What to know about Asperger’s syndrome

Asperger’s syndrome is a part of the autism spectrum and people no longer consider it an independent diagnosis.

Asperger’s syndrome (AS) used to be a stand-alone diagnosis, but in 2013, the American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and included it as part of autism spectrum disorder (ASD). It is also called “ASD — without intellectual or language impairment.”

An autistic person often finds it harder to read social signals, which can make it more difficult for them to communicate and interact with others. These difficulties can lead to anxiety and depression.

It is unclear exactly how many people are living with AS. Some estimates put the number at about 1 in every 250 people. However, this estimate may not be accurate, in part due to the lack of studies on the prevalence and the new categorization of the syndrome under the broad category of autism.

About 1 in 44 people are living with autism. Additionally, more than four times as many boys receive a diagnosis compared with girls, for a number of reasons.

Here are some key points about ASD and Asperger’s:

Fast facts on Asperger’s syndrome (now a diagnosis within ASD)

• Asperger’s syndrome (AS) is a part of autism spectrum disorder (ASD) that affects communication and socialization skills.
• An autistic child may show early signs of the disorder, but most get diagnosed between the ages of 3 and 10.
• AS is a diagnosis that happens more often for those born male than those born female.
• Signs of AS include obsessive interests, formal speech, rituals, social isolation, delay in motor skills, lack of imagination, and sensory difficulties.
• Teaching strategies and therapies can enhance the quality of life of an autistic person with AS.

Signs and support needs

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The signs of AS vary widely. Early signs of autism spectrum disorder, in general, may appear early in life, with most cases diagnosed in children from 3–10 years old. A delay in developmental evaluation could cause a later diagnosis.

These signs include poorly coordinated motor skills, leading to clumsiness or awkwardness. The main difference between AS and other forms of autism is the presence of strong verbal and intellectual skills.

Other common signs include:

• a child’s obsessive interest in a single object or topic to the exclusion of others
• repetitive routines or rituals
• peculiarities in speech and language
• socially different behavior that people may view as inappropriate
• issues interacting successfully with others
• issues with nonverbal communication
• clumsiness and lack of coordination

However, some children and adults can learn to compensate and build on their strengths. Potential strengths include:

• ability to recognize patterns easily
• strong ability to focus and pay attention to detail
• strong persistence

Therapies and support

After a person receives a diagnosis, several therapies and social supports may help. There is no therapy to cure AS, but it can help a person to learn to manage differences in the way they think, perceive the outside world, and interact with others. Common therapies include:

• Education and academic skills: A child who receives a diagnosis of AS may benefit from educational support. Aims can include organizing notes, managing homework goals, and addressing any specific learning needs. Support may also include the need for a more advanced curriculum.
• Acquiring appropriate social skills: The individual can learn strategies to enhance their interactions with others, for example, by learning how to read and respond to social cues.
• Communication skills training: Specialized speech and language therapy can help the person learn how to start and maintain a conversation, for example. This also includes learning how to use tone of voice in questions, confirmations, disagreements, and instructions, and how to interpret and respond to verbal and nonverbal cues.
• Cognitive behavioral therapy (CBT): The person learns to control emotions and decrease obsessive interests and repetitive routines.
• Behavior modifications and supports: This includes strategies for supporting positive behavior and decreasing ineffective behavior, such as through applied behavior analysis (ABA).
• Occupational or physical therapy: This can help those with sensory integration problems or poor motor coordination.
• Medication: There are no medications for AS, but a person may use drugs to treat symptoms such as anxiety.

A 2015 review of studies into alternative therapies for ASD found that, according to anecdotal evidence, music therapy, sensory integration therapy, acupuncture, and massage may also help.

However, the authors came to the conclusion that no evidence fully supports the effectiveness of alternative or complementary medication for ASD.

The role of supporting caregivers

Parents and other caregivers may benefit from learning experiences that help them gain a deeper understanding of AS.

By learning some strategies, they can better support a loved one living with AS and prevent them from feeling isolated.

For example, a person living with AS can often cope with change if they know it is coming and if someone has planned it. Family and other support networks can help the person prepare for change when appropriate and help teach family members about the importance of preparing the person for the change.

If parents believe that their child may have signs of AS, it is important to communicate with the child’s school because educational institutions can offer learning support in the form of an Individualized Education Plan (IEP) or Gifted Individualized Education Plan (GIEP).

It is important to note that not every child qualifies for an IEP or GIEP, but if an educational team believes it is necessary, the child will gain additional support protected by law.

The core characteristics of AS are lifelong, but additional support can help the individual maximize their achievements and quality of life.

Causes

The exact causes are unknown, but AS may result from a combination of genetic and prenatal brain differences.

Some researchers have proposed that environmental factors may contribute to the development of AS. While researchers and others have speculated on several potential causes, no environmental factor has substantial evidence to support its case as a direct or indirect cause of AS.

Complications

There are a few complications of Asperger’s syndrome. It can be an underlying condition that fuels other functional difficulties, or the complications can arise from some of the symptoms of AS. Some potential complications include:

• Sensory difficulties: Some people may have a distorted sensory sensitivity, so their senses can be either intensified or underdeveloped. This may affect how the person perceives noise, bright lights, intense smells, food textures, and materials.
• Social issues: Challenges with how a person interprets body language, emotions, and how they speak can lead to issues with relating to others. This can negatively affect school, work, social, and home life.
• Development of other conditions: Co-occurring conditions alongside AS may develop, such as depression or anxiety related to social isolation or other challenges. Other medical conditions are also more common in autistic people, such as immune conditions, gastrointestinal and sleep disorders, seizures, obesity, dyslipidemia, hypertension, and diabetes.

Diagnosis

Diagnosing AS is the first step to getting appropriate treatment. One of the challenges of diagnosing the condition is that a doctor may confuse the symptoms with other common mental health conditions, such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), or oppositional defiant disorder (ODD).

Another challenge is overcoming issues in diagnosing across genders, with those born female often receiving a misdiagnosis due to variations in behavior.

There are even some studies suggesting that doctors are overdiagnosing ASD, although professionals need more research to make that determination.

If a parent or caregiver suspects delays in social skills, they can refer the child to a pediatrician. Their primary doctor can then recommend a specialist, such as a developmental pediatrician or psychologist, to formally diagnose the condition.

There is no specific test for Asperger’s syndrome. However, professionals with training to diagnose will sometimes use a combination of interviews and questionnaires such as the Autism Spectrum Rating Scales (ASRS), the Gilliam Autism Scales (GARS-3), the Childhood Autism Rating Scale (CARS 2), and the Autism Diagnostic Observation Schedule (ADOS-2) to make informed clinical decisions.

Physical tests, such as hearing, blood tests, or X-rays, can rule out other conditions and determine whether a physical disorder is causing the symptoms.

Early diagnosis can be difficult due to the wide range of symptoms, so an accurate diagnosis or appropriate treatment may not occur until adulthood.

Takeaway

Asperger’s syndrome (AS) was once considered a stand-alone diagnosis until the American Psychiatric Association released the DSM-5 in 2013 which included it as part of autism spectrum disorder. It is no longer considered a separate diagnosis.

Diagnosing autism spectrum disorder can be challenging, but therapy and support methods can aid those living with ASD in managing differences in thought patterns and habits and avoiding complications.