Understanding Asperger’s Syndrome
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More than a half a century ago, Leo Kanner and Hans Asperger introduced to the professional world their understanding of a particular pattern of behavior for certain children’s lack of empathy, inability to form friendships with peers, too much concentration on particular interests, focusing too much on their one-sided conversation and somewhat awkward motor movement. Today, we call it Asperger’s Syndrome, a form of disability that is gaining more recognition in the contemporary society. Currently, the most acknowledged definition of Asperger’s Syndrome originated from the Diagnostic and Statistical Manual IV-TR of Mental Disorders (American Psychiatric Association, 2000). For it to be effectively diagnosed, there are particular symptoms that must be present, which include at least two conditions of impairment within an individual’s social cycle and interactions, and at least one in the area of restrictive interest as well as stereotyped behaviors or rituals (Tomeny, Barry, & Bader, 2011; Mayada, E. & Johnson, 2010, p.82).
Research confirms that over the previous years the diagnostic term ‘Asperger’s syndrome’ (AS) and other higher functioning related conditions such as autism, attention-deficit hyperactivity disorder (ADHD), autism disorder and autism spectrum disorder are on the rise (Wallace, Coleman & Bailey, 2008, p. 1353; Sigman, Spence & Wang, 2006, p.329). It is also established that Asperger’s Syndrome is a serious social and communication disorder that can lead to a devastating effects to the affected. However, several efforts and initiatives have shown that good support and training can help the affected children progress in their areas of weakness and proceed to lead happy and productive lives in the future.
The common social impairment syndrome associated with this disorder includes the child exhibiting poor eye contact. Children or students with AS disorder involuntarily avoid any eye contact with people within their surrounding. They are also have problem interacting with peers and are unable to keep friends as they find it easy to curve their own personal space. In certain instances, they may invade their peers’ personal space and in the end in the end don’t get any appreciation from their social and emotional cues (Whittinggham, Sofronoff, Sheffield & Sanders, 2008). Their reactions and facial expressions to unpleasant situations are normally not appropriate and find it difficult to accept other people’s perspective on issues or life.
On the restrictive interests, AS victims don’t find it strange when they focus too much on certain areas of interests until it becomes an impediment to their social life (Jonge, Kemmer, Naber & Engeland, 2009). That is, they tend to concentrate on a single area of interest and know too much about everything, and find it difficult to change their way of thinking as far as transitions are concerned. Still, their motor movements tend to be repetitive, and hence find themselves doing such things as toe-walking in a repetitive manner. They unnecessarily get preoccupied with only particular parts of certain objects. According to Hegesh, Kertzman, Vishne (2009), this group of children is not tolerant to frustrations. They find it difficult to cope or survive in areas that require a lot of skills to cope with the events or situations. This group of children will always insist on having their own way in everything they do.
This group of children has peculiar language speech traits. They have late development of speech and language mastery and superficially express language in a perfect manner (Sucksmith, Roth & Hoekstra, 2011, p.; Belmonte, Gomot & Baron-Cohen, 2010, p.266). Their interpretation of statements can be biased, and considers others opinions not acceptable. They also have limited non-verbal communication skills. That is, they cannot comprehend common gestures, and have clumsy communication model, especially on topics they are quite familiar with (Steifel et al., 2008, p.2).
This syndrome has also been associated with biological, psychosocial, and neuropsychological risk/deficit factors. Low birth weight, abnormal rate of brain development, metabolic problems, infections before and after birth, obstetric events, increased maternal or paternal age, history of maternal psychiatric disorder, and socioeconomic place of birth have all been genetic, chromosomal, and psychosocial deficits proposed to capture AS (Gousse’, 2002; Sabbagh & Seamans, 2008; Damarla, Keller, Kana et al., 2010, p.273). Several neuropsychological deficits are involved with Asperger’s Syndrome however there is no unifying theory or model of AS as a neurobiological disorder. The parents of children with these disorders often need considerable support in terms of information and intervention because the disorders are lifelong and multifaceted. In addition, autism has impact on the family as well as the individual, and so there is a growing need for family-centered intervention and support services (Bradford, 2010; Steifel et al., 2008).
