In 1994, Asperger's Disorder (AD) was recognized as a distinct clinical entity in the DSM-IV (the diagnostic reference that mental health professionals in the U.S. use; the DSM-IV also provides the diagnostic criteria for Asperger's Disorder). Since in the past, many children with Asperger's Disorder were diagnosed as having autism, one would expect to see certain features in common with autism, but also a pattern that distinguishes Asperger's Disorder (AD) from autism.
Children with Asperger's usually have a typical early development. Many children with Asperger's Disorder have normal or above-normal intelligence. Although there is no one description that will fit all children with Asperger's, perhaps the most salient features relate to their tendency to have sophisticated knowledge or passion for a narrowly defined range of interests while being socially inept.
Although children with AS have normal language development in the early years, they may not always understanding the meaning of the words and may use them incorrectly. They also think and react to the literal meaning of others' communications. Using slang or sarcasm with them -- such as saying "Hop to it!" may result in a literal interpretation instead of the child understanding that you mean, "Hurry up." Although some language skills are intact, comprehension of language and directions is often impaired. This impairment impacts academic tasks requiring following directions and drawing inferences, and also affects their social relationships.
Swedish physician Christopher Gillberg categorizes the features of Asperger's into six main domains of impairment:
--Social impairment with extreme egocentricity, which may include:
- Inability to interact with peers
- Lack of desire to interact with peers
- Poor appreciation of social cues
- Socially and emotionally inappropriate responses
--Limited interests and preoccupations, including:
- More rote than meaning
- Relatively exclusive of other interests
- Repetitive adherence
--Repetitive routines or rituals, that may be:
- Imposed on self, or
- Imposed on others
--Speech and language peculiarities, such as:
- Superficially perfect expressive language
- Odd prosody, peculiar voice characteristics
--Impaired comprehension including misinterpretation of literal and implied meanings.
--Nonverbal communication problems, such as:
- Limited use of gesture
- Clumsy body language
- Limited or inappropriate facial expression
- Peculiar "stiff" gaze
- Difficulty adjusting physical proximity
--Motor clumsiness -- may not be present in all cases.
As suggested by the above, whereas the features of autism are generally severe and noticeable within the first years of life, children with Asperger's have a more typical development. In general, a child with Asperger's Disorder does not have the language delays seen in autism (although they may have some atypical speech), and the Asperger's child functions at a higher level than the typical child with autism. Many children with Asperger's Disorder have normal intelligence.
While children with autism may have no interaction with peers, children with Asperger's do interact with peers, but may experience significant difficulty in social relationships. Children with AD often seem to be loners and their stereotypic behaviors or intense focus on their narrow interests may lead to isolation and/or peer rejection. An individual with AD may think and react to the literal meaning of others' communications, and may experience difficulty "reading" others' intentions or needs (this difficulty inferring others' mental states is known as "Theory of Mind"). But stating that individuals with AD have problems inferring others' mental or emotional states does not tell us the source of the problem. Is there just one deficit or a number of factors that contribute to this problem?
One skill that appears to be impaired relates to face gaze, and a number of studies have noted abnormal patterns. Individuals with AD do not seem to derive the same information from facial features (such as eyes) as their non-AD peers, and generally do not spend as much time watching others' eyes during conversations. Interestingly, some recent research suggests that those who watch lips are more socially competent than those who don't. Perhaps the AD individual who is unable to "read" eyes learns to compensate by getting more information from watching the lips and mouth.
But what about auditory tasks? Can children and adults with AD derive as much meaning from social communication cues such as tone, volume, and pitch as their non-AD peers? A pilot study by Rutherford et al. (2002) suggests that they are impaired in extracting such cues, and that this impairment may also contribute to difficulties drawing inferences about others' mental states (Theory of Mind).
Children or teens with Asperger's Disorder are more likely to experience problems that are not confined to just one factor or deficit. In addition to impairment in deriving accurate inferences from facial cues and auditory cues, individuals with AD are also more likely to experience difficulty in taking chunks of information and integrating them into a coherent whole so that full meaning is derived. Thus, even on a content level, students with AD may not be able to derive the same information as a non-AD peer, leading to incorrect inferences about others' states and inappropriate responses.
Another social impairment that has been suggested is that individuals with AD are too verbose (wordy), but the research on this issue has yielded somewhat contradictory results. A study by Adams et al. (2002) found that AD children were not more verbose in general than the control group of Conduct Disorder children. They also performed comparably in conversations that involved questioning and answering. Where they differed significantly, however, was that AD children experienced more difficulty in general conversations, and made more problematic comments in conversations about socially loaded or emotionally loaded topics.
Motor clumsiness is also present in many children and teens with AD, and can lead to peer impairment as the AD child may be less adept at sports and less likely to participate in group sports that are part of normal social development.
Some students with Asperger's cannot handle the frustrations in school (or at home). Their inability to make transitions when the adults ask them to switch tasks, their inability to read social cues or respond appropriately, and their difficulty with concrete rigid thinking may result in a lot of anger or "melt-downs."
In a survey of middle-class mothers of children with Asperger's Disorder or nonverbal learning disabilities (NVLD), Little (2002) reported an overall yearly prevalence rate of victimization by peers or siblings or peer shunning of 94%. A reported 10% of the children had been attacked by a gang in the past year and 15% were reported to have been victims of nonsexual assaults to the genitals. A third of the children had not been invited to a single birthday party in the past year, and many were eating alone at lunch or were picked last for teams. Peer shunning was significantly correlated with peer bullying and assault.
In second report by Little (2002), based on the same sample of middle-class mothers, difficulties in parenting a child with Asperger's or NVLD were evident, as 58% of the mothers reported using used physical (corporal) punishment and 95% reported employing psychological aggression (such as verbal abuse) in dealing with their children's misbehavior.
On a day-to-day level, then, children and adolescents with Asperger's may experience significant problems and their parents may need extensive support, which might include parent education and training in effective environmental supports and interventions for dealing with problematic behaviors. School personnel working with a student with Asperger's will need to collaborate closely with the student's parents to discuss how to support the school's efforts in the home.
While children with Asperger's will often have special education needs, many of them will do well academically and go on to attend college. Many will also be able to develop meaningful relationships with family and friends, although the quality of the relationships may be different than what most people experience.