What is Asperger Syndrome?
Asperger syndrome (AS), first described by Hans Asperger in 1944, is a condition that causes difficulties in communication and social interaction. In the past, it was recognized as a unique category of mental disorder. However, it has now been grouped with a broader range of conditions known as autism spectrum disorders (ASD). This change suggests that autism includes a variety of experiences with different levels of severity and associated characteristics.
ASD refers to a host of neurodevelopmental conditions, which affect individuals to different degrees and in different ways. They generally appear in early childhood and are signified by social communication challenges, limited interests, and repetitive behavior. The inclusion of AS within ASD has caused some controversy because of the loss of the unique Asperger identity. Regardless of this change, specialists still use AS as a unique subset of ASD, where individuals have no delay in language and display normal or above-average IQ.
Hans Asperger initially dubbed this condition “autistic psychopathy” in 1944. Years later, in 1980, the American Psychiatric Association recognized autism as a separate category. AS was officially acknowledged as a distinct entity within the Pervasive Developmental Disorders (PDD) category in 1994. Later, in 2013, the diagnostic category for AS was removed, and AS was merged into the ASD category.
As per the previous classification, PDD included five subcategories: Autism spectrum disorder, Asperger syndrome, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified (PDD-NOS), and Rett syndrome. Now, these have all merged into a broader ASD category. The new ASD classification has sparked some controversy. Some researchers worry that certain individuals, primarily those who are cognitively able or previously diagnosed with AS or PDD-NOS, may not qualify for an ASD diagnosis under the new narrower criteria. Critics also argue that merging AS into the ASD category may lead to increased stigma toward individuals formerly diagnosed with AS.
It’s important to note that these changes and the potential impacts they can have on individuals previously diagnosed with AS are ongoing topics of debate. People’s opinions are varied, with some supporting the changes, others opposing, and several expressing mixed feelings.
What Causes Asperger Syndrome?
Our understanding of Asperger syndrome and autism, collectively known as Autism Spectrum Disorder (ASD), has evolved significantly. Previously, theories falsely blamed the onset of ASD on emotionally distant mothers, or socioeconomic factors such as family lifestyle or income. These have now been dismissed. Instead, it’s recognized that ASD is likely caused by a mix of genetic, neurological, and environmental factors.
Current research indicates that many genes are thought to be linked to ASD, although there hasn’t been a specific mutation identified that’s unique to the disorder. It’s estimated that as many as 400 to 1000 genes may predispose someone to autism. These genes relate to various biological roles that play crucial parts in brain development and operation.
People with ASD, including Asperger syndrome, tend to have specific variations in a gene called GABRB3, which has previously been connected to empathy. Additionally, about 9% of clinically examined individuals with ASD have what’s known as copy number variants (CNVs). This refers to alterations in DNA that can disrupt how a gene functions.
It’s also important to note that there’s overlapping genetics between ASD and other neurological and psychiatric disorders, such as epilepsy, intellectual disability, and schizophrenia. It’s suggested that the genetic factors related to these conditions can interfere with normal brain development, and result in the emergence of ASD. For instance, abnormalities have been found in several regions of the brains of individuals with ASD, like the frontal cortex and hippocampus. Additionally, some children with ASD have shown accelerated head growth during infancy.
A number of factors support the notion that genetics plays a key role in the development of ASD, including a higher incidence of autism in siblings compared to the general population, the strong role of inheritance, overall rates in twins, and the higher rate of ASD in boys than in girls.
Environmental factors also seem to play a part in the development of ASD, and researchers are actively exploring this. Identifying environmental risk factors is crucial, as it could reduce exposure to neurotoxicants, particularly in children and pregnant women. These risk factors might independently contribute to the development of ASD, or interact with existing genetic factors in those already genetically predisposed to ASD. These factors can involve a range of things like parental age, events during pregnancy and childbirth, maternal conditions, and exposure to toxins.
Despite previous controversies, extensive reviews of multiple studies have found there’s no evidence to support a link between ASD and vaccinations. As a result, it’s recommended that children with ASD still receive vaccinations according to regularly recommended schedules.
