Asperger Syndrome (AS) is a high functioning and milder form of autism spectrum disorder (ASD). As the severity of symptoms may vary for each patient, a doctor may need to try various approaches for effective treatment.
Asperger Syndrome Treatment
Primarily diagnosed as autism spectrum disorder (ASD), Asperger’s is a neurodevelopmental disorder that affects a person’s communication skills and behavior. A study 1 explains “Asperger’s syndrome represents a type of developmental disability that profoundly limits a child’s participation in the process of growing up.” This is why doctors and clinicians should identify the limitations and develop appropriate diagnostic & treatment solutions. Although there is no specific cure for the disorder, different treatment approaches can effectively reduce symptoms and help the patient to live independently. However, there is no one size fits all approach when it comes to treating Asperger syndrome as the symptoms may vary depending on the age, needs, strengths and weaknesses of the patient. Moreover, targets of intervention as well as modality of delivery should also be considered while devising a treatment strategy.
According to a 2008 study, “No single methodology or intervention strategy has been identified as the most effective or shown to be successful for all participants, nor is there a single comprehensive treatment program for individuals with these disorders.” This is why it is crucial that the child receives an early diagnosis for better treatment outcomes. Treatment for Asperger syndrome may involve multiple approaches including psychotherapies, medications and lifestyle changes.
Who Provides Diagnosis & Treatment
Diagnosis for Asperger syndrome must always be done by a doctor or a healthcare professional. Initial diagnosis may be conducted during regular check-ups of the child. As pediatricians are trained to accurately analyze the development pattern of a child, they may perform the primary screening. If the doctor observes any potential issues related to development, then they may recommend a comprehensive diagnosis. Although a primary care doctor may be able to do a complete diagnosis, they may recommend a specialist for more accurate screening, such as:
- Child psychologist or psychiatrist
- Child neurologist
- Developmental pediatrician
- Occupational therapists
- Physical therapists
- Speech or language therapists
- Social workers
Consulting multiple specialists may be required for getting a proper diagnosis and treatment. Although the process can be time-taking, it can be highly beneficial in finding the right treatment approaches for the most favorable outcome.
Objective Of Asperger Syndrome Treatment
The main goal of asperger’s treatment is to reduce the symptoms and enhance the sufferer’s ability to function independently. The objective of treatment 2 involves maximizing functional independence, minimizing core deficits and reducing problematic behaviors which prevents functional skills. Early diagnosis and treatment can help children overcome the condition greatly as it can enable them to use vital behavioral and social tools to live a better life. Treatment must also focus on improving symptoms, like repetitive routines, obsessions, issues with communication skills and clumsiness. Moreover, the treatment program must also develop the patient’s interests, engage them in highly structured activities, offer reinforcement of behavior regularly and teach simple ways to complete tasks as a series of steps.
Asperger Syndrome Treatment Approaches
It has been observed that children and adolescents with Asperger syndrome have certain service needs in various areas, such as educational, behavioral, family, health, support, leisure and others. An effective treatment strategy for Asperger’s must consider the needs of the patient. Moreover, both the patient and the caregivers must approve and accept the treatment approaches for it to work effectively. Although different types of treatments are available for Asperger’s, “treatment strategies in individuals with ASD may vary according to patient age, strengths, weaknesses, and needs, as well as modality of delivery and targets of intervention,” explains 3 a scientific review. An effective treatment plan focuses on the strengths of the patient and promotes development in areas of weaknesses. Moreover, it is also important to continually monitor progress so that the treatment strategy can be adjusted accordingly, if needed for the best outcomes.
The following strategies are typically recommended in the treatment for Asperger syndrome:
- Alternative treatments
Let us explore each of these treatment approaches in detail below.
