Ants, bees, non-human primates, and a few other animals live in societies. Clearly, from an evolutionary viewpoint, social competence must have a neurobiological basis. We are all neurobiologically scripted for intuitive social interaction and are inherently social creatures. But, as expected, social competence, like any other neurocognitive function, must be a variable falling along a continuum. There are bound to be outliers.
NEUROTYPICAL SYNDROME
Neurotypical is a label for nonautistic people. Neurotypical syndrome (NT) is a neurobiological disorder characterized by a preoccupation with social concerns, delusions of superiority, and obsession with conformity. By autistic standards, the “normal” brain is easily distractible, is obsessively social, and suffers from a deficit of attention to detail and routine. Thus people on the spectrum experience the neurotypical world as relentlessly unpredictable and chaotic, perpetually turned up too loud, and full of people who have little respect for personal space. Autistics find most neurotypical people annoying and illogical.
There is no known cure.
Members of the Autistic Networks International (ANI) began appearing at conferences and set up booths that were little oases of autistic space where people could take a break from the probing stares, the swirl of perfumes, the press of flesh, the unpredictable outbreaks of applause, and the constant reminder that their existence was a tragic puzzle.
People struggling in social situations for most of their lives didn’t know why. Having only a small group of close friends was thought odd but they never knew how to correct it. The general public and the hiring companies must understand this group of people. Many fall through the cracks due to their “odd” behaviours despite having so much to contribute if given the chance.
Baron-Cohen looks upon the milder variants of autism and Asperger’s as differences in cognitive styles. Normal people are good at “folk psychology” (social interactions), and people with Asperger’s are interested in “folk physics” (how things work).
Neurotypical is only one kind of brain wiring, and, when it comes to hi-tech, quite possibly an inferior one.
NEURODIVERSITY can be every bit as crucial for the human race as diversity is for life itself. Who can say what form of wiring will prove best at any given moment?
It is not that more autistics were becoming visible in the world, but the world itself was becoming more autistic – and this was a good thing. The revenge of the nerds was taking shape as a society in which anyone who had access to a computer and a modem could feel less disabled by the limitations of space and time. Social status as a dork was the inevitable side effect of being highly gifted. They think differently.
Autism had come a long way since the days of Kanner when he had seen only 150 true cases. It was Asperger’s world now. American psychiatry seems unable to conceive of healthy eccentricity or complex individuality. Instead, psychiatrists have evolved an elaborate coding system, which gives them undue control over families. A diagnosis of Asperger’s may, for example, keep a talented child out of the gifted program at school.
The goal is to alleviate those with Aspergers from the pressure that they need to conform. It is best to learn how to use your uniqueness to your advantage and find your place in the world.
ASPERGER’S SYNDROME (AS)
Autism, from the Greek word meaning “self”, was coined in 1911 by Swiss psychiatrist, Eugen Bleuler, who used it to describe withdrawal into one’s inner world. Autistic children appear to be in a world of their own, isolated and alone, with senses that can overload easily.
In 1943, psychiatrist Leo Kanner studied the case histories of 11 highly intelligent children who shared a common set of symptoms consistent with autism: the need for solitude, the need for sameness, to be alone in a world that never varied. Kanner assumed that these children came into the world without innate biologically provided ways of emotionally connecting with other people.
In 1944, Viennese medical professor Hans Asperger described “a particularly interesting and highly recognizable type of child” who has an autistic personality that is an “extreme variant of male intelligence”. Asperger described four boys who had severe difficulties of social integration that were compensated for by the kind of high level of thought and experience that can lead to exceptional achievements in later life. He chose the label autism for this condition as referring to an inherent fundamental disturbance of contact, the shutting off of relations between self and the outside world. Asperger remarked that for these boys, social adaptation has to proceed via the intellect; and in fact, they have to learn everything via the intellect. He considered the autistic syndrome to be a stable personality trait that is genetically transmitted in families.
Both scientists used the term ‘autistic’ in their reports. While Kanner’s syndrome was published right away in 1943, Asperger’s report was written in German and remained undiscovered until 1991 when it reappeared in Uta Frith’s textbook Autism and AS.
In 1962, psychiatrist Gerhard Bosch compared infantile autism to Asperger’s autistic syndrome and considered them to be two variants of the same condition. In one family, one young lad has classic autism disorder and his younger brother has Asperger syndrome, thus confirming that both variations are indeed the same genetic condition.
In 1979, psychiatrist Lorna Wing introduced the term Asperger syndrome to describe the abnormal autistic personality. She was a British psychiatrist who embarked on a quest to discover the kinds of assistance and services that would be most useful to families like her autistic daughter. Her first child had autism and with other parents, they founded what was to become the National Autistic Society in 1961. The logo adopted by the society – a puzzle piece – eventually became the universal symbol of autism parents organizations worldwide.
As students became teenagers, she turned her attention to autistic adults, as she realized they were not “cured” and would require a living environment suited to their needs for the rest of their lives. “Children need praise and encouragement, but most of all they need the opportunity to continue their education and training so that they can maintain and extend abilities. . . and acquire occupational skills.” In 1972, the society launched Somerset House, the first residential facility and school in Europe for autistic adults.
These achievements put Lorna and her colleagues light years ahead of their American peers in the understanding of autism. They knew that autism might manifest itself in varying degrees of severity. She thought Kanner’s theories of refrigerator mothers were bloody stupid.
Michael Ritter conducted the first twin study of autism, providing proof of the genetic basis for the first time. He also untangled autism from schizophrenia, showing that they were separate conditions that only rarely occur together.
Using restrictive criteria, an attempt to determine the prevalence of autism came up with an estimate of 4.5 per 10,000, a very low number. This was replicated by other researchers and became the oft-quoted baseline against which all future autism prevalence estimates would be compared in the coming decades.
Lorna realized that the study left out most of the children likely to fall on the Asperger side of the line. She also had Asperger’s paper translated from German to English and realized that Asperger had seen the same thing in his Vienna clinic that she was seeing. They were kids that nobody knew what to do with. They didn’t fit into Kanner’s narrow box, were also highly intelligent but couldn’t pick up subtle social signals from the people they were talking to.
There was no diagnostic label on the books that would enable them to access psychiatric services. There were many shades and hues along the autistic continuum and all autistic people seemed to benefit from the same highly structured and supportive educational approaches, just as Asperger had predicted. Some children remained profoundly disabled while others blossomed in unexpected ways when given an accommodating environment and special consideration by their teachers.
Lorna then introduced a new diagnostic label – Asperger’s syndrome – as autism had so many negative connotations. She then wrote a case series in 1981 and changed the continuum to the autism spectrum, indicating that the continuum shades imperceptibly into garden-variety eccentricity – all the features that characterize Asperger’s syndrome can be found in varying degrees in the normal population.
