Asperger’s Syndrome

Asperger's Syndrome

Topic Overview

What is Asperger's syndrome?

Asperger's syndrome is a developmental
disorder that makes it very hard to interact with other people. Your child may
find it hard to make friends because he or she is socially awkward.

People with Asperger's syndrome have some traits of
autism. For example, they may have poor social skills,
prefer routine, and not like change. But unlike those who have autism, children
with Asperger's syndrome usually start to talk before 2 years of age, when
speech normally starts to develop.

Asperger's syndrome is a
lifelong condition, but symptoms tend to improve over time. Adults with this
condition can learn to understand their own strengths and weaknesses. And they
can improve their social skills.

Both Asperger's syndrome and
autism belong to the group of disorders called
autism spectrum disorders (ASDs), once known as pervasive developmental disorders. You may hear the term ASD used to describe Asperger's syndrome.

What causes Asperger's syndrome?

The
exact cause of Asperger's syndrome is not known. And there is no known way to
prevent it. It tends to run in families. So researchers are doing studies to
look for a genetic cause. Asperger's syndrome is more common in males than in females.

What are the symptoms?

Asperger's syndrome is usually noticed at age 3
or later. Symptoms vary, so no two children are the same. Children with
Asperger's:

  • Have a very hard time relating to others. It
    doesn't mean that they avoid social contact. But they lack instincts and skills
    to help them express their thoughts and feelings and notice others'
    feelings.
  • May be bothered by loud noises, lights, or strong tastes
    or textures.
  • Like fixed routines. Change is hard for
    them.
  • May not recognize verbal and nonverbal cues or understand
    social norms. For example, they may stare at others, not make eye contact, or
    not know what personal space means.
  • May have speech that's flat and
    hard to understand because it lacks tone, pitch, and accent. Or they may have a
    formal style of speaking that's advanced for their age.
  • May lack
    coordination; have unusual facial expressions, body postures, and gestures; or
    be somewhat clumsy.
  • May have poor handwriting or have trouble with
    other motor skills, such as riding a bike.
  • May have only one or a
    few interests, or they may focus intensely on a few things. For example, they
    may show an unusual interest in snakes or star names or may draw very detailed
    pictures.

How is Asperger's syndrome diagnosed?

If you are concerned about your child's behavior
or communication style, talk to your child's doctor. He or she will ask you
about your child's development and ask if other people have noticed your
child's social problems.

The doctor may refer you to a specialist
to confirm or rule out Asperger's syndrome. The specialist may test your
child's learning style, speech and language, IQ, social and motor skills, and
more.

The diagnosis of ASD typically occurs during childhood, but an adult can be diagnosed with ASD.

How is it treated?

Treatment is based on your child's unique symptoms. It may change often
so that it's most useful for your child.

Doctors, teachers, and
mental health counselors can help your child improve his or her behavior and
build social and learning skills. School programs, job training, and
counseling can help too. Many children with Asperger's
syndrome also have other conditions, such as
ADHD or
obsessive-compulsive disorder. So they may need other
treatments, such as medicine.

At home, you can help build your
child's confidence and skills. Use rules and daily routines, visual aids, and
role-playing. Focus on your child's strengths. Encourage your child to explore
interests at home and at school. And stay informed about what is happening in
your child's classroom.

Federal law requires public schools to have
programs for people ages 3 through 21 with special needs. Contact your school
district to find out what services your child can be a part of.

How can you help your child succeed?

It takes patience and support to help your child reach his or her full
potential. And it may take time to find a doctor who has experience treating
people with this condition.

Try to learn as much as you can about
this condition, and talk to others about it. The more that teachers, your
child's peers, and other people learn, the better they can help and support
your child.

Many parents find comfort and build acceptance with
help from support groups, counseling, and a network of friends, family, and
community.

Frequently Asked Questions

Learning about Asperger's syndrome:

Being diagnosed:

Getting treatment:

Symptoms

Although there are many possible symptoms of
Asperger's syndrome, the main symptom is significant
trouble with social situations. Your child may have mild to severe symptoms or
have a few or many of these symptoms. Because of the wide variety of symptoms,
no two children with Asperger's are alike.

