Children with Asperger's syndrome usually experience difficulty in three main areas: social interaction, social communication and imagination, and cognitive flexibility. Each of these diagnostic features can be present in different forms and varying degrees.
This might mean that difficulties with social interaction can include not understanding the subtleties of social situations, recognising and interpreting other people’s feelings, managing emotions or making and maintaining friendships.
Difficulties with social communication tend to encompass problems with using and understanding verbal and non verbal language, such as modulating tone of voice and gestures.
Children with Asperger's syndrome can often sound more mature than expected for their age, as their vocabulary may be advanced and they often use phrases they have learned from adults or books. As a result, their difficulty with expressing themselves, especially their emotions, can be underestimated.
Children with Asperger's syndrome also tend to present with intense interests, lack of flexibility and difficulties with creative play, although some children with asperger syndrome show very good creativity in certain specific areas (for example in programming).
Asperger's syndrome is often referred to as ‘mild autism’. However, the difficulties of children with Asperger's syndrome can be just as significant as difficulties of children with other diagnoses on the autism spectrum, such as high functioning autism.
The difference between the diagnosis of Asperger's syndrome and autism can be very ‘technical’ – based on whether the child did or did not have delay in development of their language abilities.
Children are diagnosed with Asperger's syndrome if they do not have a delay in development of their language abilities and if they do not have general developmental (or intellectual) delay, while children are given a diagnosis of autism if they did develop language later, or if they have a learning disability.
The most important diagnostic distinction is that language is not a problem for children with Asperger syndrome and they don’t have learning difficulties.
However, once children develop speech, the support needs and strengths of children with Asperger's syndrome and high functioning autism tend to be similar. It is therefore expected that the diagnosis of Asperger's syndrome will be no longer used in the future, and a generic term ‘autism spectrum condition’ will be used instead.
Most children with Asperger syndrome attend mainstream schools and can make good progress, but a diagnosis is important so that help can be targeted appropriately.
What causes Asperger's syndrome?
The exact causes of Asperger's syndrome are still not yet fully understood. Research suggests that there is a genetic influence that increases the child’s risk of having an autism spectrum condition. For example, if one child in a family has autism, a sibling has a three to five per cent chance of also having the condition or a related problem, such as a language disorder. This is a much higher rate than in the population as a whole.
There are also many other theories about possible causes of autism spectrum conditions, however none of these have been proven by scientific research. For example, autism spectrum conditions have been previously linked with MMR vaccination, but several large research studies investigated this in depth and have not found any such link.
The possible impact of diet has also been suggested to be one of the causes, but again this has not been proven to be the case when this was investigated further.
A concern has been raised about the increasing rate of children being diagnosed with autism spectrum conditions now as compared to the 1980s. However, it is believed that this is likely to be due to increased awareness and better recognition rather than a genuine increase in the number of children.
What are the signs and symptoms of Asperger's syndrome?
Because Asperger's syndrome is an autistic spectrum disorder (ASD), the signs and symptoms tend to be similar as those of autism.
There are a range of early signs that parents tend to report. These include a child’s avoidance of eye contact, a child’s different way of communication, for example the child may not be sharing their interest or curiosity with others, although they may be able to request what they want.
Young children with autism spectrum may also have reduced non-verbal communication, and may not point or gesture. Some parents notice that the child’s play may be different to that of their peers, for example lacking in creativity and imagination, although children can excel at more structured activities such as puzzles or LEGO. Many children with suspected Asperger's syndrome may have difficulty in joining with other children and may prefer to play alone or with adults.
Children with Asperger's syndrome do not show delay in their development, and in fact can often develop many skills ahead of their peers (for example children with Asperger syndrome can have advanced language skills and be precocious readers).
Their difficulties are therefore often not formally recognised until later on, when the demands of their environment increase, for example as they are transitioning to secondary school.
The delay in diagnosing a child’s difficulties is also often caused by people thinking that children will ‘grow out of it’. In some cases a child’s difficulties are attributed to their personality or other issues, such as shyness or ‘being naughty’.
Although difficulties of children with Asperger's syndrome are often perceived to be a lot milder, than those of children with autism, their impact must not be underestimated.
