The Complete Guide to Asperger's Syndrome

by Anthony Attwood

Young children and adolescents with Asperger’s syndrome may fear feeling or appearing stupid and dread ridicule by peers for not knowing what to do. There can also be a limited acceptance that they are wrong, which may be perceived by others as an expression of arrogance. Any advice may be perceived and reacted to as personal criticism, potentially antagonizing teachers and friends.

A more recent term is monotropism (Murray, Lesser and \Lawson 2005). A person with Asperger’s syndrome has unusual strategies for the allocation of attention, and large areas of potential information are not being cognitively registered. This leads to a very fragmented view of the world. The person may learn isolated facts but have difficulty with an overall analysis.

Children and adults with Asperger’s syndrome appear to have a problem determining what is relevant and what is redundant, and deciphering the overall pattern or meaning to create a mental framework. Psychologists use the term weak central coherence to describe this style of information processing.

In language, typical children can remember the gist of the message, the key parts, which makes the information easier to remember. In conversation, having weak central coherence means the person may remember the details but not the overall story; they may be notorious for giving irrelevant information, and have difficulty summarizing and saying just the important points.

We are not precisely sure why a person with Asperger’s syndrome can have exemplary long-term memory for details and facts and an ability to recall events in infancy. A plausible explanation is that people with Asperger’s syndrome have a different pattern of brain wiring from birth and weak central coherence affects the perception, cognitive processing and storing and retrieval of memories. The result is an ability to recall events in infancy that others cannot retrieve. The ability for the accurate recall of scenes can extend to remembering whole pages of a book. This eidetic or photographic memory can be extremely helpful in examinations, although I have known of university students with Asperger’s syndrome who have been falsely accused of cheating because their examination answers have included perfect and lengthy reproductions of the principal texts for the course. I have also known of boys, but rarely girls, with Asperger’s syndrome who have a remarkable memory for directions and places they have been. The young child may give accurate directions of how to get to my clinic from the back seat of the family car, to the great relief of his mother who wants to arrive on time for the appointment.

Older children will benefit from comprehensive class notes and study guides, as adolescents with Asperger’s syndrome are not usually as proficient as their peers in note taking and copying information from the board. The teacher will be aware of problems with executive function and provide assistance with organizational and planning skills, using a ‘to do’ list and sometimes allowing additional time for completing an activity or assignment.

a child who is not intellectually disabled but has an unconventional profile of cognitive abilities.

When walking or running, the child’s coordination can be immature, and adults with Asperger’s syndrome may have a strange, sometimes idiosyncratic gait that lacks fluency and efficiency. On careful observation, there can be a lack of synchrony in the movement of the arms and legs, especially when the person is running (Gillberg 1989; Hallett et al. 1993).

Children and sometimes adults with Asperger’s syndrome can have difficulty knowing where their body is in space, which may often cause them to trip, bump into objects and spill drinks.

The profile of movement abilities can include impaired manual dexterity (Gunter, Ghaziuddin and Ellis 2002; Manjiviona and Prior 1995; Miyahara et al. 1997), impaired coordination, balance, grasp and tone (Nass and Gutman 1997), and slower speed on manual tasks (Nass and Gutman 1997; Szatmari et al. 1989a).

I have also known several children with Asperger’s syndrome who really enjoy being upside down for long periods of time. These children, while watching television, adopt a position whereby their feet are at the top of the chair and their head rests just above the floor.

there can be signs of ataxia; that is, less orderly muscular coordination and an abnormal pattern of movement. This can include movements being performed with abnormal force, rhythm and accuracy, and an unsteady gait. Observations of walking and running, climbing stairs, jumping, and touching a target (the finger to nose test) of children with Asperger’s syndrome indicate signs of ataxia (Ahsgren et al. 2005).

One of the movement disturbances associated with Asperger’s syndrome is lax joints (Tantam, Evered and Hersov 1990).

The most common sensitivity is to very specific sounds but there can also be sensitivity to tactile experiences, light intensity, the taste and texture of food and specific aromas. There can be an under- or over-reaction to the experience of pain and discomfort, and the sense of balance, movement perception and body orientation can be unusual. One or several sensory systems can be affected such that everyday sensations are perceived as unbearably intense or apparently not perceived at all.

The sensory system can at one moment be hypersensitive and, in another moment, hyposensitive.

The intense sensory experiences, described by Nita Jackson as ‘dynamic sensory surges’ (N.Jackson 2002, p.53), result in the person with Asperger’s syndrome being extremely stressed, anxious and almost ‘shell shocked’ in situations that are not perceived as aversive but enjoyable for other children. The child with sensory sensitivity becomes hypervigilant, tense and distractible in sensory stimulating environments such as the classroom, unsure when the next painful sensory experience will occur. The child actively avoids specific situations such as school corridors, playgrounds, busy shopping malls and supermarkets which are known to be too intense a sensory experience. The fearful anticipation can become so severe, an anxiety disorder can develop, such as a phobia of dogs because they might suddenly bark, or agoraphobia (fear of public places), as home is a relatively safe and controlled sensory experience.

