| Asperger Syndrome
Asperger syndrome, also known as Asperger disorder or AS, is a pervasive developmental disorder (a spectrum of behavioral disorders including autism ). Asperger syndrome is characterized by an inability to understand how to interact socially and a pattern of repetitive behaviors and/or restricted interests. Unlike persons with autism, those with Asperger syndrome do not show a marked delay in language development or cognitive development. Asperger syndrome is commonly recognized in children after the age of 3 years and is more frequently diagnosed in boys.
Individuals with Asperger syndrome have serious impairments in their social and communication skills, including poor nonverbal communication. However, many individuals have good cognitive and verbal skills, and typically have normal to superior intelligence. Many have excellent rote memory and become intensely interested in one or two subjects.
Children with Asperger syndrome are typically educated in the mainstream setting but usually require special education services. These children often have difficulty making friends and are often teased or bullied by their peers.
The cause of Asperger syndrome is unknown. There may be a genetic component to this syndrome.
Asperger Syndrome Symptoms
An individual's symptoms can range from mild to severe. An individual may have all or only some of the described characteristics, and they may exhibit more problems in unstructured social settings or new situations that involve social problem-solving skills.
Social problems
- Although these children may express an interest in friendships, they have difficulty in making friends and may be rejected by peers; often these children are loving and affectionate with their immediate family
- Socially inappropriate behavior
- Lack of understanding social cues
- Difficulty judging personal space
- Difficulty understanding others' feelings
- Rigid social behavior due to an inability to spontaneously adapt to variations in social situations
Abnormal communication patterns
- Awkward or inappropriate body language, including limited use of gestures and absent or inappropriate facial expressions
- Unusual, formal style of speaking
- Difficulty understanding nonliteral and implied communication
- Impairments in the modulation of volume, intonation, inflection, rate, and rhythm of speech
- Speech may be tangential and circumstantial, often with irrelevant comments
- Conversation style characterized by marked wordiness
- Difficulty with “give and take” of conversation
- Lack of sensitivity about interrupting others
Activities
- Intense interest in a particular, often very restricted, subject that dominates the individual's attention
- Inflexible adherence to routines; has repetitive routines or rituals
- Apprehensive about change, may have difficulty transitioning from one activity to another
Sensory sensitivity
- Sensitivity to sound, touch, taste, light, sight, smell, pain, and/or temperature
- Sensitivity to the texture of foods
Motor skill delays
- History of delayed development of motor skills
- Visible clumsiness and poor coordination
- Deficits in visual-motor and visual-perceptual skills, including problems with balance, manual dexterity, handwriting, rapid movements, rhythm, and imitation of movements
When to Seek Medical Care
An individual should seek medical care to begin a comprehensive diagnostic assessment when problems with social skills and interaction begin in a preschool-aged or early school-aged child or when the diagnosis of Asperger syndrome is suspected in the course of a pediatric visit. Medical care is also indicated when psychopharmacologic treatment is considered for the management of problematic behaviors or symptoms associated with Asperger syndrome.
Asperger Syndrome Treatment Medical Treatment
No specific treatment for the core symptoms of Asperger syndrome is available, and no cure exists for the disorder. Educational and behavioral supports are the primary treatments used for individuals with Asperger syndrome. Psychopharmacology and other treatments may also be used to manage some of the problem behaviors associated with Asperger syndrome.
Medications
No specific medications are used to treat Asperger syndrome itself. However, medications may be used to treat specific behavioral symptoms associated with Asperger syndrome, especially when they cause the individual distress or significantly interfere with educational or social functioning. These behavioral symptoms may include anxiety, attention problems, aggression, behavioral rigidity, mood disorders (particularly depression), and stereotypy (constant repetition of certain meaningless gestures or movement) or perseveration (constant repetition of meaningless words or phrases).
Other Therapy
- Educational and behavioral supports are the primary interventions for individuals with Asperger syndrome. These interventions need to be individualized to address each person's unique strengths and weaknesses.
- Individuals with Asperger syndrome may benefit from formal social skills training, ideally provided in a group setting with peers.
- Participation in organized, supervised, and structured activities may provide these children with opportunities for social interaction and facilitation of social relationships.
- Supportive psychotherapy may be beneficial in dealing with frustration, depression, and anxiety. A direct, problem-solving focus is generally more successful than an insight-oriented approach.
- Specific behavioral interventions may need to be implemented to reduce problematic or disruptive behaviors, such as perseverations and tantrums.
- Interventions in school settings
- Parents and teachers have the opportunity to help individuals develop appropriate social behavior. Teachers can model inappropriate social behavior and encourage cooperative games in the classroom. They may also be able to identify suitable friends for children with Asperger syndrome. Parents can also help children learn appropriate behaviors by modeling skills such as flexibility, sharing, and cooperation. The strategies used by teachers, therapists, and parents should be coordinated so that they are implemented consistently by various people across settings.
- Children with Asperger syndrome may benefit from one-on-one attention in the classroom to model and coach appropriate behavior.
- Skills, concepts, and cognitive strategies should be taught in an explicit and rote fashion.
- In addition to academic goals, improvement in independent functioning and self-sufficiency should be a priority. A program should focus on enhancing communication and social competence.
- Accommodations may need to be implemented for difficulties with graphomotor skills (writing).
- Transition planning and vocational training should be included in the educational program.
- Communication and language strategies
- The learning and practice of communication and social skills by children with Asperger syndrome does not imply the eventual spontaneous implementation of these skills in natural settings.
- Children can be taught specific problem-solving strategies or to memorize specific phrases to use in specific, frequently occurring situations.
- Specific and explicit instructions and training on how to interpret other people's social behavior should be provided and practiced. Similar principles guide the training of the individual's expressive skills.
- Children should learn to ask people to rephrase confusing expressions. They should also be encouraged to ask that confusing instructions be repeated, simplified, and/or written down.
- Parents, teachers, and peers can teach children to interpret conversational cues of others, to reply to and discuss topics initiated by others, when and how to interrupt, or how to change or shift topics.
- Role playing may help children become aware of the perspectives and thoughts of other people.
Individuals with Asperger syndrome have a better outlook than those with other forms of pervasive developmental disorders. Although their underlying social impairments are believed to be lifelong, some improvement in functioning occurs through maturational processes.
Individuals with Asperger syndrome have an increased risk of mood disorders such as depression or anxiety.
Those with supportive families who are knowledgeable about the condition tend to have a better prognosis.
Individuals with special skills, abilities, or interests relevant to paid employment typically have a more positive outcome. Parents and teachers of individuals with Asperger syndrome should creatively uncover talents and skills. These individuals can often concentrate for hours on a particular task. With proper instruction, their talents can be developed enormously.
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