asplanet.info

Aspergers Syndrome History and Symptoms 

. 

We all should remember that everyone is born a unique individual and that those of us on the autism spectrum are as diverse and different as those that are not, there is no one list. Professionals often give us labels to try and understand, put us into tick boxes we may not quite fit into. So I feel it should be more about understanding, allowing and accepting self. The diagnostic criteria is a generalized "norm" and in fact we are all different, with different life experiences and that impacts on how we react to our own traits and who we are and whatever labels we are given "autistic, bipolar" they are simply words, as there is a real individual behind each diagnosis, we are all human..

 .

I also feel for far too long those not on the autism spectrum have often excluded us and written about us and they try and put us into boxes many of us will never fit into, we will never be a lists of differences, it’s a whole way of being. And of course we are as varied as those not on the spectrum, imagine trying to sum up non spectrum individuals with a simply list of criteria But hopefully some of the information below, will help you understand that little bit more, as a label does not define someone, but can help explain and help others understand, but often the start of a long process.(Alyson Bradley - May 2010)

. 

. 

. 

EMERGING 

 Basic History and Symptoms 

(Full ASD Official Criteria see below)

. 

The Cause of Aspergers Syndrome is unknown; there may be a genetic component to this syndrome. Aspergers syndrome, also known as Aspergers disorder or AS, is a pervasive developmental disorder (a spectrum of behavioral disorders including autism) Aspergers syndrome is characterized by an inability to understand how to interact socially and a pattern of repetitive behaviors and/or restricted interests. Unlike persons with autism, those with Aspergers syndrome do not show a marked delay in language development or cognitive development.

 .

Aspergers Syndrome, was first identified as a unique medical condition in 1944. Prior to this time, the disorder was probably misdiagnosed as another behavior disorder or simply not diagnosed at all.

 .

An Austrian pediatrician name Hans Aspergers named the disease after noting its presence in four of his male children patients. He called it, at the time, "autistic psychopath." He noted that his young patients seemed intelligent and had regular speech development, but simply could not communicate because they could not understand non-verbal cues. Unfortunately, no more research was done on this condition, as Aspergers did not place a high importance on it.

 .

It was not until 1981, almost 40 years late, when English doctor Lorna Wing, continued the study of AS. She was the first to call it Aspergers Syndrome, and her studies are famous in the AS world even today. Even with the research Wing was doing in the medical community, the stir she was causing about this condition did not convince the World Health Organization to recognize the condition until 1992.

 .

It was included as a disorder in the organization's tenth edition of their diagnostic manual as well as in the International Classification of Diseases of that year. However, it wasn't until two years later, in 1994, that AS was a separate disorder according to the Diagnostic and Statistical Manual of Mental Disorders.

 .

Aspergers syndrome is commonly recognized in children after the age of 3 years and is more frequently diagnosed in boys. Children with Aspergers Syndrome are typically educated in the mainstream but usually require special education services. These children often have difficulty making friends, and are often bullied or teased by their peers.

 .

An individual's symptoms can range from mild to severe. May have all or only some of the described characteristics, and they may exhibit more problems in unstructured social settings or new situations that involve social problem-solving skills. Individuals with Aspergers syndrome have serious impairments in their social and communication skills, including poor nonverbal communication. However, many individuals have good cognitive and verbal skills, and typically have normal to superior intelligence. Many have excellent rote memory and become intensely interested in one or two subjects.

..

Lorna Wing Quote:
"What we want to know is what makes this person tick in the way they are ticking? It's fascinating disentangling; its a piece of detective work, how this person has reached this point.
.
It seems to us from our experience that it is far more important than deciding whether or not someone fits the classic criteria. We have come across a lot of people who don't fit any of the classic criteria, but deep down they actually have poor development of their social understanding and their capacity for planning. These two things (they may not have anything else) in life are going to be hellishly difficult for them, and they're going to get into all kinds of silly situations and terrible trouble, even legal trouble as a result. This to us is what matters."
.
I come from one of those families who "have poor development of their social understanding and their capacity for planning." We also have members who could have/had a diagnosis of Asperger's. But because most of us have fairly normal communication, the overt difficulty is mostly hidden - until we become overwhelmed by trying to figure out how to relate to others, or make decisions, or deal with inevitable emotional stress. There is enough anxiety, depression, and suicide in my family, as a result of having a lack of social and emotional understanding, that I can attest the not-fitting-the-diagnostic-criteria end of the spectrum has it's share of human tragedy and need for understanding, too. "

.

Lora Wing full interview by Autism Connect:

http://www.autismconnect.org/core_files/interviews/transcripts/lorna_wing.htm

.

.

DESOLATE
So powerful and strong, drawing you

into its own enchanting world - A Bradley

Social problems: Although children may express an interest in friendships, they have difficulty in making friends and may be rejected by peers; often these children are loving and affectionate with their immediate family. Socially inappropriate behavior, lack of understanding social cues, difficulty judging personal space, difficulty understanding others’ feelings and rigid social behavior due to an inability to spontaneously adapt to variations in social situations.

