Asperger’s Syndrome, Anxiety, and Neurophysiology

Asperger’s Asperger’s Syndrome, Anxiety, Syndrome, Anxiety,

and Neurophysiology and Neurophysiology

Prepared by Robert S. LagosPrepared by Robert S. Lagos

For the Kiwanis ClubFor the Kiwanis Club

October 21, 2011October 21, 2011

Dexter, MEDexter, ME

Introduction: What is Introduction: What is Asperger’s Syndrome?Asperger’s Syndrome?

• Defined as an autism spectrum disorder (ASD), characterized by difficulties in social interaction and restricted, stereotyped patterns of behavior and interests.

• Named after the Austrian pediatrician Hans Asperger, who, in 1944 described children in his practice with similar traits.


• In 1994, AS is standardized as a diagnosis in the DSM IV

• Will likely be subsumed into Autism disorder in DSM V (2012 or 2013).


• Lots of information nowadays!

– Books written by people with autism/AS and also specialists in the field

– Internet

– Other Media

Introduction: What is Asperger’s?Introduction: What is Asperger’s?

• About 1 in 100 diagnosed– Why the increase? Could be:

•Increase in attention and education of autism

•Effects of a changing society and culture over last 50 years: greater anonymity, erosion of community and family, spread of solitary pursuits like TV, internet.

Frequency of Asperger’s?Frequency of Asperger’s?

• More males than females (about 3:1 or 4:1) – “true” ratio probably less. • Tony Attwood speculates 2:1• Lack of diagnosis of women: probably due to

societal roles expected of women vs. men• May also be due to the gender differences

Frequency of Asperger’s?Frequency of Asperger’s?

Hans AspergerHans Asperger

Modern Day:Modern Day:Tony AttwoodTony Attwood

World famous researcher and World famous researcher and authorauthor

(and others)(and others)

(Well known for pioneer (Well known for pioneer research work with early research work with early

infantile autism)infantile autism)

Pioneers of Asperger’s Syndrome Research

Common Themes, Symptoms, Common Themes, Symptoms, and Issues of Asperger’s/HFAand Issues of Asperger’s/HFA

• Inability to connect socially with others in outside world. Shyness, as well as a different interest focus. Inability to read and pick up non-verbal cues.


• Cultural divide, difference to that of outside world. General feeling of lack of understanding and compatibility with it. Difference in perception.

• Isolation. ?? ?


• Specialized range of interests– Often over-focused on a single topic– Can be vocationally beneficial, and at least

of entertaining value.– Many technological contributions are

attributed to intense focus in a particular area.

– Some degree of repetitive aspects/behaviors within interests.

Other frequent themes/issues Other frequent themes/issues

• Obsessive thinking• Sensory overload• Anxiety and hyper-reactivity• Language and mental

processing delay• Motor and directional skills:

some difficulties• Delays in learning physical

activities

• Lack of social interest: internalization

• Inability to respond emotionally• No small talk• May not understand sarcasm –

things taken literally


• Awkward body language• Problems with eye contact• Repetitive movements• Not flexible about routines/rituals• May be singled out by peers as

“strange”



• Common Comorbidities:• OCD• Attention deficit• Depression/mood shifts

• High Functioning Autism:• More language delay• May be more withdrawn

Some common positive Some common positive characteristicscharacteristics

• Gifted in select areas• Thinking “outside the box”• Uniqueness – personality and abilities• Reliability and truthfulness• Attention to detail• Intense dedication and focus on

different areas of interest.

Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.

• Brains of autistic persons have been found to differ in several ways from a “neurotypical” brain.– Associated with “male-like” brain:

systematizing skills over empathizing– Tend to use different areas of the brain– But many facts not yet tied together.

• Brain cells are linked by axons, long cables insulated with myelin, which form the white matter.

• In autistic people, there seem to be too many cables within local areas, but not enough links from one region to another.

• This problem may be developmental – the development of the white matter has been found to be delayed in autistic persons.


• Imbalances have been found in neurotransmitters (i.e. chemicals helping nerve cells communicate with one another):

– Serotonin (affecting emotion and behavior)

– Glutamate (plays a role in neuron activity)


1. Frontal Lobes2. Corpus Callosum3. Amygdala4. Hippocampus5. Cerebellum

Back of Head Front of Head

(Time Magazine, May 15, 2006, p.44-45)

Regions of the Brain Important in Autism

• Frontral lobes

– Important in reasoning, emotion, personality.

