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Asperger syndrome

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Asperger syndrome
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Asperger syndrome — also referred to as Asperger's syndrome, Asperger's, or just AS — is one of five neurobiological pervasive developmental disorders (PDD) that is characterized by deficiencies in social and communication skills. It is differentiated from other PDD's in that a person with AS also has normal to above normal intelligence,[1][2] and standard language development compared with classical autism. The diagnosis of AS is complicated by the lack of a standard diagnostic screen, and the use of several different screening instruments and sets of diagnostic criteria. The exact cause of AS is unknown and the prevalence is not firmly established, due partly to the use of differing sets of diagnostic criteria.

Asperger syndrome was named in honor of Hans Asperger, an Austrian psychiatrist and pediatrician, by researcher Lorna Wing, who first used the eponym in a 1981 paper.[3] In 1994, AS was recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as Asperger's Disorder.[4]

AS is typically diagnosed in childhood, but many may not be diagnosed until much later, as adults. Assistance for core symptoms of AS consists of therapies that address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most individuals with AS can learn to cope with their differences, but may continue to need support to maintain an independent life.[5]

File:Hans Aspergersmall.jpg
Hans Asperger, after whom the syndrome is named, described his patients as "little professors".

Classification and diagnosis

AS correlates with Asperger's Disorder defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by six main criteria. These criteria define AS as a condition in which there is:

  1. Qualitative impairment in social interaction;
  2. The presence of restricted, repetitive and stereotyped behaviors and interests;
  3. Significant impairment in important areas of functioning;
  4. No significant delay in language;
  5. No significant delay in cognitive development, self-help skills, or adaptive behaviors (other than social interaction); and,
  6. The symptoms must not be better accounted for by another specific pervasive developmental disorder or schizophrenia.[4]

AS is an autism spectrum disorder (ASD), one of five neurological conditions characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. The four related disorders or conditions are autism, Rett syndrome, childhood disintegrative disorder, and PDD-NOS (pervasive developmental disorder not otherwise specified).[5]

The diagnosis of AS is complicated by the use of several different screening instruments.[5] The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective.[6][7] Other sets of diagnostic criteria for AS are the ICD 10 World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria,[8] Gillberg Diagnostic Criteria,[9] and Attwood & Gray Discovery Criteria.[10] The ICD-10 definition has similar criteria to the DSM-IV version.[10] In the ICD-10, the phrase Asperger's syndrome is synonymous with Autistic psychopathy and Schizoid disorder of childhood.[11]

Some doctors believe that AS is not a separate and distinct disorder, referring to it as high functioning autism (HFA).[5] The diagnoses of AS or HFA are used interchangeably, complicating prevalence estimates: the same child can receive different diagnoses, depending on the screening tool the doctor uses, and some children will be diagnosed with HFA instead of AS, and vice versa.[5] The current classification of the pervasive developmental disorders (PDDs) is unsatisfying to many parents, clinicians, and researchers, and may not reflect the true nature of the conditions.[12] Peter Szatmari, a Canadian researcher of PDD, feels that greater precision is needed to better differentiate between the various PDD diagnoses. The DSM-IV and ICD-10 focus on the idea that discrete biological entities exist within PDD, which leads to a preoccupation with searching for cross-sectional differences between PDD subtypes, a strategy which has not been very useful in classification or in clinical practice.[12]

Characteristics

AS is characterized by:[4][5]

  • Limited interests or preoccupation with a subject to the exclusion of other activities;
  • Repetitive behaviors or rituals;
  • Peculiarities in speech and language;
  • Socially and emotionally inappropriate behavior and interpersonal interaction;
  • Problems with nonverbal communication; and
  • Clumsy and uncoordinated motor movements.