As the severity of the symptoms may vary depending on the individual, a doctor may recommend multiple types of psychotherapy approaches for the treatment. According to a 2004 study 4 , “Individual psychotherapy can be an important approach, in addition to other therapies and case management, for children with Asperger’s syndrome.” Some of the most helpful approaches include:
A. Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a well known psychological intervention that can help a person with Asperger syndrome cope with anxiety & depression. CBT 5 , a form of talk therapy, helps autistic people identify & analyze their own thought patterns and perceptions by changing certain behaviors and enables them to learn strategies for making positive changes. CBT can not only help to change anxious and polarized thoughts, it can also help both children and adult sufferers to regulate their feelings, repetitive behaviors, obsessions, meltdowns and angry outbursts. According to a 2006 study 6 titled ‘Effectiveness of a Cognitive-Behavioral Treatment on the Social Behaviors of Children With Asperger Disorder’, it was found that CBT can lead to “significant improvement in social skills.” Moreover, “parents reported a significant improvement in adaptability and reduction in unusual behavior for their children,” states the study.
Given the strong prevalence of OCD tendencies in the ASD patients, one 2017 study 7 found that when coupled with exposure and response prevention (ERP), CBT can prove to be the “best-established psychological treatment” for autistic people with obsessive-compulsive behaviors (OCBs). Cognitive behavioral therapy for Asperger syndrome typically involves the following 5 aspects:
- Fear hierarchy development
- Exposure/response prevention
- Cognitive strategies
- Generalization/relapse prevention
Another 2013 research paper 8 explains that as anxiety is one of the most common problems experienced by children and adolescents with ASD, CBT can be an effective treatment strategy for children with high-functioning ASD. “Cognitive-behavioral therapy (CBT) is a first line of treatment for anxiety in typically developing children, and there is emerging evidence that CBT can be helpful for anxiety in children with ASD,” adds the study. Apart from these, multiple studies 9 have found CBT to be an effective intervention 10 for enabling autistic children cope with anxiety, depression 11 and other psychological issues 8 .
B. Applied Behavior Analysis (ABA) interventions
Utilized since the 1960s, ABA is a helpful intervention that involves a number of different approaches, like changing specific behaviors, positive reinforcement and teaching coping skills to children and adults with ASD. The process may be personalized by a doctor or therapist according to the goals and needs of the patient. According to a 2016 study 12 ABA is a helpful treatment approach that primarily relies on theories of learning and operant conditioning for treating Asperger syndrome. ABA “includes specific intervention targets, coupled with positive reinforcement (verbal praise, tokens, or edible rewards), with repetition of learning-trials a key component,” explain the researchers.
These interventions are usually started early and developed to target the core symptoms of Asperger syndrome. Behavioral interventions are based on behavior modification & learning theory 13 principles and delivered through an intensive format. However, the most effective intervention models have been designed through the Applied Behavioral Analysis (ABA) principles. The evidence-based ABA program involves a process of in-depth behavioral interventions to help the patient improve certain behaviors that are socially desirable. It can also help to eliminate or reduce undesirable behaviors that may affect or restrict their progress. These interventions include various approaches based on the patient’s age, targeted skill or goals.
Research 14 has revealed that ABA interventions can be effective when applied to communication, academic tasks, adaptive living skills, occupational skills and social skills for better interpersonal interactions. One 2013 study 15 shows that ABA techniques can help to reduce episodes of undesirable behavior, such as verbal perseverations, repeated inappropriate gestures & coprophagia; and increase the episodes of desirable behaviors, such as compliance with medical procedures and social interactions. Researchers from a 2008 study 16 state that “ABA is a primary method of treating aberrant behavior in individuals who have autism. The only interventions that have been shown to produce comprehensive, lasting results in autism have been based on the principles of ABA.” However, some studies 17 point out that ABA intervention programs tend to be expensive, controversial & dependent on external variables.
C. Early intensive behavioral intervention (EIBI)
Early intensive behavioral intervention (EIBI 18 ), one of the most effective ABA techniques, for young children with autism spectrum disorders (ASD) can also be helpful. It is an individualized program which utilizes a number of trials to help the patient develop certain simple and complex skills. Evidence 19 shows that EIBI, based on the principles of applied behavior analysis, has been found to be a well-established approach for the treatment of Asperger syndrome. However, it should be delivered for 20-40 hours each week for several years. In fact, one 2008 study 20 found that EIBI can be an effective treatment option for children with Asperger syndrome. “There is some evidence that Early Intensive Behavioral Intervention (EIBI) is an effective treatment for some children with ASD,” explains a 2013 study 21 .
