What is Asperger Syndrome?
Asperger Syndrome (AS) is neurologically based and is classified as a pervasive developmental disorder (PDD) or autism spectrum disorder (ASD). It was first identified by Hans Asperger, a Viennese pediatrician, in 1944. Asperger Syndrome was added to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994. Related diagnoses include: High-Functioning Autism, Nonverbal Learning Disability, Semantic-Pragmatic Disorder, and PDD-NOS.
Psychologist Tony Attwood, considered one of the top experts in the field, likes to describe AS as "having a brain that's wired differently—not defectively." That's more than just an analogy. Recently, scientists in Great Britain published findings that showed there are significant differences in the connectivity of nerve cells in the brains of people with AS. The more severe the symptoms, the more abnormal the MRI scans.
What are some of the characteristics?
There is a wide range of characteristics within AS and symptoms can range from very mild to severe. However, all people with AS show marked deficiencies in social skills and have difficulty reading nonverbal cues (body language). Developing age-appropriate relationships can be quite challenging.
People with AS are often preoccupied with a particular subject of interest. (This preoccupation can lead to a specific career in which the adult with AS can be very successful.) Also, individuals with AS may be extremely good with rote memory skills (facts, figures, dates, times, etc.). Many are academically gifted and excel in math and science. Others are quite artistic. Often people with AS can be quite inflexible, especially about routines and transitions, and they may prefer sameness. (These characteristics are similar to those exhibited by individuals with OCD -- Obsessive Compulsive Disorder -- but are a part of the AS diagnosis.) Many individuals with AS are overly sensitive to certain sounds, tastes, smells, and sights. For instance, a person with AS may prefer specific clothing or be very rigid about the foods they will eat.
It is important to recognize that some behaviors caused by this neurological difference, which may be misconstrued as rudeness, are usually unintentional and certainly not the result of “bad parenting.” While often misunderstood, these special people can make significant contributions to society and have many positive qualities.
How is AS diagnosed?
AS can be difficult to diagnose. There is a wide range of characteristics within AS, and the very mildly affected child or adult often goes undiagnosed and may just appear odd or eccentric.
Unfortunately, there is no universal agreement on diagnostic criteria. One of the more recognized set of criteria (which also happens to be the most restrictive) is found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association. In order for an individual to be diagnosed with AS under DSM-IV guidelines, there must be: (1) severe and sustained impairment in social interaction; (2) the development of restricted, repetitive patterns of behavior, interests, and activities; and (3) clinically significant impairment in social, occupational, or other important areas of functioning. Additionally, there cannot be any clinically significant general delay in language (e.g., single words used by 2 years of age and communicative phrases used by 3 years of age), and there must be no clinically significant delays 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. Finally, an AS diagnosis is not given if the criteria are met for any other specific Pervasive Developmental Disorder or for schizophrenia.
A diagnosis of AS may be made at any point in an individual’s life. While some children are diagnosed as early as preschool, for others, the symptoms of AS may become more apparent with the increasing functional and social demands of adolescence. Still others may not receive a diagnosis until adulthood, perhaps following the diagnosis of one’s own child.
It is not uncommon for an individual with an AS diagnosis to be initially diagnosed with ADD or ADHD. To minimize the potential for misdiagnosis, the individual should see a clinical psychologist or psychiatrist experienced with AS.
What is the most effective treatment for AS?
That's another difficult question to which there is no agreement. Medication may help alleviate some symptoms. Dietary interventions help others. Social skills training is beneficial in most cases. Cognitive behavior therapy, speech and language therapy to work on language pragmatics, occupational therapy, physical therapy, and even music or art therapy help others. It seems that the treatment needs to be custom-fitted to the person.
Is AS and autism on the rise?
There has been a recent dramatic increase in the number of individuals being diagnosed with Asperger Syndrome. In 2005, the Centers for Disease Control & Prevention's website estimated that "between 1 in 500 (2/1,000) to 1 in 166 (6/1,000) children have an ASD." It is unknown what percentage of these cases are attributable to AS, however, a 1993 study in Sweden found the incidence of AS to be around 1 in 300 children. In the United States, the epidemiology increase for autism may be related to the fact that the AS diagnosis was first made "official" in 1994 when it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Most experts agree that it is likely that, at least in some cases, environmental triggers have resulted in an upsurge in diagnoses.
What makes a person have AS?
The cause of AS is unknown. It is believed that, at least for some people, genetic factors may be involved. To date, however, researchers have not identified a single gene that causes AS or autism to develop. Most experts also agree that for some individuals, environmental factors may be a contributor.
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