Asperger's, or just AS — is one of five
neurobiological pervasive developmental
disorders (PDD) that is characterized by
deficiencies in social and communication
skills. It is considered
to be part of the autistic spectrum and is
differentiated from other PDDs and from High
Functioning Autism (HFA) in that early
development is normal and there is no
language delay. It is possible for people
with AS to have learning disabilities
concurrently with Asperger's syndrome. In
these cases, differential diagnosis is
essential to identify subsequent support
requirements. Conversely, IQ tests may show
normal or superior intelligence and standard
language development compared with classical
autism. The diagnosis of AS is complicated
by the lack of adoption of a standardized
diagnostic screen, and, instead, the use of
several different screening instruments and
sets of diagnostic criteria. The exact cause
of AS is unknown and the prevalence is not
firmly established, due partly to the use of
differing sets of diagnostic criteria.
Asperger syndrome was named in honor of Hans
Asperger (1906-1980), an Austrian
psychiatrist and pediatrician, by researcher
Lorna Wing, who first used the eponym in a
1981 paper. In 1994, AS was recognized in
the 4th edition of the Diagnostic and
Statistical Manual of Mental Disorders
(DSM-IV) as Asperger's Disorder.
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AS is often not identified in early
childhood, and many individuals do not
receive diagnosis until after puberty or
when they are adults. Assistance for core
symptoms of AS consists of therapies that
apply behavior management strategies and
address poor communication skills, obsessive
or repetitive routines, and physical
clumsiness. Many individuals with AS can
adopt strategies for coping and do lead
fulfilling lives - being gainfully employed,
getting married or having successful
relationships, and having families. In most
cases, they are aware of their differences
and recognize when they need support to
maintain an independent life. There are
instances where adults do not realize that
they have AS personalities until they are
having difficulties with relationships
and/or attending relationship counseling.
Recognition of the very literal and logical
thought processes that are symptomatic of AS
can be a tremendous help to both partners in
a close/family relationship. (Wikipedia)
What is Asperger syndrome?
Asperger syndrome (AS)
is a developmental
disorder that is
characterized by:
limited interests or an
unusual preoccupation
with a particular
subject to the exclusion
of other activities
-
repetitive
routines or
rituals
-
peculiarities in
speech and
language, such
as speaking in
an overly formal
manner or in a
monotone, or
taking figures
of speech
literally
-
socially and
emotionally
inappropriate
behavior and the
inability to
interact
successfully
with peers
-
problems with
non-verbal
communication,
including the
restricted use
of gestures,
limited or
inappropriate
facial
expressions, or
a peculiar,
stiff gaze
-
clumsy and
uncoordinated
motor movements
AS is an autism spectrum
disorder (ASD), one of a
distinct group of
neurological conditions
characterized by a
greater or lesser degree
of impairment in
language and
communication skills, as
well as repetitive or
restrictive patterns of
thought and behavior.
Other ASDs include:
classic autism, Rett
syndrome, childhood
disintegrative disorder,
and pervasive
developmental disorder
not otherwise specified
(usually referred to as
PDD-NOS).
Parents usually sense
there is something
unusual about a child
with AS by the time of
his or her third
birthday, and some
children may exhibit
symptoms as early as
infancy. Unlike
children with autism,
children with AS retain
their early language
skills. Motor
development delays –
crawling or walking
late, clumsiness – are
sometimes the first
indicator of the
disorder.
The incidence of AS is
not well established,
but experts in
population studies
conservatively estimate
that two out of every
10,000 children have the
disorder. Boys are
three to four times more
likely than girls to
have AS.
Studies of children with
AS suggest that their
problems with
socialization and
communication continue
into adulthood. Some
of these children
develop additional
psychiatric symptoms and
disorders in adolescence
and adulthood.
Although diagnosed
mainly in children, AS
is being increasingly
diagnosed in adults who
seek medical help for
mental health conditions
such as depression,
obsessive-compulsive
disorder (OCD), and
attention deficit
hyperactivity disorder
(ADHD). No studies have
yet been conducted to
determine the incidence
of AS in adult
populations.
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Why is it called Asperger
syndrome?
In 1944, an Austrian
pediatrician named Hans
Asperger observed four
children in his practice
who had difficulty
integrating socially.
Although their
intelligence appeared
normal, the children
lacked nonverbal
communication skills,
failed to demonstrate
empathy with their
peers, and were
physically clumsy.
Their way of speaking
was either disjointed or
overly formal, and their
all-absorbing interest
in a single topic
dominated their
conversations.
Dr. Asperger called the
condition “autistic
psychopathy” and
described it as a
personality disorder
primarily marked by
social isolation.