Risk Factors and Frequency for Asperger Syndrome
The current way Autism Spectrum Disorder (ASD) is classified can sometimes complicate long-term tracking of its prevalence. It seems that the number of people diagnosed with ASD is increasing over time. This rise can partly be explained by changes in the way ASD is defined, more thorough screening methods, and increasing awareness of ASD among healthcare workers and the general public. Nevertheless, an actual increase in the number of ASD cases can’t be ruled out. The reported rates of ASD vary because of differences in population types studied and research methods used. Estimates range from as low as 0.7 to as high as 72.6 in 10,000 individuals.
As per the Centers for Disease Control and Prevention (CDC), the estimated occurrence of ASD in the United States is around 11.3 in 1,000 people. Globally, it’s estimated that around 1 in 132 people have ASD. ASD is more common in males than females, with estimations showing around 4 males for every 1 female. However, a study in 2017 suggested the ratio might actually be closer to 3 males for every 1 female, highlighting that girls with ASD might be more likely to go undiagnosed than boys.
People with ASD often have other psychiatric and physical disorders, more so in young children. Over 70% of individuals with ASD have additional conditions besides their ASD diagnosis. These additional conditions can significantly impact the individual and their family, as well as the medical treatment they require.
- Common conditions that occur alongside ASD include intellectual disability, attention deficit hyperactivity disorder (ADHD), tic disorders, anxiety, depression, and epilepsy.
- AS and High-Functioning Autism (HFA), specific subgroups of ASD, are often accompanied by conditions such as ADHD, depression, bipolar disorders, anxiety, and tic disorders.
Signs and Symptoms of Asperger Syndrome
Autism Spectrum Disorder (ASD) is a diverse condition related to brain development that includes a wide range of features and challenges. It is known for abnormal social communication and interaction, as well as restricted and repetitive behavior patterns. The severity of these symptoms varies across individuals and depends on the level of support needed by each person. For diagnosis, other conditions and factors are also considered, such as intellectual disability, language impairment, catatonia, and other neurodevelopmental, mental, or behavioral disorders.
Asperger Syndrome (AS), a subtype of ASD, is characterized by the same core symptoms but without intellectual disability or language delay. The clinical features differ according to age and other psychiatric conditions. While early symptoms of ASD can be observed as early as 1 to 3 years of age, AS diagnosis often happens around the age of 11 or later.
The key features of impaired social communication in ASD are:
- Reactions to social interactions
- Nonverbal behaviors used for social interaction
- Understanding and development of relationships
ASD is also known for restrictive and repetitive behavior which can include:
- Stereotyped and repetitive behaviors
- Insistence on sameness and inflexible adherence to routines
- Highly restricted interests
- Atypical sensory behaviors
It’s crucial to note the key symptoms of ASD differ for specific ages or certain groups. For instance, toddlers and preschoolers may not orient themselves to their names or follow pointing gestures, while these could indicate ASD in older children and adults. Similarly, the absence of close friendships isn’t concerning for a toddler but becomes significant as individuals reach adulthood.
Identifying different clinical scenarios associated with ASD and AS at distinct ages helps clinicians offer the right screening, diagnosis, and treatment. The main issues observed include social isolation, limited interests, prevalent symptoms of ADHD, a diverse range of cognitive abilities and sensory perception issues, and challenges for those with ASD transitioning into adulthood.
Adults who have been diagnosed with ASD and AS can struggle in their professional careers. Some of the professional struggles they face involve a lack of understanding of social norms and expectations, difficulties with adaptability, and a tendency to adhere to strict routines and rituals. Despite having higher education degrees, adults with ASD-AS may find it hard to get their first job due to difficulties encountered during job interviews. Nevertheless, individuals with ASD-AS have many valuable qualities including punctuality, honesty, creativity, and logical reasoning abilities.
Testing for Asperger Syndrome
Asperger syndrome shares many common traits with other conditions that fall under the Autism Spectrum Disorder (ASD) umbrella. When it comes to evaluating these conditions, we have two main methods: screening and diagnostic assessment.
1. Screening
Screening tests don’t definitively diagnose ASD but can help spot individuals who may need further evaluation. For instance, a child’s development can be screened at 9, 18, and 30 months to detect potential delays in language skills, cognitive abilities, and motor skills. However, these tests might not pick up on certain behaviors typically seen in ASD, like differences in social interaction or repetitive behaviors.
