Asperger Syndrome: Struggles with Social Interaction
Author:Christine Haran
You might think that you could recognize autism in someone without
much trouble, but neurologists and mental health specialists are now
realizing that many people with high-functioning autism disorders
often fly under the radar.
Like classical autism, Asperger syndrome and high-functioning autism
are neurological conditions that cause impairments in communication
and socialization. So people with these conditions might have trouble
having a back-and-forth conversation or picking up on body language.
Unlike people with classical autism, people with these disorders
always have average or above-average intellectual abilities. In fact,
it’s thought that a number of historic figures, such as Albert
Einstein, may have had Asperger syndrome and been aided by their
ability to zero in a given issue. But until recently, these disorders
were not widely recognized, which is why more and more adults are
being diagnosed.
Healthology talked with Marjorie Solomon, PhD, an assistant professor
in the Department of Psychiatry and Behavioral Sciences at the
University of California Davis Medical Center and a psychiatrist at
the Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.)
Institute, about how children and adults with Asperger syndrome and
high-functioning autism can learn to manage living in a social world.
What are Asperger syndrome and high-functioning autism?
Asperger syndrome and high-functioning autism are types of autism
spectrum disorders. Autism spectrum disorders range from classical
autism to milder forms like high-functioning autism and Asperger
syndrome. Symptoms occur in three areas: language or communication,
reciprocal social interaction—like being able to have a friend or to
engage in interactive conversations—and rigid or repetitive patterns
of behavior and interest.
To have a diagnosis of high-functioning autism or Asperger syndrome,
you also need to have an IQ in the average or above average range.
The difference between Asperger syndrome and high-functioning autism
is that individuals with Asperger syndrome don’t have a language
delay. In autism, single words aren’t acquired before two years of
age.
What causes autism–spectrum disorders?
Autism–spectrum disorders, in general, have a large genetic
component. There are some studies going on now taking a look at
environmental factors. I think, in five years, we’ll know more about
environmental factors that might be responsible for what’s being
called a big rise in autism. Some people say mercury in fish,
vaccines or living under high power lines or any number of things are
responsible for the increase.
Are autism-spectrum disorders more common in boys than girls?
So far, that’s what we think. The estimates range that boys outnumber
girls from 9 to 1 to 4 to 1. Girls can be harder to spot, though,
because girls tend to be socialized in our culture to fit in more and
not misbehave. For example, some girls with autism spectrum disorders
become very good at “pretending to be normal” and appear to function
well, but they really lack a complete understanding of social
interaction. So are we underdiagnosing girls? It’s actually an
interesting research question.
When are people usually diagnosed?
With autism, there is the language delay, so that’s going to start to
raise questions earlier. Asperger syndrome can show up later, because
some of the kids are extremely bright and they just seem kind of
quirky. They almost seem like little geniuses. We certainly see a lot
of cases where it’s not picked up until third grade or fourth grade.
At that time, the demands of being someone’s friend increase, and
kids with Asperger syndrome have trouble adjusting and fall behind
socially. Some kids with Asperger syndrome are really good at rote
learning, so when reading becomes more inferential and math more
complicated, the deficits become more pronounced.
Because Asperger syndrome wasn’t recognized as a disorder until the
early 90s, and because many health professionals are not trained to
recognize it, Asperger syndrome is now being diagnosed in adults who
weren’t picked up as children.
What are the symptoms?
Autism spectrum disorders involve problems engaging in nonverbal
behaviors like eye contact, facial expressions and body postures.
People with autism spectrum disorders may not use them properly and
don’t read them well in other people.
They don’t develop peer relationships that you would expect. I always
ask, “Has this child ever had a friend?” That, to me, is always a red
flag. By the time you get to third grade, you have to be able to have
a conversation and share interests and show some reciprocity.
There is generally a lack of seeking out others to share enjoyment.
But this isn’t always the case. Many kids with Asperger syndrome
actually approach others too much.
These children may also have a lack of emotional reciprocity, or
empathy. So we ask, “Does the child not get stuff? When somebody gets
hurt, do they laugh? Do they really just not get why somebody’s
upset?” That can look like defiance but it’s really a lack of
understanding.
What other kinds of behaviors might a child have?
They may have deep fascinations. Although young kids tend to have
preoccupations with topics like trucks and trains, in kids with
Asperger syndrome, it doesn’t go away. I’ve worked with some kids who
are 12, and they still are very much convinced that [the children's
TV show] Thomas the Tank Engine is a very important thing. Other
children are deeply fascinated with topics like astronomy, cosmology
or Japanese animation. They tend to memorize many facts about these
interests.