Asperger’s observations,
published in German,
were not widely known
until 1981, when an
English doctor named
Lorna Wing published a
series of case studies
of children showing
similar symptoms, which
she called “Asperger’s”
syndrome. Wing’s
writings were widely
published and
popularized. AS became
a distinct disease and
diagnosis in 1992, when
it was included in the
tenth published edition
of the World Health
Organization’s
diagnostic manual,
International
Classification of
Diseases (ICD-10),
and in 1995 it was added
to the Diagnostic and
Statistical Manual of
Mental Disorders
(DSM-IV), the American
Psychiatric
Association’s diagnostic
reference book.
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What causes AS? Is it
genetic?
Twin and family studies
suggest there is a
genetic vulnerability to
AS and the other ASDs,
but a specific gene for
AS hasn’t been
identified. It is
likely that multiple
genes cause AS, since
the symptoms and the
severity of symptoms
vary so widely among
individuals.
Researchers recently
identified an
association between
certain behavioral
traits (the insistence
on strict routines and
repetitive behavior) in
a group of children with
autism and a specific
gene – GABRB3. Another
study discovered a
strong association
between autism and the
mutation of a gene the
researchers call
ENGRAILED 2. Additional
evidence for the link
between inheritable
genetic mutations and AS
is seen in the higher
incidence of family
members of children with
an ASD who have similar
behavioral symptoms, but
in a more limited form.
For example they may
have mild social,
language, or reading
problems.
Current research points
to structural
abnormalities in the
brain as a cause of AS.
These abnormalities
impact neural circuits
that control thought and
behavior. Researchers
think that
gene/environment
interactions cause some
genes to turn on or turn
off, or turn on too much
or too little in the
wrong places, and this
interferes with the
normal migration and
wiring of embryonic
brain cells during early
development.
Researchers at the
University of
California , supported in part by the
National Institutes of
Health, have proposed
the disorder stems from
abnormal changes that
happen during critical
stages of fetal
development. Defects in
the genes that control
and regulate normal
brain growth create
abnormal growth
patterns, which cause
overgrowth in some brain
structures and reduced
growth, or excessive
cell loss, in others.
Using advanced brain
imaging techniques,
scientists have revealed
structural and
functional differences
in specific brain
regions between the
brains of normal versus
AS children. One study
found a lack of activity
in the frontal lobe of
AS children when asked
to respond to tasks that
required them to use
their judgment. Another
found differences in
brain activity when
children were asked to
respond to facial
expressions. Other
methods of investigating
brain function have
revealed abnormal levels
of particular proteins
in the brains of adults
with AS, which correlate
with obsessive and
repetitive behaviors.
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What research is being done?
The National Institute
of Neurological
Disorders and Stroke (NINDS)
is one of the federal
government’s leading
supporters of biomedical
research on brain and
nervous system
disorders. The NINDS
conducts research in its
laboratories at the
National Institutes of
Health in
Bethesda, Maryland
, and also awards grants to support research at universities and
other facilities.
Many of the Institutes
at the NIH, including
the NINDS, are
sponsoring research to
understand what causes
AS and how it can be
effectively treated.
One study is using
functional magnetic
resonance imaging (fMRI)
to show how
abnormalities in
particular areas of the
brain cause changes in
brain function that
result in the symptoms
of AS and other ASDs. A
large-scale study is
comparing
neuropsychological and
psychiatric assessments
of children with
possible diagnoses of AS
or HFA to those of their
parents and siblings to
see if there are
patterns of symptoms
that link AS and HFA to
specific
neuropsychological
profiles. A clinical
trial is testing the
effectiveness of an
anti-depressant in
individuals with AS and
HFA who exhibit high
levels of
obsessive/ritualistic
behavior. Other
investigators are
conducting a long-range
study to collect and
analyze DNA samples from
a large group of
children with AS and HFA
and their families to
identify genes and
genetic interactions
that are linked to AS
and HFA.
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What
are some common signs or
symptoms?
The most distinguishing
symptom of AS is a
child’s obsessive
interest in a single
object or topic to the
exclusion of any other.
Some children with AS
have become experts on
vacuum cleaners, makes
and models of cars, even
objects as odd as deep
fat fryers. Children
with AS want to know
everything about their
topic of interest and
their conversations with
others will be about
little else. Their
expertise, high level of
vocabulary, and formal
speech patterns make
them seem like little
professors.
Children with AS will
gather enormous amounts
of factual information
about their favorite
subject and will talk
incessantly about it,
but the conversation may
seem like a random
collection of facts or
statistics, with no
point or conclusion.
Their speech may be
marked by a lack of
rhythm, an odd
inflection, or a
monotone pitch.
Children with AS often
lack the ability to
modulate the volume of
their voice to match
their surroundings. For
example, they will have
to be reminded to talk
softly every time they
enter a library or a
movie theatre.
