Section 4 - Asperger's Disorder

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Lecturer: Simon Bignell

Section: 4 of 11

‘Autism, Asperger’s & ADHD’ (6PS055)

‘ADHD, Autism & Asperger’s’ (6PS077)

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Asperger’s Disorder

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Introduction to the Section.

• What is Asperger’s Disorder?• Symptoms of Asperger’s.• How Asperger’s was first recognised.• Characteristics of Asperger’s Disorder.• How is Asperger’s different from Classic

Autism.• Questions.

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Learning Outcomes of this Section.

On completion of the Section and with independent study you should be able to:

1. Understand the main symptoms, variations and diagnostic criteria relating to Asperger’s disorder.

2. Be able to describe Asperger’s disorder in detail.

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Autistic Spectrum Disorder.

A continuum that… “…ranges from the most profoundly

physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.”

The Autistic Spectrum (2003) Lorna Wing

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Autism

No single cause; no single cure.

Hence: A spectrum, a continuum, a

syndrome.

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Terms.

There is a confusing plethora of terms including autism, autistic disorder, Asperger syndrome or disorder, high-functioning, pervasive developmental disorder (PDD), semantic-pragmatic disorder, pathological demand avoidance, Nonverbal Learning Disability, PDD-NOS, atypical Asperger syndrome.

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The DSM-IV includes five types of disorder under the term ‘Pervasive Developmental Disorder’ PDD.

1) Autistic Disorder*.2) Rett’s Disorder.3) Childhood Disintegrative Disorder.4) Asperger’s Disorder*.5) Pervasive Development Disorder Not

Otherwise Specified*.* Mainly these form the Autistic spectrum ASD.

What Is Asperger’s Disorder?

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• ASD is a spectrum of disorders. Ranges from low functioning – high functioning / Asperger's syndrome.

• Milder / higher-functioning form of Autism characterised by impairments in the social domain, some impairment in the behaviour/interests domain.

• No significant delays in cognitive or language skills.


• The triad of impairment summarises the difficulties of the Autistic child but the actual manifestation of these can vary. Asperger’s may be a subtler form of ASD.

Restricted, repetitive and stereotyped patterns of behaviour.

Impairment in social interaction.

Impairment in verbal and non verbal communication.

Peculiarities in verbal and non verbal communication.

Wing and Gould’s triad of impairments

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Asperger’s Diagnosis.A. Qualitative impairment in social interaction, as

manifested by at least two of the following: • Marked impairment in the use of multiple

nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.

• Failure to develop peer relationships appropriate to developmental level.

• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people.

• Lack of social or emotional reciprocity.

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Asperger’s Diagnosis.B. Restricted repetitive and stereotyped patterns of

behavior, interests, and activities, as manifested by at least one of the following:

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

• Apparently inflexible adherence to specific, nonfunctional routines or rituals.

• Stereotyped and repetitive motor mannerisms.• Persistent preoccupation with parts of objects.

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Asperger’s Diagnosis.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 in social interaction), and curiosity about the environment in childhood.

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

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How AS was First Recognised.

• Leo Kanner and Hans Asperger who, independently of each other, published accounts of this disorder.

• These publications, Kanner's in 1943 and Asperger’s in 1944, contained detailed case descriptions and also offered the first theoretical attempts to explain the disorder.

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• Asperger’s paper, written in German, and published during the second world war, was largely ignored.

• Asperger’s definition of autism or, as he called it, ‘autistic psychopathy’ is far wider than Kanner's.

• The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This is not the case.

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• 1944 - First identified in Austria by Hans Asperger.• 1981 - Reintroduced as Asperger’s Syndrome by

Lorna Wing who reviewed Asperger’s paper.• Wing’s review provided a description of Asperger’s, as

well as 34 case studies, and discussed classification and differential diagnosis.

• 1994 - Recognised as a distinct disorder by the American Psychiatric Association in the DSM-IV.

• United Kingdom, Australia, and Sweden lead in research on AS.

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Characteristics Of Asperger’s.

• It’s lifelong disorder of unknown origin that usually shows up around 18 months to 3 years.

• Generally thought to be a form of Autism, it is characterised by.– Normal or above-normal intelligence.– Social awkwardness.– Verbal rigidity.– A fixation with an obscure topic that

can be learned by rote.

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• People with Asperger's have a hard time relating to other people.

• Can and do go on for hours about their obsession. (Little Professors!).

• Not interested in playing with other children but later often desire relationships.

• Preoccupation with things that seem beyond their age level.

• Little or no eye contact.• Fascinated with numbers and letters.

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Qualitative impairment of social interaction:

• Delays in nonverbal behaviors (gesturing, facial expression, body posture).

