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ASPERGER’S SYNDROME

When you meet someone who has Asperger's syndrome, you might notice two things right off. He's
just as smart as other folks, but he has more trouble with social skills. He also tends to have an
obsessive focus on one topic or perform the same behaviors again and again.
Doctors used to think of Asperger's as a separate condition. But in 2013, the newest edition of the
standard book that mental health experts use, called The Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), changed how it's classified.
Today, Asperger's syndrome is technically no longer a diagnosis on its own. It is now part of a
broader category called autism spectrum disorder (ASD). This group of related mental health issues
shares some symptoms. Even so, lots of people still use the term Asperger's.
The condition is what doctors call a "high-functioning" type of ASD. This means the symptoms are
less severe than other kinds of autism spectrum disorders.
The DSM-5 also includes a new diagnosis, called social pragmatic communication disorder, which
has some symptoms that overlap with Asperger's. Doctors use it to describe people who have
trouble talking and writing, but have normal intelligence.

Symptoms
They start early in life. If you're a mom or dad of a kid who has it, you may notice that he can't make eye contact. You
may also find that your child seems awkward in social situations and doesn't know what to say or how to respond when
someone talks to him.
He may miss social cues that are obvious to other folks, like body language or the expressions on people's faces. For
instance, he may not realize that when somebody crosses his arms and scowls, he's angry.
Another sign is that your child may show few emotions. He may not smile when he's happy or laugh at a joke. Or he may
speak in a flat, robotic kind of way.
If your child has the condition, he may talk about himself most of the time and zero in with a lot of intensity on a single
subject, like rocks or football stats. And he might repeat himself a lot, especially on a topic that he's interested in. He
might also do the same movements over and over.
He also may dislike change. For instance, he may eat the same food for breakfast every day or have trouble moving from
one class to another during the school day.

How You Get a Diagnosis


If you notice signs in your child, see your pediatrician. He can refer you to a mental health expert who specializes in
ASDs, like one of these:
Psychologist. He diagnoses and treats problems with emotions and behavior.
Pediatric neurologist. He treats conditions of the brain.
Developmental pediatrician. He specializes in speech and language issues and other developmental problems.
Psychiatrist. He has expertise in mental health conditions and can prescribe medicine to treat them.
The condition is often treated with a team approach. That means you might see more than one doctor for your child's care.
The doctor will ask questions about your child's behavior, including:

 What symptoms does he have, and when did you first notice them?
 When did your child first learn to speak, and how does he communicate?
 Is he focused on any subjects or activities?
 Does he have friends, and how does he interact with others?

Then he'll observe your child in different situations to see firsthand how he communicates and behaves.

Treatment
Every child is different, so there isn't a one-size-fits-all approach. Your doctor might need to try a few therapies to find
one that works.
Treatments can include:
Social skills training. In groups or one-on-one sessions, therapists teach your child how to interact with others and
express themselves in more appropriate ways. Social skills are often best learned by modeling after typical behavior.
Speech-language therapy. This helps improve your kid's communication skills. For example, he'll learn how to use a
normal up-and-down pattern when he speaks rather than a flat tone. He'll also get lessons on how to keep up a two-way
conversation and understand social cues like hand gestures and eye contact.
Cognitive behavioral therapy (CBT). It helps your child change his way of thinking, so he can better control his
emotions and repetitive behaviors. He'll be able to get a handle on things like outbursts, meltdowns, and obsessions.
Parent education and training. You'll learn many of the same techniques your child is taught so you can work on social
skills with him at home. Some families also see a counselor to help them deal with the challenges of living with someone
with Asperger's.
Applied behavior analysis. It's a technique that encourages positive social and communication skills in your child -- and discourages
behavior you'd rather not see. The therapist will use praise or other "positive reinforcement" to get results.

Medicine. There aren't any drugs approved by the FDA that specifically treat Asperger's or autism spectrum disorders. Some medications,
though, can help with related symptoms like depression and anxiety. Your doctor may prescribe some of these:

 Selective serotonin reuptake inhibitors (SSRIs)


 Antipsychotic drugs
 Stimulant medicines

With the right treatment, your child can learn to control some of the social and communication challenges he faces. He can do
well in school and go on to succeed in life.

Asperger's syndrome facts

 Asperger's syndrome was formerly characterized as a distinct autism spectrum disorder; the DSM-5 in May 2013

combined the diagnosis with autistic disorder into one condition called autism spectrum disorder or ASD.

