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Roger N. Meyer "...of a different mind "
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Copyright 2001-2003

Roger N. Meyer



     [This article stems from an email the author sent to a licensed clinical social worker counseling his first AS/NT couple.  The NT spouse first sought individual marriage counseling prior to her husband's recent AS diagnosis.  Her husband is in the midst of post-diagnostic depression.  There is a likelihood that since he didn't seek the diagnosis on his own that he will continue to question the validity of the diagnosis and remain in denial.


     The AS client has developed a genuine trust relationship with his therapist.  Nevertheless, the therapist is having major difficulty moving the client away from ruminative and preservative thought patterns, and is concerned with the client's short-term memory issues.  This author more thoroughly considers the issues of diagnosis ownership and working with clients with short-term memory challenges in separate articles.


     This paper was first submitted to the Autism99 International Internet Conference sponsored in England held between November 3 and November 13, 1999.  The conference was sponsored by The Shirley Foundation and hosted at a site developed by RMR Design.  During the running of the conference, some 55,000 registered participants viewed over eighty papers by authors in the field of autism.  This article appeared in its earlier form on that forum, and has been recently modified -- as of 2003.]


      I've found that when my clients lock up and remain stuck in a preservative thought pattern it is best to process the dynamic itself rather than attempt to return to content.  Until we both process the effect of the dynamic itself, we can't make any forward progress.  I've also found that when this occurs, initially enlisting the aid of the other spouse to redirect the conversation doesn't help.  The counselor's intervention should be directly focused on a direct interaction with the client without the presence of a third party.  There is too much opportunity for distraction or a likely desire to "say the right thing" rather than to focus on how the right thing is being expressed.


     It will take some backing and filling for you and the client to arrive at a variety of best approaches.  Nature of the words, the general tone of the conversation, a sense of when it would be useful to intervene and when to let the conversation wind out for a while determine my approach.  The clients' adoption of a particular conversational approach may stem from a variety of causes, some of which have to do with cognitive processing.  For example, he may be plumbing the depths of his long-term memory to arrive at an old expressive script for the current situation.  He may be unable to distinguish between his current experience and others in the past that are related but different.  (This latter condition occurs when the client has known problems with generalization and experiential differentiation challenges a common executive function issue with Asperger syndrome persons).  He may be trying to come up with a novel response appropriate to the current circumstance but his thought pattern has taken a one-way detour to old history.


     In each instance, you may want to explore not only the dynamic itself, but what in your interaction has led up to it.  By discovering and laying bare the antecedent causes for a certain communication behavior, you can build the platform for future work with your client to help him monitor his behavior.  I've found it helpful to understand how the client experiences learning, and then to use the senses or cognitive hooks he uses to teach him how to monitor his own communication.  For example, I ask the client to attend to our body postures, our facial expressions, our tone of voice, but also our bodily sensations and what we hear, see and "feel".  I mean "feel" quite literally.  If the client is leaning forward on his chair, or gesticulating with his hands, or expressing a double or confused message through a mismatch between posture and words, we look at that.  I use full-length mirrors for visual cueing.  (At present, I do not use video feedback.  I can't afford it, but for the visual learners in the crowd, I know it would be a powerful tool.)  I use squeezable rubber balls so that the client can literally "get a grip" on his words by noticing and gauging how he clutches the ball in his hand, tightly or loosely, as we speak.  I use a wall-clock with a prominent second-hand to help illustrate the value of self-imposed silence to construct "natural" breaks in the flow of conversation.  At first, the breaks occasioned by these formal methods seem unnatural, but presenting them this way ties communication components to sensual experience, and expands the conversant's awareness of the environment.  Gradually, the exercises become less stressful.  We work on gradual extinction of these formal monitoring methods as the client searches his response "tool box" for behaviors more natural to him.  If he doesn't have an appropriate response, we observe others in casual and formal conversation, and observe their conventions and cues, and agree upon which ones seem appropriate for our work.  When moving towards more sophisticated monitoring techniques, I never start with methods foreign to his basic expressive vocabulary.  Too-different, as well as too-much too-fast is a formula for disaster.


