Tony Attwood: Quotes on Asperger's

Asperger's Syndrome writer and researcher Tony Attwood has a wonderful web site full of great information on many different aspects of Asperger's. One of my favorite parts is the page of quotations by people who have AS.

A particular favorite quote of mine:

"A very frightening experience when you discover for the first time you are in world full of people who have no reason to love or even like you and some even dislike you for reasons best known to themselves."

The above quote is from the autobiography of Attwood's sister-in-law, Sarah, who is an adult with Asperger's Syndrome.

Read More:

(Deep linking into Tony's site is not possible, please explore it yourself, particularly the Quotations page.)

Tony Attwood's Official Website

How is Asperger's diagnosed?

The diagnosis of Asperger Syndrome is complicated by the lack of a standardized diagnostic screen or schedule. In fact, because there are several screening instruments in current use, each with different criteria, the same child could receive different diagnoses, depending on the screening tool the doctor uses.

To further complicate the issue, some doctors believe that AS is not a separate and distinct disorder. Instead, they call it high-functioning autism (HFA), and view it as being on the mild end of the ASD spectrum with symptoms that differ -- only in degree -- from classic autism. Some clinicians use the two diagnoses, AS or HFA, interchangeably. This makes gathering data about the incidence of AS difficult, since some children will be diagnosed with HFA instead of AS, and vice versa.

Most doctors rely on the presence of a core group of behaviors to alert them to the possibility of a diagnosis of AS. These are:

• 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

Some of these behaviors may be apparent in the first few months of a child’s life, or they may appear later. Problems in at least one of the areas of communication and socialization or repetitive, restricted behavior must be present before the age of 3.

The diagnosis of Asperger's is a two-stage process. The first stage begins with developmental screening during a “well-child” check-up with a family doctor or pediatrician. The second stage is a comprehensive team evaluation to either rule in or rule out AS. This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.

The comprehensive evaluation includes neurologic and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and non-verbal strengths and weaknesses, style of learning, and independent living skills. An assessment of communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities, and humor); patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity, and coherence of conversation. The physician will look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis.

This article appears courtesy of the US NIH.

Is Your Child Touch Sensitive?

Is Your Child Touch Sensitive?

Does your child cringe when you stroke his face?

Must he have all the labels cut out of his clothing before he
will wear them?

Does your child refuse to wear certain fabrics, such as wool
because it is scratchy?

Does your child refuse to touch anything sticky, slimy, or
dirty with his hands?

Does washing or brushing your child’s hair result in a major
battle?

Does your child hate to have his feet touched?

It could be that your child has a sensory motor integration
deficit known as tactile defensiveness or touch sensitivity.

---

What is Touch Sensitivity?

The sense of touch is essential for normal social and emotional
development. It is this system that allows us to make the
deepest connections with others. It is through touch that the
mother and child bond to each other. We connect most closely
with our spouses through touch.

Touch also serves a protective function. It is through tactile
discomfort or pain that we realize that things like fire are
dangerous. Painful or unpleasant touch experiences tell us to
prepare for a physical threat that might require a need to run
away or retaliate.

In some people this tactile sensory system is not functioning
properly. These people experience pain or distress from touch
sensations that other people find non-threatening or even
pleasant. These people have sensory integration disorder known
as tactile defensiveness or touch sensitivity.

Children with touch sensitivity are often in the state of
“red alert”. Many of the sensations that we take as meaningless,
they view as a physical threat. Children with touch sensitivity
also experience tactile sensations differently than others.
Something that we experience as smooth can seem to them painful.
The result is that often their behavior is affected. Casual
contact can cause what others view as extreme and inappropriate
reactions. These children may whine cling lash out or run away
as a result of normal things in their environment.

Sensory motor integration deficits need not affect a child’s
learning ability, but the resulting reaction often does. Because
the child is frequently on the defense, he can be emotionally
insecure and extremely distractible. This is one of the things
that differentiate touch sensitivity from ADHD. ADHD children
have difficulty sustaining attention, but they are not more
easily distracted than other children. Small stimuli that would
not affect an ADHD child who is engaged in an activity, may
cause disturb a touch sensitive child.

