Asperger Syndrome

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Original Editors - Brittany Smithson from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition

DSM-IV-TR definition of Asperger Syndrome (called “Asperger Disorder”) (APA, 1994)

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people.
4. lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts or objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g. single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

Prevalence

Asperger Syndrome affects about 1 in 200 people, more commonly in men than women.

2 per 10,000 children with Autism Spectrum Disorders have Asperger Syndrome

Characteristics/Clinical Presentation

• Childhood onset
• Limited social relationships – social isolation

Few/no sustained relationships; relationships that vary from too distant to too intense
Awkward interaction with peers
Unusual egocentricity, with little concern for others or awareness of their viewpoint; little empathy or
sensitivity
Lack of awareness of social rules; social blunders

• Problems in communication

An odd voice, monotonous, perhaps at an unusual volume
Talking ‘at’ (rather than ‘to’) others, with little concern about their response
Superficially good language but too formal/stilted/pedantic; difficulty in catching any meaning
other than the literal
Lack of non-verbal communicative behaviour: a wooden, impassive appearance with few gestures;
a poorly coordinated gaze that may avoid the other’s eyes or look through them
An awkward or odd posture and body language

• Absorbing and narrow interests

Obsessively pursued interests
Very circumscribed interests that contribute little to a wider life, e.g. collecting facts and figures of
little practical or social value
Unusual routines or rituals; change is often upsetting

Associated Co-morbidities

• Schizophrenia
• Affective disorders
• Obsessive Compulsive Disorder
• ADHD
• Alcoholism
• Offending
  
  

Medications

In general, pharmacological interventions with young children are probably best avoided. Specific medication might be indicated if AS is accompanied by debilitating depressive symptoms, severe obsessions and compulsions, or a thought disorder. It is important for parents to know that medications are prescribed for the treatment of specific symptoms, and not to treat the disorder as a whole.

Diagnostic Tests/Lab Tests/Lab Values

Some clinicians do not recognize AS as a separate disorder from autism, instead they refer to it as high-functioning autism (HFA). These doctors put it on the mild end of the Autism Scale. This has made collecting data on diagnoses difficult as they use the terms AS and HFA interchangeably.

Key behavioral features doctors are looking for:
• abnormal eye contact
• aloofness
• the failure to turn when called by name
• the failure to use gestures to point or show
• a lack of interactive play
• a lack of interest in peers

Diagnoses of AS takes two steps, the first step is during a screening performed by the family doctor of pediatrician. If problems are noted the child then moves onto the second step which is a comprehensive team evaluation to determine if the child has AS. The team normally is made up of a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS. (NIH.gov)

AS must be diagnosed by trained and experienced providers due to the complex diagnostic process and to determine the variety, intensity, and comprehensiveness of services required. The American Academy of Child and Adolescent Psychiatry published practice parameters for the assessment of individuals with AD and PDD. (B Freeman, 2002)

It is difficult to accurately diagnose an individual with AS due to the complexity of the syndrome and the overlap of symptoms into other syndromes like Autism. AS is defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) which is listed above. It is categorized as a Pervasive developmental disorder (PDD); other PDD include Rett syndrome, childhood disintegrative disorder, and Autism. It is also important to note that in order to be diagnosed as AS an individual cannot have any clinically significant delays in language or a lack of any clinically significant delay in cognitive development, including development of age-appropriate self-help skills. (B Freeman, 2002)

B Freeman, P Cronin, and P Candela. Asperger syndrome or autistic disorder? The diagnostic dilemma. Focus on Autism and other developmental disabilities 2002:17;145-151

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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http://www.aspergersyndrome.org/

http://www.autism-society.org/

http://www.autismspeaks.org/

http://www.youtube.com/watch?v=WAfWfsop1e0

Recent Related Research (from Pubmed)

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References

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