According to a 2011 study 22 , autistic children treated with EIBI have been found to make substantial improvements in composite scores related to adaptive behavior and IQ after receiving intervention for 2 years, when compared treatment as usual and special education. The study states “the outcomes from the delivery of an EIBI-based model to pre-school children in typical mainstream nursery settings led to more positive outcomes than a Treatment as Usual special education nursery model for children with autism.”
D. Educational Interventions
Most experts agree that children suffering from Asperger’s or autism spectrum disorders require a structured educational plan that should involve intensive, individualized and strategic interventions. “Educational interventions form the mainstay of management for children with autism spectrum disorder,” explains a 2017 study 23 . These interventions may help in improving communication & social interaction, promote learning, challenge thoughts and behaviors, encourage independence in autistic children. The most helpful classroom-based models for children with this condition, include:
- Learning Experiences and Alternative Programs for Preschoolers and their Parents (LEAP)
- Treatment and Education of Autism and related Communication handicapped Children program (TEACCH)
The goal of these interventions is to improve nonverbal and verbal communication skills along with their motor skills, academic performance and social skills.
E. Speech and language therapy
Although most sufferers may not experience language problems, they may struggle with expressing themselves properly. Speech-language therapy aims to improve communication skills in children affected by Asperger syndrome. Specialized communication skills training can help the sufferers learn how to use voice modulation, tone of voice, voice control and initiate & maintain conversations. They can also learn how to interpret & react to verbal and non-verbal communication, like gestures, body language, facial expressions & figures of speech. Moreover, this can even help them make and maintain better eye contact.
Speech-language therapy may involve certain strategies, like –
- Reinforcement of speech sounds
- Exaggerated imitation
- Enhancing communicative acts
- Imitation of the sounds
Moreover, Augmentative and Alternative Communication (AAC) may be recommended for sufferers who are unable to communicate spontaneously. AAC modalities generally involve sign language, communication boards, speech-generating devices, visual supports and picture exchange communication systems. According to a 2015 study 24 , children and adults with ASD can overcome communication impairments 25 with the help of the latest AAC technologies. It states “Augmentative and alternative communication (AAC) provides a means of effective communication to individuals with autism spectrum disorder (ASD), many of whom are unable to use conventional speech effectively.” According to the approach 26 of this therapy, everyone feels the need to express their thoughts and emotions by communicating with others. However, when speech is impaired due to ASD, a child can learn other effective ways to communicate and express themselves, instead of waiting for communication to develop.
Research 27 shows that augmentative and alternative communication interventions can help to improve communication skills in patients. One 2018 study 28 confirmed that such instruments can prove to be highly valuable in Asperger’s treatment by enhancing the communicative process in patients. Moreover, new technologies that aim to help autistic children to communicate better can not only promote social interaction, but improve cognitive & social development. “There is growing evidence for the potential benefits of AAC for children with autism, but there is a need for more well-designed studies and broader, targeted outcomes,” concludes a 2016 study 29 .
F. Developmental Interventions
Based on developmental theory, these interventions can help children learn emotional regulation, communication and social interaction by engaging with others. According to a scientific review, “Developmental interventions are focused on the relationship between patient and adult (parents or caregivers).” It is believed that these interventions help adults learn how they can improve their degree of responsiveness. Moreover, it can enable them to understand how to engage with children in using non-directive interactive techniques so that the affected child can be taught how to build communication and social skills in the context of playing activities.
Counselors can also help families so that they can better deal with the challenges of raising and supporting a child or a family member with Asperger’s Syndrome.
