When you meet a child with Asperger's syndrome, two things may be immediately apparent. He is not developmentally behind other children, but has problems with social skills. Such a child has a tendency to obsessively concentrate on one topic or to reproduce the same manipulation over and over again.
For a long time, experts identified Asperger's syndrome as an independent disease. Today he is no longer like that. Asperger's syndrome is part of a larger category called autism spectrum disorder. These are disorders of the nervous system characterized by difficulties with communication and social interaction, stereotypical and repetitive patterns of action, and uneven mental development, often with cognitive deficits.
Asperger's syndrome is less severe than other types of autism spectrum disorder.
The syndrome was named after Dr. Hans Asperger, a pediatrician from Austria. In 1944, he first described this condition. The doctor spoke about the four boys; they showed "a lack of empathy, poor ability to form friendships, self-talk, deep immersion in an object of interest, and clumsy movements." Because of their obsessive interests and knowledge of specific subjects, he called the boys "little professors."
Many experts today focus on the special talents and positive aspects of Asperger's disease and believe that the disorder involves a different, but not necessarily defective, way of thinking. Positive traits of people with Asperger's syndrome have been cited as beneficial in many professions and include:
- increased ability to concentrate on details;
- persistence on specific issues of interest without wavering;
- ability to work independently;
- highlighting details that may be missed by others;
- intensity and originality of thinking.
Although it is impossible to diagnose Asperger's disease without direct testing and observation of the individual, some authors have suggested that many successful historical figures likely had Asperger's syndrome, including Albert Einstein, Mozart, Thomas Jefferson, Benjamin Franklin, and Marie Curie. Of course, a definitive diagnosis of historical figures with Asperger's syndrome is impossible, and many of the signs exhibited by people with the disorder may also arise from intellectual giftedness or even attention deficit disorder.
Reasons
The etiology of Asperger's syndrome is unknown. Some children with the disorder have had complications during the prenatal and neonatal periods and during childbirth, but the link between obstetric complications and Asperger's syndrome has not been confirmed.
Adverse events during the prenatal, perinatal, and postpartum periods may increase the likelihood of developing Asperger's syndrome. In a Swedish study, negative perinatal incidents were reported in about two-thirds of 100 men with Asperger's syndrome, and the mother experienced infections, vaginal hemorrhage, preeclampsia (late-onset toxicosis) and other critical episodes during pregnancy. It is unknown whether the syndrome is a consequence or a cause of perinatal complications in such cases.
Brain imaging studies have shown that there are structural and functional differences in certain areas of the brain between individuals with Asperger's syndrome and those without.
Studies of families in which several members have Asperger's syndrome have suggested that there is a genetic contribution to the development of the disorder.
Research has shown that several genes are likely involved in autism spectrum disorder. In some children, Asperger's syndrome may be associated with genetic disorders such as (severe central nervous system pathology) or Martin-Bell syndrome (fragile X syndrome). In addition, genetic changes may increase the risk of developing autism spectrum disorder or determine the severity of symptoms.
Exogenous factor
Environmental influences are of some importance. While some families remain concerned that vaccines and/or preservatives in them may play a role in the development of Asperger's syndrome and other autism spectrum disorders, experts have discredited this theory.
Due to differences in diagnostic criteria, estimates of the prevalence of Asperger's syndrome vary widely. Various studies from the US and Canada, for example, have reported rates ranging from 1 in 250 children to 1 in 10,000. Additional epidemiological studies using generally accepted criteria and a screening tool that targets these parameters are needed.
A population study in Sweden found the prevalence of Asperger's syndrome to be 1 in 300 children. This estimate is compelling for Sweden because complete medical records are available to all citizens of this country and the population is very homogeneous. However, in other parts of the world, where none of these factors apply, the prevalence may be quite different.
Like Sweden, other Scandinavian countries maintain health records of their populations and are thus uniquely suitable locations for epidemiological research. Comparable studies cannot always be easily carried out in other parts of the world. For example, in New York City, many residents are immigrants, and it is not always possible to obtain medical records from their country of origin.
However, Asperger's syndrome may be more common than researchers once thought. Pediatricians, family physicians, general practitioners, and other health care providers may underestimate this disorder. Family members sometimes attribute symptoms of Asperger syndrome to the child's personality traits.
Asperger's syndrome in children does not have a clear racial bias. The estimated ratio between boys and girls is approximately 4:1. However, research shows that the disorder should not be considered a male disorder.
The syndrome is usually diagnosed during the early school years. Less commonly, it is detected in early childhood or in adults. However, there may be a number of adults with Asperger's syndrome who have excellent coping and coping skills and who behave in a manner consistent with societal expectations. The disease in this case is never diagnosed during their lifetime.
Children with the syndrome have a good prognosis when they receive support from family members who are knowledgeable about the disorder. These individuals may learn specific social cues, but the underlying social impairments are expected to be lifelong.
Individuals with Asperger's disease have a normal life expectancy; however, they have a higher prevalence of comorbid mental health conditions such as depression, mood disorders, obsessive-compulsive disorder (obsessive-compulsive disorder) and (neuropsychiatric disorder). Comorbid mental disorders (interrelated diseases), when present, significantly influence prognosis.
Depression and hypomania (mild mania) are common among adolescents and adults with Asperger's syndrome, especially those with a family history of these conditions. People caring for people with this condition may also be prone to depression.
An increased risk of suicide is observed in individuals with this syndrome. This risk increases in proportion to the number and severity of comorbidities. In many cases of suicide, the person has Asperger's syndrome undiagnosed because awareness of the condition is often low and the methods used to identify it are often ineffective and unreliable. People with this disorder who commit suicide often have other psychiatric problems.
Symptoms
An individual's symptoms range from mild to severe. Each child's level of functioning will also be different. Children may have all or only some of the characteristics described below. They may have more problems in unstructured social settings or in new situations involving communication problem-solving skills.
Children with Asperger syndrome have difficulty communicating with peers and may be rejected by other children. Teens with the disorder typically develop depression and feel lonely.
Outside of immediate family interactions, the affected child may make inappropriate attempts to initiate social interactions and make friends with others. Children with the syndrome may be afraid to demonstrate sincere desires to communicate with peers. But family members can teach such a child to express his love for his parents through numerous rehearsals over many years.