Research and publications on Asperger’s syndrome reached their peak during 2000-2012. Different research groups proposed a set of criteria for AS diagnosis. While several of these criteria overlap, WHO’s International Classification of Diseases and Disorders set the following key characteristics that can be diagnostic for Asperger’s Syndrome: Qualitative social impairment involving dysfunctional social adaptivity, impaired non-verbal communication for interaction, and lack of social reciprocity, the restrictive pattern of interest, motor clumsiness, repetitive behaviour, and extreme obsessiveness to specific rituals.
Autism impacts the normal development of the brain in the areas of social interaction and communication skills. The disorder makes it hard to communicate with others and relate to the social world. In some cases, aggressive and/or self-injurious behaviour may be present; however, internal behaviours such as withdrawal, depression, anxiety, eating disorders, and social isolation may be just as prevalent. Persons with autism may exhibit repeated body movements (hand flapping, rocking called stimming), unusual responses to people or attachments to objects, and resistance to changes in routines.
Developmental disorders that lie on the autistic spectrum are genetically related neurological conditions. All have stereotyped and obsessional behaviours and abnormalities in socio‐emotional and communicative behaviour.
Asperger’s syndrome (AS) as part of the autism spectrum disorder (ASD) was first described in America in the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders.
As there was not sufficient evidence of distinguishable characteristics for AS that can class the syndrome as ‘one biologically and clinically diagnosed entity’, the DSM-5 in 2013 revised and categorized Asperger’s Syndrome as another variant of autism spectrum disorder (ASD). This decision was criticized by the scientific community, and many clinicians have reservations about the DSM. Many people with Asperger’s prefer their separate diagnosis.
Due to the substantial number of overlapping similarities between Asperger’s Syndrome and Autism, it is very easy to confuse one with the other. Classical autism has delayed language development, and most have mental retardation (learning disability). Asperger’s syndrome is a mild form of autism and generally manifests without extreme mental disabilities – their IQs are typically in the normal to the very superior range. They are usually educated in the mainstream, but many require special education services.
There is no history of language delay but still shows characteristic impairments in reciprocal social interaction – there is a dissociation between cognitive and social skills.
AS subjects display age-specific or earlier verbal development, meticulous speech ability, higher desire for social reciprocation, may learn to read at an early age, and supreme imagination compared to ASD patients. On a cognitive level, AS subjects are more perceptive, and they possess superior verbal performance and visual-spatial ability compared to ASD patients.
AS patients often demonstrate high verbal IQ and strong grammatical skills and they often outperform others in fluid reasoning although they are reported to show a delayed reaction time with poor performance IQ, specifically in symbol coding and processing speed. What will differ greatly will be the person’s area of talent, visual or nonvisual modes of thinking, and severity of anxiety and oversensitivity to sensory input.
AS is more common than classical autism. Epidemiological surveys report that about 4 out of every 10,000 children are autistic whereas about 68 out of 10,000 children are diagnosed with AS.
Asperger’s children may not be identified as such until they start having social problems at age eight or nine. They are the children who are “little professors” at four and five, but later become lonely, with few friends. Adults with Asperger’s run the gamut from brilliant scientists to unhappy loners on the fringes of society.
With adolescence, the social and academic worlds become more complex and there is the expectation that the child should be more independent and self-reliant. Previously, social play was more action than conversation, friendships being transitory and social games relatively simple. In adolescence, friendships are based on more complex interpersonal needs rather than practical needs, someone to confide in rather than play ball with.
Instead of one teacher for the whole year where they develop a working relationship, different teachers may have different methods of assessment. Knowledge of history is no longer remembering dates and facts but organizing a coherent essay. English requires abilities with characterization and to ‘read between the lines’. Group projects may be difficult as the AS pupil may not assimilate into a working group of students
The symptoms and signs of AS are more conspicuous at times of stress and change and teen years have major changes in expectations and circumstances.
Brain studies demonstrate that the social deficits in autism and Asperger’s are highly correlated with measurable biological differences. But the question remains: When does a difference in the size of a certain brain region become an abnormality, instead of just a normal variation? If one selected 100 people at random from a large corporation or at an airport and scanned their brains, one would find a range of differences in the size and activation level of their amygdala (the most affected part of the brain in autism). Brain scan results from this normal cross-section of the public could likely be closely correlated with tests that evaluate sociability and social skills. Conducting this experiment on the general public would show that normal brain variation could be measured.
Furthermore, people tend to choose careers that they are good at, and it is predicted that there would be a high correlation between a person’s job and the characteristics of the amygdala. Out of the 100 hypothetical people from a large corporation whose brains were scanned, the technical people in the computer department would probably show less activation in their amygdalas compared to the highly social salesman in the marketing department.
Many accomplished families in Silicon Valley have children with autism. This mysterious rise in diagnosis was not restricted to Silicon Valley – it was happening all over the world.
Asperger’s syndrome is on a continuum with the normal. Traits associated with severe involvement are observed in mild forms in many so-called neurotypical people. One often sees Asperger-like traits in family members of people with autism: a father who is a computer programmer with poor social skills, an eccentric uncle, and other family members with depression or anxiety. Often, these “shadow syndromes” acquire no specific label or diagnosis.
Temple Grandin noticed how many parents at autistic conferences were gifted in technical fields. “I started to think of autistic traits as being on a continuum. The more traits you had on both sides, the more you concentrated the genetics. Having a little bit of the traits gave you an advantage, but if you had too much, you ended up with very severe autism.” She warned that efforts to eradicate autism from the gene pool could put humankind’s future at risk by purging the same qualities that had advanced culture, science, and technological innovation for millennia.
The whole definition of the term “neurological disorder” implies that something is going wrong in the brain. However, there is a growing recognition of the fact that when it comes to the processes in our brain, “going wrong” does not necessarily mean “going bad”. Our brain is too complicated a mechanism to be interpreted in simplistic terms. Some neurological disorders produce a peculiar state of mind often associated with high artistic and scientific achievements.
Some of the listed mental disorders in the DSM are the names of personality traits. At what point, after all, does a variation in personality become a true neurological disorder such as severe depression, bipolar disorder, schizophrenia, anxiety, or obsessive-compulsive disorder? When does moody become manic depressive? When does feeling blue become depressed? When does being fussy about cleanliness slip over into obsessive-compulsive disorder? When does autism turn into Asperger’s, and when is Asperger’s mild enough to be called something like “computer nerd”?
What, after all, is normality? Given that there is an enormous range of social behaviour with many degrees of adaptation and success or failure in the normal population, where does normality end and abnormality begin? Should one instead talk about normal and abnormal shading into each other? To put it another way, should one look at Asperger’s syndrome as a normal personality variant?
The difficulty in understanding and acknowledging autism, primarily high-functioning autism or Asperger’s Syndrome, by the medical, psychological, and psychiatric community, can lead to misdiagnosis and even failure to provide the services needed for students.
EVALUATION
Screening is only to rule out the possible presence of a developmental delay and professionals may use screening tools such as M-CHAT-R/F to assess the risk for ASD. Screening is usually followed by a detailed evaluation and assessment. Earlier identification of the condition can facilitate earlier intervention and more favourable outcomes for the child in the long term.