The most common and important characteristics of AS can be divided into several broad categories: social impairments, narrow but intense interests, and peculiarities of speech and language. Other features are commonly associated with this syndrome, but are not always regarded as necessary for diagnosis. This section mainly reflects the views of Attwood, Gillberg, and Wing on the most important characteristics of AS; the DSM-IV criteria represent a slightly different view. Unlike most forms of PDDs, AS is often camouflaged, and many people with the disorder blend in with those that do not have it. The effects of AS depend on how an affected individual responds to the syndrome itself.[10]

Social differences

Although there is no single feature that all people with AS share, difficulties with social behavior are nearly universal and are one of the most important defining criteria. People with AS lack the natural ability to see the subtexts of social interaction, and may lack the ability to communicate their own emotional state, resulting in well-meaning remarks that may offend, or finding it hard to know what is "acceptable". The unwritten rules of social behavior that mystify so many with AS have been termed the "hidden curriculum".[13] People with AS must learn these social skills intellectually rather than intuitively.[14]

Non-autistics are able to gather information about other people's cognitive and emotional states based on clues gleaned from the environment and other people's facial expression and body language, but, in this respect, people with AS are impaired; this is sometimes called mind-blindness.[15] Mind-blindness involves an impaired ability to: read others' feelings, understand intended meanings, gauge level of interest in a conversation, take into account others' level of knowledge and predict someone's reaction to a comment or action.[16]

Some people with AS make very little eye contact because it triggers a possible threat response,[17] whereas others have unmodulated, staring eye contact that can cause discomfort in other people.[18] Similarly, the use of gestures may be almost nonexistent or may seem exaggerated and differ from what would normally be considered the most appropriate for a situation.[19]

A person with AS may have trouble understanding the emotions of other people: the messages that are conveyed by facial expression, eye contact and body language are often missed. They also might have trouble showing empathy with other people. Thus, people with AS might be seen as egotistical, selfish or uncaring. In most cases, these are unfair labels because affected people are neurologically unable to understand other people's emotional states. They are usually shocked, upset and remorseful when told that their actions are hurtful or inappropriate. It is clear that people with AS do not lack emotions. The concrete nature of emotional attachments they might have (i.e., to objects rather than to people), however, often seems curious or can even be a cause of concern to people who do not share their perspective.[20]

Failing to show affection—or not doing so in conventional ways—does not necessarily mean that people with AS do not feel it. Understanding this can lead partners or care-givers to feel less rejected and to be more understanding. There are usually ways to work around the problems, such as being more explicit about one's needs. For instance, when describing emotions, it can be helpful to be direct and to avoid vague terms such as "upset" when the emotion being described is anger—some individuals with AS would interpret "upset" as mere annoyance, or even nausea. It is often effective to present in clear language what the problem is, and to ask the partner with AS to describe what emotions are being felt, or to ask why a certain emotion was being felt. It is helpful if the family member or significant other reads as much as he or she can about AS and any comorbid disorders.[21] Sometimes, the opposite problem occurs; the person with AS is unusually affectionate to significant others and misses or misinterprets signals from the other partner, causing the partner stress.[22]

Speech and language differences

People with AS typically have a highly pedantic way of speaking, using a far more formal register of language than appropriate for a context. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially concerning his or her special area of interest.[23]

Literal interpretation is another common, but not universal hallmark of this condition. Attwood gives the example of a girl with AS who answered the telephone one day and was asked, "Is Paul there?" Although the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said "no" and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone.[24]

Individuals with AS may use words idiosyncratically, including new coinages and unusual juxtapositions. This can develop into a rare gift for humor (especially puns, wordplay, doggerel and satire). A potential source of humor is the eventual realization that their literal interpretations can be used to amuse others. Some are so proficient at written language as to qualify as hyperlexic. Tony Attwood refers to a particular child's skill at inventing expressions, e.g., "tidying down" (the opposite of tidying up) or "broken" (when referring to a baby brother who cannot walk or talk).[25]

Children with AS may show advanced abilities for their age in language, reading, mathematics, spatial skills, or music, sometimes into the 'gifted' range, but these talents may be counterbalanced by appreciable delays in the development of other cognitive functions.[26] Some other typical behaviors are echolalia, the repetition or echoing of verbal utterances made by another person, and palilalia, the repetition of one's own words.[27]

A 2003 study investigated the written language of children and youth with AS. They were compared to neurotypical peers in a standardized test of written language skills and legibility of handwriting. In written language skills, no significant differences were found between standardized scores of both groups; however, in hand-writing skills, the AS participants produced significantly fewer legible letters and words than the neurotypical group. Another analysis of written samples found that people with AS appear to be able to write quantitatively similarly to their neurotypical peers using grammatical rules, but have difficulty in producing qualitative writing.[28]

