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{{ Asperger syndrome}}
{{ Asperger syndrome}}
{{CMG}} {{AE}} {{SHA}}
{{CMG}} {{AE}} {{SHA}}
==<s>Overview</s>==
<s>A [[pervasive developmental disorder]], Asperger's syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language.<ref name="BehaveNet">{{cite book |title= Diagnostic and Statistical Manual of Mental Disorders |edition= 4th ed., text revision ([[DSM-IV-TR]]) |author= [[American Psychiatric Association]] |date=2000 |isbn=0-89042-025-4 |chapter= Diagnostic criteria for 299.80 Asperger's Disorder (AD) |chapterurl=http://www.behavenet.com/capsules/disorders/asperger.htm |accessdate=2007-06-28}}</ref> Intense preoccupation with a narrow subject, one-sided verbosity, restricted [[Prosody (linguistics)|prosody]], and physical clumsiness are typical of the condition, but are not required for diagnosis.<ref name="Klin">{{cite journal |journal= Rev Bras Psiquiatr |year=2006 |volume=28 |issue= suppl 1 |pages=S3–S11 |title= Autism and Asperger syndrome: an overview |author= Klin A |doi=10.1590/S1516-44462006000500002 |pmid=16791390 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&lng=en&nrm=iso&tlng=en}}</ref></s>
==History and Symptoms==
===<s>Social interaction</s>===
{{further|[[Sociological and cultural aspects of autism#Asperger syndrome and interpersonal relationships|Asperger syndrome and interpersonal relationships]]}}
<s>The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome. Individuals with Asperger's syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest); a lack of social or emotional reciprocity; and impaired [[Nonverbal communication|nonverbal behaviors]] in areas such as eye contact, facial expression, posture, and gesture.<ref name="McPartland">{{cite journal |author= McPartland J, Klin A |title= Asperger's syndrome |journal= Adolesc Med Clin |volume=17 |issue=3 |pages=771–88 |year=2006 |pmid=17030291 |doi=10.1016/j.admecli.2006.06.010 |doi_brokendate=2008-06-25}}</ref></s>
<s>Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly, for example by engaging in a one-sided, long-winded speech about a favorite topic while being oblivious to the listener's feelings or reactions, such as signs of boredom or haste to leave.<ref name="Klin" /> This social awkwardness has been called "active but odd".<ref name="Klin" /> This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.<ref name="Klin" /> The cognitive ability of children with AS often lets them articulate social norms in a laboratory context,<ref name="McPartland" /> where they may be able to show a theoretical understanding of other people’s emotions; they typically have difficulty acting on this knowledge in fluid, real-life situations, however.<ref name="Klin" /> People with AS may analyze and distill their observation of social interaction into rigid behavioral guidelines and apply these rules in awkward ways—such as forced eye contact—resulting in demeanor that appears rigid or socially naïve. Childhood desires for companionship can be numbed through a history of failed social encounters.<ref name="McPartland" /></s>
<s>The [[hypothesis]] that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.<ref name="McPartland" /><ref name=":0">{{cite journal |journal= J Autism Dev Disord |year=2008 |title= Offending behaviour in adults with Asperger syndrome |author= Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H |pmid=17805955 |doi=10.1007/s10803-007-0442-9 |volume=38 |issue=4 |pages=748–58}}</ref> More evidence suggests children with AS are victims rather than victimizers.<ref name="Tsatsanis">{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=47–63 |title= Outcome research in Asperger syndrome and autism |author= Tsatsanis KD |pmid=12512398 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000561/fulltext |doi=10.1016/S1056-4993(02)00056-1}}</ref></s>
===<s>Restricted and repetitive interests and behavior</s>===
[[Image:Riboflavin penicillinamide.jpg|left|thumb|Those with AS often display intense interests, such as this boy's fascination with molecular structure.]]
<s>People with Asperger syndrome display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines or rituals, move in stereotyped and repetitive ways, or preoccupy themselves with parts of objects.<ref name="BehaveNet" /></s>
<s>Pursuit of specific and narrow areas of interest is one of the most striking features of AS.<ref name="McPartland" /> Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as dinosaurs or deep fat fryers,<!--This is cited text, it is not a joke, please do not remove--> without necessarily having genuine understanding of the broader topic.<ref name="McPartland" /><ref name="Klin" /> For example, a child might memorize camera model numbers while caring little about photography.<ref name="McPartland" /> This behavior is usually apparent by grade school, typically age 5 or 6 in the United States.<ref name="McPartland" /> Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because topics such as dinosaurs often capture the interest of children, this symptom may go unrecognized.<ref name="Klin" /></s>
[[Stereotypy|Stereotyped]] and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.<ref name=":1">{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=2 |pages=145–58 |title= Repetitive behavior profiles in Asperger syndrome and high-functioning autism |author= South M, Ozonoff S, McMahon WM |doi=10.1007/s10803-004-1992-8 |pmid=15909401}}</ref> They include hand movements such as flapping or twisting, and complex whole-body movements.<ref name="BehaveNet" /> These are typically repeated in longer bursts and look more voluntary or ritualistic than [[tic]]s, which are usually faster, less rhythmical and less often symmetrical.<ref name="RapinTS">{{cite journal |author= Rapin I |title= Autism spectrum disorders: relevance to Tourette syndrome |journal= Adv Neurol |volume=85 |pages=89–101 |year=2001 |pmid=11530449}}</ref>
