“Asperger’s Syndrome” was first used by British psychiatrist Lorna Wing when she described individuals she studied at the MRC Social Psychiatry Unit at the Institute of Psychiatry in London, 1981 (Wing, 1981). She noted that the participants in her studies showed symptoms and behaviors similar to what Hans Asperger referred to as autistic psychotherapy in 1944. Asperger’s findings followed research published a year earlier by Leo Kanner who described findings from 11 cases he called autistic disturbances of affective contact (Kanner, 1943). Kanner’s disturbances included developmental problems with motor skills, reluctance in accepting change and association with others, sameness. The clearest difference between Kanner (Autism) and Asperger was the mental retardation that was evident in Autism. Asperger patients showed signs of normal intelligence. In her attempt to differentiate individuals with normal intelligence from Kanner’s autistic mentally retarded patients, she established the diagnoses “Asperger’s Syndrome”.
Autism and Asperger’s Syndrome are the best known of a group of disorders referred to as Pervasive Developmental Disorders (PDD), conditions marked by significant delays in communication skills, social interaction with others and other skills, observable before the age of 3. Although no causes have been confirmed for Asperger’s Syndrome, or cures discovered, specialists attribute them to problems with the brain’s development, neurological impairment. The delays cause disruptions in the development of social, cognitive and communication abilities (Klin, 2006).
Since 1981 there has been considerable research attempting to officially establish Asperger’s Syndrome as a disorder separate from Autism. In 1993, the World Health Organization classified Asperger’s Syndrome in their official publication, The ICD–10 classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (WHO, 1993). A year following, AS was similarly defined by the American Psychiatric Association in the latest edition (1994) of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The DSM-IV is considered the official establishment of Asperger’s Syndrome since it followed an internationally based study of more than 1,000 children and adolescents with autism and other pervasive developmental disorders. They found enough evidence of differences needed to establish Asperger’s as a separate syndrome from other known disorders (Volkmar, et al., 1994).
The symptoms noted by the American Psychiatric Association in their 1994 DSM-IV include the following factors. The DSM-IV states that to be diagnosed with AS that a child should be effected by at least one or two of these characteristics, not all of them. They break these into two groups: The first group includes: (1) difficulty in eye contact and expressions with others and a lack of ability to read and understand body language; (2) not being able to develop friendships with their peers on the order or level expected for their age group; (3) not sharing with their peers what they are thinking or what they wish to do; (4) empathizing with their peers how they feel about one another or relating to them in the norm of other kids their age. The second set of criteria fall under strong concentration on particular interests and activities. These interests are confirmed by at least one of these symptoms (1) Intense and obsessive levels of
Concentration on routines and behavioral patterns (2) Inability to change repetitive play (3) excessive body movements (4) compulsivity with particular objects.
The two most common and observable characteristics of children with AS, is their inability to establish friendships with other children and their all-encompassing focus on particular hobbies. AS children highly value friendship and want to have friends but have an apparent inability to be successfully and socially interactive with their peers and other children. This impairment in their social interactive abilities prevents them from being able to empathize with or clearly understand the emotions and intentions of other children. AS limits their ability to recognize when other children react negatively or when they show reluctance to accept what the AS child wants to do. Negative responses from other children are perceived by AS children as aggressive and argumentative producing equally but misunderstood responses including possible name calling, increased volume in speaking and at times physical retaliation for what they perceive as an aggressive reply to their friendly gesture. These reactions are also common when AS children feel they are being bullied by other children and/or adults (including siblings and parents) or when they are accidentally hurt by others or teased by them.
This apparent anti-social characteristic becomes exacerbated by their all-encompassing interest in specific hobbies, which may or not be of interest to peers they reach out to for friendship. These interests could be as specific as only wanting to play with trains, Lincoln Logs, Lego’s, toy cars or particular video games. Lorna Wing suggests that AS children will seek out as much information they can about their chosen fixation, one of which she mentions being the history of the steam engine (Wing, 1981). These interests are overbearing in nature and can continue for years. Combining the AS child’s limits on what they are willing to do during playtime combined with their impairments to understand social cues creates situations that are not likely to be successful due to the extraordinary lack of flexibility from the outset. Either the other child accepts what the AS child wants to do, or there is no friendship possible. These overbearing and limited interests are not just for playtime but also can be noted in eating habits, color coordination in clothing, acceptance of certain smells or colors of food. These interests can also be ideologies they have heard or learned in environments that they take elsewhere. Due to continuous negative responses from their peers, AS children are prone to develop reactions that include levels of anxiety and depression.