     One key to all of this work is not to make it too detailed or intensive at first.  Initially, there is a lot of talk just to determine the range of the client's style of communication and to establish trust between us.  I introduce processing the dynamic of the conversation very gradually, so that the client is not overwhelmed with detail and so that he doesn't become so self-conscious that the flow is broken by hesitancy and anticipation of an interruption.  Although there are similarities to the communication styles of my clients, getting to know them, and forming a unique relationship convinces me that there is no real formulary for the work.


     Because each of your AS clients is unique, there can be no one-size-fits-all approach.


Back to your client


Due to the recency of his diagnosis, his wife is as mystified about AS as you are.  To introduce you to couples issues of Asperger syndrome and neurotypical spouses, one good resource is an Internet site built around such concerns.  That is the FAAAS (Families of Adults with Asperger Syndrome) web site.  It can be found at:




Another more positive and supportive website oriented towards repair and preservation of the marriage is ASPIRES, located at



     You will find material of direct relevance in the articles in the FAAAS web site under the "Tony Attwood" section.  This section contains a guide to adult AS communication behaviors, the transcript of a workshop that Dr. Attwood conducted in March 1999, through the auspices of FAAS and NAS (the English National Autistic Society).  A second transcript from his May 2000 session in Coventry is also at the site, and tapes of a third presentation for spouses at Cape Cod, MA in November, 2000 can be ordered from that site.  In the same location, there are two excerpts from his book "Asperger syndrome: A Guide for Parents and Professionals.".  One excerpt deals with the dynamics of the diagnostic process, while the other excerpt is his Australian Asperger Syndrome Scale, a Likert scale designed for parent and caregiver use in identifying Asperger syndrome in children.  Attwood's book remains the best single source in print on AS.  The site also contains a direct link to OASIS (On-Line Asperger Syndrome Information Source), a mother lode web site created and maintained by Barb Kirby.  Her site is a cornucopia of basic and advanced information on Asperger syndrome.  That Website is found at:




     Simon Baron-Cohen, developer of the concept of Theory of Mind, recently authored book (1998) describes successful training techniques to teach theory of mind to high functioning autistic children and adolescents.  He is currently conducting research at Cambridge University oriented to adult Asperger syndrome cognitive treatment modalities.  It might be useful to consult his book when dealing with some of the issues I discuss below.


     I've been working on line with the Non-Spectrum (NS) spouse of a couple in England for nearly a year.  Their local NAS affiliate sent two field workers out to counsel the husband and wife separately.  For a while I was proposing some step by step instructions in managing daily communication challenges between the wife and her husband which seemed to have some limited success.  Like your client, her husband is also recently diagnosed, but in his case, he's not in denial.  Theirs is a ten year marriage, and she is finally getting over her spousal "rescue" orientation and into serious self-care.  Because her plight is common to many partners of AS men, I started a discussion thread on a major closed email parent listserv addressing the issue of NS/AS marriages and spousal communication issues.  The discussion in public and between private parties continues today, and the matters raised there are the same as those shared by your client's wife.


Communication challenges 101


     Several things have occurred simultaneously in their relationship.  According to your client's wife, he's still into denial, and she finds it hard to interest him in reading anything about AS, although they've gotten the DX from a local psychologist.  In my first and only call to your client's wife, I proposed that her husband seek a medical diagnosis from the only MD qualified to diagnose adult AS in our state.  The value of the medical diagnosis is that with it, he can get psycho pharmaceutical support to moderate dysthymia and anxiety, both of which are often present even in the "mild cases."  The prescriptive recipe for each patient is unique, and if he has a good internist who has current knowledge of these medications, he will be in good hands.  Most psychiatrists are simply not prepared to deal with high functioning adult autism, and where he resides, far too many mental health professionals are heavily influenced by classical psychodynamic thought.  As you've discovered, using traditional talk therapy of any kind does not work with him.


     As I started to suggest above, some adults with AS do respond well to cognitive/behavioral work, and using a cognitive behavioral approach might produce some breakthroughs regarding his communication process.


