CHAPTER  Extensive vocabulary. persons with AS, and these individuals are often extremely good on rote memory skills such as UNDERSTANDING ASPERGER’S Other spectrum disorders include: dates, facts and figures.  Classic autism. (2 CE HOURS)  . History of Asperger’s syndrome By: Rene Ledford, MSW, LCSW, BCBA and Kathryn Brohl, MA, LMFT  Childhood disintegrative disorder. As a diagnosis, AS has been known in Europe  Learning objectives  Pervasive , not since the 1940s when it was described by a !! List the common of otherwise specified (usually referred to as Viennese pediatrician, . Dr. Asperger’s syndrome. PDD-NOS). Asperger reported observing four children !! Relate the history of Asperger’s syndrome. Unlike children with classic autism, children in his practice who had difficulty in social !! Describe the diagnostic criteria for Asperger’s with AS tend to retain their early language skills, situations. Although appearing normal in terms syndrome. often having large vocabularies for their age. of intelligence, these children appeared to !! Describe the onset of Asperger’s syndrome. Also, individuals with AS tend not to experience lack nonverbal skills, failed to !! Define the etiology (pathophysiology) of severe intellectual impairments as compared demonstrate for their peer group and Asperger’s syndrome. to individuals with other ASDs. Testing of were physically clumsy. !! List the () of individuals with AS tends to reveal IQ’s in the Dr. first published a paper in 1943 Asperger’s syndrome in the general normal to superior range, although some persons identifying autistic children. Kanner noted that population. with AS have been reported to be mildly retarded. these children (eight boys and three girls) often !! Describe the difference between Asperger’s There are some similarities with classic autism demonstrated capabilities that did not seem to syndrome and high functioning autism. without the diagnosis of mental retardation fit the patterns of other emotionally disturbed !! List characteristics of Asperger’s syndrome in (higher functioning autism or HFA), and the children. Although Dr. Asperger was unaware adolescence and adulthood. issue of whether Asperger’s syndrome and HFA of Leo Kanner’s work on autism, he did use !! Identify the basis for assessment of are different conditions has not been adequately the term “autistic psychopathy” to describe the Asperger’s syndrome. resolved. social deficits he observed in a group of boys. His !! List comorbid illnesses associated with Parents and caregivers are usually able to detect original description, in German, was essentially Asperger’s syndrome. signs that there is something unusual about a unknown in the English literature for many years. !! Describe possible treatments for Asperger’s child with AS by the time of his or her third The work of increased interest in syndrome. birthday, although some children may display the condition here in the United States. Since !! Describe the for individuals with signs and symptoms of AS as early as infancy. then, both the term Asperger’s syndrome and the Asperger’s syndrome. Unlike children with classic autism, children with number of research studies on AS have increased Introduction: What is Asperger’s AS will retain their early language abilities. steadily. syndrome? Sometimes the earliest indicators of AS are motor While AS was recognized in Europe nearly Asperger’s syndrome (AS), a developmental development delays. The child may sometimes 60 years ago, it was first recognized as a disorder, is one of a series of have difficulty crawling, will walk late, and is unique diagnosis by the American Psychiatric disorders (ASD). Autism spectrum disorders sometimes seen as clumsy, both in articulation Association in the Diagnostic and Statistical (ASD) are one of a distinct group of congenital- and gross motor behavior. Sensory integration Manual of Mental Disorders in the fourth edition neurological conditions characterized by: issues are often evident in this population. published in l994. Recognition in the DSM   Impairment in language and communication Difficulties with clumsiness are exhibited in a followed an international field trial involving skills including: variety of areas including: more than 1,000 children with classic autism ŠŠ Semantics.  Locomotion. and related disorders. The field trials provided ŠŠ Pragmatics.  Basic skills (catching, throwing, and kicking). evidence justifying the addition of Asperger’s ŠŠ Prosody (volume, intonation, inflection,  Balance. syndrome as a diagnostic category separate from and rhythm).  