Asperger’s Syndrome: Definition, Signs, Diagnosis, and Treatments

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Table of Contents

Definition of Asperger’s Syndrome
Signs and Symbols
Causes
Diagnosis
Treatments
References

Asperger’s Syndrome (AS) is considered a disorder related to autism spectrum psychological problems. Critics (Safran 2001; Dissanayake, 2004) admit that there is some evidence that mild forms of AS may be expressed in a way that might be described more as a personality style. Such cases may be so mild that a diagnosis of AS is not warranted. Such children are socially immature and loners, but do not have the eccentricities that characterize individuals with AS. As school-age children, such individuals may have seemed quite normal around adults, but different from other children in the context of a peer group.

Definition of Asperger’s Syndrome

Asperger’s Syndrome is so named because it was first described in 1944 by Hans Asperger, a Viennese pediatrician interested in finding ways to treat children with learning and emotional problems. Although he first published his work in 1944, and Kanner published his original account of autism in 1943, the two were unaware of each other’s work (Barnhill 2001). Various labels exist for a child with many or few symptoms of autism, or with severe or mild forms of autism. Following Barnhill (2001): “Asperger Syndrome (AS) is a developmental disability that is defined by impairments in social relationships and verbal and nonverbal communication and by restrictive, repetitive patterns of behavior, interests, and activities” (p. 259). Asperger’s Syndrome is a developmental disorder that affects many aspects of how a child sees the world and learns from his or her experiences. Children with AS lack the usual desire for social contact. The attention and approval of others are not important to them in the usual way. Autism is not an absolute lack of desire for affiliation, but a relative one Asperger’s Syndrome may affect boys as much as ten times more often than girls. Barnhill and Myles (2001) propose several definitions of Asperger’s syndrome:

“According to Attwood, “People with Asperger syndrome perceive the world differently from everyone else” (p. 9). Tantam (1991) asserted that Asperger syndrome is a highly disabling condition that may cause the greatest disability in adolescence and young adulthood, when social relationships are the key to almost every achievement” (cited Barnhill and Myles 2001, p. 175).

Asperger’s syndrome is said to include autistic psychopathy and schizoid disorder of childhood but is classified separately from schizotypal disorder (Mayes et al 2001). “The DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, IV] definition of Asperger’s disorder was similar to that proposed by authors preceding the DSM-IV in that social impairment and restricted and repetitive behavior and interests were both diagnostic criteria” (Mayes et al 2001, p. 263). In ICD-10, the term Asperger’s syndrome’ is clearly intended to cover the condition Asperger described (autistic psychopathy of childhood) and the syndrome: a schizoid personality of childhood. However, the implication is that schizoid disorder of childhood differs from a schizoid personality disorder in adult life, which remains within the personality disorder group of conditions in ICD-10. In this classificatory system personality disorders are described as often beginning in late childhood or adolescence, but as not appropriately diagnosed before the age of 16 or 17. “The DSM-IV also included two criteria for Asperger’s disorder not stipulated as necessary by previous authors: absence of significant cognitive and language delay” (Mayes et al 2001, p. 264). Furthermore, in ICD-10 (although not in the American diagnostic system, DSMIV) schizotypal disorder is grouped with schizophrenias, not with the other personality disorders.

Signs and Symbols

On the basis of an earlier epidemiological study of mentally and physically handicapped children, Boyle (2003) suggests that “modern society, and particularly those who rule us, display many traits of Asperger’s–yet somehow we see them only in children” (p. 27). He underlines an increasing number of people diagnosed with Asperger’s syndrome in recent years. Following Wing (cited Mayes et al 2001, p. 263) a number of symptoms that characterized children with autistic-like conditions are (1) impairment of two-way social interaction; (2( impairment of comprehension and use of language, including non-verbal communication; (3) impairment of imaginative activities with an absence of socially oriented pretend play and a narrow range of repetitive, stereotyped pursuits.”The availability of useful speech within the first three years of life places individuals with AS on a trajectory distinct from children with autism, who characteristically have a delayed onset of functional language” (Dissanayake 2004, p. 48). This demeanor has sometimes been characterized as “active, but odd,” and is different from that of higher functioning autistic people who simply won’t converse at all. On topics that are not their ‘special’ topic, they are much more cursory (but usually accurate) in their responses. Interestingly, people with Asperger’s Syndrome seldom lie, though they may not be open to disclosing information. Being able to lie convincingly also requires the “mind-reading” ability associated with a theory of mind–an ability that such individuals lack or have only to a very limited extent. “The authors concluded that Asperger Syndrome belongs on the same continuum as high-functioning autism, differing only in severity” (Dissanayake 2004, p. 48).

