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Asperger's Syndrome in Adults
Asperger's Syndrome in Adults
REVIEW ARTICLE
Asperger's Syndrome
in Adulthood
Mandy Roy, Wolfgang Dillo, Hinderk M. Emrich, Martin D. Ohlmeier
SUMMARY
Introduction: Asperger´s syndrome is one of the autism A sperger's syndrome is one of the autism
spectrum disorders. Asperger's patients usually
display a distinctive symptom pattern. Because their
spectrum disorders. Affected individuals display
considerably impaired capacity for social interaction, ability to intuitively recognize nonverbal signals in
unusual special interests, and a tendency towards other persons is impaired, patients are considerably
ritualized behavior. limited in their social interactions. Their interest in
other people is often limited; on the other hand,
Methods: The etiology, symptoms, diagnosis, and treatment
Asperger's patients typically have "special interests"
of Asperger´s syndrome in adulthood are outlined on the
that may seem unusual because of their subject matter
basis of a selective literature review via Medline and
or the intensity with which patients pursue them.
information in relevant reference books. Furthermore, the
Asperger's patients are also often fixated on ensuring
authors report their personal experience at a special clinic
for adults. that their external environment and daily routines
remain constant; sudden changes may exceed their
Results: Asperger´s syndrome in adulthood can be coping mechanisms.
diagnosed by thorough anamnesis, heteroanamnesis—
Depending on the severity of their symptoms, Asper-
with emphasis on childhood—and painstaking clinical
ger's patients may either exhibit unusual social behavior
examination. The considerable psychosocial impairments
or be severely impaired in their social and professional
affect the patients' professional, social, and private lives.
life.
The precise etiology is still unknown, but a multifactorial
Although Asperger's syndrome is one of the more
origin with genetic, neurobiological, and psychosocial
common differential diagnoses in child and adolescent
components appears probable. Although no specific,
psychiatry, in adults the disorder has received particular
empirically tested treatment concepts have yet
attention only recently.
been established, psychotherapeutic elements (structuring
and directive interventions) seem to be helpful, together This article provides an overview on the prevalence,
with pharmacotherapy—if indicated—in the presence of diagnostics, and clinical symptoms of Asperger's
comorbidity. syndrome in adults, as well as of current theoretical con-
cepts and possible treatment options.
Conclusions: Asperger´s syndrome should be included in
the differential diagnosis of adults who display the
Methods
corresponding symptoms. The etiopathogenesis and
This article is based on a selective literature search of
treatment of Asperger´s syndrome in adulthood should be
Medline, using the key words "Asperger's syndrome,"
further investigated.
"autism," "prevalence," "diagnostic," "comorbidity,"
Dtsch Arztebl Int 2009; 106(5): 59–64 "pathogenesis," and "brain." We included review ar-
DOI: 10.3238/arztebl.2009.0059 ticles and experimental original articles and reference
Key words: Asperger´s syndrome, diagnosis, books published to May 2008. We also report our own
treatment concept, autism, pediatric disease clinical experiences from a specialist outpatient clinic
for adults with Asperger's syndrome.
Prevalence
The prevalence of Asperger's syndrome in childhood is
estimated at 0.02% to 0.03% (1, 2). Asperger's is far
more common in boys than in girls, with a sex ratio of
8:1 (3). Representative studies of the prevalence in
Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie/Zentrum für adults are currently lacking. However, since the core
Seelische Gesundheit/Medizinische Hochschule Hannover (MHH): Dr. med. Roy, symptoms of Asperger's syndrome persist throughout
Dr. med. Dillo, Prof. Dr. med. Dr. phil. Emrich
Klinik für Psychiatrie und Psychotherapie (Ludwig-Noll-Krankenhaus), Klinikum patients' lifetimes (4), we can assume that Asperger's
Kassel: PD Dr. med. Ohlmeier syndrome is probably not much less common in adults.
BOX 1
A) Comprometimento qualitativo na interação social, manifestado por pelo menos dois dos seguintes:
1. Comprometimento marcante no uso de vários comportamentos não-verbais, como olhar nos olhos,
expressão facial, posturas corporais, e gestos para regular a interação social
2. Falha em desenvolver relacionamentos com pares, adequados ao nível de desenvolvimento
3. Falta de busca espontânea de compartilhar prazer, interesses ou realizações com outras pessoas
4. Falta de reciprocidade social ou emocional
B) Padrões repetitivos e estereotipados restritos de comportamento, interesses e atividades, conforme
manifestado por pelo menos um dos seguintes:
1. Abrangente preocupação com um ou mais padrões de interesse estereotipados e restritos que são
anormais em intensidade ou foco
2. Adesão aparentemente inflexível a rotinas ou rituais específicos e não funcionais
3. Maneirismos motores estereotipados e repetitivos
4. Preocupação persistente com partes de objetos
C) O distúrbio causa prejuízo clinicamente significativo no funcionamento social, ocupacional ou em outras áreas
importantes do funcionamento.
