A Viennese pediatrician, Hans Asperger, did research amongst
children who were a little unusual. Perhaps the child was
clumsy, or was a `loner'. Parents realized the child was
unusual, but had no idea why. He identified a consistent
pattern of behavior and ability which occurred mainly among
boys. This was as long ago as 1944. He died in 1980, a few
years before the condition called in his name, "Asperger's
Syndrome," was recognized internationally.
How does Asperger's manifest itself? Firstly, there
are social and emotional disabilities. The child may lack an
understanding of how to play with other children. Generally,
children are aware of the unwritten rules of social play,
and this child is not. He may even avoid other children. The
child may make personal remarks without being aware of the
other person's feelings or how hurtful his comment may be.
The child is not interested in the latest craze in toys or
clothes, and never joins in competitive games or team games.
He may show distress or emotion quite out of proportion to
the event. Very young children may also have these problems,
but they outgrow them.
Next there are communication skills. The child may take a
literal interpretation of phrases such as "wipe your feet",
"pull your socks up", "hop into the bath". The child's
speech may be over precise and he may sound like a walking
dictionary or he may use an unusual tone of voice or
monotone, without making eye contact. He may not be
interested in your answers or opinions during a
conversation, and when he does not understand something, he
will not ask for clarification, but will change the
subject.
These children may have an exceptional long term memory,
clearly recalling events which happened many years ago. They
may be unduly upset by changes in routine, and develop their
own rigid routines or rituals which they insist on
completing. The child may collect information on a
particular topic and become a walking encyclopedia of
knowledge on that subject. He may persist in imparting this
information to complete strangers.
There are other characteristics which are common to most
children to a certain degree, but parents know when their
child does not fit into the `normal' range. For instance,
there may be an unusual fear or distress at the sound of an
electrical appliance, or objection to wearing a particular
item of clothing. Fear of unexpected sounds and noisy
crowded places. A tendency to rock or flap when excited.
Unusual facial grimaces. A lack of sensitivity to low levels
of pain. There may be poor motor coordination and a lack of
coordination when running.
The normal range of abilities and behavior in childhood is
quite extensive. Many children are extremely shy, even
abnormally shy for a while, are not great
conversationalists, have unusual hobbies and are a little
clumsy. If much of the above describes the child, it does
not mean he has Asperger's.
At present, there is no universal agreement on diagnostic
criteria. Sets of criteria have been provided from Sweden,
Canada, America and the World Health Organization. Child
with ADD (Attention Deficit Disorder) are often considered
as having Asperger's. Although these are two distinct
disorders, a child could be suffering from both. Also,
social withdrawal and immature social play can be a
consequence of a language disorder. Semantic Pragmatic
Language Disorder (SPLD) has common features to Asperger's.
Children with a very high IQ can consider social play as
boring. They can acquire considerable knowledge in specific
areas and appear eccentric. However, their social and
linguistic skills are within the normal range. Then there is
the naturally shy, anxious or introverted child. No doubt,
there are some children who will be in a `grey area' where
there is considerable doubt as to whether they fit into the
diagnositc scale we have at the moment. These children may
have a modicum of the syndrome and will benefit from the
strategies used for helping children with Asperger's.
Research has shown that their progress is very rapid once
they are introduced to this help.
How do you distinguish between ADD and Asperger's?
Child with ADD find it difficult to play cooperatively with
other children, but they desperately want to do so. The
other children tend to avoid them because of their bad
behavior. On the other hand, children with Asperger's are
not interested in other children and do not want to play
with them.
Children with ADD have a wide range of linguistic skills and
interests, conventional to those of children their own age.
They also have a very limited attention and concentration
span. This can vary according to motivation and
circumstances, but by definition, children with ADD have a
deficit in sustained attention. With Asperger's Syndrome,
the attention span is remarkably long when the child is
interested in something.
Children with both conditions respond better when they
have a fixed routine and predictability, when they are told
exactly where they are going and what they are going to do.
The two conditions have specific differences but as noted,
there are some similarities. If a child is diagnosed as
having both, he will require treatment for both
conditions.
If a young child has difficulty in understanding the
language of other children and cannot speak as well as they
do, he might easily avoid interactions with them, especially
play which requires speech. Children with a language
disorder will gradually increase their motivation and
ability in social play as their language skills improve.
However, a child with Asperger's has more severe social
impairments than lack of confidence in speech or shyness,
and he is usually preoccupied with a special interest, about
which he speaks very articulately.
Finally, there is a language disorder which is common to
autism and Asperger's, which is considered part of the
autistic spectrum.
Semantic Pragmatic Language Disorder (SPLD) covers quite
a large range of speech and communication. Syntax may be
perfectly correct, but the words may be quite out of
context. Or there may be echolalia, repeating the same
phrase over and over again. Poor conversational turn-taking
is also part of SPLD. Children who are neither autistic, and
who do not have Asperger's, but, nevertheless, have SPLD,
need the help of a speech therapist to improve their
language skills but will also benefit from some of the
programs used to help children with Asperger's.
Before this syndrome was recognized, quite a few people with
Asperger's were diagnosed as having treatment resistance or
chronic mental illness, especially schizophrenia. The family
who needed professional help consulted the psychiatric
services. The treatment was usually sedation and
institutional care, rather than improving social behavior
and understanding. It is debatable whether individuals
who are eccentric, in the pleasing sense of the word, should
be diagnosed as having a personality disorder or have a
label attached to them at all.
As mentioned, Asperger's is part of the autistic continuum,
and is often called High Functioning Autism. The term autism
has negative associations for the public and professionals.
Autistic children have a relatively limited prognosis for
the future, and often require extensive support. It is also
associated with disturbed behavior. It is important for
parents and teachers to know that Asperger's is not a
mild form of autism, but a different expression of the
condition.
The term Asperger's is new, and many people have never heard
of it. Teachers are not afraid to have such a child in the
class if a parent will explain that it is a neurological
condition where the child will have to learn to socialize
and understand the feelings and thoughts of other people.
The parent will also explain that the child has difficulty
in natural conversation and perhaps has an intense interest
in a particular subject. He has clear speech and an
intellectual capacity in the normal or above normal range.
High Functioning Autism as a label has one advantage. Local
authorities know what autism is and are more prepared to
give support for a known `name'. Besides which, teachers can
use some of their expertise or that of other professionals,
to help the child, using the existing body of knowledge from
another syndrome.
Sula Wolff wrote a book (The Life Path of Unusual Children,
Routledge 1995) in which she explains the `bridge' between
Asperger's syndrome and the normal range of abilities. In
it, she demonstrates the potential outcome for some people
with Asperger's syndrome.
There is no doubt that there are many people out there
who are not exactly like others, but who have never been
labeled. Nevertheless, parents who need help are wise to go
to a clinician who can help them and also advise them how to
improve the situation.
