ASPERGER SYNDROME

http://www.co-brass.com/What_is_AS.pdf

THE AUSTRALIAN SCALE FOR ASPERGER'S

SYNDROME
http://www.aspennj.org/pdf/information/articles/australian-scale-for-asperger-
syndrome.pdf

Life Journey Through Autism:

An Educators Guide to Asperger Syndrome
http://www.researchautism.org/resources/OAR_Guide_Asperger.pdf

Aspergers syndrome
http://www.orpha.net/data/patho/GB/uk-asperger.pdf

Supporting Students
with
Aspergers Syndrome
http://www.northwestern.edu/disability/media/pdfs/supporting_students_aspergers_syndr
ome_rpg.pdf

Giftedness and Asperger's Syndrome: A New Agenda for

Education
http://www.hoagiesgifted.org/eric/fact/asperger.pdf

What Is Asperger Syndrome?

By Thaashida L. Hutton, M.S., CCC-SLP
http://www.superduperinc.com/handouts/pdf/188%20Asperger%27s%20syndrome.pdf

HISTORY OF ASPERGER'S
SYNDROME
The history of Asperger syndrome, an Autism Spectrum Disorder (ASD), is brief;
Asperger syndrome is a relatively new diagnosis in the field of autism,[1] named in honor
of Hans Asperger (190680), an Austrian psychiatrist and pediatrician. An English
psychiatrist, Lorna Wing popularized the term "Asperger's syndrome" in a 1981
publication; the first book in English on Asperger syndrome was written by Uta Frith in
1991 and the condition was subsequently recognized in formal diagnostic manuals later
in the 1990s.[1]

Asperger and Kanner

Asperger was the director of the University Children's Clinic in Vienna, spending most of
his professional life in Vienna and publishing largely in German.[1] In 1944, Asperger
described in the paper "'Autistic psychopathy' in childhood"[2] four children in his
practice[3] who had difficulty in integrating themselves socially. Although their
intelligence appeared normal, the children lacked nonverbal communication skills, failed
to demonstrate empathy with their peers, and were physically clumsy. Their speaking was
either disjointed or overly formal, and their all-absorbing interest in a single topic
dominated their conversations. Asperger called the condition "autistic psychopathy" and
described it as primarily marked by social isolation.[4] Asperger called his young patients
"little professors",[2] and believed the individuals he described would be capable of
exceptional achievement and original thought later in life.[3]

Two subtypes of autism were described between 1943 and 1944 by two Austrian
researchers working independentlyAsperger and Austrian-born child psychiatrist Leo
Kanner (18941981). Kanner emigrated to the United States in 1924;[1] he described a
similar syndrome in 1943, known as "classic autism" or "Kannerian autism",
characterized by significant cognitive and communicative deficiencies, including delayed
or absent language development.[5] Kanner's descriptions were influenced by the
developmental approach of Arnold Gesell, while Asperger was influenced by accounts of
schizophrenia and personality disorders.[6] Asperger's frame of reference was Eugen
Bleuler's typology, which Gillberg described as "out of keeping with current diagnostic
manuals", adding that Asperger's desriptions are "penetrating but not sufficiently
systematic".[7] Asperger was unaware of Kanner's description published a year before
his;[6] the two researchers were separated by an ocean and a raging war, and Asperger's
descriptions were ignored in the United States.[3] During his lifetime, Asperger's work, in
German, remained largely unknown outside the German-speaking world.[1]

Coinage
According to Ishikawa and Ichihashi in the Japanese Journal of Clinical Medicine, the
first author to use the term Asperger's syndrome in the English-language literature was
the German physician, Gerhard Bosch.[8] Between 1951 and 1962, Bosch worked as a
psychiatrist at Frankfurt University. In 1962, he published a monograph detailing five
case histories of individuals with PDD[9] that was translated to English eight years later,
[10] becoming one of the first to establish German research on autism, and attracting
attention outside the German-speaking world.[11]

Lorna Wing is credited with widely popularizing the term "Asperger's syndrome" in the
English-speaking medical community in her 1981 publication[12] of a series of case
studies of children showing similar symptoms.[1] Wing also placed Asperger's syndrome
on the autism spectrum, although Asperger was uncomfortable characterizing his patient
on the continuum of autism spectrum disorders.[3] She chose "Asperger's syndrome" as a
neutral term to avoid the misunderstanding equated by the term autistic psychopathy with
sociopathic behavior.[13] Wing's publication effectively introduced the diagnostic
concept into American psychiatry and renamed the condition as Asperger's;[14] however,
her accounts blurred some of the distinctions between Asperger's and Kanner's
descriptions because she included some mildly retarded children and some children who
presented with language delays early in life.[6]