It happens that the affected child cannot show affection to parents or other family members.
Children with Asperger's syndrome have special and narrow interests that exclude other activities. These interests may take precedence over their relationships with their family, school, and community.
Changes in a child's daily life (divorce of parents, change of school, moving) can also worsen anxiety, depression and other psychological disorders.
Communication disorders
Affected children have very limited use of gestures. Body language or nonverbal communication may be awkward and inappropriate. Facial expressions may be absent. When answering questions, the child usually makes mistakes. These children often give inappropriate answers.
Children with Asperger's syndrome exhibit several abnormalities in speech and language, including elaborate speech and oddities in delivery, intonation, prosody (stress placement), and rhythm. Misunderstanding of linguistic nuance (eg, literal interpretations of figures of speech) is common.
Children often have practical speech problems, including:
- inability to use language in social contexts;
- interrupting another person's speech;
- irrelevant comments.
Speech is unusually formal or difficult for other people to understand. Children can voice their thoughts without censorship.
The volume of speech can vary greatly and reflect the current emotional state of the child, and not the requirements for communication in the social sphere. Some children may be talkative, others silent. Moreover, the same child can demonstrate both verbosity and persistent silence at different times.
Some children may exhibit selective mutism (failure to speak in certain situations). Some people can only talk to those they like. Thus, speech can reflect individual interests and preferences of the individual.
The form of the chosen language may include metaphors that are meaningful only to the speaker. A message that means something to the speaker may not be understood by those who hear it, or it may only make sense to some people who understand the speaker's personal language.
Children often exhibit auditory discrimination and distortion, especially when faced with 2 or more people speaking at the same time.
Touch Sensitivity
Children with Asperger's syndrome may have abnormal sensitivity to sound, touch, pain, and temperature. For example, they may demonstrate either extremely great or decreased sensitivity to pain. Possible hypersensitivity to food texture. Children experience synesthesia when a stimulus in one sensory or cognitive system triggers an automatic, involuntary response in another sensory mode.
Delayed motor skills
- visible clumsiness and poor coordination;
- deficits in visual-motor and visual-perceptual skills, including problems with balance, manual dexterity, handwriting, rapid movements, and rhythm.
Several factors make diagnosing Asperger's syndrome difficult. Like other forms of autism spectrum disorder, it is characterized by impairment in social interaction accompanied by repetitive and restricted interests and behaviors; it is distinguished from other autism spectrum disorders by the absence of an overall delay in language or cognitive development. Diagnostic challenges include inconsistency between criteria, and controversy regarding the differences between Asperger's syndrome and other forms of autism spectrum disorder.
When checking a child's development, a pediatrician can identify signs that require further investigation. A comprehensive evaluation by a team of specialists is necessary to confirm or rule out the diagnosis. This team usually includes a psychologist, neurologist, psychiatrist, speech therapist, pediatrician, and other specialists experienced in diagnosing Asperger syndrome. Comprehensive assessment includes neurological and genetic aspects with in-depth cognitive and language testing to establish IQ. It also includes assessment of psychomotor function, verbal and nonverbal communication, learning style, and independent living skills.
Communication screening includes assessment of:
- non-verbal forms of communication (gaze and gestures);
- use of metaphors, irony and humor;
- setting stress and volume of speech;
- content, clarity and coherence of the conversation.
Testing may include an audiological examination to rule out hearing loss. Identifying a family history of autism spectrum disorder is important.
"Understanding the mind of others" can be considered as the ability to comprehend the meaning of the mental processes of oneself and others, which allows one to predict the reactions of other people to ordinary situations. A child with Asperger's syndrome has a deficit in developing this understanding.
In children with possible developmental problems, screening for "understanding the mind of others" is an important process that a specialist can use to identify some of the core behavioral symptoms of Asperger's syndrome. Typical children demonstrate its presence before starting school. Thus, the inability of a school child to correctly perform any screening procedure indicates the need to refer him for additional examination.
Screening for “understanding another's mind” consists of two main components: a simulation of a puppet play and an imagination task. It can be performed in a doctor's office or other everyday settings and takes only a few minutes.
The doctor and patient sit at opposite ends of the table. The specialist shows the patient 2 dolls and names them, saying: “This is Sveta. This is Anya."
Modeling includes 2 procedures. First, the doctor describes and shows Sveta, placing the pebble in the basket. Then he removes Sveta from the room and closes the door, leaving her outside. Next, the doctor describes and shows how Anya takes a pebble out of the basket and places it in a box. Finally, the specialist returns the first doll to the room and asks the patient: “Where will Sveta look for the pebble?”
A child with a developed “understanding of someone else’s consciousness” will answer that Sveta will look for the pebble in the basket where she put it before leaving the room. If this answer is received, the procedure ends and the clinician can then move on to the imagination task.
The answer “He will look for Light in a pebble in a box” signals that the child does not have “an understanding of someone else’s consciousness.” This response indicates that the patient cannot distinguish Sveta's mind from his own and thus does not recognize that Sveta was absent and could not have known that the pebble was moved from the basket to the box. The child assumes that since he knows that the pebble is in the box, Sveta must also know it.
If the patient does not answer that Sveta will look for a pebble in the basket, the doctor will continue to ask questions to clarify the patient’s understanding of the situation. The specialist asks the patient: “Where is the pebble really?” Both healthy children and children with the syndrome usually claim that the pebble is in the box. The doctor then asks, “Where was the pebble in the beginning?” A normal child and a toddler with a disorder will state that the pebble was originally in the basket.
In the second procedure, the doctor describes and shows that Sveta places a pebble in a basket, then removes it from the room and closes the door, leaving the doll outside. Then the specialist describes and shows how Anya takes the marble stone out of the basket and places it in the doctor’s pocket. Finally, the doctor returns the first doll to the room and asks the patient: “Where will Sveta look for the pebble?”
Healthy patients with “understanding of someone else’s consciousness” answer that Sveta will look in the basket, because this is where she last placed the pebble. If this answer is received, the doctor moves on to the imagination task. If not, the specialist asks the patient: “Where is the pebble really?” And “Where was the pebble in the beginning?” to make sure the patient understands the situation.
