When you meet a child with Asperger Syndrome, two things can be immediately discovered. He does not lag behind other children in development, but he has problems with social skills. Such a child has a tendency to obsessively concentrate on one topic or to repeat the same manipulation over and over.
For a long time, experts have identified Asperger's syndrome as an independent disease. Today he is no longer so. Asperger's Syndrome is part of a broader category called Autism Spectrum Disorder. These are disorders of the nervous system, characterized by difficulties with communication and social interaction, stereotyped and repetitive patterns of action, and uneven mental development, often with cognitive disabilities.
Asperger syndrome is less severe than other types of autism spectrum disorder.
The syndrome is named after Dr. Hans Asperger, a pediatrician from Austria. In 1944, he first described this condition. The doctor spoke about four boys; they showed "lack of empathy, weak ability to form friendships, self-talk, deep" immersion "in the object of interest and awkward movements." Because of their obsessive interests and awareness of specific subjects, he referred to the boys as "little professors."
Many experts today draw attention to the special talents and positive aspects of Asperger's disease and believe that this disorder implies a different, but not necessarily defective, way of thinking. Positive traits for people with Asperger Syndrome have been cited as useful in many professions and include:
- increased ability to concentrate on details;
- persistence in specific issues of interest without hesitation;
- the ability to work independently;
- highlighting details that may be overlooked by others;
- intensity and originality of thinking.
Although it is impossible to diagnose Asperger's disease without direct testing and observation of the individual, some authors have suggested that many successful historical figures probably had Asperger's syndrome, including Albert Einstein, Mozart, Thomas Jefferson, Benjamin Franklin, and Marie Curie. Of course, definitive diagnosis of historical figures with Asperger Syndrome is not possible, and many of the signs exhibited by people with Asperger Syndrome can also arise from mental giftedness or even attention deficit disorder.
Causes
The etiology of Asperger's syndrome is unknown. Some children with the disorder have had complications during the prenatal and neonatal periods and during childbirth, but the link between obstetric complications and Asperger's syndrome has not been confirmed.
Adverse events in the prenatal, perinatal, and postpartum periods can increase the likelihood of developing Asperger's syndrome. In a Swedish study, negative perinatal incidents were reported in about two-thirds of 100 men with Asperger's syndrome, and the mother had infections, vaginal hemorrhage, preeclampsia (late toxicosis), and other critical episodes during pregnancy. It is not known whether the syndrome is a consequence or cause of perinatal complications in such cases.
Brain imaging studies have shown that there are structural and functional differences in certain areas of the brain between individuals with Asperger's and those who do not.
Genetic factor
Studying the history of families in which several members have Asperger's syndrome suggested that there is a genetic contribution to the development of the disorder.
Research has shown that several genes are likely to be involved in autism spectrum disorder. In some children, Asperger's syndrome can be associated with genetic disorders, such as Rett syndrome (severe pathology of the central nervous system) or Martin-Bell syndrome (fragile X syndrome). In addition, genetic changes can increase the risk of developing autism spectrum disorder or determine the severity of symptoms.
Exogenous factor
The influence of the environment has a certain value. While some families remain concerned that vaccines and / or preservatives in them may play a role in the development of Asperger's syndrome and other autism spectrum disorders, experts have discredited this theory.
Epidemiology
Due to differences in diagnostic criteria, estimates of the prevalence of Asperger's syndrome vary widely. Various studies from the United States and Canada, for example, reported that the rate ranged from 1 in 250 children to 1 in 10,000. More epidemiological studies are needed using generally accepted criteria and a screening tool that targets these parameters.
A population study in Sweden found the prevalence of Asperger's syndrome: 1 in 300 children. This assessment is compelling for Sweden because complete medical records are available to all citizens of this country and the population is very homogeneous. However, in other parts of the world where none of these factors apply, the prevalence may be very different.
Like Sweden, other Scandinavian countries keep the medical records of their populations and are thus uniquely suitable locations for epidemiological research. Comparable studies may not always be easily carried out in other parts of the world. For example, in New York City, many residents are immigrants and it is not always possible to obtain medical records from their country of origin.
