The Complete Guide to Asperger's Syndrome

Tony Attwood draws on extensive clinical experience and research to present a comprehensive guide to Asperger's syndrome, a developmental condition on the autism spectrum characterized by differences in social reasoning, empathy, communication, and cognition. Writing for parents, professionals, and people with Asperger's syndrome themselves, Attwood argues throughout that the condition represents a different way of thinking rather than a defect.

Attwood opens with a fictional vignette. A boy named Jack arrives at a classmate's birthday party and launches into a monologue about his battery collection, oblivious to social cues. The scene introduces the hallmarks of Asperger's syndrome: limited social understanding, difficulty with reciprocal conversation, and intense preoccupation with a particular subject. Attwood traces the condition's history to Viennese pediatrician Hans Asperger, who in 1944 described children with delayed social maturity, impaired communication, intellectualized emotions, egocentric preoccupation with specific topics, clumsiness, and sensory sensitivity. Asperger considered the condition genetic or neurological in origin rather than the result of parenting failures.

The book details multiple pathways to diagnosis. Some children progress from an earlier autism diagnosis toward the Asperger's profile. Others are identified by teachers or arrive at diagnosis after prior diagnoses of Attention Deficit Hyperactivity Disorder (ADHD), language disorders, movement disorders, mood disorders, eating disorders, or Non-verbal Learning Disability, a condition involving deficits in visual-spatial reasoning and social perception. The average age of diagnosis falls between eight and 11 years, and about 46 per cent of first-degree relatives share a similar profile. Attwood identifies four compensatory strategies children develop upon realizing they are different: reactive depression and self-blame, escape into vivid imaginary worlds, denial and arrogance, and imitation of socially successful people. Imitation, for instance, can raise gender identity issues when boys imitate girls to acquire social skills or girls reject female peers and adopt male behaviors.

The diagnostic chapter traces how clinician Lorna Wing first coined the term "Asperger's syndrome" in 1981 and how researcher Christopher Gillberg published the first formal diagnostic criteria in 1989. Attwood argues that the Gillberg criteria most closely reflect Asperger's original descriptions. He identifies significant problems with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria published in 1994: key features such as pedantic language, sensory sensitivity, and motor clumsiness are omitted, and the hierarchical rule that autism must take diagnostic precedence makes an Asperger's diagnosis nearly impossible. Girls present additional challenges because they camouflage difficulties by learning social scripts, remaining on the periphery of groups, or forming close friendships with nurturing, maternal peers who help mask social struggles. Using the Gillberg criteria, prevalence is estimated at approximately one in 250 children, with only about half currently detected.

Social understanding and friendship receive extensive attention. Attwood observes that the characteristics of Asperger's syndrome effectively disappear when a person is alone, since social impairment requires at least two people. Solitude serves as an emotional restorative, and people with the syndrome function better in one-to-one interactions than in groups. The concept of friendship is typically at least two years behind that of peers. Attwood maps five developmental stages of friendship motivation and provides strategies for each, including Social Stories, a method developed by educator Carol Gray that describes social situations using relevant cues and common responses in a structured format. For older children and adolescents, strategies include assigning popular peer mentors, creating friendship groups based on shared interests, and using drama classes.

The chapter on bullying reveals that over 90 per cent of mothers in one survey reported their children had been bullied within the previous year, a rate at least four times higher than for typical peers. A form Attwood calls "backhanded bullying" involves apparent friendliness masking malicious intent. Because children with Asperger's syndrome have difficulty understanding others' thoughts and intentions, they may not even recognize they are being bullied. Strategies include a team approach involving all stakeholders, training bystanders to intervene, and appointing a guardian with high social status among peers.

Theory of Mind (ToM), the ability to recognize and understand others' thoughts, beliefs, and intentions, receives its own chapter. Attwood emphasizes that people with Asperger's syndrome have immature or delayed, not absent, empathy. In daily life, impaired ToM leads to difficulty reading facial expressions, literal interpretations of figurative language, remarkable but sometimes problematic honesty, and exhaustion from relying on intellect rather than intuition for social processing. Strategies include Comic Strip Conversations using thought and speech bubbles in different colors and the DVD Mind Reading: The Interactive Guide to Emotions, which catalogs 412 human emotions demonstrated by actors.

The chapter on emotions notes that approximately 65 per cent of adolescents have an affective or mood disorder, with anxiety being the most common. Depression affects about one in three children and adults, driven by low self-esteem, social exhaustion, loneliness, and bullying. Attwood identifies Cognitive Behavior Therapy (CBT) as the primary psychological treatment and presents the Emotional Toolbox, a framework categorizing coping strategies as physical tools (exercise), relaxation tools (solitude, music), social tools (supportive people, pets), thinking tools (self-talk, reality checks), and special interest tools that block anxious thoughts through absorbing engagement.

Special interests, distinguished from hobbies by their abnormal intensity, develop from early fixation on objects through collecting to encyclopedic knowledge of specific topics. Girls may pursue interests that appear typical, such as horses or dolls, but with unusual intensity and solitary focus. Attwood advocates working with these interests to increase academic engagement, develop employment skills, and facilitate friendships. The language chapter describes impressive vocabulary alongside significant difficulties with pragmatic conversation skills and introduces "Aspergerese," an adapted conversational style that avoids figures of speech, introduces pauses, and makes intentions explicit. The cognitive chapter reveals that at least 75 per cent of children have attention profiles indicative of Attention Deficit Disorder, while executive function deficits in planning, working memory, and flexible thinking become increasingly apparent with age. Attwood recommends that a parent or teacher serve as an "executive secretary" for organizational support.

Movement difficulties occur in almost all children assessed with specialized procedures. Attwood advocates typing over handwriting remediation. Sensory sensitivity, which Attwood argues deserves inclusion in diagnostic criteria, affects the majority: 70 to 85 per cent have extreme sound sensitivity, over 50 per cent experience tactile sensitivity involving aversion to light touch or certain textures, and some are hyposensitive to pain, risking undetected illness.

Later chapters address life transitions and relationships. College students need support with accommodation, course load, and stress management; Attwood notes they are more likely to fail from stress than from intellectual inability. Suitable careers capitalize on strengths such as reliability, attention to detail, and original problem solving. In long-term relationships, partners with Asperger's syndrome are often initially attractive as kind and intellectually gifted, but problems emerge around emotional unavailability, infrequent expressions of love, and immature conflict resolution. Three requisites for success are identified: both partners acknowledging the diagnosis, mutual motivation to change, and access to modified relationship counseling. Attwood advocates for CBT and Personal Construct Psychology, which uses structured comparison charts called repertory grids to map how a person construes the world, as the psychotherapies of first choice.

The book addresses causation, confirming through brain imaging that Asperger's syndrome involves dysfunction of the "social brain" with weak connectivity between components, primarily due to genetic factors. The condition is not more prevalent among those who commit criminal offenses, though certain offense types, such as retaliation for bullying or stalking from misread social signals, occur relatively more often. Though Asperger's syndrome can be confused with schizophrenia because of apparent paranoia and retreat into fantasy, research confirms these phenomena are qualitatively different.

The book concludes with Jack as a successful adult: a PhD engineer designing innovative energy storage systems, valued by his employer despite his eccentricities, and engaged to marry a woman he met at work. Attwood identifies key factors for positive outcomes, including early diagnosis, acceptance, mentorship, supportive relationships, and success at work or in a special interest.