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Asperger’s Disease, it`s Diagnosis

Asperger’s Syndrome

This paper describes Asperger's syndrome using published articles that report results of several research studies. Since the syndrome is classified under autism spectrum disorders, the paper highlights distinctive signs and symptoms used in its diagnosis. It also focuses on the features observed in childhood that become distinct in adulthood. The syndrome characteristics used by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for a correct diagnosis and management are explained in detail as well. Prevalence rates and a predictor of severity have been used to demonstrate the extent of the disorder. Apart from statistical data, risk factors such as genetic variations and environmental conditions are discussed to elaborate on the possible causal factors of Asperger’s condition. The study examines different treatment modalities used in all decades since the discovery of Asperger’s syndrome to alleviate the signs and symptoms of the condition. Although prognosis varies with the onset of intervention, the paper points to effective treatment. Therefore, the paper will explain Asperger’s disorder in its entirety.

Keywords: Asperger’s syndrome, autism spectrum disorders, social interaction, cognitive abilities

Asperger’s syndrome refers to a disorder affecting neurological development and resulting in deficits in language development and social communication. The syndrome causes alterations that are associated with repetitive stereotypic behavior. It is considered a variant of a high-functioning autistic spectrum disorder because it is manifested by above-average intellectual and language abilities. The disorder was discovered by Asperger in 1944 as autistic psychopathy, a year after the discovery of autism by Kanner (Toth & King, 2008). Asperger increased awareness of children’s autism to minimize mismanagement. The classic symptoms describing the illness were clumsiness, nonverbal communication, and limited understanding of other people’s feelings. The description of Asperger’s disorder was incorporated into the psychological diagnostic manual DSM-IV to enable the establishment of an accurate diagnosis. Understanding Asperger’s syndrome in its entirety is essential for proper diagnosis and management. This report will focus on the description of Asperger’s syndrome, its prevalence rates, symptoms, causes and risk factors, diagnosis and treatment.

Description of Autism and Asperger’s Syndrome

Toth and King (2008) argue that the explanation of Asperger’s syndrome came into use several years after autism’s description, which included socially active children with odd behavior. In the study, three symptom domains are regarded in the autistic spectrum disorders. They include impairment of social interaction and communication, and monotonous, limited, and typical patterns of interests and actions (Toth & King, 2008). The description of autism gave way to the proper definition of Asperger’s syndrome. High-functioning autism was the first label for children with Asperger’s syndrome with verbal ability and nonverbal intelligence in daily activities. Conversely, autism disorder was characterized by children's aloofness, socially indrawn character, and odd behavior (Barahona-Corres & Filipe, 2016). The severity of autism and Asperger’s syndrome depends on the observable symptom severity calculated on an autistic observation scale. Toth and King (2008) point out that early diagnosis, monitoring, and intervention are essential for a child’s healthy development. Although the two disorders are linked in the autistic spectrum of disorders, their individual symptoms are different, which determines distinct management.

Prevalence Rates of Asperger’s Syndrome

Asperger’s syndrome classified in the autism spectrum disorders has a population prevalence of 0.6% (Berney, 2004). The percentage indicates that Asperger’s syndrome in which children and adults have average ability accounts for approximately 70-90 %. The Center for Disease Control and Prevention explains that as many as 1 in 150 children in the United States suffers from the disorder (as cited in Strathearn, 2009). According to a similar study conducted by Attwood, there is a dramatic increase in the reported cases of autistic disorders, and the number of boys having the disorder is ten times higher than the number of girls (as cited in Wilkinson, 2006). Such discrepancy happens due to gender-specific differences.

Cause and Risk Factors of Asperger’s Syndrome

The causal factor for Asperger’s disease is unknown; however, research by Strathearn (2009) indicates a relationship between the individual’s genetic factors and environment of growth. Although there has been a technological improvement over the past decade, such as genome-wide microarray analyses and neuroimaging, a particular gene determining the psychobiological deficit in the autistic spectrum of disorders remains unknown. Research indicates that the etiology of autism swings between two points of view that are elusive. Thus, Kanner states that it is through some specific abnormal gene, and secondly, through a particular environmental factor that includes the absence of maternal warmth to the growing fetus (as cited in Strathearn, 2009).

Nature: Genetics

Strathearn (2009) acknowledges the genetic etiology of autistic spectrum disorders in approximately 60 percent of monozygotic twins compared to 5 percent of dizygotic twins. In spite of the high percentage of 60, monozygotic twins had different autistic characteristics that clued for epigenetic factors. Genetic markers identifying gene coding show little variations. Strathearn’s study indicates that some genetic disorders are linked to autism, such as the fragile X syndrome, which is similar to the findings of Berney (2008). Strathearn’s description of a class of autism-associated genes regulated by neuronal activity affirms that genetic variation contributes to the development of autism spectrum disorders.