Unlike the severe
withdrawal from the rest
of the world that is
characteristic of
autism, children with AS
are isolated because of
their poor social skills
and narrow interests.
In fact, they may
approach other people,
but make normal
conversation impossible
by inappropriate or
eccentric behavior, or
by wanting only to talk
about their singular
interest.
Children with AS usually
have a history of
developmental delays in
motor skills such as
pedaling a bike,
catching a ball, or
climbing outdoor play
equipment. They are
often awkward and poorly
coordinated with a walk
that can appear either
stilted or bouncy.
Many children with AS
are highly active in
early childhood, and
then develop anxiety or
depression in young
adulthood. Other
conditions that often
co-exist with AS are
ADHD, tic disorders
(such as Tourette
syndrome), depression,
anxiety disorders, and
OCD.
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How is it diagnosed?
The diagnosis of AS is
complicated by the lack
of a standardized
diagnostic screen or
schedule. In fact,
because there are
several screening
instruments in current
use, each with different
criteria, the same child
could receive different
diagnoses, depending on
the screening tool the
doctor uses.
To further complicate
the issue, some doctors
believe that AS is not a
separate and distinct
disorder. Instead, they
call it high-functioning
autism (HFA), and view
it as being on the mild
end of the ASD spectrum
with symptoms that
differ -- only in degree
-- from classic autism.
Some clinicians use the
two diagnoses, AS or HFA,
interchangeably. This
makes gathering data
about the incidence of
AS difficult, since some
children will be
diagnosed with HFA
instead of AS, and vice
versa.
Most doctors rely on the
presence of a core group
of behaviors to alert
them to the possibility
of a diagnosis of AS.
These are:
-
abnormal eye
contact
-
aloofness
-
the failure to
turn when called
by name
-
the failure to
use gestures to
point or show
-
a lack of
interactive play
-
a lack of
interest in
peers
Some of these behaviors
may be apparent in the
first few months of a
child’s life, or they
may appear later.
Problems in at least one
of the areas of
communication and
socialization or
repetitive, restricted
behavior must be present
before the age of 3.
The diagnosis of AS is a
two-stage process. The
first stage begins with
developmental screening
during a “well-child”
check-up with a family
doctor or pediatrician.
The second stage is a
comprehensive team
evaluation to either
rule in or rule out AS.
This team generally
includes a psychologist,
neurologist,
psychiatrist, speech
therapist, and
additional professionals
who have expertise in
diagnosing children with
AS.
The comprehensive
evaluation includes
neurologic and genetic
assessment, with
in-depth cognitive and
language testing to
establish IQ and
evaluate psychomotor
function, verbal and
non-verbal strengths and
weaknesses, style of
learning, and
independent living
skills. An assessment
of communication
strengths and weaknesses
includes evaluating
non-verbal forms of
communication (gaze and
gestures); the use of
non-literal language
(metaphor, irony,
absurdities, and humor);
patterns of inflection,
stress and volume
modulation; pragmatics
(turn-taking and
sensitivity to verbal
cues); and the content,
clarity, and coherence
of conversation. The
physician will look at
the testing results and
combine them with the
child’s developmental
history and current
symptoms to make a
diagnosis.
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Are there treatments
available?
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. There is no
single best treatment
package for all children
with AS, but most
professionals agree that
the earlier the
intervention, the
better.
An effective treatment
program builds on the
child’s interests,
offers a predictable
schedule, teaches tasks
as a series of simple
steps, actively engages
the child’s attention in
highly structured
activities, and provides
regular reinforcement of
behavior. This kind of
program generally
includes:
-
social skills
training, a form
of group therapy
that teaches
children with AS
the skills they
need to interact
more
successfully
with other
children
-
cognitive
behavioral
therapy, a type
of “talk”
therapy that can
help the more
explosive or
anxious children
to manage their
emotions better
and cut back on
obsessive
interests and
repetitive
routines
-
medication, for
co-existing
conditions such
as depression
and anxiety
-
occupational or
physical
therapy, for
children with
sensory
integration
problems or poor
motor
coordination
-
specialized
speech/language
therapy, to help
children who
have trouble
with the
pragmatics of
speech – the
give and take of
normal
conversation
-
parent training
and support, to
teach parents
behavioral
techniques to
use at home
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Do children with AS get
better? What happens when
they become adults?
With effective
treatment, children with
AS can learn to cope
with their disabilities,
but they may still find
social situations and
personal relationships
challenging. Many
adults with AS are able
to work successfully in
mainstream jobs,
although they may
continue to need
encouragement and moral
support to maintain an
independent life.
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Where can I get more
information?
US Autisim & Asperger
Association
Asperger Syndrome Foundation
Asperger Foundation
International
MAAP Services for Autism,
Asperger's, and PDD
National Institute of Mental
Health (NIMH)
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