1

ArielEllis

MelissaFilice
GemmaMinetti
AspergersSyndrome
HistoricalPerspective
AccordingtoAutismSpeaks(2014),anonlineresourcethatadvocatesforindividuals
withautismandtheirfamilies,Aspergerssyndromeischaracterizedasanautismspectrum
disorder,andismorespecificallyknownashighfunctioningautism.Thefirstcasesof
Aspergersweredocumentedin1944byAustrianpediatricianHansAsperger.Dr.Asperger
noticedthattherewerecertainchildrenthathaddifficultysocially,despitehavingaverage
intelligence.Healsonoticedcertaincharacteristicsassociatedwiththesechildrenincludinga
lackofnonverbalcommunicationskills,lackofempathy,physicalawkwardness,formalspeech,
andanoverwhelminginterestononesingletopicthatwoulddominatetheirconversations.Dr.
Aspergercalledthedisorderautisticpsychopathy,andcharacterizeditasapersonalitydisorder
withthemainsymptombeingsocialisolation.
Ittookthirtysevenyearsin1981forDr.Aspergersobservationstobepublishedby
Englishdoctor,LornaWing.Wingpublishedherowncasestudiesshowingsimilar
symptomstowhatAspergerdescribed,andrenamedthedisorderAspergerssyndrome.
AfterWingspublication,Aspergersbecameadistinct,widelyknowndiagnosis.
In1992,AspergerswasincludedintothetentheditionoftheWorldHealth
Organizationsdiagnosticmanual,the
InternationalClassificationofDiseases
(National
InstituteofNeurologicalDisordersandStroke,2012).
In1994,Aspergerswasaddedtothe
DiagnosticandStatisticalManualofMental
Disorders
(
DMSIV
).

DSM
labelsovertimeforASD(Hardman,Clifford,&Egan,2014):
EditionI(1952)SchizophrenicReaction,ChildhoodType
EditionII(1968)Schizophrenia,ChildhoodType
EditionIII(1980)InfantileAutism
EditionIIIR(1987)AutisticDisorder
CurrentThinking
AccordingtotheIndividualswithDisabilitiesEducationActin2004,classificationsfor
servicesforAspergersvarybystate.Somestatesallowforstudentstobelabeledunderthe
autismcategory,speechlanguageimpairedcategory,orotherhealthimpairedcategory.Also
dependingonstateregulations,youngchildren(usually9andunder)mightbeprovidedservices
underanoncategoricaldisabilityumbrella(Ruble&Akshoomoff,2010).
Fourmaincategoriesofdiagnosesfrom
DSMIV
:
gearedmoresotowardidentifyingschoolagedchildren
autisticdisorder
Aspergersdisorder
childhooddisintegrativedisorder
pervasivedevelopmentaldisordernototherwisespecified
TheAmericanPsychiatricAssociation(2013),statesthatthefourcategoriesofdiagnoses
fromthe
DSMIV
werenotconsistentlyappliedintreatmentcenterandclinicstherefore,the
DSM5
eliminatedtheautismrelatedcategoriesandmadediagnosesmoreaccurateby
encompassingallfourcategoriesintotheumbrelladiagnosisofautismspectrumdisorder.The
newdiagnosiscriteriaincludesmoreusefulmedicalandscientificwaysofdiagnosinginorderto

maintainahighlevelofaccuracyindiagnosing.The
DSM5
nowstatesthatchildrenmustshow
symptomsfromearlychildhood,eveniftheyarenotimmediatelyrecognized.Thisrendition
encouragesearlierdiagnosis,unlikethe
DSMIV
thatwasmorefocusedondiagnosing
schoolagechildren.
PrimarySymptoms
ThefollowingbehaviorsaretypicallyassociatedwithAspergerssyndrome,andcanvary
indegreeandpresenceinoneindividual(AutismSpeaks,2014):
difficultieswithsocialinteractions
inappropriateness,difficultieswithnonverbalcommunication,gestures,andfacial
expressionsdespitehavingaboveaverageverbalskillsandaverageintelligence
repetitiveormonotonespeech
onesidedconversationsatendencytotalkaboutoneselfandnotinquireaboutothers
failuretounderstandsarcasm,humor,ornonliteralphrases
difficultyunderstandingemotion
obsessionswithoneormorespecifictopics,routines,orrituals
ComorbidSymptomsandDisorders
InregardstoconditionsthatcoexistwithAspergerssyndrometheavailableresearchis
limited.AccordingtotheNationalInstituteofNeurologicalDisordersandStroke(NINDS)
(2014)conditionsthatoftencoexistwithAspergerssyndromespecificallyareAttentionDeficit
HyperactivityDisorder(ADHD),ticdisorders(suchasTourettesyndrome),depression,anxiety
disorders,andObsessiveCompulsiveDisorder(OCD).Anotherstudyalsofoundthatchildren

