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Asperger syndrome

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File:Hans Asperger.jpg
Asperger and one of his "little professors"

Asperger's disorder or Asperger's syndrome (AS) is a condition related to autism and commonly referred to as a form of "high-functioning" autism. The term "Asperger's Syndrome" was coined by Lorna Wing in a 1981 medical paper; she named it after Hans Asperger, an Austrian psychiatrist and pediatrician whose work was not internationally recognized until the 1990s. "Aspie" is an affectionate term used by some with Asperger's syndrome to describe themselves; others prefer "Aspergian", or no name at all.

Characteristics

Hm... Non-autistics possess a comparatively sophisticated sense of other people's mental states. Most people are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's body language. Autists (or autistic persons) do not have this ability, and the individual with Asperger's can be every bit as "mind-blind" as the person with profound classical autism. For those who are severely affected by "mind-blindness", they may, at best, see a smile but not know what it means (is it an understanding, a condescending, or a malicious smile?) and at worst they will not even see the smile — or frown, or smirk, or any other nuance of communication. They generally have trouble (or simply cannot) "read between the lines," that is, figure out those things a person is implying but is not saying directly. It is worth noting, however, that since it is a spectrum disorder, a few with Asperger's are nearly normal in their ability to read facial expressions and intentions of others. Those with Asperger's often have difficulty with eye contact. Many make very little eye contact, finding it overwhelming, while others have unmodulated, staring eye contact that can be "off-putting" to everyday people.

Asperger's Syndrome involves an intense level of focus on things of interest and is often characterized by special (and possibly peculiar) gifts; one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, another with building models out of matchsticks. Particularly common interests are means of transportation (for example trains) and computers. In general, things with order have appeal. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life — the child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reasoning, an almost obsessive focus, and eidetic memory. Hans Asperger called his young patients "little professors", based on the fact that his thirteen-year-old patients had as comprehensive and nuanced an understanding, within their area of expertise, as university professors. It is because of this that individuals with Asperger's are considered to have a higher intellectual capacity while suffering from a lower social capacity.

Autists have emotional responses as strong as, or perhaps stronger than, most "neurotypicals", though what generates an emotional response might not always be the same. What they lack is the inborn ability to express their emotional state via body language, facial expression, and nuance in the way that most neurotypicals do. Many people with Asperger's report a feeling of being unwillingly divorced from the world around them; they lack the natural ability to see the subtexts of social interaction, and equally lack the ability to broadcast their own emotional state to the world accurately.

This leads to no end of troubles both in childhood and adulthood. When a teacher asks a child with Asperger's, "And did the dog eat your homework?", the child with Asperger's will remain silent if they don't understand the expression, trying to figure out if they need to explain to the teacher that they don't have a dog and besides dogs don't generally like paper. The child doesn't understand what the teacher is asking, cannot infer the teacher's meaning or the fact that there is a non-literal meaning from the tone of voice, posture or facial expression, and is faced with a question which made as much sense to him as "did the glacier in the library bounce today?" The teacher walks away from the experience frustrated and thinking the child is arrogant, spiteful and insubordinate. The child sits there mutely, feeling frustrated and wronged.

Asperger's can also lead to problems with normal social interaction between peers. In childhood and teenage years, this can cause severe problems as a child or teen with Asperger's can have difficulty interpreting subtle social cues and as such be ostracized by his/her peers, leading to social cruelty. The child or teen with Asperger's is frequently puzzled as to the source of this cruelty, unaware of what he is doing "wrong". Recent efforts in the field of special education have worked to correct this problem, meeting with only moderate success.

In adulthood, the person with Asperger's may find it difficult to differentiate between the smiles of a waitress waiting on his table and the woman at the next table who's interested in him. He may well wind up asking the waitress out for a cup of coffee and ignoring the woman at the next table.

Asperger's Syndrome is hardly a guarantee of a miserable life, however — far from it. Often their intense focus and tendency to work things out logically will grant them a high level of ability in their fields of interest. Despite their difficulty with social interaction, many possess a rare gift for humor (especially puns, wordplay, doggerel, and satire) and written expression. In fact, sometimes their fluency with language is such that a number of them also qualify as hyperlexic. While their lives will probably not be considered a social success by the common standards, and there are a number who will remain alone their entire lives, it is possible for them to find understanding people (sometimes also on the autistic spectrum, sometimes not) with whom they can have close relationships. While they face enormous obstacles, some overcome them and prosper in society. Many autists are married and have children; their children may be neurotypical or have an autism spectrum disorder. Many autists don't know they have autism and neither do their friends and family members, because milder forms of autism are widely undiagnosed and misdiagnosed by professionals and widely misunderstood.

DSM definition

Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

  1. Qualitative impairment in social interaction, as manifested by at least two of the following:
    1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
    2. Failure to develop peer relationships appropriate to developmental level
    3. A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
    4. A lack of social or emotional reciprocity
  2. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
    1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
    2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
    3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
    4. Persistent preoccupation with parts of objects.
  3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
  4. There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years)
  5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in childhood
  6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The Diagnostic and Statistical Manual's diagnostic criteria have been roundly criticized for being far too vague and subjective: what one psychologist calls a "significant impairment" another psychologist may call insignificant.

