Asperger's Syndrome - Term Paper Example

Asperger Syndrome Introduction Asperger syndrome (AS) has received relatively little attention in American special education until recently. Not until 1994, did the disorder become a separate classification of developmental disorders in the American Psychiatric Associations Statistical Manual of Mental Disorders (DSM-IV) (Klin, McPartland, & Volkmar, 88). The diagnosis rate of Asperger syndrome appears to be increasing. Recognition of Asperger syndrome as a specific disorder combined with the increase in diagnosis of the disorder places greater responsibility on those who work with and treat those individuals with the disorder to more fully understand and meet their special needs. History and Background Though the concept of Asperger’s disorder was first introduced by Hans Asperger in 1944, the disorder did not become part of the Diagnostic and Statistical Manual (DSM) until the DSM-IV was published in 1994. Asperger described symptoms of the disorder, including socially odd/inappropriate behavior, egocentrism, idiosyncratic verbal communication, poor nonverbal skills, stereotyped interests, conduct problems, and motor clumsiness (Klin, McPartland, & Volkmar, 88-125). Though Asperger made these observations, he did not set forth any diagnostic criteria. Almost 40 years later, Wing (cited in Klin, Pauls, Schultz & Volkmar, 88-125) characterized Aspergers disorder using a number of clinical case studies. Wing brought Aspergers to the attention of researchers in autism and described the unique characteristics of these individuals with normal intelligence and severe social impairments (Klin, Pauls, Schultz & Volkmar, 88-125). Even after increased interest in the disorder, it did not receive formal attention until it was included in the World Healths Organizations International Classification of Diseases-Tenth Revision (ICD-10) in 1993. Prior to the inclusion of Aspergers disorder in the ICD-10, the term "pervasive developmental disorder" (PDD) was first used in the DSM in 1980. At that time, PDD was a global classification encompassing several conditions, such as autism, residual autism, childhood onset PDD, and atypical autism (Szatmari 81). The 1987 revision of the DSM split PDD into two categories. One category included a broad definition of autism, the other category, PDD-NOS, included the non­autistic subtypes from the previous edition (Szatmari 81). Aside from published criteria in the DSM and ICD, criteria for Aspergers disorder have also been delineated by researchers in the profession. In 1989, Gillberg and Gillberg published criteria for the disorder which included six symptom areas: social impairment; compulsive need for routines; narrow interests; speech/language peculiarities; motor clumsiness and non-verbal communication difficulty. Some researchers believe that Gillbergs criteria most closely align with Hans Aspergers original descriptions (Attwood 24-36). Currently, Aspergers disorder is classified in the DSM-IV-TR as a pervasive developmental disorder characterized by restrictive patterns of interest, difficulty in social interaction, and stereotyped behaviors (APA 1). A diagnosis of Aspergers disorder can only be made if the childs symptoms significantly impact his/her social, occupational, or other functioning (i.e., educational functioning). For a diagnosis to occur, the child must not exhibit any significant delays in language functioning, cognitive development, or adaptive behaviors. Finally, for a child to receive a diagnosis of Aspergers disorder, criteria must not be met for another pervasive developmental disorder or schizophrenia (APA 1). Defining Asperger’s Syndrome Barnhill (p. 265) expressed the concern that teachers frequently do not recognize the special academic needs of these students, because students with Asperger Syndrome often give the impression that they possess greater understanding in a subject area than is actually the case. Most importantly, many students with Asperger Syndrome often learn and process information in a manner that generally does not co-exist well with present teaching methods occurring in many classrooms (p. 263). However Grandin & Sacks indicated that individuals with Asperger Syndrome possess high intelligence, understanding, and education. Instead of suffering long-term negative effects these individuals might actually live eventful and accomplished lives filled with unique insights and courage (p. 12). Tammet described autism, including Asperger Syndrome, as impairments that affected social interactions, communication, and imagination indicated by problems with abstract or flexible thought and empathy. He further indicated that individuals with Asperger Syndrome often have good language skills and possess high IQs and excel in areas that involve logical or visual thinking (p. 6). Powers (p. 12) described Asperger Syndrome as a form of "high functioning autism." However, research still had not clearly determined the connections between austistic disorder and Asperger Syndrome other than the two disorders share severe social impairments such as "mindblindness." This meant that individuals with Asperger Syndrome may have the inability to see concepts from another persons perspective. Furthermore, individuals with Asperger Syndrome also possessed an "innocence" that can be misunderstood by others. Their innocence often places them at risk of being misunderstood or victimized by others (p. 12). Myles and Southwick (as cited in Barnhill, p. 264) argued that theory-of mind deficits often led to difficulties in the afflicted individual. An afflicted individuals difficulties can include: (a) an inability to explain their own behaviors, (b) difficulty interpreting emotions, ( c) challenges determining the behavior or emotions of others, (d) misunderstanding the perceptions of others, ( e) challenges with interpreting the intentions of others, (f) a misunderstanding