Asperger's Syndrome

What is Asperger’s syndrome?

Asperger’s syndrome is a developmental disorder in which people have severe difficulties understanding how to interact socially.

People with Asperger's syndrome have some traits of autism, especially weak social skills and a preference for sameness and routine. But unlike those with autism, children with Asperger's syndrome usually start to talk around 2 years of age (the age at which speech normally develops). They have normal to above-normal intelligence.

Both conditions belong to the group of disorders called pervasive developmental disorders. As many as 3 out of every 10,000 people have Asperger's syndrome.¹

What causes Asperger’s syndrome?

The exact cause of Asperger's syndrome is not known. It tends to run in families, suggesting a genetic link, although scientists have not discovered a distinct genetic marker.

What are the symptoms?

Children with Asperger's syndrome typically develop a good to excellent vocabulary, although they usually lack the social instincts and practical skills needed when relating to others. They may not recognize verbal and nonverbal cues or understand social norms, such as taking turns talking or grasping the concept of personal space. They may have difficulties with accent, tone, and pitch, which can make their speech sometimes odd or difficult to understand. And they may have difficulty expressing their own feelings and perceiving others' feelings. Children with Asperger's typically make efforts to establish friendships, but they may have difficulty making friends because of their social awkwardness.

Children with Asperger's syndrome often have limited and very focused interests. They are often most comfortable with fixed routines and dislike change. They may lack coordination, exhibit unusual facial expressions, body postures, and gestures, and be somewhat clumsy. Many children with Asperger's syndrome also have trouble with fine motor skills, such as handwriting.

Children with Asperger's syndrome will have some of the traits typical of the syndrome. But each child with Asperger's presents a different picture; some will have less pronounced traits, while others' traits are more noticeable. Each child will have individual interests, likes, and dislikes. All children with Asperger's syndrome have severe trouble in social situations.

How is Asperger’s syndrome diagnosed?

Asperger's syndrome is usually not diagnosed until a child is at least 3 years old, when social problems become apparent, although it may be diagnosed earlier. A diagnosis is based on a careful history of the child’s development, psychological and psychiatric assessments, communication tests, and the parents’ and clinicians’ shared observations.

Asperger's syndrome is diagnosed using specific criteria, published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

How is it treated?

Treatment for Asperger's syndrome should be tailored to meet individual needs. Communication and social skills training is usually recommended. Behavior management, in which good behavior is rewarded, can help change problem behaviors, such as interrupting and dominating conversations.

Medications for Asperger's syndrome are generally avoided, especially in young children, but may be recommended for specific symptoms, such as depression. Medication for depression may be recommended for adolescents with Asperger's syndrome.

Federal law requires public schools to provide appropriate educational services for people with Asperger's between the ages of 3 and 21. Contact your local school district to find out which services are available for your child.

How are families affected?

Parents of children with Asperger's syndrome face many challenges in raising children with special needs. They may have difficulty finding health professionals who are knowledgeable about this uncommon condition. Additionally, overtaxed teachers may not be able to offer the kind of help parents know their children need at school.

Many children with Asperger's syndrome have other coexisting conditions, such as attention deficit hyperactivity disorder (ADHD), anxiety disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, or depression. These conditions also complicate a parent's job. Many parents find comfort and build acceptance with help from support groups, counseling, and a network of friends, family, and community.

Frequently Asked Questions

Although there are many possible symptoms of Asperger’s syndrome, the main symptom is severe trouble with social situations. Your child may have mild to severe symptoms or have a few or many of these symptoms. Because of the wide variety of symptoms, no two children with Asperger's are alike.