To give you an idea of how these children experience the world,
imagine the feeling you have when someone scrapes his nails
along a blackboard, or the feeling you have when you cut your
nails too short. This is how a touch sensitive child might
experience a warm caress. There is a difference, however. When
you cut your nails too short, it bothers you for a while, but
the discomfort goes away. If a child is touch sensitive, the
discomfort never goes away.

The child may not be able to wear his dress pants because the feel
of wool is too uncomfortable to bear. He may not be able to
concentrate in school because he is enduring the hardness of the
chair or the rush of air blowing on him from the ventilation
system. He may be quick to lash out when another child bumps him,
because of the perceived attack by the other child. He may be
unable to make friends because of the fear of being bumped
prevents him from interacting in a normal fashion.

Adults with a sensory integration disorder may have problems
in their relationships with their spouses. Normal daily contact
may disturb them, and they may avoid physical contact with their
spouses even when such contact is appropriate. This desire not
to be touched can have a seriously negative impact on a marriage.


What You Might See

Here are some of the things that may indicate that your child is
touch sensitive. Your child may be touch sensitive if he:

• Reacts strongly to sensations that most people don't notice.


• Tries to avoid tactile experiences.


• Gets distracted because of the things that are touching
  him are bothering him.


• Insists on having certain textures of clothing.


• Makes you cut all the tags and labels out of his clothing.


• Won’t eat certain foods because of their texture.


• Craves certain sensations the he finds calming, like
  rocking or firm pressure.


• Fights irrationally when you are combing or shampooing
  his hair, cutting his fingernails, or brushing his teeth.

In adults and children with sensory motor integration deficits
the palms of the hands, soles of feet, mouth and tongue are
usually most sensitive areas.


Coexisting Disorders

Touch sensitivity is a sensory integration problem. Although
this disorder can exist by itself, more often it is part of a
constellation of other problems that children have. Children
with touch sensitivity often have the following other disorders:

• Motor coordination problems


• Bed-wetting


• Speech and language delays


• Hand-eye coordination difficulties


• Motor planning difficulties


• Allergies


• Frequent ear infections


• Poor eating habits


• Problems with digestion & elimination


• Sleep irregularities


• High anxiety and emotional insecurity

In addition there are a number of medical disorders that
commonly have touch sensitivity as a component. These include:

• Asperger’s Syndrome


• Autism


• ADHD


• Bipolar Disorder


• Down Syndrome


• Dyslexia


• Fetal alcohol syndrome


• Fragile X


• Learning Disabilities


• Obsessive compulsive disorder


• Pervasive developmental delay


• Selective mutism

Causes

Like so many other disorders of the brain and complex
neurological function, we do not know why children and adults
have sensory integration disorders. In medicine, when we don’t
know the cause of something we like to say that the cause is
idiopathic. This is a term which is a term derived from Greek
or Latin or some other dead language, which means
“we don’t know.”

However as scientists, not knowing something makes us very
uncomfortable. Therefore there a number of theories on what
causes disturbances in sensory processing. There are at least
five competing hypotheses. The most recent research suggests
that the abnormality may lie in the cerebellum, the part of the
brain that modulates sensory motor activity. There might be
something to these theories. However, based upon the review of
current literature it seems to me clearly, that the cause of
touch sensitivity is idiopathic.


What Should You Do Next?

Touch sensitivity is a sensory motor integration deficit. The
goal of treatment is to repair the sensory processing disorder
by giving the child a means to develop his or her sensory
integration. The goal of therapy is to normalize sensory
integration and motor planning by improving the way the nervous
system registers and interprets tactile information.

Treatment of touch sensitivity is usually done under the
auspices of an occupational therapist. If you feel that your
child may have touch sensitivity you should first try to confirm
the diagnosis by going to someone who is trained in diagnosing
sensory integration problems. You should first consult your
pediatrician with your concern and try to get a referral to a
Pediatric Occupational Therapy Service for diagnosis and
treatment. They will manage your child’s treatment plan and
teach you what you can do at home to help your child.


Conclusion

Touch sensitivity is one of a number of sensory motor
integration deficits that affect children. It often accompanies
other disorders such as ADHD, Bipolar disorder, and other
developmental childhood disorders.

