Asperger's Syndrome: Symptoms, Causes and Treatments

He Asperger syndrome It has children and adults who present an affectation in the social, communicative and imaginative area. Its main symptoms are: alterations in reciprocal social relations, interest in restricted and repetitive activities, routines or rituals, and lack of social skills.

It is a category that poses more problems as to its nosological validity since it is not proven that it is an entity other than autism or a subtype of the autistic disorder, since both have comparable qualitative deficits. However, what distinguishes it from other autistic disorders is the great ability they present in relation to language.

Asperger syndrome

As for prevalence, studies point to a higher incidence in children than in girls, the ratio is 8: 1 (8 children per girl).

History of Asperger's Syndrome

Hans Asperger In 1944, described a syndrome of characteristics very similar to the syndrome described by Kanner a year earlier, ie, autism . Many of the characteristics identified by this physician as central to the disorder have remained unchanged, such as the heterogeneous nature of the disorder, as well as its variable symptomatic manifestation in terms of the child's personality traits and learning experiences. Exposed in the school and family environment.

In the 1950s, these people were considered as subjects with a psychogenic disorder, with similar clinical presentation in all patients.

In some countries they considered that these subjects had a poor family treatment and were close to the psychosis . However, studies available since the 1970s showed that these assumptions were false and began to be understood as disorders of the development of certain childhood capacities such as socialization, communication and imagination. The international classifications placed them in the axis corresponding to other problems related to the development, as the Mental retardation .

Subsequently the term generalized disorders of development (TGD) was coined, however, this term was object of multiple critics as it is the fact to think that in these subjects the complete development is not altered.

Over time, different disorders were identified; The presence of partial pictures was recognized; The variability of symptoms was appreciated with age and degree of affectation; Its association with other developmental problems was described and it was accepted in a practically universal way that they were due to problems related to a cerebral malfunction.

It was not until the 1980s that the scientific community became interested in Asperger's syndrome. Lorna Wing, U. Fritz and Gillberg resume the diagnosis and begin to take it into account for clinical use.

In recent years the term Autism Spectrum Disorders has been incorporated, thanks to the contribution of L. Wing and J. Gould. This term refers to a continuum, not a category, in which qualitatively alters a set of capacities in social interaction, communication and imagination.

Diagnosis of Asperger's Syndrome

Asperger syndrome did not appear in the diagnostic classifications until 1994.

Both in the CIE (International Classification of Diseases) classification system developed by the World Health Organization, as in the DSM (Diagnostic and Statistical Manual of Mental Disorders), classification system of the American Psychiatric Association, Asperger has been classified and defined in criteria. However, it is true that as new editions have been emerging, some aspects have been modified.

The ICD poses the Asperger's syndrome classified within the section of disorders of psychological development in the generalized disorders of the development. Together with this, children's autism is classified as Atypical autism , he Rett syndrome And hyperkinetic disorder with mental retardation and stereotyped movements. Some criticize the inclusion of these other categories not mentioned in the DSM, because they are not valid.

With respect to DSM-IV-TR, it ranks within the section on Onset Disorder in childhood, childhood or adolescence in generalized developmental disorders along with Autistic Disorder, Rett Disorder, Childhood Disintegrative Disorder , Asperger's Disorder and unspecified disorder.

Finally, it is the DSM-5 which raises a different classification. Experts have decided that disorders previously included in generalized developmental disorders are really a single condition, so that this new category of Autism Spectrum Disorders encompasses the ancient Autism, Asperger's Disorder, Child Disintegrative Disorder and Generalized Developmental Disorder not specified, eliminating disorders of Rett and Disintegrative Disorder, previously included. The idea of ​​talking about"autistic spectrum"is a widely accepted idea that responds to the difficulty of categorically separating borderline cases between autism and Asperger's syndrome

Diagnostic criteria according to ICD-10

TO. Absence of clinically significant delays in the Language or cognitive development . Diagnosis requires that at two years it has been possible to pronounce single words and at least three years the child uses sentences suitable for communication. The capabilities that allow autonomy , a Adaptive behavior and the Curiosity about the environment Must be at the right level for normal intellectual development. However, the Motor aspects May be somewhat retarded and a clumsiness of movement (although not necessary for diagnosis) is common. Isolated special features are often present, often in relation to abnormal concerns, although they are not required for diagnosis.