Complications in Diagnoses
Since Asperger’s Syndrome has symptoms and characteristics that are common in Autism, it raises the question if AS can be misdiagnosed. Pervasive Developmental Disorders include other diagnoses that need to be considered to confirm if the diagnosis is correct. The concern for complications is also noted because the onset of symptoms for Asperger’s Syndrome is not as quickly observed as they are in Autism. Is it therefore possible that a child can be diagnosed first with Autism and then Asperger’s and if yes, is it therefore possible that if you were to wait several more years that the child’s diagnoses will once again change? (Gillberg C. , 1989)
Other disorders and their shared similarities with Asperger’s Syndrome include:
Pervasive developmental disordernot otherwise specified (PDD NOS): “asevere and pervasive impairment in the development of reciprocalsocial interaction or verbal and non-verbal communication skillsor when stereotyped behaviour, interests and activities arepresent”. (APA, 1994)
Childhood disintegrative disorder: loss of motor skills. (APA, 2000)
Rettdisorder: loss of social skills and motor clumsiness.
Schizophrenia spectrum disorders
Schizophrenia: abnormalities in understanding how other people think, difficulty understanding social norms and behaviors, saying thoughts out loud. (APA, 1994)
Schizoid personality disorder: “Asperger syndrome and schizoid/schizotypaldisorders as interchangeable terms that identify roughly thesame group of children” (Wolff, 1998)
Adult attention-deficithyperactivity disorder: “children who meetcriteria for ADHD may also meet the full criteria for Aspergersyndrome. They mention one study, in which 21% of children withsevere ADHD met the full criteria for Asperger syndrome and36% showed autistic traits.” (Fitzgerald & Corvin, 2001)
Obsessive–compulsive disorder: “repetitive activities” (Baron-Cohen, 1989)
Depression: due to ineffective attempts at social interactive relationships, feelings of depression and anxiety occur. These responses create symptoms of withdraw from situations and people around them. (Fitzgerald & Corvin, 2001)
Semantic pragmatic disorder: “near-normal vocabulary, grammar, and phonology,but language use is abnormal in content and function and comprehensionis also impaired. There are considerable difficulties in initiatingor sustaining a conversation, making cohesive links in conversationfrom topic to topic, and words are used out of context” (Szatmari, 1998)
Deficitsin attention, motor control and perception: impairment in attention. Motor skills and perception. (Gillberg, Rasmussen, & Carlstrom, 1982)
Multidimensionallyimpaired disorder (MID): impairment in interpersonal skills. (Kumra, Jacobsen, & Lenane, 1998)
Dyslogia: “inability to apply logic and common sense in decision-making.Individuals with this difficulty make decisions based on partialfacts and have difficulty in integrating data into a workingwhole; they have social difficulties similar to those of individualswith Asperger syndrome.” (Jordan, 1972)
Developmental learning disability of theright hemisphere (social–emotional learning disorder: “difficulty understandingsocial and emotional information” (Denckla, 1983)
Non-verballearning disability: “deficits in perception, coordination, socialisation, non-verbalproblem-solving and understanding of humour, but well-developedrote memory.” (Myklebust, 1975)
In a 2005 web article by British psychiatrist and clinical researcher Dr. Tony Atwood, he stated (Atwood, 2005):
“From my clinical experience I consider that children and adults with Asperger’s Syndrome have a different, not defective, way of thinking. The person usually has a strong desire to seek knowledge, truth and perfection with a different set of priorities than would be expected with other people. There is also a different perception of situations and sensory experiences. The overriding priority may be to solve a problem rather than satisfy the social or emotional needs of others. The person values being creative rather than co-operative. The person with Asperger’s syndrome may perceive errors that are not apparent to others, giving considerable attention to detail, rather than noticing the ‘big picture’. The person is usually renowned for being direct, speaking their mind and being honest and determined and having a strong sense of social justice. The person may actively seek and enjoy solitude, be a loyal friend and have a distinct sense of humour. However, the person with Asperger’s Syndrome can have difficulty with the management and expression of emotions. Children and adults with Asperger’s syndrome may have levels of anxiety, sadness or anger that indicate a secondary mood disorder. There may also be problems expressing the degree of love and affection expected by others. Fortunately, we now have successful psychological treatment programs to help manage and express emotions.”