Tony Attwood states that a teacher may spend considerable time interpreting and correcting an AS child's indecipherable scrawl. The child is also aware of the poor quality of his or her handwriting and may be reluctant to engage in activities that involve extensive writing. Unfortunately for some children and adults, high school teachers and prospective employers may consider the neatness of handwriting as a measure of intelligence and personality. The child may require assessment by an occupational therapist and remedial exercises, but modern technology can help minimize this problem. A parent or teacher aide could also act as the child's scribe or proofreader to ensure the legibility of the child's written answers or homework.[29]

Narrow, intense interests

AS can involve an intense and obsessive level of focus on things of interest. For example, one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, and another with building models out of matchsticks. Particularly common interests are means of transport (e.g., trains), computers, mathematics, science fiction, astronomy, geography, history, and dinosaurs. Note that many of these are normal interests in ordinary children; the difference in children with AS is the unusual intensity of their interest.[30] Repetitive interests in children with autism are more often in the domain of "folk physics" (how things work) and less often in the domain of "folk psychology" (how people work), suggesting that obsessions are not content free.[31]

Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally one or two interests at any given time. In pursuit of these interests, people with AS often manifest extremely sophisticated reasoning, an almost obsessive focus, and a remarkably good memory for trivial facts (occasionally even eidetic memory).[3][32] Hans Asperger called his young patients "little professors" because he thought his thirteen-year-old patients had as comprehensive and nuanced an understanding of their field of interest as university professors.[33]

Some clinicians do not entirely agree with this description. For example, Wing and Gillberg both argue that these areas of intense interest typically involve more rote memorization than real understanding,[3] despite occasional appearances to the contrary. Such a limitation is an artifact of the diagnostic criteria, even under Gillberg's criteria, however.[9]

People with AS may have little patience for things outside these narrow interests. In school, they may be perceived as highly intelligent underachievers or overachievers, clearly capable of outperforming their peers in their field of interest, yet persistently unmotivated to do regular homework assignments (sometimes even in their areas of interest). Others may be hypermotivated to outperform peers in school. The combination of social problems and intense interests can lead to unusual behavior, such as greeting a stranger by launching into a lengthy monologue about a special interest rather than introducing oneself in the socially-accepted way. In many cases adults can outgrow this impatience and lack of motivation, however, developing more tolerance to new activities and meeting new people.[26]

Other differences

Those affected by AS may show a range of other sensory, developmental, and physiological anomalies. Children with AS may evidence a slight delay in the development of fine motor skills. In some cases, people with AS may have an odd way of walking, and may display compulsive finger, hand, arm or leg movements,[34] including tics and stims.[35][36]

In general, orderly things appeal to people with AS. Some researchers mention the imposition of rigid routines (on self or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for some people with this condition.[37]

Some people with AS experience varying degrees of sensory overload and are extremely sensitive to touch, smells, sounds, tastes, and sights. They may prefer soft clothing, familiar scents, or certain foods. Some may even be pathologically sensitive to loud noises (as some people with AS have hyperacusis), strong smells, or dislike being touched; for example, certain children with AS exhibit a strong dislike of having their head touched or their hair disturbed while others like to be touched but dislike loud noises. Sensory overload may exacerbate problems faced by such children at school, where levels of noise in the classroom can become intolerable for them.[34] Some are unable to block out certain repetitive stimuli, such as the constant ticking of a clock. Whereas most children stop registering this sound after a short time and can hear it only if they consciously attend to it, a child with AS can become distracted, agitated, or even (in cases where the child has problems with regulating emotions such as anger) aggressive if the sound persists.[38] A study of parent measures of child temperament found that children with autism were rated as presenting with more extreme scores than typically-developing children.[39]

History

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a condition primarily marked by social isolation.[33] He also stated that "exceptional human beings must be given exceptional educational treatment, treatment which takes into account their special difficulties. Further, we can show that despite abnormality, human beings can fulfill their social role within the community, especially if they find understanding, love and guidance".[2]


Hans Asperger and Leo Kanner identified essentially the same population, although the group identified by Asperger was perhaps more "socially functional" than Kanner's.[40] Traditionally, Kannerian autism is characterized by significant cognitive and communicative deficiencies, including delays in or lack of language.[41] A person with AS will not show delays in language, however.

