Table of Contents
1. Asperger’s Syndrome by definition
1.2. Autism Spectrum
1.3. Commonalities of Asperger’s Syndrome and Autism
1.4. Prevalence and misdiagnosis
2. Acquisition of a Diagnosis
3. Asperger’s Syndrome Impact
3.1. Genetics as a causal factor
3.2. Impact on the parent(s)
3.3. Impact on the siblings
4. Asperger’s and Relationships
5. Discipline and Asperger’s
7. Wellness and Asperger’s syndrome
7.2. Bipolar Disorder
7.3. Anxiety and Post-Traumatic Stress Disorder
8. Asperger’s and Schooling
9. Concluding thoughts for the Parent
10. Appendix A: DSM-IV-TR Diagnostic Criteria for Asperger’s Disorder
1. Asperger’s Syndrome by definition
Asperger’s syndrome has only recently been accepted as a diagnosis on the autism spectrum even though it was first defined some sixty years ago. Asperger’s syndrome is a disorder characterized by some of the features of autism, such as abnormalities of social interaction and repetitive and stereotyped interests and activities, but without the delay of retardation and cognitive development that is seen in true autism (Reber & Reber, 2001).
This syndrome is very similar to that of autism, but the normal development of both speech and motor skills distinguish it from autism (Tilton, 2004). The syndrome is also marked by poor arithmetic skills, an impaired sense of humour and difficulty in comprehending the gestures of people around them. Barlow & Durand (2005) indicate that the child with Asperger’s syndrome usually has an average IQ, with relatively little cognitive impairment; and imply that Asperger’s is not a separate disorder from autism. This idea is supported by Reber & Reber (2001), who also note that some authorities still have doubts as to the validity of the syndrome as a separate disorder to autism.
Dr Miriam Stoppard (2006) suggests that people with Asperger’s syndrome are often highly intelligent but are perceived to be socially “a bit odd”. She places this disorder at the higher-functioning end of the autism spectrum of disorders.
Dr. Hans Asperger was the first physician to document Asperger’s syndrome in 1944. He was involved in studying children, mostly boys, who were having difficulty interacting in socially acceptable ways. The children appeared to be self-centered, socially isolated, less physically adept than others and rather uncoordinated. The children were displaying repetitive physical activities and showed a bizarre fascination with numbers, timetables and the working mechanisms of objects. He did so at the same time that Dr. Leo Kanner, a psychiatrist at the Johns Hopkins University was involved in writing about autism. Dr. Kanner was first to use the word ‘autism’ which derived from the Greek autos meaning ‘self’. Interestingly, both physicians came to the same conclusions, without collaboration, at a time when autism spectrum disorders had not even been officially identified. As a result, European physicians were diagnosing Asperger’s syndrome in their patients at the same time that American physicians were using the same criteria to diagnose Kanner’s syndrome; which was the name initially given to autism at the time (Tilton, 2004).
In the early 1980s Lorna Wing recommended that Asperger’s disorder be recognized as a separate disorder from autism, with emphasis on the unusual and circumscribed interests displayed by these individuals (Klin, Volkmar & Sparrow, 2000). As a result, Asperger’s was brought into American diagnostic procedures; a full decade after Dr. Asperger’s original paper on the topic had been translated into English. During the early 1990s, Asperger’s syndrome made it onto the autism spectrum and became a disorder independent of other spectrum disorders.
