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Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by mentalhelp.net covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

    On today's show we will be talking about Asperger's syndrome with my guest, Timothy P. Kowalski.

    Timothy Kowalski is a licensed speech-language pathologist, and nationally known expert on Asperger's syndrome and high-functioning autism. Currently, he's a consultant to private and public schools and provides diagnostic, therapeutic, and consultative services to children and adolescents with psychiatric and behavioral disorders in his office.

Mr. Kowalski has worked in a variety of settings, including home health, nursing homes, hospitals, and schools.

    He obtained his Master's degree in speech communications from Case Western Reserve University in Cleveland, Ohio and earned his Bachelor's degree in communications disorders from Connecticut State University in New Haven, Connecticut.

    Mr. Kowalski is the author of "The Source for Asperger's Syndrome," a practical resource for anyone working with this population. Mr. Kowalski's experience makes him a skilled and knowledgeable instructor. Now, here is the interview.

    Timothy Kowalski, welcome to Wise Counsel.

    Timothy Kowalski: Thank you.

    David: I found you through an educational flyer sent out to psychologists around the country, and I saw that you do workshops all over the place on Asperger's syndrome, which is a very interesting syndrome.

Most of the people that I have on my show are psychologists. You are actually training psychologists-among others-on Asperger's, but you are not a psychologist yourself. How did you develop this expertise?

    Timothy: Well, I first started working with the classic autistic population. I kept gravitating more towards the higher-functioning individuals. This was way before we had the term Asperger's Syndrome around.

    I found the higher population to be more challenging mentally in terms of trying to help them. We got them better; I got them academically doing very well; but everybody hated them because they were socially ineffective and inappropriate in terms of using their social skills.

    So I started to work more and more with this particular population. Then we came around with the label of Asperger's. I continued with my love of this particular population, wrote a book, and from that developed a quote-unquote expertise that people have been using.

    My target population is all sorts of disciplines. I've had psychiatrists and pediatricians come down to parents and grandparents--and everybody in between.

    David: What's your professional background, your training?

    Timothy: My background is a speech-language pathologist. So when I do assessments on these individuals, I am assessing what's called social communication skills. So the best diagnosis I give is a social pragmatic language disorder, and I tell people that I'm suspicious that we may be seeing Asperser but I cannot give you that label.

    So when we have people come into my office, we are very very specific that they are aware if they're looking for an Asperger label, this office can't give it.

    David: You refer them out then, to get formally diagnosed, to either a psychiatrist or psychologist. Is that right?

    Timothy: That's correct.

    David: Ah, OK. It's interesting that you're working with the high-functioning Asperger's people, and I'm surprised to hear they're frustrating in some way. I know there are some very famous high-functioning Asperger's people out there that maybe you could talk a little bit about. I know of one who has even written a book, Dr. Temple Grandin. You know her?

    Timothy: Yes, some people say she has Asperger's and some people feel she is more of a high-functioning individual. I differentiate between Asperger's and high-functioning individuals.

    David: What do you mean, high-functioning individual?

    Timothy: High-functioning autism.

    David: OK. I didn't realize there was a distinction between the two. Maybe you could talk about that.

    Timothy: What is I usually tell people is there's two debates. There's two groups of individuals. One group says that high-functioning autism is synonymous with Asperger's. I subscribe to the group that disagrees with that philosophy. I think they have two different populations.

    David: Uh-huh.

    Timothy: I think the biggest area of feature difference between the two is the relative degree for desire for social interaction. I find that high-functioning autism-whether I have you as a friend or don't have you as a friend my life isn't going to be impacted that much.

However with Asperger's, they typically really really do desire to have a social friendship, to have a relationship with other people, but they are very very ineffective at going about that, and so they alienate themselves.

    David: Interesting.

    Timothy: That to me is the big difference. If you look at Temple, she is brilliant in her area of expertise-- which is slaughterhouse design--and ability to get up and give a talk on autism.

She is excellent at those skills. She has improved dramatically in her ability to use public speaking, but if I'm correct, Temple still says that whether she develops a relationship is not of interest to her.

And I would say that that is the biggest differentiating factor as to why I would say Temple is more high-functioning autism as opposed to Asperger.

    David: OK. She invented something called her hug box. Maybe you could describe that for our audience?