The research on the aetiology of AS has been hindered by the absence of a unitary construct of AS (or Autism Spectrum Disorder) by its interchangble terminology and extrapolation from autism research. However, in the recent years a lot of studies have been undertaken to unearth the origin, impact, treatment and management of Aperger’s Syndrome.
In 1943, Leo Kanner published the first paper when he described eleven children from his Child Psychiatric Unit who had much similarity in their behaviors than to the normal referrals had had received previously (Kunihira, Senju, Dairoku, 2006; Wallace, 2008). Kanner categorized some of the common character traits this group exhibited into peculiar language, social isolation, and insistence on sameness. The remarkable description from Kanner was the base from which many scholars picked their research initiatives. He highlighted some of the characteristic that today describes Asperger’s Syndrome or Autism. In a more specific manner, he highlighted the difficulties these young people faced, their problem with expressing themselves through communication and repetitive as well as restrictive activities. Other researchers later described these traits as “triad of impairments”, as reported in Wing and Gould (1979), (as cited in Sullivan, & Allen, 2009, p.148). It is Kanner’s observation and belief that led him to describe the primary condition of this problem as ‘autism’ to express the central feature of the disability (Jonge, Kemner & Engeland, 2006; Lopez, Tchanturia, Stahl & Treasure, 2008). It is Kanner who separated autism from Childhood schizophrenia by describing the distinguishing feature of the two disorders. His observation was that people suffering from schizophrenia withdrew from social relationships while children who suffered from autism never developed them in the first place. In his report, he has been quoted as stating that, “there is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, and shuts out anything that comes to the child from the outside” (Kanner, 1943 as cited in Noland & Reznick, Stone, W.L. et al., 2010). He also noted another peculiar thing about autism in language that differentiated it from schizophrenia. The language as expressed by autism victims suggested echolalia, pronoun reversals, and unique forms of expressions. In Grinter, Maybery, Beek, et al. (2009) view, although Kanner saw distinguishing features of autism and schizophrenia, his assumption was that autism was the earliest form and precursor of adult schizophrenia. However, other researchers have since disapproved this assertion with numerous distinguishing evidences.
A lot of interests were generated by Kanner’s paper, which attracted a lot of readership and influenced many researchers. Although the reason for this wide readership is not clear, common assumption is that many professionals had started seeing an increased number of children exhibiting same disorder but were unsure on how to group or categorize them. One problem that has emerged from the original misconception presented in Kanner’s original paper has been proved difficult to overcome. From the onset, Kanner argument based on his 11 cases was that children were mostly of normal or higher than normal intelligence, with parents from higher social classes, and without neurological impairments (Cohen-Baron, Belmonte, 2005). His assertion was that social deficits were primary in instigating and emphasizing the problem. However, since Kanner’s time, his definition of autism has been modified and some of his claims have been refuted in a number of professionals but one thing is clear: many of the other ideas are still considered accurate and relevant in the modern day as they were 50 years ago (O’Neill & Menard, 2008; Ginter, Beek, Maybery, et al., 2009).
After Kanner, came Asperger with his doctoral thesis paper in 1944. Although not widely known till almost 40 years later when it was translated into English from its original manuscript in German, the manuscript has a huge contribution because it was picked from Kanner’s work. In fact, it is believed that Asperger even responded to some of Kanner’s manuscripts, albeit the less popular German language. Asperger’s preliminary observations suggested that the children he made contact with during his summer camp programs on his ward exhibited some behaviors that he found unique. Some of these children, during the activities, did not fit with the rest of their peers, preferring to play alone and avoiding rough and tumble games (Gokcen, Bora & Erermis, 2009). His curiosity drove him to search why and how these children behaved like this, and why they different from other children. He expressed empathy and described the children as “autistic psychopathic” cases (Johnson & Rausch, 2008). Overtime, this condition has been labeled as autistic personality disorder”, which has significantly described Asperger’s view of the condition. Hi view was that autism is a “stable personality trait present from birth, rather than a psychotic process” (Bolte & Poustka, 2006).
