What is Asperger’s Syndrome?

Binayak Das, Team BioXone

Introduction

In the year 1944, Hans Asperger, a Viennese pediatrician who first noticed amongst the children that were being referred to his clinic, that some of them depicted matching yet unique personality traits and behavior. The existing theoretical models and instruments to evaluate psychological aspects of childhood from that time failed to fit the description of what Asperger had noticed in those children at his clinic. He then came up with the term autistische Psychopathen im Kindesalter (which translates to “Autistic psychopaths” in English).

In 1993, The WHO in their 10^th edition of the International Classification of Diseases; in 1994, the American Psychiatric Association in the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders, both recognized Asperger’s syndrome (AS) amongst other pervasive developmental disorders (PDD). Both the manuals identified this disorder as one of several subtypes of autism although there were differences in the diagnostic criteria of the two. 

Is Asperger’s syndrome and High Functioning Autism related?

Studies have indicated that high functioning autism (HFA) and Asperger’s disorder clinically share more similarities than dissimilarities and AS is considered as an Autism Spectrum Disorder (ASD). HFA is explained as when children that depict classical signs of autism from early on, but who later show enhanced levels of intellectual capabilities, with better interactive and adaptive skills as compared to those with autism. 

What symptoms indicate AS?

The key feature of Asperger’s is the qualitative inability in social interaction scenarios. It also includes inefficiency in the ability to reciprocate social and emotional communication or inability to develop friendly relationships apposite to developmental level. To date, there does not exist any universally standardized test that defines, rather, measures social interaction and related skills of children, which could then be used for comparing with those with AS. Such parameters are subjective to clinical judgment and vary among those with AS. Children with AS may depict odd posture or move awkwardly with a lack of confidence. They may have consistently illegible handwriting or may find it difficult to execute various actions which require the coordination induce by the motor and sensory stimuli. Other major characteristics include sleep problems and alexithymia (i.e., inability in identifying and expressing one’s emotions), amongst others.

Causes of Asperger’s syndrome:

Although the exact cause is yet to be pointed out, records of data so far indicate that genetics most likely has an important role to play. Although the genetic factors which would be responsible for the onset of AS have not been identified, it is strongly suggested that multiple genetic factors must be involved in orchestrating this complex disorder, similar to what is true for the onset of autism. Genetics as a cause was concluded due to repeated observations of its occurrence in families where the existing or previous generation family members show or had depicted some degree of restricted behavioral symptoms, which would resemble or could be comparable to the symptoms that indeed do occur in case of AS. The majority of genetic studies conducted on other ASDs have shown the involvement of multiple genetic factors to be true.

It has been observed in people expressing AS that multiple or almost all functional brain regions or systems are affected rather than the effects being limited to specific regions only. Several neuroanatomical studies have regarded alterations in the brain’s development from teratogens occurring during conception to be one of the main causes. ‘Teratogens’ are toxic substances like mercury, alcohol, lead, etc., which have the potential to induce birth defects if the exposure occurs anytime during the initial eight weeks of conceiving. The changes in the developing brain can potentially modify its final structure, thereby bringing about unusual changes in the neural circuits which control cognitive process and behavior. 

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Is there any scope for treatment?

Over the years, there has been an increasing number of studies trying to understand and reveal the functioning of the mind of individuals with Asperger’s. Although these individuals improve remarkably on various fronts with the challenges they are faced with since childhood, with development and age; it has been seen that therapies can create noticeably better results. The basic layout which forms the treatment of AS resembles that of high-functioning ASDs but is more advanced as it takes more aspects into account. The general plan involves ‘Applied behavior analysis (ABA) procedures, which is also known as behavioral engineering and helps in conditioning behavior based on social significance. ‘Cognitive-behavioral therapy’ helps immensely with how to successfully manage the stress that may be induced by anxiety disorders or depression. The medication also plays an important role by helping support these steps, by improving mood or temperament, and by helping to achieve a healthy amount of sleep. Physical exercise and therapy have proven to greatly assist in improving sensory inabilities and motor coordination. Lastly, social communication practices via speech therapy have shown to drastically improve aspects concerned with day-to-day conversations and communication abilities with regular people. 

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References:

1. Attwood, Tony. ‘Asperger’s Syndrome’. Tizard Learning Disability Review, vol. 11, no. 4, Jan. 2006, pp. 3–11. Emerald Insight, doi:10.1108/13595474200600032.
2. McPartland, James, and Ami Klin. ‘Asperger’s Syndrome’. Adolescent Medicine Clinics, vol. 17, no. 3, Oct. 2006, pp. 771–88; abstract xiii. PubMed, doi:10.1016/j.admecli.2006.06.010.
3. Arndt, Tara L., et al. ‘The Teratology of Autism’. International Journal of Developmental Neuroscience, vol. 23, no. 2–3, Apr. 2005, pp. 189–99. doi:10.1016/j.ijdevneu.2004.11.001.x
4. Social skills interventions for the autism spectrum: Essential ingredients and a model curriculum. (2003). Child and Adolescent Psychiatric Clinics of North America, 12(1), 107–122. https://doi.org/10.1016/S1056-4993(02)00051-2
5. Behavioral forms of stress management for individuals with Asperger syndrome. (2003). Child and Adolescent Psychiatric Clinics of North America, 12(1), 123–141. https://doi.org/10.1016/S1056-4993(02)00048-2
6. Towbin, K. E. (2003). Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome. Child and Adolescent Psychiatric Clinics of North America, 12(1), 23–45. https://doi.org/10.1016/S1056-4993(02)00049-4
7. Paul, R. (2003). Promoting social communication in high functioning individuals with autistic spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 12(1), 87–106. https://doi.org/10.1016/S1056-4993(02)00047-0

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