| Note: Asperger Disorder and Asperger Syndrome are interchangeable terms although the preferred term now is Asperger Disorder as outlined in the DSM IV – Text Revised. Asperger’s Syndrome (AS) is a pervasive developmental disorder on the autism spectrum characterised by social deficits, and the presence of idiosyncratic interests (Henderson, 2001). Individuals with AS may also exhibit impaired verbal and nonverbal communication, motor clumsiness, sensory sensitivity, theory of mind deficits and emotional difficulties (Attwood, 1998, Barnhill, 2001). It must be noted though that within the research no universal agreement seems to exist on the characteristics of AS. AS was first described as Autistic Psychopathy by Austrian Hans Asperger in 1944, however publications about this condition were quite uncommon until the 1980’s when Lorna Wing (1981) introduced Asperger’s work to a larger English-speaking readership. The American Psychiatric Association (APA) did not recognise AS as a specific pervasive developmental disorder until 1994. Diagnostic criteria can be found in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV, APA, 1994). Tony Attwood (1998) has also published an Australian Scale for Asperger’s Syndrome. The estimations of prevalence cited in the literature range from .02-6% in children over the entire range of intellectual ability (Henderson 2001). Autism spectrum disorders have many possible causes. The assumption is that ASD are of neurobiological origin beginning before birth or in very early development, related to complex genetics. ASD has been associated with viral infections such as encephalitis or congenital rubella, metabolic imbalances such as Phenylketonuria, neurocutaneous disorders such as Tuberous Sclerosis, exposure to alcohol and drugs, exposure to environmental chemicals such as lead and mercury and genetic/chromosomal factors such as in Down Syndrome and Fragile X Syndrome (Gillberg 1995; Janzen 1996). The following characteristic challenges faced by people experiencing Asperger Disorder were outlined by Twachtman-Cullen (1997): Characteristics related to processing the environment include: · An inefficient sensory system in which sensory thresholds may be poorly calibrated. Sensory overload may seem to overwhelm the person with AS suddenly, particularly in loud, crowded or confusing places. One or several sensory systems may be affected such that ordinary sensations are perceived as unbearably intense - the most common sensitivities involve sound and touch, but in some cases the sensitivity relates to taste, light intensity, colours and aromas (Attwood, 1998). Of importance also noted by Attwood (1998) is that “in contrast the person may express minimal levels of reaction to pain and temperature that would be unbearable to others” (p129). · An amorphus sense of time, in which the person with AS is unable to plan time use or estimate time passage reliably. · Difficulty with social/emotional cues in which the person with AS does not perceive or decode facial expressions body language, intonation or other social conventions. Characteristics related to cognitive processing, particularly executive function deficits, include: · Cognitive inflexibility in which the person with AS has difficulty adapting to changing expectations, schedules, word or concept definitions, and perseverates on prescribed areas of interest. · Attentional problems, in which the person with AS has difficulty concentrating, sharing attention between two tasks, suppressing attention to nonsalient information and switching from one task to another. · Problems with perspective taking in which the person with AS has difficulty acknowledging the possibility of a perspective other than their own. Characteristics related to communication include: · High-level pragmatic communication deficits, in which the person has difficulty extracting subtleties of normal conversation, particularly those related to affect and intention. · Difficulty with sense making, in which the person with AS has very literal thinking. · Difficulty perceiving and abiding by socially expected communication behaviours, in which the person has difficulty with conversational skills, eye contact or social distance. In addition to these characteristics poor motor coordination may affect a wide range of abilities involving gross and fine motor skills (Attwood,1998). The person with AS is particularly susceptible to anxiety. Most people with AS are anxious most of the time, and their behaviour may be motivated by the desire to avoid anxiety (Tantam, 2000). Anxiety may be generated by social contact, change in routine and sensory sensitivity (Attwood, 1998). As noted by Lawson (2001), if anxiety goes unrecognised it may either become internalised (leading to ill health, skin eruptions, headaches, phobias and obsessions) or externalised (leading to self injury, physical aggression, withdrawal, problems with eating, sleeping and toileting). There is a greater risk of depression