Symptoms during childhood

Parents often first
notice the symptoms of Asperger's syndrome when their child starts preschool
and begins to interact with other children. Children with Asperger's syndrome
may:

  • Not pick up on social cues and may lack inborn
    social skills, such as being able to read others' body language, start or
    maintain a conversation, and take turns talking.
  • Dislike any
    changes in routines.
  • Appear to lack empathy.
  • Be unable
    to recognize subtle differences in speech tone, pitch, and accent that alter
    the meaning of others' speech. So your child may not understand a joke or
    may take a sarcastic comment literally. And his or her speech may be flat
    and hard to understand because it lacks tone, pitch, and
    accent.
  • Have a formal style of speaking that is advanced for his or
    her age. For example, the child may use the word "beckon" instead of "call" or
    the word "return" instead of "come back."
  • Talk a lot, usually about
    a favorite subject. One-sided conversations are common. Internal thoughts are
    often verbalized.
  • Avoid eye contact or
    stare at others.
  • Have unusual facial expressions or
    postures.
  • Be preoccupied with only one or few interests, which he
    or she may be very knowledgeable about. Many children with Asperger's syndrome
    are overly interested in parts of a whole or in unusual activities, such as
    designing houses, drawing highly detailed scenes, or studying astronomy. They
    may show an unusual interest in certain topics such as snakes, names of stars,
    or dinosaurs.
  • Have delayed motor development. Your child may be
    late in learning to use a fork or spoon, ride a bike, or catch a ball. He or
    she may have an awkward walk. Handwriting is often poor.
  • Have
    heightened sensitivity and become overstimulated by loud noises, lights, or
    strong tastes or textures. For more information about these symptoms, see
    sensory processing disorder.

A child with one or two of these symptoms does not
necessarily have Asperger's syndrome. To be diagnosed with Asperger's syndrome,
a child must have a combination of these symptoms and significant trouble with
social situations.

Although the condition is in some ways
similar to
autism, a child with Asperger's syndrome typically has
normal language and intellectual development. Also, those with Asperger's
syndrome typically make more of an effort than those with autism to make
friends and engage in activities with others.

Symptoms during adolescent and teen years

Most
symptoms persist through the teen years. And although teens with Asperger's can
begin to learn those social skills they lack, communication often remains
difficult. They will probably continue to have difficulty "reading" others'
behavior.

Your teen with Asperger's syndrome (like other teens)
will want friends but may feel shy or intimidated when approaching other teens.
He or she may feel "different" from others. Although most teens place emphasis
on being and looking "cool," teens with Asperger's may find it frustrating and
emotionally draining to try to fit in. They may be immature for their age and
be naive and too trusting, which can lead to teasing and bullying.

All of these difficulties can cause teens with Asperger's to become
withdrawn and socially isolated and to have
depression or
anxiety.footnote 1

But
some teens with Asperger's syndrome are able to make and keep a few close
friends through the school years. Some of the classic Asperger's traits may
also work to the benefit of your teen. Teens with Asperger's are typically
uninterested in following social norms, fads, or conventional thinking,
allowing creative thinking and the pursuit of original interests and goals.
Their preference for rules and honesty may lead them to excel in the classroom
and as citizens.

Symptoms in adulthood

Asperger's syndrome is a lifelong condition,
although it tends to stabilize over time, and improvements are often seen.
Adults usually have a better understanding of their own strengths and
weaknesses. They are able to learn social skills, including how to read others' social
cues. Many people with Asperger's syndrome marry and have children.

Some traits that are typical of Asperger's syndrome, such as attention to
detail and focused interests, can increase chances of university and career
success. Many people with Asperger's seem to be fascinated with technology, and
a common career choice is engineering. But scientific careers are by no means
the only areas where people with Asperger's excel. Indeed, many respected
historical figures have had symptoms of Asperger's, including Wolfgang Amadeus
Mozart, Albert Einstein, Marie Curie, and Thomas Jefferson.

Other conditions

Many children with Asperger's
syndrome also have coexisting conditions and may have symptoms of these
conditions also. They include:

Exams and Tests

Asperger's syndrome is a developmental condition in which people have difficulties
understanding how to interact socially. A diagnosis is best made with input
from parents, doctors, teachers, and other caregivers who know or who have
observed the child. Asperger's syndrome is diagnosed when specific criteria are
met. These include:

  • Poor social interaction.
  • Unusual
    behavior, interests, and activities.
  • No delay in language
    development.
  • No delay in self-help skills and curiosity about the
    environment.

Your doctor will take a medical history by asking questions
about your child's development, including information about motor development,
language, areas of special interest, and social interactions. He or she will
also ask about the mother's pregnancy and the family's history of medical
conditions.