The procedure consists of 3 parts. In the first, the doctor tells the patient: “Close your eyes and think of a big white teddy bear. Mentally take a snapshot of the image. Do you see a white teddy bear?
A healthy patient will report seeing an image of a large white teddy bear. If the patient does not state this, the doctor asks: “What do you see when you close your eyes?” If the patient reports any unusual images, the doctor asks, “What are you thinking about?” A healthy patient will readily report an image of a large white teddy bear.
The next part of the problem is a repetition of the first part, replacing the bear with a large red ball. A healthy patient will report that there is a large red ball in front of him.
In the third part of the imagery task, the examiner asks the patient to identify the first image visualized during the exercise. A healthy child will imagine a large white teddy bear. The ability to recall an earlier mental image is evidence of "understanding of another's mind"; thus, failure to recognize one's own previous mental images suggests a lack of this understanding. Accordingly, if the patient reports that the first image was a red ball, this indicates a deficit in “understanding the mind of others.”
There is no specific treatment for Asperger's syndrome. All interventions described below are primarily symptomatic and/or rehabilitation oriented.
Developing Appropriate Social Behavior
Teachers have many opportunities to help children develop appropriate social behavior. For example, they can model different situations that require a certain action and encourage cooperative games in the classroom. The teacher can model appropriate ways to seek help when a child exhibits problematic social behavior in the classroom. Teachers can identify appropriate friends for children with the syndrome and encourage promising friendships. They also help children cope with social situations by providing supervision between classes, in the cafeteria and during playground activities.
Showing videos can encourage self-monitoring of classroom rules. The child can learn to observe other children, social cues and behavior. Because changes in school, classroom, and teacher may worsen symptoms, efforts should be made to minimize changes in the patient's schedule and educational environment.
Implementation of communication and language strategies
Children with Asperger's syndrome can be taught to say phrases for specific purposes (for example, opening a conversation). They are also encouraged to be taught to seek clarification by asking people to rephrase confusing expressions. They should be encouraged to ask for complex instructions to be repeated, simplified, clarified and written down.
Educators, using modeling, can teach affected children how to interpret others' conversational cues to respond, interrupt, or change topics. Because interpretation of metaphors and figures of speech is often difficult, educators must explain these subtleties of language when they arise. When conveying a series of instructions to a child with Asperger's syndrome, it is necessary to pause between each individual point.
Role-playing can help children with Asperger's syndrome learn to understand other people's intentions and thoughts. Victimized children should be encouraged to stop and think about how the other person will feel before acting or speaking. They can be taught to refrain from uttering every thought.
Some children with Asperger's disease have good visual and figurative thinking. These children are encouraged to explain everything using diagrams and other illustrations.
Children with Asperger's syndrome can often concentrate on activities for several hours at a time without interruption and continue this concentration every day for many years. For example, many children refuse to practice a musical instrument even for a few minutes a day, but a child with the syndrome may enjoy hours of daily exercise.
With proper training, the talents of children with Asperger syndrome can flourish. Accordingly, it is useful to identify and develop a child's special interests and abilities (for example, in music or mathematics) at an early age. These talents will also help him earn respect from his classmates.
Parents and teachers must use creative approaches to explore the skills, abilities, and talents of children with Asperger's disease. Developing such talent requires skilled training.
Conclusion
Sometimes when people hear that a child has Asperger's syndrome, their first response will be something like, “But he looks completely normal.” This is wrong and ignorant because there is nothing abnormal or atypical about a child with Asperger's Syndrome. These children may have communication difficulties or other problems, but in many ways they are just like any other child. They just need someone to show them the way and help them fit into society.
Asperger's syndrome is a congenital condition that accompanies a person throughout his life. The opinion is actively expressed that this is not a disease, but a feature of the functioning of the brain. Over time, the manifestations of Asperger's syndrome change, some of its symptoms are smoothed out, while others become more pronounced. Unfortunately, most studies are conducted on a limited number of patients and cover a short period of time. Long-term programs could help to understand which adaptation programs are more effective. Alas, now doctors receive most of the information about the course of Asperger's syndrome from the stories of the Aspies themselves. Nevertheless, it was possible to identify some patterns.
Most studies confirm that people with Asperger's syndrome who had greater ability to plan and subsequently carry out complex tasks in childhood later adapted more easily to the social environment and were better able to understand others. The situation is similar in children who were treated by parents or psychologists from an early age. All studies confirm that most patients with Asperger's syndrome experience significant improvement in early school and adolescence, which for many is replaced by regression after leaving school. The general conclusion from most of these studies is that Asperger syndrome is less severe in adults than in childhood and adolescence.
Symptoms
The manifestations of Asperger's syndrome vary somewhat over time. If in children the main manifestations were problems with learning and socialization, then in adults this area of symptoms softens and concomitant conditions come to the fore. Asperger's syndrome in adults is manifested by an individual perception of reality, insufficient expression of emotions and their low intensity, high self-sufficiency, and intolerance of uncertainty.
Most or all adults with Asperger's syndrome have the following conditions:
- Changes in the emotional and motivational sphere;
- Motor and sensory disorders;
- Cognitive impairments in the area responsible for social skills remain relevant;
- There are stereotypes, obsessions;
- All patients have behavioral and thinking characteristics characteristic of Asperger syndrome.
In addition, Asperger syndrome in adults is manifested by a number of conditions that occur with less frequency:
- , which are characteristic of half of the patients;
- Affective disorders, which include depressive changes, manic changes, and their combinations, in total occurring in two thirds or more of patients;
- Somatoform and hypochondriacal disorders are characteristic of a third of patients;
- also occur in a third of patients;
- A fifth of people with Asperger's syndrome develop various types by adulthood;
- (beliefs in the presence of changes in certain parts of the body, their ugliness or illness) develops in almost half of the patients;
- About a third of patients complain of depersonalization-derealization;
- About a sixth of patients experience transient psychotic disorders.
