A 1993 broad-based population study in Sweden found that 36 per 10,000 school-aged children met Gillberg's criteria for Asperger syndrome, with the prevalence rising to 71 per 10,000 if merely suspected cases are included.[4] Gillberg estimates 30-50% of all Asperger's is undiagnosed.[5][citation needed] One study found that 36 per 10,000 of adults with IQ of 100 or above have Asperger's.[6]
Leekam et al. have documented significant differences between Gillberg's criteria and the ICD-10 criteria[7]. Considering its requirement for "normal" development of cognitive skills, language, curiosity and self-help skills, ICD-10 is considerably more narrow than Gillberg's criteria, which more closely matches Hans Asperger's own descriptions. Studies that use the DSM-IV criteria have found a prevalence of AS around 3 in 10,000,[citation needed] making it more rare than autistic disorder.
The prevalence of AS in adults is not well understood, but Baron-Cohen et al. has documented that 2% of adult controls score higher than 32 in the AQ Test.[8] All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis. Wakabayashi et al. (2004) found similar AQ Test results in Japan. Stahlberg et al. found that 30% of referred adult patients with ADHD had ASD as well.[9].
Depression[10] and poverty[11] are common in Asperger syndrome patients
Like other conditions classified as autism spectrum disorders, Asperger syndrome appears to be more prevalent among males than females, with males making up approximately 75–80 percent of diagnoses. Many clinicians believe that this may not reflect the actual incidence among females; well-known Asperger syndrome expert Tony Attwood suggests that females learn to better compensate for their impairments because of differences in socialization[12]. Some preliminary evidence for this is found in the Ehlers & Gillberg study, which found a 4:1 male to female ratio in the people they thought definitely had Asperger's but a much less lopsided 2.3 to 1 ratio when merely suspected or otherwise borderline cases were included.
The overwhelming majority of available information on Asperger syndrome relates to children; there is currently more conjecture than hard evidence on how it affects adults. It is thought that most people with Asperger syndrome learn to cope with their social impairments later in life.[citation needed] However, there is no "cure" as such, and some people, including prominent clinicians such as Attwood and some of those diagnosed with Asperger's, would strenuously argue that a cure is neither possible nor desirable (see "A gift and a curse" and "Culture" below), mainly pointing out that the syndrome is a hereditary trait and attempts to "cure" or eliminate it would be an example of eugenics. Organizations such as Cure Autism Now disagree; this remains a highly controversial area.
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Characteristics
The most common and important characteristics of Asperger syndrome can be divided into several broad categories: social impairments, narrow but intense interests, and speech and language peculiarities. Other features are commonly associated with this syndrome but not always held to be necessary for diagnosis. This section reflects mainly Attwood, Gillberg, and Wing's thinking on the most important characteristics of Asperger; the DSM-IV criteria (see above) represent a slightly different view. Asperger Syndrome is often camouflaged, and many people with the disorder often blend in with those that do not have Asperger syndrome. The effects of Asperger syndrome also depends on the individual as some deal with the characteristics differently than others with Asperger syndrome.
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Social impairments
Although there is no single feature that all people with Asperger syndrome share, difficulties with social behavior are nearly universal and are perhaps the most important criteria that define the condition. People with Asperger syndrome lack the natural ability to see the subtexts of social interaction (sometimes resulting in well-meaning remarks that may offend and so on, finding it hard to know what is "acceptable") and also tend to lack the ability to broadcast their own emotional state. The unwritten rules of social behavior which mystify so many with Asperger syndrome have been termed "The Hidden Curriculum" by academic researcher Brenda Smith Myles. [13]
Non-autistics, often called neurotypicals, are able to gather a host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's facial expression and body language, but people with Asperger syndrome have an impairment in this ability, sometimes called mind-blindness. To be mind-blind is to find it difficult or even impossible to figure out things a person implies but does not say directly (more colloquially, to "read between the lines"). This is not because they cannot imagine the answer but because they cannot choose between numerous possibilities; the mind-blind person cannot reliably gather enough information to do so or does not know how to interpret the information that they do gather.
Along with this difficulty in reading the nonverbal communication of others, most people with Asperger's have difficulty expressing their own emotional state via body language, facial expression, and nuances as most people do. Some such people have emotional responses as strong as, or perhaps stronger than, those of most people, although what generates an emotional response might not always be the same; the difficulty is in expressing these feelings, although it sometimes comes across as lacking them. Some make very little eye contact because they find it overwhelming, whereas others have unmodulated, staring eye contact that can cause discomfort to other people. Similarly, the use of gestures may be almost nonexistent or may seem exaggerated and differ from what would normally be considered the most appropriate for a situation.