B. Qualitative changes in Reciprocal social relations (Of the autism style).

C. An unusually intense and circumscribed interest Patterns of behavior, interests and activities restricted, repetitive and stereotyped , With criteria similar to autism, although in this picture the mannerisms and the inadequate preoccupations with partial aspects of the objects or with nonfunctional parts of the objects of play are less frequent.

D. The disorder can not be attributed to other types of generalized developmental disorders, Schizotypal disorder , To simple schizophrenia, to reactive disorder of childhood-type uninhibited attachment, to an ancestral personality disorder, or to Obsessive-compulsive disorder .

As we can see, ICD-10 includes the presence of stereotyped, repetitive behaviors and their restriction. In addition, the differential diagnosis of autism is the acquisition of language and cognitive development, which are often normal in children with Asperger's syndrome, who also do not present the communication problems associated with autism.

Diagnostic criteria according to DSM-IV-TR

TO. Qualitative alteration of social interaction , Manifested by at least two of the following characteristics:

1. Major alteration in the use of multiple non-verbal behaviors such as eye contact, facial expression, body postures and regulatory gestures of social interaction

2. Inability to develop relationships with peers appropriate to the level of development of the subject

3. Absence of the spontaneous tendency to share enjoyments, interests and goals with other people (eg, not show, bring or teach other people objects of interest)

4. Absence of social or emotional reciprocity

B. Restrictive, repetitive and stereotyped patterns of behavior, interests and activities manifested by at least one of the following characteristics:

1. Absorbent preoccupation with one or more stereotyped and restrictive patterns of interest that are abnormal, either by their intensity or by their purpose.

2. Apparently inflexible adherence to specific, nonfunctional routines or rituals

3. Stereotyped and repetitive motor mannerisms (eg, shaking or turning hands or fingers, or complex movements of the whole body)

4. Persistent preoccupation with parts of objects

C. The disorder causes a clinically significant impairment of social, occupational, and other important areas of the individual's activity.

D. There is no general delay of clinically meaningful language (eg, at 2 years of age use simple words, at 3 years of age uses communicative phrases).

AND. There is no clinically significant delay in cognitive development or development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment during childhood.

F. It does not meet the criteria of another generalized developmental disorder or schizophrenia.

General DSM-5 Criteria for Autism Spectrum Disorder

TO. Persistent deficiencies in social communication and social interaction in various contexts, manifested by the following, currently or by antecedents (illustrative but not exhaustive examples).

1. Deficiencies in emotional reciprocity, vary, eg;

- Abnormal social closure; Failure of normal conversation in both; Decrease in interest; Emotions or affections.

- Failure to initiate or respond to social interactions.

2. Deficiencies in nonverbal communicative behaviors used in social interaction vary:

- Verbal and non-verbal communication poorly integrated: anomalies of eye contact and body language or deficiencies in the understanding and use of gestures.

- Total lack of facial expression and non-verbal communication.

3. Deficiencies in the development, maintenance and understanding of relationships:

- Difficulties in adjusting behavior in different social contexts: difficulty in sharing imaginative games or making friends.

-Lack of interest in other people.

B. Restrictive and repetitive patterns of behavior, interests or activities, manifested in two or more of the following, currently or by antecedents:

1. Stereotyped or repetitive movements, use of stereotyped or stereotyped objects, eg simple motor stereotypies, alignment of toys or change of place of objects, echolalia and idiosyncratic phrases.