Abnormal communication patterns: Awkward or inappropriate body language, including limited use of gestures and absent or inappropriate facial expressions. Unusual, formal style of speaking, difficulty understanding non literal and implied communication. Impairments in the modulation of volume, intonation, inflection, rate, and rhythm of speech, speech may be tangential and circumstantial, often with irrelevant comments. Conversation style characterized by marked wordiness. Difficulty with “give and take” of conversation and lack of sensitivity about interrupting others.

Activities: Intense interest in a particular, often very restricted, subject that dominates the individual’s attention. Inflexible adherence to routines; has repetitive routines or rituals, and apprehensive about change, may have difficulty transitioning from one activity to another.

Sensory sensitivity: Sensitivity to sound, touch, taste, light, sight, smell, pain, and/or temperature and, sensitivity to the texture of foods.

Motor skill delays: History of delayed development of motor skills. Visible clumsiness and poor coordination and deficits in visual-motor and visual-perceptual skills, including problems with balance, manual dexterity, handwriting, rapid movements, rhythm, and imitation of movements.

A Bradley

Official Criteria for Asperger Syndrome

The official diagnostic criteria for Asperger Syndrome are found in the Diagnostic and Statistical Manual of Mental Disorders, Text Revised DSM-IVTR (2000) published by the American Psychiatric Association. The DSM-IVTR is the major diagnostic classification reference for psychologists and medical professionals. Prior to its first inclusion in the 1994 version, Asperger Syndrome was not included in the DSM. Readers can find the original descriptive language under classification 299.80, Pervasive Developmental Disorders.

The summary listed below was taken from Pediatric Neurology (http://www.pediatricneurology.com/autism.htm#Asperger’s Syndrome). It reads in a rather stilted way, but that is a common complaint about the entire DSM-IV.

(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 expression, body postures, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
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)
4. lack of social or emotional reciprocity.

(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherences to specific, non-functional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

(C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

(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)

(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 about the environment in childhood.

Basic Characteristics
The characterization of Asperger Syndrome above provides the reader with an "official view" of AS characteristics. However, among many clinicians who have seen vast numbers of autistic individuals since 1994, there is strong disagreement about the accuracy of the DSM-IV criteria. The 1994 criteria were developed after study of a relatively small number of persons. Since then, much more has been discovered about AS. Experienced child and adult diagnosticians have discovered that the official criteria are factually wrong on several critical areas; they also fail to account for many individuals seen in clinical and natural settings who exhibit classical autistic symptoms but develop speech late and demonstrate substantial deficient cognitive functioning and faulty perceptual awareness of others at an early age. There is strong pressure now being exerted on the editorial board of the DSM-V -- scheduled for publication in late 2005 or early 2006 -- to revise the criteria to better suit what sensitive diagnosticians have found to be true with thousands of late-diagnosed children and adults.

Since 1994, ethically responsible diagnosticians have adopted the view that autism is a spectrum disorder. Individuals diagnosed with Autistic Spectrum Disorder (ASD) occupy positions from one extreme end of autistic functioning continuum to the other.

To reflect current professionals' thinking about ASD's, the following section is a more accurate depiction of AS. Symptoms of AS include: impaired ability to utilize social cues such as body language, understand irony, or other “subtexts” of communication; restricted eye contact and odd, failed efforts at socialization; a marked and limited range of encyclopedic interests; perseverative, odd behaviors; didactic speech, verbosity, substantial problems with prosody, with voice tone regulation (monotone, droning voice); “concrete” thought accompanied with black and white dichotomous thinking; hyper and hyposensitivity to sensory stimuli; and unusual body awareness and movement.

For ease of discussion and reading, the term "he" is used in this article to refer generically to both AS males and females. In the writing below, where there is differentiation in responses or characteristics between the sexes, it will be noted separately.

Uta Frith, the English clinician who first translated Hans Asperger's 1944 German language paper into English in 1991, suggests that there are five main characteristics that identify AS:

(1) impaired social relationships
(2) impaired communication
(3) impaired make-believe play
(4) a peculiar pattern of intellectual abilities, and
(5) the repetitive phenomena of rituals

By analyzing each of these characteristics the reader can better understand how AS is identified. In the material below, a variety of symptoms associated with AS are discussed. Not every characteristic manifests the same way in each individual. What makes AS a syndrome as opposed to a singular description of a specific disabling condition is that its symptoms appear with high frequency within the same individual, in "clusters" as opposed to individually identifiable features, and with great consistency at any given stage of the individual's development. For this reason, it is classified in the DSM-IV as a pervasive developmental disorder.

When first being diagnosed, whether as children or adults, clinicians familiar with differential diagnosis best assess individuals. Individuals diagnosed with AS often have other mental or physical health conditions, which combined with autistic traits, limit their ability to function. Individuals diagnosed as being "on" the autistic spectrum -- a continuum that ranges all the way from extremely low functioning individuals to those whose intellect is high -- are identified as autistic precisely because they are unable to function at critical levels of child or adult cognitive, social and communicative activity.

Impaired Social Relationships
As an AS child approaches school and has opportunity to be with his non-autistic peers, his social and communication challenges become noticeable. Invariably the AS child remains off by himself rather than being actively engaged with other children. Even when with a group of children, AS children operate on what appears to be a parallel track. At this stage of social development, observers note that the AS child is a “loner. Found in their remarks may be terms phrases describing the child as "in a world of his own”.