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome.[3] Wing’s writings were widely published and popularized. In 1992, the tenth published edition of the World Health Organization’s diagnostic manual and the International Classification of Diseases (ICD-10) included AS, making it a distinct diagnosis.[5] Later, in 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the American Psychiatric Association’s diagnostic reference book also added AS.[4][42]

Uta Frith (an early researcher of Kannerian autism) wrote that people with AS seem to have more than a touch of autism to them.[43] Others, such as Lorna Wing and Tony Attwood, share Frith's assessment. Dr. Sally Ozonoff, of the University of California at Davis's MIND Institute, argues that there should be no dividing line between "high-functioning" autism and AS,[44] and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.

Clinical perspective

Research

Some research is to seek information about symptoms to aid in the diagnostic process. Other research is to identify a cause, although much of this research is still done on isolated symptoms. Many studies have exposed base differences in areas such as brain structure. To what end is currently unknown; research is ongoing, however.

Peter Szatmari suggests that AS was promoted as a diagnosis to spark more research into the syndrome: "It was introduced into the official classification systems in 1994 and has grown in popularity as a diagnosis, even though its validity has not been clearly established. It is interesting to note that it was introduced not so much as an indication of its status as a 'true' disorder, but more to stimulate research ... its validity is very much in question."[45]

Research into causes

Main article: Causes of autism

The direct cause(s) of AS is unknown. Even though no consensus exists for the cause(s) of AS, it is widely accepted that AS has a hereditary factor.[46] It is suspected that multiple genes play a part in causing AS, since the number and severity of symptoms vary widely among individuals.[5] Studies regarding the mirror neurons in the inferior parietal cortex have revealed differences which may underlie certain cognitive anomalies such as some of those which AS exhibits (e.g., understanding actions, learning through imitation, and the simulation of other people's behavior).[47][48] Non-neurological factors such as poverty, lack of sleep, substance abuse by the mother during pregnancy, discrimination, trauma during early childhood, and abuse may also contribute.[49]

Other possible causative mechanisms include a serotonin dysfunction and cerebellar dysfunction.[50][51] Simon Baron-Cohen proposes a model for autism based on his empathising-systemising (E-S) theory.[52] The E-S theory holds that the female brain is predominantly hard-wired for empathy, while the male brain is predominantly hard-wired for understanding and building systems, and that AS is an extreme of the male brain.[53]

Other research

There are several studies linking autism with differences in brain-volumes such as enlarged amygdala and hippocampus.[54] Current research points to structural abnormalities in the brain as a cause of AS.[5][55] These abnormalities impact neural circuits that control thought and behavior. Researchers suggest that gene/environment interactions cause some genes to turn on or turn off, or turn on too much or too little in the wrong places, and this interferes with the normal migration and wiring of embryonic brain cells during early development.[5]

Other finds include brain region differences, such as decreased gray matter density in portions of the temporal cortex which are thought to play into the pathophysiology of ASDs (particularly in the integration of visual stimuli and affective information),[55] and differing neural connectivity.[56][57] Research on infants points to early differences in reflexes, which may be able to serve as an "early detector" of AS and autism.[58]

Some professionals believe AS is not necessarily a disorder and thus should not be described in medical terms.[59]

Treatment

Main article: Autism therapies

Treatment coordinates therapies that address the core symptoms of AS: poor communication skills, obsessive or repetitive routines, and physical clumsiness. AS and high-functioning autism may be considered together for the purpose of clinical management.[1]

A typical treatment program generally includes:[5]

  • social skills training, to teach the skills to more successfully interact with others;
  • cognitive behavioral therapy, to help in better managing emotions that may be explosive or anxious, and to cut back on obsessive interests and repetitive routines;
  • medication, for co-existing conditions such as depression and anxiety;
  • occupational or physical therapy, to assist with sensory integration problems or poor motor coordination;
  • specialized speech therapy, to help with the trouble of the "give and take" in normal conversation; and,
  • parent training and support, to teach parents behavioral techniques to use at home.