===<s>Speech and language</s>===
<s>Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical.<ref name="Klin" /> Abnormalities include verbosity; abrupt transitions; literal interpretations and miscomprehension of nuance; use of [[metaphor]] meaningful only to the speaker; [[Auditory processing disorder|auditory perception deficits]]; unusually [[pedant]]ic, [[Register (linguistics)|formal]] or [[Idiosyncrasy#Psychiatry|idiosyncratic]] speech; and oddities in [[loudness]], [[Tone (linguistics)|pitch]], [[Intonation (linguistics)|intonation]], [[Prosody (linguistics)|prosody]], and [[rhythm]].</s>
<s>Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although [[inflection]] and intonation may be less rigid or monotonic than in autism, people with AS often have a limited range of intonation; speech may be unusually fast, jerky or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.<ref name="Klin" /></s>
<s>Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding [[figurative language]] and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of [[humor]] they seem to lack understanding of the intent of humor to share enjoyment with others.Despite strong evidence of impaired humor appreciation, there are anecdotal reports of humor in individuals with AS, which challenge theories of humor in AS.<ref>{{cite journal |author= Lyons V, Fitzgerald M |title= Humor in autism and Asperger syndrome |journal= J Autism Dev Disord |volume=34 |issue=5 |pages=521–31 |year=2004 |pmid=15628606 |doi=10.1007/s10803-004-2547-8}}</ref></s>
===<s>Other</s>===
<s>Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family. These include differences in perception and problems with motor skills, sleep, and emotions.</s>
<s>Individuals with AS often have excellent auditory and visual perception.<ref>{{cite journal |journal= J Child Psychol Psychiatry |date=2004 |volume=45 |issue=4 |pages=672–86 |title= Emanuel Miller lecture: confusions and controversies about Asperger syndrome |author= Frith U |doi=10.1111/j.1469-7610.2004.00262.x |pmid=15056300}}</ref> Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.<ref>{{cite book |chapter= Psychological factors in autism |author= Prior M, Ozonoff S |pages=69–128 |title= Autism and Pervasive Developmental Disorders |edition= 2nd ed |editor= Volkmar FR |publisher= Cambridge University Press |year=2007 |isbn=0-521-54957-4}}</ref> Conversely, compared to individuals with HFA, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory.<ref name="McPartland" /> Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli, and they may exhibit [[synesthesia]];<ref>{{cite book |author= Bogdashina O |title= Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds |publisher= Jessica Kingsley |year=2003 |isbn=1-843101-66-1}}</ref> these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased [[fight-or-flight response]] or failure of [[habituation]] in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.<ref>{{cite journal |author= Rogers SJ, Ozonoff S |title= Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence |journal= J Child Psychol Psychiatry |volume=46 |issue=12 |pages=1255–68 |year=2005 |pmid=16313426 |doi=10.1111/j.1469-7610.2005.01431.x}}</ref></s>
<s>Hans Asperger’s initial accounts<ref name="McPartland" /> and other diagnostic schemes<ref name="EhlGill">{{cite journal |author= Ehlers S, Gillberg C |title= The epidemiology of Asperger's syndrome. A total population study |journal= J Child Psychol Psychiat |year=1993 |volume=34 |issue=8 |pages=1327–50 |doi=10.1111/j.1469-7610.1993.tb02094.x |pmid=8294522}}</ref> include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.<ref name="McPartland" /><ref name="Klin" /> They may show problems with [[proprioception]] (sensation of body position) on measures of [[apraxia]] (motor planning disorder), balance, [[tandem gait]], and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.<ref name="McPartland" /></s>
<s>Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal [[Wakefulness|awakenings]], and early morning awakenings.<ref>{{cite journal |journal= J Intellect Disabil Res |year=2005 |volume=49 |issue=4 |pages=260–8 |title= A survey of sleep problems in autism, Asperger's disorder and typically developing children |author= Polimeni MA, Richdale AL, Francis AJ |doi=10.1111/j.1365-2788.2005.00642.x |pmid=15816813}}</ref><ref name="Tani" /> AS is also associated with high levels of [[alexithymia]], which is difficulty in identifying and describing one's emotions.<ref>Alexithymia and AS:
*{{cite journal |author= Fitzgerald M, Bellgrove MA |title= The overlap between alexithymia and Asperger's syndrome |journal= J Autism Dev Disord |volume=36 |issue=4 |pages=573–6 |year=2006 |pmid=16755385 |doi=10.1007/s10803-006-0096-z}}
*{{cite journal |author= Hill E, Berthoz S |year=2006 |title= Response |journal= J Autism Dev Disord |volume=36 |issue=8 |pages=1143–5 |doi=10.1007/s10803-006-0287-7 |pmid=17080269}}
*{{cite journal |journal= PLoS ONE |year=2007 |volume=2 |issue=9 |pages=e883 |title= Self-referential cognition and empathy in autism |author= Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S |doi=10.1371/journal.pone.0000883 |pmid=17849012 |url=http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000883}}</ref> Although AS, lower sleep quality, and alexithymia are associated, their causative relationship is unclear.<ref name="Tani">{{cite journal |author= Tani P, Lindberg N, Joukamaa M ''et al.'' |title= Asperger syndrome, alexithymia and perception of sleep |journal= Neuropsychobiology |volume=49 |issue=2 |pages=64–70 |year=2004 |pmid=14981336 |doi=10.1159/000076412}}</ref></s>


