CHARACTERISTICS OF ASPERGER'S SYNDROME

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.[12] 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.[3]

Social interaction

The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome.[2] Individuals with Aspergers syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or enjoy spontaneous interests or achievements with others, a lack of social or emotional reciprocity, and impaired nonverbal behaviors such as eye contact, facial expression, posture, and gesture.[1]

Unlike those with autism, people with Aspergers syndrome are not usually withdrawn around others; they approach others, even if awkwardly, for example by engaging in a one-sided, long-winded speech about an unusual topic while being oblivious to the listener's feelings or reactions, such as signs of boredom or wanting to leave.[3] This social awkwardness has been called "active, but odd".[1] This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive. The cognitive ability of children with Aspergers syndrome often lets them articulate social norms in a laboratory context,[1] where they may be able to show a theoretical understanding of other people’s emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations.[3] People with Aspergers syndrome may analyze and distill their observation of social interaction into rigid behavioral guidelines and apply these rules in awkward ways—such as forced eye contact—resulting in demeanor that appears rigid or socially naive. Childhood desires for companionship can be numbed through a history of failed social encounters.[1]

The hypothesis that individuals with Aspergers syndrome are predisposed to violent or criminal behavior has been investigated and found to be unsupported by data.[1][13] More evidence suggests children with Aspergers syndrome are victims rather than victimizers.[14]

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.[12]

Pursuit of specific and narrow areas of interest is one of the most striking features of Aspergers syndrome.[1] Individuals with Aspergers syndrome may collect volumes of detailed information on a relatively narrow topic such as dinosaurs or deep fat fryers, without necessarily having genuine understanding of the broader topic.[1][3] For example, a child might memorize camera model numbers while caring little about photography.[1] This behavior is usually apparent by grade school, typically age 5 or 6 in the U.S.[1] Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because topics such as dinosaurs often capture the interest of children, this symptom may go unrecognized.[3]

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of Aspergers syndrome and other Autism Spectrum Disorders.[15] They include hand movements such as flapping or twisting, and complex whole-body movements.[12] These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical and less often symmetrical.[16]

Speech and language

Although children with Asperger syndrome acquire language skills without significant general delay, and the speech of those with Aspergers syndrome typically lacks significant abnormalities, language acquisition and use is often atypical.[3] Abnormalities include verbosity; abrupt transitions; literal interpretations and miscomprehension of nuance; use of metaphor meaningful only to the speaker; auditory perception deficits; unusually pedantic, formal or idiosyncratic speech; and oddities in loudness, pitch, intonation, prosody, and rhythm.[1]

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in autism, people with Aspergers syndrome often have a limited range of intonation; speech may be overly fast, jerky or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with Aspergers syndrome may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.[3]

Children with Aspergers syndrome may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding metaphorical language and tend to use language literally.[1] Individuals with Aspergers syndrome appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. They usually understand the cognitive basis of humor but may not enjoy it due to lack of understanding of its intent.[10]

Other symptoms of Asperger syndrome

Individuals with Asperger syndrome may have symptoms that are independent of the diagnosis, but can affect the individual or the family. These symptoms include atypical perception and problems with motor skills, sleep, and emotions.

Asperger’s initial accounts[1] and other diagnostic schemes[17] include descriptions of motor clumsiness. Children with Aspergers syndrome 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, visual-perceptual skills, and conceptual learning.[1][3] They may show problems with proprioception (sensation of body position) on measures of apraxia (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate Aspergers syndrome from other high-functioning Autism Spectrum Disorders.[1]

Many accounts of individuals with Aspergers syndrome and other Autism Spectrum Disorders report unusual sensory and perceptual skills and experiences. They may have superior performance in tasks like visual search problems that require processing of fine-grained features rather than entire configurations.[18] They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli, and they may exhibit synesthesia, for example, a smell may trigger perception of color;[19] these sensory responses are found in other developmental disorders and are not specific to Aspergers syndrome or to Autism Spectrum Disorder. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.[20]

