Arizona Advanced Medicine Clinic

Asperger Syndrome – Having a Dollop of Autism

Asperger syndrome (AS) is part of a group of conditions called autism spectrum disorders.

They are known as spectrum disorders because the symptoms of each can appear in different combinations and in varying degrees of severity. Two children with the same diagnosis, though they may share certain patterns of behavior, can exhibit a wide range of skills and abilities.

Terms such as “low-functioning,” “high-functioning,” “autistic tendencies,” “pervasive developmental disorder,” and others are often used to describe children whose behaviors fall within the spectrum. Kids with AS share many of the same symptoms as those with “high-functioning autism.”

Some describe AS as a type of autism characterized by an inability to read body language, poor social skills, sensory sensitivity and a narrow, obsessive range of interests.

You cannot tell that someone has Asperger syndrome just by looking at them.

AS is a lifelong disability that affects how a person makes sense of the world, processes information, and relates to other people.

When we meet a person, we make judgments. From their facial expression, tone of voice and body language, we can usually tell whether they are happy, angry or sad and respond accordingly.

People with AS can find it harder, if not impossible, to read the signals that most of us take for granted. This means they find it more difficult to communicate and interact with others which can lead to high levels of anxiety and confusion. They desire interaction with others but have trouble knowing how to make it work. They do not understand why people misinterpret what they say. They tend to interpret everything in a very concrete way, since they are unable to read the “behind” signals that we all give out constantly.

Children with AS may show no delays in language development; they usually have good grammatical skills and an advanced vocabulary at an early age. However, they may be very literal, and they may have trouble using language in a social context. Often there are no obvious delays in cognitive development or in age-appropriate self-help skills such as feeding and dressing themselves.

Individuals with AS may have problems with attention span, problems with organization, and skills that seem well developed in some areas and lacking in others. However, they usually have average and sometimes above average intelligence.

AS is not caused by emotional deprivation or the way a person has been brought up. Because some of the behaviors exhibited by a person with AS may be seen by others as intentionally rude, many people wrongly assume that AS is the result of bad parenting – it isn’t.

Asperger syndrome is a neurobiological disorder whose causes are not yet fully understood. However, research suggests that a combination of factors – genetic and environmental – may account for changes in brain development. There seems to be a hereditary component to AS.

There is currently no cure and no specific treatment for Asperger syndrome. Children with AS become adults with AS.

AS got its name from Viennese physician, Hans Asperger, who in 1944 published a paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. In spite of the publication of his paper in the 1940’s, it wasn’t until 1994 that Asperger Syndrome was added to the DSM IV and only in the past few years has AS been recognized by professionals and parents. Until then they were seen usually as brilliant, eccentric, absent minded, socially inept, and a little awkward physically.

The characteristics of Asperger syndrome vary from one person to another but are generally divided into three main groups:[1]

Difficulty with social communication

“If you have Asperger syndrome, understanding conversation is like trying to understand a foreign language.”

People with AS sometimes find it difficult to express themselves emotionally and socially. For example, they may:

  • Have difficulty understanding gestures, facial expressions or tone of voice.
  • Have difficulty knowing when to start or end a conversation and choosing topics to talk about.
  • Use complex words and phrases but may not fully understand what they mean.
  • Be very literal in what they say and can have difficulty understanding jokes, metaphor and sarcasm. For example, a person with AS may be confused by the phrase ‘That’s cool’ when people use it to say something is good.

In order to help a person with AS understand you, keep your sentences short – be clear and concise. Do not expect them to infer anything from your tone of voice or your body language. They cannot interpret these communications.

Difficulty with social interaction

“I have difficulty picking up social cues, and difficulty in knowing what to do when I get things wrong.”

Many people with AS want to be sociable but have difficulty with initiating and sustaining social relationships, which can make them very anxious. People with the condition may:

  • Struggle to make and maintain friendships.
  • Not understand the unwritten ‘social rules’ that most of us pick up without thinking. For example, they may stand too close to another person, or start an inappropriate topic of conversation.
  • Find other people unpredictable and confusing.
  • Become withdrawn and seem uninterested in other people, appearing almost aloof.
  • Behave in what may seem an inappropriate manner.

Difficulty with social imagination

“We have trouble working out what other people know. We have more difficulty guessing what other people are thinking.”

People with AS can be imaginative in the conventional use of the word. For example, many are accomplished writers, artists and musicians. But people with AS can have difficulty with social imagination. This can include:

  • Imagining alternative outcomes to situations and finding it hard to predict what will happen next.
  • Understanding or interpreting other peoples thoughts, feelings or actions. The subtle messages that are put across by facial expression and body language are often missed.
  • Having a limited range of imaginative activities, which can be pursued rigidly and repetitively such as lining up toys or collecting and organizing things related to his or her interest.