withhighfunctioningautismandAspergerssyndromearevulnerabletoOppositionalDefiant
Disorderinadditiontoanxiety,depression,andADHD(Macintosh&Dissanayake,2006).
ForAutismSpectrumDisorders(ASD)ingeneral,approximatelyfouroutoffiveyoung
childrenwithASDhaveatleastoneothercondition(Levyetal.,2010ascitedinHardmanetal.,
2014).ThetypesofconditionsthatcancoexistwithASDincludedevelopmental,mentalhealth,
neurological,andgeneticdisorders.AccordingtotheCenterforDiseaseControlandPrevention
(CDC)(2009),approximately40to60percentofchildrenwithASDhavebeenshowntohave
intellectualdisabilities(ascitedinHardmanetal.,2014).Somestudieshavefoundthatthe
greatertheautismseverity,themorelikelythechildwillhavesomaticcomplaints,mood
disturbance,andsocialproblems(Mayles,Calhoun,Murry,&Zahid,2011ascitedinHardman
etal.,2014).
OnestudyfoundthatchildrenwithASDmaybemorepronetospecificgastrointestinal
symptomssuchasabdominalpain,constipation,anddiarrhea(McElhanon,McCracken,Karpen,
Sharp,2014).AndinadifferentstudydonebyKim,Szatmari,Bryson,Steinter,andWilson
(2000)itwasfoundthatchildrenwithAspergerssyndromeandautismhadhigherlevelsof
anxietyanddepressioncomparedtootherchildrentheirage.
NeuropsychologicalFactorsandEtiology
BecausethereissuchvariationinthenewdiagnosisofASD,researchisbeingconducted
toexaminethedifferencesinbrainconnectivityofpeoplewithASDcomparedtopeoplethatdo
nothaveASD(Doheny,2014).ResearcherInnaFishermanfromSanDiegoStateexplainsthat
contrarytopopularbelief,someneurologicalconnectionsmaybeoverconnected,meaningthat

theneurologicalconnectionscommunicatemuchmorethanexpected(Doheny,2014).Fishman
alsostatesthatinsteadoflookingatindividualpartsofthebrainforsignsofASD,research
shouldfocusonthebrainasawholecollectionofneurologicalnetworks(Doheny,2014).
FishmanandherteamfoundthatthegreaterthedifferencesinASDsindividualsneurological
activityascomparedtononASDindividuals,themoreprominentthesocialskilldeficits.Even
thoughthiswindowofresearchisstillpreliminary,itmaybethestartofnew,moreaccurate
researchtofinallyfindthecauseorcausesofASD(Doheny,2014).
RecentresearchaboutbrainandneuroanatomyinpeoplewithASDhascomeupwiththe
ahypothesisthatthereis,acommonmolecularmechanismunderlyingADSisaltered
translationalcontrolresultsinexaggeratedproteinsynthesis(Huynh,etal.,2013).Agroupof
micewerecreatedtoproducehighlevelsofaeukaryotictranslationinitiationfactor4E,whichis
thesuspectednucleotidethathasbeenassociatedwithbrainactivityinpeoplewithASD.This
abnormalityhasbeenconnectedtoavariationinchromosome4q.Thegeneticallyengineered
micewhoproducehighlevelsoffactor4Eshowedbehavioralsymptomssimilartopeoplewith
ASDsuchasrepetitivebehaviorsanddeficitsinsocialinteractions.Thisstudyhasalsofound
thattherearedifferencesinsynapticpathwaysinthemedialprefrontalcortex,striatumand
hippocampus.Interestingly,whenmicewereinjectedwithaninhibitorof4EGI1the
problematicbehaviorsstops.Thisstudysuggeststhatthereisageneticvariantinchromosomes
thatcausesatypeofproteintobeoverproduced,whichinturncausesthebehavioralsymptoms
ofASD.Furtherresearchneedstobeconductedtovalidatethesefindings,butasnew