Here is an age-appropriate checklist to help you self-screen your child. You can use this to know if your child is meeting the right developmental milestones and then discuss it with a developmental pediatrician, child psychiatrist, or clinical psychologist. Please note that this checklist is not a substitute for a professional assessment.
Assessment. There is no single medical or genetic test to identify ASD. However, professionals may carry out an evaluation or assessment using diagnostic tools such as Autism Diagnostic Observation Schedule (ADOS) or Autism Diagnostic Interview-Revised (ADI-R) to identify ASD.
The child will be evaluated across a range of skill development. More specifically, the assessment looks at aspects of difficulty including social skills, friendship skills, conversational skills, pedantic speech patterns, a tendency towards ego-centrism and preoccupation in a particular area of interest, lack of emotional control, and immaturity of empathetic skills. There may be difficulty attending class and demonstrated learning deficits, along with organizational, motor, and sensory concerns. including communication, social, motor, and cognitive development.
Many children with ASD may also have other medical or psychiatric conditions and this is referred to as comorbidity. Conditions that are commonly comorbid with autism are ADHD, anxiety, depression, sensory sensitivities, intellectual disability (ID), and Tourette’s syndrome, and a differential diagnosis is done to rule them out.
SYMPTOMS AND SIGNS of Asperger’s Syndrome:
Asperger’s syndrome is part of the autism spectrum disorder (ASD). According to medical experts, it is a mild form of autism and generally manifests without extreme mental disabilities. The main outward characteristics of a person with Asperger’s syndrome are poor social skills, lacking nonverbal communication, and being clumsy.
When Asperger’s people try to make sense of their problems, they often find that the description of autism doesn’t seem to apply to them. They don’t consider themselves to be someone who doesn’t have empathy, cannot form emotional bonds, and aren’t interested in relating to others. Only after reading or seeing people with high-functioning Asperger’s do they often have a profound sense of recognition – possibly for the first time in their life, they could understand their behaviour. Possibly, it could be the body language of someone or what experts could not – that many were trying to communicate through their behaviour – they weren’t oblivious but instead listening and asking for clarification because they couldn’t understand the terms.
Rather than being considered a normal child trapped within an “autistic shell,” waiting to be rescued, Asperger’s is “a way of being that colours every experience, sensation, perception, thought, emotion and encounter, every aspect of existence.
Lorna Wing. In 1979, she introduced the term Asperger syndrome to describe the abnormal autistic personality. She describes the following 11 traits common in people with Asperger’s syndrome.
• Single-mindedness combined with social isolation;
• Pedantic speech, often consisting of lengthy discourses on favourite subjects;
• Poor comprehension of other people’s expressions and gestures;
• Tendency to misinterpret or ignore non-verbal signs;
• Impairment of two-way social interaction;
• Inability to understand rules of social behaviour;
• Lacking the intuitive ability to adapt their approaches to fit in with the needs of others;
• Intensely attached to certain possessions;
• Excellent rote memories and intensely interested in one or two subjects;
• Absorb every available fact concerning their chosen field and talk about it at length, regardless of the listener’s interest; and
• Thought processes are confined to a pedantic, literal, and logical chain of reasoning.
HOW DOES ASPERGER’S PRESENT?
This is a good list of the common traits of high-functioning AS people. It implies a gradation of severity. The 15 classic symptoms of Asperger’s syndrome are:
SOCIAL TRAITS
1. Failure to Develop Friendships. Children who have Asperger’s syndrome may have difficulty cultivating friendships. They may not connect with their peers due to a lack of social skills. They may find it hard to talk to other children or to participate in group activities. They desire to fit in socially and have friends but have a great deal of difficulty making effective social connections and are frequently a target for bullying and teasing. Many of them are at risk for developing mood disorders, such as anxiety or depression, especially in adolescence.
This can be difficult for a child with Asperger’s syndrome as they may want very deeply to connect with their peers. Oppositely, some children with Asperger’s syndrome have no desire to make friends and will prefer to be by themselves.
See Friendships
2. Social Awkwardness. The idea that people with Asperger’s syndrome are not passionate is completely wrong. One common term professionals use to describe people who suffer from this illness is “active but odd.”
Deficits in social-emotional reciprocity range from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interest, emotions or affect; to failure to initiate or respond to social interaction.
Asperger’s syndrome also has a ‘signature language profile. This can include impaired pragmatic language abilities (i.e. the ‘art’ of conversation) such as attentive listening with a tendency to engage in monologues and a failure to follow conversational rules. There may be literal interpretations, with a tendency for the person to become greatly confused with idioms, figures of speech, and sarcasm. There may also be unusual prosody: for example, a child may consistently use an accent based on the voice of a television character, or an adult may speak with an unusual tone, pitch, and rhythm. All these characteristics affect the reciprocity and quality of conversation.
A deficit in emotional reciprocity can be explored by examining whether the person shows reciprocal affect in facial expressions, body language, and tone of voice. The clinician can tell a story of personal experiences and assess whether the person was ‘in tune’ and resonated with the clinician’s feelings and experiences by the use of nodding, reciprocal smiles, appropriate facial expressions, and complementary sounds or utterances.
Personal remoteness – never saying hello, failing to recognize colleagues’ faces, not acknowledging the presence of those speaking directly to them, walking down corridors paying no heed to anyone, difficulty picking up other people’s states, difficulty adapting their perspectives, not buying a gift for a colleague, or making frequent irrelevant remarks. Many of the classic qualities of autistic intelligence enable getting the job done with a minimum of fretting about offending others. Not understanding people’s emotions helps label symptoms – it provides less noise.
Others may try to surround themselves with people, making lots of close acquaintances, but no deep friendships. This can be related to how well the individual empathizes with others. People with Asperger’s syndrome may not show any outward signs of this illness.
3. Trouble Understanding Social Cues.
People with Asperger’s syndrome can be socially awkward, often due to their difficulty in empathizing with others. But another reason they may struggle in these situations is that they have trouble picking up on or understanding the nonverbal social cues of others.
These social cues include things such as body language, gestures, and facial expressions. For example, the individual “may not realize that when somebody crosses his arms and scowls, he’s angry.
Adults with AS can gradually learn to read social cues and conventions, such that the signs of deficits in social-emotional reciprocity may not be conspicuous during short interactions such as a diagnostic assessment.
There are three adaptions to this:
a. Most often this results in a tendency to be withdrawn, shy and introspective in social situations, avoiding or minimizing participation or conversation; or
b. Conversely, actively seeking social engagement and being conspicuously intrusive and intense, dominating the interaction and being unaware of social conventions such as acknowledging personal space. In each, there is an imbalance in social reciprocity.
c. Achieve reciprocal social interaction by imitation and using an observed and practiced social ‘script’ based on intellectual analysis rather than intuition. This is a compensatory mechanism often (but not exclusively) used by girls with ASD, who are thus able to express superficial social abilities that can be confusing to the diagnostician.