Some children with AS may find it difficult to play ‘let’s pretend’ games or prefer subjects rooted in logic and systems, such as mathematics.

Other related characteristics

Love of routines

“If I get anxious I get in a tizz. I have a timetable; it helps me to see what I have to do next, otherwise I get confused.”

To try and make the world less confusing, people with AS may have rules and rituals (ways of doing things) which they insist upon. Young children, for example, may insist on always walking the same way to school. In class, they may get upset if there is a sudden change to the timetable. People with AS often prefer to order their day to a set pattern. For example, if they work set hours, an unexpected delay to their journey to or from work can make them anxious or upset.

Special interests

“I remember Samuel reciting the distances of all the planets from the sun to a baffled classmate in the playground when he was five. Since then he has had many obsessions, which he loves to talk about at length!”

People with AS may develop an intense, sometimes obsessive, interest in a hobby or collecting. Sometimes these interests are lifelong; in other cases, one interest is replaced by an unconnected interest. For example, a person with AS may focus on learning all there is to know about trains or computers. Some are exceptionally knowledgeable in their chosen field of interest. With encouragement, interests and skills can be developed so that they can study or work in their favorite subjects.

Sensory difficulties

“Robert only has problems with touch when he doesn’t know what’s coming – like jostling in queues and people accidentally brushing into him. Light touch seems to be worse for him than a firm touch.”

People with AS may have sensory difficulties. These can occur in one or all of the senses (sight, sound, smell, touch, or taste). The degree of difficulty varies from one individual to another. Most commonly, an individual’s senses are either intensified (over-sensitive) or underdeveloped (under-sensitive). For example, bright lights, loud noises, overpowering smells, particular food textures and the feeling of certain materials can be a cause of anxiety and pain for people with Asperger syndrome.

People with sensory sensitivity may also find it harder to use their body awareness system. This system tells us where our bodies are, so for those with reduced body awareness, it can be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other people and carry out ‘fine motor’ tasks such as tying shoelaces. Some people with AS may rock or spin to help with balance and posture or to help them deal with stress.

In social interaction, many people with Asperger’s syndrome demonstrate gaze avoidance and may actually turn away at the same moment as greeting another.

A LIFELONG CHALLENGE

There is a general impression that Asperger’s syndrome carries with it superior intelligence and a tendency to become very interested in and preoccupied with a particular subject. Often this preoccupation leads to a specific career at which the adult is very successful. At younger ages, one might see the child being a bit more rigid and apprehensive about changes or about adhering to routines. This can lead to a consideration of OCD (obsessive compulsive disorder) but it is not the same phenomenon.

So what’s it like being in relationship with an adult with AS? Here’s one example:

Sarah, 40, and Keith, 39, got together four years ago through an internet dating site. “Being together was idyllically wonderful, yet if something wasn’t quite right it would plummet into a hideous mess,” she says. “He would become colder and colder. I would ask those stupid female questions: ‘Do you think we will live together?’ He would say: ‘Seeing you once a week is enough for me. I don’t want any more.’ I’d get terribly upset and he would just be staring at me emotionless or he’d disappear.” As the couple write in their book - Asperger Syndrome: a Love Story - their relationship became so painful that they split up for a while.

By coincidence, Sarah got a job as a training manager for a project with adults with Asperger’s and told Keith about the courses that she had been sent on. He spent many hours on the internet reading about the syndrome but sees no benefit in getting an official diagnosis. However, understanding Asperger’s has helped the couple to communicate better and Sarah is no longer upset by Keith’s literal and straightforward way of talking: “If there’s something that pops into his head, he’ll say it. He just does not have the edit button that everyone else does. One evening, in front of my brother and his wife, he said: ‘When you lean back your nose looks like the underside of my scrotum.’ They were horrified, but I laughed.”

Part of this acceptance is that Sarah has learnt how Keith’s brain works. Meanwhile, Keith has begun to realise that other people might add extra layers of meaning to what he says or does. As Sarah says: “He doesn’t understand why, but he accepts that I have a different viewpoint and later asks: ‘Did I go too far?'” [2]

Many of the weaknesses can be remediated with specific types of therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger’s can have relationships, families, happy and productive lives.

[1] The National Autistic Society, 393 City Road, London, EC1V 1NG, United Kingdom. [2] Does your partner have Asperger’s?, The Times (Britain), February 23, 2008
Asperger Syndrome – Having a Dollop of Autism
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“If you have Asperger syndrome, understanding conversation is like trying to understand a foreign language.”

People with AS sometimes find it difficult to express themselves emotionally and socially. For example, they may:

In order to help a person with AS understand you, keep your sentences short – be clear and concise. Do not expect them to infer anything from your tone of voice or your body language. They cannot interpret these communications.