Nurture: Environment

The social ecosystem also contributes to the development of Asperger’s syndrome. Strathearn (2009) describes research showing that autism is attributable to experiencing traumatic episodes. Similarly, monkeys deprived of maternal care illustrated behavioral characteristics resembling autism. Rutter et al. acknowledged that social privation and deprivation of maternal care had an impact on developmental programming essential in psychological functioning (as cited in Strathearn, 2009). Studies conducted in various geographical regions also indicate similar results. For example, Tara et al. (2014) argue that economic burden has a great impact on childhood autism spectrum disorders. In general, children in families with little income and low social and economic status are susceptible to the development of autism spectrum disorders due to the lack of maternal warmth. The study proves relation between social environment and autism disorders and concludes that emotional attachment is a promoter of gene expression and social development.

Gender Variations

Wilkinson (2008) states that the dominant gender identified with Asperger’s syndrome are young males. The research indicates that females are usually diagnosed with the disorder at an older age, which is due to underlying reasons describing the phenomenon. By contrast, the male turn-over rate decreases with age. The major factor contributing to the prevalence of Asperger’s syndrome among boys is gender role socialization. Boys come quickly to the attention of their parents due to their gender-based unique coping mechanisms (Wilkinson, 2008). Although social variation is the salient defining feature between the genders, empirical investigation is needed to identify exact causes.

Asperger’s Syndrome in DSM-IV

According to Berney (2004), Wing and Gilberg describe the uniqueness of Asperger syndrome in intellectual ability and syntactical speech. Though scholars make an emphasis on normal IQ and speech, the DSM-IV stresses on early development. The disorder affects reciprocal social interaction and stereotypical behavioral patterns and interests in the young age groups. The diagnosis of the disease can be made provided the presence of early symptoms in childhood (before 11 years), which is an essential requirement for differential diagnosis of Asperger’s syndrome from other autism subtypes (Wilkinson, 2008). The DSM-IV describes the difference between Asperger and autism without any form of a generalized learning disability (Berney, 2004).

The definitive characteristics of Asperger’s syndrome emerge early in life and intensify in adulthood. In childhood, individuals have limited social relationships, and their social isolation increases in adolescence due to the lack of sustained relationships. Autistic people have minimal interaction with peers due to little concern and sensitivity. They also tend to make blunders (Berney, 2004). Furthermore, such people may have problems with communication in childhood, which increases in midlife with the lack of non-verbal communicative behavior such as impassive expression and poorly coordinated gaze with no eye contact. They have bad posture, monotonous speech, poor body language, absorbing and narrow interests (Berney, 2004). The research describes their obsessive pursuance of interests that are insignificant in their lives besides unusual routines and rituals. These characteristics are the pillars in the description and diagnosis of Asperger’s syndrome from childhood-onset to adulthood.

Signs and Symptoms of Asperger’s Syndrome

The visible signs and symptoms determining the diagnosis of Asperger’s disorder differ between children and adults. In children the syndrome develops with no delay in language, age-appropriate self-help skills, and curiosity and cognitive development (Toth & King, 2008). However, with growth, children develop qualitative impairments. Berney (2004) points out that Asperger’s syndrome presents with specific difficulties in communication, social relationships and interests. Communication is always one-sided with underlying discrepancies in comprehension and expression. In addition, verbal and non-verbal discrepancies can be often observed in the affected individuals. Berney (2004) argues that their one-sided communication makes it difficult for them to understand friendship or engage in committed sexual relationships, which they cannot differentiate from rape and sexual seduction (a detachment reason). Another sign of the syndrome is focused performance of actions that is circumscribed by routine work and environment change (Berney, 2004).

Wilkinson (2008) describes in a case study that the classic symptoms are distinct between genders and age groups. In the study, it is evident that children dislike change in routines, appear to lack empathy, have advanced speaking abilities and other social cues such as maintaining a conversation beyond their age. Usual facial postures and a delay in motor development in some children are early symptoms of the disorder (Berney, 2004). Wilkinson (2008) illustrates that in adulthood, social withdrawal from friends and interactions and specific mannerisms become imminent. People unacquainted with the symptoms of the disorder perceive them as normal and are not aware of their deficits.