Dynamics of manifestations of Asperger's syndrome
Changes in the symptoms of Asperger's syndrome over time occur according to the periods of maturation of the individual. Compared to healthy children, children and adolescents with Asperger syndrome have delayed and distorted social skills. By adolescence, signs of concomitant mental disorders appear. In kindergarten and first grade, Asperger syndrome is most pronounced. The puberty period is characterized by the emergence of the first stable social contacts. At the same time, various affective disorders, obsessions, and even psychotic symptoms appear. Adolescence is characterized by a decrease in autistic symptoms. Asperger's syndrome in adults manifests itself to a greater extent with concomitant psychopathological symptoms with minimal manifestations. According to the patients themselves, these manifestations do not disappear, and patients learn to live with them so that autism has minimal impact on everyday communication.
Variants of the course of Asperger's syndrome in adults
To consider the symptoms and their dynamics in adults with Asperger syndrome, it is convenient to divide them into several types of course:
Treatment and prognosis
Important factors for the success of treatment are a warm family climate, comprehensive support for the patient, active participation of relatives in the socialization of patients, and trust in the doctor. Early development of communication skills, education and training of patients is important. To compensate for motor underdevelopment, physical therapy is prescribed.
Symptomatic treatment for Asperger's syndrome
Annotation
The article examines key issues related to the correct self-diagnosis of autism spectrum disorders, in particular Asperger syndrome: the correct use of screening tests, interpretation of existing diagnoses, identification of key symptoms of autism spectrum disorder in adulthood, as well as how not to confuse autistic disorders with other mental characteristics. The material may be useful in conditions where there are no official diagnostic options, as well as for reading before contacting a psychotherapist or going to a support group for people with Asperger's syndrome and autism spectrum disorders (ASD).
Introduction
The idea of writing an article about self-diagnosis of Asperger's syndrome (AS) arose among us, the leaders of a Moscow support group for people with autism spectrum disorders (ASD), during conversations with potential group members and new forum users. It turned out that due to the lack of availability in Russia of official diagnosis of AS in adults, combined with many people’s ignorance of the symptoms of ASD, we were faced with the need to answer a number of fairly similar and repetitive questions. At the same time, the FAQ format would not allow us to reflect many important things, and therefore it was decided to write a full-fledged article devoted to tips for correct self-diagnosis of ASD in adults.
- It will make it much easier to find a psychotherapist who specializes in your problem.
- promote a better understanding of oneself and speed up the solution of a number of problems (communication, sensory, etc.)
Attention! This article is not scientific, and the information in it cannot be considered as medical advice and does not replace consultation with a specialist!
Analysis of existing diagnoses
Although the vast majority of people born in the USSR would not have received a diagnosis of Asperger's syndrome, it may be worthwhile to find out whether you were the object of attention of a psychiatrist, neurologist or speech therapist as a child.
If it turns out that yes, then pay attention to the following:
- If you have a diagnosis of "early childhood autism", then you are in fact officially diagnosed, because... Asperger's syndrome is a type of autism.
- Diagnoses of “autistic personality traits,” “autistic traits,” “autistic-like behavior,” “autistic psychopathy,” and “childhood schizoid disorder” roughly correspond to Asperger’s syndrome.
- Entries in the medical record about:
- violent reaction to loud, sharp, “metallic” sounds
- inappropriate answers to the doctor’s questions, in particular, repeating the question instead of answering (i.e. echolalia)
- obsessive movements (sometimes these may be reflected as tics or increased motor excitability)
- obsessive interests
- increased nervous excitability, neurotic reactions, etc.
may indirectly indicate the presence of ASD.
Taking screening tests and interpreting them
Taking screening tests for autistic traits is an important part of self-diagnosis because... allows you to more objectively (compared to simple self-comparison with the ICD-10 criteria) assess their presence or absence. The experience of communicating in face-to-face support groups and forums allows us to conditionally divide them into several groups:
1. Tests for autistic traits
This group includes tests
, Aspie Quiz , RAADS-R ; they are intended to provide a preliminary assessment of the presence of autistic traits and their severity. The practice of running a support group has shown that the AQ test is the most preferable because:
- the shortest and simplest of them
- originally intended for use on its own as a screening test
- published in a peer-reviewed scientific journal and its sensitivity and selectivity are statistically confirmed
The Aspie Quiz test is similar in many ways to the AQ, but contains three times as many questions and is comparable in sensitivity and selectivity (The AQ test vs Aspie Quiz).
The RAADS-R test is intended for use in a clinical setting and may produce inflated results when used independently ( Ritvo R. A., Ritvo E. R., et al.// J. Autism Dev. Disorders. 2011 V.41. N.8. P.1076-1089).
Elevated (>=26) and especially high (>=32) scores on the AQ test indicate the presence of pronounced autistic traits, but do not indicate their nature (i.e. whether they are caused by ASD), and in the case of ASD, as a rule, , do not reflect the degree of its severity or ease.
2. Tests for alexithymia
This group of tests includes the Toronto Alexithymia Scale (TAS), which exists in two versions with questions.
If possible, the newer, shorter 20-question version of the TAS-20 should be used.
Alexithymia (difficulty identifying and verbally describing one’s emotions) occurs in 85% of people with autistic disorders (Berthoz S., Hill E.L. // European Psychiatry. 2005. V. 20, P. 291-298. , Hill E., Berthoz S. ., Frith U. // J. Aut. Disorders. 2004. V. 229-235.
Asperger syndrome is characterized by an elevated or high score on the TAS test. If the result indicates the absence of alexithymia, then with a high probability you are faced with something other than ASD.
3. SPQ test (for schizotypal traits)
6. Tests for behavioral characteristics in childhood
When self-diagnosing Asperger's syndrome, you need to pay attention to how you behaved in childhood: many of its symptoms are especially pronounced and specific in preschool and primary school age, which makes it possible to distinguish it from a number of other problems (primarily social phobia, personality traits and schizophrenia spectrum disorders ).
The ASSQ and the Childhood Autism Rating Scale can be used to assess the severity of autistic traits in childhood. The advantages of the ASSQ test are its simplicity and brevity, its validation on real samples of children, and its publication in a peer-reviewed journal. A strength of the Childhood Autism Rating Scale test is its detailed description of the varying degrees of severity of ASD symptoms in childhood, which can be useful in self-diagnosis.
These tests should be completed based on memories of your behavior during primary school age (7-10 years). It is strongly recommended that you let one of your parents (or another person who remembers your behavior as a child) fill them out and take the results into account when doing self-diagnosis.
