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Asperger's Disorder

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Asperger's Disorder
PSYC225: Abnormal Psychology
 

In 1943, Dr. Leo Kanner of the John Hopkins School of Medicine was the first to describe the “complex and puzzling disorder” (Prizant, 1982) known as autism.  A year later, a similar disorder was described by Austrian physician, Dr. Hans Asperger (Ozbayrak, 2007).  In 1994, this disorder was recognized in the DSM-IV as Asperger’s Disorder (ASA, n.d.), commonly referred to as AS.  AS is included in a group of developmental disorders, known as the autism spectrum disorders, which also include Autism, Rett Syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS).  Although very similar to Autism, those with AS are more “socially functional” (Wikipedia, 2007).

Many believe that Asperger’s isn’t a disorder and they therefore don’t think that it should be described in medical terms.  This leads to disagreement about the diagnostic criteria, causes, and possible treatments of AS.  As a result of such disagreements, there are many sets of diagnostic criteria for AS (Wikipedia, 2007):  the ICD-10, World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria, Gillberg Diagnostic Criteria, Attwood & Gray Discovery Criteria, and, of course, the DSM-IV.

Section 299.80 of the DSM-IV (Autism, 2007) defines Asperger’s Disorder by six main criteria.  There must be:

1.     Qualitative impairment in social interaction;

2.     Presence of restricted, repetitive, and stereotyped behaviors and interests;

3.     A result of clinically significant impairment in social, occupational, or other important areas of functioning;

4.     NO clinically significant delay in language;

5.     NO significant delay in cognitive development during childhood (other than social interaction); and,

6.     NO better explanation for the symptoms by another specific Pervasive Developmental Disorder or Schizophrenia.

Since there is so much disagreement in the diagnosis of this disorder, the prevalence of AS is not easily verified.  Asperger’s has been found in people of every race, economical background, and gender.  Although this is true, the occurrence of AS among different races is still debated, and no clear link has been made between an AS diagnosis and one’s economical background.  Age plays a small part in Asperger’s only because at a young age AS characteristics aren’t easily distinguished from those of neurologically typical people.  This results in the caretaker not realizing the possibility of the disorder at first, and then, difficulty in receiving a diagnosis for the child.  AS is not easily identifiable during early childhood, and many aren’t diagnosed until adulthood.  It usually lasts throughout one’s lifetime, although there have been cases in which it has been shown to be “cured,” or very close to it.

According to Wikipedia (2007), using the DSM-IV criteria, estimates have shown that two to three out of every ten thousand children have been diagnosed with AS.  However, another study (Ozbayrak, 2007), using Gillberg’s criteria for AS, has shown that in Sweden, the minimum prevalence of Asperger’s is thirty-six out of every ten thousand children.  This study has shown that AS may be much more common than it was once thought to be.  Gillberg (Wikipedia) estimates that thirty to fifty percent of all people with AS remain undiagnosed.

A study by Ehlers and Gillberg (Wikipedia, 2007) has found that males are four times as likely to be diagnosed with AS than are females.  This finding has also brought many questions into play.  It’s debated as to whether or not this statistic shows the actual rate of incidence.  Attwood (Wikipedia) believes that, because of gender differences, females may simply learn to better adapt to the norms of the world.  Difference in the handling of socialization is the main factor in Asperger’s; females are typically more socially adept, and “the female brain is predominantly hard-wired for empathy” (Wikipedia).  It is, therefore, understandable that females would learn to “compensate better for their impairments” (Wikipedia).  Because of these gender differences, it would make sense that results would show a lesser amount of AS diagnoses in females.  Although the Ehlers and Gillberg study (Wikipedia) showed a 4:1 male to female ratio, when borderline cases were included, the same study revealed that the male to female ratio was 2.3:1.

The direct cause of Asperger’s is unknown, but “a variety of explanations have been offered” (Comer, 2005).  Many different causes that may contribute to the development of this disorder have been found, though the causes may depend partly on the person being diagnosed.  Though AS and autism are different in many ways, the causes of each have been found to be very similar.  The most recognized cause links autism to genetics.  Positive links haven’t been made to specific “AS genes,” but it is known that multiple genes have a role in the predisposition of a person to such a disorder.

Differences in the size of parts of the brain have been linked to autism, specifically, enlarged amygdala, enlarged hippocampus, and significantly decreased brain stem size (Trivieri, 2002).  Abnormal development of the cerebellum has been linked to autism, along with a considerably decreased flow of blood throughout the brain (Trivieri).  Links to levels of certain chemicals in the brain have been made, too, especially neurotransmitters, such as serotonin.