“I have difficulty picking up social cues, and difficulty in knowing what to do when I get things wrong.”

Many people with AS want to be sociable but have difficulty with initiating and sustaining social relationships, which can make them very anxious. People with the condition may:

“We have trouble working out what other people know. We have more difficulty guessing what other people are thinking.”

People with AS can be imaginative in the conventional use of the word. For example, many are accomplished writers, artists and musicians. But people with AS can have difficulty with social imagination. This can include:

Some children with AS may find it difficult to play ‘let’s pretend’ games or prefer subjects rooted in logic and systems, such as mathematics.

“If I get anxious I get in a tizz. I have a timetable; it helps me to see what I have to do next, otherwise I get confused.”

To try and make the world less confusing, people with AS may have rules and rituals (ways of doing things) which they insist upon. Young children, for example, may insist on always walking the same way to school. In class, they may get upset if there is a sudden change to the timetable. People with AS often prefer to order their day to a set pattern. For example, if they work set hours, an unexpected delay to their journey to or from work can make them anxious or upset.

“I remember Samuel reciting the distances of all the planets from the sun to a baffled classmate in the playground when he was five. Since then he has had many obsessions, which he loves to talk about at length!”

People with AS may develop an intense, sometimes obsessive, interest in a hobby or collecting. Sometimes these interests are lifelong; in other cases, one interest is replaced by an unconnected interest. For example, a person with AS may focus on learning all there is to know about trains or computers. Some are exceptionally knowledgeable in their chosen field of interest. With encouragement, interests and skills can be developed so that they can study or work in their favorite subjects.

“Robert only has problems with touch when he doesn’t know what’s coming – like jostling in queues and people accidentally brushing into him. Light touch seems to be worse for him than a firm touch.”

People with AS may have sensory difficulties. These can occur in one or all of the senses (sight, sound, smell, touch, or taste). The degree of difficulty varies from one individual to another. Most commonly, an individual’s senses are either intensified (over-sensitive) or underdeveloped (under-sensitive). For example, bright lights, loud noises, overpowering smells, particular food textures and the feeling of certain materials can be a cause of anxiety and pain for people with Asperger syndrome.

People with sensory sensitivity may also find it harder to use their body awareness system. This system tells us where our bodies are, so for those with reduced body awareness, it can be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other people and carry out ‘fine motor’ tasks such as tying shoelaces. Some people with AS may rock or spin to help with balance and posture or to help them deal with stress.

In social interaction, many people with Asperger’s syndrome demonstrate gaze avoidance and may actually turn away at the same moment as greeting another.

There is a general impression that Asperger’s syndrome carries with it superior intelligence and a tendency to become very interested in and preoccupied with a particular subject. Often this preoccupation leads to a specific career at which the adult is very successful. At younger ages, one might see the child being a bit more rigid and apprehensive about changes or about adhering to routines. This can lead to a consideration of OCD (obsessive compulsive disorder) but it is not the same phenomenon.

So what’s it like being in relationship with an adult with AS? Here’s one example:

Sarah, 40, and Keith, 39, got together four years ago through an internet dating site. “Being together was idyllically wonderful, yet if something wasn’t quite right it would plummet into a hideous mess,” she says. “He would become colder and colder. I would ask those stupid female questions: ‘Do you think we will live together?’ He would say: ‘Seeing you once a week is enough for me. I don’t want any more.’ I’d get terribly upset and he would just be staring at me emotionless or he’d disappear.” As the couple write in their book - Asperger Syndrome: a Love Story - their relationship became so painful that they split up for a while.

By coincidence, Sarah got a job as a training manager for a project with adults with Asperger’s and told Keith about the courses that she had been sent on. He spent many hours on the internet reading about the syndrome but sees no benefit in getting an official diagnosis. However, understanding Asperger’s has helped the couple to communicate better and Sarah is no longer upset by Keith’s literal and straightforward way of talking: “If there’s something that pops into his head, he’ll say it. He just does not have the edit button that everyone else does. One evening, in front of my brother and his wife, he said: ‘When you lean back your nose looks like the underside of my scrotum.’ They were horrified, but I laughed.”

Part of this acceptance is that Sarah has learnt how Keith’s brain works. Meanwhile, Keith has begun to realise that other people might add extra layers of meaning to what he says or does. As Sarah says: “He doesn’t understand why, but he accepts that I have a different viewpoint and later asks: ‘Did I go too far?'” [2]

Many of the weaknesses can be remediated with specific types of therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger’s can have relationships, families, happy and productive lives.

[1] The National Autistic Society, 393 City Road, London, EC1V 1NG, United Kingdom.

Many of the weaknesses can be remediated with specific types of therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger’s can have relationships, families, happy and productive lives.

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