It was Asperger’s description of the condition that took many professionals with a lot of desire to learn more. His observations were described as interesting, thought provoking and vivid (Bolte & Poustka, 2006). Departing from Kanner’s approach, Asperger did not articulate which of the characteristics he believed were more essential for diagnosis, and those which did not fit the bill. However, many scholars have argued that Asperger’s descriptions sounded more like a detailed account of the many common features he saw in the children he dealt with rather than a diagnostic approach to explaining the analytic observation (Pellicano, Maybery & Durkin, 2005; Wallace, Sebastian, Pellicano, Parr & Bailey, 2010; Ruta, Mazzone, Mazzone, et.al., 2011). One of the most telling inadequacies in Asperger’s explanation was the inability to categorically state the primary features in his children’s disturbance with the social contacts. He only stated the peculiar linguistic, which involved pragmatic language deficits, which some describe as problems associated with using language as a functional tool in appropriate manner. He, in fact, interpreted the pragmatic difficulties that he saw his children experienced with eye gaze. Some of his observations have been interpreted as part of a fundamental disturbance in the expressive behaviors needed for social interaction. His therefore described the children as those unequal partners in the social interactions who had no ability to interpret complex social cues. Asperger also observed the children’s repetitive activities that Kanner had observed earlier. According to Asperger, this kind of behavior was just but one way some children used to follow their own interests and preoccupations while ignoring the social benefits of interactions and learning from each other (Yirmiya & Shaked, 2005). According to his approach, Asperger believed that what he termed as ‘autistic intelligence’ was a form of independent thinking and originality in thought which his children displayed in school. In Asperger’s view, this behavior was both a weakness and a strength exposed by the students. Contrary to what other children did, children with AS were more capable of forming their own imagination and strategies on various approaches to studying. They hardly followed what the teachers instructed them to do, a trait that Asperger believed was an intellectual strength rather than a weakness. But they could not also get into contact with those who were willing to help them, representing social weakness.
Although various scholars agree that there is a lot of similarities in their perceptions and findings about AS, it cannot escape our attentions to note that there are some significant differences in details, descriptions and conclusions of the findings of these researchers.
Autism has always been seen as the paradigm pervasive development disorder. However, other diagnostic ideas with features that are somewhat similar to the disorder have not been intensively studied as far as research is concerned. However, a few literature findings suggest that some of the studies that have been conducted are still helpful for any present and future researches.
Several diagnostic approaches from various scholars have revealed numerous efforts to have disorder exhaustively studied. For example, quite a number of these studies originated from adult psychiatry, neuropsychology, neurology, and other disciplines share, to a great degree, the phenomenological aspects of Asperger’s Syndrome (Belmonte, Gomot & Baron-Cohen, 2010; Tomeny, Barry & Bader, 2011). One outstanding study was conducted by Tomeny, Barry & Bader (2011) which revealed, to a greater extent, that people with abnormal pattern of behaviors related to autism were characterized by social isolation, rigidity of thoughts and habits, and unusual style of communication. Sucksmith, Roth & Hoekstra (2011) agreed with this study and emphasized that Asperger’s Syndrome could as well be called ‘Schizoid personality in childhood’. Unfortunately, the researcher never gave a development account of this concept, making it quite a challenge to ascertain the extent to which the person involved in the study may have experienced the autistic-like symptoms in his early life. More critical is that the concept of AS being a static personality as others claim does not carry with it the developmental process that may be in existent during growth, which may prove to be an important aspect in any effort to find diagnostic approach to its management.
In the field of neuropsychology, a lot of effort has been put on research about the delineation of the implications for individual’s social and emotional development of unique profile of neuropsychological assets and those inefficiencies that seems to have a deleterious impact on the person’s capacity to socialize, as well as on the person’s interactive and communicative styles. In Wallace’s (2008), individuals with nonverbal learning disabilities (NLD) lacks tactile perception, psychomotor coordination, visual-spatial organization, non-verbal problem solving, and appreciation of incongruities humor. These individuals also shows well-developed rote verbal capacities and verbal memory skills; difficulty in adapting to novel and complex situations. They also over-rely on rote behaviors in such situations, relative deficits in mechanical arithmetic, in relation to proficiencies in single-word reading; poor pragmatics and prosody in speech. At the end, individuals with NLD show a peculiar tendency toward social withdrawal are inevitably at risk to develop serious mood disorders. Pellicano, Maybery & Durkin (2005, p.533) describes people who suffer NLD as possessing “developmental learning disability of the right hemisphere.” In this study, they observed that children described with this disorder exhibit extreme disturbances in the interpretation and expression of affected and in other primary interpersonal skills (Pellicano, Maybery & Durkin, 2005). Most importantly, a familial link has been noted in the prevalence of NLD.