AS children may desperately want to have friends, but without formal and patient training they are unaware of how to initiate contact with others in order to move on to forming the friendship bond appropriate for "normal" persons their same age. When asked about their friends at each developmental stage where friendship is described by "normal" children in increasingly sophisticated terms, AS children describe friendship in ways quite differently than their peers. While many AS adolescents state they have a number of friends, upon closer examination their "friends" are more accurately described as acquaintances, or even individuals they see casually or once. By the time AS children reach adulthood, they have learned to be either direct in their statement that they have few or no friends, or be evasive and circumspect with their answers. Without careful prodding and determining what the AS adult "means" when describing their friendships, many diagnosticians miss critical information that would otherwise inform them that the AS adult's notion of friendship is both developmentally delayed and distorted from the ordinary meaning of the term "friend".

Without deliberate, patient instruction about the meaning of relationships, friendship, and sexual bonding, many individuals with AS remain adrift on a sea of confusion with unanswered questions about "why" they continue to have difficulty forming such relationships. Even as an adult, without proper training the AS individual may easily make "first base" acquaintanceships, but lack the expertise to change those relationships into adult friendship, a social date, or a successful spousal relationship.

Most AS individuals report being victims of childhood bullying, victimization, abuse, and teasing that they continue to fear in adulthood. Individuals not accurately diagnosed as autistic in childhood and adulthood are often abused and misunderstood within their own families, the one "last, safe refuge" of children and adults. As a result of their negative social conditioning, AS children and adults avoid strangers out of fear that earlier patterns of abuse will continue. Given ideal child-rearing conditions, even if they weren't actively abused, AS children and adults still feel misunderstood, and they often are. Out of fear of making mistakes, of being misunderstood, AS adults carry socially avoidant and distancing behavior into their hesitancy to initiate social communication and activities throughout their lives.

AS individuals appear naive and gullible to others. Studies of bullying and child abuse at the hands of non-family members show that individuals who are isolated or alone are perfect victims. They are targets for such behavior because they stand out from their contemporaries as odd, not being able to understand simple social cues and unwritten rules of social communication and the hidden or "other" meaning of words, phrases, or the facial and body gestures of others. Many AS individuals do not understand the significance of variations in vocal pitch, pauses, and expectations by others that they "keep up their end of the conversation". In addition they suffer the consequences of remaining on the outside or at the edge of social conversation and the social behavior of their non-autistic peers.

Anger, Frustration, and Dealing with Difficult Emotions
There are two common responses to thoughts and feelings of being misunderstood. One response is aggression; the other is passivity. While both responses may be present to some degree in the same AS individual, professional literature identifies at least these two phenotypes: dominant, aggressive, and controlling; passive, submissive yet controlling in more subtle ways. Throughout their lives, individuals maintain the same type of response to stress and frustration.

With both types of responses, there are common clinical conditions that accompany the AS diagnosis: depression and anxiety.

Aggression and "Behavior Problems"
In their effort to be accepted by people they do not understand, AS individuals may mimic the behavior and language of groups they hope will accept them. This tactic rarely works. They fail to understand the subtle aspects of language and non-verbal communication between members of these groups. If such groups engage in anti-social behavior, they often leave the AS individual "holding the bag". While their savvy acquaintances escape notice through denial or "acting normal", AS individuals temporarily abandoned by their cohort become "discipline" and "behavioral problems" for educators and other care providers.

Without painstaking training and repetitive opportunity to practice newly learned communication and social skills, AS persons will not, on their own, develop an intuitive understanding of social etiquette. Some AS individuals may become overbearing, domineering, bullying and controlling as a means of remaining in charge of their environment. This is far more common with boys than with girls, however cruelty and aggressiveness in AS women has been recently studied and found to be even more severe than that of their aggressive male counterparts (Aston, 2003). The domineering AS adult may demonstrate no sympathy for others, and show no remorse for any pain or suffering they inflict. This person does not understand that others have different expectations or “rules” of their own. Anger, frustration, and rage that an AS individual experiences may lead him to overstep the lines of decency, and move into outright psychological abuse, violence, and illegal activity. It is essential to the child's well being as an adult to work early and intensively to thwart this side of AS before it becomes ingrained into his personality.

Because of the rigid logic and limited cognitive flexibility of autistic persons with uncorrected behavior and attitudes, once an AS child becomes an adult, it is very difficult to "turn the behavior or attitude around". This feature of rigidity, of "hard wiring of responses" is as true for persons who are passive as those who are aggressive in their response to being misunderstood. Most AS adults who have chronic negative attitudinal or behavioral responses do not benefit from standard counseling or behavioral therapy. Only in the last several years have techniques been developed -- modifications of cognitive-behavioral therapy -- which have proven effective.

However, it is important to remember that such therapy works if and only if the AS individual accepts his Asperger Syndrome diagnosis, takes active steps to understand his own particular "flavor" of the condition and is willing to change and improve his conduct through a very painstaking and slow process inherent in such work. Even if the individual expresses a desire to change, the psychological cost may simply be too great. They and others in their lives may conclude that it is easier for others to make adjustments to their new understanding of the AS individual than to expect the AS individual to change, even though, logically, such change on their part makes perfect sense.

Most medical insurance programs will not cover the cost of such work, even if available through a small handful of trained professionals. At this time, school and public mental health programs offer no such counseling capacity.

