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Asperger Syndrome in Children
Asperger Syndrome in Children
Asperger Syndrome in Children
INTRODUCTION
Purpose
To review Asperger syndrome characteristics, In 1944, a pediatrician named Hans Asperger observed a condition in
assessment tools, interventions, outcomes, a group of male children that he named autistic psychopathy; he named it
and the role of the nurse practitioner in as such because these children had a stable personality disorder marked by
diagnosing and caring for children with social isolation (Klin, 2003). However, others believe that ‘‘autistic personality
Asperger syndrome. disorder’’ is a better translation of Asperger’s original description (Volkmar,
Klin, Schultz, Rubin, & Bronen, 2000). These children demonstrated prob-
Data Sources lems with social integration and nonverbal communication associated with
Review of published literature on and diag- idiosyncratic verbal communication and an egocentric preoccupation with
nostic criteria of the condition. unusual and circumscribed interests. Asperger (1944) noted that these af-
fected individuals also had difficulties with empathy and intuition, as well as
Conclusions a tendency to be clumsy with awkward motor skills. These were only the
Asperger syndrome is a pervasive develop- observations of Asperger, and it was not until nearly 40 years later, in 1981,
mental disorder or an autism spectrum disor- when Lorna Wing introduced Asperger’s ‘‘autistic psychopathy’’ to the English
der that is thought to have an incidence language and renamed the cluster of characteristics as Asperger syndrome.
higher than that of autism. Asperger syn- Wing (1981) presented several additional difficulties, which afflicted chil-
drome is different from autism, with a lack
dren demonstrated in the first 2 years of life. These difficulties included a lack
of delayed language as the most distinct dif-
of normal interest and pleasure in people around them, a decreased quality
ference between Asperger syndrome and
and quantity of babbling, a significant decrease in shared interests, a signifi-
autism.
cant decrease in the wish to communicate either verbally or nonverbally,
a delay in speech acquisition, and no imaginative play or play that is con-
Implications for Practice
fined to one or two rigid patterns (Fitzgerald & Corvin, 2001; Wing).
Because of the importance of early diagnosis
Wing’s group, a case series of observations of 34 children, included a small
of Asperger syndrome for outcome improve-
ment, screening at all well-child visits from number of female subjects, which differed from Asperger’s male-only popu-
infancy on is of utmost importance to pri- lation (Klin, 2003; Wing). Ten years after Wing’s listing of general charac-
mary care pediatric nurse practitioners. With teristics, Gillberg (as cited in Fitzgerald & Corvin, 2001) presented six
early diagnosis, timely intervention is possi- diagnostic criteria: social impairments, narrow interests, repetitive routines,
ble, which is proven to show improvement speech and language peculiarities, nonverbal communication problems, and
in outcomes. motor clumsiness. His criteria are believed to be the closest to Asperger’s
characteristics.
Key Words Asperger syndrome is considered a pervasive developmental disorder
Pervasive developmental disorder, autistic (PDD). PDD is an umbrella term referring to a spectrum of disorders that
spectrum disorder, Asperger syndrome. differ with respect to either the number or type of symptoms present or the
age of onset of those symptoms (Szatmari et al., 2000). Others consider
Author Asperger syndrome as part of a group of disorders called autistic spectrum dis-
Julie Schnur, RN, CPNP, is a graduate of orders (ASD). However, Asperger syndrome is clinically differentiated from
Columbia University School of Nursing, autism and high-functioning autism by the absence of clinically delayed
New York, NY 10032. Contact Ms. Schnur speech (Rinehart, Bradshaw, Brereton, & Tonge, 2002; Volkmar et al.,
by e-mail at julie_schnur@hotmail.com 2000). It is characterized by social interaction impairments and restrictive or
repetitive interests with a lack of significant delays in language acquisition and
Acknowledgments with normal intelligence (Schatz, Weimer, & Trauner, 2002). The incidence
I thank Susan W. Ledlie, PhD, CPNP, for of Asperger syndrome is believed to be much higher than that of autism, with
her advice and support. A sincere thanks to its prevalence believed to be about 26–36 out of 10,000 school-aged children
(Ehlers & Gillberg, 1993; Kadesjö, Gillberg, & Hagberg, 1999).
General Tests for Autism and Autism Spectrum Disorders Specific Screening Tests for Asperger Syndrome
a
Found in Howlin (2000).
b
Ehlers et al. (1999).
spoken or receptive language or development, with single words Yeargin-Allsopp et al. (2003) found an equal prevalence of
spoken at or before 2 years of age, and communicative phrase autism––which they defined as autism, Asperger syndrome, and
use at the latest 3 years; qualitative abnormalities in reciprocal PDD not otherwise specified––in black and white children, a
social interaction; the affected person exhibits an unusually rate of 3.4/1000 children. However, they found that the male-
intense and circumscribed interest or restrictive and repetitive to-female ratio varied within different racial and ethnic groups.
behaviors; and the disorder is not attributable to another PDD. The authors sought to determine the prevalence of autism in
For the diagnosis of Asperger syndrome, the patient must a U.S. metropolitan area by using the area surrounding Atlanta,
demonstrate qualitative impairments in social interaction and Georgia. All the 289,456 children aged 3–10 years residing in
restricted patterns of interest. Of utmost importance is that a five-county metropolitan area were screened for autism (as
there are no language and communication criteria for diagnosis previously defined), with a gender split of 51% males, 49%
of Asperger syndrome; there should be no clinically significant females and a racial split of 58% white people, 38% black peo-
delay in language acquisition, cognition, and self-help skills ple, and 4% other. The authors found that 987 of the children
(Klin, 2003). Differential diagnoses for Asperger syndrome had autism (3.4/1000) and that while the rates were similar
include other ASDs or PDDs, attention deficit hyperactivity dis- between racial groups, the sex ratios varied between the groups,
order (ADHD), affective disorders, developmental disabilities, with the highest male-to-female ratio seen in black people. The
childhood onset schizophrenia, selective mutism, separation anxi- authors also found that the prevalence rates of autism varied
ety, stereotypic movement disorders, obsessive compulsive dis- between age groups, with the highest prevalence seen in 8-year-
order, and bipolar disorder (Fitzgerald & Corvin, 2001; Foster old children.
& King, 2003). While ADHD is on the list of differentials,
attention deficits are not a part of the diagnostic criteria for
Asperger syndrome. CHARACTERISTICS OF ASPERGER SYNDROME
Although attentional difficulties are not a part of the diag-
nostic criteria, the article by Schatz et al. (2002) ‘‘Brief report: Some characteristics of Asperger syndrome are social, devel-
Attention differences in Asperger syndrome’’ studied attentional opmental, and attentional warning signs that alert the NP dur-
differences between eight male children and young adults ing well-child care visits that the development is abnormal.
with Asperger syndrome (mean age of 16.00 years) and eight Other characteristics are more discrete because language devel-
matched male control subjects (mean age of 16.05 years). The opment usually is not delayed in these children; yet, other char-
subjects’ ethnicity was not specified. The authors found evi- acteristics, such as genetic factors, are even further concealed as
dence of attention deficits in most of the Asperger group and, they cannot be seen or noted by the naked eye when observing
while these deficits and hyperactivity are not included in the the patient.
diagnostic criteria, they have been observed in conjunction with The typical age of diagnosis for Asperger syndrome is 11
Asperger syndrome in other instances (Eisenmajer et al., 1996). years. However, parents can usually trace their concerns regarding