Asperger Syndrome: General Information and Across the Lifespan (continued)
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The most obvious hallmark of Asperger syndrome, and the characteristic that makes these children so unique and fascinating, is their peculiar, idiosyncratic areas of "special interest." In contrast to more typical Autism, where the interests are more likely to be objects or parts of objects, in AS the interests appear most often to be specific intellectual areas. Often, when they enter school, or even before, these children will show an obsessive interest in an area such as math, aspects of science, reading (some have a history of hyperlexiaórote reading at a precocious age), or some aspect of history or geography, wanting to learn everything possible about that subject and tending to dwell on it in conversations and free play. I have seen a number of children with AS who focus on maps, weather, astronomy, various types of machinery, or aspects of cars, trains, planes, or rockets. Interestingly, as far back as Asperger's original clinical description in 1944, the area of transport has seemed to be a particularly common fascination (he described children who memorized the tram lines in Vienna down to the last stop). Many children with AS, as young as three years old, seem to be unusually aware of things such as routes taken on car trips. Sometimes the areas of fascination represent exaggerations of interests common to children in our culture, such as Ninja Turtles, Power Rangers, dinosaurs, etc. In many children the areas of special interest will change over time, with one preoccupation replaced by another. In some children, however, the interests may persist into adulthood, and there are many cases where the childhood fascinations have formed the basis for an adult career, including a good number of college professors.
The other major characteristic of AS is the socialization deficit, and this too, tends to be somewhat different than that seen in typical Autism. Although children with AS are frequently noted by teachers and parents to be somewhat "in their own world" and preoccupied with their own agenda, they are seldom as aloof as children with Autism. In fact, most children with AS, at least once they get to school age, express a desire to fit in socially and have friends. They are often deeply frustrated and disappointed by their social difficulties. Their problem is not a lack of interaction or interest so much as a lack of effectiveness in interactions. They seem to have difficulty knowing how to "make connections" socially. Gillberg has described this as a "disorder of empathy," the inability to effectively "read" others needs and perspectives and respond appropriately. As a result, children with AS tend to misread social situations and their interactions and responses are frequently viewed by others as "odd." Although "normal" language skills are a feature distinguishing AS from other forms of Autism and PDD, there are usually some observable differences in how children with AS use language. It is the more rote skills that are strong, sometime very strong. Prosodyóthose aspects of spoken language such as volume of speech, intonation, inflection, rate, etc. is frequently unusual. Sometimes the language sounds overly formal or pedantic, idioms and slang are often not used or are misused, and things are often taken too literally. Language comprehension tends toward the concrete, with increasing problems often arising as language becomes more abstract in the upper grades. Pragmatic, or conversational, language skills often are weak because of problems with turn-taking, a tendency to revert to areas of special interest, or difficulty sustaining the "give and take" of conversations. Many children with AS have difficulties dealing with humor, tending not to "get" jokes or laughing at the wrong time; this is in spite of the fact that quite a few show an interest in humor and jokes, particularly things such as puns or word games. The common believe that children with pervasive developmental disorders are humorless is frequently mistaken. Some children with AS tend to be hyperverbal, not understanding that this interferes with their interactions with others and puts others off. When one examines the early language history of children with AS there is no single pattern: some of them have normal or even early achievement of milestones, while others have quite clear early delays on speech with rapid catch-up to more normal language by the time of school entry. In such a child under the age of three years in whom language has not yet come up into the normal range, the differential diagnosis between AS and milder Autism can be difficult to the point that only time can clarify the diagnosis. Frequently, also, particularly during the first several years, associated language features similar to those in Autism maybe seen, such as perseverative or repetitive aspects to language or use of stock phrases or lines drawn from previously heard material. |
Asperger Syndrome Through the Lifespan
In his original 1944 paper describing the children who later came to be described under his name, Hans Asperger recognized that although the symptoms and problems change over time, the overall problem is seldom outgrown. He wrote that "in the course of development, certain features predominate or recede, so that the problems presented change considerably. Nevertheless, the essential aspects of the problem remain unchanged. In early childhood there are the difficulties in learning simple practical skills and in social adaptation. These difficulties arise out of the same disturbance which at school age cause learning and conduct problems, in adolescence job and performance problems, and in adulthood social and marital conflicts." On the other hand, there is no question that children with AS have generally milder problems at every age compared to those with other forms of Autism or PDD, and their ultimate prognosis is certainly better. In fact, one of the more important reasons to distinguish AS from other forms of Autism is its considerably milder natural history.
The Preschool Child
As has been noted, there is no single, uniform presenting picture of Asperger syndrome in the first 3-4 years. The early picture may be difficult to distinguish from more typical Autism, suggesting that when evaluating any young child with Autism and apparently normal intelligence, the possibility should be entertained that he/she may eventually have a picture more compatible with an Asperger diagnosis. Other children may have early language delays with rapid "catch-up" between the ages of three and five years. Finally, some of these children, particularly the brightest ones, may have no evidence of early developmental delay except, perhaps, some motor clumsiness. In almost all cases, however, if one looks closely at the child between the age of about three and five years, clues to the diagnosis can be found, and in most cases a comprehensive evaluation at that age can at least point to a diagnosis along the PDD/Autism spectrum. Although these children may relate quite normally with the family setting, problems are often seen when they enter a preschool setting. These may include: a tendency to avoid spontaneous social interactions or to show very weak skills in interactions, problems sustaining simple conversations or a tendency to be perseverative or repetitive when conversing, odd verbal responses, preference for a set routine and difficulty with transitions, difficulty regulating social/emotional responses involving anger, aggression, or excessive anxiety, hyperactivity, appearing to be "in one's own world," and the tendency to overfocus on particular objects or subjects. Certainly, this list is much like the early symptom list in Autism or PDD. Compared to those children, however, the child with AS is more likely to show some social interest in adults and other children, will have less abnormal language and conversational speech, and may not be as obviously "different" from other children. Areas of particularly strong skills may be presen t, such as letter or number recognition, rote memorization of various facts, etc.
Elementary School
The child with AS will frequently enter kindergarten without having been adequately diagnosed. In some cases, there will have been behavioral concerns (hyperactivity, inattention, aggression, outbursts) in the preschool years. There may be concern over "immature" social skills and peer interactions, and the child may already be viewed as being somewhat unusual. If these problems are more severe, special education may be suggested, but probably most children with AS enter a more mainstream setting. Often, academic progress in the early grades is an area of relative strength; for example, rote reading is usually good, and calculation skills may be similarly strong, although pencil skills are often considerably weaker. The teacher will probably be struck by the child's "obsessive" areas of interest, which often intrude in the classroom setting. Most AS children will show some social interest in other children, although it may be reduced, but they are likely to show weak friend-making and friend-keeping skills. They may show particular interest in one or a few children around them, but usually the depth of their interactions will be relatively superficial. On the other hand, quite a number of children with AS present as pleasant and "nice," particularly when interacting with adults. The social deficit, when less severe, may be under appreciated by many observers.
Reprinted with the permission of MAAP Service, Inc. © 2008 MAAP Service, Inc.
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