Asperger's Syndrome

What is Asperger Syndrome?

Asperger syndrome or Asperger disorder is one of the many disorders that form the range of autism spectrum disorders (ASDs). 

The symptoms of this condition may be present from early in life but the diagnosis may be confirmed once the child starts attending school.

The exact cause of this condition is unknown but several theories including genetic influences have been studied in causation of this condition.

Symptoms of Asperger syndrome

Like all types of disorders that belong to the autism spectrum disorders, children with Asperger syndrome also have problems with their social, emotional, and communication skills.

They may appear socially withdrawn and unable to communicate. These children may have unusual behaviors and sometimes obsessive interests.

They typically may have difficulty in talking about their own feelings or understanding others’ feelings and body language. The children with the condition avoid eye contact and fail to interact with others of their age.

They may speak with little modulation in a flat tone and are nervous in large gatherings. Many children with Asperger syndrome are unusually sensitive to sensory stimuli like noises etc.

Diagnosing, screening and treatment of Asperger syndrome

Children with Asperger syndrome differ from children with other developmental delay related disorders by one factor – they have little or no language delay and may have an average or above average IQ (measure of intelligence). 

Children with other autism spectrum disorders may have a significant language delay and variations in IQ. Several questionnaires and psychological tests are used to determine the condition.

More often than not, diagnosis is made on the basis of clinical symptoms as described by parents, teachers, caregivers or observed by the developmental paediatrician.

Asperger syndrome may often be misdiagnosed as high-functioning autism (HFA) or atypical autism, pervasive developmental disorder not otherwise specified (PDD-NOS) or semantic pragmatic disorder instead of Asperger syndrome.

Several behavioral approaches as well as vocational and occupational treatments form part of the treatment regimen of Asperger syndrome. Asperger syndrome is a lifelong condition with no cure and children with the condition grow into adults with the condition.

However, with adequate support, a person with Asperger syndrome may live a productive life with gainful employment and possibility of raising a family.

Asperger syndrome statistics

Asperger syndrome is considerably more common than typical autism. Autism occurs in about 4 out of every 10,000 children and Asperger syndrome occurs in 20-25 per 10,000 children. This means the prevalence of this condition is much more than typical or classic autism.

Asperger syndrome is also commonly associated with other disorders like Tourette disorder, attention deficit and hyperactivity related behavioral disorders and mood problems such as depression and anxiety.

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Asperger Syndrome Causes

The exact cause of Asperger syndrome is unknown and the pathology that underlies this condition is not well understood. However, research suggests that the factors that cause this condition may be a combination of both genetic and environmental variables. These factors may lead to changes in brain development that develops into Asperger syndrome.

What is evidenced in medicine and extensive studies is that Asperger syndrome does NOT depend on a person’s upbringing, their social or economic circumstances or due to the person’s own fault.

Primary and secondary autism

When autism in general is considered, there are two ways that causation may be explained:-

  • Primary autism that is also called idiopathic autism with no underlying medical condition that could be the trigger. This forms 90% of all the cases of autism spectrum disorders (ASD).

For primary autism genetics, environmental factors like exposure to certain toxins during pregnancy, psychological and neurological factors in the development of the brain may be the cause.

Environmental factors that are associated with autism spectrum disorders and not only Asperger syndrome include mother having a viral or bacterial infection during pregnancy, mother smoking during pregnancy, exposure to air pollution and pesticides and the advanced age of the father.

Psychological evaluations into the brains of the children with ASD shows that the connection between the cerebral cortex, the amygdala and the limbic system are awry. The amygdale is the center that regulates emotions and relays them to the cerebral cortex for further processing.

  • Secondary autism usually has an underlying medical condition. These form very few cases of autism and are not specific for Asperger syndrome.

Some of the conditions associated with autism in general include Fragile X syndrome, Tuberous sclerosis, Rett syndrome etc.

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Asperger Syndrome Mechanism

Asperger Syndrome is a development disorder that was first described by Viennese paediatrician, Hans Asperger, in the 1940’s. The disease however found a place in the official guidebook of all mental diseases called the Diagnostic and Statistical Manual of Mental Disorders DSM-IV (Fourth Edition) in 1994.

Asperger syndrome is part of the Autism Spectrum disorders (ASD) but is significantly different from typical autism by the fact that the children with this condition have normal or high IQ.

The exact cause of the condition is unknown but it seems to have a basis in genetics as well as neurological development.

Developmental disorders

Developmental disorders are classified into three broad categories:-

  • Development of social skills and relations
  • Use of language for communication
  • Behavioural and stylistic characteristics repetitive features or narrow range of interests

The defects in each of these categories may range from relatively mild to severe and ranges widely among the various disorders in the autism spectrum including Asperger syndrome.

