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Asperger's syndrome

Asperger's syndrome (AS), is a pervasive developmental disorder commonly referred to as a form of "high-functioning" autism. Individuals with Asperger's are considered to have a higher intellectual capacity while suffering from a lower social capacity. The term "Asperger's syndrome" was coined by Lorna Wing in a 1981 medical paper; she named it after Hans Asperger, an Austrian psychiatrist and pediatrician whose work was not internationally recognized until the 1990s.

Characteristics

Like other conditions currently classified as an Autism Spectrum Disorder, Asperger's Syndrome is strongly gender biased, with males currently comprising approximately 75 percent of diagnoses. However, this figure may not be completely accurate, as girls are arguably more exposed to social situations and thus have more of a chance to learn to imitate the non-autistics and behave "normally".

Non-autistics — called neurotypicals, or NTs, by people on the autistic spectrum who reject the word "normal" — possess a comparatively sophisticated sense of other people's mental states. Most people are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's body language. Persons with autism are relatively deficient in this ability, and the individual with Asperger's can be every bit as "mind-blind" as the person with profound classical autism. For those who are severely affected by "mind-blindness", they may, at best, see a smile but not know what it means (is it an understanding, a condescending, or a malicious smile?) and at worst they will not even see the smile, frown, smirk, or any other nuance of interpersonal communication. They generally find it difficult or impossible to "read between the lines"; that is, figure out those things a person is implying but is not saying directly. It is worth noting, however, that since it is a spectrum disorder, a few with Asperger's are nearly normal in their ability to read facial expressions and intentions of others. Those with Asperger's often have difficulty with eye contact. Many make very little eye contact, finding it overwhelming, while others have unmodulated, staring eye contact that can be off-putting to others.

Asperger's syndrome can involve an intense and obsessive level of focus on things of interest and is often characterized by special (and possibly peculiar) gifts; one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, another with building models out of matchsticks. Particularly common interests are means of transport (for example trains), computers, and dinosaurs. These interests are often coupled with an unusually high capacity to retain and recall encyclopedic amounts of information about the favored subject.

In general, orderly things have appeal to individuals with Asperger's. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life. The child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reason, an almost obsessive focus, and eidetic memory. Hans Asperger called his young patients "little professors", based on the fact that his thirteen-year-old patients had as comprehensive and nuanced an understanding of their field of interest, as university professors.

Individuals with Asperger's have emotional responses as strong as, or perhaps stronger than, most people, though what generates an emotional response might not always be the same. What they lack (or are markedly slower to develop) is the inborn ability to perceive the emotional states of others or to express their own emotional state via body language, facial expression and nuance in the way that most people do. Many people with Asperger's report a feeling of being unwillingly detached from the world around them; they lack the natural ability to see the subtexts of social interaction, and equally lack the ability to broadcast their own emotional state to the world accurately.

This leads to many troubles in childhood and adulthood. Asperger's children are often the target of bullying at school because of their idiosyncratic behaviour, language, and interests, and because of their lower or delayed ability to perceive and respond appropriately to non-verbal cues, particularly in situations of interpersonal conflict.

When a teacher asks a child with Asperger's, "Did the dog eat your homework?", the child with Asperger's will remain silent if they don't understand the expression, trying to figure out if they need to explain to the teacher that they don't have a dog and also that dogs don't generally like paper. The child doesn't understand what the teacher is asking, cannot deduce the teacher's meaning, or the fact that there is a non-literal meaning, from the tone of voice, posture or facial expression, and is faced with a question which makes as much sense to him as "Did the glacier in the library bounce today?". The teacher may walk away from the experience frustrated and thinking the child is arrogant, spiteful, and insubordinate. The child sits there mutely, feeling frustrated and wronged.

Those affected by Asperger's may also manifest a range of other sensory, developmental, and physiological anomalies. It is common for Asperger's children to evidence a marked delay in the development of fine motor skills. They may display a distinctive 'waddling' or 'mincing' gait when they walk and may walk with their arms held out in an unusual manner. Compulsive finger, hand, or arm movements, such as flapping, are also observed.

