Asperger syndrome or Asperger’s (AS) – A Pervasive Developmental Disorder

Asperger syndrome is often considered a high functioning form of autism. People with Asperger’s have difficulty communicating and interacting socially, repeat behaviors and are often clumsy. Motor milestones may be delayed.

Causes, incidence and risk factors

The exact cause is unknown. More than likely, an abnormality in the brain is the cause of Asperger syndrome.
There is a possible link to autism, and genetic factors may play a role. The disorder tends to run in families. However, a specific gene has not been identified.

The condition appears to be more common in boys than in girls. Although people with Asperger syndrome often have difficulty socially, many have above‐average intelligence. They may excel in fields such as computer programming and science. There is no delay in their cognitive development, ability to take care of themselves, or curiosity about their environment.

Symptoms

• People with Asperger syndrome become over‐focused or obsessed on a single object or topic, ignoring all others. They want to know everything about this topic, and often talk about little else.
• Children with Asperger syndrome will present many facts about their subject of interest, but there will seem to be no point or conclusion.
• They often do not recognise that the other person has lost interest in the topic.
• Areas of interest may be quite narrow, such as an obsession with train schedules, phone books, a vacuum cleaner or collections of objects.

People with Asperger syndrome do not withdraw from the world in the way that people with autism do. They will often approach other people. However, their problems with speech and language in a social setting often lead to isolation.

• Their body language may be off.
• They may speak in a monotone, and may not respond to other people’s comments or emotions.
• They may not understand sarcasm or humour, or they may take a figure of speech literally.
• They do not recognise the need to change the volume of their voice in different settings.
• They have problems with eye contact, facial expressions, body postures, or gestures (non‐verbal communication).
• They may be singled out by other children as ‘weird’ or ‘strange’.

People with Asperger syndrome have trouble forming relationships with children their own age or other adults, because they:

• Are unable to respond emotionally in normal social interactions.
• Are not flexible about routines or rituals.
• Have difficulty showing, bringing, or pointing out objects of interest to other people.
• Do not express pleasure at other people’s happiness.

Children with Asperger syndrome may show delays in motor development, and unusual physical behaviours, such as:

• Delays in being able to ride a bicycle, catch a ball, or climb play equipment.
• Clumsiness when walking or doing other activities.
• Repetitive behaviours, in which they sometimes injure themselves.
• Repetitive finger flapping, twisting, or whole body movements.

Many children with Asperger syndrome are very active, and may also be diagnosed with attention deficit hyperactivity disorder (ADHD). Anxiety or depression may develop during adolescence and young adulthood. Symptoms of obsessive‐compulsive disorder and a tic disorder such as Tourette syndrome may be seen.

Signs and tests

No standardised test is used to diagnose Asperger syndrome.

Most doctors look for a core group of behaviours to help them diagnose Asperger syndrome. These behaviours include:

• Abnormal eye contact
• Aloofness
• Failure to turn when called by name
• Failure to use gestures to point or show
• Lack of interactive play
• Lack of interest in peers.

Symptoms may be noticeable in the first few months of life. Problems should be obvious by the age of 3 years.
Physical, emotional and cognitive tests are done to rule out other causes and to look more closely for signs of this syndrome. The team that will see a child includes a psychologist, neurologist, psychiatrist, speech therapist and other professionals who are experts in diagnosing children with Asperger syndrome.

Treatment

There is no single best treatment for all children with Asperger syndrome. Most experts feel that the earlier treatment is started, the better.

Programs for children with Asperger syndrome teach skills by building on a series of simple steps, using highly structured activities. Important tasks or points are repeated over time to help reinforce certain behaviours.

Types of programs may include:

• Cognitive behavior or talk therapy, to help children manage their emotions, repetitive behaviours and obsessions.
• Parent training, to teach techniques that can be used at home.
• Physical or occupational therapy, to help with motor skills and sensory problems.
• Social skills training, often taught in a group.
• Speech and language therapy, to help with the skill of everyday conversation.

Medications such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics and stimulants may be used to treat problems such as anxiety, depression and aggression.

Prognosis (expectations)

With treatment, many children and their families can learn to effectively manage Asperger syndrome. Social interaction and personal relationships may still be problematic. However, many adults work successfully in mainstream jobs and are able to have an independent life, if they have the right kind of support available.

Consulting your health care provider

Set up an appointment with your health care provider if your child:

• Does not respond to people
• Has odd or peculiar speech
• Has behavior that may lead to self‐harm.