Asperger’s Syndrome – Signs and Symptoms, and More

Asperger’s syndrome

Summary

Asperger’s syndrome is a pervasive developmental disorder that causes patients to have difficulty interacting (both verbally and nonverbally) with others. It usually occurs in children between the ages of 2 and 6 years, although it may not actually be diagnosed for many years.

This disorder belongs to a group of conditions known as autistic spectrum disorders that all involve problems with social skills. Boys are three to four times more likely than girls to have Asperger’s syndrome, according to the National Institute of Neurological Disorders and Stroke.

The causes of Asperger’s syndrome and other autistic spectrum disorders remain unknown. Widespread brain abnormalities may contribute to Asperger’s syndrome. In addition, the disorder appears to have a strong genetic component.

Children with Asperger’s syndrome typically have normal-to-high levels of intelligence and verbal skills, but are awkward in social situations. In many cases, they also display a fixation with unusual topics of interest, such as aliens or bus schedules. They may share many of the same symptoms as patients with high-functioning autism. However, mental retardation typically does not occur in patients with Asperger’s syndrome, and patients do not experience delays in language and cognitive development.

Asperger’s syndrome is often marked by difficulty making friends. Patients may talk for long periods of time without allowing others to contribute to the conversation and may avoid eye contact. Their faces may lack expression as they speak, and they may talk in monotone, fast or unusual patterns. Patients may also engage in unusual body postures or gestures.

Diagnosing Asperger’s syndrome can be difficult. Observations of the child and parental reports about the child’s history of social interaction offer important clues to a diagnosis. Tests of the child’s intellect and academic abilities – including their speech, language and visual-motor abilities – may also be part of the diagnosis process.

Early diagnosis is crucial to treating Asperger’s syndrome effectively. Speech pathologists, social workers, psychologists and developmental pediatricians all may be involved in treatment. Patients can learn behavioral management tools and other skills that will help them to better interact with others.

Difficulties with social interaction remain a lifelong problem for many people with Asperger’s syndrome. It is not uncommon for adolescents with this disorder to become anxious or depressed as they come to recognize their differences. Adults may desire to form friendships, but lack the social skills to do so successfully. Individuals with Asperger’s syndrome often have difficulty in dating and marriage. As a result, they are more likely to form relationships with people much younger or older than themselves.

About Asperger’s syndrome

Asperger’s syndrome is a developmental disorder in which children have significant problems with social interaction and communication. They may also engage in repetitive behaviors or display a fixation on certain interests. Asperger’s syndrome usually manifests between ages 2 and 6, although it may not be evident until many years later and often goes undiagnosed until young adulthood. The problems in social relations are quite severe in patients with the disorder, and can interfere with learning basic skills. Asperger’s syndrome belongs to a group of five conditions – including autism, childhood disintegrative disorder (CDD), Rett syndrome and pervasive developmental disorder not otherwise specified – which are known as pervasive developmental disorders (sometimes collectively referred to as autistic spectrum disorders) and all involve problems with social skills. The estimates of people affected with Asperger’s syndrome vary, and the disorder may be underdiagnosed. Mental health experts in population studies conservatively estimate that two out of every 10,000 children have the disorder, according to the National Institute of Neurological Disorders and Stroke (NINDS). 

The causes of Asperger’s syndrome and other autistic spectrum disorders remain unknown. Widespread brain abnormalities may contribute to Asperger’s syndrome. In addition, the disorder appears to have a strong genetic component.

Children with Asperger’s syndrome typically have normal-to-high levels of intelligence and verbal skills, but are very awkward when interacting with others and display a fixation with certain topics of interest. Boys are three to four times more likely than girls to have the disorder, according to the NINDS. This disorder has only recently been widely recognized. As a result, guidelines for diagnosing and treating Asperger’s syndrome are still being established.

