Asperger’s syndrome is a neurological disorder. It is a form of autism that involves restrictive, repetitive behavior and communication & social difficulties.
What Is Asperger’s Syndrome?
Asperger’s syndrome (AS) is a neurodevelopmental disorder which affects a person’s behavior, social interaction patterns and nonverbal communication skills. A 2017 study 1 describes the condition as “as a social deficiency, limited interest, obligatory behavior with no verbal communication problem.” Also known as Asperger syndrome, Asperger disorder or simply as Asperger’s, it is a type of autism spectrum disorder 2 (ASD). However, this condition is separate from other autism spectrum disorders as cognitive development and language generally remains unaffected. But abnormal use of language and awkward physical movements may be observed in some sufferers.
Mind Journal explains that Asperger syndrome is “marked by a lesser or greater level of impairment communication & language skills along with limited yet repetitive thought and behavior patterns.” Signs and symptoms of the condition usually begin before the age of two. However, it has been observed that abnormalities tend to continue even in adolescence and adulthood, according to the International Classification of Diseases (ICD-10). Moreover, psychotic episodes can also be occasionally experienced during early adulthood.
There is no specific treatment or prevention for Asperger’s syndrome. Moreover, research 3 indicates that the effectiveness of treatment is not well established. But early diagnosis & intervention can dramatically enhance the treatment process and positively impact the patient’s quality of life. Moreover, many experts tend to focus on the positive aspects of the condition and consider the disorder simply as a different way of thinking, instead of being a defect or retardation.
Prevalence Of Asperger’s Syndrome
According to a 2015 study 4 , around 0.5% of the global population or about 37.2 million people suffer from this condition. It has also been observed that it affects 0.03-4.84 individuals in every 1,000 people. According to the Centers for Disease Control and Prevention (CDC 5 ), a survey of parents found that prevalence may be as high as 1 in 50 children. Moreover, men are four times more likely to be affected by Asperger’s than women.Generally, women are diagnosed when they are older.
Children having this disorder may show symptoms as early as their first year of life. Common symptoms include delay in motor skills, sensory difficulty, lack of imagination, rituals, formal speech, obsessive interests and social isolation.
History Of Asperger’s Syndrome
Asperger’s syndrome was originally described by Austrian paediatrician Hans Asperger while examining “autism-like behaviors,” and impairment in communication and social skills. However, it was later popularized by British psychiatrist Lorna Wing during the 1980s. As experts initially believed that Asperger’s was a “milder form of autism”, it was identified as high-functioning autism due to less severe symptoms. According to The Autism Society of America, German developmental psychologist Uta Frith “describes individuals with Asperger’s as having a dash of autism.”
In 1993, the condition was added as a “pervasive developmental disorder” in the 10th International Classification of Diseases (ICD-10 6 ). Later in 1994, Asperger’s syndrome was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) under the American Psychiatric Association as a separate diagnosis. But, now this condition is no longer considered as a separate diagnosis. In 2013, Asperger’s Disorder was replaced and included as a part of autism spectrum disorder (ASD) in the DSM-5. However, people diagnosed with this disorder may choose to use the term Asperger’s or may identify themselves as on the autistic spectrum. The National Institute of Mental Health (NIMH 7 ) explains “Although the official diagnosis of ASD has changed, there is nothing wrong with continuing to use terms such as Asperger’s syndrome to describe oneself or to identify with a peer group.”
Individuals with this condition may have normal or even above-average intelligence, however, they may face challenges with social conventions and interactions. They also tend to have engrossing and pervasive interests in specific topics. However, they may tend to appear rude or tactless. As they often feel confused with complicated feelings, a person with this disorder may have difficulties in developing social and intimate connections. According to Harvard Health Publishing, “They may be unable to take hints, keep secrets, or understand metaphor, irony, and humor. The meaning of gestures, tone of voice, and facial expressions are a mystery to them, and their own body language and expressions may be inappropriate or hard to interpret.”
Sufferers often have a single-minded focus, talk loudly, invade personal space and talk only about subjects they are interested in. They can also be highly sensitive, socially awkward and emotionally remote. “They are often clumsy, with poor handwriting and sometimes repetitive movements like rocking, or routines that resemble obsessive-compulsive behavior. They are easily upset when their expectations are not met or their routines disturbed,” adds Harvard Health.