Early studies
The first systematic studies appeared in the late 1980s in publications by Tantam (1988)
in the UK, Gillberg and Gilbert in Sweden (1989), and Szatmari, Bartolucci and
Bremmer (1989) in North America.[1] The diagnostic criteria for Asperger's syndrome
were outlined by Gillberg and Gillberg in 1989; Szatmari also proposed criteria in 1989.
[13] Asperger's work became more widely available in English when Uta Frith, an early
researcher of Kannerian autism, translated his original paper in 1991.[1] Asperger's
syndrome became a distinct diagnosis in 1992, when it was included in the 10th
published edition of the World Health Organizations diagnostic manual, International
Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder.
[4]

Contemporary
Less than two decades after the widespread introduction of Asperger's syndrome to
English-speaking audiences, there are hundreds of books, articles and websites describing
it; prevalence estimates have increased dramatically for Autism Spectrum Disorder, with
Asperger's syndrome recognized as an important subgroup.[1] However, questions
remain concerning many aspects of Asperger's syndrome; whether it should be a separate
condition from high-functioning autism is a fundamental issue requiring further study.[3]
The diagnostic validity of Asperger syndrome is tentative, there is little consensus among
clinical researchers about the usage of the term "Asperger's syndrome", and there are
questions about the empirical validation of the DSM-IV and ICD-10 criteria.[6] It is
likely that the definition of the condition will change as new studies emerge[6] and it will
eventually be understood as a multifactorial heterogeneous neurodevelopmental disorder
involving a catalyst that results in prenatal or perinatal changes in brain structures.[3]

References
1 Baron-Cohen S, Klin A (2006). "What's so special about Asperger Syndrome?" (PDF).
Brain and cognition 61 (1): 14. doi:10.1016/j.bandc.2006.02.002. PMID 16563588.
2 Asperger H; tr. and annot. Frith U [1944] (1991). "'Autistic psychopathy' in childhood",
in Frith U: Autism and Asperger syndrome. Cambridge University Press, 3792. ISBN
052138608X.
3 Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol
Dis 3 (1): 17. PMID 16596080.
4 National Institute of Neurological Disorders and Stroke (NINDS) (July 31, 2007).
Asperger Syndrome Fact Sheet. Retrieved 24 August 2007.
5 Kanner L (1943). "Autistic disturbances of affective contact". Nerv Child 2: 21750.
Reprint (1968) Acta Paedopsychiatr 35 (4): 10036. PMID 4880460.
6 Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr 28
(Suppl 1): S3S11. PMID 16791390.
7 Ehlers S, Gillberg C. "The epidemiology of Asperger's syndrome: a total population
study." J Child Psychol Psychiatry. 1993 Nov;34(8):132750. PMID 8294522 Full Text.
8 Ishikawa G, Ichihashi K (2007). "[Autistic psychopathy or pervasive developmental
disorder: how has Asperger's syndrome changed in the past sixty years?]" (in Japanese).
Nippon Rinsho 65 (3): 40918. PMID 17354550.
9 (German) Bosch G (1962). Der frhkindliche Autismus - eine klinische und
phnomenologisch-anthropologische. Untersuchung am Leitfaden der Sprache. Berlin:
Springer.
10 Bosch G (1970). Infantile autism a clinical and phenomenological anthropological
investigation taking language as the guide. Berlin: Springer.
11 Blte S, Bosch G. "Boschs Cases: a 40 years follow-up of patients with infantile
autism and Asperger syndrome" (PDF). Journal of Psychiatry. Retrieved on 2007-08-20.
^ Wing L (1981). "Asperger's syndrome: a clinical account". Psychological medicine 11
(1): 11529. PMID 7208735. Retrieved on 2007-08-15.
12 Mattila ML, Kielinen M, Jussila K, et al (2007). "An epidemiological and diagnostic
study of Asperger syndrome according to four sets of diagnostic criteria". Journal of the
American Academy of Child and Adolescent Psychiatry 46 (5): 63646.
doi:10.1097/chi.0b013e318033ff42. PMID 17450055.
13 McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771
88. doi:10.1016/j.admecli.2006.06.010. PMID 17030291.

http://www.autism-help.org/asperger-syndrome-history.htm

http://www.sabp.nhs.uk/advice/FAQs-and-diagnoses/index_html/What%20is
%20Asperger%20Syndrome.pdf

Asperger Syndrome Fact Sheet

http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm
What is Asperger syndrome?
Why is it called Asperger syndrome?
What are some common signs or symptoms?
What causes AS? Is it genetic?
How is it diagnosed?
Are there treatments available?
Do children with AS get better? What happens when they become adults?
What research is being done?
Where can I get more information?

What is Asperger syndrome?

