What is Asperger's syndrome? How does it manifest itself and how to manage it?

Asperger syndrome, sometimes called social dyslexia, is a separate category of autism spectrum disorders.

It's hard to understand them, they in turn have a hard time understanding us...
Misunderstood weirdos, Asperger's patients.

It is a neurodevelopmental brain disorder that, unlike autism, does not manifest itself in a speech impairment in the true sense of the word or impaired intelligence.
However, the extent of the overlap between Asperger's and high-functioning autism is still not entirely clear.

In the past, manifestations of Asperger's were classified as mental disorders.
In 2013, the syndrome was removed from the Diagnostic and Statistical Manual of Mental Disorders.
As of 2019, Asperger's is classified as an autism spectrum disorder in the International Classification of Diseases.
It forms a separate category due to some distinction from other autistic disorders.

Manifested by a basic triad of symptoms at the level of social interaction, communication and behaviour and imagination.

Despite this, it is characterised by a normal intelligence quotient, in some cases even above average.

Asperger's syndrome and its 3 core traits significantly affect:

• the way the patient communicates with the environment
• make it impossible for him to relate to others
• an inability to relate to other people
• does not understand the meaning of decency, usually behaves differently than social norms
• the individual is often excluded from the collective
• resorts to isolation and introverted behaviour
• is regarded as an oddball

Asperger's syndrome is significantly more common in males than females, at a ratio of 3:1. However, researchers believe that it may be better hidden in girls.

As with other autism spectrum disorders, the cause of the disorder is not entirely clear.

However, it is certain that genetics is responsible for the anomalies of the right hemisphere of the brain. It is just not entirely clear which genes and genetic mutations are responsible for the syndrome.
Evidence is also provided by the presence of the disorder in the family.

Interesting:
People with Asperger's have elevated levels of serotonin, which transmits signals in the brain, dampens pain, and affects emotions, memory, and sleep.
These people also have impaired production of endogenous opioids, the so-called happiness hormones.

The manifestations of Asperger's syndrome are variable. They occur on several levels simultaneously, and not everyone experiences them to the same degree.

The normal to above-average intelligence of these individuals often masks other symptoms. No one would think that such an intelligent person was ill.

Social interaction disorders

Patients with Asperger's syndrome have a hard time integrating into a social group.
They don't have many people around them because they don't understand them and at the same time people don't understand them.

They are typically isolated from their surroundings, which is not intentional.
Many of these patients want to fit in, but they feel uncomfortable in society, uncomfortable, different and misunderstood.
Loneliness causes sadness, helplessness and progression of isolation.

They also do not understand the behaviour of their surroundings, their gesticulations and body language.
They avoid eye contact and also do not understand the looks of other people, which are unreadable to them.

The condition can result in complete loss of contact and even lead to phobias.

The most common phobias in patients with Asperger's syndrome:

• Anthropophobia (fear of people).
• agoraphobia (fear of open spaces)
• autophobia (fear of loneliness)
• bacteriophobia (fear of bacteria)
• catagelophobia (fear of other people's teasing)
• cherophobia (fear of happiness)
• chiraptophobia (fear of touch)
• decidophobia (fear of making decisions)
• didaskaleinophobia (fear of going to school)
• enosiophobia (fear of criticism)
• claustrophobia (fear of enclosed spaces)
• ochlorophobia (fear of crowded spaces)

Speech and communication disorders

The paradox is that patients do not have a speech problem, but still have a problem with communication as such.
The problem lies not in speech itself, but in the social aspects of communication, which are closely related to social interaction.

The patients' speech develops at a reasonable age, they have a good vocabulary, they talk fluently, and therefore this syndrome is rarely discovered in childhood.
Speech itself is monotonous, they look away when communicating with others.

The bigger problem is communication. They are unable to start, carry on and sustain a conversation with another person because the content of the communication turns out to be uninteresting.
On the other hand, they can carry on a complex and detailed conversation, incomprehensible to the average person, on a specialist topic that interests them.

In fact, a conversation on their favourite topic is a monologue, because they are not interested in the listener's feedback, his lack of interest or inability to enter the conversation.
If the other party manages to engage, they don't let him finish, they jump in and have a monologue again.

Their intelligence quotient (IQ) is at a good to high level, but their inability to interact with the environment on common topics makes them different.
The outside world does not perceive them as highly intelligent, but the opposite is true.

Another problem associated with communication is expressing and showing feelings towards another person.
We rarely observe initiative in confessing feelings to another person, kissing, caressing, possessing outward emotional coldness.

They also have a problem in understanding symbolic or obscure expressions (metaphors, jokes, sarcasm, black humour). They take them literally and are therefore often confused.

Disorders of abstract perception - imagination

Perception of abstract things is at a low level. They are characterized by poor imagination.

Lack of imagination is seen as an inability to find alternative solutions to a problem.

They are unable to understand context like healthy people, they are more detail oriented.

For trees they cannot see the forest...
For flowers they cannot see the meadow...
For stars they cannot see the sky...

Unlike autism, Asperger's syndrome is relatively difficult to diagnose.
Most patients with this syndrome do not differ significantly from other healthy people, but in its more severe form it is often confused with other disorders.

In a young child, this disorder is almost impossible to detect. It requires a lot of time and constant monitoring of his activities, which is sometimes virtually impossible.
The child develops and learns normally, and speech skills come on at a reasonable age for the child.

The first difference is usually noticed by the parent or the kindergarten teacher.
Most often it is a problem with inclusion in a group, isolation, loneliness.
However, these symptoms can be explained in different ways, they do not always mean a disease.