     His ruminative thought patterns and preservative thinking are the mental equivalent of echolalia, and they serve the same calming and self-centering function.  In adults, such behavior is left over from early childhood adaptive behavior that parents and other adults found difficult to extinguish.  If you think of his mental behavior as serving the same function as the visible self-stimulatory physical behavioral manifestations commonly found in younger children with autism ("stims"), then it is easy to see that instead of extinguishing them outright, it is more useful to move towards their gradual replacement and substitution with behaviors which serve the same adaptive functions as stims do in children.  As he finds other behaviors more appropriate for communication, his less functional responses will subside.  Children can learn to substitute more socially appropriate stims, or to take their most disruptive ones and express them under "safe conditions" unobserved by others.  Parents report this substitution and response rationing process works quite well.  Work with adults can produce impressive results, especially where the stakes involved are higher.  It often takes the threat of one spouse to leave the AS spouse to impress him with the seriousness of the failure of their communication.  I say "him" because the sex ratio of male to female AS incidence appears to be in the range of  4:1.


     When I first began to work with transition age young adults, I often found myself wanting to use variants of "worse case scenario" thinking with them in discussing their dysfunctional behaviors.  I quickly learned that such an approach eroded the trust base.  Cajoling the client with "if not now, when?" arguments, or badgering them to "just stop" had a negative effect.  There is an internally logical reason why AS persons hold on to dysfunctional patterns of thought and behaviors.  It may appear perverse to others, but to the AS person, such behaviors were successful survival responses in the distant past.  For persons with excellent long term memories that don't self-prune or fade with time, the disjunctive consequences of their "time-warp" inappropriate response are not obvious to them.


     Even when they become aware of the inappropriateness of their current response patterns, they nevertheless feel locked into revisiting them time after time.  This behavior is obsessive and compulsive in appearance.  For AS adults, time management and executive function problems at work and in their other relationships and functions demonstrate the frustrating effect of this ingrained behavior.


     The trick to working with persons exhibiting such behavior can be boiled down to a single word:




     I've found that gradually, on their own speed, they can appreciate the need to change for reasons of their own self- interest.  Where the counselor comes into the picture is in assisting them to get from this realization to its actualization.  Clients bring in their own quiet desperation about being stuck or unable to move in directions they know they must.  After trust is established, I move them in the direction of slight discomfort by alluding to their original reasons for having sought help.  Since there is a charge behind that need, I help them access it as the source of energy to tap while undergoing change.  In doing this, I proceed with great caution so as to avoid fostering dependence or learned helplessness.


     So far, more by flying by the seat of my pants than by doing anything methodical, I've seen some significant shifts in my clients' ability to function as verified by their own self-reports.  We so often get used to hearing reports of rapid change by neurotypical clients that experiencing the same shift at a glacial pace with Asperger syndrome clients is truly trying to our own sense of professional competence.


     When I get frustrated with a given client's rate of change, all I need to remind me of how slow a process change can be is to look at my own 57 years, 55 of which were spent without a clue about my own flavor of Asperger syndrome.  Now I turn to other mental health professionals both for case consultation and personal check-ins.  I've been fortunate to find other professionals willing to do this work with me.


     According to your client's wife, you are the first person he really trusts.  That is a major breakthrough for anyone with AS.  For all recently diagnosed adults, self-trust and self-esteem are so low and their self-definitions have been so dependent upon ascription of others that many AS adults require a long time following diagnosis to trust others.  From this point forward, your client will have less trouble trusting others as you help him strengthen his self-confidence.


     Once he accepts his diagnosis and he isn't there yet, you will be able to access a lot of his resistance much as an Aikido master uses the energy of an opponent to succeed.  He can learn to give himself the same gift once he experiences its benign exercise from another trusted person.  That's you.


     All of this will take time.


     He's going through a stage of self-determination that may take some time to complete.  One factor complicating your client's progress is that initially it was not his idea to seek a diagnosis.  He rode into the psychologist's office on the agenda of his spouse.  Whenever this happens, a person with inadequately formed self-concept can dismiss the results precisely because the impetus for seeking the knowledge was not his alone.  Successful and more rapid progress towards personal change occurs when the AS individual has an exclusive sense of ownership over the entire diagnostic scenario.


     Another complicating factor comes with the territory of this neurobiological condition.  Self-determination is an ongoing process for everyone.  For persons with AS, there is a strong need for closure and a discomfort with incompleteness.  The whole process of stopping to process a conversation may leave him frustrated and feeling thwarted in a desire to complete his monologues.  It's your job to sense this frustration, and work just at the outer edge of it.  Once you understand his frustration "triggers", you can help him identify them as well.  That is advanced work, but you can start it early, and by keeping it simple by remaining aware of your task of focusing the work, you both can point to progress.


