Unknown: Asperger Syndrome

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Asperger syndrome is commonly defined as a pervasive developmental disorder (PDD). PDDs are defined as a group of behavioral disorders that have two common features: problems in social interaction and problems with communication, both verbal and nonverbal.

Description

Children with AS are not mentally retarded. They learn to talk at the usual age and often have above-average verbal skills. They have normal or above-normal intelligence and the ability to feed or dress themselves and take care of their other daily needs. The most distinctive features of AS are problems with social interaction, particularly making friends with others; difficulties with nonverbal communication (e.g., facial expressions); peculiar speech habits that include repeating words or phrases or talking in a flat tone of voice; an apparent lack of “common sense” and a fascination with odd or obscure subjects (e.g., the parts of a clock or small machine, railroad schedules, astronomical data, etc.) that may prevent the child's developing other interests.

Although AS is not a physical disorder as such, some children with the syndrome are clumsy or make awkward repetitive physical movements. They typically find team sports and skills like swimming or riding a bicycle much more challenging than most children. They may also have strange or eccentric behaviors like hand wringing, finger flapping, or swaying in place. Some children with AS are unusually sensitive to bright lights, loud sounds, and changes in temperature.

Demographics

The exact frequency of AS is not known, partly because doctors in different countries disagree about its exact definition. Some think that AS is a subtype of autism while others think it is a distinct disorder. Estimates range between one child in 250 and one child in 10,000. What is known is that the disorder affects four times as many boys as girls. AS is thought to affect all racial and ethnic groups equally.

Causes and Symptoms

The cause of AS is not known, although some think it may be related to a decreased flow of oxygen to the baby's brain during childbirth. Another theory is that AS is genetic because it appears to run in families; however, no specific gene has yet been identified with the disorder. A team of German researchers reported in January 2008 that they had excluded a specific gene that other scientists thought might be a partial cause of AS.

The symptoms of AS vary somewhat according to the child's age. Young children with AS typically have problems picking up social cues and understanding the basics of interacting with other children. The child may want friendships but find him- or herself unable to make friends.

The symptoms of AS usually become much more noticeable during the elementary school years. It is at this point that the child's physical clumsiness, difficulty making eye contact, unusual but restricted interests, and odd behaviors increase his or her difficulty making friends. Although the child learns language easily, he or she may speak in a rapid, jerky, or overly loud way. Children with AS are also extremely literal in their use of language; they often fail to understand the symbolic or humorous uses of language, such as the saying that “it's raining cats and dogs.”

Adolescence is one of the most painful periods of life for young people with Asperger's, because social interactions are more complex in this age group and require more finely tuned social skills. In addition, teenagers with AS are often naïve and may be easily manipulated or cheated by their more sophisticated peers.

Hans Asperger (1906–1980)

Hans Asperger was an Austrian pediatrician who is credited with the earliest description of the disorder that now carries his name. He was born on a farm near Vienna and graduated from medical school in 1931. The next year he took a position in the University Children's Hospital in Vienna. He also worked as a psychiatrist in Leipzig in eastern Germany for several years.

In 1944 Dr. Asperger published his landmark paper on what he called autistic psychopathy in a group of four boys. He described the disorder as an unusual pattern of behaviors and abilities that included, in his words, “a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements.” He called his young patients “little professors” because they could talk about their favorite subjects in great detail.

Some people who knew Dr. Asperger as a child thought that he had some characteristics of AS: he was a lonely boy who had difficulty making friends, but he was good at languages and had a special interest in an Austrian dramatist named Franz Grill-parzer. Asperger used to bore his elementary school classmates by reciting long speeches from Grillparzer's plays.

Adults with AS are usually able to complete their education and join the workforce. Some become exceptional scholars; one of the

children that Hans Asperger studied in the 1940s became a noted astronomer, publishing a paper on an error in Isaac Newton'sworkthat he had first noticed in childhood. The chief difficulties that men with AS have in adult life are courtship and marriage. They may want very much to marry and have a family but do not understand the many social interactions that are part of the dating process leading to marriage. One man with AS became a surgeon and accomplished musician, but lived with his parents until he was fifty years old. He then married a distant cousin half his age who lived in another country; the marriage lasted only a few months.