Passivity, Non-Responsiveness and Anger
The second response to being misunderstood is social avoidance and passivity. This, too, is a life-long response.

AS children and adults can become submissive and cautious in their actions. They may show considerable empathy for others, and repeatedly apologize for their actions. In most cases, however, they continue to repeat the same conduct or behavior because they know of no other alternative, all the while knowing that at its conclusion they will engage in an inevitable round of apologies. With their aggressive counterparts, they develop a hypersensitive sense of justice and fairness. As with their their aggressive AS counterparts, they are unsure how to respond to others in order to develop friendships and normal social relationships. Their response is anger turned inward. Professionals reporting on these children find levels of self-injurious behavior that are above average. Self-injurious behavior and serious thoughts and attempts at suicide often result in these children being prescribed heavy dosages of anti-depressive and mood-regulating medications. A small but significant minority of children are "frequent flyers" in psychiatric emergency facilities, and some have long histories of hospitalization and institutionalization.

Quiet AS adults describe being overcome with rage—they feel as if something is taking over their body—they cannot control it. In deeply private moments when they are sure they aren't observed, they may let their rage go, screaming, destroying objects (often the same type of object time after time) until the rage subsides. Like their aggressive counterparts, they feel that once dissipated, they can "go on." In their case, this may be possible because no one has witnessed their volcanic explosion. Instead of stifling their emotions, these adults may express a desire to be happier by learning how to safely express their feelings in socially acceptable ways.

In the case of their "aggressive" counterparts, there is a similar feeling that once they are finished with their tantrum, nothing further should be made of their behavior. Such expectations are totally out of sync with others' expectations about how the individual should make amends for a recent explosive outburst. Even though their outbursts and controlling nature are right at the surface, individuals prone to explosive rage rarely acknowledge their feeling state. It is equally difficult for them to perceive the effect of their conduct on others.

Both aggressive and passive AS individuals tend to blame others for things leading up to their own explosions. While in the midst of a stressful event, they do not accurately perceive their contribution to an escalating situation. With aggressive individuals disinterested in changing their responses to frustration and anger, there may be little choice for others involved with them other than to physically leave the scene or the relationship. Passive individuals may be similarly inclined to feel that they can't change, but there is a greater likelihood that because much of their response to anger and frustration has been "private" others in their lives are willing to tolerate their passivity and non-responsiveness and accept the notion that they are unlikely to change. Such individuals may rely on others to perform many executive functions for them, such as time management, financial management, or short-term and long-term activities that require complex planning. Passive AS adults can be charming and attractive, especially to others who consider themselves helpers. Once married or after settling into a relationship, the AS adult's dependence becomes obvious, often earlier to others than their own partners. With an understanding of AS by their partners and others, people who consider themselves helpers or rescuers can make more informed decisions about whether they wish to maintain such a relationships. Often, they do.

Navigating the Social Mine Field
Individuals with AS cannot quickly study situations to decide on a socially appropriate course of action. Instead of having learned communication and social skills by intuition -- the process used by non-autistic children and adults -- they rely on a different process. In their writings and self-descriptions, many AS individuals describe how they make social decisions. They draw upon an experience-based knowledge base. Adults describe this knowledge base as working exactly like a computerized data bank. Asperger Syndrome individuals use this vast storehouse of knowledge to compare their perception of a current situation with ones experienced in the past.

Users of computerized data banks understand the concept of "Garbage In/Garbage Out." Asperger Syndrome individuals are notoriously inefficient organizers of information. Asked about a present situation, their perception of a given situation and its important noteworthy issues is highly idiosyncratic. Invariably, it is" I-centered". Their associations between past perceptions and their categories of response "folders" are likely to be wrong at the time they were first formed, and even more out of sync with a current event they find themselves in. Through life-long experience, they know this to be the case. Given time and enough "similar events", they eventually identify situationally appropriate responses, but the mental energy and processing time expended in finding the right words or the right behavior is enormous. When they are in a secure or stable adult relationship, their more functional partner often acts as a social go-between or interpreter of the social world for the AS partner. AS adults' dependence on their higher functioning partner is often characterized by their partner as "childlike" or even "like having another child in the household".

In all instances where AS individuals find themselves in different or unstructured social settings, they must take extra time to cognitively process their experience before responding. Others do not realize that this “processing time" is needed by the AS person to make sense of "new data". They tend to become aggravated at the slow or delayed pace of the AS person's reactions.

Exasperation and irritation of others "waiting" for a response, or realizing that the time it takes for an autistic person to respond at all is too long often leads to social rejection. Without being able to precisely name the cause -- but knowing that something "just isn't right" with the AS individual -- others respond as they often do when they don't understand strangers who act differently than themselves. Social rejection and other adverse reactions by others is a frequent cause for school drop out in AS child and adult students, termination of employment, or frequent physical changes in the AS individual's living arrangements. Indecision stemming from a real fear of making a mistake often leaves an AS person "spinning his wheels and getting nowhere". Equally distressing to others experiencing an AS person's inefficient problem solving is the AS person's repeated reliance on solutions or techniques they may once have found helpful but that don't work well any more.

