FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ASPERGER’S SYNDROME -- “LITTLE PROFESSORS” WITHOUT SOCIAL SKILLS

Question: My young grandson has recently been diagnosed with Asperger’s Syndrome. Could you explain to me exactly what Asperger’s is?  His usage of words and the way he relates to us shows that he is highly intelligent. He loves numbers, and he does follow instructions.  However, it is hard sometimes to get him to do his homework because he loses interest.  Will he get over this as he gets older?  Any help you could give so that we would understand this better would be appreciated.

Answer: Asperger’s Syndrome (AS) is officially part of the autism spectrum of disorders. In general, these conditions are characterized by impairment in language and communication skills plus repetitive patterns of thought and behavior. Asperger’s, however, is kind of an uneasy fit into this classification. While children with AS show marked deficiencies in social and communication skills as well as exhibiting autistic-like behaviors, they have normal to superior intelligence and language skills. This sounds like your description of your grandson. By contrast, children with true autism usually lose any language that develops before the onset of autism.

In addition to their excellent language skills, these children usually have formal speech patterns. Children with AS also exhibit behavioral rituals and poor interaction with peers as well as socially and emotionally inappropriate behavior. They tend to have poor motor skills and muscular coordination.

The primary presenting symptom of AS is an obsessive interest in an object or topic to the exclusion of almost everything else. For example, some children with AS have become experts on railroad engines, the passenger list of the Titanic, clocks, the philosophical nature of time, deep-fat fryers, the makes and models of cars, and fast-food restaurants.

Children with AS have an insatiable desire to know everything about their topic of interest. They will talk about little else. They will lecture their family and schoolmates on that topic. In fact, Hans Asperger, the Austrian physician who first wrote about this syndrome that now bears his name, called these children his “little professors.”

The diagnosis of AS can be difficult because there is no one standardized test for AS. Also, AS can be hard to differentiate from other behavioral or developmental disorders like hyperactivity(ADD) and high-functioning autism. The core group of symptoms that the doctor uses to diagnose AS are abnormal eye contact, aloofness, failure to turn when called by name, failure to use gestures to point or show something, lack of interactive play and lack of interest in peers. At least one of these behaviors plus repetitive or restrictive behavior must be present before the age of 3 to make this diagnosis.

Treatment of AS is geared toward the presenting symptoms. A good program is individualized for the child and his or her interests. There are no medications for AS, but coexisting problems may need to be treated. Speech therapy can be very helpful for these kids. They are taught such things as how to react to social cues and the kinds of responses that are appropriate to use in various social situations.

AS is a lifelong disorder, so your grandson won’t outgrow it. However, afflicted adults can lead productive lives, but they may need continuing counseling. There is research going on to find the cause of AS and to develop new treatments.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.