There is no specific treatment or "cure" for Asperger's Disorder. All the interventions outlined below are mainly symptomatic and/or rehabilitational.
Psychosocial Interventions
- Individual psychotherapy to help the individual to process the feelings aroused by being socially handicapped
- Parent education and training
- Behavioral modification
- Social skills training
- Educational interventions
Psychopharmacological Interventions
- For hyperactivity, inattention and impulsivity: Psychostimulants (methyphenidate, dextroamphetamine, metamphetamine), clonidine, Tricyclic Antidepressants (desipramine, nortriptyline), Strattera (atomoxetine)
- For irritability and aggression: Mood Stabilizers (valproate, carbamazepine, lithium), Beta Blockers (nadolol, propranolol), clonidine, naltrexone, Neuroleptics (risperidone, olanzapine, quetiapine, ziprasidone, haloperidol)
- For preoccupations, rituals and compulsions: SSRIs (fluvoxamine, fluoxetine, paroxetine), Tricyclic Antidepressants (clomipramine)
- For anxiety: SSRIs (sertraline, fluoxetine), Tricyclic Antidepressants (imipramine, clomipramine, nortriptyline)
Asperger's Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Oppositional Defiant Disorder (ODD)
- Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
- Bipolar Disorder
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder presents with difficulty in focusing (inattention), hyperactivity and impulsiveness. Almost 60-70 % of children with Pervasive Developmental Disorders ( = PDD or Autistic Spectrum Disorders) have severe enough inattention, hyperactivity and impulsiveness to meet the diagnostic criteria for ADHD. Technically, if a child is diagnosed with any of the PDD diagnoses (Autistic Disorder, Asperger's Disorder, PDD-NOS or others), a separate ADHD diagnosis cannot be made. However, I believe that it is important to recognize the presence of co-existing ADHD since this syndrome can respond to medication treatment, unlike the core PDD symptoms. When ADHD co-exists with Asperger's Disorder, anger may easily turn to aggression because of the individual's impulsiveness. Methylphenidate (Ritalin, Concerta, Metadate, Focalin), dextroamphetamine (Dexedrine, Adderall), atomoxetine (Strattera), bupropion (Wellbutrin) or tricyclic antidepressants (imipramine, nortriptyline and others) may be beneficial. Common complications of untreated ADHD are ODD (see below), depression (losing self esteem due to academic failure and repeated negative feedback and punishment from adults), increased likelihood of drug and alcohol use, breaking traffic rules more frequently and having more accidents, and eventually getting lower-paying jobs for not fulfilling true potential.
Oppositional Defiant Disorder (ODD)
ODD represents more of a relationship dynamic between a child and the authority figures around her or him, than a disease process itself. Symptoms include argumentativeness with adults, talking back, refusing to follow adults' requests or rules, losing temper, deliberately annoying others, not taking responsibility for one's own actions, and being touchy, angry and resentful all the time. This can happen only at home, or may start at home and may eventually spill over to the school. Most children with ADHD, if untreated, eventually develop ODD because of daily negative feedback and punishment from adults, as a consequence of their impulsive behaviors. It is important to note that depression, in children and adolescents, may present with similar symptoms, rather than the expected symptoms like looking sad and crying frequently. A Child and Adolescent Psychiatrist should be consulted to differentiate the two. There is no medication treatment for ODD. Individual psychotherapy and sometimes family therapy are the best treatment methods. If there is ADHD underlying ODD, it has to be treated with medication for psychotherapies to be effective.
DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER
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 adherence to specific, nonfunctional 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.
F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER
1.Severe impairment in reciprocal social interaction
(at least two of the following)
(a) inability to interact with peers
(b) lack of desire to interact with peers
(c) lack of appreciation of social cues
(d) socially and emotionally inappropriate behavior
2.All-absorbing narrow interest
(at least one of the following)
(a) exclusion of other activities
(b) repetitive adherence
(c) more rote than meaning
3.Imposition of routines and interests
(at least one of the following)
(a) on self, in aspects of life
(b) on others
4.Speech and language problems
(at least three of the following)
(a) delayed development
(b) superficially perfect expressive language
(c) formal, pedantic language
(d) odd prosody, peculiar voice characteristics
(e) impairment of comprehension including misinterpretations of literal/implied meanings
5.Non-verbal communication problems
(at least one of the following)
(a) limited use of gestures
(b) clumsy/gauche body language
(c) limited facial expression
(d) inappropriate expression
(e) peculiar, stiff gaze
6.Motor clumsiness: poor performance on neurodevelopmental examination
(All six criteria must be met for confirmation of diagnosis.)
Despite the now widely accepted fact that biological factors are of crucial importance in the etiology of autism, so far the brain imaging studies have shown no consistent pattern, no consistent evidence of any type of lesion, and no single location of any lesion in subjects with autistic symptoms. This inconsistency in the results of various brain imaging studies has been attributed to the fact that people with autism represent a highly heterogeneous group in terms of underlying pathology. Therefore there is an ongoing effort to specify more homogenous subgroups among autistic individuals to enhance the accuracy of etiologic inquiry. This approach has been supported with the inclusion of the diagnosis 'Asperger's Disorder' in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association.
Associated medical conditions such as fragile-X syndrome, tuberous sclerosis, neurofibromatosis, and hypothyroidism are less common in Asperger's Disorder than in classical autism. Therefore it may be expected that there are fewer major structural brain abnormalities associated with Asperger's Disorder than with autism. To our knowledge, a very small number of structural brain abnormalities have been so far associated with Asperger's Disorder, which include left frontal macrogyria, bilateral opercular polymicrogyria, and left temporal lobe damage. On the other hand brain imaging techniques like positron emission tomography (PET), and single photon emission tomography (SPECT) which provide information about the functional status of brain may be more helpful in determining the brain dysfunction in individuals with Asperger's Disorder. Detailed neuropsychological testing may support these findings providing information about the performances of individual right or left hemispheric brain regions. The first SPECT study in a patient with Asperger's Disorder was published by the host of this page and his colleagues, and found left parietooccipital hypoperfusion. Continuation of research in Asperger's Disorder with various brain imaging techniques in coordination with neuropsychological evaluation in larger samples is clearly needed in this area.
It is believed that in Asperger's Disorder
- onset is usually later
- outcome is usually more positive
- social and communication deficits are less severe
- circumscribed interests are more prominent
- verbal IQ is usually higher than performance IQ (in autism, the case is usually the reverse)
- clumsiness is more frequently seen
- family history is more frequently positive
- neurological disorders are less common