     Depending on the degree of acceptance, and how soon after the actual diagnosis the therapist works with the client, an AS adult lives in a post-diagnostic world explainable by the very self-knowledge they expend energy in denying and affirming at the same time.  Even if their knowledge was perfect, AS persons still harbor lingering doubts.  They often revisit imperfectly swept corner housing old dysfunctional habits.  A life's worth of low self-trust can't be overcome just through will power.  In the end, the product is never perfect because it is undergoing constant bewildering modification.  Resistance to change a diagnostic hallmark is not overcome with an identity tag, even if the label "fits".  One can't will the brain to be different, but one can learn new positive behaviors that can supplant negative or dysfunctional ones.  This is as good as "willing".  Perhaps it is better, because the process appeals to the logic of many men with Asperger syndrome.  If the process is something they buy in to, then they assume a sense of control over more parts of their lives they experienced as chaotic and unpredictable.


A few "How-To's"


A brief, general remark about what follows.  I believe that many traditional therapy models can be counterproductive for people with Asperger syndrome.  Rather than starting from a stance of viewing the client as someone with a disorder to be dealt with using the concept of normalization and functional remediation, I've found it more effective to employ the paradigms of progressive adult education.  So much of what is involved in working with high functioning autistic adults is new learning and new insight that it makes little sense to approach personal work with a medical overlay.  The medical model inevitably calls "cure" and normalization into play.


    Autistic persons do not want to be cured.  They are not sick, although some of their behaviors are clearly dysfunctional.  High functioning autistic people also do not want to be made "normal."  They see themselves as different, and wish to be respected as persons with a built-in neurological difference.  Their brains operate differently.  Because of the neurobiological character of the disability, there are many things they cannot change.  Expecting them to do so is like asking a diabetic to produce Insulin.  It simply isn't going to happen.


     Even though I've found it effective to approach each adult client using the educational model, I realize that I am up against the client's generally negative experiences with education at all levels.  I approach each client as a unique adult learner, and in doing so, don't allow much room for categorical thinking.  I do attend to any information they can provide about how they learn and part of my assessment process involves identification of specific learning disabilities.  If I have questions about these challenges, and if the resources are available, I ask the client to seek a full adult functional evaluation conducted by a neurophysiologist and as complete a specific learning disability screening as possible.  So far, in working with transition age young adults, their health plans or other community service agency enrollment has made this possible.  An informed client makes a good student, especially when his subject matter is himself.


On to specifics    


     One way to start, even when your client is in a high state of denial, is to focus on how he solves problems.  The learning styles of people with AS are often startlingly different than that of their neurotypical peers.  When he seems particularly stuck or ruminative, surprise or distract him by introducing your problem:  you don't understand his problem-solving process.  Could he explain it to you?


     You may come up with your own ideas, but struggle against letting them impede the direct information about to come at you.  Ask HIM for help with the problem of understanding how he is "working" now.  Engaging him in a mutual problem-solving task will simultaneously accomplish several tasks.  Placing a problem on the table can temporarily pull him away from his inward focus.  If he is a visual thinker and learner, use actual objects to represent the problem on a desk or coffee table.  If he is a verbally oriented learner, encourage him to use his command of precise language to pin down a description of how he solves this problem.  If he best learns through multi-sensory input, or favors a single sense, have him indulge that one sense with the proviso that he must communicate so that you understand the meaning of his communication without a lot of additional interpretation from you.  You are asking him to relate to "your" problem and asking him to help you with it.  This depersonalizes the process, and drains hidden and unknown to you threat factors so that he can concentrate on "your" problem.


     Share your difficulty by using expressions that objectify your concerns, and try to avoid any "you" statements.


     Put simply, don't assume anything.  You have no more magic power to guess what is going on in his head than he has in guessing what is going on in yours.  Keep an open mind.  You are both about to learn something.


     By intervening with a request for common work, you are taking back control of the interaction at the same time you invite him to join with you in a common task.  This may be a new experience for him, and each new experience will force his own dysfunctional rumination further into the background while he works in the present tense with you.  Rehearse your approach out loud with some self-talk prior to seeing him.  You can also present him with the "acceptable" process of self-talk.


