Asperger syndrome

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Classification according to ICD-10
F84.5 Asperger syndrome
ICD-10 online (WHO version 2019)
People with Asperger's Syndrome often develop special interests; this boy deals with molecular structures .

The Asperger's syndrome (AS) is a variant of autism and to the disturbances of the neural and mental development expected. It differs from other forms of autism mainly in that there is usually an unimpaired language development and no intellectual disability.

Characteristics are peculiarities and difficulties in social interaction and communication as well as differences in perception and stimulus processing (this includes in particular sensory over- and under-sensitivity and difficulties in filtering stimuli) as well as often unusual interests and talents.

Above all, the ability to recognize non-verbal signals ( gestures , facial expressions , eye contact ) in other people, to evaluate them (to mentalize them ) or to send them out oneself is impaired. The contact and communication behavior of people with Asperger's autism can appear strange and clumsy as a result. Since their intelligence is normal in most cases, they are easily perceived as strange by those around them. Occasionally, Asperger's syndrome coincides with giftedness or island talent .

Asperger's syndrome is not only associated with impairments, but also with strengths (for example in the areas of objective, non-emotional perception, self- observation, attention or memory performance ). Whether it should be classified as a disease or as a standard variant of human information processing is answered inconsistently by scientists and doctors as well as by Asperger's autistic people and their relatives. The basic condition for the diagnosis of Asperger's Syndrome, however, is that there are impairments in several areas of life (see criterion C in the DSM ). Medically it therefore has disease value and is therefore currently classified as a mental disorder . The research community also disagrees as to whether Asperger's syndrome should be seen as a qualitatively independent disorder or a weakened variant of early childhood autism .

In the DSM-5 and the ICD-11 (valid from 2022) the traditional autism subtypes (and with it Asperger's syndrome ) have been completely abandoned and all manifestations are now included in a general spectrum of autistic diseases (autism spectrum disorders, ASD ) together. The reason for this was the increasing knowledge in science that a clear delimitation of subtypes is not (yet) possible - and instead one should assume a smooth transition between mild and severe forms of autism.

Discovery of Asperger's Syndrome

Asperger's syndrome was discussed in psychiatry from the mid-1920s. The oldest depiction comes from the Russian child psychiatrist Grunja Sucharewa , who in 1926 used the expression "schizoid psychopathy" for it. The Austrian pediatrician Hans Asperger called it "autistic psychopathy" in his habilitation thesis submitted in 1943 .

At that time Asperger's work appeared almost at the same time as Leo Kanner's fundamental essay on early childhood autism (1943). It is believed that both authors initially had no knowledge of the other author's work. Kaner's work, published in the US, immediately garnered international attention; the essay by the Austrian Asperger was hardly known outside the German-speaking scientific community at that time - in the middle of the Second World War. An essay published in 1962 by two Dutch authors attempting to differentiate between Asperger's “autistic psychopathy” and Kanner's autism initially met with little response.

Asperger's syndrome was not noticed by the international research community until after 1981, when the British psychiatrist Lorna Wing continued Asperger's work and named the deviation, which had previously been considered psychopathy , as part of the autism spectrum after Hans Asperger.

In the late 1980s, diagnostic criteria were formulated by various parties, some of which differed considerably from one another. In 1992 Asperger's Syndrome was included in the ICD medical classification system of the World Health Organization . It was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the classification system of the American Psychiatric Association , from 1994 to 2013.

Related terms

In the English-speaking world, a distinction was often made between different forms of early childhood autism. One of them was what is known as Highly Functional Autism (HFA). In 1995, the authors of a study by the Yale Child Study Center suggested distinguishing between highly functional autism and Asperger's syndrome. This distinction was confirmed in a 2013 review by authors at the University of Freiburg. It is important to differentiate between high- and low-functional Asperger's syndrome on the one hand and between high- and low-functional early childhood autism on the other.

Earlier, Lorna Wing autism as seamless whole (proposed 1991 Continuum describe) varying degrees of interference form in the HFA and Asperger's Syndrome mild manifestations. Therefore, authors now and then sometimes speak of autism spectrum disorders (ASD).

Since the autism spectrum does not end with Asperger's syndrome, but extends far into the normality into - for example to the "normal" shyness or eccentricity - was the term used for appearances with poorly developed autistic personality traits and behaviors Broader Autism Phenotype ( BAP). In German, this is best matched by the term “autistic traits”.

frequency

The frequency ( prevalence ) of Asperger's syndrome in childhood varies depending on the diagnostic criteria used. In a 2007 study of 4,422 eight-year-old children in Finland, the proportions were 0.25% (according to DSM-IV), 0.29% (according to ICD-10), 0.27% (according to the Gillberg criteria) and 0, 16% according to the Szatmari criteria.

The ratio of affected boys and girls in the Finnish study was 0.8: 1 according to DSM-IV and 2: 1 according to the Gillberg criteria. With regard to the entire autism spectrum, an overview from 2015 showed that the numbers on the gender distribution varied greatly due to methodological difficulties. The male-female ratio is at least 2: 1 to 3: 1, which indicates a biological factor in this question.

Representative studies on the frequency of Asperger's syndrome in adulthood are not yet available (as of 2009). However, the autistic traits tend to persist into adulthood.

Diagnostic criteria

According to DSM

While the DSM IV still contained Asperger's Syndrome as a separate category, it was removed as a single disorder in the current DSM-5 (2013). It is now summarized in the autism spectrum disorders ; similar to childhood disintegrative disorder and other pervasive developmental disorder (not otherwise specified) .