G. Social skills training (SST)
According to researchers 30 , “Social skills training (SST) is one of the most common interventions to help address social deficits in individuals with autism spectrum disorder.” Although SST was originally delivered through face-to-face (F2F-SST) interventions, technological enhancement now allows computer-based programs & therapeutic robots to improve social skills deficits. SST educates autistic children about how to interact with others using problem-solving skills, in vivo instruction on conversation and building friendships. Therapists can help the child with Asperger syndrome learn how to express themselves in a healthy way and interact with others appropriately in group or individual sessions. It often proves effective when they follow typical behavior. Group or individual therapy associated with social skills can also help in relieving certain symptoms like depression & obsessive-compulsive behaviors in people with Asperger syndrome. Common SST strategies 31 may include –
- Social problem solving
- Video modeling
- Social stories
- Scripting procedures
- Peer mentoring/training
- Priming procedures
- Social skills groups
- Pivotal response training
- Computer-based interventions
- Prompting procedures
As social skill deficits are a prevalent aspect of Asperger syndrome, “social skills training (SST) should be a critical component of programming for youth with ASD,” claims a 2008 study 32 . Moreover, social skills group training (SSGT 33 ) and group social skills interventions (GSSIs 34 ) are also commonly applied for treating children and adolescents with high functioning autism spectrum disorder.
H. Occupational or physical therapy
This can help patients who are experiencing poor motor coordination or sensory integration problems. Occupational therapy 35 helps patients improve their ability to perform daily activities, while physical therapy enhances their ability to move their body normally and in a healthy manner. Research 36 indicates that paediatric occupational therapy can help to improve engagement in affected children and promote better participation in various roles for living a more independent life. Studies 37 also suggest that intensive physical therapy intervention programs can improve therapeutic outcomes and successfully reduce motor-related impairments in patients with Asperger syndrome.
Other therapy approaches for treating Asperger’s may also involve the following strategies:
- Anger management
- Support group
- Family therapy
Currently, there are no specific medications for the main symptoms related to communication and social interaction difficulties of Asperger’s or ASD. The U.S. Food and Drug Administration (FDA) has approved only two medications 13 for the treatment of ASD:
Both these medications can be used for symptomatic treatment of irritability, aggression, self-injury and tantrums among children & adolescents with this disorder. Risperidone can decrease restrictive, repetitive behaviors, impulsivity, aggressive outbursts and self-injurious tendencies. It can also improve standard behavior patterns and enhance social relatedness in the short run. As per one 2008 study “risperidone seems to be moderately efficacious and safe for treating behavioral disorders.” Another 2016 study found that Aripiprazole, which is a relatively new third‐generation atypical antipsychotic drug, can be highly effective. The study adds “After a short‐term medication intervention with aripiprazole, children/adolescents showed less irritability and hyperactivity and fewer stereotypies (repetitive, purposeless actions).”
However, it should be noted that although both risperidone and aripiprazole are the only FDA approved medications for autism spectrum disorders, these mainly target the irritability and aggression 12 symptoms associated with Asperger syndrome. Apart from these, a doctor may prescribe some other medications for associated comorbid symptoms like anxiety disorders, major depressive disorder and aggression. Some common may medications include:
- SSRI antidepressants (Selective serotonin reuptake inhibitors)
- Stimulant medicines
- Atypical antipsychotic drugs
A 2015 study 38 outlines the following medications which may also be prescribed for the treatment of Asperger syndrome:
Pharmacotherapy can also help to set realistic expectations, monitor care systems at home and school, and establish collaboration with parents, doctors, teachers and other caregivers. In a 2003 study 39 , Dr. Kenneth E. Towbin, M.D., Clinical Professor of Psychiatry and Behavioral Science at the George Washington University School of Medicine, explains that pharmacologic treatment of high functioning autism and Asperger syndrome is “moving to design medications that target more specific populations of receptor and brain functions. This is likely to produce medicines that have fewer side effects, are more effective, and are more symptom-specific.” However, researchers 12 warn that doctors must recommend low doses of medications initially and progress slowly as “children and adolescents with autism spectrum disorder appear to be more susceptible to adverse effects with medications.”
3. Alternative treatments
Apart from psychotherapies and medications, certain alternative and complementary and alternative treatments (CATs 40 ) can also prove to be beneficial for Asperger syndrome. According to a 2019 study 41 , around 46.8% of patients with Asperger’s have received alternative treatments in their lifetime. However, it should be noted that research is yet to confirm the effectiveness of such alternative therapies, even though many patients tend to report improvements in their symptoms. But as the severity of symptoms depend on the patient, the effectiveness may also vary to a great extent. This is why it is crucial to consult your doctor before trying out any alternative treatment options.