Manual dexterity issues (such as autism, under the diagnostic class of pervasive   Impairment in the use of nonverbal handwriting). developmental disorders (PDD). behaviors:  Inability to take slow, considered approaches Before the publishing of the diagnostic standards Š Š . to activities. by the World Health Organization (1990) and the Š Š Facial expression.  Lax joints. American Psychiatric Association (1994), the Š Š Body posture.  Rhythm. main diagnostic criteria was provided by either ŠŠ Body gestures.  Many individuals with AS are at risk for Gillberg and Gillberg, or Szatmari et al, both  Repetitive or restrictive patterns of thought. published in 1989.  Inflexible adherence to routines, rituals. developing a wide range of disorders,  Socially or emotionally inappropriate including anxiety or , especially during DSM-IV-TR diagnostic criteria for behavior. the emotionally difficult years of adolescence. Asperger’s syndrome   Difficulty with sensory integration issues: In terms of strengths, individuals with AS The DSM-IV-TR criteria for diagnosis of ŠŠ Motor clumsiness. can have normal or superior intelligence, and Asperger’s disorder (299.80) are similar to that ŠŠ Sensitivity to: they are often able to make great intellectual for autistic disorder except they do not include   Noises. contributions despite severe social problems the communication problem areas seen frequently   Food. such as insensitivity or indifference toward in autistic populations. Official DSM-IV-TR   Clothing. others. Brasic noted that there are case reports criteria include the presence of:   Smell. and studies of men with AS that suggest the A. Qualitative impairment in social interaction, Children with AS often exhibit: ability to accomplish cutting-edge research in as manifested by at least two of the  A limited capacity for empathy. fields such as computer science, mathematics following:  A failure to develop friendships. and physics. Many individuals with AS can and 1. Marked impairment in the use of multiple  A limited number of intense and highly have experienced positive outcomes, especially nonverbal behaviors such as eye-to-eye focused interests. in areas not dependent solely upon social gaze, facial expression, body postures,  Superior rote memory. interaction. Outstanding skills in mathematics and gestures to regulate social interaction. and computer science are sometimes seen in 2. Failure to develop peer relationships appropriate to developmental level. Elite CME Page 1 3. A lack of spontaneous seeking to share autism, the presence of qualitative deficiencies the condition was originally reported only in enjoyment, interests or achievements in reciprocal social interaction and restricted, boys, reports of girls with the syndrome have with other people (e.g., by a lack of repetitive, stereotyped patterns of behavior, now appeared. However, boys are significantly showing, bringing or pointing out objects interests and activities. There may or may not more likely to be affected, and it is estimated that of interest to other people). be problems in communication similar to those boys are four times more likely than girls to have 4. Lack of social or emotional reciprocity. associated with autism, but significant language AS. However, it is also speculated that girls are B. Restricted repetitive and stereotyped patterns retardation would rule out the diagnosis. underdiagnosed. There is no race predilection of behavior, interests and activities as related to the prevalence of AS. It is estimated It includes: manifested by at least one of the following: that over 400,000 families in the United States  Autistic psychopathy. 1. Encompassing preoccupation with one or are affected by AS.  Schizoid disorder of childhood. more stereotyped and restricted pattern There is no evidence that suggests that of interest that is abnormal either in It excludes: individuals with AS have less-than-normal life intensity or focus.  Anakastic (excessive spans. 2. Apparently inflexible adherence to doubt and caution, preoccupied with rules specific, nonfunctional routines or rituals. and organization, perfectionism that leads to Asperger’s syndrome vs. high functioning 3. Stereotyped and repetitive motor failure in task completion, pedantic, rigid and autism (HFA) mannerisms (e.g., hand or finger flapping stubborn). In some circles, AS has been described as high  or twisting, or complex whole-body  Attachment disorders of childhood. functioning autism (HFA). More recent work has  movements).  Obsessive-compulsive disorder. gone into differentiating the two diagnoses. It is  4. Persistent preoccupation with parts of  Schizotypical disorder. believed that in Asperger’s disorder:  objects.  