== Overview ==
== Overview ==
Line 157: Line 115:
*These symptoms might not be recognized because some topics and interests like dinosaurs are common among children.<ref name="pmid16791390">{{cite journal| author=Klin A| title=[Autism and Asperger syndrome: an overview]. | journal=Braz J Psychiatry | year= 2006 | volume= 28 Suppl 1 | issue=  | pages= S3-11 | pmid=16791390 | doi=10.1590/s1516-44462006000500002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16791390  }} </ref>
*These symptoms might not be recognized because some topics and interests like dinosaurs are common among children.<ref name="pmid16791390">{{cite journal| author=Klin A| title=[Autism and Asperger syndrome: an overview]. | journal=Braz J Psychiatry | year= 2006 | volume= 28 Suppl 1 | issue=  | pages= S3-11 | pmid=16791390 | doi=10.1590/s1516-44462006000500002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16791390  }} </ref>
*These interests may immerse the family and disrupt family activities.<ref name="pmid16791390">{{cite journal| author=Klin A| title=[Autism and Asperger syndrome: an overview]. | journal=Braz J Psychiatry | year= 2006 | volume= 28 Suppl 1 | issue=  | pages= S3-11 | pmid=16791390 | doi=10.1590/s1516-44462006000500002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16791390  }} </ref><ref name="pmid15909401">{{cite journal| author=South M, Ozonoff S, McMahon WM| title=Repetitive behavior profiles in Asperger syndrome and high-functioning autism. | journal=J Autism Dev Disord | year= 2005 | volume= 35 | issue= 2 | pages= 145-58 | pmid=15909401 | doi=10.1007/s10803-004-1992-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15909401  }} </ref>
*These interests may immerse the family and disrupt family activities.<ref name="pmid16791390">{{cite journal| author=Klin A| title=[Autism and Asperger syndrome: an overview]. | journal=Braz J Psychiatry | year= 2006 | volume= 28 Suppl 1 | issue=  | pages= S3-11 | pmid=16791390 | doi=10.1590/s1516-44462006000500002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16791390  }} </ref><ref name="pmid15909401">{{cite journal| author=South M, Ozonoff S, McMahon WM| title=Repetitive behavior profiles in Asperger syndrome and high-functioning autism. | journal=J Autism Dev Disord | year= 2005 | volume= 35 | issue= 2 | pages= 145-58 | pmid=15909401 | doi=10.1007/s10803-004-1992-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15909401  }} </ref>
*Patients with autism spectrum disorder (ASD) usually have stereotyped and repetitive motor behaviors and speech such as lining up toys, flipping objects or [[echolalia]].<ref name=":0">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Patients with autism spectrum disorder (ASD) usually have stereotyped and repetitive motor behaviors and speech such as lining up toys, flipping objects or [[echolalia]].<ref name=":0">{{cite journal |journal= J Autism Dev Disord |year=2008 |title= Offending behaviour in adults with Asperger syndrome |author= Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H |pmid=17805955 |doi=10.1007/s10803-007-0442-9 |volume=38 |issue=4 |pages=748–58}}</ref>
*Atypical behaviors such as peculiar mannerisms, unusual attachments to objects, obsessions, compulsions, self-injurious behaviors, and stereotypes.<ref name="pmid17967920" />
*Atypical behaviors such as peculiar mannerisms, unusual attachments to objects, obsessions, compulsions, self-injurious behaviors, and stereotypes.<ref name="pmid17967920" />
* Stereotypes are repetitive and atypical behaviors such as hand flapping, finger movements, rocking, or twirling, finger flicking, unusual eye gazing, habitual toe walking, and/or persistent sniffing and licking of nonfood items.<ref name="pmid17967920" />
* Stereotypes are repetitive and atypical behaviors such as hand flapping, finger movements, rocking, or twirling, finger flicking, unusual eye gazing, habitual toe walking, and/or persistent sniffing and licking of nonfood items.<ref name="pmid17967920" />

