Asperger’s Syndrome: A Psychologist’s Insight

August 22, 2014 at 12:17 pm

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Asperger’s, like ADHD, is a neurobiological disorder. It differs from ADHD in that it is a form of autism, or as the experts say, is on the autism spectrum. Conditions on the autism spectrum are characterized by difficulties in social functioning paired with high verbal intelligence and a tendency to have very narrow and focused interests.
Asperger’s syndrome (AS) was first identified by the Austrian pediatrician Hans Asperger (1906-80) who, in 1944, published a paper describing a pattern of behavior he had detected in a number of young boys who had normal intelligence and language skills but who also displayed marked deficiencies in social and communication skills. It was not until 1994, however, that AS was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook that lists and categorizes mental disorders and provides practitioners with criteria for diagnosing them. If a condition is not listed in the DSM, it is not recognized as a mental disorder. Even so, it is only within the last several years that AS has been widely recognized by physicians and parents. Today, it is estimated that 400,000 Americans have AS.

SYMPTOMS OF ASPERGER’S

The DSM IV lists six criteria used to diagnose AS. They are:
1. Measurable impairment with social interaction.
2. Restricted, repetitive stereotyped behaviors and interests.
3. Significant impairment in areas of function.
4. No measurable delays in language and speech.
5. No significant delays in cognitive development, self-help skills, or adaptive behavior other than social functioning.
6. Other developmental disorders or schizophrenia do not better explain the symptoms.
In practice, people with AS may have a variety of symptoms, and the disorder can range from mild to severe. Many people with the syndrome dislike change and prefer stable routines. Many are obsessive about their routines and may be focused on a narrow set of interests. These interests may include areas that most people consider normal, such as music, or the weather, or snakes. Some people with AS, however, are fascinated with such seemingly odd or trivial things as train schedules, deep-fry cookers, or telegraph-pole insulators. People with AS are often extremely knowledgeable about these subjects and may talk at length about them without recognizing that other people are not quite as interested. Children with AS may have highly specialized, pedantic vocabularies; it was, in fact, this characteristic, combined with their extensive knowledge, that caused Asperger himself to dub his patients “little professors.”
Individuals with AS have difficulty in behaving appropriately in social situations. They miss nonverbal signals and crucial social cues and often cannot empathize with others or understand complex emotions. They may also be unable to imagine how their own behavior looks to others. Many have trouble recognizing faces. Several studies confirm that the brains of people with AS react quite differently from those of normal individuals to tasks that involve mentalizing—intuiting other people’s mental states from behavior or facial expressions.

Fact Or Fiction?

“I have heard that people with Asperger’s can be very violent. There have been several recent high-profile cases in which young men with Asperger’s have committed murder.”

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The Facts: While there have been instances in which people with Asperger’s have become violent, violence is not commonly associated with the syndrome. Usually, any violent behavior on the part of a young person with a neurobiological condition stems from frustration and the inability to control impulses. Research demonstrates that three of five teens with Asperger’s say they were bullied at school, and their parents report that they are frequently teased. When they are extremely frustrated, people with Asperger’s can be disruptive, but they are seldom violent.
People with AS may seem naive and lacking in common sense, and some may have learning disabilities in reading, writing, or, most commonly, math. Some people with AS may be unusually sensitive to sensory stimuli and may be bothered by sounds or light levels that no one else notices. People with AS may also have gross motor deficits and may be seen as clumsy or awkward.

