«Unanswered questions are stressful for children with autism»

Mr Huber, the first thing you notice when you walk into your surgery is the many little plastic animals on the wall shelf. Do people with autism like animals?

It is not uncommon for people on the autism spectrum to enjoy the company of animals. Animal behaviour is often easier to interpret than that of humans. For example, when a dog is happy, it wags its tail. A person, on the other hand, may express joy through laughter one moment and in a different way the next. They use more subtle forms of expression. This can be difficult for people on the autism spectrum, as they often find it challenging to understand the facial expressions and body language of those around them.

I can use language in such a way that the child is very likely to respond to me and talk.

Matthias Huber, psychologist

You yourself have Asperger's syndrome, and interpreting other people's behaviour and feelings is part of your job. Do you find this presents any challenges?

On the contrary. I find it easier to assess autistic children, as I have a similar way of looking at the world, analysing it, and using and decoding language. I can use language in such a way that the child is highly likely to respond to me and talk.

For example?

Unanswered questions cause stress. That's why I phrase my questions very precisely and in detail. For example: «When you practise the guitar, do you look at the strings, straight ahead, or at a place I haven't mentioned?» People on the autism spectrum are detail-oriented – both in their thinking and in their perception. A conversation with precise questions is interesting to them, and they find it easier to answer. Children without autism find this approach strange. «Is he mad?» a teenager once asked. My questions were too detailed for him.

With whom and how do you carry out autism assessments?

We see children with a suspected diagnosis of ASD, Asperger's syndrome, early-onset autism or atypical autism. The diagnosis is always made by a team of medical and psychological specialists. Together with the parents, we compile a family and developmental history, gather information from teachers and special needs teachers, and carry out perceptual, IQ and autism-specific tests.

The clinical interview plays an important part. The content and form of the response, as well as non-verbal behaviour, provide valuable insights. For example, if I ask a child with autism whether they have a favourite colour, they often reply «Yes». A child without autism would name the colour and might even mention their bike, which is the same colour.

What is the average age of the children you examine?

They can be aged between 1.5 and 18 years. On average, they are around 11 years old. Often, young people come to us who have previously been given other diagnoses that did not explain all their behavioural issues or characteristics.

How did Asperger's syndrome manifest itself in you when you were a child?

I hardly spoke. I only answered questions if I knew the answer 100 per cent. I also couldn't formulate my thoughts out loud and turn them into sentences. So I often didn't reply until the topic had already been dealt with. I also usually looked away when someone was speaking. Otherwise, I'd get too distracted by visual stimuli and all I'd hear was «wuwuh, wuwuh». What's more, I often failed to recognise irony in the past. That's typical of people on the autism spectrum. It can lead to interpersonal problems.

Other children don't realise that someone with autism wants a best friend too.

Matthias Huber, psychologist

Are autistic children able and willing to form friendships?

I know lots of people who don't have any friends. They'd actually like to have some, but they find it difficult to make contact with others. Other children are often put off by them: «He just stares» or «He doesn't look at you». They don't realise that someone with autism also wants a best friend and would like to be invited to a birthday party sometimes. Many autistic children are also afraid of being bullied.

Are you speaking from experience?

As a child, I was spat on and hit because I didn't communicate in the way society expects. Children often bully out of a sense of helplessness. They simply don't know enough about autism. In other words, anyone who bullies people with autism needs more information.

A sense of helplessness pervades the whole situation. Where, for example, can parents find information and support?

You can get support from specialist counselling services. With greater awareness and understanding, therapy may not always be necessary. I often find that the diagnosis alone brings a sense of relief. Those affected realise that there is nothing strange about them. They realise that their way of perceiving and thinking opens up new perspectives for them.

What new perspectives has your way of thinking opened up for you?

I had many specialist interests: as well as palaeontology and smoke detectors, I was also interested in human thought, which led me to psychology. As my CV wasn't exactly perfect, I initially struggled to find a job after graduating.

Twelve years ago, I was offered a position by the then Director of the KJP Bern, Professor Felder, to conduct clinical interviews with children suspected of having autism, in order to find out how they think, feel and perceive the world. Over the years, this developed into a 70 per cent post. I limit my work to autism. I feel very confident in this field, even though I am constantly learning new things.

This brings us to the final question: People with autism rely on familiar situations and routines. So what was it like for you to answer questions that you hadn't seen before the interview?

Generally speaking, unexpected questions on unfamiliar topics are more difficult. In this case, it wasn't a problem because the questions all concerned autism. I accessed a database containing all the questions I'd been asked over the last 12 years and looked for similarities. That way, I was able to draw on existing answers.