Testing can help your doctor find out whether your
child's problem is related to Asperger's syndrome. Your primary care provider
may refer your child to a specialist for testing, including:

  • Psychological assessment. Intellectual function and learning style are evaluated. IQ
    (intelligence quotient) and motor skills tests are common. Personality
    assessment tests may also be done.
  • Communication assessment. Speech and formal language are evaluated. Children are
    tested to find out how well they understand and use language to communicate
    ideas. Your doctor will also test for understanding of nonverbal forms of
    communication and nonliteral language skills, such as understanding of humor or
    metaphor. He or she will listen to your child's voice for volume, stress, and
    pitch.
  • Psychiatric examination. Your doctor
    may examine your child's family and peer relationships, reactions to new
    situations, and the ability to understand the feelings of others and types of
    indirect communication such as teasing and sarcasm. Your doctor may want to
    observe your child at home and at school. He or she may also look for
    conditions such as
    anxiety and
    depression, which are often found in people with
    Asperger's syndrome.

When making a diagnosis, your doctor will see if your child
meets the criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a publication of the American
Psychiatric Association.

Treatment Overview

Treatment for
Asperger's syndrome strives to improve your child's
abilities to interact with other people and thus to function effectively in
society and be self-sufficient. Each child with Asperger's syndrome has
differences in the number and severity of symptoms, so treatment should be
designed to meet individual needs and available family resources. Specific treatments are based on symptoms.

Securing services

Start by contacting your local
school district to find out which services are available for your child. Become
informed about your
child's educational rights. Federal law requires
public schools to provide appropriate educational services for people ages 3 to
21 who have disabilities (including Asperger's). Also, there may be state and
local laws or policies to aid children with Asperger's.

You will
meet with school personnel to identify goals and establish an individualized
education program (IEP). IEPs are designed to fit the child's specific needs
based on the evaluation of his or her level of disability.

School programs

Look at what is being offered at
different schools to find out which services your child needs and where you can
best find them. Qualities to look for include:

  • Small work groups with individual
    attention.
  • A communication specialist with an interest in social
    skills training.
  • Opportunities for social interaction in a
    structured setting and in supervised activities.
  • A concern for
    teaching real-life skills and encouraging a child's special interests and
    talents.
  • A willingness to individualize the
    curriculum.
  • A sensitive counselor who can focus on your child's
    emotional well-being and serve as a liaison with the family.
  • An
    emphasis on respect for diversity and empathy for students.

Stay informed about what is happening in your child's
classroom. Frequent communication can be managed with a communication diary
that goes back and forth between teacher and parent.

Treatment strategies

Treatment is geared toward
improving communication, social skills, and behavior management. A treatment
program may be adjusted often to be the most useful for your child.

Take advantage of your child's strengths by encouraging him or her to
explore interests at home and at school. Activity-oriented groups and focused
counseling can also be helpful.

Many children with Asperger's
syndrome also have other coexisting conditions, including
attention deficit hyperactivity disorder (ADHD),
bipolar disorder,
obsessive-compulsive disorder (OCD),
social anxiety disorder, and
depression. These conditions can place extra demands
on parents who are already dealing with a child with extra needs. These
conditions may require treatment with medicines and other therapies.

Prevention

Researchers
have not yet found a way to prevent Asperger's syndrome. Some advocacy
groups claim the measles-mumps-rubella (MMR) vaccine causes Asperger's and
autism. But numerous studies have not found a link between these conditions and
the vaccine.footnote 2 Doctors recommend that you have your
children immunized, because not doing so puts them and others in your community
at risk for serious diseases and even death.

Home Treatment

You can best serve your child by
learning about
Asperger's syndrome and providing a supportive and
loving home environment. Remember that your child, just like every other child,
has his or her own strengths and weaknesses and needs as much support,
patience, and understanding as you can give.

Educating yourself
about the condition and about what to expect is an important part of helping
your child develop independence and succeed outside of his or her home. Learn about
Asperger's syndrome by talking to your doctor or contacting Asperger's
organizations. A good source is OASIS @ MAAP: The Online Asperger Syndrome Information and Support Center at www.aspergersyndrome.org. Learning about Asperger's will reduce your and your family
members' stress and help your child succeed.

The following are some suggestions on how to help your
child who has Asperger's syndrome. Some of the ideas will be helpful, and some
may not work for you. Flexibility, creativity, and a willingness to continue to
learn will all help you as you raise your child.