of how behaviors impact how other individuals think or feel, (g) conflicts regarding joint attention and other social niceties, and (h) challenges with differentiating fiction from fact. Moreover, individuals with Asperger Syndrome possess a level of maturity significantly below what is expected for their chronological age. For example, adolescents with Asperger Syndrome often possessed the maturity of someone two-thirds their age (Myles & Adreon 15). Attwood (p. 88) noted that impairment of the brains frontal lobes, which handle social reasoning, made it difficult for those with the disorder to understand social cues tied to human interaction. Prevalence Prevalence estimates of Aspergers disorder have been increasing in recent years (Klin, McPartland, & Volkmar, 88-125). During the 1980s when Aspergers was first beginning to be recognized, estimates were approximately 10-26 per 10,000 children (Gillberg & Gillberg, 631-638). McClaren & Adam (p. 1) reported that estimates of AS have ranged as high as 20 to 25 per 10,000. Aspergers disorder is four times more prevalent in males than in females (Connor, 80-86). Researchers have hypothesized that accurate prevalence rates are difficult to obtain due to the ambiguity of the definition and the validity of the diagnostic criteria (Klin, McPartland, & Volkmar, 88-125). The ambiguity of the definition of Aspergers further underscores the need for both valid research-based diagnostic criteria and for researchers to identify the characteristics used by clinicians in making their diagnostic determination. Another hypothesis concerning the increasing prevalence rate of Asperger s disorder is that as practitioners are becoming more aware of the specific characteristics of this disorder, more children appear to be identified early (Wing & Potter 151-161). There is greater public awareness of autism and pervasive developmental disorders, which allows parents to become more willing to have their children assessed when showing signs of pervasive developmental disorders. Potential Causes There are two main theories about causes for autistic disorders such as Asperger Syndrome. One theory suggests the behavioral, cognitive, affective, and neural abnormalities in autistic spectrum disorders are caused in large part by genetic factors. Molecular genetic studies are beginning to narrow down candidate regions on certain chromosomes that may contribute to symptoms of autistic disorders. In his work, Baron-Cohen (p. 73-78) cited the International Molecular Genetic Study of Autism Consortium study indicating that regions on six chromosomes were identified that demonstrated significance in determining a genetic connection. Specifically, a region on chromosome 7q was the most significant indicating a substantial genetic link. Moreover, the strong connection between autistic disorders and language impairment may be related to the two disorders sharing a commonality of the 7q chromosome. Furthermore, In a paper reviewing potential causes of autistic disorders, including Asperger Syndrome, Wing & Potter argued, "Genetic factors alone were very unlikely to account for a real rise in rates that appears to have occurred so rapidly and continuously year on year" (p. 158). Genetics seemed to play an important role, but not the only factor, in causing the disorder. Other theorists have suggested vaccines as contributing to the growing numbers of children diagnosed with autistic disorders and Asperger Syndrome. Wing & Potter argued that there is a possibility that MMR vaccination precipitated autism in a small number of children who are somehow genetically predisposed (p. 158). Likewise, Fuentes agreed, "Genetics may also playa role in susceptibility" (p. 41). Overall, strong and convincing evidence suggests a strong heritable propensity for autistic disorders, even if the identity and number of genes involved are not yet known (Muhle et al. 475). Studies have demonstrated a 30% to 50% increase in serotonin levels of individuals with autistic disorders, like Asperger Syndrome. Investigators failed to find a physiologic basis for this well-documented phenomenon (Muhle et al. 479). Parsell stated that “some scientists were convinced that environmental factors must be at play because autism appears to be increasing rapidly” (p. 311) Educational Intervention and Support Children with Aspergers disorder are cognizant of their disability and exceptionality. Because of this, they may often feel different from their peers. As a result they may become angry easily and cause disruptions frequently in the classroom, preventing themselves and others from learning. Although, evidence exists that there are interventions that are useful for children with specific learning disabilities (U.S. Department of Education 1). However, problems exist with generalization of skills learned by children to the natural environments. Even when children show qualitative improvements in social interaction, it is questionable whether the skills are transferred into the more global social competence with peers (Bauminger 283-298). Additionally, few examples of peer-reviewed empirical studies of interventions and curricula are available. Studies have been conducted mostly in classroom settings and have not been evaluated for use in the home and community (Simpson 135-144). Despite all that has been learned about Asperger syndrome over the past several years, there is little empirical evidence to suggest the value of specific interventions in classrooms (Simpson 135­-44). Research suggests that early intervention programs, direct instruction in social communication, and interventions used to address students sensory over-stimulations in the classroom may be promising. Early intervention and the age of intake have been shown to be reliable predictors of progress (Harris & Handleman 137-142). Others have found that children with Aspergers disorder require sufficient opportunities