It is strongly recommended that you combine the completion of these tests with a conversation with a parent about your childhood behavior and its similarities to Asperger's syndrome. “An outside view” makes self-diagnosis more objective. If a parent does not know what Asperger syndrome is, then you can give him/her the following articles to read:
"What is Asperger's syndrome?" ,
"diagnostic criteria for Asperger's syndrome,
"children with Asperger's syndrome. What is Asperger's syndrome?," answers to some frequently asked questions about ASD.
Resume
For high-quality self-diagnosis, you must pass the AQ, TAS, SPQ and HS1944 tests. It is also advisable to take an EQ test and one of the tests for behavioral characteristics in childhood (the “Childhood Autism Rating Scale” or ASSQ test).
Characteristic results in the presence of ASD:
- - high or elevated
- TAS-20 - high or elevated
- SPQ - normal
- HS1944- weakened tendency to anthropomorphize
- - short
- ASSQ test and Childhood Autism Rating Scale - high
What to look for?
So, you took the screening tests and they showed a positive result. It is even possible that your parents completed the Childhood Autism Rating Scale and ASSQ tests, and also recognized the similarity of your behavior in childhood with the criteria for Asperger syndrome, and there was some indirect evidence of ASD in your medical records. What should you pay attention to now? when trying to understand the origin of your autistic traits? Next, we will look at several groups of symptoms that are characteristic of Asperger syndrome in adulthood.
1. Congenitality of Asperger's syndrome
In the case of ASD, symptoms begin at 2-3 years of age and are obvious by 6-7 years of age.
They do not go away with age, but their severity often gradually decreases.
2. Specific problems with communication from early childhood:
The main problems in communication with Asperger's syndrome are not shyness or withdrawal, but difficulties with intuitive and quick understanding of other people's emotions, states, and unwritten rules of behavior in social situations.
Typical examples of such difficulties in adulthood:
- intuitive understanding by look and facial expressions of only basic and fairly expressed emotions such as joy, fear or anger. Trouble reading weak and complex emotions: For example, it may be difficult to tell whether a person is calm, tired, upset, irritated, or hurt.
- using “eye contact” more as a skill for maintaining decorum than for better understanding the interlocutor; on the contrary, for an autistic person, the need to make eye contact can distract from the perception of speech and interfere with understanding the subject of the conversation
- orientation in social situations rather due to life experience and memorization of ready-made and detailed behavior patterns. Anxiety in situations where existing experience is unacceptable and intuition is needed.
- weak “infection” with other people’s emotions and reduced spontaneous sensitivity to other people’s physical pain
- alexithymia and problems with regulating one’s own emotional state (for example, a tendency to increased anxiety and/or outbursts of poorly controlled rage (so-called “meltdowns”).
- tendency to make remarks “perceived by others as excessive straightforwardness, categoricalness, rudeness or rudeness, and not because of any conscious motives, but due to a lack of understanding of the intricacies of human relationships and informal hierarchy
3. Sensory difficulties
With Asperger's syndrome, it is very common to experience increased sensitivity to any sensory stimuli: sounds, touches, light. Examples:
- sounds: sharp, high-pitched, “metallic”, as well as complex noise in shopping centers, noisy companies, noisy audiences, etc. It often leads to the inability to understand someone else’s speech even against a background of fairly quiet noise, and in some cases to disorientation, fragmentation of perception, derealization, lightheadedness and even fainting.
- visual stimuli: flickering of fluorescent lamps, old monitors, a large number of objects in the field of view, especially moving and/or flickering.
- tactile stimuli: increased sensitivity to touch, very unpleasant sensations from certain fabrics (for example, coarse wool), tags on clothing, certain types of food due to its consistency
- increased or decreased sensitivity to pain. Unusual perception of certain types of pain
During self-diagnosis, it is recommended to watch the following videos, which show pronounced sensory overload (i.e. attempts to recreate the sensations of an autistic person).
Remember that a person may not always be aware of the presence of sensory overloads and “attribute” their manifestations to lightheadedness, fatigue, anxiety, vegetative-vascular dystonia, etc. However, sensory overload should not be confused with panic attacks.
4. Special interests
Obsessive interests are a very common manifestation of ASD. They are distinguished from ordinary hobbies by obsession (somewhat reminiscent of falling in love), a natural tendency to reduce the conversation to them, often by a narrow focus, unusualness, and lack of practical significance. Special interests manifest themselves especially clearly in childhood; as they grow older, they can become more abstract and practical, and resemble a hobby and/or passion for a profession.
5. Stimming, i.e. motor stereotypies, obsessive movements
Stereotypes often persist into adulthood. They often involve repetitive hand movements, rocking, leg swinging, etc. What distinguishes them from similar movements of neurotypical people is b O greater degree of obsession, often their unconsciousness.
6. Clumsiness (problems with coordination of movements)
Motor clumsiness is a common, but not necessary, manifestation of Asperger's syndrome.
It usually appears from early childhood and can create problems with learning to write, use cutlery, tie shoelaces, fasten buttons, thread a needle, ride a bicycle, roller skate, run, gymnastics, dance, etc.
7. Poor and/or peculiar facial expressions, as well as prosody (intonation) of speech, as well as “body language” in general.
From the outside, the nonverbal communication of an autistic person may come across as “eccentric” and/or distant.
The intonation may be perceived by others as “robot-like” or “chanting.” The severity of this symptom varies greatly from person to person. Also, without experience communicating with obviously autistic people, it can be difficult to assess exactly what features of nonverbal communication we are talking about
What can be mistaken for Asperger's Syndrome and Autism Spectrum Disorder?
When self-diagnosing autism spectrum disorders, a certain problem is their external similarity with other mental and neurological disorders and/or character traits, especially for a person who has studied their symptoms little and has no experience of communicating with autistic people “in real life.” Next, we will look at some mental features that are most often mistaken for ASD.
1. Social phobia
Social phobia is a strong and poorly controlled fear of any specific social situations (public speaking, romantic dating, talking with a salesperson in a store, etc.) or fear of communication in general. Often its appearance is associated with some past negative communication experience and/or fear of making a negative impression on others. May (not always) result in higher scores on the AQ and sometimes on the TAS.
