Asperger Syndrome

ON THIS PAGE:

Asperger Syndrome

Asperger & Social Skills

Sexual Relationships

Test For Asperger's

Getting A Diagnosis

What doctors look for

DSM-IV Diagnostic Criteria

Personal Accounts

Career & Autism

Asperger's & Success

Testosterone & AS

Neanderthal Theory

Stims & Traits

Links


Asperger Syndrome

www.udel.edu/bkirby/asperger/aswhatisit.html

Asperger Syndrome is named for a Viennese physician, Hans Asperger. He observed four children in his practice who had difficulty integrating socially. Their intelligence appeared normal but they lacked nonverbal communication skills ("body language"), failed to demonstrate empathy with their peers, and were physically clumsy. Their speech was either disjointed or overly formal. An all-absorbing interest in a single topic dominated their conversations.

Dr. Asperger described the condition as primarily marked by social isolation. He also stated, "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".

Asperger's observations were not widely known until 1981, when English doctor Lorna Wing published a series of case studies of children showing similar symptoms, which she called "Asperger's" syndrome. In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included AS, making it a distinct diagnosis recognized by professionals.

Asperger's Syndrome has a variety of characteristics and can range from mild to severe. Persons with AS show marked deficiencies in social skills, have difficulties with transitions or changes and prefer sameness. They often have obsessive routines and may be preoccupied with a particular subject of interest.

They have a great deal of difficulty reading nonverbal cues (body language) and very often the individual with AS has difficulty determining proper body space. Often overly sensitive to sounds, tastes, smells, and sights, the person with AS may prefer soft clothing, certain foods, and be bothered by sounds or lights no one else seems to hear or see. It's important to remember that the person with AS perceives the world very differently. Therefore, many behaviors that seem odd or unusual are due to those neurological differences and not the result of intentional rudeness, bad behavior, or "improper parenting".

Persons with AS can be extremely literal and have difficulty using language in a social context. A child may have a wonderful vocabulary and even demonstrate hyperlexia but not truly understand the nuances of language and have difficulty with language pragmatics. Social pragmatics also tend be weak, leading the person to appear to be walking to the beat of a "different drum".

Motor dyspraxia (inhibited coordination) can be reflected in a tendency to be clumsy. In social interaction, many people with Asperger's syndrome demonstrate gaze avoidance and may actually turn away at the same moment as greeting another. The children I have known do desire interaction with others but have trouble knowing how to make it work. They are, however, able to learn social skills much like you or I would learn to play the piano.

Many of the weaknesses can be remediated with therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger's can have relationships, families, happy and productive lives.

There is growing evidence that Asperger Syndrome may be caused by a variety of factors that affect brain development and sensory perception. It is not uncommon for a child who was initially diagnosed with ADD or ADHD be re-diagnosed with AS.

Common Traits:

  • Excellent rote memory

  • Generally anxious and unable to cope with any form of criticism or imperfection

  • Can be the victims of teasing in a school environment, which may cause them to withdraw into isolated activities

  • Often appear clumsy and may have an unusual gait or stance

  • Often have a good vocabulary but have dificulty in non-literal social communication.

An example of the "literal" type of communication used by someone with Asperger's: He referred to a hole in his sock as "a temporary loss of knitting".

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Other Points

  • Fluorescent lighting causes severe problems for many autistic people, because they can see a sixty cycle flicker. Household electricity turns on and off sixty times each second, and some autistic people see this. Problems with flickering can range from excessive eyestrain to seeing a room pulsate on and off.

  • People with autism require much more time than others to shift their attention between auditory and visual stimuli, and they find it more difficult to follow rapidly changing, complex social interactions. "If I relate to people too much, I become nervous and uncomfortable." Using videotapes to observe people's emotional & social reactions helps develop this area.

    Career Issues:

  • greater need for sensory stimulation
  • disinclined to extemporaneous speaking
  • resists change to working procedures
  • disinclined to "office politics" (doesn't recognize hierarchical routing, seeks direct communication with the person having information)
  • trouble recognizing or generating customary business/social "lies"
  • disinclined to use of metaphors
  • difficulty in recognizing questions as "rhetorical"



Social Skills


www.baltimorepsych.com/aspergers.htm

Social Skills Training: This is one of the most important facets of treatment for all age groups of people with Asperger's. The individual needs to learn body language the way an adult learns a foreign language. People with Asperger's must learn concrete rules for eye contact, social distance and the use of slang. Global empathy is difficult, but they can learn to look for specific signs that indicate another individual's emotional state. Social skills are often best practiced in a small group setting. Such groups serve more than one function. They give people a chance to learn and practice concrete rules of interpersonal engagement. They may also be a way for the participant to meet others like himself. Individuals with Asperger's do best in groups with similar individuals. If the group consists of street-wise, antisocial peers, the Asperger's individual may retreat into himself or be dominated by the other members.

Social Differences


Edited from: wikipedia

People with AS lack the natural ability to see the subtexts of social interaction. They have trouble communicating 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". People with AS must learn these social skills intellectually rather than intuitively.

Non-autistics intuitively gather information about other people's cognitive and emotional states from clues in the environment and other people's facial expressions and body language, but, in this respect, people with AS are impaired; this is sometimes called mind-blindness.

A person with AS can have trouble understanding the emotions of other people: the "messages" from facial expression, eye contact and body language are often missed. This caused problems in their showing empathy with other people. 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. Emotions are not usually shown in a conventional way. Sometimes, the opposite problem occurs: the person with AS is unusually affectionate to a significant other and misses or misinterprets signals from the other partner, causing the partner stress.

"Professorial" Speech...

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 child with this condition may regularly speak in language that could easily have come from a university textbook, especially if it's their special area of interest. 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).