Asperger syndrome (AS) is a developmental disorder that is characterized by: 1

limited interests or an unusual preoccupation with a particular subject to the exclusion of

other activities

repetitive routines or rituals

peculiarities in speech and language, such as speaking in an overly formal manner
or in a monotone, or taking figures of speech literally
socially and emotionally inappropriate behavior and the inability to interact
successfully with peers
problems with non-verbal communication, including the restricted use of gestures,
limited or inappropriate facial expressions, or a peculiar, stiff gaze
clumsy and uncoordinated motor movements

AS is an autism spectrum disorder (ASD), one of a distinct group of neurological

conditions characterized by a greater or lesser degree of impairment in language and
communication skills, as well as repetitive or restrictive patterns of thought and
behavior. Other ASDs include: classic autism, Rett syndrome, childhood disintegrative
disorder, and pervasive developmental disorder not otherwise specified (usually referred
to as PDD-NOS).

Parents usually sense there is something unusual about a child with AS by the time of his
or her third birthday, and some children may exhibit symptoms as early as infancy.
Unlike children with autism, children with AS retain their early language skills. Motor
development delays crawling or walking late, clumsiness are sometimes the first
indicator of the disorder.

The incidence of AS is not well established, but experts in population studies

conservatively estimate that two to six out of every 1,000 children have the disorder.
Boys are three to four times more likely than girls to have AS.

Studies of children with AS suggest that their problems with socialization and
communication continue into adulthood. Some of these children develop additional
psychiatric symptoms and disorders in adolescence and adulthood.

Although diagnosed mainly in children, AS is being increasingly diagnosed in adults who

seek medical help for mental health conditions such as depression, obsessive-compulsive
disorder (OCD), and attention deficit hyperactivity disorder (ADHD). No studies have
yet been conducted to determine the incidence of AS in adult populations.
1
Adapted from the Diagnostic and Statistical Manual of Mental Disorders IV and the
International Classification of Diseases - 10

Why is it called Asperger syndrome?

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his
practice who had difficulty integrating socially. Although their intelligence appeared
normal, the children lacked nonverbal communication skills, failed to demonstrate
empathy with their peers, and were physically clumsy. Their way of speaking was either
disjointed or overly formal, and their all-absorbing interest in a single topic dominated
their conversations. Dr. Asperger called the condition autistic psychopathy and
described it as a personality disorder primarily marked by social isolation.

Aspergers observations, published in German, were not widely known until 1981, when
an English doctor named Lorna Wing published a series of case studies of children
showing similar symptoms, which she called Aspergers syndrome. Wings writings
were widely published and popularized. AS became a distinct disease and diagnosis in
1992, when it was included in the tenth published edition of the World Health
Organizations diagnostic manual, International Classification of Diseases (ICD-10), and
in 1994 it was added to the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV), the American Psychiatric Associations diagnostic reference book.

What are some common signs or symptoms?

The most distinguishing symptom of AS is a childs obsessive interest in a single object

or topic to the exclusion of any other. Some children with AS have become experts on
vacuum cleaners, makes and models of cars, even objects as odd as deep fat fryers.
Children with AS want to know everything about their topic of interest and their
conversations with others will be about little else. Their expertise, high level of
vocabulary, and formal speech patterns make them seem like little professors.

Children with AS will gather enormous amounts of factual information about their
favorite subject and will talk incessantly about it, but the conversation may seem like a
random collection of facts or statistics, with no point or conclusion.

Their speech may be marked by a lack of rhythm, an odd inflection, or a monotone pitch.
Children with AS often lack the ability to modulate the volume of their voice to match
their surroundings. For example, they will have to be reminded to talk softly every time
they enter a library or a movie theatre.

Unlike the severe withdrawal from the rest of the world that is characteristic of autism,
children with AS are isolated because of their poor social skills and narrow interests. In
fact, they may approach other people, but make normal conversation impossible by
inappropriate or eccentric behavior, or by wanting only to talk about their singular
interest.

Children with AS usually have a history of developmental delays in motor skills such as
pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often
awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

Many children with AS are highly active in early childhood, and then develop anxiety or
depression in young adulthood. Other conditions that often co-exist with AS are ADHD,
tic disorders (such as Tourette syndrome), depression, anxiety disorders, and OCD.

What causes AS? Is it genetic?

Current research points to brain abnormalities as the cause of AS. Using advanced brain
imaging techniques, scientists have revealed structural and functional differences in
specific regions of the brains of normal versus AS children. These defects are most likely
caused by the abnormal migration of embryonic cells during fetal development that
affects brain structure and wiring and then goes on to affect the neural circuits that
control thought and behavior.

For example, one study found a reduction of brain activity in the frontal lobe of AS
children when they were asked to respond to tasks that required them to use their
judgment. Another study found differences in activity when children were asked to
respond to facial expressions. A different study investigating brain function in adults
with AS revealed abnormal levels of specific proteins that correlate with obsessive and
repetitive behaviors.

Scientists have always known that there had to be a genetic component to AS and the
other ASDs because of their tendency to run in families. Additional evidence for the
link between inherited genetic mutations and AS was observed in the higher incidence of
family members who have behavioral symptoms similar to AS but in a more limited
form. For example, they had slight difficulties with social interaction, language, or
reading.