Social phobia is often found among autistic people, but it is not autism in itself, because Its symptoms do not include disorders of empathy and social intelligence, sensory overload, special interests, a tendency to routine, features of facial expressions and prosody characteristic of ASD, etc.
2. Introversion, schizoid character accentuation, schizoid personality disorder
Often confused with ASD are variants of a normal character or personality disorder, which are manifested by isolation, a desire to remain in one’s inner world, selectivity in communication, a heightened perception of violation of personal boundaries, etc. At first glance, a deep introvert is very similar to an autistic person (and even screening testing can give a false positive result), but in fact there are several important differences:
- ASD manifests itself from the age of 2-3 and is very noticeable by the time of entry into school, but character is formed more likely in adolescence
- social intelligence and empathy with ordinary introversion or schizoidism are usually normal, although communication skills may be poorly developed due to little communication experience
- Introversion and schizoidism are not characterized by stimming (stereotypical movements), sensory overload, or special interests
- introversion - a tendency to withdraw, regardless of communication abilities; Asperger's syndrome - serious problems with intuitive understanding of other people, regardless of the desire to communicate (moreover, an autistic person can be an extrovert)
- Asperger syndrome is not characterized by a tendency to strongly metaphorical thinking, complex allegories, “metaphysical intoxication,” etc.
Although many autistic people are introverts, some are still extroverts (the so-called “active Gillberg group”).
You can read more about the difference between autism and introversion/schizoidness in the note
Danielle Tate: "Differential diagnosis: schizoid personality disorder vs. autism").
3. Secondary autism
The causes of secondary autism are not due to autism spectrum disorder, but to unfavorable conditions in childhood:
- lack of communication (due to physical disability, for example, cerebral palsy, and/or frequent stays in hospitals, secluded family lifestyle, exclusively home-schooling of the child),
- psychological trauma (domestic violence, upbringing in an orphanage, death of loved ones, bullying by peers, etc.).
Sometimes it can also appear due to transsexuality or homosexuality due to the need to hide one's true nature in a society that is not very tolerant of such mental characteristics.
Externally, secondary autism may look similar to Asperger's syndrome due to low communication skills, isolation, alexithymia, and distrust. But, as in the case of introversion, it will not have such obvious violations of empathy, “model of mind”, social intelligence, as with Asperger’s syndrome, and a set of symptoms specific to autistic disorders such as sensory overload, stimming, special interests, adherence to routine and rituals.
4. Schizotypal disorder and schizophrenia
Although this group of disorders is characterized by withdrawal, it has little in common with Asperger's syndrome. On screening testing, they may show high scores in the AQ and TAS tests, as well as the SPQ. Important differences:
- Asperger's syndrome always begins in early childhood, while schizophrenia usually begins in adolescence or young adulthood.
- Asperger's syndrome is not characterized by psychotic symptoms (hallucinations, delusions, “voices”), as well as negative symptoms (thought disturbances, etc.)
- SA does not progress, but it is not treatable with psychotropic drugs and does not have exacerbations or remissions
- about schizotypal disorder - see above for a more detailed description of the SPQ test.
Attention! If you suspect schizophrenia or schizotypal disorder, you should consult a psychotherapist! Self-diagnosis and especially self-medication are unacceptable: dangerous!
5. Other mental disorders
Sometimes generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar affective disorder, depression, etc. are confused with ASD. It should be remembered that
- none of these disorders produces the full range of symptoms of ASD, and their overall picture is significantly different
- they generally do not begin in early childhood
- Either neurotypical or autistic person can have any of them
6. Extended autism phenotype (EPA)
RFA is a variant of the normal psyche, from a qualitative point of view, extremely similar to Asperger's syndrome, but in terms of the severity of the problems, it does not reach a psychiatric or neurological diagnosis. In adulthood, XRF may be difficult to distinguish from mild variants of SA, even for specialists.
When self-diagnosing, remember that Asperger's syndrome is more likely a mild form of autism (but in many ways borderline with the norm) than a character trait.
Conclusion
Thus, correct self-diagnosis of Asperger syndrome (and autism spectrum disorders in general)
includes the following steps:
- Collecting information about diagnoses already made in early childhood that are directly or indirectly related to ASD
- Passing screening tests AQ, TAS, SPQ, HS1944 is mandatory, as well as, if possible, EQ and Childhood Autism Rating Scale tests.
- If possible, talk with your parents (or other people who knew you well in early childhood) about your childhood and show information about Asperger's syndrome; filling out one of them with the “Childhood Autism Rating Scale”
- Look for key symptoms of ASD (see above).
- Comparing your problems with other mental features that look similar to ASD, to reduce the likelihood of erroneous self-diagnosis
The authors of the article express gratitude to all participants and visitors of the support group in Moscow, as well as users of the asdforum.ru forum for the valuable experience we acquired in communicating and identifying autistic traits in other people.
For the first time, mention of such a disease as Asperger's syndrome was noted in 1944 A psychotherapist who monitors children with various types of mental disorders identified this ailment as an independent disease and described its manifestations in detail.
It is believed that Asperger's syndrome is light form, a mental deviation in the development of a child, manifested in his peculiar attitude towards people, surrounding objects, and the perception of new information.
Today, many doctors are inclined to consider Asperger's syndrome not a disease, but a functional feature brain activity, because this condition does not imply a lag in intellectual development, as happens in children with autism. We will talk about the symptoms of Asperger's syndrome in children in this article.
How to recognize Down syndrome in a child? Find out about this from ours.
Characteristics of the pathology
Photo of a boy with Asperger's syndrome:
Asperger's syndrome is a condition in which a child's general characteristics change. Pathology has innate character, and accompanies the patient throughout his life.
A child suffering from this disease does not show signs characteristic of autistic children and has a fairly high ability to socialize in society.
The violations arising in this case are expressed characteristic triad of symptoms.
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Communication |
Interaction |
Social imagination |
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A child with Asperger's syndrome is often confused by facial expressions, intonation, and facial expressions of people around him. All this creates communication problems. It is difficult for such a child to be the first to start a conversation, to choose a topic for conversation, especially if he communicates with unfamiliar people, because he cannot correctly determine the person’s attitude towards him and his behavior. |
The character of a child with Asperger's syndrome is distinguished by certain characteristics. |
Often children with this disease have a developed imagination, but cannot use it in everyday life. The child is not able to distinguish between the emotions and sensations of another person, and cannot understand the messages of body movements and facial expressions. The child is not inclined to creative activities, but games based on the use of logic, where there is a clear order of actions, do not cause any difficulties for him. |
Causes
Asperger's syndrome is considered congenital malformation.