Characteristics Of Asperger’s Syndrome
As Asperger’s is classified as high-functioning autism, sufferers don’t generally have impairment in intelligence or delayed language skills, which is common with ASDs. Hence, they can often pursue general education in mainstream classrooms and do normal jobs. People suffering from Asperger disorder may –
- Have trouble with social interactions
- Have restricted interests
- Engage in repetitive behavior
- Have strong beliefs and thoughts
- Intensely focus on routines and rules
- Have unique strengths
- Lack empathy
- Unable to understand conventional social rules
A person with this condition may have certain strengths and weaknesses as well.
1. Positive characteristics
Some positive traits of people with Asperger’s syndrome can prove to be highly helpful in their lives. Common positive characteristics may include:
- Extraordinary focus
- Aptitude for identifying patterns that can be easily missed by others
- Enhanced attention to details
- Increased ability to persevere in particular interests
- Excellent ability to work independently
- Not getting influenced by the opinions of others
- Intensity and passion
- A unique way of thinking
However, there are certain challenges that they may have to face on a daily basis, such as:
- Anxiety and depression
- Trouble with nonverbal communications
- Difficulty with interactions and conversations
- Clumsiness and uncoordinated movements
- Hypersensitiveness to touch, taste, sound, lights etc.
These behaviors and challenges may vary from person to person and most sufferers will eventually learn to build their strengths and overcome weaknesses through proper diagnosis and treatment.
Asperger’s vs Autism
One study 8 claims that there is adequate controversy regarding what constitutes Asperger’s “and whether it should be declared a separate disease or higher-functioning autism.” But today Autism and Asperger’s Syndrome are not regarded as separate diagnoses. Although people with Asperger’s are now diagnosed with autism, most sufferers tend to identify as having Asperger’s due to the prevalent stigma around autism diagnosis. However, the primary difference between the two conditions is perhaps the belief that people with Asperger’s tend to have only less severe symptoms and lack any language delays, which can be considered as neurotypical, when compared to people having autism.
The Autism Society of America explains “Children with autism are frequently viewed as aloof and uninterested in others. This is not the case with Asperger’s Disorder.” People with Asperger’s want to interact with others but lack the understanding of the process. Cognitive ability is also another prominent distinction between the two conditions. “While some individuals with autism have intellectual disabilities, by definition, a person with Asperger’s Disorder cannot have a clinically significant cognitive delay, and most possess average to above-average intelligence,” adds The Autism Society of America. Moreover, they may also be subtle grey matter differences between Asperger’s Disorder and autism according to one study 9 .
Symptoms Of Asperger’s Syndrome
Symptoms typically tend to manifest within the first year of life. Although symptoms may vary from one patient to the other, the condition has some common symptoms, such as having obsessive focus on a particular topic of interest. Moreover, they are often unable to accurately understand non-verbal communication, such as body language, gestures and facial expressions. They may also fail to identify other’s emotions and make eye contact. Sufferers tend to have limited facial expressions and speak in a robotic or formal manner. Children with AS also have issues with basic motor skills like walking or running and often lack coordination.
Some of the most common signs of the disorder may include:
1. Communication symptoms
Impaired communication is one of the basic signs of AS and may include the following symptoms:
- Repetitive speech
- Unusual manner of speaking
- Unable to understand body language or facial expressions
- Inability to express emotions in social situations
- Speech may be high-pitched & loud
2. Physical Symptoms
Some sufferers may tend to be awkward or clumsy and may face challenges in performing basic daily tasks or activities. Physical symptoms of AS may include the following:
- Odd or inappropriate movements
- Delay in motor development
- Difficulty with coordination
- Sensitive to touch, smell, sound and other senses
3. Cognitive Symptoms
Generally, some sufferers tend to have above-average intelligence, whether they are children or adults. Cognitive signs of Asperger’s syndrome may include:
- Higher IQ
- Better rote memory
- Ability to intensely focus on something
- Unusual sense of humor
- Focus on finer details
- Capable of understanding technical information
- Inability to understand abstract information
4. Social symptoms
The condition may cause the following issues during social interactions:
- Inability to maintain eye contact
- Social withdrawal or isolation
- Difficulty building or maintaining relationships and friendships
- Unsuitable mannerisms & behaviors
- Incapable of identifying sarcasm or humor
- Lack of common sense
- Lack of empathy & emotion regulation
- Strict adherence to routines
- Obsession with specific topics
- Conversations about self
However, it should be noted that the severity of the symptoms may vary as they depend on the individual. Often the disorder may only be recognized in adulthood when one of the parents may identify their own symptoms in the child.