In written language skills, no significant differences were found between standardized scores of AS & non-AS children; however, in hand-writing skills, the AS participants produced significantly fewer legible letters and words than the neurotypical group.

Narrow, intense interests

Asperger Syndrome 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 computers, and another with building models out of matchsticks. Many of these are normal interests; the difference in people with AS is the unusual intensity of their interest. Repetitive interests in people with autism are more often in the domain of "how things work" and less often in the domain of "how people work", suggesting that the obsessions are not arbitrary, but reflect the AS focus on objects over people.

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. Hans Asperger called his young patients "little professors" because he thought they had as comprehensive and nuanced an understanding of their field of interest as university professors.

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. This proclivity toward 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 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. Some people with AS experience varying degrees of sensory overload. Some may even be pathologically sensitive to loud noises.



Communication:
Speaking to an Apergan


Be selective with what you say. Aspergans take what you tell them literally. So, it can be a problem if you use figures of speech since they will hear these literally. You'll likely be surprised at how well he knows a specific area that you may not know yourself.

If this is a business or professional setting (or just someone with whom you haven't spoken before), it is usually more productive to speak in direct terms rather than in colloquial, circumspect "social" language.

You may notice one or more of these characteristics in an Aspergan's speech & behavior (more noticable if they're young):

  • Assumes that you are interested in what he is talking about.
  • Assumes you want to participate in the things he wants to do, and appears upset if you donít.
  • Gets upset over requests or instructions unrelated to the subject being discussed.
  • Asks detailed questions to in respose to casual comments.
  • Will respond to a criticism as if he were defending a thesis, but struggle at answering basic open-ended questions about the same topic.
  • Have a few, fixed routines. A suggestion of adding to, or altering them produces great irritation.


Hate At First Sight


SOCIAL REFLEXES. People assess one another in social contexts intuitionally rather than analytically. By this process, the Asperger Gait can engender a "hate at first-sight" response. You will see people greeting each other politely, then suddenly turn to you with a glaring, hateful countenance. There's some kind of Aspie body language that's odd to them.

It's also seen in the animal kingdom: a flock of birds ignoring an awkwardly-moving bird who appears otherwise normal and healthy. People will frequently look a stranger in the eye with disgust, even loathing, based on nothing but this "there's something about him" reflex.

Be aware that simple-minded reflexes can be easily "fooled" by using simple gestures that are familiar to the simpleton. The "Alpha" stance: eye-contact, chest out, walking assertively, cause man and beast to respond favorably to one's "aura."

related: www.wrongplanet.net/postxf30621-0-0.html



Sexual Relationships


Establishing sexual relationships requires a knowledge of a wide array of nonverbal communication. People in the autistic spectrum aren't "wired" for that. Some may learn enough to be able to have relationships, though that learning process may mean a decade-long delay in starting a real relationship.

People on the high functioning end, i.e., Asperger Syndrome, have sexual desires as strong as a neurotypical person. But consider how hard it is for NT adolescents to deal with their awakening sexuality, approaching people of the opposite sex, etc. Then consider the innate social impairments of someone in the autistic spectrum. It doesn't take much for the poor kid to conclude that "normal" sexual relationships are no more attainable than "normal" friendships had been up to that point. Yet those sexual desires still demand an outlet.

Duscussions on sexual forums often reveal that many fetishists of all stripes (not just AS) talk of having experienced an unusual attraction to the fetish object long before puberty.

So the big question for a fetishist on the spectrum is which came first: Did the fetish develop out of the person's frustration over believing they cannot have normal relationships? Or was the fetish there all along as part-and-parcel of the autistic condition?

But one problem is clear: Fetishes can be realized alone. That's a "perfect" trap for someone whose wiring keeps them on the fringes of social interaction. Learning the communication idioms necessary to "break through" into the world of normal relationships is the inconvenient necessity for the AS individual.

Related discussion

Google: autism, Sexual Development



Do You Have Asperger's?


paulcooijmans.lunarpages.com/p/gaia

  1 Write complaint letters to authorities, professionals, companies etc.
  2 Read full manual before taking equipment into use
  3 Severely bullied at school
  4 Little or no facial expression
  5 Not well able to read another's facial expression
  6 Flat or monotonous voice
  7 Rigid day or week schedule (repetitive patterns)
  8 Strong interest in arcane subjects (either scientific, occult or trivial)
  9 Lack sensitivity to nonverbal cues and social codes
10 Employed below ability level
11 Poor work record
12 Never had a steady job
13 Social isolation
14 Educated below ability level
16 Never married
17 Never had an amorous relationship
18 Still virgin
19 Fetishism
20 Read reference works from A to Z
21 Motor clumsiness
22 "Talk too much"
23 "Talk too little"
24 Low "social skills"
25 Little eye contact
26 Shy
28 One-sided eating habits
29 Capable of sustained rigorous hard work
32 Savant
33 Not taken seriously or misunderstood in face-to-face situations
34 Neurotic habits or tics
36 Diagnosed Schizophrenia
37 Diagnosed Obsessive-Compulsive Disorder
38 Diagnosed any Personality Disorder
39 Very honest
41 Peculiar or (for males) too high-pitched voice
42 Not emotional
43 Highly sensitive to criticism
44 Lack "common sense"
45 Bitten by dogs (unable to "read" its signals)
46 A-rhythmic speech or abnormal speech rhythm
47 Teased by children in adulthood
48 Clumsy or exaggerated gestures when talking
49 Unrightfully punished at school
50 Perfectionist
51 Longing for death or suicidal thoughts
52 Eating disorder (like anorexia)
53 Depression or on anti-depressant
54 Attached to animals or things rather than humans
55 On tranquillizers
56 Drug addict
57 Homeless
58 Sleeping problems
59 Stilted and overformal in social interaction
60 Oversensitive to particular sounds



You checked items.