– Found to be enlarged in autistic persons, due mainly to excess white matter, the brain’s connector cables.

– Often found to grow at an unusual rate by age 2.


• Cerebellum

– Important in motor activity, coordination, and motor/sensory planning.

– Like frontal lobes, overloaded with white matter.

– The above skills can all be weak for people with autism.


• Corpus Callosum

– Facilitates communication between the left and right hemispheres of the brain.

– Found to be undersized.– Activity across regions of the brain are

poorly coordinated.


• Hippocampus

– Vital to memory.– Found to be about 10% larger than

normal for autistic persons.• May, however, be because autistic persons

rely on memory to interpret situations that most people process elsewhere.


• Amygdala

– Important in emotion and social behavior.

– Also found to be enlarged for autistic persons.• Size may be related to the high level of

anxiety in autistic people.


• Genetics

– No single gene has been isolated. But different gene combinations have been associated.

– Lately it has been found that autistic persons tend to have fewer copies of certain genes (due to depletion in chromosome #16).

– Asperger’s and autism tend to run in families, i.e., higher chance if relative such as sibling or parent has it.


• Still uncertain as to whether many structural differences are the cause or the result.

• Some physiological differences not as pronounced in person’s with Asperger’s

• Although differences evident, it is all very much a puzzle yet to be pieced together!


Anxiety and A.S.Anxiety and A.S.

• Anxiety is normal – but likely to be significantly more disabling in AS than in general population.

• Important AS symptom: excessively overwhelmed by stimuli: May be highly correlation with anxiety.

• Could other A.S. symptoms be a form of this hyper-reactivity toward stimuli?

• Could this hyper-response toward stimuli, in fact, even define A.S./autism?• But harder to observe than more obvious

symptoms.

Anxiety and A.S.Anxiety and A.S.

• For many, the biggest obstacle in life – can interfere with quality of life.

• Can severely affect human relationships, business dealings, and ability in general to deal with people.

• Often painful as well as disabling.

• May be impossible to reason out even if reasoning seems obvious.

How anxiety may affect persons How anxiety may affect persons with A.S. with A.S.

• Gets in the way of getting things done. – Paralyzing.– Many situations uncomfortable and terrifying.

• Feeling of being overwhelmed; sometimes leads to depression and meltdowns (breakdowns).

• Affects confidence in being able to connect and interact with others.

Experiences of persons with A.S. Experiences of persons with A.S. surveyed regarding anxietysurveyed regarding anxiety

• Awkward/erratic eye contact another manifestation – social discomfort.

• Hard to say “no” or assert needs.

• Tension of socializing expends much energy; need to lie down to relax after social event to recoup energy.

Experiences of persons with A.S. Experiences of persons with A.S. surveyed regarding anxietysurveyed regarding anxiety

Situations which particularly trigger Situations which particularly trigger anxiety (A.S. group survey)anxiety (A.S. group survey)::

• Meeting somebody for the first time

• Not knowing how to interpret signals from other people– feeling clueless as to how to go about

approaching people– fear of alienating the other person

• Confrontation or even anticipation of anxiety

• New place, routine, situation

• Job interviews (***)

• Social climate in school

• Anticipation of school work and homework


• Tasks needing to be done which may seem huge or forbidding, creating feeling of being overwhelmed

• Attempting to apply the same principles and advice given to clients or others to oneself

• Performances, competitions.


Coping RemediesCoping Remedies

• Possible to find areas in which to excel or enjoy which are less anxiety dependent. – Can tap into certain special interests and talents.

• Drug therapy sometimes helpful, but may not justify side-effects, effort, and cost. Effectiveness can vary according to the person.

• Cognitive therapy (see later) is a helpful tool. But can require repeated applications.

• Peer support and empathy particularly helpful.

• Parental empathy and support very important in development.

Coping RemediesCoping Remedies

Comorbidities tying in with anxietyComorbidities tying in with anxiety

• OCD (Obsessive Compulsive Disorder)

• Depression• Acute sensory sensitivity

What are the common What are the common connections?connections?

Research and DiagnosisResearch and Diagnosis

• Diagnostic criteria for AS do not include mood disorders such as anxiety, depression, OCD.

• But many with AS are overwhelmed by:– Life experiences– Social rejection/bullying/not being understood– Isolation– Vulnerability– Sensory overloads

• It has been found that anxiety symptoms cannot be explained by increased stress alone– Environment and biology may be interrelated.

