Asperger Syndrome

While Asperger Syndrome is generally believed to be a form of autism, unlike the classic autistic individual who appear withdrawn and uninterested in the world around them, people with Asperger Syndrome want to be sociable and involved, yet have difficulty in the areas of social, behavioral, motor, and sensory skills.

In 1944, Asperger Syndrome was identified by Hans Asperger and focused on children who were withdrawn and self-absorbed. Then in 1980, Dr. Lorna Wing rediscovered the condition and coined the term 'Asperger Syndrome' (Gingras 2006). It has been defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnostic criteria. The criteria include:

an impairment in social interaction;

repetitive and restrictive stereotyped patterns of behavior, activities, and interests;

significant social, occupational, or other impairments in functioning;

absence of significant delay in language; and absence of delays in cognitive development, self-help skills, curiosity about the environment, and adaptive behavior other than social interaction) (Gingras 2006).

It should be noted that schizophrenia and other pervasive developmental disorders are not included in this condition. Individuals with Asperger Syndrome have difficulty making friends, difficulty using nonverbal social cues, narrow area of interest, and poor motor skills. Moreover, they are inflexible in the process of routine change, and demonstrate an inability to take another person's perspective (Gingras 2006).

Children with Asperger Syndrome generally exhibit no significant cognitive delays or impairments in language development, and usually speak and read during early childhood (Gingras 2006). These children tend to have motor problems and easily become over-stimulated by crowded rooms and cluttered situations. The January 2006 issue of Intervention in School and Clinic reports that individuals with Asperger Syndrome have problems in "social interaction, communication, and thought flexibility; have narrow interests, lack imagination, and love routine," and compared to individuals with autism, those with Asperger have few language problems or other learning difficulties (Gingras 2006).

Both children and adults with this condition exhibit severe social interaction deficits, such as impaired social interactions, repetitive patterns of behavior, restricted interests and activities, and may have difficulty understanding or interpreting the nonverbal behavior of other people (Gingras 2006). Moreover, they have little to no understanding that other people think differently than they themselves, and in fact have difficulty understanding what social communication is about (Gingras 2006). Individuals with Asperger Syndrome have difficulty in asking for help, exhibit poor control of voice volume, tend to speak in monotonous tones, lack facial expressions, and are cannot judge other people's body language (Gingras 2006). Although they want to have social interactions, the interactions tend to be inept and non-age appropriate. They often have problems with aggression, hyperactivity, conduct, and depression, and appear to be socially self-centered, with no empathy and understanding (Gingras 2006).

According to twin and family studies, there is a genetic vulnerability to Asperger Syndrome, however as yet a specific gene has not been identified, although due to the symptoms and because the severity of symptoms vary so greatly among individuals, it is likely that multiple genes are responsible for Asperger (Asperger 2007). Recent research indicates that Asperger Syndrome is caused by structural abnormalities to the brain which impact neural circuits that control behavior and thought process (Asperger 2007). The National Institute of Neurological Disorders and Stroke states that researchers believe "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" (Asperger 2007). According to research conducted at the University of California, Asperger Syndrome is caused by abnormal changes that occur during "critical stages of fetal development" (Asperger 2007). Defects in the genes cause abnormal growth patterns, which in turn create overgrowth in "some brain structures and reduced growth, or excessive cell loss, in others" (Asperger 2007).

Treatment for Asperger Syndrome should include therapies that address the three basic symptoms: "poor communication skills, obsessive or repetitive routines, and physical clumsiness" (Asperger 2007). While there is no one treatment package that addresses the needs of all children with this disorder, the earlier treatment is sought, the better. Generally, an effective program 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 (Asperger 2007).

Although children who receive treatment learn to cope with the disabilities of this disorder, they still may have difficulties in social situations and personal relationships (Asperger 2007). While adults with Asperger Syndrome may be able to maintain a successful career, they may still need encouragement and support to lead a productive independent life (Asperger 2007).

Dr. Stephen Bauer notes that the hallmark of Asperger Syndrome and the characteristic that "makes these children so unique and fascinating, is their peculiar, idiosyncratic areas of 'special interest'" (Bauer 1996). While the interests of individuals with autism tend to be objects or parts of objects, the interests of people with Asperger Syndrome seem to be certain intellectual areas (Bauer 1996). For example, children with this disorder demonstrate an obsessive interest in such subjects as science, reading, math, history, and geography, and even express this interest in conversations and free play (Bauer 1996). Bauer notes that he has witnessed children who focus on astronomy, weather, maps, and different aspects of cars, planes or rockets. In fact, in 1944, Asperger described children who were particularly fascinated with transportation and memorized the tramlines in Vienna (Bauer 1996). Children as young as three years of age appear to be particularly aware of things connected to transportation, such as routes taken on automobile trips (Bauer 1996). According to Bauer, often the "areas of fascination represent exaggerations of interests common to children in our culture, such as Nina Turtles, Power Rangers, dinosaurs, etc.," and often the areas of interests will change over time, "with one preoccupation replaced by another" (Bauer 1996). However, sometimes a child's interest will continue into adulthood and actually form the basis for an adult career, including college professor (Bauer 1996).

In his original 1944 paper, Hans Asperger was aware that while the symptoms and problems might change over time, the overall problem generally continues into adulthood (Bauer 1996). Asperger wrote:

in the course of development, certain features predominate or recede, so that the problems presented change considerably.

Nevertheless, the essential aspects of the problem remain unchanged. In early childhood there are the difficulties in learning simple practical skills and in social adaptation. These difficulties arise out of the same disturbance which at school age cause learning and conduct problems, in adolescence job and performance problems and in adulthood social and marital conflicts" (Bauer 1996).

Yet, children with Asperger Syndrome do have milder problems over time compared to those with autism and other disorders, and moreover, their prognosis is better (Bauer 1996). In fact, its milder history is what distinguishes Asperger Syndrome from other forms of autism.

Bauer points out that there is limited concrete information concerning the eventual outcome for the majority of children with Asperger Syndrome. It is important to note that only recently has Asperger Syndrome been "distinguished from more typical autism in looking at outcomes, and milder cases were generally not recognized" (Bauer 1996). Yet available data suggest that children with Asperger Syndrome are more likely to become independent adults who are successfully employed and maintain marriages and families (Bauer 1996).

According to Bauer, one of the most useful and interesting sources on outcome has come from observing parents and relatives of children with Asperger Syndrome, for they themselves seem to have the disorder. These observations strongly indicate that Asperger Syndrome does not "preclude the potential for a more 'normal' adult life" (Bauer 1996). More often than not, adults with Asperger Syndrome will naturally gravitate to a career or job that relates to their special interest area, often becoming very proficient (Bauer 1996). Although many students with this disorder often complete college and even graduate school, in the majority of cases they will continue to exhibit, to some extent, "subtle differences in social interactions" (Bauer1996). While many of these adults do marry, they will likely continue to be challenged by the emotional and social demands of marriage. Moreover, notes Bauer, their "rigidity of style and idiosyncratic perspective on the world can make interactions difficult, both in and out of the family" (Bauer 1996). They are also vulnerable to emotional problems such as depression and anxiety, thus may eventually seek out psychiatrist and other mental health care professionals,…