It is noted that there are some unclear concepts that can describe different entities or give us different perspective on the heterogeneity and overlapping nature of individuals suffering from this disorder. Many professionals concur that the current research must focus on convergence among the various accounts of specific disciplines so as to put into usage the different methodologies in an effort to validate the behavioral concepts of Asperger’s Syndrome (Sabbagh & Seamans, 2008; Hegesh, Kertzman & Vishne, 2009; Mayada & Johnson, 2010). However, for ease of enhancing comparability studies, it is of critical importance to establish consensual and stringent rules or guidelines to make it easy to diagnose AS, specifically in regard to its similarities to the related disorders.
World Health Organization (ICD-10) provides tentative criteria for Asperger’s Syndrome, with the focus on symptomatological aspect of its clustered social and emotional behaviors. According to WHO, the ‘restricted interests’ criteria and some of the two, in motor deficits and isolated special skills cap the traits of AS children (Wallace, 2008; Ginter, Beek, Maybery, et al., 2009). The other approach is the necessity to exclude other conditions, especially autism or sub-threshold form of autism. One interesting thing is that ICD-10 definition of AS is offered with autism when making the reference, thus some of the criteria involves ignoring the possible abnormalities in some functional areas that are common in autism. It is also important to note that the definition of Asperger’s Disorder is nearly identical to the ICD-10 definition. However, the existing differences suggest that there is some unclear circumstances that define the difference in approach given to the treatment or management by different groups of professionals.
The Onsite Criteria
In the ICD-10 or the WHO criteria, individual history must indicate some absence of clinically significant general delay during language acquisition, cognitive development, and adaptive behavior. This kind of approach differs with the typical developmental accounts of autistic children, who show pervasive deficits and deviance in there areas prior to the age of three. However, this may not apply on cases of normal-IQ autistic children. It must also be noted that despite the willingness to adopt the ‘adaptive behavior’ in the formulation of the criterion, it’s apparently implied that deficiencies in the social and emotional functions during play behavior don’t rule out the AS diagnosis.
The onset criteria are in agreement with Asperger’s account. However, Cohen-Baron & Belmonte (2005) note that there is presence of deficits in the use of language for communication, other than the formal language aspects, in certain case studies they carried out. To date, it is still unclear whether the lack of delays in the prescribed areas is a differential factor between Asperger’s Syndrome and autism, or simply a reflection of the higher developmental level associated with the usage of the term AS.
Some other common characterization of early development of individuals with AS involves particular precociousness in an attempt to learn to talk, mostly described in common language as “learnt to talk before walk. In fact, the child sometimes learns to code numbers or words, even if with little or no understanding. They also develop certain attachment to patterns to family members but lack the appropriate approaches to peers.
Theory of Mind
Earlier studies have revealed a subgroup of people who suffer from AS who managed to pass second-order tests of theory of mind. However, these kinds of tests have a limit in the ascpect of development and terms corresponding to a mental age of a six-year old child. It is thus quite difficult to categorically state if such individuals are intact or have some form of impairment in their theory of mind. Sullivan & Allen (2009) reported the performance of very high functional criteria with adults suffering from autism. With their methodology, these researchers used the information from photographs of a person’s eye to infer the mental state of a person. In relation to age-matching of the normal controls and a clinical control group of the adults suffering from Tourette Syndrome, those with AS experienced significant impairment on the task. Specifically, individuals suffering from autism or AS were impaired on tasks related to strange stories of Hape’s. However, they were not impaired on some two control tasks. First they could easily recognize gender from the eye region of the face, and recognize basic emotions from the entire face. This kind of finding gives an evidence for subtle mindreading deficits in some high caliber autism or AS.
Some level of evidence suggests that most of the children suffering from autism are impaired during the development of theory of mind (Whittinggham, Sofronoff, Sheffield & Sanders, 2008). Such impairment may be a reflective of the underlying social, communicative, and imaginative abnormal diagnostic conditions, as theory of mind is necessary for normal development in each of the areas. In fact, the theory of mind is seemingly expressed quite early, at least from final stage of the first 5 years of life, as reflected in the deficiency in the joint attention (Sigman & Wang, 2006).