 People with Asperger's syndrome have normal to above-average intelligence but typically have difficulties with

social interactions and often have pervasive, absorbing interests in special topics.

 Abnormalities in the subtle use of language and interpretation of language are common with Asperger's

syndrome, although language development (grammar, syntax, etc.) is normal.

 The degree of severity of symptoms can vary among affected individuals.

 Anxiety and frustration may contribute to disruptive behaviors or depression in people with Asperger's syndrome.

 Successful treatment generally involves one or multiple social, behavioral, and/or educational interventions.

 The personality and cognitive traits common to those with Asperger's syndrome are seen as beneficial by many,

and many people with Asperger's syndrome believe it has helped advance their professional lives.

What is Asperger's syndrome?


Asperger's syndrome, also known as Asperger disorder or Asperger syndrome, is one of a group of neurodevelopmental
disorders that have effects on an individual's behavior, use of language and communication, and pattern of social
interactions. Asperger disorder was formerly characterized as one distinct autism spectrum disorder (others included
autistic disorder, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise
specified [PDD-NOS]), although Asperger's syndrome was considered to be at the milder, or higher-functioning, range of
this spectrum. There is still some controversy as to whether Asperger's syndrome should be regarded as a separate
clinical entity or simply represents a high-functioning form of autism. In the revised Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) published in May 2013, Asperger's syndrome and autistic disorder have been combined into
one condition for diagnostic purposes, known as ASD. This change was controversial, because many experts believe that
people formerly diagnosed with Asperger's syndrome will not meet the diagnostic criteria for ASD. Also, many experts
feel that Asperger's syndrome should be preserved as a separate diagnostic entity to represent a condition related to,
but not the same as, autism. Those diagnosed with Asperger's disorder were felt to have a higher-functioning form of
autism or autism-related condition. People with Asperger's syndrome typically have normal to above-average
intelligence but typically have difficulties with social interactions and often have pervasive, absorbing interests in special
topics.

Asperger's syndrome is named for Dr. Hans Asperger, an Austrian pediatrician, who first described the condition in 1944.
Dr. Asperger described four boys who showed "a lack of empathy, little ability to form friendships, one-sided
conversation, intense absorption in a special interest, and clumsy movements." Because of their obsessive interests in
and knowledge of particular subjects, he termed the boys "little professors." The American Psychiatric Association (APA)
recognized Asperger disorder as a specific entity and published diagnostic criteria in the Diagnostic and Statistical
Manual of Mental Disorders-IV (DSM-IV) in 1994. Most recently, after significant deliberation, the APA recommended
"subsuming" Asperger's Disorder into Autism Spectrum Disorders for the next edition DSM-V.

Today, many experts in the field stress the particular gifts and positive aspects of Asperger syndrome and consider it to
represent a different, but not necessarily defective, way of thinking. Positive characteristics of people with Asperger
syndrome have been described as beneficial in many professions and include:

 the increased ability to focus on details,

 the capacity to persevere in specific interests without being swayed by others' opinions,

 the ability to work independently,

 the recognition of patterns that may be missed by others,

 intensity, and

 an original way of thinking.

Dr. Temple Grandin, a noted engineer, author, and professor who suffers from Asperger disorder believes that her
condition has been an asset in her professional life. Her life and story was featured in a film that first aired in 2010.

Although the diagnosis of Asperger's syndrome is not possible without direct testing and observation of an individual, it
has been suggested by some authors that many successful historical figures may have had Asperger's syndrome,
including Mozart, Albert Einstein, Benjamin Franklin, Thomas Jefferson, and Marie Curie. Of course, definitive diagnosis
of historical figures with Asperger's syndrome is not possible, and many of the traits exhibited by people with Asperger's
syndrome can also occur because of intellectual giftedness or even attention deficit disorder (ADD).

What causes Asperger's syndrome?


If one accepts the conclusion that Asperger's syndrome is one of the autistic disorders, then the causes of Asperger's
syndrome would be expected to be the same as the causes of autism. The precise causes of autistic disorders have not
been identified, although an inherited (genetic) component is believed to be involved. Supporting this idea is the fact
that Asperger's syndrome has been observed to run in families. In some cases, autistic disorders may be related to toxic
exposures, teratogens, problems with pregnancy or birth, and prenatal infections. These environmental influences may
act together to modify or potentially increase the severity of the underlying genetic defect.