4. Difficulty Judging Personal Space. Gauging personal space is another challenge that people with Asperger’s commonly face. For example, “They may stand too close to others and walk between people who are talking.”
They may also be very sensitive about their own space. For example, they tend to need more of it than the average person and can be intolerant if others invade it—like if people sit too close to them, bump into them, or try to give them hugs.
5. Inability to Empathize. Individuals with Asperger’s syndrome may find difficulty empathizing with others. As they age, the affected person will learn the accepted social response for interacting with others. While they may react appropriately and say the “right” things, they may not understand why the other person is truly upset.
This can be an issue in childhood as the individual with Asperger’s may play too roughly with their peers or say harsh things, unknowingly hurting the other person. When confronted about this behaviour, the child may respond that what they said was true and that they do not understand the issue.
See Theory of Mind
6. Unable to Make Eye Contact or Forcing Eye Contact. People who suffer from Asperger’s syndrome may find it difficult to make and hold eye contact with people they are speaking to. Some believe this condition is brought about by a lack of confidence. Others recount how making eye contact can make them very uncomfortable, almost painful.
There is also the theory that people with Asperger’s syndrome do not realize how important eye contact is for social communication. This may lead to the opposite problem of forcing eye contact. This can make people even more uncomfortable, while the individual with Asperger’s believes they are being more approachable.
COMMUNICATION
7. Literal Interpretations. One of the symptoms of Asperger’s syndrome is literally interpreting what people say. The affected individual may not understand sarcasm, instead of taking what the person has said as truth.
The idea that people with Asperger’s syndrome do not understand humour is wrong. These individuals may be the funniest people you have ever met. When they realize the fault of their literal interpretations, they can understand the true meaning behind what is being said, perhaps with some explanation.
8. Abnormal Language and Speech Patterns. There are a variety of different communication symptoms associated with Asperger’s syndrome. Taking what people say literally, as already discussed, is just one of them. Another one is having a usual style of speaking, which can sound formal and scripted, almost robot-like with an absence of facial expressions and gestures.
People with the condition may also use complex words or phrases, even if they don’t fully understand what they mean. They may have trouble moderating “volume, intonation, inflection, rate, and rhythm of speech” as well. And, when engaging in conversations, they may not know when it is their turn to speak, resulting in them frequently interrupting others.
See Language
9. Selective Mutism. Young children with Asperger’s may demonstrate selective mutism as a symptom. This occurs when they will only speak freely with people they are comfortable with and may not speak at all to strangers. Extreme cases last for years. Immediate family members are typically unaffected, as the child often feels comfortable speaking to them.
Selective mutism more often occurs at school and in public, and some children may refuse to speak to anyone starting from a very young age. This condition can go away on its own, or your child may benefit from therapy.
MOTOR
10. Poor Motor Skills. Some people with Asperger’s syndrome may find it difficult to control their gross and fine motor skills. The motor issues may manifest through poor handwriting thought to be caused by poor hand-eye coordination.
This is a result of the involvement of the cerebellum.
See Movement & Coordination
METHODS OF REDUCING ANXIETY
11. Repetitive Motor Mannerisms. Along with having a very narrow set of interests and a need for routine, individuals with Asperger’s may demonstrate restricted and repetitive patterns of behaviour in physical form. Most noticeably, they may make repetitive motor mannerisms.
These can include arm or hand-flapping, finger-flicking, rocking, jumping, spinning or twirling, head-banging, and complex body movements. These repetitive movements may also involve an object, “such as flicking a rubber band or twirling a piece of string,” or the senses, “such as repeatedly feeling a particular texture.” AS people call this “stimming”.
12. Narrowed Interests. Individuals with Asperger’s syndrome may do poorly in school, but that is not to say they don’t have specific interests. Instead, their interests are likely very narrowed and focused. It could be playing video games, making models, or drawing.
These activities focus their minds and provide a sense of comfort for them. If they are forced to leave their projects, they may become distressed. Likewise, if their projects are failing. Fostering these narrowed interests is important for emotional and mental support.
13. Sticking to a Routine. Sticking to a routine can be very important for people with Asperger’s syndrome. They may become greatly distressed and anxious when their schedule changes. New situations can be frightening.
A routine can help manage the anxiety of people with Asperger’s syndrome. Thankfully, much of our world runs on tight schedules. If you suspect your child may have Asperger’s syndrome, putting them on a tight schedule may be an effective way to help manage some of their symptoms.
14. Pattern Recognition. Another symptom of Asperger’s syndrome is the amazing ability to recognize patterns. Often these individuals’ brains are trying to make sense of their surroundings, so a break in the pattern may show itself quite clearly.
This ability may be evident in childhood, as early schooling develops the neural pathways of pattern recognition. While children with Asperger’s syndrome may find the school setting difficult and struggle with their grades, pattern problems like math and art may be very enriching. Fostering this natural talent is a great idea.
SENSORY OVERLOAD
15. Heightened Sensitivity. Some individuals with Asperger’s may also exhibit sensory sensitivities in the five senses of sight, hearing, touch, smell, and taste. This is because “the nervous system has difficulty receiving, filtering, organizing and making use of sensory information.
As a result, they may experience sensitivity or overstimulation when exposed to things such as loud noises, bright lights, and certain textures or tastes. Additionally, a child with Asperger’s “may also be unresponsive to sensations that their parents find unpleasant, such as extreme heat, cold, or pain.” For a parent who doesn’t have Asperger’s syndrome, such sensitivities can be hard to understand and may be misunderstood as misbehaviour.
It can be painful to read about unhappy, angry people with Asperger’s. One man was so sensitive to sound that he experienced the ringing of a cell phone as excruciating. These extreme sensitivities make functioning in a normal workplace uncomfortable or even painful.
One person with autism or Asperger’s syndrome may have few problems with anxiety or sensory overload, while another is crippled by oversensitivity. Even if we consider Asperger’s to be at the end of normal variation in personality, sensory oversensitivity problems are a real disability that interferes with normal activities. Fortunately, some problems with sensory oversensitivity can be reduced through special diets, medication, auditory training, or special glasses. (See Donna Williams’s book Autism—An Inside-Out Approach: An Innovative Look at the Mechanics of “Autism” and Its Developmental “Cousins.”)
See Sensory Sensitivity
David Rowland & His Theories on AS
Rowland has a very restrictive definition of Asperger’s syndrome. He doesn’t believe that there is a spectrum – that Asperger’s is an all-or-nothing condition. From his point of view, AS has been grossly overdiagnosed and many people have accrued benefits they don’t deserve. He believes the common criteria for AS are so overly broad as to be meaningless: • Difficulty with communication and interaction with people; • Restricted interests and repetitive behaviours; • Symptoms that impair the ability to function properly in school, work, and other areas of life. Rowland believes that none of them applies exclusively to autism.
Autism is not a developmental disorder but rather an inherent brain anomaly.
Rowland gives this comprehensive list of signs that I find very useful, but view them as being on a spectrum of expression in the individual person – from marked involvement to being almost normal.
