ASPERGER’S
SYNDROME
PRESENTED BY- DR RESHMA NAIR
MODERATOR- DR JOHN DINESH
HISTORY
• Asperger’s syndrome (also known as Asperger’s disorder) – first
described by Viennese paediatrician Hans Asperger in 1940s,
• He observed autism- like behaviours and difficulties with social and
communication skills in boys who had normal intelligence and
language development.
• Many thought – milder form of autism and used the term “high-
functioning autism” to describe them.
• 1981- British psychiatrist Lorna Wing- coined term Asperger
syndrome.
• Asperger’s disorder was added to DSM-IV in 1994 as a separate
disorder from autism.
• In 2013, the DSM-5 replaced Autistic disorder, Asperger’s disorder and
other pervasive developmental disorders with the umbrella diagnosis
of autism spectrum disorder.
ETIOLOGY
- It has a complex etiology including genetic contribution ;
- and potentially environmental
- and perinatal contributing factors
Characteristics:
• Less severe symptoms and absence of language delays from classic
autism.
• Mildly affected, frequently have good language and cognitive skills.
• Individuals with Asperger’s usually want to fit in and have interaction
with others, but often do not know how to do it.
• May be socially awkward, not understand conventional social rules or
show a lack of empathy.
• May have limited eye contact, seem unengaged in a conversation and
not understand use of gestures or sarcasm.
• They often like to collect categories of things such as rocks or bottle
caps.
• There is no speech delay seen, frequently have good language skills
they simply use language in different ways.
• Speech patterns maybe unusual, lack inflection, or have a rhythmic
nature, or may be formal, but too loud or high pitched.
• By definition, a person with Asperger’s cannot have a clinically
significant cognitive delay, and most possess average to above-
average intelligence.
DIAGNOSIS
• The first step to diagnosis is an assessment, including a
developmental history and observation.
• Include at least two of following indications of qualitative social
impairment :
- Markedly abnormal nonverbal communicative gestures,
- Failure to develop peer relatonships at the expected level.
- Restricted interests and patterns may be present, but if subtle-
difficult to identify or single out from those of other children.
• Currently, clinical phenotype of Asperger’s disorder is subsumed
within the DSM-5 diagnosis of autism spectrum disorder.
• Early diagnosis is important as children who are diagnosed and
treated early in life have an increased chance of being successful in
school and eventually living independently.
SCREENING TOOLS
• Childhood Autism Spectrum Test or CAST (formerly known as the
Childhood Asperger’s Syndrome test) – 39 item, yes or no evaluation
aimed at parents.
- To assess the severity of autism spectrum symptoms in children.
• IN ADULTS:
• 2 Self- assessment instruments
- Autism Spectrum Quotient (AQ)- recommended by the NICE
guidelines.
- Empathy Quotient (EQ)
• Non self assessment instruments-
- Marburg rating scale for Asperger’s syndrome (MBAS)
- Social Communication Questionairre (SCQ)
DIFFERENTIAL DIAGNOSIS
• ADHD
• Alexithymia
• Avoidant personality disorder
• Antisocial personality disorder
• Borderline personality disorder
• PTSD
• Schizoid personality disorder
• Residual schizophrenia
• Obsessive compulsive disorder
• Social phobia
COMORBIDITIES
• ADHD
• Bipolar disorder
• Depression
• Epilepsy
• Eating disorder
• Generalized anxiety disorder
• Insomnia
• Self injurous behaviour
• Substance use
COURSE & PROGNOSIS
• Factors associated with good prognosis in this subgroup- normal IQ
and more competencies in social skills.
• Reports of some adults with Asperger’s indicate that their social and
communication deficits remain- continue to relate in an awkward way
and appear socially uncomfortable.
MANAGEMENT
• Ideally involves multiple therapies that address core symptoms of
disorder – to promote social communication & peer relationships.
• Applied behaviour analysis (ABA) procedures- includes positive
behaviour support or training of parents and faculty in behavior
management strategies, social skills training for effective
interpersonal interactions.
• Cognitive behavioural therapy- improve stress management relating
to anxiety, to help reduce obsessive interests & repetitive patterns
• Medications for coexisting conditions- major depressive disorder and
anxiety disorders.
• Occupational/ physical therapy- to assist with poor sensory processing
and motor coordination.
• Social communication intervention – specialized speech therapy to help
with pragmatics and normal conversation.
• Self sufficiency and problem solving techniques
• Medications effective in combination with behavioural interventions
and environmental accomodations to treat cormorbid symptoms.
• Atypical antipsychotics- risperidone, olanzapine and aripiprazole to
reduce associated symptoms of AS.
• SSRIs – effective in treating restricted and repetitive interests and
behaviour.
CASE REPORT
• A boy was brought to surgery at age of 11 by his mother as she was
concerned,he was being bullied & teased at school.
• His early developmental stage was unremarkable, from age of 5 he was
noticed to have unusual preoccupations.
• Poor mixer with children, standing alone and showing no aptitude for
games.
• Attended 3 schools between age of 7 and 10.
• Is articulate and supercilious in attitude to others, considering others as
imbeciles or morons.
• Is of average intelligence, but when he speaks on favourite topics, suggests
he is bright.
• Worrying behaviour at home- surrounded by imaginary people
• Loves to dress up and has 22 outfits, representing people of great
power, like Napolean, Julius Caesar, Nazi officer- spends hours
admiring himself in a mirror.
• Has worn a shirt and tie everyday since age of 7.
• Plans to become dictator of Poland, has videotaped programme on
Poland and watches repeatedly.
• Afraid to go out, fearing attack, cannot tolerate being teased.
• Has no friends,
• When angry or upset- mocks hanging procedure and on 2 occasions
stated he was better off dead.
• To talk to he is tensed, unable to relax.
• Speech is staccato, intimidating facial expression with penetrating
stare, which is continuous.
• Has a younger brother, both parents are professional people and a
history of schizophrenia on paternal side of family.
• Following psychiatric referral and 6 weeks in child unit, diagnosis of
Asperger’s syndome was made.
Famous People with AS
• Many famous people that we know of have been rumoured to have or
diagnosed with Asperger’s syndrome.
• Graham Bell, Thomas Edison, Darwin, Marie Curie, Sir Isaac Newton,
Albert Einstein, Henry Cavendish
• Thomas Jefferson ,Abraham Lincoln ,Donald Trump – U.S. President
(rumored),George Washington – (rumored) – Famous Politicians
• Bill Gates (rumored),Steve Jobs – (rumored), Elon Musk ,Nikola Tesla
(rumored),Mark Zuckerberg – (rumored)
• Marilyn Monroe, Michael Jackson, Susan Boyle, Greta Thunberg,
Eminem – famous celebrities.
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THANKYOU
