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Nov 10
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by Jess

Asperger’s disorder or “syndrome” is not a new diagnosis; in fact it was described in the 1940’s.  “Asperger's Syndrome was first identified in 1944, but was only officially recognized as a diagnostic category in the DSM-IV in 1994. As a result, many children were misdiagnosed over the years as ADD/ADHD, Autistic, OCD, or even schizophrenic.”  While Hans Asperger was describing this disorder in Austria, Leo Kanner was describing something else a half a world away.  Kanner described Autism at almost the same time.  The two disorders share some symptoms, but the degree of disability can vary widely.

Asperger’s is very poorly understood in clinical practice.  The DSM IV TR doesn’t begin to adequately describe and leaves many out given the criteria.  I recently saw a very high functioning “Aspie” who is having work related issues and depression due to the stress of having too many verbal requests directed at him.  This caused confusion and a type of disorientation to occur.  He becomes anxious felt like a failure; became more depressed which affected his cognition which caused him to do worse on the job.  He would go home and obsesses or perseverates on his failures during the day, got less sleep than he needed and then did even worse at work.  He was stuck in the “tornado” of “Aspie” life.

What is Asperger's Syndrome?

Asperger's Syndrome is a neurobiological disorder that is classified as one of the Pervasive Developmental Disorders (PDD). It is characterized by a variety of impairments in social interaction, as well as the development of repetitive and restricted fields of interest and activities.  These fields of interest can be quite unusual, such as vacuum cleaners, dinosaurs, bugs, ships, etc.  It is often misdiagnosed as Obsessive Compulsive Disorder and treated with certain medications that often make the problem worse for these folks.  People with real OCD don’t like their symptoms as it causes anxiety.  People with Asperger’s enjoy their interests and love talking about them, albeit to extreme excess. 

While there are some similarities with Autism, people with Asperger's usually have average to above average IQ, and do not demonstrate clinically significant delays in language or self help skills.  Many will show some difficulty with eye contact, but not all of them.   As they get older, due to their social skill difficulties they often become involved in alternative “styles”.  They may dress oddly and get overly involved in things such as anime or “Role Playing” games.  They may show a lack of awareness of personal hygiene, something parents of teen Aspies complain about all the time.   This population also often has major issues with clothing from the perspective of how it feels on their skin.  They often want soft clothes such as sweat pants etc.  The tactile issues carry over to food as well.  Many often have a very restricted range of food that they will consume and often it has to do with the texture of what they like.  Another sensitivity they have is sound.  Often they don’t like loud sounds and prefer to stay away from crowds and noisy places.  Parents, when asked about this, will frequently remember them covering their ears as a child when a loud noise was present such as a vacuum cleaner.

While they may have an extremely good command of language and have a very rich vocabulary, they are unable to use language appropriately in a social context and often speak in a monotone with little nuance and inflection in their voice.  Using abstract concepts in language is frequently a real area of difficulty for them.  A saying such as, “don’t cry over spilled milk” will get you a recitation of why would someone cry because they spilled their milk?  Their cognitive rigidity causes them real problems in the classroom, as they take what the teacher says absolutely literally.  If a parent attempts to assist the child with homework and doesn’t do it exactly as the teacher did, this is the formula for a real meltdown at home.

When these children are tested by an educational psychologist the findings are often things such as; verbal IQ higher than performance IQ, auditory processing difficulties, learning better through visual than auditory, impaired ability to abstract.  The majority of these children will need to have an “accommodation plan” in place.  They are more often bullied and made fun of, especially the boys.  Their accommodation plan should include an awareness of this and steps should be taken to protect them from harassment, both verbal and physical.  They may need accommodations for extended time for testing or being tested in a small office.  A classroom can be too over stimulating.  Make sure that lessons are given in smaller steps or sequences etc.

The emotional dysregulation has recently been looked at more carefully due to what appears to be depression in this population.  A reason many are referred for treatment is often due to pervasive sadness or for what the parents see as these uncontrollable tantrums.   As we learn more about the genetics of various disorders it is becoming clearer that many share symptoms of mood disorder.  When we do a genetic history of the child or adult with Asperger’s we often find first degree blood relatives with histories of depression, alcoholism, or bipolar disorder to name a few.  Whether or not this is directly and genetically related to this disorder is not yet clear, however the numbers with this background seems high.  Another interesting genetic history is that we have families that have one parent who is high functioning yet socially awkward.  They have one child with Asperger’s, one with autism and one that seems symptom free.  All of this points to the strong genetic influence this disorder has.  

Children with Asperger's may or may not seek out social interaction, but always have difficulty in interpreting and learning the skills of social and emotional interaction with others, leading to significant impairment in relationships and peer interaction.

Although parents often notice problems at an early age, diagnosis is usually made during preschool age or later. While both boys and girls can have Asperger's, the syndrome is more commonly diagnosed in boys.  We see a different presentation in girls and girls are often more able to “fake” normal in the school situation.  The girls also are often involved to excess with some unusual areas of interest.  They tend to be quiet, loners and stay out of the way.  Parents frequently remember that they weren’t invited to parties and sleep overs; the same is true for boys.  Both are often physically clumsy and often awkward.   As a group, they tend to avoid physical activities and group sports for obvious reasons.  One is that they are often not very good at this and second is the fact that there is too much going on around them to be able to make good decisions. 

The prognosis or outcome for these children and adolescents is guarded.  If they receive assistance and coaching early on they can do very well.  Some may go on to become very high tech as they often are more at home with a computer than another person.  People with Asperger’s are scientists and inventors.  They are sensitive and caring people that just need some understanding in this cookie cutter world that can be so difficult for them to navigate.

William Shryer, DCSW, LCSW is the Clinical Director of Diablo Behavioral Healthcare in Danville, California.  Their group of psychiatrists, psychologists, social workers and other specialties strives to increase the proper treatment and decrease the stigma for many of the most misunderstood, yet highly treatable patients. www.behaviorquest.com

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