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?”
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
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.