In 2012, The American Psychiatric Association (APA) announced changes to its flagship manual that doctors use to diagnose patients with mental disorders. It's the first significant rewriter to the DSM in nearly 20 years. According to these changes, the condition formerly known as "Asperger's syndrome" along with some similar disorders, will be lumped together under autism spectrum disorder (ASD).
The Association lists ASD as being "a complex developmental condition that involves persistent challenges in social interaction, speech, and nonverbal communication, and restricted/repetitive behaviors," which occurs in every 4 out of every 1000 people. To differentiate between all the related autistic disorders, however, we will continue to refer to this condition as Asperger's syndrome.
This neurodevelopmental condition tends to be detected within the first years of life, and it's mainly identified in boys, which is why some people have associated it exclusively with them. Asperger's however, can be present in girls as well. We will examine the definition of Asperger's syndrome, what its symptoms are, what differentiates it from other autistic disorders and to conclude, we will look at eight main traits of this condition.
A "syndrome" is defined as a group of symptoms which occur in a given situation. Psychopathology sometimes uses the words syndrome and disease interchangeably, but neither term should be interpreted as illness seeing how the causes of this syndrome are not limited to biologic activity. As mentioned previously, the terminology for Asperger's syndrome has been recently changed into autism spectrum disorder (ASD).
The words autism is derived from the Greek autos (meaning self), and the suffix ism (indicates a state or condition) and autism spectrum is the new accepted terminology. It is a group of developmental conditions which include communication problems, and repetitive behavior and symptoms which appear in early childhood and require specific treatment.
Before the changes to the DSM-5, Asperger's syndrome was considered an independent diagnosis, entirely separate from ASD. The term Asperger's originates from the Viennese pediatrician Hans Asperger, who studied some of the traits of this condition in the second half of the 20th century. According to APA, Asperger's is marked by developmental problems in specific areas from the first year of life.
Language acquisition takes place just as it would with non-Asperger's children, but other areas such as communication and interaction are atypical. More specifically, communication in the case of Asperger's patients is literal and stereotyped which sometimes creates the impression that the person in question lacks empathy. There is also a lack of development in the area of non-verbal communication which hinders social interaction. The reason for that is because the child with Asperger's cannot accurately decode the entire message he or she is receiving and they also struggle to produce appropriate feedback.
Children with Asperger's display specific characteristics such as isolation, stereotyped behaviors, specific and restrictive interests, or preference for playing alone from the first years of their life. Nevertheless, there are no cognitive difficulties; in fact, it is quite common to meet people with Asperger's who are also highly intelligent.
One common trait is that Asperger's patients only stand out in areas that interest them, partly because of the characteristics described earlier, which compel the person to learn everything related to a specific subject, as well as due to a difficulty in experiencing new things.
It isn't until the age of 3, however, that the language and interaction difficulties become evident. This has been attributed to the social demands of the period such as going to school, developing fluid speech, interacting with others, controlling the bladder and sphincter, etc.). Therefore, sometimes we might observe developmental issues with fine motor skills which are marked by uncoordinated and stereotyped movements.
The exact causes remain unknown, but one of the primary hypothesis includes genetic factors which generate a specific brain function, different to that of neurotypical people (people who are not on the autism spectrum). Similarly, Asperger's syndrome has been viewed as a part of a multitude of phenomena associated with neurodiversity.
From a biopsychosocial point of view, Asperger's syndrome is considered to have its own function within human diversity. Although some biological or hereditary causes may exist, its treatment may be determined mainly by the support needs in the near-by social context.
Asperger's has been identified in 36 cases out of approximately 10.000 people, especially with males (four times more prevalent than with women). There is also a significant degree of variation with this condition. In simple terms, despite the main difficulties happening in the area of social interaction, the degree of these symptoms varies immensely from case to case.
For example, while a group of people with Asperger's may have as their main problem the type of language used and the way of interacting, another group might struggle with the lack of a particular routine. Both traits are indicative of the autism spectrum disorder.
As mentioned earlier, Asperger's syndrome has been classified under the autism spectrum disorder in the DSM-5. According to the same classification, autism spectrum disorder combines different diagnostics which used to be studied as individual conditions: autistic disorder, Asperger's syndrome, and pervasive developmental disorder not otherwise specified.
Using this combination as a starting point, the terminology types of autism has disappeared making way to a cluster of symptoms, all included in the ASD. This means that instead of types we now deal with a spectrum that has degrees of severity which are measurable depending on the levels of support needed by the boy or girl living with the condition.
For a person to be diagnosed with ASD, they have to display irregularities in three areas of social communication and interaction: social reciprocity, non-verbal communication, and understanding relationships. The patient must also manifest at least two of the following elements that make up the set of restrictive and repetitive behaviors: repetitive behaviors, adversity to change, restricted interests, and sensory disturbances.
Following these guidelines, Asperger's syndrome, according to the DSM-V, is an ASD level 1 of support (the lowest of three), considering that the person in question needs moderate assistance with social communication but none when it comes to other intellectual or social adaptive skills.
There are multiple tools which can be used to diagnose Asperger's syndrome (now ASD) ranging from medical manuals and clinical observations to family meetings. Similarly to many diagnoses, detection tests for ASD are approximate tools, so it's vital to undergo an in-depth specialist evaluation as well, to complement these. This way we can avoid overdiagnosis, which in the last decade has marked patients with Asperger's especially in the United States and other high-income countries.