Other factors such as prenatal circumstances or birth complications may influence the development of autism.  If the mother was exposed to toxic chemicals such as heavy metals before or during pregnancy, the chances of the child developing autism are higher.  The same is true if the mother had rubella or cytomegalovirus during pregnancy.  Postnatal occurrences have been shown to contribute as well.  A child’s risk of becoming autistic has been shown to increase if the child received a vaccination with mercury in it or had a serious infection during infancy.

It was once thought that certain characteristics of parents created an unfavorable environment for the development of the child and that this significantly contributed to the disorder (Comer, 2005).  Yet, there is no evidence to support this thought, and it is now believed to have a much smaller impact on the development of AS in a child.  It has been found, however, that this and other such home situations do affect how and if a child overcomes AS.

Many treatment options have been found to at least help in the elimination of Aspergian tendencies and sometimes even cure someone of Asperger’s altogether.  Because the causes of AS are so similar to those of autism, so too are the treatment options.  Just like there isn’t one specific cause, there isn’t one specific treatment.  Treatment options vary immensely, and which options are most effective depend on the person receiving the treatment.

As with any disorder, certain drugs have been found to keep the effects manageable—in autism, antidepressants and anti-anxiety medication; unfortunately, the causes are still there, whether we know what they are or not.  In many cases, drugs may help to keep the effects under control, but actions should be taken to find what other treatments will help, and, ultimately, replace such medications.

Perhaps the most important thing is for the parents to have continual support and learning about techniques to use at home.  Counseling for both the parents and the child has been found to be very beneficial.  Many behavioral approaches have been proven to help in autism cases, such as teaching appropriate behaviors while reducing negative ones (Comer, 2005).  Speech and physical therapy, as well as social and self-help skills training have been very rewarding.

Auditory integrative training has been found to help, also.  This is because, as Constantine A. Kotsanis, M.D., said, “Many autistics have highly sensitive hearing beyond the normal human range.  To an autistic individual, rain sounds like rocks falling on a roof.  This hypersensitivity can result in a number of problems, including blocking out other sounds, fear of noises and people, and an inability to concentrate” (Trivieri, 2002).  This type of training has been shown to help these individuals block out unnecessary sounds, concentrate better, and, overall, communicate with others.  Billie Thompson, Ph.D., says, “Auditory training gives autistic children the desire to communicate.  It allows them to hear sounds in a different way and can profoundly affect the way they learn and relate to others” (Trivieri).

Research has shown that thirty to sixty percent of autistic people benefit significantly from the use of vitamin B6 and magnesium (Trivieri, 2002).  Other B vitamins and zinc have also been shown to help, as well as detoxifying the autistic individual.  This detoxification clears the body of toxic chemicals they or their mother (during or prior to pregnancy) may have been exposed to.  Diet is a very important factor in the treatment of autism; many are allergic to milk, gluten, processed sugar, eggs, MSG, aspartame, and certain food dyes.  Not every autistic person is allergic to one of these, but most are allergic to something.  Behavioral changes should be observed as foods are added or taken away.

It is thought that pressure on certain parts of the brain may bring about the effects of Asperger’s Syndrome.  Though it hasn’t been found to be common in AS, “head banging” has been thought to be a way in which autistic individuals seek to relieve such pressure.  This is perhaps why craniosacral therapy has worked in many cases.  “Craniosacral therapy manipulates the bones of the skull and the underlying membranes to alleviate pressure and restrictions” (Trivieri, 2002).

Although every situation differs, the following is one story of a child with Asperger’s Syndrome, her parents, their struggles, and the continuing conclusion.

My parents were very excited to have their first child.  Mom had a perfect pregnancy and had the baby on her due date.  Although the labor was long and the delivery very difficult, she gave birth to a beautiful 9lb 3oz baby girl.  Mom was anxious to keep her first born close, but when she got tired, they took the little one to be with the other babies.  “I was a little puzzled when they brought her back a few hours later and asked if I minded her staying in my room, it seemed that her ‘screaming’ was keeping the other babies awake” (VanderKlok, 2006).  Then, when they were getting ready to take the baby home, Mom’s nurses quietly sat her down and spoke to her about remaining calm and that if there were any problems with the child to call a friend for help and to not get upset or abuse her.  After a long cry on the way home, Mom convinced herself that she was overreacting and that they probably gave that talk to all new mothers.

My parents had a smart daughter with great fine motor skills; she learned quickly and they never had to move items so she wouldn’t touch; she seemed to be content in doing whatever she happened to be doing at the time.  The only problem was the screaming.  They were told it was just colic, but after a year and a half, they began to wonder.  They also noticed that she never cried any tears, ever.

Mom and Dad were eager to show off their little girl to some friends who were having a get together.  But, they were truly concerned when, as each child showed up and joined in the play area, she withdrew farther and farther away until she was observing them from behind a tree.