1.2 Autism Spectrum
During the 1950s and 1960s there was growing recognition of autism as a diagnosis; surprisingly, at this time the work of Hans Asperger was largely unnoticed. A large number of individuals were identified as having autistic-like symptoms but they lacked the cognitive difficulties associated with the disorder. Despite the work of Asperger, the patients were diagnosed as having mental illness or nervous anxiety. It is sad to discover that many of these people were institutionalized or imprisoned as a result of their odd behaviour or because they were coerced into making poor or dangerous choices.
illustration not visible in this excerpt
While autism spectrum disorder (ASD) is a broad classification of conditions sharing similar objective symptoms, many times ASD is referred to as pervasive developmental disorder (PDD) (Tilton, 2004). The pervasive developmental disorders are severe childhood disorders in which qualitative impairment in verbal and nonverbal communication and social interaction are the primary symptoms. These disorders affect psychological functioning in such areas as language, social relationships, attention, perception and affect. They include autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified (Sue, Sue & Sue, 1997). These disorders form sub-sections of pervasive developmental disorder, all with slightly different symptoms. The chart above, taken from Sue, Sue & Sue (1997), indicates the connectedness between them.
1.3 Commonalities of Asperger’s Syndrome and Autism
There are a number of criteria for a diagnosis of Asperger’s syndrome, which will be discussed later but there are certain commonalities between Asperger’s and autism that are not defined on the DSM-IV as clinical criteria for a diagnosis. One of the most common is sensory sensitivity; this is caused by the lack of ability to filter sensory input, resulting in a child who suffers with ‘sensory overload’ giving expression in outbursts of screaming or covering of the ears when sensations are ‘too much’ for him to handle.
The most common sensory sensitivities include the following:
- Auditory (sensitivity to noise)
- Smells and tastes
Auditory sensitivity may manifest in a child recoiling or crying when certain noises are heard. It is feasible to believe that the intensity of noise is hurting the child, this is increased when the sounds are unpredictable; noises such as dogs barking, crowds, fire engines, police sirens, loud music, tapping, laughing or sneezing.
Food smells, perfume and toilets may be overwhelming for the child with Asperger’s syndrome. This may result in a child vomiting or at the least gagging to the smell of certain texture of foods.
Children with Asperger’s tend to be very visual learners and too many pieces of visual stimulation at once can cause severe discomfort for the child. A combination of people, colours, moving objects and sounds can easily send a child into sensory overload. Fluorescent lighting is a common cause of discomfort, the intensity of light, the flickering or the buzzing of the motor may be almost unbearable for a child.
Displays of physical affection from others may cause a child with Asperger’s to lash out. Simple forms of affection such as hugs, a pat on the back or unpredictable displays may cause discomfort for the child. It is not uncommon to have a child complain about the texture of a piece of clothing or how it feels against their skin; adversely some children with Asperger’s may welcome the physical affection languished on them and may enjoy the sensory input from textured clothing.
While commonalities are resent, differences are also of importance to note. There are several signs that distinguish Asperger’s syndrome from other disorders on the autism spectrum, these include the following:
- Normal speech development with phrases being used by age three
- Normal cognitive development
- Normal development in self-help and curiosity about the world around him
- Gross motor skills are often delayed and clumsiness is common
- Eye contact, facial expression, body language inappropriate to the social situation
- Difficulty establishing and maintaining peer relationships
- Difficulty expressing emotions and relating to others with those emotions
- Intense and persistent association with particular subjects, objects or topics
- Repetitive mannerisms such as flapping
- Insistence on routine
1.4 Prevalence and misdiagnosis
As an educator by occupation, I find, what seems to be an increasing number of children presenting at high school level with signs or symptoms of mild to moderate autism, significantly more than I am used to. Fifteen years ago, it was estimated that approximately 1 in 10 000 children were autistic. Brook & Bowler (1992) estimated that around 22 in 10 000 children showed some but not all of the characteristics of autistic disorder, and they also showed severe social impairment. In the 1990s, estimates had risen dramatically to 1 in 1 000, and eventually to 1 in 250 children. Today, Time magazine (2002) suggested that 1 in 150 children under the age of ten had autism (Stillman, 2005). In the past fifteen years the number of children diagnosed with autism has increased by 643%. Volkmar & Klin (2000), placed prevalence levels at only between 1 and thirty-six children per 10 000. Recent statistics indicate that 1 in 5 children have either autism, dyslexia, ADHD or some for of uncontrollable aggression; as an educator, these statistics are extremely worrying.