Asperger’s syndrome (Autism Spectrum Disorder)

Asperger’s syndrome was first described in the 1940s by Viennese paediatrician Hans Asperger, who observed autism-like behaviours and difficulties with social and communication skills in boys who had normal intelligence and language development. Many professionals felt Asperger’s syndrome was simply a milder form of autism and used the term ‘high-functioning autism’ to describe these individuals. In 1994 Asperger’s Disorder was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(DSM-IV) as a separate disorder from autism.

However, in 2013, the diagnostic criteria for autism and Asperger’s syndrome changed and as a result Asperger’s no longer has a separate diagnosis of its own. Instead it is grouped together with previous sub-divisions of autism and pervasive development disorder and is now called Autism Spectrum Disorder (ASD).  The reason for this change was the result of decades of research that indicated that there was not enough evidence to suggest that the conditions of autism and Asperger’s syndrome were distinct conditions.

What is Autism?

Autism is a neurological brain disorder that disrupts normal childhood development in the first few years of life.

Symptoms are evident in early childhood although they can be subtle and diagnosis may not occur until some years later. Children with autism don’t usually look different from other children and, as yet, autism cannot be detected by a blood test or brain scan.

Autism is diagnosed only by observing behaviour and characterised by differences in delays in communication, social interaction, routines and repetitive behaviours as well as interests and activities.

What is Autism Spectrum Disorder (ASD)?

While all individuals with autism share the common problems associated with social and communication delays as well as restricted and repetitive interests, the severity of these problems and their impact on a person’s life can vary considerably which is why it is named a ‘spectrum.’ An individual on the spectrum can be termed as high-functioning and low-functioning. These terms are not clearly defined, but low-functioning autism is generally used to describe individuals who have a significant intellectual disability (low IQ) whereas high-functioning autism describes those with anything from a near normal to an above average IQ.

Symptoms of ASD in Children

Many ASD symptoms will start early in life. Parents often report that they first notice that their child cannot make eye contact or that their child seems awkward in social situations and doesn't know what to say or how to respond when someone talks to them. 

An ASD child may also miss social cues that are obvious to other people, like body language or the expressions on people's faces. For instance, an ASD child may not realize that when somebody folds their arms and frowns, that they are showing they are angry. Another early sign is that a child may show few emotions. They may not smile when they are happy or laugh at a joke. He/she may also speak in a flat, robotic way.

It is not uncommon for a child with ASD to also talk about themselves a majority of the time and focus a lot on a single subject. He/she might repeat things a lot, especially on a topic of interest. They might also do the same movements over and over. An ASD sufferer will invariably dislike change. For example, they may eat the same food for breakfast every day.

Common Characteristics Seen in Children with ASD include: 

• Have trouble detecting social cues and body language
• Have difficulty with maintaining conversations and knowing when it is their turn to speak
• Appear to lack empathy for other people and their feelings. Some people can appear to be introverted and almost aloof
• Dislike changes in routines
• Employ a formal style of speaking using complex words or phrases despite not fully understanding their meaning
• Be unable to recognise subtle differences in speech tone, pitch, and accent that alter the meaning of others’ speech
• Have difficulty when playing games which require the use of imagination
• Have limited range of interests which he or she may be very knowledgeable about
• Have poor handwriting and late development in motor skills such as catching a ball or using a knife and fork
• Have heightened sensitivity and become overstimulated by loud noises, lights, or strong tastes or textures

Symptoms of Asperger’s in Adults

ASD may be harder to detect in adults than in children because an adult has had decades to consciously focus on changing their behaviours and hide the more obvious symptoms. A professional may need to look underneath the layers of self-preservation strategies and avoidance tactics in order to arrive at an ASD diagnosis.

Not all symptoms apply to all people with ASD and individuals present each symptom in numerous ways. Adults with ASD can de different just like any human being can, but they do share certain specific traits that follow the diagnostic criteria. 

Common Characteristics seen in Adults with ASD include: 

• difficulties with high-level language skills such as verbal reasoning, problem solving, making inferences and predictions
• problems with understanding another person’s point of view
• difficulties initiating social interactions and maintaining an interaction 
• may not respond in the way that is expected in a social interaction 
• a preference for routines and schedules – disruption of a routine can result in stress or anxiety
• specialised fields of interest or hobbies
• find emotions confusing, uninteresting, or nerve-wracking
• misreads allowable space between people
• tendency to rock, fidget, or pace
• may be particular about the softness of clothing or the taste of foods

Diagnosing ASD in Children

There are many professionals who specialize in the diagnosis of ASD. These include:

Psychologist. Diagnoses and treats problems with emotions and behaviour.
Paediatric neurologist. Treats conditions of the brain.
Developmental paediatrician. Specializes in speech and language issues and other developmental problems.
Psychiatrist. Has the expertise in mental health conditions and can prescribe medicine to treat symptoms of ASD.

ASD is often treated with a team approach which means a patient might see more than one doctor for their long-term care.

The doctor will ask questions about a child's behaviour, including:

• What symptoms does he/she have, and when where they first noticed?
• When did the child first learn to speak, and how does he/she communicate?
• Is he/she focused on any subjects or activities?
• Does he/she have friends, and how does he/she interact with others?

Then he'll observe your child in different situations to see firsthand how he/she communicates and behaves.

Diagnosing of ASD in Adults

It is not unusual for people on the autism spectrum to have reached adulthood without a diagnosis.