A specific gene for AS, however, has never been identified. Instead, the most recent
research indicates that there are most likely a common group of genes whose variations
or deletions make an individual vulnerable to developing AS. This combination of
genetic variations or deletions will determine the severity and symptoms for each
individual with AS.

How is it diagnosed?

The diagnosis of AS is complicated by the lack of a standardized diagnostic screen or

schedule. In fact, because there are several screening instruments in current use, each
with different criteria, the same child could receive different diagnoses, depending on the
screening tool the doctor uses.

To further complicate the issue, some doctors believe that AS is not a separate and
distinct disorder. Instead, they call it high-functioning autism (HFA), and view it as
being on the mild end of the ASD spectrum with symptoms that differ -- only in degree --
from classic autism. Some clinicians use the two diagnoses, AS or HFA,
interchangeably. This makes gathering data about the incidence of AS difficult, since
some children will be diagnosed with HFA instead of AS, and vice versa.

Most doctors rely on the presence of a core group of behaviors to alert them to the
possibility of a diagnosis of AS. These are:
 abnormal eye contact
aloofness
the failure to turn when called by name
the failure to use gestures to point or show
a lack of interactive play
a lack of interest in peers

Some of these behaviors may be apparent in the first few months of a childs life, or they
may appear later. Problems in at least one of the areas of communication and
socialization or repetitive, restricted behavior must be present before the age of 3.

The diagnosis of AS is a two-stage process. The first stage begins with developmental
screening during a well-child check-up with a family doctor or pediatrician. The
second stage is a comprehensive team evaluation to either rule in or rule out AS. This
team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and
additional professionals who have expertise in diagnosing children with AS.

The comprehensive evaluation includes neurologic and genetic assessment, with in-depth
cognitive and language testing to establish IQ and evaluate psychomotor function, verbal
and non-verbal strengths and weaknesses, style of learning, and independent living
skills. An assessment of communication strengths and weaknesses includes evaluating
non-verbal forms of communication (gaze and gestures); the use of non-literal language
(metaphor, irony, absurdities, and humor); patterns of inflection, stress and volume
modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content,
clarity, and coherence of conversation. The physician will look at the testing results and
combine them with the childs developmental history and current symptoms to make a
diagnosis.

Are there treatments available?

The ideal treatment for AS coordinates therapies that address the three core symptoms of
the disorder: poor communication skills, obsessive or repetitive routines, and physical
clumsiness. There is no single best treatment package for all children with AS, but most
professionals agree that the earlier the intervention, the better.

An effective treatment program builds on the childs interests, offers a predictable

schedule, teaches tasks as a series of simple steps, actively engages the childs attention
in highly structured activities, and provides regular reinforcement of behavior. This kind
of program generally includes:

social skills training, a form of group therapy that teaches children with AS the
skills they need to interact more successfully with other children
 cognitive behavioral therapy, a type of talk therapy that can help the more
explosive or anxious children to manage their emotions better and cut back on
obsessive interests and repetitive routines
medication, for co-existing conditions such as depression and anxiety
occupational or physical therapy, for children with sensory integration problems
or poor motor coordination
specialized speech/language therapy, to help children who have trouble with the
pragmatics of speech the give and take of normal conversation
parent training and support, to teach parents behavioral techniques to use at home

Do children with AS get better? What happens when

they become adults?

With effective treatment, children with AS can learn to cope with their disabilities, but
they may still find social situations and personal relationships challenging. Many adults
with AS are able to work successfully in mainstream jobs, although they may continue to
need encouragement and moral support to maintain an independent life.

What Treatments Are Available for Adults

with Asperger Syndrome?
Question: What Treatments Are Available for Adults with Asperger Syndrome?
Your symptoms seem to point to Asperger syndrome. But is it worth doing all the work of
getting a diagnosis? What good will a diagnosis do and what therapies are available to
you once you have an "official" diagnosis in hand?
Answer: Children with Asperger syndrome (AS) and other forms of autism usually
receive a set of treatments and therapies in school. Often, they'll receive physical,
occupational and speech therapy along with some kind of social skills training and
behavior support. If they over- or under-react to sensory input (lights seem too bright,
sounds seem too loud, etc.), their parents might also sign them up for sensory integration
therapy. As they get older, they might get involved with social skills groups and cognitive
therapy.

While some of these therapies are appropriate for adults with AS, says Dr. Shana Nichols
of the Fay J. Lindner Center for Autism, treatment for adults really depends upon the
individual adult's response to the diagnosis. And responses can run the gamut from joy to
anger -- and everything in between.

Says Dr. Nichols: "Some people are overjoyed because finally everything makes sense to
them -- why they can't hold a job, keep a relationship. They have blamed themselves all
their lives. Now they have a framework in which to understand their difficulties and their
strengths. For a lot of people, it's a relief."

