Asperger's Service

Autism Spectrum Condition (ASC) is a lifelong disability that affects how a person makes sense of the world, processes information and relates to other people. Autism is often described as a ‘spectrum disorder’ because the condition affects people in many ways and to varying degrees.

The linear version of the spectrum is not a very good representation of how autism is experienced by an individual. It doesn’t give any indication of what someone might struggle with and can lead some to assume that people “aren’t that autistic” which can lead to that person becoming more easily overwhelmed. Instead, the circle below shows some of the differed areas autism affects. Everyone will have a different level of difficulty in each area.

ASC is mostly a ‘hidden disability’. This means that you can’t tell that someone has the condition from their outward appearance. However, with the right support and encouragement, people with ASC can lead full and independent lives. This is another benefit of viewing the autistic spectrum as a circle of different areas rather than a line ranging from very autistic to not autistic.

People with the condition have difficulties in two main areas that are often referred to as the “dyad of impairments”. They are described below.

Social communication

People with ASC sometimes find it difficult to express themselves emotionally and socially. For example, they may:

• Have difficulty understanding gestures, facial expressions, or tone of voice
• Have difficulty knowing when to start or end a conversation and choosing topics to talk about
• Use complex words and phrases but may not fully understand what they mean
• Be very literal in what they say and can have difficulty understanding jokes, metaphor and sarcasm. For example, a person with ASC may be confused by the phrase ‘That’s cool’ when people use it to say something is good.

Many people with ASC want to be sociable but have difficulty with initiating and sustaining social relationships, which can make them very anxious. People with the condition may:

• Struggle to make and maintain friendships
• Not understand the unwritten ‘social rules’ that most of us pick up without thinking. For example, they may stand too close to another person, or start an inappropriate topic of conversation
• Find other people unpredictable and confusing
• Become withdrawn and seem uninterested in other people, appearing almost aloof
• Behave in what may seem an inappropriate manner.

People with ASC can be imaginative in the conventional use of the word. For example, many are accomplished writers, artists and musicians. But people with ASC can have difficulty with social imagination. This can include:

• Imagining alternative outcomes to situations and finding it hard to predict what will happen next
• Having a limited range of imaginative activities, which can be pursued rigidly and repetitively, e.g., lining up toys or collecting and organising things related to his or her interest
• Imagining and understanding other people’s motives for behaving in a certain way.

Restrictive and repetitive behaviours and interests

People with ASC may also have one or more of the following traits:

• Love of routines: To try to make the world less confusing, people with ASC may have rules and rituals (ways of doing things) which they insist upon. Young children, for example, may insist on always walking the same way to school. In class, they may get upset if there is a sudden change to the timetable. People with ASC often prefer to order their day to a set pattern. For example, if they usually read a newspaper before having breakfast but one day the newspaper is delivered late, this can be very distressing for the person. They may struggle to continue with their morning while it is “out of order” and they may devote a lot of attention and effort to trying to get things back “in order” rather than moving on with their day in a slightly different order.
• Special interests: People with ASC may develop an intense, sometimes obsessive, interest in a hobby or topic, or have a strong desire to build a collection of items of interest. Sometimes these interests are lifelong; in other cases, one interest is replaced by an unconnected interest. For example, a person may focus on learning all there is to know about trains or computers. Some are exceptionally knowledgeable in their chosen field of interest. With encouragement, interests and skills can be developed so that people with ASC can study or work in their favourite subjects.
• Sensory difficulties: People with ASC may have sensory difficulties. These can occur in one or more of any of the senses (sight, sound, smell, touch or taste). The degree of difficulty varies from one individual to another. Most commonly, an individual’s senses are either intensified (over-sensitive) or underdeveloped (under-sensitive). For example, bright lights, loud noises, overpowering smells, particular food textures and the feeling of certain materials can be a cause of anxiety and pain for people with ASC. People with sensory sensitivity may also find it harder to use their body awareness system. This system tells us where our bodies are, so for those with reduced body awareness, it can be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other people and carry out fine motor tasks such as tying shoelaces.
• Repetitive behaviours: Some people with ASC may rock or spin to help with balance and posture or to help them deal with stress or feel more grounded. They may also repeat certain words or sounds which are enjoyable for them or have fidget toys and objects they like to hold or play with.

Who is affected by ASC?

