Asperger Syndrome
Asperger Syndrome is a type of autism. Autism a disorder that affects how a person interprets language, communicates, and socializes. Asperger Syndrome is a developmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests (autismspeaks.org). Children are normally diagnosed with Asperger Syndrome after the age of three, but most are diagnosed between the ages of 5 and 9. Children with Asperger Syndrome are considered to be on the “high-functioning” end of the autism spectrum. “High-functioning” is a term used to describe people on the autism spectrum who can speak, read, write, and handle basic life skills such as eating and getting dressed. People who are categorized as “high-functioning” may even live independently. Asperger Syndrome often remains undiagnosed until the child or adult begins to have serious difficulties in school, the workplace, or within their personal lives (kidshealth.com).
Asperger Syndrome is believed to be caused by many different factors. The causes of Asperger Syndrome can be broken down into three categories: genetic, physical, and environmental. In some children, the presence of Asperger Syndrome can be associated with genetic disorders such as Rett Syndrome or Fragile X Syndrome (genetic factor). Brain imaging studies have shown that there are structural and functional differences in specific areas of the brain. These differences may be caused by abnormal migration of the embryonic cells during fetal development which then affects the way in which the brain is wired and further goes on to affect the neural circuits that control thought and behavior (physical factor). Viral infections, prenatal complications, and air pollutants, as well as exposure to environmental toxins such as chemicals are all environmental factors that may play a factor in being diagnosed with Asperger Syndrome. Although there are many factors that are believed to cause Asperger Syndrome, changes in the brain being responsible for many symptoms, doctors have still not been able to determine precisely what causes these changes/Asperger Syndrome. Being male, presence of a co-occurring mental health disorders (such as depression and anxiety), family history of autism spectrum disorders or other mental health conditions, being born 10 or more weeks premature, and being born to older parents, are all risk factors for Asperger Syndrome (millcreekofmagee.com).
Being diagnosed with Asperger Syndrome can be hard, even though symptoms start early in life. Parents may notice early on that their child cannot make eye contact and that their child seems awkward in social situations, as well as the child misses social cues such as body language and facial expressions. Other symptoms of Asperger Syndrome can be divided into four categories: behavioral, physical, cognitive, and psychosocial. Behavioral symptoms are: lack of interpersonal relationship skills and instincts, inability to express one’s own feelings, often verbalizes internal thoughts that most would keep private, flat tone/speaking style that lacks pitch, appears to lack empathy, talks excessively (especially about one specific topic), frequently has one-sided conversations, is unable to understand societal norms, and does not understand the concept of personal space. Physical symptoms are: heightened sensitivity and overstimulation to loud noises, bright, lights, unusual textures, or strong tastes, poor coordination, clumsiness, poor fine motor skills, poor handwriting skills, unusual body postures and gestures, and difficulties using gross motor skills. Cognitive symptoms are: difficulties with changes or upsets in routine, difficulties picking up in the subtle changes in tone, pitch, and voice that accompany regular conversation, may be unable to understand sarcasm or jokes, poor organizational skills. And may have one or a few select interest that one is extremely knowledgeable about. Psychosocial symptoms are: loneliness and social isolation, lowered self-esteem, tendency toward shyness, anxiety, moodiness, and depression (millcreekofmagee.com).
There are many disorders commonly associated with autism, but specifically with Asperger’s. The comorbid disorders associated with Asperger’s are: gastrointestinal disorders, sensory problems, seizures and epilepsy, intellectual disability, Fragile X Syndrome, Attention Deficit Hyperactivity Disorder (ADHD), bipolar disorder, Obsessive Compulsive Disorder (OCD), Tourette Syndrome, general anxiety disorder, tuberous sclerosis, clinical depression, visual problems, nonverbal learning disorder, bipolar disorder, and tic disorder (autism-help.org).
Although there is no cure for Asperger Syndrome, there are various treatments that can help reduce the symptoms of the disorder. For the most part, medications are often used to treat Asperger Syndrome symptoms, mostly problematic behavioral symptoms. Some medications are: aripiprazole (Abilify) which is used to reduce irritability, guanfacine (Tenex), olanzapine (Zyprexa), and naltrexone (ReVia) which are used to reduce hyperactivity, selective serotonin reuptake inhibitors (SSRIs) which are used to reduce repetitive behaviors, and risperidone (Risperdal Consta) which is used to reduce agitation and insomnia. Other treatments are used to improve communication skills, emotional regulation, and social interaction. Many children with Asperger Syndrome also receive: social skills training, speech and language therapy, occupational therapy, physical therapy, and cognitive behavioral therapy. Not only do children with Asperger Syndrome receive treatment/therapy, but their parents are also provided with therapy as well. Receiving therapy can help a parent of a child with Asperger Syndrome cope with the challenges involved with raising a child with this disorder (healthline.com).
