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Asperger syndrome (AS) is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical (peculiar, odd) use of language are frequently reported.
The exact cause is unknown. Although research suggests the likelihood of a genetic basis there is no known genetic cause and brain imaging techniques have not identified a clear common pathology. Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most children improve as they mature to adulthood, but social and communication difficulties may persist. Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.
The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy. The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization, becoming standardized as a diagnosis in the early 1990s. Many questions remain about aspects of the disorder. There is doubt about whether it is distinct from high-functioning autism (HFA); partly because of this, its prevalence is not firmly established. The diagnosis of Asperger's was eliminated in the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and replaced by a diagnosis of autism spectrum disorder on a severity scale.
Asperger syndrome may lead to problems in social interaction with peers. These problems can be severe or mild depending on the individual. Children with AS are often the target of bullying at school due to their idiosyncratic behavior (odd habits), precise language, unusual interests, and impaired ability to perceive and respond in socially expected ways to nonverbal cues, particularly in interpersonal conflict. Children with AS may be overly literal, and may have difficulty interpreting and responding to sarcasm, banter, or metaphorical speech. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a wish to change the topic of talk or end the interaction. Difficulties with social interaction may also manifest in a lack of play with other children.
The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated, but is not supported by data. More evidence suggests children with AS are victims rather than victimizers. In many cases, violent criminals with AS had coexisting psychiatric disorders.
Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share enjoyment with others.
Many causes of autism have been proposed, but understanding of the theory of causation of autism and the other autism spectrum disorders is incomplete. Research indicates that genetic factors predominate. The heritability of autism, however, is complex, and it is typically unclear which genes are responsible. In rare cases, autism is strongly associated with agents that cause birth defects. Many other causes have been proposed, such as childhood immunizations, but numerous clinical studies have shown no scientific evidence supporting any link between vaccinations and autism.
Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems. Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged, it is still possible that AS's mechanism is separate from other ASDs. Neuroanatomical studies strongly suggest that the mechanism includes alteration of brain development soon after conception. Abnormal migration of embryonic cells during fetal development may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior. Several theories of mechanism are available; none are likely to provide a complete explanation.
Several factors complicate the diagnosis of Asperger syndrome. Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. Problems in diagnosis include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome. As with other ASD forms, early diagnosis is important.
Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age. Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation. The diagnosis of AS is complicated by the use of several different screening instruments, including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ) and other evaluation instruments.
Prevalence estimates vary enormously. Epidemiological studies of children found autism prevalence rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1.
There is no cure for the syndrome. Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development, with intervention tailored to the needs of the individual based on multidisciplinary assessment. Although progress has been made, data supporting the efficacy of particular interventions are limited.
The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package. AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS.
No medications directly treat the core symptoms of AS. Although research into the efficacy of pharmaceutical intervention for AS is limited, it is essential to diagnose and treat comorbid (additional disorders) conditions.
There is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist.
Although many attend regular education classes, some children with AS may utilize special education services because of their social and behavioral difficulties. Adolescents with AS may exhibit ongoing difficulty with self care or organization, and disturbances in social and romantic relationships. Despite high cognitive potential, most young adults with AS remain at home, although some do marry and work independently.
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