Though a casual questionnaire with tongue slightly in cheek, 17 or more items may indicate a gifted adult with Aspinger's Syndrome. More on these stats from source site.



Asperger - Getting a Diagnosis

What the Indicators Are

• To: What doctors look for

• To: DSM-IV Diagnostic Criteria

The "Triad of Impairments:"
http://www.brookdalecare.co.uk/www/asdinfo.php?mm=5&sm=16

  1. Impairment of social relationships
  2. Impairment of social communication, and
  3. Impairment of imagination*
* "Lack of imagination" refers to difficulty imagining alternative outcomes and finding it hard to predict what people will do next. It doesn't refer to creative ability.

The way that each individual is affected by the triad is along a continuum: one person may have more deficits in the area of imagination than in social relationships or social communication.



Hans Asperger defined the indicators as:

  • Social impairment - extreme egocentricity
  • Speech and language peculiarities
  • Repetitive routines
  • Motor clumsiness
  • Narrow interests
  • Non-verbal communication problems


"Social" Triad of Impairments:

  • Aloof - over-formal or stilted in social contact, to schizoid and isolative behavior, including becoming electively mute and complete withdrawal from interpersonal interactions. In extreme circumstances individuals may neglect all aspects of personal care and hygiene, some decompensate into a psychotic state.

  • Active but odd - own needs seen as priority. Little or no concept of consensus or compromise. Little or no understanding of social rules and societal norms. These difficulties are compounded by deficits in interpreting non-verbal behaviors, abstract concepts and complex social language.

  • Passive - accepts social approaches with indifference, will often comply with all requests, therefore making them vulnerable to exploitation. May show some pleasure in social contact, but make no spontaneous approaches. Has difficulties dealing with stress and changes in routines.



Getting A Diagnosis


From: www.as-if.org.uk/procedure.htm

Because Asperger syndrome has only really been recognised within the last 25 years, and barely heard about at all until during the last 15 years, many adults are still only just getting diagnosed after a lifetime of being different and not knowing why.

There are many different routes to getting a diagnosis, but one of the first places you could try is your family doctor.



Step 1 - Be Prepared

Read the diagnostic criteria and make notes of some examples relevant to yourself.

If you are an adult seeking a diagnosis for yourself, be ready to give examples of AS traits from your childhood. Recall reactions from parents, teachers, and other kids, to these traits.

You won't need to give the GP a life story. They just need to know that you have valid reasons for suspecting you meet the diagnostic criteria and that it has been life-long, not just a stage you are going through.

Practice talking about the issues you want to raise. If you haven't got someone to talk to, then just practice saying them out loud to yourself or writing them down. Take some notes along with you to refer to.



Step 2 - See Your GP

Make an appointment to see your GP specifically about Asperger Syndrome. (Don't try and tag it on to the end of a consultation about something else.)

Your GP will not diagnose you himself. What you are asking for is a referral to a specialist. The doctor won't do this unless he feels there is good cause to do so. They will want to know:

  • how you found out about Asperger syndrome
  • some examples you can give meeting the diagnostic criteria
  • why you want a diagnosis

Some doctors might be suspicious of your motives and be reluctant to refer you, so it is important to be persistent and quite clear about how important it is to you. He may actually be willing to refer you but not be sure who to refer you to.



Step 3 - The Referral Appointment

The term "diagnosis" is misleading, as it is more like a professional opinion that you are obtaining. The value of the opinion depends on the experience of the professional who gives it. A diagnosis certainly isn't is a pass or fail test.

A number of different doctors and health professionals may be involved in the actual diagnosis. You may have more than one appointment and see more than one specialist. It could take a long time until you get anything confirmed. It is important to ensure that whoever and whatever the consultant and/or diagnostic team is that they have some experience of diagnosing Asperger Syndrome.

Referral appointments can vary:

  • Sometimes they will just interview you
  • Sometimes they will want to speak to family
  • They might do some simple psychological tests

It can be a difficult experience. But if it really matters to you, then commit to pursuing the matter until you get the results you're seeking.



CHARACTERISTICS THAT CLINICIANS USE TO DIAGNOSE ASPERGER SYNDROME

This is from the "Australian Scale for Asperger Syndrome". Though it is directed toward diagnosing children, the symptoms are similarly relevant to adults with AS. As there is more interest in treating children, it is a bit more work for an adult to pursue a serious and accurate diagnosis. But take note of the criteria described here and apply it to pertinent examples from your life both in childhood and as an adult.

[A version of the original can be found on: www.aspennj.org/atwood.html ]

A: SOCIAL AND EMOTIONAL ABILITIES

1. Does the individual lack an understanding of how to play with other children? For example, unaware of the unwritten rules of social play

2. When free to play with other children, such as school lunchtime, does the individual avoid social contact with them? For example, finds a secluded place or goes to the library.

3. Does the individual appear unaware of social conventions or codes of conduct and make inappropriate actions and comments? For example, making a personal comment to someone but the individual seems unaware how the comment could offend.

4. Does the individual lack empathy, i.e., the intuitive understanding of another person's feelings? For example, not realizing an apology would help the other person feel better.

5. Does the individual seem to expect other people to know their thoughts, experiences and opinions? For example, not realizing you could not know about something because you were not with the child at the time.

6. Does the individual need an excessive amount of reassurance, especially in changing situations or when thing go wrong?

7. Does the individual lack subtlety in their expression of emotion? For example, the individual shows distress or affection out of proportion to the situation.

8. Does the individual lack precision in their expression of emotion? For example, not understanding the levels of emotional expression appropriate for different people.