Sometimes people will read some information or see something about ASD that makes them relate to the symptoms. They may then choose to talk to a health professional for a diagnosis, or they may not. 

An adult may choose to seek a diagnosis for suspected ASD if:

• They been diagnosed with a mental health condition or intellectual disability during childhood or adolescence, but think that may have ASD
• They have struggled with feeling socially isolated and different
• A child or other family member has been diagnosed with ASD and some of the characteristics of autism sound familiar.

An adult with suspected ASD may firstly speak with their GP to get a referral to a either a psychologist or a psychiatrist that has experience in the assessment and diagnosis of ASD.

A speech therapist may also be consulted to assess social communication skills and then all information will be collated to help make a diagnosis.

What causes Autism Spectrum Disorder?

ASD is a neurobiological condition that appears to be partly hereditary. If one parent has ASD, it is possible that one or more of the children and/or grandchildren will show ASD traits. Because ASD is related to the development of the brain it is most often first recognised in childhood when a child is supposed to emerge into the social world but does not. There have been numerous studies discussing the amygdala which is the part of the brain that plays a role in social impairment and how this may be effected given that ASD revolves around issues of social impairment. In addition, the wiring in the frontal and temporal lobes of the brain in ASD patients are different.

So, what exactly causes ASD?

There are many allegations as to what the root cause of ASD is. Everything from vaccinations to environmental poisons, hereditary links and differing parts and functions of certain areas of the brain have been looked at. However, to this day nobody knows for sure what causes ASD. For now, researches will continue to work in this area and perhaps someday there will be a better understanding of why some people develop ASD.   

Treatment Options

Every individual with ASD is different so there isn't a one-size-fits-all approach. A professional might need to try a few therapies to find one that works.

Social skills training. In groups or one-on-one sessions, therapists teach individuals with ASD how to interact with others and express themselves in more appropriate ways. Social skills are often best learned by modelling after typical behaviour.

Cognitive behavioural therapy (CBT) may help to change a person’s way of thinking, so he/she can better control their emotions and repetitive behaviours.
This will enable the individual to get a handle on things like outbursts, meltdowns, and obsessions.

Speech-language therapy. This helps improve communication skills. For example, and ASD patient will learn how to use a normal up-and-down pattern when they speak rather than a flat tone. They may also get lessons on how to keep up a two-way conversation and understand social cues like hand gestures and eye contact.

Applied behaviour analysis.  Is a technique that encourages positive social and communication skills in a child or adult with ASD, and discourages behaviour that is not desirable. The therapist will use praise or other "positive reinforcement" to get results.

Education and training. Techniques that can be done at home for a parent to help a child with ASD or for the adult themselves. Some families also see a counsellor to help them deal with the challenges of living with someone with ASD.

Medicine. Not drugs are approved by the FDA at present that specifically treat ASD. Some medications, though, can help with associated symptoms like depression and anxiety. A Doctor may prescribe either an anti-depressant, an antipsychotic or a stimulant.

Alternative Therapies. Numerous therapies have been used in the treatment and symptom relief of ASD. These include looking at nutritional deficiencies, supplementing with good fats, addressing vitamin A and vitamin B12 deficiency, removing foods that cause allergies, fixing any gut issues and supplementing with a good probiotic, removing wheat and gluten from the diet, and detoxification from heavy metals. Manual treatments and techniques like chiropractic, osteopathy and kinesiology may also be of benefit as might the use of essential oils.

ASD has been classified as a ‘disorder,’ the reason being that everyone is expected to have the same level of social ability. People with ASD are expected to fit in with the expectations of our modern society, but they literally have to pretend to be ‘normal’ and have to work hard to appear to be the same as the neurotypical population.  With time and the correct treatment plan both children and adults with ASD can live a fulfilling and happy life that embraces their differences and allows them to believe in themselves and their abilities.

References

1. Evans, A.M (2014). Autism Treated and Cured. USA:Card Cataloging.
2. Searle, Dr R (2010). Asperger Syndrome in Adults. Great Britain:Sheldon Press.
3. Stanford, A (2015). Asperger Syndrome (Autism Spectrum Disorder) and Long-Term Relationships 2nd Ed.  London:Jessica Kingsley Publishers.
4. O’Reilly, B. Wicks, K. (2016). The Complete Autism Handbook. NSW:Ventura Press.
5. Lara, J (2016). Autism Movement Therapy Method. London: Jessica Kingsley Publishers.
6. Holford, P. Colson, D. (2006). Optimum Nutrition for Your Child’s Mind. Great Britain: Piatkus Books Ltd. 
7. Asperger’s Syndrome in Adulthood https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695286/
8. Pilot study of a moderate dose multivitamin/mineral supplement for children with autistic spectrum disorder https://www.ncbi.nlm.nih.gov/pubmed/15673999
9. https://www.autismspeaks.org/science/grants/double-blind-placebo-controlled-trial-subcutaneous-methyl-b12-behavioral-and-metaboli?destination=about-us%2Fgrant-search%2Fresults%2Ftaxonomy%3A9771+Hendren
10. https://www.autismspeaks.org/blog/2013/01/11/guidance-probiotics
11. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders https://www.ncbi.nlm.nih.gov/pubmed/20406576
12. Complementary and Alternative Therapies for Autism Spectrum Disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439475/