«Susan Teresa Ruggeri A Thesis submitted in fulfilment of the requirements of the University Of Wolverhampton for the degree of Doctor of Counselling ...»
The Experience of Humour in
Asperger s syndrome
Susan Teresa Ruggeri
A Thesis submitted in fulfilment of the requirements of the
University Of Wolverhampton for the degree of Doctor of
This work or any part thereof has not previously been presented in any form to the
University or any other body whether for the purpose of assessment, publication or for
any other purpose (unless otherwise specified). Save for any express
acknowledgements, references, and/or bibliographies cited in the work, I can confirm that the intellectual content of the work is the result of my own efforts and no other person.
The right of Susan Ruggeri to be identified as author of this work is asserted in accordance with ss. 77& 78 of the Copyright, Designs and Patent Act 1988. At this date copyright is owned by the author.
Abstract This study investigated the experience of humour of people with Asperger s syndrome. It aimed to explore the lived experience of this phenomenon. A literature review was undertaken which revealed that people with Asperger s syndrome are thought not to have a sense of humour and a number of theories are proposed to explain the difficulties that may be experienced in regard to humour. In order to gain insight into the lived experience a qualitative approach was adopted using semi structured research interviews with eight, adult, male participants. Interpretative Phenomenological Analysis was then used to illuminate the insider perspective. The analysis highlighted four main themes, the experience of difference, the experience of learning, what I find amusing and how I use humour. It was suggested that people with Asperger s syndrome do have a sense of humour but they may need to put in extra effort to develop it. The importance of individuality and acceptance of differences was also recognised. The report highlighted a number of clinical implications such as the role humour plays in social interactions and the importance of asking questions rather than making assumptions when working with people with Asperger s syndrome.
Contents Section 1 Literature Review
1.1 Search strategy 7
1.3 What is Asperger s syndrome 9
1.4 Are autism and Asperger s syndrome different conditions 10
1.5 Triad of difficulties 15 1.5.1 Difficulties with imagination 15 1.5.2 Difficulties with language 16 1.5.3 Difficulties with social interaction 17
1.6 Humour 19 1.6.1 Theories of humour
There are numerous people I would like to thank for helping to make it possible for me to complete this thesis A special thank you goes to the participants whose openness and honesty made the study possible. I hope I can help bring about a better understanding of the experience of humour for people with a diagnosis of Asperger s syndrome.
I would like to thank my co-facilitator at the ASG who introduced me to the world of Asperger s syndrome and the group members who provided advice and support in the initial stages of my investigation.
Thank-you to my Supervisors, Dr Neil Morris and Dr. Biza Kroese who provided support, guidance and encouraging words during the writing of this research.
To my friends, colleagues, Mum, brother and partner, thank you for your patience and for listening to my frustrations throughout all my trials and tribulations and for encouraging me to complete this piece of work.
Section 1 Literature Review
1.1 Search Strategy Key words: Asperger s syndrome, high functioning autism, autism, humour, laughter.
Data bases used: psycINFO, Swetswise, DataStar, Google Scholar. See Table 1.1 below. Further articles were identified from a hand search of referenced papers and books. Articles were included if they were from a peer reviewed journal.
Table 1.1 Initial Literature Search Papers Reviewed
A critical review of the current literature on Asperger s syndrome and humour was undertaken as it has been suggested that people with this diagnosis lack a sense of humour. The main difficulties associated with a diagnosis of Asperger s syndrome were considered and the validity of the diagnosis questioned. Difficulties establishing a theory of humour were also highlighted as it was found to be a multifaceted phenomenon.
There were a number of theories proposed to account for the difficulties experienced by people with a diagnosis of Asperger s syndrome but these were all found to give partial explanations. A deficit in the research of the lived experience of humour was highlighted even though this was considered likely to give valuable insight into the lives of people with Asperger s syndrome. A recommendation was made that research should be undertaken to consider the experience of humour for people with this diagnosis from an insider perspective and Interpretative Phenomenological Analysis was identified as the most appropriate method to achieve this aim.
1.3 What is Asperger s syndrome Asperger s syndrome is a neuro-developmental disorder listed in DSM-IV (APA,1994) and ICD-10 (WHO, 1994). It is defined primarily in behavioural terms noting difficulties in three key areas, communication, imagination and socialisation.
Wing (1981) was the first person to use the term Asperger s syndrome. She gave an account of a group of people who had characteristics that very closely resembled the profile of abilities and behaviour originally described by Asperger in his doctoral thesis, published in 1944.
In 1944 Asperger described four boys whose social maturity and social reasoning were delayed; however, some aspects of their social abilities were quite unusual at all stages of development. According to his observation the boys began to speak at the age expected of children and had acquired a full command of grammar but experienced difficulty in using pronouns correctly. He described the boys as having difficulty making friends and often being teased by other children. Asperger observed there were impairments in verbal and non-verbal communication, especially in the conversational aspects of language. He reported that the content of speech was usually abnormal and pedantic, and consisted of lengthy monologues on favourite subjects.
Asperger (1944) also described conspicuous impairments in the communication and control of emotions, and a tendency to intellectualise feelings. Empathy was not as mature as one would expect, considering the children s intellectual abilities. He described an impairment of two-way social interactions, with the boys, ignoring the demands of their environment. According to Asperger the children also had an egocentric preoccupation with a specific topic or interest, such as train timetables, that would dominate their thoughts and time. He also noted that some children were extremely sensitive to particular sounds, aromas, textures and touch.
1.4 Are autism and Asperger s syndrome different conditions?
For the purpose of research it is important to have a clear understanding and definition of the areas of investigation and when researching Asperger s syndrome the term high functioning autism (HFA) is often used interchangeably. This review will now examine the differences and describe the frame of reference for the current research.
