Asperger’s DisorderAsperger’s Disorder

Ashleigh Pogue and Kayla RothAshleigh Pogue and Kayla Roth

What is Asperger’s Syndrome?What is Asperger’s Syndrome?

Considered to be a subtype of Pervasive Considered to be a subtype of Pervasive Development DisordersDevelopment DisordersCharacterized by limited interests or a Characterized by limited interests or a preoccupation with a certain subject that leads to preoccupation with a certain subject that leads to exclusion of other activitiesexclusion of other activitiesAlso involves language and communication skills Also involves language and communication skills impairmentimpairmentIs part of the Autism Spectrum DisorderIs part of the Autism Spectrum Disorder

- - Autism, Rett syndrome, childhood disintegrative disorder and PDD-Autism, Rett syndrome, childhood disintegrative disorder and PDD-NOSNOS

Overview of Asperger’sOverview of Asperger’s

First observed in children by Hans First observed in children by Hans Asperger in 1944Asperger in 1944

Young AS children generally have normal Young AS children generally have normal development in language skillsdevelopment in language skills

Motor development delays are usually the Motor development delays are usually the first to indicate the disorderfirst to indicate the disorder

Boys are three to four times more likely to Boys are three to four times more likely to have AShave AS

SymptomsSymptomsAS children are usually of normal to above-AS children are usually of normal to above-average intelligenceaverage intelligenceIn addition to a specific interest, the disorder is In addition to a specific interest, the disorder is characterized by differences in speech patterns, characterized by differences in speech patterns, poor expression recognition and poor expression recognition and underdeveloped motor skillsunderdeveloped motor skillsAre more social than children with classic autism Are more social than children with classic autism but are frequently rejected because if their but are frequently rejected because if their eccentric behavior and narrow interestseccentric behavior and narrow interestsAsperber’s if frequently comorbid with anxiety, Asperber’s if frequently comorbid with anxiety, depression, ADHD, tic disorders and OCDdepression, ADHD, tic disorders and OCD

CausesCausesA genetic component exists but a specific gene A genetic component exists but a specific gene has not yet been identifiedhas not yet been identified

Recent research suggests that there are specific Recent research suggests that there are specific interactions between multiple mutated genesinteractions between multiple mutated genes

The varied genes produce brain abnormalities The varied genes produce brain abnormalities which have been found to cause ASwhich have been found to cause AS

Brain defects are due to abnormal migration of Brain defects are due to abnormal migration of embryonic cells embryonic cells

These cells later form the neural connections for These cells later form the neural connections for thought and behaviorthought and behavior

Diagnosis and TreatmentDiagnosis and TreatmentDiagnosis criteria is included in the DSM-IVDiagnosis criteria is included in the DSM-IV

Some doctors consider AS to be a form of high-Some doctors consider AS to be a form of high-functioning autism (HFA) and not a separate functioning autism (HFA) and not a separate disorderdisorder

Treatment focuses on 3 core symptoms: Treatment focuses on 3 core symptoms: communication skills, repetitive routines and communication skills, repetitive routines and clumsinessclumsiness

The most effective treatments includes The most effective treatments includes numerous therapies, medication and parental numerous therapies, medication and parental training and supporttraining and support

DSM-IV CriteriaDSM-IV CriteriaDiagnostic criteria for 299.80 Asperger's Disorder Diagnostic criteria for 299.80 Asperger's Disorder 

A. Qualitative impairment in social interaction, as manifested by at least two of the following: A. Qualitative impairment in social interaction, as manifested by at least two of the following: (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction expression, body postures, and gestures to regulate social interaction (2) failure to develop peer relationships appropriate to developmental level (2) failure to develop peer relationships appropriate to developmental level (3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other (3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) (4) lack of social or emotional reciprocity (4) lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: manifested by at least one of the following: (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus that is abnormal either in intensity or focus (2) apparently inflexible adherence to specific, nonfunctional routines or rituals (2) apparently inflexible adherence to specific, nonfunctional routines or rituals (3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or (3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) complex whole-body movements) (4) persistent preoccupation with parts of objects (4) persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. important areas of functioning. D. There is no clinically significant general delay in language (e.g., single words used by age 2 D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). years, communicative phrases used by age 3 years). E. There is no clinically significant delay in cognitive development or in the development of age-E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. about the environment in childhood. F. Criteria are not met for another specific F. Criteria are not met for another specific Pervasive Developmental DisorderPervasive Developmental Disorder or or SchizophreniaSchizophrenia..

