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Asperger’s Syndrome is a neurological disorder that is often described as a milder variant of autistic disorder, and both conditions are grouped under the broad diagnostic category of autistic spectrum disorders, or pervasive developmental disorders. Pervasive developmental disorders (PDDs) are marked by significant impairment in several areas of development, especially those involving social interaction, language development, and communication skills. The trait most characteristic of Asperger’s, though it is not present in all cases of the syndrome, is a pedantic, monotonic speech pattern, usually focused on a particularly narrow area of interest.
Asperger’s Syndrome was first identified in 1944 by Dr. Hans Asperger, a Viennese pediatrician. Dr. Asperger identified a number of children (mostly boys) with a cluster of traits that included egocentricity, difficulties with social interaction, clumsiness (including problems with both fine and gross motor control), and pronounced language peculiarities.
Among individuals with PDDs there is a wide range of intelligence, abilities, and adaptive or maladaptive behaviors. Those with Asperger’s Syndrome usually function at a fairly high level. The line between Asperger’s and high-functioning autism is not clearly marked, and many individuals who manifest autistic traits but who have well-developed language skills are diagnosed as having Asperger’s Syndrome. Nevertheless, despite commonalities, there usually are identifiable differences between the two syndromes, and the American Psychiatric Association’s “Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV) presents them as separate and distinct disorders.
Individuals with Asperger’s usually begin to show symptoms after age three, and the average age of diagnosis is about eleven. The symptoms of autism, on the other hand, usually manifest before age two. In both conditions, however, the underlying brain abnormalities are present from birth. It is likely that Asperger’s Syndrome is less readily diagnosed because its symptoms are less pervasive and severe, and also because many U.S. physicians are unfamiliar with the condition, though it has been recognized in Europe for almost sixty years.
Because individuals with Asperger’s have normal cognitive abilities and less severe deficits in social and communication skills, the outcome for Asperger’s is usually more positive than it is for all but the most high-functioning cases of autism. But people with Asperger’s are usually more physically clumsy than autistic individuals, which is part of the distinction between the two syndromes. An individual with Asperger’s will usually have a higher verbal IQ relative to his or her performance IQ, whereas in autism the reverse is usually true. The extreme limitation in areas of interest is also more prominent in Asperger’s than in autism. However, there is still a fair amount of controversy over the issue of the precise relationship between autism and Asperger’s. As spectrum disorders, they are placed on a continuum, and depending upon the number and severity of symptoms, may be subjectively defined as “high-functioning” or “low-functioning” or as “mild” or “severe.”
Diagnosis of Asperger’s Syndrome is made in terms of one or both of two main sets of diagnostic criteria: the DSM-IV criteria, and Gillberg’s criteria (published by Swedish psychiatrist Christopher Gillberg).
THE DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER’S SYNDROME
(A) Qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity.
(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, non-functional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
(C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
(D) There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
(E) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
(F) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
GILLBERG’S CRITERIA FOR ASPERGER’S SYNDROME
1. Severe impairment in reciprocal social interaction
(at least two of the following)
(a) inability to interact with peers
(b) lack of desire to interact with peers
(c) lack of appreciation of social cues
(d) socially and emotionally inappropriate behavior
2. All-absorbing narrow interest
(at least one of the following)
(a) exclusion of other activities
(b) repetitive adherence
(c) more rote than meaning
3. Imposition of routines and interests
(at least one of the following)
(a) on self, in aspects of life
(b) on others
4. Speech and language problems
(at least three of the following)
(a) delayed development
(b) superficially perfect expressive language
(c) formal, pedantic language
(d) odd prosody, peculiar voice characteristics
(e) impairment of comprehension including misinterpretations of literal/implied meanings
5. Non-verbal communication problems
(at least one of the following)
(a) limited use of gestures
(b) clumsy/gauche body language
(c) limited facial expression
(d) inappropriate expression
(e) peculiar, stiff gaze
6. Motor clumsiness: poor performance on neurodevelopmental examination
(All six criteria must be met for confirmation of diagnosis.)
There is no specific treatment or cure for any of the PDDs, including Asperger’s Syndrome. However, early diagnosis is essential, for the earlier intervention is initiated, the more promising the outcome. Treatment is individualized, based on specific symptoms and rehabilitative requirements. Appropriate educational programs will emphasize improving communication skills and social interaction, enhancing academic development, modifying maladaptive behaviors, encouraging adaptive behaviors, improving physical coordination, and developing daily living skills.
Social skills are more effectively developed through interaction with normal peers, who then can also serve as models of appropriate behavior and use of language. But the educational environment must also be structured and consistent, and information should be presented visually as well as verbally. In order to help the child with Asperger’s to generalize behaviors and skills learned at school, they need also to be reinforced at home. Thus parental involvement is absolutely essential to an integrated developmental program for an Asperger's child.
Intervention may also require medication, including psychostimulants, tricyclic antidepressants, and beta-blockers. As the individual with Asperger’s enters adulthood, he or she may also need specialized adult support services in order to locate and maintain employment and living arrangements.
This is not to suggest that there is any cognitive impairment in the Asperger’s individual. On the contrary, those with Asperger’s have no clinically significant delay in language development or in cognitive abilities. Many with Asperger’s are of average intelligence, but many are actually highly gifted and even brilliant. People with Asperger’s often obtain one or more college degrees, and they may become mathematicians, philosophers, scientists, university professors, etc. But adult functioning usually requires some degree of communication skill and social adaptability, and these are notably lacking in Asperger’s Syndrome, which is why adult support services are often helpful or even necessary.
What else is often lacking is comprehension of the nonliteral aspects of language, especially spoken language. Just as they miss nonverbal signals when interacting with others, people with Asperger’s usually are stymied by humor, irony, metaphor, or any other use of language that goes beyond literal meaning. This makes normal interaction with coworkers or acquaintances difficult.
Of all the pervasive developmental disorders, Asperger’s Syndrome has the most positive prognosis, and children with Asperger’s more often than not become independently functioning adults. However, their social impairments often lead to psychological difficulties, including poor self-image and depression, and as adults their social interactions will continue to be marked by typical Asperger’s disturbances, though usually in more subtle form if intervention has been initiated early and successfully.
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