The reason for this was that the researchers recently assumed that it was less a question of different diseases than a seamless whole (continuum) of very mild to severe forms of a developmental disorder that began in early childhood. In terms of symptoms, a distinction is made between deficits in two categories: First, social interaction and communication are disrupted (for example, eye contact, the ability to communicate or build relationships are weak). Second, repetitive behaviors and fixed interests and behaviors are hallmarks of autistic disorders.

In DSM-IV of the American Psychiatric Association in 2000 following diagnostic criteria (A-F) were included for Asperger Syndrome:

  • A) Qualitative impairment of social interaction, which manifests itself in at least two of the following areas:
  1. noticeable impairment of several non-verbal behaviors that control social interaction, such as eye contact, facial expression, posture, and gestures
  2. Relationships with peers are not developed or not developed according to the level of development
  3. Lack of spontaneous turning to others in order to share joy, interests or pride about an achievement with them (for example, affected children tend not to show other people things that interest them)
  4. Lack of social or emotional reciprocity
  • B) Limited repetitive and stereotypical behavior, interest and activity patterns that show up in at least one of the following characteristics:
  1. extensive preoccupation with one or more stereotypical and limited patterns of interest that are abnormal because of their intensity or because of the subject matter
  2. obviously rigid adherence to certain non-functional routines or rituals
  3. stereotypical and repetitive motor habits (for example hand or finger movements or complex movements of the whole body)
  4. persistent occupation with object parts
  • C) The disorder causes clinically significant impairment in a social, professional, or other important area.
  • D) There is no clinically significant general speech delay (e.g. use of individual words in the second year of life, communicative sentences in the third year of life)
  • E) There is no clinically significant delay in the development of cognition, practical skills ( self-help skills ) and adaptive behavior (except for social interaction) and - in childhood - curiosity about the environment
  • F) The disorder does not qualify as another pervasive developmental disorder or schizophrenia .

According to ICD

The ICD-10 is the current diagnostic system of the World Health Organization and is preferred in Germany, Austria and Switzerland for disease classification. The following criteria are mentioned there:

General criteria for developmental disorders (F80 – F89)

Criteria according to F84.5 - Asperger's Syndrome

  • qualitative deviations in mutual social interactions (as in autism )
  • a restricted, stereotypical, repetitive repertoire of interests and activities
  • no general developmental delay (unlike autism)
  • no deficit in language and cognitive development (unlike autism)

In the German version ICD 10-GM 2015 valid since January 1, 2015 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision German Modification Version 2015) , no changes have been made to the categorization of autistic disorders since the publication of DSM-5, Asperger's syndrome can still be found under the classification F84.5.

In the ICD-11 , as in the DSM-5, Asperger's syndrome is no longer an independent diagnosis, but is included in the autism spectrum disorders (ASD) (as of June 2018).

  • 6A02 Autism spectrum disorder
    • 6A02.1 Spectrum of autistic disorders without disruption of intellectual development and mild or no impairment of functional language (Autism spectrum disorder without disorder of intellectual development and mild or no impairment of functional language)
    • 6A02.2 Autism spectrum disorder with disorder of intellectual development
    • 6A02.3 Autism spectrum disorder with impairment of functional language
    • 6A02.4 Spectrum of autistic disorders with both disorder of intellectual development and impairment of functional language (Autism spectrum disorder with both disorder of intellectual development and impairment of functional language)

Gillberg criteria

Before the appearance of the two current classification systems DSM and ICD, some authors published their own diagnostic criteria. In 2008, there was the opinion that the DSM and ICD criteria "were questioned because of the [contained] requirement for inconspicuous early childhood development or the lack of communicative or motor characteristics" and therefore often found "hardly ever used". The Swedish professor of child and adolescent psychiatry Christopher Gillberg , together with his wife Carina Gillberg, published the diagnostic criteria below in 1989. The British psychologist Tony Attwood stated in 1998 that it was "a matter of opinion" which criteria you use. He himself prefers that of the Gillbergs.

Social impairment
(at least two of the following characteristics):
  1. Inability to interact with their peers
  2. lack of desire to interact with their peers
  3. lack of understanding of social signals
  4. socially and emotionally inappropriate behavior
Limited interests
(at least one of the following characteristics):
  1. Exclusion of other activities
  2. repetitive following the activity
  3. more routine than importance
Repetitive routine
(at least one of the following characteristics):
  1. for yourself, in relation to certain aspects of life
  2. for others
Speech and language peculiarities
(at least three of the following characteristics):
  1. delayed development
  2. (on the surface) perfect linguistic expression
  3. formal, pedantic language
  4. strange prosody , strange voice characteristics
  5. impaired understanding including misinterpretation of literal / implied meanings
Nonverbal communication problems
(at least two of the following characteristics):
  1. limited eye contact
  2. limited gesture
  3. awkward or awkward body language
  4. limited facial expressions
  5. inappropriate expression
  6. gaze
Motor awkwardness
lack of performance in the study of neurological development

Appearance

While the first signs of other forms of autism appear in the first few months of life, Asperger's syndrome usually only becomes apparent after the age of three. General characteristics are: a qualitative impairment of social communication and interaction, a lack of empathy , sensory, motor and linguistic peculiarities as well as pronounced special interests.

Motor skills

In Asperger's syndrome, motor peculiarities often occur that are normally absent in other autism. These include awkward movements, clumsiness, and gross and fine motor coordination disorders. Some children with Asperger's show, when they are excited or anxious, strange movements ( mannerisms ) that also occur with other autism, for example flapping arms, hands or fingers.