It is conservatively estimated that one person in 66 is on the autistic spectrum. People with Asperger’s come from all nationalities, cultures, social backgrounds and religions.

What causes ASC?

The exact cause of ASC is still being investigated. However, research suggests that a combination of factors – genetic and environmental – may account for changes in brain development. Asperger’s is not caused by a person’s upbringing, their social circumstances and is not the fault of the individual with the condition or their parents.

Is there treatment available?

Autism is not a disease or illness so there is no “cure” for autism. However, there is help available to better understand what being diagnosed with the condition means, how to manage the difficulties associated with the condition, and how to access other support services, such as support workers and benefits if necessary.

Mersey Care’s Asperger team also believes that autism isn’t negative. There are several strengths and desirable characteristics associated with autism, such as a better ability to focus for long periods of time, punctuality, honesty and attention to detail.

We also believe that anyone diagnosed with ASC does not need to be “fixed”, rather supported to manage difficulties better to improve their quality of life. Everyone with ASC is a unique individual and should not feel as though they must change who they are to fit in with others.

What about Asperger’s?

Asperger’s Syndrome is a type of autism, also sometimes referred to as “high functioning autism”. Asperger’s Syndrome is no longer used as a diagnosis, instead, a diagnosis of Autistic Spectrum Disorder (ASD) is given. If you have already been diagnosed with Asperger’s, your diagnosis will not change to ASD, but you can use the term if you prefer. Our team prefer to use the term ASC rather than ASD, because we believe “disorder” to portray the diagnosis in a more negative way.

Though ASC certainly brings challenges, as mentioned in the previous section, there are also strengths associated with the condition.

Pros and cons of diagnosis

Pros

• Being able to make sense of past difficulties
• Increased access to support services
• Increased chances for eligibility for certain benefits
• Additional help in educational settings, such as extra time or special conditions to help you focus on an exam
• Legal obligation for employers to make reasonable adjustments at work to help you manage difficulties you may be facing.

Cons

• Though it should not be the case, some people with an ASC diagnosis experience more difficulty with gaining employment. Especially in certain careers, such as the military
• Unfortunately, some people still experience stigma, prejudice, and discrimination due to their diagnosis
• People diagnosed with ASC may also face additional barriers with accessing appropriate health support services.

(Some of this information was taken from The National Autistic Society and The Art of Autism)

For more information and support, come along to our monthly Asperger Collective meeting and meet other families in similar situations.

Guides for professionals and carers

Supporting an autistic individual who is experiencing anxiety

A guide to reasonable adjustments for:

• GP surgeries
• Council services
• Employment
• DWP
• Job Centres
• Housing
• Police
• Probation

ADDvanced Solutions - Find brief summaries of common difficulties associated with autism and some ways to help support them

LivPac - voluntary group of parents and carers providing support and advice for carers of young people aged 0 to 25 years with disabilities or additional needs. Email: info@livpac.co.uk Phone: 0151 727 5271

Mersey Care’s Liverpool and Sefton Autistic Spectrum Condition team:

Clinical psychologists: a clinical psychologist has a doctorate in clinical psychology and specialist knowledge in thoughts, feelings, behaviour and understanding who we are. They are often actively engaged in research projects and experienced in at least one type of psychotherapy. They also supervise junior members of staff, such as trainees and assistant psychologists.

Community nurse: A qualified registered nurse who works in a community based team. They have specialist knowledge in physical health and formal training in ASC. They are also experienced in promoting positive mental wellbeing and working on developing self-help strategies for people struggling with common mental health difficulties, such as mild-moderate anxiety and depression.

Clinical specialists: A qualified social worker who now works in a clinical setting. They are experienced in diagnostic assessment, care planning, and review. They also help deliver our: Understanding ASC post-diagnostic support, in both group and one to one format.

Occupational therapist: An occupational therapist has a degree in occupational therapy and specialist knowledge of adapting our daily lives and our environment to improve our quality of life. Within our team, our occupational therapist focuses on helping service users understand how their brain may differ from someone who does not have ASC, as well as with understanding and managing sensory processing difficulties.

Assistant psychologist: An assistant psychologist has at least one degree in psychology and experience of working with people to improve their mental wellbeing. In the ASC team, the assistant psychologist helps deliver the: Understanding ASC post-diagnostic support, as well as delivering low level psychological support for anxiety and understanding and managing emotions. Their work is supervised by the clinical psychologist.