• The amygdala (part of the brain)– Involved with regulation of emotions– Some evidence of it being different for those with

A.S.– Important in anxiety problem

Research and DiagnosisResearch and Diagnosis(continued)(continued)

Comments on Research and Comments on Research and DiagnosisDiagnosis

Thomas EdisonThomas Edison


• ASD Not an exact diagnosis. However, the symptoms are very real: marked differences, both from standpoint of person’s life history as well as behavior, as well as physical development.


• Still many medical professionals uninformed about Asperger’s.– But information is on the rise.


• Maybe in the future, people within the AS umbrella may be grouped differently? Will diagnosis acquire a different name? ex: “basal ganglia” problem?

TherapiesTherapies

• Medications which may be used:– Anti-anxiety, anti-depressants:

Tricyclics, SSRI Inhibitors; Prozac, Imipramine, Celexa, Zoloft, many others.

– Effectiveness varies widely according to the individual. Some see a significant improvement due to medication, others do not.

• Cognitive Therapy

– This addresses thought distortions and obsessive thinking.

– A time-limited approach which allows one to view more objectively distortions in thought patterns and emotions.

– “Thought stoppers”

Therapies (continued)Therapies (continued)

• Peer and other support

– Peer group support– Asperger Chat lines– Internet, other media– Parents, spouses, friends who know

about and empathize with Asperger’s

Therapies (continued)Therapies (continued)

Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC


• Probably won’t be easy.


• Best suggestion: LISTEN TO CHILD. Don’t assume to know everything about human psychology. Don’t force-mold the child.


• Child still needs guidance, direction, and discipline. But different psychology may be needed.


• “I don’t know” may be best answer, hand-in-hand with intuition and “trial and error” supportive approach.


• Professional or therapeutic help encouraged, and in some cases, may be necessary.

Intimate RelationshipsIntimate Relationships

• Can be difficult to get• Most frequent relationship with

someone on opposite end of spectrum• Other can be a “social mentor”

• Partner with A.S. next most frequent• Internet a good source (Tony Attwood)

The Emerging “Aspie” CultureThe Emerging “Aspie” Culture

• Chat lines and internet a great source of social contact for “aspies”.

• Asperger support groups: meeting others, in person, with similar issues.

• Culture can be “cliquish”, like many other cultures. Countering culture domination an issue.

Services for persons with ASC in Services for persons with ASC in New EnglandNew England

• Autism Society of America: incl. Maine, New Hampshire, Vermont, Massachusetts, other states: events, conferences, legislation work. Email (Maine): asmonline.org

• AANE (Asperger’s Association of New England): adult groups, parent groups, conferences, referrals. Email: aane.org

Services for persons with ASC in Services for persons with ASC in New EnglandNew England

• Some Special schools in New England:– Aucocisco School in Cape Elizabeth– New England Center for Children in Boston

• Autism chat lines / group sites:– Wrong planet.net– Startlink-IRC– Maine Asperger Group (newly formed):

http://maineaspergers.ning.com/

• SENG: Supporting Emotional Needs of the Gifted: sengifted.org

• A lot more information on the web

Other Services OnlineOther Services Online

• Temple Grandin: Doctor of animal science who developed humane slaughter technique (High Functioning Autism)

• John Robeson: Author of “Look me in the eye” (Asperger’s)

• Others

Celebrities having HFA or Celebrities having HFA or Asperger’s Asperger’s (featured in media recently)(featured in media recently)

Historical/famous people Historical/famous people ““associatedassociated”” with Asperger’s with Asperger’s

• Thomas Edison• Albert Einstein• Thomas Jefferson• Richard Nixon• Sir Isaac Newton• Ludwig Van Beethoven• Bill Gates• Glenn Gould (pianist)• Andy Warhol• Hans Christian Anderson• others

Some ReferencesSome References(Work done on topic of AS and Anxiety)(Work done on topic of AS and Anxiety)

• Judith Reaven and Susan Hepburn: Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder in a Child with Asperger Syndrome… (2003)

• Meena Desari: Asperger Syndrome and Anxiety (2009)

• Nick Dubin: Asperger Syndrome and Anxiety: A Guide to Successful Stress Management (2009)

• Tony Attwood: The Complete Guide to Asperger Syndrome (2007)

• Valerie Gauss: Cognitive Behavioral Therapy for Adult Asperger Syndrome (2007)

Contact: [email protected]

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Asperger’s Syndrome, Anxiety, and Neurophysiology