technologyandbrainimagingdevelopsfurtherresearchtoinvestigatethecausesofASDcanbe
evaluated.
AccordingtoRuble&Akshoomoff(2010),thecausesofASDareunknowntothisday.
IthasbeenspeculatedthatvaccinationscausedASD,howeverthereislittletonoempirical
evidencetosupportthatclaim(ascitedinHarmanetal.,2014).Manyexpertsconjecturethat
ASDmaybecausedbyavarietyofbiologicalfactors,includingbutnotlimitedto,genetic,
infections,neurological,metabolic,andimmunologicfactors(Harmanetal.,2014).Accordingto
theCDC(2014),childrenwhoareborntoolderparentsareatahigherriskofdevelopingASD.
ChromosomalconditionsmayplayaroleaswellsinceASDtendstooccurmorefrequentlyin
peoplewhohavecertaingeneticorchromosomalconditionssuchasDownsyndrome,fragileX
syndrome,etc(CDC,2014).
Prevalence
Inrecentyears,peoplehavefearedthatanautismepidemicisamongus.However,
comparedwithotherconditions,autismisrelativelyrare(Hardmanetal.,2014).Sinceveryfew
studieshavebeendonelittleisknownabouthowcommonAspergerssyndromeis.
TheNational
AllianceonMentalIllness(2014)statesthattheprevalenceofAspergerssyndromeare
estimatedtorangefrom.024percentto.36percent.Areviewofstudiesfoundprevalencerates
torangefrom.03to4.84per1,000,andaratioof5to1forautismtoAspergerssyndrome
(Autismhelp,2008).TheCDC(2014)statesthatabout1in68childrenhavebeenidentified
withautismspectrumdisorder.TheCDC(2014)alsostatesthat,whenitcomestoASDmales
tendtooutnumberfemalessubstantiallywitharatioofaround5to1.
TheCDCstatesthatone

reasoningbehindthegenderdifferenceinASDisthatfemalestendtobelesssociallyaberrant
thanmaleswhichcanmakeitmoredifficulttorecognizeinfemales(Hardmanetal.,2014).A
previousreportfromtheCDCinregardstoraceandethnicitymentionedthatsomestudieshave
foundgreaterprevalenceofASDamongnonHispanicblackchildrenandHispanicchildren(as
citedinHardmanetal.,2014).
However,itisimportanttonotethatASDoccursinallracial,
ethnic,andsocioeconomicgroups(CDC,2014).
DevelopmentalCourse
Aspergersdoesnotgoaway,infactmanystudiesofchildrenwithAspergerssyndrome
suggestthattheirproblemswithsocializationandcommunicationcontinueintoadulthood
(NINDS,2014).AlthoughAspergersandASDcannotbecured,earlyinterventionandtreatment
isthemostimportantthingaparentcandotoimprovetheoutcomesforachildoradolescent
withASDorAspergers(NAMI,2014).Earlydiagnosisandinterventionisimportant,however,
itisimportanttonotethatinterventionatanyageisgoingtobehelpful.Providinginterventions
andtreatmentsforachildwithAspergersorASDisgoingtomakeindependenceforthischild
muchmorepossiblethroughouttheirlife.
AssociatedSchoolRelatedProblems
ChildrenwithAspergerssyndromehavelanguageabilitysimilartotypicalchildren,
howevertheirabnormalityarisingwithunderstandingsocialinteractionsandsocialcues
(Hardmanetal.,2014).Additionally,studentswithAspergerssyndromecangetstucktryingto
understandcolloquialismsorjokesandhaveadifficulttimemovingontocompletetheschool
work(AutismSpeaks,2014).Furthermore,ChildrenwithAspergershaveahardtime
interactingappropriatelywithpeersandareoftenrejectedbecauseoftheirinappropriatesocial