Symptoms during childhood

Parents often first notice the symptoms of Asperger's syndrome when their child starts preschool and begins to interact with other children. Children with Asperger's syndrome may:

• Not pick up on social cues and lack inborn social skills, such as being able to read others' body language, start or maintain a conversation, and take turns talking.
• Dislike any changes in routines.
• Appear to lack empathy.
• Be unable to recognize subtle differences in speech tone, pitch, and accent that alter the meaning of others’ speech. Thus, your child may not understand a joke or may take a sarcastic comment literally. Likewise, his or her speech may be flat and difficult to understand because it lacks tone, pitch, and accent.
• Have a formal style of speaking that is advanced for his or her age. For example, the child may use the term “beckon” instead of “call,” or “return” instead of “come back.”
• Avoid eye contact.
• Have unusual facial expressions or postures.
• Be preoccupied with only one or few interests, which he or she may be very knowledgeable about. Many children with Asperger's syndrome are overly interested in parts of a whole or in unusual activities, such as doing intricate jigsaw puzzles, designing houses, drawing highly detailed scenes, or astronomy.²
• Talk a lot, usually about a favorite subject. One-sided conversations are common. Internal thoughts are often verbalized.
• Have delayed motor development. Your child may be late in learning to use a fork or spoon, ride a bike, or catch a ball. He or she may have an awkward walk. Handwriting is often poor.
• Have heightened sensitivity and become overstimulated by loud noises, lights, or strong tastes or textures. For more information about these symptoms, see sensory integration dysfunction.

Although the condition is in some ways similar to autism, a child with Asperger's syndrome typically has normal to advanced language and intellectual development. Also, those with Asperger's syndrome typically make more of an effort than those with autism to make friends and engage in activities with others.

Symptoms during adolescent and teen years

Most symptoms persist through the teen years, and although teens with Asperger's can begin to learn those social skills they lack, communication often remains difficult. They will probably continue to have difficulty "reading" others' behavior.

Your teen with Asperger's syndrome (like other teens) will want friends but may feel shy or intimidated when approaching other teens. He or she may feel "different" from others. Although most teens place emphasis on being and looking "cool," trying to fit in may be frustrating and emotionally draining for teens with Asperger's. They may be immature for their age and be naive and too trusting, which can lead to teasing and bullying.

All of these difficulties can cause teens with Asperger's to become withdrawn and socially isolated and to have depression or anxiety.³

However, some teens with Asperger's syndrome are able to make and keep a few close friends through the school years. Some of the classic Asperger's traits may also work to the benefit of your teen. Teens with Asperger's are typically uninterested in following social norms, fads, or conventional thinking, allowing creative thinking and the pursuit of original interests and goals. Their preference for rules and honesty may lead them to excel in the classroom and as citizens.

Symptoms in adulthood

Asperger's syndrome is a lifelong condition, although it tends to stabilize over time, and improvements are often seen. Adults usually obtain a better understanding of their own strengths and weaknesses. They are able to learn social skills and how to read others' social cues. Many people with Asperger's syndrome marry and have children.

Some traits that are typical of Asperger's syndrome, such as attention to detail and focused interests, can increase chances of university and career success. Many people with Asperger's seem to be fascinated with technology, and a common career choice is engineering. However, scientific careers are by no means the only areas where people with Asperger's excel. Indeed, many respected historical figures have had symptoms of Asperger's, including Wolfgang Amadeus Mozart, Albert Einstein, Marie Curie, and Thomas Jefferson.

Other conditions

Many children with Asperger's syndrome also have coexisting conditions and may have symptoms of these conditions as well. They include:

• Attention deficit hyperactivity disorder (ADHD).
• Anxiety disorder.
• Depression, especially in adolescents.
• Nonverbal learning disorder.
• Obsessive-compulsive disorder (OCD).
• Social anxiety disorder.

Asperger’s syndrome is a developmental condition in which people have difficulties understanding how to interact socially. A diagnosis is best made with input from parents, doctors, teachers, and other caregivers who know or who have observed the child. Asperger's syndrome is diagnosed when specific criteria are met. These include:

• Poor social interaction.
• Unusual behavior, interests, and activities.
• No delay in language development.
• No delay in self-help skills and curiosity about the environment.

Your health professional will take a medical history, asking questions about your child's development, including information about motor development, language, areas of special interest, and social interactions. He or she will also ask about the mother's pregnancy and the family's history of medical conditions.

