By MARINA BENJAMEN, PH.D.
Asperger’s Disorder is a syndrome that typically appears first in childhood, and is primarily characterized by a person’s difficulty in everyday social interactions with others. For instance, a person with Asperger’s may engage in long-winded, one-sided conversations without noticing or caring about the listener’s interest. They also often lack usual nonverbal communication skills, such as engaging in eye contact with others they’re talking to, or failing to react and empathize with other people’s stories and conversation. This may make them seem insensitive, although that is rarely the case. They may have a hard time “reading” other people or understanding humor.
Approximately 18 to 23 % of people with anorexia have Asperger’s.
Adults, too, may have Asperger’s, as often the disorder is not properly diagnosed in childhood. Asperger’s is considered the mildest, least severe form of autism. The following five criteria primarily characterize Asperger’s Disorder.
- A significant, ongoing impairment in social interactions with others, as demonstrated by at least two of the following symptoms:
- Significant difficulty in the use of multiple nonverbal behaviors such as the lack of eye contact, few facial expressions, awkward or clumsy body postures and gestures
- Failure to develop friendships with other children of the same age
- 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)
- Failure to express appropriate and corresponding social or emotional reactions, such as when conversing or playing with others. For example, a child who shows little or no reaction, feelings or empathy to another child talking with them.
- Restricted and repetitive patterns of behavior, interests, and activities, as shown by at least one of the following symptoms:
- A significant and encompassing preoccupation or obsession with one or two restricted topics, that is abnormal either in intensity, subject or focus (such as baseball statistics or the weather)
- Seemingly inflexible adherence to specific routines or rituals that serve little purpose
- Repetitive motor mannerisms. For example, hand or finger flapping or twisting, or complex whole-body movements.
- A persistent preoccupation with parts of objects
- The set of symptoms causes significant impairment in social, occupational, or other important areas of functioning.
- There is no significant general delay in language (e.g., single words used by age 2, communicative phrases used by age 3).
- There is no significant delay in cognitive development (such as reading or math skills) or in the development of age-appropriate self-help skills, behavior, and curiosity about the environment in childhood.
Early Signs of Asperger’s Disorder
It’s important to note that a person with Asperger’s disorder has no general delay in language acquisition, cognitive development and adaptive behavior (other than in social interaction). This contrasts with typical developmental accounts of autistic children who show marked deficits and deviance in these areas prior to age 3.
Other common descriptions of the early development of individuals with Asperger’s include certain characteristics that may be helpful in identifying it earlier on. These characteristics include:
- A certain precociousness in learning to talk (e.g., “He talked before he could walk!”)
- A fascination with letters and numbers. In fact, the young child may even be able to decode words, with little or no understanding of them (“hyperlexia”)
- The establishment of close relationships to family members, but inappropriate relationships or interactions with friends and others (rather than withdrawal or aloofness as in autism). For example, in Asperger’s the child may attempt to initiate contact with other children by hugging them or screaming at them and then puzzle at their responses.
These behaviors are sometimes described for higher-functioning autistic children as well, albeit much more infrequently than they are for children with Asperger’s.
By MARGARITA TARTAKOVSKY, M.S.
Asperger’s Disorder — also known as Asperger’s Syndrome or just AS — is a mild form of autism, recognized as a mental health concern that sometimes requires treatment. Asperger’s is usually diagnosed in childhood or as a young teenager, and is characterized by social impairment, isolation, and what others might see as eccentric behavior.
The disorder’s name comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.
Asperger’s: Impairments in Social Interactions with Others
Although the social criteria for Asperger’s Disorder (also known as Asperger’s Syndrome or AS) and autism are identical, AS usually involves fewer symptoms and presents differently than autism.
Individuals with Asperger’s Disorder often isolate themselves, but they’re still aware of the presence of others, even though the way they approach people can be inappropriate and even peculiar. For example, they might have a one-sided and long-winded conversation with a person — usually an adult — about an unusual and narrow topic.
Also, although individuals with Asperger’s are often self-described loners, they usually express great interest in making friends and meeting people. Unfortunately, their awkward approach, insensitivity to other’s feelings and odd facial expressions and body language (e.g., signs of boredom, quick to leave, avoiding eye contact or staring inappropriately) make developing relationships difficult. This can lead to chronic frustration. Even worse, some individuals get so upset that they develop symptoms of depression, which may require treatment, including medication.
Individuals with AS often also display inappropriate emotional aspects of social interactions. They can come off as being insensitive. They might appear to lack empathy or to disregard another person’s expressions and gestures altogether. However, people with AS usually are able to describe other people’s emotions and intentions — they’re just unable to act on this knowledge in an intuitive and spontaneous way, so they end up losing the rhythm of the interaction. Because they have such a poor sense of intuition and spontaneity, people with AS rely on formal, rigid rules of behavior, making them appear inappropriately and overly formal in social situations.
Some of these symptoms also appear in individuals with higher-functioning autism, though perhaps to a lesser extent. Most autistic people seem withdrawn and unaware of or uninterested in other people.
