What is
Asperger's Disorder?
by Dr Avril Brereton
Background
One year after Leo Kanner’s
original paper on autism, Hans Asperger published a paper in
1944 that formed the basis of what was to become known as
Asperger’s disorder. Both Kanner and Asperger trained in
medicine in Vienna, but unlike Kanner, who moved to the USA,
Asperger remained working in Europe. Asperger and Kanner
were apparently unaware of each other’s work, probably
because of World War II. Asperger’s paper remained
relatively unknown as it was published in German and was not
widely available in translation.
Asperger’s paper described a
group of children and adolescents who had deficits in
communication and social skills, had obsessional interests
and behaviour, disliked change and had a dependence on
rituals and routines. In addition many were physically
clumsy. Unlike the children described by Kanner, the
children in Asperger’s paper generally had no significant
delays in early cognitive or language development. Asperger
described this condition as autistic psychopathy.
There has been increasing
interest in Hans Asperger and his syndrome over the past
twenty years. In the early nineties, Asperger’s paper was
translated by Frith (Frith, 1991) and became more widely
available. Since that time Asperger’s disorder has been more
frequently used to describe a group of children who
presented with developmental deficits in social skills and
behaviour but were difficult to classify.
Is it
different from Autism?
For the past decade or so
there has been a continuing debate as to whether or not
Asperger’s disorder is a type of autism or whether it
constitutes a separate disorder. Many publications have
tried to delineate the boundaries, if any, between autism
and Asperger’s disorder. Despite the differences that can be
seen when looking at the original cases described by both
Kanner and Asperger, there is continuing confusion over the
diagnostic criteria for Asperger’s disorder, particularly as
subsequent accounts and case studies have not necessarily
adhered to the criteria suggested by Asperger himself. The
principal areas of inconsistency relate to early development
in the areas of cognition, motor skills and language.
The Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) and the Classification
of mental and behavioural disorders (ICD-10) have attempted
to introduce a consistent international approach to
diagnosis and specify that the key differentiation is that
persons with Asperger’s disorder do not have delayed
language development which is a characteristic of Autistic
disorder. Persons with Asperger’s disorder have overall
normal intellectual ability. Approximately 20% of persons
with Autistic disorder also have IQ in the normal range and
are referred to as high functioning.
Age
of Onset
Asperger’s disorder tends to
be diagnosed later than autism in young children. Neither
ICD-10 nor DSM-IV stipulates the criteria for age of onset
as they do for autism. However, in his original paper,
Asperger described children as having difficulties by the
age of two.
Parents of young children with
autism often recognise problems with behaviour and in
particular, language development by about 18 months to two
years of age. Because children with Asperger’s disorder do
not have delayed early language, or problems with cognitive
development, there are few early signs that all is not well.
It is more usual for parents to become concerned about their
child’s emerging unusual or odd behaviour and social
development but these tend to be identified later, usually
from about 3 to 4 years of age. Diagnosis of Asperger’s
disorder may not occur until the child has attended
pre-school or some other early childhood setting such as
crèche. This is probably because the child’s social and
behavioural problems become more noticeable when the child
is seen with peers in a more structured social setting where
there are more demands for social interaction.
Causes
There is widespread agreement
that genetic factors predominate as the primary cause of
Asperger’s disorder. Asperger himself noted that in all
cases where he studied the family closely, similar traits
were found to some degree in parents and other family
members. Later studies have found similar autistic traits in
the relatives of young people with Asperger’s disorder.
Some
examples of how Asperger’s disorder affects children
-
Acquisition of language
follows a normal or even accelerated pattern, but
content of speech is abnormal - pedantic, and may centre
on one or two favoured topics.
-
Little facial expression,
vocal intonation may be monotonous and tone may be
inappropriate.
-
Impairment in two-way social
interaction including an inability to understand the
rules governing social behaviour. May be easily led.
-
Problems with social
comprehension despite superior verbal skills.
-
Very rigid, prefer structure.
-
Well developed verbal memory
skills, absorb facts easily, generally good level of
performance at maths and science.
-
Highly anxious with a dislike
of any form of criticism or imperfection.
-
Most attend mainstream
schools and are often victims of teasing which causes
withdrawal into isolated activities.
- Are seen to be “odd” or
“eccentric”.
References
American Psychiatric
Association. (1994). Diagnostic and Statistical Manual
of Mental Disorders. (4th ed.). Washington, DC:
American Psychiatric Association Press.
Asperger, H. (1944). Die "Autistichen
Psychopathen" in Kindersalter. Archiv fur Psychiatrie
und Nervenkrankenheiten. 117, 76-136.
Frith, U. (Ed.). (1991).
Autism and Asperger’s disorder. London: Cambridge
University Press.
World Health Organisation.
(1992). ICD-10: Classification of mental and behavioural
disorders. Clinical description and diagnostic guidelines.
Geneva: World Health Organisation.
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