Among the many manifestations of mental illness, psychological and developmental deficits and behavioral disorders regularly portrayed on television and film, conspicuously missing is Asperger’s Syndrome, a developmental Autism-spectrum disorder. ScriptPhD.com eagerly took in a private screening of Fox Searchlight’s thoughtful new film Adam, a sensitive love story with a groundbreaking portrayal of Asperger’s in a leading character. In addition to simply reviewing the film, we wanted to provide a background primer on the basics of Asperger’s diagnosis and treatment, as well as an ensuing discussion of accuracy in portrayal and plot by the filmmakers. To do so, ScriptPhD.com enlisted the help of two leading international Asperger’s experts, Timothy P. Kowalski and Dr. Tony Attwood. Please click “continue reading” for our full story.

Timothy P. Kowalski, M.A., C.C.C. is a world-renowned speech-language pathologist with extensive experience in treating individuals with Asperger’s Syndrome, high-functioning autism, and various psychiatric and behavioral/emotional deficits. Frequently asked to give national and international seminars as well as university guest lectures, Mr. Kowalski is the director of Professional Communication Services, Inc., a resource and treatment consulting center based in Orlando, Florida for a range of behavioral disorders. He is also the author of one of the most widely acclaimed books on this topic: The Source for Asperger’s Syndrome. Mr. Kowalski graciously and generously took time away from his vacation to provide ScriptPhD.com with a fundamental primer on the basics of Asperger’s Syndrome.

ScriptPhD: Asperger’s (in comparison with Autism) is rarely portrayed by leading characters in the collective media. As such, there is a lot of misinformation within the general public about what it is and what it is not. Can you dispel some of those notions for us?

Timothy P. Kowalski: It’s been said that the skill and knowledge of the diagnostician to fully understand what constitutes Asperger’s Syndrome (AS) is highly dependent upon whether or not an individual receives a diagnosis of Asperger’s Syndrome. Too many individuals are misdiagnosed because the diagnostician has a preconceived notion of what constitutes AS. While many individuals present with the classic speech pattern in which they talk incessantly about a specific topic, one does not have to have this characteristic to be diagnosed as such. Likewise, many also have difficulty with eye contact although this too is not a prerequisite for the diagnosis. When presenting on this topic I use a chart that compares three major classification systems used throughout the world to help comprehend the features seen in AS. Based on the criteria established by the DSM IV-TR [Diagnostic and Statistical Manual of Mental Disorders, the psychiatric bible of diagnosing mental disorders], these features may be best described as follows. A social impairment characterized by two “hits” from the following four characteristics:

1. A difficulty with appropriate use of eye gaze. They may look at something else while either talking or listening to someone without regard to how it is perceived by their communicative partner or they may look straight through the person as if focused on something about 18 inches behind them causing the person to feel extremely uncomfortable. Or…
A difficulty with facial expression. Frequently their face does not match their current emotional state. As such, individuals cannot “read” them and misinterpret their intentions. Or…
Inappropriate or unusual body posture. Many individuals don’t understand that body posture communicates a message. Slouching, lounging, laying on the floor all communicate a message of ambivalence or lack of concern to another person. However, they don’t realize this message is being “read” by their partner. Or…
A difficulty reading or using gestures. The fluidity of movement when gesturing is extremely difficult for many individuals with AS. Their movements may be perceived as awkward, stilted or just plain unusual.
But one doesn’t have to have any of the above because there are still three other criteria sets which are:

2. Difficulty developing appropriate peer relationships that are consistent with their age.
They often gravitate to younger children who are thrilled that an older child is playing with them. But the child with AS typically is not “playing” with them. Instead, he is dictating what and how they will act as if he is a director on a movie set. While many younger children will not recognize this form of manipulation, their peers do. Adults, however, have learned social graces. It is politically incorrect to tell someone they are obnoxious. But we communicate the message by subtle body language. Those of us who don’t have AS can read the message and we alter our social interaction accordingly but for the child with AS he can’t read it and may continue to talk incessantly on his current topic of interest. As a result, he may gravitate to adults who he perceives as being more accepting of his behavior.

3. Inappropriate sharing of enjoyment, interests, or achievements with others. Besides the obvious of sharing toys and objects, he may also have difficulty sharing his friends. He may avoid them or smother them and in doing so, continue to isolate himself from others.