They then decided that, although she wasn’t quite three, preschool and other children were probably the best remedy for a shy child, although “shy” was the last word that came to Mom’s mind when she thought of her; to her it seemed more “selective”.  When she walked her to and from school, they talked about everything she did and learned in school, so Mom was especially surprised when two teachers, who had observed them having an animated conversation, said they had never seen or heard the child speak.

About this time, she had a new baby brother, and she was very kind to him.  “I’m not sure what developed over the next few years but slowly my angel was slipping away.  It was very subtle, and everyone else seemed to have “reasonable” answers for why her behavior was changing.  There was no emotion or compassion” (VanderKlok, 2006).

This bright child, who had learned to read at such a young age, was now reading in a whisper and would not speak at all if someone else was in the room.  Her short-term memory was almost gone, obsessive behavior became the norm, and tantrums when she could not finish a started project became violent.  Mom and Dad searched for help.  She was taken to counseling, but when talked to one-on-one, she was almost normal.  They looked for a diagnosis, but anxiety was the only one they would give them.  A friend suggested that Mom look up information on autism and, although very high functioning, this diagnosis seemed to explain everything.

“I cannot go into detail about the everyday trauma we faced…” (VanderKlok, 2006).  She wasn’t able to put on clothes for lack of decision making, and then she couldn’t wear them because everything felt funny.  She loved school and teachers but wouldn’t enter the car, then the school, and then the classroom without a nudge.  “I remember curling up in a ball and crying in the gym before composing myself enough to drive home.  But my poor daughter, she spent a lot of time curled up in a fetal position under any chair or table she could find, anytime things were difficult for her mind to handle” (VanderKlok, 2006).  Still, they received no new diagnosis.  Each year, to each new counselor or teacher, they had to re-explain that there was no abuse, just an EI (Emotionally Impaired) diagnosis because nothing else seemed to fit.

In second grade, her teacher insisted they test her.  This teacher found ways to get her to finish projects and even leave the classroom after school so Mom didn’t have to wait half an hour for her to finish whatever she was doing.  Mom also met another mother at church who had an autistic child.  This mom explained that a diagnosis for children like theirs was very difficult, especially if the first psychiatrist didn’t label them autistic; even if they suspected it, it was very unlikely that any others would overrule the decision.  She also explained how important diet was, and within one week of eliminating all dairy, the glaze over Mom’s daughter’s eyes had diminished, and her short-term memory had started to return.  “She was out of the cloud; we had our child back, and there was hope” (VanderKlok, 2006).

Diet became a big part of the process of returning this child to her wonderful self: no food coloring, no preservatives, no dairy, and herbs to help with the anxiety.  This and “her sheer determination to never let anything stop her from her goal was the rainbow we needed” (VanderKlok, 2006).  In fourth grade, she started speaking to people; although slowly at first and barely audible, it was certainly a great start.  In fifth grade, a clinical hospital testing center diagnosed her with Asperger’s.  There was no question in their mind, and they said it was quite obvious.  Apparently, Autism and its testing had come a long way.

There were, and continue to be, many struggles in my life due to Asperger’s.  My parents especially struggled, but we’ve overcome the worst.  At times I have “relapses” and I know I’m not so-called “normal,” but I’ve come a long way.  My hope is to work with children who need love and a few breaks in their life.  Next year, I plan to travel abroad to begin in the pursuing of this dream.  I know there are many struggles yet to come my way, but I also know that it’s a miracle that I am who I am today.  God has blessed me with great parents and many others who have helped me to overcome Asperger’s to the point that most don’t even realize that I am an Aspie.

References

 

Autism in the Christian Home. (2007). What are the DSM-IV Diagnostic Criteria for Autism? Retrieved April 2, 2007, from http://www.autism-in-the-christian-home.com

ASA: Autism Society of America. (n.d.). Asperger’s Disorder (299.80 DSM-IV).  Retrieved April 2, 2007, from http://www.autism-society.org

Comer, R.J. (2005). Fundamentals of Abnormal Psychology (4th ed.). New York: Worth Publishers.

Ozbayrak, R.K., MD. (2007, February 18). Asperger’s Disorder Homepage. Retrieved April 2, 2007, from http://www.aspergers.com

Prizant, B.M. (1982).  Speech-language pathologists and autistic children: What is our role? American Speech-Language-Hearing Association.

Trivieri, Jr., L. & Anderson, J.W. (Eds.) (2002). Alternative Medicine: The Definitive Guide (2nd ed.). Berkeley, CA: Celestial Arts.

VanderKlok, D. (2006, April 29). Personal Interview.

Wikipedia. (2007, March 12). Asperger syndrome. Wikimedia Foundation. Retrieved March 26, 2007, from http://en.wikipedia.org/wiki/Asperger_syndrome