Simple .  Onset is usually later than with HFA.  C. The disturbance causes clinically significant Onset  Outcome is usually more positive, with many impairment in social, occupational or other The apparent onset of the condition, or at least individuals able to function on their own important areas of functioning. its recognition, is probably somewhat later than upon reaching adulthood. D. There is no clinically significant general  classic autism. According to the information  Social and communication deficits are less delay in language (e.g., single words used by provided by the Asperger’s Syndrome Coalition severe than with HFA. age 2, communicative phrases used by age 3).  of the United States, a large number of children  Restricted patterns of interest are generally E. There is no clinically significant delay in are diagnosed after the age of 3, with most more prominent with AS. or in the development  diagnosed between the ages of 5 and 9. The delay  Verbal IQ is usually higher than performance of age-appropriate self-help skills, adaptive in diagnosis has been attributed to the relatively IQ (in most cases of autism, the case is behavior (other than in social interaction) and more preserved language skills and cognitive usually the reverse). curiosity about the environment in childhood.  functioning found in individuals with AS.  Motor clumsiness is more frequently seen in F. Criteria are not met for another specific AS. pervasive developmental disorder or Etiology (pathophysiology)  Neurological disorders are less common. schizophrenia. The pathophysiology of Asperger’s disorder Assessment of Asperger’s syndrome ICD-10 Criteria for Asperger’s syndrome is unknown. At this juncture, the medical community has been unable to agree on the In order to properly assess and diagnose the The following information is reproduced causes of AS, though there is a growing body presence of AS in an individual, the clinician verbatim from the ICD-10 Classification of of evidence (generally though twin and family must complete a detailed history and assessment Mental and Behavioral Disorders, World Health studies) that suggests a strong genetic component. including: Organization, Geneva, 1992. Development history: It is somewhat likely that multiple genetic factors  F84.5 Asperger’s syndrome cause AS. It has been hypothesized that events  Prenatal history.  Maternal health factors. A disorder of uncertain nosological validity, in early development may play a role in the  Beginning from birth an evaluation of: characterized by the same kind of qualitative development of Asperger’s disorder. At present, ŠŠ Social behaviors. abnormalities of reciprocal social interaction it is uncertain whether AS and classic autism are ŠŠ Language. that typify autism, together with a restricted, genetically related. ŠŠ Interests. stereotyped, repetitive repertoire of interests Some studies have linked AS to structural ŠŠ Routines. and activities. The disorder differs from autism abnormalities in the brain, specifically neural ŠŠ Physical coordination (often learning to primarily in that there is no general delay circuits that have an impact on thought and walk a few months later than expected). or retardation in language or in cognitive behavior. A recent study by the University of ŠŠ Sensory sensitivity issues. development. Most individuals are of normal California suggests that AS stems from abnormal Social history: general intelligence, but it is common for changes that happen in the brain during critical  Difficulty with peer relationships. them to be markedly clumsy; the condition stages of fetal development. One study is using  Rejection by other children. occurs predominately in boys (in a ratio of functional magnetic resonance imaging (fMRI) to  Inappropriate attempts to initiate social about eight boys to one girl). It seems highly show how abnormalities in particular areas of the interaction and to make friends. likely that at least some cases represent mild brain cause changes in brain function that result  May not display affection to family members. varieties of autism, but it is uncertain whether in the symptoms of AS and ASDs.  Separations, divorce and other changes may that is so for all. There is a strong tendency for be particularly stressful. the abnormalities to persist into adolescence There is no evidence to suggest that AS is caused  May have difficulty in dating, marriage and and adult life and it seems that they represent by emotional deprivation, maltreatment or intimate relationships. individual characteristics that are not greatly neglect.  