The most noticeable thing about individuals with AS is the social difficulties they have. For a teacher or other person familiar with children with very specific learning disabilities, AS can be characterized as a specific and severe inability of social understanding. Just as a deaf person may end up with a distorted idea of what is going on because one of his senses is “turned off,” an AS individual can be thought of as selectively “people-deaf” or at least “people hard-of-hearing.” People with AS are very literal and tend not to comprehend aspects of social interaction that vary in meaning depending upon the context. People with AS are rule-oriented; they can learn by rote basic social rules, like “stand at least three feet away from someone you are talking to,” or “look at the person you are talking to,” but tend to apply the rule inflexibly, standing three feet away when the arrangement of furniture would make five feet more natural, or staring too fixedly while talking. A feature of individuals with Asperger’s Syndrome is their inability to comprehend what friendships are about. Most are either indifferent to the idea of friendships or have no idea how to make a friend.

“Children with AS are not only socially isolated but also demonstrate an abnormal range or type of social interaction that cannot be explained by other factors such as shyness, short attention span, aggressive behavior, or lack of experience in a given area” (Barnhill 2001, p. 259).

Some young adults with AS really seem to want friends but aren’t able to cope with all the things they need to do right to make a friend. On the other hand, if anyone shows an interest in being friendly, “Although these individuals usually have average to above-average intelligence, they may demonstrate academic difficulties because they lack higher-level thinking and comprehension skills and tend to be very literal” (Barnhill 2001, p. 259).

Causes

Some research suggests that 30 percent to 50 percent of cases of Asperger’s Syndrome may have an inherited component. AS is seldom directly inherited, since it is rare for autistic adults to want to have children, but there is increasing evidence that partial forms of autism occur in many family trees where there is an autistic or PDD child (Boyle, 2003). Along with certain diseases and other inherited characteristics, personality traits may also be inherited. In families with autistic children, odd personality traits focusing on poor social skills seem prevalent. The presence of odd family members as well as very mathematically bright, but socially awkward relatives, are more frequent in families with an autistic child. Sometimes these family members are socially a bit awkward, but nonetheless very intelligent and accomplished (Asperger Syndrome 2007). Autism seems to be a case of inheriting an extreme version of the trait of social isolativeness. There is some, but no real evidence that conditions like schizophrenia or major depression occur in families with autistic children. Physical disorders like heart disease or cancer have never been related to Asperger’s Syndrome (Safran, 2001).

A clinician taking a family history for possible genetic contributions to Asperger’s Syndrome will therefore focus on socially unusual relatives in addition to ones who may have actually had an autistic spectrum disorder. Following Rourke et al (2002), “half of all cases have some form of cerebral dysfunction arising from pre-, peri-, or postnatal distress. A genetic component is strongly suggested, particularly given the high incidence of AS features observed in relatives of children with AS” (p. 309). During a developmental history, a doctor will want to know about the mother’s pregnancy with the child, since certain pregnancy risk factors have been associated with autism. Most of the risks in pregnancy-related to autism are just that–risks, not causes.

In addition to possible genetic causes of Asperger’s Syndrome, cases of Asperger’s Syndrome have been linked to a variety of risk factors associated with pregnancy and delivery. A “risk factor,” however, is not the same thing as a “cause,” and it can be very difficult to say with confidence what “caused” any specific case of autism. There is likely a combination of factors–genetic factors as well as factors related to the pregnancy and delivery that determine whether a specific child develops autism or another PDD (“pervasive developmental disability”). But it should be emphasized that “risks” associated with pregnancy are not necessarily things that the expectant mother did wrong, but are often a variety of events over which she had no control. There is no evidence to support the idea that autism or any form of PDD is caused by the way a child is treated, although severely maltreated children and severely mentally retarded children sometimes do things that a casual observer might understandably confuse with autism. Years ago, some doctors suggested that autism might be caused by an early rejection of the child by the parents, but such harmful theories have long since been definitively disproved. Today, “there is strong evidence to suggest that Asperger syndrome can be caused by a variety of physical factors, all of which affect brain development – it is not due to emotional deprivation or the way a person has been brought up” (Asperger Syndrome 2007).