It is worth noting that because it is classified as a spectrum disorder, some people with Asperger syndrome are nearly normal in their ability to read and use facial expressions and other subtle forms of communication. However, this ability does not come naturally to most people with Asperger syndrome. Such people must learn social skills intellectually, possibly delaying social development until later in life.
Some people feel that much of the social difficulties in Asperger Syndrome are more accurately characterized as "mutual misunderstanding", in that neither the autistic nor the neurotypical understands each other. Some autistics assert that they have a much easier time reading body language of other autistic people, and that neurotypicals have difficulties interpreting autistic body language. Comparing the nonverbal communication problems that often occur between people from different cultures is a common support given for this theory.
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Narrow, intense interests
Asperger syndrome can involve an intense and obsessive level of focus on things of interest. For example, one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, or another with building models out of matchsticks. Particularly common interests are means of transport (for example, trains), computers, mathematics, astronomy, geography, history, and dinosaurs. Note that all of these last items are normal interests in ordinary children; the difference in Asperger children is the unusual intensity of their interest.
Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally one or two at any given time. In pursuit of these interests, the person with Asperger's often manifests extremely sophisticated reason, an almost obsessive focus, and great memory for apparently trivial facts (occasionally even eidetic memory). Hans Asperger called his young patients "little professors" because he thought his thirteen-year-old patients had as comprehensive and nuanced an understanding of their field of interest as university professors.
Some clinicians would not entirely agree with this description; for example, Wing and Gillberg both argue that there is often more rote memorization than real understanding of these areas of interest, despite occasional appearances to the contrary. However, such a limitation is not required for diagnosis, even under Gillberg's criteria.
Children and adolescents with Asperger syndrome often have little patience for things outside these areas of interest. During the school years, many are perceived as highly intelligent underachievers, clearly capable of outperforming their peers in their field of interest yet persistently unmotivated to do regular homework assignments (sometimes even in their areas of interest). Others, in contrast, may be overachievers who are hypermotivated to outperform peers in school. This adds to the difficulties of diagnosing the syndrome. In more serious cases, the combination of social problems and intense interests can lead to unusual behavior, such as greeting a stranger by launching into a lengthy monologue about a special interest rather than introducing oneself in the socially-accepted way. However, in many cases adults can outgrow this impatience and lack of motivation and develop more tolerance to new activities and meeting new people.
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Speech and language peculiarities
People with Asperger syndrome often are noted for having a highly pedantic way of speaking, using language far more formal and structured than the situation normally would be thought to call for. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially on his or her special area of interest.
Literal interpretation is another common but not universal hallmark of this condition. Attwood gives the example of a girl with Asperger syndrome who answered the telephone one day and was asked, "Is Paul there?" Although the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said "no" and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone.[14]
Many people with Asperger syndrome also make idiosyncratic use of words, including new coinages and unusual juxtapositions. This can develop into a rare gift for humor (especially puns, wordplay, doggerel, satire) or writing. Another potential source of humor is the eventual realization that their literal interpretations can be used to amuse others. Some are so proficient with written language as to qualify as hyperlexic. Tony Attwood refers to a particular child's skill at inventing expressions, e.g. "tidying down" (the opposite of tidying up) or "broken" (when referring to a baby brother who cannot walk or talk.[15]
Another noted behavioural characteristic that may be present is echolalia, which causes the subject to repeat words, or parts of words, when they speak, like an echo, or palilalia repeating one's own words.[16] Children with Asperger's often display advanced abilities for their age in language, reading, mathematics, spatial skills, or music, sometimes into the 'gifted' range, although as noted above, they may be counterbalanced by appreciable delays in other developmental areas.
