Asperger's Syndrome: Diagnosis and Treatment

What is Asperger’s Syndrome?

Asperger’s is a type of high functioning autism characterised by the following behavioural traits.

Diagnosing Asperger’s

Under the International Classification of Diseases (ICD 10), Asperger’s is diagnosed according to the following criteria:

“Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behaviour, interests, and activities. There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis.”[2]

“It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness. There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life.”[3]

Because those with Asperger’s often have a mastery of language from an early age, it can be hard to diagnose in children, often labelling them as particularly intelligent or more cognitively developed. This absence of any delay in cognitive development is the main marker of when trying to differentiate between Asperger’s and autism and is key to avoid misdiagnosis.

Risk Factors

• Genetics: Having a relative with Asperger's increases the risk of developing the syndrome[4]. Also, chromosomal abnormalities such as fragile X syndrome increase risk of developing Asperger’s[5].
• Certain medications taken during pregnancy, for example valproic acid for seizures and mood disorders have been linked to Asperger’s in children[6].

Interventions

• Social skills training: A specialist will help the client to improve eye contact and understanding social cues such as body language nonverbal behaviours. Work can also be done on conversational skills and tone of voice as well as understanding nonliteral and figurative language such as slang and sarcasm. Teaching on how to recognise and appropriately respond to the emotions of others is also key. Research has shown social skills training to be effective, particularly if parents continue with the education at home[7][8]
• Speech language therapy: Individuals with Asperger’s can be very verbally advanced in terms of the range of words they can use, however they often lack the conversational skills to use this language appropriately. ?Speech therapy can successfully teach those with Asperger’s how and when to use certain language and can have long lasting effects if given during childhood[9].
• Cognitive Behavioural Therapy (CBT): CBT has been adapted for individuals with Asperger’s to help them overcome socially isolating and traumatic situations which are unfortunately common for those with Asperger’s. Part of this can be helping to develop a kind of social skills ‘toolbox’ to help overcome social anxiety. CBT is particularly effective as it can also be used to address other mental illnesses which are more prevalent in those with Asperger’s, such as anxiety and depression [10]. This is done through challenging and replacing irrational and negative thought patterns.

References

[1] Goodman, G., & Athey-Lloyd, L. (2011). Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger's disorder.?Journal of Child Psychotherapy,?37(3), 311-326.

[2] World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines.?www.who.int/classifications/icd/en/bluebook.pdf?

[3] World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines.?www.who.int/classifications/icd/en/bluebook.pdf?

[4] Rinehart, N. J., Bradshaw, J. L., Brereton, A. V., & Tonge, B. J. (2002). A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder.?Australian & New Zealand Journal of Psychiatry,?36(6), 762-770.

[5] Dalton, K. M., Holsen, L., Abbeduto, L., & Davidson, R. J. (2008). Brain function and gaze fixation during facial‐emotion processing in fragile X and autism.?Autism Research,?1(4), 231-239.

[6] Roullet, F. I., Lai, J. K., & Foster, J. A. (2013). In utero exposure to valproic acid and autism—a current review of clinical and animal studies.?Neurotoxicology and teratology,?36, 47-56.

[7] Tse, J., Strulovitch, J., Tagalakis, V., Meng, L., & Fombonne, E. (2007). Social skills training for adolescents with Asperger syndrome and high-functioning autism.?Journal of autism and developmental disorders,?37(10), 1960-1968.

[8] Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with Asperger’s syndrome or high-functioning autism: A review and recommendations.?Journal of autism and developmental disorders,?38(2), 353-361.

[9] Noterdaeme, M., Wriedt, E., & H?hne, C. (2010). Asperger’s syndrome and high-functioning autism: Language, motor and cognitive profiles.?European child & adolescent psychiatry,?19(6), 475-481.

[10] Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review.?Developmental neurorehabilitation,?13(1), 53-63.

Goodman, G., & Athey-Lloyd, L. (2011). Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger's disorder.?Journal of Child Psychotherapy,?37(3), 311-326.