Social behavior

Like other autistic children, children with Asperger's syndrome tend to make little and only fleeting eye contact . In everyday life, a lack of empathy and incomprehension for interpersonal feelings is noticeable. Children with Asperger's Syndrome are often socially isolated and easily offended because of their specifics. In the class, they are often teased, marginalized and bullied. In the English-speaking world, many people call with Asperger their otherness jokingly as "Wrong Planet Syndrome" (German: Wrong Planet syndrome ) and thus express their feeling of being mistakenly stranded on an alien planet whose rules and residents do not understand.

People with Asperger's Syndrome are often perceived as formal, callous, fearful, shy, evasive, dismissive or disinterested , even when they want to contact others, due to their often averted gaze and their closed body language , which often leads to failure.

Hans Asperger observed that the affected children also tend to "autistic self-examination". In situations where other children obliviously "go live," Asperger's children and their bodily functions are often themselves (critical) watching over.

A lack of self-confidence often shows up in field reports and in the advice literature. Specific scientific studies on this are not yet available (as of August 2015). However, the subject is sometimes treated in passing. In any case, it is of great importance in the field of work and employment.

language

In the area of ​​linguistic development, Asperger's syndrome shows clearly different abnormalities than other early childhood autism. The latter is characterized by a general delay in speech development. This is associated with symptoms such as inappropriate repeating ( echolalia ) or exchange of pronouns . Even with highly functional autism, articulation, verbal expression, auditory perception, vocabulary and verbal memory are disturbed.

Such symptoms are absent in Asperger's syndrome. The affected children develop a grammatically and stylistically superior language. The observations at the beginning of language differ. For example, while Remschmidt found that Asperger's children begin to speak early, Attwood reports that almost half of these children learn to speak late, but that this gap is made up by the age of five. As Hans Asperger already observed, affected children regularly stand out due to an adult, pedantic expression that is not appropriate to their age and an unusual intonation ( prosody ). In the English-speaking world, Asperger's Syndrome is therefore also known as the “Little Professor Syndrome” (German: Little Professor Syndrome ). The pitch is often monotonous and does not, for example, support the difference between serious and humorous utterances. Often speaking speed and volume are inappropriate or unusual. Loss of jerky speaking also occurs.

Many children and adults with Asperger's Syndrome tend to talk incessantly and lengthy, usually about their favorite topic, and often completely disregard whether the listener is interested in the topic and supports the conversation. Some authors consider this monological, egocentric speech, which clearly reveals Asperger's insensitivity to social subtleties, to be one of the most striking features of the syndrome. Further characteristics are a very detailed narrative style with difficulties in distinguishing the essentials from the inessentials, abrupt changes of subject that are incomprehensible to the listener, taking pictorial expressions literally and answering rhetorical questions .

Typical is also the use of figurative expressions ( metaphors ) and word creations that are only familiar to them, or the clinging to formulations that sound like memorized or read from a book, as well as the failure to grasp subtleties ( nuances ) - for example Irony, teasing - and imprecise listening. Some Asperger's autistic people talk to themselves in order to organize their thoughts, for example in order to fully understand a conversation that has already been held or to rehearse an upcoming conversation.

Special interests

From the outside, people with Asperger's syndrome seem to have little interest in their fellow human beings. However, there is a lot of evidence that those affected develop a keen interest in social contact, but do not know how to implement it. Difficulties in recognizing the body language and facial expressions of others play a role and are often understood as a lack of empathy. While people are evolutionarily referred to as specialists in social contact, Asperger's patients do not develop this specialty, or develop it insufficiently. Typically, however, they have other special interests that seem unusual in the matter or in their intensity. These interests often lie in technical or scientific areas such as computer science, mathematics, physics, biology or astronomy. Other sufferers are passionate about music or memorizing various facts. Some are passionate collectors, often of unusual objects.

Individuals within the autism spectrum are occasionally gifted or isolated. The estimates of the frequency diverge very widely because of great methodological difficulties in recording. It is now assumed that due to the special flow of information in the brain (see below: Neuropsychology ) autistic characteristics and the tendency towards special talents can be linked.

Emotions

Hans Asperger did not perceive the emotions of his subjects as underdeveloped, but rather as of a different quality.

Commenting on her feelings, autistic scientist and inventor Temple Grandin said, “My emotions are simpler than most other people's. I don't know what a multilayered emotion is in an interpersonal relationship. I only understand simple emotions like anger, fear, happiness and sadness. "

intelligence

In contrast to some other forms of autism, intelligence in people with Asperger's syndrome is often normal. Premature reading ( hyperlexia ) is also occasionally observed in Asperger’s children . Often times, children with Asperger's Syndrome have an unbalanced intelligence profile. They often show strengths in the verbal parts of the task.

Asperger's Syndrome and Genius

As Hans Asperger wrote: "It seems that success in science or in the arts requires a dash of autism." The question of the relationship between Asperger's Syndrome and outstanding performance also preoccupied the Irish child psychiatrist Michael Fitzgerald . Since 1999 he has published a number of articles and books in which he examined the résumés of famous people for signs of Asperger's Syndrome. Fitzgerald believes that many features of Asperger's syndrome encourage creativity and that the ability to focus intensely on one object and go through endless toil to create is characteristic of this syndrome.

Christopher Gillberg and Oliver Sacks have made similar posthumous attempts at diagnosis. Some personalities - such as Isaac Newton and Albert Einstein - have created real controversies. Still other researchers are fundamentally skeptical of such diagnostic attempts, for example Fred Volkmar of the Yale Child Study Center , who (2001 or earlier) said: "Unfortunately there is a kind of domestic industry to uncover that everyone has Asperger's."