May exhibit socially inappropriate behavior. affected by environmental influences. Psychotic Prevalence (epidemiology)  Fails to understand social cues. episodes occasionally occur in early adult life. The incidence of AS has not been well  May not understand why people become Diagnostic guidelines established. Estimates of the prevalence of AS upset when he or she violates social rules and Diagnosis is based on the combination of a lack vary widely in the United States. Studies suggest norms. of any clinically significant general delay in that between two to 36 children out of every Communication issues: language or cognitive development plus, as with 10,000 have this disorder, with four out of every  Use of gestures is frequently limited. 10,000 as the most quoted statistic. Although Page 2 Elite CME  Body language () shower and brush teeth because of sensory collecting facts and figures of little may be awkward and/or inappropriate. issues, such as the water, soap, shampoo practical or social value.  Facial expressions may be absent or at times, or toothpaste do not “feel right.” Hair and ŠŠ Unusual routines or rituals; change is inappropriate. nail cutting may be a major problem for often upsetting.  Problems with language pragmatics (social caregivers. Bauer does not preclude the potential for a more use of language).  Dressing – Often wears the same clothes “normal” life in adults with AS. He indicates  At times may interpret language literally. and shoes for days, weeks or months. Again, that these individuals will often gravitate to  Has difficulty with: sensory issues come into play as they will professions that relate to their own areas of ŠŠ Idioms. complain that their clothes don’t “feel right” interest. ŠŠ Double meanings. after they have been laundered. Others may Gillberg has estimated that between 30 percent ŠŠ Sarcasm. change clothes obsessively, sometimes to 50 percent of all adults with AS are never  Speech and functioning: several times a day. evaluated or correctly diagnosed. ŠŠ Demonstrates several abnormalities in  School work – The adolescent with AS often speech, including: will not realize the importance of school Co-morbidity  Pedantic speech. and related work. Work in groups can cause Persons with AS may be vulnerable to mental  Oddities in pitch, intonation, considerable difficulty for the AS adolescent health problems. Few studies have systematically pronunciation and rhythm. because of his/her communication and addressed these issues, although children with Sensory integration issues: social impairments. Teasing and of developmental disabilities are thought to have  May be sensitive to: the adolescent with AS remains a problem a two-to-six-times-greater risk of experiencing ŠŠ Sound. throughout the school years. co-morbid psychiatric conditions than their ŠŠ Touch.  Eating – Youths with AS may be quite developmentally normal peers. These problems ŠŠ Taste. choosy about their food preferences. This often evidence themselves in adolescence and ŠŠ Sight. also seems to be mainly a result of sensory early adulthood. One research report indicates ŠŠ Smell. integration issues where not only the taste that up to 65 percent of individuals with AS ŠŠ Pain. but also the temperature and texture of the presented with symptoms of one or more ŠŠ Temperature. food become an issue. For others, the issue psychiatric disorders. It is worth noting that Activities assessment: of food selection or rejection may be due symptoms of psychiatric problems, especially  Peculiar and narrow interests. to the individual’s beliefs about the food in mood disorders, can be masked by observed  Interests may be so focused that the question. behaviors of individuals with AS. individual does not develop normal  Sleeping – For reasons that remain uncertain, Individuals with AS can exhibit psychological relationships. many individuals with AS begin having conditions including: Physical issues: problems with sleep during the adolescent  Attention deficit hyperactivity disorder.  Lax joints (exhibited as immature or unusual years.  . grasp). Characteristics of Asperger’s syndrome in  Oppositional defiant disorder.  Clumsiness (though not unique to individuals  Major depressive disorder. with AS). adulthood   Dysthymic disorder.  Odd motor mannerisms such as:  Childhood onset.   with depressed mood. ŠŠ Hand flapping.  Limited social relationships or social  . ŠŠ Awkward body movements. isolation:  Generalized .  