9. Is the individual uninterested in playing competitive sports or activities with other children?

10. Is the individual indifferent to peer pressure? For example, does not follow the latest craze in toys or clothes.

B. COMMUNICATION SKILLS

11.Does the individual take a literal interpretation of comments? For example, is confused by phrases such as, "get your act together," "looks can kill," or "pull yourself up by your bootstraps".

12. Does the individual speak using unusual intonations? For example, the individual seems to have a "foreign" accent or monotone that lacks emphasis on key syllables.

13. When talking to the individual, does he appear uninterested in your side of the conversation? For example, not asking about or commenting on your thoughts or opinions on the topic.

14. When in a conversation, does the individual tend to use less eye contact than you would expect?

15. Is the individual's speech over-precise or pedantic? For example, talks in a formal way or like a walking dictionary.

16. Does the individual have problems repairing a conversation? For example, when confused by the speaker's choice of words, he does not ask for clarification but either switches to a familiar topic, or takes ages to think of a reply.

C. COGNITIVE SKILLS

17. Does the individual read books primarily for information not seeming to be interested in fictional works? For example, being an avid reader of encyclopedias and science books but not keen on adventure stories.

18. Does the individual have an exceptional long-term memory for events and facts? For example, remembering the neighbor's car license plate from several years ago, or clearly recalling events that happened many years ago.

19. Does the individual lack social imaginative play? For example, other children are not included in the child's imaginary games, or the child is confused by the pretend games of other children.

20. Is the child fascinated by a particular topic and avidly collects information or statistics on that interest? For example, the child becomes a walking encyclopedia of knowledge on vehicles, maps, or league tables.

21> Does the individual become unduly upset by changes in routine or expectation? For example, is distressed by going to school by a different route.

22. Does the individual develop elaborate routines or rituals that must be completed? For example, lining up the toys before going to bed.

E. MOVEMENT SKILLS

23. Does the individual have poor motor coordination? For example, is not skilled at catching a ball.

24. Does the child have an odd gait when running?

F. OTHER CHARACTERISTICS

Does the person display any of the following characteristics: (Check all that apply)

a. Unusual fear or distress due to:

  • ordinary sounds, e.g., electrical appliances

  • light touch on the skin or scalp

  • wearing particualr items of clothing

  • unexpected noises

  • seeing certain objects

  • noisy, crowded places, e.g., supermarkets

b. A tendency to rock backward and forward when excited or distressed

c. A lack of sensitivity to low levels of pain

d. Late in acquiring speech [more associated with basic Autism than with Asperger Syndrome]

e. Unusual facial grimaces or tics.



Getting Diagnosed as an Adult - National Autistic Society (UK)



299.80 Asperger's Disorder
[ As it appears in the "DSM-IV-TR", p80-84 ]

(To: Summary of Diagnostic Criteria)

Diagnostic Features

      The essential features of Asperger's Disorder are severe and sustained impairment in social interaction (Criterion A) and the development of restricted, repetitive patterns of behavior, interests, and activities (Criterion B).   The disturbance must cause clinically significant impairment in social, occupational, or other important areas of functioning (Criterion C).   In contrast to Autistic Disorder, there are no clinically significant delays or deviances in language acquisition (e.g.,single non-echoed words are used communicatively by age 2 years, and spontaneous communicative phrases are used by age 3 years)(Criterion D), although more subtle aspects of social communication (e.g.,typical give and take in conversation) may be affected.  In addition, during the first 3 years of life, there are no clinically significant delays in cognitive development as manifested by expressing normal curiosity about the environment or in the acquisition of age-appropriate learning skills and adaptive behaviors (other than in social interaction)(Criterion E).   Finally, the criteria are not met for another specific Pervasive Developmental Disorder or for Schizophrenia (Criterion F).   This condition is also termed Asperger's Syndrome.

      The impairment in reciprocal social interaction is gross and sustained.   There may be marked impairment in the use of multiple nonverbal behaviors (e.g.,eye-to-eye gaze, facial expression, body postures and gestures) to regulate social interaction and communication (Criterion A1).  There may be failure to develop peer relationships appropriate to developmental level (Criterion A2) that may take different forms at different ages.   Younger individuals may have little or no interest in establishing friendships.   Older individuals may have an interest in friendship but lack of understanding the conventions of social interaction.  There may be a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g.,not showing, bringing, or pointing out objects they find interesting) (Criterion A3).   Lack of social or emotional reciprocity may be present (e.g.,not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids)(Criterion A4).   Although the social deficit in Asperger's Disorder is severe and is defined in the same way as in Autistic Disorder, the lack of social reciprocity is more typically manifest by an eccentric and one-sided social approach to others (e.g.,pursuing a conversational topic regardless of other' reactions) rather than social and emotional indifference.

      As in Autistic Disorder, restricted, repetitive patterns of behavior, interests, and activities are present (Criterion B).   Often these are primarily manifest in the development of encompassing preoccupations about a circumscribed topic or interest, about which the individual can amass a great deal of facts and information (Criterion B1).  These interests and activities are pursued with great intensity often to the exclusion of other activities.

        The disturbance must cause clinically significant impairment in social adaptation , which in turn may have a significant impact on self-suffiency or on occupational or other important areas of functioning (Criterion C).   The social deficits and restricted patterns of interests, activities, and behavior are the source of considerable disability.

      In contrast to Autistic Disorder, there are no clinically significant delays in early language (e.g.,single words are used by age 2, communicative phrases are used by age 3)(Criterion D).   Subsequent language may be unusual in terms of the individual's preoccupation with certain topics and his or her verbosity.   Difficulties in communication may result from social dysfunction and the failure to appreciate and utilize conventional rules of conversation, failure to appreciate nonverbal cues, and limited capacities for self-monitoring.

