Impairments in Social Interactions with Others
Although the social criteria for Asperger’s Disorder (also known as Asperger’s Syndrome, or AS) and autism are identical, the former condition usually involves fewer symptoms and has a generally different presentation than does the latter. Individuals with Asperger’s Disorder are often socially isolated but are not unaware of the presence of others, even though their approaches may be inappropriate and peculiar.
For example, they may engage another person — usually an adult — in one-sided conversation characterized by long-winded, pedantic speech, about a favorite and often unusual and narrow topic. Also, although individuals with Asperger’s are often self-described “loners”, they often express a great interest in making friendships and meeting people. These wishes are invariably thwarted by their awkward approaches and insensitivity to other person’s feelings, intentions, and nonliteral and implied communications (e.g., signs of boredom, haste to leave, and need for privacy). Chronically frustrated by their repeated failures to engage others and make friendships, some of these individuals develop symptoms of depression that may require treatment, including medication.
In regard to the emotional aspects of social transactions, individuals with Asperger’s Syndrome may react inappropriately to, or fail to interpret the valence of, the context of the affective interaction, often conveying a sense of insensitivity, formality, or disregard to the other person’s emotional expressions. That notwithstanding, they may be able to describe correctly, in a cognitive and formal manner, other people’s emotions, expected intentions and social conventions. But they are unable to act upon this knowledge in an intuitive and spontaneous fashion, thus losing the tempo of the interaction.
Such poor intuition and lack of spontaneous adaptation are accompanied by marked reliance on formalistic rules of behavior and rigid social conventions. This presentation is largely responsible for the impression of social naivete and behavioral rigidity that is so forcefully conveyed by these individuals.
As with the majority of the behavioral aspects used to describe AS, at least some of these characteristics are also exhibited by individuals with higher-functioning autism, though, again, probably to a lesser extent. More typically, autistic persons are withdrawn and may seem to be unaware of, and disinterested in, other persons. Individuals with AS, on the other hand, are often keen, sometimes painfully so, to relate to others, but lack the skills to successfully engage them.
Impairments in Communication with Others
In contrast to autism, there are no symptoms in this area of functioning In the definition of Asperger’s Disorder. Although significant abnormalities of speech are not typical of Asperger’s Syndrome, there are at least three aspects of these individuals’ communication skills which are of clinical interest.
First, though inflection and intonation may not be as rigid and monotonic as in autism, speech may be marked by poor prosody. For example, there may a constricted range of intonation patterns that is used with little regard to the communicative functioning of the utterance (assertions of fact, humorous remarks, etc.).
Second, speech may often be tangential and circumstantial, conveying a sense of looseness of associations and incoherence. Even though in some cases this symptom may be an indicator of a possible thought disorder, it is often the case that the lack of coherence and reciprocity in speech is a result of the one-sided, egocentric conversational style (e.g., unrelenting monologues about the names, codes, and attributes of innumerable TV stations in the country), failure to provide the background for comments and to clearly demarcate changes in topic, and failure to suppress the Vocal output accompanying internal thoughts.
The third aspect typifying the communication patterns of individuals with AS concerns the marked verbosity observed, which some authors see as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often in complete disregard to whether the listener might be interested, engaged, or attempting to interject a comment, or change the subject of conversation. Despite such long-winded monologues, the individual may never come to a point or conclusion. Attempts by the interlocutor to elaborate on issues of content or logic, or to shift the interchange to related topics, are often unsuccessful.
Despite the possibility that all of these symptoms may be accounted for in terms of significant deficits in pragmatics skills and/or lack of insight into, and awareness of, other people’s expectations, the challenge remains to understand this phenomenon developmentally as strategies of social adaptation.
Restrictive, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities
Although in the DSM-IV definition the criteria for Asperger’s Disorder and autism are identical, requiring the presence of at least one of the symptoms in the list provided (see table above), it appears that the most commonly observed symptom in this cluster refers to an encompassing preoccupation with restricted patterns of interest.
In contrast to autism, where other symptoms in this area may be very pronounced, individuals with AS are not commonly reported to exhibit them with the exception of the all-absorbing preoccupation with an unusual and circumscribed topic, about which vast amounts of factual knowledge are acquired and all too readily demonstrated at the first opportunity in social interaction. although the actual topic may change from time to time (e.g., every year or two years), it may dominate the content of social interchange as well as the activities of individuals with AS, often immersing the whole family in the subject for long periods of time. Even though this symptom may not be easily recognized in childhood (because strong interests in dinosaurs or fashionable fictional characters are so ubiquitous among young children), it may become more salient later on as interests shift to unusual and narrow topics. This behavior is peculiar in the sense that often times extraordinary amounts of factual information are learned about very circumscribed topics (e.g., snakes, names of stars, maps, TV guides, or railway schedules).
In addition to the required criteria specified above, an additional symptom is given as an associated feature though not a required criterion for the diagnosis of Asperger’s Disorder, namely delayed motor milestones and presence of “motor clumsiness”. Individuals with Asperger’s Syndrome may have a history of delayed acquisition of motor skills such as pedaling a bike, catching a ball, opening jars, climbing “monkey-bars”, and so on.
They are often visibly awkward, exhibiting rigid gait patterns, odd posture, poor manipulative skills, and significant deficits in visual-motor coordination. Although this presentation contrasts with the pattern of motor development in autistic children, for whom the area of motor skills is often a relative strength, it is similar in some respects to what is observed in older autistic individuals. Nevertheless, the commonality in later life may result from different underlying factors, for example, psychomotor deficits in the case of AS, and poor body image and sense of self in the case of autism. This highlight the importance of describing this symptom in developmental terms.
This article by Ami Klin, Ph.D., and Fred R. Volkmar, M.D., Yale Child Study Center, New Haven, Connecticut and was originally published by the Learning Disabilities Association of America, June 1995. To learn more about Asperger’s Syndrome and Autism, please visit the Yale Developmental Disabilities Clinic website.