     Though it may seem obvious to you, many persons with AS are unaware of just how much silent self-talk they engage in.  By modeling audible self-talk yourself, you can encourage him to externalize his own self-talk process.  I know you wouldn't want a babbling self-talker to walk out of your office into public spaces, but in the privacy of your relationship with him, you can both do the self-talk modeling as well as accomplish a second level of training for him.  The second level teaches him how to safely handle self-talk out loud.  Teaching deliberate process verbalization is considered a best practice in cognitive rehabilitation therapy.  Largely, that is what your work is all about: your focus is to help the AS client gain, rather than recover, critical executive function skills.


     Once you get to this stage in your work with him, you can enlist his spouse as an active communication skills training partner.  What she may experience with him, in the safety of their relationship, is this novel (for him) method of expression, something he now knows how to deliberately share with her because he has a problem he is working out.  In their own work with one another, his first issues may be totally self-centered.  As she learns to tolerate his self-talk, he will be drawn into desiring reciprocity from her just as he has experienced it with you.  The process will not be quite the same as your work with him, because you don't have a complex history of past communication failure with him.


     They both have that history with one another.  In their relationship, they have developed their own set of communication codes.  Working under the conditions of that background noise may make their new work with one another very difficult.  It can also be very exciting and scary to both of them.  What they are both doing in the process is unlearning and dismantling one style of dysfunctional, non-informative communication as they construct another one.  There too, just as with his working with you, there will be backing and filling and a lot of "seat of the pants flying".  But this will be healthy, non-threatening risk taking because it can always be focused on an objectified "thing" a problem.


     Initially objectifying a problem removes much of the emotive load that impedes learning.  Learning to consciously objectify a problem is a process that must be taught.  You can develop a set of signals or shorthand to make this "stop-and-process procedure" an automatic behavior after many repetitions.  For the ease of his learning, it may be advisable that his spouse uses the same signals so that the process is reinforced in the same way at home.  Initially, all of you will be self-conscious about the process.  Later, they can develop subtler, less disruptive means to halt dysfunctional communication behavior in which they both indulge.


     There is one last topic relating to work with AS adults worthy of note.  I'm sure that his spouse first came to you with a concern that her husband didn't show his emotions easily or at all.  Persons with AS have difficulty identifying and then expressing their emotions.  Some materials describing AS refer to apparent "flat" affect.  This is an accurate but misleading description.  It is accurate from the point of view of an observer or a diagnostician.  This characterization is neither accurate nor helpful for working in a therapeutic relationship with an AS client.  What you encounter isn't "flat" as much as a condition expressive of a state of mind that is more aptly described by the client as "I don't know what to call it" phenomenon.  For the therapist, it is important to recognize that even if the client is successful in identifying a feeling state, he's had a lifetime of failure with expressing it appropriately.


     As a mediator, I've long recognized that when people get stuck or keep repeating themselves or are silent and truly at a loss for words, it is because their needs aren't being met.  They stay stuck or silent until they are "heard".  For persons as intelligent as most persons with Asperger syndrome are, this condition presents both the client and the therapist with a unique challenge.


     Housed in the body of the AS adult is a child who has yet to develop an appropriate vocabulary to describe undifferentiated feeling states.  The client truly lacks a vocabulary to differentiate, name, and express his emotional needs.  This leads his neurotypical partners into a regular game of twenty questions of "Name that feeling" often with no clearer understanding at the twentieth question than before the first.  Although many AS persons are highly verbal, there is something "not quite right" about their use of words which is strange and often distancing to others.  Technically speaking, this is a language pragmatics problem.  The French have the perfect phrase to describe this: "Je ne sais quois." Apart from sheer eccentricity, there is both a receptive and expressive blindness to emotional states of the person himself as well as others in that person's world.  When you encounter AS adults whose coping mechanisms and adaptive scripts effectively mask this deficiency, it is a shock to discover just how profound is this absence of basic skill in an otherwise advanced semantic pragmatic language development.


     If you ask many AS adults what they are feeling at a given moment, a common answer is "I don't know".  Believe me, we don't.  Not at that moment, anyway, and not with the pressure applied to come up with a response the other person can make sense of.