Children with Aspergers syndrome are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.[21][22] Aspergers syndrome is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.[23] Although Aspergers syndrome, lower sleep quality, and alexithymia are associated, their causal relationship is unclear.[22]

References

1. McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010. PMID 17030291.
2. Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
3. Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr 28 (suppl 1): S3–S11. PMID 16791390.
4. National Institute of Neurological Disorders and Stroke (NINDS) (2007-07-31). Asperger syndrome fact sheet. Retrieved on 2007-08-24. NIH Publication No. 05-5624.
5. Baron-Cohen S (2000). "Is Asperger syndrome/high-functioning autism necessarily a disability?". Dev Psychopathol 12 (3): 489–500. doi:10.1017/S0954579400003126. PMID 11014749.
6. World Health Organization (2006). "F84. Pervasive developmental disorders", International Statistical Classification of Diseases and Related Health Problems, 10th ed. (ICD-10).
7. Piven J, Palmer P, Jacobi D, Childress D, Arndt S (1997). "Broader autism phenotype: evidence from a family history study of multiple-incidence autism families" (PDF). Am J Psychiatry 154 (2): 185–90. PMID 9016266.
8. Lord C, Cook EH, Leventhal BL, Amaral DG (2000). "Autism spectrum disorders" (PDF). Neuron 28 (2): 355–63. doi:10.1016/S0896-6273(00)00115-X. PMID 11144346.
9. ^ Schopler E, Mesibov GB, Kunce LJ (eds) (1998). Asperger syndrome or high-functioning autism?. Plenum. ISBN 0306457466.
10. Kasari C, Rotheram-Fuller E (2005). "Current trends in psychological research on children with high-functioning autism and Asperger disorder". Curr Opin Psychiatry 18 (5): 497–501. doi:10.1097/01.yco.0000179486.47144.61. PMID 16639107.
11. Szatmari P (2000). "The classification of autism, Asperger's syndrome, and pervasive developmental disorder". Can J Psychiatry 45 (8): 731–38. PMID 11086556.
12. American Psychiatric Association (2000). "Diagnostic criteria for 299.80 Asperger's Disorder (AD)", Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR). ISBN 0890420254.
13. Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H (2007). "Offending behaviour in adults with Asperger syndrome". J Autism Dev Disord. doi:10.1007/s10803-007-0442-9. PMID 17805955.
14. Tsatsanis KD (2003). "Outcome research in Asperger syndrome and autism". Child Adolesc Psychiatr Clin N Am 12 (1): 47–63. PMID 12512398.
15. South M, Ozonoff S, McMahon WM (2005). "Repetitive behavior profiles in Asperger syndrome and high-functioning autism". J Autism Dev Disord 35 (2): 145–58. doi:10.1007/s10803-004-1992-8. PMID 15909401.
16. Rapin I (2001). "Autism spectrum disorders: relevance to Tourette syndrome". Adv Neurol 85: 89–101. PMID 11530449.
17. Ehlers S, Gillberg C (1993). "The epidemiology of Asperger's syndrome. A total population study". J Child Psychol Psychiat 34 (8): 1327–50. doi:10.1111/j.1469-7610.1993.tb02094.x. PMID 8294522. Retrieved on 2007-09-18.
18. Mottron L, Dawson M, Soulières I, Hubert B, Burack J (2006). "Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception". J Autism Dev Disord 36 (1): 27–43. doi:10.1007/s10803-005-0040-7. PMID 16453071.
19. Bogdashina O (2003). Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds. Jessica Kingsley. ISBN 1843101661.
20. Rogers SJ, Ozonoff S (2005). "Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence". J Child Psychol Psychiatry 46 (12): 1255–68. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.
21. Polimeni MA, Richdale AL, Francis AJ (2005). "A survey of sleep problems in autism, Asperger's disorder and typically developing children". J Intellect Disabil Res 49 (4): 260–8. doi:10.1111/j.1365-2788.2005.00642.x. PMID 15816813.
22. Tani P, Lindberg N, Joukamaa M et al. (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology 49 (2): 64–70. doi:10.1159/000076412. PMID 14981336.

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