Asperger's disorder entities

Clinic

• AS is a former neurodevelopmental disorder
• It is characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests.
• It belongs to ASD but diagnosed from other ASDs by relatively unimpaired language and intelligence.

Characteristics

• They often display restricted or specialized interests, such as this boy's interest in stacking cans.
• As a pervasive developmental disorder, Asperger is distinguished by a pattern of symptoms rather than a single symptom.
• It is characterized by
  • Qualitative impairment in social interaction
  • Stereotyped and restricted patterns of Behavior / Activities / Interests
  • No clinically significant delay in Cognitive / Language
  • Hyper focous: Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis.
  • Suicidal behavior appears to occur at rates similar to those without ASD

• Recently Asperger is characterized by Cerebellar ataxia. Autism has also Ataxia, but it seems that Asperger ataxia is not sensory but cerebellar.
  

Social interaction

• Lack of demonstrated empathy affects aspects of social reliability for persons with Asperger syndrome.
• They experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others
• Lack of social or emotional reciprocity
• Impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.

Violent or criminal behavior

• The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.
• A 2008 review found that an overwhelming number of reported violent criminals with Asperger syndrome also had other coexisting psychotic psychiatric disorders such as schizoaffective disorder.

Stereotypic Interests / Behavior

• People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused.
  • Inflexible routines
  • Move in stereotyped and repetitive ways
  • Preoccupy themselves with parts of objects
  • Compulsive behavior
  • Collect volumes of detailed information on a relatively narrow topic
  • Stereotyped motor behaviors such as flapping or twisting, and complex whole-body movements. These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical, and less often symmetrical.

Speech and language

Although they acquire language skills without significant general delay, there are some abnormalities including

• Loquacity; changing subjects quickly
• Literal interpretations and miscomprehension of nuance
• Use of metaphor meaningful only to the speaker
• Auditory perception deficits; unusually pedantic, formal, or idiosyncratic speech; and oddities in loudness, pitch, intonation, prosody, and rhythm.
• Echolalia
• Limited range of intonation
• Their speech may be unusually fast, jerky, or loud.
• Speech may convey a sense of incoherence
• The conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.
• Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors" but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share the enjoyment with others. Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.

Motor and sensory perception

• Differences in perception
• Problems with motor skills, sleep, and emotions.

• Excellent auditory and visual perception. Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.

Conversely, compared with individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory. Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli; these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.

Hans Asperger's initial accounts and other diagnostic schemes include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated or have an odd or bouncy gait or posture, poor handwriting, or problems with motor coordination. They may show problems with proprioception (sensation of body position) on measures of developmental coordination disorder (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.

Sleep problems

• Difficulty in falling asleep
• Frequent nocturnal awakenings
• Early morning awakenings.
• AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.
• Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.
• The most significant finding is high prevalence of parasomnia in ASD children, especially the Disorders of Partial Arousal, (60.8%)

Asperger black box

	CJD	EBV	KRU	GSS	HSV-1
Cerebellar Ataxia	+++	+++	+++	+++	+++
Dysarthria	+++		+++	+++
Psychosis	+++	+++	+++	+++	+++
Seizure	+++	+++			+++