However, Asperger's Syndrome may be more common than researchers once thought. Pediatricians, family doctors, general practitioners, and other healthcare professionals can underestimate this disorder. Family members sometimes attribute the symptoms of Asperger's to a child's personality.
Asperger's Syndrome in children does not have an overt racial bias. The estimated ratio between boys and girls is approximately 4: 1. However, research suggests that the disorder should not be considered a male disorder.
The syndrome is usually diagnosed during the early school years. Less commonly, it is detected in early childhood or in an adult. However, there may be a number of adults with Asperger Syndrome who have excellent awareness and adaptation skills and who behave in accordance with the expectations of society. The disease in this case is never diagnosed during their lifetime.
Forecast
Children with the syndrome have a good prognosis when they receive support from family members who are knowledgeable about the disorder. These individuals may learn specific social orientations, but the underlying social impairments are expected to be lifelong.
Individuals with Asperger's disease have a normal life span; however, they have more common comorbid mental illnesses such as depression, mood disorders, obsessive-compulsive disorder (obsessive-compulsive disorder), and Tourette's syndrome (neuropsychiatric disorder). Comorbid mental disorders (interrelated diseases), when present, significantly affect prognosis.
Depression and hypomania (mild mania) are common among adolescents and adults with Asperger's syndrome, especially those with a family history of these conditions. People caring for people with this condition may also be prone to depression.
Individuals with this syndrome have an increased risk of suicide. This risk increases in proportion to the number and severity of comorbidities. In many cases of suicide, Asperger's Syndrome is not diagnosed in a person because the level of awareness of the condition is often low and the methods used to identify it are often ineffective and unreliable. People with this disorder who commit suicide often have other psychiatric problems.
Symptoms
An individual's symptoms range from mild to severe. There will also be a different level of functioning for each child. Children may have all or only some of the characteristics described below. They may have more problems in unstructured social settings or in new situations related to communication skills.
Social problems
Children with Asperger Syndrome have difficulty communicating with peers and may be rejected by other children. Adolescents with the disorder usually develop depression and feel lonely.
Outside of contact with immediate family members, the affected child may display inappropriate attempts to initiate social interactions and make friends with those around them. Children with the syndrome may be afraid to show a sincere desire to communicate with peers. But family members can teach such a child to express their love for their parents through numerous rehearsals over the years.
There are times when a child who is affected cannot show affection for their parents or other family members.
Children with Asperger Syndrome have special and narrow interests that exclude other activities. These interests may take precedence over their relationships with their family, school, and community.
Changes in a child's daily life (parental divorce, school change, relocation,) can also exacerbate anxiety, depression, and other psychological disorders.
Communication disorders
Affected children have very limited use of gestures. Body language or non-verbal communication can be awkward and inappropriate. Facial expressions may be absent. When answering questions, the child usually has errors. These children often give inappropriate answers.
Speech and hearing impairment
Children with Asperger Syndrome have several abnormalities in speech and language, including scrupulous speech and strangeness in presentation, intonation, prosody (stress setting), and rhythm. Misunderstanding of linguistic nuances (such as literal interpretations of turns of speech) is common.
Practical speech problems are common in children, including:
- inability to use language in social contexts;
- interruption of another person's speech;
- irrelevant comments.
Speech can be unusually formal or difficult for other people to understand. Children can voice their thoughts uncensored.
The volume of speech can vary greatly and reflect the child's current emotional state, and not the requirements for communication in the social sphere. Some children may be talkative, others quiet. Moreover, the same child can demonstrate both verbosity and persistent silence at different times.
Some children may exhibit selective mutism (refusal to speak in certain situations). Some can only talk to those they like. Thus, speech can reflect individual interests and personality preferences.
The form of the chosen language may include metaphors that only make sense to the speaker. A message that has something meaningful to the speaker may not be understood by those who hear it, or it may only make sense to some people who understand the speaker's personal language.
Children often exhibit auditory discrimination and distortion, especially when 2 or more people face each other speaking at the same time.
