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Asperger syndrome: a literature study

Geir Bjørklund
Department of Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction Etiology Epidemiology Prognosis
In 1944, Hans Asperger (1906-80), an Austrian pediatrician (Fig 1), Causal relations with Asperger syndrome are likely to have much in How frequently Asperger syndrome occurs in the population, depends The social prognosis of Asperger syndrome is generally good, and
described a pattern of behavior and abilities in a group of children that common with the causal factors in autism. Evidence indicates that on how the disorder is diagnosed and defined. The syndrome is probably better than for autists with similar intelligence (5).
he called “autistic psychopathy” (1). The British child psychiatrist genetic factors play an important role in autism (6). Hans Asperger difficult to delineate. There is no clear consensus on the inclusion Intellectual level is important for how well the individual will succeed
Lorna Wing introduced the term Asperger syndrome for this disorder suggested that autistic psychopathy is hereditary. Systematic studies criteria for Asperger syndrome, and different diagnostic criteria form in adult life. Hans Asperger suggested that the clinical picture would
in 1981 (2). She suggested that the syndrome had to be incorporated indicate that inheritance plays a significant role in Asperger syndrome the basis by various authors (2, 4). The syndrome is considered to remain fairly stable for those with the condition, and that most of these
into a broader spectrum of autistic and autistic-like disorders (autistic (6, 7-9). It is not uncommon to find some of the same behavioral traits occur more frequently than autism (5). In both conditions, more boys would function in the workplace. He also thought that some of the
continuum) (2, 3). Asperger syndrome is in the diagnostic systems in other family members (7, 9). than girls are affected. Fully developed Asperger syndrome occurs 5- people with the syndrome would be able to reach very far in their
DSM-IV and ICD-10 listed under the category of pervasive Asperger syndrome probably has an organic basis (5, 6). Surveys 10 times more frequently in boys than in girls (6). Wolff & Chick (11) particular area of interest.
developmental disorder. Infantile autism and Asperger syndrome are suggest that neurobiological causal factors are found in 60-75% of considers that at least 3-4% of child psychiatric clientele have a Gillberg (12) states that about half of people with Asperger
two closely related forms of developmental disorders (4). cases of Asperger syndrome and infantile autism with normal schizoid disorder or Asperger syndrome. syndrome have a relatively trouble-free adult life, many are married
This presentation is based on a literature study. intelligence (4, 10). It is unknown what changes in the brain causes and have academic careers. For the remaining half of people with the
this type of behavior. Neuropsychological studies suggest a syndrome, adult life involves great mental strain or psychiatric
dysfunction in the frontal lobes (6). Different authors present problems.
circumstantial evidence that the damage can be localized in the right
hemisphere, cerebellum, brain stem, limbic system or in the temporal
lobes (6, 7). It is also conceivable that a primary injury in a part of the
brain brings dysfunction through important connections to other brain Differential diagnoses
sections (6). It has been difficult to reveal specific findings by EEG, Infantile autism and Asperger syndrome are not well delineated,
Figure 1. The Austrian pediatrician Hans
Asperger (1906-80) described in 1944 a
CT, chromosome examination and examination of brain stem function unique diagnostic units (4). Both disorders belong to the so-called
autistic spectrum. There are many similarities between Asperger
Conclusions
(5). However, pathological changes have been found in both Asperger
group of children with impaired social inter-
syndrome and autism in terms of impaired ability for mutual The diagnosis Asperger syndrome is today used relatively frequently.
action and communication abilities. The syndrome and autism by using these methods (4).
interaction, communication and the range of interests and activities. There is, however, still a great need for further research. Among other
name of this disorder today is Asperger
Differences are primarily in the degree of impaired language and things, the differences between Asperger syndrome and high
syndrome.
cognitive development. Asperger syndrome includes schizoid functioning autism need to be further investigated. Increased
disturbance in childhood, but is different from schizotypal personality knowledge about the syndrome is important for child and youth
disorder and schizophrenia (5). Individuals with the syndrome do not psychiatry as well as for adult psychiatry.
develop classic schizophrenia more often than the general population.
Examination Many people with Asperger syndrome develop depression in
Early diagnosis and treatment can prevent uneven development and adolescence, and suicide is not uncommon (5, 6). In families with
limit bad effects (such as bullying and becoming suspicious of family). Asperger syndrome, increased incidence of manic-depressive disorder
In some cases the children remain undiagnosed or incorrectly
Personality diagnosed until adulthood. A thorough medical anamnesis and
is found (5). In adolescents and adults who come under pressure,
paranoid reactions and regular paranoid psychoses are common (12). Literature cited
Children with Asperger syndrome usually show a lack of interest in observation by experts with specialized knowledge about Asperger 1. Asperger H. Die “Autistischen Psychopathen” im Kindesalter. Arch Psychiatr
The ritualized behavior of Asperger syndrome can be differentiated
play and interaction with other children of the same age. Those who syndrome during childhood is essential (6). Nervenkr 1944; 117: 76-136.