Some authors have suggested a causal role for vaccine exposure (particularly measles vaccine and thimerosal, a mercury
preservative used in some vaccines) in autism. However, the overwhelming majority of epidemiologic evidence shows
no evidence for an association between immunizations and autism, and experts have discredited this theory.

How common is Asperger's syndrome?


Asperger's syndrome is five times more common in boys than in girls. In recent years, the number of autism spectrum
disorders has increased dramatically in the U.S. The reason for the increase is not fully clear, but is likely due to both
improvements and modifications in the diagnostic process that result in an increase in the number of children being
identified, as well as some degree of true increase in the incidence of the disorders themselves. The CDC notes one out
of every 59 children in the U.S. has an autism spectrum disorder.
Asperger's syndrome has been estimated to affect two and a half out of every 1000 children, based upon the total
number of children with autistic disorders.
What are the signs and symptoms of Asperger's syndrome?
Social-behavioral symptoms can begin as early as infancy. Characteristic differences are seen in social development, but
these changes are hard to identify in toddlers and may be attributed to another condition or not perceived as abnormal.
Most cases of Asperger's syndrome are identified when the child is school-aged or older; studies have shown an average
age at diagnosis of 11 years. Some of the symptoms that may be present are:

 lack of social awareness;

 lack of interest in socializing/making friends;

 difficulty making and sustaining friendships;

 inability to infer the thoughts, feelings, or emotions of others;

 either gazing too intently or avoiding eye contact;

 lack of changing facial expression, or use of exaggerated facial expressions;

 lack of use or comprehension of gestures;

 inability to perceive nonverbal cues or communications;

 failure to respect interpersonal boundaries;

 unusually sensitive to noises, touch, odors, tastes, or visual stimuli;

 inflexibility and over-adherence to or dependence on routines; and

 stereotypical and repetitive motor patterns such as hand flapping or arm waving.

Another defining characteristic of Asperger's syndrome is the presence of perseverative and obsessive interests in
special topics (such as cars or trains, or even more narrow topics such as vacuum cleaners), which may be of little
interest to others.

 These interests are unusually repetitive and intense when compared to other children's interests.

 Specific or narrow interests remain the focus of the child's interest and conversation in spite of efforts to redirect

the child's attention.

Language development in children with Asperger's syndrome is generally normal, in contrast to other autistic conditions.
Children with Asperger's syndrome have normal scores on tests for language function involving vocabulary, syntax, and
grammar. In fact, some experts believe the presence of normal language development distinguishes Asperger's
syndrome from high-functioning autism. However, the use or application of language skills is altered in people with
Asperger's syndrome:
 Their speech may be disorganized or not relevant to the discussion, or they may focus too intently on their
defined area of interest (see above) in conversations. The child may switch topics for no apparent reason in
conversation, often in an attempt to steer the conversation toward his or her area of interest.

 Changes in voice and speaking (for example, speaking too loudly or dramatically, using an invariant tone or

incorrect intonation, loud pitch, or speaking too rapidly or too slowly) can also be seen.

 Language may be interpreted literally, and difficulties can arise with interpreting language in a specific context.

 There are difficulties with understanding the subtle use of language, such as irony or sarcasm.

In school, children with Asperger's syndrome tend to excel with the rote learning often required in the early grades. As
they get older, they may have more difficulties in school due to the nature of reading comprehension and written
assignments. Special education support is sometimes, but not always, necessary.
Sometimes, people with Asperger disorder have other associated psychiatric conditions or may show behaviors that are
typical for other conditions. Some common associated conditions include the following (but these are not always
present):
 Attention deficit hyperactivity disorder (ADHD)

 Anxiety disorder

 Oppositional defiant disorder or other disruptive behavior disorders

 Depression or other mood disorders

How is Asperger's syndrome diagnosed?

Diagnosis is based upon interviews and observation of the individual along with interviews of his/her family members and

sometimes teachers or counselors. The Diagnostic and Statistical Manual of Mental Disorders is published by the

American Psychiatric Association and includes the diagnostic criteria for all recognized psychiatric conditions.

The DSM-IV had specific diagnostic criteria for Asperger's syndrome. However, revision of the DSM-IV was carried out,

with a 5th edition (DSM-V) published in May 2013. In this new version, Asperger's syndrome is included in the same

diagnostic group as people with autism and pervasive developmental disorders.

What are the risks or complications of Asperger's syndrome?