Concentration and learning problems

Some children with Asperger's syndrome are noticeable because they are unable to control their attention deliberately ( executive functions ) and are highly unfocused in activities that they have not chosen themselves - for example at school - which leads to a great lack of concentration high intelligence can result in significant learning difficulties.

“This disorder of active attention is found almost regularly in children of this type. So it is not, or not only, the common concentration disorder of many neuropathic children to be observed, who are distracted from their work goal by all external stimuli, from every movement and restlessness around them. Rather, these children are not inclined from the outset to direct their attention, their concentration of work, to what the outside world, in this case the school, demands of them. "

- Hans Asperger : The "autistic psychopaths" in childhood. P. 119

If such concentration difficulties exist, Asperger's syndrome can even be confused with AD (H) D (see delimitation ). Another obstacle to learning is the impairment of central coherence , which is typical of Asperger's syndrome : the ability to differentiate between what is important and what is unimportant.

Ritualized acts

People with Asperger's are often fixated on making their external environment and daily routines as consistent as possible. Sudden changes can overwhelm you or make you very nervous. This is because changes require a higher level of attention, which adds to the stress in people with autism spectrum disorder's supposed weakness to block out information.

Asperger's Syndrome in Adults

Adults with Asperger's Syndrome often live withdrawn and have few direct social contacts. In their place nowadays contacts are often made via the Internet. Although some people with Asperger's manage to build a stable partnership and start a family, it is difficult for others to even establish contact with possible partners due to a lack of social skills. In Asperger's and highly functional autistic people, the difficulties in intuitively perceiving non-verbal signals , adopting the perspective of others, and social interaction and communication represent hidden barriers which, despite the normal intellectual and linguistic abilities of those affected, impair the search for a partner. This problem can already show up during adolescence , as the development of the social skills of those affected cannot keep up with the increasing demands in this regard. Affected women are more likely to be in a relationship than affected men, which could be because they have better developed coping strategies, such as mimicking inconspicuous social behaviors. Often the requirements of a partnership are also perceived as strenuous.

For the professional development of people with Asperger's, the decisive question is whether they can successfully implement their special interests professionally.

Some adult people with Asperger's Syndrome knowingly or subconsciously make acquaintances with people whose personality traits they can easily deal with. You build up a social network with people who are also mostly introverted , mainly communicate on a factual level and often also have special interests, but who are not necessarily autistic themselves ( fashionable terms : geeks and nerds ). Adult people with Asperger's Syndrome and a well-functioning social environment are often unaware of their autistic traits. You can u. You may be overwhelmed when you involuntarily deal with people whose personality is too different from your own.

Diagnosis in adulthood

A study by the Autism Research Cooperation (AFK) with 271 adult test persons with autism showed that their average age at the time of diagnosis was 35 years and that 87% of the test persons had received their diagnosis after the age of 18. Asperger's autism in particular is often diagnosed very late because the problems of normally intelligent autistics are less “obvious”.

When diagnosing in adulthood, it is often less the severity than the living conditions that plays a role. If there is good private and professional integration, no diagnosis or additional therapy may be necessary. Life crises, caused for example by unemployment or divorce, can lead to a difference in social interaction becoming more clearly visible and leading to a diagnosis. This is what many autistic people who are only diagnosed in adulthood report.

job

"With the autistic in particular we see - with far greater clarity than with the 'normal' - that they appear predestined for a certain profession from an early age, that this profession grows fatefully out of their particular talents."

- Hans Asperger: The "autistic psychopaths" in childhood. P. 133

The geophysicist Peter Schmidt describes how Asperger's Syndrome affects modern academic professional life. According to this, because of his Asperger's syndrome, the author is more likely to be perceived as a problem case (which causes resistance) and because of his strengths as a capacity (top performer). People with Asperger's Syndrome, who seem to be predestined for a certain profession from childhood on, encounter great difficulties in the modern working world, in which mobility, flexibility, teamwork and communication skills are increasingly important. The extent to which they succeed in finding a niche that corresponds to their characteristics depends both on the people with whom the autistic person has to work, especially their superiors, and on the working conditions provided. It therefore makes sense for those affected to have precise knowledge of the requirements at the workplace as well as the environment and the premises before they start working so that they can prepare in good time for the upcoming changes. According to a 2013 report by Deutsche Welle , only 15 percent of people with Asperger's have a normal job.

Crime statistics

Sometimes the question arises whether autism sufferers have an increased tendency to criminal acts. This cannot be answered with certainty at the moment, as insufficient epidemiological studies are available. However, most authors suspect that autistic people have a lower crime rate than non-autistic people. They are more victims than perpetrators. They would also tend to apply laws rigidly and have problems with exceptions to rules and violations of the law. On the other hand, descriptions of individual cases show that people with Asperger's definitely come into conflict with the law.

forecast

According to Hans Asperger, a favorable prognosis depends on the degree of intellectual talent. Less talented people often only get into a subordinate outsider profession and, in the worst case, hang around the streets as "strange originals". In the case of "intact" and above-average gifted people with autism:

"To a good professional performance and thus to a social classification, often in high-ranking professions, often in such an excellent way that one has to come to the view that no one but precisely these autistic people are capable of such performance."

