Asperger’s syndrome is the name given to a developmental disorder that is included in the autistic spectrum of disorders. Asperger’s syndrome is associated with impaired social interaction and recurrent patterns of behavior. Since the causes of the disorder have not been clarified to date, Asperger’s syndrome is not considered curable.
What is Asperger’s syndrome?
Asperger syndrome is a developmental disorder that is often compared to mild autism and is characterized by disturbances in social and communicative interaction despite normally developed intelligence. Individuals affected by Asperger’s syndrome usually have a limited capacity for empathy and are conspicuous for inappropriate social behavior. This is due to the fact that verbal and nonverbal signs of human communication cannot be interpreted by those affected by Asperger syndrome. They cannot interpret irony or sarcasm, nor facial expressions or gestures of the other person. Unconventional interests and preferences (memorization of certain dates) that appear abnormal to outsiders in terms of intensity and content, as well as repetitive, almost ritualistic patterns of behavior from which affected individuals find it difficult to break away, are characteristic symptoms of Asperger syndrome.
Causes
To date, the causes of Asperger’s syndrome have not been adequately elucidated. It is assumed that Asperger syndrome is largely genetic. Furthermore, disturbances in the development of neuronal structures are suspected, which cause a defective information processing of complex correlations (central coherence). In addition, neurophysiological impairments in Asperger’s syndrome lead to disturbances in fine and sensory motor skills, restrict visual-spatial perception and non-verbal category formation. This is partly attributed to reduced activity in specific areas of the prefrontal cortex (part of the cerebral cortex belonging to the frontal lobe) observed in affected individuals. The amygdala (almond nucleus), which as a component of the limbic system is essential for the emotional assessment and allocation of situational contexts, also shows abnormalities in people affected by Asperger syndrome. In contrast, non-somatic (trauma) and socialization-related causes (education) are excluded.
Symptoms, complaints, and signs
People with Asperger syndrome have problems empathizing with others. They cannot correctly interpret the tone of voice, as well as facial expressions and gestures of their counterparts. They are usually above average intelligence and eloquence. Before they can walk, Asperger’s children begin to talk. Their tone of voice is monotonous and facial expressions are hardly present. A fixed and regular daily routine is important to them. Children have difficulty making friends and are often teased. Their physical coordination is clumsy to poor and their posture is conspicuous. They have poor control of their emotions and are sensitive to touch, sounds and smells. People who have Asperger’s syndrome are considered perfectionists, love attention to detail, and are hyper-accurate in their actions. They develop preferences and strong interest in certain things and become intensely involved with them. For example, some people memorize timetables or are fascinated by history and its dates. They appear arrogant and rude to those around them and are honest in every situation in life. Asperger syndromes are similar to the symptoms of autistic people, but differ significantly in the totality of the disease. Thus, Asperger’s syndrome is not noticeable until kindergarten age, and autism in infancy.
Diagnosis and course
For a confirmed diagnosis of Asperger syndrome, disorders with similar symptomatology (early childhood autism, ADHD, obsessive-compulsive disorder) should be excluded in advance. For example, in contrast to early childhood autism, the first symptoms of Asperger’s syndrome usually become apparent after the age of three, when social integration skills are required of the child (such as at kindergarten entry). In order to diagnose Asperger syndrome, a psychiatrist determines the cognitive and social developmental status of the affected person, taking into account the previous history and with the help of specific characteristic and assessment scales, and attempts to determine characteristic behavioral abnormalities through observation.In the case of adults, special questionnaires are used and childhood is examined in more detail, since behavioral problems can best be observed during this period of life. Ideally, people from the socialization context (parents, siblings) are also interviewed. An Asperger syndrome shows a chronic course, although the individual deficits can be mitigated by psychological care of the person affected by Asperger syndrome.
Complications
Asperger syndrome is congenital and mostly affects children of the male sex. The resulting complications depend on the particular use of various therapeutic measures. These vary from case to case and vary with age. The underlying problems are often more stressful for the parents or caregivers than for the child itself. Children show the first symptoms of Asperger’s between the first and third year of life during language acquisition. Either they articulate or they do not. Often, Asperger’s children seem withdrawn and have difficulty making contact. The affected person remains self-referential for the rest of his or her life. Because of his individual behavior, complications can arise in school and in adult life. At times, this self-isolation can end in depression. In some cases, Asperger’s sufferers become care cases, unable to integrate into society either professionally or in general. The child’s impairments intensify negatively if parents do not seek a medical diagnosis. School problems then result from the hyperactive and rowdy behavior, which is why, if the diagnosis is not made, these children with ADHD are stigmatized and wrongly treated. However, Asperger’s children show above-average intelligence. Provided the diagnosis is made early, the child, despite the deficit, can fully develop his talents.
When should you go to the doctor?
