Could Asperger's Syndrome be inherited?
Some research shows that there are strikingly similar features in first or second degree relatives on either side of the family, or the family history includes “eccentric” individuals who have a mild expression of the syndrome. There are also some families with a history of children with AS and classic Autism. Should a relative have had similar characteristics when younger, they have a unique advantage in helping the child – they know what they are going through. There is no formal identification of the precise means of transmission if the cause is genetic, but we do have some suggestions as to which chromosomes may be involved. As our knowledge of genetics improves, we may soon be able to predict the recurrence rate for individual families.
Could a difficult pregnancy or birth have been a cause?
Some studies state that quite a high percentage of cases had a history of natal conditions that might have caused damage. But, in general, pregnancy may well have been unremarkable. However, the incidence of obstetric abnormalities is high. No one factor can be identified, but labour crises and neonatal problems are recorded with a significant number of children with AS. There is also a greater incidence of babies who are small for gestational age, and mothers in the older age range. It is recognised that there are three principal causes of Asperger’s Syndrome – genetic factors, unfavourable genetic events, and infections during pregnancy or early infancy that affect the brain.
Is there a specific area of the brain that is Dysfunctional?
There is increasing evidence to suggest that the frontal and temporal lobes of the brain are dysfunctional.
Could we have caused the condition?
Asperger’s Syndrome is not caused by emotional trauma, neglect or failing to love your child. The research studies have clearly shown that AS is a developmental disorder due to a dysfunction of specific structures and systems of the brain. These structures may not have fully developed due to chromosomal abnormalities or may have been damaged during pregnancy, birth or the first few months of life.
Can Asperger's Syndrome occur with another disorder?
The simple answer to this question is YES. The symptoms of AS have been recognised in people with other conditions and disorders. Once a single diagnosis of AS is confirmed, it is wise to continue the diagnostic process to see if there is another specific medical condition associated with the AS.
What is the difference between the syndrome and the normal range of abilities and personalities?
The normal range of abilities and behaviour in childhood is quite extensive. Many children have a shy personality, are not great conversationalists, have unusual hobbies and are a little clumsy. However, with AS the characteristics are qualitatively different. They are beyond the normal range and have a distinct pattern (see diagnostic scale in Information Sheets).
Could the pattern be secondary to a language disorder?
If a young child has difficulty understanding the language of other children and cannot speak as well as their peers, then it would be quite understandable for them to avoid interactions and social play, as speech is an integral part of such activities. However, the child with AS has more complex and severe social impairments, which identify the syndrome from other disorders.
Can Asperger's Syndrome occur with Attention Deficit Disorder?
These are two distinct conditions, but it is possible for a child to have both. They have specific differences, but there are some similarities, and a child can have a dual diagnosis and require treatment for both conditions.
What is the difference between High Functioning Autism and Asperger's Syndrome?
Some children have the features of autism in early childhood and then develop the ability to talk using complex sentences, develop basic social skills and an intellectual capacity within the normal range. This group was first described as having High Functioning Autism. It is most likely to be used as a term for those who had a diagnosis of autism in their early childhood. It is less likely to be used for children whose early development was not consistent with classic autism. Both autism and Asperger’s Syndrome are on the same seamless continuum, and there will be those children who are in a diagnostic “grey area”, where one is unsure which term to use.
Could Asperger's syndrome be a form of schizophrenia?
These are again, two distinct conditions. The chances of a person with AS developing schizophrenia are only marginally greater than for any individual. Some people with AS are wrongly diagnosed with schizophrenia, when they have extreme stress, anxiety and depression related to their AS. A false diagnostic trail is easily created and it is important to re-trace the steps and see what is causing the stress and anxiety for the person with AS.
Do girls have a different expression of the syndrome?
The boy to girl ratio for referrals for a diagnostic assessment is about ten boys to one girl. However, the evidence indicates that the actual ratio of diagnosed children is 4 boys to one girl (this is the same ratio as occurs with classic autism). Why are so few girls referred for a diagnosis? In general, boys tend to have a greater expression of social deficits, whereas girls tend to be relatively more able in social play and have a more even profile of social skills. Girls seem to be more able to follow social actions by delayed imitation because they observe other children and copy them, perhaps masking the symptoms of Asperger’s Syndrome. (See Tony Attwood’s Paper on Girls in our Information Sheets section).
How can you reduce the person's level of anxiety?
A person with Asperger’s Syndrome is especially susceptible to high levels of anxiety, and this can only be reduced by practical strategies to cope with the issues causing the anxiety. Sensory issues, social skills and the need for structure and routine can cause unbearable stress and anxiety and this increases the expression of their Asperger’s Syndrome itself, thus causing a vicious circle. Stress management programmes can help minor levels of anxiety – providing a sanctuary without social or conversational interruption and using relaxation techniques. If a person becomes increasingly anxious or agitated, it may help to start an activity that requires physical exertion (e.g. a trampoline or swing). Offering a child an alternative to the playground at break-time can be invaluable, and using specific ways (such as sending the child to the school office with a message) to give the child a break from the classroom. It helps if the teacher can establish a special code with the child with AS, so that they can signal their anxiety without drawing attention to themselves. We recommend Cognitive Behaviour Therapy as an excellent way to reducing anxiety for people with Asperger’s Syndrome.
