Do you remember learning how far to stand from someone that you are talking to? Do you remember learning to discern when a person is using humor or sarcasm in his/her conversation with you? What if you had to go through this cynical world never sure if someone was being facetious or not? Could you do it? Can you imagine those that have to everyday despite normal to above average intelligence? Can you imagine a preschool age child who does not like to play games that involve use of his/her imagination? Imaginative games is one of the hallmarks of early childhood. These are some of the problems that people with Asperger's syndrome live with every day.
Asperger's syndrome is a relatively new diagnosis in the DSM-IV, the manual that mental health professionals use to diagnose patients. The disorder was first included in the latest edition in 1994. It is one of the pervasive developmental disorders (PDDs) which make up the spectrum of the autism disorders (1). Characterized by impairments in social interaction and motor coordination, people with the disorder often have odd interests and rigid patterns of behavior. Moreover, they tend to shun social interaction so that they are perceived by others as loners. These people also have normal to above average intelligence but lack the ability to think abstractly and synthesize a body of facts that they have memorized.
Prior to inclusion in the DSM-IV, many people with the disorder were diagnosed with high functioning autism (HFA). The difference between this disorder and HFA lies in the intelligence difference as well as later age of onset. Where as people with HFA display a higher performance IQ than verbal IQ, people with Asperger's syndrome have a much higher verbal IQ than performance IQ. Moreover, the full scale IQ score for people with HFA tends to be lower than those with Asperger's syndrome (2). In addition, the age of onset for HFA is much earlier at age 3. In fact, some children with Asperger's syndrome are not diagnosed until grade school.
In keeping with the trend of a high verbal IQ, people with Asperger's syndrome do not display the severe language delays that is typical of the autism spectrum disorders. Rather, they seem to develop language at the age of 2. Still there word choices and overall speech patterns are often perceived as odd (3).
It is also important to understand that people with Asperger's syndrome have poor nonverbal communication skills. This explains why they do not seem to understand the amount of space that is usually between you and the person with whom you are speaking (4). Another example of poor non-verbal communication skills is that they often cannot tell that the person with whom they are speaking with has no interest in the subject that they are talking about. In fact, people with Asperger's disorder often talk incessantly about their favorite subject that itself is odd such as the bus schedule which they have memorized (5). That is, they cannot seem to interpret the facial cues of others.
In addition to the high verbal ability of these children, people with Asperger's disorder show gross motor clumsiness. Some people with Asperger's syndrome show delays in gross motor skills but often this delay is seen more in the development of fine motor skills. Some of these deficits include awkward gait, poor eye-hand coordination, and little ability to manipulate objects well. On the other hand, motor skills are a relative strength for people who suffer with other PDDs (2).
Consistent with the PDDs, Asperger's disorder is more common in boys at a ratio of 4:1 boys to girls (6). One can speculate as to other reasons that boys are more often diagnosed than girls. Perhaps since girls tend to be quiet when they have problems in school they are not seen as "problem children" to teachers. On the other hand, a child that act out will be seen as a problem and will more often be picked out as needing help outside of school. The rate of Asperger's disorder is higher than that of autism at 3.6-7 per 1,000 children age 7-16 years whereas autism has a rate of 7-16 per 10,000 children (2). This can reflect the idea that Asperger's disorder is a less severe type of autism in which the patient functions at normal intelligence but still exhibits the social awkwardness of PDD.
But what is the cause of this social awkwardness? This is the question that may neurobiologists have asked to no avail. Genetic studies have shown that Asperger's disorder does run in families and is usually seen in the father's family (2). Neurochemical studies have produced little in reliable and valid results (7). The only consistent abnormality is the lack of Purkinje cells in the cerebellum in people with autism. Perhaps those with Asperger's syndrome are a variant in which more of the Purkinje cells are lacking (2,7). The problem in the cerebellum can explain the problems with motor skills since this is the area of gross and fine motor control.