Some Asperger's children suffer from varying degrees of sensory overload, and may be pathologically sensitive to loud noises or strong smells and may dislike being touched — for example, certain Asperger's children exhibit a strong dislike of having their head touched or their hair disturbed. The "sensory overload" factor may exacerbate problems faced by Asperger's children at school, where levels of noise in the classroom can become almost intolerable for them.

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. 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.

As with most gifted children, children with Aspergers are often misdiagnosed by teachers as being a "problem child" or a "poor performer," but the reality is that they simply have an extremely low tolerance and motivation for what they perceive to be mundane and mediocre tasks, and will often rather daydream within their own focussed universe than work on the task at hand.

There seems to be a strong correlation between those with Asperger's/High-Functioning Autism (HFA) and the INTP type of the Myers-Briggs Type Indicator (MBTI).

Social interaction and cognitive patterns

Asperger's can also lead to problems with normal social interaction between peers. In childhood and teenage years, this can cause severe problems as a child or teen with Asperger's can have difficulty interpreting subtle social cues, and as such be ostracized by their peers, leading to social cruelty. A child or teen with Asperger's is frequently puzzled as to the source of this cruelty, unaware of what has been done "wrong". Recent efforts in the field of special education have concentrated on teaching children with Asperger's how to interact with their peers, achieving only moderate success, while the alternative of teaching their peers to cope with Asperger's children does not seem to have been seriously considered by many professionals. The social alienation of some people with Asperger's syndrome is so intense in childhood that some create imaginary friends for companionship.

Asperger's syndrome hardly guarantees a miserable life. Often the intense focus and tendency to work things out logically, characteristic of Asperger's, will grant them a high level of ability in their field of interest. Despite their difficulty with social interaction, many people with Asperger's possess a rare gift for humor (especially puns, wordplay, doggerel, satire), and writing. In fact, sometimes their fluency with language is such that a number of them also qualify as hyperlexic. While many people with Asperger's will probably not have lives that are considered a social success by common standards - and there are some who will remain alone their entire lives - it is possible for some to find understanding people with whom they can have close relationships. Many autistics have children, in which case their children may be neurotypical or may have an autism spectrum disorder. Many autistics are unaware of their autism, because milder forms of autism are widely misunderstood and often undiagnosed or misdiagnosed by professionals.

DSM definition

Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

1. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction

2. Failure to develop peer relationships appropriate to developmental level

3. A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

4. A lack of social or emotional reciprocity

2. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

2. Apparently inflexible adherence to specific, nonfunctional routines or rituals

3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

4. Persistent preoccupation with parts of objects.

3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

4. There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years)

5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in childhood

6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The Diagnostic and Statistical Manual's diagnostic criteria have been roundly criticized for being vague and subjective: what one psychologist calls a "significant impairment" another psychologist may call insignificant.

Relationship to autism

Experts today generally agree that there is no single mental condition called autism. Rather, there is a spectrum of autistic disorders, with different forms of autism taking different positions on this spectrum. But within certain circles of the autism/AS community, this concept of a "spectrum" is being severely questioned. If differences in development are purely a function of differential acquisition of skills, then attempting to distinguish between "degrees of severity" may be dangerously misleading. A person may be subjected to unrealistic expectations, or even denied life-saving services, solely on the basis of 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, Asperger's group being perhaps more "socially functional" than Kanner's as a whole. Some of Kanner's originally identified autistic children, might today get an Asperger's syndrome diagnosis, and vice versa. It is a mistake to say that a "Kanner autistic" is a child who sits and rocks and does not communicate. Kanner's study subjects were all along the spectrum.

Researchers are grappling with the problem of how to divide up the spectrum. There is no easy way to do this. It would appear that one can divide the population of autistics in any particular way and define the group accordingly. Autistics who speak, those who don't. Autistics with seizures, those without. Autistics with more "stereotypical behaviors", those with fewer, and so forth. Some are trying to identify genes associated with these traits as a way to make logical groupings. Eventually, one may hear about autistics with or without the HOXA 1 gene, with or without changes to chromosome 15, etc. Traditionally, Kannerian autism is characterized by significant cognitive and communicative deficiencies, including delays in or lack of language. Often it will be clear that these people do not function normally. An individual with Asperger's on the other hand will not show delays in language. It is a more subtle disorder and affected individuals will often only appear to be odd. Kanner's syndrome is described in the article autism.