I have not seen any statistics, but it seems that sensory
integration disorders are fairly common. This condition can be
severely handicapping. However, it is often very treatable.
If you feel that your child may have this condition, it is
definitely in your child’s best interest to have a thorough
evaluation by an Occupational therapist trained in sensory
integration and motor planning.

---

Anthony Kane, MD

ADD ADHD Advances

http://addadhdadvances.com



================================================================
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
child behavior and discipline, ODD, and education.

You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart

Misdiagnosing Narcissism - Asperger's Disorder

Note: The use of gender pronouns in this article reflects the clinical facts: most narcissists and most Asperger's patients are male.

By Sam Vaknin

Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD), though evident as early as age 3 (while pathological narcissism cannot be safely diagnosed prior to early adolescence).

In both cases, the patient is self-centered and engrossed in a narrow range of interests and activities. Social and occupational interactions are severely hampered and conversational skills (the give and take of verbal intercourse) are primitive. The Asperger's patient body language - eye to eye gaze, body posture, facial expressions - is constricted and artificial, akin to the narcissist's. Nonverbal cues are virtually absent and their interpretation in others lacking.

Yet, the gulf between Asperger's and pathological narcissism is vast.

The narcissist switches between social agility and social impairment voluntarily. His social dysfunctioning is the outcome of conscious haughtiness and the reluctance to invest scarce mental energy in cultivating relationships with inferior and unworthy others. When confronted with potential Sources of Narcissistic Supply, however, the narcissist easily regains his social skills, his charm, and his gregariousness.

Many narcissists reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of Narcissistic Supply usually put an end to the narcissist's career and social liaisons.

The Asperger's patient often wants to be accepted socially, to have friends, to marry, to be sexually active, and to sire offspring. He just doesn't have a clue how to go about it. His affect is limited. His initiative - for instance, to share his experiences with nearest and dearest or to engage in foreplay - is thwarted. His ability to divulge his emotions stilted. He is incapable or reciprocating and is largely unaware of the wishes, needs, and feelings of his interlocutors or counterparties.

Inevitably, Asperger's patients are perceived by others to be cold, eccentric, insensitive, indifferent, repulsive, exploitative or emotionally-absent. To avoid the pain of rejection, they confine themselves to solitary activities - but, unlike the schizoid, not by choice. They limit their world to a single topic, hobby, or person and dive in with the greatest, all-consuming intensity, excluding all other matters and everyone else. It is a form of hurt-control and pain regulation.

Thus, while the narcissist avoids pain by excluding, devaluing, and discarding others - the Asperger's patient achieves the same result by withdrawing and by passionately incorporating in his universe only one or two people and one or two subjects of interest. Both narcissists and Asperger's patients are prone to react with depression to perceived slights and injuries - but Asperger's patients are far more at risk of self-harm and suicide.

The use of language is another differentiating factor.

The narcissist is a skilled communicator. He uses language as an instrument to obtain Narcissistic Supply or as a weapon to obliterate his "enemies" and discarded sources with. Cerebral narcissists derive Narcissistic Supply from the consummate use they make of their innate verbosity.

Not so the Asperger's patient. He is equally verbose at times (and taciturn on other occasions) but his topics are few and, thus, tediously repetitive. He is unlikely to obey conversational rules and etiquette (for instance, to let others speak in turn). Nor is the Asperger's patient able to decipher nonverbal cues and gestures or to monitor his own misbehavior on such occasions. Narcissists are similarly inconsiderate - but only towards those who cannot possibly serve as Sources of Narcissistic Supply.

More about Autism Spectrum Disorders here:

McDowell, Maxson J. (2002) The Image of the Mother's Eye: Autism and Early Narcissistic Injury , Behavioral and Brain Sciences (Submitted)

Benis, Anthony - "Toward Self & Sanity: On the Genetic Origins of the Human Character" - Narcissistic-Perfectionist Personality Type (NP) with special reference to infantile autism

Stringer, Kathi (2003) An Object Relations Approach to Understanding Unusual Behaviors and Disturbances

James Robert Brasic, MD, MPH (2003) Pervasive Developmental Disorder: Asperger Syndrome

---

ABOUT THE AUTHOR


Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, United Press International (UPI) and eBookWeb and the editor of mental health and Central East Europe categories in The Open Directory, Suite101 and searcheurope.com.
Visit Sam's Web site at http://samvak.tripod.com

Living with Asperger's Syndrome

This article is adapted from Wikipedia.

