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Asperger's syndromeBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/aspergers-syndrome/DS00551
Asperger's syndrome is a developmental disorder that affects a person's ability to socialize and communicate effectively with others. Children with Asperger's syndrome typically exhibit social awkwardness and an all-absorbing interest in specific topics.
Doctors group Asperger's syndrome with other conditions that are called autistic spectrum disorders or pervasive developmental disorders. These disorders all involve problems with social skills and communication. Asperger's syndrome is generally thought to be at the milder end of this spectrum.
While there's no cure for Asperger's syndrome, if your child has the condition treatment can help him or her learn how to interact more successfully in social situations.
Asperger's syndrome symptoms include:
- Engaging in one-sided, long-winded conversations, without noticing if the listener is listening or trying to change the subject
- Displaying unusual nonverbal communication, such as lack of eye contact, few facial expressions, or awkward body postures and gestures
- Showing an intense obsession with one or two specific, narrow subjects, such as baseball statistics, train schedules, weather or snakes
- Appearing not to understand, empathize with or be sensitive to others' feelings
- Having a hard time "reading" other people or understanding humor
- Speaking in a voice that is monotonous, rigid or unusually fast
- Moving clumsily, with poor coordination
Unlike children with more-severe forms of autism spectrum disorders, those with Asperger's syndrome usually don't have delays in the development of language skills. That means your child will use single words by the age of 2 and phrases by the time he or she is 3 years old. But, children with Asperger's syndrome may have difficulties holding normal conversations. Conversations may feel awkward and lack the usual give and take of normal social interactions.
Toddlers and school-age children with Asperger's syndrome may not show an interest in friendships. Youngsters with Asperger's often have developmental delays in their motor skills, such as walking, catching a ball or playing on playground equipment.
In early childhood, kids with Asperger's may be quite active. By young adulthood, people with Asperger's syndrome may experience depression or anxiety.
When to see a doctor
All kids have their quirks, and many toddlers show a sign or symptom of Asperger's syndrome at some point. It's natural for small children to be egocentric, and many children show a strong interest in a particular topic, such as dinosaurs or a favorite fictional character. These generally aren't reasons to be alarmed.
However, if your elementary schoolchild has frequent problems in school or seems unable to make friends, it's time to talk with your child's doctor. These difficulties have many possible causes, but developmental disorders such as Asperger's syndrome need to be considered. Children who have behaviors that interfere with learning and social development should have a comprehensive evaluation.
It's not clear what causes Asperger's syndrome, although changes in certain genes may be involved. The disorder also seems to be linked to changes in the structure of the brain.
One factor that isn't associated with the development of Asperger's syndrome or other autism spectrum disorders is childhood immunizations.
Boys are far more likely to develop Asperger's syndrome than are girls.
Preparing for your appointment
You'll probably first see your child's pediatrician or family doctor, who will likely refer your child to a mental health expert, such as a child psychologist or psychiatrist.
Being well prepared can help you make the most of your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you've noticed in your child, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of any medications, as well as any vitamins or supplements, that your child is taking.
- Ask a family member or friend to join you and your child for the appointment, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Preparing a list of questions ahead of time will help save time for the things you want to discuss most. List your questions from most important to least important in case time runs out. For Asperger's syndrome, some basic questions to ask your doctor include:
- What is likely causing my child's behavior?
- Are there other possible causes?
- What kinds of tests does my child need?
- Will he or she outgrow this condition?
- What treatments can help?
- Can these treatments cure Asperger's syndrome?
- Are there any specialized programs available to help educate my child regarding social skills?
- What should I tell his or her school?
- What are the alternatives to the primary approach that you're suggesting?
- Would changes in diet help?
- What's the prognosis for my child? Can he or she live a relatively normal life?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- What specific behaviors prompted your visit today?
- When did you first notice these symptoms in your child?
- Have these behaviors been continuous, or occasional?
- Does anything seem to improve your child's symptoms?
- What, if anything, appears to worsen your child's symptoms?
- When did your child first crawl? Walk? Say his or her first word?
