Asperger syndrome history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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.[1] 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.[2]

History and Symptoms

Social interaction

The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome. Individuals with Asperger's syndrome 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.[3]

Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly, for example by engaging in a one-sided, long-winded speech about a favorite topic while being oblivious to the listener's feelings or reactions, such as signs of boredom or haste to leave.[2] This social awkwardness has been called "active but odd".[2] This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.[2] The cognitive ability of children with AS often lets them articulate social norms in a laboratory context,[3] where they may be able to show a theoretical understanding of other people’s emotions; they typically have difficulty acting on this knowledge in fluid, real-life situations, however.[2] People with AS 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 naïve. Childhood desires for companionship can be numbed through a history of failed social encounters.[3]

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.[3][4] More evidence suggests children with AS are victims rather than victimizers.[5]

Restricted and repetitive interests and behavior

Those with AS often display intense interests, such as this boy's fascination with molecular structure.

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.[1]

Pursuit of specific and narrow areas of interest is one of the most striking features of AS.[3] Individuals with AS 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.[3][2] For example, a child might memorize camera model numbers while caring little about photography.[3] This behavior is usually apparent by grade school, typically age 5 or 6 in the United States.[3] 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.[2]

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.[6] They include hand movements such as flapping or twisting, and complex whole-body movements.[1] 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.[7]

Speech and language

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical.[2] 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.

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 AS often have a limited range of intonation; speech may be unusually 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 AS 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.[2]

Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of humor they seem to lack understanding of the intent of humor to share enjoyment with others.Despite strong evidence of impaired humor appreciation, there are anecdotal reports of humor in individuals with AS, which challenge theories of humor in AS.[8]

Other

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

Individuals with AS often have excellent auditory and visual perception.[9] Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.[10] Conversely, compared to individuals with HFA, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory.[3] Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli, and they may exhibit synesthesia;[11] these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. 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.[12]

Hans Asperger’s initial accounts[3] and other diagnostic schemes[13] include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "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.[3][2] 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 AS from other high-functioning ASDs.[3]

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.[14][15] AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.[16] Although AS, lower sleep quality, and alexithymia are associated, their causative relationship is unclear.[15]

References

  1. 1.0 1.1 1.2 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) ed.). ISBN 0-89042-025-4. Retrieved 2007-06-28.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr. 28 (suppl 1): S3–S11. doi:10.1590/S1516-44462006000500002. PMID 16791390.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 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. Unknown parameter |doi_brokendate= ignored (help)
  4. Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H (2008). "Offending behaviour in adults with Asperger syndrome". J Autism Dev Disord. 38 (4): 748–58. doi:10.1007/s10803-007-0442-9. PMID 17805955.
  5. Tsatsanis KD (2003). "Outcome research in Asperger syndrome and autism". Child Adolesc Psychiatr Clin N Am. 12 (1): 47–63. doi:10.1016/S1056-4993(02)00056-1. PMID 12512398.
  6. 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.
  7. Rapin I (2001). "Autism spectrum disorders: relevance to Tourette syndrome". Adv Neurol. 85: 89–101. PMID 11530449.
  8. Lyons V, Fitzgerald M (2004). "Humor in autism and Asperger syndrome". J Autism Dev Disord. 34 (5): 521–31. doi:10.1007/s10803-004-2547-8. PMID 15628606.
  9. Frith U (2004). "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". J Child Psychol Psychiatry. 45 (4): 672–86. doi:10.1111/j.1469-7610.2004.00262.x. PMID 15056300.
  10. Prior M, Ozonoff S (2007). "Psychological factors in autism". In Volkmar FR. Autism and Pervasive Developmental Disorders (2nd ed ed.). Cambridge University Press. pp. 69–128. ISBN 0-521-54957-4.
  11. Bogdashina O (2003). Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds. Jessica Kingsley. ISBN 1-843101-66-1.
  12. 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.
  13. 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.
  14. 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.
  15. 15.0 15.1 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.
  16. Alexithymia and AS:




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