Definition

-         It is a form of pervasive developmental disorder characterized by severe persistent impairment in social interactions, repetitive behavior patterns, and restricted interests. 

 

Differences between Autism and Asperger disorder

-         Sometimes Asperger syndrome is classified as a subset of Autism, because many symptoms present in individuals with Asperger syndrome overlap with those exhibited by high-function persons with Autism. 

-         However there are differences between the two PDD disorders.  Unlike a child with autism, children with Asperger syndrome do not suffer from a significant delay in cognitive development nor do they experience a significant delay in language acquisition. 

-         Also, children with Asperger disorder usually show motor coordination difficulties, particularly with fine motor control such as holding a pencil.  Children with autism do not experience such problems.

-         Children with autism find it very difficult to think in abstract symbolic states, resulting in difficulties in pretend play; they generally think in very concrete terms.  However, children with Asperger syndrome tend to show that they have a larger degree of imagination despite the fact that what they imagine can be the same thing over and over again. (It can be repetitive)

 

Frequency

-         In the United States, about 20-25 in 10,000 children are born with Asperger syndrome

 

Sex

-         Males are more afflicted than female with a mal-to-female ratio approximately 4:1

 

Age

-         Usually diagnosed when the child is in the earlier part of elementary school; diagnosis comes less frequently during early childhood or when the individual is an adult

 

Cause

-         As of yet, this is unknown.  Believed to be genetically based though, involving some influence on the CNS.

 

Clinical Symptoms

-         According to the DSM IV – look at print out

o       A. Impairment in social interactions (at least two)

§         Impairments in use of multiple nonverbal behaviors

·        May avoid eye-to-eye contact

·        May not return to right social and emotional responses because of lack of understanding social cues

·        Seems clueless towards the body language of others

·        Inappropriate or absent facial expression, body postures, and gestures for the circumstance

·        Has problems judging personal space; may stand too close to someone else

§         Fail develop age-appropriate peer relationships

·        May want to join a group of children and make new friends, but do not have the proper social skills to affectively accomplish this goal; usually exhibit inappropriate attempts to initiate social interaction

·        They usually show a naïve trust in other individuals which makes them susceptible to be taken advantage; this becomes more important during adolescence when peer pressure becomes more of a problem

·        Show difficulty distinguishing between whether someone is a friend or acquaintance

§         Spontaneous sharing is absent

·        These children do not show, bring, or point out objects of interest to other people

·        They do not share their happiness, interests, or achievements with other people like what a typically developing child would do

§         Do not show social or emotional reciprocity

·        No theory of mind

·        May not understand why people become upset when he or she breaks social rules

·        Do not show much empathy for other people; have difficulty comforting another because may not understand that person needs comforting

o       B. Restricted repetitive and stereotyped patterns of behavior, behavior, interests, and activities (at least one)

§         An all-encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

§         Adhere very rigidly to a specific, nonfunctional routines or rituals

·        Rigid adherence to rules and social conventions

·        Limited clothing and food preferences

·        Adhere to certain eating behaviors

·        Need for explicit step-by-step instructions; will become disoriented if a step is taken away

·        Difficulty generalizing

·        If change must occur in the child’s life in some way, it is advised to ease the child into it and explain what is to occur

§         Stereotyped and repetitive motor mannerisms (self-stimulatory behavior)

·        Examples include – hand or finger flapping or twisting, or complex whole-body movements

·        Express self-injurious behaviors

·        May be to reduce anxiety, stress, or for pleasure

§         Persistent preoccupation with parts of objects

·        Often their entire focus is on small details, parts of a whole, thus they fail to see the overall big picture of what is happening in any situation

o       C. These have to cause significant problems for the individual preventing him or her from functioning normally in everyday life

o       D. Must not show clinical significant general delay in language

§         By 2 years – single words

§         By 3 years – multiple words into a communicative phrase

o        E. Must not experience significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (besides social interaction), and curiosity about the environment in childhood

-         According to Gillberg’s Criteria (a bit more comprehensive diagnostic criteria) – look at print out

o       Severe impairment in reciprocal social interaction (at least two)

§         Look on print out; same as above

o       All-absorbing narrow interest (at least one)

§         Look on print out; same as above

§         (c) More rote than meaning (probably why they like strict rules and routines)

o       Imposition of routines and interests (at least one)

§         Look on print out; same as above

o       Speech and language problems (at least three)

§         Delayed development

§         Superficially perfect expressive language

·        May experience hyperlexia early in childhood; this is the ability to read fluently without understanding the meaning (fits well, because Asperger syndrome individuals excel at rote memory)

§         Formal, pedantic language

·        May talk incessantly on a topic of interest only to themselves without knowing the boredom of the listener

·        Seem to talk at you rather than to you, giving you information rather than holding a proper conversation (Been compared to talking like a professor)

·        May lack sensitivity about reciprocal rules of conversation- may inappropriately interrupt others, or have little participation at all, difficult to shift topics, hard to initiate and terminate conversation

·        Speech may be idiosyncratic (can only have meaning in certain contexts and perhaps only understood by certain people)

§         Odd prosody, peculiar voice characteristics

·        May not have the local accent

·        May be too loud or overly formal

·        Monotonous tone

§         Impairment of comprehension including misinterpretations of literal-implied meanings

·        Metaphors, similes, jokes, and the like usually need to be explained

o       Non-verbal communication problems (at least one)

§         Look on print out; same as above

§         (b) Clumsy/gauche body language

§         (e) Peculiar, stiff gaze

o       Motor clumsiness: poor performance on neurodevelopmental examination

§         Unusual gait, stance, posture

§         Usually quite clumsy

§         Gross or fine motor coordination problems; lax joints often observed (i.e. – immature or unusual grasp for handwriting and other fine hand movements)

·        May show anomalies of locomotion, balance, manual dexterity, handwriting, rapid movements, rhythm, and imitation of movements

§         Some may show impaired ball-playing skills

§         Sensory sensitivity; may have unusual responses to touch, sound, taste, sight, smell, pain, lighting, colors, and temperature (i.e. – might be overly sensitive to a soft touch, but undersensitive to pain)

§         May exhibit synesthesia (don’t know what that is)

 

Mortality

-         Individuals with this disorder generally have a normal lifespan

-         But do have high rate of comorbid psychiatric problems

 

Morbidities

-         Depression, mood disorders, obsessive-compulsive disorder, Tourette’s disorder

-         Learning disability, attention deficit disorder

-         Central auditory processing disorder, non-verbal learning disorder, semantic pragmatic language disorder

 

Treatment

-         Medications

o       Don’t usually treat with medication, but sometimes do to treat specific target symptoms

o       SSRI, selective serotonin reuptake inhibitors, like Paxil, Prozac, Zoloft, might help with obsessions or perseveration, may also help with depression and anxiety

o       To help with stereotyped movements, agitation and idiosyncratic thinking, may prescribe low dose of antipsychotic drugs like risperidone

-         I didn’t really get very much info on treatment of this disorder.  In one article they talked about social skills training briefly and educational intervention because many of such children still attend regular schools.  But I don’t know if the same behavioral treatments (i.e. - Pivotal Response Training) used for autistic children are also used for children with asperger’s syndrome.  Maybe someone else found some more info on this, if we even want to include this in our presentation.