Asperger’s Disorder



Carol E.

Watkins, M.D.

Asperger’s Disorder is not widely

recognized by the public or by health care providers. What does it mean to have

Asperger’s Disorder? Do they have severe AD/HD, mild autism, learning

disabilities, or are they just “nerds?” 

For years,

psychiatrists have debated how to classify and subdivide the category of

Pervasive Developmental Disorder (PDD). 

Pervasive Developmental Disorder is a category that contains

several specific diagnoses. Individuals with PDD have problems with the

social interaction and often show delays in several other areas. These

other areas may include language, coordination, imaginative activities,

and intellectual functioning. The degree of severity can vary tremendously

in the various forms of PDD. Autism is one of the more severe forms of PDD.

An individual with Autism has marked difficulty relating to other human

beings. He or she frequently has delayed or absent speech and may be

mentally retarded. Asperger’s Disorder is on the milder end of PDD.

Individuals with Asperger’s generally have normal intelligence and

normal early language acquisition. However, they show difficulties with

social interactions and non-verbal communications. They may also show

perseverative or repetitive behaviors.  


Young Child: A preschool aged child might show difficulty

understanding the basics of social interaction. He or she may have

difficulty picking up social cues. He may want friends but be unable to

make or keep any friends.  


School Aged Child: One often hears the phrase, “poor pragmatic

language skills.” This means that the individual cannot use the right

tone and volume of speech. He may stand too close or make poor eye

contact. He may have trouble understanding age-appropriate humor and slang

expressions. Many are clumsy and have visual-perceptual difficulties.

Learning difficulties, subtle or severe, are common. The child may become

fixated on a particular topic and bore others with frequent or repetitive

talk even when the other children have given clear signals that they are

no longer interested in the topic. Some have difficulties tolerating

changes in their daily routine. Change must be introduced gradually.



Adolescent: This may be the most difficult time for an individual with

Asperger’s Disorder. Those with milder forms of the disorder may first

come to treatment when they are in middle school. In adolescence, social

demands become more complex. Subtle social nuances become important.  Some may show an increase in oppositional or aggressive

behavior. Individuals with Asperger’s have difficulty understanding

which of their peers might want to be a friend. A socially marginal boy

might try to date the most popular girl in his class. He will probably

experience rejection. He is unaware that some other girl might accept his

invitation. Because of his social naiveté, he may not realize when

someone is trying to take advantage of him. He can be especially

vulnerable to manipulation and peer pressure.  


There is less information on Asperger’s Disorder in adulthood. Some

individuals with mild Asperger’s Disorder are able to learn to

compensate. They become indistinguishable form everyone else. They marry,

hold a job and have children. Other individuals live an isolated existence

with continuing severe difficulties in social and occupational

functioning. Individuals with Asperger’s often do well in jobs that

require technical skill but little social finesse. Some do well with

predictable repetitive work. Others relish the challenge of intricate

technical problem solving. I knew a man, now deceased, who had many of the

characteristics of Asperger’s Disorder. He lived with his mother and had

few social contacts. When he visited relatives, he did not seem to

understand how to integrate himself into their household routine. When the

relatives would explain the situation to him, he was able to accept it.

However, he was unable to generalize this to similar situations. Although

he was a psychologist, his work involved technical advisory work, not

face-to-face clinical sessions. 


Difficulties: Asperger’s Disorder may be associated with learning

difficulties and attention deficit disorder. Indeed, many children and

adolescents with Asperger’s have previously been diagnosed with AD/HD

instead of Asperger’s. Individuals with AD/HD may have difficulty with

social interaction, but the primary difficulties are inattention,

hyperactivity and impulsivity. In individuals with Asperger’s, the

social awkwardness is a greater concern. As individuals with Asperger’s

enter adolescence, they become acutely aware of their differences. This

may lead to depression and anxiety. The depression, if not treated, may

persist into adulthood. 


for Asperger’s Disorder : 


There is no one specific medication for Asperger’s syndrome. Some are on

no medication. In other cases, we treat specific target symptoms. One

might use a stimulant for inattention and hyperactivity. An SSRI such as

Paxil, Prozac or Zoloft might help with obsessions or perseveration. The

SSRIs can also help associated depression and anxiety. In individuals with

stereotyped movements, agitation and idiosyncratic thinking, we may use a

low dose antipsychotic such as risperidone. 


