Asperger’s syndrome is a neurobiological condition in which the development of the child is hampered in such a way that they are unable to communicate, interact and socialize with others (unable to mix with peers), and also develops issues with language (only in social situations) and speech (for example speaking in a formal or monotonous manner), and other problems such as repetitive or restrictive thought, rituals, activities and behaviors occurs (NICHHD, 2007).
Besides, the movement of the child may be uncoordinated and abnormal, and they also have problems in non-verbal communications (such as gestures, facial expressions and gaze) (NINDS, 2007). Asperger’s syndrome belongs to a group of disorders known as ‘autism spectrum disorders’ in which the individual due to a developmental problem is unable to communicate and interact with others in society, and also develops abnormal patterns of thinking and behaving with others (such as repetitive or restrictive features) (NINDS, 2007).
In autism spectrum disorder, the intensity of the symptoms varies from one individual to another, and in Asperger’s syndrome the disability is mild. Some of the conditions that belong to autism spectrum disorder include autistic disorder, Asperger’s syndrome, Rett’s syndrome, childhood disintegrative disorder and atypical autism (NICHHD, 2006).
In Asperger’s syndrome, the child may develop problems with interaction and communicating socially with others (which may be similar to autism), but may have a normal level of intelligence and verbal competence (NICHHD, 2007). Some children may have an unusually high level of talent and skill in a particular skill or related to a particular topic. Children with Asperger’s syndrome seem to be interested only in one topic, object or issues and try to exclude others that may not be of any interest to them. They may behavior eccentrically when communicated with. They seem to be perfectionists in their topic of interest, and know everything about that particular subject or topic.
They are obsessed with that particular topic and are interested in knowing everything about that or talking with others about that topic (NINDS, 2007). The disorder was first described by the Viennese physician, Hans Asperger in 1944. In 1981, Lorna Wing researched the findings of Hans Asperger, and felt that it could be considered as a separate condition. Although, Asperger described the pattern of behavior that he observed in 4 boys having normal intelligence and language skills, and abnormal social and communication skills, his disorder was considered as a separate entity only in the year 1994, when it was included in the DSM-IV classification by the APA (Kerby, 2005).
The WHO considered Asperger’s syndrome to be a separate disorder in 1992 in its ICD-10 list (NINDS, 2007). Such children were clumsy and tried to speak with others in a formal manner. Asperger felt that his condition leads to the child being isolated from others. He referred to his condition by the name of “autistic psychopathy’ (NINDS, 2007).
About 0.02 % of the children develop Asperger’s syndrome, and it occurs in about 400, 000 families (Meduri, 2004). The condition occurs more frequently in boys compared to girls (in the ratio of 3 or 4 is to 1). The exact period during which Asperger’s syndrome initiates is not known clearly, but may usually develop when the child is about 3 years. Some children demonstrate certain signs of Asperger’s syndrome as early as infancy (NINDS, 2007), whereas others may develop between 5 and 9 years.
The child begins to acquire several motor skills such as learning to drive a bicycle, swimming, etc, at a later age than normal (NINDS, 2007). The incidence of Asperger’s syndrome is seemingly increasing due to the fact that the condition is slowly being recognized and given more importance. Nowadays milder versions of the disease are also considered for treatment.
The exact cause of Asperger’s syndrome is still not understood properly. Current evidence suggests that it may develop due to a defect in the genes (Mayo, 2006). However, the gene/s that is responsible for expressing the disease has not been identified (NINDS, 2007). A specific gene GABRB3 was found to be responsible for the expression of certain behavioral traits (such as repetitive behavior and compulsions) in children suffering from autism (NINDS, 2007). When the gene was mutated, the new version was known as ‘ENGRAILED 2’. This gene can be inherited and transmitted down the family (demonstrated through familial and twin studies). The mutations that develop in the gene may be due to an influence from the environment. Although, the Asperger’s syndrome has not been studied, the symptoms that develop in Asperger’s syndrome have been observed (NINDS, 2007).
Several portions of the brain may be abnormal in this condition suggesting that the behavioral symptoms develop from a biological cause. Studying the pattern of behavior that develops in children with Asperger’s syndrome, researchers suggest that a single cause may give rise to the several symptoms that occur in this condition. The condition is purely development and does not depend on the manner in which the child is brought up or is treated in society (such as child abuse or sexual abuse) (Gymraeg, 2007). In some cases, Asperger’s syndrome may be closely related with other psychiatric disorders such as bipolar disorders and depression. At present the role of the environment on the development of this condition is not known.