Several authorities believe that Asperger syndrome is just a milder form of autism or that the conditions are linked by broad clinical similarities.

Asperger syndrome is characterized by normal or higher cognitive abilities and a relatively normal language function compared to other disorders in the Autism spectrum disorders.

Clinical features of Asperger syndrome

The hallmark features of Asperger syndrome include normal language development and normal or higher than normal IQ. The children with the condition tend to have a narrow range of interest.

The interest may be in specific intellectual areas with an obsessive intensity. There may be interest in math or in reading or science. The child may want to learn everything possible on the subject and want to dwell in the subject in all conversations and play time.

In fact when the first case was described in 1944, the interest was in modes of transport with the children described being fascinated with memorizing tram lines in Vienna.

There is also a definite lack of social skills. The difficulty is not in interacting with the others but in making effective interactions and conversations. The children with Asperger syndrome tend to fail in reading the other person’s needs and body language and thus fail to respond appropriately.

Children with Asperger syndrome may also fail to understand jokes and appreciate humour. This however is not universal among all children with Asperger syndrome and the mistaken belief that all children with autism and Asperger syndrome are humour-less is baseless.

Asperger syndrome with age

With age the symptoms may change but the overall problem remains in place. While some features increase or decrease in severity some like social and communication problems may remain.

In preschool aged child there is no single, uniform presenting picture of Asperger syndrome. The problems may be similar to typical autism with language delays and social difficulties.

However, with age the child catches up on language skills and IQ but fails to recover the social difficulties. Most children enter kindergarten without having been diagnosed. Those with other problems such as hyperactivity, inattention, aggression or frequent tantrums and outbursts may be detected earlier.

The problems of socialization and behavioural adjustment surface as the child grows into middle and high school.

As the Asperger children grow up they overcome most of the problems but fail to recover from their social and behavioural difficulties.

Pathology

The defect is not clearly understood. However, with extensive brain imaging studies and neuroanatomical studies it is found that there is a defect in the connections between the amygdala – seat of human emotions, and the cerebral cortex that regulate response.

Exposure to toxins while still within the mother’s womb also acts as a major link to autism and Asperger syndrome.

Cerebellar dysfunction and dysfunction in the levels of serotonin in the brain are also cited as underlying pathologies behind autism in general. None of these are clearly proven.

Asperger Syndrome Screening

Asperger syndrome, like other autism related disorders, is usually detected by parents when the child is around two years old. In rare cases mild symptoms may mean the disorder can go undetected until adulthood.

Diagnosis of Asperger syndrome in children

Children whose parents suspect a disorder in their development need to consult their paediatricians. Paediatricians, general physicians and developmental paediatricians deal with diagnosing a referral of these children.

A common checklist of questions is used initially for detection in toddlers. It is called the CHAT questionnaire. The questions include:-

  • Does the child take an interest in other children?
  • Does the child ever pretend play?
  • Does the child ever bring objects to show to their parents?

A multidisciplinary team including a psychologist, a psychiatrist, a paediatrician or a developmental paediatrician are involved in diagnosis of Asperger syndrome.

Diagnosis according to the DSM-IV criteria

“The Diagnostic and Statistical Manual of Mental Disorders IV states the presence of Asperger syndrome in case of:–

  • impaired use of non-verbal behaviors to regulate social interaction
  • failure to develop age-appropriate peer relationships
  • lack of spontaneous interest in sharing experiences with others
  • lack of social or emotional reciprocity

In addition there are repetitive, restrictive and stereotyped patterns of activities, behaviours and interests. There may be:-

  • preoccupation with one or more stereotyped and restricted pattern of interest
  • inflexible adherence to specific non-functional routines or rituals
  • stereotyped or repetitive motor mannerisms
  • preoccupation with parts of objects

In addition there must be no significant associated –

  • Delay in either general cognitive function
  • Self-help/adaptive skills
  • Interest in the environment or
  • overall language development.

Christopher Gillberg, a Swedish physician who elaborated on the six criteria for the diagnosis of Asperger syndrome. These include –

  • Social impairment with extreme egocentricity including inability to interact with peers, lack of desire to interact with peers, poor appreciation of social cues, socially and emotionally inappropriate responses.
  • Limited interests and preoccupations that include more rote than meaning relatively exclusive of other interests, repetitive adherence, repetitive routines or rituals that could be imposed on self or others.
  • Speech and language peculiarities that include delayed early development but not consistently seen and others including odd prosody, peculiar voice characteristics, impaired comprehension including misinterpretation of literal and implied meanings.
  • Non-verbal communication problems including limited use of gesture, clumsy body language, limited or inappropriate facial expression, peculiar "stiff" gaze, difficulty adjusting physical proximity etc.