    Timothy: Her hug box or squeeze box -whichever term that you've used - was a technique that she used. She has some sensory processing difficulties, and she found that deep pressure helped reduce some of her anxiety and some of her stresses that she was experiencing.

She developed this type of box out of wood that had compression. She noticed it was from the slaughterhouse design again. That the cows that were going through, when they were under deep pressure, seemed to calm them down.

    So she tried developing this on her own, and she has a device that allows her to control the relative degree of pressure that's presented. So she kind of gets inside this thing.

It looks like a glorified refrigerator box laying on its side. She lies in it, and the two sides compress, and she can control the degree of pressure that's there. And it provides her with the relaxation technique that she needs. It helps her in terms of organization.

    David: That's so interesting. So, in a sense, she is getting a hug, but it is a very impersonal hug.

    Timothy: Correct.

    David: As you point out, she has no real need for people to be involved.

    Timothy: That's my recollection. Every time I've been around Temple: a very brilliant individual, but still very aloof in terms of how she engages with other individuals.

    David: Now, are there other authors or people in the public eye that come to mind who are like Temple? Who are what you describe as high-functioning autism?

    Timothy: Not that I can think of off the top of my head. I know that there's an individual by the name of Luke Jackson. He was 13-years-old when he wrote a book describing Asperger's.

And I know that he's one of five siblings in the same household that has autism-spectrum type labels. In his situation, he's pretty coherent in terms of how he expresses things like dating and school and personal hygiene. It's wonderful.

    David: OK. Do we know anything at the physiological, biochemical level that would differentiate the Asperger from the high-functioning autism?

    Timothy: Not that I have read. I know that they're doing a lot of studies in terms of structural differences with the brain. They're looking at frontal lobe regions. They're looking at the verbal regions.

Eric Courchesne is doing a lot of research in that particular area. But I haven't read of anything specifically as yet, in terms of the etiological aspects. And I'll also be honest with you, as a speech pathologist, it's not an area that I can really deal with, shall we say. So I'm not spending that much time in that area either.

    David: Right. Right. So how does one recognize and identify the behavioral symptoms of Asperger's Syndrome? I know that's one of the things you cover in your workshop, and obviously, you can't go into as much detail here.

    Timothy: Well the things that I usually look for is a relative degree of difficulty in terms of initiating conversations with other individuals, or what are the three triads: the social interaction, the social communication skills and the social-emotional regulation.

Their interaction, how they engage with others leaves a lot to be desired. And typically in a preschool environment, you're going to see signs of more aggressive-like behavior and inappropriate interacting.

    The individual may go up to another child whose playing peacefully on the playground and whop them one in the back, and he tears off. And what usually happens is then the child who just got hit chases after him.

So the child with Asperger's perceives it as "I'm interacting. We're having fun", yet the child who just got hit doesn't see it that way. So how he engages that other individual leaves a lot to be desired.

    As they advance in years, they become a little more savvy to certain things, however they're perceived as being odd and idiosyncratic. Newsweek, a couple of years ago, ran an article called "The Geek Syndrome", and they said that Silicon Valley would not be Silicon Valley if it weren't for all the Asperger's out there.

[NOTE by Talent Development Resources editor:
see The Geek Syndrome, By Steve Silberman, WIRED magazine.]

    And when you start to look at some of the things that those individuals may do, most people perceive those types of behaviors as very odd and idiosyncratic - the classic 'geeky' type of individual.

So what happens, inadvertently, is that they have a tendency to make themselves stand out from the crowd in a manner that's not perceived as being positive, and so social isolation develops. They don't perceive it as being an isolating type of thing, and as a result, it perpetuates the whole cycle.

    Then the other area that I look for is the communication. There's a thing in Asperger's that's called 'pedantic language', and that is also known as the 'little professor'.

It's the quality where I give you everything that you needed to know about Glade Plug-ins and then some more. So it's way too much, above and beyond, what we would expect.

    And there's a classic phrase in Asperger's that goes "Don't be blinded by the brilliance."

Because a lot of parents may perceive their six-year-old holding quantum physics discussions and can tell you everything about the celestial bodies, but they absolutely have no friendships whatsoever.

They become blinded by that child's ability to be so brilliant in that one particular area, but fail to see the whole picture of what's happening with this child.

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Continued in Wise Counsel Interview by David Van Nuys, Ph.D.:
Timothy Kowalski, MA on Asperger's Disorder
- see site for rest of transcript and audio podcast.

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