The exact reasons contributing to the occurrence of the disease are not studied to date. The most likely cause is a genetic mutation or hereditary predisposition.
In addition, there are also such unfavorable factors as a polluted environment, the harmful effects of external factors on the body of a pregnant woman (smoking, drinking alcohol or drugs) and the fetus in the early stages of pregnancy.
As a result of such influences, disruption of brain formation, Various types of developmental anomalies of this organ arise, as a result of which there is a disturbance in the perception of the surrounding world after the birth of the child.
The brain can also lead to the development of Asperger's syndrome.
Main features of the disease
Children with Asperger's syndrome have a range of features, and not all of them can be considered negative.
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Positive qualities |
Negative qualities |
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How does fetal alcohol syndrome manifest in a child? find out right now.
Symptoms and signs
Children with Asperger syndrome are characterized by the following clinical manifestations of this condition:
Is there a difference between Asperger's syndrome and autism?
Of course, these are two different diseases that different from each other.
In particular, children with autism have significant intellectual development, writing, and a special facial expression, by which the presence of deviations can be easily recognized.
Children with Asperger's syndrome do not have such disorders. At first glance a child seems completely normal, no different from their peers. In some cases, there are certain speech disorders, which, according to doctors, are minor, and disappear as the child grows.
Tests to identify
To establish the presence of Asperger's syndrome and determine the degree of its severity, special testing is used in the form of answering questions, assessing and assessing the child's perception of graphic information depicted in the pictures offered to him. Depending on the patient’s age, the doctor chooses one of the testing options:
You will find information on the treatment of obsessive movement neurosis in children on our website.
Treatment
To correct the symptoms of the disease, the child needs appropriate treatment, which consists of: formation of those skills in the child which he does not possess.
In particular, this is the ability to communicate with other people, including strangers, the ability to recognize their emotions, intonations, behavior patterns, the ability to correctly perceive one’s actions and the actions of others, the development of fine motor skills and coordination of movements.
Drug therapy
Prescribing any medications to treat this disease is dangerous, especially for young children. However, if certain symptoms are present drug therapy is still necessary. The child is prescribed the following groups of drugs:
Treatment should be prescribed on a strictly individual basis, willful use of potent medications is strictly prohibited.
Behavioral correction
The main goal of therapy is teach your child communication skills, expressing their emotions and understanding others. Classes are conducted in a group mode or individually in the presence of parents.
At the initial stage of treatment, the second option is preferable, since in the company of other people, even with similar problems, such a child will feel uncomfortable. In the future, a transition to a group form of classes is planned.
In addition to behavioral skills that allow a child to successfully adapt to society, he needs therapeutic activities to develop fine motor skills and coordination of movements.
Features of education
Parents of children with special needs must take them into account in the process of raising and follow certain rules, which will help the child feel better in the world around him:
Asperger's syndrome is violation of the mental and emotional development of the child. The disease is congenital, but the causes of its occurrence have not been precisely established to date.
A child with this disease has a number of character traits, many of which can be called positive. However, the baby requires specialized treatment that will help him acquire the missing skills.
A specialist will talk about Asperger's syndrome in children in this video:
We kindly ask you not to self-medicate. Make an appointment with a doctor!
Asperger's syndrome is identified as a type of perception of the surrounding world and as a special form of autism, characterized by deficits in social interaction and communication. Features of the condition include limited interests and uniform actions.
Modern psychiatry classifies the condition in question as one of the five autistic disorders, as well as childhood disintegrative disorder, atypical and classic autism.
According to statistics, pathology is 2-3 times more common among men.
Among schoolchildren, diagnosis occurs in 0.36-0.71% of situations, but in 30-50% of suspected cases the syndrome is not officially diagnosed.
The disease is named after pediatrician Hans Asperger from Austria, who works with children who have similar symptoms. The doctor called the disease autistic psychopathy. The official name was registered in 1981.
Children with this disorder are characterized by learning difficulties, behavioral dysfunctions, and underdeveloped abilities for social communication, which requires increased attention from child psychiatrists, psychologists and, above all, teachers.
Story
Hans Asperger observed four children with symptoms of the condition in question in 1944 who clearly demonstrated a lack of skills in the area of social integration. Along with this problem, they had normal intelligence, but in communication there was physical clumsiness, an inability to show empathy, and a lack of nonverbal communication skills.
As for the speech, it was too formal or, on the contrary, difficult. Analyzing their conversation, it was possible to clearly note the dominant, all-consuming, one-sided interest.
Until 1981, Asperger's observations were unknown, although they were published in German. Interest in the syndrome was renewed by British physician Lorna Wing, who published similar findings and named the complex of symptoms after the Austrian discoverer.
The following year, the pathology was recognized as a separate disease and included in the diagnostic manual of the World Health Organization (tenth edition of the ICD) and in the fourth edition of the DSM of the American Psychiatric Association.
Causes of pathology
When considering the causes of pathology, one cannot fail to mention autism.
Key triggers:
- genetic and biological predisposition;
- exposure to toxic substances in the first trimester of pregnancy;
- the autoimmune reaction of the maternal body can provoke brain damage;
- preventive vaccinations and vaccinations can negatively affect the immune system;
- the theory of hormonal imbalance, which has not yet been scientifically confirmed, suggests increased levels of cortisol and testosterone in the baby;
- studying the impact of prematurity on the occurrence of illness and autistic disorder;
- The harmful effects of the environment on the baby are considered a serious reason.
Postnatal and intrauterine viral infections are considered risk factors: toxoplasmosis, herpes, rubella or cytomegalovirus infection.
Asperger's syndrome in adults
The difficulty of diagnosing the pathology in question in an adult is due to an adequate assessment of strengths and weaknesses in adulthood.
But the condition lasts throughout life and you cannot get it as an adult.
The conclusion is that the disorder stabilizes with age, and if treatment has been carried out correctly since childhood, there is a high probability of achieving significant improvements.