4. A lack of social or emotional reciprocity. The inability to relate appropriately to others, coupled with inappropriate facial expression often leads others to believe they lack empathic concern. However, parents indicate their child is often extremely empathic. They just don’t communicate it with the same degree of finesse as those who don’t have AS.

A restricted range of interest characterized by two “hits” from the following characteristics:

1. Preoccupation with an interest that is highly intense: Someone with AS may obsess over a given topic by collecting things or discussing it with such intensity that it causes others to recognize this behavior pattern as unusual. Or…

2. A demand for following a routine or ritual that he may impose on himself or others. Or…

3. A preoccupation with parts of objects or the object itself that is seen as odd by others.

The presence of these symptoms must cause the individual to have a “clinically significant impairment” in the areas of social or occupational functions, no delay in language development (although many articles in peer reviewed journals are now stating a delay is possible), and the behaviors are not characteristic for another form of Pervasive Developmental Disorder or Schizophrenia.

The behaviors described above are required for the individual to be given the diagnostic label of Asperger’s Syndrome. Unfortunately, some diagnosticians do not look at the “whole picture” and instead focus on just one aspect when making a diagnostic decision.

SPhD: Can Asperger’s be categorized in the same vein as Autism? Does it have a similarly nebulous body of research as to the root cause?

TK: Asperger’s Syndrome is one of 6 diagnostic labels under the DSM umbrella of “Pervasive Developmental Disorder” which is often referred to as Autism Spectrum Disorders. The other 5 are Pervasive Developmental Disorder, Autism, Pervasive Developmental Disorder – Not Otherwise Specified, Rhett’s Disorder and Childhood Disintegrative Disorder.

There are two philosophies of where to place AS within the [above] spectrum. Some believe it is synonymous with “High Functioning Autism” while others believe it is a separate entity. My belief is that AS is a separate entity and it is based on their desire for social interaction. They want friends but have a significant difficulty making and keeping friends. Causal factors still have yet to be determined, however there is widespread agreement that it is a neuro-biological deficit and some families seem to have a predisposition to autistic spectrum disorders with many family members diagnosed with ASD labels.

SPhD: How treatable/manageable is this condition?

TK: There seems to be two “types” of individuals presenting with AS: those who realize they are having a difficult time navigating the social arena and understand they have to try to do so to get ahead, and those who simply don’t care about how they are perceived by others and refuse to admit they have any difficulty and simply want to do what they do without regard to others. It is my opinion that the outcomes for the latter are much worse than the other group. Structured intervention based on the principles of Cognitive Behavior Therapy coupled with extensive use of visual cues and a heavy emphasis on cognitive retraining will produce positive change. Whatever approach is used, one must emphasize the concept of social skills using a meta-cognitive approach in which the individual is always thinking about how he relates to his surroundings. By doing so greater generalization of functional gains will occur. A simple teaching of specific skills will not produce the desired result of greater social acceptance.

SPhD: In the movie “Adam”, a highly-functioning engineer with Asperger’s forms a
relationship with his understanding neighbor. Because of his condition, there are a lot of ups and (mostly) downs for them. Are people with this condition capable of forming strong relationships and marriages despite their diminished emotional capacity?

TK: For the spouse with AS, reading the subtleties required in a relationship is an extreme struggle. Quite frequently they want to please and try hard to do so, but unfortunately often fall short of what their spouse desires. Sadly many don’t realize they weren’t measuring up to their spouse’s expectations until their partner threatens to move out. It’s at this point where the spouse with AS realizes there’s a problem. Unfortunately their partner is completely exasperated.

Just to make things more interesting, add in an extreme dose of anxiety because the spouse with AS is consumed with a constant concern for producing social blunders. Be aware that when an individual is under a heightened degree of stress, linguistic competence is one of the first areas to decrease. History has taught him to be wary of new situations, group outings, and settings where he may be unsure of himself. Ultimately the spouse needs to realize where his social “Achilles heel” is in order to more effectively deal with it. Blaming others may seem like an appropriate way to fix the problem but more than likely it serves to compound the problem.

