AAA Section 04 Asperger's Disorder Ver 04 2013

1 33

Lecturer: Simon BignellSection: 4 of 11

‘Autism, Asperger’s & ADHD’ (6PS055)‘ADHD, Autism & Asperger’s’ (6PS077)

UN

DE

RG

RA

DU

ATE

Asperger’s Disorder

Ver: 004

Updated for 2013

2 33



UN

DE

RG

RA

DU

ATE

Introduction to the Section.

• What is Asperger’s Disorder?• Symptoms of Asperger’s.• How Asperger’s was first recognised.• Characteristics of Asperger’s Disorder.• Comorbidity.• How is Asperger’s different from Classic

Autism.• Questions.

3 33



UN

DE

RG

RA

DU

ATE

Learning Outcomes of this Section.

On completion of the Section and with independent study you should be able to:

1. Understand the main symptoms, variations and diagnostic criteria relating to Asperger’s disorder.

2. Be able to describe Asperger’s disorder in detail.

4 33



UN

DE

RG

RA

DU

ATE

Autism Spectrum Disorder.

A continuum that… “…ranges from the most profoundly physically and

mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.”

The Autistic Spectrum (2003) Lorna Wing

In her 1981 paper ‘Asperger's syndrome: a clinical account’ Lorna Wing proposed Asperger's syndrome as a separate condition.

5 33



UN

DE

RG

RA

DU

ATE

AutismNo single cause; no

single cure.

Hence: A spectrum, a continuum, a

syndrome.

6 33



UN

DE

RG

RA

DU

ATE

Terms.

There is a confusing plethora of terms including autism, autistic disorder, Asperger syndrome or disorder, high-functioning, pervasive developmental disorder (PDD), semantic-pragmatic disorder, pathological demand avoidance, Nonverbal Learning Disability, PDD-NOS, atypical Asperger syndrome.

7 33



UN

DE

RG

RA

DU

ATE

The DSM-V will combine the currently separate diagnoses of Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder-not otherwise specified (PDD-NOS) and Childhood Disintegrative Disorder.

The major change to the diagnosis of Asperger’s Disorder and Autism is the use of the umbrella term of ‘Autism Spectrum Disorder’. [from May 2013]

Asperger’s Disorder is not in the DSM-V

The age of onset will be more flexible, allowing for older children and adults to be diagnosed.

8 33



UN

DE

RG

RA

DU

ATE

The DSM-IV includes five types of disorder under the term ‘Pervasive Developmental Disorder’ PDD.

1) Autistic Disorder*.2) Rett’s Disorder.3) Childhood Disintegrative Disorder.4) Asperger’s Disorder*.5) Pervasive Development Disorder Not

Otherwise Specified*.* Mainly these form the Autistic spectrum ASD.

What Is Asperger’s Disorder (DSM-IV)?

9 33



UN

DE

RG

RA

DU

ATE

What Is Asperger’s Disorder?

• ASD is a spectrum of disorders. Ranges from low functioning – high functioning / Asperger's syndrome.

• Milder / higher-functioning form of Autism characterised by impairments in the social domain, some impairment in the behaviour/interests domain.

• No significant delays in cognitive or language skills.

What Is Asperger’s Disorder?

• The triad of impairment summarises the difficulties of the Autistic child but the actual manifestation of these can vary. Asperger’s may be a subtler form of ASD.

Restricted, repetitive and stereotyped patterns of behaviour.

Impairment in social interaction.

Impairment in verbal and non verbal communication.

Peculiarities in verbal and non verbal communication.

Wing and Gould’s triad of impairments

11 33



UN

DE

RG

RA

DU

ATE

Asperger’s Diagnosis (DSM-IV).A. Qualitative impairment in social interaction, as

manifested by at least two of the following: • Marked impairment in the use of multiple

nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.

• Failure to develop peer relationships appropriate to developmental level.

• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people.

• Lack of social or emotional reciprocity.

12 33



UN

DE

RG

RA

DU

ATE

Asperger’s Diagnosis (DSM-IV).B. Restricted repetitive and stereotyped patterns of

behavior, interests, and activities, as manifested by at least one of the following:

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

• Apparently inflexible adherence to specific, nonfunctional routines or rituals.

