ASPERGER SYNDROME

About Asperger syndrome

Asperger syndrome is a form of autism, which is a lifelong disability that affects how a person makes sense of the world, processes information and relates to other people. Autism is often described as
a 'spectrum disorder' because the condition affects people in many different ways and to varying degrees. (For more information about autism, please read our leaflet What is autism?)
Asperger syndrome is mostly a 'hidden disability'. This means that you can't tell that someone has the condition from their outward appearance. People with the condition have difficulties in three main areas. They are:

• social communication
• social interaction
• social imagination.

They are often referred to as 'the triad of impairments' and are explained in more detail on page 3.
While there are similarities with autism, people with Asperger syndrome have fewer problems with speaking and are often of average, or above average, intelligence. They do not usually have the accompanying learning disabilities associated with autism, but they may have specific learning difficulties. These may include dyslexia and dyspraxia or other conditions such as attention deficit hyperactivity disorder (ADHD) and epilepsy.
With the right support and encouragement, people with Asperger syndrome can lead full and independent lives.

Three main areas of difficulty

The characteristics of Asperger syndrome vary from one person to another but are generally divided into three main groups.

Difficulty with social communication

If you have Asperger syndrome, understanding conversation is like trying to understand a foreign language.

People with Asperger syndrome sometimes find it difficult to express themselves emotionally and socially. For example, they may:

• have difficulty understanding gestures, facial expressions or tone of voice
• have difficulty knowing when to start or end a conversation and choosing topics to talk about
• use complex words and phrases but may not fully understand what they mean
• be very literal in what they say and can have difficulty understanding jokes, metaphor and sarcasm. For example, a person with Asperger syndrome may be confused by the phrase 'That's cool' when people use it to say something is good.

In order to help a person with Asperger syndrome understand you, keep your sentences short - be clear and concise.

Difficulty with social interaction

I have difficulty picking up social cues, and difficulty in knowing what to do when I get things wrong.

Many people with Asperger syndrome want to be sociable but have difficulty with initiating and sustaining social relationships, which can make them very anxious. People with the condition may:

• struggle to make and maintain friendships
• not understand the unwritten 'social rules' that most of us pick up without thinking. For example, they may stand too close to another person, or start an inappropriate topic of conversation
• find other people unpredictable and confusing
• become withdrawn and seem uninterested in other people, appearing almost aloof
• behave in what may seem an inappropriate manner.

Difficulty with social imagination

We have trouble working out what other people know. We have more difficulty guessing what other people are thinking.

People with Asperger syndrome can be imaginative in the conventional use of the word. For example, many are accomplished writers, artists and musicians. But people with Asperger syndrome can have difficulty with social imagination. This can include:

• imagining alternative outcomes to situations and finding it hard to predict what will happen next
• understanding or interpreting other peoples thoughts, feelings or actions. The subtle messages that are put across by facial expression and body language are often missed
• having a limited range of imaginative activities, which can be pursued rigidly and repetitively, eg lining up toys or collecting and organising things related to his or her interest.

Some children with Asperger syndrome may find it difficult to play 'let's pretend' games or prefer subjects rooted in logic and systems, such as mathematics.

Characteristics of Asperger syndrome

The characteristics of Asperger syndrome vary from one person to another but as well as the three main areas of difficulty, people with the condition may have:

• love of routines
• special interests
• sensory difficulties.

Love of routines

If I get anxious I get in a tizz. I have a timetable; it helps me to see what I have to do next, otherwise I get confused.

To try and make the world less confusing, people with Asperger syndrome may have rules and rituals (ways of doing things) which they insist upon. Young children, for example, may insist on always walking the same way to school. In class, they may get upset if there is a sudden change to the timetable. People with Asperger syndrome often prefer to order their day to a set pattern. For example, if they work set hours, an unexpected delay to their journey to or from work can make them anxious or upset.