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Writing peculiarities
A 2003 study conducted by Brenda Smith Myles, investigated the written language of children and youth with Asperger's syndrome. They were compared by use of a standardized test of written language skills and overall legibility of handwriting. In written language skills, no significant differences were found between standardized scores of both groups; however, in hand writing skills, the group of individuals with AS produced significantly fewer legible letters and words than the neurotypical group. Another analysis of written samples found that people with AS appear to be able to write quantitatively similar to their neurotypical peers using grammatical rules but have difficulty producing qualitative writing.[17]
Tony Attwood mentions that a teacher may spend considerable time interpreting and correcting the child's indecipherable scrawl. The child is also aware of the poor quality of their handwriting, and may be reluctant to engage in activities that involve extensive writing. Unfortunately for some children and adults, high school teachers and prospective employers may consider the neatness of handwriting a measure of intelligence and personality. The person with AS then becomes embarrassed or angry at their inability to write neatly. The child may require assessment by an occupational therapist and remedial exercises, but modern technology can help minimise this problem. A parent or teacher aide could also act as the child's scribe or proofreader to ensure the legibility of the child's written answers or homework.[18]
People with Asperger's are often very skilled at using computers and keyboards. This allows for the child possible special dispensation to type rather than write homework and examinations. The presentation of their work is then comparable to other children.[19]
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Emotional peculiarities
A person with Asperger syndrome may have trouble understanding the emotions of other people, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. They also might have trouble showing empathy with other people. Because of this, a person with Asperger syndrome might be seen as egotistical, selfish or uncaring. In most cases these are unfair labels, because the affected person is neurologically unable to understand other people's emotional states. They are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate. It is clear that people with Asperger's Syndrome do not lack emotions. However, the concrete nature of attachments they might have (i.e. to objects rather than to people) often seems curious, or even can be cause of concern, to people who do not share their perspective.
However, not showing affection (or not doing so in conventional societally-acceptable ways) does not necessarily mean that he or she does not feel it. Understanding this can lead the significant other to feel less rejected and be more understanding. There are usually ways to work around the problems, such as being more explicit about one's needs. For instance, when describing emotions, it can be helpful to be direct and to avoid vague terms such as "upset" when the emotion being described is anger (some individuals with Asperger's would interpret "upset" as mere annoyance, or even nausea). It is often effective to lay out in clear language what the problem is and to ask the partner with Asperger's to describe what emotions are being felt or ask why a certain emotion was being felt. It is very helpful if the family member or significant other reads as much as he or she can about Asperger’s syndrome and any comorbid disorders. In a minority of situations the opposite problem occurs; the person with Asperger's is unusually affectionate to significant others and misses or misinterprets signals from the other partner, causing the partner to get annoyed and leave the person with Asperger syndrome feeling depressed and alone.
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Other characteristics
Those affected by Asperger's may also manifest a range of other sensory, developmental, and physiological anomalies. Children with Asperger's may evidence a slight delay in the development of fine motor skills. In some cases (although with many exceptions) people with AS may have an odd way of walking, or display compulsive finger, hand, arm or leg movements.
In general, orderly things appeal to people with Asperger's. Some researchers mention the imposition of rigid routines (on self or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for some people with this condition. [20]
Some people with Asperger's experience varying degrees of sensory overload and are extremely sensitive to touch, smells, sounds, tastes, and sights. They may prefer soft clothing, familiar scents, or certain foods. Some may even be pathologically sensitive to loud noises (as some people with AS have hyperacusis) or strong smells or dislike being touched; for example, certain children with Asperger's exhibit a strong dislike of having their head touched or their hair disturbed while others like to be touched but dislike loud noises. Sensory overload may exacerbate problems faced by such children at school, where levels of noise in the classroom can become intolerable for them. Some are also unable to block out certain repetitive stimuli, such as the constant ticking of a clock. Whereas most children stop registering this sound after a short time and can hear it only if they consciously listen for it, the child with Asperger's can become distracted, agitated, or even (in rare cases if the child has anger problems) violent if the sound is not removed.
Additionally, people with Asperger's exhibiting severe symptoms may frequently be diagnosed with clinical depression, Oppositional defiant disorder, antisocial personality disorder, Tourette syndrome, ADHD, General anxiety disorder, Bipolar disorder, Obsessive compulsive disorder, or Obsessive-compulsive personality disorder. There are also people with Asperger's who are also diagnosed with Dysgraphia, Dyspraxia, Dyslexia, or Dyscalculia. However, while elements from all of these conditions are associated with Asperger syndrome, the cause is usually Asperger's itself and not a separate condition. While there may be a correlation between them, the disorders are in fact distinct from one another. There is research which indicates people with Asperger's may in fact be far more likely to have the associated conditions, but for now the connection is largely one of resemblance.
Comparisons are sometimes made between Asperger Syndrome and the descriptions of some Myers-Briggs types, notably INTJ and INTP, but these tend to be speculative in nature and no formal studies have been carried out to establish a connection.