As they do not lag behind in knowledge, patients may not have major problems during their studies.
Therefore, if Asperger's syndrome is not detected in a preschooler, it may become increasingly difficult as they get older.

Anamnestic data

The most important diagnostic element is the medical history.
This is a targeted identification of differences at the levels of social interaction, communication and imagination.

Impairments found in areas of this triad mean the patient has a high probability of having Asperger's syndrome.

As far as paediatric patients are concerned, anamnestic data are usually provided to the doctor or psychologist by the parent.

In order to make a definitive diagnosis, it is necessary that the symptoms mentioned have lasted for several years and are not simply the result of the patient's current experience, for example, a post-traumatic reaction.

It does not mean that the professional will now observe the patient for many years. It means that he takes into account information provided by a family member or other close person in retrospect.

In the differential diagnosis, several psychiatric disorders come into consideration that only a specialist in psychiatry or paedopsychiatry can rule out.

Differential diagnosis in childhood

In the paediatric patient, the biggest problem for professionals is differentiating Asperger's syndrome from schizoid disorder. The boundaries between the two disorders are unclear.

In fact, the two disorders have certain common features and to some extent the symptomatology overlaps. Schizoid disorder does not have clearly defined diagnostic criteria.

In both, there is heightened sensitivity, social isolation, lack of empathy, bizarre thinking, odd interests, a preference for routine activities, eccentric behaviour, paranoid thoughts, even episodes of hallucinations and delusions.

Interesting:
Experts believe that there is a relationship between Asperger's syndrome and schizotypal disorder in a child patient.
There are those who believe that they are one and the same disorder.

Differential diagnosis in adulthood

There are also problems in making the correct diagnosis in adult individuals.
If certain symptoms are at the forefront, the patient may be misdiagnosed.

In an adult, it is more difficult to extract a medical history. Some symptoms may be deliberately concealed or the patient may not want to admit them even to himself.

Most often, Asperger's syndrome in adulthood is confused with schizoid disorder, similar to childhood schizotypal disorder, paranoid disorder or schizophrenia.

Another problem in the adult is the differentiation of Asperger's syndrome from a more severe form of depression.

Test for Asperger's syndrome

There are several criteria and tests that can be used to make a realistic suspicion of Asperger's syndrome.
The tests include the most typical manifestations of the disorder and can reveal a diagnosis based on true answers.

Table - Gilberg and Gilberg test

Table - diagnostic criteria/test according to Szatmari, Brenner and Nagy

SPET examination

A SPET (single photon emission thompgraphy) examination is a single photon emission computed tomography scan that uses gamma rays to image the part being examined.

The gamma camera or projection can scan not only the 3D image, but also the level of biological activity at the site of the analyzed area.

It is a relatively new examination and diagnostic method in nuclear medicine that is capable of aiding in the diagnosis of Asperger's syndrome.

With this examination, it is possible to demonstrate a certain morphological abnormality that Asperger's patients have, namely an asymmetry in the structure of the brain hemispheres. Typically, the right hemisphere of the brain has a different structure than the left.

The disease usually begins to manifest itself at an early age (usually in infancy), but may not yet have all the typical features, which means that it may be hidden for a long time.
The manifestations are not very noticeable and the course of the syndrome is stable without remission (lessening of symptoms) or relapses (worsening of symptoms).

This pervasive personality disorder develops most during adolescence and early adulthood, when the person with Asperger's syndrome first comes into conflict with the environment and the rest of society.

Puberty is generally a difficult time for all of us.
It is even more difficult for people with Asperger's syndrome. That is why they cope with it less well than others.

One may notice social clumsiness, behavioural and attention disorders, difficulty forming friendships, unusual reactions to environmental stimuli, a preference for routine activities, outbursts of aggression alternating with shyness and other symptoms.

The patient is aware of his/her differences and tries to cope with them either alone or with the help of a psychologist or psychiatrist.

• Máte doma dieťa, ktorému diagnostikovali Aspergerov syndróm?
• Máte veľa otázok a žiadne odpovede?
• Neviete si rady?
• Nevzdávajte to!

Rada nad zlato znie: Všetko sa dá prekonať správnym prístupom.

Možno to vyzerá banálne, ale práve Aspergerov syndróm je jedným z ochorení, kde správny postoj a prístup rodiča zohráva kľúčovú úlohu.

Rodič je pre dieťa autorita, a niekedy jediná osoba, ktorej naozaj dôveruje. Pacienti s Aspergerom zvyčajne lipnú na jednom z rodičov, pričom ich vzťah k tejto osobe je z ich pohľadu nadštandardný a neobyčajný.

Pokiaľ to situácia dovoľuje, mala by sa mu venovať práve táto osoba. Spravidla sa jedná o matku, avšak môže to byť aj otec, prípadne babička.

Jediné čo treba urobiť je byť trpezlivý, nájsť si čas a dostatočne sa dieťaťu venovať od útleho veku. Pozornosť a komunikácia s dieťaťom mu uľahčuje komunikáciu s inými ľuďmi, čím mu napomáha prekonať pomyslené bariéry v sociálnej interakcii a vytváraní nových kontaktov.

Avšak, skúseného psychológa nenahradíte!

Aj napriek mimoriadnej snahe rodiča, by ten nemal nahradiť psychológa. Skúsený psychológ pracuje s dieťaťom cielene, pretože má dostatok informácií o danej problematike a zároveň aj o spôsoboch jej zvládania.

Psychológ si obvykle pacienta rýchlo získa, a teda si k nemu vytvorí pozitívny vzťah. Následne je schopný dieťa správne usmerňovať.