Is the person likely to become depressed?
Clinical evidence shows that there is a greater risk of depression in people with AS. In early childhood the person may be less concerned about their differences to other children. During adolescence they start to become more interested in socialising with others and become acutely aware of their difficulties. The most common cause of depression is the person with AS wanting to be like others and to have friends, but not knowing how to succeed. Should one suspect that the person with AS is depressed, it is essential that they obtain a referral to a psychiatrist who is knowledgeable in Asperger’s Syndrome and obtain treatment. Treatment for depression involved conventional medicine, but should also include programmes to deal with the origin of the depression.
What are the changes we can expect during adolescence?
The physical changes of adolescence are likely to occur at the same age as for their peers, but young people with Asperger’s Syndrome may be confused by such changes. During the hormonal changes and increased stress associated with adolescence, the teenager may have a temporary increase in their expression of AS. Parents need to be supportive and patient, and remember that this is a difficult time for virtually all children. Some of the emotional changes of adolescence may be significantly delayed in children with AS, and while other teenagers are intent on romance and testing the rules, the teenager with AS still wants simple friendships, has strong moral values and wants to achieve high grades. They can be ridiculed for these qualities, but it is important to explain that they are valuable qualities, not yet recognised by others. Some traits of adolescence can occur later than usual and extend well into a person with AS’s twenties, thus the emotional changes of adolescence are often delayed and prolonged.
Can the person develop normal relationships?
In early childhood, a child with AS may need to be given instructions on the different ways of relating to family members, to a teacher, to friends and to strangers. Teenagers with AS can be delayed in their social/emotional maturity compared to the other children in their class. It may be necessary to repeat some school programmes on human relationships and sexuality when the person with AS has reached that stage of their emotional development. With a prolonged emotional adolescence and delayed acquisition of social skills, the person may not have a close and intimate relationship until much later than their peers. Many people with AS have loving relationships, but the partners may need counselling on each other’s background and perspective. One could describe these relationships as similar to those between people of two different cultures, unaware of the conventions and expectations of the other partner.
Are people with Asperger's Syndrome more likely to be involved in criminal activity?
Some people with AS have found themselves before the criminal justice system for a variety of offences that are usually related to their special interests, sensory sensitivity or strong moral code. If a person’s special interest is of a dangerous nature it can sometimes lead them into unusual crimes associated with that interest. The courts are becoming increasingly aware of the nature of AS and are responding accordingly. More often than not, individuals with AS are more likely to be victims than offenders. Their naivety and vulnerability make them easy targets.
What should we look for in a school or teacher?
What are the attributes of a good school? Most important is the personality and ability of the class teachers and their access to support and resources. It is not essential that the teacher has experience of similar children, as each child with AS is unique and a teacher uses different strategies for each individual. It is very important to find as small-sized a class as possible, to have a quiet, well-ordered classroom, with an atmosphere of encouragement not criticism, and to have practical support from the school administration. It is important to maintain consistency for the child with AS, so try not to change school unless absolutely necessary once a child is settled.
How do you share the news?
This varies according to each child and their circumstances. For some it may help if the diagnosis becomes public, while for others it may be preferable that they are not distinguished from other children. A principle of who needs to know is considered to be useful. There are classroom activities that can be used to help other children to understand the condition, and how to help their classmate with AS. At home, it will become apparent to siblings that a diagnosis has been reached, and it is important to explain things properly to them. There are some useful books on this topic (see www.jkp.com), also local help groups may run workshops for siblings. How do you tell the child themselves that they have AS? The answer may be to tell the child when they are emotionally able to cope with the information and want to know why they have difficulties in situations that other children find so easy. It is important to give the person with AS a sense of their many positive qualities, and to give examples of the many scientists and artists who have AS and have used these qualities for great achievements. Once the person knows they have AS it can provide a sense of relief and understanding.
What are the advantages of using the term Asperger's Syndrome?
If the term Asperger’s Syndrome is used it can avoid misunderstandings in relation to the use of the term autism. Many people have a negative association with the term autism, so it is good to use a different one. When a child is said to have Asperger’s Syndrome, the usual response is “I’ve never heard of that. What is it?” The reply can simply explain that the child has a neurological condition which means that they are learning to socialise and understand the thoughts and feelings of other people, have difficulty with a natural conversation, can develop an intense fascination in a particular area of interest, and can be a little clumsy.
These FAQ’s are abridged from Tony Attwood’s book: Asperger’s Syndrome, A Guide for Parents and Professionals. We are extremely grateful to Tony for allowing us to use his material.