• Stereotyped and repetitive motor mannerisms.• Persistent preoccupation with parts of objects.

13 33



UN

DE

RG

RA

DU

ATE

Asperger’s Diagnosis (DSM-IV).C. The disturbance causes clinically significant impairment in social,

occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

14 33



UN

DE

RG

RA

DU

ATE

How AS was First Recognised.

• Leo Kanner and Hans Asperger who, independently of each other, published accounts of this disorder.

• These publications, Kanner's in 1943 and Asperger’s in 1944, contained detailed case descriptions and also offered the first theoretical attempts to explain the disorder.

15 33



UN

DE

RG

RA

DU

ATE

How AS was First Recognised.

• Asperger’s paper, written in German, and published during the second world war, was largely ignored.

• Asperger’s definition of autism or, as he called it, ‘autistic psychopathy’ is far wider than Kanner's.

• The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This is not the case.

16 33



UN

DE

RG

RA

DU

ATE

How AS was First Recognised.• 1944 - First identified in Austria by Hans Asperger.• 1981 - Reintroduced as Asperger’s Syndrome by Lorna

Wing who reviewed Asperger’s paper.• Wing’s review provided a description of Asperger’s, as well

as 34 case studies, and discussed classification and differential diagnosis.

• 1994 - Recognised as a distinct disorder by the American Psychiatric Association in the DSM-IV.

• United Kingdom, Australia, and Sweden lead in research on AS.

• 2013 – DSM-V, new cases are ‘Autism Spectrum Disorder’, previously diagnosed are retained.

17 33



UN

DE

RG

RA

DU

ATE

Characteristics of Asperger’s.

• It’s lifelong disorder of unknown origin that usually shows up around 18 months to 3 years.

• Generally thought to be a form of Autism, it is characterised by:– Normal or above-normal intelligence.– Social awkwardness.– Verbal rigidity.– A fixation with an obscure topic that

can be learned by rote (memory).

18 33



UN

DE

RG

RA

DU

ATE


• People with Asperger's have a hard time relating to other people.

• Can and do go on for hours about their obsession. (Little Professors!).

• Not interested in playing with other children but later often desire relationships.

• Preoccupation with things that seem beyond their age level.

• Little or no eye contact.• Fascinated with numbers and letters.

19 33



UN

DE

RG

RA

DU

ATE

Qualitative impairment of social interaction:• Delays in nonverbal behaviors (gesturing, facial

expression, body posture).

• Impairments in establishing peer relationships.

• Absence of spontaneous seeking to share enjoyment, interests, or achievements with others.

• Theory of Mind - Some have described individuals with AS as having a low ‘EQ’ or Empathy Quotient or as having a ‘Learning Disability’ in social skills.


20 33



UN

DE

RG

RA

DU

ATE

• Stereotyped Behaviors, Activities, and Interests.

• Preoccupation with narrow area of interest.• Inflexibility or rigidity – often causes stress.• Sticking to a set, sometimes nonfunctional

routine.• Repetitive motor movements.• Preoccupation with objects.


21 33



UN

DE

RG

RA

DU

ATE

• Sensory differences - touch, taste, odours, textures, noise levels, lighting.

• Motor clumsiness, especially in younger children.

• Poor problem-solving and organisational skills.


22 33



UN

DE

RG

RA

DU

ATE

Characteristics of Asperger’s.• Talks in a flat affect.

– Voice and tone modulation – failure to make voice interesting to listener because they lack the concept of the listener as interested.

– May sound robotic.• Speech may be characterised by poor

prosody, awkward intonation, and odd/inappropriate subject matter.

• Echolaic speech.

23 33



UN

DE

RG

RA

DU

ATE


• People with Asperger's Disorder are inclined to construe language very literally. – so they may not understand slang or informal

speech. • People with Asperger's Disorder may also have

difficulty decoding tone of voice and facial expressions. – Derisive statements such as, "Oh, that was

great!" may inadvertently provide positive reinforcement of an inappropriate behaviour.

