What is asperger?

Asperger disorder (AD), also known as asperger syndrome (AS) or asperger is an autism disorder that is typically characterized by difficulties in nonverbal communication and social interaction along with repetitive and restrictive patterns of behavior. Asperger syndrome is different to other autism spectrum disorders because of the preservation of cognitive development and linguistics. Physical clumsiness and unusual use of language are often observed. It was 1st noted in 1944 by the Austrian pediatrician Hans Asperger who noticed children that lacked nonverbal communication skills and showed little empathy and were physically clumsy. Most individuals show improvement as they mature despite social and communication difficulties persisting. ASD begins in infancy or childhood, it has a continuous course without any remissions or relapses and shows

impairments that are a result from maturation related change in different systems of the brain. ASD is a subset of the autism phenotype that describes individuals that may not have ASD but that have autistic similar trait like social deficits. Of the 4 ASD forms, autism is the one most similar to asperger in symptoms and possible causes. Its diagnosis though requires impaired communication and permits delay in cognitive development. Childhood disintegrative disorder and Rett syndrome share signs with autism but can have unrelated causes and PDD-NOS or pervasive developmental disorder not otherwise specified is diagnosed when criteria for a specific disorder are not met.

What is the cause of asperger syndrome?

The causes are yet still unknown although there is growing evidence towards genetics. There is some evidence for it running in the family and it is observed to be with family members that display behavioral symptoms like AS but in a milder form like with difficulties in social interaction, reading or language. Brain imaging techniques are yet to show a conclusive common pathology. There has been many hypothesizes involving environmental factors but there still is no solid prove.

Aspergers symptoms

This pervasive developmental disorder is distinguished by the pattern of symptoms rather than 1 single symptom. It is characterized by the quality of impairment in social interactions and by restricted patterns behavior, interests and activities and by no clinical significant delay in the cognitive development or delay in language. There is also focused preoccupation with a specific topic or subject, physical clumsiness,

restricted prosody and one sided verbosity are normal but not required for the diagnosis.

Aspergers and social interaction

There is a definitive lack of empathy and individuals with asperger syndrome have difficulties in basic social interaction that cause problems creating friendships or to share enjoyment with others like showing others objects of interest, a strong lack of emotional and social reciprocity and nonverbal behaviors that are impaired like eye contact, posture and facial expression.

People with aspergers may be less introverted around others as opposed to people with more debilitating forms of autism, and even if awkwardly, will approach others. An individual with AS may engage in a one sided talk about a topic while not understanding the listeners wish to change topic or end the conversation. This is not always the case where some AS people may only want to talk to some selective people for example or even not to anyone.

Restricted and repetitive behaviors

People with AS show behavior, activities and interests that are restricted as well as repetitive and are at times intense and focused. At times showing an unwillingness to change routines, they become repetitive and preoccupied with specific subjects which is the most striking features of people with AS that may collect extensive data on a particular subject like names of historical people or models of cars without not necessarily understanding the full topic. This is more pronounced in 5-6 year olds.

Communication

People with asperger syndrome can go onto acquiring language skills without any delays and the speech lacks any obvious abnormalities although language acquisition and its use can be described as atypical. Abnormalities like abrupt transitions, verbosity, miscomprehension of nuance and literal interpretations, the use of metaphors that is only meaningful to the speaker, unusual pedantic, formal or idiosyncratic talk, perception deficits and unusual loudness, prosody, pitch and rhythm. Echolalia has also been observed.

Three areas of patterns in communication are noted. Poor prosody, tangential and circumstantial speech and marked verbosity. Inflection and intonation can be less rigid than in classic autism, AS people often have a limited range of intonation so that speech can be jerky, fast or even loud. Speech has a sense of incoherence; the conversations become a monologue with topics that bore the listener. AS people will fail to understand if the listener is interested in the conversation.

Despite an advanced sophisticated vocabulary at young ages, children find difficulties understanding the finer points of figurative language and use the language literally. Children with AS show weakness in non literal language that has humor, teasing, irony and sarcasm. It is noted though that individuals with AS understand the cognitive points of humor, although lacking understanding of the intention of humor to be shared with others. This is at times a controversial point as some anecdotal reports of humor in people with AS, at times challenges some theories.

Sensory and motor perception

Asperger syndrome sometimes shows signs or symptoms that are independent of the diagnosis and include differences in perception and difficulties with motor skills, emotions and sleep.

Persons with asperger frequently have above average visual and auditory perception. Children with asperger will often notice small changes in patterns like arrangements of objects. Also they may be too sensitive or under sensitive to stimuli like sound and light. There is an indication of lower responsiveness to stimuli although other studies show otherwise. Basic motor skills like riding a bicycle and other tasks involving motor dexterity are often delayed. Signs that often show are poor coordination, odd posture, poor handwriting or difficulties with visual motor integration. There may also be signs of problems with tandem gait, balance and finger thumb apposition. Little indicates that these problems differentiate people with asperger from other high functioning ASDs. Individuals with asperger may also have trouble with sleep and falling asleep, sleep very lightly and are prone to waking up during the night. They also have difficulties expressing their emotions (alexithymia).

Treating asperger syndrome

Most professionals agree that early intervention is more beneficiary and that the ideal treatment for AS address the basics problems that include obsessive or repetitive patters and poor communication skills. Treatment is similar to that of high functioning ASDs but takes into account the verbal strengths and non verbal vulnerabilities of language. A common approach to treatment involves:

- Applied behavior analysis (ABA) technique that is for social skills training for effective interpersonal interactions.

- Cognitive behavior treatment to better the stress management in relation to emotions and anxiety and to lower repetitive routines and obsessive interests.

- Medication for conditions that coexist like anxiety disorder and depressive disorder.

- Physical or occupational therapy to help with weak motor coordination and sensory processing.

- Specialized speech therapy focusing on the pragmatics of give and take of normal conversation.

- Positive behavior support that includes support and training of the primary care givers and school faculty in the behavior management strategies to apply at home and school.

Medication for asperger syndrome

There is no medication that directly treats the symptoms of AS. Despite the effectiveness of medical treatment being limited, it is found to be essential in the treatment of comorbid conditions. The lack of understanding of people with AS to see why the medication may help due to deficits in self identifying emotions is normal. In conjunction with environmental accommodations and behavioral intervention, medication can be effective in treating comorbid symptoms like major depressive disorder and anxiety disorder, aggression and inattention. Olanzapine and risperidone that are atypical antipsychotic medication have shown to lower the symptoms of AS. Great care and professional supervision is important as the side effects can be common and harder to ascertain in individuals with AS. Further concerns with the use of medication include increased risk of type 2 diabetes, cardiac conduction times and abnormalities in metabolism as well as long term neurological side effects. It is also

noted that SSRIs can further lead to higher impulsivity, sleep disturbances and aggression. Side effects of risperidone can also be fatigue, weight gain, increased risk for extrapyramidal symptoms like dystonia, restlessness and higher serum prolactin levels. Weight gain and sedation are more frequent with olanzapine that is also linked to diabetes. Sedative effects will show ramifications for learning in school for children with aspergers.

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