- Hans Asperger: The "autistic psychopaths" in childhood. P. 133

Demarcation

Differential diagnosis

Highly functional autism and Asperger's syndrome must be differentiated from the following other mental illnesses ( differential diagnosis ):

Schizoid Personality Disorder (SPS)
Differentiating it from schizoid personality disorder can be complicated as some autistic people (up to 26%) meet the criteria for schizoid PS at the same time. Social communication (facial expressions, gestures, eye contact, etc.) can be noticeable in both Asperger's syndrome and SPS. What differs, however, is that schizoid people often appear reserved, withdrawn and closed (or even secretive) and tend to be reluctant to talk about themselves. In contrast, many people with mild autism are often very open, honest, direct, and occasionally unintentionally pushy. Those affected are often only slightly afraid of giving others an insight into their inner workings. This can be seen in the very open and personal self-portrayal in the many autobiographies of autistic people and in public interviews. As an adult, you often want friends and acquaintances. However, because of their difficulty in noticing complex feelings in the other person or in reacting to them appropriately, they are often only able to form friendships to a limited extent.
Schizotypic Personality Disorder (STP)
The differentiation from the schizotypic PS is not easy either, because here too overlaps can occur in up to 40% of the cases (i.e. AS and additional schizotypal characteristics). In the case of autism spectrum disorders, however, symptoms such as impaired experience and expression, paranoid ideas and suspicion are not the focus. Schizotypic personalities usually recognize social cues (gestures, facial expressions, etc.), but then interpret them in a rather suspicious way (hyper-mentalizing). People with Asperger's Syndrome are more likely to have problems reading and perceiving social signs at all ( hypo-mentalizing ).
Unlike people with autism, schizotypical people have a theory of mind (ToM). The Imprinted Brain Theory by Bernard Crespi (according to which autism and psychosis are supposed to be opposing extremes) sees the schizotypal PS and Asperger's syndrome analogously as each weakened form.
schizophrenia
Classic schizophrenic symptoms (such as delusions, hallucinations, and thought disorders) are not observed in Asperger's syndrome. In about five percent of cases, however, there is a transition from Asperger's syndrome to a schizophrenic disease. People with Asperger's Syndrome occasionally take refuge in their imaginations or special interests, but this has nothing to do with schizophrenia because they are quite capable of returning to everyday reality.
paranoia
People with Asperger's Syndrome are impaired in their understanding of interpersonal events and are probably more prone than others to paranoid patterns of world interpretation for this reason . Their paranoid tendencies, however, are weaker than those of people with delusions and can be distinguished from them.
Urbach-Wiethe syndrome
Autistic behaviors can also occur in Urbach-Wiethe syndrome . The skin and mucous membrane changes occurring there and genetic examinations usually allow a differentiation from autism.
Atypical autism
The diagnosis of atypical autism (F84.1) is made when the criteria do not match either early childhood autism or Asperger's syndrome, but there are still characteristics or problems that can be assigned to the autism spectrum.

For the differential diagnosis in adulthood, an overview from 2013 also explains the following other deviations that must be distinguished from Asperger's syndrome: social anxiety disorder ( social phobia ), obsessive-compulsive disorder , obsessive-compulsive personality disorder and attention deficit / hyperactivity disorder (ADHD).

Possible side effects

Sometimes Asperger's syndrome also occurs together with other mental disorders ( comorbidity ):

  • One of the most common side effects is depression , which is mostly caused by impairments in private and professional life.
  • Some people with Asperger's syndrome also meet the criteria for obsessive-compulsive disorder or obsessive-compulsive personality disorder . In the case of simple obsessive-compulsive disorder, the differentiation from Asperger's syndrome is easier than in the case of obsessive-compulsive personality disorder. Asperger's syndrome and obsessive-compulsive disorder can also be present at the same time.
  • When people have difficulty concentrating, Asperger's Syndrome is easily mistaken for ADHD . However, both disorders can also occur together. A 2012 overview emphasizes that both their overlaps and their differences need to be considered.
  • Occasionally, Asperger's syndrome and Tourette's syndrome have been described together. However, when Asperger's syndrome is present on its own, it is easy to distinguish from Tourette's syndrome.
  • Asperger's syndrome and anorexia nervosa are also sometimes observed together.

causes

According to the current state of research, the causes of Asperger's syndrome (and the entire spectrum of autism) lie in deviations in developmental biology in the development and growth of the brain. Both anatomy and function are changed, especially the formation of certain nerve connections ( connectom ). The subject of research is the possible causes of these deviations, which primarily - but not exclusively - affect embryonic development . In addition to special inherited genetic conditions, all factors that influence the work of the genes in critical time windows ( teratology ) come into question .

genetics

The genetic causes of the full range of the autism spectrum have proven to be extremely diverse and highly complex. In an overview from 2011, 103 genes and 44 gene locations ( gene loci ) were already identified as candidates for participation, and it was assumed that the numbers would continue to rise sharply. An overview from 2020 also took the view that there was not yet sufficient evidence of genes that were specific for the autism spectrum. It is generally assumed that the immense combination possibilities of many genetic deviations are the cause of the great diversity and breadth of the spectrum of autism, including Asperger's Syndrome.

Deletion (1), duplication (2) and inversion (3) of certain sections of a chromosome.

Since around 2010 it has become increasingly clear that, in addition to the hereditary changes that have been known for a long time, submicroscopic changes in chromosomes play a key role, especially in the autism spectrum , namely the copy number variations . First and foremost, it is a question of gene duplication or deletion . They arise during the formation of egg cells from the mother or from the father's sperm cells ( meiosis ). That is, they are created anew ( de novo ). However, if a child receives such a deviation from a parent, it can pass it on, with a 50% chance. As a result, it is possible that a deviation that contributes to the autism spectrum only occurs once in a child and is not inherited, or that it affects several family members in different generations. In the latter case, the impact ( penetrance and expressivity ) of such a genetic deviation can vary greatly from person to person (0–100%). Modern analysis methods ( DNA chip technology ) today allow the determination of such deviations that contribute to the disease (analysis of the karyotype ), whereby the involvement of family members is often helpful or even necessary.