• Impairments in establishing peer relationships.

• Absence of spontaneous seeking to share enjoyment, interests, or achievements with others.

• Theory of Mind - Some have described individuals with AS as having a low ‘EQ’ or Empathy Quotient or as having a ‘Learning Disability’ in social skills.


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• Stereotyped Behaviors, Activities, and Interests.

• Preoccupation with narrow area of interest.• Inflexibility or rigidity – often causes stress.• Sticking to a set, sometimes nonfunctional

routine.• Repetitive motor movements.• Preoccupation with objects.


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• Sensory differences - touch, taste, odours, textures, noise levels, lighting.

• Motor clumsiness, especially in younger children.

• Poor problem-solving and organisational skills.


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Characteristics Of Asperger’s.• Talks in a flat affect.

– Voice and tone modulation – failure to make voice interesting to listener because they lack the concept of the listener as interested.

– May sound robotic.• Speech may be characterised by poor

prosody, awkward intonation, and odd/inappropriate subject matter.

• Echolaic speech.

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• People with Asperger's Disorder are inclined to construe language very literally.

– so they may not understand slang or informal speech.

• People with Asperger's Disorder may also have difficulty decoding tone of voice and facial expressions.

– Derisive statements such as, "Oh, that was great!" may inadvertently provide positive reinforcement of an inappropriate behaviour.

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• Have unusual fear based or stress based reactions.

– Tear up a room.

– Tantrum.

– Reactions are not proportionate to the situation.

– Very easily upset.

• Have a strong desire for routine or sameness.

• Have limited ability to form friendships.

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• Unlike Autistic individuals, who may seem aloof and disinterested in others, people with Asperger’s tend to desire to interact with others, but don’t know how to in an appropriate way.

• Often self-described “loners.”

• May live very successful independent lives in appropriate job settings.

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Assessment & Diagnosis.

• Similar to Autism (We’ll cover more on this in later Sections).

• It’s easier to ‘spot’ Autism at the low-functioning end of the spectrum.

• Not so easy to spot Asperger’s Disorder.

• High functioning children do adapt .

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Prevalence Of Asperger's.

• More common in males.• Prevalence estimates vary widely (36/1000

to 1/10,000) depending on what literature you read. We just don’t know accurately.

• Incidence increasing greatly recently.• Increase due to better identification or true

increase due to unknown factor?

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Prognosis.• The factors associated with a good prognosis

are a normal IQ, high-level social skills, better communication skills and later onset.

• Prognosis depends on severity and services available.

• Jobs often in area of their interest, which can also help with social integration.

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Co-morbid Disabilities.• In addition to Asperger's disorder, many people with Asperger's

will also exhibit:– Tics (blinking, sniffing, facial grimaces, throat clearing).– Obsessive Compulsive Disorder.– Executive Dysfunction.– ADHD.– Anxiety.– Sleep Disturbances.– Eccentric eating habits.– Self-injurious behaviors.– Depression – especially in adolescents.

• Learning Disabilities.

• …Even though they may not be formally diagnosed with those disorders.

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Co-morbid Disabilities.

• Tics.– Are distinguished by sudden, repetitive movements

(motor tics) or sounds (phonic tics).– Frequently preceded by a premonitory feeling of an

urge, anxiety, distress, or other sensory phenomena.

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• Obsessive Compulsive Disorder.– Repeated and unrelenting beliefs, impulses, or

images cause marked anxiety or distress.

The person endeavors to ignore or restrain such thoughts, impulses, or images, or to counterbalance them with some other thought or action that the person feels compelled to complete in response to an obsession, or concurrent to rules that must be applied inflexibly.

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• Executive Dysfunction– planning for the future – the ability to inhibit or delay responding – initiating behavior, and – shifting between activities flexibly

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Unique Difficulties Of AS.• The very characteristics that make child higher functioning can

produce its own difficulties.– Awareness of social difficulties.– Disabilities not always taken seriously.– Late/difficult diagnosis.

• Until school, symptoms not always disruptive, child may seem simply extremely bright.

• Easy to miss diagnose or misdiagnose.• Teachers’ Misunderstandings. (Disabilities not always taken

seriously).– Compensates for lack of social insight with logic.– Verbal abilities appear intact.– Rote memory.– Logical thinking.

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Differences In Presentation From Autism.

Asperger’s• Later onset• Higher range of IQ• No language deficit• Non-verbal

communication problems less severe

• Clumsiness in basic motor skills

Autism• Early onset• IQ tends to be lower• Often fail to develop

spoken language• Problems with non-verbal

communication• Tend to be adept at basic

motor skills

Section 4 - Asperger's Disorder

Education

Transcript of Section 4 - Asperger's Disorder