Asperger Syndrome

Asperger syndrome is a neurodevelopmental disorder that is characterized by repetitive behaviors, clumsiness, and difficulties with social interactions. It is considered to be the mildest form of autism spectrum disorder (ASD) and is sometimes referred to as high-functioning autism.

Asperger syndrome is considered to be a pervasive developmental disorder at the mild end of the autism spectrum. It is primarily distinguishable from other ASDs by the absence of language and cognitive delays. In fact, children with Asperger syndrome often have above-average intelligence and unique abilities or talents.

In the 1940s, the Austrian pediatrician Hans Asperger described four children who had difficulty with social relationships, lacked empathy and nonverbal communications skills, and were physically clumsy. The children appeared to be of normal intelligence and did not seem to be emotionally disturbed, but they had unusual patterns of speech and were completely absorbed by single topics of interest to them. Asperger's case studies were not widely recognized until 1981, when Lorna Wing, an English physician, published case studies of children who she described as having “Asperger's syndrome.” In 1992, the World Health Organization (WHO) included Asperger syndrome in its diagnostic manual. Asperger syndrome was added to the 4th edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. In 2013, the DSM-V reclassified Asperger syndrome as an ASD rather than a distinct developmental disorder.

Demographics

Estimates of the prevalence of Asperger syndrome range from 1 in 250 to 1 in 5,000 children. It is unclear whether the incidence of Asperger syndrome is increasing or whether greater awareness of its characteristics has led to its increased diagnosis. It is presumed to be a lifelong disorder. However, because of changes in the classifications of developmental disorders, Asperger syndrome has only recently been routinely diagnosed in adults. Furthermore, it is likely that many cases of Asperger syndrome continue to go undiagnosed. The syndrome affects three or four times more males than females.

Causes and symptoms

The cause(s) of Asperger syndrome are unknown, but there are believed to be multiple inherited components to the disorder. It tends to run in families and, in the case of twins, both siblings are often affected. Furthermore, other family members of a child with Asperger syndrome may have similar but milder symptoms. There are probably multiple genes involved in susceptibility to Asperger syndrome, and these genes may interact with unidentified environmental factors for the development of the disorder. New (de novo) mutations in the egg, sperm, or developing fetus may also play a role in the syndrome. Advanced imaging techniques have shown structural and functional changes in specific regions of the brains of children with Asperger syndrome. These changes may result from abnormal brain development in the fetus and abnormal connections that form among nerve cells (neurons) in the brain during early childhood. These abnormalities may affect neural circuits that control thoughts and behaviors. Children with Asperger syndrome may also have abnormal levels of certain brain proteins.

OLIVER SACKS' AN ANTHROPOLOGIST ON MARS

Sacks' essay An Anthropologist on Mars, the titular piece in his 1995 book, focuses on his observations of Temple Grandin, perhaps the most well-known figure in the autism community.

Though doctors suggested lifelong institutionalization when she was diagnosed with autism at age three, Grandin has gone on to become an author and professor in the Animal Sciences Department at Colorado State University and to make many important contributions to the humane management of livestock animals.

Grandin's own needs and experiences as a person with autism offer her a special insight into the needs and experiences of animals. For instance, she says that like many autistic people, cattle are disturbed by certain high-pitched or hissing sounds, as well as shadows or sudden movements. She notes that a light touch makes cows pull away, while a firm touch is calming, adding, “the way I would pull away from being touched is the way a wild cow will pull away—getting me used to being touched is very similar to taming a wild cow.” Grandin describes herself as highly visual, saying she “thinks in pictures,” and says that this makes it easier to identify with animals, rather than having language-centered thought processes.

This insight into the psychology and experiences of animals is in contrast to B.F. Skinner's view of animals as mere automata whose behaviors are results of conditioned responses. Temple saw the Skinner era as one of great cruelty in the treatment of animals, both in experimentation and husbandry, and has sought to bring humane treatment and a focus on animals’ feelings into the field of animal behaviorism and livestock management.

Grandin's gift for drawing has enabled her to create intricate blueprint designs of slaughterhouse and ranch facilities which minimize pain, suffering, and stress to the animals. For instance, she famously designed a curved corral system to be used in slaughterhouses. These corrals cause less stress to cattle because they cannot see what is coming at the end of the ramp.

When Grandin takes Dr. Sacks to her house, he describes seeing a large, strange-looking object nextto the bed. Grandin calls this her “squeeze machine” and says that some people call it a “hug machine.” The padded wooden machine is hooked up to an industrial compressor, so that when one stands inside of it, it exerts pressure on the bodyfrom shoulders to knees. Sacks asks why she designed it, why one would desire the feeling of pressure in the machine. “When she was a little girl, she said, she had longed to be hugged but had at the same time been terrified of all contact. When she was hugged, especially by a favorite (but vast) aunt, she felt overwhelmed, overcome by sensation, she had a sense of peacefulness and pleasure, but also of terror and engulfment. She started to have daydreams—she was justfive atthe time— of a magic machine that could squeeze her powerfully but gently, in a huglike way, and in a way entirely commanded and controlled by her. Years later, as an adolescent, she had seen a picture of a squeeze chute designed to hold or restrain calves and realized that that was it: a little modification to make it suitable for human use, and it could be her magic machine.” Temple says that being in the machine relaxes her; often her thoughts turn to loved ones, and she seems to feel empathy. When she emerges from the machine, Sacks notes that she is visibly more relaxed and less rigid.

