Pervasive Developmental Disorder: Asperger Syndrome Last Updated

Physical findings

Typical physical findings in children with Asperger syndrome include the following:

Lax joints are often observed (eg, an immature or unusual grasp for handwriting and 

other fine hand movements).

Clumsiness is common.

Affected children may exhibit anomalies of locomotion, balance, manual dexterity, 

handwriting, rapid movements, rhythm, and imitation of movements.

Individuals exhibit impaired ball-playing skills.

Causes: Although its etiology is unknown, Asperger disorder is a behavioral syndrome caused 

by one or more factors acting on the CNS. Reports of families with multiple members meeting

the criteria for this disorder indicate a genetic contribution to development of the disorder.

Asperger disorder and autistic disorder may or may not be related genetically.

 

DIFFERENTIALS

Section 4 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

Miscellaneous

 

Bibliography

Adrenal Hypoplasia 

Birth Trauma 

Child Abuse & Neglect: Dissociative Identity Disorder 

Child Abuse & Neglect: Physical Abuse 

Child Abuse & Neglect: Posttraumatic Stress Disorder 

Child Abuse & Neglect: Psychosocial Dwarfism 

Child Abuse & Neglect: Reactive Attachment Disorder 

Child Abuse & Neglect: Sexual Abuse 

Cognitive Deficits 

Conduct Disorder 

Cornelia De Lange Syndrome 

Fetal Alcohol Syndrome 

Fragile X Syndrome 

Head Trauma 

Hearing Impairment 

Human Immunodeficiency Virus Infection 

Other Problems to be Considered: 

Basic phonological processing disorder

Callosal dysgenesis

Catatonia

Cerebellar dysfunction

Dyslexia

Fahr syndrome

Hyperlexia

Interventricular hemorrhage

Leukodystrophy

Multiple sclerosis

Nonverbal learning disability

Personality disorder

Pragmatic language disorder

Right cerebral hemisphere damage or dysfunction

Schizoid personality

Semantic-pragmatic processing disorder

Sensory integration disorder

Substance abuse

Toxicant-induced encephalopathy

Traumatic brain injury

Triple X syndrome

 

WORKUP

Section 5 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

Imaging Studies: 

Computed tomography

CT scanning cannot be used either to diagnose or rule out Asperger disorder because no consistent 

findings are evident in people with this condition. Rather, CT can aid by excluding treatable conditions in 

the differential diagnosis such as neurological and neurosurgical disorders (eg, tumors).

Head analysis inconsistently demonstrates enlargement of the third ventricle and diminution of the 

caudate nucleus.

Magnetic Resonance Imaging

MRI can uncover a variety of deficits, but results are inconsistent.

MRI helps demonstrate cortical defects in the right-central perisylvian area and incomplete formation of 

the posterior-inferior frontal gyrus (ie, pars opercularis, pars triangularis).

MRI demonstrates the following:

Inferior precentral gyrus and the anterior portion of the superior temporal gyrus, resulting in a 

widening of the sylvian fissure and a partial exposure of the insular cortex

Hypoplasia of the right temporo-occipital cortex

Small gyri of the posterior parietal lobes

Enlargement of the right lateral ventricle

Diminished size of the midbrain and medulla oblongata

Positron emission tomography

Positron emission tomography (PET) scanning reveals multiple deficits in some individuals.

With F-18 2-deoxyglucose, the anterior rectal gyrus of some people with Asperger disorder is larger on the 

left than on the right, opposite the asymmetry seen in most people.

Other patients exhibit an increased glucose metabolic rate in the right posterior calcarine cortex and a 

decreased glucose metabolic rate in the left posterior putamen and left medial thalamus.

For more information on imaging studies, see 

PET Scanning in Autism Spectrum Disorders

.

Other Tests: 

Audiography is indicated to rule out auditory discrimination deficits.

 

TREATMENT

Section 6 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

Consultations: 

Consult a neurologist for examination and neuropsychology testing.

Neuropsychological assessments should focus on both simple and complex problem-solving tasks, using 

such tests and scales as the Wisconsin Card Sorting Test, the Trail-Making Test, and the Stanford-Binet 

Scale. Such diagnostic measures can demonstrate marked deficits in verbal and nonverbal functioning 

and intelligence level.

Neuropsychological assessment is likely to demonstrate frontal system dysfunction.

Consult with an otolaryngologist, audiologist, and speech pathologist to exclude treatable auditory and vocal 

system anomalies. Speech testing helps assess children with developmental disabilities, and speech therapy is

often helpful.