Abnormalities of: ŠŠ Few or no sustained relationships;  Obsessive compulsive disorder. ŠŠ Basic skills. relationships that vary from too distant to  issues. ŠŠ Locomotion. too intense. ŠŠ Balance. ŠŠ Awkward interaction with peers. Depression Š ŠŠ Manual dexterity. Š Unusual egocentricity, with little The presence of depressive symptoms in ŠŠ Handwriting. concern for others or awareness of their individuals with AS is fairly common. This ŠŠ Rapid movements. viewpoint; little empathy or sensitivity. depression may be related to the individual’s Š ŠŠ Rhythm. Š Lack of awareness of social rules; social increasing awareness of his disability as he goes ŠŠ of movements. blunders.  through the adolescent and early adult years.  Problems in communication: The inability to form and maintain relationships There are several instruments in use to diagnose ŠŠ An odd voice, monotonous, perhaps at an the presence of AS in individuals. The Adult and engage in meaningful social activities is unusual volume. often at the root of the depression. At times the Asperger’s Assessment (AAA), the Childhood ŠŠ Talking “at” (rather than “to”) others, Asperger’s Syndrome Test (CAST), the individual’s depression may be so severe that he with little concern about their response. begins to experience suicidal thoughts. These Asperger’s Syndrome Diagnostic Scale (ASDS), ŠŠ Superficially good language but too the Gilliam Asperger’s Disorder Scale (GADS), seem to be most frequent in adolescence and formal/stilted/pedantic; difficulty in early adult life. Children with AS may speak of and a variety of autism tests can be used to catching any meaning other than the diagnose the presence of AS. death and suicide, and adolescents with AS may literal. act upon their suicidal thoughts. Gillberg noted Š Characteristics of Asperger’s syndrome in Š Lack of nonverbal communicative that individuals with AS tend to respond well to adolescence behavior: a wooden, impassive the simple suggestion (from a professional) that appearance with few gestures; a poorly It can be difficult to recognize, assess and attempting suicide is not good for them. coordinated gaze that may avoid the diagnose symptoms of AS during the adolescent other’s eyes or look through them. Anxiety years. This may be due in part to the considerable ŠŠ An awkward or odd posture and body Anxiety is also common in individuals with AS. issues that may arise during the language. The inability to handle normal changes in school, adolescent years. Teenagers with AS may have  Absorbing and narrow interests: home and work often exacerbates of major problems with daily life such as: ŠŠ Obsessively pursued interests. anxiety. As with depression, the social demands  Personal hygiene – General refusal to ŠŠ Very circumscribed interests that of adolescence and adulthood may generate manage personal hygiene to socially accepted contribute little to a wider life, e.g. standards. Often refuses to wash, bathe, Elite CME Page 3 extreme levels of anxiety. manner. children. Children with AS often prosper when Obsessive-compulsive disorder  The client should be taught, if possible, to paired with a slightly older teenager who can OCD does appear often to coincide with self-monitor elements of his/her speech for serve as a mentor. Formal training Asperger’s syndrome, with as many as 8 percent volume, rhythm, naturalness, proximity to the can also take place in the classroom as well as in of individuals with AS exhibiting signs of OCD. audience and context. other therapeutic individualized settings.  It is important that the individual with AS be Care must be taken to differentiate between the management narrow interests of a person with AS and the able to evaluate himself so he is able to gain (psychopharmacotherapy) obsessive nature of persons with OCD. awareness of situations that are potentially troublesome. Individuals with AS often Little information regarding pharmacotherapy Substance abuse issues have many cognitive strengths and interests and the AS individual is available. It is It is not uncommon for individuals with AS to that can be used to their advantage in these generally thought that a conservative approach start using and abusing alcohol toward the end of situations. to medication management should be used in adolescence. To some degree, this may be related dealing with AS clients. In general, to normal peer pressure experienced by every Behavior management can be used to deal with comorbid disorders teenager. For others, the process of intoxication Individuals with AS often display a wide range frequently seen with AS: may ease feelings of social discomfort, allowing of problematic behaviors that others often  Depression and OCD-like symptoms such the AS individual to feel more “normal.” Several view as willful and malicious. Far from being as obsessions, compulsions, rituals, and studies have suggested that alcohol abuse rates willful, these behaviors, though challenging, preoccupations: may be extremely high in individuals with AS. As must be viewed in the context of the individual’s ŠŠ SSRIs. with suicide attempts, some individuals with AS disability and treated accordingly. Klin and ŠŠ Tricyclic antidepressants. tend to respond positively to the suggestion that Volkmar suggest that behavior management  Anxiety: they not use alcohol or drugs. strategies include: ŠŠ SSRIs.  