As mentioned earlier, Asperger's syndrome has been classified as being part of Autism Spectrum Disorder, ranking on the lowest position regarding severity.
Nevertheless, this condition is still being discussed regarding its defining characteristics which is why we will present the eight most essential traits of Asperger's.
One of the leading indicators of Asperger's is that the person in question has what is considered to be "normal" intelligence and adequate language (although sometimes too formal). Aside from fixating over certain objects and sensations, Asperger's patients display very specific and limited interests.
On the other hand, people who receive an ASD diagnosis but are not Asperger's, will develop their language until the ages of 9 or ten, or sometimes never reach these developmental stages. This is why their intellect appears to be limited.
Girls and boys with Asperger's syndrome share the same problem of unsuccessful social interaction. Lack of understanding of the implicit social norms, as well as the inability to interpret emotions, make establishing social relationships extremely difficult.
Asperger's patients struggle to identify and manage both their own emotions and those of others, as well as face the issue of not grasping irony, sarcasm, and double meanings.
Aside from being rejected by society, people with Asperger's face anxiety and insecurities because of conflictual situations caused by misunderstandings.
Non-verbal communication in people with Asperger's can be regarded as atypical and it's usually misinterpreted by NT persons. Eye contact is limited and the gaze tends to be rigid.
Due to the same difficulty with social interaction, the face tends to remain expressionless. Body posture and gait are also influenced by the reduced perception of their body movement, a defining trait of people with ASD.
On many occasions, the peculiar stances and stereotyped movements function as a coping mechanism to reduce anxiety in new situations.
Little interest in social interaction means that the Asperger's patient isolates themselves from others and focuses on their specific interests instead of playing with others (and other types of cooperation as the person grows older).
The implicit rules of the game, as well as those of the relationships between players, are non-existent for the child with Asperger's which is why it's vital to explain everything in a literal, concrete manner.
Moreover, low tolerance to change turns people's unpredictable behaviors in sources of extreme anxiety for Asperger's patients, which is why they will choose to be alone over interacting with others. These abilities, however, can be practiced within an appropriate support programme.
Repetitive and rhythmic movements that are done for no apparent reason are called stereotyped movements (or stereotypy). While aimless for an untrained eye, these movements help the patient cope with their emotions.
This way, the stereotyped movements help reduce anxiety caused by disrupions to their routine or failure to establish a social relationship. Asperger's patients get a sense of protection and safety while performing those movements.
It is very common for Asperger's patients to be real experts on very specific subjects, considering their ability to focus their interest on particular themes.
The interest might be limited but at the same time, it runs deep to the point of obsession. This could be connected with the inability to regulate emotions, and this way they find comfort in these specific areas of interest which also keeps them protected from any change that might occur.
Although it may sound complicated and even a little disheartening, exploring specific interests could be a useful tool in facilitating the development of adaptive and cohabitation skills.
It's important to know the boy or girl with Asperger's and use their interests and needs to plan an appropriate support programme.
People with Asperger's have a low tolerance to change which means that any modification to their environment creates a lot of anxiety. This is why it's vital to have an established routine that they feel comfortable with, can plan around and assess any potential consequences that a new event may have.
Potential changes to their schedule should be communicated at the beginning of the week, this way the person with Asperger's can manage and process the information accordingly, and internalize those changes without any emotional distress.
Obsessions and compulsions that are meant to avoid any catastrophic situation are also common. Worrying about future situations that can cause anxiety is a major factor in the life of anyone with Asperger's.
Similarly to other conditions on the spectrum, some children and adults with Asperger's have powerful and diverse sensory experiences.
They could display a reaction or an unusual level of interest regarding the stimuli offered by the environment. For example, apparent indifference to pain or temperature, discomfort when exposed to certain sounds or textures, need to touch or smell objects, attraction toward certain visual stimuli, among others.
Much like the rest of the Asperger's traits, hypo/hypersensitivity to sensory stimuli could happen in one child and not in another.
One of the most common questions asked to people with Asperger's as well to their families, is about how adults experience Asperger's.
An essential aspect of the treatment plan for Asperger's depends on the support system that the patient has received (at home, school, and work).
Adaptive skills can be improved with appropriate care that tends to the specific needs of the child, offering, in turn, a possibility for a better quality of life for the adult they will develop into.
Moreover, becoming familiar with adults' experiences helps reduce the stigma associated with Asperger's syndrome, offering a positive image of people living with this condition.
Numerous associations deal with raising awareness about Asperger's Syndrome, and many of them are run either by the families of patients of by the individuals living with Asperger's themselves who share their own experiences of the challenges and victories they've lived.
About us (2018). Asperger/Autism Network. Available at https://www.aane.org
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Asperger syndrome (2018). National Autistic Society. Available at https://www.autism.org.uk/about/what-is/asperger.aspx
Bonilla, M. F. y Chaskel, R. (2016). Trastorno del espectro autista. CCAP, 15(1): 19-29.
Palomo, R. (2014). DSM-5 la nueva clasificación de los TEA. Recuperado 31 de diciembre de 2018. Available at http://apacu.info/wp-content/uploads/2014/10/Nueva-clasificación-DSMV.pdf