Neuroimaging

Using imaging methods , structural and functional deviations in the brain were repeatedly identified (at group level, but not yet in individual cases). Graphic representations of individual brains do not yet allow any conclusions to be drawn due to the natural range of variation, but in the case of statistically determined group data, the deviations are clear compared to a comparison group. They affect large parts of the brain and correspond to the typical deviations in behavior. In general, however, children with autism show an enlarged amygdala and a faster growing brain, 65% more neurons in the frontal cortex, but a smaller corpus callosum , as well as less synapse elimination .

Connectivity

Noticeably repeated stacking or stringing as a possible expression of over- specialization

In 2004, a group of researchers led by Marcel Just and Nancy Minshew at Carnegie Mellon University in Pittsburgh (USA) discovered the appearance of changed connectivity (large-scale information flow , English connectivity ) in the brain in the group data of 17 test subjects from the Asperger's range of the autism spectrum. Compared to the control group, functional brain scans ( fMRI ) showed both areas of increased and decreased activity and a reduced synchronization of the activity patterns of different brain areas. Based on these results, the authors developed the first time the theory of sub connectivity (underconnectivity) for the explanation of autism spectrum.

The results were confirmed, expanded and refined relatively quickly in further studies, and the concept of sub-connectivity was further developed accordingly. With regard to other theories, it was not presented as a counter-model, but as an overarching general model. In the years that followed, the number of studies of connectivity in the autism spectrum skyrocketed.

In addition to more global sub-connectivity , more local over- connectivity was often found. The latter, however - based on knowledge of early childhood brain development in autism - is understood more as over-specialization and not as an increase in effectiveness. To accommodate both phenomena, the concept is now called atypical connectivity . It is becoming apparent (as of July 2015) that it is establishing itself as a consensus model in research. This also applies when considering the Asperger's part of the autism spectrum in isolation. The atypical connectivity present in the autism spectrum is understood as the cause of the particular behavior observed here, such as in the recording of connections between things, people, feelings and situations.

treatment

Not every diagnosis of Asperger's Syndrome leads to classification as a disease that should be considered or even treated. There is currently (as of 2017) no causally effective therapy. Possible is a symptomatic therapy , focusing on behavioral approaches (for example, TEACCH , ABA and practice social skills based). Klin and Volkmar, in particular, have dealt with the treatment principles for people with Asperger's. A comprehensive overview from 2013 by the Freiburg Autism Study Group is available for treatment in adults. Adapting the external environment to the patient's difficulties can also be useful.

If symptoms such as pronounced hyperactivity and restlessness, aggressive behavior, sleep disorders or depressive moods are added, drugs are also used. A systematic review from 2012 analyzed 32 studies that examined the effectiveness of treatments for adolescents and young adults with autism spectrum disorders. The result was that none of the 32 studies could be qualified as good and only five of them could still be regarded as acceptable.

Attwood considers seclusion (such as letting a child play alone ) as "one of the most effective emotional tonic for an Asperger's autist" . As a therapy for affective disorders as a concomitant symptom, he suggests cognitive behavioral therapy .

Autism rights movement

In neuroscientific and medical research, Asperger's Syndrome is described as an abnormality in the way the brain processes information. The British psychologist Tony Attwood , for example, takes a different approach, who sees the syndrome not as a deviation, but as a standard variant of information processing. Attwood admits that Asperger's autistic people are structurally disadvantaged in a social environment whose behavioral rules are difficult to follow, but emphasizes that this normal variant of the brain has a full right to exist.

Attwood also derives the expression "neurologically typical" ( neurotypical , NT) as a designation for people who are not autistic. While "NT" s are emotionally controlled and learn through intuition, Asperger's autistic people are logically controlled and learn through instruction. It is more helpful than a diagnosis and showing the deficiencies of an Asperger's autistic person to identify their strengths and talents. As an alternative to clinical-sounding terms such as “Asperger's patient” or “Asperger's autist”, the American educator Liane Holliday Willey coined the term “Aspie” in 1999, a (self) term that primarily describes skills and Designed to emphasize strengths of people with Asperger's.

Some people with Asperger's are now organized and demand - at events such as Autistic Pride Day  - for the depathologization and social recognition of the autistic personality. The battle  term of the autism rights movement - " neurodiversity " - expresses the idea that an atypical neurological development is a normal human difference that deserves acceptance as well as any other - physiological or other - variant of being human.

Research institutions

Institutions with a focus on Asperger's Syndrome include the Center for Cognitive Brain Imaging at Carnegie Mellon University in Pittsburgh / USA (Marcel Just, Nancy Minshew), the Yale Child Study Center of the Yale University School of Medicine ( Fred Volkmar), the Gillberg Neuropsychiatry Center of the University of Gothenburg (Christopher Gillberg, Carina Gillberg) and the University Center Autism Spectrum (UZAS) in Freiburg .

Current results of international autism research are presented at the Scientific Conference Autism Spectrum (WTAS), which has taken place annually since 2007 . With the founding of the Scientific Society for Autism Spectrum (WGAS) in 2008, this conference is also its main organ.

Legal situation

Since the so-called Asperger's Syndrome is seen as a variant of autism, the corresponding information on disabilities and severe disabilities also apply analogously.