Asperger Syndrome Treatment

There is at present no cure and no specific treatment for Asperger syndrome. However, early detection and intervention may help children with the condition to develop into adults who can live a relatively independent life.

These children may have more opportunity of reaching their full potential. Therapies and management include:-

  • communication based interventions
  • behavioural therapy
  • dietary and lifestyle changes

General interventions

This includes ensuring that the child receives adequate and normal education as far as possible.

Parents should make an attempt to check the educational placements and service providers available in their school district to ensure that the child gets as near normal education as possible.

The schools in question need to be checked for appropriate setting, adequate staffing, adult/student ratio, range of special/support services etc.

Parents need to enquire and find the programs (public or private) that can help these children with Asperger syndrome and help families and parents learn how to cope and deal with difficult situations arising out of the condition.

Parents must be acquainted with the PPT (Planning and Placement Team) process to provide effective advocates for their children.

Some of the positive program specifications include small setting with ample opportunities for more individualized attention, availability of a communication specialist and an expert in social skills development and adequate opportunities for social interaction and formation of social relationships.

Specific interventions

These include teaching practices and approaches along with strategies for emotional support, behavioral management techniques, activities towards social and communication competence etc.

For example some of the skills, procedures and concepts related to behaviour and social skills need to be taught in an explicit and rote fashion with verbal teaching methods. Children need to be trained in problem-solving areas and handling situations out of their ordinary routine.

A social skill development culture should be fostered. Children with the disorder need to be taught ways to interpret visual information simultaneously with auditory information in order to interpret other people's nonverbal behaviour or body language and teach oneself to respond accordingly.

Self evaluation, self esteem and confidence should be fostered. The child is encouraged to become more self reliant and sufficient as he or she grows into an adult.

Individuals with Asperger syndrome may often have challenging and difficult behaviour that needs to be addressed. Coexisting mental disorders also need to be addressed. These include depression, anxiety, phobias, mood disorders, schizophrenia etc.

Another area of specific approach includes vocational and occupational training in order to prepare for the child to lead a more independent life.

Medications and psychotherapy

In general medications have not shown much promise in treatment of Asperger syndrome. They may be used in presence of co-existing mental disorders. Specific medications thus are used in patients with depressive symptoms, severe obsessions and compulsions and thought disorders.

Psychotherapy has not shown effectiveness in management of Asperger syndrome but it has been seen that focused and structured counselling can be very useful. This is particularly so in patients with negativism, anxiety, frustration etc.

Asperger Syndrome Prognosis

Asperger syndrome is not a curable condition. However, being one of the milder forms in the Autism Spectrum Disorders, with little language development difficulties and normal or high IQ, this disorder allows a child to live a normal or near normal life.

Education and employment

Children with Asperger syndrome may need special attention when it comes to education. This is because they have social and behavioural difficulties that need to be addressed while imparting education.

Since most of the sufferers have normal or high IQs these children may receive normal education and may even excel in their field of interest. Due to this normal intellect and ability to receive normal education, many of the sufferers may go on to have sustainable gainful employment.

Relationships and social life

Teenagers with the condition may have trouble with social interactions, self-care, relationships (both social and romantic), organization etc.

During teenage years those with Asperger syndrome may experience anxiety, depression and severe mental trauma.

Depression arises from inability to form meaningful friendships and relationships or failure to engage others socially. Some may also suffer from mood disorders and other mental ailments that need to be treated and addressed.

Many children with the condition remain at home after they grow into adulthood but some of them may marry and work independently. Early intervention is crucial in the potential normal functioning of these children.

Family and self education

It is crucial that the families, especially parents, guardians, teachers and caregivers are taught ways to deal with children with Asperger syndrome and help them get the best out of their lives.

Families must be helped to be able to cope with the diagnosis and its development in order to improve the child’s care and finally the outcome of the disorder in the child as he or she grows into an adult. The outcome of the situation is improved by diagnosis at a younger age that allows for early interventions.

Prognosis in adults with Asperger syndrome

Adults with Asperger syndrome may commonly be gainfully employed in mainstream jobs and may need moral support and encouragement to live an independent life.

Since these individuals have narrow but obsessive and intense interest in some fields they may also excel in what they like to do for example computer science, mathematics, music, sciences etc. These areas also require less social interaction than others.

Other pathologies that may be seen with Asperger syndrome

Several mental ailments may co-exist with Asperger syndrome. These may affect the outcome of the condition unless treated effectively.

Some of the coexisiting conditions include Schizophrenia, affective disorders like chronic dysphoria, depression, anxiety, phobias, obsessive–compulsive disorder, tic disorders (including Tourette syndrome), ADHD etc.