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Asperger Syndrome: Causes, Symptoms And Treatments

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Asperger Syndrome is an old diagnosis, and doctors do not use it anymore. People with this health condition are now considered to have autism spectrum disorder (ASD), a social behavioral disorder.

In 1994, the American Psychiatric Association included Asperger Syndrome in the "Diagnostic and Statistical Manual of Mental Disorders (DSM)" as a sub-variant of autism. The 2013 revised manual, DSM-5, folded Asperger Syndrome into the broader category of ASD.

ASD refers to a wide range of conditions that affect a person's communication skills, ability to process social cues, and delays or deficiencies in fine and gross motor skills. Different levels of disease severity fall under the ASD classification, which causes varying levels of impairment.

DSM-5 identifies three levels of ASD severity, with level 1 requiring the least amount of support and level 3 requiring "very substantial support."

Intellectually, people that are "on the spectrum" may range from extremely gifted to intellectually disabled. According to the CDC, approximately one-third of 8-year-old children identified with ASD also had intellectual disabilities.

Prevalence of ASD

 The current data on ASD show that:

• 1 in 44 children in the U.S. have ASD
•  Young males are four times more likely than young females to have ASD
•  Race and ethnicity do not affect the prevalence of ASD

Mild ASD Symptoms: Primary Indicators

People with level 1 ASD can be considered mild autism, and these patients may demonstrate the following symptoms:

•  Poor communication skills – unable to "read" facial expressions or pick up on social cues
•  Socially and emotionally inappropriate behavior
• Repetitive behaviors/routines
•  Obsessive interest in a single topic or object to the exclusion of all others
•  Anxiety when asked to switch from one task to another
•  Physical awkwardness/developmental delays in motor skills
•  Hypersensitivity to physical stimulation (sounds, smells, touch, sights)

Individuals with mild ASD generally have average to above-average verbal skills and vocabulary. However, they are very literal-minded and unable to understand metaphors and shades of meaning. They can be rigid in their interpretations of language. For example, an individual with mild ASD may become alarmed seeing someone throwing bread crumbs on the ground to feed the birds when a nearby sign prohibits littering.

What Causes ASD?

The causes of ASD are not well understood, and most cases occur randomly. The disorder runs in families, about 1 in 10 people with ASD, which points to a genetic origin. Recent research suggests that exposure to environmental pollutants may be a risk factor for ASD.

Screening and Diagnosis of ASD

All children get screening for ASD as part of their routine care when they go to the pediatrician's office. Therefore it's important to keep up with all the check-ups that your pediatrician recommends, as this is the best way for your doctor to track your child's development. There are different ASD screening tools, such as ASQ and MCHAT.

The diagnosis of ASD is from an assessment of a child's development and observation of their behavior. There are several diagnostic tools that your doctor may use in making the diagnosis of ASD, such as ADI-R and ADOS-G.

The American Academy of Pediatrics recommends screening children at each visit for ASD risk. Early red flags include when a child dies not:

• Respond to name (at 12 months)
• Point to objects (at 14 months)
• Pretend play (at 18 months)

Or if your child:

• Avoids eye contact
• Has delayed speech
• Repeats words over and over
• Has obsessive interests
• Is upset by minor changes
• Makes repetitive movements like rocking or spinning

 Comorbidities

As many as 7 in 10 individuals with ASD develop attention deficit and hyperactivity disorder (ADHD), and individuals with ASD are 4 times more likely to develop depression. Anxiety and insomnia are also common problems in people with ASD.

Interventions

The mainstay of ASD treatment is early educational intervention. People with ASD are supported with language therapy, speech therapy, social skills lessons, and sensory integration to support their unique developmental needs. There currently are no drug therapies to treat ASD symptoms. However, individuals may take medication to treat secondary disorders such as depression and anxiety.

Early intervention is critical to ensuring children on the spectrum can reach their full potential. Speech and language therapy can help address problems with speech patterns, and occupational therapy can mitigate deficits in fine and gross motor skills. An effective treatment plan will include:

• Social skills training
• Cognitive behavioral therapy to help deal with stressful situations
• Predictable routine with highly structured activities

Help for Caregivers

Parents or caregivers will be incorporated into the treatment plan to continue the therapies at home and help provide an optimized environment for their child to succeed. The World Health Organization offers a free online Caregivers Skills Training course that covers topics such as helping children to participate in play and preventing challenging behavior.

Organizations such as Autism Speaks and the Autism Society also offer resources and support for individuals and families dealing with autism.

Next Steps

Under the Individuals with Disabilities Education Act (IDEA), children aged 3 and older with ASD are eligible for support from their local school district. Children younger than age 3 are eligible for services from Early Intervention programs provided by their state. Parents or caregivers concerned that their child is not meeting developmental milestones should talk to their pediatrician. A pediatrician can refer a child to the local Early Intervention program or the school district's Committee on Pre-School Special Education for screening, diagnosis, and services.

What Does the Future Hold for a Child with mild ASD?

While ASD is a disorder, recent efforts are in progress to shift the societal understanding of ASD. The term neurodiversity has been coined to describe how different people view the world, with an understanding that there isn't one right way of thinking. Conforming to perplexing social expectations may frustrate individuals with ASD. However, they often are compensated with an ability to focus deeply on a particular subject, and many excel in their chosen field.

Resource Links

• "Asperger's syndrome: a clinical account" via Cambridge University Press
• "Diagnostic and Statistical Manual of Mental Disorders" via American Psychiatric Association
• "Autism Spectrum Disorder Fact Sheet" via National Institute of Neurological Disorders and Stroke
• "Community Report on Autism 2021" via Centers for Disease Control and Prevention
• "Dioxins as Potential Risk Factors for Autism Spectrum Disorder" via Environment International
• "Identification, Evaluation, and Management of Children With Autism Spectrum Disorder" via American Academy of Pediatrics
• "Cognitive Behavioral Therapy" via The Mayo Clinic
• "WHO eLearning Caregiver Skills Training for Families of Children with Developmental Delays or Disabilities" via World Health Organization
• "Overview of Early Intervention" via Center for Parent Information & Resources
• "Autism spectrum disorder" via National Institute of Mental Health
• "Levels of autism: understanding the different types of ASD" via PsychCentral
• "Genetic Causes and Modifiers of Autism Spectrum Disorder" via Frontiers in Cellular Neuroscience
• "Screening and diagnosis of autism spectrum disorder for healthcare providers" via Centers for Disease Control and Prevention
• "ASD and ADHD Comorbidity: What Are We Talking About?" via Frontiers in Psychiatry
• "The deep emotional ties between depression and autism" via Spectrum News
• "Autism Spectrum Disorder" via StatPearls
•  "What is neurodiversity?" via Harvard Health

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