Many studies have been done on early behavioral interventions. Most of these are single case with one to five participants.[60] The single case studies are usually about controlling non-core autistic problem-behaviors like self-injury, aggression, noncompliance, stereotypies, or spontaneous language. Packaged interventions such as those run by UCLA or TEACCH are designed to treat the entire syndrome and have been found to be somewhat effective.[60]

Unintended side effects of medication and intervention have largely been ignored in the literature about treatment programs for children or adults,[60] and there are claims that some treatments are not ethical and do more harm than good.[61][62]

Prognosis

Persons with AS appear to have normal lifespans, but have an increased prevalence of comorbid psychiatric conditions such as depression, mood disorders, and obsessive-compulsive disorder.[1]

Children with AS can learn to manage their differences, but they may continue to find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.[5]

Individuals with AS may make great intellectual contributions: published case reports suggest an association with accomplishments in computer science, mathematics, and physics. The deficits associated with AS may be debilitating, but many individuals experience positive outcomes, particularly those who are able to excel in areas less dependent on social interaction, such as mathematics, music, and the sciences.[1]

Epidemiology

The prevalence of AS is not well established, but conservative estimates using the DSM-IV criteria indicate that two to three of every 10,000 children have the condition, making it rarer than autistic disorder itself. Three to four times as many boys have AS compared with girls.[5][63] The universality of AS across races, and validity of epidemiologic studies to date, is questioned.[64]

A 1993 broad-based population study in Sweden found that 36 per 10,000 school-aged children met Gillberg's criteria for AS, rising to 71 per 10,000 if suspected cases are included.[7] The estimate is convincing for Sweden, but the findings may not apply elsewhere because they are based on a homogeneous population. The Sweden study demonstrated that AS may be more common than once thought and may be currently underdiagnosed.[1] Gillberg estimates 30-50% of all persons with AS are undiagnosed.[26] A survey found that 36 per 10,000 adults with an IQ of 100 or above may meet criteria for AS.[65]

Leekam et al. documented significant differences between Gillberg's criteria and the ICD-10 criteria.[66] Considering its requirement for "normal" development of cognitive skills, language, curiosity and self-help skills, the ICD-10 definition is considerably more narrow than Gillberg's criteria, which more closely matches Hans Asperger's own descriptions.

Like other autism spectrum disorders, AS prevalence estimates for males are higher than for females,[5] but some clinicians believe that this may not reflect the actual incidence rates. Tony Attwood suggests that females learn to better compensate for their impairments due to gender differences in the handling of socialization.[67] The Ehlers & Gillberg study found a 4:1 male to female ratio in subjects meeting Gillberg's criteria for AS, but a lower 2.3:1 ratio when suspected or borderline cases were included.[7]

The prevalence of AS in adults is not well understood, but Baron-Cohen et al. documented that 2% of adults score higher than 32 in his Autism Spectrum Quotient (AQ) questionnaire, developed in 2001 to measure the extent to which an adult of normal intelligence has the traits associated with autism spectrum conditions.[68] All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis; a Japanese study found similar AQ Test results.[69]

Comorbidities

Main article: Conditions comorbid to autism spectrum disorders

Most patients presenting in clinical settings with AS have other comorbid psychiatric disorders.[70] Children are likely to present with attention-deficit hyperactivity disorder (ADHD), while depression is a common diagnosis in adolescents and adults.[70] A study of referred adult patients found that 30% presenting with ADHD had ASD as well.[71]

Research indicates people with AS may be far more likely to have the associated conditions.[72] People with AS symptoms may frequently be diagnosed with clinical depression, oppositional defiant disorder, antisocial personality disorder, Tourette syndrome, ADHD, general anxiety disorder, bipolar disorder, obsessive compulsive disorder or obsessive-compulsive personality disorder.[73] Dysgraphia, dyspraxia, dyslexia or dyscalculia may also be diagnosed.[74]

Non-clinical perspective

Some professionals contend that, far from being a disease, AS is simply the pathologizing of neurodiversity that should be celebrated, understood and accommodated instead of "treated" or "cured".[59]

Shift in view

Autistic people have contributed to a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured.[75] Proponents of this view reject the notion that there is an 'ideal' brain configuration and that any deviation from the norm is pathological. They demand tolerance for what they call their neurodiversity in much the same way physically handicapped people have demanded tolerance.[76] These views are the basis for the autistic rights and autistic pride movements.[77] Researcher Simon Baron-Cohen has argued that high-functioning autism is a "difference" and is not necessarily a "disability."[78] He contends that the term "difference" is more neutral, and that this small shift in a term could mean the difference between a diagnosis of AS being received as a family tragedy, or as interesting information, such as learning that a child is left-handed.