It is, however, noted that there is some evidence that suggests some level of contradiction with the notion that theory of mind deficit is a core cognitive deficiency experienced in autism. Bolte & Poustka (2006) revealed that adults with AS, who happen to share the social and communicative symptoms of autism but who had not experienced any deficiency as far as language mastery and delay is concerned in their entire life passed second-order theory of mind tests. Another second-order theory of mind test was carried out, which involved test on reasoning about what one person thinks about another’s thoughts. Hegesh, Kertzman, Vishne (2009) also found out some adults with ‘high-degree autism’, who passed second-order theory of mind.
However, there’s some level of understanding that these studies cannot conclusively give evidence that intact theory of mind among the individuals with autism or AS. The reason is that second-order tests used can easily be used to produce ceiling effects if applied together with a mental age of more that 6 years old children or students. Moreover, children with normal intelligence pass second-order of mind tasks at about six years old (Hegesh, Kertzman & Vishne, 2009).
The Empathy Quotient Analysis
It is no doubt that empathy is a critical aspect if normal social functioning, yet there are important few instruments that can help measure difference between its level on individual basis. An important ability to empathize allows us to put ourselves in someone’s position in order to understand how they feel about a situation. Empathy also allows us to understand other people’s intentions and undergo the influence that is triggered by their social world. In short, we can understand what social world is all about if we are able to sympathize. However, many individuals with Asperger’s Syndrome have problems interacting with their peers and are deficient in empathy (Sullivan & Allen, 2009). A number of case reports have reported the case for empathy deficit among the AS patients. In a systematic study of a rather larger cohort of individuals with Asperger’s Syndrome, the prevalence of empathy deficient is evident in several instances (Sullivan & Allen, 2009). In a similar rejoinder, a general population study of Asperger’s Syndrome revealed a very high rate of associated ties, which included a fully-blown Tourette’s syndrome. Thus, whichever dimension it takes, it is obvious that empathy deficits, autistic features and Asperger’s syndrome are common problems affecting people diagnosed with such disorders. The difference in approach all depends on the individual’s clinician’s preference on the main diagnosis is portrayed as the clinically most important problem.
Although most professionals in the field of clinical practice believe that individuals diagnosed with Asperger’s Syndrome have a disorder which is believed to have a strong relation to genetics or family background, there is a clinical conviction in some quarters that there are subgroups within the Asperger’s group that might not have any close relation to the core autism phenotype as currently assumed. Ginter, Beek, Maybery, et al. (2009) state that in their clinical studies, he has come across at least three different family subtypes of those who have been diagnosed with AS disorders.
It is clear that those who have been diagnosed with autism or Asperger’s syndrome other being normal in general perspective, they have above average IQ and would never be impaired on a simple theory of the mind set as some scholars have suggested. On another perspective, it cannot be easily accounted or expressed that IQ of individuals diagnosed with AS Syndrome. In fact, no study within the realm of this literature revealed any correlation between IQ and Asperger’s Syndrome disorder. It is therefore critical to note that management of Asperger’s Syndrome is dependent on individual clinician to understand the child. It does not utterly depend on just emotional terms, but also includes terms that can describe cognitive mental states.
The observation of the real social world also debugs the theory of mind as it is deemed too simple than the real and actual demand of the actual social world. Its clear that those who suffer Asperger’s Syndrome often sidelines themselves from real world, depicting the fact that their social action proceeds rapidly, and they tend to focus a lot on why a person said or did something. They even wonder why people rejoice at some things such watching a nice episode of a movie. With the increased interactions with modern social media, it is clear that people can easily notice individuals with symptoms of Asperger’s Syndrome.
Clinicians give AS a different approach to that of onsite criteria individuals and even the theory of mind. Most clinical approach involves concentration on the emotional and social behaviors. Clinicians also exclude certain conditions such as autism from the actual characteristics of AS. Onsite criteria on the other hand focus on the cognitive development process, general delay of language skills acquisition. In other word, onsite approach does focus mainly on the developmental stage of the problem. It is thus prudent to conclude that Asperger’s Syndrome requires a multidimensional approach to management and treatment.
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