Read more to know about : Symptoms Of Asperger’s Syndrome
Causes Of Asperger’s syndrome
Experts are yet to understand the exact causes for the development of this condition. As Asperger’s syndrome is a type of autistic disorder, the causes may be similar to that of autism. However, Asperger’s may be caused by a combination of different factors, like genetics, environment and even changes in brain development.
Let us take a look at some of the most common causes for the development of Asperger’s disorder:
1. Genetic factors
Asperger’s disorder may run in families as some cases show that it may be hereditary. According to Harvard Health, “The autistic spectrum has strong genetic roots.” Around 90% of identical twins tend to share the entire range of autistic symptoms from severe to mild. Moreover, about 33% of parents with a child suffering from Asperger’s disorder tend to have at least some associated symptoms. According to a recent scientific analysis 10 published by the National Center for Biotechnology Information (NCBI), genes leading to ASD “are involved in a variety of biological functions related to brain development and function.” Although the genetic basis for the development of the condition has been established, no particular organic cause has been identified.
2. Environmental factors
Research 11 indicates that certain environmental factors 12 can also lead to high-functioning autism spectrum disorder. Some common environmental risk factors may include certain events related to birth, like:
- Advanced paternal and maternal age 1 during conception
- Prenatal exposure to toxic elements, like viruses, chemicals, teratogens or pollution
- Prenatal infections
- Problems with pregnancy or birth
- Excessive prematurity or extremely low birth weight
- Immune system disorders, diabetes or obesity during or before pregnancy
- Oxygen deprivation to the infant’s brain or other birth difficulties
- Intrauterine exposure to valproic acid and thalidomide, and neonatal encephalopathy
However, these factors alone cannot lead to the condition. But these may increase the likelihood of a child for developing symptoms of ASD along with genetic factors.
3. Brain abnormalities
Certain changes in the brain may be responsible for most of the symptoms of this condition. Advanced brain imaging technology has revealed that brain abnormalities, like functional and structural differences in particular areas of the brain can be a contributing factor. According to a 2002 study 13 , sufferers tend to have differences in brain anatomy along with structural abnormalities “in fronto‐striatal systems and the cerebellum, and impaired sensorimotor gating.” The researchers suggest that the disorder develops from general abnormality in brain development. It explains “Some regions are more affected than others.”
Read more to know about : Causes Of Asperger Syndrome
Complications Related To Asperger’s
Asperger’s syndrome is an underlying disorder that may lead to other functional complications, apart from learning and behavior problems 14 . Some sufferers may experience abnormal sensory sensitivity which can either intensify or weaken their senses. It affects how they perceive loud sound, bright lights, touch, food textures, strong scents and other objects. Moreover, children with this condition may tend to be hyperactive and overwhelmed. They can also develop anxiety and depression in their adulthood.
According to a 2012 study 15 , certain psychiatric conditions may coexist with asperger syndrome and high functioning autism. Some of the common psychiatric comorbidities may include:
- Attention deficit hyperactivity disorder (ADHD)
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Tic disorders, like Tourette syndrome
- Disruptive behaviors, like aggression, tantrums and self-injury
Sufferers may experience anxiety and may be hypersensitive to specific stimuli even when anxiety disorders are not present. Apart from this, people having Asperger’s may also experience problems with anger management as a response to frustration and anxiety. However, not every sufferer will necessarily experience related psychiatric conditions.
Asperger’s Syndrome And Violent Behavior
It is often believed that violent behavior is related to this condition which can leave many parents feeling confused and distressed. However, the truth can be somewhat complicated. One 2016 study 16 indicates that “aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities.” Research 17 shows that approximately 5% to 26% prevalence was observed in the adult and juvenile delinquent population with ASD. Aggression in children with ASD or Asperger’s can lead to negative outcomes, such as higher likelihood of being victimized, utilization of physical intervention, being placed in restrictive residential or school settings and impaired social relationships. It can also affect the quality of education provided to children, and cause higher stress levels and financial issues for the caregivers. Aggression and violent behavior from patients can also adversely affect support services and lead to poorer quality of life for the sufferer and the caregivers.