      Individuals with Asperger's Disorder do not have clinically significant delays in cognitive development or in age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood (Criterion E).   Because early language and cognitive skills are within normal limits in the first 3 years of life, parents or caregivers are not usually concerned about the child's development during that time, although upon detailed interviewing they may recall unusual behaviors.   The child may be described as talking before walking, and indeed parents may believe the child to be precocious (e.g.,with a rich or "adult" vocabulary).   Although subtle social problems may exist, parents or caregivers often are not concerned until the child begins to attend a preschool or is exposed to same-age peers may become apparent.

      By definition the diagnosis is not given if the criteria are met for any other specific Pervasive Developmental Disorder or for Schizophrenia (although the diagnosis of Asperger's Disorder and Schizophrenia may coexist if the onset of the Asperger's Disorder clearly preceded the onset of Schizophrenia)(Criterion F).

Associated Features and Disorders

      In contrast to Autistic Disorder, Mental Retardation is not usually observed in Asperger's Disorder, although occasional cases in which Mild Mental Retardation is present have been noted (e.g.,when the Mental Retardation becomes apparent only in the school years, with no apparent cognitive or language delay in the first years of life).   Variability of cognitive functioning may be observed, often with strengths in areas of verbal ability (e.g.,vocabulary, rote auditory memory) and weaknesses in non-verbal areas (e.g.,visual-motor and visual-spatial skills).   Motor clumsiness and awkwardness may be present but usually are relatively mild, although motor difficulties may contribute to peer rejection and social isolation (e.g.,inability to participate in group sports).   Symptoms of overactivity and inattention are frequent in Asperger's Disorder, and indeed many individuals with this condition receive a diagnosis of Attention Deficit/Hyperactivity Disorder prior to the diagnosis of Asperger's Disorder.   Asperger's Disorder has been reported to be associated with a number of other mental disorders, including Depressive Disorders.

Specific Age and Gender Features

      The clinical picture may present differently at different ages.   Often the social disability of individuals with the disorder becomes more striking over time.   By adolescence some individuals with the disorder may learn to use areas of strength (e.g.,rote verbal abilities) to compensate for areas of weakness.   Individuals with Asperger's Disorder may experience victimization by others; this, and feelings of social isolation and an increasing capacity for self-awareness, may contribute to the development of depression and anxiety in adolescence and young adulthood.   The disorder is diagnosed much more frequently (at least five times) in males than in females.

Prevalence

      Definitive data regarding the prevalence of Asperger's Disorder are lacking.

Course

      Asperger's Disorder is a continuous and lifelong disorder.   In school-age children, good verbal abilities may, to some extent, mask the severity of the child's social dysfunction and may also mislead caregivers and teachers - that is, caregivers and teachers may focus on the child's good verbal skills but be insufficiently aware of problems in other areas (particularly social adjustment).   The child's relatively good verbal skills may also lead teachers and caregivers to erroneously attribute behavioral difficulties to willfulness or stubbornness in the child.   Interest in forming social relationships may increase in adolescence as the individuals learn some ways of responding more adaptively to their difficulties - for example, the individual may learn to apply explicit verbal rules or routines in certain stressful situations.   Older individuals may have an interest in friendship but lack understanding of the conventions of social interaction and may more likely make relationships with individuals much older or younger than themselves.   The prognosis appears significantly better than in Autistic Disorder, as follow-up studies suggest that, as adults, many individuals are capable of gainful employment and personal self-sufficiency.

Familial Pattern

      Although the available data are limited, there appears to be an increased frequency of Asperger's Disorder among family members of individuals who have the disorder.   There may also be an increased risk for Autistic Disorder as well as more general social difficulties.

Differential Diagnosis

      Asperger's Disorder must be distinguished from the other Pervasive Developmental Disorder, all of which are characterized by problems in social interaction.   It differs from Autistic Disorder in several ways.   In Autistic Disorder there are, by definition, significant abnormalities in the areas of social interaction, language, and play, whereas in Asperger's Disorder early cognitive and language skills are not delayed significantly.   Furthermore, in Autistic Disorder, restricted, repetitive, and stereotyped interests and activities are often characterized by the presence of motor mannerisms, preoccupation with parts of objects, rituals, and marked distress in change, whereas in Asperger's Disorder these are primarily observed in the all-encompassing pursuit of a circumscribed interest involving a topic to which the individual devotes inordinate amounts of time amassing information and facts.   Differentiation of the two conditions can be problematic in some cases.   In Autistic Disorder, typical social interaction patterns are marked by self-isolation or markedly rigid social approaches, whereas in Asperger's Disorder there may appear to be motivation for approaching others even though this is then done in a highly eccentric, one-sided, verbose, and insensitive manner.

      Asperger's Disorder must also be differentiated from Pervasive Developmental Disorders other than Autistic Disorder.   Rett's Disorder differs from Asperger's Disorder in its characteristic sex ratio and pattern of deficits.   Rett's Disorder has been diagnosed only in females, whereas Asperger's Disorder occurs much more frequently in males.   In Rett's Disorder, there is a characteristic pattern of head growth deceleration, loss of previously acquired purposeful hand skills, and the appearance of poorly coordinated gait or trunk movements.   Rett's Disorder is also associated with marked degrees of Mental Retardation and gross impairments in language and communication.

      Asperger's Disorder differs from Childhood Disintegrative Disorder, which has a distinctive pattern of developmental regression following at least 2 years of normal development.   Children with Childhood Disintegrative Disorder also display marked degrees of Mental Retardation and language impairment.   In contrast, in Asperger's Disorder there is no pattern of developmental regression and, by definition, no significant cognitive or language delays.