Autism spectrum disorder (ASD) has 52 signs:
Social Traits
• Considers self to be an outsider
• Lacks innate motivation to socialize
• Unaware of feelings, needs, and interests of others
• No awareness of how perceived by others
• Unaware of socially appropriate responses
• Misses subtleties, unable to take hints
• Unable to read body language
• No awareness of flirting
Relationships
• Failure to develop friendships
• Understands love intellectually but cannot feel love
• May understand empathy but not be able to feel it
• Cannot be emotionally available to others
• Others cannot provide an emotional safety net
In Conversation
• Speaks factually with no trace of emotion
• Takes everything literally
• Easier to monologue than dialogue
• Oblivious to the motivations of others while they are speaking
• Misses sarcasm
• Misses social cues and nonverbal communication
• Participating in 3-way conversations may be overwhelming
• May have difficulty following topic changes
Sensory Overload
• Hypersensitive to noise and other sensory stimuli
• Experiences anxiety from being mentally trapped in a sensory assault
• Overwhelmed from hearing unwanted conversations
• Overwhelmed by too much information
• Coping with electronics and filling out forms may cause anxiety
• Sensory overload makes it impossible to think or focus
• Difficulty listening to the radio or talking with others while driving
Emotional Traits
• Unable to feel emotion
• Has physiological responses instead of emotions
• Processes emotions intellectually
• Anxiety bypasses the intellect to warn of unprocessed emotions
• Incapable of experiencing fear
• Can be angry without knowing so
• Never (or rarely) cries or laughs
• Cannot nurture self psychologically
• Shrinks from emotional displays by others
• Unable to defend against emotional attacks
Temperament
• Drawn more strongly to certain things than to people
• Innate forthrightness tends to scare others
• Never bored, always engaged in some mental activity
• Consistent with daily routines, agitated if the routine is disrupted
• Spontaneity is not possible, activities must be pre-planned
• Cannot lie spontaneously, can tell only premeditated lies
Rowland’s Views on the Neurobiology of AS. The neurological structure of the autistic brain is the same as for any other brain. What is different about the autistic brain is how it functions in its neurophysiology. In a neurotypical brain, the anterior cingulate cortex (ACC) acts like an automatic transmission that seamlessly switches attention back and forth between frontal lobes, as required.
In autism, however, a dysfunctional ACC keeps the person trapped in his/her left frontal lobe, the intellectual, analytical, problem-solving part of the brain – with no ability to access the emotional/creative processing right frontal lobe, which plays a central role in spontaneity, social behaviour, and nonverbal abilities. Some neurotypical people are left-brain dominant whereas others are right-brain dominant. Autistic people, however, are left-brain exclusive.
They always speak factually, with no trace of emotion, and a deadpan facial expression.
Being left-brain exclusive means that one can only process his/her emotions intellectually, by deduction or inference, a process that can take about 24 hours. Failure to process emotions causes anxiety, which is an upsetting physiological response (different from emotion) that bypasses the intellect.
Dysfunction of the anterior cingulate cortex is the probable cause of hyperfocus, the perpetual state of intense single-minded concentration fixated on one thought pattern at a time, to the exclusion of everything else. Hyperfocus is so intensely single-minded that an autistic person cannot divide attention between two trains of thought. An autistic person takes everything you say literally because s/ he cannot also be running a second mental program questioning how you use words. While talking at length about a favourite topic, autistic people are incapable of running a second mental program asking how they are being received or perceived by their audience. Autistic people require structured activities because they cannot divide their attention between what they are doing and trying to figure out what may be about to happen next.
Hyperfocus also causes various kinds of sensory overload. A sudden loud or high-pitched noise switches hyperfocus to the noise, which the autistic person then experiences with many times the intensity than does a neurotypical person. Seeing too many words on a page can cause cognitive impairment whereby the autistic person’s mind goes disturbingly blank. Too many products on shelves and overhearing unwanted conversations in stores can trigger anxiety. Lighting displays in hardware stores can trigger intense anxiety. For some, hyperfocus exaggerates the sense of touch, making close-fitting clothing irritating and hugs unbearable.
Autism is caused by an inherent neurophysiological anomaly that creates a perpetual state of hyperfocus: intense mental concentration fixated on one thought pattern at a time to the exclusion of everything else, including one’s feelings. Hyperfocus is the sole factor responsible for the autistic person’s withdrawal into an inner world that is entirely mental. Hyperfocus keeps a person’s awareness trapped in the intellectual/analytical left frontal lobe with no ability to access whatever may be happening in the right frontal lobe, where emotions and social connectivity are felt. Autistic hyperfocus explains all 11 traits of Asperger syndrome as listed by Lorna Wing above.
Hyperfocus is the unique and defining characteristic of autism that is responsible for 52 of its observed traits listed below. Hyperfocus is the perpetual and unrelenting state of intense single-minded concentration fixated on one thought pattern at a time, to the exclusion of everything else.
Approximately one-third of the traits above can also have other causes. That is why the symptom survey approach to diagnosing fails. Without understanding causality, the categorizing of symptoms creates only confusion. The autism spectrum idea is counterproductive and needs to be scrapped. This erroneous concept has been a major contributor to the epidemic of false diagnoses of autism.
Autism does not belong on any spectrum. There is only one kind of autism, not several. There are no shades of autism, nor any such thing as autistic tendencies. Autism is 100 percent. Either one is autistic, or s/he is not. There is no middle ground.
The only variable within autism is the intensity with which hyperfocus is experienced. Low-functioning autistic people (an autism disorder) are so intensely locked into hyperfocus as to be unreachable. High-functioning autistic people (Asperger syndrome) experience hyperfocus less intensely.
Non-communicative autistic children are the ones most intensely trapped in hyperfocus, and there is no known way to bring them out of it. Intensely autistic children cannot be taught to speak; however, some spontaneously start to speak on their own initiative, as Einstein did at age four. The only non-communicative children who can be taught to speak are those who have developmental, learning, language, communication, or social disorders unrelated to autism.
Diagnostic Questionaire (Rowland)
The surest way to find out if someone is autistic is to ask these five questions, to which you should receive the following responses. Example of an intellectual answer: “No, I’m not angry. That wouldn’t be logical.”
Anyone who answers all five questions above is autistic. Anyone who answers four or fewer as above is not autistic. Note: If the person answers the third question with a phobia (e.g., of heights), then re-ask the question this way, “Aside from this phobia, do you normally experience fear of any kind?”
1. How often do you cry? “never” or “rarely”
2. How often do you laugh? “never” or “rarely”
3. What are you afraid of? “nothing” or an intellectual answer
4. What are you feeling now? “nothing” or an intellectual answer
5. Do you ever get bored? “never”
COMPENSATORY & ADJUSTMENT STRATEGIES TO BEING DIFFERENT
The strategy used will depend on the child’s personality, experiences, and circumstances. Those children who tend to internalize thoughts and feelings may develop signs of self-blame and depression, or use imagination and a fantasy life to create another world in which they are more successful. Those children who tend to externalize thoughts and feelings can either become arrogant and blame others for their difficulties, or view others, not as the cause but as the solution to their problems and develop an ability to imitate other children or characters. Thus some psychological reactions can be constructive while others can lead to significant psychological problems.