In addition to routine developmental screenings, it’s recommended to specifically screen for ASD with:
– Routine developmental surveillance: This involves observing how a child interacts with their caregivers, asking the caregivers about any concerns they might have, and keeping an eye out for symptoms at every routine check-up.
– Standard Autism-specific screening tests at 18 and 24 months: These tests are based on early ASD symptoms that caregivers or medical providers can notice. Certain significant symptoms, known as “red flags,” suggest a higher risk of ASD.
There are also a number of screening tools for ASD. Some of these tools include:
– Q-CHAT, for children younger than 24 months.
– M-CHAT, a modified version of Q-CHAT for children younger than 30 months.
– M-CHAT-R/F, a two-phase parent screening for children younger than 30 months.
– STAT, a tool administered by a trained professional for children aged 24 to 36 months.
– ASIEP-3, a screening tool for children between 2 and 13 years showing high autistic behavior.
– ABC, a subtest of ASIEP-3.
– CAST, a screening tool for children between 5 and 11 years suspected of having Asperger syndrome.
– SCQ, a tool for children older than 30 months.
– RAADS-R, a self-scoring screening tool developed for adults.
2. Diagnostic Assessment
If a child’s screening or developmental surveillance suggests a risk for ASD, a comprehensive diagnostic evaluation can determine if they indeed have ASD and if they need early intervention.
This could involve a standard psychiatric assessment, which includes thorough interviews with patients and caregivers to get a detailed understanding of an individual’s psychiatric history. Various tools have also been developed for the assessment of ASD. While none of these are sufficient for diagnosis on their own, they can support the diagnostic process.
Also important to the diagnostic process are evaluations of any other development disorders that might be present, as these may impact ASD symptoms. Medical checkups like genetic testing, neuroimaging, and EEGs might be needed in certain situations.
A comprehensive physical exam is necessary, too, to assess for growth, organ abnormality, presentation of neurologic disorders or unusual physical features. This exam can help guide subsequent medical workup.
Treatment Options for Asperger Syndrome
Treatment strategies for Autism Spectrum Disorder (ASD) vary greatly, depending on the person’s age, abilities, needs, and challenges. The aim of treatment is to minimize key difficulties, maximize individual independence, and reduce problematic behavior that hampers functional skills. Although there are many treatments available, none have proven to be superior.
Behavioral interventions are typically started early, focusing on adapting social behaviors and learning. The most recognized method is called Applied Behavioral Analysis (ABA), which is often led by behavior analysts. The goal is to enhance positive behaviors and reduce those that may hinder progress. This strategy improves social, academic, communicative, adaptive living, and occupational skills. It should be noted that there’s debate over whether the popular ABA approach aligns with bioethics norms.
Educational interventions are also critical for children with ASD and should be strategic, intensive, and personalized. Two widely regarded educational programs are the Learning Experiences and Alternative Program (LEAP) and the Treatment and Education of Autism and Communication Handicapped Children Program (TEACCH). These aim to enhance verbal and non-verbal communication, social skills, academic abilities, and motor skills.
Speech and language therapy is another common treatment, particularly focusing on communication skills. The therapy encompasses techniques like reinforcing speech sounds, replicating sounds, and using devices for children who find it challenging to speak spontaneously.
Developmental interventions involve training children to interact, communicate, and regulate their emotions. These strategies are mostly implemented through parent or caregiver interactions, focusing on playful activities that boost social and communication skills.
No existing medications directly target the main social and communication symptoms of ASD. However, certain drugs like risperidone and aripiprazole are approved by the U.S. Food and Drug Administration (FDA) for short-term management of associated symptoms such as aggression, self-injury, irritability, and tantrums.
What else can Asperger Syndrome be?
Asperger syndrome is a type of developmental disorder that affects a person’s ability to socialize with others. While individuals with Asperger syndrome usually show normal language and cognitive development, they often experience social limitations. It’s important to note that these social challenges are not exclusive to Asperger’s and can be seen in other conditions as well.