If Asperger’s syndrome is suspected, a doctor should definitely be consulted. Through a diagnosis of the developmental disorder, the affected person can almost always be given an easier life – whether through various therapeutic measures or through appropriate medication. Anyone who notices symptoms of Asperger’s syndrome in their child should therefore seek medical help in any case. Depending on the severity of the disorder, untreated Asperger’s syndrome can cause major problems in everyday life and at work. A medical clarification is recommended especially if the impairments cause suffering in the affected person. Medical or therapeutic advice is required at the latest when Asperger’s syndrome leads to behavior that is dangerous to oneself or others. However, the affected person must also be prepared for this, which is why prior discussions are recommended. Children who may have Asperger’s syndrome should be well prepared for a visit to the doctor and possible treatment measures. Parents and acquaintances should inform themselves about the syndrome and how to deal with it by means of information brochures, forums and conversations with doctors and therapists, before finally daring to take the step to the doctor.
Treatment and therapist
A therapy for Asperger’s syndrome aims, since the disease is not curable, to reduce the individual deficits as well as the promotion of existing skills. It is designed depending on the severity of the symptoms. Affected persons with mild Asperger’s syndrome do not necessarily need therapeutic treatment and are often able to integrate socially and professionally. In the case of a pronounced Asperger syndrome, on the other hand, long-term therapy should be started at an early stage. Within the framework of this, behavioral rules for everyday life are learned with the help of various therapy concepts, and compulsive and ritualized behavior is attempted to be reduced. Within the framework of an ABA program (Applied Behavior Analysis) as well as small talk training, socially adapted behavior patterns are practiced through constant repetition. The TEACCH program (Treatment and Education of Autistic and related Communication handicapped Children) promotes the processing and acquisition of new learning contents by preparing them according to individual interests and existing competencies. Drug therapy is not the rule for Asperger’s syndrome and is usually only used when other disorders (ADHD) occur.
Outlook and prognosis
In contrast to early childhood autism, there is too little long-term evidence for Asperger syndrome to realistically assess the long-term development of affected individuals. Experts observe a relatively stable development with a tendency of improvement of the symptoms in the course of the biography. However, Asperger’s syndrome cannot be cured; the characteristic symptoms remain throughout life. However, some affected persons succeed in leading a stable couple relationship or other stable social relationships despite their social restrictions. Professionally, they can find fulfillment if the job requirements match their interests. Many Asperger’s autistic individuals succeed in information technology professions, where they are not required to constantly interact socially with other people. Even though they often come across as hypothermic and self-centered, that doesn’t mean they don’t have feelings. Most Asperger’s autistics do not seek treatment; rather, they want those around them to accept them with their limitations. It depends very much on the individual circumstances of the affected person and the acceptance by their social environment whether they feel comfortable and can lead a fulfilling life despite their limitations. If they experience them as a nuisance, depression can also develop. A blanket prognosis is difficult because prognosis depends on individual factors.
Prevention
Although no preventive measures exist for Asperger syndrome, an early diagnosis as well as an early start of therapy can ensure a better treatment success and help to avoid secondary diseases (depression). Furthermore, a successful therapy depends on the willingness of the social environment to integrate and the available care options for people affected by Asperger syndrome.
Aftercare
Because Asperger’s syndrome, like all autism spectrum disorders, is a lifelong, congenital, psychological disability, there is never true closure or even a cure. Depending on the patient, a single course of therapy may be all that is needed to help them cope with everyday life with little or no support. It is equally possible that lifelong support is needed. The aftercare that follows autism-specific psychotherapy usually consists of outpatient care in the form of outpatient assisted living or placement in a residential home or shared apartment that specializes in autistic individuals and provides full-day support. Because the main difficulty for Asperger’s autistics is social interaction with non-autistics, i.e. neurotypicals, this is also where they are most likely to need support. Where therapy can only theoretically run through scenarios, assisted living offers the opportunity to accompany an autistic person’s daily life and provide support where the problems occur. Especially because many autistic people are unable to work, there are many existentially important visits to authorities and doctors where accompaniment is necessary. In some cases, the assignment of a legal representative can also be useful, because this takes the pressure off the patient to be responsible for securing his or her own existence.
What you can do yourself
The most crucial thing in the daily life of a person with Asperger syndrome is structure. Fixed plans and rules take away the pressure of having to make quick decisions under stimulus overload and give them the necessary security to tackle everyday things. First, personal strengths and weaknesses should be analyzed. Which situations are perceived as particularly overwhelming? Which activities are considered calming? On this basis, daily and weekly plans can then be drawn up that do not involve completely avoiding exciting situations. The goal is to find a balance between stressful activities and rest periods in which the tension can be relieved. Another important strategy is to consciously study and learn social behavior. Affected persons find it difficult to interpret facial expressions and gestures of the other person and to react appropriately themselves. Many social procedures are consistent and can be practiced in role play. These exercises do not have to take place within the framework of behavioral therapy or a special course. Family, friends and partners can help as well. To facilitate communication, there are now a number of apps for the smartphone.They use picture cards and sentence blocks to help formulate sentences even when speaking is particularly difficult.