Special interests

I remember Samuel reciting the distances of all the planets from the sun to a baffled classmate in the playground when he was five. Since then he has had many obsessions, which he loves to talk about at length!

People with Asperger syndrome may develop an intense, sometimes obsessive, interest in a hobby or collecting. Sometimes these interests are lifelong; in other cases, one interest is replaced by an unconnected interest. For example, a person with Asperger syndrome may focus on learning all there is to know about trains or computers. Some are exceptionally knowledgeable in their chosen field of interest. With encouragement, interests and skills can be developed so that people with Asperger syndrome can study or work in their favourite subjects.

Sensory difficulties

Robert only has problems with touch when he doesn't know what's coming - like jostling in queues and people accidentally brushing into him. Light touch seems to be worse for him than a firm touch.

People with Asperger syndrome may have sensory difficulties. These can occur in one or all of the senses (sight, sound, smell, touch, or taste). The degree of difficulty varies from one individual to another. Most commonly, an individual's senses are either intensified (over-sensitive) or underdeveloped (under-sensitive). For example, bright lights, loud noises, overpowering smells, particular food textures and the feeling of certain materials can be a cause of anxiety and pain for people with Asperger syndrome.
People with sensory sensitivity may also find it harder to use their body awareness system. This system tells us where our bodies are, so for those with reduced body awareness, it can be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other people and carry out 'fine motor' tasks such as tying shoelaces. Some people with Asperger syndrome may rock or spin to help with balance and posture or to help them deal with stress.
Who is affected by Asperger syndrome?
There are over half a million people in the UK with an autism spectrum disorder - that's around 1 in 100. People with Asperger syndrome come from all nationalities, cultures, social backgrounds and religions. However, the condition appears to be more common in males than females; the reason for this is unknown.

Causes and cures

What causes Asperger syndrome?
The exact cause of Asperger syndrome is still being investigated. However, research suggests that a combination of factors - genetic and environmental - may account for changes in brain development.
Asperger syndrome is not caused by a person's upbringing, their social circumstances and is not the fault of the individual with the condition.

Is there a cure?
There is currently no 'cure' and no specific treatment for Asperger syndrome. Children with Asperger syndrome become adults with Asperger syndrome. However, as our understanding of the condition improves and services continue to develop, people with Asperger syndrome have more opportunity than ever of reaching their full potential.
There are many approaches, therapies and interventions, which can improve an individual's quality of life. These may include communication-based interventions, behavioural therapy and dietary changes. Information about many of these can be found at: www.autism.org.uk/approaches

Diagnosis

Because Asperger syndrome varies widely from person to person, making a diagnosis can be difficult. It is often diagnosed later in children than autism and sometimes difficulties may not be recognized and diagnosed until adulthood.
The typical route for getting a diagnosis is to visit a GP. He or she can refer an individual to other health professionals who can make a formal diagnosis. Most frequently they will be psychiatrists or clinical psychologists and, in the case of children, pediatricians.
Some people see a formal diagnosis as an unhelpful label; however, for many a diagnosis:

• Helps the individual, families, friends, partners, carers, professionals and colleagues to better understand and manage their needs and behaviour
• Is the key needed to open the door to specialised support, eg supported living or finding suitable employment.

There are diagnostic differences between conditions on the autism spectrum. Sometimes people may receive a diagnosis of autism or autistic spectrum disorder (ASD), high-functioning autism (HFA) or atypical autism instead of Asperger syndrome. Alternatively, they may be given a diagnosis of pervasive developmental disorder - not otherwise specified (PDD-NOS) or semantic pragmatic disorder. However, people who have been given these diagnoses will have similar difficulties and similar support needs to those who have Asperger syndrome. You can find more information about diagnosis and how to get one here.
If you would like to read more about the different types of autism (including Asperger syndrome) and the diagnoses that people get, see:

• High-functioning autism and Asperger syndrome: what's the difference? 
• The use and misuse of diagnostic labels