Asperger Syndrome, or Asperger’s, is a neurodevelopmental condition which is a subset of autism spectrum disorders (ASD) with poorly understood causes and mechanisms.
Key Symptoms: Problems with social, emotional and communication skills, however, unlike typical autism, which usually involved some degree of intellectual disability, individuals with Asperger’s tend to have a normal or high-IQ, in what is known as high-functioning ASD.
Prevalence: 20-25 per 10,000 children (<1:100), affecting boys more than girls.
Onset & Prognosis: Onset is usually from birth (young age) that persist through the rest of life. Lifespan is not affected, though in some cases quality of life may be impaired.
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What is Asperger Syndrome?
Asperger syndrome or Asperger’s is one of the many disorders that is a part of the autism spectrum disorders (ASDs). Like all types of disorders that belong to the autism spectrum disorders, children with Asperger’s also have problems with their social, emotional, and communication skills. However, unlike some people with autism, those with Asperger’s typically do not tend to have a learning disability and are referred to as ‘high-functioning’.
Asperger’s is considerably more common than other forms of autism. Autism occurs in about 4 out of every 10,000 children and Asperger’s occurs in 20-25 per 10,000 children. This means the prevalence of this condition is much more than typical or classic autism.
Asperger’s is also commonly associated with other disorders like Tourette syndrome, attention deficit and hyperactivity disorder (ADHD) and mood problems such as depression and anxiety.
It is important to state that ASD/Asperger’s is not an illness; rather it is a spectrum of having different personality and behaviour traits, attributed to how the way the brain works. You are born with autism and you remain autistic for your entire life, and this is not something that can be ‘cured’ in its literal sense. Complications with severe forms may need additional support, such as in the case of specific traits or symptoms such as anxiety or epilepsy.
Asperger Syndrome Signs & Symptoms
At the base of ASD including Asperger’s is the perception of the world in the eyes of the individual as well as having key social differences that cause issues with understanding and relating to other people.
The symptoms of Asperger’s overlap significantly with other forms of ASD and include:
- Difficulty in the interpretation of verbal and non-verbal language, which can include facial expressions, tone of voice, sarcasm, irony and abstract concepts. As such, individuals may only be able to interpret a very literal understanding of language.
- Unlike other forms of ASD, individuals with Asperger’s typically have good language skills with high-functioning IQ levels.
- Difficulty in interpreting emotions, feelings, and intentions of others and in expressing their own emotions – as such many people with Asperger’s can come across as being insensitive or avoid situations in which they do not feel comfortable. This can have an impact on relationships, friendships and general workplace environments. However, this does not mean they lack empathy, it is simply that they cannot comprehend emotion and therefore cannot express theirs either.
- Repetitive behaviours or routines e.g. eating dinner on the same plate at the same time each day, with little scope for accepting and being comfortable with changes.
- Specific interests that arise from a young age that may persist lifelong or change in adulthood. These can be to specific items such as a toy, to general objects such as trains or busses, all the way to specific concepts such as death, for example.
- Sensitivity to specific sensory stimuli e.g. oversensitivity to bright lights or loud noises. Some individuals may actually be under-sensitive to sensory stimuli.
- Inability to make or maintain eye contact – often starts early on and persists.
- Excessive repetition, especially when it comes to an interest of theirs. This can also apply to behaviours and movements.
- Speaking in a monotone or ‘robotic’ way with very little enthusiasm or emotion. Some individuals may speak too quietly or too loudly, that is inappropriate for a specific setting.
As with all ASD, the symptoms and their severity vary significantly from individual to individual and may not have all the symptoms and traits listed.
Causes and Mechanisms of Asperger Syndrome
The mechanisms of how ASD develops are still poorly understood, though at the heart of it is an atypical brain development, which results in the symptoms in early childhood.
Unlike many other conditions, there is no specific genetic candidate that has been identified in the cause of ASD and Asperger’s. However, it has been noted that Asperger’s does tend to run in families (more so than other forms of ASD) suggesting that there may be stronger genetic bases for Asperger’s. Studies have shown that heritability of ASD is thought to be between 60-90% in twin studies, and up to 30% in general siblings.