from classic obsessive compulsive disorder, where the patient
try to participate in children’s activities often fell short due to a lack of The gold standard to be used for Asperger syndrome 2. Wing L. Asperger’s syndrome: a clinical account. Psychol Med 1981; 11: 115-
recognizes the irrationality of the obsessive acts and feels a reluctance 29.
understanding of "natural" play. They have playground behavior diagnostics is clinical judgment used together with a combination of to act upon them (2, 5). Some children with Asperger syndrome have 3. Wing L. Aspects of autism: biological research. Oxford: Gaskell/The National
characterized by repetition without social function (5). Most of the the autism diagnostic interview revised (ADI-R) and the autism certain similarities with hyperactivity (5). Right hemisphere syndrome Autistic Society, 1987.
children with Asperger syndrome have impaired ability in gross motor diagnostic observation scale (ADOS) (7). A widely used alternative 4. Bjørklund G. Barn med Aspergers syndrom. Tidsskr Nor Legeforen 1998; 118:
has some similarities with the syndrome (6). Tourette syndrome may
skills and coordination. This can for example become apparent in the instrument is the diagnostic interview for social and communication 1567-9.
occur with Asperger syndrome.
gym classes at school. They have problems understanding what other disorders (DISCO). There are also a number of other screening and 5. Rasmussen M, Sponheim E. Aspergers syndrom. Tidsskr Nor Legeforen 1993;
people think and feel, and take little notice of others' wishes and needs. 113: 2807-10.
diagnostic instruments available (7). 6. Hjort C. Asperger’s syndrom. En ny diagnose i den internationale
Especially poor is their ability to correct behavior based on feedbacks Cognitive psychological testing, monitoring of social sygdomsklassifikation. Ugeskr Laeger 1994; 156: 2729-34.
from the environment (5, 6). development, language development, development of play behaviors 7. Woodbury-Smith MR, Volkmar FR. Asperger syndrome. Eur Child Adolesc
Grammar and syntax are relatively strong areas in children and interests is important. Measures that are introduced (special Psychiatry 2009; 18: 2-11.
with Asperger syndrome (6). They develop a formally correct old and
wise language, but with interference of meaning and communicative
treatment) should be adapted to the individual child's specific Management 8. Volkmar FR, Klin A, Schultz R, Bronen R, Marans, WD, Sparrow S, Cohen DJ.
Nosological and genetic aspects of Asperger syndrome. J Autism Dev Disord
conditions and needs. It is therefore important to measure the child's Appropriate treatment can be conveniently laid out training, behavior 1998; 28: 457-63.
value, frequent misunderstandings, and often an inability to understand strengths and weaknesses (5, 6). modification, special education, telephone support (especially for 9. Ghaziuddin M. A family history study of Asperger syndrome. J Autism Dev
irony and jokes. Children with Asperger syndrome often have great Asperger syndrome appears often in conjunction with Disord 2005; 35: 177-82.
problems understanding and communicating through non-verbal adolescents and adults). The treatment should be adapted to each
congenital somatic diseases, and a careful medical and neurological 10. Steffenburg S. Neuropsychiatric assessment of children with autism: a
communication (6). They have reduced ability to form social meaning individual, and it is very important to use the child's pedantic behavior population-based study. Dev Med Child Neurol 1991; 33: 495-511.
investigation is therefore important (4, 10). The child must be given a in the treatment (6). It is important for the therapist/pedagogue to win
through language, and can for example hold "lectures" about their 11. Wolff S, Chick J. Schizoid personality in childhood: a controlled follow-up
thorough clinical examination, with special regard to neurological the child's confidence without violating emotional boundaries. study. Psychol Med 1980; 10: 85-100.
special interests without regard to whether the listener shares the aberration, vision, hearing (brainstem response), and skin changes. Requirements for the child must be expressed in a clear and concrete 12. Gillberg C. “Asperger-människan” – en kylig särling utsatt för stora psykiska
interest or not (4). Conducting thorough investigation of cerebral CT/MT, EEG, eyes, ear- påfrestningar. Läkartidningen 1990; 87: 2971-4.
language. The child receives specific information to follow the adults'
Children with Asperger syndrome often cultivate one or a few nose-throat, spinal fluid, chromosomes (including examination with a rules. This often leads to improvement of problem behavior (6).
special interests, often to such a degree so that other activities are view to fragile X syndrome), metabolic screening, and various other Learning of "behavioral rules" may to some extent compensate for the
excluded (5, 6). These activities are not performed in interaction with blood- and urine examinations are indicated (4, 10). lack of social intuition. Examples of other treatment principles that
others. They often have an excellent memory, good ability to learn by In an interview with the child's parents, it is important to may be relevant are family therapy, socialization training and
heart, and often very well-developed skills related to special interest investigate how the pregnancy and birth progressed, and how the communication training in groups. In-depth information to family
areas. In other areas they may have learning difficulties (5). child's early development has been (5). In connection with such an members and teachers is especially important (4). This may prevent For further information
interview, a thorough family anamnesis to determine any genetic behavior problems such as bullying, as well as misunderstood For further information or comments, please contact:
predisposition should also be done. educational measures. It may be appropriate to treat additional
Geir Bjørklund
conditions and secondary symptoms pharmacologically (4, 7). Email: info@vitalpress.no