Asperger's syndrome almost always leads to problems with normal social interaction with peers. Though not always insurmountable, these issues can be severe, especially in childhood and adolescence.

Children with Asperger's syndrome are often the target of bullying at school due to:

1. their idiosyncratic behaviour, language, and interests, and



2. because of their generally poor ability to understand and respond "properly" to non-verbal cues (such as body language), particularly in situations of interpersonal conflict.

A child or teen with Asperger's syndrome is frequently puzzled as to the source of this mistreatment, unaware of what has been done "wrong". The social alienation of children with Asperger's syndrome can in some cases be so intense that they create imaginary friends for companionship (although this is certainly not specific to Asperger's syndrome as non-autistics may do the same as well). Even later in life, many people with Asperger's report a feeling of being unwillingly detached from the world around them.

Children with Asperger's syndrome often demonstrate precocious abilities in areas such as:

• language


• reading


• mathematics


• spatial skills


• music

Sometimes these abilities may extend into the "gifted" range, but this may be offset by significant delays in other developmental areas. This combination of traits can create problems with teachers and other authority figures.

It may be relevant here that one of the social conventions many people with AS ignore is respect for authority. The researcher Attwood notes a tendency to feel that everyone should be treated much the same regardless of what social position they may occupy; the student with AS may not give respect until he or she feels it has been earned, an attitude many teachers will either not understand or take strong exception to.

As with many gifted children, a child with Asperger’s might be regarded by teachers as a "problem child" or a "poor performer". The child’s extremely low tolerance and motivation for what they perceive to be mundane and mediocre tasks (such as typical homework assignments) can easily become frustrating; the teacher may well consider the child arrogant, spiteful, and insubordinate. Meanwhile, the child sits there mutely, feeling frustrated and wronged – and often having no idea how to express these feelings.

Asperger's syndrome hardly guarantees a miserable life. The intense focus and tendency to work things out logically, a characteristic of Asperger's syndrome, often grants people with the syndrome a high level of ability in their field of interest. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life. The child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance.

On the other hand, many people with Asperger’s syndrome may experience inordinate levels of distress at having their routines disrupted or being denied the opportunity to express their special interests. For example, a child with Asperger’s Syndrome may be a gifted writer for her age, and may be happiest when spending class time working on her stories. The teacher may insist that the student instead pay attention to the lesson or work on assigned homework assignments.

A non-autistic child in such circumstances may be mildly upset, but would probably reluctantly go along with the teacher; for a child with Asperger’s Syndrome, on the other hand, such an experience can be extremely traumatic and leave the teacher and the rest of the class wondering why the normally withdrawn child is suddenly angry or upset, seemingly out of proportion to the situation. Dismissing the child’s concerns at such a juncture – perhaps by calling the concerns "immature" or "disrespectful" – can be a serious blow to the child’s self-esteem, which is often already fragile.

While many people with Asperger's will not have lives that are considered a social success by common standards - and there are many who will remain alone their entire lives - it is certainly possible for them to find understanding people with whom they can have close relationships. Many autistics have children, in which case their children may or may not have an autism spectrum disorder.

Significant others and family members of people with Asperger's are often more prone to depression than the general population because people with Asperger's may not spontaneously show affection, and can be very literal and hard to communicate with in an emotional way.

However, not showing affection (or not doing so in conventional ways) does not necessarily mean that he or she does not feel it. Understanding this can lead the significant other to feel less rejected and be more understanding.

There are usually ways to work around problems of this type. One example may be by being more explicit about their needs. For instance, when describing emotions, it can be helpful to be direct and to avoid vague terms like "upset" when the emotion being described is "anger". It is often effective to lay out in clear language what the problem is and to ask the partner with Asperger's to describe what emotions are being felt or ask why a certain emotion was being felt. It is very helpful if the family member or significant other reads as much as he or she can about Asperger’s syndrome and any comorbid disorders that may exist.

Where does the name "Asperger's Syndrome" come from?

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation.

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s syndrome”. Wing’s writings were widely published and popularized. AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10), and in 1995 it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.