Some of the genes that cause other neurodevelopmental conditions also cause ASD symptoms. For example, mutations to FMR1 causes Fragile X Syndrome in boys, of which up to 20% of affected boys display ASD behaviours. Another example is mutations in MECP2, which causes Rett Syndrome leading to ASD behaviours in girls.
Other causes of Asperger’s/ASD may include:
- Toxic metal poisoning during pregnancy
- Infectious diseases to the mother during pregnancy
- Teratogen exposure including alcohol during pregnancy
- Thyroxine deficiency in the mother during pregnancy
- Gestational diabetes in the mother
- SSRI usage during pregnancy
Over time, many theories of autism development have been explored, including the effect of vaccines (e.g. MMR vaccine) on autism. However, these theories have been refuted overwhelmingly, and the scientists involved in such claims have been discredited. There is no link between MMR vaccination (or any other vaccination) and autism spectrum disorders. MMR vaccinations are incredibly important as measles rates are still high due to ‘anti-vaccine’ sentiment fuelled from false science and false media. It is imperative that all children receive their regular vaccinations including the MMR jab, and there is absolutely no evidence or mechanism that contributes to autism.
The pathophysiology of Asperger’s is rather unclear at the genetic, molecular and cellular levels. However, atypical brain development is the primary neurological basis for ASD & Asperger’s. Neurodevelopmental issues that are thought to contribute to Asperger’s include impaired neuronal migration as well as impaired development of synaptic connections.
In addition to neurodevelopmental issues, there is evidence of significant neuroinflammation in Asperger’s/ASD with the immune system thought to be playing a crucial role. This may directly stem from the mothers own enhanced inflammation during pregnancy from infection and can lead to impaired brain development in the developing foetus. Several studies have supported this hypothesis that found an increased risk of ASD if there was an infection during pregnancy.
There are many other proposed mechanisms for autism development, which include a reduced connectivity of major brain networks including the default mode network (DMN) which is involved in social and emotional processing, as well as weaker connections between different lobes of the brain and the cortex. Other neuro-mechanisms may include slower neural responses to different stimuli e.g. auditory signals, therefore having a direct impact on attention, language processing and emotional regulation.
Much research has tried to elucidate the causes and mechanisms of ASD & Asperger’s with lots of novel insights into how the brain is altered post-development. However, the causes of impaired neurodevelopment seen in Asperger’s is still poorly understood, thus the need for more research.
Asperger Syndrome Diagnosis
In the UK amongst many other countries, doctors do not typically diagnose individuals with Asperger’s anymore, rather diagnose with ASD, with high-functioning autism. Diagnosis is usually made by a multidisciplinary team of speech pathologists, paediatricians, psychiatrists and psychologists.
Due to the significant variability in the severity of symptoms in individuals with Asperger’s, getting a formal diagnosis can take some time and may be rather difficult to achieve, especially in milder forms, where some or many symptoms may not be present at all.
As mentioned throughout this article, Asperger’s and ASD is not all illness, therefore getting a formal diagnosis can have polar effects. For many it can be helpful as it allows friends, families, employers, and teachers etc. to understand the ‘odd’ behaviours, as well as allowing access to support both in school (special needs) and other professional services. However, for others, getting a diagnosis (especially in adulthood) can prove to be an unhelpful label and stigmatising.
At the centre of the diagnostic criteria for Asperger’s, several types of umbrella symptomology must be confirmed. These notably include persistent difficulties in social interactions, communication skills, restricted or repetitive behaviours or interests. All of these symptoms must reach to an extent that they begin to limit everyday functioning for a diagnosis to be made. However, what sets Asperger’s apart from most other ASD cases is that there is little or no intellectual disability (i.e. no delay in language or cognitive development).
Diagnosis is made using standardised criteria as set by the International Classification of Diseases 10th Edition (ICD-10) which is the most used manual in the UK authored by the WHO, or the Diagnostic and Statistical Manual 5th Edition (DSM-5) which is used widely in the US. The newer version of the ICD (ICD-11), set to be in use worldwide as of 2022, will share more similarities to the DSM-5 therefore closely aligning both manuals in a nod to standardising international assessment criteria.
