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In 1994, Asperger's Disorder
(AD) was recognized as a distinct clinical entity
in the DSM-IV (the diagnostic reference that mental
health professionals in the U.S. use; the DSM-IV
also provides the diagnostic
criteria for
Asperger's Disorder). Since in the past, many
children with Asperger's Disorder were diagnosed as
having autism, one would expect to see certain
features in common with autism, but also a pattern
that distinguishes Asperger's Disorder (AD) from
autism.
Children
with Asperger's usually have a typical early
development. Many children with Asperger's Disorder
have normal or above-normal intelligence. Although
there is no one description that will fit all
children with Asperger's, perhaps the most salient
features relate to their tendency to have
sophisticated knowledge or passion for a narrowly
defined range of interests while being socially
inept.
Swedish
physician Christopher Gillberg categorizes the
features of Asperger's into six main domains of
impairment:
--Social
impairment with extreme egocentricity, which may
include:
- Inability
to interact with peers
- Lack
of desire to interact with peers
- Poor
appreciation of social cues
- Socially
and emotionally inappropriate responses
--Limited
interests and preoccupations, including:
- More
rote than meaning
- Relatively
exclusive of other interests
- Repetitive
adherence
--Repetitive
routines or rituals, that may be:
- Imposed
on self, or
- Imposed
on others
--Speech
and language peculiarities, such as:
- Superficially
perfect expressive language
- Odd
prosody, peculiar voice characteristics
--Impaired
comprehension including misinterpretation of
literal and implied meanings.
--Nonverbal
communication problems, such as:
- Limited
use of gesture
- Clumsy
body language
- Limited
or inappropriate facial expression
- Peculiar
"stiff" gaze
- Difficulty
adjusting physical proximity
--Motor
clumsiness -- may not be present in all
cases.
As suggested by the above,
whereas the features of autism are generally severe
and noticeable within the first years of life,
children with Asperger's have a more typical
development. In general, a child with Asperger's
Disorder does not have the language delays seen in
autism (although they may have some atypical
speech), and the Asperger's child functions at a
higher level than the typical child with autism.
Many children with Asperger's Disorder have normal
intelligence.
While children with autism
may have no interaction with peers, children with
Asperger's do interact with peers, but may
experience significant difficulty in social
relationships. Children with AD often seem to be
loners and their stereotypic behaviors or intense
focus on their narrow interests may lead to
isolation and/or peer rejection. An individual with
AD may think and react to the literal meaning of
others' communications, and may experience
difficulty "reading" others' intentions or needs
(this difficulty inferring others' mental states is
known as "Theory of Mind"). But stating that
individuals with AD have problems inferring others'
mental or emotional states does not tell us the
source of the problem. Is there just one deficit or
a number of factors that contribute to this
problem?
One skill that appears to be
impaired relates to face gaze, and a number of
studies have noted abnormal patterns. Individuals
with AD do not seem to derive the same information
from facial features (such as eyes) as their non-AD
peers, and generally do not spend as much time
watching others' eyes during conversations.
Interestingly, some recent research suggests that
those who watch lips are more socially competent
than those who don't. Perhaps the AD individual who
is unable to "read" eyes learns to compensate by
getting more information from watching the lips and
mouth.
But what about auditory
tasks? Can children and adults with AD derive
as much meaning from social communication cues such
as tone, volume, and pitch as their non-AD peers? A
pilot study by Rutherford et al. (2002) suggests
that they are impaired in extracting such cues, and
that this impairment may also contribute to
difficulties drawing inferences about others'
mental states (Theory of Mind).
Children or teens with
Asperger's Disorder are more likely to experience
problems that are not confined to just one factor
or deficit. In addition to impairment in deriving
accurate inferences from facial cues and auditory
cues, individuals with AD are also more likely to
experience difficulty in taking chunks of
information and integrating them into a coherent
whole so that full meaning is derived. Thus, even
on a content level, students with AD may not be
able to derive the same information as a non-AD
peer, leading to incorrect inferences about others'
states and inappropriate responses.
Another social impairment
that has been suggested is that individuals with AD
are too verbose (wordy), but the research on this
issue has yielded somewhat contradictory results. A
study by Adams et al. (2002) found that AD children
were not more verbose in general than the control
group of Conduct Disorder children. They also
performed comparably in conversations that involved
questioning and answering. Where they differed
significantly, however, was that AD children
experienced more difficulty in general
conversations, and made more problematic comments
in conversations about socially loaded or
emotionally loaded topics.
Motor clumsiness is also
present in many children and teens with AD, and can
lead to peer impairment as the AD child may be less
adept at sports and less likely to participate in
group sports that are part of normal social
development.
Some students with Asperger's
cannot handle the frustrations in school (or at
home). Their inability to make transitions when the
adults ask them to switch tasks, their inability to
read social cues or respond appropriately, and
their difficulty with concrete rigid thinking may
result in a lot of anger or "melt-downs."
In a survey of middle-class
mothers of children with Asperger's Disorder or
nonverbal learning disabilities (NVLD), Little
(2002) reported an overall yearly prevalence rate
of victimization by peers or siblings or peer
shunning of 94%. A reported 10% of the children had
been attacked by a gang in the past year and 15%
were reported to have been victims of nonsexual
assaults to the genitals. A third of the children
had not been invited to a single birthday party in
the past year, and many were eating alone at lunch
or were picked last for teams. Peer shunning was
significantly correlated with peer bullying and
assault.
In second report by Little
(2002), based on the same sample of middle-class
mothers, difficulties in parenting a child with
Asperger's or NVLD were evident, as 58% of the
mothers reported using used physical (corporal)
punishment and 95% reported employing psychological
aggression (such as verbal abuse) in dealing with
their children's misbehavior.
On a day-to-day level, then,
children and adolescents with Asperger's may
experience significant problems and their parents
may need extensive support, which might include
parent education and training in effective
environmental supports and interventions for
dealing with problematic behaviors. School
personnel working with a student with Asperger's
will need to collaborate closely with the student's
parents to discuss how to support the school's
efforts in the home.
While children with
Asperger's will often have special education needs,
many of them will do well academically and go on to
attend college. Many will also be able to develop
meaningful relationships with family and friends,
although the quality of the relationships may be
different than what most people experience.
As one adult with AD commented
to me sadly one time, "My wife shouldn't have to
hold up a sign that says 'Hug me now' when she's
upset, but even when she tells me that she's upset,
I never seem to know what to say or do."
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