Autistic culture

Main article: Autistic culture

People with AS may refer to themselves in casual conversation as "aspies", coined by Liane Holliday Willey in 1999,[79] or as an "Aspergian".[80] The term neurotypical (NT) describes a person whose neurological development and state are typical, and is often used to refer to people who are non-autistic.

A Wired magazine article, The Geek Syndrome,[81] suggested that AS is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It posited that AS may be the result of assortative mating by geeks in mathematical and technological areas. AS can be found in all occupations, however, and is not limited to those in the math and science fields.[82]

The popularization of the Internet has allowed individuals with AS to communicate with each other in a way that was not possible to do offline due to the rarity and the geographic dispersal of individuals with AS. As a result of increasing ability to connect with one another, a subculture of "Aspies" has formed. Internet sites have made it easier for individuals to connect with each other.[83]

Social impact

AS may lead to problems in social interaction with peers. These problems can be severe or mild depending on the individual. Children with AS are often the target of bullying at school due to their idiosyncratic behavior, language, interests, and impaired ability to perceive and respond in socially expected ways to nonverbal cues, particularly in interpersonal conflict. Children with AS may be extremely literal and may have difficulty interpreting sarcasm. A child or teen with AS is often puzzled by this mistreatment, unaware of what has been done incorrectly. Unlike other pervasive development disorders, most children with AS want to be social, but fail to socialize successfully, which can lead to later withdrawal and asocial behavior, especially in adolescence.[84]

Children with AS often display advanced abilities for their age in language, reading, mathematics, spatial skills, and/or music—sometimes into the "gifted" range—but this may be counterbalanced by considerable delays in other developmental areas. This combination of traits can lead to problems with teachers and other authority figures. A child with AS might be regarded by teachers as a "problem child" or a "poor performer." The child’s extremely low tolerance for what they perceive to be ordinary and mediocre tasks, such as typical homework assignments, can easily become frustrating; a teacher may well consider the child arrogant, spiteful, and insubordinate. Lack of support and understanding, in combination with the child's anxieties, can result in problematic behavior (such as severe tantrums, violent and angry outbursts, and withdrawal).[85]

Although adults with AS may have similar problems, they are not as likely to be given treatment as a child would. They may find it difficult finding employment or entering undergraduate or graduate schools because of poor interview skills or a low score on standardized or personality tests. They also may find themselves more vulnerable to poverty and homelessness than the general population, because of their difficulty finding employment, lack of proper education, premature social skills, and other factors.[65] If they do become employed, they may be misunderstood, paid less than those without AS, and be subject to bullying and discrimination. They may also have difficulty finding a life partner and getting married due to poor social skills, and their poverty. People with AS report a feeling of being unwillingly detached from the world around them. On the other hand, some adults with AS do get married,[86] get graduate degrees, get wealthy, and hold jobs.[10] The intense focus and tendency to work things out logically often grants those people with AS a high level of ability in their field of interest. When these special interests coincide with a materially or socially useful task, the person with AS often can lead a profitable life. The child obsessed with naval architecture may grow up to be an accomplished shipwright.[87] More research is needed on adults with AS.[88]

Notable cases

Albert Einstein may have had AS.
Main articles: List of autistic people and People speculated to have been autistic

AS is sometimes viewed as a syndrome with both advantages and disadvantages,[89] and notable adults with AS or autism have achieved success in their fields. Prominent AS-diagnosed individuals include Nobel Prize-winning economist Vernon Smith,[90] industrial rocker Gary Numan,[91] Vines frontman Craig Nicholls,[92] and Satoshi Tajiri, the creator of Pokémon.[93]