Treatment of Asperger’s syndrome  Setting limits that are appropriate, explicit, ŠŠ Tricyclic antidepressants. clear and consistent.  It is thought that the core symptoms of AS cannot  Irritability and :  Helping the individual with AS make Š be cured. However, children and adults with Š Mood stabilizers. appropriate choices. This involves exploring Š AS can benefit from a variety of specialized Š Beta blockers. the full range of choices available to the Š interventions that focus on behavior management, Š Neuroleptics. individual, not just what the person likes or  social skills training and management of  Thought disorders: dislikes. ŠŠ Anti-psychotics. comorbid symptomatology.  Cognitive behavior therapy  Hyperactivity, inattention, and impulsivity: Any treatment program for AS should begin ŠŠ Psychostimulants. Focused and structured cognitive behavioral with a thorough assessment of the individual’s ŠŠ Tricyclic antidepressants. strengths and deficits. After a complete psychotherapy can be useful in dealing with evaluation, a diagnosis can be made and a the symptoms of AS. The cognitive style of Occupational/vocational training and treatment plan developed that focuses on treatment is heavily biased toward addressing therapy (sensory integration training) addressing the needs of the client, while at the and improving verbal functioning and addressing Individuals with AS, particularly those in mid- to same time reducing symptoms of the disorder and and working through real-life problems late adolescence or early adulthood can prosper embracing the client’s individual strengths. experienced by the client. This involves listening from a variety of vocational training strategies: closely to the client, ferreting out issues that  Clients with AS should generally not be Because of the multimodal nature of treatment for are problematic and at times offering advice placed in jobs that require manual labor individuals with AS, it is very important that all to overcome these issues. Although periods because the individual’s lack of motor members of the treatment team are aware of all of distress or transition will be times that the coordination will be a significant factor in job the interventions under way and have the ability person with AS needs cognitive therapy, regular success. to communicate with one another as needed. contact offers the best possible insurance against  Likewise, jobs that require a high degree of Communication and social skills training psychological decompensation. Group cognitive social interaction are probably not advised for Communication and social skills training is sessions (with other AS individuals) may be the individual with AS. central to the treatment of AS. That said, the helpful for older adolescents and adults with  may address strategies practice of communication and social skills does AS. Sessions will often focus on social skills for motor clumsiness including: not imply that individuals with AS will acquire and communication issues. Again, as with other ŠŠ Developing better body awareness and normal communication skills. It does, however, interventions, therapy is not curative in nature, postural security. better prepare the person with AS to deal with the but works toward maximizing the client’s ability ŠŠ Improving tactile discrimination. inherent difficulties with social and interpersonal to function in society. ŠŠ Improving balance. interactions in everyday life. Parent education and training ŠŠ Improving motor planning.  