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Updated 12 December 2013

Asperger syndrome

Asperger syndrome is a pervasive developmental disorder characterised by an inability to understand how to interact socially.

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Summary

Asperger syndrome (AS) is a term used to describe one of the disorders on the Autistic Spectrum. It is regarded as a pervasive developmental disorder, characterised by an inability to understand how to interact socially. It was first identified by Hans Asperger, a Viennese paediatrician more than 50 years ago. He identified a consistent pattern of abilities and behaviours that occurred predominantly in boys. This pattern included a lack of empathy, little ability to form friendships, one-sided conversations, intense absorption in a special interests and clumsy movements.

A child is seldom diagnosed with Asperger Syndrome below the age of five. As very young children they seem quite typical and/or even advanced in their development. Children with AS develop speech as a typical child does (sometimes earlier) and have a particularly good vocabulary. They are often advanced in areas of numeracy and other areas of cognitive skills, compared to their peers. They often act like “little professors”.

Description

The typical impairments of the Autistic Spectrum are present in children with Asperger Syndrome. However, they seem not as severely impaired in all of these areas. A child with AS might show:

• Good speech and language development but impaired in the area of communication and a limited ability to have a reciprocal conversation

• Social motivation, but may a lack social skills and be unable to read appropriate social cues (impaired relative thinking)

• Odd and stereotypic behaviours (possibly lining up cars), as well as perseverance  in limited areas of interest (obsessed with one topic or area of interest)

• Sensory dysfunction is also common in people with Asperger Syndrome

Symptoms and signs

• Lack of empathy
• Pedantic, repetitive speech with a very literal understanding language (Take the expression: “It’s raining cats and dogs.” A child with AS might go outside to see if there are cats and dogs falling from the sky.)
• Intense absorption in certain subjects with incessant talking about the area of interest
• Naïve, inappropriate, “one-sided” interactions (They may talk at length about a favourite subject, without showing any awareness of the recipient's interest. They might also repeat a word or phrase many times, not answer questions, or show any interest in anyone else’s opinion or reaction.)
• Clumsy and ill-coordinated motor movements and odd postures (As in many children with autism, a child with AS often has a clumsy gait and low muscle tone. They are very often not interested in playing sport, but would rather focus on computers/specific areas of interest.)
• Poor non-verbal communication, leading to social impairment - difficulty in understanding social cues (gestures, body language or facial expressions)
• Little or no ability to form friendships
• Limited interests and/or unusual preoccupations (Some people with AS have an excellent rote memory and musical ability. They usually have a very restricted range of interest and can become intensely interested in or preoccupied with one or two subjects, often animals, transport or science.)
• Repetitive routines or rituals (AS often co-occurs with other disorders like anxiety disorder, obsessive compulsive disorder.)
• Lack of motivation and attention for activities that would be of general interest or might enthral most others
• Children with AS might seem quite unmoved and clinical in their approach to other children and adults. They usually function very well and are able to attend regular schools, as their academic skills are seldom impaired. (Some people with Asperger Syndrome are able to be very successful in a particular field and are often seen as brilliant, eccentric, absent minded, socially inept and a little awkward physically.)
• Although the criteria of AS indicate no significant delay in the development of language milestones, what one might see is a "different" way of using language. A child may have a wonderful vocabulary and even demonstrate hyperlexia (an affinity for the written word and ability to read from a very young age), but not truly understand the nuances of language and have difficulty with pragmatics. They may also enjoy playing with language by making up new words and speaking in rhymes. Their tone of voice may be unusual.
• Children with AS have the potential to be independently functioning adults if they have access to appropriate therapies. (Research however shows that very few adults with AS are capable of living independently, even though they might be employed.)

Qualify of life for adults with HFA or Asperger Syndrome

Study                                       N          Job       Indep

NAS                                         217      12%     3%

Farelly                                     13          8%      0%       (Ireland)

Engstrom                               16          6%      0%       (Sweden)

In many cases these individuals will continue to demonstrate problems with social interaction. There is also an increased risk for the development of psychosis (a mental disorder) and/or mood problems, such as depression and anxiety in later years.

Treatment

Rehabilitating the social deficits in children with Asperger Syndrome is possible through a multidisciplinary approach. As with autism, the role of gut related issues needs to be explored and all possible dietary interventions implemented (see Autism Review).

One of the most successful treatments is Relationship Development Intervention, a developmental approach to teaching social coordination to children with autism and Asperger Syndrome.

Sharing our experiences requires a unique type of information processing called Emotional Co-ordination. “Autism” can be defined as the inability to develop the capacity to use emotional coordination in experience-sharing relationships. This approach teaches the foundations of experience-sharing in a systematic manner.

Many children with Asperger Syndrome, although functioning very well on many levels, fail to develop the very early stages of emotional coordination, e.g.

• Relying on mother’s facial expressions for guidance and reassurance
• Desiring and appreciating guidance from mother
• Preferring shared activities with peers over solo activity

And in a slightly older child

• Valuing shared enjoyment more than achieving any specific goal

RDI is modelled upon the means by which typical children become competent in the world of emotional relationships.

Some other therapies

• Sensory integration therapy
• Autism specific therapies, like Applied Behaviour Analysis, Floortime (DIR), Son-Rise and others (It is of the utmost importance that a child-specific approach is used and child-specific deficits are addressed.)
• Auditory Integration Training
• Listening Programmes
• Primal Reflex Therapy, HANDLE therapy
• Braingym

Previously reviewed by Noleen Seris, clinical psychologist

Reviewed by Jenny Buckle, Reach Autism SA, (November 2010)

 
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