Asperger's Syndrome
Dr. Ian Newey, Clinical Psychologist
06-June-03

History of Asperger's syndrome and its context within the "autistic spectrum".

Hans Asperger was a Viennese Paediatrician who first noticed a pattern of able people with impairments of social interaction, communication and imagination. We now see this group of people as similar to, but more able than the people with classical autism. Whereas people with classical autism may well have severe global learning difficulties and relate to other people like they are objects rather than independent 'agents', people with Asperger's syndrome have much more subtle deficits. Indeed, autism and Asperger's syndrome seem to represent "extreme points" on a scale of severity within "the autistic spectrum". Although some people with Asperger's syndrome manage to function quite well as adults (often in engineering or computer careers), most have difficulties throughout their entire lifespan.

Demographics of Asperger's syndrome

Estimates of the prevalence of Asperger's syndrome range from 0.01% (Wing, 1981) to 3.6% of live births (Ehlers and Gillberg, 1993). Gillberg (1989) estimated that the male to female ratio was 10:1 based on his clinical experience.

Attwood (1998) and Klin, Volkmar and Sparrow (2000) agree that people with Asperger's syndrome lack empathy, have naive inappropriate one-sided interaction and an impaired ability to form friendships. They tend to be very concrete in their understanding of the world and can find abstract concepts difficult. People with the syndrome have pedantic repetitive speech, poor non-verbal communication and an intense absorption in certain subjects. Features also include clumsy and ill co-ordinated movements and odd postures, and being described as eccentric, odd, and difficult to get on with. This group tends to insist on sameness, and have difficulties accommodating to change. However, people with Asperger's syndrome have average to above-average intelligence according to most criteria used to diagnose the condition.

We do not know for sure where Asperger's syndrome comes from, but some people have theories; Asperger's syndrome might be related to:

• Theory of mind deficit (an inability to recognise that other people have thoughts, feelings and intentions that are different to one's own, and an inability to intuitively guess what these might be)
• Weak central coherence (an inability to bring together various details from perception to make a meaningful whole - poor 'gist' processing)
• Biological causes:
• brain chemicals, especially a particular neurotransmitter called 5HT
• problems with the structure of the brain: for example it might be that a particular part of the brain, the amygdala, is different in people with Asperger's syndrome

There is no cure, and currently no hard evidence suggesting that psychological interventions are effective in treating people with Asperger's syndrome. Social skills training programmes are ineffective due to difficulties with generalising to different social situations. Recent studies suggest that even secondary problems, such as anxiety and depression, are not effectively treated using talking therapies (despite some poorly evidenced claims in the literature).

Indeed, Asperger's syndrome is not a mental illness amenable to therapy, in fact it is a specific learning difficulty, a cognitive style, and therefore something to be aided by a life-long learning task. Non-aversive social contact should be facilitated (some supervised social contact with peers, to ensure there are occasions when these people are not bullied by others) to ensure that people do not withdraw from social situations completely. As problems emerge, an adult with good social functioning can "problem solve" individual social problems raised: Temple Grandin, a Professor with Asperger's syndrome in the USA describes building an encyclopaedia of context dependent socially appropriate behaviour in this way.

Support for families is essential: the voluntary sector can usually help by allowing parents and carers to meet up. The National Autistic Society and, locally for people in East Anglia, Asperger Norfolk, are very helpful agencies.

'Autistic friendly' educational recommendations:

1. Keep distractions in the classroom to a minimum: no wall decorations, face desks away from windows, do not use group learning techniques for academic subjects (of course for the social learning, other people are needed).
    
2. Old fashioned didactic teaching is much easier for this group - desks facing toward teacher or chalkboard. Seat the individual with Asperger's syndrome at the front of the class.
    
3. Break tasks down into small steps. Use short clear sentences if you perceive that the student is not fully understanding you. Telegraph your main points and highlight important information.
    
