What is Asperger syndrome?

Causes and Symptoms

Asperger syndrome has social
and behavioral components. Socially, the person is significantly impaired in the ability to engage in meaningful interaction. Behaviorally, the person has restricted, repetitive patterns of behaviors, interests, and activities. Unlike autism, however, Asperger syndrome does not involve severe delays in language or other cognitive skills, although subtle aspects of social communication, such as give-and-take conversation, may be impaired. Also, during the first three years, the child has no clinically significant delays in cognitive development. Rather, the child expresses normal curiosity and age-appropriate learning skills and adaptive behavior. This is why clinicians prefer not to refer to Asperger syndrome as high-functioning autism; they are truly different disorders, despite the fact that they share some commonalities.

The impairment in social interaction is gross and sustained. The child may be unable to maintain normal eye-to-eye contact or may show unusual facial expressions, body posture, or gestures. The child may fail to develop age-appropriate peer relationships. A younger child may show little or no interest in establishing friendships. An older individual may have an interest in friendship but lack understanding of the conventions of social interaction. The individual may lack a spontaneous seeking to share enjoyment, interests, or achievements. The individual may lack social or emotional reciprocity, preferring solitary activities, involving others in activities only as tools or mechanical aids, or not participating actively in simple social play or games. The social impairment typically is manifested as an eccentric and one-sided approach to others, such as pursuing a conversational topic regardless of others’ reactions, rather than as social and emotional indifference.

The behavioral impairment takes the form of stereotypical behavior. Persons with Asperger syndrome may have encompassing preoccupations about a specific topic, such as a professional baseball team, about which they can amass a great deal of information and pursue with great intensity, often to the exclusion of other activities. In contrast to autism, however, language development is normal, with the exception that these individuals are preoccupied with talking about their own arcane interests. They can be verbose, and they fail to self-monitor. In addition, they often exhibit clumsiness and poor coordination.

Because language development is normal, parents or caregivers are not usually concerned about the child’s development until the child begins to attend a preschool or is exposed to peers. At this point, the child’s social difficulties typically become apparent.

The course of Asperger syndrome is continuous and lifelong. The patient’s verbal abilities may, to some extent, mask the severity of the social dysfunction and may prove misleading for parents and teachers, who are blinded by the child’s vocabulary. Despite these problems, however, follow-up studies suggest that, as adults, many individuals with Asperger syndrome are capable of gainful employment and personal self-sufficiency.

Some diagnosticians are relatively unfamiliar with Asperger syndrome, and some experts believe that many individuals go undiagnosed. Asperger syndrome is one of the pervasive developmental disorders and so is similar to autism, Rett syndrome, and disintegrative disorder. Controversies exist, however, concerning the precise definitions of these autistic spectrum disorders and the boundaries between the milder manifestations of these disorders and nonautistic conditions. As such, the causes and estimates of these disorders are still a topic of debate.

In 2000, Fred R. Volkmar and Ami Klin estimated that the prevalence of Asperger syndrome varied between 1 and 36 out of 10,000; in 1991, Volkmar and Donald J. Cohen found that more boys than girls are affected. Taking into account the entire spectrum of autistic disorders, a 1992 study by Peter Szatmari indicated that as many as one child in one hundred shows autistic traits. Conservative estimates in 2010 suggest that two of every ten thousand children have this disorder; boys are three to four times more likely than girls to have the disorder. Some of the differences demonstrated in prevalence rates may be the result of differences in research sampling or diagnostic practices, or both.

Little is known about the causes of Asperger syndrome, although experts Susan E. Folstein and Susan L. Santangelo suspect a genetic contribution because it appears to run in some families. Recent research has not identified any one gene as being responsible for the disorder. Two genes, however, GABRB3 (GABA receptor B3) and Engrailed-2, have been shown to have a relationship with some of the behavioral traits Asperger syndrome shares with autism. Other research has started to examine whether any abnormalities may have occurred during fetal development, thus affecting how the brain grows.

Treatment and Therapy

As with the other pervasive developmental disorders, no completely effective treatment exists for Asperger syndrome. Most treatment efforts focus on enhancing communication skills and reducing problem behaviors. In the mid-1960s, O. Ivar Lovaas and colleagues developed treatment for autism that involved the basic behavioral procedures of shaping and discrimination training. This therapy is also used with persons with Asperger syndrome. Therapists reward social behaviors, such as playing with peers, by giving food or praise.

Medication typically focuses on specific behaviors or symptoms. Little research support exists for the benefits from vitamins or dietary changes. To the extent that improper habits can generally be disruptive to any person, however, such an approach may be worthy of consideration in the management of pervasive developmental disorders, such as taking care to eat nutritious foods and to avoid foods that are linked to hyperactivity or otherwise are unhealthy.

For children with Asperger syndrome, most therapy consists of school education combined with special psychological supports for communication and socialization problems. Parents also need support because of the great demands and stress involved in living with and caring for such children.

Occasionally, persons with Asperger syndrome may be quite successful as adults, especially in professions in which their attention to routine, concentration on detail, and relative indifference to sentiment are an asset. A 1991 study by Christopher Gillberg of individuals with Asperger traits included a dentist, a financial lawyer, a military historian, and a university professor.

Perspective and Prospects

In the 1940s, while working as a pediatrician, Hans Asperger identified what is now known as Asperger syndrome. In the mid-1960s, psychologists Lovaas and Charles Ferster developed a behavioral approach for treating autism and related disorders. Though refined since that time, the basic tenet, that people with autistic spectrum disorders can learn and be taught some of the skills that they lack, remains the treatment of choice. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013, Asperger syndrome is no longer considered a separate diagnosis from autism spectrum disorder.

Bibliography:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, Va.: Author, 2013.

Ariel, Cindy N., and Robert A. Naseef, eds. Voices from the Spectrum: Parents, Grandparents, Siblings, People with Autism, and Professionals Share Their Wisdom. Philadelphia: Jessica Kingsley, 2006.

Bertrand, Jacquelyn, et al. “Prevalence of Autism in a United States Population: The Brick Township, New Jersey, Investigation.” Pediatrics 108 (2001): 1155–61.

Folstein, Susan E., and Susan L. Santangelo. “Does Asperger Syndrome Aggregate in Families?” In Asperger Syndrome, edited by Ami Klin, Fred R. Volkmar, and Sara S. Sparrow. Philadelphia: W. B. Saunders, 2003.

Gillberg, Christopher. “Clinical and Neurobiological Aspects of Asperger Syndrome in Six Family Studies.” In Autism and Asperger Syndromes, edited by Uta Frith. New York: Cambridge University Press, 1991.

MedlinePlus. "Asperger Syndrome." MedlinePlus, Mar. 5, 2013.

Szatmari, Peter. “The Validity of Autistic Spectrum Disorders: A Literature Review.” Journal of Autism and Developmental Disorders 22 (1992): 583–600.

Volkmar, Fred R., and Ami Klin. “Diagnostic Issues in Asperger Syndrome.” In Asperger Syndrome, edited by Klin, Volkmar, and Sara S. Sparrow. New York: Guilford, 2000.

Wood, Debra. "Asperger Syndrome." Health Library, Mar. 15, 2013.