Asperger’s: Impairments in Communication with Others
Unlike autistic individuals, those with AS don’t usually have significant speech problems, but their language and speech skills still differ from people without the disorder. As a whole, people with AS have an odd way of using language. Specifically, their communication differs in three major ways.
- People with AS don’t have quite the degree of rigid inflection and intonation as autistic individuals, but they still tend to speak in a monotone. Pitch typically lacks variation and is simply peculiar. They might talk too loudly or too formally. They tend to misunderstand the nuances of language, such as taking a sarcastic remark seriously or not grasping a joke or a metaphor.
- They may go off on tangents during a conversation and their speech can seem incoherent. Even though in some cases this symptom might mean a possible thought disorder, it’s more likely that the incoherent speech is a result of their one-sided, egocentric conversational style, inability to provide background information, clearly distinguish changes in topic and tendency to express their inner thoughts.
- Some experts view the long-winded and one-sided conversations as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often completely disregarding whether the listener is interested, engaged or trying to interject a comment, or change the subject. Despite such long-winded monologues, the individual may never come to a point or conclusion. Usually the other person can’t get a word in and is unable to change the conversation.
Even though it’s possible that these symptoms stem from significant deficits in pragmatics skills or a lack of insight into, and awareness of, other people’s expectations, the challenge is to understand them developmentally as strategies of social adaptation.
Asperger’s: Restricted and Repetitive Patterns of Behavior, Interests and Activities
The DSM-IV criteria for Asperger’s Disorder and autism are identical, requiring the presence of at least one symptom from this category. The most commonly seen symptom in AS is an all-absorbing preoccupation with an unusual and very narrow topic (e.g., snakes, names of stars, maps, TV guides, railway schedules). A person with AS will usually know the topic inside and out and want to talk about it all the time during social interactions. Although this symptom may not be easily recognized in children, since strong interests in one topic are so common, it may become more salient with age, as interests shift to odd and narrow topics. The topics may change every year or two, but the intensity with which they are studied remains the same.
Individuals with AS tend to have rigid routines and dislike change. For instance, children may be very particular about how they eat.
Asperger’s: Physical Clumsiness
Delayed motor development — that is, the ability to move one’s physical body with ease and grace — is an associated feature, although it’s not a required criterion for diagnosis of Asperger’s Disorder. Individuals with AS may have a history of delayed motor skills such as riding a bike, catching a ball or opening jars. They are often awkward, with a rigid walk, odd posture and problems with visual-motor coordination.
Although this differs from motor development in autistic children, whose motor skills often are a relative strength, it is somewhat similar to patterns seen in older autistic individuals. The similarity might stem from different underlying factors, however, such as psychomotor deficits in AS and poor body image and sense of self in autism. This highlights the importance of describing this symptom in developmental terms.
By MARINA BENJAMEN, PH.D.
There are a wide variety of helpful treatments for Asperger’s Disorder that help an individual learn better social skills and communication cues, to help them be able to interact socially more naturally. At present, like most mental disorders, there is no “cure” for Asperger’s Disorder. But by focusing on learning ways to cope with the symptoms and pick up on social cues, most individuals with Asperger’s Disorder lead fairly typical lives, with close friends and loved ones.
Psychosocial Interventions for Asperger’s
According to the National Institute of Neurological Disorders and Stroke, the ideal treatment for Asperger’s coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.
An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures.
- Individual psychotherapy to help the individual learn social skills training, to better detect social cues, and how to deal with the emotions surrounding the disorder
- Parent education and training
- Behavioral modification
- Social skills training
- Educational interventions
- 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)
- Neurofeedback is a primary treatment of choice for Asperger’s. Please see Healthy Within Brian Institute for detailed studies on the success of Neurofeedback for Aspergers.
With effective treatment, children with Asperger’s disorder can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.
What Does It Mean To Have Asperger Syndrome?
What is this Asperger’s Syndrome, anyway? As I alluded to in my previous post, Neurological Disorder or Natural Diversity?, after many years of knowing that I was different, I finally learned why when I read Wired Magazine (The Geek Syndrome), which described an autism spectrum disorder called Asperger’s Syndrome.
The more I read the descriptions of these people, the more I saw myself.The clincher came when, at the end, they provided a copy of Simon Baron-Cohen’s Autism Quotient Test, a questionnaire designed to indicate the presence of autistic traits. I took it on the spot and scored very high – and I realized I was onto something, and I began to learn about Asperger’s and what it meant to my life.
So, overall, what does it mean to have Asperger’s? How does it affect how a person interacts with the world? What are the challenges?
In general, people with Asperger’s generally have trouble with social interaction, communication, as well as regulation of the motor skills and sensory systems.They also can develop obsessive and compulsive tendencies, which manifest themselves in various ways. I’ve said many times that there are many “flavors” of Asperger’s – but I’ll touch on some of the common areas of challenge:
Many people with Asperger’s appear to be “nerds” or “geeks.” Kind people might call us “eccentric.” Socially, we must learn by rote what your average person picks up by instinct, such as the interpretation of facial expressions, other’s emotions, or social overtures.
