A s p e r g e r ’ s S y n d r o m e : A G u i d e f o r P a t i e n t s a n d L o v e d O n e s

1. Asperger’sSyndrome:AGuideforPatientsandLovedOnes Skip Intro Continue

2. Asperger’s Syndrome Asperger’s Syndrome (AS) is a condition on the high end of the Autism Spectrum. It is characterized by marked social deficits and is often under diagnosed in female and adult populations. Although Asperger’s Syndrome is a form of autism, many that suffer from it are considered to have average or above average intelligence. In fact, some of the most famous and talented people in the world are thought to have AS. An earlier diagnosis means that a child will have a better chance to take full advantage of programs that can help him or her overcome the social deficits and learning difficulties that coincide with AS. In addition, comorbid disorders (including depression, anxiety and ADHD) must be closely monitored and treated as soon as possible. This presentation is designed to inform families and friends of those with AS about the condition, its causes, and how it is commonly treated. Continue

3. MainMenu Background Famous People with AS Diagnosis and Treatment Prognosis Helpful Resources Site Map Restart Exit

4. Background Asperger’s Syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy. Fifty years later, it was standardized as a diagnosis, but many questions remain about aspects of the disorder. For example, there is doubt about whether it is distinct from high-functioning autism (HFA); partly because of this, its prevalence is not firmly established. It has been proposed that the diagnosis of Asperger's be eliminated, to be replaced by a diagnosis of autism spectrum disorder on a severity scale. Restart Site Map Main Menu Exit

5. Background The exact cause is unknown, although research supports the likelihood of a genetic basis; brain imaging techniques have not identified a clear common pathology. There is no single treatment, and the effectiveness of particular interventions is supported by only limited data. Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Site Map Restart Main Menu Exit

6. Background A pervasive developmental disorder, Asperger’s 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 behavior, 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 physical clumsiness are typical of the condition, but are not required for diagnosis. Restart Site Map Main Menu Exit

7. Background The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger’s Syndrome. Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture. Restart Site Map Exit Main Menu

8. Background People with AS may not be as withdrawn around others as those with other, more debilitating, forms of autism; they approach others, even if awkwardly. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a need for privacy or haste to leave. This social awkwardness has been called "active but odd”. This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive. However, not all individuals with AS will approach others. Some of them may even display selective mutism, speaking not at all to most people and excessively to specific people. Some may choose to talk only to people they like. Main Menu Exit Restart Site Map

9. FamousPeoplewithAS Many influential people have been suspected of having AS. These people have made great strides in their respective fields due to their fixation and obsession with specific topics and their abilities in math and science. In addition, many composers and musicians have been thought to have Asperger’s, because musical talent frequently accompanies high levels of proficiency in math and science. In recent years, many fictional characters have also been created to mimic symptoms of AS. Main Menu Exit Restart Site Map

10. FamousPeoplewithAS • Dan Akroyd • Beethoven • Leonardo Da Vinci • Emily Dickinson • Albert Einstein • Bill Gates • Al Gore • Temple Grandin • Alfred Hitchcock • Mozart • Isaac Newton • Daniel Tammet Restart Site Map Main Menu Exit

11. FamousCharacterswithAS • Charlie Babbitt from the movie Rain Man • Christopher Boone (protagonist of the novel The Curious Incident of the Dog in the Night-Time) • Dr. Temperance Brennan from the television show Bones • Sheldon Cooper from the television show The Big Bang Theory • Dr. Spencer Reid from the television show Criminal Minds • Edward Scissorhands from the movie Edward Scissorhands Restart Site Map Exit Main Menu

12. DiagnosisandTreatment Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard, U.S. criteria also require significant impairment in day-to-day functioning. Other sets of diagnostic criteria have been proposed by Szatmari et al. and by Gillberg and Gillberg. Diagnosis is most commonly made between the ages of four and eleven. A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. Main Menu Exit Restart Site Map

13. DiagnosisandTreatment The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semi-structured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child. Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior. Many children with AS are initially misdiagnosed with attention-deficit hyperactivity disorder (ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age; adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior. Restart Site Map Main Menu Exit

14. DiagnosisandTreatment Under-diagnosis and over-diagnosis are problems in marginal cases. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to over-diagnose ASD. There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties. In 2006, it was reported to be the fastest-growing psychiatric diagnosis in Silicon Valley children; also, there is a predilection for adults to self-diagnose it. Restart Site Map Exit Main Menu

15. Prognosis There is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist. 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. Individuals with AS appear to have normal life expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressive disorder and anxiety disorder that may significantly affect prognosis. Main Menu Exit Restart Site Map

16. Prognosis Although social impairment is lifelong, the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders; for example, ASD symptoms are more likely to diminish with time in children with AS or HFA. 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 has not 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. Adolescents with AS may exhibit ongoing difficulty with self care, organization and disturbances in social and romantic relationships; despite high cognitive potential, most young adults with AS remain at home, although some do marry and work independently. Restart Site Map Main Menu Exit

17. Prognosis The "different-ness" adolescents experience can be traumatic. 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; the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop. Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies. Education of families is critical in developing strategies for understanding strengths and weaknesses; helping the family to cope improves outcomes in children. Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. Restart Site Map Main Menu Exit

18. Prognosis Autistic people have advocated 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 is 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. There is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents of children with AS, who typically seek assistance and a cure for their children. Restart Site Map Exit Main Menu

19. Helpful Resources • Wikipedia • Online Asperger's Syndrome Information and Support (OASIS) • Asperger's Association of New England • National Institute Neurological Disorders and Stroke • Asperger's Advice for Adults • Families Affected by Adults with Asperger's Syndrome • Diagnostic Criteria for Asperger's Syndrome (DSM-IV) Restart Site Map Exit Main Menu

20. SiteMap Introduction 1 Introduction 2 Helpful Resources Main Menu Site Map Background Diagnosis and Treatment Prognosis Famous People with AS Prognosis 2 Background 2 Famous People with AS Diagnosis and Treatment 2 Background 3 Famous Characters with AS Prognosis 3 Diagnosis and Treatment 3 Background 4 Prognosis 4 Background 5 Restart Exit Main Menu