These conditions include:
- Intellectual disabilities
- Language disorders
- Impairments in the senses such as hearing
- Reactive attachment disorder, a condition that affects a child’s ability to form proper emotional connections
- Obsessive-compulsive disorder, a neurotic disorder characterized by obsessive thoughts and compulsive behaviors
- Anxiety disorders, including selective mutism, which causes an inability to speak in certain situations
- Childhood-onset schizophrenia, a severe mental disorder that affects a child’s ability to think and behave appropriately
- Rett syndrome, a rare genetic neurological disorder mostly affecting girls
- Social communication disorder, which affects a person’s verbal and nonverbal communication skills
- Attachment disorder, where a child struggles to form normal, loving relationships with others
- ADHD (Attention Deficit Hyperactivity Disorder), characterized by persistent patterns of inattention, hyperactivity, or impulsivity
- Tic disorders, which cause sudden, repetitive movements or sounds that people do involuntarily
- Schizoid personality disorder, characterized by a lack of interest in social relationships, a tendency towards solitary behavior, secretiveness, and emotional coldness
- Schizotypal personality disorder, characterized by severe social anxiety, thought disorder, and paranoid ideation
- Semantic-pragmatic processing disorder, which refers to difficulty with understanding and using language
What to expect with Asperger Syndrome
The results for patients with ASD-AS can vary significantly, according to various studies. This variation often depends on the size and nature of the study sample, the criteria for including participants, the definition of cases, and how outcomes are measured. Nevertheless, a few factors seem to play a key role in predicting the patients’ progress. These crucial factors include a person’s intelligence quotient (IQ), language skills, and co-existing mental health conditions.
One lengthy study found out that about 23% of patients with AS had limited progress, 47% had moderate progress, and 27% showed good progress.
Patients with AS tend to have a better chance of improvement if they get support from their knowledgeable families about the disorder. These patients can gain a lot from learning specific social rules. However, it’s important to always remember that these individuals’ social difficulties are expected to continue throughout their lifetime.
Possible Complications When Diagnosed with Asperger Syndrome
People with Asperger Syndrome (AS) and Autism Spectrum Disorder (ASD) often face difficulties in developing social skills, especially if they also have intellectual disabilities. These challenges can increase if the person also has trouble with language. In essence, a child’s intelligence and language abilities can often indicate how they will fare as an adult. Interestingly, about 9% of children who are diagnosed with ASD at a young age don’t meet the criteria for ASD when they become adults.
Those who have higher cognitive skills and take part in early intervention services often have better results. Similarly, those who significantly improve their verbal IQ often have less severe symptoms as adults. It’s important to point out that the support of family and community is crucial. It has been found to greatly improve the quality of life for adults with AS and ASD, even more so than specific symptom management.
Key Points:
- Individuals with Asperger Syndrome (AS) and Autism Spectrum Disorder (ASD) often struggle with social skills, especially if they also have intellectual disabilities and language impairments.
- A child’s intelligence and language abilities can suggest how they’ll progress into adulthood.
- About 9% of early-diagnosed ASD children don’t meet the criteria when they’re adults.
- Having higher cognitive abilities and availing early intervention services often bring better outcomes.
- Significant improvement in verbal IQ often leads to less severe adult symptoms.
- The support of family and the community has a greater impact on quality of life for adults with AS and ASD than specific symptom management.
Preventing Asperger Syndrome
When a child is diagnosed with Angelman Syndrome (AS), the whole family can face numerous challenges. Feelings of frustration, loneliness, relationship issues, and money woes can all come into play. The stress levels may be higher, and the outcomes often worse than those experienced by families with children who have other disabilities. However, it’s important to remember that family involvement is key to managing AS.
There are specific ways to help parents, which can be done at home. These are known as parent support interventions. They’re like training programs that give parents the tools they need to better help their child. They boost parents’ confidence, coordinate care, and provide much-needed psychological education. Meanwhile, parent-mediated interventions give caregivers special techniques they can use that have direct benefits for the child.
Parents and caregivers are also essential when it comes to teaching social skills, especially to younger children. This role is really important and helps the family unit as a whole. Education programs that include social skill training are another important piece of the puzzle when it comes to managing AS effectively.