Courtesy of the US NIH

Causes: Is Asperger's Syndrome Genetic?

Courtesy of the National Institute of Neurological Disorders and Stroke

Twin and family studies suggest there is a genetic vulnerability to Aspergers Syndrome and the other ASDs, but a specific gene for AS hasn’t been identified. It is likely that multiple genes cause Aspergers, since the symptoms and the severity of symptoms vary so widely among individuals.

Researchers recently identified an association between certain behavioral traits (the insistence on strict routines and repetitive behavior) in a group of children with autism and a specific gene – GABRB3. Another study discovered a strong association between autism and the mutation of a gene the researchers call ENGRAILED 2. Additional evidence for the link between inheritable genetic mutations and AS is seen in the higher incidence of family members of children with an ASD who have similar behavioral symptoms, but in a more limited form. For example they may have mild social, language, or reading problems.

Current research points to structural abnormalities in the brain as a cause of AS. These abnormalities impact neural circuits that control thought and behavior. Researchers think that gene/environment interactions cause some genes to turn on or turn off, or turn on too much or too little in the wrong places, and this interferes with the normal migration and wiring of embryonic brain cells during early development.

Researchers at the University of California , supported in part by the National Institutes of Health, have proposed that Asperger's Syndrome stems from abnormal changes that happen during critical stages of fetal development. Defects in the genes that control and regulate normal brain growth create abnormal growth patterns, which cause overgrowth in some brain structures and reduced growth, or excessive cell loss, in others.

Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific brain regions between the brains of normal versus AS children. One study found a lack of activity in the frontal lobe of AS children when asked to respond to tasks that required them to use their judgment. Another found differences in brain activity when children were asked to respond to facial expressions. Other methods of investigating brain function have revealed abnormal levels of particular proteins in the brains of adults with Asperger's Syndrome, which correlate with obsessive and repetitive behaviors.

Asperger's Syndrome: Treatment, Prognosis and Research

Courtesy of the US National Institutes of Health

Asperger's Syndrome: Is there any treatment?

The ideal treatment for Asperger Syndrome coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures.

What is the prognosis?

With effective treatment, children with Asperger Syndrome can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

What research is being done on Asperger's Syndrome?

Many of the Institutes at the NIH (US National Institutes of Health), including the NINDS (National Institute of Neurological
Disorders and Stroke), are sponsoring research to understand what causes Asperger Syndrome and how it can be effectively treated. One study is using functional magnetic resonance imaging (fMRI) to show how abnormalities in particular areas of the brain cause changes in brain function that result in the symptoms of Asperger's and other ASDs. Other studies include a clinical trial testing the effectiveness of an anti-depressant in individuals with Asperger Syndrome and HFA (High Functioning Autism) who exhibit high levels of obsessive/ritualistic behavior and a long-range study to collect and analyze DNA samples from a large group of children with Asperger's and HFA and their families to identify genes and genetic interactions that are linked to Asperger Syndrome and HFA.

Further Reading:

Asperger's Huh? A Child's Perspective [Amazon]

What is Asperger Syndrome?

Courtesy of the US National Institutes of Health

Asperger syndrome (AS) is a developmental disorder. It is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Other ASDs include: classic autism, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Unlike children with autism, children with AS retain their early language skills.

The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other. Children with AS want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors. Other characteristics of AS include repetitive routines or rituals; peculiarities in speech and language; socially and emotionally inappropriate behavior and the inability to interact successfully with peers; problems with non-verbal communication; and clumsy and uncoordinated motor movements.

Children with AS are isolated because of their poor social skills and narrow interests. They may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest. Children with AS usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

Read More:
Asperger's Syndrome: A Guide for Parents and Professionals [Amazon]

A Technical Definition of Asperger's Syndrome

Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

1. Qualitative impairment in social interaction, as manifested by at least two of the following:
   1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, 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, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people).
   4. A lack of social or emotional reciprocity.
2. 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 of objects.
3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
4. There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years).
5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Please read the DSM cautionary statement. The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective; a condition which one psychologist might define as a "significant impairment" might be defined by another psychologist as merely insignificant.

