AAA Section 04 Asperger's Disorder Ver 04 2013

Asperger’s
Disorder

UNDERGRADUATE
3
or 201
dat ed f
Up

Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1
Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077)
Ver: 004
33

Introduction to the Section.

• What is Asperger’s Disorder?
• Symptoms of Asperger’s.

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• How Asperger’s was first recognised.
• Characteristics of Asperger’s Disorder.
• Comorbidity.
• How is Asperger’s different from Classic
Autism.
• Questions.

33

Learning Outcomes of this
Section.
On completion of the Section and with independent
study you should be able to:

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1. Understand the main symptoms, variations and
diagnostic criteria relating to Asperger’s disorder.

2. Be able to describe Asperger’s disorder in
detail.

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Autism Spectrum Disorder.
In her 1981 paper ‘Asperger's
syndrome: a clinical account’ Lorna
Wing proposed Asperger's syndrome
as a separate condition.

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A continuum that…
“…ranges from the most profoundly physically and
mentally retarded person ... to the most able,
highly intelligent person with social impairment
in its subtlest form as his only disability. It
overlaps with learning disabilities and shades
into eccentric normality.”

The Autistic Spectrum (2003) Lorna Wing

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Autism
No single cause; no
single cure.

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Hence: A spectrum, a
continuum, a
syndrome.

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Terms.

There is a confusing plethora of terms
including autism, autistic disorder,

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Asperger syndrome or disorder, high-
functioning, pervasive developmental
disorder (PDD), semantic-pragmatic
disorder, pathological demand
avoidance, Nonverbal Learning
Disability, PDD-NOS, atypical
Asperger syndrome.
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Asperger’s Disorder is not in the DSM-V
The DSM-V will combine the currently separate
diagnoses of Autistic Disorder, Asperger's
Disorder, Pervasive Developmental Disorder-not
otherwise specified (PDD-NOS) and Childhood

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Disintegrative Disorder.

The major change to the diagnosis of Asperger’s
Disorder and Autism is the use of the umbrella
term of ‘Autism Spectrum Disorder’. [from May 2013]

The age of onset will be more
flexible, allowing for older children
and adults to be diagnosed.
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What Is Asperger’s Disorder
(DSM-IV)?
The DSM-IV includes five types of disorder
under the term ‘Pervasive Developmental

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Disorder’ PDD.
1) Autistic Disorder*.
2) Rett’s Disorder.
3) Childhood Disintegrative Disorder.
4) Asperger’s Disorder*.
5) Pervasive Development Disorder Not
Otherwise Specified*.
* Mainly these form the Autistic spectrum ASD.

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What Is Asperger’s Disorder?

• ASD is a spectrum of disorders. Ranges from
low functioning – high functioning / Asperger's

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syndrome.
• Milder / higher-functioning form of Autism
characterised by impairments in the social
domain, some impairment in the
behaviour/interests domain.
• No significant delays in cognitive or language
skills.

33

What Is Asperger’s Disorder?
Wing and Gould’s triad of impairments

Impairment in social interaction.

Impairment in verbal
and non verbal
communication.
Restricted, repetitive and
Peculiarities in verbal stereotyped patterns of
and non verbal behaviour.
communication.

• The triad of impairment summarises the difficulties of
the Autistic child but the actual manifestation of these
can vary. Asperger’s may be a subtler form of ASD.

Asperger’s Diagnosis (DSM-IV).
A. Qualitative impairment in social interaction, as
manifested by at least two of the following:
• Marked impairment in the use of multiple

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nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures
to regulate social interaction.
• Failure to develop peer relationships appropriate
to developmental level.
• A lack of spontaneous seeking to share
enjoyment, interests, or achievements with other
people.
• Lack of social or emotional reciprocity.

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B. Restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested by
at least one of the following:

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• Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus.
• Apparently inflexible adherence to specific,
nonfunctional routines or rituals.
• Stereotyped and repetitive motor mannerisms.
• Persistent preoccupation with parts of objects.

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C. The disturbance causes clinically significant impairment in social,
occupational, or other important areas of functioning.

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D. There is no clinically significant general delay in language (e.g.,
single words used by age 2 years, communicative phrases used by
age 3 years).

E. There is no clinically significant delay in cognitive development or in
the development of age-appropriate self-help skills, adaptive
behavior (other than in social interaction), and curiosity about the
environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental
Disorder or Schizophrenia.

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How AS was First Recognised.

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• Leo Kanner and Hans Asperger who, independently
of each other, published accounts of this disorder.
• These publications, Kanner's in 1943 and Asperger’s
in 1944, contained detailed case descriptions and also
offered the first theoretical attempts to explain the
disorder.

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• Asperger’s paper, written in German, and
published during the second world war, was

UNDERGRADUATE
largely ignored.
• Asperger’s definition of autism or, as he
called it, ‘autistic psychopathy’ is far wider
than Kanner's.
• The belief has grown that Asperger
described quite a different type of child, not
to be confused with the one Kanner
described. This is not the case.
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• 1944 - First identified in Austria by Hans Asperger.
• 1981 - Reintroduced as Asperger’s Syndrome by Lorna
Wing who reviewed Asperger’s paper.

UNDERGRADUATE
• Wing’s review provided a description of Asperger’s, as
well as 34 case studies, and discussed classification and
differential diagnosis.
• 1994 - Recognised as a distinct disorder by the American
Psychiatric Association in the DSM-IV.
• United Kingdom, Australia, and Sweden lead in research
on AS.
• 2013 – DSM-V, new cases are ‘Autism Spectrum
Disorder’, previously diagnosed are retained.
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Characteristics of Asperger’s.
• It’s lifelong disorder of unknown origin that
usually shows up around 18 months to 3 years.

