Asperger's Syndrome (Asperger Syndrome, Asperger Disorder)

What is Asperger's Syndrome (AD)?

  • Asperger's syndrome, also known as Asperger disorder, Asperger syndrome, or AS, was formerly felt to be a distinct disorder related to autism, one of the pervasive developmental disorders (a spectrum of behavioral disorders including autism).
  • Asperger's syndrome was characterized as one of the autism spectrum disorders (which also include autistic disorder, Rett disorder, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specified [PDD-NOS]). In the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published in May 2013, Asperger's syndrome and autistic disorder have been combined into one condition for diagnostic purposes, known as autism spectrum disorder. However, many experts still believe that Asperger's syndrome should be preserved as a separate diagnostic entity to represent a condition related to, but not the same as, autism.
  • Unlike persons with autistic disorder, those with Asperger's syndrome do not show a marked delay in language development or cognitive development.
  • Asperger's syndrome is commonly recognized in children after the age of 3 years and is more frequently diagnosed in boys.
  • Individuals with Asperger's syndrome have serious impairments in their social and communication skills, including poor nonverbal communication.
  • However, many individuals have good cognitive and verbal skills, and those with Asperger's syndrome typically have normal to superior intelligence.
  • Many have excellent rote memory and become intensely interested in one or two subjects.
  • Children with Asperger's syndrome are typically educated in the mainstream setting but sometimes require education accommodations or special education services.
  • These children often have difficulty making friends and are often ostracized, teased, or bullied by their peers.
  • Asperger's syndrome is named for Dr. Hans Asperger, an Austrian pediatrician, who first described the condition in 1944.
  • The condition was first recognized as a diagnostic entity by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) in 1994 but was combined with autistic disorder in the DSM-V issued in 2013.

Asperger's Syndrome Causes

The cause of Asperger's syndrome is unknown. A genetic component to this syndrome is likely, given that the condition has been observed to run in families. It is also likely that environmental influences play a role. Although there remain concerns among some families that vaccines and/or the preservatives in vaccines may play a role in the development of Asperger's syndrome and other autism spectrum disorders, experts have discredited this theory.

Asperger's syndrome is much more common in boys than in girls. In fact, it is 5 times more common in boys. The number of children diagnosed with autism spectrum disorders is increasing in the U.S. Recent studies show that approximately 1 out of every 110 children has an autism spectrum disorder. It is not entirely clear whether the increase in the number of children is due to improvements and modifications in the diagnostic process and/or some degree of true increase in the incidence of the disorders themselves. Both factors likely are involved.

Asperger's Syndrome Symptoms

An individual's symptoms and level of functioning can range from mild to severe. An individual may have all or only some of the described characteristics. They may exhibit more problems in unstructured social settings or new situations that involve social problem-solving skills.

Social problems

  • Although these children may express an interest in friendships, they have difficulty in making and keeping friends and may be rejected by peers; often these children are loving and affectionate with their immediate family
  • Socially inappropriate behavior for their age
  • Lack of understanding of age appropriate social cues including gestures and nonverbal communication
  • Difficulty judging personal space
  • Difficulty understanding others' feelings or showing empathy
  • Rigid social behavior due to an inability to spontaneously adapt to variations in social situations

Abnormal communication patterns

  • Awkward or inappropriate body language, including limited use of gestures and absent or inappropriate facial expressions
  • Unusual, formal style of speaking
  • Difficulty understanding nonliteral and implied communication
  • Impairments in the modulation of volume, intonation, inflection, rate, and rhythm of speech
  • Speech may be tangential (consisting of unconnected topics) and circumstantial (giving significantly excessive detail about a topic), often including irrelevant comments
  • Conversation style characterized by marked wordiness
  • Difficulty with "give and take" of conversation
  • Lack of sensitivity about interrupting others

Activities

  • Intense interest in a particular, often very restricted, or immature subject that dominates the individual's attention
  • Inflexible adherence to routines; has repetitive routines or rituals
  • Apprehensive about change, may have difficulty transitioning from one activity to another