In the case of children and adolescents, early and consistent formal training through role playing, guided instruction in social skills through the use of other socially savvy children and adults, Social Stories?, and the sensitive use of modified cognitive behavioral techniques can make a difference in an AS person’s understanding of how to form and sustain lasting relationships. (Attwood 2003)

For all such formal instruction, the AS individual must have safe opportunities to practice newly learned skills with another person in a supportive and respectful one-to-one setting. From that level, they can move into supportive small group settings, testing and generalizing social and thinking skills "scripts" into structured educational, social, community and work environments. (Winner, 2001; Gutstein 2002) As they experience success, many AS individuals can generalize those skills with strangers in the world at large. With rare exceptions, public school systems are unprepared for the cost and time involved in this type of social skills coaching. Because of the intensity of intervention required to work permanent results, parents of AS children spend thousands of dollars for private social skills training for their children.

For AS adults, almost nothing is known about effective treatment to obtain a similar "turnaround". For one thing, money and research time is not focused on adults; it is focused exclusively on children. Second, even for techniques that show promise with adults, formally conducted sessions by speech/language pathologists and specially trained psychologists have seen only mixed results. Third, in all cases with adults remedial work is extremely expensive and time-consuming and not covered by insurance or health care programs. For the present, AS adults' participation in support groups skillfully facilitated by other AS adults with AS appears to be one effective way that AS adults can learn to become comfortable with themselves, and, as they report, increasingly comfortable with others not on the autistic spectrum.

Impaired Communication

Impaired Theory of Mind combined with Processing Delays
From research in the early 1980's has come the term "mind blindness" and "failure of Theory of Mind" describing autistic individuals' difficulty in perceiving and understanding the intentions of others. AS is characterized by rigidity of thought, black and white thinking, and impulsive behavior (or its opposite - indecision). AS individuals tend to take everything literally, understanding everything said to them just the way they hear it spoken. Their hearing is "often wrong". When put the test, many AS children and adults demonstrate little true understanding of language pragmatics or how given words or a phrases' use changes depending upon an ever-shifting context. They do not intuitively understand hidden ideas, idioms, and double meanings. When informed about these social language short cuts, some AS individuals become sullen, angry, or withdrawn when in the presence of people using these conventions of speech. Others become "students of the hidden language", going to great lengths to catalogue this information in their data banks.

Even if an AS person masters the words, he will have difficulty understanding the meaning of non-verbal methods of communication (posture, gestures, nods, winks, or minute but detectable changes in facial expressions). Even if an AS individual gets the meaning right, additional problems with language pragmatics (proper use; proper context) and delays in processing auditory information means that he experiences difficulties keeping up with rapid receptive speech (spoken and nonverbal). The result is that the AS individual often feels left behind in ordinary conversation.

Savvy AS adults can develop sophisticated language and behavioral responses to new situations (Shore, 2003). Their mastery of listening and "sounding as if" skills is akin to mimicry. Even so, they operate within a very tight envelope. When pressed, many bright AS adults cannot further demonstrate an understanding of complex concepts or complex behaviors that have additional meanings. Many AS individuals who depend upon their verbal fluency know how to "fake it" or "pass as normal". (Willey, 1999) This coping behavior may get them by for a while. However, their oddness and slow processing eventually becomes known to others who interact with them frequently. Depending on the social context, others can adjust to their communication impediments because of the value of their contribution to a given enterprise or project.

Unusual Speech
Many AS children and adults develop a style of expression characterized by long, fact-filled monologues. They show an apparent disinterest about engaging other children or adults in a reciprocal exchange of conversation. They talk "to" individuals rather than "with" them. Some AS adults describe this speech process as a "data dump". They report that once started with a monologue, they find it difficult to stop. Much to the irritation of their age mates as well as adults, they also find comfort in repeating the same routine ad nauseum.

Asperger Syndrome children characteristically develop an erudite mastery of a special topic that may be of initial interest to their age mates, but just as likely not. AS individuals have a poor understanding of the visual and gestural non-verbal signs of listener boredom. Wrapped up in their monologue, when told to cut their presentation short, they may not hear an adult or another child asking them to stop or switch topics. Unless they've been repeatedly coached and have good self-monitoring skills, AS individuals don't understand polite but indirect hints to stop. Vague or non-concrete hints don't work either. Children are often direct and brutal when they correct one another. They leave or shun their motor-mouthed age mates.

Adults offer acceptance not available from their age peers. AS children seek out adults who indulge them out of true curiosity and amazement at their knowledge. Adults are socialized to be polite and subtle when dealing with people who run on. With their patience taxed to the breaking point, adult listeners often become exhausted, exasperated and bored. They can extricate themselves from uncomfortable situations because, as adults they have more power to control time and place.

Listeners wonder why AS individuals continually return the conversation to their favorite interest no matter how far the conversation has progressed into new topics. Sometimes this is because the AS person has mastered a script to tell a long story. He will turn to exactly the same choice of words and order of events as the last time the story was told. Some AS individuals react to interruptions to their monologues by starting them over again. Until they feel completed with their presentation, it is often impossible to have them move on in a conversation without their appearing irritated or even rude. The same need to start all over again when interrupted in a task impacts AS children and adults alike.

Oddly constricted special interests of AS individuals may be very difficult for listeners to deal with. As an example, a child that knows the manufacturing process of every toilet in Central Oregon may at first be interesting, but will bore others after an hour or two if they are even still listening and have not walked away.