Christopher Gillberg in A Guide to Asperger Syndrome (Cambridge: Cambridge University Press, 2002), also criticizes the "no significant delay" clauses of the DSM, and to a lesser extent some of the others as well, and argues the clauses represent a misunderstanding or oversimplification of the syndrome. He states that while there may well be significant delay in some areas of language development, it is often combined with exceptionally high functioning in other language-related areas, and argues that this combination superficially resembles, but is in reality very different from, normal development in language and adaptive behaviour.

Partly due to Asperger's Syndrome's relatively recent appearance in the DSM, and partly due to differences of opinion such as Gillberg's, there are at least three other, slightly different sets of diagnostic criteria used in the field besides the DSM-IV definition above. One is due to Gillberg himself and his wife, and is also endorsed by Attwood; among other differences, this definition emphasizes the linguistic peculiarities which go unmentioned in the DSM-IV criteria. Another definition is due to a team of Canadian researchers, and is often referred to as the Szatmari definition, after the first listed author of the paper in which these criteria first appeared. Both of these definitions were first published in 1989. The third is the ICD-10 definition; this one is similar to the DSM-IV version, and Gillberg criticizes it in much the same manner as he does the DSM-IV version.

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This article appears courtesy of Wikipedia.

How Prevalent is Asperger's Syndrome?

This article appears courtesy of Wikipedia.

A 1993 total population study carried out in Sweden found that, at a minimum, 3.6 per 1000 school-aged children definitely meet the criteria for Asperger's syndrome. If merely suspected cases are included, the prevalence becomes approximately 7.1 per 1000. Data for the adult population is not available.

Like other conditions classified as autism spectrum disorders, Asperger's syndrome appears to be somewhat more prevalent among males than females, with males comprising approximately 75-80 percent of diagnoses. Many clinicians believe that this may not reflect the actual incidence among females; well-known Asperger's syndrome expert Tony Attwood suggests that females learn to better compensate for their impairments due to differences in socialization. Some preliminary evidence for this is found in the Ehlers & Gillberg study, which found a 4:1 male to female ratio in the cases they felt definitely had Asperger's, but a much less lopsided 2.3 to 1 ratio when merely suspected or otherwise borderline cases were included.

The overwhelming majority of the available information on Asperger's syndrome relates to children; there is currently more conjecture than hard evidence on how it affects adults. It is thought that most people with Asperger's syndrome learn to better cope with their symptoms later in life, but there is no "cure" as such and many, including prominent clinicians such as Attwood as well as many of those diagnosed with Asperger's, would strenuously argue that a cure is neither possible nor desirable. Organizations such as Cure Autism Now disagree; this remains a highly controversial area.

What Are The Symptoms of Asperger's Syndrome?

This article appears courtesy of Wikipedia.

The most common and important characteristics of Asperger's syndrome can be divided into several broad categories — social impairments, narrow but intense interests, and speech and language peculiarities. There are also other features commonly associated with this syndrome, but not always held to be necessary for diagnosis. It should be noted that this article reflects the thinking of certain researchers on what the most important characteristics of Asperger's are; the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, edition 4) criteria represent a slightly different view.


Social impairments

Though there is no single feature that all people with Asperger's syndrome share, difficulties with social behaviour are nearly universal and are perhaps the most important criteria that define the condition. People with Asperger's syndrome lack the natural ability to see the subtexts of social interaction and equally lack the ability to broadcast their own emotional state.

Non-autistics are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's facial expression and body language, but people with Asperger's syndrome have an impairment in this ability, sometimes referred to as mind-blindness. To be mind-blind is to find it difficult or even impossible to figure out things a person implies but does not say directly (more colloquially, to "read between the lines"). This is not because they cannot imagine the answer, but because they cannot choose among the possibilities — the mind-blind individual cannot reliably gather enough information to do so, or does not know how to interpret the information he or she does gather.

Along with this difficulty in "reading" the non-verbal communication of others, most individuals with Asperger's have difficulty expressing their own emotional state via body language, facial expression, and nuance in the way that most people do. Such people have emotional responses as strong as, or perhaps stronger than, most people, though what generates an emotional response might not always be the same; the difficulty is with expressing these feelings, though it sometimes comes across as lacking them. For example, many people with Asperger's syndrome have difficulty with eye contact. Some make very little eye contact because they find it overwhelming, while others have unmodulated, staring eye contact that can cause discomfort to other people. Similarly, the use of gestures may be almost nonexistent, or may seem exaggerated and differ from what would normally be considered appropriate for a situation.