A reactive depression
Social ability and friendship skills are highly valued by peers and adults and not being successful in these areas can lead dome children with AS to internalize their thoughts and feelings by being overly apologetic, self-critical, and increasingly socially withdrawn. The child, sometimes as young as 7 years old, may develop clinical depression as a result of insight into being different and perceiving him- or herself as socially defective.
The fact is, no one likes others to know their weaknesses, but with an affliction like mine, it’s impossible to always avoid making a fool of yourself or looking indignant/undignified. Because I never knew when the next “fall” was going to occur, I avoided climbing up onto a ‘confidence horse’ so to speak.
There can be increased social withdrawal due to a lack of social competence that decreases the opportunities to develop social maturity and ability. Depression can also affect motivation and energy for other previously enjoyable activities in the classroom and at home. There can be changes in sleep patterns and appetite and a negative attitude that pervades all aspects of life and, in extreme cases, talk of suicide, or impulsive suicide attempts.
Escape into imagination
A more constructive internalization of thoughts and feelings of being socially defective can be to escape into imagination. Children with AS can develop vivid and complex imaginary worlds, sometimes with make-believe friends.
In their imaginary worlds with imaginary friends, children with AS are understood, and successful socially and academically. Another advantage is the responses of the imaginary friends are under the child’s control and the friends are instantly available. Imaginary friends can prevent the child from feeling lonely. Having imaginary friends is not pretend play, so much as the only play that works.
Having an imaginary friend is typical of the play of many young children and is not necessarily of clinical significance. However, the child with AS may only have imaginary friends, and the intensity and duration of the imaginary interactions can be qualitatively unusual.
Searching for an alternative world can lead some children to develop an interest in another country, culture, period of history, or the world of animals.
Another country or culture may fascinate the child as it was nothing like they had seen before and unrelated and removed from our world and our culture. “Because of its foreignness, it is alien and opposite to anyone and anything is known to me. That was my escape, my dream world where nothing would remind me of daily life and all it had to throw at me. The people from this wonderful place look totally unlike any people in the ‘real world. Looking at these faces, I could not be reminded of anyone who might have humiliated, frightened or rebuked me. The bottom line is I was turning my back on real life and its ability to hurt and escape.”
The interest in other cultures and worlds can explain the development of special interest in geography, astronomy, and science fiction, such that the child discovers a place where his or her knowledge and abilities are recognized and valued.
Sometimes the degree of imaginative thought can lead to an interest in fiction, both as a reader and author. Some children, especially girls, with AS can develop the ability to use imaginary friends, characters, and worlds to write some remarkable fiction. This could lead to success as an author of fiction for children or adults. For example, both Hans Christian Anderson and Lewis Carrol had Asperger’s syndrome.
The escape into imagination can be a psychologically constructive adaptation, but there are risks of other people misinterpreting the child’s intentions or state of mind. They may be seen as an inveterate ‘liar’. They do not lie to get out of something that they have done – this is not the problem, as they always told the truth very brazenly – but they tell long, fantastic stories, their confabulations becoming ever more strange and incoherent. In the fantastic stories, they may always be the hero.
Under conditions of extreme stress or loneliness, the propensity to escape into an imaginary world and imaginary friends can lead to an internal fantasy becoming ‘a reality for the person with AS. The person may be considered as developing delusions and being out of touch with reality. This could result in a referral for a diagnostic assessment for schizophrenia.
Denial and arrogance
An alternative to internalizing negative thoughts and feelings is to externalize the cause and solution to feeling different. The child can develop a form of over-compensation for feeling defective in social situations by denying that there is any problem, and by developing a sense of arrogance such that the ‘fault’ or problem is in other people and that the child is ‘above the rules’ that he or she finds so difficult to understand. The child or adult goes into ‘God mode’, an omnipotent person who never makes a mistake, cannot be wrong, and whose intelligence must be worshipped. Such children can deny that they have difficulties making friends or reading social situations or someone’s thoughts and intentions. They consider they do not need any programs or to be treated differently from other children. They vehemently do not want to be referred to a psychologist or psychiatrist and are convinced that they are not mad or stupid.
Nonetheless, the child does know, but will not publicly acknowledge, that he or she has limited social competence, and is desperate to conceal any difficulties in order not to appear stupid. A lack of ability in social play with peers and in interactions with adults can result in the development of behaviours to achieve dominance and control in a social context; these include the use of intimidation and an arrogant and inflexible attitude. Other children and parents are likely to capitulate to avoid yet another confrontation. The child can become ‘intoxicated’ by such power and dominance, which may lead to conduct problems.
When such children are confused as to the intentions of others or what to do in a social situation or have made a conspicuous error, the resulting ‘negative’ emotion can lead to the misperception that the other person’s actions were deliberately malicious. The response is to inflict equal discomfort, sometimes by physical retaliation: ‘He hurt my feelings so i will hurt him.’ Such children and some adults may ruminate for many years over past slights and injustices and seek resolution and revenge.
the compensatory mechanism of arrogance can also affect other aspects of social interaction. The child may have difficulty admitting to being wrong and be notorious for arguing. There is a great danger of getting involved in endless arguments with these children, be it in order to prove that they are wrong or to bring them some insight. This is especially true for parents, who frequently find themselves trapped in endless discussions.
There can be a remarkably accurate recall of what was said or done to prove a point and no concession, or acceptance of a compromise or a different perspective. Parents may consider that this characteristic could lead to a successful career as a defence lawyer in an adversarial court. Certainly, the child has had a great deal of practice arguing his or her point.
Unfortunately, the arrogant attitude can further alienate the child from natural friendships, and denial and resistance to accepting programs to improve social understanding can increase the gap between the child’s social abilities and those of his or her peers. We can understand why the child would develop these compensatory and adjustment strategies. Unfortunately, the long-term consequences of these compensatory mechanisms can have a significant effect on friendships and prospects for relationships and employment as an adult.
Imitation
An intelligent and constructive compensatory mechanism used by some children is to observe and absorb the persona of those who are socially successful. Such children initially remain on the periphery of social play, watching and noting what to do. They may then re-enact the activities that they have observed in their solitary play, using dolls, figures, or imaginary friends at home. They are rehearsing, and practicing the script and their role, to achieve fluency and confidence before attempting to be included in real social situations. Some children may be remarkably astute in their observational abilities, copying gestures, tone of voice, and mannerisms. They are developing the ability to be a natural actor, capturing the essence and persona of people. They can be uncanny in their ability to copy accents, vocal inflections, facial expressions, hand movements, gaits, and tiny gestures. It is as if they became the person they were emulating.