      Schizophrenia of childhood onset usually develops after years of normal, or near normal, development, and characteristic features of the disorder, including hallucinations, delusions, and disorganized speech, are present.   In Selective Mutism, the child usually exhibits appropriate communication skills in certain contexts and does not have the severe impairment in social interaction and the restricted patterns of behavior associated with Asperger's Disorder.   Conversely, individuals with Asperger's Disorder are typically verbose.  In Expressive Language Disorder and Mixed Receptive-Expressive Language Disorder, there is language impairment but no associated qualitative impairment in social interaction and restricted, repetitive, and stereotyped patterns of behavior.   Some individuals iwth Asperger's Disorder may exhibit behavioral patterns suggesting Obsessive-Compulsive Disorder, although special clinical attention should be given to the differentiation between preoccupations and activities in Asperger's Disorder and obsessions and compulsions in Obsessive-Compulsive Disorder.   In Asperger's Disorder these interests are the source of some apparent pleasure or comfort, whereas in Obsessive-Compulsive Disorder they are the source of anxiety.   Furthermore, Obsessive-Compulsive Disorder is typically not associated with the level of impairment in social interaction and social communication seen in Asperger's Disorder.

      The relationship between Asperger's Disorder and Schizoid Personality Disorder is unclear.   In general, the social difficulties in Asperger's Disorder are more severe and of earlier onset.   Although some individuals with Asperger's Disorder may experience heightened and debilitating anxiety in social settings as in Social Phobia or other Anxiety Disorders, the latter conditions are not characterized by pervasive impairments in social development or by the circumscribed interests typical of Asperger's Disorder.   Asperger's Disorder must be distinguished from normal social awkwardness and normal age-appropriate interests and hobbies.   In Asperger's Disorder, the social deficits are quite severe and the preoccupations are all-encompassing and interfere with the acquisition of basic skills.


Diagnostic Criteria For 299.80 Asperger's Disorder
[Conclusion to above, p84, DSM-IV-TR]

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
  1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
  2. failure to develop peer relationships appropriate to developmental level
  3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people)
  4. lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
  1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  2. apparently inflexible adherence to specific, nonfunctional routines or rituals
  3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  4. persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

Sources:
• http://www.ourspecialkids.org/dsmivtraspergers.html
• http://www.udel.edu/bkirby/asperger/aswhatisit.html



Personal Accounts


From: www.nas.org.uk/nas/jsp/polopoly.jsp?d=120&a=2202
...Normal people seem to put a great deal of emphasis on independence, despite the fact that they are much more socially dependent than I am. I have lived independently now for most of the last 7 years. I really don't think total independence is all it's made out to be.... people have called Asperger Syndrome "nerd disorder" because it is a higher-functioning form of autism...I have a very good "guest mode" where I can appear quite normal; however, being forced to sustain guest mode for an extended period can, and has, lead to a serious breakdown. My ability to behave near normally at times has led others to believe that I can do it all the time and if I don't then I am lazy, unmotivated, manipulative, and deliberately annoying. No one expects a tightrope walker to do it all the time...

... If I was placed in a slight stress situation, words would sometimes overcome the barrier and come out.... a person with autism is: "I am what I think rather than what I feel" ...

When a "normal" person thinks about something, the facts and the emotions are combined into a seamless whole. (I now understood why so many people allow emotions to distort the facts.) As an autist, my mind always separates the two. Even when upset, I scan my mind for "What's the customary response for this type of event/conversation/behavior?"

I keep reviewing the facts until I can come to a logical conclusion. For me, social relationships have been learned solely by intellect and use of my visualization skills. All my thoughts are in pictures, like videotapes. When I encounter a new social situation I scan my data banks for a similar situation that I can use as a model to guide me. My data banks also contain an archive of previous experiences, even news articles about diplomatic relationships between different countries. I use these scenarios to guide me in different situations. I then run videotapes in my imagination of all the possible ways to predict how the other person might act. Other people appear ridiculous to me, unpredictable, emotional unguided missles who's trajectory I have to somehow "predict." I have great difficulty with new social situations if I cannot recall a similar situation to use as a guide. Over time, I have built up a tremendous library of memories of my past experiences, TV, movies, and newspapers to spare me the social embarrassments caused by my autism.

Dr. Asperger noted that autistic children observe themselves constantly. They see themselves as an object of interest. For most people social interactions and emotions are the most important thing in their life. I have emotions but they are more like child emotions and only when I was working on my book, Thinking in Pictures, I realized I'm missing emotional complexity in my life, but I have replaced it with intellectual complexity. I obtain great satisfaction out of using my intellect. I like to figure things out and solve problems. This really turns me on. When I observe emotional complexity in others, it is sort of a rhythm that goes on between a boyfriend and a girlfriend. I often observe this on airplanes. Sometimes I get to sit next to them. It is similar to observing beings from another planet. The relationship is what motivates them; but for me, it is figuring out how to design something.

Self-stimulation, obsessions, rituals etc. are common behaviors in autistic persons. Self-stimulation releases tension and regulates sensory input. It compensates for the lack of interpersonal stimulation autistic people experience. There's often a direct correlation between increases in self-stimulation and decreases in self-injury. When it's necessary to blend-in, self-stimulation needs to be modified, of course. But obsessions are an inherent part of autism, providing the "sense of reality" necessary to maintain one's sanity.

Playground teasing for autistic children is routine due to the way they appear to non-autists. Some people believe they should allow children to be bullied because it will "toughen them up", they need to learn to act normal, they brought it on themselves (by acting weird), or, simply, "kids will be kids". Teasing may not affect the more oblivious autistics. Some autists have very little awareness of other people as kids, let alone whether those people are teasing them.