Diagnosis

AS is usually diagnosed when the child is between four and eleven years old. There is no laboratory or imaging test that can detect AS, although the child may be given a CT scan to rule out other disorders of the nervous system or a hearing test to rule out partial deafness. Since a diagnosis of AS is based on a pattern of behaviors rather than a set of specific physical characteristics, the child is usually diagnosed by being observed by several different doctors, including a psychiatrist and neurologist, to look for recurrent patterns in the child's speech, movements, and interactions with other people. A test that is sometimes used to screen for AS involves asking the child to carry out a task that depends on the ability to predict how another person might respond to a given situation. Children with AS usually lack the ability predict someone else's thoughts and feelings.

Treatment

Treatment for AS depends on the specific child's range of abilities and interests. There is no single set or series of treatments that will work for every child with AS. Some children who are very clumsy benefit from physical therapy that improves their coordination and ability to participate in sports. Some children may need to work with a speech therapist in order to learn to speak in a normal tone of voice. Teachers and parents can often help a child with AS work on his or her social skills.

Medications are not used to treat AS itself, although adults with AS may be given antidepressant medications if they become depressed. In some cases psychotherapy is useful for adults with AS who are

discouraged by their condition or who have developed other mental disorders.

Prognosis

The prognosis of AS varies depending on the person'slevel of intelligence, career interests, and the amount of support he or she receives from friends and family. Divorce and family breakup can be very upsetting to children with AS and complicate their educational and social development. Career counseling can help a child with AS choose an occupation that will make the most of his or her interests and preferably allow him or her to work alone rather than as part of a team. In addition, children with AS actually have an advantage in some fields, like music or mathematics, because of their ability to spend hours developing and practicing skills in their field of interest. People with AS have become successful scientists, mathematicians, architects, medical researchers, computer scientists, musicians, and engineers. Some famous people who are thought to have had AS include such writers as Jonathan Swift and Patricia Highsmith; such philosophers as Bertrand Russell and Ludwig Wittgenstein; and such musicians as Bela Bartok, Erik Satie, and Glenn Gould.

As far as is known, people with AS have the same life expectancy as others of their age, race, or sex, but they do have a higher risk of developing eating disorders, depression, schizophrenia, or Tourette syndrome. Having another mental disorder then places them at a higher risk of suicide than people in the general population.

Prevention

There is no known way to prevent AS because its causes are not completely understood.

The Future

There are no new treatments for Asperger syndrome, nor is it known whether the disorder is becoming more common, partly because of disagreement about its definition.

One major change since 2000 is the development of an autistic rights or autistic pride community. Rather than accepting the standard definition of Asperger syndrome as a disease to be cured, some adults with AS prefer to describe it as simply having a different type of brain

organization. A Web site for “aspies,” as they have nicknamed themselves, called Wrong Planet was set up in 2004. As with many other disorders, the Internet is offering people with AS the opportunity to form their own communities, find support, share their personal experiences, and learn about the latest research.

SEE ALSO Autism; Autism spectrum disorders; Tourette syndrome

WORDS TO KNOW

Aspie: An informal name for a person with Asperger syndrome.

Autism: A developmental disorder that appears by three years of age and is characterized by limited communication skills, difficulties in communicating with others, and difficulties forming relationships. Some doctors think that Asperger syndrome is a subtype of autism.

Pervasive developmental disorder (PDD): Adiagnostic category for a group of childhood disorders characterized by problems in communication skills and social interactions. Asperger syndrome is classified as a PDD.

Tourette syndrome: A neurological disorder characterized by recurrent involuntary body movements and repeated words or grunts.

For more information

BOOKS

Attwood, Tony. The Complete Guide to Asperger's Syndrome. Philadelphia: Jessica Kingsley, 2007.

James, Ioan. Asperger's Syndrome and High Achievement: Some Very Remarkable People. Philadelphia: Jessica Kingsley, 2006.

PERIODICALS

Blume, Harvey. “Autistics, Freed from Face-to-Face Encounters, Are Communicating in Cyberspace.” New York Times, June 30, 1997. Available online at http://query.nytimes.com/gst/fullpage.html?res=9803E7DC1F31F933A05755C0A961958260 (accessed March 2, 2008).

WEB SITES

Autism Society of America. What's Unique about Asperger's Disorder?http://www.autism-society.org/site/PageServer?pagename=life_aspergers (accessed September 12, 2008).

KidsHealth. Asperger Syndrome. http://www.kidshealth.org/parent/medical/brain/asperger.html (accessed September 12, 2008).

Wrong Planet. What Is Asperger's Syndrome?http://www.wrongplanet.net/ (accessed September 12, 2008). Wrong Planet is an online discussion community for people with AS.