Consult with physical and occupational therapists because therapy often improves the handwriting and other fine 

motor activities of patients with lax joints and unusual grasps. Sensory integration therapy reportedly helps some

individuals.

Activity: 

Observe patients walking and running. Adult patients may model appropriate motions to improve the

coordination of their upper and lower extremities.

Helping patients learn to catch and throw balls proficiently can facilitate their ability to participate in team sports 

and thereby enhance their social skills.

Wearing sunglasses and avoiding intense light may help children with Asperger disorder who exhibit 

photosensitivity.

Remedial exercises may improve handwriting. Alternatively, use of assisted technology (eg, laptop computer)

often helps.

Using earplugs may also help children who exhibit extreme intolerance or sensitivity to sound.

 

MEDICATION

Section 7 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

Many pharmacologic agents (eg, antipsychotics, selective serotonin reuptake inhibitors [SSRIs], clonidine, naltrexone) 

have been tried to improve some of the symptoms associated with Asperger disorder and related conditions; these 

symptoms include stereotyped movements, self-injury, hyperactivity, and aggression. Recent studies suggest SSRIs

help treat repetitive behaviors, impulsivity, irritability, and aggression. Controlled clinical trials, based on well-diagnosed

populations, are needed to confirm the impressions that SSRIs and atypical neuroleptics may alleviate core symptoms 

of Asperger syndrome and related conditions.

No drugs are used routinely to treat Asperger syndrome. Pharmacologic interventions are used to treat comorbid

disorders, including attention problems, mood disorders, dysthymia, bipolar disorder, and obsessive-compulsive 

disorder.

 

FOLLOW-UP

Section 8 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

Complications: 

Depression and hypomania are common among adolescents and adults with Asperger disorder, particularly 

those with a family history of these conditions. An increased risk of suicide exists, with risks possibly rising in

proportion to the number and severity of comorbid maladies. Asperger disorder is probably undiagnosed in many

suicide cases because of (1) the dearth of awareness of the condition's existence and (2) the ineffective and 

unreliable tools used to identify it. Therefore, people with Asperger disorder who commit suicide are probably

reported as having other or undiagnosed psychiatric problems. In cases of unexpected suicide, Asperger 

disorder is a strong possibility.

People with Asperger disorder can have other neuropsychiatric disorders, including Tourette disorder, anorexia 

nervosa, and schizophrenia; treating such comorbid disorders may be beneficial.

Patients may lose employment because their impaired comprehension of social norms may lead to poor 

judgment in work site behavior (eg, speaking inappropriately to colleagues, bosses, or administrators).

Changes to a child's environment may exacerbate symptoms. Therefore, minimize separations if the child is 

fond of family members, teachers, and others.

Prognosis: 

Comorbid psychiatric disorders, when present, significantly affect the patient's prognosis.

Individuals tend to have a better prognosis when they have supportive families who are knowledgeable about 

Asperger disorder.

Individuals with Asperger disorder may be taught specific social guidelines, but the underlying social impairment 

is believed to be lifelong.

Patient Education: 

Individuals with Asperger disorder can often concentrate on activities for hours without interruption and can 

continue this concentration daily for years. With proper instruction, their talents can be developed enormously,

so identifying and nurturing their interests and abilities (eg, music, mathematics) at an early age is beneficial. 

While many children might refuse to practice a musical instrument for even a few minutes a day, a child with 

Asperger disorder may enjoy hours of daily practice. Skilled instruction is necessary to develop these talents

fully. Parents and teachers should creatively uncover skills, abilities, and talents; these talents may also help the

child earn respect from classmates.

Social behaviors in school settings

Teachers have many opportunities to help children develop appropriate social behaviors.

Children can learn to watch other children for social cues and for behaviors to imitate.

Teachers can model socially appropriate behavior and encourage cooperative games in the classroom.

Teachers can explain appropriate means of seeking help when the child demonstrates problematic social 

behaviors in the classroom.

Teachers may identify suitable friends for children and encourage prospective friendships.

Teachers may help children in challenging social situations by supervising breaks between classes and

lunchroom and playground activities.

Children may benefit from a full-time, trained, 1-on-1 teacher aide to shadow them in the classroom and to

coach appropriate behavior.

Because changes in schools, classrooms, and teachers may exacerbate symptoms, attempt to minimize 

alterations to the patient's schedule and educational environment.

Children, adolescents, and adults with Asperger disorder typically benefit from a weekly, therapist-guided, social 

skills group with peers.

Auditory integration training helps some children with social interactions.

Interaction with other children

Children may benefit from an organized club, chaperoned by adult leaders who provide advance 

preparation and a discussion forum.