Revision as of 14:25, 22 June 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Overview

Several symptoms may be seen in Asperger Syndrome (AS) with impairments in social interaction, communication and restricted, repetitive behaviors and interests being the most important. There may be impairments in motor and sensory functions, speech, language and.sleep.

Diagnostic Criteria

The Diagnostic Criteria for Autism Spectrum Disorder (ASD) released by the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) is:[1]

“ A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.  
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.  
  3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Specify current severity:
  • Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.).

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):  

  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).  
  2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).  
  4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity:
  • Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).  

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.  


Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.  

Specify if:

  • With or without accompanying intellectual impairment
  • With or without accompanying language impairment
    • (Coding note: Use additional code to identify the associated medical or genetic condition.)
  • Associated with another neurodevelopmental, mental, or behavioral disorder
    • (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
  • With catatonia
    • (Coding note: Use additional code 293.89 catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)
  • Associated with a known medical or genetic condition or environmental factor
    • (Coding note: Use additional code to identify the associated medical or genetic condition.)
 ”


Table: Severity levels for autism spectrum disorder[1]

(the following table is a quotation from DSM-5)[1]

Severity level Social communication Restricted, repetitive behaviors
Level 3

"Requiring very substantial support”

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social

interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.  

Inflexibility of behavior, extreme difficulty coping

with change, or other restricted/repetitive behaviors markedly interfere with functioning in all

spheres. Great distress/difficulty changing focus

or action.  

Level 2

"Requiring substantial support”

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of

social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences,

whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.  

Inflexibility of behavior, difficulty coping with

change, or other restricted/repetitive behaviors

appear frequently enough to be obvious to the

casual observer and interfere with functioning

in a variety of contexts. Distress and/or difficulty

changing focus or action.  

Level 1

"Requiring support”

Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.   Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.  

