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Asperger syndrome

Asperger syndrome is often considered a high functioning form of autism. It can lead to difficulty interacting socially, repeat behaviors, and clumsiness.

Alternative Names

Pervasive developmental disorder - Asperger syndrome; Autistic spectrum disorder - Asperger

Causes, incidence, and risk factors

Hans Asperger labeled this disorder "autistic psychopathy" in 1944. The exact cause is unknown. More than likely, an abnormality in the brain is the cause of Asperger syndrome.

Genetic factors may play a role, since the disorder tends to run in families. A specific gene has not been identified.

Asperger syndrome is a pervasive developmental disorder (PDD) or autism spectrum disorder (ASD). The main difference between Asperger syndrome and autistic disorder is that children with Asperger syndrome do not have speech or cognitive delays.

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 recognize 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 do not withdraw from the world in the way that people with an autistic disorder 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 unusual.
  • They may speak in a monotone, and may not respond to other people's comments or emotions.
  • They may not understand sarcasm or humor, or they may take a figure of speech literally.
  • They do not recognize the need to change the volume of their voice in different settings.
  • They have problems with eye contact, facial expressions, body postures, or gestures (nonverbal 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 behaviors, 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 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

A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no physical test for Asperger syndrome, the diagnosis will often be based on very specific criteria from a certain medical handbook.

Most doctors look for a core group of behaviors to help them diagnose Asperger syndrome. These behaviors 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 age 3 years.

Physical, emotional, and mental tests are done to rule out other causes and look more closely for signs of this syndrome. The team that will see your child may include 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 behaviors.

Types of programs may include:

  • Cognitive behavior or talk therapy, to help children manage their emotions, repetitive behaviors, 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, problems with paying attention, and aggression.

Expectations (prognosis)

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

Calling your health care provider

Call for 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

References

Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 69.

Raviola G, Gosselin GJ, Walter HJ, DeMaso DR. Pervasive developmental disorders and childhood psychosis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed.Philadelphia, Pa: Saunders Elsevier; 2011:chap 28.

Updated: 5/16/2012

Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital. Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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