Asperger syndrome (Asperger's syndrome)
Asperger Syndrome (AS), also known as Asperger syndrome, is a syndrome within the pervasive developmental disorders (PDD) and is part of the autism spectrum disorder (ASD). Its key features include social and nonverbal communication difficulties, accompanied by narrow interests and repetitive specific behaviors, but compared to other autism spectrum disorders, individuals with AS still tend to have relatively preserved language and cognitive development. Patients often exhibit clumsiness and atypical language expressions, occasionally emitting strange sounds, but this alone is not used as a diagnostic criteria. Symptoms generally appear before the age of two and persist throughout the individual's lifetime.
The exact cause of Asperger Syndrome has not been fully clarified. While there may be some genetic factors, currently there is no genetic basis behind it, and environmental factors are also believed to play a role. Brain imaging techniques currently cannot identify common underlying issues. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association merged Asperger's disorder into the autism spectrum, including autism and unspecified pervasive developmental disorders. In 2019, Asperger Syndrome was still retained in the 11th Revision of the International Classification of Diseases (ICD-11), and in 2021, it was merged into a subtype of autism spectrum disorder in the 11th Revision of the International Classification of Diseases (ICD-11).
Asperger's disorder is not limited to a single treatment method, however, the evidence supporting specific intervention measures for it is also limited. Treatment goals aim to improve weaker communication skills, obsessions, repetitive routine tasks, and coordination of motor actions. Intervention measures include: social skills training, cognitive-behavioral therapy, occupational therapy, speech therapy, parent training, and medication for psychological or anxiety-related issues. As children grow older, the condition of some pediatric patients may improve, but social and communication difficulties typically persist. Some researchers and individuals in the autism spectrum advocate another point of view, considering autism as just individual differences rather than a disease requiring treatment or cure.
Asperger Syndrome is named after the Austrian pediatrician Hans Asperger. In 1944, he first documented children with lack of nonverbal communication skills, low empathy in peer interactions, and clumsy behavior, but his paper was not widely recognized due to being published in German during World War II.
In 1981, British physician Lorna Wing introduced the discovery of Asperger Syndrome, which gradually became more well-known from the 1990s onwards. Fifty years later, it was standardized as a diagnostic criterion, but the academic community still has unclear definitions of the disease symptoms. Controversies include whether Asperger Syndrome is equivalent to High-Functioning Autism (HFA); part of the reason for this controversy is that its prevalence has not been established. The academic community is now planning to abolish the old diagnostic criteria for Asperger Syndrome and adopt a severity scale for Autism Spectrum Disorder.
The actual causes of Asperger Syndrome still remain unknown. Some studies support genetic arguments, but cognitive development in offspring is not absolute, and no specific gene causing the disease has been found, hence there is still debate. Several studies statistically point to brain damage in fetuses in the womb as a possible cause, with a higher proportion becoming Asperger's, e.g., maternal impacts/umbilical cord wrapping...etc., but the exact pathological reasons remain unclear; neuroimaging techniques have not found a common definitive cause. Asperger Syndrome does not have a single diagnostic and treatment method, and many specialized treatment methods do not have sufficient data to confirm their effectiveness.
Current diagnostic and treatment methods mainly focus on improving symptoms and functionality, often using behavioral therapy to address specific challenges in communication skills, obsessive or repetitive behaviors, and motor coordination. Most cases show some progress with treatment, however, difficulties in communication, social adaptation, and independent living may persist, even into adulthood. Some scholars and individuals with Asperger Syndrome advocate changing the public perception of these symptoms, defining it as a cognitive difference rather than a disease, not a defect or disorder requiring urgent treatment.
There are various opinions on the definition of Asperger Syndrome, whether it is the same as High-Functioning Autism, with some considering Asperger Syndrome and High-Functioning Autism (without intellectual disability, or almost no autism) to be the same (while others believe that Asperger Syndrome specifically refers to autism without language impairment), but there are also dissenting views. Generally, individuals with Asperger Syndrome have normal intelligence and less frequent language delays.
In addition, attention-deficit hyperactivity disorder (ADHD) and learning disabilities (LD) are often comorbid. For reasons such as prejudice against terms like Asperger's syndrome and autism because of the presence of co-occurring disorders, physicians are increasingly referring to them as "pervasive developmental disorders (PDD)" and developmental disorders. Furthermore, within the autism spectrum, it is considered to be in between neurotypical individuals and individuals with low-functioning autism.
Asperger's syndrome is believed to be a collection of various symptoms rather than a single symptom pattern, characterized by qualitative impairments in social interaction, restrictive and repetitive patterns of behavior, activities, and interests, with no apparent cognitive or language delays. Strong interests in specific topics, lack of rhythm and intonation, and clumsiness in movement are typical features of this condition but not necessary for diagnosis purposes.
The difference between Asperger's syndrome and autism lies in the absence of significant issues with verbal communication with the public, and the distinction from terms like high-functioning autism is ambiguous. However, in cases of Asperger's syndrome, the degree of autistic symptoms is usually milder, allowing individuals to interact well with those who share similar interests or temperaments, maintain this to some extent due to a lack of sociability, and the avoidance of eye contact is also noted as a difference. Patients diagnosed with Asperger's syndrome may exhibit symptoms like a singular or narrow interest.
In terms of interests, patients generally exhibit intense interest in one or multiple patterns of interest. They may feel a particular interest in certain things or subjects, eagerly gathering information in that area, with rigid and limited patterns of interest. Within these interest circles, Asperger's syndrome and other types of mental health sufferers are often seen, even displaying special talents. In terms of rigidity, individuals with Asperger's disorder have repetitive and rigid behavior and activity patterns, difficulty in flexibly following various rules, leading to social difficulties.
Language Ability
Although individuals with Asperger's syndrome do not experience significant delays in acquiring language skills and their language may not show overt abnormalities, language acquisition and usage are often atypical, including lengthy discussions on singular topics of no interest to others, literal interpretations and misunderstandings of subtle differences, repetitive pedantic language, peculiar intonation, etc. While intonation may not be as rigid or monotonous as in typical autism, individuals with Asperger's syndrome typically exhibit characteristics such as exceptionally fast, rapid, or loud speech. Communication may convey a sense of incoherence, with conversation styles often comprising monologues on topics that bore the listener. Children with Asperger's syndrome may have acquired complex vocabulary early in childhood, but may struggle to understand figurative language. In non-verbal language aspects, children with Asperger's syndrome seem to have particular weaknesses in humor, sarcasm, irony, and ridicule.
Currently, there are no viable treatment methods for Asperger's syndrome, such as medications to alleviate core symptoms; only behavioral therapy can be relied upon. However, certain medications (such as antidepressants, anti-anxiety drugs, antipsychotics, and mood stabilizers) can alleviate mood disorders, while central nervous system stimulants (e.g., methylphenidate) and atomoxetine can reduce hyperactive behavior.
Researchers debate whether Asperger's syndrome should be viewed as a different cognitive style rather than a disease or disability. In a paper published in 2002, Simon Baron-Cohen pointed out, "In social circles, an adherence to details may not be beneficial, but in certain areas such as mathematics, programming, creating catalogs, music, linguistics, and engineering, a focus on details may lead a person to success rather than failure." However, the same scholar listed two main reasons why Asperger's syndrome may still be considered a disability: the need for social assistance and difficulty in adapting. Yet, he emphasized that individuals with Asperger's syndrome carry various abilities that have repeatedly contributed significantly to human evolution and civilization development.