When autism was first described by Leo Kanner and Hans Asperger in the 1940's it was suggested that the mothers were to blame. Specifically, it was suggested that the mothers were to "cold" towards their children. As a result, their children developed this social awkwardness. It was later proven that the quality of parenting has nothing to do with the development of any of the PDDs (8).
Still, there is some familial component to the disorder. Since it has been determined that there is at least a partial genetic link involved in the etiology of the disorder, many implications can be drawn. If this is genetically determined then perhaps there is a part of the brain responsible for social behavior just as there is a module of the brain responsible for vision. The social module is then a predetermined outline of behavior that is innate to human beings just as swimming in innate to fish. When this unit of the brain malfunctions, abnormal behavior is exhibited by the individual. If this is true, then there should be a way to correct any apparent deficits or abnormalities just as there is a way to help people with deficits in the visual system.
However, there are inherent problems with "correcting" social behavior. If someone can declare that standing too close to another person is wrong then another person can begin to correct other forms of behavior that he/she determines is outside the norm. For example, society could begin to correct the behavior of a shy person or a person perceived as too friendly. This can progress down the slippery slope to the point where everyone needs behavioral correction and we become a society of drones because everyone behaves in exactly the same way. Since a person's behavior gives him/herself uniqueness, "correcting" that behavior creates a society in which there is no uniqueness.
Moreover, the correction of behavior would rely on researchers being able to locate a portion of the nervous system that is responsible for social graces. Most probably, there is not one specific structure that is responsible for behavior in social situations, but rather a series of integrated parts that only produces social behavior when acting in harmony. Perhaps then Asperger's syndrome is not a total lack of this module but rather a disorder in which part of this module is missing. Similarly, the more severe form of PDD that a person has, the more of this module that is lacking or malfunctioning in the brain.
Currently, there are different forms of treatment for Asperger's disorder but none is a cure. Each one tries to correct the abnormal behaviors that an individual with Asperger's disorder displays. Interventions include the use of applied behavioral analysis when the child is young and specialized classrooms that encourage the growth of social skills when the child is of school age. Psychiatric medication is also used to help with any symptoms of other diseases such as attention deficit/ hyperactivity disorder (9). Each of these treatments limits the uniqueness of the individual at the expense of helping them to feel more comfortable in society.
Much work lies in the field of Asperger's disorder. It is an interesting disorder because despite average to above average intellect, these people cannot learn basic social cues that everyone else is able to acquire. Nonetheless, people with Asperger's syndrome are able to graduate from high school and some go on to college and even graduate school. Still, in order to better fit into society, these individuals need to learn how to think about what someone else might be thinking. When they are taught to do this task adequately, they can often go on to marry and lead successful lives.
1)What is Asperger's Disorder? , On the Asperger's Disorder Homepage.
2)"Research Paper", on the Asperger's Disorder Homepage.
3)Asperger's Disorder, Part of the American Academy of Child & Adolescent Psychiatry web site.
4) Pervasive Developmental Disorders, PDD-NOS, Asperger's Disorder and Autism , Part of Harvard's Children's Hospital website. This is an information book designed for parents.
5) Educating the person with Asperger's syndrome , From the O.A.S.I.S. Online Asperger Syndrome Information and Support web site.
6) What is the epidemiology of Asperger's disorder?, Part of the Asperger's Disorder Homepage.
7) Patzer DK, Volkmar FR. "The neurobiology of autism and the pervasive developmental disorders" Neurobiology of Mental Illness. editors Charney DS, Nestler EJ, & Bunney BS. Oxford: Oxford Univ. Press; 1999; 761-773.
8) Asperger syndrome: a clinical account , From the PDD Information Pages.
9) What is the treatment of Asperger's disorder?, Part of the Asperger's Disorder Homepage.
I was suprised to read in your report that the incidence of AS is 3.5-7 per 1,000. I have never known anyone else besides my sister. Why is that? ... Joyce McMahon, 19 September 2006