According to a 2017 study 18 , certain factors, like male gender and psychiatric disorders among people with autism were found to be the most prominent predictors of violent criminality. However, other factors like socioeconomic factors, psychiatric history and “parental criminal” should also be considered. The researchers found that a lack or delay in diagnosis of autism was linked to a higher likelihood of a violent crime. The study explains “An initially observed association between autism and violent crimes at a population level was explained by comorbidity with ADHD and conduct disorder.” Although Asperger’s may be related to aggressive behaviors, no conclusive evidence has been found for a direct association of autism and violent crime. Some experts believe that other comorbid mental health disorders may trigger violent and violent behaviors in individuals with ASD.
“Children with ASD were reported to have less aggression and were more likely to be rated as reactive rather than proactive,” found a 2015 study 19 . The researchers concluded that gender of the sufferer was not a determining factor for aggression. However, lower IQ and adaptive behavior were found to be linked with more physical aggression, while “higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression.” Further research 20 reveals that aggressive behavior problems (ABP) are related to certain factors, like-
- Attention problems
- Lower ASD severity
- Lower cognitive functioning
- Frequent use of melatonin & psychotropic drugs
However, there is a lack of conclusive evidence that shows people suffering from Asperger’s or ASD tend to be more violent than individuals without these conditions. But studies 21 have found that “specific generative and associational risk factors may increase violence risk among individuals with ASD.” Regardless, further research may be required to gain additional insight about the relationship between Asperger’s, aggression and violent crime.
Diagnosis Of Asperger’s syndrome
There is no specific test for the diagnosis of Asperger’s disorder in adults. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders outlines the following criteria:
An adult or child with no intellectual development deficiencies or any problems with language or self-help skills, should –
- Experience at least two symptoms from the following:
- Difficulty using body language, facial expressions, eye contact and gestures in social interactions.
- Unable to form connections or relationships with peers or people of same age
- Inability to appropriately reciprocate emotionally or socially
- Lack of interest to share pleasures, achievements or interest with others
- Experience at least one from the following:
- Excessive preoccupation with a specific interest or abnormally limited single interest
- Strong adherence to apparently purposeless rituals and routines
- Repetitive and stereotyped movements
- Preoccupation with certain parts of specific objects
However, as the condition is no longer identified as a separate disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), currently there is no diagnostic criteria for the condition in adults. Now, sufferers are diagnosed with autism spectrum disorder, although a healthcare professional may still use the term Asperger’s. But diagnosis can be challenging as the symptoms tend to vary greatly. The syndrome is often diagnosed later than autism in children and in some cases an accurate diagnosis is done only in adulthood.
Diagnosis typically begins with a complete assessment involving the medical and family history of the patient. The doctor may also assess the patient’s developmental history, behavioral delays and symptoms and may conduct some physical tests, like X-rays and blood tests. It is crucial that such assessments are done only by trained medical professionals, like doctors or pediatricians. Asperger’s should be diagnosed early as it can increase the patient’s likelihood of getting treated successfully and living an independent life. However, as varying symptoms make early diagnosis challenging, diagnosis and treatment may only be possible in adulthood in most cases.
The diagnosis process may involve a dedicated diagnostic team of multidisciplinary healthcare professionals, like a psychologist or a psychiatrist, a paediatrician and a speech and language therapist. Healthcare professionals may conduct some other tests to rule out underlying health conditions, like other mental disorders or physical conditions.
Screening Tools For Asperger’s Syndrome
Due to a lack of standardized diagnostic screening, many sufferers may be misdiagnosed with other mental conditions with similar symptoms, like attention deficit hyperactivity disorder (ADHD). However, there are certain screening tools that may be used for accurately screening ASD, including:
- Quantitative Checklist for Autism in Toddlers (Q-CHAT)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Modified Checklist for Autism in Toddlers, Revised, with Follow up (M-CHAT-R/F)
- Screening Tool for Autism in Toddlers and Young Children (STAT)
- Autism Screening Instrument for Educational Planning, 3rd Version (ASIEP-3)
- Autism Behavior Checklist (ABC)
- Childhood Asperger Syndrome Test (CAST)
- Social Communication Questionnaire (SCQ)
- Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R)
A recent 2019 study 22 reveals that Asperger’s is usually diagnosed late at around 11years of age and in a few cases, in adulthood. “This late diagnosis has a significant impact on the risks of depression and a poor quality of life,” adds the study. This is why early, accurate and multiple diagnosis is crucial. If you think you, your child or someone you know may have Asperger’s syndrome, then see a doctor immediately and seek treatment.