General strategies for success

  • Children with Asperger's syndrome benefit from
    daily routines for meals, homework, and bedtime. They also like specific rules,
    and consistent expectations mean less stress and confusion for
    them.
  • Many people with Asperger's syndrome do best with verbal
    (rather than nonverbal) teaching and assignments. A direct, concise, and
    straightforward manner is also helpful.
  • People with Asperger's
    syndrome often have trouble understanding the "big picture" and tend to see
    part of a situation rather than the whole. That's why they often benefit from a
    parts-to-whole teaching approach, starting with part of a concept and adding to
    it to demonstrate encompassing ideas.
  • Visual supports, including
    schedules and other written materials that serve as organizational aids, can be
    helpful.
  • Be aware that background noises, such as a clock ticking
    or the hum of fluorescent lighting, may be distracting to your
    child.
  • Children with autism spectrum disorders (which include Asperger's syndrome) may be especially interested in video games, computers, or other screen-based media such as TV. If possible, keep televisions, video games, and computers out of your child's bedroom. When children with autism spectrum disorders (ASDs) have these devices in their bedroom, they are more likely to sleep fewer hours. This is especially true when video games are in the bedroom. If your child doesn't get enough sleep, his or her ASD symptoms may be worse.
  • Children with Asperger's syndrome often mature more slowly.
    Don't always expect them to "act their age."
  • Try to identify stress
    triggers and avoid them if possible. Prepare your child in advance for
    difficult situations, and teach him or her ways to cope. For example, teach
    your child coping skills for dealing with change or new situations.

Strategies for developing social skills

  • Your child may not understand the social norms
    and rules that come more naturally to other children. Provide clear
    explanations of why certain behaviors are expected, and teach rules for those
    behaviors.
  • Encourage your child to learn how to interact with
    people and what to do when spoken to, and explain why it is important. Give
    lots of praise, especially when he or she uses a social skill without
    prompting.
  • Practice activities, such as games or
    question-and-answer sessions, that call for taking turns or putting yourself in
    the other person's place.
  • Help your child understand others'
    feelings by role-playing and watching and discussing human behaviors seen in
    movies or on television. Provide a model for your child by telling him or her
    about your own feelings and reactions to those feelings.
  • Teach
    your child how to read and respond appropriately to social cues. Give him or
    her "stock" phrases to use in various social situations, such as when being
    introduced. You can also teach your child how to interact by
    role-playing.
  • Foster involvement with others, especially if your
    child tends to be a loner.
  • Teach your child about public and
    private places, so that he or she learns what is appropriate in both
    circumstances. For example, hugging may not be appropriate at school but is
    usually fine at home.

Strategies for school

  • Use visual systems, such as calendars,
    checklists, and notes, to help define and organize schoolwork.
  • Orient your child to the school setting. Before the school year
    starts, take time to "walk through" your child's daily schedule. You can also
    use pictures to make your child familiar with the new settings before school
    starts.
  • Be aware of and try to protect your child from bullying and
    teasing. Talk to your child's teacher or school counselor about educating
    classmates about Asperger's syndrome.
  • Ask your child's teacher to
    seat your child next to classmates who are sensitive to your child's special
    needs. These classmates might also serve as "buddies" during recess, at lunch,
    and at other times.
  • Encourage your child's teacher to include your
    child in classroom activities that emphasize his or her best academic skills,
    such as reading, vocabulary, and art.
  • Set up homework routines for
    your child by doing homework at a specific time and place every day. This will
    help your child learn about time management.
  • Use rewards to
    motivate your child. Allow him or her to watch TV or play a favorite video game
    or give points toward a "special interest" gift when he or she performs
    well.
  • Some children with Asperger's have poor handwriting. Typing
    schoolwork on a computer may be one way to make homework easier. Using
    computers can also help children improve fine motor skills and organize
    information.
    Occupational therapy may also be helpful.

Other Places To Get Help

Organization

National Institute of Neurological Disorders and Stroke (U.S.)
www.ninds.nih.gov

References

Citations

  1. Volkmar FR, et al. (2008). Asperger's syndrome of Pervasive developmental disorders. In RE Hales et al., eds., The American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 882–884. Washington, DC: American Psychiatric Publishing.
  2. Taylor LE, et al. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccines, 32(29): 3623–3629.

Other Works Consulted

  • Reiff MI (2011). Autism spectrum disorders. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 352–355. New York: McGraw-Hill.
  • Sadock BJ, et al. ( 2007). Pervasive developmental disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1191–1205. Philadelphia: Lippincott Williams and Wilkins.
  • Volkmar FR, et al. (2009). Asperger's syndrome section of Pervasive development disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3554–3559. Philadelphia: Lippincott Williams and Wilkins.
  • Woodbury-Smith MR, Volkmar FR (2009). Asperger syndrome. European Child and Adolescent Psychiatry, 18(1): 2–11.

Credits

ByHealthwise StaffPrimary Medical Reviewer John Pope, MD - Pediatrics Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Louis Pellegrino, MD - Developmental Pediatrics

Current as ofNovember 16, 2017

Do NOT follow this link or you will be banned from the site!