What is Asperger’s Syndrome?
Asperger’s syndrome is a brain-based developmental disorder. It is considered to be a type of autism spectrum disorder (ASD), but it lies at the high-functioning end of the autism spectrum. While people at the low-functioning end of the autism spectrum typically have severe language and intellectual limitations, people with Asperger’s usually have no problems with language development, and their intelligence is often higher than normal. It is common for people with Asperger’s to excel in the areas of science, math, technology, and music.
Symptoms of Asperger’s Syndrome
The symptoms of Asperger’s typically fall into the same broad categories as the symptoms of other autism spectrum disorders. People with Asperger’s have problems with communication and social interaction, and they often engage in unusually repetitive and restricted behavior. However, the symptoms take a much less severe form than those on the other end of the autism spectrum.
A person with Asperberger’s will exhibit at least two of the following symptoms:
- Difficulty using, noticing, and understanding nonverbal social cues such as eye contact, facial expressions, gestures, and body language
- Difficulty engaging in reciprocal (back-and-forth) conversations and social interactions
- Lack of interest in sharing interests and emotional reactions with others
- Inability to develop appropriate relationships with other people of their own age
At least one of the following symptoms also must be present:
- An unusually intense interest or preoccupation with a single topic
- A need to adhere strictly to established routines or rules of behavior
- Engaging in repetitive behaviors or movements
- Preoccupation with parts of objects rather than the whole object
What Causes Asperger’s Syndrome?
The causes of Asperger’s and autism spectrum disorders have not yet been discovered. Some studies have identified risk factors that seem to be associated with ASD, but much of the research into causes has been inconclusive.
It is important to note that no reliable scientific study has found a connection between childhood vaccines and autism spectrum disorders.
The following factors may increase the risk of autism, but none of them is a reliable predictor of the disorder:
- Sex. Boys are much more likely than girls to be diagnosed with Asperger’s.
- A mother or father who is 35 or older.
- Family history. A family with one child with Asperger’s or ASD is more likely to have other children with the disorders.
- Pregnancy and birth complications, including extreme prematurity (earlier than 26 weeks), low birth weight, and multiple births (twins, triplets, etc.).
- Pregnancies spaced less than one year apart.
- Chronic stress during pregnancy.
- Vitamin D deficiency during pregnancy.
- Too much or too little folic acid (also called folate or vitamin B). Pregnant women should talk to their doctor before taking vitamin supplements.
- Viral infections during pregnancy. Exposure of the mother to rubella (German measles) or a cytomegalovirus (CMV) infection during pregnancy may increase the risk.
- Use of certain drugs, such as valproic acid, thalidomide, and misoprostol, during pregnancy.
- Environmental triggers and exposure to toxic chemicals such as bisphenol-A (BPA).
Is Asperger’s Syndrome Hereditary?
Asperger’s arises from a complex interplay of genes and the environment. Genetics plays a role in ASD, but scientists still don’t know exactly how risk for the disorder is inherited. While some genes and gene variations are known to increase the risk of the disorder, the presence of these genes doesn’t necessarily mean that an individual will develop ASD.
Even if the genetic connection is not understood, it is clear that there is a strong genetic component in Asperger’s and other autism spectrum disorders. Among identical twins, if one twin has a disorder on the ASD spectrum, the other twin also has an autism spectrum disorder as much as 90% of the time. In people with Asperger’s, at least one of the person’s parents also exhibits some symptoms of ASD about a third of the time.
How Is Asperger’s Syndrome Detected?
Asperger’s often goes undiagnosed until late in childhood or even adulthood because its symptoms don’t always impair daily functioning to a great degree. The symptoms may impede social interaction and communication, but people with Asperger’s often have extraordinary intelligence or skills. This may allow them to function well, or even excel, especially within their areas of particular interest.
To identify Asperger’s as early as possible, look for these signs:
- Difficulty making eye contact
- Difficulty understanding gestures and body language
- Difficulty understanding metaphors, hints, humor, irony, and sarcasm
- Difficulty carrying on a back-and-forth conversation
- Difficulty understanding emotional situations and concepts
- Difficulty understanding the concept of personal space
- Preference for routines and well-defined rules
- Intense interest in a specific topic (and tendency to talk about the topic even when others aren’t interested)
- Unusual speaking pattern (monotone, lack of emotional inflection, stilted language)
- Physical clumsiness or awkwardness
- Repetitive, habitual movements
- Sensitivity to sensory stimulation from sounds, touch, etc.