Becoming an expert mimic can have other advantages. The child may become popular for imitating the voice of a teacher or character from television. The adolescent with AS may apply the knowledge acquired in drama classes to everyday situations, determining who would be successful in this situation and adopting the persona of that person. The child or adult may remember the words and body postures of someone in a similar situation in real life or in a television program or film. He or she then re-enacts the scene using ‘borrowed’ dialogue or body language. There is a veneer of social success but, on closer examination, the apparent social competence is not spontaneous or original but artificial and contrived. However, practice and success may improve the person’s acting abilities such that acting becomes a possible career option. As an actor, they may find the scripts in a theatre far more real than everyday life. Role-playing comes naturally. It may be impossible to talk in a normal voice. They can put on a strong American accent, making up a history and identity for themselves to go with it. They convince themselves that this was a new character and can consistently keep this up for months.
There are several possible disadvantages. The first is observing and imitating popular but notorious models., for example, the school ‘bad guys’. This group may accept the adolescent with AS, who wears the group’s uniform, speaks their language, and knows their gestures and moral code, but this, in turn, may alienate the adolescent from more appropriate models. The group will probably recognize that the person with AS is a fake, desperate to be accepted, who is probably not aware that he or she is being covertly ridiculed and ‘set up.’ Another disadvantage is that some psychologists or psychiatrists may consider that the person has signs of multiple personality disorder, and fail to recognize that this is a constructive adaption to having AS.
Some children with AS dislike who they are and would like to be someone other than themselves, someone who would be socially able and have friends. A boy with AS may notice how popular his sister is with his peers. He may also recognize that girls and women, especially his mother, are naturally socially intuitive; so to acquire social abilities, he starts to imitate girls. This can include dressing like a girl. There are several published reports of several males and females with AS who have issues with gender identity. This can also include girls who have self-loathing and want to be someone else. Sometimes such girls want to be male, especially when they cannot identify with the interests and ambitions of other girls, and the actions of boys seem more interesting. However, changing gender will not automatically lead to a change in social acceptance and self-acceptance.
When adults with AS have used imitation and acting to achieve superficial social competence, they can have considerable difficulty convincing people that they have a real problem with social understanding and empathy; they have become too plausible in their role to be believed.
ADVANTAGES & DISADVANTAGES OF HAVING A DIAGNOSIS
A diagnosis may prevent or reduce the effects of some compensatory or adjustment strategies but also removes worries about other diagnoses, such as being insane. The child can be recognized as having genuine difficulties coping with experiences that others find easy and enjoyable. When an adult has problems with the non-verbal aspects of communication, especially eye contact, there can be an assumption made by the general public that he or she has a mental illness or malicious intent. Once the characteristics of AS are explained, such assumptions can be corrected.
Children with AS have no physical characteristics to indicate that they are different, and having intellectual ability may lead others to have high expectations about their social knowledge. Once the diagnosis is confirmed and understood, there can be a significant positive change in other people’s expectations, acceptance, and support. The child is now understood and more likely to be respected. There should be complements rather than criticism concerning social competence, and acknowledgment of the child’s confusion and exhaustion from learning two curricula at school: the academic curriculum and the social curriculum.
The advantage of acknowledging and understanding the diagnosis for parents is that, at last, they have an explanation for their son’s or daughters’ unusual behaviours and abilities and knowledge that the condition is not caused by faulty parenting. The family may then have access to knowledge on Asperger’s syndrome from literature and the Internet, resources from government agencies and support groups, as well as access to programs to improve social inclusion and emotion management that will greatly benefit the whole family. There may also be greater acceptance of the child within the extended family of friends. The parents can now provide an acceptable explanation to other people regarding the child’s unusual behaviour. It is also important that parents explain to the child that having AS is not an excuse to avoid chores and responsibilities.
Siblings may have known for some time that their brother or sister is unusual and may have been either compassionate, tolerant, and concerned about any difficulties, or embarrassed, intolerant, and antagonistic. Each sibling will make his or her own accommodations towards the sibling with AS. Parents can now explain to their children why their sibling is unusual, and how the family has had to and will need to, adjust and work cooperatively and constructively to implement the strategies. Parents and professionals can provide the siblings with age-appropriate explanations about their brother or sister, to give their friends, without jeopardizing their own social networks. Siblings will also need to know how to help their brother or sister at home when friends visit and be made aware of their roles and responsibilities at school and in the neighbourhood.
The advantage for school services, especially teachers, is that the child’s unusual behaviour and profile of social, cognitive, linguistic, and motor skills are recognized as legitimate disorders that should provide access to resources to help the teacher. Confirmation of the diagnosis should also have a positive effect on the attitudes of other children in the classroom and other staff who have contact with the child. The teacher can access information from textbooks and resource programs specifically developed by the teachers of children with AS. The teacher can also explain to other children and staff who teach or supervise the child why he or she behaves and thinks differently.
The advantages of the diagnosis for the adolescent or adult with AS can be in terms of support while a student or college or university or in employment. Acknowledgment of the diagnosis can lead to greater self – understanding, self-advocacy, and better decision-making about careers, friendships, and relationships. An employer is then more likely to understand the profile of abilities and needs of an employee with AS: for example, the problems that may arise if an employee with visual sensitivity is assigned a work cubicle lit with fluorescent lighting.
Other emotional reactions can be an adult with a diagnosis of AS may benefit from joining an adult support group that has local meetings or an Internet support group or chat room. This can provide a sense of belonging to a distinct and valued culture and enable the person to consult members of the culture for advice. We also know that acceptance of the diagnosis can be an important stage in the development of successful adult relationships with a partner, and invaluable when seeking counselling and therapy from relationship counselors.
When an adult is diagnosed with AS, there can be a range of emotional reactions. Most adults report that having the diagnosis has been an extremely positive experience. There can be intense relief: “I am not going mad”, euphoria at ending a nomadic wandering from specialist to specialist, at last discovering why they feel and think differently to others; and excitement as to how their lives may now change for the better. A young man with AS said in an email “I know I have Asperger’s because nothing else comes even close to describing my weirdness as flawlessly and perfectly as Asperger’s syndrome does.”
There can be moments of anger at the delay in being diagnosed and at ‘The System’ for not recognizing the signs for so many years. There can be a feeling of despair regarding how their lives would have been much easier if the diagnosis had been confirmed decades ago. Other emotional reactions can be a sense of grief for all the suffering in trying to be as socially successful as others, and the years of feeling misunderstood, inadequate, and rejected.
Because Asperger’s people can be stubborn and denial can be a problem. The less they acknowledge their condition, the less they can improve upon their social skills, and consequently the higher the probability of them being friendless and/or victimized. Don’t think that acknowledgment solves everything (it doesn’t), but at least it brings a certain amount of self-awareness, which can be built upon. Once the person has this acknowledgment. learning the tricks of the trade – or the rules of the game – will be feasible, providing they are advised and directed by people who have at least a basic understanding of the syndrome.