Of course, there is no obligation to do anything about an AS diagnosis, and some people

simply stop with the diagnosis and walk away. For those people who are interested in
exploring their AS further, says Nichols, "We do a debriefing and exploration focused
what they feel now that they know about it. We do a diagnostic 'life mapping' and explore
that; we talk about how all people with AS are different from one another. Then we make
a plan from there: We say you came there for a reason,' and we ask, 'Where would you
like to go next?'"

Some of the issues Nichols explores with her patients include quality of life concerns
such as leisure interests, social activities, health, employment and family. "We look at all
the different areas that make up quality of life, see how they're doing, and where they
want to make some changes."

In addition to working on personal goals, says Nichols, "Family work is often indicated.
There are often rifts that have occurred where siblings are no longer talking. We explore
the questions, 'What do you want to tell your family? How would you like to repair
relationships?' Sometimes we have families come in to work on issues together."

Beyond cognitive therapy, adults with an AS diagnosis have a number of other treatment
options. They can request that their diagnostician write a report that clearly outlines
diagnostic issues, IQ, and adaptive behaviors. With that report, adults diagnosed with AS
can often qualify for services provided by state and/or federal agencies. Such services
range from cognitive therapy to vocational training, job placement, health insurance, and,
in some cases, housing.

Some of the therapies that are useful for children are also helpful for adults with AS. For
example, sensory integration therapy can be helpful in alleviating hypersensitivity to
sound and light; social skills therapy (often in the form of life or job coaching) can
improve job situations and even friendships.

Perhaps most important, say AS advocates, is "do it yourself" therapy. Adults with AS
have access to books, support groups, conferences and other resources that provide
insight, ideas and information on all aspects of life with AS. The Global and Regional
Partnership for Asperger Syndrome (GRASP) offers a whole page of links to sites and
resources to support adults with AS seeking ideas, insights, and next steps.

Sources:

Asperger's Syndrome Fact Sheet, National Institutes of Neurological Disorders. Prepared by: Office of Communications and Public Liaison National
Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892 Publication date January 2005.

Interview with Michael John Carley, Executive Director of the Global and Regional Asperger Syndrome Partnership. April, 2007.
Interview with Dr. Shana Nichols, North Shore Long Island Jewish Health System, Fay J. Lindner Center for Autism. May, 2007.

Online Asperger Syndrome Issues and Support (OASIS) Website. "Adult Issues, Resources and Contributions From and For Individuals with AS and
Autism."

http://autism.about.com/od/adultsaspergersyndrom1/f/treatadultas.htm

Asperger's syndrome
Definition
By Mayo Clinic staff

Asperger's syndrome is a developmental disorder that affects a person's ability to

socialize and communicate effectively with others. Children with Asperger's syndrome
typically exhibit social awkwardness and an all-absorbing interest in specific topics.

Doctors group Asperger's syndrome with other conditions that are called autistic
spectrum disorders or pervasive developmental disorders. These disorders all involve
problems with social skills and communication. Asperger's syndrome is generally thought
to be at the milder end of this spectrum.

While there's no cure for Asperger's syndrome, if your child has the condition treatment
can help him or her learn how to interact more successfully in social situations.

Risk factors
By Mayo Clinic staff

Boys are far more likely to develop Asperger's syndrome than are girls.

Causes
By Mayo Clinic staff

It's not clear what causes Asperger's syndrome, although changes in certain genes may be
involved. The disorder also seems to be linked to changes in the structure of the brain.

One factor that isn't associated with the development of Asperger's syndrome or other
autism spectrum disorders is childhood immunizations.
Symptoms
By Mayo Clinic staff

Asperger's syndrome symptoms include:

Engaging in one-sided, long-winded conversations, without noticing if the listener

is listening or trying to change the subject
Displaying unusual nonverbal communication, such as lack of eye contact, few
facial expressions, or awkward body postures and gestures
Showing an intense obsession with one or two specific, narrow subjects, such as
baseball statistics, train schedules, weather or snakes
Appearing not to understand, empathize with or be sensitive to others' feelings
Having a hard time "reading" other people or understanding humor
Speaking in a voice that is monotonous, rigid or unusually fast
Moving clumsily, with poor coordination

Unlike children with more-severe forms of autism spectrum disorders, those with
Asperger's syndrome usually don't have delays in the development of language skills.
That means your child will use single words by the age of 2 and phrases by the time he or
she is 3 years old. But, children with Asperger's syndrome may have difficulties holding
normal conversations. Conversations may feel awkward and lack the usual give and take
of normal social interactions.

Toddlers and school-age children with Asperger's syndrome may not show an interest in
friendships. Youngsters with Asperger's often have developmental delays in their motor
skills, such as walking, catching a ball or playing on playground equipment.

In early childhood, kids with Asperger's may be quite active. By young adulthood, people
with Asperger's syndrome may experience depression or anxiety.

When to see a doctor

All kids have their quirks, and many toddlers show a sign or symptom of Asperger's
syndrome at some point. It's natural for small children to be egocentric, and many
children show a strong interest in a particular topic, such as dinosaurs or a favorite
fictional character. These generally aren't reasons to be alarmed.