interactions.Theseinappropriatesocialinteractionscanbecharacterizedbyaskingimproper
questions,inabilitytotaketurns,aswellasmisjudginghowmuchorhowlittletosayin
conversation.Typicalchildrenandadultsoftenfindthisbehaviorannoyingandoffputting
whichleadtostudentswithAspergerstoberejectedorbulliedbypeersandteachers(Myles&
Simpson,2002).ThisrejectionleadschildrenwithAspergerstobeupsetbytheirpoorsocial
competence(Macintosh&Dissanayake,2006).StudentswithAspergershavehigherperceived
levelsofhyperactivityandinternalizingbehaviorsinconjunctionwithlowerlevelsof
selfcontrol,whichfurtherleadtodifficultiesbeingacceptedbypeers.Itissuggestedthatthese
negativebehaviorsmaybecomeexacerbatedbygainingattentionfromtheirpeersorresultfrom
frustrationofnotbeingabletopredictwhatwillhappeninsocialsettings.Sincechildrenwith
Aspergershaveproblemsintegratingsociallytheymaypersistinnegativebehaviorssotheyare
abletogainsomeformofattentionfrompeersandteachers.Thesenegativebehaviorscan
continueandmakechildrenwithAspergerssusceptibletoOppositionalDefiantDisorder.This
canleadtobeingsociallydisruptiveduringclasswhichmayleadtothestudentbeingaskedto
leaveclassandmissinginstructionaltime,orbeingdisciplinedinfrontofpeerswhichmay
furtherleadtointernalizationissues.StudentswithAsperger'shavenormalintelligencelevels
butdostrugglewithunderstandingabstractconcepts,poororganizationalskills,andinflexibility
inthinkingprocessesandproblemsolving(Myles&Simpson,2002).
Assessment
Aspreviouslymentioned,symptomsofAspergerssyndromeaswellasASDvarywith
eachuniqueindividual.Unfortunatelythiscausesassessmentanddiagnosistobemoreofa
collaborationandlessexacting.FourofthemostcommonlyusedassessmentsofASDarethe

AutismDiagnosticInterviewRevised(ADIR),theAutismDiagnosticObservationSchedule
(ADOS),ChildhoodAutismRatingScale(CARS),andtheGilliamAutismRatingScaleSecond
Edition(GARS2),(CDC,2014).Thesetestsassesscommunication,socialinteractions,and
repetitivebehaviorsofchildrensuspectedtohaveASDaswellasotherbehaviorstypicalof
childrenwithASDduringdifferentages.InastudydonebyCouteur,Haden&Hammal(2008)
therewerediscrepantresultsofagreementofthebestestimateclinicaldiagnosis(BECD)
betweentheADIRandADOS.WhenusedtodiagnoseAutismthetwotestswereinagreement
67%ofthetimewhilewhenusedtodiagnoseASDwasonlyinagreement14%ofthetime.
Additionally,thereweresixchildrenwhowerediagnosedbyprofessionalsashavingASDbut
werebelowthecutoffscoresforASDonboththeADIRandADOS.Thesemeasuresmaybe
usefultohelpdiagnosispeopleinthemiddlerangeofASDhowevertheymaybeinconclusive
aboutchildrenwhohavehigherfunctioningASDorAspergers.
FurtherdifficultyaccuratelyorconclusivelyassessingforAspergersisillustratedwith
informationfromtheCenterforDiseaseControl(2014).Thedevelopmentalscreeningprocess
mayresultinpositiveornegativescreeningsofASD,however,itisstillpossibletobediagnosed
withASDevenwithnegativescreening.Theprocessseemstoinvolveusinganassessmentand
thenusingprofessionaljudgementtodetermineifachilddoeshaveASDeventhoughthechild
scoresbelowthecutoffscoreforASD.SimilartothestudybyCouteuretal.(2008),achild
maytrulyhaveASDbutnotbediagnosedbytheassessmenttools.Thesefindingsaboutthe
assessmenttoolscanmakediagnosingAspergers,orhighfunctioningASDevenmoredifficult
sincethesymptomsoftheseformsofASDaremuchmoremildthanmoderatelevelsofASD.