Some clinicians believe that communicative and/or cognitive deficiencies are so essential to the concept of autism that they prefer to consider Asperger's as a separate condition altogether from autism. This opinion is a minority one. 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 don't start to produce speech until a later age is no reason to divide the two groups, as they are identical in the way they need to be treated.

Asperger's syndrome and other forms of autism are often grouped together in a Pervasive Developmental Disorder family.

Possible causes and origins

The causes and origins of autism and Asperger's syndrome are subjects of continuing conjecture and debate, and there is still considerable debate on these topics, alongside the broader debate about whether Asperger's and other conditions (such as ADHD) are part of the so-called autism spectrum or not.

Amongst several competing theories are the underconnectivity theory developed by cognitive scientists at Carnegie Mellon University and the University of Pittsburgh, the Neanderthal theory, the extreme male brain theory by Simon Baron-Cohen, the lack of theory of mind, and the Pre-operational autism theory, which states that autistic people are those who get neurologically stuck at the pre-operational stage of cognitive development, where much of information processing is at a holistic-visual level and is largely musical and non-verbal. This also addresses the issue of the theory of mind where children at the pre-operational stage of cognitive development have not attained decentralisation from egocentrism.

The Monotropism hypothesis argues that the central feature of Autism is attention-tunnelling, monotropism. The hypothesis is founded on the model Mind as a Dynamical System: Implications for Autism. In this model of mind, the fundamental and limited resource is mental attention. Mental events compete for and consume attention. In a polytropic mind, many interests are aroused to a moderate degree. In a monotropic mind, few interests are very highly aroused. When many interests are aroused, multiple, complex, behaviours emerge. When few interests are aroused then a few, intensely motivated, behaviours are engendered. From monotropism hypothesis, autism results from different strategies of distributing attention in the brain.

The underconnectivity theory indicates a deficiency in the coordination among brain areas. With the aid of functional magnetic resonance imaging (fMRI), it was seen that white matter, which connects various areas of the brain like cables, has abnormalities in people with autism.

The underconnectivity theory holds that autism is a system-wide brain disorder that limits the coordination and integration among brain areas. This theory is parsimonious, in that it explains why autistic people are matured on certain dimensions, such as visual information processing and logical analysis, and yet are socially — and sometimes neuro-physiologically — significantly younger than their chronological age. The underconnectivity theory can be regarded as monotropism in the brain.

Other theories address the rise of autism in recent times. They suggest that the rise of visual media and the increasingly central role of visual information processing in the breakdown of language contributes to the increase of autism. Other theories involve the effect of toxins and poisons on neural development. It has been suggested that high levels of heavy metals such as lead may be a causal factor, and lead poisoning has been strongly linked to some cases of severe autism.

One of the most controversial claims is that conditions such as autism and Asperger's are caused by adverse side-effects of immunisation — particularly the so-called triple antigen vaccine — and from the heavy-metal preservatives that in the past were used in their manufacture. Although this theory has a degree of popular currency and has been discussed in a number of documentaries on the subject, it fails to address the basic empirical observation that Asperger's and related disorders are overwhelmingly predominant in males, yet children of the two sexes are immunised in roughly equal numbers.

A lesser known theory is that Asperger's and related syndromes may, in part, perpetrate genetic traits which were once highly advantageous to survival. One of the most notable characteristics of many people with Asperger's is that even very young children display a prodigious and often eidetic (photographic) memory, with the ability to precisely recall very large amounts of music, dialogue and speech after even a single hearing.

Although being able to precisely memorize and recall vast amounts of detail, such as cricket scores, dinosaur facts or television-show dialogue, may seem little more than an unusual trait in our society, it is important to realize that such a skill would have had a high value in pre-literate society. The ability to accurately memorize and re-tell stories, myths, histories and other important oral traditions — such as directions to a remote food or water source — could have meant the difference between life and death before the invention of writing.

