Asperger’s syndrome is a type of autism. It is characterized by social and communication difficulties and repetitive or restrictive patterns of behavior.
Asperger’s syndrome (AS) used to be a standalone condition, but in 2013, it was brought under the category of autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorder 5 (DSM-5).
AS affects between 0.03 to 4.84 in every 1,000 people. It affects males around four times as often as females.
The signs and symptoms of AS vary widely. Early signs of AS may appear in the first year of life. These include poorly coordinated motor skills, leading to clumsiness, or awkwardness.
Restrictive and repetitive interests, for example, becoming an expert in a single object or topic to the exclusion of all others. Activities usually involve collecting, numbering, or listing.
Formal or distinct speech: There may be a lack of rhythm or intonation. Speech can sound flat, monotonous, unusually slow or fast, or the volume may be inappropriate.
Routines: People with AS may have rules and rituals that they methodically maintain to reduce confusion. A surprise change in routine can sometimes cause upset or anxiety.
Social isolation: Poor social skills and a tendency to talk only about their singular interest can lead to isolation. The person can become withdrawn. They may seem uninterested in other people and appear distant or aloof. Making and keeping friends may be challenging.
Delays in motor development: Poor coordination can make it hard to carry out detailed tasks, such as tying shoelaces. The person’s gait can appear either stiff or bouncy, and they may not swing their arms as they walk.
Issues with proximity: People with AS may find it hard to know how close to stand to another person while conversing.
Jokes, sarcasm, and irony may cause distress and confusion: The person may have a highly literal interpretation of the world. Irony and humor may be difficult for them to understand, leading to frustration and confusion.
Imagination: It can be hard to imagine alternative outcomes to situations, so role-playing and make-believe games may seem pointless or impossible.
However, the difficulties are often not recognized until the demands of their environment increase. This can happen as late as early adulthood, when the individual leaves high school for college.
Topics based on logic, memory, and systems are more interesting for a person with AS. The individual may be exceptionally skilled in math, computer science, and music.
An accurate diagnosis can lead to a better understanding of the challenges the person is facing, and it may enable the individual to access appropriate support.
A range of therapies can help the person to adapt their behavior for a better social outcome, and to deal with anxiety. This can reduce the risk of social isolation.
Training may include:
Education and academic skills: A child who receives a diagnosis of AS can benefit from educational support. Aims can include organizing notes, managing homework goals, and addressing any specific learning needs. Most children with AS are best suited to a mainstream school environment.
Acquiring appropriate social skills: The individual can learn strategies to enhance their interactions with others, for example, by learning how to read and respond to social cues.
Communication skills training: Specialized speech and language therapy can help the person learning how to start and maintain a conversation, for example.
This also includes learning how to use tone of voice in questions, confirmations, disagreements and instructions, and how to interpret and respond to verbal and non-verbal cues.
Cognitive behavioral therapy (CBT): The person learns to control emotions and decrease obsessive interests and repetitive routines.
Behavior modification: This includes strategies for supporting positive behavior and decreasing ineffective behavior.
Occupational or physical therapy: This can help those with sensory integration problems or poor motor coordination.
Medication: There are no medications for AS, but drugs may be used to treat symptoms such as anxiety.
Alternative medicine: Some studies suggest that special diets, such as gluten-free diets and vitamin supplements, can be beneficial. Anecdotal evidence suggests that a regular intake of fish oils may help with anxiety and some cognitive issues.
A review of studies into alternative therapies for ASD, published in 2015, found that, according to anecdotal evidence, music therapy, sensory integration therapy, acupuncture, and massage may help.
However, the authors conclude, “There is no conclusive evidence supporting the efficacy of [complementary and alternative medicine] therapies in ASD.”
The role of supporting caregivers
Parents and other caregivers may benefit from learning experiences that help them gain a deeper understanding of AS.
By learning some strategies, they can become better placed to support a dependent loved one with AS, and prevent them from feeling isolated.
A person with AS can often cope with change if they know it is coming, and if it is planned. Family and other support networks can help the person prepare for change when appropriate.
If parents believe that their child may have symptoms of AS, it is important to communicate with the child’s school, because educational institutions can offer learning support.
The core characteristics of AS are lifelong, but additional support can help the individual maximize their achievements and quality of life.
The exact cause is unknown, but AS may result from a combination of genetic and environmental factors that cause changes in brain development.
AS tends to run in families, suggesting that some cases may be hereditary.
Some researchers have proposed that environmental factors early in pregnancy may have an impact, but experts have not yet confirmed this.
Brain abnormalities may be linked to AS. Advanced brain imaging technology has identified structural and functional differences in specific regions of the brain among people with AS.
There are a few complications of Asperger’s syndrome. It can be an underlying condition that fuels other functional difficulties, or the complications can arise from the tics that accompany the condition.
Sensory difficulties: Some people may have a distorted sensory sensitivity, so their senses may be either intensified or underdeveloped. This can affect how the person perceives noise, bright lights, intense smells, food textures, and materials.
Related conditions: Young children with AS are often unusually active. By young adulthood, they may develop anxiety or depression.
Other conditions related with AS are:
- attention deficit hyperactivity disorder (ADHD)
- depression, especially later in life
- tic disorders such as Tourette syndrome
- anxiety disorders, and obsessive-compulsive disorder (OCD)
There is no specific test for Asperger’s syndrome.
Physical tests, such as hearing, blood tests, or X-rays can rule out other conditions and determine whether a physical disorder is causing the symptoms.
Early diagnosis can be difficult due to the wide range of symptoms, so an accurate diagnosis or appropriate treatment may not occur until adulthood.
To assess a child, the team will consist of a pediatrician and other specialists, such as a psychologist. Parents will provide information about symptoms, and the team may also consider observations from teachers.
When assessing adults, a professional may ask the person’s parents, spouse, and close family members to find out about their developmental history.