The trend is explained by a person’s ability to develop social skills with age, which involve elements of non-verbal communication, so many people enjoy a full social life - family, work, children, friends.
Thanks to some features, the chances of successful study and career increase significantly. This means special attention to specific topics, concentration on details and trifles. The disease suffered from outstanding personalities who were able to express themselves excellently - Albert Einstein, Thomas Jefferson, Wolfgang Mozart, Marie Curie.
Asperger's syndrome in children
As for the manifestation of pathology in children, the symptoms are similar to autistic signs, but you should definitely perceive the disorder yourself, since the level of intelligence is normal, but the educational needs are special.
Parents should pay maximum attention to the development of their child’s social skills.
The key feature is a more developed intelligence compared to peers in 95% of cases, although the perception of the world around them and the line of behavior in such children are unique.
Triad of violations
The underlying manifestations vary, but experts identify three key groups.
Symptoms in the field of social communication:
- misunderstanding the tone of voice, facial expression or gestures of the interlocutor;
- the use of complex phrases and words along with a lack of understanding of them fully;
- difficulties in determining the end and start time of a conversation, as well as in determining the topic for conversation;
- not accepting sarcasm, metaphors, anecdotes.
The interlocutor should be as concise and clear as possible in terms of expressing thoughts in a conversation with a person with such a syndrome.
Symptoms of the sphere of social interaction:
- behavior considered incorrect by others;
- apparent isolation, indifference and indifference;
- other people are confusing and unpredictable;
- unwritten social norms are not perceived;
- friendships are difficult to form and maintain.
Problems in the field of social imagination
The imagination of people with this type of perception of the world is rich in the standard understanding of this concept. Some people become musicians, artists or writers as they age, but in terms of social imagination, problems may arise:
- creative activity can be limited, as well as repetitive or strictly sequential;
- thoughts are interpreted problematically, as are the actions or feelings of others;
- barely noticeable facial messages of the interlocutor are missed;
- It is quite difficult to imagine predictions and alternative developments of the situation;
- It is also difficult to imagine and understand other people's points of view.
Children often give preference to activities related to consistency and logic.
Distinctive features
Symptoms are also represented by the following signs.
- The desire to maintain a certain order always and in everything is determined by the desire to make the world less confusing and disorderly. The patient can insist on his own routines and rules.
- Special passion is expressed by a strong, in some cases obsessive, interest in collecting or other hobbies. Sometimes interest does not fade throughout life, and in some cases the patient switches his attention to something else. Under the influence of the stimulus, skills and interests are improved to such an extent that a person with the pathology in question is incredibly successful in working and studying in the circle of his own interests.
- Sensory problems may involve taste, touch, smell, hearing or vision, and there may also be difficulties in all types of sensations at the same time. The degree of these difficulties is determined depending on the patient. Two options are often considered: low sensitivity or hypersensitivity.
Diagnostics
The difficulty in diagnosing the disease in question lies in the similarity of its symptoms with signs of other pathologies.
Identification of the disorder most often occurs between the ages of 4 and 12 years, and early diagnosis directly affects the success of further treatment and socialization
Among the current diagnostic methods, the following should be noted:
- conversation with parents and communication with the child through games;
- conducting psychomotor tests, determining independent behavior skills;
- conducting intellectual tests;
- genetic and neurological studies.
The importance of differential diagnosis for this disease is difficult to overestimate. In some cases, it is possible to identify the following pathologies:
- generalized or obsessive-compulsive anxiety or bipolar disorder;
- depression;
- attention deficit hyperactivity disorder;
- defiant oppositional disorder.
Moreover, the mentioned disorders occur simultaneously with the type of perception of the world under consideration, and the diagnosis of the patient will be different in each individual case.
Guidelines for differential diagnosis
Differentiation from autism (Kanner syndrome) is often required.
- In the first year of a child’s life, the first signs of autism can be noticed, while in a situation with Asperger’s, symptoms appear only 2-3 years after birth.
- An autistic child first learns to walk and then talk, while with the pathology in question, rapidly developing speech first appears, and then walking skills.
- In autism, the communication function is impaired, and speech skills are not used for communication; in the second case, there is a peculiar use of speech to communicate with others.
- Autistic children in 40% of situations have reduced intelligence, and in 60% mental retardation is pronounced. With Asperger's, normal and high levels of intelligence are observed.
- In autistic disorder, one should prepare for a poor prognosis due to atypical dementia and further schizoid psychopathy. The syndrome discussed in this article is characterized by a favorable prognosis, but in rare cases, schizoid psychopathy develops with age.
- Experts often compare it with schizophrenia, while the symptoms of Asperger's are more similar to psychopathy.
Treatment
A thorough diagnosis is required before treatment planning begins. This process involves a neurologist, psychologist and other specialists competent in this matter. It is necessary to take into account not only the symptoms, but also the age of the patient, as well as the individual characteristics of his development. Among the effective areas it is worth noting the following:
- Psychotherapy. The task of a psychiatrist is to observe and correct behavioral skills. Together with the therapist, he plans individual drug and non-drug therapy. Trainings aimed at maintaining and developing communication skills, as well as tests adapting to social life, are in high demand.
- For preventive and health-improving purposes, compulsory physical therapy should be introduced into the daily routine, which will have a positive effect on the functioning of all systems and organs of the body. Temporarily wasted and impaired functions can be restored. The therapeutic and physical training complex is compiled by a doctor for each patient on an individual basis.
- Possible side effects are the reason for such rare and careful use of drug therapy. This approach is relevant for symptom control in the presence of concomitant diseases. This list includes:
- medications to control seizures;
- psychotropic drugs;
- stimulants;
- serotonin reuptake inhibitors;
- neuroleptics
- Alleviation of symptoms is also facilitated by a special approach to nutrition and individual diet planning. Products with gluten and casein, flour products and dairy products have a negative effect, so they must be excluded.
Forecast
It is important to talk about a favorable and sometimes relatively favorable prognosis for treatment, which directly depends on how early a reliable diagnosis was made.
A fatal outcome is not expected in this case, but the status of the individual is lost in 20% of cases. Competent treatment and prevention allows the patient to lead a full life, start a family and friends, climb the career ladder, and do what he loves.