The case study that I chose came from BioMed Central (BMC) which is a scientific open access publisher. BMC has an evolving portfolio of high quality peer-reviewed journals that span all areas of biology and biomedicine. The particular scientific journal I chose studied three different patients of different backgrounds, ages, and lives dealing with Asperger Syndrome and found that mood stabilizers and 2nd generation antipsychotics were effective in the treatment of the patients with Asperger Syndrome with comorbid Bipolar Disorder (BD), while the use of antidepressants were associated with worsening the mood disorder. These researchers also found that it is of importance to recognize both the psychiatric diagnoses in order to arrange an exhaustive therapeutic program to define specific realistic goals of treatment (cpementalhealth.biomedcentral.com). The case study is below.
“A 19-year-old girl was admitted to a psychiatric intensive care unit and committed for psychomotor agitation, suicidal ideation, violent behavior against her parents. Her father suffered from anxiety, had overvalued somatic concerns, and was treated with alprazolam. Her paternal grandfather had suffered from anxiety and depression, with hypochondriac ideation. A maternal uncle, with a bewildering temperament and suffering from periodic acute crises with paranoid ideas, had been admitted to psychiatric wards and had attempted suicide in the past.
Patient’s delivery at term was normal. Mild delay in walking and precocious speech were reported. In her childhood, the patient was hyperactive, restless and had difficulties in relationships with her fellows. She was afraid of her contemporaries and preferred to spend her time with adults. When she was nine, she presented a suspected seizure during sleep. Cerebral MRI and EEG were normal. She was treated with carbamazepine 400 mg/day for 5 years. Until the junior high school, her school outcomes were good. She had an excellent memory and wrote poetries and novels. She did not like television programs or cartoons, except in a period of time during which she loved to see the same scenes of the film Cinderella, endlessly. At junior high school, she was anxious, nervous, agitated. Nocturnal enuresis appeared. The patient was visited by a psychiatrist who made the diagnosis of “psychosis” and treated her with haloperidol and paroxetine. When she was fifteen, obsessive preoccupations about sex first appeared. She was troubled by the fact that “men and women are different”. She often caught far and indirect references to this difference in people’s speech, television, newspapers or books and became upset or agitated. She presented similar reactions when she grasped remote references to “the difference between North and South”. She had gone by herself and had broken off any contact with her fellows. When she was seventeen, she left the school. A psychiatrist prescribed olanzapine (10 mg/day) with moderate improvement. The drug was withdrawn for severe weight gain and substituted with risperidone. However, this last drug seemed to be less effective. One year before admission, the patient was visited by a psychiatrist who made the diagnosis of bipolar disorder (BD) and borderline personality disorder and prescribed paroxetine 40 mg/day, ox-carbazepine 600 mg/day, haloperidol 2.5 mg/day, and alprazolam 2 mg/day. Ten days before admission, the patient withdrew haloperidol by herself. On visit, she was lucid, oriented, anxious, agitated, and poorly cooperating. Abnormal face and clumsiness were evident. Speech was scanty and poor of content. There were neither hallucinations nor typical delusions. However, bizarre ideas and obsessions were prominent. Currently, she had no hobby or interest, did not watch TV, read books or papers, hear music, fearing to run into love or sexual contents. She was afraid to have a bath because the imagine of her body was disturbing and insisted on evacuating only every other day. A mixed mood state was evident. Dysphoria, agitation, decreased need for sleep, talkativeness, hostility, and aggressiveness against objects and people were associated with depressed mood, hopelessness, sense of guilty, suicidal thoughts. Blunt affect and social retirement were also prominent. Brain MRI was normal. EEG showed diffuse 5–6 Hz rhythm. WAIS-R revealed an I.Q. of 70 (verbal: 88; performance: 54). She met the DSM-IV criteria for AS and BD, mixed state. The first diagnosis was made for the first time and was immediately accepted by her treating psychiatrist. As soon as her parents were instructed about the clinical features of AS, they recognized them in patient’s history. Although they were informed that the core symptoms of AS are not responsive to treatment, they were relieved by the fact that symptoms and behavior of her daughter, until then considered unusual and strange, were typical manifestations of a described disorder. She was treated with ox-carbazepine 600 mg b.i.d. and risperidone 2 mg b.i.d., with moderate improvement of mood symptoms, behavioral disorder, and global functioning” (cpementalhealth.biomedcentral.com).