But as they grow older, the teasing, beating, and social ostracism can lead to depresion, self-injury, and suicidality. Teasing and bullying can have very serious consequences. Training the kid in self-defense is essential. Don't impart the lie that the world is inherently fair. It's WAR, and any parent who doesn't enable their offspring to fight their enemies is leaving their kids' survival in the hands of every mal-adjusted idiot they will encounter.



CAREER & AUTISM


From: www.leadershipmedica.com/scientifico/sciefebbr03/scientificaing/2sedrane/2sedraning.htm

[Book - "Thinking In Pictures: and Other Reports from My Life with Autism" - Temple Grandin ]

This brings up the importance of getting autistic people in high school and junior high school interested in something they can turn into a career. They need to build on their talents, such as art work and computer programming. Autistics also need mentors to explain the ways of the world and to help in selling themselves to get a job. In fact, getting and maintaining a job is one of the most difficult steps in the life of a person with autism; often during interviews, people are turned off by our direct manner, odd speech patterns and funny mannerisms.

While I was working at Corral Industries, I learned that being technically right was not always socially right. I criticized some sloppy welding in a very tactless way, and the workers got angry. The plant engineer gave me some good advice: "You must apologize to the workers before a small problem turns into a big one". He made me go to the cafeteria and apologize, and he helped me learn to criticize more tactfully. I quit the job at Corral Industries and continued to write for the Arizona Farmer Ranchman while I started my design business on a free-lance basis.

Free-lancing enabled me to avoid many of the social problems that can occur at a regular job. It meant I could go in, design a project, and leave before I got into social difficulties. I still don't easily recognize subtle social cues for trouble, though I can tell a mile away if an animal is in trouble. However, I would never stress enough how important it is that High Functioning and Asperger people develop their talents. There should be places for these guys to work, making shoes or painting for example: they need to be developed, they need to go to University. It is important to allow these people to get a job and, if there are difficulties at a regular job, you can avoid sensory problems being a free lance and working at home. But, I think also it's important to let all children with autism develop their talents from the beginning.



Career Comments


• "...Most people go into a new job and will be able to sum up the social hierarchy pretty quickly. They watch others to see how they are expected to behave. But a person with Asperger syndrome will probably have all their attention devoted to making sense of their environment and the work they are going to be asked to do."

• Social communication can be a big obstacle at work. You've got: Social bonding rituals like sarcastic banter and teasing; networking and developing rapport with colleagues; the pressure to perform well and impress at after-work social activities; handling bullies and exploiters; and projecting an image of competence and intelligence. Trying to do work and cope with all that at the same time is like doing the same job as the person next to you while blindfolded.



Asperger's & Success

www.autisticsociety.org/autism-article562.html

Some of the world's most famous people showed signs of autism or Asperger's syndrome, according to Jo Douglas, of The Spectrum Diagnostic, Assessment and Therapy Centre in Belfast.

"People with autism have an ability to see the world differently and have moved society on," she said.

"People with Asperger's have went on to become mathematical geniuses.

"They also can brilliant actors, as they've a better ability to read a script and adapt the character."

"Asperger's Syndrome provides a plus - it makes people more creative,"said Professor Michael Fitzgerald, a leading expert at Dublin's Trinity College.

Historial Irish writer WB Yeats may have had an autism disorder, the professor believes.

He has just published a new book, about autism and creativity: Is there a Link Between Autism in Men and Exceptional Ability?

Professor Fitzgerald said that Yeats' parents were told he would never amount to much after he failed to get into Trinity College.

Even though he had problems with reading and writing and a poor academic record at school, he went on to write poetic works of art and win the Nobel Prize for Literature, in 1923.

Famous people who, according to experts, have displayed signs of Autistic Spectrum Disorders include:

  • Jane Austen (1775 - 1817), English novelist and author of Pride and Prejudice.

  • Ludwig van Beethoven (1770-1827), composer of classical music during 18th - 19th century.

  • Alexander Graham Bell (1847 - 1922), inventor of the telephone.

  • Albert Einstein (1879 - 1955), scientist who developed the theory of relativity.

  • Vincent Van Gogh (1853 - 1951), Dutch painter.

  • Woody Allen (1935 - ), US comedian, director and actor.



Testosterone and Aspergers


  • There are about nine males with Asperger syndrome for every one female with the disorder.

http://www.websitetoolbox.com/tool/post/bgrh/vpost?id=736299
•Google: Asperger, testosterone, women

Asperger Syndrome has been described as an "extreme male brain". This theory holds that AS simply matches an extreme of the male profile:

  • with a particularly intense drive to systemize

  • and an unusually low drive to empathize.

The "tomboy" theory: women with Aspergers display more male behaviors than NT women.

The amount of prenatal testosterone - produced by the fetus and measurable in the amniotic fluid in the womb - predicts how sociable a child will be. The higher the level of testosterone, the less eye contact the child will make as a toddler, and the slower the child will develop language.



Neanderthal Theory


The "Neanderthal Theory" attempts to link autistic, Asperger, and ADHD traits to the presence of Neanderthal genes. The theory does not enjoy support from the scientific community.

Some of the points of this theory:

The main difference between Neanderthals and modern humans that can be observed in the archaeologic record is raw material movement. Modern humans moved raw materials much longer distances than Neanderthals did. This indicates that modern humans had much larger social networks than Neanderthals had. The sudden explosive development during the Upper Paleolithic, when Neanderthals and modern humans met, needs an explanation.

Neither modern humans nor Neanderthals had a comparable rate of technology development before this. Since modern humans would contribute with larger social networks, and therefore the spread of new technology, the role of Neanderthals in this must have been as inventors. It would then follow that Neanderthals were much more inventive, but that they kept their inventions within their groups. For several reasons explained in the theory, it then follows that a probable group structure of Neanderthals were matriarchal and with no exchange between groups other than of mates upon maturity. This postulate predicts:

  • Autistics will often lack social adaptations for dealing with unknown people.