Children with Asperger's syndrome are often very socially motivated and very keen to make friends and ‘fit in’ with their peers and their difficulties with initiating and maintaining social relationships often result into those children feeling lonely and socially isolated.
Children with Asperger's syndrome can also be greatly troubled due to being misunderstood. For example, as they are often so precise, they might, with best intentions, correct others, and then get in trouble for being perceived as inappropriate.
Many children with Asperger's syndrome find change upsetting and often prefer familiar routines, which enable them to understand and know what is going to happen every day.
In school, this may lead to a child being seen as uncooperative or difficult. They might, for instance, become very anxious when ask to sit on a different place in class. Some children will develop intense interests, which they prefer to engage with most of the time and can become distressed if interrupted.
Sensory sensitivities are another common problem. This can mean a child’s sense of sight, sound, smell, touch or taste is intensified (hyper-sensitive) or under-sensitive (hypo-sensitive). For example, some children can find certain sounds (such as vacuum cleaner) or textures (such as certain fabrics) very uncomfortable, or even distressing.
However, it is also important to recognise specific strengths that children with Asperger's syndrome often present with. For example, they can have much better attention to detail, may be very precise, trustworthy and reliable.
Some people report that a child with Asperger's syndrome would never lie or break a promise they have given. It is also possible to help children to channel their intense interests into developing useful skills.
How is Asperger's syndrome normally diagnosed?
In a lot of cases receiving a diagnosis for a child can be very helpful, as it enables parents, as well as others, to understand and support the child better.
As children with Asperger's syndrome tend to be often so bright and academically very able, their social difficulties can often be misunderstood and perceived as the child being ‘naughty’ or deliberately difficult.
Formal diagnosis can help with this kind of misperception and the child can benefit from range of proactive strategies which can be implemented to help them.
Diagnostic assessment can also help to clarify if a child requires any extra support or resources for their special needs. Input from voluntary organisation and opportunities to meet parents of children with similar difficulties can also be a source of great support.
The assessment of Asperger's syndrome tends to be conducted at child developmental centres or child and adolescent mental health services by professionals such as paediatricians, psychologists, speech and language therapists or psychiatrists.
It usually involves detailed interviews with the child’s parents/carers with focus on the child’s early development and current behaviour, direct play assessment with the child and collecting information from the child’s nursery or school.
The child’s GP can refer them to an appropriate specialist.
How is Asperger's syndrome normally treated?
There is no known cure for conditions on the autism spectrum (including Asperger's syndrome). However, there have been many useful approaches and programs developed to help the child with specific difficulties which may be impacting on them or their family’s quality of life.
Some programs tend to focus on addressing the primary difficulties associated with Asperger's syndrome.
This includes interventions aimed at helping the child to develop appropriate social skills (such as social skills training) or specific strategies to teaching the child to develop a more appropriate from of behaviour or to developing insight into a particular social situation (such as using strategies such as social stories or comic strip conversations).
Other approaches are aimed at eliminating the secondary difficulties children with Asperger's syndrome tend to experience. For example, children with Asperger's syndrome may be more vulnerable to being bullied or socially isolated and specific management plan addressing these important issues can therefore be essential.
Children with Asperger's syndrome can be very effectively supported through people around them having an increased awareness of their condition, their support needs and their unique profile of their strengths and difficulties.
An intervention that helps one child may not be suitable for another, so parents should always seek professional guidance. Parents are advised to be cautious about any treatment that claims to be a ‘cure’ for autism.
What happens next?
Asperger's syndrome affects every child in a different way.
Many children with Asperger's syndrome develop a range of coping strategies and grow up to lead relatively independent lives. Others may be more successful in some areas of their life but need long term support in other aspects to ensure they lead a fulfilling life.
When children are younger it can be difficult to predict how their particular difficulties will develop as they get older.
There can also be times in life when their difficulties may be more apparent, for example during puberty or transition to secondary school or adulthood.
It is helpful to be aware that young people with Asperger's syndrome are at increased risk of developing other difficulties, in particular anxiety, depression or behavioural problems. These conditions are not part of Asperger's syndrome and are often treatable, so it is important to seek professional advice if concerns arise.
While it is beneficial to help children with areas of their difficulties, it is equally as important to support children in the areas of their strengths. It is often the child’s strengths that increase their quality of life, help them to achieve their potential and contribute to society.