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Revision as of 02:56, 18 January 2003 by Candicejvs (talk | contribs)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)Asperger's Disorder is perhaps better called Asperger's Syndrome. It is a condition related to, but perhaps not classifiable as, autism.
There is no single mental condition called autism. Rather, there is a spectrum of autistic disorders (the "autistic disorder spectrum"), with different forms of autism taking different positions on this spectrum. In the 1940s, Leo Kanner and Hans Asperger, working independently in the United States and Europe, identified the polar ends of the autistic disorder spectrum. If the different autistic disorders were to be arranged according to the autist's ability to function effectively in society, Kanner's would run the gamut from no ability all the way to the so-called "high functioning autists", who may be capable of independent living. Asperger's begins where Kanner's leaves off, and runs all the way into autists who can compensate for their symptoms enough to conduct themselves normally in society.
Kannerian autism is characterized by significant cognitive and communicative deficiencies. There are no readily apparent cognitive and/or communicative deficiencies in Asperger's autism (aka Asperger's Syndrome); in fact, the presence of either deficiency is enough to rule out Asperger's altogether.
Kanner's syndrome is described in the article autism.
A high-functioning autistic may possess enough communicative and/or cognitive skills to function in society, but will still be obviously and significantly impaired. Whereas, by the very definition of Asperger's Syndrome, the individual with Asperger shows no significant cognitive/communicative deficiencies.
Some clinicians believe that communicative and/or cognitive deficiencies are so essential to the concept of autism that they prefer to consider Asperger's as a separate condition altogether from autism. This opinion is so far a minority one. Uta Frith (an early researcher of Kannerian autism) has written that people with Asperger's seem to have more than a touch of autism to them. Others, such as Lorna Wing and Tony Attwood, share in Frith's assessment.
People without autism (what people with Asperger's tend to call "neurotypicals" or "NTs") generally possess a very sophisticated sense of other people's mental states. Most people are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's body language. Autists do not have this ability, and the individual with Asperger's is every bit as "mind-blind" as the person with profound Kannerian autism. At best they will see a smile but not know what it means, and at worst they will not even see the smile - or frown, or smirk, or any other nuance of communication.
Asperger's Syndrome is characterized by special (while at the same time very peculiar) gifts; one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, another with toilet brushes. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life - the child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reasoning, an almost obsessive focus, and eidetic memory. Hans Asperger called his young patients "little professors", based on the fact that his thirteen-year-old patients had as comprehensive and nuanced an understanding, within their area of expertise, as university professors.
Autists have emotional responses as strong as, or perhaps stronger than, most "neurotypicals". What they lack is the inborn ability to express their emotional state via body language, facial expression and nuance. Many people with Asperger's report a feeling of being unwillingly divorced from the world around them; they lack the natural ability to see the subtexts of social interaction, and equally lack the ability to broadcast their own emotional state to the world.
This leads to no end of troubles both in childhood and adulthood. When a teacher asks a child with Asperger's, "And did the dog eat your homework?", the child with Asperger's will look the teacher coldly in the eye and not say a word. The child doesn't understand what the teacher is asking, cannot infer the teacher's meaning from the tone of voice, posture or facial expression, and is faced with a question which made as much sense to him as "why is purple and who is mathematics?" The teacher walks away from the experience frustrated and thinking the child is arrogant, spiteful and insubordinate. The child sits there mutely, feeling frustrated and wronged.
In adulthood, the person with Asperger's may find it difficult to differentiate between the smiles of a waitress waiting on his table and the woman at the next table who's interested in him. He may well wind up asking the waitress out for a cup of coffee and ignoring the woman at the next table.
The spouses of people with Asperger's are more prone to major depression because often Asperger's people are not affectionate, are very literal and hard to communicate with in an emotional way. A spouse of a person with Asperger's will often go to the well to seek affection and find that the well is dry. It is very helpful for the spouses to read as much as they can about Asperger's syndrome, OCD, hyperlexia and other comorbid disorders. A spouse will often be much less angry and/or depressed if they understand that the Asperger's symptoms are not intentionally directed at them, but that they are part of a mental disorder. Thus the spouse will feel a lot less rejected and be a lot more understanding.
There are many comorbid disorders associated with Asperger's Syndrome. (A comorbid disorder is a disorder which is often found in conjunction with another disorder, although neither may cause the other.) The major comorbid disorders associated with Asperger's include post-traumatic stress disorder, anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder and depression. If a comorbid disorder is present with Asperger's, it often cannot be treated in the same manner as when it is present in neurotypicals.
Clinical depression is by far the most common comorbid disorder, affecting over half of all people with Asperger's. People with AS attempt suicide at a staggeringly high rate in comparison to the general population, although whether this is due to AS or depression comorbid to AS is a matter of debate.
Asperger's Syndrome is not a death sentence, however - very far from it. Despite their difficulty with social interaction, many possess a rare gift for humor (especially puns, wordplay and doggerel) and written expression. In fact, their fluency with language is such that most of them also qualify as hyperlexic. While they face enormous obstacles, some manage to overcome them and prosper in society.
Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders as:
- Qualitative impairment in social interaction, as manifested by at least two of the following:
- Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
- Failure to develop peer relationships appropriate to developmental level
- A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
- A lack of social or emotional reciprocity
- Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
- Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- Apparently inflexible adherence to specific, nonfunctional routines or rituals
- Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
- Persistent preoccupation with parts of objects.
- The disturbance causes clinically significant impairments 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 two years, communicative phrases used by age three years)
- There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in chidhood
- Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
The Diagnostic and Statistical Manual's diagnostic criteria have been roundly criticized for being far too vague and subjective. A broken bone is clear to diagnose; either the X-ray shows a break or it does not. It is difficult to diagnose Asperger's with such clarity, because what one psychologist calls a "significant impairment" another psychologist may call insignificant.
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