How Is Asperger’s Syndrome Diagnosed?
No lab test, blood work, or imaging exams are used to diagnose Asperger’s. Pediatricians normally do an assessment at a child’s 18- and 24-month checkups to look for developmental signs of the disorder.
Doctors observe the child’s behavior and talk to parents. If concerns arise, an autism specialist may be recommended to evaluate a child’s behavior and development to make a diagnosis.
If Asperger’s is suspected, healthcare professionals will work through a series of diagnostic steps in pursuit of a diagnosis. Some of these steps might include:
- Observation of the person’s social interactions and communication skills
- Administrations of tests to measure sensory function, language skills, cognitive skills, social skills, and behavior
- Comparison of the person’s symptoms to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
- Possible genetic testing to look for disorders that are risk factors for ASD, such as fragile X syndrome and Rett syndrome
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Asperger’s Syndrome Treated?
Current approaches to the treatment of Asperger’s focus on managing behavioral symptoms and helping with social skills.
No drugs have been approved by the FDA to treat the core symptoms of Asperger’s. Some other conditions such as obsessive-compulsive disorder (OCD), anxiety, and depression are often co-existent with Asperger’s. Some medications such as selective serotonin reuptake inhibitors (SSRIs) are sometimes used to treat symptoms of these co-existent disorders.
A wide range of behavioral therapies and psychotherapy approaches have proven to be effective at treating Asperger’s. Commonly used therapies include:
- Behavioral management therapy
- Cognitive behavior therapy (CBT)
- Educational and school-based therapies
- Joint attention therapy
- Nutritional therapy
- Occupational therapy
- Parent-mediated therapy
- Physical therapy
- Social skills training
- Speech-language therapy
How Does Asperger’s Syndrome Progress?
People with Asperger’s syndrome are very often able to function well on a day-to-day basis. In many cases, their special skills and abilities lead them to very productive, successful lives. With treatment, many people with Asperger’s are able to compensate for their social difficulties. They are able to live independently and have fulfilling friendships and relationships.
Without proper treatment and support, however, people with Asperger’s are at risk for falling into patterns of behavior that endanger their social and professional lives. Co-existent disorders such as depression and anxiety can have long-term negative impacts, as well.
Long-term complications can include:
- Social isolation
- School or work difficulties
- Financial problems
- Depression or anxiety
- Obsessive-compulsive disorder
How Is Asperger’s Syndrome Prevented?
There is no known way to prevent or cure Asperger’s syndrome. The causes of the disorder are unknown, making it difficult to develop treatments. Although some risk factors for the disorder have been identified, there is no strong data to suggest that avoidance of the risk factors is effective at preventing Asperger’s.
Early detection and prompt treatment of Asperger’s is the best course of action. The earlier a child is diagnosed with the disorder, the better the chance that therapeutic intervention will help the child manage their symptoms.
Asperger’s Syndrome Caregiver Tips
Some of the ways you can help your loved one cope with Asperger’s include:
- Learn about Asperger’s, ASD, and your loved one’s unique challenges. Everyone experiences Asperger’s differently, and it’s important that you know how the disorder affects your loved one. People with Asperger’s have unique limitations and strengths. If you understand how your loved one is special, you can help them capitalize on what they do best and more easily overcome their challenges.
- Learn how to spot pseudo-science. The causes of Asperger’s and ASD are unknown, so you should be skeptical of anyone who claims to know why your loved one has Asperger’s or how they can be “cured.”
- Be an advocate for your child. Teachers and other authority figures often have trouble understanding children with Asperger’s, especially when the child is skilled in certain areas. Make sure educators know about your child’s sensitivities, behavioral issues, and learning style. You and your child have a right to a supportive educational environment, and it’s up to you to advocate for it.