  • Autistics will often be very efficient with conflict resolution in close-knit groups.

  • Autistics will often feel they were born with the wrong gender when participating in neurotypical cultures.

  • Autistics will often be involved in BDSM, fetishes, exhibitionism, and other sexual deviations.

More on this at:Wikipedia - Neanderthal Theory



Stims & Traits

http://www.autism-resources.com/autismfaq-glos.html

STIMS: "self-stimulation", behaviors believed to stimulate one's own senses. Examples include:

  • rocking one's body
  • hand-flapping
  • toe-walking
  • spinning
  • echolalia (the repetition of vocalizations made by another person).
People with autism report that some 'self stims' serve a regulatory function for them, such as calming them, improving concentration, or shutting out overwhelming sounds.


"Toe-Walking"

Ref: http://www.autism.org/toewalk.html

The vestibular system provides the brain with feedback regarding body motion and position. This is commonly dysfunctional in Autism, and may be responsible for toe walking. Research studies at the Center for Visual Management in Tarrytown, New York, four children who were toe walkers had their toe walking eliminated within seconds after wearing prism lenses.

A splint attempting to train the foot to the more customary position held by the cow-walking non-aspergerian.
leedergroup.com/MultiUseBoot . . . Google Results

"Another intervention used to stop toe walking involves wearing a cast to stretch out the tendon. The cast is applied every two weeks for a total of 6 to 8 weeks. Another treatment involves surgery. Long-leg casts are then worn for six weeks and followed by night splinting for several months."

http://www.crazyboards.org/forums/index.php?showtopic=14220

• Some try the phone book reverse stretch. Stand on a medium thick book and try to touch your heels to the floor. Hurts at first so get into it slowly.

• It is assumed that toe walking has to do with sensory overload when the whole foot contacts the ground or sole of the shoe.



WHY WOULD ASPERGER'S/AUTISM CAUSE TOE-WALKING? Some find that it improves balance, coordination and motor-control. One seems to become more unsteady with normal heel-toe walking. Those who experience this exhibit it more frequently indoors. This may be due to the narower pathways one must maneuver within to negotiate furniture, walls, etc., while one has a much wider field to operate within outdoors (It is believed that coordination difficulties are associated with AS & Autism).

SHOULD IT BE PREVENTED? Probably yes, since its odd appearance will cause problems fitting-in socially. In an ideal world, it would probably be better to let people practice their natural walking inclinations freely, but such hypothetical fantasies are useless for everyday living situations.

As I further examined this trait, I wondered: Why is one inclined to do this while sitting, where balance is not an issue? Is the calf-muscle conditioned to this raised position from general toe-walking? After decades of normal walking, the calf muscle must certainly be used to flexing normally by now. So the cause must be neurological rather than physical. But what would be the neurological reason for doing this while seated?

When I assume a flat-footed position while seated, my upper body tends to lean forward as if to compensate. I then arch my back sufficiently to assume normal upright seating. Perhaps the toe-walking habit has conditioned the back to assume a partially-stooped position, and the seated "toe-walking" is done to balance the forward-leaning back (and the resultant shift in one's center of gravity). I think I'm onto something here...

POSSIBLE CORRECTIONS: braces for the foot to hold it flat while the back is held erect with a posture-trainer or back-brace. (Such apparatus may have to be improvised from removable casts and ordinary back-braces). A bit odd for wearing at the office, but while on one's home computer this would draw fewer comments.



Google Search: www.wrongplanet.net "stim" stimming
"How do you stim?" - WrongPlanet Thread



Links


AS Messageboard - WrongPlanet.net - Multiple threads

GRASP - "Global, Regional AS Partnership" - Pro-AS; Multiple info & history articles

"Asperger Syndrome" - Wikipedia
AS Info Site - Links, an AS Test; - rdos.net (Sweden)
Personal Accounts, National Autistic Society UK

Asperger & Career (on this site)

Asperger's & Employment - Sensory overload, Selling yourself, - "...I became overloaded and couldn't even speak. My boss thought I was drunk. The store: blasting music, flashing lights, people shouting for attention... They all thought I was trying to get out of doing the work."

Adult Resources

Amazon: Adult Asperger Books List

Google: Asperger, Getting Diagnosed . . . "Diagnosed * adult" . . . "Get a diagnosis"

Getting Diagnosed as an Adult - National Autistic Society (UK)

aane NE Groups . . . aane Home Page . . . aane ADULT Resources

List: AS Clinics & Supports in MA - maapservices.org

MIT Asperger Messageboard (Poss source of diag Dr)
•"Resources" tree
•Msgs on diagnosing Drs

--- * * * ---
---Money-Grubbing Org. - Poss.diagnostician resources - Temp, Delete: ---
Autism Services Association, (Geocities page)
47 Walnut Street, Wellesley Hills, MA 02481 • Tel: (781) 237-0272 ext. 17 •(Poss. diagnostician locator)

•Autism Society of America "By State" Locator (1 for MA) . . . •Log In
--- * * * ---

Google: Asperger Groups
Google: "Living with Asperger's"
Google: Autism


STIM, Google Search: www.wrongplanet.net STIMMING:
"How do you stim?" - WrongPlanet Thread



HUMOR: "Diagnosis for NT" - http://isnt.autistics.org



ALTERNATIVE VIEWS

"INDIGO & CRYSTAL" - The idea that asperger/autism/ADD behaviors indicate a "scrambled energy pattern" which is more sensitive to negative energy emanating from envrionment and people. Solutions include becoming more gounded, physical contact with the earth (electromagnetic harmonization, discharging negative energies from the artificial environment), and becoming aware of their different order of perceptions.
• Google: "Indigo & Crystal"



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