CHAPTER Extensive vocabulary. persons with AS, and these individuals are often extremely good on rote memory skills such as UNDERSTANDING ASPERGER’S Other autism spectrum disorders include: dates, facts and figures. SYNDROME Classic autism. (2 CE HOURS) Rett syndrome. 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 developmental disorder, not since the 1940s when it was described by a ! List the common signs and symptoms of otherwise specified (usually referred to as Viennese pediatrician, Hans Asperger. 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 communication skills, failed to ! Define the etiology (pathophysiology) of severe intellectual impairments as compared demonstrate empathy for their peer group and Asperger’s syndrome. to individuals with other ASDs. Testing of were physically clumsy. ! List the prevalence (epidemiology) of individuals with AS tends to reveal IQ’s in the Dr. Leo Kanner 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 Lorna Wing increased interest in syndrome. birthday, although some children may display the condition here in the United States. Since ! Describe the prognosis 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 autism spectrum 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 Semantics. Locomotion. and related disorders. The field trials provided Pragmatics. Basic skills (catching, throwing, and kicking). evidence justifying the addition of Asperger’s 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 Eye contact. to activities. by the World Health Organization (1990) and the Facial expression. Lax joints. American Psychiatric Association (1994), the Body posture. Rhythm. main diagnostic criteria was provided by either 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 mood disorders, Socially or emotionally inappropriate including anxiety or depression, 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 Motor clumsiness. can have normal or superior intelligence, and Asperger’s disorder (299.80) are similar to that 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 personality disorder (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 schizophrenia. Onset is usually later than with HFA. C. The disturbance