What Is Asperger's Syndrome?

Social and Emotional Problems
Language and Communication Problems
Asperger's or Autism?
Flexibility and Imagination Problems
Asperger's Syndrome Is an Autism Spectrum Disorder
Autism Spectrum Disorders
Special Interests
Asperger's Savants
Other Asperger's Syndrome Impairments
The Stress of Asperger's Syndrome

Asperger's syndrome is a developmental disorder of childhood, meaning that it interrupts or delays the normal growth and acquisition of abilities as a person matures. It is also called Asperger's disorder, Asperger syndrome, or just AS. Psychiatrist Lorna Wing refers to it as a mysterious, puzzling, and fascinating disorder because it can be so difficult to identify and to understand. Nevertheless, AS is generally characterized by a basic triad of developmental problems. The delays and interruptions of AS occur in social and emotional interactions, language and communication skills, and in flexibility of thought and imagination. These disabilities exist despite normal and often gifted intellectual capabilities.

Social and Emotional Problems

Normal social and emotional interactions are difficult for people with AS to understand. They may be happiest alone and have trouble making friends because they cannot read facial expressions or correctly interpret body language and gestures. Because of this, they may fail to empathize with the feelings of others. As typical children grow up, they learn almost automatically how to read an angry grimace, a puzzled frown, a welcoming smile, a sad, quivering mouth, and many other

emotions that people express on their faces. People with AS do not naturally know what these facial signals mean. They have the same trouble with the body language that typical people read easily. They cannot interpret the tense body of an offended or angry companion. They do not see the signals of discomfort or boredom in crossed arms, backing up when someone gets too close, or turning one's back on someone. People with AS know they are missing cues or doing things wrong; they just cannot understand why they are failing to figure out other people. They may feel detached from the rest of the world and unable to change this isolation.

Asperger's syndrome also causes difficulties in expressing one's own emotions. Facial expressions and body language may not reflect feelings accurately. A person with AS may smile when he or she is told a sad story. His or her face may look rigid, expressionless, or robotic to other people. They may assume that the person with AS has no feelings. Eye contact can be a big problem for people with AS, too. Many AS people do not look others in the eye when they are listening or talking. Other people may assume this means disinterest, rudeness, dishonesty, or defiance, but for an AS person, eye contact may feel unnecessary or even uncomfortable.

Language and Communication Problems

Verbal language is a critical form of social communication that is also impaired for people with AS. Children with AS develop normal language skills at the normal age. As they grow up, they often have high vocabularies and reading levels. However, their use of language can seem stilted and artificial. They may speak in a monotone, instead of with expression. They may sound like serious little adults. Even when they are teens or adults, people with AS can seem overly serious and may have problems with using language as others do. Joking, teasing, and social small talk may make no sense. Psychologist and AS expert Tony Attwood says, “I have the impression that many people with Asperger's syndrome consider a conversation to be primarily an opportunity to exchange information, to learn or inform, and if there is no practical information to exchange, why waste time talking?”³ This approach can result in the Asperger's individual interrupting others' conversations or talking on and on about a subject of interest even though the other person is bored and uninterested. Friends might interpret the behavior as rude or disrespectful, but a person with AS does not mean to be impolite. He or she just does not grasp the normal give-and-take of conversation. Temple Grandin, a grown woman with this difficulty, explains: “I have observed that when several people are together and having a good time, their speech and laughter follow a rhythm.…I have always had a hard time fitting in with this rhythm, and I usually interrupt conversations without realizing my mistake. The problem is that I can't follow the rhythm.”⁴

A person with AS may also be confused by conversation that typical people assume is completely clear. An individual with Asperger's usually takes language literally and cannot understand idioms, implied requests, sarcasm, or figures of speech. For example, a mother may say to her AS child, “I'm losing patience with you,” and the child may decide to help her look for it.⁵ If someone says “How are you?” an older person with AS may not say “Fine,” but instead begin a long monologue about his or her physical or mental state.

People with AS have both a problem with social skills and a problem with grasping how people typically use words to relate to each other. Attwood explains:

An example of a relatively simple literal interpretation of what the other person says was when a young man was asked by his father to make a pot of tea. Some time later his father was concerned that he had not received his refreshment and asked his son, “Where's the tea?” His son replied, “In the pot, of course.” His son was unaware that the original request implied not just the preparation of the tea, but the presentation of a cup of tea for each person. The person with Asperger's syndrome is not being deliberately lazy, obtuse [dense], or defiant, but responding to the literal, not the implied, meaning.⁶

Because people with Asperger's do not understand social language, they do not know how to respond to other people appropriately. They are very logical and often have trouble seeing the sense of using language in illogical, imprecise ways. They can consider the social rules of conversation tricky and confusing. People with AS can be like foreigners trying to grasp a brand new language and culture. The words and meaning in social conversation are grasped very slowly and with a lot of mistakes.

Some mistakes happen because it is so hard to generalize from one situation to the next. Just because a person learns to say “I'm fine” when greeted with “How are you?” does not mean he or she knows what to say when asked “What's up?” A lack of social imagination means it is hard to be flexible with

Asperger's or Autism?