The condition does not develop due to a problem in parenting or environmental factors. Asperger’s syndrome is basically is disorder caused due to a problem of the neurobiological mechanism. Areas and neural circuitry that control behavior and thoughts are affected in Asperger’s syndrome. As the cause is not still understood, medically a cure is not available to treat the condition (Meduri, 2004). The NIH suggests that Asperger’s syndrome may develop due to an abnormality during the fetal development. The growth and development of the brain is hampered due to an abnormality in the gene that controls the development of the brain. There may be some amount of overgrowth, reduced growth or loss of the cells in the brain (NINDS, 2007).
The symptoms and signs are characteristic of Asperger’s syndrome. The disorder usually develops in the child of age 3 years, or sometimes between 5 to 9 years (NINDS, 2007). The intensity of the disorder may vary from mild, moderate to severe. The child may lack social and interaction skills, and finds it difficult to adapt to changes or transitions (Kerby, 2005).
They lack even ways of interacting with others through non-verbal means such as facial expressions, sign language, humor, eye contact, body movements, etc. As they lack humor, they tend to take certain words expressed in a humorous manner seriously and are often disturbed by it. The child exhibits deep interest in a particular subject, object or a topic. They tend to exclude other subjects from their talk with others. Some of the areas of interests include cars, vacuum cleaners, aeroplanes, space, snakes, weather, Television, schedules, music, sports, etc. They seem to know everything about their area of interest and always want to converse about it. They may exhibit speech in such a way that they are experts in that particular area (NINDS, 2007).
They tend to gather a lot of information about there area of interest, and always try to share this information with others. Their speech seems to be monotonous, repetitive and sound in appropriate in a particular situation. They do not take interest in the reaction of their listeners and frequently continue to speak continuously. They seem to be perfectionist and sometimes even over-precise. Children with Asperger’s syndrome have very poor social skills.
They find it very difficult to converse, socialize or interact with others for a normal conversation. Their behavior seems to be eccentric and inappropriate for others. Such children may also find it difficult to perform certain motor activities such as riding a bicycle, learning to swim, etc. Their movement seems to be abnormal and uncoordinated. Some of the children may have an associated mental disorder such as anxiety, depression, Attention Deficit Hyperactivity Disorder, tic disorders and Obsessive-Compulsive disorder (NINDS, 2007).
They frequently engage in several compulsions and routines, such as taking a same route to school, and may get disturbed with any alterations to their daily schedules (NAS-UK, 2007). They may get anxious if any alterations are brought to their daily schedule. The child with Asperger’s syndrome may be oversensitive to light, sounds, texture, tastes, train, and smell. They may like to wear a certain type of clothing or be interested in eating a certain type of food only, and may dislike other clothes and foods. They may also be interested in certain voices or objects they hear, and which do not seem to be present by others.
These individuals tend to look at the world in a different manner. This condition basically arises due to a nerve disturbance and not due to improper parenting (Kerby, 2005). Individuals with Asperger’s syndrome have a normal IQ, and some may even have a greater than normal IQ. The talent and skill they seem to demonstrate in a particular area seems to astonish others such that they may be considered as eccentric or odd by others. In other autistic disorders, the child’s IQ, mental functioning and vocabulary seems to be abnormal (NICHHD, 2007).
Frequently in the school, such children may be abused or teased by other children. The language development of the child may be normal without any delay in the development of language, vocabulary and grammatical skills (Meduri, 2004). They may demonstrate a high expertise of language in their area of interest, but when it comes to social skills, adapting to the language is a problem (Kerby, 2005). Their speech seems to be one-sided and long-winged and does not interest others. These individuals also take up rigid postures and walk in an abnormal manner (Mayo, 2006).
The child also lacks social imagination, ability to demonstrate creativity whilst playing with others and poor abstract thinking. Literature and religious studies which require a lot of creativity may be particularly difficult for the child as they do not have a creative sense (NAS-UK, 2007). As the child may find it difficult to get along with others in a school, they may often leave the school and join a non-mainstream career.