Bogdashina (2003) and Harrison and Hare (2004) have suggested that a person with Asperger’s syndrome can have: •both hyper- and hyposensitivity to sensory experiences •sensory distortions •sensory ‘tune outs’ •sensory overload •unusual sensory processing •difficulty identifying the source channel of sensory information.

Clinical observation and personal accounts of people with Asperger’s syndrome suggest that there are three types of noise that are perceived as extremely unpleasant. The first category is sudden, unexpected noises, that one adult with Asperger’s syndrome described as ‘sharp’, such as a dog barking, telephone ringing, someone coughing, a school fire alarm, the clicking of a pen top, or crackling sounds. The second category is high-pitched, continuous sounds, particularly the sound of small electric motors used in domestic electrical equipment such as food processors or vacuum cleaners or the high-pitched sound of a toilet flushing. The third category is confusing, complex or multiple sounds such as occur in shopping centres or noisy social gatherings.

Sensitivity to specific types of touch or tactile experiences occurs in over 50 per cent of children with a diagnosis of Asperger’s syndrome (Bromley et al. 2004; Smith Myles et al. 2000). There can be an extreme sensitivity to a particular type of touch, the degree of pressure or the touching of particular parts of the body.

The experience of having a haircut can also be affected by auditory sensitivity, namely an aversion to the ‘sharp’ sound of scissors cutting hair and the vibration of electric clippers. There can also be a reaction to the tactile sensation of cut hair falling on the child’s face or shoulders,

Asperger noted that some of the children he saw hated the sensation of water on their face. Leah wrote to me and explained that: I hated having showers as a child, and preferred baths. The sensation of water splashing my face was unbearable.

Liane Holliday Willey has considerable tactile pleasure from being underwater. In her autobiography she described how: I found solace underwater. I loved the sensation that came from floating with the water. I was liquid, tranquil, smooth; I was hushed. The water was solid and strong. It held me safe in its black, awesome darkness and it offered me quiet – pure and effortless quiet.

Sean Barron has explained his perception of the taste and texture of food: I had a big problem with food. I liked to eat things that were bland and uncomplicated. My favourite foods were cereal–dry, with no milk – bread, pancakes, macaroni and spaghetti, potatoes, potatoes and milk.

Carrots in a green salad and celery in a tuna fish salad are still intolerable to me because the contrast in texture between carrots or celery and salad or tuna fish is too great. However, I enjoy eating celery and baby carrots by themselves. Often as a child, less now, I would eat things serially, finishing one item on the plate before going on to the next. (Shore 2001, p.44) The young child may insist on a plain or restricted diet, such as only having boiled rice or sausages and chips for every evening meal for several years.

Sensitivity to particular levels of illumination or colours, or a distortion of visual perception occurs in about one in five children with Asperger’s syndrome (Smith Myles et al. 2000). Such children and adults report being ‘blinded by brightness’ and avoid intense levels of illumination.

There can be a hypo- and hypersensitivity to pain (Bromley et al. 2004). The low threshold for some types of pain and discomfort can be a frequent source of distress for the child whose reaction can be judged by peers as being a ‘cry baby’.

The person with Asperger’s syndrome can be overly detached or attached.

Thus, the relationship was considered as contributing to improved mental and physical health by the majority of partners with Asperger’s syndrome, but the reverse for the non-Asperger’s syndrome partner. This explains the perception of many partners with Asperger’s syndrome that the relationship is just fine, and they cannot understand why their relationship skills are criticized. The relationship is just fine for their needs, while their partner feels more like a housekeeper, accountant and mother figure.

We now have self-help literature on relationships written by couples with one partner who has Asperger’s syndrome, and by specialists in Asperger’s syndrome (Aston 2003; Edmonds and Worton 2005; Jacobs 2006; Lawson 2005; Rodman 2003; Slater-Walker and Slater-Walker 2002; Stanford 2003).

When talking to children with Asperger’s syndrome about their special interest, the listener can be amazed at the depth of knowledge but also the ability of the children to understand or develop their own classification or cataloguing system for the interest. However, this is in stark contrast to their immaturity in the natural cataloguing system of people based on descriptions of character or personality. The child or adult with Asperger’s syndrome may be able to categorize objects and facts according to a logical framework but have considerable difficulty developing a framework for people.

The research studies have clearly established that Asperger’s syndrome is due to a dysfunction of specific structures and systems in the brain. In short, the brain is ‘wired’ differently, not necessarily defectively, and this was not caused by what a parent did or did not do during the child’s development.

However, research has clearly established that the rate of convictions for adults with Asperger’s syndrome is actually the same as for the general population and that the incidence of violent offences is remarkably low (Ghaziuddin, Tsai and Ghaziuddin 1991; Isager et al. 2005).