Actress Daryl Hannah was diagnosed as having “autistic tendencies” when she was three years old. She had few friends and daydreamed a lot in school. Today she says, “I maybe had Asperger's. It wasn't widely understood at the time.” If she does have Asperger's syndrome or mild autism, she has overcome most of her childhood problems as an adult. However, she is still well-known for her shyness and her dislike of publicity. She is more comfortable acting a role than talking about her real life. She is so anxious about public appearances that she once had to take a tranquilizer to be able to attend an Oscar ceremony. She lives a very private life and rarely gives interviews. She is extremely passionate about ecology and living a lifestyle that does not harm the planet. Whether these characteristics are related to special interests, social interaction problems, and emotional confusions cannot be known for sure, but despite any disorder she may have, she has achieved success in living a normal life and functioning normally in society.

Quoted in John-Paul Flintoff, “Hollywood's Full-On Green Guerrilla,” Times Online, December 2, 2007. http://women.timesonline.co.uk/tol/life_and_style/women/celebrity/article2982771.ece.

social behavior. One AS individual explains, “We have trouble working out what other people know. We have more difficulty guessing what other people are thinking.”⁷ This lack of empathy does not mean that a person with AS lacks sympathy. He or she likely cares very much about other people's feelings. However, reading those feelings and putting oneself in another's shoes is often impossible.

Flexibility and Imagination Problems

A lack of empathy can make a person with AS behave rigidly and believe that there is only one way to do things. Situations are right or wrong, black or white. It can be difficult to understand that other people may prefer a different way or feel different emotions. This problem with social imagination is the last leg of the AS triad. It means that children with AS may not be able to play pretend games, even though they are gifted in mathematics or well-versed in computer technology. It means they may dissolve in frustration when someone plays with a toy “in the wrong way.”

This inflexibility can pervade other areas of life with AS. People may depend on a rigid routine in their daily lives and resist change. They prefer sameness and become upset and flustered if they have to move from classroom to classroom or eat breakfast before showering when they are used to the reverse. A need for sameness may, in an extreme, manifest itself in a fascination for watching the spinning wheels of a toy car rather than actually playing with the car. It may be evident in constant rocking motions to soothe and calm oneself or twiddling the fingers repetitively.

Asperger's Syndrome Is an Autism Spectrum Disorder

Watching wheels spin, rocking the body, and twiddling are kinds of self-stimulation that are identified as autistic behaviors. Asperger's syndrome is considered by experts to be related to autism. Autism is a severe development disorder in which an infant may begin to develop normally but then regresses in ability. He or she stops responding to other people

Autism Spectrum Disorders

Of the five developmental disorders included on the autism spectrum, autistic disorder symptoms are the most severe, while those of Asperger's are mildest.

Symptoms

Prevalence

• Autism disorder is the most common of the 5 autism spectrum disorders, affecting an estimated 1 in 166 births.
• As many as 1.5 million Americans have some form of autism.
• Disorders occur 3 to 4 times more often in boys than in girls.
• Autism disorders are increasing at an estimated rate of 10-17 percent each year.
• Experts estimate that up to 4 million Americans could be affected by some form of autism over the next 10 years.

except in very limited ways. Any words are lost, and language abilities fail to develop. The child is unable to form loving and social relationships, resists being touched, seems uninterested in people, and has an intense need for sameness in the environment. Self-stimulation and repetitive movements are common. Usually the child's intelligence tests as subnormal or retarded. Some autistic people, however, can be highly intelligent, learn to speak and relate to others, and overcome many of their disabilities with training and therapy. When the disability is severe, most experts say that autistic people are lost and locked in their own little worlds. Many seem not to recognize that the world is out there, and they may require lifelong care.

Autism, however, is not a neat label that fits every individual with certain specific symptoms. That is because individuals may have so many different symptoms in varying degrees. Specialists are still learning how to recognize autistic disorders, how they affect people, and even what to name them. Arguments continue about which people are autistic and which are not, as well as which symptoms are most important. In recent years, experts have realized that autism can range from mild to severe and that people who are not truly autistic may evidence autistic traits.

Psychiatrists, psychologists, and educators now recognize that there is an autism spectrum—a range of autistic disorders. So far experts recognize five distinct developmental disorders on the spectrum. On this spectrum, people may range from nonverbal and unreachable to brilliant and gifted but a little “odd.” Autism, of course, is one of the developmental disorders. Two other rare disorders are Rett's disorder (which is like autism except that it affects only girls) and childhood disintegrative disorder (in which a child develops normal language abilities and then loses them). The term for a person with autistic problems who does not fit into any other autistic categories is pervasive developmental disorder not otherwise specified. And finally, Asperger's syndrome is the disorder on the high-functioning end of the autistic spectrum, marked by normal language development and normal intelligence. Autism expert and clinical psychologist Uta Frith says that people with AS have “a dash of autism”;⁸ others call it a mild form of autism. Those with AS have the same triad of social, emotional, and communication problems as autistics do, but these symptoms are not as severe or as limiting as they are in the other disorders on the spectrum.