It may be very difficult to diagnose Asperger’s syndrome, mainly because it is a recognized as a relatively new disorder. Some psychiatrists may not consider it as a separate disorder. The symptoms and signs of Asperger’s syndrome may be similar to other psychiatric disorders such as ADHD and obsessive-compulsive disorder, and a thorough differential diagnostic process is essential.
The diagnosis of Asperger’s syndrome may be particularly difficult when the symptoms are mild, or when other symptoms such as anxiety, obsessions and compulsions are dominant suggesting possible overlap with several of the anxiety disorders. In some mild versions of the disease, the condition may go unnoticed and the behavior of the child may be attributed to improper parenting or the environment the child is brought up in.
The child may also be considered to be a trouble-maker. The outcome of the condition is usually better if it is recognized early and treated immediately. The diagnosis of Asperger’s syndrome is made based on the history, symptoms, signs, psychiatric examination, physical examination, imaging techniques and laboratory tests. In the history, the exact period of the initiation of certain symptoms may have to be noted.
The family history of the existence of this or like disorders should also be brought out. Frequently, the parents, peers, sibling, friends, teachers and the people living in the neighborhood should be included in the assessment process. Their versions of the child’s obsessions should be included. The psychiatrist will hold a discussion with the child, to determine his/her obsessions and the manner in which it is interfering with its social development. Several psychological functioning tests such as IQ tests, language and speech tests and visual-motor problem-solving tests are also required to ensure that the disorder is closely differentiated from similar ones (Mayo, 2006).
The emotional, behavioral and other psychological problems are assessed by the psychiatrist using appropriate tests. Neurological tests are also required to determine the motor capabilities (NINDS, 2007). Frequently, laboratory tests are also conducted to rule out a physical disorder. Images of the brain obtained through X-rays, MRI and CT scanning techniques may also be required to look for any abnormality.
Researchers have recently recognized structural and functional abnormalities in certain regions of the brain in children with Asperger’s syndrome. There was a lack of activity in the frontal lobe when the child was asked to perform certain activity requiring judgment. The brain activity was also abnormal when the child had to react to facial expressions in social situations. The level of certain neurochemicals was also abnormal in individuals suffering from Asperger’s syndrome (NINDS, 2007).
The diagnosis is made based on the guidelines laid down in DSM-IV-TR and the IC-10 criteria (Kerby, 2005). Some of these guidelines include:
- Impediment of social interactions skills
- Inappropriate non-verbal skills such as eye contact, body movements, facial expressions, etc
- Poor relationship with peers
- Repetitive or restrictive areas of interests and behaviors associated with the areas of interest
- Preoccupation with the areas of the interest
- The emotional development of the child is abnormal
- Performing certain routines or rituals with the area of obsession
- There is significant distortion in social functioning and performance in school
- Language or speech delay is usually not present
- Cognitive function development are usually normal
- The characteristic features of schizophrenia or pervasive developmental disorder are usually not present
The diagnosis is usually performed in two stages. In the first stage, the development of the child is screened. In the second stage, the child’s condition is thoroughly evaluated using a team of physicians, psychiatrist, psychologists, neurologists, speech therapists, etc (NINDS, 2007).
The parents may have to seek medical treatment when the child finds it very difficult to get along with other children in the school. The child, the parents, siblings, teachers and the peers, may find it very difficult to adjust to the disorder of the child. However, it should be noted that bad parenting or environmental situations may not have an effect on the development and progression of the disorder. Previously, the disorder was not recognized, and children affected with it were considered to be bad and anti-social elements.
However, after the APA included it as a separate disorder in 1995, there have been a lot of improvements in the way such children are handled. The parents should be able to identify the problems the child is facing at school and in social situations. They should effectively make a note of them so that a clear record is presented to the medical professionals. As management of Asperger’s syndrome requires a lot of time and specialized care, the parents should be able to find a medical team that would efficiently manage the disorder (Mayo, 2007). The symptoms such as eccentric behavior and constant preoccupation may cause difficulties in learning and social development of the child (Mayo, 2007). Currently, there is no specific treatment available to cure Asperger’s syndrome (NINDS, 2007).
However, the symptoms and the social impairments can be minimized through several psychological modalities. Presently, treatment is administered to solve three major problems, including the poor social interaction skills, the repetitive behavior and routines, and the motor deformities (NINDS, 2007). The child has to work with a team of professionals and has to be given a number of treatments over a long period of time.