However, if your elementary schoolchild has frequent problems in school or seems

unable to make friends, it's time to talk with your child's doctor. These difficulties have
many possible causes, but developmental disorders such as Asperger's syndrome need to
be considered. Children who have behaviors that interfere with learning and social
development should have a comprehensive evaluation.

Preparing for your appointment

By Mayo Clinic staff

You'll probably first see your child's pediatrician or family doctor, who will likely refer
your child to a mental health expert, such as a child psychologist or psychiatrist.

Being well prepared can help you make the most of your appointment. Here's some
information to help you get ready for your appointment, and what to expect from your
doctor.

What you can do

Write down any symptoms you've noticed in your child, including any that
may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent
life changes.
Make a list of any medications, as well as any vitamins or supplements, that
your child is taking.
Ask a family member or friend to join you and your child for the
appointment, if possible. Sometimes it can be difficult to soak up all the
information provided during an appointment. Someone who accompanies you
may remember something that you missed or forgot.
Write down questions to ask your doctor.

Preparing a list of questions ahead of time will help save time for the things you want to
discuss most. List your questions from most important to least important in case time
runs out. For Asperger's syndrome, some basic questions to ask your doctor include:

What is likely causing my child's behavior?

Are there other possible causes?
What kinds of tests does my child need?
Will he or she outgrow this condition?
What treatments can help?
Can these treatments cure Asperger's syndrome?
Are there any specialized programs available to help educate my child regarding
social skills?
What should I tell his or her school?
What are the alternatives to the primary approach that you're suggesting?
Would changes in diet help?
What's the prognosis for my child? Can he or she live a relatively normal life?
Should I see a specialist?
Are there any brochures or other printed material that I can take home with me?
What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask
additional questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:

What specific behaviors prompted your visit today?

When did you first notice these symptoms in your child?
Have these behaviors been continuous, or occasional?
Does anything seem to improve your child's symptoms?
What, if anything, appears to worsen your child's symptoms?
When did your child first crawl? Walk? Say his or her first word?
Does your child have close friends?
What are some of your child's favorite activities? Is there one that he or she
favors?
Have you noticed a change in his or her level of frustration in social settings?

Tests and diagnosis

By Mayo Clinic staff

Because Asperger's syndrome varies widely in severity and signs, making a diagnosis can
be difficult. If your child shows some signs of Asperger's syndrome, your doctor may
suggest a comprehensive assessment by a team of professionals.

This evaluation will likely include observing your child and talking to you about your
child's development. You may be asked about your child's social interaction,
communication skills and friendships. Your child may also have a number of tests to
determine his or her level of intellect and academic abilities. Tests may examine your
child's abilities in the areas of speech, language and visual-motor problem solving. Tests
can also identify other emotional, behavioral and psychological issues.

To be diagnosed with Asperger's syndrome, your child's signs and symptoms must match
the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders
(DSM), a manual published by the American Psychiatric Association and used by mental
health providers to diagnose mental conditions.

Some of the DSM criteria for Asperger's syndrome are:

No significant language delays

A lack of eye to eye contact
Unusual body posture or social expressions
Difficulty making friends
A preoccupation with one subject
No interest in interactive play
An inflexible attitude toward change
Unfortunately, some children with Asperger's syndrome may initially be misdiagnosed
with another problem, such as attention-deficit/hyperactivity disorder (ADHD) or
obsessive-compulsive disorder, possibly because the symptoms of some conditions are
similar to those of Asperger's. Additionally, these other conditions may coexist with
Asperger's, which can delay the diagnosis.

Treatments and drugs

By Mayo Clinic staff

The core signs of Asperger's syndrome can't be cured. However, many children with
Asperger's syndrome grow into happy and well-adjusted adults.

Most children benefit from early specialized interventions that focus on behavior
management and social skills training. Your doctor can help identify resources in your
area that may work for your child.

Asperger's syndrome treatment options may include:

Communication and social skills training

Children with Asperger's syndrome may be able to learn the unwritten rules of
socialization and communication when taught in an explicit and rote fashion, much like
the way students learn foreign languages. Children with Asperger's syndrome may also
learn how to speak in a more natural rhythm, as well as how to interpret communication
techniques, such as gestures, eye contact, tone of voice, humor and sarcasm.

Cognitive behavioral therapy

This general term encompasses many techniques aimed at curbing problem behaviors,
such as interrupting, obsessions, meltdowns or angry outbursts, as well as developing
skills such as recognizing feelings and coping with anxiety. Cognitive behavioral therapy
usually focuses on training a child to recognize a troublesome situation such as a new
place or an event with lots of social demands and then select a specific learned
strategy to cope with the situation.