Testing can help your health professional determine whether your child's problem is related to Asperger's syndrome. Your primary care provider may refer your child to a specialist for testing, including:

• Psychological assessment. Intellectual function and learning style are evaluated. IQ (intelligence quotient) and motor skills tests are common. Personality assessment tests may also be done.
• Communication assessment. Speech and formal language are evaluated. Children are tested to determine how well they understand and use language to communicate ideas. Your health professional will also test for understanding of nonverbal forms of communication and nonliteral language skills, such as understanding of humor or metaphor. He or she will listen to your child's voice for volume, stress, and pitch.
• Psychiatric examination. Your doctor may examine your child's family and peer relationships, reactions to new situations, and the ability to understand the feelings of others, as well as indirect communication such as teasing and sarcasm. Your doctor may want to observe your child at home and at school. He or she may also look for conditions such as anxiety and depression, which are often found in people with Asperger's syndrome.

When making a diagnosis, your health professional will see if your child meets the criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a publication of the American Psychiatric Association.

Treatment for Asperger’s syndrome strives to improve your child's abilities to interact with other people and thus to function effectively in society and be self-sufficient. Since each child with Asperger's syndrome has differences in the number and severity of symptoms, treatment should be designed to meet individual needs and available family resources.⁴ Specific treatments are based on symptoms.

Securing services

Start by contacting your local school district to find out which services are available for your child. Become informed about your child's educational rights. Federal law requires public schools to provide appropriate educational services for people with disabilities (including Asperger's) between the ages of 3 and 21. In addition, there may be state and local laws or policies to aid children with Asperger's.

You will meet with school personnel to identify goals and establish an individualized education program (IEP). IEPs are designed to fit the child's specific needs based upon the evaluation of his or her level of disability.

School programs

Look at what is being offered at different schools to determine which services your child needs and where you can best find them. Qualities to look for include:

• Small work groups with individual attention.
• A communication specialist with an interest in social skills training.
• Opportunities for social interaction in a structured setting and in supervised activities.
• A concern for teaching real-life skills and encouraging a child's special interests and talents.
• A willingness to individualize the curriculum.
• A sensitive counselor who can focus on your child's emotional well-being and serve as a liaison with the family.
• An emphasis on respect for diversity and empathy for students.

Stay informed about what is happening in your child's classroom. Frequent communication can be managed with a communication diary that goes back and forth between teacher and parent.

Treatment strategies

Treatment is geared toward improving communication, social skills, and behavior management. A treatment program may be frequently adjusted to be the most useful for your child.

Take advantage of your child's strengths by encouraging him or her to explore interests at home and at school. Activity-oriented groups and focused counseling can also be helpful.

Many children with Asperger's syndrome also have other coexisting conditions, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and depression. These conditions can place extra demands on parents who are already dealing with a child with extra needs. These conditions may require treatment with medications and other therapies. For more information, see the topics:

• Attention Deficit Hyperactivity Disorder.
• Bipolar Disorder.
• Childhood and Adolescent Depression.
• Nonverbal learning disorder.
• Obsessive-Compulsive Disorder.
• Social Anxiety Disorder.

Prevention

Researchers have not yet identified a way to prevent Asperger's syndrome. Some advocacy groups claim the measles-mumps-rubella (MMR) vaccine causes Asperger's and autism. Numerous studies have not found a link between these conditions and the vaccine.⁵ Doctors recommend that you have your children immunized, because not doing so puts them and others in your community at risk for serious diseases and even death.

You can best serve your child by learning about Asperger’s syndrome and providing a supportive and loving home environment. Remember, your child, just like every other child, has his or her own strengths and weaknesses and needs as much support, patience, and understanding as you can give.

Educating yourself about the condition and knowing what to expect is an important part of helping your child succeed outside of home and develop independence. Learn about Asperger's syndrome by talking to your health professional or contacting Asperger's organizations. A good source is OASIS (Online Asperger Syndrome Information and Support) at http://www.udel.edu/bkirby/asperger/. This will reduce your and your family members' stress and help your child succeed.

The following are some suggestions on how to help your child with Asperger's syndrome. Some of them will be helpful; some may not work for you. Flexibility, creativity, and a willingness to continue to learn will all help in raising your child with Asperger's syndrome.