Sensory sensitivity
Children with Asperger Syndrome may show abnormal sensitivity to sound, touch, pain, and temperature. For example, they can exhibit either extremely greater or decreased sensitivity to pain. Possible hypersensitivity to food texture. Children experience synesthesia when stimulation in one sensory or cognitive system triggers an automatic, involuntary response in another sensory mode.
Delayed motor skills
- apparent clumsiness and poor coordination;
- deficits in visual-motor and visual-perceptual skills, including problems with balance, manual dexterity, handwriting, fast movements, and rhythm.
Diagnostics
Several factors make it difficult to diagnose Asperger's syndrome. Like other forms of autism spectrum disorder, it is characterized by impaired social interaction accompanied by repetitive and limited interests and behaviors; it differs from other autism spectrum disorders in the absence of a general delay in speech or cognitive development. Diagnostic problems include inconsistency between criteria, controversy regarding the differences between Asperger's and other forms of autism spectrum disorders.
When checking a child's development, the pediatrician can identify signs that require further study. A comprehensive assessment by a team of specialists is required to confirm or exclude a diagnosis. This group usually includes a psychologist, neurologist, psychiatrist, speech therapist, pediatrician, and other professionals with experience in diagnosing Asperger's syndrome. Comprehensive assessment includes neurological and genetic aspects with in-depth cognitive and speech testing to establish IQ. It also includes an assessment of psychomotor function, verbal and non-verbal communication, learning style, and independent living skills.
Communication screening includes an assessment of:
- non-verbal forms of communication (glance and gestures);
- the use of metaphors, irony and humor;
- staging stress and loudness of speech;
- content, clarity and consistency of the conversation.
Testing may include audiologic examination to rule out hearing impairment. Identifying a family history of autism spectrum disorders is essential.
Screening for "understanding someone else's consciousness"
"Understanding someone else's consciousness" can be viewed as the ability to comprehend the meaning of the mental processes of oneself and others, which makes it possible to predict the reactions of other people to ordinary situations. A child with Asperger Syndrome lacks the development of this understanding.
In children with possible developmental disabilities, screening for “understanding the consciousness of others” is an important process that the professional can use to identify some of the basic behavioral symptoms of Asperger's syndrome. Typical children demonstrate its presence before starting school. Thus, the failure of a school child to perform any screening procedure correctly indicates the need to refer him for additional examination.
The screening for “understanding someone else's consciousness” has two main components: puppet play simulation and imagination tasks. It can be done in a doctor's office and other day-to-day environments and only takes a few minutes.
Puppet play simulation
The doctor and the patient sit at opposite ends of the table. The specialist shows the patient 2 dolls and names them, saying: “This is Sveta. This is Ann".
Modeling includes 2 procedures.First, the doctor describes and shows Sveta by placing a pebble in a basket. Then he removes Sveta from the room and closes the door, leaving her outside. Then the doctor describes and shows how Anya takes out a pebble from a basket and places it in a box. Finally, the specialist returns the first doll to the room and asks the patient: "Where will Sveta look for the pebble?"
A child with a developed "understanding of someone else's consciousness" will answer that Sveta will look for a pebble in the basket where she put it before leaving the room. If this answer is received, the procedure ends, and then the doctor can move on to the imagination task.
The answer “The light will look for a pebble in a box” signals that the child does not have “an understanding of someone else’s consciousness”. This answer indicates that the patient cannot distinguish the mind of Sveta from his own and, thus, does not recognize that Sveta was absent and could not know that the pebble was moved from the basket to the box. The child assumes that since he knows that the pebble is in the box, Sveta should also know this.
If the patient does not answer that Sveta will be looking for a pebble in the basket, the doctor will continue asking questions to clarify the patient's understanding of the situation. The specialist asks the patient: "Where is the pebble really?" Both healthy children and children with the syndrome usually claim that the pebble is in the box. Then the doctor asks: "Where was the pebble in the beginning?" An ordinary child and toddler with frustration will claim that the pebble was originally in the basket.
In the second procedure, the doctor describes and shows that Sveta places a pebble in a basket, then removes it from the room and closes the door, leaving the doll outside. Then the specialist describes and shows how Anya takes out a marble pebble from a basket and places it in the doctor's pocket. Finally, the doctor returns the first doll to the room and asks the patient: "Where will Sveta look for the pebble?"