Asperger’s in Girls

For every 10 boys diagnosed with AS, only one girl is identified with the condition. Researchers believe that the real ratio should be more like four to one, as it is in autism, and they speculate that girls go undiagnosed because of basic gender differences and social expectations of girls. While boys with AS may be interested in science, chess—or telegraph poles—girls may be obsessed with animals (especially horses) and classic literature. Neither of these interests is likely to alert parents to a potential problem, since many girls who do not have Asperger’s love horses and reading. The difference is in the degree of the obsession and the depth of focus.
Researchers also believe that girls are more able than boys to imitate socially acceptable behavior and may, therefore, not seem to be quite so socially awkward. Liane Holliday Willey, who has Asperger’s, entitled her autobiography Pretending to Be Normal—a title that could well apply to the life stories of many girls with the syndrome. Many boys are first diagnosed with AS because of aggression and other kinds of behavior problems. Girls, who are better at expressing their emotions and less inclined to act out aggressively, may slip under the diagnostic radar.
The Australian psychiatrist Tony Attwood, a leading expert on the syndrome, says that while boys with AS may be little professors, girls are more like little philosophers, wondering, for example, if everyone sees the color red in the same way.

TREATING ASPERGER’S

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There is no medication to treat this condition, although AS is often associated with obsessive-compulsive disorder (OCD) and depression, both of which can be treated with a variety of medications. Because AS can differ so much from person to person, there is no one standard treatment. As with many such conditions, the younger the child is at diagnosis, the easier it is to make an impact with various forms of intervention. Social skills training is very important; because children with AS do not easily understand social cues, they must be taught acceptable responses to situations that other children might simply know by intuition.
AS4On the television sitcom The Big Bang Theory, the character of Sheldon is portrayed with many AS-like characteristics. When his neighbor Penny tries to persuade him to buy a gift for his roommate’s birthday, he demands to know why he should. She tries various explanations, all of which Sheldon rejects. She gives up until another friend whispers, “Try telling him it’s a non-optional social convention.” She does; this satisfies Sheldon’s need for a logical explanation, and he goes shopping with her. This is in some ways a model of the sort of training children with AS need—making explicit and rule-bound social conventions, which for most people are automatic. It is important to teach social skills to boys and girls separately, since their needs and deficits are so dissimilar.
People with AS who are overly sensitive to sound or light may benefit from sensory integration training, which is usually provided by an occupational therapist. This involves gradually exposing children to the offending stimuli in order to desensitize them. In addition many therapists employ a routine known as the Willbarger protocol to help treat children who have difficulties with sensory integration. Although the technique has not been validated by research, many occupational therapists report remarkable improvements using the protocol, which involves a sort of deep massage using a surgical brush and compressions to various joints and the sternum.
As children with AS grow older, and especially through their teenage years, psychotherapy and/or cognitive-behavioral therapy may be important to help with some of the scars that can come from being different. People with AS can suffer from depression and may be lonely, longing for more social contact, yet unsuccessful in making friends.

INTO THE FUTURE

What the future holds for young people with AS depends very much on the help and advice they get from friends, family, and teachers. Many successful adults who thought they had ADHD or OCD or were thought to be simply odd or eccentric have recently been diagnosed with AS, and their stories seem to have something in common: These people pursued their passions and found the right niche in life. Lars Perner, a professor of marketing at the University of Southern California and winner of the Nobel Prize in economics, was diagnosed with AS at the age of 32. He believes that his choice of profession has helped him. He said in a paper presented at the annual meeting of the Autism Society of America in 2002 that “As an academic, I have come into an environment where eccentric people, at least within reason, are tolerated and sometimes even admired,” and he notes that he gave up the idea of being a trial lawyer when he realized that he was not very good at “getting things ‘right’ on the first try.” His chosen profession does not require him to think on his feet and allows him time for revision and reflection.
Temple Grandin, who has been diagnosed as having high-functioning autism, is another remarkable success story. She transformed her love of animals and orderliness into a career in which she has become one of the world’s most distinguished designers of animal-handling facilities.

 

FURTHER READING

Attwood, Tony. The Complete Guide to Asperger’s Syndrome. London: Jessica Kingsley, 2006.
—–, et al. Asperger’s and Girls. Arlington, Tex.: Future Horizons, 2006.
Griffiths, Jonathan, and Hugh Jones. Asperger Meets Girl: Happy Endings for Asperger Boys. London: Jessica Kingsley, 2008.
Liane, Holliday Willey. Pretending to Be Normal: Living with Asperger’s Syndrome. London: Jessica Kingsley, 1999.