General strategies for success

• Children with Asperger's syndrome benefit from daily routines for meals, homework, and bedtime. They also like specific rules, and consistent expectations mean less stress and confusion for them.
• Many people with Asperger's syndrome do best with verbal (rather than nonverbal) teaching and assignments. A direct, concise, and straightforward manner is also helpful.
• People with Asperger's syndrome often have trouble understanding the "big picture" and tend to see part of a situation rather than the whole. That's why they often benefit from a parts-to-whole teaching approach, starting with part of a concept and adding to it to demonstrate encompassing ideas.
• Visual supports, including schedules and other written materials that serve as organizational aids, can be helpful.
• Be aware that background noises, such as a clock ticking or the hum of fluorescent lighting, may be distracting to your child.
• Children with Asperger's syndrome often mature more slowly. Don't always expect them to "act their age."
• Try to identify stress triggers and avoid them if possible. Prepare your child in advance for difficult situations, and teach him or her ways to cope.

Strategies for developing social skills

• Your child may not understand the social norms and rules that come more naturally to other children. Provide clear explanations of why certain behaviors are expected, and teach rules for those behaviors.
• Encourage your child to make eye contact when spoken to, and explain why it is important. Give lots of praise, especially when he or she uses a social skill without prompting.
• Practice activities, such as games or question-and-answer sessions, that call for taking turns.
• Help your child understand others' feelings by role-playing and watching and discussing human behaviors seen in movies or television. Provide a model for your child by telling him or her about your own feelings and reactions to those feelings.
• Teach your child how to read and respond appropriately to social cues. Give him or her "stock" phrases to use in various social situations, such as when being introduced. You can also teach your child how to interact by role-playing.
• Foster involvement with others, especially if your child tends to be a loner.
• Teach your child about public and private places, so that they learn what is appropriate in both circumstances. For example, hugging may not be appropriate at school but is usually fine at home.

Strategies for school

• Use visual systems, such as calendars, checklists, and notes, to help define and organize school work.
• Orient your child to the school setting. Before the school year starts, take time to "walk through" your child's daily schedule.
• Be aware of and try to protect your child from bullying and teasing. Talk to your child's teacher or school counselor about educating classmates about Asperger's syndrome.
• Ask your child's teacher to seat your child next to classmates who are sensitive to your child's special needs. These classmates might also serve as "buddies" during recess, at lunch, and at other times.
• Encourage your child's teacher to include your child in classroom activities that emphasize his or her best academic skills, such as reading, vocabulary, and art.
• Set up homework routines for your child by doing homework at a specific time and place every day.
• Use rewards to motivate your child. Allow him or her to watch TV or play a favorite video game or give points toward a "special interest" gift when he or she performs well.
• Some children with Asperger's have poor handwriting. Typing schoolwork on a computer may be one way to make homework easier. Using computers can also help children improve fine motor skills and organize information.

Online Resources

Organizations

• Attention Deficit Hyperactivity Disorder (ADHD)
• Autism
• Depression
• Obsessive-Compulsive Disorder (OCD)
• Social Anxiety Disorder

Citations

1. Fombonne E (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66(Suppl 10): 3–8.

2. Volkmar FR, Schultz RT (2005). Asperger's syndrome section of Pervasive development disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 3177–3181. Philadelphia: Lippincott Williams and Wilkins.

3. Popper CW, et al. (2003). Disorders usually diagnosed in infancy, childhood, or adolescence. In RE Hales, SC Yudofsky, eds., Textbook of Clinical Psychiatry, 4th ed., pp. 833–974. Washington, DC: American Psychiatric Publishing.

4. Klin A, Volkmar FR (2003). Asperger syndrome: Diagnosis and external validity. Child and Adolescent Psychiatric Clinics of North America, 12(1): 1–13.

5. Centers for Disease Control and Prevention (2003). National Immunization Program: Thimerosal and vaccines. Available online: http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/faqs-thimerosal.htm.

Author:	Sabra L. Katz-Wise	Last Updated May 4, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Fred Volkmar, MD - Child Psychiatry
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