Children with Asperger’s syndrome display many of the symptoms of patients with high-functioning autism. However, unlike autism, mental retardation typically does not occur in patients with Asperger’s syndrome. Children with Asperger’s syndrome do not experience delays in language and cognitive development, but are likely to display less-accomplished verbal and nonverbal skills than children with high-functioning autism. Children with Asperger’s syndrome are also more likely to think imaginatively and to have mild motor coordination difficulties than children with high-functioning autism.

To outsiders, children with Asperger’s syndrome may appear rude or “odd.” In some cases, children with Asperger’s syndrome may see their condition improve as they grow older, whereas in others social difficulties may become more obvious. It is not uncommon for adolescents with this disorder to become anxious or depressed as they come to recognize their differences.

Difficulties with social interaction remain a lifelong problem for many people with Asperger’s syndrome. Adult patients may have an increased desire to form friendships but their inability to grasp conventions of social interaction may pose an obstacle to such relationships. As a result, these patients sometimes form friendships with people much older or younger than themselves.

Signs and symptoms of Asperger’s syndrome

Symptoms of Asperger’s syndrome range from relatively mild to severe. In many cases, parents and physicians may be unaware of the problem early in a child’s life, as it is common for children with Asperger’s syndrome to exhibit normal to high levels of intelligence.

The first symptoms usually appear by age 3, although some children may exhibit signs as early as infancy. Developmental delays in motor skills (such as crawling, walking, catching a ball or pedaling a bike) or excessive clumsiness are sometimes the first signs of Asperger’s syndrome. Other symptoms of the condition typically become more apparent when the child reaches school age and begins regularly interacting with peers.

Children with Asperger’s syndrome may struggle to make friends and may talk for long periods of time without allowing others to contribute to the conversation. When communicating, these children may avoid eye contact and their faces may lack expression. They may speak in monotone, fast or unusual patterns. They also may engage in unusual body postures or gestures.

Other symptoms related to social skills include:

  • Difficulty empathizing or being sensitive to others’ feelings
  • Self-absorption
  • Difficulty understanding the nuances of language
  • Inability to interpret other peoples’ body language
  • Hyperactivity and inattention

Children with Asperger’s syndrome may also exhibit unusual behavior patterns. It is very common for such children to become obsessed with a topic of interest, such as reciting sports statistics, or having an unusually strong fixation on a particular subject, such as the weather. In many cases, these topics may be unusual, such as excessive interest in aliens or bus routes.

Repetitive rituals and movements, the ability to memorize facts easily, clumsy or uncoordinated movements, rigid routines, violent outbursts (e.g., tantrums) and hypersensitivity to light and sound are all hallmarks of Asperger’s syndrome. Some patients with Asperger’s syndrome may also injure themselves.

Symptoms of Asperger’s syndrome may appear different depending on the patient’s age. For example, a child’s difficulties in social situations may not be as evident at first and may become more apparent over time. Adolescents with Asperger’s syndrome may learn to use areas of strength (such as memorization abilities) to overcome areas of weakness. On the other hand, adolescents may experience depression and anxiety as they become more aware of their disorder and their social isolation.

Diagnosis methods for Asperger’s syndrome

The early signs of Asperger’s syndrome sometimes can be difficult to recognize. Parents often seek medical help when it becomes apparent that their child has extreme difficulty with social interaction at school or another venue. Regular physical examinations by a physician, typically a pediatrician, with emphasis on developmental milestones in children can identify symptoms that help to diagnose the disorder.

Diagnosing this condition can be difficult. A physician will perform a complete physical examinationand compile a thorough medical history in trying to make a diagnosis. Additional health professionals may be asked to assess the child’s condition.

Important information can also be gained through observing the child and from listening to a parent’s description of the child’s history of social interaction and ability to form friendships. Screening tests for Asperger’s syndrome have been developed which focus on social and behavior problems. Tests of the child’s intellect and academic abilities – including speech, language and visual-motor abilities – may also be part of the diagnostic process.