Quite apart from the similarities of symptoms in the Asperger’s Syndrome and autism, clear genetic links have been established between schizoidAsperger disorders and childhood autism. A few families have been reported who had both an autistic child and a child with Asperger’s autistic psychopathy (van Krevelen, 1963 cited Boyd 2003) or in whom both conditions occurred in close relatives. De Long and Dwyer (1988 cited boyd 2003) found a high incidence of Asperger’s syndrome among first and second-degree relatives of high-functioning autistic people (68 percent) compared with autistic people with an IQ less than 70 (6 percent). These workers also found an increased rate of manic-depressive illness in the first group of families. Boyle (2003) reported social and cognitive deficits, similar to but milder than those of autistic people, among grown-up siblings of autistic patients. evidence is that autism and Asperger’s syndrome aggregate in families; that among the biological relatives of autistic children there is an excess of people with mild schizoid features; and also an excess with features (atypical social interactions, communication deficits, and circumscribed interests) similar to but milder than the deficits of autism itself, which some workers have hesitated to label as either ‘schizoid’ or indicative of Asperger’s syndrome (Boyd, 2003).

Diagnosis

Behavioral assessment is the part of an Asperger’s Syndrome evaluation that requires the most expertise. There are two main ways of collecting behavioral information. One is through informal or unstructured observation. The second is through structured or standardized observation. Some clinicians prefer a combination of the two (Boyd, 2003). A doctor may try to get the child to play with various toys, which is an example of an unstructured observation. In such an unstructured assessment, the mother might be asked to get the child to play with the toys. An unstructured observation might take place in a waiting room, a doctor’s office or playroom, in the child’s home, or even in the child’s classroom. One goal of an unstructured observation is to see how the child typically reacts when certain everyday things happen.

AS differs from autism in a number of key ways: First, children with AS may not be detected as early because they may have no delays in language or only mild delays. In fact, it is usually not until parents notice that their child’s use of language is unusual, or their child’s play is also unusual, that concern sets in. Unlike autism, where the vast majority of children also experience some degree of mental retardation, children (and adults) with AS are rarely mentally retarded although many have low-average intelligence. The diagnostic criteria for Asperger’s syndrome are isolated behavior, odd speech/non-verbal communication/ preoccupations, impaired social relations, and onset before age 6 years. Szatmari et al (2001). found that more mothers of high-functioning autistic than of Asperger’s syndrome children reported their child to lack social responsiveness to them, to have a complete lack of interest in social relations, to show echolalia, repetitive speech, and stereotypies, and to show no imaginative play. More Asperger’s syndrome than high-functioning autistic children showed affection as a baby, shared their special interest with their parents, and enjoyed the company of adults other than their parents according to the mothers’ report. Interestingly, no major difference emerged on pegboard tests for motor skills, arguing against claims that Asperger’s syndrome is distinguished from autism by clumsiness. A lack of any striking difference was also found in a study of early history and outcomes with these subject groups. Echolalia, pronoun reversal, global social impairment, and restricted activity were more common in high-functioning autistic children. Perhaps the only finding of note, and not easily explained by a failure to match subject groups on verbal IQ, was that the Asperger’s syndrome group was more likely to develop a secondary psychiatric disorder than were the high-functioning autistic subjects.

