Asperger's Syndrome (AS)CharacteristicsCommon characteristics of Asperger's syndrome, Asperger's or AS for short, include:
Comparison of AS, NLD, and High Functioning AutismAsperger's syndrome is considered by many to be an Autism Spectrum Disorder (ASD) and is often confused with NLD and high functioning autism. Here is an overview comparison of these three:
BooksTwo good references for both parents and professionals are:Helping a Child With Nonverbal Learning Disorder or Asperger's Disorder: A Parent's Guide (Parents Guide)  The Complete Guide to Asperger's Syndrome  James' story:James was an extremely negative and extremely bright, 14 year old who had been diagnosed with Asperger's Syndrome, depression, and oppositional defiance disorder. He was a very lonely and angry young man. His world was made of things, pets, and people, in that order of preference. People, including his family, were way down on his list of things he liked. His parents were both highly articulate and well educated. James had a younger sister that did not have any of his problems and seemed a normal child by all counts. James preferred computer games and reading over relationships. He had a large vocabulary and liked to write. He was working on a fantasy book with great fervor. His characters in the book, however, had the depth of computer game characters. James had the social skills of a rock and non-verbal learning disorder (NLD). The only real person in James' world was himself as far as he was concerned. All others were just there to serve or annoy him. His conversations were one-dimensional, consisting primarily about what ever topic he was obsessed with at the time. He was also not good at sports and would try to avoid anything physical. He had only marginal hand-eye coordination and in general was very awkward when he tried physical games and sports. Unfortunately for him, his therapist liked sports and occasionally used them in his therapy. James had great difficulty recognizing other people's personal boundaries. One of his worst habits was walking up to someone and poking them. It was his way of trying to be friendly but would really offend others. He would interrupt other's conversations or otherwise impose himself intrusively. We spent a lot of time in therapy working on his social skills. This included how to carry on a real conversation with someone. That meant social courtesies and norms, such as saying "hello" or asking "how are you doing". He worked on learning to actually listen to what the other person was saying and responding appropriately to that.We also spent a lot of time helping him learn to recognize body and facial language in context of social interactions. His brilliant intellect allowed him to do cognitively what most of us do naturally and easily. Even with his intellect, this would be a lifelong challenge for him. We also worked a lot on his learning to respect other people's personal boundaries. Finally, we got him involved in sports. I would go out and we would play basketball or catch with a football. He was encouraged to participate in athletic activities at his school. He did get better at some of these and actually had fun at them, but it took some doing. Neurobiology of Asperger's Syndrome (AS)What causes AS? Is it genetic? Are mirror neurons involved?(SOURCE: National Institute Neural Disorders and Stroke) Brain differencesResearch is pointing to brain abnormalities as the underlying cause of AS. Researchers have used brain imaging techniques that point to structural and functional differences in specific regions of the brains of AS children versus normal children. These differences most likely originate during embryonic development and result in a "wiring" difference in the brains of AS children. This difference is in the control of thoughts and behaviors.Looking at how AS children brains functioned in tasks that required them to use their judgment, one study found a reduction in activity in the frontal lobe of the brain. In another study, difference were found in AS children when asked to respond to facial expressions (see mirror neurons below). In a study with AS adults, a protein that correlates with obsessive/repetitive behaviors was found in abnormal levels. GeneticsAsperger's syndrome along with ASD's tends to run in families. In these families there is a higher incidence of family members that have Asperger's-like behavioral symptoms but not as full blown. These symptoms included some difficulties in social interactions, reading, and/or language skills.However, a specific gene for Asperger's syndrome has not been identified. Most likely AS is a what is known as a polygenic trait, that is it determined by several genes with genetic variants (alleles) that make an individual carrying them vulnerable to developing AS. There may be both genetic and environmental components involved. This would give rise to a range of AS severity and symptoms. Mirror neuronsMirror neurons are an important class of recently discovered neurons that enable us to recognize and interpret emotions and body language in others and to learn by imitation. They are critical for normal social interactions. Want to read more about mirror neurons, click here.There is increasing evidence that ASD's is a result of deficit in mirror neurons or dysfunction of the same. See references below:
TreatmentTraditionalAccording to the National Institute of Neural Disorders and Strokes, the ideal treatment for Asperger's syndrome needs to coordinate therapies that address the three core symptoms of the disorder: communication skills, obsessive/ repetitive routines, and physical clumsiness. Treatment needs to be individualized for the teen's specific symptoms.In Jame's case above, depression was co-morbid with his other AS symptoms. Also, unlike many AS teens, James had good writing skills. Consequently, we also treated the depression and encouraged his writing. He was working on his first book by the end of therapy and had dreams of being a writer. Effective treatment programs build on the teen’s interests and includes structure in terms of his/her schedule and living and school environments. Predictability in their schedule is important for these teens. Tasks need to be broken down into simple series of steps. Parents often need coaching on how to do these. Additionally, Reality Therapy (see choices and consequences) can be very effective with these teens. Therapy often includes:
Equine Assisted TreatmentOur experience is that AS teens can often relate better to pets and horses than people. Equine Assisted Counseling sessions can serve as bridge to help AS teens gain self-confidence, become more sensitive to body language, and to develop better problem solving skills. They seem to be more relaxed with the horses once they overcome their initial hesitancy with these large, powerful animals that readily accept them for who they are. Index to Teen Problems and Issues:
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