The incidence of Asperger's Syndrome is on the rise. Asperger's is one of the Autistic Spectrum Disorders, or Asd's. Whenever we see a spike in the incidence of a disorder, I always ask the questions "is this disorder/syndrome occurring more frequently? Or, are we plainly diagnosing it more often? Is it the new 'fashionable' diagnosis?" These are leading expert questions. Labels and diagnoses can shape a future for the better or worse. We shouldn't diagnose lightly. Many implications ensue a diagnosis.
I am looking with more frequency, elements of Asperger's Syndrome in children but an absence of some key identifying symptoms. The diagnostic criteria listed in the Diagnostic and Statistical manual Iv (Dsm-Iv, the manual authorized by the American Psychiatric Association) is far too lengthy to re-print here in an article. Some highlights are as follows:
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1. Qualitative impairment in public interaction.
2. Restricted repetitive and stereotyped patterns of behavior, interests, and activities.
3. The disturbance causes clinically essential impairment in social, occupational, or other leading areas of functioning.
4. There is no essential general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
5. There is no clinically essential delay in cognitive development of age-appropriate self-help skills, adaptive behavior (other than in public interaction), and curiosity about the environment in childhood.
6. Criteria are not met for other specific Pervasive Developmental Disorder or Schizophrenia. (1)
You can crusade on-line or at your library for a more detailed listing of the diagnostic criteria.
I am using the term "Atypical Asperger's Syndrome" to refer to children whom seem to meet some of the criteria but not all. Things just don't seem to click for these kids. They just don't engage the way other children do.
Atypical Aspergers may be best discussed by comparing it to some other possible diagnoses that we may be ruling out. They are as follows:
· public Anxiety Disorder: Children with this disorder may appear quite shy. They are hesitant to engage with other children. They prefer the business of adults. In differentiating this from Atypical Asperger's, the Asperger's child isn't remotely upset, involved or bothered by the fact that they aren't included in the group. Or, they are included in the group but remain somewhat constantly distant. They can play side by side with other children without no ifs ands or buts interacting with the other child.
· Low Intellectual Functioning: Upon first observation, the Atypical Aspergers child may appear dull or lacking in intelligence. The low intellectual functioning child ordinarily will perform poorly in school and need basic skills level classes. The Atypical Asperger's child any way is most often bright. They do well on test despite appearing lost or disinterested.
Asperger's Syndrome children typically make poor eye contact, speak in miniature phrases, are tangential, prefer public isolation. They display a lack of spontaneous seeking to share enjoyment, interests or achievements with others. They also display a lack of public or emotional reciprocity.
I am looking Atypical Asperger's children who make good eye contact. They are often capable of conducting a conversation with me in the office. They often perform this better in the office because I'm an adult. Parents and teachers narrative that these children are less skilled in conversation with their peer age group. They may candidly share experiences or achievements but often at inappropriate times, interjecting such into a argument somewhat randomly. And although they are bright, if I were their age I wouldn't be very interested in what they talk about. They appear immature, because they are socially immature.
For some reason, the Atypical Asperger's child doesn't seem interested in athletics and also not very good at them. I don't fully understand the neurology complex but I'm suspecting a connection.
Fashionable Syndrome?
I was discussing Asperger's with my 24 year old son just last week. We were looking at the homes of America's richest tech guys, Bill Gates, Steve Jobs and "the facebook guy" Mark Zuckerberg. Our conversation led us to "how many of these very tantalizing and creative guys have Asperger's." And we must make an leading point, just because man appears socially awkward doesn't mean that they have any disorder at all, let alone Aspergers. It was plainly a conversation. I am not diagnosing any of these individuals from afar and have no idea if any of them have any version of Asperger's Syndrome. The point though is that he told me that in his 20 something age group it has come to be "fashionable" to say that you have Asperger's. It is sort of a badge of honor and an easy explanation for ones "quirkiness" now in public situations. Guys in bars and clubs are using this to generate an aura of "intellectual elite" connected to themselves. I see it as a way of saying "I'm no ifs ands or buts better and smarter than you and you couldn't maybe no ifs ands or buts understand me so don't even try." It's the new "I'm a nerd" declaration. Remember when being called a nerd was an insult? Remember when it became a badge of honor years later? This also points out that the more obvious cases of adult Atypical Asperger's Syndrome occur in tantalizing creative people. I don't believe that the incidence is higher in tantalizing population than less tantalizing people. We plainly observation it more because we observation high achievers full, more than lesser achievers.
This may seem strange or unusual at first glance. But think of how often you hear population referring to "my Add." I hear this all the time. It's come to be the excuse for everything. Any time man forgets, fails to perfect a task or return a phone call promptly, they announce that it's there Add. So to think that now the fashionable disorder or "disorder du jour" is something called Asperger's, doesn't surprise me in the least. We, as a society, are influenced by media and current fashion. All of the Autistic Spectrum disorders are in "fashion" in the media.
And this points to a concern. Sure diagnoses come to be popular. Think of this timeline. The beloved prognosis in the 1980's was "Chronic Fatigue Syndrome." I bet you forgot about that one. When was the last time you heard of man having it? Not recently, eh. Where did it go? What was the cure? In the 1990's Add and Adhd came into full bloom, even though we were talking about it in the 80's. They've hung on pretty well too. But in the 2000's we began to see a lot of children with Bipolar Disorder. When I first began in this field in the 1980's this prognosis was restricted for adults. The, it was expanded. Eventually, it became an all too often used diagnosis. Today, the incidence of all of the Autistic Spectrum Disorder (Asd) diagnoses is seen with greater and greater frequency. Asperger's Syndrome and what I'm calling Atypical Asperger's Syndrome fall under the kind of Asd. We must remember that diagnoses can carry instruction and public baggage. This baggage can be beneficial or limiting. Hiding behind a prognosis can limit growth and development. Self-Esteem can be enhanced or damaged by a diagnosis. A proper prognosis can lead to understanding and open up opportunity.
I believe that I'm looking a lot of Atypical Asperger's in my practice. Truth is, we're all different from one another. Reasoning that there is a way to be, grow and institute in childhood or adulthood is inaccurate. We all function within a range on a scale. Atypical Asperger's is plainly on a different part of that scale than most population are accustomed.
Here are some basic considerations if you question either your child may have a form of Asperger's Syndrome:
Your child is tantalizing but doesn't interact well with peers. Your child doesn't have a general filter when expressing himself. He says inappropriate things at inappropriate times. He doesn't seem too bothered to be on the "outside" of things socially. He is preoccupied or his focus on Sure activities is abnormal or unusually intense. He is preoccupied with parts of objects in a way that others are not. His conversation runs to things that are completely dis-interesting to others, and he fails to notice.
This is not an exhaustive or full, list. But it's a good start. Get a full, appraisal if you think this may be a problem.
Feel free to feel me for aid in appraisal or treatment. Even if just to ask me a question via email, I am available.
Copyright 2010 John Hudome, all ownership reserved.
References: (1) Desk Reference To The Diagnostic Criteria From Dsm-Iv-Tr, Copyright 2000 American Psychiatric Association.
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