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アスペルガー症候群:最も分かりにくい障害(2)

 さて、アスペルガー症候群の話題を続けます。

 ほぼ時期を同じくして論文を発表したカナーとアスペルガーが着目したのは、

 社会的相互作用の乏しさ
 コミュニケーション障害
 特定の興味対象への強いこだわり

 の3点でした。しかし、カナーが対象とした自閉症は、知的発達の遅れや他人への著しい反応の欠如(単に全く興味を示さないというのではなく言語・非言語的な反応が乏しいという意味)、言語発達の重度の遅れを伴うものでした。

 これに対し、アスペルガーが対象としたのは、知能も正常域かそれ以上で、言葉の発達に著しい遅れがなく、他人との交流もある程度は持てる人たちでした。カナーが論文発表後早期に業績を認められたのに対し、アスペルガーの発見が認められるのにしばらく時間がかかったのは、このような対象者の特性の違いも一つの要因だったのではないかと思います。確かに、アスペルガー症候群は、経験を積んだ専門家でも時々診断に迷うほど、分かりにくいところがあります。

 ローナ・ウイングが自閉症を「スペクトラム」と呼んでいるのは確かに妥当なことではないか、と実際に様々な当事者にお会いしてみると余計にそう感じます。上記の3つの特徴も、人によってその障害の程度が様々で、カナータイプとひとことで言っても、育ち方や環境、個人の能力によって、発見後の発達が少しずつ違う経路をたどるからです。アスペルガー症候群も、自閉症スペクトラムの中に含まれますが、カナータイプよりさらに多様性が大きいと考えられます。しかも、アスペルガーの人たちは、時に非常に能力的に恵まれていて、この高い能力が社会性やコミュニケーションの障害を目立ちにくくしていることもあり、今でもこの障害に対する専門家の共通理解は決して得られているとは言えないのです。

 カナータイプであれアスペルガーであれ、私も上記の3つを基本的な診断基準として使っています。ただ、この3つだけでは十分とは言えません。

 ある30代の男性は、数年間他人との接触がほとんどない毎日を過ごしており、自発的に話すこともなく、会話も続かない状態でした。また、ある仕事へのこだわりがあり、アルバイトなどの短期の仕事にも就くのをためらっていました。ここまでの情報だと、発達障害か?と思われるかもしれませんが、面接と検査の結果、いわゆる「社会不安障害」にあてはまるだろうということになりました。なぜでしょう?社会性も乏しく、コミュニケーションも十分にとれていない、しかもこだわりもあって仕事に就けない…それでも発達面全体からはアスペルガーを裏付けるものは得られませんでした。

 自閉症スペクトラム、特にアスペルガー症候群の特徴をひとことで言うと、「感じかた、考え方が多くの人のそれと違っている」ということです。そして、器用さと不器用さ、敏感さと鈍感さが一人の人間の中に同時に存在していて、その差が際だった状態にあると言えます。

 感じ方の違いは、知覚の異常などさまざまな形で現れます。味覚、触覚、嗅覚、視覚、聴覚のいずれかに、過敏性あるいは鈍感さが必ずといっていいほど見られます。さらに、人によっては、発汗など体温調節機能に問題がある人、頭痛、消化器症状、低血圧などの自律神経系のバランスの悪さからくる、様々な身体症状を持っている人もいます。気圧の変化に敏感な人もたまに見られます。多くの人にとってそれほど気にならない程度の刺激が、非常に不快で耐えられないように感じるのが知覚過敏ですが、逆に刺激を感じにくいこともあります。痛みに対しては、過剰に敏感な人と、逆に感じにくい人がいます。自閉症はいわゆる前頭葉や側頭葉などの高次脳機能だけでなく、小脳や脳幹の神経にも異常があるのではないかと言われていますが、これらの症状はそれを裏付けるものの一つと捉えることもできそうです。

 考え方に関しては、とらえ方だけでなく情報処理の仕方も独特であると言えます。ブロックにたとえるなら、ピース同志の組み立て方の違いといえるでしょう。アスペルガーの人は、「気にしなければならないところが気にならず、気にしなくてよいところを非常に気にする」傾向があります。会話がかみ合わないように感じるのは、相手がこちらの話す内容を聞いていないからではなく、その内容のどこを中心に聞いているのかが、こちらの意図していることと合わないからということも少なくありません。さらに、まったく別の話題で話していても、いつの間にか自分の興味ある話題にすり替わることも多く、情報の関連づけの仕方が一定のパターンに限られ、物事をいろいろな方向から見ることが難しいため、自己中心的で融通が利かないように相手には見えてしまうことがよくあります。

 しかしこれらは意識的でなく大半は自動的に行われ、少なくとも意図的に話しを自分に有利な方向へ引っ張ろうとしているのではなく、そういう風にしか反応することができないのです。