Skills training needs to be conducted in a Š It is very important that parents of children Š Improving fine motor skills. fashion that is explicit, verbal and rote in Š with AS be fully informed about the nature and Š Reducing gravitational insecurity. nature. Both training and repeated exercise Š symptoms of AS. Often, without this knowledge, Š Improving ocular control and visual- are often needed to facilitate long-term parents can easily see the child’s behavior as spatial . retention of the material. willful and malicious. In other cases, parents,  Training cannot rely on instruction that is Prognosis lacking an understanding of the illness, can subtle, uses metaphors, similes, humor, While individuals with AS may be taught excuse the child’s behavior away as due to sarcasm or analogies, because the individual specific skills to compensate for the disorder, intellectual brightness or individual eccentricities. with AS may take these in a it is believed that the underlying impairment is literal sense. Educational considerations lifelong. The prognosis will vary according to  The types of problems frequently experienced AS children seem to do best in highly structured the severity of the disorder and the interventions by individuals with AS respond well to educational environments. In these settings, they used to ameliorate existing symptoms. In general, problem-solving strategies that teach can learn practical problem-solving and social the prognosis for persons with AS is better than identification of these problems and strategies skills as well as continuing with their academic for those who have been diagnosed with classic to deal with them in a socially acceptable coursework. Children with AS often require autism. protection from the teasing and bullying of other Page 4 Elite CME Social situations and personal relationships will behavioral therapy and medication management. 3. One of the earliest indicators of Asperger’s likely be a lifelong challenge. Although social Due to the intelligent nature of many individuals syndrome can be problems with motor difficulties may persist, with the proper care with AS, they tend to respond to a mix of development, including crawling, walking and treatment, many individuals will be able to therapeutic interventions. These multimodal and clumsiness. achieve self-sufficiency as an adult. Individuals interventions should include communication with AS tend to do better in the presence skills training, behavior management, cognitive True False of supportive family members who, while behavioral therapy, parent education and training, encouraging, also have an adequate grasp of the medication management (for certain symptoms) disorder. and occupational/vocational training and therapy 4. As a diagnosis, AS has been known in to address sensory integration issues. Europe since the 1940s when it was Conclusion described by Viennese pediatrician Hans Asperger’s syndrome was first described by The prognosis for AS is generally good if Asperger. Hans Asperger in 1943. His research was largely detected, diagnosed and treated early. Individuals unknown in English-speaking countries until can lead full and productive lives when given True False 1981 after Lorna Wing published a paper on proper care and support.

AS. Since then, interest and research on AS has Bibliography ŠŠDSM-IV – American Psychiatric Association… 5. The American Psychological Association grown steadily. ŠŠAttwood, T. (2006). Motor Clumsiness. Retrieved from http://www.maapservices.org/ MAAP_Sub_Find_It_-_Publications_Tony_Attwood_Clumsiness_Article.htm first recognized the diagnosis of Asperger’s syndrome is a complex, and ŠŠBaker, J.E. (2006). AS or ADHD? Alphabet Soup. Retrieved from http://www.aspennj. Asperger’s syndrome prior to 1978. org/baker2.html often confounding, disorder that often goes ŠŠBauer, S. (2006). Asperger Syndrome. Retrieved from http://www.maapservices.org/ MAAP_Sub_Find_It_-_Publications_Stephen_Bauer_Article.htm undiagnosed or at times is misdiagnosed. When ŠŠBrasic, J. R. (2006, April). Pervasive Developmental Disorder: Asperger Syndrome. True False Retrieved from http://www.emedicine.com/ped/topic147.htm evaluated and diagnosed correctly, the individual ŠŠDeudney, C. (2006). Aspergers Syndrome - Comorbid Issues. Retrieved with AS will show symptoms affecting language, from http://suicideandmentalhealthassociationinternational.org/aspinfo.html ŠŠEhlers, S. & Gillberg C. (1993, November). The Epidemiology of Asperger Syndrome: 6. Asperger’s syndrome is often diagnosed communication skills, thought and social/ A Total Population Study. The Journal of Child Psychology and and Allied Disciplines, Vol. 34, No. 8, pp. 1327-1350, November 1993 in children before the age of 2 or after the emotional behavior. Children with AS often ŠŠFrazier, J, et al. (2002, January). Treating a Child With Asperger’s Disorder and Comorbid Bipolar Disorder. American Journal of Psychiatry, Volume 159, No. 1, pp. age of 15. exhibit a limited capacity for empathy, problems 13-21, January 2002 ŠŠGillberg, C. (2002). A