What’s needed is a quick fix in communication strategies. AS produces problems due to a neurobiological problem. They are not learned. Cognitive intervention is highly dependent upon self-reporting of behavior and feelings. But for the spouse with AS, how can he describe what he doesn’t realize he’s feeling, especially when he doesn’t have the words to describe what he doesn’t know what he’s feeling? Effective intervention focuses not on a quick fix but in assisting the client to identify and learn the social reasoning skills that those of us not impacted by AS have acquired through natural osmosis learning.

Despite these difficulties it is possible to have a meaningful relationship. It may not be filled with the same degree of “warm fuzziness” that others may have, but not everyone wants that in a relationship. As long as both partners find satisfaction in their relationship than it’s a positive relationship.

SPhD: How do you feel about Boston Legal‘s portrayal of Asperger’s in the form of the character Jerry “Hands” Espensen? Some Asperger’s awareness groups have complained about the extent of some of his tics and outbursts (the stiff hands on the side of the body, the random bleeps and noises, etc). In your opinion, does his character represent a realistic take on someone with Asperger’s and if not, where do the show runners go astray?

TK: When I talk about AS in my seminars I am often asked about how the media portrays specific characters. Some are seen as “over-the-top oddballs” in which we are made to laugh at their disability (something I find discomforting) and some are seen as having specific patterns of behavior that are definitely odd, yet the character is holding a job and functioning in society in his own unique way. The character Jerry “Hands” Espensen is presented in a manner that has characteristics of AS. Does he “typify” the classic form of AS? Of course not. But then, if the character was modeled after the stereotypical model of AS I believe it would be just as much of a disservice to the community as the current model is because that character’s performance will be seen by the general public as characterizing AS. To assume all individuals presenting with AS are going to be similar is unrealistic just as it is to assume all individuals with learning disabilities are exactly the same.

Movie Review: Adam
ScriptPhD Grade: A-

Adam, a new independent feature from Fox Searchlight Films, is more than the love story it’s being marketed as. Written and directed by acclaimed theater director Max Mayer, Adam is a movie about friendship, fidelity, and connection in an often ephemeral world. Adam (Hugh Dancy) is a brilliant but sheltered electroengineer with an insatiable curiosity for space and astronomy. After his father dies, his lone remaining friend is an old buddy of his dad’s that encourages Adam to expand his social circle. He gets that chance when the new neighbor moves in. Beth (Rose Byrne) is an aspiring children’s author and well taken care of city girl with a penchant for choosing the wrong guy. She feels an immediate connection with Adam, who showers her with unusual affection. She soon learns that the root of his quirky behavior is Asperger’s Syndrome. Rather than being repelled by Adam’s condition, Beth learns more about it, bring her closer to Adam in the process. Their romance is tested by their diametrical views of the world and learning to trust one another—themes universal to any relationship. In an extremely satisfying ending, both Beth and Adam fulfill their dreams and grow as individuals by embracing the other’s philosophy.

Actor Hugh Dancy took his portrayal of Adam very seriously. In addition to researching the disorder in books, online and with Mayer, Dancy also met with several Aspies. “People were very generous in talking with me,” he says, “and it was invaluable to me both to listen to what they had to say and to observe them. I felt a real responsibility to do that.” It shows. Dancy’s every flitter of the eye, his every facial expression and verbal enunciation so transforms him, that by the end of the shooting, co-star Rose Byrne remarked “Oh my goodness, this is not the person I just spent the last few weeks with!” Byrne, too, brought a personal connection to this role. “I have a family friend who has Asperger’s and I think it’s becoming more common. More and more people are touched by some form of autism,” she remarked. Some of Byrne’s own natural charm and zest for life bleeds over into her portrayal of romantically-challenged New Yorker Beth, creating an immediate chemistry between herself and Dancy. That chemistry lies at the heart of making the love story between Adam and Beth so satisfying and believable. In addition to its two talented leads, Adam touts a rich supporting cast, that includes Peter Gallagher as Beth’s doting yet imperfect wealthy father, the delectable Amy Irving as her wise mother, Frankie Faison, Adam’s caretaker and lone close friend, and Mark Lin-Baker as Adam’s boss.