In September 2004, Marc-Antoine Alexandre Bourget has published his master thesis at UQAM showing that 29% of autistics have a mitochondrial DNA anomaly that allowed him to formulate his hypothesis of a mitochondrial neanderthal Eve that six genetic markers dated circa 27000 BC. While his hypothesis is considered controversial, it could explain the origin of autism by hybridation of neanderthal characteristics in homo sapiens lineage. That would explain the crossing over and inprinting in Prader-Willi Syndrome. However, the hypothesis that Neanderthals and Homo Sapiens interbred is itself controversial, with some researchers claiming that their recent DNA studies show that the two species never interbred.

Effect on relationships

The significant others of people with Asperger's are more prone to major depression than the general population because people with Asperger's often have trouble showing affection or have little desire to show affection, and can be very literal and hard to communicate with in an emotional way. It is helpful for those involved with someone with Asperger's to read as much as they can about Asperger's syndrome, obsessive-compulsive disorder, hyperlexia and other comorbid disorders. It also helps to visit support groups' websites on the Web and talk with others who are involved with people with Asperger's. A significant other will often be much less angry or depressed if he or she understands that the Asperger's symptoms are not intentionally directed, but are part of a neurodevelopmental disorder. That when someone does not spontaneously show affection, it does not necessarily mean that he or she does not feel it. Thus, the significant other will come to feel less rejected and be more understanding. Light will be shed on the nature of the misunderstandings. They may figure out ways to work around the problems; for example, by being more explicit about their needs. For instance, when describing emotions, it can be helpful to be direct and to avoid vague terms like "upset" when the emotion being described is "anger". Another suggestion could be 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.

A gift and a curse

Recently, some researchers have speculated that many well-known people including Andy Warhol, Andy Kaufman, Craig Nicholls, Glenn Gould, Gary Numan, Mozart, Erik Satie, Nikola Tesla, Albert Einstein, Isaac Newton, Friedrich Nietzsche, Theodore Kaczynski, William James Sidis, Steven Spielberg and Bill Gates have or had AS, as they showed some Asperger's related tendencies, such as intense interest in one subject and social problems. Such diagnoses remain controversial, however and some more so than others, as most scholars seem to agree that Satie suffered at least from some form of autism.

The obvious social contributions of such individuals has led to a shift in the perception of Asperger's and autism away from the simple view of a disease needing to be cured towards a more complex view of a syndrome with advantages and disadvantages. There is a semi-jocular theory within science fiction fandom, for example, which argues that many of the distinctive traits of that subculture may be explained by the speculation that a significant portion thereof is composed of people with Asperger's. A Wired Magazine article called The Geek Syndrome suggested that Asperger's syndrome is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It created an enduring myth popularized in the media and self-help books that "Geek Syndrome" equals Asperger's syndrome, and precipitated a rash of self-diagnoses. Though these conditions do share traits, there is a consensus that most geeks are arguably "variant normal" and do not exhibit autistic-spectrum behaviors. "Geeks" may exhibit an extreme professional or casual interest in computers, science, engineering and related fields, and may be introverted; however, they do not suffer from impairments per se. This does not imply that there is no overlap between "geeks" and Asperger's patients, but it should be noted that self-diagnosis is a dangerous practice, and one prone to error.

Criticisms

Some people, including some people diagnosed with Asperger's syndrome, argue that Asperger's syndrome is a social construct. Professor Simon Baron-Cohen of the Autism Research Centre has written a book arguing that Asperger's syndrome is an extreme version of the way in which men's brains differ from women's. He says that, in general, men are better at systematizing than women, and that women are better at empathizing than men. Hans Asperger himself is quoted as saying that his patients have 'an extreme version of the male form of intelligence'.

One objection which has been put forward to this view is that, although AS is more common among males than females, females with AS do not necessarily come across as particularly masculine personalities, and some of them can show an exceptional interest in "feminine" activities e.g. dancing.

Affectionate terms

"Aspie" is an affectionate term used by some with Asperger's syndrome to describe themselves. Others prefer "Aspergian,", "Asperger's Autistic" or no name at all.


The information above is not intended for and should not be used as a substitute for the diagnosis and/or treatment by a licensed, qualified, health-care professional. This article is licensed under the GNU Free Documentation License. It incorporates material originating from the Wikipedia article "Asperger's syndrome".

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