APA. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC.: American Psychiatric Association.
APA. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Atwood, T. (2005). What is Asperger Syndrome. Retrieved from Aspergers Syndrome: http://aspergersyndrome.org/Articles/What-is-Asperger-Syndrome-.aspx
Baron-Cohen, S. (1989). Do autistic children have obsessions and compulsions? British Journal of Clinical Psychology, 28, 193-200.
Denckla, M. (1983). The neuropsychology of social-emotional learning disabilities. Archives of Neurology(40), 461-462.
Fitzgerald, M., & Corvin, A. (2001). Diagnosis and differential diagnosis of Asperger syndrome. Retrieved from http://apt.rcpsych.org/cgi/content/full/7/4/310
Gillberg, C. (1989). Asperger syndrome in 23 Swedish children. Developmental Medicine and Child Neurology(31), 520-531.
Gillberg, C., & Billstedt, E. (2000). Autism and Asperger syndrome: coexistence with other clinical disorders, (pp. 321-300).
Gillberg, C., Rasmussen, T., & Carlstrom, G. (1982). Perceptual, motor and attentional deficits in 6 year old children. Epidemiological aspects., (pp. 131-144).
Gillberg, C., Rasmussen, T., & Ehlers, S. (1998). In E. Schoplar, G. Mesibov, & L. J. Kunce (Ed.), High functioning people with autism and Asperger’s syndrome (pp. 77-100). New York: Plenum.
Jordan, D. (1972). Dyslexia in the Classroom. Columbus: Merril.
Kanner, L. (1943). Autistic disturbances of affective contact. Nerv Child. Nerv Child, 2:217-50.
Klin, A. (2006). Autism and Asperger syndrome: an overview. Retrieved 2006, from Rev Bras Psiquiatr 28: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&Ing=en&nrm=iso&tlng=en
Kumra, S., Jacobsen, L. K., & Lenane, M. (1998). Multidimensionally impaired disorder: is it a variant of very early-onset schizophrenia? Journal of the American Academy of Child and Adolescent Psychiatry(37), 91-99.
Matila, M., Kielinen, M., & Jussila, K. (2007). An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria. Journal of the Amereican Academy of Child and Adolescent Psychiatry, 46(5), 636-46.
Myklebust, H. (1975). Non-verbal learning disabilities: Assessment and intervention. In H. R. Myklebust (Ed.), Progress in Learning Disabilities. New York, NY: Grune and Stratton.
Szatmari, P. (1998). Differential diagnosis of Asperger’s disorder. In E. Schoplar, G. Mesibov, & L. Kunce (Eds.), Is Asperger’s Syndrome or High Functioning Autism? (p. 71). New York.
Volkmar, F. R., Klin, A., Siegel, B., Szatmari, P., Lord, C., Campbell, M., et al. (1994). DSM-IV Autism/Pervasive Developmental Disorder Field Trial. Journal of Psychiatry(151), 1361-1367.
WHO. (1993). The IDC-10 classification of Mental and Behavioural Disorders: Diagnostic Critera for Research. World Health Organization. Geneva: World Health Organization.
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Wolff, S. (1998). Schizoid personality in childhood: the links with Asperger’s syndrome, schizophrenia spectrum disorders, and elective mutism. In E. Schopler, G. Mesibov, & L. Kunce (Eds.), Asperger’s Syndrome or High Functioning Autism (pp. 123-145). New York: Plenum.
- What is the Difference Between Autism and PDD? (brighthub.com)
- The Diagnostic Criteria for Asperger’s Syndrome (brighthub.com)
- Diagnosis and differential diagnosis of Asperger syndrome — Fitzgerald and Corvin 7 (4): 310 — Advances in Psychiatric Treatment (apt.rcpsych.org)
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