We may only sporadically pick up unwritten social rules, or we may not learn to execute them in an appropriate way. Like a computer, we must figure social situations out logically, and build sets of instructions for each situation, which makes interaction extremely painstaking and difficult. Because of this, we lag behind our peers in social skills, and may come to avoid social interaction altogether.
Many of those of us who have learned to cope with this in adulthood, have developed a comprehensive program, “social scripts,” if you will, to logically handle social situations. As these become more and more complex, the more we are able to “act normal” – but this is simulation. We think differently, and must shoe-horn our thinking processes into a social world that is, for us, completely alien.
It is also very difficult for many of us to learn to use and interpret body language. We may have difficulty looking someone in the eye, and may not use appropriate facial expressions. Because of this, we can be very misunderstood by people who cannot “read” what we are thinking and feeling through our body language, because we don’t know how to convey it or even realize that others do this. Many find it very difficult to look another person in the eye, or if they do, appear to do so in a way that may feel to the other person as “stiff” or “unnatural.”
Unlike people with “classic” autism, people with Asperger syndrome typically do not appear to have any significant delays in the development of language. Some of us even speak early, but the quality of our speech is different. Language is used in a very atypical way.
Like our social skills, it’s learned by rote. The social quotient is lacking – we don’t fully understand (until taught), the social aspects of language.To us, it begins as a simple means of information exchange, not as a means of connecting with people (for example, the concept and execution of “small talk” can be difficult for someone with Asperger’s).
We may not master the art of using inflection to imbue language with meaning, and so develop a very monotonous or odd manner of speech. We also frequently miss the social cues that tell us what language to use when, and how often – so we may talk too much, too little, use overly formal, or informal language, or use inappropriate language for a specific situation (for example, swearing in front of a boss, or speaking overly familiarly to an authority figure).
Ironically, some children can appear very advanced, because we will pick up very sophisticated “adult” language – either from listening to adults, or from reading books. This can lead to further social ostracization from other kids, who’ll say “How come you talk like a grown up?”
On the other side, seemingly “simple” concepts as pronouns may throw a person with Asperger’s. A child learning to talk may refer to everyone using the same pronoun, or refer to themselves in third person. The concept that a single person can be referred to using several different pronouns, and those pronouns can be used for multiple people, can be a difficult one. In another example, as a child, a person I know observed hisparents referring to each other using their first names, or endearments such as “honey” – and adopted the same manner of address. All attempts during his childhood to break him of the habit failed. He never used “mama” or “dada”, or later “mom” or “dad” to refer to his parents. Although he now understands how most people address to their parents, in his adulthood, he still refers to his parents by their first names. The habit is ingrained.
From a young age, most people with Asperger’s develop a specific “pet subject,” which they will throw all their energy and time into learning. Most frequently, a person with Asperger’s will choose only one at a time (or as many people with Asperger’s will say, it chooses them), and it will become the core of their lives. The special interest often fall in to the areas of science, mathematics, engineering, or mechanics, but there are also many people who develop interests in art, writing, or other creative pursuits.
As adults, we will often be drawn by that special interest into our careers. Many scientists, computer programmers, and academics are believed to have Asperger’s. We typically have prodigious memories, which allow us to catalog and store large amounts of information, and a laser focus to acquire all possible information on a subject.
In order to keep order in our world, and cope with our other challenges, many people with Asperger’s develop a very rigid “rules based” way of doing things. Many struggle with change, and prefer, and almost obsessively maintain “sameness” in their world. Because of the lack of certain instincts, and our “script based” way of relating to the world, we have trouble varying routines. We have to rely on rote.
Because the nervous system is wired differently in a person with Asperger’s, we experience the world very differently. We can be oversensitive or under sensitive to certain stimuli. Smells or sounds that may not bother another, may be incredibly intrusive to us. We might not be able bear certain textures. The brain and nervous system my overload when any one sense, or combination of senses, is overwhelmed. A loud stadium, or big crowd may cause us intense stress and perhaps an angry outburst. Even certain types of lighting might cause distress.
Another symptom of a differently wired neurological system can be a difficulty in coordinating movement. In short, we’re often clumsy. A person with Asperger’s may struggle with sports, or other activities that require coordination. We may be unable to sense our bodies in space, and therefore constantly hurt ourselves by bumping into things. Further, handwriting can be a very difficult and laborious process.
While navigating the social realm can feel to us like driving a race car blindfolded, but many of us have learned to compensate. With the right teachers and mentors, we learn. As we get older, we learn. As I mentioned in my first post (referenced above), there can be many advantages. Because our brains are different, we think differently, which can lead to “out of the box” solutions that your average person does not think of.
Our extreme ability to focus, combined with our intense special interests can make us extremely effective in our field, whatever that may be. We typically have very good, sometimes encyclopedic memories, and have IQs in average to well above average range. Many “geniuses” such as Mozart, and Albert Einstein have been thought to have Asperger’s or high functioning autism.
So, those of us who learn to cope with the difficulties, can develop lives as fulfilling as any other. Just a little differently.
(From Psychology Today website)