The incidence of Asperger's Syndrome is on the rise. Asperger's is one of the Autistic Spectrum Disorders, or ASD's. When we see a spike in the incidence of a disorder, I always ask the questions “is this disorder / syndrome occurring more frequently? Or, are we simply diagnosing it more often? Is it the new 'fashionable' diagnosis?” These are important professional questions. Labels and diagnoses can shape a future for the better or worse. We should not diagnose lightly. Many implications follow a diagnosis.
I am seeing with more frequency, elements of Asperger's Syndrome in children but an absence of some key identifying symptoms. The diagnostic criteria listed in the Diagnostic and Statistical Manual IV (DSM-IV, the manual authorized by the American Psychiatric Association) is far too lengthy to re-print here in an article. Some highlights are as follows:
1. Qualitative impairment in social interaction.
2. Restricted repetitive and stereotyped patterns of behavior, interests, and activities.
3. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
4. There is no significant general delay in language (eg, single words used by age 2 years, communicative phrases used by age 3 years).
5. There is no clinically significant delay in cognitive development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood.
6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. (1)
You can search on-line or at your library for a more detailed listing of the diagnostic criteria.
I am using the term “Atypical Asperger's Syndrome” to refer to children whom seem to meet some of the criteria but not all. Things just do not seem to click for these kids. They just do not engage the way other children do.
Atypical Aspergers may be best discussed by comparing it to some other possible diagnoses that we may be ruling out. They are as follows:
· Social Anxiety Disorder: Children with this disorder may appear quite shy. They are hesitant to engage with other children. They prefer the company of adults. In differentiating this from Atypical Asperger's, the Asperger's child is not remotely upset, concerned or bothered by the fact that they are not included in the group. Or, they are included in the group but remain somewhat permanently distant. They can play side by side with other children without really interacting with the other child.
· Low Intellectual Functioning: Upon initial observation, the Atypical Aspergers child may appear dull or lacking in intelligence. The low intellectual functioning child generally will perform poorly in school and require basic skills level classes. The Atypical Asperger's child however is most often bright. They do well on test respectively appearing lost or disinterested.
Asperger's Syndrome children typically make poor eye contact, speak in limited phrases, are tangential, prefer social isolation. They display a lack of spontaneous seeking to share enjoyment, interests or achievements with others. They also display a lack of social or emotional recipocracy.
I am seeing Atypical Asperger's children who make good eye contact. They are often capable of conducting a conversation with me in the office. They often perform this better in the office because I'm an adult. Parents and teachers report that these children are less skilled in conversation with their peer age group. They may spontaneously share experiences or achievements but often at appropriate times, interjecting such into a discussion somewhat randomly. And although they are bright, if I were their age I would not be very interested in what they talk about. They appear immature, because they are socially immature.
For some reason, the Atypical Asperger's child does not seem interested in athletics and also not very good at them. I do not fully understand the neurology involved but I'm considering a connection.
I was discussing Asperger's with my 24 year old son just last week. We were looking at the homes of America's richest tech guys, Bill Gates, Steve Jobs and the “facebook guy” Mark Zuckerberg. Our conversation led us to “how many of these very bright and creative guys have Asperger's.” And we must make an important point, just because someone seems socially awkward does not mean that they have any disorder at all, let alone Aspergers. It was simply a conversation. I am not diagnosing any of these individuals from afar and have no idea if any of them have any version of Asperger's Syndrome. The point though is that he told me that in his 20 something age group it has become “fashionable” to say that you have Asperger's. It is sort of a badge of honor and an easy explanation for ones “quirkiness” now in social situations. Guys in bars and clubs are using this to create an aura of “intellectual elite” associated to themselves. I see it as a way of saying “I'm really better and smarter than you and you could not possibly really understand me so do not even try.” It's the new “I'm a nerd” declaration. Remember when being called a nerd was an insult? Remember when it became a badge of honor years later? This also points out that the more evident cases of adult Atypical Asperger's Syndrome occurs in bright creative people. I do not believe that the incidence is higher in bright people than less bright people. We simply notice it more because we notice high achievers overall more than less achievers.
This may seem strange or unusual at first glance. But think of how often you hear people referring to “my ADD.” I hear this all the time. It's become the excuse for everything. Any time someone hopes, fails to complete a project or return a phone call promptly, they announce that it's there ADD. So to think that now the fashionable disorder or “disorder du jour” is something called Asperger's, does not surprise me in the least. We, as a society, are influenced by media and current fashion. All of the Autistic Spectrum disorders are in “fashion” in the media.
And this points to a concern. Certain diagnoses become popular. Think of this timeline. The popular diagnosis in the 1980's was “Chronic Fatigue Syndrome.” I bet you forgot about that one. When was the last time you heard of someone having it? Not recently, eh. Where did it go? What was the cure? In the 1990's ADD and ADHD came into full bloom, even though we were talking about it in the 80's. They've hung on pretty well too. But in the 2000's we began to see a lot of children with Bipolar Disorder. When I first began in this field in the 1980's this diagnosis was restricted for adults. The, it was expanded. Occasionally, it became an all too frequently used diagnosis. Today, the incidence of all of the Autistic Spectrum Disorder (ASD) diagnoses is seen with greater and greater frequency. Asperger's Syndrome and what I'm calling Atypical Asperger's Syndrome fall under the category of ASD. We must remember that diagnoses can carry education and social baggage. This baggage can be useful or limiting. Hiding behind a diagnosis can limit growth and development. Self-Esteem can be enhanced or damaged by a diagnosis. A proper diagnosis can lead to understanding and open up opportunity.
I believe that I'm seeing a lot of Atypical Asperger's in my practice. Truth is, we're all different from one another. Thinking that there is a way to be, grow and develop in childhood or adulthood is inaccurate. We all function within a range on a scale. Atypical Asperger's is simply on a different part of that scale than most people are accredited.
Here are some basic considerations if you question whether your child may have a form of Asperger's Syndrome:
- Your child is bright but does not interact well with peers.
- Your child does not have a normal filter when expressing himself. He says inappropriate things at appropriate times.
- He does not seem too bothered to be on the “outside” of things socially.
- He is preoccupied or his focus on certain activities is abnormal or unusually intense.
- He is preoccupied with parts of objects in a way that others are not.
- His conversation runs to things that are completely dis-interesting to others, and he fails to notice.
This is not an exhaustive or comprehensive list. But it's a good start. Get a comprehensive assessment if you think this may be a problem.
Feel free to contact me for assistance in assessment or treatment. Even if just to ask me a question via email, I am available.
Copyright 2010 John Hudome, all rights reserved.
References: (1) Desk Reference To The Diagnostic Criteria From DSM-IV-TR, Copyright 2000 American Psychiatric Association.