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AssessmentscanbehelpfulasafirststepindiagnosingASD,howevereachindividualwith
ASDisuniqueandtrulyneedsamultidisciplinarydiagnosiscomprisedofseveralindividuals.
Diagnosis

ASDdifferscomparedtomostdisordersbecausethediagnosisisbasedonbehaviors,and
notmedicaltesting(Ruble&Akshoomoff,2010).Toreceiveanaccuratediagnosis,children
withsuspectedASDshouldbeevaluatedbyaprofessionalthatspecializesinidentifying
languagedifference,andskilldevelopmentinthebehavioral,social,andcognitivedomains
(Ruble&Akshoomoff,2010).Thesespecialistscanreliablydiagnoseachildattwoyearsold,
andthisearlyofadiagnosiscanhelpparentsdevelopanunderstandingofwhatthechild
specificallyneeds,andanyaccommodationstheyneedtomakefortheirchild(Ruble&
Akshoomoff,2010).
ThediagnosisofAspergerssyndromehasincreasedinrecentyears,andthismaybedue
toanincreaseinprevalence,ortheuseofmoreeffectivescreeningtechniquesfordiagnosisand
symptomrecognition(AutismSociety,2013).Inthe
DSMIV
whenautismandAspergerswere
consideredtobeseparatedisorders,theonlykeydifferencebetweenthesymptomswasthat
Aspergerschildrendidnothaveanyverbalcommunicationandlanguagedelaysforchildrento
bediagnosedwithAspergers,thechildmusthavenormallanguagedevelopmentandaverage
intelligencewhencomparedtootherchildrentheirage(AutismSociety,2013).
Interventions/Treatment
CommunicationbetweenteachersandparentsofachildwithASDiscritical.Itis
suggestedthattherebeadailyjournalforteachersandparentstowriteinformationdownto
easilypassontotheother(Ruble&Akshoomoff,2010).Itisalsoimportanttorememberthat

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eachchildisaffecteddifferentlybyASDandneedstobetreatedonanindividualbasis.There
areseveralinterventionsthatarerecommendedforchildrenwithASD,howeverindividual
teachingstyleshouldvarytohelpeachuniqueindividual.Oneofthemostimportantfacetsto
recognizewithchildrenwhohaveAspergersisthattheydonotknoworunderstandtypically
inherentsocialcuesandsocialskills.Thesechildrenneedtohavetheseskillsandinteractions
explainedandtaughttothem.ChildrenwithASDshouldbegivenopportunitiestointeractwith
otherchildrenandlearnsocialskillsthroughtheseinteractions.Oncechildrenhavebeen
diagnosedwithASDitisrecommendedthatthereisoneadultforeverytwochildrenwithautism
intheclassroom.However,sinceAspergersisaformofhighfunctioningautismthis
suggestionmaynotbeascrucial.Again,itisimportanttoinvestigatetheindividualand
determinetheappropriateinterventions.
AnotherimportantfactortohelpthelearningofASDstudentsistomodifythechilds
environment.Thereshouldbeclearexamplesandremindersofdailyroutines,expected
behaviors,andlocationsofwherebehaviorsshouldoccur.Thiscanbeachievedbypostingsigns
orimagessuchasimagesofthestepstowashoneshands.Additionally,therecanbeacalendar
withdifferentimagestorepresentwhatdaysareforschool,suchasaschoolbus,andwhichdays
aretheweekend,suchasapictureofahouse.Limitingsensoryinputcanalsohelpaidinthe
abilityofthestudenttofocusaswellascommunicatebetter.
Typicalchildrenrespondwelltobehaviormodification,howeverchildrenwithASDdo
notrespondinsimilarwaystocommonbehaviormodificationtechniquessuchastimeoutsand
takingawayfavoreditems.Itisimportanttoobtainafunctionalbehaviorassessmenttohelpget

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abehaviorinterventionplan.Again,eachchildwithASDpresentswithuniquevariationsof
symptomsandbehaviorandneedstobeassessedandtreatedonanindividualbasis.
Medicationisapossibleoptiontousetotreatperipheralsymptoms.Pharmaceutical
treatmentsfordepression,anxiety,selfinjuriousbehaviors,sleepproblemsorinattentionmaybe
helpfultoincreasethestudentslearning.Someexamplesofthesemedicationsarestimulants
suchasRitalinandAdderalltotreatADHDsymptoms,antianxietymedicinessuchasProzacand
Zolofttotreatdepression,andantipsychoticssuchasRisperdalandZyprexatotreatsleep
disturbances,aggression,andirritability(Hardman,Drew,&Egan,2014).

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