in people with AS especially in adolescents and adults (Attwood, 1998: Tantam, 2000). The depression may be linked to difficulty in coping and the resulting social stigma or may be the outcome of biologic or genetic factors linked to the origin and development of AS (Barnhill, 2001). In discussing the resources needed to diagnose, treat and support a child or person with AS Attwood (1998) suggests that no single group or agency should have a monopoly. Moreover a programme should be designed by a multidisciplinary range of professionals including teachers, speech, behavioural and occupational therapists utilising the resources provided by parents and the individual with AS. According to Klin and Volkmar (2000) treatment programs for individuals with AS require a thorough understanding of the specific individuals profile of skills and deficits in areas important for learning, for communicating and relating to others and for acquiring independent living skills. Holliday –Willey (1999) notes that it is essential to realise that AS symptoms are manifested in a variety of unique and diverse ways, depending on the overall abilities of the person affected. Taking into account the individual, a programme designed for a person with AS should address the characteristic challenges faced by those with AS. The programme should: include problem solving skills and strategies, social skills, awareness and flexibility, tuition on feelings and friendships, improve gross and fine motor skills, encourage the understanding of the perspectives and thoughts of others, provide remedial tuition for specific learning problems, enable the individual to cope with their auditory and tactile sensitivity, enable management of anxiety and if necessary depression (Attwood 1998; Klin &Volkmar, 2000). Implementation of such a programme can occur within inclusive settings such as schools and vocational centres. Additional costs to the individual or the individual’s family may be incurred when consulting a wide range of professionals, however an initial investment of resources into such a programme may increase the capacity of the individual to become financially and otherwise independent in the future. In discussing the long-term outcomes for a person with AS Attwood(2998) says the following: Asperger’s Syndrome is a developmental disorder and eventually the person does learn to improve their ability to socialise, converse, understand the thoughts and feelings of others, and to accurately and subtly express their own thoughts and feelings (p183) People with AS may achieve academic and vocational success especially if they are able to focus on an area of special interest. The individual’s intellectual ability, the severity of the person’s behavioural challenges, and the availability of a personal support system appear to be factors in determining this success (Henderson 2001). Practical and emotional support may also be factors that are integral to independent living for person with AS. Although relationships for a child and adolescent with AS can be a minefield the person with AS can develop normal relationships. Many people With AS (Grandin, 1995 cited in Attwood, 1998; Holiday-Willey 1999, 2001; Lawson, 2001; Williams, 1996) have described relationship states within the wide range of what constitutes ‘normal’ these include celibacy, friendships, partnerships, marriage and parenthood. References American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychiatric Association. Atwood, T. (1998). Asperger’s Syndrome: A guide for parents and professionals. London: Jessica Kingsley Publishers. Barnhill, G.P. (2001). What’s new in AS research: A synthesis of research conducted by the Asperger Syndrome project. Intervention in School and Clinic, 36, 5, 300 – 306. Barnhill, G.P. (2001). What is Asperger Syndrome? Intervention in School and Clinic, 36, 5, 259- 266. Henderson, L.M. (2001). Asperger Syndrome in gifted individuals. Gifted Child Today. Waco: Prufrock Press. Holliday Willey, L. (1999). Pretending to be normal. London: Jessica Kingsley Publishers. Holliday Willey, L. (2001). Asperger syndrome in the family: Redefining normal. London: Jessica Kingsley Publishers. Janzen, J. (1996). Understanding the nature of autism: A practical guide. Texas: Therapy Skill Builders. Klin, A., Volkmar, F. R. (2000). Treatment and intervention guidelines for individuals with Asperger Syndrome. In A. Klin, F. R. Volkmar, & S.S. Sparrow (Eds.). Asperger Syndrome. New York: The Guilford Press. Lawson, L. (2001). Understanding and working with the spectrum of Autism: An insiders view. London: Jessica Kingsley Publishers. Tantam, D. (2000). Adolescence and adulthood of individuals with Asperger Syndrome. In A. Klin, F. R. Volkmar, & S.S. Sparrow (Eds.). Asperger Syndrome. New York: The Guilford Press. Williams, D. (1996). Like color to the blind. New York: Times Books. Wing. L. (1981). Asperger’s Syndrome: A clinical account. Psychological Medicine 11, 115-129 |
 |
| Asperger Disorder |