History and Symptoms

Some major neuropsychological abnormalities in patients with Asperger Syndrome (AS) are:[2]

  • Difficulty in passing theory of mind tasks
  • Executive dysfunction
  • Tendency to interpret visual stimuli in parts rather than wholes (poor central coherence)
  • There are studies that suggest in patients with AS there is a Verbal IQ (VIQ) > Poor Performance IQ (PIQ) profile which shows strength on verbal skills relative to visuospatial skills and non-verbal problem solving (nonverbal learning disability)[3]

Social interaction and communication

  • They usually fail to build friendships due to their odd or lack of social communication skills.[4]
  • They have interest in to play or interact with others and social communication but find themselves isolated.[4][5]
  • They do not realize that relationships and friendships are based on common interests and flexibility.[4]
  • They often make formal communications with others and make one-sided speech and monologues about a specific topic regardless of other people's interest.[6][2][5]
  • They are verbal about a certain topic, but can not express feelings or recognize the feelings of others.[7]
  • They do not understand social and conversational rules.[5]
  • Children with AS are usually victims of bullying at school.[8]

Restricted and repetitive behaviors and interests

  • Repetitive, limited and circumscribed interests[9][4]
  • Extensive factual information about circumscribed topics (e.g., snakes, names of stars, dinosaurs, computers, train engine numbers)[9][10]
  • These symptoms might not be recognized because some topics and interests like dinosaurs are common among children.[10]
  • These interests may immerse the family and disrupt family activities.[10][9]
  • Patients with autism spectrum disorder (ASD) usually have stereotyped and repetitive motor behaviors and speech such as lining up toys, flipping objects or echolalia.[11]
  • Atypical behaviors such as peculiar mannerisms, unusual attachments to objects, obsessions, compulsions, self-injurious behaviors, and stereotypes.[7]
  • Stereotypes are repetitive and atypical behaviors such as hand flapping, finger movements, rocking, or twirling, finger flicking, unusual eye gazing, habitual toe walking, and/or persistent sniffing and licking of nonfood items.[7]
  • The have unusual attachments for hard items; for example, ballpoint pens, flashlight, keys, action figures.[7]  

Language and Speech

  • Language is usually adequate or even precocious.[5] Although mild language delay has been reported in AS.[12]
  • Atypical language development.[7]
  • Usually there is difficulty in communicative use of language:
    • Verbosity (e.g., the child ‘‘talks too much’’)[5]
    • Pragmatic deficits (e.g., one-sided style, tangential content)[5]
    • One-sided speech and monologues about a specific topic.[8][5]
    • Poor prosody in regard to intonation, volume, rhythm and pitch[6][7]
    • Overly formal (pedantic)[7]
  • Pauses may be due to difficulty in answering questions and structuring their discourse.[2]

Motor Functions and Sensory System  

  • Delay in acquiring motor skills such as catching a ball and opening jars.[6]
  • Difficulty in fine motor skills such as writing, drawing and tying laces. [4]
  • Poor coordination, bouncy gait patterns and odd posture and awkwardness.[6]
  • Clumsiness[4]
  • Problems with sensory impairments may affect movement performance by causing problems in motor planning.[13]
  • Hyporsensitivity[4]
    • Lower pain thresholds (injuries going unnoticed and becoming infected)
    • Indifference to temperature (wearing a t-shirt in winter)
    • Vestibular symptoms (rocking or circular movements).  
  • Hpersensitivity[4]
    • Hearing (e.g. noisy environments, vacuum-cleaning),
    • Taste (food selectivity)
    • Touch (strongly reacting to the contact of certain types of clothing)
    • Smell (body odour)

Play Skills

  • Problems in pretend play skills with persistent sensory-motor play stage.[7]
  • Preference to play with common objects (string, rocks, or sticks).[7]
  • The nature of play is usually constructive (puzzles, computer games, and blocks), ritualistic (lining objects up or sorting/matching shapes or colors) or sensory-motor (mouthing, banging, twirling).[7]