     What you encounter with many AS adults are persons who have never had the formal training as they must have to identify and express their emotional needs in a manner which is both socially correct and appropriate for the occasion.  One of the major reasons why adults with AS self-isolate, often dragging their mates and families along with them, is because they have experienced a lifetime of negative consequences flowing from inappropriate expression of those needs.  Avoidance is a natural way of averting future pain.  That's exactly what many adults with AS do.  As a relationships therapist, you have met one of very few Asperger syndrome adults who has made it to a stage of some kind of intimate relationship and some kind of marriage.  This condition is not typical of the vast majority of adults with the diagnosis.  They remain single and singular.  For the most part, their lives are spent in physical and emotional isolation from others, but with a great longing early in life that this not be so.  In later years, it is common to experience resignation to and even a defiant preference for an unconnected social existence.


     Getting a handle on the first part of your personal work with him will be a challenge, but once you begin work on process, no matter how small the pieces you cut a problem into, you both will experience success.  One very common feature of AS is the presence of specific learning disabilities.  Many of them remain life-long challenges.  Breaking a multifaceted problem into smaller components has proven to be an effective technique in teaching Asperger Syndrome children.  Learning disabled adults appear to benefit from the same approach.


     Another technique to try is to propose challenges that go just to the edge of his tolerance for accepting change.  At first, it will be hard to know where those limits are because he may not be aware of them.  Even once he becomes aware of them, he may not express himself clearly or at all, so be prepared for surprises.  You may find many of his responses to be non-sequiturs or appearing to come out of nowhere.  Much of his internal logic may be hard for him to express in words, and he may manifest his responses behaviorally.  He may either not respond, or you may see frustration and anger.  If he has a very limited sense of how to modulate his response, he may take some time in learning how to adjust his responses from almost unnoticeable displays of emotion to dramatic, yet appropriate expression.


     If he can't be engaged on a formal, abstract level and most persons with AS can't with these kinds of challenges you might want to ask him if he has interests through which he can literally act out his responses.  Despite a high level of abstraction in formal speech, many persons with AS are very concrete thinkers.  Their imaginations can be engaged by encouraging them to express themselves through talk of things of special interest.  Once you are introduced to what that interest is, you won't have any trouble finding the "on" button.  The challenge for you, and your AS client, is to find the "off" button, and to know how and when to press it.  Special educators and parents of Asperger syndrome children have found learning to be effective when it can be hooked to the child's unique interests, and that could be a route appropriate for a reluctant adult client.


     Reluctance to consider and accept change, and a general conservatism about acting affirmatively may be an essential part of your client's character.  While some persons with AS act impulsively with respect to major life decisions, many others are hesitant and cautious.  Within their particular areas of interest or expertise, they may be very high performers, but this high level of activity rarely translates to other parts of their lives.  There, movement towards change can seem excruciatingly slow to others.  In making progress in these other areas, it is essential for your client to experience success at taking baby steps with positive reinforcement every step of the way.  People with AS do not respond well to negative discipline, and are very sensitive to what they often misperceive as criticism or disapproval by others.


     As his counselor, a major role you might to assume is in helping him deal with his own impatience.  Once he experiences progress, he'll want to be successful at times when it just doesn't seem to happen.  These are refractory periods, and you have undoubtedly experienced them as a therapist in working with other clients with developmental disorders.  Sometimes it seems like one step forward and four backward.  The saving grace is that with adults, the periods are shorter and their ability to express gratitude and pride in their own progress is a powerful incentive to future learning.  Reflection on this progress is something that his wife can also provide him, because her experience of him is constant and occurs in real time.


     I hope this very long post will prove to be of some help to you.  Asking the questions you did has gotten me much more in touch with the actual processes I've used that have been effective for me.


     I hope some of them work for you as well.



Copyright Issues


This article is copyright, all rights reserved by the author, Roger N. Meyer.  It may be reproduced in single copy once for personal use, and in no more than ten copies total for educational purposes.  Fair Use is authorized for all purposes and under conditions established by US Statute and the International Copyright Convention, to which the United States is a signatory nation.  No person shall publish, distribute, copy, or by other means make this material available to others for purposes of personal gain or professional self-aggrandizement.  Individuals wishing permission to exercise other than fair use or limited distribution as outlined above must contact the author, in writing, and receive explicit written permission from the author prior to engaging in further use of this material.

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