The AS as a topic in art

Asperger's Syndrome is also often dealt with as a topic in books, films and video games, as the following lists show.

Fiction

Detective series about Commissioner Lost, written by Gil Ribeiro . Lost is an Asperger's; in the books, the characteristics of a person with Asperger's are described. Example:

Youth literature

Feature films / series

Cartoons

Video games

literature

Research literature

  • Hans Asperger: The mentally abnormal child. In: Wiener Klinische Wochenzeitschrift. Vol. 51, 1938, ISSN  0043-5325 , pp. 1314-1317.
  • Hans Asperger : The "Autistic Psychopaths" in Childhood. In: Archives for Psychiatry and Nervous Diseases. Volume 117, 1944, pp. 73-136. doi: 10.1007 / bf01837709 ( autismus-biberach.com (PDF; 197 kB))
  • Lorna Wing : Asperger's syndrome: a clinical account. In: Psychological Medicine. Volume 11, Number 1, February 1981, pp. 115-129. PMID 7208735 . (Scientific publication in which the symptom picture is referred to as "Asperger's Syndrome" for the first time.)
  • Ami Klin, Fred R. Volkmar, Sara S. Sparrow (Eds.): Asperger Syndrome . Guilford, New York 2000, ISBN 1-57230-534-7 .
  • Kyra Müller: Autism and Work. Inclusion of people on the autistic spectrum in working life. Framework. Funding opportunities. Empirical Study. (= Scientific work on the autism spectrum, Volume 4) Verlag Rad und Demokratie, (without location) 2015, ISBN 978-3-945668-29-0 (book) and ISBN 978-3-945668-28-3 (E- Book).
  • Helmut Remschmidt , Inge Kamp-Becker: Asperger's Syndrome. Verlag Springer, 2006, ISBN 3-540-20945-X .
  • Mandy Roy et al. a .: Asperger's syndrome in adulthood . In: Dtsch Arztebl Int . No. 106 (5) , 2009, pp. 59-64 ( Article ).
  • Nicole Schuster: A good day is a day with savoy cabbage. (M) a life in extremes: Asperger's Syndrome from the perspective of an affected person. (= Autism. Studies, materials and sources , Volume 17) Weidler Buchverlag, Berlin 2007, ISBN 978-3-89693-483-3
  • Ludger Tebartz van Elst : Asperger's Syndrome in Adulthood: and Other Highly Functional Autism Spectrum Disorders. MWV Medizinisch Wissenschaftliche Verlagsges., 2012, ISBN 978-3-941468-80-1 .
  • Timo Lorenz, Kathrin Heinitz: Aspergers - Different, Not Less: Occupational Strengths and Job Interests of Individuals with Asperger's Syndrome . PLOS ONE , June 20, 2014, doi : 10.1371 / journal.pone.0100358 (English).
  • Reinhard Krüger: homo significans: the human being as a creator of signs. Promotion of communicative competence and the neurobiological basics of learning in people with ASD. In: supported communication & research. Volume 1: Brain Research and Autism Spectrum Disorder. From Loeper, Karlsruhe 2011, pp. 4–20.
  • Hans W. Saloga / Jack: … it's always nice not to have to carry your thoughts around with you, Asperger's autism - his work process, seen in the texts of a young person. In: Child and adolescent psychotherapy. Issue 182, No. 2/2019. Brandes & Apsel, Frankfurt / Main May 2019, pp. 249–275, ISSN  2366-6889

Introductory and advisory literature

  • Tony Attwood: Asperger's Syndrome. The successful practical handbook for parents and therapists. 3. Edition. TRIAS, Stuttgart 2010, ISBN 978-3-8304-3862-5 .
  • Tony Attwood: A Lifetime With Asperger's Syndrome. From childhood to adulthood - everything that helps. 2nd Edition. TRIAS, Stuttgart 2012, ISBN 978-3-8304-6504-1 .
  • Dieter Ebert, Thomas Fangmeier, Andrea Lichtblau, Julia Peters, Monica Biscaldi-Schäfer, Ludger Tebartz van Elst : Asperger's autism and highly functional autism in adults. A therapy manual from the Freiburg Autism Study Group. Hogrefe Verlag, Göttingen 2013, ISBN 978-3-8409-2501-6 .
  • Ole Sylvester Jørgensen: Asperger. Syndrome between autism and normalcy. Diagnosis and chances of recovery. Beltz, Weinheim / Basel 2002, ISBN 3-407-22112-6 .
  • Christine Preißmann : Psychotherapy and counseling for people with Asperger's Syndrome. Concepts for successful treatment from the perspective of the patient and the therapist. 2nd, completely revised and enlarged edition. Kohlhammer, Stuttgart 2009, ISBN 978-3-17-020757-8 .
  • Steve Silberman: Ingenious disruption. The Secret History of Autism and Why We Need People Who Think Different. DuMont Buchverlag, Cologne 2016, ISBN 978-3-8321-9845-9 .
  • Kai Vogeley : Be different. Asperger's Syndrome and Highly Functional Autism in Adulthood - A Guide. Beltz, Weinheim 2012, ISBN 978-3-621-27933-8 .
  • Christine Preißmann : Surprisingly different - girls & women with Asperger's. Trias, Stuttgart 2013, ISBN 978-3-8304-6819-6 .