Other

References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  2. ↑ 2.0 2.1 2.2 Woodbury-Smith MR, Volkmar FR (2009). "Asperger syndrome". Eur Child Adolesc Psychiatry. 18 (1): 2–11. doi:10.1007/s00787-008-0701-0. PMID 18563474.
  3. ↑ Lincoln, Alan; Courchesne, Eric; Allen, Mark; Hanson, Ellen; Ene, Michaela (1998). "Neurobiology of Asperger Syndrome": 145–163. doi:10.1007/978-1-4615-5369-4_8.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Mirkovic B, Gérardin P (2019). "Asperger's syndrome: What to consider?". Encephale. 45 (2): 169–174. doi:10.1016/j.encep.2018.11.005. PMID 30736970.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Klin A, Pauls D, Schultz R, Volkmar F (2005). "Three diagnostic approaches to Asperger syndrome: implications for research". J Autism Dev Disord. 35 (2): 221–34. doi:10.1007/s10803-004-2001-y. PMID 15909408.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr. 28 (suppl 1): S3–S11. doi:10.1590/S1516-44462006000500002. PMID 16791390.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities (2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–215. doi:10.1542/peds.2007-2361. PMID 17967920.
  8. ↑ 8.0 8.1 Zablotsky B, Bradshaw CP, Anderson CM, Law P (2014). "Risk factors for bullying among children with autism spectrum disorders". Autism. 18 (4): 419–27. doi:10.1177/1362361313477920. PMID 23901152.
  9. ↑ 9.0 9.1 9.2 South M, Ozonoff S, McMahon WM (2005). "Repetitive behavior profiles in Asperger syndrome and high-functioning autism". J Autism Dev Disord. 35 (2): 145–58. doi:10.1007/s10803-004-1992-8. PMID 15909401.
  10. ↑ 10.0 10.1 10.2 Klin A (2006). "[Autism and Asperger syndrome: an overview]". Braz J Psychiatry. 28 Suppl 1: S3–11. doi:10.1590/s1516-44462006000500002. PMID 16791390.
  11. ↑ Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H (2008). "Offending behaviour in adults with Asperger syndrome". J Autism Dev Disord. 38 (4): 748–58. doi:10.1007/s10803-007-0442-9. PMID 17805955.
  12. ↑ de Giambattista C, Ventura P, Trerotoli P, Margari M, Palumbi R, Margari L (2019). "Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome". J Autism Dev Disord. 49 (1): 138–150. doi:10.1007/s10803-018-3689-4. PMC 6331497. PMID 30043350.
  13. ↑ Siaperas P, Ring HA, McAllister CJ, Henderson S, Barnett A, Watson P; et al. (2012). "Atypical movement performance and sensory integration in Asperger's syndrome". J Autism Dev Disord. 42 (5): 718–25. doi:10.1007/s10803-011-1301-2. PMID 21643861.
  14. ↑ 14.0 14.1 Tani P, Lindberg N, Joukamaa M, Nieminen-von Wendt T, von Wendt L, Appelberg B; et al. (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology. 49 (2): 64–70. doi:10.1159/000076412. PMID 14981336.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N (1998). "Comorbidity of Asperger syndrome: a preliminary report". J Intellect Disabil Res. 42 ( Pt 4): 279–83. doi:10.1111/j.1365-2788.1998.tb01647.x. PMID 9786442.
  16. ↑ 16.0 16.1 16.2 16.3 Lugnegård T, Hallerbäck MU, Gillberg C (2011). "Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome". Res Dev Disabil. 32 (5): 1910–7. doi:10.1016/j.ridd.2011.03.025. PMID 21515028.
  17. ↑ Marinopoulou M, Lugnegård T, Hallerbäck MU, Gillberg C, Billstedt E (2016). "Asperger Syndrome and Schizophrenia: A Comparative Neuropsychological Study". J Autism Dev Disord. 46 (7): 2292–304. doi:10.1007/s10803-016-2758-9. PMID 26936160.
  18. ↑ Cederlund M, Gillberg C (2004). "One hundred males with Asperger syndrome: a clinical study of background and associated factors". Dev Med Child Neurol. 46 (10): 652–60. doi:10.1017/s0012162204001100. PMID 15473168.
  19. ↑ Miles SW, Capelle P (1987). "Asperger's syndrome and aminoaciduria: a case example". Br J Psychiatry. 150: 397–400. doi:10.1192/bjp.150.3.397. PMID 3664113.
  20. ↑ Tantam D, Evered C, Hersov L (1990). "Asperger's syndrome and ligamentous laxity". J Am Acad Child Adolesc Psychiatry. 29 (6): 892–6. doi:10.1097/00004583-199011000-00008. PMID 2273016.
  21. ↑ Berthier ML, Santamaria J, Encabo H, Tolosa ES (1992). "Recurrent hypersomnia in two adolescent males with Asperger's syndrome". J Am Acad Child Adolesc Psychiatry. 31 (4): 735–8. doi:10.1097/00004583-199207000-00023. PMID 1644738.


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