4. If necessary, present tasks in several ways (e.g., visually, verbally, physically).
    
5. Do not try to force eye contact - it can be distracting for someone with Asperger's syndrome and does not mean that someone with Asperger's syndrome is concentrating on what you say - sometimes it is better if they look at your mouth rather than your eyes when you are talking.
    
6. Do not assume that people with Asperger's syndrome know how you feel - one of their difficulties is guessing about the internal world of others - if you want them to know that you are happy with them, cross with them, etc - tell them explicitly.
    
7. Emotional nuances, multiple levels of meaning (such as sarcasm, irony, metaphor, idioms), and relationship issues as presented in novels will often not be understood.
    
8. People with autism are egocentric, and in some cases find it difficult to even understand that other people might have thoughts, feelings, or opinions of their own, that might differ from the individual with autism's view. Facial expressions, "body language" and other non-verbal social cues may not work.
    
9. Concrete 'facts' are easy to learn by rote, understanding is harder: Do not assume that people with Asperger's syndrome understand something just because they 'parrot back' what they have heard.
    
10. Equally, with written information, though people with Asperger's syndrome often have excellent reading recognition skills, language comprehension is often weak. Do not assume they understand what they so fluently read.
     
11. Abstract concepts are difficult to comprehend for the concrete literal individual with Asperger's syndrome: Offer added explanation and try to simplify when lesson concepts are abstract. Use visual cues, such as drawings or written words, to augment the abstract idea.
     
12. Offer a high level of consistency. Prepare people with Asperger's syndrome for changes in daily routine (use a written or visual timetable) to lower anxiety. Teach the individual strategies to manage anxiety when it becomes overwhelming, e.g. diaphragmatic breathing relaxation. Note that anxiety may be manifested in challenging behaviour/anger/excitement.
     

Facilitate social learning:

1. Although they lack intuitive understanding of the emotions of others, people with Asperger's syndrome can learn the correct way to respond academically. When they make a social error, an alternative, more socially appropriate response should be offered.
    
2. The teacher should foster involvement with others and encourage active socialisation.
    

Bibliography

Attwood, T. (1998). Asperger's Syndrome; A Guide for Parents and Professionals. London: Jessica Kingsley.

Ehlers, S and Gillberg, C. (1993). The epidemiology of Asperger's syndrome: A total population study. Journal of Child Psychology and Psychiatry, 34(8), 1327-1350.

Frith, U. (Ed.) (1991) Autism and Asperger syndrome. Cambridge, England: Cambridge University Press.

Gillberg, C. (1989). Asperger syndrome in 23 Swedish children. Developmental Medicine and Child Neurology, 31(4), 520-531.

Klin, A., Volkmar, A., Sparrow, S. (Eds) (2000). Asperger syndrome. New York, NY, US: The Guilford Press.

Moreno, S. and O'Neal, C. (1996) Tips for teaching high functioning people with autism. O.A.S.I.S. (On-line Asperger's Syndrome Information and Support) page

Williams, K. (1996) Understanding the student with Asperger Syndrome: Guidelines for teachers. O.A.S.I.S. (On-line Asperger's Syndrome Information and Support) page

Wing, L. (1981). Asperger's syndrome: A clinical account. Psychological Medicine, 11, 115-129.

O.A.S.I.S. (On-line Asperger's Syndrome Information and Support).
http://www.udel.edu/bkirby/asperger/

The National Autistic Society
http://www.nas.org.uk/

Asperger Norfolk
http://www.asperger.org.uk/

Listen to a feature on Radio 4's Woman's Hour about Asperger's syndrome.
http://www.bbc.co.uk/radio4/womanshour/13_05_02/wednesday/info2.shtml

My Family and Autism was a BBC2 documentary of the story of The Jacksons, a Blackpool family consisting of mother Jacqui and 7 children, 4 of whom are on the autistic spectrum in some way. Ouch, the BBC's disability website, has a Jacksons minisite: http://www.bbc.co.uk/ouch/tvradio/autism/