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• Generally thought to be a form of Autism, it is
characterised by:
– Normal or above-normal intelligence.
– Social awkwardness.
– Verbal rigidity.
– A fixation with an obscure topic that
can be learned by rote (memory).

33

• People with Asperger's have a hard time
relating to other people.

UNDERGRADUATE
• Can and do go on for hours about their
obsession. (Little Professors!).
• Not interested in playing with other children
but later often desire relationships.
• Preoccupation with things that seem beyond
their age level.
• Little or no eye contact.
• Fascinated with numbers and letters.

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Qualitative impairment of social interaction:
• Delays in nonverbal behaviors (gesturing, facial

UNDERGRADUATE
expression, body posture).
• Impairments in establishing peer relationships.
• Absence of spontaneous seeking to share enjoyment,
interests, or achievements with others.
• Theory of Mind - Some have described individuals
with AS as having a low ‘EQ’ or Empathy Quotient or
as having a ‘Learning Disability’ in social skills.

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• Stereotyped Behaviors, Activities, and
Interests.

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• Preoccupation with narrow area of interest.
• Inflexibility or rigidity – often causes stress.
• Sticking to a set, sometimes nonfunctional
routine.
• Repetitive motor movements.
• Preoccupation with objects.

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• Sensory differences - touch,
taste, odours, textures, noise
levels, lighting.

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• Motor clumsiness, especially in
younger children.
• Poor problem-solving and
organisational skills.

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• Talks in a flat affect.
– Voice and tone modulation – failure to
make voice interesting to listener

UNDERGRADUATE
because they lack the concept of the
listener as interested.
– May sound robotic.
• Speech may be characterised by poor
prosody, awkward intonation, and
odd/inappropriate subject matter.
• Echolaic speech.
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• People with Asperger's Disorder are inclined to
construe language very literally.

UNDERGRADUATE
– so they may not understand slang or informal
speech.
• People with Asperger's Disorder may also have
difficulty decoding tone of voice and facial
expressions.
– Derisive statements such as, "Oh, that was
great!" may inadvertently provide positive
reinforcement of an inappropriate behaviour.

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• Have unusual fear based or stress based
reactions.
– Tear up a room.

UNDERGRADUATE
– Tantrum.
– Reactions are not proportionate to the
situation.
– Very easily upset.
• Have a strong desire for routine or sameness.
• Have limited ability to form friendships.

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• Unlike Autistic individuals, who may seem
aloof and disinterested in others, people with

UNDERGRADUATE
Asperger’s tend to desire to interact with
others, but don’t know how to in an
appropriate way.
• Often self-described “loners”, “Geeks”.
• May live very successful independent lives
in appropriate job settings.

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Assessment & Diagnosis.
• Similar to Autism (we’ll cover
more on this in later sections).
• It is easier to ‘spot’ Autism

UNDERGRADUATE
at the low-functioning end
of the spectrum.
• Not so easy to spot
Asperger’s Disorder.
• High functioning children
do adapt .

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Prevalence of Asperger's.
• More common in males.
• Prevalence estimates vary widely

UNDERGRADUATE
(36/1000 to 1/10,000) depending on
what literature you read. We just don’t
know accurately.
• Incidence increasing greatly recently.
• Increase due to better identification or
true increase due to unknown factor?

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Prognosis.
• The factors associated with a good prognosis
are a normal IQ, high-level social skills, better
communication skills and later onset.

UNDERGRADUATE
• Prognosis depends on severity and services
available.
• Jobs often in area of their interest, which can
also help with social integration.

Web Search for ‘Temple Grandin’
http://www.templegrandin.com/

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Comorbid Disabilities.
• In addition to Asperger's Disorder, many people with
Asperger's will also exhibit:
– Tics (blinking, sniffing, facial grimaces, throat clearing).
– Obsessive Compulsive Disorder.
– Executive Dysfunction.

UNDERGRADUATE
– ADHD.
– Anxiety.
– Sleep Disturbances.
– Eccentric eating habits.
– Self-injurious behaviors.
– Depression – especially in adolescents.

• Learning Disabilities.

• …Even though they may not be formally diagnosed with those
disorders.

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• Tics
– Are distinguished by sudden, repetitive movements
(motor tics) or sounds (phonic tics).

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– Frequently preceded by a premonitory feeling of an
urge, anxiety, distress, or other sensory phenomena.
• Executive Dysfunction
– planning for the future
– the ability to inhibit or delay responding
– initiating behavior
– shifting between activities flexibly

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• Obsessive Compulsive Disorder
– Repeated and unrelenting beliefs, impulses, or
images cause marked anxiety or distress.

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The person endeavors to ignore or
restrain such thoughts, impulses,
or images, or to counterbalance
them with some other thought or
action that the person feels
compelled to complete in response
to an obsession, or concurrent to
rules that must be applied inflexibly.

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Unique Difficulties of AS.
• The very characteristics that make child higher functioning can
produce its own difficulties.
– Awareness of social difficulties.
– Disabilities not always taken seriously.

UNDERGRADUATE
– Late/difficult diagnosis.
• Until school, symptoms not always disruptive, child may seem
simply extremely bright.
• Easy to miss diagnose or misdiagnose.
• Teachers’ Misunderstandings. (Disabilities not always taken
seriously).
– Compensates for lack of social insight with logic.
– Verbal abilities appear intact.
– Rote memory.
– Logical thinking.

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Differences in AS Presentation
from Autism.
Asperger’s Autism
• Later onset • Early onset

UNDERGRADUATE
• Higher range of IQ • IQ tends to be lower
• No language deficit • Often fail to develop
• Non-verbal spoken language
communication problems • Problems with non-verbal
less severe communication
• Clumsiness in basic • Tend to be adept at basic
motor skills motor skills

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AAA Section 04 Asperger's Disorder Ver 04 2013

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