Medication
There are no medications that specifically treat Asperger's syndrome. But some
medications may improve specific symptoms such as anxiety, depression or
hyperactivity that can occur in many children with Asperger's syndrome. Examples
include:

Aripiprazole (Abilify). This drug may be effective for treating irritability related
to Asperger's syndrome. Side effects may include weight gain and an increase in
blood sugar levels.
 Guanfacine (Intuniv). This medication may be helpful for the problems of
hyperactivity and inattention in children with Asperger's syndrome. Side effects
may include drowsiness, irritability, headache, constipation and bedwetting.
Selective serotonin reuptake inhibitors (SSRIs). Drugs such as fluvoxamine
(Luvox) may be used to treat depression or to help control repetitive behaviors.
Possible side effects include restlessness and agitation.
Risperidone (Risperdal). This medication may be prescribed for agitation and
irritability. It may cause trouble sleeping, a runny nose and an increased appetite.
This drug has also been associated with an increase in cholesterol and blood sugar
levels.
Olanzapine (Zyprexa). Olanzapine is sometimes prescribed to reduce repetitive
behaviors. Possible side effects include increased appetite, drowsiness, weight
gain, and increased blood sugar and cholesterol levels.
Naltrexone (Revia). This medication, which is sometimes used to help alcoholics
stop drinking, may help reduce some of the repetitive behaviors associated with
Asperger's syndrome. However, the use of low-dose naltrexone in doses as low
as two to four mg a day has been gaining favor recently. But, there's no good
evidence that such low doses have any effect on Asperger's syndrome.

Alternative medicine
By Mayo Clinic staff

Because there are no definitive treatments for Asperger's syndrome, some parents may
turn to complementary or alternative therapies. However, most of these treatments haven't
been adequately studied. It's possible that by focusing on alternative treatments, you may
miss out on behavior therapies that have more evidence to support their use.

Of greater concern, however, is that some treatments may not be safe. The Food and Drug
Administration has warned about over-the-counter chelation medications. These drugs
have been marketed as a therapy for autism spectrum disorders and other conditions.
Chelation is a therapy that removes heavy metals from the body, but there are no over-
the-counter chelation therapies that are approved by the Food and Drug Administration
(FDA). This type of therapy should only be done under the close supervision of medical
professionals. According to the FDA, the risks of chelation include dehydration, kidney
failure and even death.

Other examples of alternative therapies that have been used for Asperger's syndrome
include:

Melatonin
Sleep problems are common in children with Asperger's syndrome, and melatonin
supplements may help regulate your child's sleep-wake cycle. The recommended dose is
3 mg, 30 minutes before bedtime. Possible side effects include excessive sleepiness,
dizziness and headache.

Other dietary supplements

Numerous dietary supplements have been tried in people with autism spectrum disorders,
including Asperger's syndrome. Those that may have some evidence to support their use
include:

Vitamin B-6 and magnesium

Vitamin C (usually in combination with other vitamins)
Carnosine
Omega-3 fatty acids

Avoidance diets
Some parents have turned to gluten-free or casein-free diets to treat autism spectrum
disorders. There's no clear evidence that these diets work, and anyone attempting such a
diet for their child needs guidance from a registered dietitian to ensure the child's
nutritional requirements are met.

Secretin
This gastrointestinal hormone has been tried as a potential treatment. Numerous studies
have been conducted on secretin, and none found any evidence that it helps.

Other therapies that have been tried, but lack objective evidence to support their use
include hyperbaric oxygen therapy, immune therapies, antibiotics, antifungal drugs,
chiropractic manipulations, massage and craniosacral massage, and transcranial magnetic
stimulation.

Coping and support

By Mayo Clinic staff

Asperger's syndrome can be a difficult, lonely disorder both for affected children and
their parents. The disorder brings difficulties socializing and communicating with your
child. It may also mean fewer play dates and birthday invitations and more stares at the
grocery store from people who don't understand that a child's meltdown is part of a
disability, not the result of "bad parenting."

Luckily, as this disorder gains widespread recognition and attention, there are more and
more sources of help. Here are a few suggestions:

Maintain a consistent schedule whenever possible. If you have to introduce

change, try to do so gradually.
Learn about the disorder. There are numerous books and websites dedicated to
the disorder. Do some research so that you better understand your child's
 challenges and the range of services in your school district and state that may
help.
Learn about your child. The signs and symptoms of Asperger's syndrome vary
for each child, and young children have a hard time explaining their behaviors and
challenges. But, with time and patience, you'll learn which situations and
environments may cause problems for your child and which coping strategies
work. Keeping a diary and looking for patterns may help.
Find a team of trusted professionals. You'll need to make important decisions
about your child's education and treatment. Find a team of teachers and therapists
who can help evaluate the options in your area and explain the federal regulations
regarding children with disabilities.
Help others help your child. Most children with Asperger's syndrome have no
visible sign of disability, so you may need to alert coaches, relatives and other
adults to your child's special needs. Otherwise, a well-meaning coach may spend
time lecturing your child on "looking at me while I'm talking" something that
can be very difficult for a child with Asperger's syndrome.
Help your child turn his or her obsession into a passion. The tendency to fixate
on a particular narrow topic is one of the hallmarks of Asperger's syndrome, and it
can be annoying to those who must listen to incessant talk about the topic every
day. But a consuming interest can also connect a child with Asperger's syndrome
to schoolwork and social activities. In some cases, kids with Asperger's syndrome
can even turn their childhood fascination into a career or profession.
Find support. Lean on family and friends when you can. Ask someone who
understands your child's needs to babysit sometimes so that you can get an
occasional break. You may also find a support group for parents of children with
Asperger's syndrome helpful. Ask your child's doctor if he or she knows of any
groups in your area. Or, visit the Online Asperger Syndrome Information and
Support website.