Treatment For Asperger’s Syndrome
There is no specific treatment for this condition. However, certain treatment strategies can effectively help in alleviating symptoms and enable patients to reach their full potential. But treatment may vary depending on specific symptoms, patient’s age, their needs, strengths & shortcomings, targets of intervention and modality of delivery. According to research 23 , an effective treatment plan must focus on minimizing basic deficiencies, optimizing functional independence, and eliminating problematic behaviors that may affect the patient’s functional skills. It should also help them become interested in more highly-structured activities, teach strategies to successfully complete tasks and reinforce positive behavior regularly.
Effective treatment options for Asperger’s syndrome may include various types of therapies, medications and other measures. Therapy can be especially helpful with Asperger’s and autism reveals one 2013 study 24 . It states that although counselling patients with Asperger’s and high functioning autism “may seem a daunting prospect at the outset, however therapy with these individuals can be very rewarding.”
Here are some most effective treatment methods available for Asperger’s syndrome:
A number of therapy approaches may be recommended by healthcare professionals for treating this syndrome as the intensity of symptoms may vary depending on the person. Studies 25 have found that psychotherapy can be effective in helping children overcome the symptoms of Asperger’s. Even though there are limited therapy options 26 for adults, research 27 shows that psychotherapy for adults with high-functioning ASD can also help with communication issues and depression.
Cognitive behavioral therapy (CBT 28 ) has been found to be the most effective forms of talk therapy for autistic children and adults with anxiety, depression and “high rates of co-occurring emotional problems.” One 2017 study 29 states that as experts are identifying a high comorbidity of anxiety in ASD patients, CBT is being increasingly recommended for treatment. However, due to specific and unique needs of individuals with Asperger syndrome, standard CBT approaches may be required to be personalized. The researchers add “There are several studies that have demonstrated that a personalized variant of CBT can result in successful outcomes when treating anxiety symptoms within the ASD population.”
Apart from cognitive behavioral therapy, some other psychotherapy approaches may also be recommended for treating autism spectrum disorder, such as:
- Applied Behavior Analysis (ABA 30 ) interventions
- Early intensive behavioral intervention (EIBI 31 )
- Educational Interventions 32
- Speech and language therapy 33
- Developmental Interventions
- Social skills training (SST 34 )
- Occupational 35 or physical therapy 36
- Parent education & training
Although there is no specific medication for curing Asperger’s syndrome, a doctor may prescribe certain medicines to reduce symptoms related to depression, anxiety or inattention. Commonly prescribed medications for ASD typically include the following:
- Antipsychotic drugs
- Selective serotonin reuptake inhibitors (SSRIs) or antidepressants
- Stimulant medicines
However, it should be noted that according to research 37 , aripiprazole and risperidone are the only FDA-approved medications for the management of irritability associated with ASD. “Although numerous medications are used to treat the symptoms of ASD, such as irritability, aggression, and aberrant social behavior, only risperidone and aripiprazole are FDA-approved for ASD patients,” adds the study. With effective therapy and medications, a person with the condition, whether a child or an adult, can learn to manage their symptoms and overcome common challenges related to the syndrome.
Read more to know about : Treatment For Asperger Syndrome
Role Of Caregivers
It can be a great idea for parents and other caregivers to learn more about Asperger’s syndrome. Learning experiences can enable them to gain a better understanding about the condition. Learning certain strategies can empower them to provide better support to a loved one with Asperger’s, who is dependent on them. Moreover, it can also keep away feelings of isolation and depression.
Family, friends and other support groups may help a patient cope with change by preparing them well in advance and embrace the change when they are ready. Moreover, parents also need to inform the school, if they believe their child is showing symptoms of high-functioning autism or Asperger’s disorder. This is crucial because academic institutions may be able to provide special learning support. Support from all facets can help the sufferer improve their quality of life.
Prognosis For Asperger’s Syndrome
On average, about 9% of children with autism spectrum disorder (ASD) may not meet the criteria for diagnosis of ASD in adulthood. According to the National Institute of Neurological Disorders and Stroke (NINDS) “With effective treatment, children with AS can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging.” Several adults with this condition tend to do and hold mainstream jobs successfully. However, they may need moral support and encouragement to live an independent life.
Read more to know about : Coping With Asperger Syndrome
Leading Productive Lives
Early diagnosis at a young age followed by prompt treatment and interventions can be highly valuable and beneficial. Treatment can drastically improve the outlook for individuals with Asperger’s syndrome in the long run. With effective and necessary educational, behavioral and social support, sufferers can be expected to live happy, independent lives.
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