 知能の高いアスペルガーの人の中には、相手の言葉や非言語的なサインに過剰に反応するために適切に理解できない人もいます。言いかえると「見えなくてもいいところが見えてしまう」といったところです。逆に、相手のサインに鈍感な場合もあり、この差が大きいことがアスペルガー症候群の難しさでもあります。アスペルガーの人は、周囲が想像するよりも、自分のことも他人の事も自分の能力の範囲内でよく理解しています。しかしその理解の仕方が他人と違っていて、多くの当事者は、その違いに気付いているようです。どのように違うのか、どのようにその違いに対処すればいいのかが分からないためにとまどい、そのとまどいを適切に表現する手段が十分に発達していないために相手に分かってもらえないジレンマを抱えていて、相手にとっては通じ合えないように感じてしまうのです。

 アスペルガー症候群だけではなく、自閉症全体に言えることですが、援助に携わる人たちはこの「感じかた、考え方の違い」がどのようなものであるのか、ある程度の想像力を働かせながら彼らを理解する能力が必要だと思います。


(続きます…次は多分週末かな?)


 
 

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Comments

先日、内山登紀夫先生の講演が関東S市であり、解りやすいお話でしたが、sanaさんの記事を読みさらに、頷いてしまいました。
>理解の仕方が他人と違う・・・・
  映画などを見る時、普通の人は登場人物の目を中心に見るのにアスペの人は口元や背景を見ることが多いのだそうです。目の付け所が違うから、おのずとストーリーの理解も違ってくるわけだというお話もありました。

目の付け所が違うのは困ったことばかりではないはずだ、いいことにもつなげられるのでは、とちょっと息子を平静な目で見てあげようと思いました。


Posted by: マーキー | 2005.06.20 at 09:54 AM

先日はありがとうございました。

本当ですね、理解の仕方が違う。

そういう個性なんだと割り切るにはまだ時間がかかりそうですが、
重い症状の中で17年も主人なりにがんばってくれていたのだと思うと、
一番幸せになれる方法をゆっくり探してみようか。。。。
なんて気持ちになって私自身も少し力がわいてきました。

のんびりやっていこうと今は思ってます。

Posted by: ふじた | 2005.06.21 at 01:24 PM

初めまして、「ネット起業家!30歳で起業を目指すブログ」のLife☆TrackBackです。
今回、「超カンタン!最強メディア ブログ成功バイブル」の感想をブログで書きこんだ際に、勝手にトラックバックをしてしまった上に複数回のトラックバックを送信してしまい申し訳ありませんでした。
上手く更新が出来なくて、複数回のトラックバックになってしまいました。申し訳ありませんでした。

Posted by: Life☆TrackBack | 2005.06.21 at 11:35 PM

>マーキーさん、

 確かに、目の付け所が違うからといって、困ったことばかりではないでしょうね。偉大な発明や発見は、違う視点からもたらされるものですしね。

>ふじたさん

 そうですね、急がなくても、ゆっくりでいいですよ。

>Life☆Trackbackさま

 ごていねいにありがとうございました。
全然影響ありませんのでご安心下さい。
よろしければ、そちらへも時々寄らせて頂きます。
よろしくお願いします。

Posted by: Sana | 2005.06.22 at 01:48 AM

はじめまして(*^^*ゞ ココログで『アスペルガー症候群』で検索してたら、ここにたどり着きました。
とっても詳しく、分かりやすく書いてあってすばらしいです^^
私の書きたかったことがみんな書いてあるページです。

我が家にも小5のアスペの娘がいます。
毎日、大騒ぎで暮らしています。
この文の最後にありましたが、ほんと支援者は想像力と予測が不可欠ですよね。
彼女の話しを聞くときも、いろいろ想像しながらでないと話しが見えてこないし、
こちらからの発言も これを言ったらどうなる??などと予測しながら話さなければいけない。
だから、彼女とは私が運転中は話せません^^;

また、ぜひ遊びに来させてください^^
今後ともよろしくお願いします(*^^*ゞ

Posted by: けい | 2005.06.23 at 11:39 AM

>けいさん、

 ようこそおいで下さいました。
うーん、ココログ検索でも引っかかるのですね。
私の言語力ではうまく表現できないところもありますが、これからもよろしくおつきあい下さい。

Posted by: Sana | 2005.06.24 at 02:41 AM

記事へトラックバックさせていただきました。

自分のサイトで過去に「自称」についてもめたことが何度かあり、どうやってASじゃないケースもあるんだよってことを伝えればいいのだろうかと思っていたのですが、Sanaさんがわかりやすい例を書いて下さったので引用させていただきました。

Posted by: 空音 | 2005.07.06 at 09:40 PM

>空音さん、

 トラバありがとうございます。

 そうですね…安易な自称はやらない方がいいですね。

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