Assistant practitioner: An assistant practitioner has a great deal of experience in Autism and a related diploma. They help deliver the post-diagnostic support group and are supervised by the team manager.

Trainees/students: A trainee or student is someone training to be a clinical psychologist, nurse, social worker, or occupational therapist. Occasionally, the ASC team supports them with gaining experience towards their qualification. They work under the supervision of a member of the ASC qualified in their profession.

Collective drop in leaflet

National Autistic Society: https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/pre-diagnosis

The Girl with the Curly Hair: https://thegirlwiththecurlyhair.co.uk/

Reach Men’s Centre: https://reachmenscentre.com/

Venus Women’s Centre: https://www.venuscharity.org/

Self help

Mersey Care have self help guides for many common mental health issues:

https://www.merseycare.nhs.uk/self-help-guides

Self help online for common mental health issues: www.getselfhelp.co.uk

Free online courses, leaflets and workbooks to improve wellbeing, reduce stress, anxiety and low mood at Living Life to the Full: www.lltft.com

Learn mindfulness and meditation with the Headspace app: Meditation and Sleep Made Simple - Headspace

Listen to free mindfulness meditation recordings: https://www.freemindfulness.org/download

Sleep help: https://www.sleepfoundation.org/

Understanding Autism: Eight session self-directed course: https://www.open.edu/openlearn/science-maths-technology/understanding-autism/content-section-overview?active-tab=description-tab

Women with autism: https://www.autismempowerment.org/resource-center/resources-for-females-on-the-autism-spectrum/

• Mersey Care self help guides
• Self-help online for common mental health issues
• Free online courses, leaflets and workbooks to improve wellbeing, reduce stress, anxiety and low mood at Living Life to the Full
• Meditation and Sleep Made Simple - Headspace
• Listen to free mindfulness meditation recordings
• Sleep Foundation - help with sleeping
• Understanding autism 8 session self-directed course
• Women with autism

• The Samaritans: 116 123
• The Life Rooms
• Live Well Sefton details
• The Live Well Directory
• Healthwatch
• NHS Cheshire and Merseyside
• The National Autistic Society
• Citizens Advice
• Careers Service
• PALS and Complaints
• Private assessments
• Social needs assessment
• Access Sefton
• In-Trust
• James’ Place Men’s Suicide Prevention
• Reach Men’s Centre
• Venus Women’s Centre
• Young Person’s Advisory Service
• Liverpool Light Café out of hours crisis support
• Turn2us
• Disability grants
• Family Fund
• Kooth - Online mental wellbeing community for ages 11 to 24 years
• Liverpool Adult ADHD Ladders of Life (meetings for people with ADHD/Asperger’s) Call 0151 298 3837 or 07798 585 656

Facebook and Twitter @teresashir:

Liverpool Adult ADHD group

• Sefton SENDIASS - Special Educational Needs and Disabilities Information, Advice and Support Service - 0151 934 3334 seftonsendiass@sefton.gov.uk provides information, advice and support for disabled children and young people, and those with special educational needs (includes ASC), aged 0 to 25 years, and their parents, for example, support with the Education and Health Care Plan (EHCP) process, personal budgets, preparing for adulthood, the law on SEN, help with forms and reports, resolving disagreements, local parent support groups and more

Sefton's Information, Advice and Support Service (SENDIASS) | The Sefton Directory

In the event of an emergency, go to A&E call 999 or 111

The Asperger service accepts referrals for adults aged 18 or over. 

Before a referral is made by a GP, the person being referred must have consented to the referral. This must be clearly indicated on the referral form to avoid delays, or the referral being rejected.

You can make a referral by completing the referral form and either posting or emailing it to the service, via Referralsliverpoolaspergerteam@merseycare.nhs.uk.

What happens when I am referred?

The Asperger Service offers diagnostic assessment and brief interventions. The team does not offer ongoing support and monitoring.

The team does not have psychiatry attached, so is unable to handle any medication queries or management, nor can we care coordinate. People who require these services can remain open to other teams, such as CMHT, whilst being open to the Asperger service.

To refer a child or young person for an ASC assessment, please visit Alder Hey Children's Hospital Trust's Autism Spectrum Disorder (ASD).