A series of studies have supported the thesis that there are in fact no or only very few cases that strictly meet the above DSM-IV definition of Asperger's: patients typically show communication impairment, which then qualifies them for a diagnosis of autistic disorder and not Asperger's. See [1].

Relationship to autism

File:Asperger kl2.jpg
Hans Asperger

Experts today generally agree that there is no single mental condition called autism. Rather, there is a spectrum of autistic disorders, with different forms of autism taking different positions on this spectrum. But within certain circles of the autism/AS community, this concept of a "spectrum" is being severely questioned. If differences in development are purely a function of differential acquisition of skills, then attempting to distinguish between "degrees of severity" may be dangerously misleading. A person may be subjected to unrealistic expectations, or even denied life-saving services, solely on the basis of very superficial observations made by others in the community.

In the 1940s, Leo Kanner and Hans Asperger, working independently in the United States and Europe, identified essentially the same population, Asperger's group being perhaps more "socially functional" than Kanners as a whole. Some of Kanner's originally identified autistic children, might today get an Asperger's syndrome diagnosis, and vice versa. It is a mistake to say that a "Kanner autistic" is a child who sits and rocks and does not communicate. Kanner's study subjects were all along the spectrum.

Researchers are grappling with the problem of how to divide up the spectrum. There is no easy way to do this. It would appear that one can divide the population of autistics in any particular way and define the group accordingly. Autistics who speak, those who don't. Autistics with seizures, those without. Autistics with more "sterotypical behaviors", those with less, and so forth. Some are trying to identify genes associated with these traits as a way to make logical groupings. Eventually, one may hear about autistics with or without the HOXA 1 gene, with or without changes to chromosome 15, etc.

Kanner's syndrome is described in the article autism.

According to Dr. Peter Szatmari, and others in the field of autism research, if one strictly applies the DSM-IV guidelines, then, in fact, there are almost NO people with "Asperger's syndrome" pointing to the flawed nature of the DSM-IV description.

File:Kanner kl2.jpg
Leo Kanner

Dr. Sally Ozonoff, of the University of California at Davis's MIND institute, argues that there should be no dividing line between "high-functioning" autism and Asperger's, and that the fact that some don't start to produce speech until a later age is no reason to divide the two groups, as they are identical in the way they need to be treated..

Asperger's Syndrome and other forms of autism are often grouped together in a Pervasive Developmental Disorder family.

Comorbid disorders

There are many comorbid disorders associated with Asperger's Syndrome. The major comorbid disorders associated with Asperger's include post-traumatic stress disorder, Sensory Integration Dysfunction, anxiety disorder, panic disorder, social anxiety disorder, Attention-Deficit Hyperactivity Disorder (ADHD), obsessive-compulsive disorder (OCD), seizures, Tourette syndrome and depression. If a comorbid disorder is present with Asperger's, it often cannot be treated in the same manner as when it is present in neurotypicals.

Clinical depression is by far the most common comorbid disorder, affecting over half of all people with Asperger's, especially during early adulthood. People with AS attempt suicide at a staggeringly high rate in comparison to the general population, although whether this is due to AS or depression comorbid to AS is a matter of debate.

Effect on spouses

The spouses of people with Asperger's are more prone to major depression than the general population because Asperger's people often have trouble showing affection or understanding the need to show affection, and are very literal and hard to communicate with in an emotional way. A spouse of a person with Asperger's will often go to the "well" to seek affection and find that the well is dry! It is very helpful for the spouses to read as much as they can about Asperger's syndrome, OCD, hyperlexia and other "comorbid disorders". It also helps to visit the support groups' websites online and talk with other spouses of people with Asperger's Syndrome. A spouse will often be much less angry or depressed if they understand that the Asperger's symptoms are not intentionally directed at them, but that they are part of a neurological condition. That someone does not spontaneously show affection does not necessarily mean that they do not feel it. Thus the spouse will feel a lot less rejected and be a lot more understanding. Light will be shed on the nature of the misunderstandings. They may figure out ways to work around the problems, for example being more explicit about their needs.

A gift and a curse

Recently, some researchers have speculated that many well-known people including Glenn Gould, Nikola Tesla, Albert Einstein and Isaac Newton had AS, as they showed some Asperger's related tendencies (such as intense interest in one subject and social problems); such diagnoses remain controversial, however (c.f. BBC News, Einstein and Newton "had autism", 30 April 2003). The obvious social contributions of such individuals has led to a shift in the perception of Asperger's and autism away from the simple view of a disease just needing to be cured towards a more complex view of a syndrome with both advantages and disadvantages. There is a semi-jocular theory within science fiction fandom, for example, which argues that many of the distinctive traits of that subculture may be explained by the speculation that a significant portion thereof is composed of people with Asperger's. A Wired Magazine article called The Geek Syndrome suggests that Asperger's syndrome is more common in the Silicon Valley because of all the computer scientists and mathematicians who inhabit the region.

Asperger's in the media

Detective Robert Goren from the television series Law & Order: Criminal Intent, has a touch of Asperger's. The series has also dealt with a suspect who has a much more pronounced form.

References

  • [1] Mayes SD, Calhoun SL, Crites DL: Does DSM-IV Asperger's disorder exist?, Journal of Abnormal Child Psychology 2001 June;29(3), pages 263-271, online version

See also

Autism Awareness Ribbon
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