Medication TreatmentMedication TreatmentOften problematic to treat because of the Often problematic to treat because of the difficulty in distinguishing AS symptoms from difficulty in distinguishing AS symptoms from comorbid problemscomorbid problems

Research suggests that medication is effective Research suggests that medication is effective in treating comorbid symptomsin treating comorbid symptoms

A complete medical assessment must be A complete medical assessment must be performed and the patient must be closely performed and the patient must be closely monitored for side effectsmonitored for side effects

Stimulants, antidepressants, anti-anxiety Stimulants, antidepressants, anti-anxiety medications and treatments for Tourettes’ and medications and treatments for Tourettes’ and sleep disorders have been found to be effectivesleep disorders have been found to be effective

Medication TreatmentMedication Treatment

Additional TreatmentsAdditional Treatments

Social-Behavioral Learning StrategySocial-Behavioral Learning Strategy

SODA Strategy: Stop, Observe, Deliberate, ActSODA Strategy: Stop, Observe, Deliberate, Act

Developed to help children with AS learn social Developed to help children with AS learn social cues, process cues, and utilize social skills in cues, process cues, and utilize social skills in activitiesactivities

A baseline was used to compare behavior A baseline was used to compare behavior without SODA to behavior with SODAwithout SODA to behavior with SODA

Three dependent measures of replacement Three dependent measures of replacement behavior: participate in cooperative learning, behavior: participate in cooperative learning, play a board game with peers and visit one or play a board game with peers and visit one or more peers while eating lunchmore peers while eating lunch

SODA ResultsSODA Results

A significant result was found more all A significant result was found more all dependent measuredependent measureSocial interaction with peers increased in all Social interaction with peers increased in all areasareasLong-term memory of the program was found to Long-term memory of the program was found to exist and participant continued to use SODA exist and participant continued to use SODA even after the study endedeven after the study endedMay help adolescents to use metacognitive May help adolescents to use metacognitive processes to understand the mental state of processes to understand the mental state of othersothers

Cognitive-Behavioral TherapyCognitive-Behavioral TherapySummer program that compared two Summer program that compared two treatment types: social skills instruction treatment types: social skills instruction (SS) only versus social skills instruction (SS) only versus social skills instruction with behavioral treatment (SS+BT)with behavioral treatment (SS+BT)

Dependent measures included social Dependent measures included social skills, adaptability and atypicalityskills, adaptability and atypicality

The Skillstreaming curriculum was used to The Skillstreaming curriculum was used to address the specific problems associated address the specific problems associated with ASwith AS

ResultsResultsSignificant main effects were found for each of Significant main effects were found for each of the dependent measures or the parent’s ratingsthe dependent measures or the parent’s ratingsStaff ratings found significant main effects for Staff ratings found significant main effects for social skills and atypicalitysocial skills and atypicalityProvides evidence a cognitive-behavioral Provides evidence a cognitive-behavioral approach is a promising approach for developing approach is a promising approach for developing social skills social skills The significant increase in social skills ratings The significant increase in social skills ratings was found to exist even after the program endedwas found to exist even after the program endedParent’s reported social skills improvement, Parent’s reported social skills improvement, better adaptability and a decrease in odd or better adaptability and a decrease in odd or unusual behaviorunusual behavior

Teaching Emotion RecognitionTeaching Emotion RecognitionInvolved an emotion recognition pretest, 10 Involved an emotion recognition pretest, 10 week intervention and posttestweek intervention and posttestMind Reading software was used to present Mind Reading software was used to present material in the form of photographs, movie and material in the form of photographs, movie and audio clipsaudio clipsSignificant results were foundSignificant results were foundAll children demonstrated increased skill in All children demonstrated increased skill in recognizing emotion in facial expressions and recognizing emotion in facial expressions and voicevoiceThey were also found to be able to better They were also found to be able to better recognize emotion in voices not used in the recognize emotion in voices not used in the program suggesting that their learned skills can program suggesting that their learned skills can be generalizedbe generalized

ReferencesReferences

http://www.behavenet.com/capsules/disorders/ahttp://www.behavenet.com/capsules/disorders/asperger.htmsperger.htmhttp://www.autism.com/treatable/form34qrasperghttp://www.autism.com/treatable/form34qraspergersyndrome.htmersyndrome.htmLopata, Christopher, Marcus L. Thomeer, Martin Lopata, Christopher, Marcus L. Thomeer, Martin A. Volker, and Robert E. Nida. Effectiveness of a A. Volker, and Robert E. Nida. Effectiveness of a cognitive-behavioral treatment on the social cognitive-behavioral treatment on the social behaviors of children with Asperger disorder. behaviors of children with Asperger disorder. [Electronic version]. [Electronic version]. Focus on Autism and Other Focus on Autism and Other Developmental DisabilitiesDevelopmental Disabilities 21.4 (Winter  21.4 (Winter 2006): 237(8). 2006): 237(8). 

ReferencesReferences

Tsai, Luke Y. Asperger syndrome and Tsai, Luke Y. Asperger syndrome and medication treatment. [Electronic version] medication treatment. [Electronic version] Focus Focus on Autism and Other Developmental on Autism and Other Developmental DisabilitiesDisabilities 22.3 (Fall 2007): 138(11).  22.3 (Fall 2007): 138(11). 

Bock, Marjorie A. A social-behavioral learning Bock, Marjorie A. A social-behavioral learning strategy intervention for a child with Asperger strategy intervention for a child with Asperger syndrome: brief report. [Electronic version]. syndrome: brief report. [Electronic version]. Remedial and Special EducationRemedial and Special Education 28.5 (Sept-Oct  28.5 (Sept-Oct 2007): 258(8). 2007): 258(8).