Asperger syndrome from childhood into adulthood
Advances in Psychiatric Treatment
(2004), vol. 10. http://apt.rcpsych.org/ changing concepts and diagnostic boundaries aswell as by the wider recognition of autistic-spectrumdisorders rather than by any real substantialincrease (Fombonne, 2003).As the developmental model embraces moreof psychiatry, it appears increasingly difficult tomake a sharp distinction between autistic-spectrum disorder and other entities such as thepersonality disorders, simple schizophrenia andcatatonia; at times the diagnostic label reflects theclinician
s specialty rather than the syndrome.
How does Asperger syndromechange with age?
Like many other developmental disorders, autistic-spectrum disorders improve with age, although thesymptoms, such as stereotypies, may resurface witharousal, whether from anxiety, boredom, anger orexcitement. However, while the more overt symptomsof autism are usually at their most florid in earlychildhood, the symptoms of Asperger syndrome mayonly become obvious with the social and functionaldemands of adolescence.Besides an innate link with varied comorbidity,there is the stress of growing up with Aspergersyndrome that arises from unrecognised disability,limited achievement and a sense of failure, oftenrevealed by an increasing contrast with moreautonomous and successful siblings or peers. Inaddition, the syndrome distorts relationships withfamily and peers, who can be infuriated by theperson
s self-centred insensitivity, obsessivenessand rigid inflexibility. All this can add secondarydisability and result in a degree of dependency thatis out of proportion to the person
s intellectualability (Howlin
, 2004).Over a third of people with autistic-spectrumdisorders develop epilepsy, the risk being linked tothe degree of developmental delay and receptivelanguage deficit. There is no specific study of epilepsy in Asperger syndrome, although therelatively normal ability and language suggest thatthe risk is lower, possibly 5
10%, and that it is morelikely to start later, in adolescence or early adulthood(Tuchman & Rapin, 2002).
The presentation in adulthood
Asperger syndrome in adults presents withparticular, and often subtle, difficulties, especiallyin communication, social relationships and interests.Not all individuals are affected as extremely as inthe descriptions below. In some it is questionablewhether they simply fall within the normal range of variation, particularly male, and whether theirbehaviour represents psychiatric disorder orisolated, specific developmental characteristics.
This is often obviously abnormal,
taking the form of one-sided, circumstantial lecturesdelivered impassively by a seemingly robotic figurewith a mechanical voice. However, less obviousconversational abnormality includes unrecognised,underlying discrepancies between verbal and non-verbal language, and between comprehension andexpression. These can lead both the affectedindividual and those around him to misjudge hisabilities, expectations being either too high or toolow. Very often, reading works where listening hasbrought incomprehension. Often, the life of someonewith Asperger syndrome can be transformed if asmuch as possible is presented to him in writing.
These are one-sided, distant or even absent, ratherthan really reciprocal. Behind this is an unempathicobjectivity that results in difficulties that range fromunderstanding friendship (and how friends differfrom acquaintances) through to making sexualrelationships and grasping the rules that dis-tinguish, for example, seduction from date rape. Theperson is not uninterested in relationships but,misunderstanding them, is too intense or toodetached.
A key feature of Asperger syndrome is repetitive orfocused activities. At their most extreme, these resultin an eccentric whose life is characterised by itsroutine, rigid and systematic approach and whoseworld might narrow down to railway timetables orstamp collecting. Any development of an interestremains circumscribed (for example, restrictedsimply to collecting more of something rather thangaining wider expertise) and, far from becoming thebasis of a social network, is enjoyed in solitude.
Psychiatric diagnosisand assessment
on its own is of limited value, but it is thegateway to a great deal of information, specialistgroups and resources, including financial support.It is often not recognised that a diagnosis is simplya working hypothesis: it is a clinical judgement that