People with AS may be on the high-functioning end of the spectrum, but that does not mean that they do not face significant difficulties in relating to the rest of the world. In addition there is a range of severity among AS individuals, from mild to serious, within the triad of impairments. Along with the social and language problems, people with AS also commonly experience and perceive the world in a different—sometimes autistic —way. Sometimes, these differences cause more problems for the individual as he or she tries to fit into society. Sometimes they can actually turn out to be advantages.

Special Interests

Most people with AS have a special interest, or a preoccupation or fascination with a particular subject. With a young child, the special interest may be collecting batteries or learning all about vacuum cleaners. The interest may be so absorbing that the child has trouble focusing on anything else and spends many hours a day concentrating on and talking about the special interest. It may be obsessive, to the point where the person exhibits an excessive need to be involved in the special interest.

Special interests, however, can be positive aspects of AS. With their ability to concentrate intently and memorize facts and details about an interesting topic, people with AS can become extremely knowledgeable in the area of special interest. Since special interests change as children mature, special interests often become special talents. It may not be valuable to love AA batteries, but it can be very useful to know all there is to know about opera or how a computer works. Many AS people develop special talents and skills in mathematics, computer technology, music, or art and become experts in their fields when they are grown.

With normal or gifted intelligence, an extremely logical mind, and the ability to focus on a particular topic until it is completely

Asperger's Savants

Perhaps 10 percent of people with an autism spectrum disorder are savants. A savant is a person with a developmental disability who has an area of brilliance or a remarkable talent. Although no one knows why, many more people with Asperger's syndrome are savants than are typical people. Some experts hypothesize that the extraordinary skill arises from the ability to concentrate and focus on a special interest. Some of the most common savant skills involve amazing memory capabilities, early musical genius, and performing complex mathematical calculations in one's head. Jerry Newport, for example, is a savant with Asperger's syndrome. Since he was seven years old, he could instantly solve multiplication problems involving huge numbers without pencil and paper. He can calculate square roots to many decimal places, announce in a moment what day of the week any date in history falls on, and tell strangers how many hours, minutes and seconds it has been since they were born when given their birth dates. Qazi Fazli Azeem, another Asperger's savant, can understand almost nothing mathematical, but he is a high-speed reader with a phenomenal memory and can remember entire books he has read. Many people with Asperger's syndrome have special talents, but few are actual savants.

understood, a person with AS is equipped with assets as well as impairments. However, he or she may need all these assets to overcome the problems associated with AS. Using logic and intelligence to figure out socially acceptable conversation is much harder than intuitively understanding how to have a friendly chat. Noting and memorizing what facial expressions mean is an arduous chore that may make a person with AS prefer to avoid people instead of trying to socialize. People with AS want friends, want to fit in, and want to be accepted. They are very aware that they don't fit into society. Yet the accepted rules of social behavior make no sense to them.

Other Asperger's Syndrome Impairments

To make matters worse, AS is often accompanied by other problems. Many people with AS also have attention deficit/hyperactivity disorder (ADHD). They have trouble concentrating and trouble holding still. They may also have trouble with senses that are acutely responsive and overreactive. This is called hypersensitivity or sensory overload. It means that sounds, sights, smells, and touches that seem normal and unimportant to typical people may feel unbearable to people with AS. Noises may be screamingly loud; the touch of rough cloth may be painful; bright lights in the classroom may feel like an attack on the eyes that has to be shut out. Crowds of people may feel so confusing and overwhelming that an AS individual has to escape, rock, or twiddle to sooth himself or herself, or just melt down and fall apart.

Claire Sainsbury has Asperger's syndrome. She describes how difficult a school day can be for a person with this sensitivity:

The corridors and halls of almost any mainstream school are a constant tumult of noises echoing, fluorescent lights (a particular source of visual and auditory stress for people on the autistic spectrum), bells ringing, people bumping into each other, the smells of cleaning products and so on. For anyone with sensory hyper-sensitivities and processing problems typical of an autistic spectrum condition, the result is that we often spend most of our day perilously close to sensory overload.⁹

Sensory overload is but one barrier to school success. Many people with AS are also awkward. Their motor coordination is impaired, and so they may have tremendous difficulty with skills like holding a pencil or catching a ball. In small children this means a delay in developing motor skills such as running, skipping, coloring, cutting with scissors, or tying one's shoelaces. In older kids it means lack of success at team sports, illegible writing, or trouble balancing and coordinating body movements for dancing or driving a car.

The Stress of Asperger's Syndrome

The difference between AS individuals and most others on the autism spectrum is that people with AS know something is wrong with them. They wonder why they are so different. And it hurts.

Because of their awareness, people with AS may develop emotional problems. They can become so anxious and frightened in social situations that they have panic attacks. They may become so angry and frustrated that they have tantrums or bouts of rage. They are at risk of developing real depression and even committing suicide. Emotional problems are worse for people who do not know why they have the trouble they do. Most people with AS are in this category. Their AS is not diagnosed until they are teenagers or adults. By this time, explains Michael John Carley, a man with AS, the “individual has been made to feel bad about what separates him or her from the rest of the world.”¹⁰ Unfortunately diagnosing AS can be quite difficult, especially when the symptoms are mild.