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How to Identify Atypical Aspergers Syndrome
The incidence of Asperger syndrome is increasing. Asperger’s is one of the autism spectrum disorders or ASD. Whenever we see a spike in the incidence of a disorder, I always ask, “Is this disorder/syndrome occurring more often? Or is it just being diagnosed more often? Is it the new ‘fashionable’ diagnosis?” These are important professional questions. Labels and diagnoses can shape the future for better or worse. We should not take the diagnosis lightly. The diagnosis has many consequences.
More often I see elements of Asperger syndrome in children, but the absence of some key identifying symptoms. The diagnostic criteria listed in the Diagnostic and Statistical Manual IV (DSM-IV, a manual approved by the American Psychiatric Association) are far too long to reprint in this article. Some highlights are as follows:
1. Qualitative deterioration of social interaction.
2. Restricted repetitive and stereotyped behaviors, interests and activities.
3. The disorder causes clinically significant impairment in social, occupational, or other important functional areas.
4. There is no significant general delay in language (e.g. single words used by a 2-year-old, communicative expressions by a 3-year-old).
5. In childhood, there is no clinically significant delay in cognitive development in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction) and environmental curiosity.
6. The criteria for another specific pervasive developmental disorder or schizophrenia are not met. (1)
You can search the web or your library for a more detailed list of diagnostic criteria.
I use the term “atypical Asperger syndrome” to refer to children who seem to meet some of the criteria, but not all. Things just don’t seem right for these kids. They just don’t interact like other kids.
Atypical Asperger’s is best discussed by comparing it to some other possible diagnoses that we might rule out. They are as follows:
· Social Anxiety Disorder: Children with this disorder may seem quite shy. They hesitate to interact with other children. They prefer the company of adults. Differentiating this from atypical Asperger’s, a child with Asperger’s is not remotely upset, worried or bothered about not belonging to the group. Or they belong to the group but remain somewhat permanently distant. They can play side by side with other children without actually interacting with another child.
· Low intellectual functioning: At first glance, an atypical Asperger’s child may appear dull or unintelligent. A child with low intellectual functioning usually does poorly in school and requires basic skills classes. However, a child with atypical Asperger’s is usually bright. They do well in tests despite appearing lost or disinterested.
Children with Asperger’s syndrome typically have poor eye contact, limited speech, are tangential, and prefer social isolation. They lack the spontaneous drive to share pleasure, interests, or accomplishments with others. They also lack social or emotional reciprocity.
I see atypical children with Asperger’s who have good eye contact. They are often able to talk to me in the office. They often do this better in the office because I’m an adult. Parents and teachers report that these children are less adept at conversing with their age group. They may spontaneously share their experiences or achievements, but often at inappropriate times, and bring them into conversation somewhat randomly. And even though they’re bright, I wouldn’t be very interested in what they’re talking about at their age. They appear immature because they are socially immature.
For some reason, a child with Atypical Asperger’s doesn’t seem to be interested in athletics, nor is he very good at it. I don’t fully understand the neurology involved, but I suspect a connection.
A fashionable syndrome?
I was discussing Asperger’s with my 24 year old son just last week. We looked at the homes of America’s richest technologists, Bill Gates, Steve Jobs and the “Facebook man” Mark Zuckerberg. Our conversation led us to “how many of these very bright and creative men have Asperger’s”. And we have to make an important point, just because someone seems socially awkward doesn’t mean they have any disorder, let alone asperger’s. It was just a conversation. I don’t remotely diagnose any of these people, and I don’t know if any of them have some version of Asperger’s syndrome. The thing is, though, she told me that in her 20s it has become “fashionable” to say you have Asperger’s. It’s a kind of badge of honor and an easy explanation for their “quirks” now in social situations. Bars and clubs use this to create an aura of “intellectual elite” associated with themselves. I see it as saying “I really am better and smarter than you, and there’s no way you can understand me, so don’t even try.” It’s the new “I’m a geek” announcement. Remember when being called a nerd was an insult? Remember when it became a badge of honor years later? This also shows that more pronounced cases of adult atypical Asperger syndrome occur in creative people. I don’t think the incidence is higher in fair people than in less fair people. We simply notice it more because we generally notice the high achievers more than the low achievers.
This may seem strange or unusual at first glance. But think about how often you hear people refer to “my ADD.” I hear this all the time. It has become an excuse for everything. Whenever someone forgets, doesn’t complete a project, or doesn’t answer a phone call right away, he lets you know that it’s ADD there. So to think that the now fashionable disorder or “disorder du jour” is something called Asperger’s doesn’t surprise me in the least. Media and contemporary fashion affect us as a society. All autism spectrum disorders are “fashionable” in the media.
And this suggests concern. Certain diagnoses are popular. Think about this timeline. A popular diagnosis in the 1980s was “chronic fatigue syndrome”. I bet you forgot that. When was the last time you heard of someone having it? Not recently, eh. Where did it go? What was the cure? In the 1990s, ADD and ADHD flourished, even though we were talking about them in the 80s. They have also lasted well. But in the 2000s, we started seeing a lot of children with bipolar disorder. When I started in this field in the 1980s, this diagnosis was limited to adults. It was expanded. In the end, it became an all-too-often used diagnosis. Today, all diagnoses of autism spectrum disorder (ASD) are more common. Asperger’s syndrome and what I call atypical Asperger’s syndrome fall under the category of ASD. We must remember that diagnoses can carry educational and social baggage. This baggage can be useful or limiting. Hiding behind a diagnosis can limit growth and development. A diagnosis can improve or damage self-esteem. A correct diagnosis can lead to understanding and open up possibilities.
I think I see a lot of atypical aspergers in my practice. The truth is that we are all different from each other. The idea that there is a way to be, grow and develop in childhood or adulthood is inaccurate. We all operate on a scale. Atypical Asperger’s is simply to a different degree than most people are used to.
Here are some basic considerations if you suspect your child may have Asperger 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 inappropriate times.
- He doesn’t seem too bothered about being “on the outside” of things socially.
- He is preoccupied or his concentration on certain activities is abnormal or unusually intense.
- He is interested in parts of things in a way that others are not.
- His conversation extends to things that are completely of no interest to others, and he doesn’t notice.
This is not an exhaustive or comprehensive list. But it’s a good start. Get a comprehensive assessment if you think this is a problem.
Feel free to contact me for help with evaluation or treatment. Even if you just ask me by email, I’m 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.
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