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Living with Asperger syndrome
Asperger syndrome usually leads to problems in social interaction with peers. These can be severe or mild depending on the individual, especially in childhood and adolescence; children with Asperger syndrome often are the target of teasing and bullying at school because of their idiosyncratic behavior, language, interests, and their lowered or delayed ability to perceive and respond in socially expected ways to nonverbal cues, particularly in interpersonal conflict. Additionally, these children are extremely literal and can have difficulty interpreting sarcasm. A child or teen with Asperger syndrome often is puzzled as to the source of this mistreatment, unaware of what has been done incorrectly. Those who are aware of their condition may come to recognize such errors, but almost never immediately upon making them. Unlike other pervasive development disorders, most children with Asperger Syndrome start out wanting to be social but are extremely poor at the hidden curriculum involved in socialization, which can lead to later withdrawal and asocial behaviors, especially in adolescence.
Children with Asperger syndrome often display advanced abilities for their age in language, reading, mathematics, spatial skills, and/or music, sometimes into the "gifted" range, but this may be counterbalanced by considerable delays in other developmental areas. This combination of traits can create problems with teachers and other authority figures. (It may be relevant here that one of the social conventions many people with Asperger's syndrome ignore is respect for authority. Attwood notes a tendency to feel that everyone should be treated much the same regardless of what social position they occupy; the student with Asperger's syndrome may not give respect to an authority figure until he or she feels it has been earned, an attitude many teachers either do not understand or take strong exception to.) Like many other gifted children, a child with Asperger’s might be regarded by teachers as a "problem child" or a "poor performer". The child’s extremely low tolerance for what they perceive to be ordinary and mediocre tasks (such as typical homework assignments) can easily become frustrating; the teacher may well consider the child arrogant, spiteful, and insubordinate. These children often exhibit problem behaviors and can be mislabeled as "disciplinary problems". Lack of supports, understanding of the syndrome, and the child's anxieties all lead to these problem behaviors [such as severe tantruming, violent outbursts, and withdrawal].
However, Asperger syndrome does not guarantee one will have a miserable life. The intense focus and tendency to work things out logically, a characteristic of Asperger syndrome, often grants people with the syndrome a high level of ability in their fields of interest. When these special interests coincide with a materially or socially useful task, the person with Asperger's often can in fact lead a profitable life. The child obsessed with naval architecture may grow up to be an accomplished shipwright.
Although many people with Asperger's are not considered socially successful by common standards — and there are many who remain alone their entire lives — it is certainly possible for them to find understanding people with whom they can have close relationships. Many autistics have children, in which case their children may or may not have an autism spectrum disorder. Also, many people with Asperger syndrome recognize that there is a problem and try to adapt to living among people without the syndrome, even if they are unaware of the term "Asperger syndrome" itself or believe it does not apply to them. It is not unusual for people with Asperger's to feel most comfortable with people much younger due to their immature social skills or older than they are due to their intelligence.
Although they are not recognised as often, there are adults with Asperger's. Adults are not as regularly treated, yet they still have similar problems as children. They may find it difficult gaining a job or getting into undergrad or graduate schools because of poor interview skills or a low score on Standardized or Personality tests, due to this they may be more vulnerable to poverty than the general population. If they do get a job they may become victims of bullying or be misunderstood at work. They may also have difficulty finding a life partner and getting married because of poor social skills. Even later in life, many people with Asperger's report a feeling of being unwillingly detached from the world around them. On the other hand there is a large group of Asperger adults who do get married, get a doctorate from a fine university, and hold a job; it just depends on the individual. More research is needed on adults with Asperger's.
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Relationship to autism
Asperger syndrome is named after Hans Asperger.Experts generally agree that there is no single condition called autism, rather, a spectrum of autistic conditions, with different forms of autism taking different positions on this spectrum,[citation needed] although the concept of a spectrum has been questioned.[citation needed] If differences in development are purely a function of differences in skill acquisition, then attempting to distinguish between degrees of severity may be misleading. A person may be subjected to unrealistic expectations, or even denied life-saving services, based solely on very superficial observations made by others in the community.
In the 1940s, Leo Kanner and Hans Asperger, working independently in the United States and Austria, identified essentially the same population, although the group identified by Asperger was perhaps more "socially functional" than Kanner's as a whole.[citation needed] Some of Kanner's originally identified autistic children might today get an Asperger syndrome diagnosis, and vice versa.
Traditionally, Kannerian autism is characterized by significant cognitive and communicative deficiencies, including delays in or lack of language.[citation needed] Often it is clear that these people do not function according to developmental norms. On the other hand, a person with Asperger's will not show delays in language. It is a more subtle condition, and affected people often appear only to be eccentric.
Researchers are grappling with the problem of how to divide the spectrum.[citation needed] There are many potential divisions, such as autistics who speak versus those who do not, autistics with seizures versus those without, autistics with more "stereotypical behaviors" versus those with fewer, and so forth. Some researchers are trying to identify genes associated with these traits as a way to make logical groupings.