24 33



UN

DE

RG

RA

DU

ATE

Characteristics of Asperger’s.• Have unusual fear based or stress based

reactions.– Tear up a room.– Tantrum. – Reactions are not proportionate to the

situation.– Very easily upset.

• Have a strong desire for routine or sameness.• Have limited ability to form friendships.

25 33



UN

DE

RG

RA

DU

ATE


• Unlike Autistic individuals, who may seem aloof and disinterested in others, people with Asperger’s tend to desire to interact with others, but don’t know how to in an appropriate way.

• Often self-described “loners”, “Geeks”.• May live very successful independent lives

in appropriate job settings.

26 33



UN

DE

RG

RA

DU

ATE

Assessment & Diagnosis.• Similar to Autism (we’ll cover

more on this in later sections).

• It is easier to ‘spot’ Autism at the low-functioning end of the spectrum.

• Not so easy to spot Asperger’s Disorder.

• High functioning children do adapt .

27 33



UN

DE

RG

RA

DU

ATE

Prevalence of Asperger's.

• More common in males.• Prevalence estimates vary widely

(36/1000 to 1/10,000) depending on what literature you read. We just don’t know accurately.

• Incidence increasing greatly recently.• Increase due to better identification or

true increase due to unknown factor?

28 33



UN

DE

RG

RA

DU

ATE

Prognosis.• The factors associated with a good prognosis

are a normal IQ, high-level social skills, better communication skills and later onset.

• Prognosis depends on severity and services available.

• Jobs often in area of their interest, which can also help with social integration.

Web Search for ‘Temple Grandin’http://www.templegrandin.com/

29 33



UN

DE

RG

RA

DU

ATE

Comorbid Disabilities.• In addition to Asperger's Disorder, many people with Asperger's

will also exhibit:– Tics (blinking, sniffing, facial grimaces, throat clearing).– Obsessive Compulsive Disorder.– Executive Dysfunction.– ADHD.– Anxiety.– Sleep Disturbances.– Eccentric eating habits.– Self-injurious behaviors.– Depression – especially in adolescents.

• Learning Disabilities.

• …Even though they may not be formally diagnosed with those disorders.

30 33



UN

DE

RG

RA

DU

ATE

Comorbid Disabilities.• Tics

– Are distinguished by sudden, repetitive movements (motor tics) or sounds (phonic tics).

– Frequently preceded by a premonitory feeling of an urge, anxiety, distress, or other sensory phenomena.

• Executive Dysfunction– planning for the future – the ability to inhibit or delay responding – initiating behavior – shifting between activities flexibly

31 33



UN

DE

RG

RA

DU

ATE

Comorbid Disabilities.

• Obsessive Compulsive Disorder– Repeated and unrelenting beliefs, impulses, or

images cause marked anxiety or distress.

The person endeavors to ignore or restrain such thoughts, impulses, or images, or to counterbalance them with some other thought or action that the person feels compelled to complete in response to an obsession, or concurrent to rules that must be applied inflexibly.

32 33



UN

DE

RG

RA

DU

ATE

Unique Difficulties of AS.• The very characteristics that make child higher functioning can

produce its own difficulties.– Awareness of social difficulties.– Disabilities not always taken seriously.– Late/difficult diagnosis.

• Until school, symptoms not always disruptive, child may seem simply extremely bright.

• Easy to miss diagnose or misdiagnose.• Teachers’ Misunderstandings. (Disabilities not always taken

seriously).– Compensates for lack of social insight with logic.– Verbal abilities appear intact.– Rote memory.– Logical thinking.

33 33



UN

DE

RG

RA

DU

ATE

Differences in AS Presentation from Autism.

Asperger’s• Later onset• Higher range of IQ• No language deficit• Non-verbal

communication problems less severe

• Clumsiness in basic motor skills

Autism• Early onset• IQ tends to be lower• Often fail to develop

spoken language• Problems with non-verbal

communication• Tend to be adept at basic

motor skills

Date post:	07-Apr-2017
Category:	Education
Upload:	simon-bignell
View:	2,114 times
Download:	2 times

AAA Section 04 Asperger's Disorder Ver 04 2013

Education