As mentioned before, Asperger's syndrome may coexist with other psychiatric conditions such as attention deficit

hyperactivity disorder (ADHD) or anxiety disorder. Even when anxiety disorder is not present, people with Asperger's

syndrome may suffer from anxiety or hypersensitivity to certain stimuli such as loud noises. In some cases, disruptive

behaviors (tantrums, self-injury, and aggression) and/or depression may occur in response to the anxiety and frustration

experienced by sufferers of Asperger's syndrome. Other behaviors that have been reported in people with Asperger's

syndrome include obsessive-compulsive behaviors and difficulties with anger management.

As with any condition, the degree of severity of symptoms can vary widely among individuals, and not all persons with

Asperger's syndrome will experience associated psychiatric disorders, depression, or disruptive behaviors.

What are the treatments for Asperger's syndrome?

Treatment of Asperger's syndrome involves a multidisciplinary approach.

Medical therapy is not effective in treating Asperger syndrome, although medications may be prescribed to help control

troubling symptoms or symptoms of other psychiatric conditions that may coexist with Asperger's syndrome. In some

cases, selective serotonin reuptake inhibitor (SSRI) medications are used for relief of anxiety or depression. Medical

treatments for ADHD may also be tried if there is significant hyperactivity and/or distraction.

A number of behavioral and educational interventions can help people with Asperger's syndrome, although all of these

may not be necessary in a given individual. The type of interventions chosen must be based upon the individual's age and

needs. Types of interventions that have been shown to be of benefit include:

 efforts to reduce overstimulation or overload of sensory input;

 supporting executive function skills by provision of an environment that is predictable, structured, and organized;
 organization skills training;

 speech/language therapy that addresses the ambiguous use of language and the use of language in social

settings;

 social skills training programs, including training in the awareness of social cognition, use of gestures and facial

expressions, and conversational language;

 adaptive skills or life-skills training;

 educational supports such as assistance with organization, note-taking, allowing oral rather than written testing,

use of scripts, and assistance with reading comprehension and subtlety of language use; and

 self-advocacy training.

What is the prognosis for Asperger's syndrome?


An estimation of the prognosis of Asperger's syndrome is difficult, if not impossible, since affected individuals have
variable degrees of impairment, and the provision of treatment can dramatically improve the long-term outlook for
people with Asperger's syndrome. In general, when social, behavioral, and educational support is provided as needed,
people with Asperger's syndrome can be expected to lead happy and productive lives.

Asperger syndrome, or Asperger’s, is a previously used diagnosis on the autism spectrum. In 2013, it
became part of one umbrella diagnosis of autism spectrum disorder (ASD) in the Diagnostic and Statistical
Manual of Mental Disorders 5 (DSM-5).

Typical to strong verbal language skills and intellectual ability distinguish Asperger syndrome from other
forms of autism.

It generally involves:

 Difficulty with social interactions


 Restricted interests
 Desire for sameness
 Distinctive strengths

Strengths can include:

 Remarkable focus and persistence


 Aptitude for recognizing patterns
 Attention to detail

Challenges can include:

 Hypersensitivities (to lights, sounds, tastes, etc.)


 Difficulty with the give and take of conversation
 Difficulty with nonverbal conversation skills (distance, loudness, tone, etc.)
 Uncoordinated movements, or clumsiness
 Anxiety and depression

The tendencies described above vary widely among people. Many learn to overcome their challenges by
building on strengths.

Though the diagnosis of Asperger syndrome is no longer used, many previously diagnosed people still identify
strongly and positively with being an “Aspie.”

Therapies and services

Find the following services near you using the Autism Speaks Resource Guide.
Cognitive behavioral therapy can help address anxiety and other personal challenges.

Social skills training classes can help with conversational skills and understanding social cues.

Speech therapy can help with voice control.

Physical and occupational therapy can improve coordination.

Psychoactive medicines can help manage associated anxiety, depression and attention deficit and
hyperactivity disorder (ADHD).

How has our understanding evolved?

1944: Austrian pediatrician Hans Asperger described four strikingly similar young patients. They had normal to
high intelligence. But they lacked social skills and had extremely narrow interests. The children also shared a
tendency to be clumsy.

1981: British psychiatrist Lorna Wing published a series of similar case studies. In it, she coined the term
“Asperger syndrome.”

1994: Asperger syndrome listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-4).

2003: Asperger syndrome and other previously separate types of autism folded into one umbrella diagnosis of
“autism spectrum disorder” in DSM-5.

 Conditions Similar to Autism

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