Asperger Syndrome

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.

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.

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.

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:

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) .