Some AS individuals maintain the same interest in a given topic throughout their lives, while others move from one intense interest to another, often returning to earlier ones at later times in their lives. (Shore, 2003). If their special interest fits into the fold of general adult interests such as sports, entertainment or electronics, it is easier for them to make connections with like-minded individuals. AS individuals frequently put much effort into finding "targets" for their monologues by hanging around locations where such interests are common. While their knowledge still remains erudite, AS individuals can form intense, interest-based relationships with other adults. Adults who succeed in forming these relationships can gradually "catch the cues" of others. True adult friendship can arise from such relationships, but with a difference: the enjoyment an AS adult expresses when describing these relationships is often described in intellectual terms rather than emotional ones. Regardless of the terms they use, these relationships do have a substantial emotional component to them.

Expressive Speech Issues
Individuals with AS are often unaware of how their words and non-verbal signals "sound" to others. They may speak with loud, authoritative, monotone voices, droning on and on. Others, especially AS women, retain a small-person, child-like prosody and pitch to their voices, causing listeners to strain to hear them. Other AS individuals have normal adult speech, but they may be exceedingly quiet, limiting their contributions in conversations to a few words. They may go for hours at a stretch without saying anything. The AS person is quite unaware of the unintentional messages their style of speech sends to listeners. Many AS individuals do not know how to send the small postural, gestural, or vocal signals indicating they are still tracking what others are saying. When asked, AS individuals will say that they see no need to do that. They expect their mere presence to be enough of a signal to others that they are listening. They are unskilled in the art of repairing communication that has run off track or has "misfired". Based on voice tone, volume and postures that send a different message, listeners may conclude that the person is disinterested, angry, or hasn't heard them.

Employment problems of adults are often traceable to their poor social and communication skills. They may have some awareness that others are confused by or displeased with them, but don't have the social skills or conversational tools to find out why and correct their conduct. When asked about repeated instances involving the same faux pas, they cannot "connect the dots" or divine patterns in their own social conduct or speech responsible for their dilemma. By the time they realize they are making mistakes -- often in the midst of a string of behavioral and language-choice errors -- it is often too late for them to repair a deteriorated relationship. If the AS adult is lucky to have other adults available to help them unravel a confusing situation, the individual may learn how to sense danger signals and self-monitor his conduct before things reach a point of no return. Many AS adults reporting success and a tolerable level of social comfort later on in life can identify others in their lives who have acted as personal coaches or patient adult-skills instructors.

Stilted Speech
Highly verbal AS individuals tend to use more advanced vocabulary and grammar when simple words and simple syntax are called for. Their speech sounds stilted and "professorish". If they are fluent writers, they tend to write in an overly complex way. How much they say and write is related to their personal interest in a topic. An AS individual has difficulty tailoring his response to the situation, which includes differentiating the information needs of listeners. He is just as likely to go on and on with a classmate as he is with the teacher or professor.

Saying too Little
If the AS person is not interested in a topic, his answer is likely to be short. To illustrate, correct but short answers to essay questions are a constant problem for AS school children. The student may have mastered the subject matter, but doesn't "see any need" to expostulate on it. AS adults are likely to treat conversations in which they have no personal interest in the same way. They may abruptly walk away or turn their back, leaving others confused or insulted.

Humor
AS individuals do have a sense of humor, but it can be creative and idiosyncratic. If an AS person is very verbal, his humor often involves making complex puns. This reflects his advanced, dictionary-like vocabulary. Some AS individuals haul out entire memorized scripts from comedy shows and put on the whole show, whether or not their audience is interested or amused. They also enjoy humor if a story includes a familiar topic or punch line.

AS individuals do not like practical jokes. Even if the joke is harmless, their response to them is way out of scale. They are likely to harbor resentment for having been "victimized" for a long time.

If a joke made by others involves something unfamiliar, an AS individual may be totally lost. (The response is a blank stare reminiscent of Data in Star Trek.) It may take the person a while to process everything. Their reaction and laughter may be delayed or subdued. In other instances, once having been given explicit information and clarifying the meaning, they may join in the laughter.

Proving One's Point and Getting Things Right
AS individuals have problems identifying their emotions and the emotions of others, problems that can lead to outbursts of frustration, anger and rage. To convince others of their point of view, some individuals become argumentative, righteous and persistent beyond reason. Passive AS individuals might go silent or withdraw from the same stressful conditions. AS individuals are unable to learn social manners simply by watching others unaided. Behaviors and ways of doing things that come automatically to others must be taught step by step. Once the individual learns the basic steps, the other component to manners mastery is role-playing the behavior. Only through role-play may an AS individual learn to distinguish proper responses from socially inappropriate ones. For example, patient instruction can teach a 12-year-old answering the family phone with "Hello" rather than a gruff "Who's talking?"

Impaired Make-Believe Play

Parallel Play
Under unstructured conditions, AS children are often observed engaged in their own, separate play activity despite the presence of other children. This is because AS children do not understand the imaginary play of other youngsters their same age. They are unable to understand the projected emotions of others or imagine that others have emotions different than their own. For many AS children, their version of play hinges on the safety of scripts and dialogue memorized from movies, videos or favorite stories told to them.