Some AS researchers speculate that well-known figures, including Albert Einstein, Isaac Newton, Glenn Gould, and Ludwig Wittgenstein, had AS because they showed some AS-related tendencies or behaviors, such as intense interest in one subject, or social problems.[94][95][96][97][98] Stanley Kubrick [99] is speculated to have/had the syndrome. Posthumous diagnoses remain controversial, however, and autistic rights activists use such speculative diagnoses to argue that it would be a loss to society if autism were cured.[100]

See also

  • Groups
  • Lists
  • General

Notes

  1. ^ a b c d e Brasic, JR. Pervasive Developmental Disorder: Asperger Syndrome. eMedicine.com (April 10 2006). Retrieved 7 July 2006. Cite error: The named reference "emed" was defined multiple times with different content (see the help page).
  2. ^ a b Treffert, DA. Asperger's Disorder and Savant Syndrome. Wisconsin Medical Society. Retrieved on 19 July 2006.
  3. ^ a b c d Wing, Lorna. Asperger syndrome: a clinical account. Retrieved 2 July 2006.
  4. ^ a b c d BehaveNet® Clinical Capsule™. DSM-IV & DSM-IV-TR: Asperger's Disorder (AD). Retrieved 28 June 2006.
  5. ^ a b c d e f g h i j k l m n NINDS (May 11, 2006). Asperger Syndrome Fact Sheet. Retrieved 2 July 2006.
  6. ^ Timini S. "Diagnosis of autism: Adequate funding is needed for assessment services." BMJ. 2004 Jan 24;328(7433):226. PMID 14739199 Full Text
  7. ^ a b c Ehlers S, Gillberg C. "The epidemiology of Asperger's syndrome: a total population study". J Child Psychol Psychiatry. 1993 Nov;34(8):1327-50. PMID 8294522 Full Text. Cite error: The named reference "EhlGill" was defined multiple times with different content (see the help page).
  8. ^ Szatmari P, Brenner R, Nagy J. (1989) "Asperger's syndrome: A review of clinical features." Canadian Journal of Psychiatry 34, pp. 554-560.
  9. ^ a b Gillberg IC, Gillberg C. "Asperger syndrome-some epidemiological considerations: A research note." J Child Psychol Psychiatry. 1989 Jul;30(4):631-8. PMID 2670981
  10. ^ a b c d AS-IF.org. Asperger Syndrome Information and features: Definition. Retrieved 29 June 2006.
  11. ^ Fitzgerald M, Corvin A (2001). Diagnosis and differential diagnosis of Asperger syndrome. Advances in Psychiatric Treatment 7: pp. 310-318.
  12. ^ a b Szatmari P. "The classification of autism, Asperger's syndrome, and pervasive developmental disorder." Can J Psychiatry. 2000 Oct;45(8):731-8. Review. PMID 11086556 Full text.
  13. ^ Myles, Brenda Smith; Trautman, Melissa; and Schelvan, Ronda (2004). The Hidden Curriculum: practical solutions for understanding unstated rules in social situations. Shawnee Mission, Kansas: Autism Asperger Publishing Co., 2004. ISBN 1-931282-60-9.
  14. ^ Levanthal-Belfer, Laurie and Coe, Cassandra (2004). "Asperger Syndrome in Young Children: A Developmental Approach for Parents and Professionals". London: Jessica Kingsley Publishers, p. 161. ISBN 1-84310-748-1
  15. ^ Romanowski, Patricia; Kirby, Barbara L. Forewards by Simon Baron-Cohen and Tony Attwood (2005). "The Oasis Guide to Asperger Syndrome". New York: Crown Publishers. pp. 335-336. ISBN 1-4000-8152-1
  16. ^ Romanowski and Kirby (2005, p. 336.
  17. ^ Scientific American (May 2005). Eye Contact Triggers Threat Response in Autistic Children. Retrieved 19 July 2006.
  18. ^ Romanowski and Kirby (2005), p. 24.
  19. ^ Levanthal-Belfer and Coe (2004), pp. 160-161.
  20. ^ Attwood, Tony. "Asperger's Syndrome: A Guide for Parents and Professionals". Jessica Kingsley, London, 1997. ISBN 1-85302-577-1, pp. 89-92.
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  22. ^ Attwood (1997), pp. 165-169.
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