Definition
-
It is a form of
pervasive developmental disorder characterized by severe persistent impairment
in social interactions, repetitive behavior patterns, and restricted
interests.
Differences between
Autism and Asperger disorder
-
Sometimes Asperger
syndrome is classified as a subset of Autism, because many symptoms present in
individuals with Asperger syndrome overlap with those exhibited by
high-function persons with Autism.
-
However there are
differences between the two PDD disorders.
Unlike a child with autism, children with Asperger syndrome do not
suffer from a significant delay in cognitive development nor do they experience
a significant delay in language acquisition.
-
Also, children with
Asperger disorder usually show motor coordination difficulties, particularly
with fine motor control such as holding a pencil. Children with autism do not experience such
problems.
-
Children with autism
find it very difficult to think in abstract symbolic states, resulting in
difficulties in pretend play; they generally think in very concrete terms. However, children with Asperger syndrome tend
to show that they have a larger degree of imagination despite the fact that
what they imagine can be the same thing over and over again. (It can be
repetitive)
Frequency
-
In the
Sex
-
Males are more
afflicted than female with a mal-to-female ratio approximately 4:1
Age
-
Usually diagnosed
when the child is in the earlier part of elementary school; diagnosis comes
less frequently during early childhood or when the individual is an adult
Cause
-
As of yet, this is
unknown. Believed to be genetically
based though, involving some influence on the CNS.
Clinical Symptoms
-
According to the DSM
IV – look at print out
o A. Impairment in social interactions (at least
two)
§
Impairments
in use of multiple nonverbal behaviors
·
May avoid
eye-to-eye contact
·
May not
return to right social and emotional responses because of lack of understanding
social cues
·
Seems
clueless towards the body language of others
·
Inappropriate
or absent facial expression, body postures, and gestures for the circumstance
·
Has problems
judging personal space; may stand too close to someone else
§
Fail develop
age-appropriate peer relationships
·
May want to
join a group of children and make new friends, but do not have the proper
social skills to affectively accomplish this goal; usually exhibit
inappropriate attempts to initiate social interaction
·
They usually
show a naïve trust in other individuals which makes them susceptible to be
taken advantage; this becomes more important during adolescence when peer
pressure becomes more of a problem
·
Show
difficulty distinguishing between whether someone is a friend or acquaintance
§
Spontaneous
sharing is absent
·
These
children do not show, bring, or point out objects of interest to other people
·
They do not
share their happiness, interests, or achievements with other people like what a
typically developing child would do
§
Do not show
social or emotional reciprocity
·
No theory of
mind
·
May not
understand why people become upset when he or she breaks social rules
·
Do not show
much empathy for other people; have difficulty comforting another because may
not understand that person needs comforting
o B. Restricted repetitive and stereotyped patterns
of behavior, behavior, interests, and activities (at least one)
§
An
all-encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus
§
Adhere very
rigidly to a specific, nonfunctional routines or rituals
·
Rigid
adherence to rules and social conventions
·
Limited
clothing and food preferences
·
Adhere to
certain eating behaviors
·
Need for
explicit step-by-step instructions; will become disoriented if a step is taken
away
·
Difficulty
generalizing
·
If change
must occur in the child’s life in some way, it is advised to ease the child
into it and explain what is to occur
§
Stereotyped
and repetitive motor mannerisms (self-stimulatory behavior)
·
Examples
include – hand or finger flapping or twisting, or complex whole-body movements
·
Express
self-injurious behaviors
·
May be to
reduce anxiety, stress, or for pleasure
§
Persistent
preoccupation with parts of objects
·
Often their
entire focus is on small details, parts of a whole, thus they fail to see the
overall big picture of what is happening in any situation
o C. These have to cause significant problems for
the individual preventing him or her from functioning normally in everyday life
o D. Must not show clinical significant general
delay in language
§
By 2 years –
single words
§
By 3 years –
multiple words into a communicative phrase
o E. Must not
experience significant delay in cognitive development or in the development of
age-appropriate self-help skills, adaptive behavior (besides social
interaction), and curiosity about the environment in childhood
-
According to
Gillberg’s Criteria (a bit more comprehensive diagnostic criteria) – look at
print out
o Severe impairment in reciprocal social interaction
(at least two)
§
Look on print
out; same as above
o All-absorbing narrow interest (at least one)
§
Look on print
out; same as above
§
(c) More rote
than meaning (probably why they like strict rules and routines)
o Imposition of routines and interests (at least
one)
§
Look on print
out; same as above
o Speech and language problems (at least three)
§
Delayed
development
§
Superficially
perfect expressive language
·
May
experience hyperlexia early in childhood; this is the ability to read fluently
without understanding the meaning (fits well, because Asperger syndrome
individuals excel at rote memory)
§
Formal,
pedantic language
·
May talk
incessantly on a topic of interest only to themselves without knowing the
boredom of the listener
·
Seem to talk
at you rather than to you, giving you information rather than holding a proper
conversation (Been compared to talking like a professor)
·
May lack
sensitivity about reciprocal rules of conversation- may inappropriately
interrupt others, or have little participation at all, difficult to shift
topics, hard to initiate and terminate conversation
·
Speech may be
idiosyncratic (can only have meaning in certain contexts and perhaps only
understood by certain people)
§
Odd prosody,
peculiar voice characteristics
·
May not have
the local accent
·
May be too
loud or overly formal
·
Monotonous
tone
§
Impairment of
comprehension including misinterpretations of literal-implied meanings
·
Metaphors,
similes, jokes, and the like usually need to be explained
o Non-verbal communication problems (at least one)
§
Look on print
out; same as above
§
(b)
Clumsy/gauche body language
§
(e) Peculiar,
stiff gaze
o Motor clumsiness: poor performance on
neurodevelopmental examination
§
Unusual gait,
stance, posture
§
Usually quite
clumsy
§
Gross or fine
motor coordination problems; lax joints often observed (i.e. – immature or
unusual grasp for handwriting and other fine hand movements)
·
May show
anomalies of locomotion, balance, manual dexterity, handwriting, rapid
movements, rhythm, and imitation of movements
§
Some may show
impaired ball-playing skills
§
Sensory
sensitivity; may have unusual responses to touch, sound, taste, sight, smell,
pain, lighting, colors, and temperature (i.e. – might be overly sensitive to a
soft touch, but undersensitive to pain)
§
May exhibit
synesthesia (don’t know what that is)
Mortality
-
Individuals with
this disorder generally have a normal lifespan
-
But do have high
rate of comorbid psychiatric problems
Morbidities
-
Depression, mood
disorders, obsessive-compulsive disorder, Tourette’s disorder
-
Learning disability,
attention deficit disorder
-
Central auditory processing
disorder, non-verbal learning disorder, semantic pragmatic language disorder
Treatment
-
Medications
o Don’t usually treat with medication, but sometimes
do to treat specific target symptoms
o SSRI, selective serotonin reuptake inhibitors,
like Paxil, Prozac, Zoloft, might help with obsessions or perseveration, may
also help with depression and anxiety
o To help with stereotyped movements, agitation and
idiosyncratic thinking, may prescribe low dose of antipsychotic drugs like
risperidone
-
I didn’t really get
very much info on treatment of this disorder.
In one article they talked about social skills training briefly and
educational intervention because many of such children still attend regular
schools. But I don’t know if the same
behavioral treatments (i.e. - Pivotal Response Training) used for autistic
children are also used for children with asperger’s syndrome. Maybe someone else found some more info on
this, if we even want to include this in our presentation.