There has been much debate as to whether Asperger s syndrome is a variant of autism. Wing (1981) has suggested that Asperger s syndrome may be part of the autism continuum. She argues that it is possibly a mild variant of autism in relatively bright children, a view that has been supported by Gillberg (1985) and Szatmari, Tuff, Finlayson and Bartolucci (1990). Asperger (1944) disagrees that it is a variant of autism. Instead, Asperger s data suggests that children with autism and Asperger s syndrome differ in both their early history and their developmental outcome. In classic autism the person often has learning disabilities and language delay, which impact on their future development.
In 1994, the World Health Organisation (WHO) published the tenth edition of the International Classification of Diseases (ICD-10) and in 1994 the American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This was the first time both diagnostic textbooks included Asperger s syndrome as one of several Pervasive Developmental Disorders. There is currently ongoing controversy as to whether to eliminate Asperger's syndrome as a separate disorder, and instead merge it under autism spectrum disorders (ASD) in DSM -V to be released in 2013.
There is still an ongoing controversy as to whether the two disorders are different conditions. According to Howlin (2003) there is also considerable disagreement about the validity of the diagnostic criteria used in DSM-IV (APA, 1994) and ICD-10 (WHO, 1994) to distinguish between the two conditions. This is a view supported by many including Kim, Szatmari, Bryson, Streiner and Wilson (2000) and Kugler (1998).
Howlin (1998) notes how the DSM criteria exclude the diagnosis of Asperger s syndrome if the child also fulfils the criteria for autism, whereas ICD rules for this are less exclusive. Schopler (1985) suggests there is little or no justification for using the category of Asperger s syndrome.
Table 1.1 below [taken from Howlin (1998)] summarises the criteria adopted by ICDWHO, 1994) and DSM-IV (APA, 1994) used in some large-scale studies showing the principal areas of inconsistency relate to early cognitive, linguistic and motor development.
Table 1.2 Differing criteria for Asperger s syndrome [source; Howlin (1998)] Eisenmajer, Prior, Leekam, Wing, Gould, Welham and Ong (1996) attempted to identify the characteristics that were most likely to lead to a diagnosis of Asperger s syndrome rather than autism.
They found that lack of early delays in language was the most significant factor and that the Asperger s group also had a higher verbal mental age and tended to be more proactive in their social relationships. In addition, they found that people with Asperger s syndrome were generally diagnosed at a later stage and were more likely to receive a co-diagnosis of attention deficit disorder.
Attwood (2006) suggests that at present there is no data or convincing argument that clearly confirms that high functioning autism and Asperger s syndrome are two separate and distinct disorders. Further research into the differences is therefore required before a definitive answer can be reached as to whether there is a distinction between high-functioning autism and Asperger s syndrome.
The final decision however on whether a person receives a diagnosis of Asperger s syndrome is a subjective decision made by a clinician. According to Attwood (2006) this decision is based on the clinician s clinical experience, the current diagnostic criteria and the effect the unusual profile of abilities has on the person s quality of life.
There is much debate around the issue of psychiatric diagnosis. Boyle (1999) suggests that diagnosis involves many assumptions about behaviour and experience, and questions if they should be treated as the same sort of phenomena as bodily processes, as these assumptions have never been shown to be valid. This therefore questions the legitimacy of a psychiatric diagnosis, which she claims, gains its professional and social status by presenting itself as equivalent to a medical diagnosis. There is no biological test for Asperger s syndrome; the diagnosis is based on reports of behavioural differences. One may question whether it is right to make assumptions about people s experiences based on a label attached to them by another person who is making a subjective judgement about their lives. This research takes an ideographic approach, examining individual experiences of a phenomenon, which it values as a valid basis of knowledge.
It should be remembered that whether a person is diagnosed as autistic or having Asperger s syndrome or not, the actual diagnosis has little effect on their abilities. The label attached to them may however alter how they are treated by others and may make a significant difference to the level of support and services they can access throughout their life. Some people may seek a diagnosis in order to access the services and assistance they require to improve their quality of life. On the other hand, many people with similar behavioural patterns may go undiagnosed as they do not wish to access external agency involvement.
Regardless of whether a person has a diagnosis of Asperger s syndrome or high functioning autism, they frequently have difficulties with a number of areas in their life, including social interaction, and they or the people around them often seek advice and assistance to help improve their quality of life. Researchers such as Mesibov (1986) have shown that improvements can be made with specific interventions and if these are to benefit the individual then it is important that they are made available to them whatever label they have attached.
Diagnosis is therefore an area that invites further investigation. It does not matter what label is given to a person, we are dealing with individuals who are all different and assumptions about their experiences should not be made. Instead what is required is a better understanding of lived experiences and the impact these have on a persons life. Therefore, because the diagnosis of Asperger s syndrome is such a subjective decision, for the purpose of this research, a distinction between Asperger s syndrome and high functioning autism will not be made in the literature review. However, only participants who have been given a diagnosis of Asperger s syndrome by a psychiatrist or psychologist will be interviewed about their experiences of humour.
1.5 Triad of difficulties Although all individuals are unique there may be some areas of experience that are common to a particular group. In the case of Asperger s syndrome a diagnosis centres on the experience of a triad of difficulties, in social interaction, communication and imagination (National Autistic Society, 2009).
1.5.1 Difficulties with imagination Often people with the diagnosis are characterised by a lack of imagination. The Adult Asperger Assessment (Baron-Cohen, Wheelwright, Robinson and Woodbury-Smith,