Sensory sensitivity in some individuals with Asperger's syndrome

  • Excessive sensitivity to sound, touch, taste, light, sight, smell, pain, and/or temperature
  • Excessive sensitivity to the texture of foods

Motor skill delays in some individuals with Asperger's syndrome

  • History of delayed development of motor skills
  • Visible clumsiness and poor coordination
  • Deficits in visual-motor and visual-perceptual skills, including problems with balance, manual dexterity, handwriting, rapid movements, rhythm, and imitation of movements

People with Asperger's syndrome can have other associated psychiatric conditions or may show behaviors that are typical for other conditions. Some common associated conditions include the following (but these are not always present in everyone with Asperger's):

Asperger's Syndrome Signs and Symptoms

People with Asperger's syndrome typically have trouble with certain social skills involved in making and sustaining relationships and friendships.

Asperger's syndrome can be characterized by an unusual, formal style of speaking that lacks appropriate intonation or gestures. People with this disorder can speak at length and be very wordy about topics that hold their interest, yet they may not be able to participate in the give and take of a normal conversation. Those with Asperger's syndrome often attempt to "hijack" the conversation and may go off on tangents that are not related to the topic being discussed. They may interrupt conversations and appear to be insensitive to what others are saying.

When to Seek Medical Care for Asperger's

An individual should seek medical care to begin a comprehensive diagnostic assessment when problems with motor skills become apparent; or when problems with behaviors, social skills, and interaction begin in a preschool-aged or early school-aged child; or when the diagnosis of Asperger's syndrome is suspected in the course of a pediatric or other health care visit. Medical care is also indicated when psychopharmacologic treatment is considered for the management of problematic behaviors or symptoms associated with Asperger's syndrome.

Asperger's Syndrome Diagnosis

An interdisciplinary team is generally required for a comprehensive clinical assessment. This comprehensive evaluation should include a psychological assessment (including, at a minimum, intellectual and adaptive functioning), a communication evaluation (particularly focused on nonverbal forms of communication), and a neurological, psychiatric, and medical evaluation. Intellectual (IQ) testing may be of specific help, since verbal IQ scores are often significantly higher than performance IQ scores for children with Asperger's syndrome.

Asperger's Syndrome Treatment

Treatment for Asperger's syndrome may include

  • educational,
  • career, or
  • vocational support and
  • interventions.

Behavioral, social, and family support are the primary treatments. Medications may be used to treat behavioral symptoms that often occur with Asperger's syndrome.

Asperger's Syndrome Medical Treatment

No specific treatment for the core symptoms of Asperger's syndrome is available and no cure exists for the disorder. Educational, career, or vocational support, as well as behavioral, social, and family support are the primary treatments used for individuals with Asperger's syndrome. Psychopharmacology and other treatments may also be used to manage some of the problem behaviors associated with Asperger's syndrome or some of the associated psychiatric conditions (see above), if present.

Asperger's Syndrome Medications

No specific medications are used to treat Asperger's syndrome itself. However, medications may be used to treat specific behavioral symptoms associated with Asperger's syndrome, especially when they cause the individual distress or significantly interfere with educational, career/vocational, or social functioning. These behavioral symptoms may include anxiety, attention problems, aggression, behavioral rigidity, mood disorders (particularly depression), and stereotypical patterns (constant repetition of certain meaningless gestures or movement) or perseveration (constant repetition of meaningless words or phrases).