A program for the development of the child is planned in such a way that as the child is made to perform certain simple steps, it may be slowly exposed to the much tougher tasks. Regularly, feedback and reinforcement is given for the child’s development (NINDS, 2007). The professionals demonstrate the manner in which the child should socialize and interact with others, so that they are able to get along with other children. As the child would be having a lot of emotions including anxiety and sensitivity, they are told the manner in which such emotions should be controlled using counseling or ‘cognitive behavior therapy’.
The child is also taught the manner in which it should adapt to new places, situations and people. The child is also given some home work, so that they can apply the theoretical models to much practical situations (NINDS, 2007). Short-term administration of medications is also required to treat co-existing psychological disorders including anxiety and depression (NINDS, 2007).
Some of the medications that are administered frequently in Asperger’s syndrome include SSRIs’ (to treat depression and anxiety), anti-psychotics, stimulants and anti-anxiety agents. As the child may find it difficult to perform certain movements, physiotherapy, exercises and occupational therapy may be required. The child may also have to attend language and speech classes so that their speech and verbal communication skills with others are improved (NINDS, 2007).
It is taught the manner in which it should communicate with others with a natural rhythm, eye contact, humor, tone, topics and body language (Mayo, 2007). The child may also require behavior therapy sessions in which they are exposed to stimuli that they are sensitive to such as light, sounds, voices, or tastes, in a controlled environment (Meduri, 2004).
The parents could also help their child convert their areas of interest into a very useful career or profession. This would definitely help to reduce the obsessions that the child might be having. However, the child should be made to understand that although their obsessions may be unique and useful, it would also be necessary to concentrate on academics at the school and socialize with others (Mayo, 2006). Children with severe forms of the disorder may have to attend a specialized school in which the individual needs of the child are given special attention.
In the school, the child suffering from Asperger’s syndrome may be at a risk of suffering humiliation from others because they may look normal to others, although they have special needs and suffer from a medical disorder. They are also bound to get depressed and anxious easily and hence, the parents should constantly monitor the emotional status of the child. It is found that when children with Asperger’s syndrome are encouraged in their area of interest and brought into the right career and profession, they could really thrive and lead a very successful life. Constant support from the parents and the teachers are required. Such children could turn out to be motivated, dedicated, reliable and effective professionals in the future (NICHHD, 2007).
Some parents may have to attend educational and training programs so that they can help their children better. The parents hold the key in supporting their child throughout its growth and development. The parents have to demonstrate to the child, the manner in which it should be independent and self-supportive. The parents should also make it aware to the teachers and the medical personnel that the child is having a special problem and requires special care. It may be essential that the education program for the child be adjusted in such a way that it suits the needs and abilities of the child. It may also be essential that programs that benefit the long-term outcome of the condition are provided. Within, the family, the child’s needs should be balanced (Meduri, 2004).
References
- Kirby, B. L. (2005). What Is Asperger Syndrome?, Retrieved on April 22, 2007, from OASIS Web site: http://www.udel.edu/bkirby/asperger/aswhatisit.html
- Mayo Clinic Staff (2006). Asperger’s Syndrome, Retrieved on April 22, 2007, from Mayo Clinic Web site: http://www.mayoclinic.com/health/aspergers-syndrome/DS00551/DSECTION=1
- Meduri, A. (2004). Asperger Syndrome, Retrieved on April 22, 2007, from The Nemours Foundation Web site: http://www.kidshealth.org/parent/medical/brain/asperger.html
- NICHHD (2006). Autism Spectrum Disorders (ASDs), Retrieved on April 22, 2007, from NICHHD Web site: http://www.nichd.nih.gov/health/topics/asd.cfm
- NICHHD (2007). Asperger Syndrome, Retrieved on April 22, 2007, from NICHHD Web site: http://www.nichd.nih.gov/health/topics/asperger_syndrome.cfm
- NINDS (2007). Asperger Syndrome Fact Sheet, Retrieved on April 22, 2007, from NINDS Web site: http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm
- NINDS (2007). NINDS Asperger Syndrome Information Page, Retrieved on April 22, 2007, from NINDS Web site: http://www.ninds.nih.gov/disorders/asperger/asperger.htm
- The National Autistic Society – UK (2007). What is Asperger syndrome?, Retrieved on April 22, 2007, from NAS-UK Web site: http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=21