It is worth noting that since it is classified as a spectrum disorder, some people with Asperger's syndrome are nearly normal in their ability to read and use facial expressions and other relatively subtle forms of communication. However this does not come naturally to most people with Asperger's syndrome. Such people must learn social skills intellectually, delaying social development.


Narrow, intense interests

Asperger's syndrome can involve an intense and obsessive level of focus on things of interest. For example, one person might be obsessed with 1950's professional wrestling, another with national anthems of African dictatorships, and another with building models out of matchsticks. Particularly common interests are means of transport (such as trains), computers, and dinosaurs. Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally one or two at any given time. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reason, an almost obsessive focus, and eidetic memory. Hans Asperger called his young patients "little professors", based on the fact that he thought his thirteen-year-old patients had as comprehensive and nuanced an understanding of their field of interest as university professors.

Some clinicians would not entirely agree with this description; Wing and Gillberg, for example, both argue that there is often more rote memorization than real understanding of these areas of interest, despite occasional appearances to the contrary. It may be worth pointing out, however, that such a limitation is not required for diagnosis, even under Gillberg's criteria.

People with Asperger's syndrome often have little patience for things outside these areas of interest. During the school years, many are perceived as highly intelligent underachievers, clearly capable of massively outperforming their peers in their field of interest yet seemingly impossible to motivate to do regular day-to-day homework assignments (sometimes even in their areas of interest). Additionally, in more serious cases, the combination of social impairments and intense interests can lead to peculiar behaviour, such as greeting a stranger by launching into a lengthy monologue about a special interest rather than by saying "hello" and introducing oneself.


Speech and language peculiarities

People with Asperger's syndrome are often noted for having a highly pedantic way of speaking, using language far more formal and structured than the situation would normally be thought to call for. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially on their special areas of interest.

Literal interpretation is another common, though not universal, hallmark of this condition. Attwood gives the example of a girl with Asperger's syndrome who answered the telephone one day and was asked "Is Paul there?". Though the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said "no" and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone (Attwood, 78).

Many people with Asperger's syndrome also make idiosyncratic use of words, including new coinages as well as unusual juxtapositions. This can develop into a rare gift for humour (especially puns, wordplay, doggerel, satire) or writing. (Another potential source of humour is the eventual realization that their literal interpretations can be used to amuse others.) Some are so proficient with written language as to qualify as hyperlexic. Researcher Tony Attwood refers to a particular child's skill at inventing expressions, e.g. "tidying down" (the opposite of tidying up) or "broken" (when referring to a baby brother who cannot walk or talk).

Other characteristics

Those affected by Asperger's may also manifest a range of other sensory, developmental, and physiological anomalies. It is common for Asperger's children to evidence a marked delay in the development of fine motor skills. They may display a distinctive "waddling" or "mincing" gait when they walk and may walk with their arms held out in an unusual manner. Compulsive finger, hand, or arm movements, such as flapping, are also observed.

In general, orderly things have appeal to individuals with Asperger's. Some researchers mention the imposition of rigid routines (on self or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for at least some people with this condition.

Some people with Asperger's suffer from varying degrees of sensory overload, and may be pathologically sensitive to loud noises or strong smells or dislike being touched — for example, certain Asperger's children exhibit a strong dislike of having their head touched or their hair disturbed. Such sensory overload may exacerbate problems faced by Asperger's children at school, where levels of noise in the classroom can become intolerable for them. Some are also unable to block out certain repetitive stimuli, such as the constant ticking of a clock. Whereas most children will stop registering this sound after a short time and can only hear it if they consciously listen for it, the child with Asperger's can become distracted, agitated, or even (in rare cases) violent if the sound is not removed.

There seems to be a strong correlation between those with Asperger's syndrome or high functioning autism (HFA), and the INTP type of the Myers-Briggs Type Indicator (MBTI). Another theory states that Asperger's correlates to the INTJ personality type, whereas high functioning autism correlates to the INFJ personality type.

Further Reading:
Parenting Your Asperger Child : Individualized Solutions for Teaching Your Child Practical Skills [Amazon]