Other Therapy for Asperger's Syndrome

  • Educational, career, and/or vocational support, as well as behavioral support are the primary interventions for individuals with Asperger's syndrome and their caregivers. These interventions need to be individualized to address each person's unique strengths and challenges.
  • Individuals with Asperger's syndrome may benefit from formal social skills training; ideally provided in a group setting with peers.
  • Participation in organized, supervised, and structured activities may provide these children with opportunities for social interaction and facilitation of social relationships.
  • Supportive psychotherapy may be beneficial in dealing with frustration, depression, and anxiety. A direct, problem-solving focus is generally more successful than an insight-oriented approach.
  • Specific behavioral interventions may need to be implemented to reduce problematic or disruptive behaviors, such as perseverations, odd behaviors, and tantrums.
  • Interventions in school settings including the following:
    • Parents and teachers have the opportunity to help individuals with Asperger's syndrome develop appropriate social behavior. Teachers can model appropriate social behavior and encourage cooperative games in the classroom. They may also be able to identify suitable friends for children with Asperger's syndrome. Parents can also help children learn appropriate behaviors by modeling skills such as appropriate emotional responses, flexibility, sharing, and cooperation. The strategies used by teachers, therapists, and parents should be coordinated so that they are implemented consistently by various people across different settings.
    • Children with Asperger's syndrome may benefit from one-on-one attention in the classroom to receive modeling and coaching of appropriate behavior. Skills, concepts, and cognitive strategies should be taught in an explicit and rote fashion.
    • In addition to academic goals, improvement in independent functioning and self-sufficiency should be a priority. A program should focus on enhancing communication and social competence.
    • Accommodations may need to be implemented for difficulties with graphomotor skills (writing).
    • Self-advocacy skills training should be included in the educational program.
  • Communication and language strategies including:
    • Speech/language therapy that addresses the ambiguous use of language and the use of language in social settings can be of great value.
    • The learning and practice of communication and social skills by children with Asperger's syndrome does not imply the eventual spontaneous implementation of these skills in natural settings.
    • Children can be taught specific problem-solving strategies or to memorize specific phrases to use in specific, frequently occurring situations.
    • Specific and explicit instructions and training on how to interpret other people's social behavior should be provided and practiced. Similar principles guide the training of the individual's expressive skills.
    • Children should learn to ask people to rephrase confusing expressions. They should also be encouraged to ask that confusing instructions be repeated, simplified, and/or written down.
    • Parents, teachers, and peers can teach children to interpret conversational cues of others; to reply to and discuss topics initiated by others; when and how to interrupt; or how to change or shift topics.
    • Role playing may help children become aware of the perspectives and thoughts of other people.

Asperger's Syndrome Prognosis

Individuals with Asperger's syndrome have a higher level of functioning and a better outlook than those with other forms of autism spectrum disorders. Although their underlying social impairments are believed to be lifelong, some improvement in functioning often occurs through maturational processes.

Individuals with Asperger's syndrome have an increased risk of mood disorders such as depression or anxiety.

Those with supportive families who are knowledgeable about the condition tend to have a better prognosis.

Many experts stress the particular gifts and positive aspects of Asperger's syndrome and consider it to represent an alternative, but not necessarily defective, way of thinking. Positive characteristics of people with Asperger's syndrome are undoubtedly of benefit in many professions and include the increased ability to focus on details and concentrate for long periods; the capacity to persevere in specific interests without being swayed by others' opinions; the ability to work independently; the recognition of patterns that may be missed by others; a unique level of intensity; and an original way of thinking. Individuals with special skills, abilities, or interests relevant to paid employment typically have a more positive outcome. Parents and teachers of individuals with Asperger's syndrome should creatively help them to uncover talents and skills.

Reviewed on 11/20/2017

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-V Fifth Edition. Washington, D.C.: American Psychiatric Association, 2013.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. Arlington: American Psychiatric Association, 2000.

Centers for Disease Control and Prevention. "How Many Children Have Autism?" 2 Feb. 2012.
<http://www.cdc.gov/ncbddd/features/counting-autism.html>

Landrigan, Phil J. "What causes autism? Exploring the environmental contribution." Current Opinion in Pediatrics 22.2 (2010): 219-225.

Macintosh, K. E. and C. Dissanayake. "Annotation: The similarities and differences between autistic disorder and Asperger's disorder: a review of the empirical evidence." Journal of Child Psychology and Psychiatry, and Allied Disciplines 45.3 (2004): 421-434.

Mattila, Marja-Leena, et al. "Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study." Journal of the American Academy of Child and Adolescent Psychiatry 50.6 (2011): 583-592.

Sugarman, S. D. "Cases in vaccine court-legal battles over vaccines and autism." New England Journal of Medicine 357.13 (2007): 1275-1277.

Attwood, Tony. The Complete Guide to Asperger's Syndrome. Philadelphia: Jessica Kingsley Publishers, 2006.

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