Aspergers Syndrome

Aspergers Syndrome, or AS is one of the autism spectrum disorders (ASD) where children have difficulty with social interaction and display certain patterns of restricted behavior, interests and activities. The main difference with AS from other ASD is the lack of delay in language or cognitive development. Motor clumsiness (i.e. constantly tripping, bumping into things, dropping things, etc.) is a typical trait of AS, although it is not part of the standard diagnostics.

Why call it Aspergers? AS is named after Austrian pediatrician Hans Asperger who, in 1944, described children in his practice who lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. It is sometimes referred to as a “high functioning autism”.

The main treatment is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and clumsiness. Most individuals with AS can learn to cope with their differences, but may continue to need moral support and encouragement to have an independent life, as opposed to the constant care required of other types of disabilities.

A typical program generally includes:

• the training of social skills for more effective interpersonal interactions

• cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions, and to cut back on obsessive interests and repetitive routines

• medication, for coexisting conditions such as depression and anxiety

• occupational or physical therapy to assist with poor sensory integration and motor coordination

• social communication intervention, which is specialized speech therapy to help with the pragmatics of the give and take of normal conversation

the training and support of parents, particularly in behavioral techniques to use in the home

Unlike those with autism, people with Aspergers are not usually withdrawn around others; they approach others, even if awkwardly, for example by engaging in a one-sided, long-winded speech about a favorite topic while being oblivious to the listener's feelings or reactions. This failure to react appropriately in social situations often appears as a disregard for other people's feelings, or that the person or child is insensitive and uncaring.

Children with Aspergers are usually smart enough to memorize what to do in specific social situations, and will have a theoretical or “book knowledge” understanding of other people’s emotions. However, they have a hard time acting on what they know in real social situations.

People with Aspergers will sometimes take what they have learned and observed about social and behavioral guidelines and apply these rules in rigid and awkward ways. This could be something like forced eye contact, or a pasted on smile, to the ill-placed laugh. Often, a child’s desire for a friend and companionship is lost through a series of failed and devastating social failures.

The restricted and repetitive behavior, interests and activities for people with Aspergers can be abnormally focused and intense. Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate their social interaction so much that the entire family may become immersed. Because topics such as dinosaurs often capture the interest of children, this symptom may go unrecognized.

Stereotyped and repetitive motor behaviors are a central part of how Apergers and other ASDs are diagnosed. They include hand movements such as flapping or twisting, and complex whole-body movements. Walking on tip-toes – constantly – or just sitting and repeating the same word, phrase or sound over and over again are very typical of the stereotyped and repetitive behaviors of Asperger Syndrome.

Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family. These include differences in perception and problems with motor skills, sleep, and emotions. They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli, which can appear as Sensory Integration Disorder.

Children with Aspergers are more likely to have sleep problems, including difficulty in falling asleep, waking up often at night, and early morning awakenings. Aspergers is also associated with alexithymia, which simply means having difficulty in identifying and describing one's emotions. My daughter certainly has emotions and feelings, but she has no idea how to describe them or even what they are, or why they are there. Very frustrating.

Children with AS may require special education services because of their social and behavioral difficulties, although many attend regular education classes. Adolescents with Aspergers may show an ongoing difficulty with self-care, organization and disturbances in social and romantic relationships; despite high cognitive potential, most remain at home, although some do marry and work independently. The "different-ness" adolescents experience can be traumatic.

Anxiety may stem from preoccupation over possible changes of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern with failing in social encounters. The stress that results may show up as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may also develop. Medication can be effective in combination with behavioral interventions and environmental accommodations in treating co-existing symptoms such as anxiety, depression, inattention and aggression.

Education of families is critical in developing strategies for understanding strengths and weaknesses; helping the family to cope improves outcome in children. An earlier intervention and diagnosis, is much better for the long-term outcome of those with Aspergers, although treatment at any stage can be helpful.

Return from Aspergers Syndrome to Developmental