- Does your child have close friends?
- What are some of your child's favorite activities? Is there one that he or she favors?
- Have you noticed a change in his or her level of frustration in social settings?
Tests and diagnosis
Because Asperger's syndrome varies widely in severity and signs, making a diagnosis can be difficult. If your child shows some signs of Asperger's syndrome, your doctor may suggest a comprehensive assessment by a team of professionals.
This evaluation will likely include observing your child and talking to you about your child's development. You may be asked about your child's social interaction, communication skills and friendships. Your child may also have a number of tests to determine his or her level of intellect and academic abilities. Tests may examine your child's abilities in the areas of speech, language and visual-motor problem solving. Tests can also identify other emotional, behavioral and psychological issues.
To be diagnosed with Asperger's syndrome, your child's signs and symptoms must match the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a manual published by the American Psychiatric Association and used by mental health providers to diagnose mental conditions.
Some of the DSM criteria for Asperger's syndrome are:
- No significant language delays
- A lack of eye to eye contact
- Unusual body posture or social expressions
- Difficulty making friends
- A preoccupation with one subject
- No interest in interactive play
- An inflexible attitude toward change
Unfortunately, some children with Asperger's syndrome may initially be misdiagnosed with another problem, such as attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder, possibly because the symptoms of some conditions are similar to those of Asperger's. Additionally, these other conditions may coexist with Asperger's, which can delay the diagnosis.
Treatments and drugs
The core signs of Asperger's syndrome can't be cured. However, many children with Asperger's syndrome grow into happy and well-adjusted adults.
Most children benefit from early specialized interventions that focus on behavior management and social skills training. Your doctor can help identify resources in your area that may work for your child.
Asperger's syndrome treatment options may include:
Communication and social skills training
Children with Asperger's syndrome may be able to learn the unwritten rules of socialization and communication when taught in an explicit and rote fashion, much like the way students learn foreign languages. Children with Asperger's syndrome may also learn how to speak in a more natural rhythm, as well as how to interpret communication techniques, such as gestures, eye contact, tone of voice, humor and sarcasm.
Cognitive behavioral therapy
This general term encompasses many techniques aimed at curbing problem behaviors, such as interrupting, obsessions, meltdowns or angry outbursts, as well as developing skills such as recognizing feelings and coping with anxiety. Cognitive behavioral therapy usually focuses on training a child to recognize a troublesome situation — such as a new place or an event with lots of social demands — and then select a specific learned strategy to cope with the situation.
There are no medications that specifically treat Asperger's syndrome. But some medications may improve specific symptoms — such as anxiety, depression or hyperactivity — that can occur in many children with Asperger's syndrome. Examples include:
- Aripiprazole (Abilify). This drug may be effective for treating irritability related to Asperger's syndrome. Side effects may include weight gain and an increase in blood sugar levels.
- Guanfacine (Intuniv). This medication may be helpful for the problems of hyperactivity and inattention in children with Asperger's syndrome. Side effects may include drowsiness, irritability, headache, constipation and bedwetting.
- Selective serotonin reuptake inhibitors (SSRIs). Drugs such as fluvoxamine (Luvox) may be used to treat depression or to help control repetitive behaviors. Possible side effects include restlessness and agitation.
- Risperidone (Risperdal). This medication may be prescribed for agitation and irritability. It may cause trouble sleeping, a runny nose and an increased appetite. This drug has also been associated with an increase in cholesterol and blood sugar levels.
- Olanzapine (Zyprexa). Olanzapine is sometimes prescribed to reduce repetitive behaviors. Possible side effects include increased appetite, drowsiness, weight gain, and increased blood sugar and cholesterol levels.
- Naltrexone (Revia). This medication, which is sometimes used to help alcoholics stop drinking, may help reduce some of the repetitive behaviors associated with Asperger's syndrome. However, the use of low-dose naltrexone — in doses as low as two to four mg a day — has been gaining favor recently. But, there's no good evidence that such low doses have any effect on Asperger's syndrome.