There can be a new sense of personal validation and optimism, at last not feeling stupid, defective, or insane. There can be benefits in terms of self-esteem and moral support in identifying with other adults with AS. The group meetings can be initially organized by a local parent support group or by disability support staff at a large university or college that has several students registered with AS. Some support groups have formed spontaneously in large cities as occurred in Los Angeles (Jerry Newport formed AGUA – Adult Gathering, United and Autistic). There can be an affinity, empathy, and support network with fellow members of the same ‘tribe’ or clan who share the same experiences, thinking, and perception of the world.
Self Affirmation Pledge:
• I am not defective. I am different.
• I will not sacrifice my self-worth for peer acceptance.
• I am a good and interesting person.
• I will take pride in myself
• I am capable of getting along with society.
• I will ask for help when I need it.
• I am a person who is worthy of others’ respect and acceptance.
• I will find a career interest that is well suited to my abilities and interests.
• I will be patient with those who need time to understand me.
• I am never going to give up on myself.
• I will accept myself for who I am.
This last pledge is a major goal when conducting psychotherapy with an adolescent or adult with AS.
One reaction, though rare, is to deny that they have AS, insisting there is nothing wrong with or different about them. Despite acknowledging that the clinical descriptions match their developmental history and profile of abilities, they may question the validity of the syndrome and reject any programs or services. However, this may only be an initial reaction, and, given time to reflect, they may eventually accept that their personality and profile of abilities include the characteristics of AS and that this is invaluable information when making major decisions in aspects of life such as employment and relationships.
There could be disadvantages in having a diagnosis in terms of how the person and others perceive the characteristics. If the diagnosis news is broadcast widely, there will inevitably be some children or adults who misuse this disclosure to torment and despise the person with AS. Care must be taken when using the diagnostic term Asperger’s syndrome as some children may consider the condition infectious (or tease the child that it is), or corrupt the term in a variety of ways – Asparagus syndrome, Sparrow syndrome, Hamburger syndrome or Arseburger syndrome, among others. Children can be quite inventive in stigmatizing differences, but more compassionate people may be able to repair some of the damage to the self-esteem of someone with AS who has been ridiculed for being different.
One of the concerns of adults with AS is whether they should include a reference to the diagnosis that is unknown to the employer might lead to the application being rejected. A potential solution is for the adult to write a brief description of AS and the qualities and difficulties that would be relevant to the job. This personalized brochure could also be used ot explain AS to colleagues, juniors, and line managers. A shorter version can be reduced to a business card that can be given to anyone who needs to know about the person’s diagnosis.
Having a diagnosis of AS could limit the expectations of others, who may assume that the person will never be able to achieve as well as his or her peers in social, academic and personal success. The diagnosis should facilitate realistic expectations but not dictate the upper limits of ability. Successful careers can range from a professor of mathematics to a social worker; and those whose ability in the areas of relationships ranges from employing a fulfilling but celibate life, to having a life-long partner and being a much-loved parent.
As a society, we need to recognize the value of having people with AS in our multi-cultural and diverse community. Perhaps Asperger’s syndrome is the next stage of human evolution.
OTHER DEVELOPMENTAL DISORDERS that could be AS
Some developmental disorders can be associated with Asperger’s syndrome.
Attention Deficit Hyperactivity Disorder (ADHD)
Characterized by problems with sustained attention, impulsivity, and hyperactivity, but does not explain the child’s unusual profile of social, linguistic, and cognitive abilities, usually in the diagnostic criteria for Asperger’s syndrome. ADHD was diagnosed first but this is not the end of the diagnostic trial.
Children with AS can also have signs of ADHD. The two diagnoses are not mutually exclusive and a child may benefit from the medical treatment and strategies used for both disorders.
Young children with AS who also have hyperactivity may not have ADHD but rather are hyperactive as a response to high levels of stress and anxiety, particularly in new social situations, making the child unable to sit still and relax. Attention span can also be influenced by factors like motivation.
A Language Disorder
A young child with AS may first be recognized with a delay in the development of speech. There may be both a delay in language development and specific characteristics that are not typical of any of the stages in language development. Semantic Pragmatic Language Disorder has relatively good language skills in the areas of syntax, vocabulary, and phonology but poor use of language in a social context, i.e. the art of conversation or the pragmatic aspects of language. the child tends to make a literal interpretation of what someone says. An assessment of abilities and behaviour by be explained by a diagnosis of AS. The diagnostic boundaries between the two are not clear-cut. A child with difficulty understanding someone’s language may become anxious and withdrawn in social situations. The reason is then due to language impairment rather than the impaired social reasoning that is part of AS.
A Movement Disorder
Children with clumsiness, coordination, and dexterity may have difficulty in tying shoelaces, learning to ride a bicycle, handwriting and catching a ball, and an unusual or immature gait when running or walking. They may also be due to AS. The child will benefit from programs to improve motor skills.
Some children with AS can develop motor tics (involuntary, rapid, and sudden body movements), or vocal tics (uncontrollable vocalizations) that resemble signs of Tourette’s syndrome.
A Mood Disorder
Young children with AS are prone to develop mood disorders. Some children seem to be almost constantly anxious, which might indicate a Generalized Anxiety Disorder (GAD). AS children who use their intellect rather than intuition to succeed in some social situations, they may be in an almost constant state of alertness and anxiety. leading to a risk of mental and physical exhaustion.
The child may have developed compensatory mechanisms to avoid anxiety-provoking situations such as school, by refusing to go to school or being mute at school. There may be intense anxiety or a phobic reaction to certain social situations, to sensory experiences such as a dog barking, or to a change in expectations such as an alternation in the daily school routine. This may lead to a diagnosis of AS.
Some children with AS can become clinically depressed as a reaction to their realization of having considerable difficulties with social integration. The depressive reaction can be internalized, leading to self-criticism and even thoughts of suicide; or externalized, resulting in criticism of others and an expression of frustration or anger, especially when the child has difficulty understanding a social situation. Blame is directed at oneself: “I am stupid”, or others: “It’s your fault.” These could be the first sign of AS.
An Eating Disorder
This can include refusal to eat foods of a specified texture, smell, or taste due to sensory hypersensitivity. There can also be unusual food preferences and routines regarding meals and food presentation. AS is overrepresented with low body weight which may be due to anxiety or sensory sensitivity associated with food.
Serious eating disorders such as anorexia nervosa can be associated with AS. About 18-23% of adolescent girls also have AS and this could be the starting point for a diagnostic assessment for AS.
Non-Verbal Learning Disability
Formal testing may show a significant discrepancy between verbal reasoning abilities (verbal IQ) and visual-spatial reasoning (performance IQ). If the discrepancy is a significantly higher verbal IQ may indicate a diagnosis of Non-verbal Learning Disability (NLD).
The main characteristics of NLD are deficits in visual perception – organizational abilities; complex psychomotor skills and tactile perception; adapting to novel situations; time perception; mechanical arithmetic; and social perception and social interaction skills. They are good at auditory perception, word recognition, rote verbal learning, and spelling. This pattern of abilities suggests right-hemisphere dysfunction and white matter damage to the brain. The teacher needs to adapt the school curriculum for a distinct learning style.