Diagnosis of Asperger’s Syndrome

The diagnosis of the disease follows a comprehensive assessment of a development history and observatory remarks (Berney, 2004). The procedure is performed by a medical professional with experience in autism and other associative psychotic disorders. Wilkinson (2008) in a similar research maintains that the diagnosis differs from other autistic subtypes and therefore needs to be differentiated during the assessment stages. As stated in the DSM-IV criteria, a child must have normal language development and intelligence, whereas an adult is characterized with sustained impairment in social interaction, the development of monotonous patterns of behavior and activities in normal life that significantly impair school and occupation activities respectively (Berney, 2004; Toth & King, 2008). In children, cognitive inability and delay in the onset of language is the major predictor of the disorder.

Asperger’s syndrome is diagnosed using a core diagnostic assessment tool that evaluates functional and cognitive ability. Lord, Rutter, and Lecouteur highlight that a minimum of a detailed developmental history and a review of social, communication, and behavioral development is required for establishing the diagnosis (as cited by Toth& King, 2008). Although the scales are not standardized with confirmed diagnoses from participants and psychometric properties, the Gilliam Asperger’s Disorder Scale, Asperger’s Syndrome Diagnostic Scale, and Adult Asperger’s Assessment Scales are in wide use. An evaluation involving medical, psychiatric, and behavioral issues such as peer interaction and a review of school records for previous and current performance are essential (Toth & King, 2008). Assessments involving the family system for stress and depression and occupational therapy before treatment planning mitigates sensory issues, and thus improves outcomes for children with Asperger’s syndrome.

Treatment of Asperger’s Syndrome

Despite extensive research conducted in autism and Asperger’s disorder, there is no known effective treatment modality (Toth & King, 2008). As a result of poor prognosis, the majority of children are diagnosed with the disorder at the age of 10 years. Late diagnosis affects early provision of structured education programs that help develop cognitive and language abilities and intervention aimed at social competence. For instance, in Heather’s case study, a misdiagnosis and delayed intervention had a negative impact on her school education (Wilkinson, 2008). Despite little awareness and knowledge of interventional strategies, the commonly used treatment approach is an adult-directed behavioral program. The programs have a structure and support program that reduces stress accumulated from everyday life and are aimed at independent individual functioning (Berney, 2004). They include individualized modes of instruction, the creation of support groups at school, and proper transition strategies.

Social competence programs incorporate the use of social skills to make socially isolated children interactive (Toth & King, 2008). Social interaction restoration occurs in classroom activities through friendship groups in school, mentoring programs, and individual therapies. Wilkinson’s case study (2008) indicates that teaching skills through direct instruction, the creation of social stories, and role-playing are essential in the enhancement of child understanding and were used in Heather’s case to increase classroom focus. The absence of a specific social skills milestone indicates that role-playing in children restores reciprocal conversation and eye contact, which is a form of social responsiveness. Skills are broken into sub-skills, such as initiating talks and greeting others, and higher-level skills, such as resolving conflicts and handling criticism. Another strategy that Wilkinson (2008) emphasizes is targeted interventional strategies of social competence that have a positive outcome. It includes joint attention, recognition of emotions, and theory focused on mental abilities. The modality uses small sample sizes with a particular focus on individual treatment that augments education programs and social skills. It aims to capitalize on strengths and certain areas of impairment.

Conclusion

Asperger’s syndrome is an autism spectrum disorder that affects neurological development and results in a deficit of social communication. The disorder is considered a high-functioning autistic disorder because the affected individuals have developed intellectual and language abilities. Asperger discovered the illness in 1944 and indicated intact intellectual and language ability as a distinctive feature differentiating it from autism. The prevalence rate of Asperger’s syndrome is 70-90% of autism spectrum disorder. Although its etiological cause remains unknown, research indicates a link between genetic and environmental factors. Gender disparities are affected by gender role socialization. The DSM-IV describes that Asperger’s syndrome can be observed through the IQ in early childhood to social deficits in progression to adulthood. Childhood signs and symptoms are less intensive compared to adulthood ones. For example, in childhood, social interactions are determinant, while later in life social relationships and daily activities indicate illness. Focused performance related to routine activities is another predictor. The diagnosis is established through a focused individual’s assessment that takes account of his/her cognitive and functional abilities. Accurate diagnosis of the condition should distinguish Asperger’s syndrome from other autistic spectrum disorders. Treatment follows a structured education and competency programs aimed at improving the patient’s social skills that influence his/her cognitive and language abilities. Apparently, with no definitive and effective treatment, research needs to be conducted on potential medication. The paper has described Asperger’s disease, its diagnosis, and treatment in light of classification in DSM-IV.