D) Não há atraso geral clinicamente significativo na linguagem, por exemplo, palavras isoladas usadas aos dois
anos de idade, frases comunicativas usadas aos três anos de idade).
E) Não há atraso clinicamente significativo no desenvolvimento cognitivo.
F) Os critérios não são válidos para outro transtorno invasivo do desenvolvimento específico ou esquizofrenia.
MEDICINE
BOX 2
Additionally: Qualitative impairments in verbal or nonverbal communication with at least three of the following symptoms:
1. Tendency to turn any conversation back on to self or own topic of interest
2. Marked impairment in the ability to initiate or sustain a conversation with others. Cannot see the point of superficial social
contact, niceties, or passing time with others, unless there is a clear discussion point/debate or activity.
3. Pedantic style of speaking, inclusion of too much detail
4. Inability to recognize when the listener is interested or bored
5. Frequent tendency to say things without considering the emotional impact on the listener
syndrome may have difficulties to make contact with so-called high functioning autism has been much dis-
potential partners in an appropriate way. In a developing cussed. Compared with patients with early childhood
or existing relationship they may appear selfish or cold. autism, high functioning autists have greater intellectual
The patients often experience the demands that are asso- and better social and communicative abilities, but over-
ciated with relationships—a desire for more intense all their cognitive and speech development is delayed.
communication or mutual sympathy—as a strain. Often, More recent studies have concluded that with regard to
persons with Asperger's syndrome will therefore con- deviant behavior there is no fundamental difference
duct relationships over greater geographical distances, between Asperger's syndrome and high functioning au-
which results in time constrained contacts. This also tism (11).
includes the whole area of sexuality. Some people with Differential diagnostic distinction from schizoid and
Asperger's have a very low need for physical closeness, schizotype personality disorders can be difficult. In both
others even have an aversion to it. Some have great in- disorders, affected persons withdraw from interpersonal
securities regarding sex, although their fundamental relationships; they are usually loners. The schizoid type
need is undiminished (8, 9), since sexual intimacy has a flattened or restricted range of emotions, affective
results from an intense capacity for mutual empathy. distance (a lack of affective rapport), and a diminished
However, some patients manage to build stable rela- capacity for enjoyment/joy. The schizotype personality
tionships and have families. disorder is characterized by odd behavior, often with
With respect to Asperger's patients' professional devel- magical ideas and a mistrustful to paranoid experience
opment, two tendencies are obvious. Some Asperger's of relationships. Neither disorder features the limited
patients are quickly strained by contacts with colleagues special interests that are typical of Asperger's, nor do
and clients. Their direct, seemingly impolite manner they entail a tendency towards stereotypical behavior.
may result in conflict, or they cannot adjust flexibly Schizophrenic psychosis can also be accompanied by
enough to different demands. Some, however, achieve social withdrawal and a lack of empathy. Important
great professional success owing to their special inter- distinctive features include disorganized thinking and
est—for example, in information technology. High delusions, which are characteristic for schizophrenia.
cognitive skills seem to enhance the potential to achieve The symptoms of Asperger's syndrome can be observed
professional and private objectives (clinical example, in early childhood, whereas, for example, the onset of
see box 3). hebephrenic schizophrenia does usually not predate
adolescence. The onset of illness is also important in dif-
Differential diagnosis and comorbidities ferential diagnostic distinction to simple schizophrenia
In early childhood autism according to Kanner, the in- disorder, which does not have productive symptoms.
ability to make contact in a nonverbal manner is often Especially in women, borderline emotional personality
accompanied by incomprehensible or lacking speech. disorders have to be differentiated, because this pathology
Affected children display extensive stereotypical and also features difficulties in empathizing and recognizing
unusual activity patterns (10). The clinical impairment nonverbal signals. However, these disorders are mostly ac-
in Kanner autism is more pronounced than in Asperger companied by severe mood swings, whereas special inte-
autism. The distinction of Asperger's syndrome from the rests and pronounced rational thinking are usually lacking.
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