Web links

Commons : Asperger's Syndrome  - Collection of Pictures, Videos, and Audio Files
Wiktionary: Asperger's Syndrome  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ DSM-5 : Descriptive text and criteria for autism spectrum disorder (Code 299). 2015, ISBN 978-3-8017-2599-0 , chapter on disorders of neural and mental development, p. 64 f.
  2. ^ A b Clausen: Autism Spectrum Disorders in Adults . Psychiatrie Verlag GmbH, Cologne 2016, ISBN 978-3-88414-629-3 .
  3. ↑ a b c ICD-10-GM 2019. Retrieved on March 7, 2020 (on the DIMDI website).
  4. ↑ Tony Attwood: A Whole Life with Asperger's Syndrome: From Childhood to Adulthood; everything that helps . 2nd Edition. TRIAS, Stuttgart 2012, ISBN 3-8304-6504-1 .
  5. ↑ Daniela Schreiter : Shadow Jumper What it's like to be different . Panini, Stuttgart 2014, ISBN 978-3-86201-950-2 .
  6. ↑ What is Autism? - Reality filter. Retrieved June 23, 2019 .
  7. ↑ a b c d e f g h i Mandy Roy et al .: Asperger's Syndrome in Adulthood . In: Deutsches Ärzteblatt . No. 106 (5) , 2009, pp. 59–64 , doi : 10.3238 / arztebl.2009.0059 , PMC 2695286 (free full text) - ( German article ).
  8. ↑ Ludger Tebartz van Elst : Autism and ADHD: Between norm variant, personality disorder and neuropsychiatric illness . Kohlhammer Verlag, 2016, ISBN 978-3-17-028687-0 .
  9. ↑ Guideline on Autism Spectrum Disorders in Children, Adolescents and Adults, Part 1: Diagnostics . Long version p. 14 f. (PDF) See under A.2.2 Classification of Autism Spectrum Disorders and A.2.3 Autism Spectrum Disorders as a dimensional disorder . Status 2016, Working Group of Scientific Medical Societies .
  10. ^ FR Volkmar, JC McPartland: From Kanner to DSM-5: autism as an evolving diagnostic concept. In: Annual review of clinical psychology. Volume 10, 2014, pp. 193-212, doi: 10.1146 / annurev-clinpsy-032813-153710 , PMID 24329180 (review).
  11. ↑ a b c d e Hans Asperger : The "Autistic Psychopaths" in Childhood . In: Archives for Psychiatry and Nervous Diseases . tape 117 , no. 1 , 1944, pp. 76-136 , doi : 10.1007 / bf01837709 ( autismus-biberach.com [PDF; Retrieved on December 14, 2017]).
  12. ↑ Christian Schanze (Ed.): Psychiatric diagnostics and therapy for people with intellectual disabilities: a work and practice book for doctors, psychologists, curative educators and educators. 2. revised and exp. Edition. Schattauer, Stuttgart 2014, ISBN 978-3-7945-2951-3 , p. 259.
  13. ↑ D. van Krewelen, C. Kuipers: The psychopathology of autistic psychopathy. In: Acta paedopsychiatrica. Volume 29, January 1962, pp. 22-31. PMID 14459626 .
  14. ↑ Lorna Wing : Asperger's syndrome: a clinical account. In: Psychological Medicine. Volume 11, Number 1, February 1981, pp. 115-129. PMID 7208735 .
  15. ↑ D. Tantam: Asperger's syndrome. In: Journal of child psychology and psychiatry, and allied disciplines. Volume 29, Number 3, May 1988, pp. 245-255. PMID 3047159 (Review).
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  18. ↑ M. Ghaziuddin, LY Tsai, N. Ghaziuddin: Brief report: a comparison of the diagnostic criteria for Asperger syndrome. In: Journal of autism and developmental disorders. Volume 22, Number 4, December 1992, pp. 643-649. PMID 1483981 .
  19. ↑ a b c d e f g h i Helmut Remschmidt: The Asperger Syndrome. An under-known disorder? (PDF) In: Deutsches Ärzteblatt 97, Issue 19, May 12, 2000.
  20. ↑ Daniel Tibi: How is Asperger's Syndrome noticeable? Brief information (PDF)
  21. ↑ The expression was coined in 1971 by an American research team: MK DeMyer, DW Churchill, W. Pontius, KM Gilkey: A comparison of five diagnostic systems for childhood schizophrenia and infantile autism. In: Journal of autism and childhood schizophrenia. Volume 1, Number 2, 1971 Apr-Jun, pp. 175-189. PMID 5172391 . Reviewed in: MK DeMyer, JN Hingtgen, RK Jackson: Infantile autism reviewed: a decade of research. In: Schizophrenia bulletin. Volume 7, Number 3, 1981, pp. 388-451. PMID 6116276 , (free full text) (review).
  22. ↑ Ami Klin et al. (1995): Validity and neuropsychological characterization of Asperger syndrome: convergence with nonverbal learning disabilities syndrome. In: Journal of child psychology and psychiatry, and allied disciplines. Volume 36, Number 7, pp. 1127-1140. PMID 8847376 .
  23. ↑ L. Tebartz van Elst, M. Pick, M. Biscaldi, T. Fangmeier, A. Riedel: High-functioning autism spectrum disorder as a basic disorder in adult psychiatry and psychotherapy: psychopathological presentation, clinical relevance and therapeutic concepts. In: European archives of psychiatry and clinical neuroscience. Volume 263 Suppl 2, November 2013, pp. S189-S196, doi : 10.1007 / s00406-013-0459-3 , PMID 24105433 (review), PDF .
  24. ^ Lorna Wing: The Relationship Between Asperger's Syndrome and Kanner's Autism. In: U. Frith (Ed.): Autism and Asperger Syndrome . Cambridge University Press, Cambridge 1991, pp. 93-121.
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  39. ↑ For example WrongPlanet.net
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