Here are some of the most common alternative strategies for treating Asperger syndrome:
A. Herbal medicine treatment
Different types of herbal remedies and medicines can help to manage ASD symptoms. Research 42 has found that “the efficacy of herbal medicines for the treatment of ASD appears to be encouraging but was inconclusive.” However, you should consult a doctor before giving any herbal supplements to patients, especially children as these are less regulated.
B. Art & music therapy
Creative therapies involving art and music are often used in addition to medical treatment to help the sufferer cope with certain symptoms, like excessive sensitivity to sound or touch. One 2014 study 43 found that “music therapy may help children with ASD to improve their skills in primary outcome areas that constitute the core of the condition including social interaction, verbal communication, initiating behaviour, and social-emotional reciprocity.” It can also improve skills in secondary outcome areas, like non-verbal communication skills, social adaptation skills in children and the quality of parent-child relationships.
C. Massage therapy
Massages can help a person with Asperger’s to calm down, relieve stress, anxiety, depression and even reduce sensory-related symptoms. Studies 44 have found that massage therapy can improve symptom severity & sensory challenges in the short run. According to a 2015 study 45 , parent-delivered massage strengthens parent-child bonds, leads to a better experience of touch and improves relationships. It was observed that children with Asperger syndrome sought affection and touch from parents, while the parents felt more connected. It can also help to reduce stress and improve educational outcomes for children. However, “limited evidence exists for the effectiveness of massage as a symptomatic treatment of autism. Because the risk of bias was high, firm conclusions cannot be drawn,” concludes a 2010 study 46 .
It is believed that acupuncture can help to alleviate some symptoms of Asperger syndrome, however more research may be required to understand the mechanism. One 2018 study 47 found that “acupuncture may improve the overall symptoms of ASD.” It also helped to reduce overall Childhood Autism Rating Scale (CARS) scores and is considered to be “effective and safe for pediatric ASD.”
Yoga tends to improve balance and encourage relaxation and flexibility. It is believed that yoga 48 may be helpful in making autistic children reduce stress and make improvements in core symptoms 49 of ASD. Research 50 indicates that yoga can be a promising treatment strategy for ASD as it helps in improving motor impairments, such as incoordination, poor balance & poor motor performance in children with Asperger syndrome. One 2010 study analyzed the application of integrated approach to yoga therapy (IAYT) as a complementary therapy for children diagnosed with Asperger syndrome. It found that IAYT can effectively help in increasing imitation, cognitive skills & social-communicative behaviors in austictic children. Moreover, “children exhibited increased skills in eye contact, sitting tolerance, non-verbal communication and receptive skills to verbal commands related to spatial relationship,” explains the study.
F. Animal therapy
Also known as animal-assisted therapy or pet therapy, this approach uses animals to enable patients improve their interaction and communication skills. It also helps to increase social function 50 , develop a sense of companionship and reduce feelings of isolation and loneliness. The approach may involve different animals, such as birds, guinea pigs, dogs or horses, depending on the purpose of therapy and the patient. One 2015 study 51 found that pet therapy for ASD mainly focuses on the use of dogs and horses. The study states that research has “shown positive effects for the therapy, including high satisfaction rates among the participants’ families.” Another 2020 study 52 found that “dogs facilitated therapeutic gains.”
Takeaway Of Asperger Syndrome Treatment
Effective treatment involving a combination of various therapies and medication can help control the patient’s problematic behaviors and other symptoms of Asperger’s syndrome. However, not every patient suffering from Asperger syndrome may require treatment. A 2009 study 53 found that “If symptoms are pronounced to a certain extent, however, and especially in patients with comorbid disorders, a multimodal therapeutic concept with symptom oriented pharmacological and psychotherapeutic elements seems appropriate.”
Early intervention and effective treatment can help a child manage their communication and social challenges and live a healthier, successful life in the long run. Parents need to cooperate with doctors to figure out the most successful treatment and must have patience regarding noticing improvements. Hence, you need to ensure that you work closely with your child’s healthcare provider for devising the best treatment plan.
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