Asperger’s Syndrome

What is Asperger’s Syndrome/Disorder?

Asperger’s Disorder is a milder variant of Autistic Disorder. Both Asperger’s Disorder and Autistic Disorder are in fact subgroups of a larger diagnostic category. This larger category is called either Autism Spectrum Disorders, or Pervasive Developmental Disorders (“PDD”). In Asperger’s Disorder, affected individuals are characterized by social isolation and eccentric behaviour in childhood. There are impairments in two-sided social interaction and non-verbal communication. They may have age appropriate vocabulary and use good sentences. Language for socialization is impaired. They may use the same language over and over such as talking about dinosaurs, cartoon characters etc. and have trouble shifting to something else. Turn taking in conversation is difficult. They may not be interested in what others have to say. They may repeat facts or other grammatically correct phrases in a social exchange that has little meaning for the other person. This may increase under stress. Their voice tone may be unusual (flat or sing-song). They will usually have poor eye contact, unusual or limited use of gesture and facial expression not appropriate to a situation at times. Clumsiness may be evident. They may be very rigid and have difficulty transitioning to new situations, people, activities and have difficulty sharing. Some may actively resist social interaction and others will pursue it in a very clumsy manner. This may take the form of focusing on a particular child or person and then being very distressed when rejected. There is usually real difficulty in understanding the boundaries of socialization and how to adjust behaviour for particular people or situations. Difficulties with regulating emotional control are usually evident. They have a focused area of interest which usually leaves much less space for more age appropriate, common interests. Some examples are cars, trains, dinosaurs, French Literature, door knobs, hinges, meteorology, music or history. They may have oversensitivity to noise or other stimuli. The name “Asperger” comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.

How many people have Asperger’s Disorder?

In a total population study of children between ages 7-16 in Goteborg, Sweden, minimum prevalence of Asperger’s Disorder was 36/10,000 (55/10,000 of all boys, and 15/10,000 of girls), and the male/female ratio was 4:1.
The prevalence of autism has traditionally been estimated around 4-5/10,000. A recent study from United Kingdom found the prevalence of autism at 17/10,000. and the prevalence of all Autistic Spectrum Disorders (including autism) at 63/10,000.

What are the differences between Asperger’s Disorder and ‘High Functioning’ (i.e. IQ >70) Autism?

It is believed that in Asperger’s Disorder:

  • There is no significant language delay in Asperger’s Disorder
  • recognition is usually later
  • outcome is usually more positive
  • social and communication deficits are less severe
  • circumscribed interests are more prominent

What causes Asperger’s Disorder?

Despite the now widely accepted fact that Asperger and other autistic disorders are the result of problems in the development of the brain and nervous system , so far the brain imaging studies have shown no consistent pattern. This inconsistency in the results of various brain imaging studies has been attributed to the fact that people with autism spectrum disorders including Asperger’s Syndrome represent a highly diverse group in terms of underlying brain functioning.

Associated medical conditions such as fragile-X syndrome, tuberous sclerosis, neurofibromatosis, and hypothyroidism are less common in Asperger’s Disorder than in classical autism. Therefore it may be expected that there are fewer major structural brain abnormalities associated with Asperger’s Disorder than with autism. Continuation of research in Asperger’s Disorder with various brain imaging techniques in coordination with neuropsychological evaluation in larger samples is clearly needed in this area.

Asperger’s Disorder is not caused by bad parenting or bad schools.

What are the diagnostic criteria of Asperger’s Disorder?

DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER’S DISORDER

A. Qualitative impairment in social interaction, as manifested by at least two of the
following :

(1) marked impairment in the use of multiple nonverbal behaviours 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 behaviour, 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 behaviour (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.
***It is now widely accepted that the criteria for no significant language delay no longer
applies.

 

GILLBERG’S CRITERIA FOR ASPERGER’S DISORDER

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 behaviour

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, staff gaze

6. Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis)
What are the other psychological problems that can co-exist with Asperger’s Disorder?

Asperger’s Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:

Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)
Depression (Major Depression Disorder or Adjustment Disorder with Depressed Mood)
Bipolar Disorder
Generalized Anxiety Disorder
Obsessive Compulsive Disorder

What is the treatment of Asperger’s Disorder?

There is no specific treatment or “cure” for Asperger’s Disorder.

Psychosocial Interventions

  • Parent education and training
  • Behaviour modification
  • Social skills training
  • Educational interventions including increasing teacher’s understanding of Asperger’s Disorder.
  • Individual counselling to help the individual to process the feelings aroused by being socially handicapped.

Medication may also be used if a person with Asperger has associated difficulties that interfere with school, work or social functioning:

For hyperactivity, inattention and impulsivity: Psychostimulants (methyphenidate, dextroamphetamine, metamphetamine), clonidine, Tricyclic Antidepressants (desipramine, nortriptyline), Strattera (atomoxetine)
For irritability and aggression: Mood Stabilizers (valproate, carbamazepine, lithium), Beta Blockers (nadolol, propranolol), clonidine, naltrexone, Neuroleptics (risperidone, olanzapine, quetiapine, ziprasidone, haloperidol)
For preoccupations, rituals and compulsions: SSRIs (fluvoxamine, fluoxetine, paroxetine), Tricyclic Antidepressants (clomipramine)
For anxiety: SSRIs (sertraline, fluoxetine), Tricyclic Antidepressants (imipramine, clomipramine, nortriptyline)

Additional Information on Childhood Autism

Asperger’s Disorder Homepage

KidsHealth for Parents – Asperger Syndrome

The Asperger’s Syndrome Institute

Mayo Clinic – Asperger’s Syndrome

BC HealthGuide- Asperger’s Syndrome

Asperger’s Syndrome

Online Asperger Syndrome Information & Support