Children with Asperger’s syndrome often perform poorly on tests of joint attention. This is a social skill in which two people simultaneously look at an object or watch an event. The ability to follow another person’s gaze or to point at an object is a crucial indicator of developing language and social skills.

An evaluation also may reveal the presence of other disorders often associated with Asperger’s syndrome. These include attention deficit disorders, anxiety, depression, hyperactivity and nonverbal learning disabilities.

Patients who do not have the symptoms of another specific autistic spectrum disorder or schizophrenia and meet the following criteria may be diagnosed with Asperger’s syndrome:

  • Observable impairment in social interaction that includes at least two of the following: significant impairment in the use of multiple nonverbal gestures, failing to develop relationships with friends, lack of desire to share experiences with others, lack of social or emotional reciprocity.
  • Restricted repetitive and stereotyped patterns of behavior, interests and activities characterized by at least one of the following: intense preoccupation with one or more areas of interest, rigid adherence to routines or rituals, stereotyped and repetitive motor mannerisms, and preoccupation with parts of objects.
  • Clinically significant impairment in social, occupational or other areas of functioning.
  • Lack of clinically significant delay in language or cognitive development.

Treatment options for Asperger’s syndrome

The earlier a person is diagnosed with Asperger’s syndrome, the more effective treatment is likely to be. Various professionals – including speech pathologists, social workers, psychologists and developmental pediatricians – may be involved in therapy.

Though Asperger’s syndrome itself cannot be cured, patients can learn behavioral management tools and other skills that will help them to better interact with others. Behavioral therapies include teaching patients to recognize bothersome situations (such as social occasions) and to use a learned strategy that will help them to cope with the circumstances. This is intended to defuse the potential for violent outbursts associated with the disorder.

Patients may also benefit from being formally taught the rules of socialization and communication. This can be learned through memorization and practice. Patients can also learn to speak in a more natural rhythm and to interpret the body language and verbal cues of others.

Occupational or physical therapy can be beneficial for improving sensory integration problems and poor motor coordination. 

There are no medications specifically designed to treat Asperger’s syndrome. However, patients can benefit from drugs that relieve symptoms of associated disorders such as anxiety, depression, hyperactivity and schizophrenia.

Parents and other caring adults can help children to better cope with the condition by providing love, support and plenty of encouragement. Support groups and other resources are available for parents and other family members, including education that teaches behavioral techniques to use at home that may be especially effective with children who have Asperger’s syndrome.

Lifestyle issues for Asperger’s syndrome

Schooling can present a challenge for children with Asperger’s syndrome, but most obstacles can be overcome. Because patients often display high intelligence and good verbal skills, the child’s special needs may not always be evident. Teachers and other caregivers should be informed of the child’s disorder so that they understand that extra attention or special teaching techniques may be necessary.

Although children with Asperger’s syndrome often excel in class, they may struggle during social periods such as gym class, lunch and recess. Parents are urged to work with a child’s teachers and other school staff in creating an environment in which the child can thrive.

Even though patients with Asperger’s syndrome will continue to need moral support and encouragement through adulthood, many are able to maintain independent lifestyles and work successfully in mainstream jobs.

Questions for your doctor about Asperger’s

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Parents or guardians may wish to ask their child’s doctor the following questions related to Asperger’s syndrome:

  1. What symptoms should I look for that might indicate that my child has Asperger’s syndrome?
  2. How will you attempt to diagnose my child’s condition?
  3. How might Asperger’s syndrome affect my child’s life?
  4. Will my child’s symptoms remain the same or will they evolve?
  5. Which treatments do you recommend for my child?
  6. How successful have the treatments been for other children with Asperger’s?
  7. Which professionals will be involved in my child’s treatment program?
  8. How can I help with my child’s therapy?
  9. Will my child be able to attend regular school?
  10. What steps should I take to make sure my child succeeds at school?
  11. What challenges might my child face in adolescence and adulthood?
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