Healthy patients with "understanding of someone else's consciousness" answer that they will look for Sveta in the basket, because this is where she placed a pebble for the last time. If this answer is received, the doctor moves on to the imagination task. If not, the specialist asks the patient: "Where is the pebble really?" And “Where was the pebble first?” To make sure the patient understands the situation.
Imagination challenge
The procedure consists of 3 parts. In the first, the doctor tells the patient, “Close your eyes and think of the big white teddy bear. Take a mental snapshot of the image. Do you see a white teddy bear?
A healthy patient will report seeing a picture of a large white teddy bear. If the patient does not state this, the doctor asks: "What do you see when you close your eyes?" If the patient reports any extraneous image, the doctor asks: "What are you thinking?" A healthy patient will readily report an image of a large white teddy bear.
The next part of the problem is to repeat the first part, replacing the bear with a large red ball. A healthy patient will report that there is a large red ball in front of him.
In the third part of the imagination problem, the specialist asks the patient to identify the first image rendered during the exercise. A healthy child will imagine a big white teddy bear. The ability to recall an earlier mental image is proof of the presence of "understanding of someone else's consciousness"; thus, the inability to recognize one's own previous mental images suggests a lack of this understanding. Accordingly, if the patient reports that the first image was a red ball, this indicates a lack of "understanding someone else's consciousness."
Treatment
There is no specific treatment for Asperger's syndrome. All of the interventions described below are primarily symptomatic and / or rehabilitation oriented.
Developing proper social behavior
Teachers have many opportunities to help children develop appropriate social behavior. For example, they can simulate different situations that require action and encourage group play in the classroom. The educator can show appropriate ways to seek help when a child exhibits problem social behavior in the classroom. Teachers can identify suitable friends for children with the syndrome and encourage promising friendships. They also help children cope with social situations by monitoring between classes, in the cafeteria and during activities on the playgrounds.
Showing videos can help you self-monitor classroom rules. The child can learn to observe other children, social cues and behavior. Since changing school, classroom, and teacher can aggravate symptoms, efforts should be made to minimize changes in the patient's schedule and educational environment.
Implementation of communication and language strategies
Children with Asperger Syndrome can be taught to speak phrases for specific purposes (such as opening a conversation). They are also encouraged to be taught to seek clarification by asking people to paraphrase confusing expressions. They should be encouraged to ask for complex instructions to be repeated, simplified, clarified, and recorded.
Educators can use simulations to teach affected children how to interpret other people's conversational cues to respond, interrupt, or change topics. Because the interpretation of metaphors and figures of speech is often difficult, educators should explain these language subtleties when they arise. When giving a series of instructions to a child with Asperger Syndrome, pause between each item.
Role play can help children with Asperger Syndrome learn to understand the intentions and thoughts of others. Affected children should be encouraged to stop and think about how the other person will feel before acting or speaking. They can be taught to refrain from uttering every thought.
Some children with Asperger's disease have good visual-figurative thinking. These children are encouraged to explain everything using diagrams and other illustrations.
Promotion of special skills
Children with Asperger Syndrome can often focus on class for several hours without interruption and continue that concentration daily for many years. For example, many children give up playing a musical instrument even for a few minutes a day, and a child with the syndrome can enjoy daily exercise for hours.
With the right training, the talents of children with Asperger Syndrome can develop fruitfully. Accordingly, it is helpful at an early age to identify and develop a child's special interests and abilities (for example, in music or mathematics). These talents will also help him earn the respect of his classmates.
Parents and teachers should be creative in uncovering the skills, abilities, and talents of children with Asperger's disease. Qualified training is required to develop these talents.
Conclusion
Sometimes when people hear that a child has Asperger's Syndrome, their first response will be something like, "But he looks completely normal." This is misleading and ignorant because there is nothing abnormal or atypical about a child with Asperger's Syndrome. These children may have communication difficulties or other problems, but in many ways he is just like any other child. They just need someone to show them the way and help them fit into society.