Repetitive and/or Age-inappropriate Play Activities
If they favor play figures or dolls, AS children may act out these scripts in creative ways. Creativity with roles and ability to fashion complete and novel fantasy parts is more common in girls' play than in the play of boys. Boys are more apt to engage in endless repetition of the same memorized scripts or act out roles in more violent ways than girls. AS girls may desperately hue to the social scripts they see being acted out by their peers, or reject the expected social roles of girls by engaging in tomboy behavior or other kinds of activities not favored by their age-mates.

As they get older, many boys remain infatuated with role-playing fantasy games, a special interest that often follows them into young adulthood. Video games and role-play games involving cards and complicated scripts engage the attention of many young AS adults to the extent that moving into more adult game and leisure activities becomes a problem for them. Young AS adults with such interests often seek one another out, continuing a pattern of "group parallel play" difficult for non-autistic young adults to relate to. Friendships can develop from mutual involvement in such young adult "play groups", but just as likely, connections remain instrumental and focused on mutual enjoyment of a limited and predictable range of activities. AS individuals are at a loss when their companions lose interest in these activities and drift away. They do not know how to expand a friendship or allow it to move through stages where other's different interests provide the basis the basis for continued involvement.

Some young AS adults continue their play activities with child-age play objects, such as small stuffed toys or action figures. While such objects offer them comfort, the later on in life they continue to choose such play objects, the more difficult it is for others to make contact with them and pull them out of their I-centered world into the social life of non-autistic adults.

For AS boys, finding acceptance with their own age-mates is a great challenge. As mentioned above, they will seek out adults, engaging them intellectually as a result of their specialized knowledge, and less often just for unstructured social interaction. In response to their not understanding the play of their peers, they may prefer the company of younger children. This way, they can demonstrate an advanced mastery and take charge of the play experience of their playmates. The danger to this type of age mismatch for boys comes when they reach puberty and are seen playing with much younger children. Although the boys' experience is commonly devoid of sexual overtones, adults in charge act unfavorably to such arrangements. When their parents or caregivers remove these younger playmates, older AS children may not understand the reason. This is because they find it difficult to understand the intentions of others, or that others have different concerns than they do.

Because of differences in socialization, AS girls are less prone to seek out differently aged playmates. Age and developmental hierarchies are more rigidly enforced between girls than boys. (Attwood, 1999; Thompson, O'Neil and Cohen, 2001). AS girls are likely to suffer more from depression as they are rejected by their age-mates, and are far more likely to internalize their anger than boys, whose aggressive responses to rejection at almost any stage of childhood is more accepted. Out of desperation to be accepted by both sexes, later adolescent and young adult AS women stand a higher risk than AS males of becoming promiscuous and engaging in risky social behavior.

Memory
AS individuals are known for their remarkable memories. There is a social disadvantage to having a capacious but unselective memory. In many settings, they use their recall of facts to "win" arguments. Details long forgotten by others have a disturbing way of resurfacing especially when an AS individual acts to "remind" others of facts which, though correct, are irrelevant or don't fit a current context. Arguments often arise when the AS person demands that a present situation match their recall of a similar event or experience from the past.

AS children and adults are great historians, especially about events that they participated in. (if you want to review what happened last Tuesday at noon, and who said what, ask your AS child or AS partner.) Their desire for sameness and adverse reactions to any current variation on an historical theme are responsible for their abrupt reactions to change.

There is another unpleasant social consequence to having total recall. AS individuals may uncritically divulge things to others that were told to them in confidence. They feel compelled to share all, thus breaking confidences and hurting feelings. They are unaware of the intention of the person who confided the information. They may disclose secrets out of anxiety to say something during a lull in conversation. Individuals who have been betrayed by this conduct may avoid additional contact with the AS individual. They are so often taken aback by the disclosure that they can't convert the situation into a “teachable moment” for the AS individual.

Peculiar Patterns of Intellectual Abilities
As seen above, AS individuals have strong but relatively constricted interests. They may develop them as children and persevere in their pursuit of knowledge in the same topic throughout their lives. Other individuals develop strong but successive interests, moving from one intense perseveration to the next. Many AS children and adults, regardless of whether they are introverts or extroverts, become known by others as "little professors". Many AS adults actually do become teachers or professors due to their considerable knowledge on one subject. Universities and research institutes are perfect homes for persons with exquisite and arcane knowledge. Even if the AS person does not master many of the social conventions of professional, academic life, disciplines such as linguistics, mathematics, esoteric areas of science, accounting, and information technology all tend to attract individuals of both sexes who were earlier known as geeks, but now have perfectly acceptable titles and tenure.

Repetitive Phenomena of Rituals
Unanticipated change is the major stressor for AS individuals, but even when change is scheduled and known well in advance, AS individuals still experience inordinate amounts of anxiety about it. For autistic individuals, repetitive rituals and behaviors are means to gain a personal sense of self-control in constantly changing, unpredictable environments.

