Asperger’s syndrome: symptoms and therapies

Asperger’s syndrome (AS), which can affect both children and adults, is a pervasive disorder (that is, compromising the areas of social interaction, verbal and non-verbal communication, activities and interests) of neurological development.

It belongs to the category of autism spectrum disordersor that, like Asperger’s Syndrome, presents very variable manifestations, different from each other in characteristics and severity. Each case, whether it is a child, a boy or an adult, is different from the other, also with regard to the intensity of the symptoms. The subtle differences with which the disease manifests itself make diagnosis more difficult.

In general, autism spectrum disorders are characterized by a deficit in the development of communication skills, social interaction and in the area of interests and activities. The main characteristics of subjects with Asperger’s syndrome concern in particular the difficulty in daily relationships with others, the lack of certain motor skills and the presence of repetitive behaviors.

Although this is a clinical picture closely related to autism, Asperger children, unlike what happens in classical autism, do not show mental retardation or intellectual and language deficits. Children and adolescents with this disorder, on the contrary, possess good linguistic and cognitive qualities, often with above-average intelligence.

In addition, while individuals with autism often present as isolated, lonely, uninterested in others, most children with Asperger’s syndrome want to fit in and interact with others, but have difficulty doing so.

Here are summarized the main differences between the two diseases.

Why this name?

The term “Asperger’s syndrome” is due to Hans Asperger, an Austrian psychiatrist and pediatrician who in the 40s first identified and described a group of children in whom he had observed particular behaviors in terms of social interaction, communication skills and interests.

In 1994 the syndrome was introduced in the DSM (Diagnostic and Statistical Manual of Mental Disorders) IV and inserted, like autism, in the category of pervasive developmental disorders. Only in recent years, therefore, this condition has come to the attention of clinicians, who have begun to recognize the symptoms and know how to intervene, while in the past the characteristics of the disorder were interpreted as particularities of the character.

According to the World Health Organization, Asperger’s affects one in 250 children. It is believed that currently about 50% of children with Asperger’s go unrecognized and diagnosed. A 2001 British study revealed that 46% of adults with Asperger’s syndrome were only diagnosed in late adolescence or adulthood.

The disorder is much more frequent in males than in females, but some clinicians believe that females are underdiagnosed because, compared to males, they learn better to compensate for their socialization difficulties.

Causes and manifestations of Asperger’s syndrome

Psychology does not help in tracing the causes of Asperger’s syndrome, which is thought to be due to an alteration of genetic origin to damage some structures of the brain. Most likely, the disorder is not attributable to the mutation of a single gene, so polygenetic transmission is preferred. Research has shown that about 20% of fathers and about 5% of mothers of an Asperger’s child are also affected by this syndrome and that about 50% of the child’s first-degree relatives have similar characteristics.In addition to persistent impairment of social interactions, individuals with Asperger’s syndrome exhibit repetitive and stereotyped behavior patterns and a tendency to engage in and practice very narrow activities and interests.

As for the affective-relational and communicative area, Asperger’s syndrome is manifested by the inability to have an effective verbal interaction, with inadequate non-verbal communication and with the inability to understand the “implicit rules of the game”. In addition, individuals with Asperger’s syndrome usually lack empathy, have a low tolerance for frustration, and may have particular anxieties and fears.

From an affective point of view they show great difficulty in expressing affection and attention towards others and are difficult to establish a relationship of reciprocity in relationships.

Two typical features of Asperger’s syndrome that affect the motor and sensory area are clumsiness in movements and limited coordination. These people also show reduced or excessive sensitivity to touch and sensory disturbances that result in intolerance to lights and noises, sometimes smells.

In the cognitive area there is a tendency tosystematicity and cataloguing, the difficulty of understanding metaphors or “idioms”, the excessive attention to the particular, the tendency to devote oneself to a particular interest, cultivated with meticulousness. Typical manifestations are also attachment to preconceived and repetitive ways of doing things, lack of personal autonomy, difficulty concentrating and attention. People with Asperger’s syndrome tend to have a schematic mind and rigid thinking and generally have little flexibility.

In primary school, Asperger’s syndrome may not be noticed, but often it is the teachers who report the child’s discomfort in integration, as these individuals are often bullied by peers and social isolation. Finally, in 70% of people with Asperger’s there are disorders that affect the sphere of mental health:a nsia, depression, hyperactivity, problems in anger management.

Distinguishing features

Identifying people affected by this syndrome is not easy. Often, in fact, the characteristics of the disorder can remain nuanced.

Language Children with Asperger’s syndrome do not present the delay in language typical of children with classic autistic disorder, but abnormalities in the way of communicating, with a tendency to interpret sentences literally and difficulty understanding jokes or grasping the meaning of indirect or ironic sentences.

They struggle to follow the rhythm of a conversation, especially if not themed. Often they are considered monothematic as they tend to talk only about their own interests, circumscribed and rarely shared by others. From the point of view of expressiveness they generally have a monotonous tone of voice and a very reduced facial expression; As a result, they struggle to interpret the non-verbal aspects of communication such as gestures, intonation of voice, facial expressions.

Motor capacity Almost all children with Asperger’s syndrome show problems in movement, with lack of coordination: for example, throwing or catching a ball can be difficult, as well as learning to ride a bicycle.

Adults with Asperger’s syndrome may have astrange gait, which appears not very fluid. Motor clumsiness is present in the majority of children with Asperger’s, but does not seem to affect sports activities such as swimming, trampoline use, horseback riding. Subjects with this syndrome are distinguished in individual sports or games that require resistance and visual precision, such as rowing, swimming, bowling, chess.

Special interests, which differ from a simple hobby for the particularity of the topic and for the focus shown towards it, is a very important theme for the framing of an Asperger’s child. Sometimes children, already from the first years of life, show a particular interest in the parts of an object, such as the wheels of a car or electrical switches. Very frequent is also the tendency to collect a large number of objects belonging to the category of interest, as well as the acquisition of alot of information and knowledge with respect to a specific topic.

Special interest fulfills various functions, including relaxing, overcoming anxiety, creating an alternative world and a sense of identity, seeking a sense of security and strengthening self-esteem. However, it is also a source of learning, which can be used constructively by parents, teachers and therapists.

Diagnosing Asperger’s syndrome

Diagnosis is made by specialists in child neuropsychiatry with experience in the field of autism and generalized developmental disorders. It makes use of clinical observation, interviews with parents, the collection of information at the school and the use of scales and specific diagnostic questionnaires. Often the consultation of the specialist is required for motor or attention problems, behavioral disorders, emotional difficulties, eating disorders or school learning difficulties.

The diagnosis can hardly be made before the age of five, since it is not considered sufficiently reliable; Not infrequently the diagnosis even comes in adulthood.

Asperger’s syndrome must be distinguished from obsessive-compulsive disorder, with which it shares repetitive and stereotyped modes of behavior, and schizoid personality disorder.

Therapies

For Asperger’s syndrome there is no cure. However, the social and emotional skills of the person can be improved through a specific cognitive-behavioral therapy, focused on the development of awareness and on the management and communication of emotions.

In order for the therapy to be effective, it is also essential to intervene on the education of parents, teachers and all adults who interact with the Asperger subject so that they can better deal with the disorder that, consequently, involves the family, school, etc.

For the treatment of psychiatric conditions sometimes associated with the disorder, and only if deemed strictly necessary, patients are prescribed drug therapy to control the symptoms given by depression, anxiety, hyperactivity.