Asperger’s Signs and Symptoms
Societal awareness of Asperger Syndrome—most easily described as a milder form of autism—is perhaps at an all time high, and yet, the diagnosis, cause and very definition of this developmental brain disorder remains complicated. For one, its actual existence as a disorder independent of the autism spectrum has been ruled out in the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5). This is further complicated by the fact that there is no physical test for the existence of Asperger’s, nor is there a standardized diagnostic exam. Instead it is determined by a series of behaviors and criteria similar to autism spectrum disorders (ASD), but to a lesser degree.
Many mental health professionals do, and will likely continue to, find the description to be useful when diagnosing and treating patients. This article will discuss common diagnosis methods, signs, and symptoms ascribed to Asperger’s. However, please keep in mind that this is not a tool for self-diagnosis or diagnosis of others, and is just to be used as an entry point to understanding Autism Spectrum Disorders. See below for more references, or speak to a health care professional for more information about any specific mental heath questions you or someone you know might have.
There are those among us, and perhaps you good reader are one of them, who consider themselves amateur psychologists, diagnosing co-workers and friends with any number of disorders. It’s also understandably tempting to self-diagnose, or diagnose a loved one, perhaps in the absence of affordable health care coverage. It cannot, however, be emphasized enough the importance of professional diagnosis when dealing with autism spectrum disorders, especially when dealing with children. Aside from a primary care physician, the Autism Society is a good place to start. They offer extensive information and have an easy-to-use guide to finding resources for people of all economic or personal circumstances.
As mentioned above, the process of diagnosis is a complicated one, because of the lack of standardized methods, but also the subtle nature of the disorder. It is often said that no two patients will display the same set of symptoms. And those who do have some symptoms may not be on the spectrum. Signs may be noticeable in infants, or others may not surface until much later.
Diagnosis must be performed by health care providers with experience in autism spectrum disorders, starting with a family doctor who first identifies relevant symptoms. The second stage of diagnosis should involve a team of professionals, likely including a psychologist, neurologist and a speech therapist, who will then rule out other possible issues or make a diagnosis of Asperger Syndrome or high-functioning autism.
Signs and Symptoms
Health care professionals use a set of criteria not unlike that used when diagnosing autism spectrum disorders, but the symptoms are usually less severe and absent key indicators in patients further along the spectrum. The DSM-IV, the last manual to include Asperger’s as an independent diagnosis, states that to be diagnosed with AS, a patient must display “severe and sustained impairment in social interaction, and the development of restricted, repetitive patterns of behavior, interests and activities that must cause clinically significant impairment in social, occupational or other important areas of functioning.”
Those two areas—social impairment and repetitive or fixated behaviors are the main indicators of Asperger Syndrome, and all sets of symptoms fall into those categories. There are, however, some behavioral symptoms that can be notably physical.
The social signs observed in people with Asperger Syndrome are:
- Different speech patterns. People with Asperger’s tend to speak in a way that might seem robotic or lacking rhythm or typical inflection. They often have difficulty modulating volume of their voices, talking too loud in quiet places.
- While autism is often marked by delays in development of language, or poor verbal skills, children with Asperger’s often have very well developed language skills, they simply use them in ways that don’t align with social norms. For example, during conversation they often continue with a line of discussion for a long period of time without being aware that they have lost the interest of the other person involved. Conversations can seem like a cataloguing of random facts without conclusion.
- Similarly, people with AS commonly have a hard time reading social cues, like when it is appropriate to say certain things in conversation, or subtle suggestions in conversation that are not literally explained.
- People with Asperger’s often have a hard time understanding figurative language, such as use of metaphor or non-literal meanings. They tend to have difficulty detecting sarcasm or irony.
- There is often difficulty understanding or conducting nonverbal communication, including sustaining appropriate eye contact, facial expressions or hand gestures.
- Adults with Asperger’s will often have a difficult time connecting emotionally with others, due to difficulty expressing empathy. They often struggle to respond in an emotional way in social interactions. For example, they may not express happiness in response to another person’s happiness.
- None of this is to say that people with Asperger’s don’t experience emotion. This is a common misunderstanding. They experience the same feelings such as sadness, happiness, empathy and regret. They just process and express emotions differently, often in overly intellectual or “concrete” ways. In this way, they struggle with emotional connections with others. People with AS will report that they experience deep emotions, but the process of expressing those emotions in a social or external context will feel unnatural and require great effort.
In addition to social symptoms, the other key set of behaviors involve repetition and fixation on certain topics and routine:
- Children with Asperger’s become heavily focused on specific topics, such as planes, trains, stamps or anything that can be collected, classified or categorized.
- The interest in these subjects may seem to be obsessive, but the knowledge obtained and shared is often quite impressive. In his original case studies, Hans Asperger called his patients “little professors.”
- Similarly, patients diagnosed with more severe autism can often have intellectual disabilities. In contrast, people with Asperger’s by definition cannot have any significant cognitive disability. In fact, many possess above average intelligence, although it may be highly focused or expressed in different ways.
- The subjects of interest are often very narrow. For example, they may be obsessed with train schedules or the Latin names of flowers.
- People with Asperger’s are often highly talented in certain areas, especially those that require intense concentration or fixation. It’s been noted that the tech industry, and areas of the country where the tech industry is prevalent, show a high concentration of Asperger’s. People who have worked with Facebook CEO Mark Zuckerberg have observed that he displays a number of symptoms that could be signs of Asperger’s.
- There tends to be a strong attachment to routine, and straying from that routine can lead to great discomfort. They often settle into rituals or require surroundings to be a certain way to avoid anxiety.
- As children, they may appear to be clumsy, or not comfortable in their own bodies. There is often a delay in learning to play catch or ride a bike.
- They are sometimes overly active, and appear “bouncy” or stilted.
- Similar to people with more severe autism, they sometimes repeat certain motions with their hands or arms, such as “flapping” fingers or hands.
Related to the first two areas, but not necessary for diagnosis, Asperger’s symptoms often display themselves in noticeable physical ways:
This is a fairly exhaustive list, but as a reminder, symptoms vary wildly, and just having one or more of these symptoms does not in any way mean someone has Asperger Syndrome. Rather, it is a combination of symptoms and their severity, as determined by a mental health professional, that can indicate the presence of an autism spectrum disorder.
A Note on Causes
There is no determined cause for autism spectrum disorders or Asperger Syndrome. Scientists are investigating a number of possible theories for its occurrence, and its apparent increase over time, but no single factor has been isolated as a cause. It is very likely, based on brain scan research, related to some kind of abnormality in brain structure.
Currently, researchers suspect the disorders are caused by some combination of genetic and environmental factors, as is the case for other brain disorders such as schizophrenia. The genetic factors are apparent because of coinciding appearance of ASD in twins, and the fact that its likelihood seems to run in families. Scientists have not, however isolated a specific gene behind autism, rather they suspect it’s some combination of activity in a set of genes.
They do, however, also suspect there are environmental factors involved. In other words, not everyone who has the genetic disposition to developing ASD will. Instead, there are likely environmental, or external, non-inherited factors that may trigger the syndrome or determine severity. Research has not isolated what that factor or factors may be. There is a small and active minority of parents who fear vaccines may be an environmental trigger, but research has roundly disproven that theory.