What is Asperger's ?

Common Deficits

Social Interactions: Most individuals with AS have interest in people around them, including peers. However, they often lack the skills to achieve their social goals. They often come across as insensitive, eccentric, odd or awkward. As a result, they might be alienated by peers around them and fail to make friends or sustain friendships. Due to their social oddities, some of them could easily be a victim of bullying and teasing at school or easily be taken advantage of. Their social deficits will be described in more detail:

• Lack of social reciprocity: relationship is often one-sided and mostly sustained by adults or peers; social give-and-take is lacking or not age appropriate. Some individuals with AS engage others in a one-sided conversation about their own favourite topics, disregard or are oblivious to the interest or reactions of their communicative partners.
  
• Not adept to use eye gaze to modulate social interactions: this does not equate to a total lack of eye contact; individuals with AS are not skilful in using eye gaze to initiate, sustain or terminate social interactions.
  
• Difficulties in reading social cues, both verbal and non-verbal: including facial expressions, body postures, social distance; deciphering social dynamics from the integration of these cues, intent of the people involved and the social setting is another layer of difficulties for people with ASD. Some people with AS memorize these cues as rules and fail to take the fluidity of social interactions into account.
  
• Difficulties in taking perspectives: some individuals with ASD find it hard to understand that others do not see what they see, think in the same way as they think or feel what they are feeling. Some individuals with AS is able to take perspectives when asked in a structured way but failed to apply their knowledge during day to day social interactions. Another description is a lack of empathy.

Communication:
As distinguished from individuals with autism, people with Asperger’s Syndrome do not present any delay in their language development. However, deficits in communication can still be discerned, particularly in the non-verbal part of communication. Oddities in loudness, pitch, intonation, prosody and rhythm are often reported. Some children with AS can be perceived as “pedantic” or acting like a little professor due to their use of formal language regardless of the situation.

Most individuals are described as “literal”. They might take some idioms and slang literally (e.g. they literally give you their “hands” when asked to give you a hand). They might fail to take into account all the information in a social context and hence, fail to understand sarcasms or jokes. Often, they might use “metaphors” or language that are meaningful only to themselves and fail to explain to others around them. Conversation of some AS individuals is tangential, or failure to shift topics for other AS individuals. It is often characterized by a collection of facts rather than an exchange of thoughts or ideas.

Restricted repetitive and stereotyped patterns of behaviours & interests:

Some individuals with ASD display odd motor or bodily mannerisms. Some examples of such include, hand flapping, tip-toeing, hand regarding, eye cornering, finger flicking, raking objects. Some spend hours focusing on parts of objects. Some examples of such include, looking at the spinning wheels of toys and real cars, putting objects close to their eyes and scanning some part of it repetitively, attending to the logos on various items (e.g. clothing, cars, etc.), staring at the pilot light of electronic equipment.

Some do not have peculiar mannerisms but might be engrossed in repetitive motions with objects. Some examples include, opening and closing doors, lining up objects, stacking objects, flipping switches. Some adhere to non-functional routines or rituals: e.g. pressing certain buttons on the lift panel (instead of the functional ones), insisting to have the same place for certain activities or the same utensils without apparent reasons, insisting to go onto the same route when going somewhere.Some have very few interests and often, they are very intense and seem to be preoccupied by these interests. Sometimes, these interests might not be common in one’s peer group or subculture: e.g. interest in bus routes, tomb stones, octopus. Some AS individuals are so obsessive in their interests that they become experts in the area.

The lack of delay in language and cognitive development usually distinguish AS from the other forms of ASD. Some individuals with AS also display motor clumsiness. In fact, Dr. Hans Asperger described the individuals he observed as “physically clumsy” in his original paper on “autistic psychopathy” in 1944. However, physical clumsiness or lack of coordination is not a reliable diagnostic indicators for AS.

Due to their unaffected language and intellectual development, most children with AS are not diagnosed until 3 years old or when they are at school age. There is also a growing population of adults approaching clinicians for the diagnosis because this disorder was not known years ago when they were children. Due to lack of appropriate interventions as a result of misdiagnosis or no diagnosis, some individuals develop depression and anxiety disorders after repetitive failure in the social world.

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Diagnostic Criteria I

The diagnostic criteria for Asperger’s Disorder, according to the Diagnostic & Statistical Manual: 4th Edition, are listed: 299.80 Asperger’s Disorder

• Qualitative impairment in social interaction, as manifested by at least 2 of the following:

1. marked impairment in the use of multiple nonverbal behaviours 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, interest, or achievement 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.

• Restricted repetitive and stereotyped patterns of behaviour, 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, non-functional 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.

The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. 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) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behaviour (other than in social interaction), and curiosity about the environment in childhood. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

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Diagnostic Criteria II

Christopher Gillberg’s diagnostic criteria is different from the DSM:IV and are also commonly used as a reference to the diagnosis. His criteria are listed:

All six criteria must be met for confirmation of diagnosis:

1. Severe impairment in reciprocal social interaction (at least two of the following)

• inability to interact with peers
• lack of desire to interact with peers
• lack of appreciation of social cues
• socially and emotionally inappropriate behavior

2. All-absorbing narrow interest (at least one of the following)

• exclusion of other activities
• repetitive adherence
• more rote than meaning

3. Imposition of routines and interests (at least one of the following)

• on self, in aspects of life
• on others

4. Speech and language problems (at least three of the following)

• delayed development
• superficially perfect expressive language
• formal, pedantic language
• odd prosody, peculiar voice characteristics
• impairment of comprehension including misinterpretations of literal/implied meanings

5. Non-verbal communication problems (at least one of the following)

• limited use of gestures
• clumsy/gauche body language
• limited facial expression
• inappropriate expression
• peculiar, stiff gaze

6. Motor clumsiness: poor performance on neurodevelopmental examination

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Prevalence

There is no official report about the prevalence rate of Asperger’s Disorder in Hong Kong. Epidermiological studies elsewhere vary tremendously due to the use of different diagnostic criteria. The other complication is about the diagnosis in itself, particularly the difference between Asperger’s Disorder (AS) and High Functioning Autism (HFA). HFA is a common term used to refer to individuals with a diagnosis of autism and an IQ of higher than 80.