Everything about Asperger S Syndrome totally explained
Asperger syndrome (also called
Asperger's syndrome,
Asperger's disorder,
Asperger's or
AS) is one of several
autism spectrum disorders (ASD) characterized by difficulties in
social interaction and by restricted,
stereotyped interests and activities. AS is distinguished from the other ASDs in having no general
delay in language or
cognitive development. Although not mentioned in standard diagnostic criteria,
motor clumsiness and atypical use of language are frequently reported. Researchers and people with AS have contributed to a shift in attitudes away from the notion that AS is a deviation from the norm that must be treated or cured, and towards the view that AS is a difference rather than a disability. ASD, in turn, is a subset of the broader autism
phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like
traits, such as social deficits. Of the other four ASD forms,
autism is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in
cognitive development;
Rett syndrome and
childhood disintegrative disorder share several signs with autism, but may have unrelated causes; and
pervasive developmental disorder not otherwise specified (PDD-NOS) is diagnosed when the criteria for a more specific disorder are unmet. The extent of the
overlap between AS and high-functioning autism (
HFA—autism unaccompanied by mental retardation) is unclear.
The current ASD classification may not reflect the true nature of the conditions.
Characteristics
A
pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of activities and interests, and by no clinically significant delay in cognitive development or general delay in language. Intense preoccupation with a narrow subject, one-sided verbosity, restricted
prosody and
intonation, and
motor clumsiness are typical of the condition, but are not required for diagnosis.
Social interaction
The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome.
Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly, for example by engaging in a one-sided, long-winded speech about a favorite topic while being oblivious to the listener's feelings or reactions, such as signs of boredom or haste to leave. More evidence suggests children with AS are victims rather than victimizers.
Restricted and repetitive interests and behavior
People with Asperger syndrome display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines or rituals, move in stereotyped and repetitive ways, or preoccupy themselves with parts of objects. They include hand movements such as flapping or twisting, and complex whole-body movements.
Speech and language
Although children with Asperger syndrome acquire language skills without significant general delay, and the speech of those with AS typically lacks significant abnormalities, language acquisition and use is often atypical. Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features. Conversely, compared to individuals with HFA, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory. these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased
fight-or-flight response or failure of
habituation in autism; there's more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.
Hans Asperger’s initial accounts include descriptions of
motor clumsiness. Children with AS may be delayed in acquiring motor skills that require motor dexterity, such as bicycle riding or opening a jar, and may appear awkward or "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration. Although AS, lower sleep quality, and alexithymia are associated, their causal relationship is unclear.
Causes
Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the
expression of autism, given the
phenotypic variability seen in this group of children. Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation.
Mechanism
Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects. Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,
Neuroanatomical studies and the associations with
teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception. Several theories of mechanism are available; none are likely to be complete explanations.
[[Image:FMRI.jpg|thumb|
Functional magnetic resonance imaging provides some evidence for both underconnectivity and mirror neuron theories. It maps well to general-processing theories such as
weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD. A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and
perceptual operations in autistic individuals.
The
mirror neuron system (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment. For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS. This theory maps well to social cognition theories like the
theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others, or
hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at
empathizing by handling events generated by other agents.
Other possible mechanisms include
serotonin dysfunction and
cerebellar dysfunction.
Screening
Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age. and by
Gillberg and Gillberg.
Diagnosis is most commonly made between the ages of four and eleven. Conditions that must be considered in a
differential diagnosis include other ASDs, the
schizophrenia spectrum, ADHD,
obsessive compulsive disorder,
depression,
semantic pragmatic disorder,
nonverbal learning disorder,
Tourette syndrome,
Underdiagnosis and overdiagnosis are problems in marginal cases. The cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD. There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who don't have autism but have social difficulties. There are questions about the external validity of the AS diagnosis, that is, it's unclear whether there's a practical benefit in distinguishing AS from HFA and from PDD-NOS; the same child can receive different diagnoses depending on the screening tool. Although progress has been made, data supporting the efficacy of particular interventions are limited.
The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there's no single best treatment package.
cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions, and to cut back on obsessive interests and repetitive routines;
medication, for coexisting conditions such as depression and anxiety;
the training and support of parents, particularly in behavioral techniques to use in the home.
Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants, and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored. Despite the popularity of social skills training, its effectiveness isn't firmly established. A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children. Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants to improve the work and life management of people with AS are useful. Although research into the efficacy of pharmaceutical intervention for AS is limited, along with serious long-term neurological side effects. Sedation and weight gain are more common with olanzapine, have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people wouldn't be problematic.
Prognosis
As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS. Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics and AS hasn't prevented some adults from major accomplishments such as winning the Nobel Prize.
Children with AS may require special education services because of their social and behavioral difficulties although many attend regular education classes. Anxiety may stem from preoccupation over possible violations of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern with failing in social encounters; combining the average ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000. Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be at higher risk for AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria. Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies. AS is associated with tics, Tourette syndrome, and bipolar disorder, and the repetitive behaviors of AS have many similarities with the symptoms of obsessive-compulsive disorder and obsessive-compulsive personality disorder.
History
Named after the Austrian pediatrician Hans Asperger (1906–80), Asperger syndrome is a relatively new diagnosis in the field of autism.
In 1944, Asperger described four children in his practice who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by social isolation. He called his young patients "little professors", and believed some would be capable of exceptional achievement and original thought later in life. of a series of case studies of children showing similar symptoms, AS became a standard diagnosis in 1992, when it was included in the tenth edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of the American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The word neurotypical (abbreviated NT) describes a person whose neurological development and state are typical, and is often used to refer to non-autistic people.
The Internet has allowed individuals with AS to communicate and celebrate with each other in a way that wasn't previously possible due to their rarity and geographic dispersal. A subculture of aspies has formed. Internet sites like Wrong Planet have made it easier for individuals to connect.
Autistic people have contributed to a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there's an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance for what they call neurodiversity. These views are the basis for the autistic rights and autistic pride movements.
Simon Baron-Cohen has argued that AS and high-functioning autism are different cognitive styles, not disabilities, and that a diagnosis of AS/HFA shouldn't be received as a family tragedy, but as interesting information, such as learning that a child is left-handed. According to Baron-Cohen, "people with AS/HFA might not necessarily be disabled in an environment in which an exact mind, attracted to detecting small details, is an advantage." Tony Attwood argues, "the unusual profile of abilities that we define as Asperger's syndrome has probably been an important and valuable characteristic of our species throughout evolution."
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