Asperger’s Syndrome Brain Science
Many scientists believe that people with Asperger’s and ASD think and behave differently because their brains work differently than typical brains in some key ways. For example, brain scans have shown that people with Asperger’s react to facial expressions using their brain’s planning and judgment center, while typical brains respond to facial expressions with the brain’s emotion center. This suggests that the person with Asperger’s sees a facial expression as a puzzle to be solved rather than as evidence of another person’s emotion.
One study has found, too, that the brains of people with Asperger’s may function differently than the brains of people with other autism spectrum disorders. The study found that connections in the brain’s language center were weak in children with both Asperger’s and ASD. But connections in the part of the brain responsible for logic and reasoning were stronger in Asperger’s brains than they were in the brains of both children with ASD and typical children. This finding seems to support the argument of some scientists who continue to think that Asperger’s is distinct from ASD in important ways.
Asperger’s Syndrome Research
Title: Cognitive Neuroscience of Autism Spectrum Disorders
Contact: Alex Martin, PhD
National Institutes of Health Clinical Center
Objective: The primary objective of the proposed studies is to utilize neuroimaging (functional Magnetic Resonance Imaging [fMRI], structural MRI [sMRI], Magnetoencephalography [MEG]) and neuropsychological tools (eye-tracking, cognitive experiments, clinical neuropsychological measures, questionnaires, etc.) to identify cognitive idiosyncrasies (e.g., social-cognitive deficits, visual perceptual assets, and savant skills) characteristic of individuals on the autism spectrum and their neural underpinnings across childhood and adulthood.
Study Population: Children, adolescents, and adults with autism spectrum disorders (ASDs), controls (i.e., typically developing children, adolescents, and adults and those with mild to moderate mental retardation), as well as caregivers/legal guardians/parents of these individuals.
Design: Descriptive/Characterization/Observational studies using primarily neuropsychological and neuroimaging methodologies.
Outcome Measures: Behavioral (reaction time, accuracy, eye movements, etc.) and neuroimaging (brain morphometry, BOLD, electrophysiology, etc.).
Title: Studies of Brain and Body Interaction
Principal investigator: Elizabeth Torres, PhD
The goal of this study is to characterize bio-physiological signals as a comprehensive profile of the nervous systems in order to understand interactions between the brain and body, while an individual performs naturalistic behaviors (ex. walking, pointing) and while breathing at a slow controlled pace. The investigators aim to study these interactions among a variety of populations, from healthy individuals to those with disorders such as Autism Spectrum Disorder(s), including those who may also have an ADHD (Attention-deficit/hyperactivity disorder) diagnosis, Asperger’s Syndrome, Alzheimer’s Disease, and/or Fragile X syndrome.
Title: TMS for the Investigation of Brain Plasticity in Autism Spectrum Disorders
Principal investigator: Alexander Rotenberg, MD, PhD
Boston Children’s Hospital
Autism Spectrum Disorders (ASD) are diagnosed clinically, based on key symptoms. As ASD phenotypic variability is large, and symptoms can manifest at different ages and degrees, the clinical diagnosis is challenging. To date, there remains an unmet need for a valid and reliable endophenotype that would facilitate ASD diagnosis early in life, enable the efficient study of ASD risk factors, and eventually serve as a useful biomarker to inform the development of effective therapies and assess treatment response in future clinical trials.
As compared with behavioral or neuroimaging methods, transcranial magnetic stimulation (TMS) offers the advantage of providing behaviorally independent results that are largely unaffected by attention or cognitive ability. Therefore, a TMS based endophenotype may be applicable to all individuals across the autism spectrum.
At Boston Children’s Hospital, each subject’s participation in the study will consist of four visits: two screening visits, and two TMS sessions. At Beth Israel Deaconess Medical Center, each subject’s participation will consist of three visits: one screening visit, and two TMS sessions. Each screening visit is expected to last between 2-3 hours, during which participants will first provide informed consent. Participants will then receive a thorough medical examination by a neurologist, and a neuropsychological evaluation (including IQ measures and ASD specific evaluations). If eligible to continue, participants will then come back for two identical TMS visits, that are spaced 1-5 weeks apart. These visits are expected to last between 3-4 hours and include the TMS measures of brain plasticity.