Asperger's Disorder Health Article

Definition

Asperger's disorder, which is also called Asperger's syndrome (AS) or autistic psychopathy, belongs to a group of childhood disorders known as pervasive developmental disorders (PDDs) or autistic spectrum disorders. The essential features of Asperger's disorder are severe social interaction impairment and restricted, repetitive patterns of behavior and activities. It is similar to autism, but children with Asperger's do not have the same difficulties in acquiring language that children with autism have.

In the mental health professional's diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders fourth edition text revised, or DSM-IV-TR, Asperger's disorder is classified as a developmental disorder of childhood.

Description

AS was first described by Hans Asperger, an Austrian psychiatrist, in 1944. Asperger's work was unavailable in English before the mid-1970s; as a result, AS was often unrecognized in English-speaking countries until the late 1980s. Before DSM-IV (published in 1994) there was no officially agreed-upon definition of AS. In the words of ICD-10, the European equivalent of the DSM-IV, Asperger's is "a disorder of uncertain nosological validity." (Nosological refers to the classification of diseases.) There are three major reasons for this lack of clarity: differences between the diagnostic criteria used in Europe and those used in the United States; the fact that some of the diagnostic criteria depend on the observer's interpretation rather than objective measurements; and the fact that the clinical picture of Asperger's changes as the child grows older.

Asperger's disorder is one of the milder pervasive developmental disorders. Children with AS learn to talk at the usual age and often have above-average verbal skills. They have normal or above-normal intelligence and the ability to feed or dress themselves and take care of their other daily needs. The distinguishing features of AS are problems with social interaction, particularly reciprocating and empathizing with the feelings of others; difficulties with nonverbal communication (such as facial expressions); peculiar speech habits that include repeated words or phrases and a flat, emotionless vocal tone; an apparent lack of "common sense"; a fascination with obscure or limited subjects (for example, the parts of a clock or small machine, railroad schedules, astronomical data, etc.) often to the exclusion of other interests; clumsy and awkward physical movements; and odd or eccentric behaviors (hand wringing or finger flapping; swaying or other repetitious whole-body movements; watching spinning objects for long periods of time).

Demographics

Although the incidence of AS has been variously estimated between 0.024% and 0.36% of the general population in North America and northern Europe, further research is required to determine its true rate of occurrence—especially because the diagnostic criteria have been defined so recently. In addition, no research regarding the incidence of AS has been done on the populations of developing countries, and nothing is known about the incidence of the disorder in different racial or ethnic groups.

With regard to gender differences, AS appears to be much more common in boys. Dr. Asperger's first patients were all boys, but girls have been diagnosed with AS since the 1980s. One Swedish study found the male/female ratio to be 4:1; however, the World Health Organization's ICD-10 classification gives the male to female ratio as 8 to 1.

Causes and symptoms

There is some indication that AS runs in families, particularly in families with histories of depression and bipolar disorder. Asperger noted that his initial group of patients had fathers with AS symptoms. Knowledge of the genetic profile of the disorder continues to be quite limited, however.

In addition, about 50% of AS patients have a history of oxygen deprivation during the birth process, which has led to the hypothesis that the disorder is caused by damage to brain tissue before or during childbirth. Another cause that has been suggested is an organic defect in the functioning of the brain.

Research studies have made no connection between Asperger's disorder and childhood trauma, abuse or neglect.

In young children, the symptoms of AS typically include problems picking up social cues and understanding the basics of interacting with other children. The child may want friendships but find him- or herself unable to make friends.

Most children with Asperger's are diagnosed during the elementary school years because the symptoms of the disorder become more apparent at this point. They include:

• Poor pragmatic language skills. This phrase means that the child does not use the right tone or volume of voice for a specific context, and does not understand that using humorous or slang expressions also depends on social context.
• Problems with hand-eye coordination and other visual skills
• Problems making eye contact with others
• Learning difficulties, which may range from mild to severe
• Tendency to become absorbed in a particular topic and not know when others are bored with conversation about it. At this stage in their education, children with AS are likely to be labeled as "nerds."
• Repetitive behaviors. These include such behaviors as counting a group of coins or marbles over and over; reciting the same song or poem several times; buttoning and unbuttoning a jacket repeatedly; etc.

Adolescence is one of the most painful periods of life for young people with Asperger's, because social interactions are more complex in this age group and require more subtle social skills. Some boys with AS become frustrated trying to relate to their peers and may become aggressive. Both boys and girls with the disorder are often quite naive for their age and easily manipulated by "street-wise" classmates. They are also more vulnerable than most youngsters to peer pressure.

Little research has been done regarding adults with AS. Some have serious difficulties with social and occupational functioning, but others are able to finish their schooling, join the workforce, and marry and have families.