They also might have rigid patterns of behavior. One boy would get
upset if there was going to be an assembly at 10 o’clock instead of
math. Or some kids need to drive to school a certain way or they get
extremely upset. Another child we were working with was upset because
his mother dropped him off at preschool in the morning and his father
picked him up.
What are some coexisting problems?
Problems including depression and anxiety may occur with autism
spectrum disorders. It’s hard to know whether they are due to related
brain abnormalities or some of the problems and consequences
associated with autism spectrum disorders. Children with autism
sometimes get diagnosed with attention deficit-hyperactivity disorder
(ADHD) before receiving an autism spectrum disorder diagnosis.
How do problems change in adolescence and adulthood?
I don’t think we have great studies on individuals with Asperger
syndrome and high-functioning autism in later life, though we are
hearing more about people with Asperger syndrome in college. Some of
these kids are very good at school. If you get the hang of school,
the expectations are a lot clearer than they are in the work world.
I chatted recently with one mother about her son with Asperger
syndrome. He did fine at a good university undergrad. But then he had
several jobs where he could not understand the social expectations.
At his firm, he had to work in teams. He did not realize the politics
among his team members, so he would step on other people’s toes
without realizing it. His reviews repeatedly said, “You are arrogant
and act as if you’re the only who knows anything,” but he really
didn’t get what was going on.
It’s also complicated to maintain long-term intimate relationships.
You have to be able to read somebody’s nonverbal cues.
How is a diagnosis made?
Diagnosis has to involve collecting information from several sources,
such as parents and teachers. The doctor should do a psychosocial
history, finding out when language developed, what other kinds of
symptoms were present, what kind of social issues were present, if
there were any academic issues. A clinician should then sit with the
patient and evaluate them with a standardized evaluation tool. The
best advice is to go to somebody that has a recognized reputation in
autism spectrum disorders in your community.
How is Asperger syndrome or high-functioning autism treated?
To help people reach their potential, I advise at least assessment
and some form of treatment in the vast majority of cases. One of the
recommendations is a type of speech therapy called pragmatic language
work, or knowing how to use language appropriately. In social skills
groups, a form of therapy that often includes language pragmatics,
kids get together and learn skills in the context of a group setting.
For example if we’re working on conversation, we’re going to model a
conversation by passing a tennis ball back and forth. We’re teaching
them to ask someone else about themselves, and not just talk about
their own interests.
Cognitive-behavior therapy is a treatment that is being adapted to
deal with the anxiety and depression. We are also experimenting with
a therapy called parent-child interactive therapy to help children
with behavioral problems and inflexibility. Sometimes we recommend
others kinds of psychotherapy to deal with thinking issues, such as
learning how to become better at learning how to broaden their
perspective. Some people are experimenting with neural retraining
literatures, such as recognition of facial expression of emotion done
on computers.
Are medications helpful?
Medications can be helpful to deal with some of the symptoms. For
instance, attention medications are frequently given to help kids to
focus better and do better in school and not be so distractible.
Sometimes, a class of medications called SSRIs is used to help with
inflexibility, anxiety, depression or obsessiveness. Sometimes
atypical antipsychotics are used, if kids are having a lot of
behavioral issues. So medications can be helpful, but there’s no
medication that cures autism.
What is your overall advice to parents?
You want to seek professionals who have experience dealing with this
disorder. They can follow your child as different issues appear in
development. We can help kids with social skills that are appropriate
to an 8-year-old but, when they’re 14, the rules of the game change,
and they usually need more help.
There’s not a cure, but we are optimistic that with proper help and
guidance, people with Asperger syndrome and high-functioning autism
can have really good lives. And we hope that as we understand more
about social cognition, more tools and medications will be developed
that might be more specific for social interaction. This research has
attracted a lot of attention, because neural scientists and
geneticists really want to understand what makes us social beings;
there are a lot of broader implications.
{ 2 comments… read them below or add one }
Greatest advice I can give as a 12 year veteran parent raising a 16 year old son with Aspergers I heard at a Horizon's conference in Kansas City. "Raise your Aspergers child to be a great adult. Your focus is not give them a great teenage experience, because they won't have one. Your goal is to prepare them for adulthood and self sufficiency." The reality, all parents should do this for all their children, but with Aspie kids, it is very focused and intentional for long term success. You need to push them our of their comfort zone so they can gain experience. Lastly, quit making Aspi or Autism Spectrum an excuse. Do what you have to do to prepare your child for the future. Yes it will take more time and attention, but they were gifted with Aspie and God gave them to you to raise. You will learn alot about yourself in process.
) You may even find out you are similar in many ways. Hmmmm
Excellent advice for any parent. thank you for posting!