misdiagnosed as ADHD by those clinically unfamiliar with Asperger’s. A central difference between Asperger’s and ADHD is that the individual with ADHD has a neurobiological difficulty in focusing and paying attention, therefore an Attention Deficit Disorder, while an individual with Asperger’s will have difficulty deciding on what to pay attention to, or not be able to shift attention from what they want to think about to what someone else wants them to think about. When misdiagnosed as ADHD the individual with Asperger’s will often be prescribed the medications to treat ADHD and have their internal anxiety state go to into high gear. If they have stuck thoughts the stimulant medications can increase their stuckness so now they have what I call “Attention Surplus Disorder”. The higher functioning the individual with Asperger’s may be the more likely they are to be misdiagnosed by the uninformed.
Q. Does it affect more boys than girls?
Asperger’s was thought to affect more boys than girls by a wide margin; however, this is being called into question lately. While the number of boys referred for evaluation is around 10:1, it now appears that girls are more likely to present very differently than boys. Girls are more likely to give aid and support to an “Aspie” peer while boys are more likely to be bullied and made fun of. With so many of our diagnostic categories’ it seems that girls present differently and therefore are missed, or misdiagnosed.
Q. What are the typical behavioral manifestations? Their talents, their shortcomings?
The behavioral manifestations vary depending on age and severity of the disorder. Younger children and more often boys than girls will be very concrete in their interpretations of things asked of them. They often have an odd quality to their speech patterns often speaking in a pedantic, “little professor” manner. They are famous for starting an answer with, “actually”. They have real difficulty with social nuance and the unwritten rules of social discourse. They often don’t get what comes naturally to other children, they make talk too loud or too quiet, and they may stand too close to someone or too far away. They often have great difficulty with ADL’s or activities of daily living such as teeth brushing, hair combing and other issues related to hygiene making them easy prey for targeting. Eye contact is often difficult for them and much more common in boys than girls. It seems girls with Asperger’s are better at watching and copying the behavior of other girls in order to appear to fit in. As far as their talents go, they are often very intelligent as the so often have a parent that is an engineer or some other occupation that requires high intelligence. Since they have a very concrete way of perceiving the world they often do poorly at algebra but can be a whiz at calculus or trigonometry. They often have great skills in the computer area and as kids love computer games as they are not played with others directly.
Q. What kind of partners / spouses are they?
I have seen several who are in fact married and it always seems to be an Aspie man married to a non-aspie woman. Maybe it’s the idea of some women that they can change the man or nurture them so they will change. Often the woman married to an aspie man needs to learn proper expectations of their spouse. Remembering birthdays and to say kind things in a relationship are important and the individual with Asperger’s will have to be taught these things as they will not come naturally to them. In the movie Adam, which is a wonderful movie about Asperger’s and relationships the woman in the show says to Adam, “Can I have a hug?” Adam responds with, “yes” and then does nothing. The woman realizing he was being concrete say to Adam, “Can I have a hug Now” and receives one. This is a great example of how they handle intimacy.
Q. How were these young people diagnosed in the past?
In the past most young people with Asperger’s were misdiagnosed. Some of the more common misdiagnoses were ADHD, Obsessive Compulsive Disorder even though most with Asperger’s stuck on their own particular fascination, be it vacuum cleaners, algae, dinosaurs, or medieval history show little to no anxiety while thinking about their special area. The anxiety that these folks feel is in relation to knowing on some level that they don’t know how to navigate the social landscape. They have been misdiagnosed as schizophrenia, schizotypal personality disorder, avoidant personality disorder, obsessive compulsive personality disorder, even antisocial personality disorder. When these poor young people that fell into the grasp of poorly trained clinicians it gives new meaning to the old saying that if “all you have is a hammer, everything looks like a nail”. The professionals that saw them didn’t know about Asperger’s so they tried to fit them into categories they did know to the misfortune of many children and teens over the years.
Q. How can therapy help them?
The reality is that typical therapy really doesn’t help them. The abstract world of “How does that make you feel” is beyond them. They frustrate most clinicians that don’t know the patient they have is Asperger’s. They need a lot of direction and coaching and training. While what I do I call therapy with this group, it is highly directed, very structured and involves the entire family, the school and often other groups. Assisting the schools to provide the support they need is central for them as well. Often the schoolsand the parents are overwhelmed with the often odd and preservative behavior they can demonstrate. This is one diagnostic category where the saying, “It takes a village” was never more true.
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