Individuals later diagnosed with Asperger Syndrome are sometimes earlier diagnosed with Tourette's Syndrome (TS) and Obsessive Compulsive Disorder (OCD). Some TS diagnoses are written very tentatively, as though the diagnostician made the best guess but still wasn't sure. Autistic childhood vocalizations (echolalia) are often accompanied by repetitive motions (echopraxia). Both behaviors occur as the autistic child experiences stress (from any source, internal or external). Some children diagnosed with TS make regular return trips to specialists who continue to confirm the diagnosis far longer than were the child to be seen by a new diagnostician at the same time. What many TS specialists "confirm" are successive, repetitive autistic ritualistic behaviors. As those behaviors lessen in intensity and frequency as the child matures, the child is pronounced "cured" by the specialist but rarely does the patient lose the diagnostic label. General medicine providers seeing the adult continue to refer to the childhood diagnosis and continue prescribing medication for their patient's "non-condition" without conducting any evaluation of the effectiveness or of their prescriptions. By history, they are prompted to look for TS, which they don't find. If they don't look for autism, they don't find ASD either.

OCD may be present in childhood and adulthood, and is a closer behavioral description of the social distress many autistic individuals experience from their ritualistic behaviors. While both childhood diagnoses may be correct, the function that ritual and repetitive behavior and vocalizations serve for the autistic individual is quite different than either purpose or function in TS and OCD.

Comforting Issues
As higher functioning autistic individuals mature, their expressive vocabularies can expand as they move through a succession of echolalic and echopraxic activities more closely approximating "appropriate" behaviors much less disturbing and distracting to others. Under conditions of stress, their need to engage in these activates -- which they find calming and "centering" -- does not disappear. As they move into adulthood and gain greater understanding of the concept of social appropriateness, they find places and times to let themselves go without upsetting others. However, for AS adults experiencing extreme stress, their behavioral response may regress to forms of reaction that typified much cruder childhood behavior.

Most adults with AS find working with people to be a very stressful experience, mainly because people are not predictable. Many AS individuals engage in repetitive activities or prefer mindless work tasks. Fondness for doing things in a rote, mechanical manner has a calming effect allowing the AS employee the time and an officially defined job task guaranteeing them a means of dealing with confusion they experience in otherwise challenging environments. These repetitive tasks are also readily given away to them by other workers. AS individuals can master such activities and perform them with accuracy, speed and ease. Following routines by the book, they may perform far better than their non-autistic workmates.

The intensity of the AS individual's adverse response to change is directly related to his desire for routine, sameness and to be in control. In all cases where AS individuals become upset with change, it is because they haven't developed an efficient mechanism to exert socially appropriate control over themselves or the situation.

Many AS individuals develop patterns and routines that must be followed. Predictable bedtime rituals are common with children, but just as common, though less noticed in adults. Dependence upon a set, ritualistic routine is commonly found with eating habits, self-care, and approaches to common personal, household or work tasks. This routine is not negotiable—it must be followed—and if interrupted, it has often been noted that an AS individual must start the full routine over, from the very beginning. They are not able to restart in the middle of the routine, and they are not able to accomplish the task without following that routine. If the AS individual is in an adult relationship or in a family setting, their rituals often have the effect of "terrorizing" other members of the family into submission to their routine. (McCabe, 2003; Stanford 2003)

Socially challenged AS adults may act impulsively, changing jobs and locations with the hope that the next change will "fix things". The fix doesn't happen. Given their dependence upon routine but their poor self-understanding of how badly they respond to change, in their new settings they re-create their favored routines in desperate efforts to surround themselves with conditions they can predict and control. Through successive moves, they rely on persons important to them to remain unperturbed by uprootings and upheaval caused by moving. They are often oblivious to the pain and discomfort their impulsive moves have on family members whose other relationships are constantly under threat with the prospect of yet another move in the future.

Other AS individuals, desperate to stave off the effects of change over which they have no control, hang on to a situation or a relationship for dear life, long after the life has been squeezed out of the arrangement due to their reliance on their helper-type partner coming to their rescue.

Providers working with AS adolescents or adults must be sensitive to the social context in which the AS individual operates. They must understand that if the individual is a "loner", unemployed or frequently unemployed, disconnected from effective support services or not in a relationship, their client's awareness of the world is vastly different than AS individuals who have made significant social connections. Loners' social-problem-solving skills are likely to be rudimentary and very inefficient. Because of their disconnectedness, results of their poor decision-making are confined to a small circle.

If the AS adult has made significant progress in the social world of adults, the perspective of any helping professional must widen to include everyone touched by the individual. Adult problems are far more complex than the problems encountered by children. The consequences of making a bad decision can be far-reaching, affecting the lives of many persons in the AS adult's life. When AS individuals marry and have children, consequences of indecisiveness and/or impulsiveness in inefficient adult decision-making and poor parenting affects the whole family. As a result of repeated experiences of poor problem-solving by the AS parent in an intact marriage, the higher functioning partner may "close" the family to the outside community, averting future embarrassment and shame caused by the past conduct of the on-spectrum partner. When families become closed, either as a result of an autistic adult or an autistic child's behavior, the closed character of the family presents special challenges to community service providers.

An Interesting Exception
All individuals diagnosed with AS demonstrate unusual responses to change. Without being prepared for anticipate change, AS individuals have difficulty responding to new problems. However, if their "data bank" is large enough, they may be the cool one in situations where everyone else is in a panic. This is because they've learned the drill to handle such emergencies. The one thing they know how to do is take control. This fact may account for the successful law enforcement, corrections, military, and first-responder careers of a few people with Asperger Syndrome. Others defer to such persons. Rules governing their roles call for them to be in charge.

.