http://ajp.psychiatryonline.org/data/Journals/AJP/3867/08aj0958.PDF

Curr Opin Pediatr. 2003 Oct;15(5):491-4.

Asperger syndrome: to be or not to be?

Foster B, King BH.

Source

Dartmouth Medical School, Lebanon, New Hampshire, USA.

Abstract
PURPOSE OF REVIEW:

Asperger syndrome is a pervasive developmental disorder characterized by impairments

in social interactions, such as nonverbal behaviors, failure to develop peer relationships,
and lack of social reciprocity with restricted, repetitive and stereotyped patterns of
interest or behavior. The diagnosis of Asperger syndrome is increasingly common, and it
is timely to review its phenomenology and treatment.

RECENT FINDINGS:

As there is a growing public awareness and acceptance of Asperger syndrome, clinical

research has produced mixed results that do not clearly discriminate Asperger syndrome
from high-functioning autism. However, research does indicate that children with
pervasive developmental disorder achieve better outcomes when diagnosis is made early
and appropriate community supports can be marshaled.

SUMMARY:

The history and phenomenology of Asperger syndrome is briefly reviewed, and recent
literature relating to assessment and treatment is highlighted.

J Autism Dev Disord. 2005 Apr;35(2):221-34.

Three diagnostic approaches to Asperger

syndrome: implications for research.
Klin A, Pauls D, Schultz R, Volkmar F.

Source

Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA.
ami.klin@Yale.Edu

Abstract

OBJECTIVE:

To examine the implications for research of the use of three alternative definitions for
Asperger syndrome (AS). Differences across the three nosologic systems were examined
in terms of diagnostic assignment, IQ profiles, comorbid symptoms, and familial
aggregation of social and other psychiatric symptoms.

METHOD:
Standard data on diagnosis, intellectual functioning, comorbidity patterns, and family
history were obtained on 65 individuals screened for a very high probability of having
autism without mental retardation (or higher functioning autism, HFA) or AS. Diagnoses
of AS were established based on three different approaches: DSM-IV, presence/absence
of communicative phrase speech by 3 years, and a system designed to highlight
prototypical features of AS.

RESULTS:

Agreement between the three diagnostic systems was poor. AS could be differentiated
from HFA (but not from PDD-NOS) on the basis of IQ profiles in two of the three
systems. Differences in patterns of comorbid symptomatology were obtained in two of
the three systems, although differences were primarily driven by the PDD-NOS category.
Only one of the approaches yielded differences relative to aggregation of the "broader
phenotype" in family members.

CONCLUSIONS:

Diagnostic assignments of AS based on three commonly used approaches have low

agreement and lead to different results in comparisons of IQ profiles, patterns of
comorbidity, and familial aggregation of psychiatric symptoms across the approach-
specific resultant groups of HFA, AS, and PDD-NOS.

Compr Psychiatry. 2004 May-Jun;45(3):184-91.

Asperger's disorder: a review of its

diagnosis and treatment.
Khouzam HR, El-Gabalawi F, Pirwani N, Priest F.

Source

Chemical Dependency Treatment Program, Veteran's Affairs Central California Health

System, Fresno, CA 93703-2286, USA.

Abstract

Asperger's disorder is a pervasive developmental disorder that shares similar features of

social impairment disorder, restricted interests, and repetitive behaviors with autistic
disorder. Although both Asperger's disorder and autistic disorder persist into adulthood,
autistic disorder is usually apparent before the age of 3, while Asperger's disorder usually
manifests itself at preschool age. Asperger's disorder in the majority of cases is not
associated with delay in language development and there is an increased likelihood to
seek social interactions and to engage in activities and friendship with others. In contrast
to autistic disorder, most Asperger's disorder patients have normal intellectual functioning
and some have motor clumsiness. Although the etiology of Asperger's disorder is still
undetermined, this article will review the assessment and treatment interventions that
could improve the prognosis of this illness. The historical background, epidemiology,
diagnostic features, differential diagnosis, and course and overall management/treatment
of Asperger's disorder will be discussed. Despite the absence of a cure for Asperger's
disorder, the awareness of its distinctive clinical features that differentiate it from autistic
disorder could improve its prognosis and differentiate response to treatment and
comorbid conditions.