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In 1994, Asperger's
Disorder (AD) was recognized as a distinct clinical
entity in the DSM-IV (the diagnostic reference that
mental health professionals in the U.S. use; the
DSM-IV also provides the diagnostic
criteria for
Asperger's Disorder). Since in the past, many
children with Asperger's Disorder were diagnosed as
having autism, one would expect to see certain
features in common with autism, but also a pattern
that distinguishes Asperger's Disorder (AD) from
autism.
Whereas the features
of autism are generally severe and noticeable
within the first years of life, children with
Asperger's have a more typical development. In
general, a child with Asperger's Disorder does not
have the language delays seen in autism (although
they may have some atypical speech), and the
Asperger's child functions at a higher level than
the typical child with autism. Many children with
Asperger's Disorder have normal
intelligence.
While children with
autism may have no interaction with peers, children
with Asperger's do interact with peers, but may
experience significant difficulty in social
relationships. Children with AD often seem to be
loners and their stereotypic behaviors or intense
focus on their narrow interests may lead to
isolation and/or peer rejection. An individual with
AD may think and react to the literal meaning of
others' communications, and may experience
difficulty "reading" others' intentions or needs
(this difficulty inferring others' mental states is
known as "Theory of Mind"). But stating that
individuals with AD have problems inferring others'
mental or emotional states does not tell us the
source of the problem. Is there just one deficit or
a number of factors that contribute to this
problem?
One skill that
appears to be impaired relates to face gaze, and a
number of studies have noted abnormal patterns
(see, for example, Trepagnier et al., 2002).
Individuals with AD do not seem to derive the same
information from facial features (such as eyes) as
their non-AD peers, and generally do not spend as
much time watching others' eyes during
conversations. Interestingly, some recent research
suggests that those who watch lips are more
socially competent than those who don't. Perhaps
the AD individual who is unable to "read" eyes
learns to compensate by getting more information
from watching the lips and mouth.
But what about
auditory tasks? Can children and adults with
AD derive as much meaning from social communication
cues such as tone, volume, and pitch as their
non-AD peers? A pilot study by Rutherford et al.
(2002) suggests that they are impaired in
extracting such cues, and that this impairment may
also contribute to difficulties drawing inferences
about others' mental states (Theory of Mind).
Swedish physician
Christopher Gillberg categorizes the features of
Asperger's into six main domains of
impairment:
-- Social
impairment with extreme egocentricity, which may
include:
- Inability to
interact with peers
- Lack of desire
to interact with peers
- Poor
appreciation of social cues
- Socially and
emotionally inappropriate
responses
-- Limited
interests and preoccupations,
including:
- More rote than
meaning
- Relatively
exclusive of other interests
- Repetitive
adherence
-- Repetitive
routines or rituals, that may be:
- Imposed on
self, or
- Imposed on
others
-- Speech and
language peculiarities, such as:
- Superficially
perfect expressive language
- Odd prosody,
peculiar voice
characteristics
-- Impaired
comprehension including misinterpretation of
literal and implied meanings.
-- Nonverbal
communication problems, such as:
- Limited use of
gesture
- Clumsy body
language
- Limited or
inappropriate facial expression
- Peculiar
"stiff" gaze
- Difficulty
adjusting physical
proximity
-- Motor
clumsiness -- may not be present in all
cases.
As suggested by the
above, individuals with AD are more likely to
experience problems that are not confined to just
one factor or deficit. In addition to impairment in
deriving accurate inferences from facial cues and
auditory cues, individuals with AD are also more
likely to experience difficulty in taking chunks of
information and integrating them into a coherent
whole so that full meaning is derived (Jolliffe
& Baron-Cohen, 2000). Thus, even on a
content level, individuals with AD may not be able
to derive the same information as a non-AD peer,
leading to incorrect inferences about others'
states and inappropriate responses.
Another social
impairment that has been suggested is that
individuals with AD are too verbose (wordy), but
the research on this issue has yielded somewhat
contradictory results. A study by Adams et al.
(2002) found that AD children were not more verbose
in general than the control group of Conduct
Disorder children. They also performed comparably
in conversations that involved questioning and
answering. Where they differed significantly,
however, was that AD children experienced more
difficulty in general conversations, and made more
problematic comments in conversations about
socially loaded or emotionally loaded
topics.
Motor clumsiness is
also characteristic of AD, and can lead to peer
impairment as the AD child may be less adept at
sports and less likely to participate in group
sports that are part of normal social
development.
In a survey of
middle-class mothers of children with Asperger's
Disorder or nonverbal learning disabilities (NVLD),
Little (2002) reported an overall yearly prevalence
rate of victimization by peers or siblings or peer
shunning of 94%. A reported 10% of the children had
been attacked by a gang in the past year and 15%
were reported to have been victims of nonsexual
assaults to the genitals. A third of the children
had not been invited to a single birthday party in
the past year, and many were eating alone at lunch
or were picked last for teams. Peer shunning was
significantly correlated with peer bullying and
assault.
Because the data were
parental reports based on an Internet survey, it is
possible that the reported rates are an
overestimate of the true population values for
children with Asperger's, but it is interesting to
note that these rates are significantly higher than
those reported by parents of children and
adolescents with Tourette's Syndrome in another
Internet-based survey. In the latter study (Packer,
2002, in press), peer teasing and some rejection
were reported, but more children had been invited
to birthday parties and there was only one report
of a child being physically assaulted because of
their tics. Thus, even allowing for design
limitations, Little's data are consistent with
clinical reports suggesting significant social
impairment associated with Asperger's
Disorder.
In second report by
Little (2002), based on the same sample of
middle-class mothers, difficulties in parenting a
child with Asperger's or NVLD were evident, as 58%
of the mothers reported using used physical
(corporal) punishment and 95% reported employing
psychological aggression (such as verbal abuse) in
dealing with their children's
misbehavior.
On a day-to-day
level, then, children and adolescents with
Asperger's may experience significant problems and
their parents may need extensive support, which
might include parent education and training in
effective environmental supports and interventions
for dealing with problematic behaviors. On a
positive note, Sofronoff and Farbotko (2002)
provide some data suggesting that parenting
workshops may be of benefit to parents of children
with Asperger's Disorder.
While children with
Asperger's will often have special education needs,
many of them will do well academically and go on to
attend college. Many will also be able to develop
meaningful relationships with family and friends,
although the quality of the relationships may be
different than what most people experience. Many
adults with AD will experience significant
impairment socially, however. In a recent study of
adults with AD, Soderstrom, Rastam, and Gillberg
(2002) compared the self-reports of 31 adults with
AD to age- and sex-matched controls. Those with AD
scored significantly higher on harm avoidance and
lower on self-directedness and cooperativeness. As
a group, they also scored significantly higher on
scores reflecting idiosyncratic perspectives. The
most common temperament configurations were
'obsessional', 'passive-dependent' and'explosive'.
Their findings, then, indicate that adults with AD
are more likely to have anxious personalities, more
likely to experience coping difficulties in social
interaction, and less likely to be self-directeded.
As one adult with AD
commented to me sadly one time, "My wife shouldn't
have to hold up a sign that says 'Hug me now' when
she's upset, but even when she tells me that she's
upset, I never seem to know what to say or do."
Social skills training for adults with AD and
counseling that involves spouses and family members
may be of benefit to adults with AD, and over the
past few years, more and more resources have
appeared.
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