Skills Training: This is one of the most important facets of treatment

for all age groups. I often tell parents and teachers that the individual

needs to learn body language as an adult learns a foreign language. The

individual with Asperger’s must learn concrete rules for eye contact,

social distance and the use of slang. Global empathy is difficult, but

they can learn to look for specific signs that indicate another

individual’s emotional state. Social skills are often best practiced in

a small group setting. Such groups serve more than one function. They give

people a chance to learn and practice concrete rules of interpersonal

engagement. They may also be a way for the participant to meet others like

himself. Individuals with Asperger’s do best in groups with similar

individuals. If the group consists of street-wise, antisocial peers, the

Asperger’s individual may retreat into himself or be dominated by the

other members. 


Interventions: Because Asperger’s covers a wide range of ability

levels the school must individualize programming for each student with

Asperger’s Disorder. Teachers need to be aware that the student may

mumble or refuse to look him in the eye. Teachers should notify the

student in advance about changers in the school routine. The student may

need to have a safe place where he can retreat if he becomes over

stimulated. It may be difficult to program for a very bright student with

greater deficits. In one case, a student attended gifted classes but also

had an aide to help her with interpersonal issues. That student is now in

college. Children with Asperger’s are often socially naive. They may not

do well in an Emotionally Disturbed class if most of the other students

are aggressive, street-wise and manipulative. I have seen some do well

when placed with other students with pervasive developmental disorders.

Some do well in a regular classroom with extra support. This extra help

might include an instructional assistant, resource room or extra training

for the primary teacher. 


Individuals with Asperger’s Disorder may have trouble with a

therapist who insists that they make an early intense emotional contact.

The therapist may need to proceed slowly and avoid more emotional

intensity than the patient can handle. Concrete, behavioral techniques

often work best. Play can be helpful in a limited way if the therapist

uses it to teach way of interaction of the therapist uses play as a break

form an emotionally tense if it is used to lower emotional tension. Adults

and children may also do well in group therapy. Support groups can also be



play an important role in helping their child or adolescent. This child or

adolescent will require time and extra nurturance. It is important to

distinguish between willful disobedience and misunderstanding of social

cues. It is also important to sense when the child is entering emotional

overload so that one can reduce tension. They may need to prepare the

child for changes in the daily routine. One must choose babysitters

carefully.  Parents may have

to take an active role in arranging appropriate play dates for the younger

child. Some parents seek out families with similar children. Children with

Asperger’s often get along with similar playmates. Parents should help

teachers understand the world from the child’s unique point of view. Parenting

an adolescent with Asperger’s can be a great challenge. The socially

naive adolescent may not be ready for the same degree of freedom as his

peers. Often parents can find a slightly older adolescent who can be a

mentor. This person can help the adolescent understand how to dress, and

how to use the current slang. If the mentor attends the same school, he

can often give clues about the cliques in that particular setting. 


may benefit from group therapy or individual behavioral therapy. Some

speech therapists have experience working with adults on pragmatic

language skills. Behavioral coaching, a relatively new type of

intervention, can help the adult with Asperger’s Disorder organize and

prioritize his daily activities. Adults may need medication for associated

problems such as depression or anxiety. It is important to understand the

needs and desires of that particular adult. Some adults do not need

treatment. They may find jobs that fit their areas of strength. They may

have smaller social circles, and some idiosyncratic behaviors, but they

may still be productive and fulfilled.



Online Asperger’s Syndrome Information and Support. Diagnostic

information and resources for treatment. Support areas for families

affected by Asperger’s Syndrome.


Holliday-Willey An adult who is self-identified as having

Asperger’s Syndrome writes about coping with the disorder in family, work

and social situations. 


to Sites by and About individuals with Asperger’s Syndrome and

other Pervasive Developmental Disorders. 


 Northern County Psychiatric


Our practice has experience in the treatment of Attention

Deficit disorder

(ADD or ADHD), Depression, Separation Anxiety Disorder, Obsessive-Compulsive

Disorder Aspergers Disorder, and other

psychiatric conditions. We are located in Northern Baltimore County and serve the

Baltimore County, Carroll County and Harford County areas in Maryland. Since we are near

the Pennsylvania border, we also serve the York County area.   Our

services include psychotherapy, psychiatric evaluations, medication management, and

family therapy. We treat children, adults, and the elderly.

We also maintain a list of informative web sites on mental health

topics, such as Attention Deficit Disorder, Parenting and Support Groups. We have links of

interest to the general public and links of interest to primary care physicians and other professionals.

Awards for 

the NCPA site

Northern County Psychiatric Associates
Niacin Pills to Pass a Drug Test

Lutherville and Monkton

Baltimore County, Maryland

Phone: 410-329-2028

Web Site 

Copyright 2000

Carol E. Watkins, M.D.

Glenn Brynes, Ph.D., M.D.