In addition to first-rate performances by the two leads and a rich supporting cast, Adam benefits from a well-researched, tightly-composed screenplay by writer/director Max Mayer. “When I heard [a] man on the radio talking about Asperger’s Syndrome, I realized that not only was he describing his own very moving journey, but also something about the general condition,” says Mayer. “That’s what inspired me to begin [writing] Adam. As I started writing, I realized that Adam’s relationship to Beth is an extreme version of a very common dilemma we all face in life: the urge for an intimate connection to that which is necessarily strage—another person with their own view of the world.” Mayer’s script develops this unlikely relationship with sweetness, a humor that never plays on its lead’s disability, and material that stays true to the characters. Adam’s courtship of Beth is certainly unusual—when is the last time someone recreated the galaxy for you in their living room or showed up in a space suit to squeegee your windows? Likewise, funny moments abound, such as Adam ranting off the history of a New York theater when meeting Beth’s parents—a symptom of his illness—and yet, they never veer into the absurd or pejorative satire. The only quibble, and our reasoning for the A- grade, is that the script gets too disjointed, preachy, and didactic when explaining Adam’s disease. It felt a bit like, “Let us now pause this film while our character provides a brief run-down of Asperger’s symptoms.” The script, and disease, is best served when it shows the characters in their respective elements. Mayer’s direction, too, provides another layer of depth to visual cinematic experience. At times shooting with a jerky handheld camera from Hugh Dancy’s point of view, Mayer provides the audience with a visceral sense of the frenetic, fast-paced, noisy world within Adam’s brain.

Ultimately, the strength of Adam lies in the commitment of on and off-screen talent to provide a genuine story without succumbing to Hollywood romantic comedy staple cliches.

Adam goes into limited release this week. Check your local listings for showtimes.

To help us get in-depth answers about the portrayal of Asperger’s in Adam, ScriptPhD.com contacted Dr. Tony Attwood. Based in Queensland, Australia, where he runs the Asperger’s Syndrome Clinic, Dr. Attwood is considered a world-renowned expert in the research, diagnosis and treatment of Asperger’s Syndrome. His book, The Complete Guide to Asperger’s Syndrome, has now been translated into several languages. Dr. Attwood graciously provided us his thoughts on the film and its accuracy:

ScriptPhD: You said that you were really impressed by this film’s portrayal of Asperger’s symptoms and the storyline. Can you elaborate on certain details from the film (Adam’s habits, his tidiness, the freakouts, etc) that are accurate portrayals of what Aspies go through in real life?

Dr. Tony Attwood: The details that I noticed were aspects such as Adam’s eye gaze, mannerisms, interests and social confusion that are typical of some adults with Asperger’s syndrome. The actor gave a very credible portrayal of the life circumstances and romantic relationships of a man with Asperger’s syndrome.

SPhD: Why was Beth’s little white lie such an instigator for Adam? He couldn’t seem to delineate between something tiny and a major lie, and was basically ready to cut her off entirely as a liar and a betrayer.

TA: People with Asperger’s syndrome seek the truth and find it very difficult to understand and appreciate why someone would lie, even if it is a ‘white lie’. They often have clear expectations with regard to friendships and, if these are broken, can be very black and white in terms of continuing the friendship. There can be reluctance to tolerate a friendship transgression. The lie can also be a trigger to intense emotions, sometimes due to past experiences of confusion as to why someone would lie and whether someone could be trusted.

SPhD: Adam seems to get “better” somewhat through the movie. He can pick up on social cues at the end (such as helping a lady with heavy boxes or improving interactions with colleagues) that he couldn’t at the beginning. Is this true? Can an Aspie “learn” certain behaviors to help them function socially or ameliorate their skill sets? How difficult is this for them?

TA: People with Asperger’s syndrome can acquire social abilities through guidance and positive experiences. This takes time. Other people may not realise and appreciate the amount of intellectual effort that goes into achieving social success which can be exhausting.

SPhD: The trust factor for Adam seemed extremely difficult. In fact, his only seeming friendship was with his father’s best friend, who looked out for him since childhood. Is it typical of people with Asperger’s to have a small social circle like that, or to form the one really close friendship?

TA: An adult with Asperger’s syndrome can usually cope very well with a small circle of friends and acquaintances. The person can feel most comfortable in a one-to-one relationship. I use the phrase ‘two’s company, three’s a crowd’. One of the characteristics that I enjoyed about the film was that, at the end, he has achieved a wider circle of friends and adapted to a different environment where his abilities were recognized and appreciated.

~*ScriptPhD*~
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