Asperger’s Syndrome (AS), also referred to as High Functioning Autism, is a developmental disorder that affects approximately 3-5% of the population according to available research. It has recently received much attention in the media and mental health communities, which has many parents asking questions and concerned about their children – but what is Asperger’s? Like many developmental syndromes, there is a list of "core" symptoms that are associated with AS, but each child may manifest a somewhat unique set of symptoms, including idiosyncratic symptoms. AS is an autistic spectrum disorder, and falls on the upper end of the continuum, hence the name High Functioning Autism. Those features thought to be "core" impairments in AS include social impairment, stereotypical behaviors, interests and activities, subtle to more pronounced language peculiarities, impairments of nonverbal communication, and motor problems. Other symptoms associated with AS are mood instability and mood disorders, concrete, back and white thinking, rigidity, inflexibility, sensory integration difficulties, attentional problems, oppositional behaviors, high IQ or "splinter skills," and learning difficulties. So what does all this mean? In truth, it means something different for each child. However, examples of some of the symptoms may shed light on the process in AS.

Social impairments may include: difficulties making and keeping friends, lack of age-appropriate friendships, lack of adherence or understanding of social norms, manners, and rules, social disinterest or aloofness, lack of sharing emotional experiences or interests with others, impaired use and understanding of non-verbal communication, and lack of empathy or emotional reciprocity. Many experts in the area of AS believe that this spectrum of social impairment seen in AS is the "core deficit" or defining characteristic of AS. AS children may be able to overcome other challenges but the social world remains a mystery to them that they attempt to negotiate it haphazardly, not understanding the responses that the receive from others. Other children or adults may perceive an AS child to be willfully rude or belligerent when the child truly does not know how to behave in social situations without training and cues from a familiar person. It is then critical for those adults who work with AS children to be educated not only about AS, but also about how to best intervene with that individual child.

Stereotypical behaviors, interests and activities vary greatly among children with AS. Some have keen, almost obsessive interests in things such as trains, cars, boats, a certain TV show, music, certain series of books, a certain sport, or an activity such as playing a sport or play theme. Stereotypic behaviors can include things such as unusual, repetitive movements such as hand flapping or a facial tic. It is not clear why this set of symptoms manifest – some experts believe that at least some of the stereotypic behaviors are driven by anxiety. It is important to determine to cause or motivation for each child’s stereotypic behavior so that interventions to address or reduce them are planned appropriately.

Language peculiarities include use and understanding of language. Some children with AS display unusual prosody (intonation) in speech, unusual voice inflection, peculiar voice characteristics, and sometimes mildly delayed early speech. While children with AS appear to have good language skills, we often find that these skills are superficial and there are underlying impairments of language, especially social language. AS children often to not understand the pragmatics of language, innuendo, jokes, tone of voice, and abstract language such as metaphor. It is important to understand each child’s language abilities in order to intervene at a level of communication that is appropriate.

Nonverbal communication is typical difficult for children with AS. They have difficulty reading body language such as facial expression, gestures, and a person’s posture. In other words, someone may clearly be angry from their facial expression and body language, but an AS child may not pick up on all or any or those cues. Also part of nonverbal communication is the concept of body space and body boundaries and eye contact. Children with AS often use limited eye contact and tend to be too close or too far away from others, not able to establish body boundaries that meet the needs of others. Being aware of each child’s level of nonverbal communication is key to helping them communicate better.

Motor problems are sometimes found in AS. Children can manifest either fine (small) or gross (large) motor difficulties. AS children may be clumsy, uncoordinated, have an unstable gait, or have difficulty with paper and pencil skills.

Concrete, back and white thinking, rigidity, and inflexibility are both emotional and cognitive characteristics of many AS children. Adherence to routine and inability to handle transition times are a hallmark of this impairment. However, children may have more subtle difficulty such as being inflexible in their thinking. A child might try to solve a problem one way and not be able to think of another solution or be resistant to suggestions about another strategy. They tend to follow rules by rote, taking things literally and do not see the "shades of gray."

Sensory integration difficulties are common in AS. This is a large set of symptoms but typically includes tactile defensiveness (strong dislike for certain textures, touch), reactivity to sound, environmental overstimulation, and visual-perceptual difficulties.

Attentional problems are common among children with AS, and in fact, many children with AS are first diagnosed with ADHD and later with AS. Attentional difficulties include inattention, distractibility, impulsiveness, hyperactivity, and difficulties with executive functioning (planning and organizing).

Oppositional behaviors are sometimes seen in children with AS. The oppositional behavior often stems from social deficits, rigidity and sensory problems, so that this behavior is sometimes dealt with indirectly.

High IQ or "splinter skills," and learning difficulties are other characteristic seen in AS children. Above average to gifted IQ is common, and AS children often display "splinter skills" such as unusually good memory, a giftedness in one academic area, musical giftedness or the like. In the other hand, despite average to high IQ, many AS children have difficulties learning for a variety of reasons, including attention, rigidity, and specific learning disability. A subset of children with AS also have a learning disability called Nonverbal Learning Disorder. While many of it’s symptoms are identical to AS, it includes a specific disability in learning math.

Mood instability and mood disorders also tend to affect children with AS. While anxiety and depression are most common, there is also a subset of children dually diagnosed with AS and Bipolar Disorder.

The above is an introduction to the Syndrome known as Asperger’s. If you would like to learn more, we encourage you to read Tony Atwood’s book, "Asperger’s Syndrome," available from RPCS’s lending library, or access his website at www.tonyattwood.com.au/. You can also browse the OASIS website at http://www.udel.edu/bkirby/asperger/ .