What is Asperger's Syndrome?
Asperger's Disorder is a milder variant of Autistic Disorder. Both Asperger's Disorder and Autistic Disorder are in fact subgroups of a larger diagnostic category. This larger category is called either Autistic Spectrum Disorders, mostly in European countries, or Pervasive Developmental Disorders ("PDD"), in the United States. In Asperger's Disorder, affected individuals are characterized by social isolation and eccentric behavior in childhood. There are impairments in two-sided social interaction and non-verbal communication. Though grammatical, their speech may sound peculiar due to abnormalities of inflection and a repetitive pattern. Clumsiness may be prominent both in their articulation and gross motor behavior. They usually have a circumscribed area of interest which usually leaves no space for more age appropriate, common interests. Some examples are cars, trains, French Literature, door knobs, hinges, cappucino, meteorology, astronomy or history. The name "Asperger" comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.What are the diagnostic criteria of Asperger's Disorder?
DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER
A.Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity
B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects
C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D.There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
E.There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
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GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER
1.Severe impairment in reciprocal social interaction (at least two of the following)
(a) inability to interact with peers
(b) lack of desire to interact with peers
(c) lack of appreciation of social cues
(d) socially and emotionally inappropriate behavior
2.All-absorbing narrow interest (at least one of the following)
(a) exclusion of other activities
(b) repetitive adherence
(c) more rote than meaning
3.Imposition of routines and interests (at least one of the following)
(a) on self, in aspects of life
(b) on others
4.Speech and language problems (at least three of the following)
(a) delayed development
(b) superficially perfect expressive language
(c) formal, pedantic language
(d) odd prosody, peculiar voice characteristics
(e) impairment of comprehension including misinterpretations of literal/implied meanings
5.Non-verbal communication problems (at least one of the following)
(a) limited use of gestures
(b) clumsy/gauche body language
(c) limited facial expression
(d) inappropriate expression
(e) peculiar, stiff gaze
6.Motor clumsiness: poor performance on neurodevelopmental examination (All six criteria must be met for confirmation of diagnosis.)
What are the other psychological problems that can co-exist with Asperger's Disorder?
Asperger's Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:
Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)
Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
Bipolar Disorder
Generalized Anxiety Disorder
Obsessive Compulsive Disorder
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Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder presents with difficulty in focusing (inattention), hyperactivity and impulsiveness.
Almost 60-70 % of children with Pervasive Developmental Disorders ( = PDD or Autistic Spectrum Disorders) have severe enough inattention, hyperactivity and impulsiveness to meet the diagnostic criteria for ADHD. Technically, if a child is diagnosed with any of the PDD diagnoses (Autistic Disorder, Asperger's Disorder, PDD-NOS or others), a separate ADHD diagnosis cannot be made. However, I believe that it is important to recognize the presence of co-existing ADHD since this syndrome can respond to medication treatment, unlike the core PDD symptoms. When ADHD co-exists with Asperger's Disorder, anger may easily turn to aggression because of the individual's impulsiveness. Methylphenidate (Ritalin, Concerta, Metadate, Focalin), dextroamphetamine (Dexedrine, Adderall), atomoxetine (Strattera), bupropion (Wellbutrin) or tricyclic antidepressants (imipramine, nortriptyline and others) may be beneficial. Common complications of untreated ADHD are ODD (see below), depression (losing self esteem due to academic failure and repeated negative feedback and punishment from adults), increased likelihood of drug and alcohol use, breaking traffic rules more frequently and having more accidents, and eventually getting lower-paying jobs for not fulfilling true potential.
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Oppositional Defiant Disorder (ODD)
ODD represents more of a relationship dynamic between a child and the authority figures around her or him, than a disease process itself. Symptoms include argumentativeness with adults, talking back, refusing to follow adults' requests or rules, losing temper, deliberately annoying others, not taking responsibility for one's own actions, and being touchy, angry and resentful all the time. This can happen only at home, or may start at home and may eventually spill over to the school. Most children with ADHD, if untreated, eventually develop ODD because of daily negative feedback and punishment from adults, as a consequence of their impulsive behaviors. It is important to note that depression, in children and adolescents, may present with similar symptoms, rather than the expected symptoms like looking sad and crying frequently. A Child and Adolescent Psychiatrist should be consulted to differentiate the two. There is no medication treatment for ODD. Individual psychotherapy and sometimes family therapy are the best treatment methods. If there is ADHD underlying ODD, it has to be treated with medication for psychotherapies to be effective.