Asperger Syndrome was first described in 1944 by Austrian pediatrician Hans Asperger. It is characterized by difficulties in social communication and restricted, repetitive behaviors. In 2013, it was removed as a separate diagnosis and incorporated under the Autism Spectrum Disorder (ASD) umbrella. However, in clinical practice, it continues to be recognized as a distinct diagnosis by many child and adolescent psychiatry specialists.
Asperger Syndrome is more prevalent in males than in females, and the age of diagnosis may extend until the period when the child begins school. Unlike ASD, language development is not significantly delayed. Similarly, intelligence levels may be average or above average, in contrast to ASD. These children primarily experience difficulties in social communication and interaction.
Symptoms of Asperger Syndrome
Among the most prominent symptoms of Asperger Syndrome are difficulties related to social communication and interaction. Restricted or qualitatively different eye contact is observed in these children. There is limited ability in using or comprehending facial expressions, body language, gestures, and mimicry. Inability to understand nuances related to personal space or physical contact, failure to perceive social cues, and difficulty with empathy are also among the frequently encountered symptoms. Poor quality of peer relationships in childhood, one-sidedness in conversation, and monotony are also noteworthy characteristics.
From a language and communication perspective, vocabulary and grammar may be good or even superior. However, these children experience difficulty understanding figurative meanings, irony, and idioms. Intense and specific areas of interest are generally present — trains, dinosaurs, geography, and computer systems are examples. Excessive adherence to routines and resistance to change is also a frequently observed characteristic. Repetitive movements such as hand-flapping and rocking are seen less frequently than in ASD. Sensory sensitivity to sounds, light, touch, and certain tastes is also among the symptoms of this syndrome.
Etiology of Asperger Syndrome
When examining the causes of Asperger Syndrome, genetic factors are found to be influential. Twin studies have reported heritability rates above 50%. Not a single gene but multiple genes are implicated. Advanced parental age, particularly advanced paternal age, is considered an important risk factor. It has been scientifically demonstrated that vaccines do not cause ASD or Asperger Syndrome. Pregnancy infections, particularly those occurring in the first trimester, as well as premature birth or birth complications, may be influential; however, the certainty of this association has not yet been established.
Course According to Life Stages
Asperger Syndrome presents different characteristics at different stages of life. In the preschool period, language delay is not very prominent; play quality is characterized by limited imagination, and specific interests begin to emerge. During the school-age period, differences in the social domain become more apparent, and the risks of peer pressure and bullying increase. During adolescence, awareness increases and the individual begins to recognize that they are different from others. In this period, there may be an increased risk of identity crisis, depression, and anxiety. Interest in romantic relationships may emerge; however, the social skills deficit becomes more pronounced with age.
How Should the Treatment and Follow-Up Process Be?
General Principles
The fundamental goal of treatment is to maximize functionality through a supportive approach. Approaches that highlight the strengths of the child and the adolescent are adopted. It is necessary to act with a multidisciplinary team. This team should include a child and adolescent psychiatry specialist, a clinical psychologist, a speech and language therapist, a special education specialist, a school specialist, and an occupational therapist. Family education and coaching are an integral part of the process.
Social Skills Training and Therapy
Social skills training will be very beneficial. Evidence-based programs delivered in group format, particularly the program known as PEERS, are recommended. The goal is to build skills such as initiating and maintaining conversations, forming friendships, and problem-solving. In the presence of anxiety disorder, Obsessive-Compulsive Disorder, and depression in particular, Cognitive Behavioral Therapy (CBT) is the most effective therapeutic method.
School and Daily Life Support
Sensory integration therapy is beneficial when needed. The goal is to develop daily living skills such as self-care and organizational skills. Work is carried out to improve language skills; pragmatic language skills, social conversation, and the use of figurative language are the focal points of these efforts. An individualized education program is arranged. Classroom adaptations, extended exam time, and break corners are among the practices found to be beneficial.
Family and Parental Support
Parent education programs must be incorporated into the process. Participation in family therapy and support groups for sibling relationships and parental burnout symptoms may be beneficial. Psychoeducation aimed at helping the adolescent, whose awareness increases during puberty, understand Asperger Syndrome should be provided. Sex education, establishing appropriate social boundaries, building independent living skills, and providing appropriate high school and higher education guidance will be beneficial.
Pharmacological Treatment
There is no specific pharmacological treatment for Asperger Syndrome. Medications may be prescribed to treat accompanying conditions. Melatonin is the most commonly used medication for sleep problems. Selective serotonin reuptake inhibitors (SSRIs) may be prescribed for symptoms of anxiety or depression. Risperidone and aripiprazole may be prescribed for irritability and anger-related problems.