Diseases

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 it 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 most recent studies show that one out of every 110 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.

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.

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.

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

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.

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.

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. However, there has been significant academic debate regarding this decision, and since this edition is not expected to be approved and published until 2013, there will be more debates on the matter. 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).

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.