to apply newly learned skills in wide-ranging, naturalistic contexts to achieve generalization and maintenance. Klin and Volkmar (p. 13) present intervention guidelines for students with Asperger syndrome. They highlight the use of social perception training, visual supports, training in practical and conversational rules, improving prosody in speech, and self-monitoring. Simpson believes the productive intervention programs are those that include a range of multidisciplinary practices based on individual requirements. Some options include applied behavior analysis, environmental supports such as visual instruction, and biologically based psychopharmacologic treatments. Behavioral contracts focusing on agreements between students, teachers, and parents, specifying consequences for behaviors such as aggression by using reinforcement that identifies desired outcomes might be promising as an intervention (p. 135-­144) Klin and Volkmar claim that interventions should be multi-disciplinary, practical, individualized, and research based. Decisions should be made by a team including the teacher, developmental pediatrician, psychologist, occupational therapist, speech language therapist, community, and vocational support personnel, with long-term outcomes the goal. The two aspects of any educational intervention should be primarily social and communicative. Support for the development and evaluation of new approaches to better serve students with autism spectrum disorders continues to be a significant need (Simpson 135-­144). Conclusion Aspergers Syndrome is a constellation of symptoms that affects all aspects of development, including social, emotional, behavioral, and academic. Prevalence estimates of Aspergers disorder have been increasing in recent years. Aspergers disorder is found to be more prevalent in males than in females. Furthermore, the numbers of children diagnosed with Asperger Syndrome increase every year. Multifactorial factors and a shortage of research due to the relative newness of the disorder make it difficult to identify one specific cause for Asperger Syndrome. Although, biological factors seem to play an important role in the disorder, but other factors such as environmental factors also play its role. Furthermore, early educational interventions programs such as direct instruction in social communication, and interventions used to address students sensory over-stimulations in the classroom may be promising for students with Aspergers Syndrome. However, problems exist with generalization of skills learned by children to the natural environments. Therefore, it has been suggested that interventions must include a range of multidisciplinary practices and should be based on individual requirements. Work Cited American Psychiatric Association. “Diagnostic and statistical manual of mental disorders” (4th ed). - text revision. Washington, D.C.: Author, 2000. Attwood, T. “The complete guide to Asperger s syndrome.” London: Jessica Kingsley Publishers, 2007. Attwood, T. “What does Aspergers look like?” Biography Magazine, (2003). 88. Barnhill, G. “What is Asperger Syndrome?” Intervention in School and Clinic, 5, 2001 258-265. Baron-Cohen, S. “Autism: Research into causes and intervention.” Pediatric Rehabilitation, 7, 2003, 73-78. Bauminger, N. “The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: Intervention outcomes.” Journal of Autism and Developmental Disorders, 32 (4), 2002, 283-298. Connor, M.. “Children on the autistic spectrum: Guidelines for mainstream practice.” Support for Learning, 14, 1999, 80-86. Fuentes, A. “Injecting Mercury: Is Thimerosal the missing link in autism and developmental problems?” E Magazine, 2004. 40-41. Gillberg, I, & Gillberg, E. “Asperger syndrome: Some epidemiological considerations.” Journal of Child Psychology and Psychiatry, 30, 1989, 631-638. Grandin, T. & Sacks, O. “Thinking in pictures and other reports from my life with autism.” New York: 1995. Vintage Books. Harris, S.L., & Handleman, J.S. “Age and IQ at intake as predictors of placement for young children with autism: A four-to six-year follow-up.” Journal of Autism and Developmental Disorders, 30, 2000, 137-142. Klin, A., & Volkmar, F.R. “Treatment and intervention guidelines for individuals with Asperger syndrome.” In: A. Klin, F.V. Volkmar, S.S. Sparrow (eds.). Asperger syndrome. New York, NY: Guilford Press, 2000. Klin, A., McPartland, J., & Volkmar, F.R. “Asperger syndrome.” In F. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.) Handbook of autism and pervasive developmental disorders (3rd ed.): Vol. 1 Diagnosis, development, neurobiology, and behavior (pp. 88-125). New Jersey: Wiley. 2005. McClaren, E., and Adam W. “Asperger Syndrome.” Encyclopedia of Human Development. Sage Publications, 2005. Muhle, R., Trentacoste, S., & Rapin, L. “The genetics of autism.” Pediatrics. 13(5). 2004, 472-486. Myles, B. S. & Adreon, D. “Asperger Syndrome and adolescence: Practicons for school success.” Shawnee Mission, KS: Autism Asperger Building, 2001. Parsell, D. “Assault on autism.” Science News, 166(20), 2004. 311-312. Powers, M. “Asperger Syndrome and your child: A parents guide.” New York: HarperCollins, 2002. Simpson, R. “Finding effective intervention and personnel preparation practices for student with autism spectrum disorders.” Exceptional Children, 79 (2), 2004, 135-144. Szatmari, P. “Aspergers Syndrome: Diagnosis, treatment, and outcome.” Psychiatric Clinics of North America, 14, 1991, 81. Tammet, D. “Born on a blue day” New York: Free Press, 2006. United States Department of Education, Office of Special Education Programs, “Researcher Consensus Statement, NRCLD Information Digest #3,” National Research Center on Learning Disabilities, 2001. Wing, L., & Potter, D. “The epidemiology of Autism spectrum disorders: Is the prevalence rising?” Mental Retardation and Developmental Disabilities Research Reviews, 8, 2002, 151-161. Read More