guide to Asperger Syndrome. Cambridge, U.K.: Cambridge developing appropriate friendships and will often University Press True False ŠŠGillberg, C., Gillberg, C., Rastam, M., et al (2001) The Asperger Syndrome (and display a limited number of intense and highly high-functioning autism) Diagnostic Interview (ASDI). A preliminary study of a new focused interests. structured clinical interview. Autism, 5, 57–66. ŠŠGhaziuddin E., Weidmer-Mikhail E. and Ghaziuddin N. (1998) Comorbidity of 7. Males are thought to be four times more Asperger syndrome: a preliminary report. Journal of Research Asperger’s syndrome can be diagnosed only Vol. 42 (4), pp. 279-283. likely to have Asperger’s syndrome than ŠŠKranowitz, C. (1998). The out-of-sync child. Perigree: New York with observation of a variety of impairments ŠŠKlin, A. and Volkmar, F. (1995, June). Asperger’s Syndrome: Guidelines for Treatment females. and Intervention. Retrieved from http://info.med.yale.edu/chldstdy/autism/astreatments. including: qualitative impairment in social html interactions, as well as restricted repetitive and ŠŠLord, R. (2006). Asperger Syndrome. Retrieved from http://www.aspennj.org/lord.html ŠŠMayo Foundation for Medical Education and Research (2006, November). Asperger’s True False stereotyped patterns of behavior, interests, and Syndrome – Causes. Retrieved from http://www.mayoclinic.com/health/aspergers- syndrome/DS00551/DSECTION=3 activities. These symptoms must cause significant ŠŠNational Institute of Neurological Disorders and Stroke. (2006, July). NINDS Asperger 8. Asperger’s syndrome is thought to be impairment in social, occupational or other Syndrome Information Page. Retrieved from http://www.ninds.nih.gov/disorders/ asperger/asperger.htm identical to high functioning autism as important areas of functioning. There must be no ŠŠNemours Foundation (2004, June). Asperger Syndrome. Retrieved from http:// kidshealth.org/parent/medical/brain/asperger.html they are the same disorder. clinically significant general delay in language, ŠŠOzbayrak, R. (2006). What are the differences between Asperger’s Disorder and ‘High Functioning’ (i.e. IQ > 70) Autism? Retrieved from http://www.aspergers.com/aspdiff. cognition or adaptive behavior. htm ŠŠOzbayrak, R. (2006). What are the other psychological problems that can co-exist with True False Asperger’s Disorder? Retrieved from http://www.aspergers.com/aspcomor.htm It is thought that most children with AS are ŠŠOzbayrak, R. (2006). What is the treatment of Asperger’s Disorder? Retrieved from diagnosed between the ages of 3 and 9. Adults http://www.aspergers.com/aspctrt.htm ŠŠVolkmar, F., Klin, A., Schultz, R., Rubin, E., and Bronen, R. (2000, February). Clinical 9. Individuals with Asperger’s syndrome are with AS are often diagnosed at the behest of Case Conference: Asperger’s Disorder. American Journal of Psychiatry, Volume 157, No. 2, pp. 262-267, February 2000 rarely diagnosed with other psychological family members, generally in response to marital, problems such as depression and anxiety. social, occupational or other types of adaptive malfunction. True False The etiology of AS is unknown at this juncture. The medical and psychological community 10. One important aspect of treatment for has been unable to agree on the causes of AS, Asperger’s syndrome is comprehensive though there is evidence suggesting a genetic UNDERSTANDING ASPERGER communication and social skills training. component to the illness. It is also thought that SYNDROME events in early development may play a role in True False the development of AS. Final Examination Questions Choose true or false for questions To properly assess and diagnose the presence of 1 through 10 and then proceed to AS in an individual, the clinician must complete www.elitecme.com to complete your a detailed history and assessment focusing final examination. on elements of developmental history, social history, communication skills, speech/hearing 1. Asperger’s syndrome is one of a series of functioning, sensory integration issues, as well autism spectrum disorders. as numerous physical issues. There are several psychological instruments that can be used in the True False assessment of AS. Persons with AS are particularly vulnerable 2. Children with Asperger’s syndrome to other mental health problems including often exhibit a strong ability to develop depression, anxiety, behavior disorders, ADHD numerous friendships. and thought disorders. These comorbid issues can be addressed in the course of treatment for True False AS and often respond to a mix of cognitive SWTX02UA12 Elite CME Page 5