Based on the criteria of both ICD-10 and DSM-5 are the basis for diagnostic questionnaires which commonly include the DISCO (diagnostic interview for social and communication disorders) and the ADI-R (autism diagnostic interview – revised).
Below are some of the diagnostic criteria from the DSM-4 (prior edition to DSM-5 that differentiated Asperger’s to autism) states that there must be the following symptoms consistently that diagnose Asperger’s:
- Impaired use of non-verbal behaviours to regulate social interaction
- Failure to develop age-appropriate peer relationships
- Lack of spontaneous interest in sharing experiences with others
- Lack of social or emotional reciprocity
- Preoccupation with one or more stereotyped and restricted pattern of interest
- Inflexible adherence to specific non-functional routines or rituals
- Stereotyped or repetitive motor mannerisms
- Preoccupation with parts of objects
In addition, for Asperger’s specifically, there must be no significant impairments to:
- Delay in either general cognitive function
- Self-help/adaptive skills
- Interest in the environment or
- Overall language development
The DSM-5 follows similar criteria, though the diagnosis will result in ASD rather than Asperger’s syndrome.
Treatment Strategies & Prognosis for Asperger Syndrome
There is at present no cure and no specific treatment for Asperger syndrome. However, early detection and intervention may help children with the condition to develop into adults who can live a relatively independent life.
General interventions include ensuring that the child receives adequate and normal education as far as possible. Parents should try to check the educational placements and service providers available in their school district to ensure that the child gets as near normal education as possible. The schools in question need to be checked for appropriate setting, adequate staffing, adult/student ratio, range of special/support services etc.
Parents need to enquire and find the programs (public or private) that can help children with Asperger syndrome and help families and parents learn how to cope and deal with difficult situations arising out of the condition.
Some of the positive program specifications include small setting with ample opportunities for more individualized attention, availability of a communication specialist and an expert in social skills development and adequate opportunities for social interaction and formation of social relationships.
Specifically, tailored therapies and management can include:
- Communication based interventions
- Behavioural therapy
- Occupational and physical therapies
- Dietary and lifestyle changes
These include teaching practices and approaches along with strategies for emotional support, behavioural management techniques, activities towards social and communication competence etc.
For example, some skills, procedures, and concepts related to behaviour and social skills need to be explicitly taught using rote and verbal teaching methods. Children need to be trained in problem-solving areas and handling situations out of their ordinary routine.
A social skill development culture should be fostered. Children with Asperger’s need to be taught ways to interpret visual information simultaneously with auditory information in order to interpret other people's nonverbal behaviour or body language and teach oneself to respond accordingly.
Self-evaluation, self-esteem and confidence should be adopted. Children should be encouraged to become more self-reliant and sufficient as they grow into an adult. Another area of specific approach includes vocational and occupational training in order to prepare for the child to lead a more independent life.
Individuals with Asperger syndrome may often have challenging and difficult behaviour that needs to be addressed. Coexisting mental disorders also need to be addressed. These include depression, anxiety, phobias, mood disorders, schizophrenia etc.
Other therapies may include medication. In general, medications have not shown much promise in treatment of Asperger syndrome. They may be used in presence of co-existing mental disorders (such as those mentioned). Specific medications are therefore used for patients with depressive symptoms (e.g. SSRIs), severe obsessions, compulsions and thought disorders.
Psychotherapy has not been shown to be effective in the management of Asperger syndrome; however, focused and structured counselling can be very useful. This is particularly so in patients with negativism, anxiety, frustration etc.
Support for Individuals and Caregivers
There are many national organisations that provide excellent support from individuals with Asperger’s as well as for caregivers. For example, in the UK there is the National Autistic Society, Child Autism UK, and other links on the NHS website. In the US, there is the Autism Society, as well as the American Autism Association. Their websites contain lots of information about accessing support services, as well as more information about the condition.