The title of Sacks’ piece comes from a conversation he had with Grandin about Greek myths and Shakespeare. When asked how she felt about them, Grandin said that she had difficulty following them, which Sacks felt resulted from her inability to empathize with the characters: “She said that she could understand ‘simple, strong, universal’ emotions but was stumped by more complex emotions and the games people play. ‘Much of the time,’ she said, ‘I feel like an anthropologist on Mars.” ’

Grandin is an autism activist and a proponent of neurodiversity, meaning she does not see autism as something to be ‘cured.’ She notes that autistic traits are also associated with valuable traits, creativity, and even genius in some cases. She is quoted as saying, “If I could snap my fingers and be nonautistic, I would not—because then I wouldn't be me. Autism is part of who I am.”

Children with Asperger syndrome do not exhibit the social withdrawal that is common with other ASDs, and they frequently approach other people; however, they are often isolated because of their poor social skills and narrow interests. Children with Asperger syndrome often collect large amounts of information about a particular topic, and talk about it incessantly, without reaching any conclusions. Many children with Asperger syndrome are very active, despite delayed motor development and poor coordination, and they may be diagnosed attention deficit hyperactivity disorder (ADHD). They may be bullied by other children because of their differences. Teens and young adults may develop anxiety, depression, symptoms of obsessive-compulsive disorder, or tic disorders such as Tourette syndrome.

Diagnosis

There is no standard diagnostic test for Asperger syndrome, and various screening tools use different criteria. Diagnosis is often based on the specific criteria for ASD in the DSM-5. Physical, mental, and emotional tests are used to rule out other disorders. Experienced physicians may diagnose Asperger syndrome based on:

Treatment and management

Diagnosis and treatment will probably involve a team of healthcare professionals including a neurologist, psychologist, psychiatrist, and speech therapist. The sooner intervention and treatment are initiated, the better the prognosis. Ideally, treatment programs are designed for the individual child. They generally teach skills using simple steps and very structured activities that are repeated over time to reinforce desired behaviors. These activities should build on the child's interests and take place on a predictable schedule. Specific treatments may include:

KEY TERMS

Attention deficit hyperactivity disorder (ADHD)—
Conditions characterized by age-inappropriate attention span, hyperactivity, and impulsive behavior.
Autism spectrum disorder (ASD)—
A range of syndromes that includes Asperger syndrome at the mild end of the range, classic autism, and childhood disintegrative disorder at the severe end of the range.
Cognitive behavioral therapy—
A type of “talk” therapy in which people learn to recognize and change negative and self-defeating patterns of thinking and behavior.
Pervasive developmental disorder—
Disorders, including Asperger syndrome and other autism spectrum disorders, that are characterized by developmental delays or impairments.

Prognosis

The socialization and communication difficulties associated with Asperger syndrome generally continue into adulthood, sometimes with additional psychiatric symptoms and disorders. However, although personal relationships and social situations may continue to be difficult, many adults with Asperger syndrome lead independent and fulfilling lives. They may be very successful in certain fields, such as mathematics or science.

See also Autism spectrum disorder (ASD) .

Resources

BOOKS

Bradshaw, Stephen. Asperger's Syndrome—That Explains Everything: Strategies for Education, Life and Just About Everything Else. London, UK: Jessical Kingsley, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Association, 2013.

Gnaulati, Enrico. Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder. Boston: Beacon, 2013.

O'Toole, Jennifer Cook. The Asperkid's Launch Pad: Home Design to Empower Everyday Superheroes. Philadelphia: Jessica Kingley, 2013.

O'Toole, Jennifer Cook. The Asperkid's Secret Book of Social Rules: The Handbook of Not-So-Obvious Social Guidelines for Tweens and Teens with Asperger Syndrome. Philadelphia: Jessica Kingley, 2013.

Robison, John Elder. Raising Cubby: A Father and Son's Adventures with Asperger's, Trains, Tractors, and High Explosives. New York: Crown, 2013.

PERIODICALS

Hall, Stephen S. “Solving the Autism Puzzle.” Technology Review 118, no. 1 (January/February 2015): 36–43.

WEBSITES

“100 Day Kit for Newly Diagnosed Families of School Age Children.” Autism Speaks Family Services. December 2014. http://www.autismspeaks.org/docs/family_services_docs/AS-HFA_Tool_Kit.pdf (accessed June 15, 2015).

MedlinePlus. “Asperger Syndrome.” U.S. National Library of Medicine, National Institutes of Health. May 16, 2012. http://www.nlm.nih.gov/medlineplus/ency/article/001549.htm (accessed June 15, 2015).

Office of Communications and Public Liaison. “Asperger Syndrome Fact Sheet.” National Institute of Neurological Disorders and Stroke. November 6, 2014. http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm (accessed June 15, 2015).

ORGANIZATIONS

Autism Speaks, 1 E. 33rd St., 4th Fl., New York, NY, 10016, (212) 252-8584, (888) 288-4762, Fax: (212) 252-8676, familyservices@autismspeaks.org, https://www.autismspeaks.org.

National Institute of Neurological Disorders and Stroke, NIH Neurological Institute, PO Box 5801, Bethesda, MD, 20824, (301) 496-5751, (800) 496-5751, http://www.ninds.nih.gov.

Online Asperger Syndrome Information and Support (OASIS) @ MAAP, PO Box 524, Crown Point, IN, 46308, (219) 662-1311, info@aspergersyndrome.org, http://www.aspergersyndrome.org .