2. Insist on monotony, excessive inflexibility of routines or ritualized patterns of verbal or non-verbal behavior, eg: great anguish over small changes; Difficulty with transitions; Rigid thinking patterns; Greeting rituals; Need to take the same path or eat the same foods every day.

3. Very restrictive and fixed interests in terms of intensity or focus of interest: strong attachment or concern for unusual objects, overly circumscribed or persevering interests.

Four. Hyper or hyporeactivity to the sensorial stimuli or unusual interest for sensorial aspects of the environment; Apparent indifference to pain / temperature, adverse response to specific sounds or textures, excessive nudging or palpation of objects, visual fascination with light or movement.

C. Symptoms must be present in the early stages of the developmental period.

D. Symptoms cause clinically significant deterioration in social, work, or other important areas of normal functioning.

AND. These alterations are not best explained by intellectual disability or global developmental delay.

DSM-5 adds several specifications, one regarding the severity of the disorder and others regarding the existence or absence of an accompanying intellectual deficit, language impairment, association with another neurodevelopmental, mental or behavioral disorder or Existence of catatonia.

Characteristics of Asperger's Syndrome in Children

Asperger children are those who have reduced and absorbing fields of interest. They are generally good at Memory skills (Facts, figures, dates, times...), many stand out in the areas of mathematics and knowledge of the environment.

They use language in a slightly weird way and often take literal meanings from what they read or hear. That is, for example, they would not understand the phrase"the child was laughing", and would understand the meaning of leaving as such.

They prefer to have a routine and a structured environment. The bad behavior they usually present is motivated by the inability to communicate their frustrations and anxieties. They are people who need to feel protected, and demands love, affection, tenderness, care, patience and understanding. Within this framework they make great progress.

They appear to be for the most brilliant, happy and caring people and have a need to finish the tasks they have begun.

Asperger's Syndrome Treatments

Research conducted over time has concluded that those therapeutic techniques of choice for children with Asperger's syndrome are applied behavioral analysis for global interventions and applied behavioral analysis for specific interventions.

The former refer to those applied behavioral treatments that agglutinate a battery of techniques for an extended time.

As for the latter, behavioral interventions have been used to establish from the most basic conditions for learning, to complex behaviors such as language or academics.

Possible strategies for children with Asperger's

Taking into account all the strategies that have been discussed throughout this article, there are certain strategies that we can use with these children to help them adapt to life.

In principle, simple language should be used, using words and phrases that are easy to understand, as well as simple instructions, limiting the options to two or three items.

They are told to look at their faces when they speak, as well as try to keep the turn of words and listen. In addition, they are praised for any achievements they achieve.

It will try to introduce a certain flexibility in its routine, agreeing periods of time in which they can be dedicated to carry out the activities that interest to him.

They will be taught some strategies to deal with difficult situations, such as deep breathing or chill out .

conclusion

Although there have been many advances over this syndrome over the years, it is true that there are aspects that have not yet been clarified and specified. In addition, with the publication of the DSM-5 and the creation of the new category Autism Spectrum Disorders, it has contributed in some way to going back, in the sense that it may actually between Asperger's Syndrome and other disorders of this spectrum There are no palpable differences.

Bibliography

  1. Belloch, A., (2008), Manual of Psychopathology II , Madrid Spain. S.A. Mcgraw Hill.
  2. AMERICAN PSYCHIATRIC ASSOCIATION (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR . [Links]
  3. AMERICAN PSYCHIATRIC ASSOCIATION (APA). (2014). Diagnostic and Statistical Manual of Mental Disorders DSM-5 . [Links]
  4. ICD-10 (1992). Mental and behavioral disorders. London: Oxford University Press.
  5. Bauer, S. (1995). Asperger Syndrome through the lifespan. New York, The developmental unit, Genesee Hospital Rochester.
  6. López, R and Munguía, A. (2008). Asperger syndrome. Revista de Postgrado de Psiquiatría UNAH, vol. 1, no. 3.


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