Parents can help children learn appropriate play by modeling and rehearsing such skills as flexibility, 

cooperation, and sharing.

Parents should encourage an affected child to invite a friend to their home.

Communication and language strategies

Children can be taught to memorize phrases for specific purposes (eg, to open conversations).

Children can learn to seek clarification by asking people to rephrase confusing expressions. Encourage

children to ask that confusing instructions be repeated, simplified, clarified, and written down.

Encourage children, when appropriate, to admit that they do not know an answer.

Caregivers, through modeling, can teach affected children how to interpret the conversational cues of 

others to reply, to interrupt, or to change topics.

Since interpretation of metaphors and figures of speech is often difficult, caregivers should explain these 

language subtleties when they arise.

Children can be taught to refrain from vocalizing every thought.

When communicating a series of instructions to a child with this disorder, pause between each separate 

statement.

Role-playing may help a child learn to understand the perspectives and thoughts of other people. 

Encourage the child to stop and think how another person will feel before the child acts and speaks.

Some children with Asperger disorder may have good visual thinking abilities; they may be encouraged to 

visualize using diagrams and visual analogues.

Career counseling and orientation

Career choice is crucial for persons with Asperger disorder because social impairment limits their success 

in many occupations.

Career choices using technology, especially the Internet, are often particularly suitable for people with 

Asperger disorder. Computer science, engineering, and natural sciences are common career choices for 

individuals with this disorder. Other special interests may be developed into careers.

Individuals may need special help to prepare for job interviews and to maintain an appropriate demeanor 

in a work environment.

For excellent patient education resources, visit eMedicine's 

Brain and Nervous System Center

. Also, see 

eMedicine's patient education article 

Asperger Syndrome

.

 

MISCELLANEOUS

Section 9 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

Medical/Legal Pitfalls: 

Failure to consider comorbid movement disorders: Various rating scales, when used regularly, help identify and

differentiate among various movement disorders. These rating scales include the following:

Movement Disorders Checklist (see Figures 7 and 8 in 

Tardive Dyskinesia

)

Hillside Akathisia Scale (see Figure 6 in 

Tardive Dyskinesia

)

Timed Stereotypies Rating Scale (see Figure 10 in 

Tardive Dyskinesia

)

Prescription of drugs without indication: Regular administration of the Psychoactive Medication Quality 

Assurance Rating Survey (see Figure 5 in 

Tardive Dyskinesia

) helps ascertain the need for psychoactive 

medication use.

Failure to identify toxicity of medications: For example, regular administration of the Serotonin Syndrome

Checklist (see Image 1 in 

Pervasive Developmental Disorder: Autism

) helps identify early evidence of adverse 

effects of SSRIs.

Special Concerns: 

Individuals with Asperger disorder (and related conditions), their families, teachers, and communities benefit

from the experiences of other individuals with this disorder and from the experiences of their advocates. The

following organizations provide information and advice to persons with Asperger disorder and related conditions:

Asperger Syndrome Coalition of the United States (ASC-U. C.), Inc.

PO Box 49267

Jacksonville, FL 32240-9267

Telephone: [phone]

Email: [e-mail]

ASPEN®

Asperger Syndrome Education Network, Inc.

9 Aspen Circle

Edison, NJ 08820

Telephone: [phone]

Email: [e-mail]

Asperger Norfolk

Old Lion Cottage

Thurne, Great Yarmouth

NR29 3AP

United Kingdom

Telephone: [phone]

Individuals with Asperger disorder and their families benefit from intensive assessments and treatment 

interventions. Contact the above resources for information about assessment and treatment facilities located

near the patient.

Several other resources have been recorded in a recent manual for parents of young people with Asperger 

syndrome (Ozonoff, 2002). This excellent guide for lay people who encounter people with Asperger syndrome 

provides practical suggestions for day-to-day life.

The social deficits exhibited by many people with Asperger syndrome and related conditions remain major 

obstacles to their functioning in family, educational, occupational, and community settings. Research is needed 

to develop programs to train individuals in the nuances of social interaction.

The ability to communicate with groups with people can be developed. Toastmasters International, Inc. 

(www.toastmasters.org), is an organization of clubs to promote the communication and leadership skills of 

members. Some individuals with Asperger syndrome may develop special skills, such as interpretive reading 

and storytelling, by participation in the activities of Toastmasters. Toastmasters has local clubs around the world 

to help members become better speakers in public.

 

BIBLIOGRAPHY

Section 10 of 10   

 

 

Author Information

 

Introduction

 

Clinical

 

Differentials

 

Workup

 

Treatment

 

Medication

 

Follow-up

 

Miscellaneous

 

Bibliography

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