Because there are no definitive treatments for Asperger's syndrome, some parents may turn to complementary or alternative therapies. However, most of these treatments haven't been adequately studied. It's possible that by focusing on alternative treatments, you may miss out on behavior therapies that have more evidence to support their use.
Of greater concern, however, is that some treatments may not be safe. The Food and Drug Administration has warned about over-the-counter chelation medications. These drugs have been marketed as a therapy for autism spectrum disorders and other conditions. Chelation is a therapy that removes heavy metals from the body, but there are no over-the-counter chelation therapies that are approved by the Food and Drug Administration (FDA). This type of therapy should only be done under the close supervision of medical professionals. According to the FDA, the risks of chelation include dehydration, kidney failure and even death.
Other examples of alternative therapies that have been used for Asperger's syndrome include:
Sleep problems are common in children with Asperger's syndrome, and melatonin supplements may help regulate your child's sleep-wake cycle. The recommended dose is 3 mg, 30 minutes before bedtime. Possible side effects include excessive sleepiness, dizziness and headache.
Other dietary supplements
Numerous dietary supplements have been tried in people with autism spectrum disorders, including Asperger's syndrome. Those that may have some evidence to support their use include:
- Vitamin B-6 and magnesium
- Vitamin C (usually in combination with other vitamins)
- Omega-3 fatty acids
Some parents have turned to gluten-free or casein-free diets to treat autism spectrum disorders. There's no clear evidence that these diets work, and anyone attempting such a diet for their child needs guidance from a registered dietitian to ensure the child's nutritional requirements are met.
This gastrointestinal hormone has been tried as a potential treatment. Numerous studies have been conducted on secretin, and none found any evidence that it helps.
Other therapies that have been tried, but lack objective evidence to support their use include hyperbaric oxygen therapy, immune therapies, antibiotics, antifungal drugs, chiropractic manipulations, massage and craniosacral massage, and transcranial magnetic stimulation.
Coping and support
Asperger's syndrome can be a difficult, lonely disorder — both for affected children and their parents. The disorder brings difficulties socializing and communicating with your child. It may also mean fewer play dates and birthday invitations and more stares at the grocery store from people who don't understand that a child's meltdown is part of a disability, not the result of "bad parenting."
Luckily, as this disorder gains widespread recognition and attention, there are more and more sources of help. Here are a few suggestions:
- Maintain a consistent schedule whenever possible. If you have to introduce change, try to do so gradually.
- Learn about the disorder. There are numerous books and websites dedicated to the disorder. Do some research so that you better understand your child's challenges and the range of services in your school district and state that may help.
- Learn about your child. The signs and symptoms of Asperger's syndrome vary for each child, and young children have a hard time explaining their behaviors and challenges. But, with time and patience, you'll learn which situations and environments may cause problems for your child and which coping strategies work. Keeping a diary and looking for patterns may help.
- Find a team of trusted professionals. You'll need to make important decisions about your child's education and treatment. Find a team of teachers and therapists who can help evaluate the options in your area and explain the federal regulations regarding children with disabilities.
- Help others help your child. Most children with Asperger's syndrome have no visible sign of disability, so you may need to alert coaches, relatives and other adults to your child's special needs. Otherwise, a well-meaning coach may spend time lecturing your child on "looking at me while I'm talking" — something that can be very difficult for a child with Asperger's syndrome.
- Help your child turn his or her obsession into a passion. The tendency to fixate on a particular narrow topic is one of the hallmarks of Asperger's syndrome, and it can be annoying to those who must listen to incessant talk about the topic every day. But a consuming interest can also connect a child with Asperger's syndrome to schoolwork and social activities. In some cases, kids with Asperger's syndrome can even turn their childhood fascination into a career or profession.
- Find support. Lean on family and friends when you can. Ask someone who understands your child's needs to babysit sometimes so that you can get an occasional break. You may also find a support group for parents of children with Asperger's syndrome helpful. Ask your child's doctor if he or she knows of any groups in your area. Or, visit the Online Asperger Syndrome Information and Support website.
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