Leo Kanner identified another form of autism around the same time as Hans Asperger.Some clinicians believe that communicative or cognitive deficiencies are so essential to the concept of autism that they prefer to consider Asperger's a separate condition from autism. This opinion is a minority one.[citation needed] 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. Dr. Sally Ozonoff, of the University of California at Davis's MIND institute, argues that there should be no dividing line between "high-functioning" autism and Asperger's, and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.
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A gift and a curse
With the increase of Asperger syndrome diagnoses,[citation needed] it is increasingly viewed as a syndrome with both advantages and disadvantages.[citation needed] Adults with Asperger syndrome or autism achieved success in their fields, possibly as a result of intellectual gifts and above-average focus and motivation associated with the syndrome.[citation needed] Prominent Asperger-diagnosed individuals include Nobel Prize-winning economist Vernon Smith, industrial rocker Gary Numan, Noot vir Noot champion Daantjie Badenhorst, Vines frontman Craig Nicholls, and Satoshi Tajiri, the creator of Pokémon.[21]
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Speculation about recognized people who may have Asperger syndrome
Main articles: List of autistic people and People speculated to have been autistic
It has been speculated that Albert Einstein had what is now considered Asperger syndrome.Asperger's researchers Simon Baron-Cohen and Ioan James have speculated that well-known figures including Albert Einstein and Isaac Newton had Asperger syndrome because they showed some Asperger's-related tendencies or behaviors, such as intense interest in one subject, or social problems. A chapter of Gillberg's book[22] is devoted to this subject, including a detailed case study of philosopher Ludwig Wittgenstein, concluding that he met the criteria for the condition. Fitzgerald reviewed the evidence and concluded that Wittgenstein had the major features of the syndrome.[23]. Stanley Kubrick and Glenn Gould are also speculated to have had the syndrome.
However, such posthumous diagnoses remain controversial. Autistic rights activists often use such speculative diagnoses to argue that it would be a loss to society if autism were cured[24]. Others in the autistic rights movement dislike these arguments because they say autistics should be able to value their uniqueness without the desire for a cure, regardless of whether people such as Einstein were autistic.[citation needed]
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Cultural and sociological views of the condition
Main article: Autistic culture
People with Asperger syndrome may refer to themselves in casual conversation as "aspies", a name first used by Liane Holliday Willey in her 1999 book Pretending to be Normal: Living With Asperger's Syndrome. [25] Willey was among the first females with Asperger syndrome to speak publicly about the challenges and rewards of living with the condition. Others prefer "Aspergian", "Asperger's autistic" or just no name at all. Many who think there is no significant difference between Asperger syndrome and autism because of the spectrum-analogous variances in autism may prefer the term "autie" or just "autistic" as a more general term.[citation needed]
The term neurodivergent, which comes from the fact that Asperger syndrome is classified medically as a neurological disorder, is also used by some people with Asperger syndrome. The term neurotypical (NT) is used to refer to people who are non-autistic. In addition, people who seek a cure for autism are sometimes pejoratively called "curebies".[citation needed]
The social contributions of autistic people are believed to have contributed to a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured.[citation needed] Proponents of this view reject the notion that there is an 'ideal' brain configuration and that any deviation from the norm must be considered pathological. They demand tolerance for what they call their neurodiversity in much the same way physically handicapped people have demanded tolerance for theirs. Views such as these are the basis for the autistic rights and autistic pride movements.[citation needed]
Researcher Simon Baron-Cohen has argued that high-functioning autism is a difference and not necessarily a disability.[26] He contends that the term "difference" is more neutral and value-free, and that this small shift in a term could mean the difference between a diagnosis of Asperger's being received as a family tragedy, or interesting information, such as learning that a child is left-handed.
A Wired magazine article, The Geek Syndrome,[27] suggested that Asperger syndrome is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It created an enduring notion, popularized in the media and self-help books, that "Geek Syndrome" is the same as Asperger syndrome, and caused an explosion of self-diagnoses,[citation needed] in part because it was printed alongside Simon Baron-Cohen's 50-question Autism Spectrum Quotient Test[28]. However, no medical connection between the "Geek Syndrome" personality type and the autism spectrum has been determined.
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Controversies
Main article: Controversies in autism
There is disagreement[citation needed] regarding understanding and treatment of pervasive developmental disorders, such as Asperger syndrome and autism. Many of these arguments revolve around the social ramifications of living with the condition
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