• Asperger Syndrome

    (Asperger Disorder)

    Definition

    Asperger syndrome is a neurological disorder resulting in a group of social and behavioral symptoms. It is part of a category of conditions called autism spectrum disorders. Children with Asperger syndrome usually have normal intelligence and do not have the language problems typical of autism.

    Causes

    The cause of Asperger syndrome is unknown. Some experts believe a variety of factors may be responsible.
    Infant Brain—Period of Rapid Development
    Infant Brain and skull
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Asperger syndrome is more common in boys. Family history of autism spectrum disorder may also be a risk factor.

    Symptoms

    Symptoms usually become noticeable around 2-½ or 3 years of age. Symptoms may range from mild to severe and can include:
    • Difficulty interacting with others
    • Trouble making friends
    • Poor understanding of other people's feelings
    • Insensitivity to social cues and facial expressions
    • Inappropriate social and emotional responses
    • Preoccupation with one's own world
    • Not sharing enjoyment, interests, or achievements with others
    • Following repetitive routines or rituals
    • Difficulty with any changes in routine or schedule
    • Single mindedness
    • Limited interests, usually one or two subjects
    • Repeating words or phrases over and over
    • Intense interest in a few topics
    • Good rote memory without understanding the information
    • Limited verbal skills or using words in odd ways
    • Difficulty imagining things or thinking abstractly
    • Taking things very literally
    • Focusing on small details and having trouble seeing the bigger picture
    • Ability to read without understanding the words
    • Problems with nonverbal communication
    • Poor eye contact
    • Few facial expressions, except for anger or unhappiness
    • Impaired body posturing or use of gestures
    • Clumsy movements
    • Hand flapping
    • Poor coordination
    • Inflexibility or trouble accepting change
    • Difficulty accepting loss or criticism
    • Obsessive desire to finish any tasks that are started

    Diagnosis

    There are no tests for Asperger syndrome. The diagnosis is based on observations of the child's behavior. Neuropsychological and IQ tests may be done. Medical tests may be ordered to help rule out other conditions. Children and their families can benefit from early intervention. Knowing what is wrong also helps families understand why the child acts differently than other children.

    Treatment

    There is no treatment to cure Asperger syndrome. Treatments aim to control symptoms and improve social skills. Children often learn to function independently when they become adults. However, they usually continue to experience problems with social interaction. They may be at risk for learning disabilities, such as attention deficit disorder (ADD) . They also may develop mental health problems, such as depression and anxiety . Children with Asperger syndrome need love and understanding, as well as a structured schedule.

    Medication

    Drugs to help control symptoms may include:
    • Stimulants
    • Mood-altering drugs
    • Drugs to control seizures
    • Serotonin selective reuptake inhibitors (SSRIs), such as citalopram, sertraline, and fluoxetine
    • Neuroleptics—such as risperidone

    Alternative Therapies

    The supplement melatonin may be helpful in improving sleep. But, talk to the doctor before giving herbs or supplements to your child.

    Counseling

    Behavior modification therapy and training can help children develop social skills. Learning how to make and keep friends is a challenge for children with Asperger syndrome.

    Family Care

    Caring for a child with Asperger syndrome can be stressful. Counselors help parents learn how to manage the child's behavior. Suggestions include:
    • Give warnings that an activity is about to end and provide ways to save the task for later. For instance, a favorite television show may be recorded for later viewing.
    • Try to include some flexibility into the day.
    • Set limits on the amount of time the child can spend on a single, obsessive activity.
    • Keep directions simple.
    • Use precise words.
    • Limit choices to two or three things.
    • Avoid using figures of speech.
    • Make lists.
    • Do not assume a child with this disorder understands what has been said simply because he can repeat it back to you.
    • At an early age, start explaining what is appropriate behavior for public and private places.
    • Do not make idle threats or promises.
    • Give praise for accomplishments, especially social skills.

    Educational Needs

    Children with Asperger syndrome usually have a normal IQ. However, they have special educational needs. They often can attend regular schools. They may need extra support in the classroom. Special attention should be paid to building social skills. Teachers should be informed of the child's needs. Children with Asperger syndrome may be teased or bullied because they seem different.

    Prevention

    There are no guidelines for preventing Asperger syndrome.

    RESOURCES

    Asperger Syndrome Education Network http://www.aspennj.org

    Online Asperger Syndrome Information and Support (OASIS) http://www.aspergersyndrome.org

    CANADIAN RESOURCES

    Autism Society Canada http://www.autismsocietycanada.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Asperger syndrome. Nemours KidsHealth.org website. Available at: http://kidshealth.org/parent/medical/brain/asperger.html. Updated January 2012. Accessed February 21, 2013.

    Asperger syndrome fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/asperger/detail%5Fasperger.htm. Updated February 4, 2013. Accessed February 21, 2013.

    Asperger's syndrome. Autism Society website. Available at: http://www.autism-society.org/about-autism/aspergers-syndrome/. Accessed February 21, 2013.

    Autism spectrum disorders. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 14, 2013. Accessed February 21, 2013.

    Cashin A, Sci DA. Two terms-one meaning: the conundrum of contemporary nomenclature in autism. J Child Adolesc Psychiatr Nurs . 2006;19:137-144.

    Filipek PA, et al. Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000;55(4):468-79.

    Marcus RN, Owen R, Manos G, et al. Safety and tolerability of aripiprazole for irritability in pediatric patients with autistic disorder: a 52-week, open-label, multicenter study. J Clin Psychiatry. 2011;72(9):1270-6

    Mattila ML, Hurtig T, Haapsamo H, et al. Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study. J Autism Dev Disord . 2010;40(9):1080-93.

    Nass R, Ross G. Developmental Disabilities. In: Bradley WG, ed. Neurology in Clinical Practice . 5th ed. Philadelphia, PA: Butterworth Heinemann Elsevier; 2008.

    Nelson Textbook of Pediatrics .16th ed. Philadelphia, PA: WB Saunders Company; 2000.

    Simonoff E. Genetic counseling in autism and pervasive developmental disorders. J Autism Dev Disord . 1998; 28: 447–56.

    Venkat A, et al. Care of the patient with an autism spectrum disorder by the general physician. J Postgrad Med. 2012;88(1042):472-81.

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