Treatments

There is no special medical treatment for Asperger’s syndrome. In some cases, medical treatment can be used for symptoms like anxiety and depression, distress, and mood disorders. According to Hallahan & Kauffman (2005) children with Asperger’s syndrome “are an extraordinarily diverse group compared with the general population” (p. 15). The main types of therapy are educational and social supports, supportive psychotherapy and behavior interventions, special educational programs and interventions. “The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness” (The National Institute of Neurological Disorders 2007). Higher functioning teenagers and young adults with Asperger’s Syndrome may benefit from psychotherapy for a couple of reasons. First, as it does for similarly affected younger children, psychotherapy may be able to serve as an educational setting for rehearsing and learning scripts and rules for appropriate kinds of social interactions. This type of work comes under the heading of social skills training and is sometimes done in groups as well as individually. A major limitation to this kind of work for autistic young adults is that they learn what to say, but have no drive toward social conformity, and therefore, little motivation to implement what they learn. Parents should “check with local medical services what medical help may be available” (Boyd 2003, p. 17). In teenagers and young adults, psychiatric disorders that may co-occur with Asperger’s Syndrome, like depression or manic episodes, can be monitored, but when they do occur, are most likely to remit as a result of psychotropic medications rather than as the result of insight-oriented therapy. The potential use of psychotherapy for autistic children needs to be considered carefully beforehand and on an individual basis. If it is to be used, the goals in terms of expectations for specific behavioral changes need to be planned in advance and reevaluated frequently to determine whether a benefit is being accrued.

Educational programs and courses can help children with Asperger’s syndrome to become a part of the community. Following Elder et al (2006) social skills treatment is one of the best ways to help children socialize. “The group goals included targeting interpersonal skills, enhancing self-esteem, and promoting positive peer experience. Techniques included modeling, coaching and role-play” (p. 635). Children are typically very intelligent with an originality of thought and spontaneity of activity, although not adapted to the environment unusual thinking, with special ability in logic and abstraction; children follow their own path regardless of outside influences; this can lead to the pursuit of useless and abstruse subjects highly grammatical speech begins early, with excellent, spontaneous expressions resembling schizophrenic neologisms, often they don’t wish to communicate or make contact with others; they hold forth. In this case, “structured teaching is a general set of educational principles involving the establishment of routines, schedules, physical organization of material, visual boundaries defining space, and other individualized strategies designed to facilitate learning” (Safran 2001, p. 151).

In sum, the research has suggested that this type of “personality style” may be quite prevalent among siblings of autistic children who are thus suspected of having a genetic form of autism. Educational programs and psychotherapy can help many children and teenagers overcome this illness and socialize. Through these programs, children can learn appropriate social behavior, verbal instructions, modeling techniques, and sensing. Children with AS are sometimes described as “active, but odd”, not avoiding others the way autistic children often do, but relating in a more narrow way, usually centering activity around their own needs and peculiar interests. In fact, having one or more areas of narrow, encompassing interest is highly characteristic of those with AS.

References

Asperger Syndrome. (2007). The National Autistic Society. Web.

Barnhill, G.P. (2001), What Is Asperger Syndrome? Intervention in School & Clinic 36 (5), 259.

Barnhill, G. P., Myles, B.S. (2001). Attributional Style and Depression in Adolescents with Asperger Syndrome. Journal of Positive Behavior Interventions 3 (3), 175.

Boyle, D. (2003). The Syndrome That Became an Epidemic. New Statesman 132, p. 27.

Boyd, B. (2003). Parenting a Child with Asperger Syndrome: 200 Tips and Strategies. Jessica Kingsley Publishers.

Dissanayake, C. (2004). Change in Behavioural Symptoms in Children with High-Functioning Autism and Asperger Syndrome: Evidence for One Disorder? Australian Journal of Early Childhood 29 (3), 48.

Elder, L.M. et al (2006). The Efficacy of Social Skills Treatment for Children with Asperger Syndrome. Education & Treatment of Children, 29 (4), 635.

Hallahan, D.P. & Kauffman, J.M. (2005). Exceptional Learners: Introduction to Special Education (10th edition).

Mayes, S.D., Calhoun, S.L., Crites, D.L. (2001). Does DSM-IV Asperger’s Disorder Exist?. Journal of Abnormal Child Psychology 29 (3), 263.

The National Institute of Neurological Disorders and Stroke (2007). Web.

Rourke, B.P. et al (2002). Child Clinical/pediatric Neuropsychology: Some Recent Advances. Warriner; Annual Review of Psychology, 309.

Safran, S. P. (2001). Asperger Syndrome: The Emerging Challenge to Special Education. Exceptional Children 67 (2), 151.

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